Safety is an essential factor to consider before using any type of medication, and treatments for ED are no exception. Luckily, ED is a treatable issue with a number of well-known options such as sildenafil (the active ingredient in Viagra), tadalafil (Cialis) and newer, second-generation ED treatments such as avanafil (Stendra).
All of the FDA-approved ED medications on the market right now are safe for most men to use on a regular basis. However, there are some side effects and drug interactions that you should be aware of if you’re considering using any type of medication for ED. These side effect rates can differ from one medication to another, meaning one may be a more effective option for you than its alternatives.
Below, we’ve explained how ED medications work, their potential side effects, drug interactions and other key safety data that you should be aware of before using medication to treat ED, and how to determine the right and safe option for yourself.
ED Drugs: An Overview
ED affects an estimated 30 million men in the United States alone, of all ages.
In fact, findings from large-scale studies suggest that as many as 40 percent of all men will deal with some level of ED by the age of 40 — a number that increases with age.
So you can imagine what it must have been like for guys before treatment options offered medication for ED.
ED medication has been around since the late 1990s, when the FDA approved Viagra as the first pill for treating ED. Currently, there are four different oral medications available to treat ED that have received FDA approval. These “safe ED pills” according to the FDA are:
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Sildenafil. The active ingredient in Viagra, sildenafil is the most well-known medication for ED. It’s designed for use at least approximately one hour before intimacy and is capable of providing relief from ED for approximately four hours per dose. Sildenafil is available as brand name Viagra and as a generic medication. It’s a popular choice that works well for most men affected by ED.
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Tadalafil. The active ingredient in Cialis, tadalafil is a long-lasting ED drug that offers relief from ED for up to 36 hours per dose — a duration of action that’s earned it the nickname, the “weekend pill.” Tadalafil is available as brand name Cialis and as a generic medication. It can be used as needed before intimate activity or taken daily at a reduced dosage to provide ongoing ED relief.
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Vardenafil. The active ingredient in Levitra, vardenafil works similarly to sildenafil but has a slightly longer half-life, meaning it remains active in the body for longer. It’s sold as Levitra and is also available as a generic medication.
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Avanafil. The active ingredient in Stendra, avanafil is a second-generation medication for ED. It’s more selective in its effects than older ED drugs, starts working in as little as 15 minutes and is less likely to cause some side effects. Currently, it’s only available as the brand-name medication.
There are other ED medications besides these oral ones. Alprostadil (Caverject) is FDA approved for ED and comes as an injectable medication. Alprostadil can also be used intraurethrally. Compounded medications like BiMix, TriMix, and QuadMix can also be used for ED and are given by injection or intraurethrally.
How Do ED Medications Work?
All four of the oral medications listed above belong to a class of drugs called PDE5 inhibitors, which work by inhibiting the effects of the enzyme phosphodiesterase type 5 (PDE5). PDE5 is found inside the smooth muscle cells of your blood vessels and is responsible for regulating blood flow to the privates.
Getting hard are all about blood flow. When you’re aroused, nerve signals trigger the flow of blood to the corpora cavernosa — a pair of sponge-like tissues inside your privates.
By blocking the effects of PDE5, oral ED medications like sildenafil, tadalafil, vardenafil and avanafil dilate the blood vessels that supply your privates, improving blood flow and making it easier to get hard and maintain it.
The other treatment options for ED work through a variety of different mechanisms, from dilating the blood vessels in different ways, to stimulating the nerves of the privates, to pulling more blood into the privates with negative pressure.
However, these treatments don’t treat the psychological side of ED, meaning they won’t cause you to feel more stimulated.
ED can have physical and psychological causes. Physical causes include heart and blood vessel disease, diabetes, atherosclerosis (clogged arteries) and damage to the privates or surrounding tissue, which can affect nerve function and blood flow.
Psychological causes may include depression, feelings of guilt, performance anxiety and stress. Although these don’t physically reduce blood flow, they can affect a person’s comfort in intimate situations and interest in stimulation.
(Related: 14 Ways to Last Longer In Bed)
What Is the Safest Drug for ED?
There is no one safest ED drug. Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil) and Caverject (alprostadil) are all FDA-approved for the treatment of ED and safe for most men to use.
These medications for ED underwent extensive clinical testing to check that they’re safe and effective before they were approved by the FDA.
This testing process involved multiple phases of clinical trials and thousands of participants. The FDA reviews the findings from these studies to check that drugs aren’t just effective, but also that they’re safe for patients to use.
All FDA-approved ED medications have passed this process, meaning the FDA has determined that they’re safe and effective for their intended use — in this case, treating ED.
The safest one for you, specifically, depends on your specific health history, needs, and other factors. You can work with a healthcare provider to figure out which medication is best and least likely to cause side effects for you.
Are Over-the-Counter ED Drugs Safe?
If you’ve searched for information about treating ED, you may have seen certain products marketed as over-the-counter alternatives to prescription ED medications.
Some of these products, such as Rhino pills and other “herbal” products, are perceived as safer than prescription drugs (the only real safe love-making pills), since they’re sold in gas stations and other stores with no need for a visit to the doctor.
The reality is that these products are almost always significantly less safe than FDA-approved prescription drugs used as treatments for ED.
Over the years, the FDA has investigated many of these products and found that they often use unlabeled, hazardous ingredients. Some contain the same ingredients as prescription ED pills in either unusually low or dangerously high amounts.
The FDA maintains a list of tainted enhancement products that includes recent products found to contain unlabeled and/or dangerous ingredients.
Because they’re not held to the same standards as real medications, these “ED pills” may cause side effects, interactions and other issues even in healthy individuals.
ED Medication Side Effects
Is there a best medicine for ED without side effects? Not really.
Like all medications, ED drugs like sildenafil, tadalafil, vardenafil and avanafil do have the potential to cause side effects, and while they may be mild or nonexistent for some users, others may see more intense effects.
Most of the side effects associated with oral ED drugs are mild and temporary. The most common side effects of these oral medications include:
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Headaches
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Muscle aches
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Nasal congestion
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Dizziness
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Facial flushing
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Indigestion/heartburn
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Nausea (upset stomach)
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Visual disturbances
Side effects of other ED medications differ.
The rate of side effects can vary from one ED medication to another, but most issues affect a small portion of users and subside quickly.
For example, headache — the most common side effect of most oral ED medication — was reported by 21 percent of men who used sildenafil citrate in clinical trials at a 50mg dosage. In clinical trials of tadalafil and vardenafil, headaches were reported by 11 and 15 percent of men, respectively.
For most men who use ED medications, these side effects aren’t serious.
As a newer, more selective medication for ED, avanafil (Stendra) is less likely to produce certain side effects than other ED medications.
For example, in trials of avanafil, only 6.9 percent of men reported developing headaches while using the medication at a typical starting dosage of 100mg. Other side effects only occurred in a small percentage of users, even at the maximum 200mg dosage.
If you’re worried about side effects from ED medications, you may prefer avanafil to older drugs such as sildenafil or tadalafil.
Although uncommon, ED medications can cause more serious side effects, including temporary vision loss, sudden decrease or loss of hearing and priapism — getting hard in a painful, persistent way that lasts more than four hours and requires medical attention.
If you develop any serious or concerning side effects after taking ED medication, it’s best to talk to your healthcare provider. In the event of an emergency, seek urgent medical attention.
Overall, side effects — both mild and serious — are rare with ED medication. The vast majority of men with ED are able to safely use all FDA-approved medications as directed without major issues, with few reporting more than mild, transient adverse effects.
(Related: What Happens If You Take 2 Viagra In 24 Hours?)
ED Drug Interactions
While oral ED drugs are safe for most men, there are certain medications that shouldn’t be used with them. These include several medications prescribed for angina (chest pain caused by low blood flow to the heart), heart failure, high blood pressure and other conditions.
Interactions can potentially happen with all ED medications, including newer, second-generation oral ED meds such as avanafil (Stendra).
In particular, oral ED medications can interact with nitrates and nitroglycerin used to treat angina and cardiovascular disease and other heart conditions, such as congestive heart failure (CHF).
When taken with nitrate drugs, prescription medications for ED can trigger a dangerous drop in blood pressure that may cause dizziness, fainting or life-threatening cardiovascular events such as myocardial infarction (heart attack) or stroke.
Other medications that can interact with oral ED medicine include alpha blockers used to manage hypertension (high blood pressure) and other anti-hypertensive medications. They should only be combined with proper medical advice.
To use ED drugs safely, make sure to tell your healthcare provider about all medications, herbal supplements and/or other substances you currently use or have recently used before discussing any treatment for ED.
Warnings to Consider Before Taking ED Medication
It’s important to take caution with ED medication if you have any type of cardiovascular health condition, such as heart disease, congestive heart failure, an irregular heartbeat, hypertension (high blood pressure), hypotension (low blood pressure) or a heart valve issue.
It’s also important to exercise caution before using ED medication if you’ve ever suffered a heart attack, stroke or undergone heart surgery within the last six months.
These conditions may increase your risk of experiencing side effects or safety issues from some ED medications. To keep yourself safe, make sure to inform your healthcare provider about any of these medical issues before using any medication for ED.
Other conditions that may affect ED medication include:
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Injuries to or deformations of the privates
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Blood cell disorders, such as sickle cell anemia
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Blood or bone marrow cancers, such as leukemia or multiple myeloma
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Eye disorders, such as retinitis pigmentosa
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Previous cases of priapism (getting hard is long-lasting, painful)
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Liver or kidney problems
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Stomach ulcers or a history of stomach ulcers
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Bleeding problems
The best way to keep yourself safe while using ED medication is to tell your healthcare provider about your full health history, including any current medical conditions and issues that you have experienced in the past.
You may also wish to get medical advice on what lifestyle changes might be helpful in restoring hardening function.
They’ll be able to assess your risk of issues from ED medication and recommend a treatment plan that’s both safe and effective for you.
The Safest Pill for ED
The safest ED medication is the one your healthcare provider recommends. All of the ED medications approved by the FDA are safe for most men to use.
However, just like other medications, ED medications do have the potential to cause side effects and drug interactions in certain situations.
As the newest ED medication, avanafil (Stendra) has a more selective effect on blood flow than older ED drugs, meaning it may be worth considering if you’re concerned about side effects.
This article originally appeared on Hims.com and was syndicated by MediaFeed.org.
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The 7 Best Vitamins & Supplements for ED
If you’ve been googling “what is the best vitamin for ED” or “supplements for ED” and coming up short on answers, there’s a reason for it: the “natural male enhancement” pills that you find online and in gas stations are released by brands that make dubious claims about what their products can do, and often, those claims aren’t backed by a lot of research. In fact, many of them are dangerous.
That said, certain vitamins and supplements (not the stuff you see at the gas station) — like vitamins B3 and D, or supplements like L-arginine, to name a few — may offer some erectile function benefits that are backed up by some science.
So, whether you came here in search of vitamins for erectile strength or supplements for ED, we’re happy to share what research shows about vitamins that help with ED…maybe. We’re going to go through all the vitamins you should look for, and the foods in which you can find them
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You’re probably aware of ED treatments like Viagra, which work by increasing blood flow to your privates when you’re in the mood for love-making. But what about the options available without a prescription?
Well, if you’ve been looking at the “natural male enhancement” stuff on gas station shelves, we have some bad news. As we’ve discussed in our guide to herbal supplements for ED, most non-prescription products for treating ED are, to put it lightly, lacking in scientific evidence (unless they are something specifically approved or authorized by the FDA for ED, like vacuum devices or the topical gel, Eroxon).
That said, as we mentioned above, some research shows that deficiencies of certain vitamins might contribute to ED. If you’re deficient, adding these vitamins to your diet might improve your overall health, including your ability to get and stay so.
To put things in perspective, here’s the current wisdom:
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Numerous factors can play a role in ED, including your cardiovascular health, psychological well-being and your level of interest in love-making.
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Currently, the most effective oral treatments for ED are PDE5 inhibitor medications, such as sildenafil (the active ingredient in Viagra).
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Vitamins B3, B9, C and D have been linked with blood flow, ED or testosterone levels in scientific studies. However, there’s very limited research on the link between vitamins and ED, meaning our understanding of this potential link isn’t very strong right now.
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To get reliable relief from ED, it’s best to talk to a licensed ED healthcare provider online to learn how you can improve blood flow to your privates and strengthen your erections.
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Depending on your medical history, they may check your blood pressure, cholesterol and other tests that can screen for health conditions like heart disease, type 2 diabetes and other things that are a risk factor for ED.
Okay, now that we’ve covered the basics, let’s talk vitamins.
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Vitamins are critical for the proper functioning of your body. They play vital roles in the development of your bones and organs. They also power essential biological processes that keep you alive, from your metabolism to the operation and function of your brain.
Because vitamins play such important roles in your health and survival, vitamin deficiencies can have serious negative effects on your well-being. What vitamins are good for erectile dysfunction, then, are the ones you don’t have enough of.
Some potential vitamins for ED include:
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Vitamin B3 (niacin)
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Vitamin B9 (folic acid)
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Vitamin C (ascorbic acid)
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Vitamin D
Let’s look into each one to learn more.
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Some scientific research suggests that vitamin B3, or niacin, may be helpful for managing ED.
For example, a study in 2011 found that adult men with ED and dyslipidemia (abnormal amounts of lipids in the blood) experienced improvements in erectile function after taking niacin for 12 weeks.
Vitamin B3 is an important vitamin for metabolic function. It’s linked to a reduced risk of certain types of cardiovascular disease thanks to its anti-inflammatory and anti-oxidative effects.
Niacin is widely available as a health supplement. It’s also found in a variety of foods, including:
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Red meat, poultry and fish
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Bran, yeast and whole-grain cereals
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Peanuts, legumes and seeds
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Eggs
(Related: The Best ED Pills for Men: Pros & Cons of ED Medication)
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Another vitamin that may be linked with ED is vitamin B9, or folic acid.
A study published in the Asian Journal of Andrology analyzed the folic acid levels of men with ED and found that men with ED typically had lower levels of folic acid than healthy, unaffected men.
Interestingly, low levels of vitamin B9 were also linked to PE — another common male performance issue.
A newer study from 2020 noted a more direct link between vitamin B9 and health. In this study, men with ED showed measurable improvements in erectile function after taking a vitamin B9 supplement on a daily basis for three months.
Vitamin B9 plays key roles in the synthesis of DNA and RNA — essential molecules for storing and reading genetic information. It’s also important for the production of healthy red blood cells.
You can purchase vitamin B9 as a health supplement, but it’s also found in a wide range of foods, like:
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Leafy green vegetables, such as broccoli, spinach, asparagus and lettuce
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Meats, including liver
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Fish and other seafood
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Peanuts, sunflower seeds and beans
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Milk and other dairy products
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Eggs
Folic acid is also commonly added to many breads, cereals, pastas and other grain products in order to prevent nutritional deficiencies.
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Vitamin C is one of the most important vitamins for our bodies. When it comes to erectile health, research suggests that it might play a role in certain biochemical pathways that allow you to get and stay hard during intimacy.
For example, a review published in the journal Fertility and Sterility noted that vitamin C is one of several vitamins and minerals that support the biochemical pathway that leads to the release of nitric oxide.
Nitric oxide, or NO, is generally viewed as the principal agent responsible for relaxing the tissues inside your privates and allowing blood to flow in and create arousal.
Beyond its potential role in your health, vitamin C plays a key role in the biosynthesis of several neurotransmitters, as well as important structural proteins — like collagen, for example.
It’s also essential for maintaining healthy teeth and gums, absorbing iron and promoting proper wound healing.
Good sources of vitamin C include:
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Citrus fruits, such as orange, grapefruit, lemon and lime
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Other fresh fruits, including kiwifruit, guava and papaya
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Strawberries, blackberries, raspberries and blueberries
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Red peppers, green peppers, broccoli and other vegetables
Many fruit and vegetable juices also contain plenty of vitamin C. You can also find it in most multivitamin supplements.
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Although research into the effects of vitamin D on performance is limited, some studies have found that vitamin D deficiency is linked to ED.
A small study published in the International Journal of Impotence Research found that men with vitamin D deficiency or insufficiency had lower levels of function than men with normal vitamin D levels.
However, it’s also worth noting that this study only investigated function and depression symptoms in young men with low vitamin D status.
A meta-analysis from 2020 also found that vitamin D deficiency may be associated with severe forms of ED.
According to a review published in the European Journal of Clinical Nutrition, around 24 percent of people in the United States have low vitamin D levels. Low vitamin D levels are even more common in Canada and Europe.
Your skin produces vitamin D when it’s exposed to sunlight, and it doesn’t take much to maintain healthy levels. Most people will be able to produce enough vitamin D to stay healthy with natural sun exposure from going for a daily walk or running errands.
If you live in an area with limited sunlight or prefer not to spend too much time outdoors, you can also take in vitamin D from food or vitamin D supplementation.
Foods that contain vitamin D include:
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Fish, including salmon, trout, tuna, sardines and many fish oils
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Cheese, milk and other dairy products
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Red meat and poultry
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Soy, almond and oat milks
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Mushrooms
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Apples, bananas and other fruits
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Rice, lentils, sunflower seeds and almonds
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Broccoli, carrots and other vegetables
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Research on other supplements for ED is often inconsistent or not very strong. Some men might see an effect, many might not.
ED supplements that may produce improvements in function and health include:
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L-arginine. This amino acid plays a key role in the production of nitric oxide, which is a molecule that relaxes your blood vessels and promotes healthy blood flow.
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Dehydroepiandrosterone (DHEA). This hormone is a precursor to testosterone, which is important for regulating your drive.
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Ginseng. This herbal supplement might produce improvements in function and satisfaction, but the quality of research is low.
Just like with vitamins, it’s important to keep in mind that supplements aren’t subject to clinical trials like medications. This means that there’s a lot that we don’t know about them, including the safety and effectiveness of using them as ED treatments.
(Related: What Foods Help You Get Hard: 8 Foods For Erectile Dysfunction)
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None of the “vitamins for erection health” listed above — or anything else you can find in a multivitamin — are proven, evidence-based treatments for ED.
Currently, among the most effective options for treating ED are FDA-approved medications called PDE5 inhibitors. These treatments work by dilating the arteries that supply your privates, allowing for better blood flow to your tissues.
Unlike vitamins and natural remedies, they’re subject to large-scale clinical trials before they go onto pharmacy shelves, meaning we know that they’re safe and effective for most men.
If you find it difficult to get or maintain an erection, consider one of the following medications:
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Sildenafil. The active ingredient in Viagra, sildenafil provides relief from ED for around four hours per dose.
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Tadalafil. The active ingredient in Cialis, tadalafil is a long-lasting medication that can provide relief from ED for up to 36 hours.
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Vardenafil. The active ingredient in Levitra, vardenafil provides relief from ED for four to five hours.
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Avanafil. Sold as Stendra, avanafil is a newer treatment that provides relief from ED for up to six hours, with a lower risk of side effects than other oral ED medications.
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Chewable ED medications. These fast-acting chewable mints include ingredients like sildenafil, tadalafil and vardenafil to help you get and stay hard during intimacy.
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Although research is limited, some studies have shown a link between ED and certain vitamin deficiencies.
If you’re deficient in vitamins B3 (niacin), B9, C or D, increasing your consumption might improve your overall health, and maybe your ED symptoms. However, there are several things you’ll want to keep in mind before turning to vitamins as a “proven” ED treatment:
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Vitamins like B3, B9, C and D are important for your overall health and health, and may help in the management of ED. More research is needed to determine whether natural supplements containing L-arginine, ginseng and others are as effective as supplement makers claim.
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It isn’t clear if these vitamins help with function if you don’t have a vitamin deficiency. In other words, if you’re healthy, taking extra vitamin C may not have any impact on your performance in the bedroom.
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More isn’t always better when it comes to vitamins. Certain vitamins are toxic when consumed in excess, meaning you shouldn’t exceed the recommended intake if you choose to use a vitamin supplement.
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Vitamins aren’t a replacement for FDA-approved ED medication, or for healthy, natural habits and lifestyle changes that can make maintaining an arousal easier.
This article originally appeared on Hims.com and was syndicated by MediaFeed.org.
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Featured Image Credit: stefanamer/istockphoto.
