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Oral Medications to Treat Erectile Dysfunction

Overview of Oral ED Medications

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Updated January 26, 2009

Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for satisfactory sexual performance. ED happens when not enough blood flows to your penis when you are sexually stimulated.

If you have ED, your treatment will focus on:

  • Determining the cause of your ED
  • Managing any chronic condition, such as diabetes or high blood pressure, that may be causing or contributing to your ED
  • Reviewing your current medications to find out if any of them have an ED side effect
  • Helping you make lifestyle changes that may decrease your risk for ED, including quitting smoking, losing weight, exercising and stopping use of recreational drugs (such as marijuana and cocaine)

In addition, your physician may prescribe medication to help improve blood flow to your penis or to help increase your libido. Medication options for the treatment of ED include oral medications (PDE-5 inhibitors), drugs injected in to the penis, intraurethral alprostadil and the male hormone, testosterone.

What Are the PDE-5 Inhibitors?

The PDE-5 inhibitors are the most commonly used medical treatment for ED. These medications have a high success rate, are easy to use and often result in an erection if you are sexually stimulated.

The PDE-5 inhibitors currently approved by the U.S. Food and Drug Administration (FDA) are Viagra (Sildenafil), Cialis (tadalafil) and Levitra (vardenafil).

How Do the PDE-5 Inhibitors Work?

The PDE-5 inhibitors relax smooth muscle around arteries, allowing your penis to fill with blood. They should be taken about an hour before you plan to be sexually active.

If you are sexually stimulated, Viagra and Levitra usually will allow you to get an erection for roughly four hours after taking it. Cialis (often called the “weekend pill”) may enhance your ability to have an erection for up to 36 hours after taking it.

Can I Take a PDE-5 Inhibitor with Meals?

When using a PDE-5 inhibitor, you may need to avoid eating a high-fat meal at the time you are planning to take it.

Each medication, though, is different. Viagra may work best on an empty stomach. Levitra can be taken with food but may be less effective if the meal has a high-fat content. Cialis can be taken at any time and is not impacted by the food you eat.

What Are the Side Effects of the PDE-5 Inhibitors?

The more common side effects of the PDE-5 inhibitors may include:

  • Abdominal symptoms, such as diarrhea, heartburn and upset stomach
  • Abnormal vision, such as blurring, sensitivity to light and blue-green color tint
  • Dizziness
  • Flushing
  • Headache
  • Nasal congestion
Talk with your doctor if any of these side effects persist or are severe.

Heart attack, stroke, abnormal heart beat and sudden death have been reported after use of a PDE-5 inhibitor. These serious health problems most often occur in men with existing heart disease or cardiac risk factors and typically during or shortly after sex.

If you have had a recent heart attack or stroke, life-threatening arrhythmia (abnormal heartbeat), high blood pressure or moderate-to-severe heart failure, you should not use a PDE-5 inhibitor. You should discuss the risks with your doctor.

Why Is Having an Erection Lasting More than Four Hours a Problem?

An extremely rare but serious side effect of the PDE-5 inhibitors is priapism, a painful, prolonged erection. Priapism develops when blood in the penis becomes trapped and is not able to drain following completion of sexual activity.

If not treated immediately, priapism can lead to scarring and permanent erectile dysfunction.

Do the PDE-5 Inhibitors Interact with Other Drugs or Food?

If you take nitroglycerin or other nitrate medications to treat heart disease, you should never use a PDE-5 inhibitor, due to a risk of severe low blood pressure.

Alpha-blockers used to treat an enlarged prostate (BPH) can also cause hypotension, and they should be used with caution. Discuss the risks with your doctor if you are taking Cardura (doxazosin), Flomax (tamsulosin), Hytrin (terazosin) or Uroxatral (alfuzosin).

The PDE-5 inhibitors can also interact with certain medications used to treat fungal infections, AIDS and heartburn. Your doctor and pharmacist can advise you about these interactions.

The PDE-5 inhibitors also interact with grapefruit juice, and you should avoid grapefruit products. Grapefruit juice may increase the amount of the PDE-5 inhibitor that gets in to your blood. This increases your risk of side effects from your medication.

Are the PDE-5 Inhibitor Drugs Expensive?

Viagra, Cialis and Levitra are expensive medications with an approximate cost of $15 for each pill. Since this cost and the fact that these drugs are considered “quality-of-life” medications, many health plans do not pay for them.

Some health plans limit the number of pills they will pay for each month. For example, Medicare does not pay for the treatment of erectile dysfunction. Some Medicare Part D prescription plans that are trying to attract more seniors, though, may pay for up to eight pills each month.

There are ways to save money when purchasing the PDE-5 inhibitors, though.

Mr. Jones Splits His Viagra
Each month, Mr. Jones uses 8 tablets of Viagra 25mg to treat his ED. He pays $15 for each pill at a local pharmacy. His monthly cost is $120, which he pays for out of his pocket since it is not covered by his health plan.

To save money, Mr. Jones tried pill splitting. These are the steps Mr. Jones took to save $696:

  1. His pharmacist told him that it was safe to split Viagra.
  2. He asked his doctor to write a prescription for Viagra 50 mg, twice the dose that he usually takes.
  3. When he filled his prescription, he noted that the price for each pill was $15.50; only 50 cents more, even though each pill had twice the amount of Viagra. Although Mr. Jones’ cost to have his prescription filled was $124, the medication will now last for two months.
  4. Each time Mr. Jones has sex, he splits one of the Viagra 50 mg pills in half using a pill splitter recommended by his pharmacist. He takes half the pill and saves the other half for the next time he has sex.

Mr. Jones' monthly cost for his Viagra is now $62 (one-half of $124) instead of $120, a monthly savings of $58, which on a yearly basis is a savings of almost $700.

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