How can Erectile Dysfunction (ED) be treated by Medication?
My performance in bed is getting pretty bad and I think I have erectile dysfunction, what can I do about this?
You are looking for a solution. Don’t worry, there are many solutions to erectile dysfunction. The key is finding which one is best for you.
When we are talking about erectile dysfunction (ED), I like to talk about first-line treatment–drugs–and then break down all the other options separately in a later post.
The first question that we have to ask is, “do you get any erection at all?” This is the key question. If you do not get any erection at all, the pills won’t work. Period. End of story. The pills are designed to improve your erection, not to create one.
If you can get some sort of an erection, then there are two different ways that pills are taken: on demand or daily. On demand (this is where you will see the medical term “PRN”) means that you will take the pill(s) whenever you think you are going to have sex. On the other hand, there is an option for one drug to be taken on a daily basis whether you are planning to have sex or not.
How do I know if I'm allowed to take erectile dysfunction meds?
Now, some people aren’t good candidates for taking any of these medications. First and foremost, you have to be healthy enough to have sex. When the erectile dysfunction meds first came out, docs were seeing people coming in with heart issues. Sex is exercise and if you aren’t physically strong enough to have sex, then you aren’t a good candidate for the medications, or you may need to see your primary doc or heart doc to get clearance before starting erectile dysfunction treatment.
On that note, for those who take nitroglycerin, this is an absolute contraindication with these medications. This means that if you have been prescribed nitroglycerin, then you cannot take any of the ED meds. The reason for this is that if you take the two together, you will have a sudden and severe drop in your blood pressure which could be catastrophic.
Is one brand better than the other?
In general, no.
There is no study that says that Viagra is better than Levitra or Levitra is better than Cialis or Cialis is better than Viagra. The analogy I give to all my patient’s is that it’s kinda like Coke and Pepsi. Some people like Coke. Some people like Pepsi. In general, each drug has its particular niche or its claim to fame for why you could consider using it over a different brand.
So now that we have made that clear, let’s break each drug down. I’ll go over the dose range, whether you need to take it with or without food, how long it takes to work as well as how long it is in your system.
Let me explain those last two issues in a little more detail. When I say ‘how long it takes to work’, I don’t mean to set your alarm clock to one hour and then say alright babe let’s go. If I say it takes an hour to work, that means don’t get disappointed if you don’t see a result after ten minutes. Additionally, when I say ‘how long it is in your system’, that doesn’t mean you will have an erection for 6 hours. It just means that during this window of time, if you have sex, this med will give you a boost.
How to take Viagra?
- Dose: 20-100 mg
- Generic form: sildenafil
- Works better on empty stomach: means one hour before or two hours after you eat
- How long does it take to start working: 1 hour
- How long it is in your system: around six hours
- Click here for the full prescribing information
How to take Cialis?
- Dose: 2.5-20 mg
- Generic form: tadalafil
- Can be taken with or without food
- How long does it take to start working: 2 hours
- How long is it in your system: around 24-36 hours
- Click here for full prescribing information
How to take Levitra?
- Dose: 2.5-20 mg
- Generic form: vardenafil
- Works better on an empty stomach
- How long does it take to start working: 2 hours
- How long is it in your system: around six hours
- Click here for full prescribing information
How to take Stendra?
- Dose: 50-200 mg
- Generic form: avanafil
- Can be taken with food
- How long does it take to start working: 15 minutes
- How long is it in your system: around six hours
- Click here for full prescribing information
Do these medications have side effects?
Of course, let’s walk through them.
In general, these medications have the risk of headache, flushed feeling in face, backache, nasal congestion and upset stomach. Cialis has a higher risk of muscle aches and Stendra has the lowest risk of headaches.
The degree of how severe these side effects is really variable with patients. Also, the length of these side effects vary by how the drugs are designed. For example, Cialis is nice because it gives you a long window to have sex. On the other hand, if you get side effects that are bothersome, these also stay in your system longer. This is what I mean when I stated above that each patient may have a different ‘best’ drug for them.
Another potential side effect with Viagra is seeing a bluish tint with your eyesight.
Lastly, there are two serious but really really unlikely side effects. One is priapism. This is a condition where the penis stays hard for four hours. Before you get too excited with this, this is actually a problem. If the penis stays erect for that long, it can potentially cause permanent penile damage. The other side effect has a crazy long name—non-arteritic ischemic optic neuropathy (NAION)—which can lead to blindness. This is super-duper rare and debatable if this is directly related to the medication, but nonetheless, in theory it’s possible so important to know.
Why would I decide to take on demand versus daily?
Now first off, the only medication that is designed to take on a daily basis is Cialis (tadalafil).
The reason to consider this option is if you aren’t getting an ideal response with taking it as needed. There are some studies that show that patients may respond better taking a low-dose of Cialis everyday rather than an on demand medication. So if you aren’t getting an ideal response with the as needed version, this may be an option to consider. There are two main downsides with taking it on a daily basis. One is the fact that you have to take a pill every day. The other is that it is a more expensive option because you are using more pills overall. In terms of its advantages, again there are some studies that will show that it may lead to a better result. Also, for some guys it really helps alleviate some of the anxiety with taking the medication because you don’t have to worry about timing your dose related to sex. Essentially, it’s always in your system so when the time is right, you are good to do.
Dr. Jafri Wrap up
So I hope this is a good primer for all the ED meds and how to take them.
If the medications don’t work and you aren’t quite ready for surgery, then head over here to learn about penile injections.
I started doing some research to aid a buddy of mine who has erectile dysfunction because it has seriously diminished his self-confidence. I’m delighted you said that before taking medication, you should make sure you are well enough. I believe that seeking professional advice would be beneficial for him in order to receive a prescription for oral medications. I appreciate you sharing this. I’ll make sure to check the local services for him!