Alternatives to Sildenafil
Sildenafil (Viagra, Viagra connect)
Works for: up to 94% of men
Starts to work in: 30 minutes to 1 hour
Stays in the body for: 4 to 6 hours
Pros: Does not require a prescription (Viagra Connect), highly effective
Cons: For best results should be taken on an empty stomach
Common side effects: Headache, temporary visual changes, dizziness, flushing, blocked nose, and indigestion
Tadalafil (Cialis)
Works for: up to 86% of men
Starts to work in: 30 minutes
Stays in the body for: 24 to 36 hours
Pros: Stays in the body for a long time, so can be taken once a day at a low dose. May be a good choice if you don’t want to plan sex in advance. Tadalafil is also approved to treat enlarged prostate
Cons: Lasts a long time in the body which may be a problem if you experience side effects.
Common side effects: Headache, flushing, blocked nose, indigestion, nausea, diarrhoea, and muscle aches.
Vardenafil (Levitra)
Works for: Up to 83% of men
Starts to work in: 25 minutes to 1 hour
Stays in the body for: 4 to 6 hours
Pros: A good choice for men with diabetes when sildenafil hasn’t worked
Cons: Available on prescription only
Common side effects: Headache, stuffy or runny nose, dizziness, indigestion and flushing.
Avanafil (Spedra)
Works for: up to 80% of men
Starts to work in: 15 to 30 minutes
Stays in the body for: 4 to 6 hours
Pros: Works quickly, so less need to plan sex in advance. Potentially fewer side effects than alternatives
Cons: Only available with a prescription
Common side effects: Headache, flushing and a stuffy nose.
Other treatments
If you have tried oral medications without success, or you would like to try another treatment, the following options may be good for you.
Alprostadil (Vitaros) is a cream, tablet or injection that is applied directly to the penis before sex. It works by dilating (widening) blood vessels and increasing blood flow to the penis. It normally works within 5 to 20 minutes and lasts for 1 to 2 hours. Alprostadil is normally used when other treatments like oral medications haven’t worked.
Penis pumps consist of a tube that fits over the penis, a handheld or battery-operated pump, and a ring that fits over the base of the penis. Air is pumped out of the tube, creating a vacuum, and triggering an erection by increasing blood flow to the penis. Water can be used to create a similar effect. The ring constricts the base of the penis to maintain the erection long enough to have sex. Penis pumps are one of the few non-medical treatments for erectile dysfunction and may be a good choice for men who can’t or don’t want to take tablets or injections.
Surgery for erectile dysfunction can involve placing inflatable rods inside the shaft of the penis. These rods are attached to a fluid solution and pump that are hidden inside the scrotum. When you use the pump, the rods fill with fluid and create an erection. Surgery is only considered for certain types of non-reversible erectile dysfunction, or when other treatments haven’t worked.
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