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Erectile dysfunction (ED) is a common condition that doctors treat with prescription medication. Over-the-counter (OTC) ED supplements are not typically recommended. Most do not have Food and Drug Administration (FDA) approval.
ED refers to difficulty developing or maintaining an erection. It is a common condition: At least
Different medical and psychological conditions can work together or independently to cause ED. The American Urological Association (AUA) has clear treatment guidelines for the condition.
Viagra is only available with a prescription, and there are no OTC ED pills. However, some supplements and natural remedies may help improve ED.
This article looks at various treatment options for ED, including OTC supplements, natural remedies, and prescription medications. It also discusses the evidence and risks associated with these options.
Sildenafil is the generic name for Viagra. This medication is only available via prescription in the United States. Therefore, Viagra is not available OTC.
An OTC ED medication, also known as a nonprescription ED medication, refers to any supplement or herb that claims to produce similar effects to Viagra.
In most cases, there is insufficient research to suggest that OTC ED pills can benefit sexual function.
The FDA does not regulate OTC ED pills for their safety or effectiveness. Moreover, the FDA
OTC ED pills are supplements. The FDA does not regulate supplements for their safety or effectiveness. Supplements may contain a combination of ingredients, or product labels may not specify the product’s ingredients.
Since OTC ED pills are not FDA regulated, manufacturers are not legally allowed to state that their products treat ED. Instead, they may market products as “sexual enhancers” to help people achieve or maintain an erection.
Dehydroepiandrosterone (DHEA) is an important hormone for sexual function. It helps create sex hormones, including testosterone and estrogen.
The adrenal gland naturally produces DHEA. However, DHEA levels in the body peak in a person’s 20s, then gradually decrease with age.
According to a
DHEA manufacturers also claim their supplements can boost energy, enhance immunity, and slow aging. However, there is not enough evidence to suggest DHEA has any of these effects.
One significant drawback of DHEA is that it is not suitable for athletes. The U.S. Anti-Doping Agency prohibits the use of DHEA in sports and notes that the substance falls under the category of anabolic agents on the World Anti-Doping Agency Prohibited List.
Another drawback of DHEA is the lack of studies investigating its safety, effectiveness, and dosages.
Since DHEA is readily available as a supplement, the premise is that people who take it do so for the long term. Unlike Viagra, any potential results build up over time rather than producing an immediate erection or sexual benefit.
L-arginine is a common amino acid in men’s health supplements.
The body converts L-arginine into the chemical nitric oxide. This chemical may help the blood vessels open wider, improving blood flow throughout the body.
Research from 2021 found a link between L-arginine deficiency and ED. Researchers note that combining L-arginine with a prescription ED treatment, such as tadalafil, may improve ED.
However, a person should talk with a doctor before combining supplements and medications. Doing so can cause adverse effects.
L-arginine in 1,500–5,000 milligrams (mg) can be
Additionally, a
However, a person should be cautious when taking L-arginine or similar supplements. Side effects
- nausea
- diarrhea
- slightly lower blood pressure
As with other supplements, any benefits of taking L-arginine will likely arise from continuous use. However, scientists currently do not know how safe it is to take high dose L-arginine supplements for more than
Ginseng is a popular herbal remedy available in the form of pills and creams. Manufacturers claim it can help with fertility and improve sexual function.
Ginseng contains chemicals called ginsenosides. One action of these chemicals is to promote nitric oxide, which may help trigger an erection by relaxing the smooth muscles in and around the penis.
A 2021 review found that ginseng has a trivial effect on ED in comparison to placebos. However, more research is necessary.
The
According to the NCCIH, other potential side effects include:
A person must talk with their doctor before taking ginseng since this supplement can interact with a variety of medications,
Learn more about ginseng and ED.
Propionyl-L-carnitine is one of the commercially available forms of L-carnitine. This chemical
A
It is also not clear whether propionyl-L-carnitine alone would have the same beneficial effects on ED.
Scientists have also not established safe and effective dosages for propionyl-L-carnitine.
Yohimbe is an African evergreen tree. Its bark contains a compound called yohimbine, which has
According to the
However,
The
The NCCIH also notes the possible side effects of yohimbe, such as:
Yohimbe has also been associated with heart attacks and seizures.
The NCCIH states that yohimbe can interact with certain medications, including a class of antidepressants called monoamine oxidase inhibitors (MOAIs).
A person should speak with a doctor before taking yohimbe.
The table below compares all of the above OTC ED pills.
OTC ED products claim to relieve ED either by increasing levels of certain sex hormones or by widening blood vessels to facilitate an erection.
However, there is currently
The FDA does not test or regulate OTC ED pills. There is insufficient research to determine whether these supplements are safe or effective.
A person should be particularly cautious with ED pills that:
- claim to produce fast results, such as within 30–40 minutes
- are available in single servings
- are labeled as alternatives to prescription drugs
- are marketed through unsolicited emails
- have labels in a different language without trusted translation
- contain warnings and directions that mimic those of prescription products
In addition, the FDA has a database of
For example, these products may interact with drugs that contain nitrates, such as:
- nitroglycerin, which helps treat angina and coronary heart disease
- isosorbide or nitroprusside, which helps treat high blood pressure
- amyl nitrate, which helps treat angina
Given the above, speaking with a doctor before taking any supplement is best.
Potential risks of using OTC treatments for ED include:
- Drug interactions: Some supplements may cause unsafe interactions with other medications or supplements that a person is taking.
- Undisclosed ingredients: Inaccurate reporting of ingredients could lead to a person consuming harmful ingredients or a harmful dose of ingredients.
- Quality control: A lack of quality control and FDA regulation can lead to dangerously different levels of active ingredients in the same product.
It is important not to purchase products that advertise themselves as “herbal ED products” or over-the-counter (OTC) ED pills.
The FDA does not regulate these supplements and warns that these products
A 2022 study found that 3 out of the 12 herbal ED products investigated contained undisclosed sildenafil. This is particularly dangerous for people who take nitrates, as their blood pressure can become dangerously low.
In addition to sildenafil, these products can contain other ingredients that interact with a person’s medications or supplements. Some OTC supplements may contain ingredients without any safety evaluation in the United States.
A doctor may prescribe medications that stimulate blood flow to the penis, thereby causing an erection.
These drugs are known as PDE-5 inhibitors. They
The four main FDA-approved oral drugs for ED are:
- Sildenafil (Viagra): People typically take sildenafil around 1 hour before sex, up to once daily. Hims offers generic sildenafil at around $4 per dose. Branded Viagra starts from $139 per dose.
- Avanafil (Stendra): People taking avanafil in doses of 100 or 200 mg should take the medication up to 15 minutes before sex, whereas those taking a 50 mg dose should take the medication around 30 minutes before sex. In both cases, a person should not take more than one dose in 24 hours. It costs $53 per dose via Hims.
- Tadalafil (Cialis): Depending on a doctor’s instructions, people can take tadalafil daily, or as they need around 30 minutes before sex. However, they should not exceed more than one dose within 24 hours. Hims offers a generic version for around $40 monthly for daily tablets.
- Vardenafil (Levitra): People can take vardenafil around 60 minutes before sexual activity. They should not exceed more than one dose per day. The generic version of vardenafil costs around $126 for six tablets at Blink Health.
Learn more about which is best out of Viagra, Cialis, Levitra, and Stendra.
Side effects
Different drugs vary in dose, how long they work, and possible side effects. Roughly
Below is a table featuring the four main PDE-5 inhibitors and some of their more common side effects:
Interactions
Sildenafil, the
People with any of the above conditions should consult a doctor before taking ED medications or supplements, whether prescription or OTC.
Medications for ED may also not be suitable for people with certain underlying medical conditions, including:
- heart problems
- very low blood pressure or untreated high blood pressure
- liver disease
- kidney disease
A person’s doctor can determine which medication is the best fit for them.
There are several other treatment options for ED. These include vacuum devices and ED rings.
Vacuum devices are mechanical pumps that create an erection by drawing blood into the penis. A patient satisfaction survey found around 77% of people who use vacuum devices or penis pumps for ED were satisfied with the results.
ED rings are bands that go around the base of the penis to help maintain an erection. A 2022 case report states that ED rings can effectively improve ED.
Learn more about the various treatment options for ED here.
However, there are some risks involved with penis pumps and rings, including:
- bruising
- pain, including painful erections
- numbness and tingling
- burst blood vessels
A person should always speak with a doctor before trying a new ED treatment to ensure it is safe.
Certain lifestyle factors can increase a person’s chance of erectile problems. Addressing these factors may help improve their symptoms.
The following may help naturally treat erectile problems and boost a person’s overall health:
Prescription medications can help people manage ED symptoms, but they require a consultation with a physician.
Alternatively, some businesses offer telehealth services that include ED diagnostic and treatment options. The ability to access evaluation and treatment online can help people save money, time, and preserve anonymity, which may make it more likely that they can get the safe and professional help they need.
Learn more about the benefits of telemedicine.
However, telehealth should not replace in-person exams, since ED can be
Learn more about prescription drugs for ED here.
According to the National Center for Complementary and Integrative Health, there are no safe and effective alternative treatments for ED. Some nonprescription ED pills may contain active ingredients found in prescription drugs, but not at safe levels. They may also contain other unapproved drugs with unknown and potentially dangerous effects.
Lifestyle measures are typically the first step in treating ED. These may be the best approach to treating the condition since there are no safe and effective alternative treatments for ED.
These lifestyle strategies may include:
- not smoking
- increasing physical activity
- eating a balanced, nutritious diet
- limiting or avoiding alcohol use
- managing chronic conditions, such as diabetes and high cholesterol
The best pill to maintain an erection are FDA-approved PDE5 inhibitors, such as Viagra, Cialis, and their generic versions.
People can get these pills by making an appointment with a doctor, either in person or online.
Telehealth makes it possible for people to consult doctors and receive prescriptions for ED medications from the privacy of their homes. Telehealth can also help people save time and money and avoid feeling uncomfortable when discussing ED in person.
Yes, alprostadil is a medication that comes in topical form. The brand name is Vitaros.
This topical medication is a second-line treatment for ED, which means a healthcare professional may prescribe it if a person cannot tolerate oral medication or in combination with more traditional tablets like Viagra.
However, this medication is not available over the counter. People need a valid prescription to purchase it at a pharmacy.
There are no OTC ED pills available as a natural alternative to Viagra. One can try some of the natural supplements in this article, which may improve some ED symptoms. Additionally, a person can try certain lifestyle strategies to try to help improve their ED symptoms.
Prescription medications may be an effective treatment for ED, although they are not safe for everyone. Telehealth options make it more convenient and private for people to access the medical consultations they need to obtain prescription ED drugs.
To date, research has not confirmed any OTC pills or supplements that safely or effectively treat ED, but prescriptions and supplements are not the only ways to address this condition. People with questions about ED treatment should discuss options with a physician.
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