ED Treatment: Which Pills Are The Most Effective?

Erectile dysfunction(ED) is a condition that leads to the constant inability to achieve and maintain an erection firm enough to have sexual intercourse.

At least one in ten men have, at some point, problems getting or holding an erection. It may be due to physical or psychological causes or both, but regardless of the cause, muscle and blood vessel disorders result in poor blood flow in the penis to obtain and maintain an erection.

Fortunately, there are currently many treatment options for ED, being phosphodiesterase type 5 (PDE5) inhibitors the most effective and recommended ones according to physicians and testimonials.

There are only four main FDA-approved inhibitors that vary in efficacy, effects duration, and side effects. But with such an offer, which one is the best to choose? Let's find out.

Phosphodiesterase-5 inhibitors as a pill against ED

One of the most important components responsible for the erection is the corpus cavernosum. Smooth muscle relaxation within this tissue is the key to penile erection during intercourse.

Erection begins with sensory or mental stimulation, or both, and these cause the muscle to relax to allow greater blood flow, ultimately increasing the size of the penis. During it, some natural enzymes regulate the muscular process by preventing its relaxation.

Phosphodiesterases (PDEs) are the enzymes responsible for preventing this relaxation and stopping the erection. Their inhibition causes a greater blood flow to the penis and, therefore, erection. Their three main purposes are 1) smooth muscle relaxation, 2) vasodilation, and 3) penile enlargement.

How do phosphodiesterase-5 inhibitors work?

All men have phosphodiesterases in their bodies because they allow the penis to return to normal after arousal. These attempt to destroy two chemicals essential for corpus cavernosum relaxation: cGMP and cAMP. Specifically, cGMP promotes vasodilation and, in turn, induces the release of more muscle relaxants.

Phosphodiesterase 5 inhibitors aim to inhibit phosphodiesterase 5, responsible for cGMP degradation, stimulate the release of muscle relaxants, such as nitric oxide, and thus achieve a strong, sustainable erection.

Four potent and selective PDE5 inhibitors treat ED: sildenafil, tadalafil, vardenafil, and avanafil. They are not erection starters and need sexual stimulation first.


Sildenafil, or sildenafil citrate, was initially developed to treat heart conditions since it dilated the blood vessel walls. It is now a well-known treatment for erectile dysfunction because of its ability to selectively inhibit phosphodiesterase-5 and promote corpus cavernosum blood inflow.

Key points about sildenafil:

  • It is effective within 30 minutes to 1 hour after you take it, so sexual stimulation must occur during this time
  • If you are going to masturbate or have sex, be aware that its effectiveness decreases after a fatty meal because it disrupts its proper intestinal absorption.
  • You should use it mainly for long-lasting sexual encounters, as its effects can last up to 12 hours after you take it.
  • Side effects are usually mild and self-limiting once your body gets used to the pill. The most common are headache, heat and flushing sensation, and intestinal discomfort.

Sildenafil (also commercially known as Viagra) is taken in doses of 25, 50 and 100 mg, with the recommended initial dose starting at 50 mg. However, it should be based on each person's response and side effects, if any.


Tadalafil was marketed in January 2003 with a significant improvement in its time to act. Like sildenafil, it is a potent and selective inhibitor of PDE5.

According to clinical studies, it also has an antihypertensive effect in uncontrolled individuals, with the additional benefit of reducing mortality and morbidity.

Key points about tadalafil:

  • It effectively promotes erection from 30 minutes after taking it, reaching its peak after 2 hours.
  • Lasts in your body for about 36 hours, so its effects are long-lasting, and you will not need to take another pill if you are likely to have sex again.
  • You can take the pill with meals since, compared to Viagra, its absorption is not influenced by food.
  • It is more specific to PDE5, so its action on blood vessels, retina, and other organs is low, hence the side effects.

Tadalafil is commercially known as Cialis and is the longest-lasting PDE5 drug for ED. Its recommended doses are lower compared to Viagra, ranging from 2.5mg to 20 mg, but always tailored to the response and tolerance of each person.

Cialis's common side effects include headaches, intestinal discomfort, back pain, nasal congestion, and sweating.


Like the previous ones, it is a potent PDE5 inhibitor launched in 2003 but even more affordable.

Key points include:

  • It is effective from 30 minutes after taking it.
  • Its effectiveness is reduced if taken with large or fatty meals.
  • It is administered in small doses similar to those of tadalafil.
  • Like the previous ones, its side effects are usually mild and improve as your body gets used to the pill. Headache, intestinal discomfort, back pain, vision problems, and overheating are mentioned.

Sold as Levitra, Vardenafil comes in doses of 5, 10 and 20 mg. The usually recommended starting dose is 10 mg, but your physician should adjust this depending on your response and side effects.


It is also a powerful and highly selective inhibitor of cGMP-specific type 5 phosphodiesterase. Like the others, it is effective and safe as a treatment for ED.

Key points about avanafil:

  • It is recommended to take it 15 to 30 minutes before sexual intercourse.
  • Depending on the response and individual tolerability, the dose can be increased to a maximum of 200 mg or decreased to 50 mg.
  • Its absorption decreases when taken with meals, so it is advisable to take it on an empty stomach.
  • According to a study, it may not be as effective as the rest of PDE5 inhibitors as it is likely that not all men will respond to it, or only to a limited extent 2.

Due to its fast and short action, between 6 and 17 hours, it is not recommended for daily use, only occasionally.

What is the best erectile dysfunction pill on the market today?

Understanding that the differences between inhibitors are based more on how long the effects last than on any other aspect, you should consider your sexual rhythm before choosing one.

If you are a person who daily, or almost daily, has sex, then Cialis is for you. On the other hand, Viagra and Levitra will suit you better if you have occasional encounters.

Remember that these medications are prescribed after a thorough cardiovascular examination as there is some risk of cardiac problems linked to sexual activity.

Online Treatment for ED at Doko MD

Get erectile dysfunction pills online, starting at $1/pill with FREE shipping. You can select Generic (Sildenafil or Tadalafil) or Branded Viagra and Cialis. Our U.S. board-certified doctors are available for consultation.


As a service to our readers, Doko MD provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or our online doctors or other qualified clinician.

If you believe you are experiencing a medical emergency, call 911 immediately or go to the nearest emergency room.