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Needing a little help to get hard isn’t uncommon. One study estimated that 18.4% of men over the age of 20 in the United States experience erectile dysfunction, also known as ED, at some point in their lives. It’s also a condition associated with age, so the frequency may be even higher in certain age groups (Selvin, 2007). But it’s something men don’t want to talk about.
- The FDA currently requires a prescription for Viagra, Levitra, Cialis, and the generic versions of these erectile dysfunction (ED) drugs.
- There’s currently no public plan to make any of these drugs available over-the-counter (OTC).
- Herbal supplements may help with mild erectile dysfunction but have not been compared in a clinical trial to prescription options.
- One type of prescription medication, known as PDE5 inhibitors (like Viagra) are commonly prescribed, but they are not the only ED treatment option.
- It’s possible to get a prescription for Viagra discreetly online.
- There are resources that claim to offer Viagra without a prescription, but these websites are untrustworthy, and using these medications can be deadly.
Researchers in one study looked at 27,000 men from eight different countries and found that only 58% of participants who had experienced ED had ever sought help from a medical professional for the condition (Rosen, 2004).
No matter your reason for seeking over-the-counter options to treat ED, here’s what you need to know about what’s available.
Pills like Viagra over-the-counter
Viagra is the brand name for sildenafil citrate, which is also sold as a generic drug. The US Food and Drug Administration requires a prescription for both Viagra and “generic Viagra.” Both the brand-name medication and generic sildenafil come with potentially dangerous side effects and possible drug interactions, which is why medical advice from your healthcare provider is essential (FDA, 2014-b).
You should also avoid any sources claiming to offer you OTC Viagra. Viagra is one of the most counterfeited drugs in the world. Pfizer, the company that makes brand-name Viagra, found printer ink, amphetamines (“speed”), and metronidazole (an antibiotic) in these fake Viagra pills when they conducted a study in 2011 (Pfizer, n.d.).
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There’s been interest in OTC erectile dysfunction drugs for a while. There were rumblings of potential OTC sales when Sanofi, a French pharmaceutical company, announced efforts to push for an OTC version of Cialis (tadalafil) (Sanofi, 2014). But they’re likely to face a number of hurdles.
Pfizer applied to sell OTC Viagra in the UK in 2008 but withdrew the application after a major regulator voiced concerns. While they eventually did manage to get their plan passed, making OTC available in the UK in 2017, there are currently no public efforts to reach the same achievement in the United States (Bulik, 2017).
In the meantime, some supplements are being marketed as “natural Viagra,” including something called horny goat weed, red ginseng, yohimbine, l-arginine, and DHEA. It’s important to note that studies have not directly compared these herbal supplements and prescription ED medications such as Viagra. Some of these herbal remedies do show promise for helping to get and maintain erections, though. Here’s what you need to know about them:
One class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) have successfully been used to treat premature ejaculation. In fact, the effects of delaying ejaculation can be seen within days of starting SSRI treatment, past studies have found (Mark, 2016). Discuss all of your options with a healthcare professional who can make recommendations based on your individual circumstances and state of health.
- Red ginseng or Korean ginseng: This dietary supplement “significantly improved erectile function” compared to placebo, according to researchers behind a 2018 meta-analysis that considered 24 controlled trials involving 2,080 men with ED. They concluded that the herb may be an effective erectile dysfunction treatment but also called for further research to verify their findings (Borrelli, 2018).Horny goat weed: The effects of this dietary supplement have not been tested for improvement of ED in humans, so we don’t know for sure that this works. But horny goat weed does contain a compound called icariin, which inhibits PDE5, just like Viagra, Levitra, and Cialis, making it a promising option (Dell-Agli, 2008).
- Yohimbe/yohimbine: Human studies on yohimbine for ED in humans is limited. One study found that it helped men with mild erectile dysfunction successfully achieve and maintain an erection long enough to complete sexual intercourse (Guay, 2002). More research is needed, though, since this study only included 18 participants.
- L-arginine: This amino acid has been shown to lower blood pressure by boosting the production of nitric oxide in the body. In fact, it’s as effective as lifestyle changes such as diet and exercise (Khalaf, 2019).
- DHEA (dehydroepiandrosterone): DHEA is a hormone produced by your body that helps your body produce sex hormones such as estrogen and testosterone. Although taking supplements containing DHEA boosts levels of DHEA in the body, past studies have found it doesn’t significantly impact total testosterone levels and may even increase estrogen levels (Kovac, 2015). High estrogen levels are associated with erectile dysfunction (Zuniga, 2019).
Buy Viagra online
If you have a prescription, though, buying Viagra online is a viable and convenient option. Both the brand-name medication and generic sildenafil are available for the treatment of erectile dysfunction. It’s worth knowing about the generic version since there can be over a $50 difference—per pill—between Viagra and its generic alternative (Blue Cross Blue Shield, n.d.).
Sildenafil is the active ingredient in Viagra and “generic Viagra,” but it’s also used in other prescription medications. It’s approved by the FDA in the treatment of conditions other than ED, including Revatio, which is a medication used to treat a condition known as pulmonary arterial hypertension (PAH) (Barnett, 2006). Generic versions of this medication may be prescribed off-label to treat ED since they use sildenafil as the active ingredient.
Viagra and generic Viagra come in three doses: 25 mg, 50 mg, and 100 mg (FDA, 2014-b). But PAH medications used off-label to treat ED expands the dosages available. In addition to the 20 mg dose Revatio comes in, these can also be prescribed in 40 mg, 60 mg, 80 mg, and 100 mg doses (FDA, 2014-a).
The recommended starting dose for men with ED is 50 mg sildenafil, though many are eventually increased to 100 mg (Loran, 2009). Considering these medicines for the treatment of ED also makes it easier to work with healthcare providers to find the right dose to maximize the effects of sildenafil that make it easier to achieve an erection while minimizing potential side effects.
The possible side effects of Viagra include headache, flushing, upset stomach, abnormal vision, blurred vision, stuffy or runny nose, back pain, muscle pain, nausea, dizziness, and rash. Priapism, a painful and persistent erection unrelated to sexual stimulation, is also a possible adverse effect (FDA, 2014-b).
What is erectile dysfunction?
Erectile dysfunction, more commonly known as ED, is a condition that can make it difficult to achieve or maintain an erection long enough to have sex. It’s hard to get an exact sense of how many people experience ED since so many never seek medical care for the condition. But we do know that it’s common and that experiencing ED is associated with lower self-esteem, symptoms of depression, and diminished confidence in men (Selvin, 2007; McCabe, 2014).
Certain medical conditions also make it more likely that someone will experience erection problems, including high blood pressure and diabetes (Selvin, 2007).
Luckily, there are many treatment options for ED. Oral medications called PDE5 inhibitors are some of the most common ED treatments. These prescription medicines ensure that two chemical messengers that control blood flow to your penis work as they should in order to improve sexual function in those with ED (Dhaliwal, 2020). These oral prescription drugs include:
- Avanafil (brand name Stendra)
- Sildenafil (brand name Viagra)
- Tadalafil (brand names Adcirca and Cialis)
- Vardenafil (brand names Levitra and Staxyn)
Generic versions of a medication used for pulmonary artery hypertension— such as generic Revatio—contain the same active ingredient as Viagra. They may also be used off-label to treat ED. Another medication commonly used for the treatment of ED is Alprostadil, which is available as a self-administered injection (brand names Caverject and Edex) or a urethral suppository (brand name Muse).
If your healthcare provider finds that your ED is caused by low testosterone levels, they can also prescribe testosterone replacement therapy (TRT).
- Barnett, C. F., & Machado, R. F. (2006). Sildenafil in the treatment of pulmonary hypertension. Vascular Health and Risk Management, 2(4), 411–422. doi: 10.2147/vhrm.2006.2.4.411. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994020/
- Blue Cross Blue Shield. (n.d.). MyBlue – Blue Cross and Blue Shield Rx Cost Tool – Viagra. Retrieved August 25, 2020, from https://www.fepblue.org/pilot/rx-cost-tool/results?med=69421030
- Borrelli, F., Colalto, C., Delfino, D. V., Iriti, M., & Izzo, A. A. (2018). Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis. Drugs, 78(6), 643-673. doi:10.1007/s40265-018-0897-3. Retrieved from https://link.springer.com/article/10.1007%2Fs40265-018-0897-3
- Bulik, B. (2017, November 29). OTC Viagra: Pfizer snags nod for nonprescription sales of the little blue pill for men in the U.K. Retrieved August 25, 2020, from https://www.fiercepharma.com/marketing/otc-viagra-pfizer-snags-nod-for-non-prescription-sales-uk
- Dell’Agli, M., Galli, G. V., Cero, E. D., Belluti, F., Matera, R., Zironi, E., . . . Bosisio, E. (2008). Potent Inhibition of Human Phosphodiesterase-5 by Icariin Derivatives. Journal of Natural Products, 71(9), 1513-1517. doi:10.1021/np800049y. Retrieved from https://pubs.acs.org/doi/10.1021/np800049y
- Dhaliwal, A., & Gupta, M. (2020). PDE5 Inhibitor. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549843/
- Food and Drug Administration (FDA). (2014-a, January). REVATIO (sildenafil) Label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021845s011,022473s004,0203109s002lbl.pdf
- Food and Drug Administration (FDA). (2014-b, March). VIAGRA (sildenafil citrate) Label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf
- Guay, A. T., Spark, R. F., Jacobson, J., Murray, F. T., & Geisser, M. E. (2002). Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial. International Journal of Impotence Research, 14(1), 25-31. doi:10.1038/sj.ijir.3900803. Retrieved from https://www.nature.com/articles/3900803
- Khalaf, D., Krüger, M., Wehland, M., Infanger, M., & Grimm, D. (2019). The Effects of Oral l-Arginine and l-Citrulline Supplementation on Blood Pressure. Nutrients, 11(7), 1679. doi:10.3390/nu11071679. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683098/
- Kovac, J. R., Pan, M., Arent, S., & Lipshultz, L. I. (2016). Dietary Adjuncts for Improving Testosterone Levels in Hypogonadal Males. American Journal of Men’s Health, 10(6), NP109-NP117. doi:10.1177/1557988315598554. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1557988315598554#_i7
- Loran, O. B., Ströberg, P., Lee, S. W., Park, N. C., Kim, S., Tseng, L., . . . Stecher, V. J. (2009). ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Sildenafil Citrate 100 mg Starting Dose in Men with Erectile Dysfunction in an International, Double-Blind, Placebo-Controlled Study: Effect on the Sexual Experience and Reducing Feelings of Anxiety About the Next Intercourse Attempt. The Journal of Sexual Medicine, 6(10), 2826-2835. doi:10.1111/j.1743-6109.2009.01428.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19817982/
- Mccabe, M. P., & Althof, S. E. (2014). A Systematic Review of the Psychosocial Outcomes Associated with Erectile Dysfunction: Does the Impact of Erectile Dysfunction Extend Beyond a Man’s Inability to Have Sex? The Journal of Sexual Medicine, 11(2), 347-363. doi:10.1111https://www.getroman.com/jsm.12374. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24251371/
- Pfizer. (n.d.). Avoid Counterfeit VIAGRA (sildenafil citrate). Retrieved August 25, 2020, from https://www.viagra.com/getting/avoid-counterfeits
- Rosen, R. C., Fisher, W. A., Eardley, I., Niederberger, C., Nadel, A., & Sand, M. (2004). The multinational Mens Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Current Medical Research and Opinion, 20(5), 607–617. doi: 10.1185/030079904125003467. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15171225/
- Sanofi. (2014, May 28). Sanofi and Lilly announce licensing agreement for Cialis® (tadalafil) OTC. Retrieved August 25, 2020, from https://www.sanofi.com/en/media-room/press-releases/2014/2014-05-28-06-00-00
- Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and Risk Factors for Erectile Dysfunction in the US. The American Journal of Medicine, 120(2), 151-157. doi:10.1016/j.amjmed.2006.06.010. Retrieved from https://www.amjmed.com/article/S0002-9343(06)00689-9/fulltext
- Toda, N., Ayajiki, K., & Okamura, T. (2005). Nitric oxide and penile erectile function. Pharmacology & Therapeutics, 106(2), 233-266. doi:10.1016/j.pharmthera.2004.11.011. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15866322/
- Zuniga, K. B., Margolin, E. J., Fazio, A. D., Ackerman, A., & Stahl, P. J. (2019). The association between elevated serum oestradiol levels and clinically significant erectile dysfunction in men presenting for andrological evaluation. Andrologia, 51(9), E13345. doi:10.1111/and.13345. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31317572/