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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Needing a little help to get hard isn’t uncommon. One study estimated that nearly 20% of men over 20 in the United States experience erectile dysfunction (ED) at some point in their lives, and that number generally goes up with age (Selvin, 2007).
But, even though it’s so common, many men don’t want to talk about it—even with their healthcare providers. In fact, one large study estimated that only 58% of men who experience ED seek help from a medical professional for their condition (Rosen, 2004).
It’s no wonder so many people are seeking out pills like Viagra over-the-counter. We’ve covered everything you need to know about various ED treatment options.
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Can you get over-the-counter Viagra?
The short (and probably disappointing) answer is: no. You can’t get prescription-only ED medications like Viagra (generic name: sildenafil; see Important Safety Information) over-the-counter. Since 2017, Viagra has been available over-the-counter in the United Kingdom, but there are currently no public efforts to do the same in the United States (Bulik, 2017). But, that doesn’t mean it’s difficult to get the treatment you need. It’s easier than ever to get ED medications discreetly.
- Viagra (generic: sildenafil)
- Cialis (generic: tadalafil; see Important Safety Information)
- Levitra (generic: vardenafil)
- Stendra (generic: avanafil)
These drugs can help treat ED by improving blood flow to the penis, allowing for harder, longer-lasting erections. The U.S. Food and Drug Administration (FDA) requires a prescription for all of these medications, including the brand name and generic versions.
Warnings, risks, and side effects
You might see some sources online claiming to offer OTC Viagra. Steer clear. Viagra is one of the most counterfeited drugs in the world. Pfizer, the company that makes brand-name Viagra, has found dangerous substances like printer ink, amphetamines (“speed”), and metronidazole (an antibiotic) in these fake Viagra pills (Pfizer, n.d.).
Viagra and other medications like it come with a risk of potentially dangerous side effects and drug interactions, which is why medical advice from your healthcare provider is essential (FDA, 2014-b).
What about other types of over-the-counter ED pills?
While you can’t get the “real deal” over-the-counter, there are some products available OTC that are advertised as treatments for ED. Certain supplements are being marketed as “natural Viagra,” including horny goat weed, red ginseng, yohimbine, l-arginine, and DHEA.
Different types of penis pumps for erectile dysfunction
It’s important to note that studies have not directly compared these herbal supplements and prescription erectile dysfunction drugs such as Viagra. Some of these herbal remedies do show promise for improving erections, though. Here’s what you need to know about them:
Red ginseng or Korean ginseng
A large study published in 2018 examined 24 different controlled trials with a total of more than 2,000 participants showed that this dietary supplement “significantly improved erectile function” compared to placebo. They concluded that Korean red ginseng might 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 haven’t been tested for improvement of ED in humans, so we don’t know for sure that it 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).
Studies on yohimbine for ED in humans are limited. One study found that it helped men with mild erectile dysfunction successfully achieve and maintain an erection long enough to have sex. More research is needed, though, since this study only included 18 participants (Guay, 2002).
This amino acid has been shown to lower blood pressure by boosting the production of nitric oxide in the body, a chemical that plays an important role in erections. In fact, for the treatment of high blood pressure, some research shows that it’s as effective as lifestyle changes such as diet and exercise (Khalaf, 2019). The research on l-arginine for ED is not as clear, but some small studies have shown that it may make it easier to get an erection or make sex more enjoyable, at least when compared to a placebo (Rhim, 2019).
DHEA (dehydroepiandrosterone) side effects
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). Bottom line? DHEA probably isn’t a slam dunk for treating your ED. You’re better off asking a healthcare provider about prescription options.
Where to get Viagra safely and discreetly
While you can’t get Viagra or other PDE5 inhibitors OTC, these medications are easy to get if you have a prescription. It’s easier than ever to get ED meds online, shipped discreetly to your home. Some companies offer specific brands, generic versions only, or a combination.
It’s worth knowing about the generic version since there can be a serious price difference between Viagra and its generic alternative (GoodRx, 2021).
Sildenafil is the active ingredient in Viagra and “generic Viagra,” but it’s also used for the treatment of conditions other than ED. Revatio (generic name: sildenafil; see Important Safety Information), for example, is also sildenafil, but it comes in different doses than Viagra and is used to treat a lung condition called pulmonary arterial hypertension (PAH) (Barnett, 2006). Generic versions of Revatio may be prescribed off-label to treat ED since sildenafil is 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 expand the dosages available. In addition to the 20 mg dose Revatio comes in, it 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 your care provider might up your dose to 100 mg if 50 mg doesn’t do the trick, or lower your dose to 25 mg if you find that 50 mg causes intolerable side effects.
Erectile dysfunction pills and medications: Viagra, Cialis, and more
The possible side effects of Viagra and other PDE5 inhibitors include headache, flushing, upset stomach, vision changes, low blood pressure, stuffy or runny nose, muscle pain, nausea, dizziness, or rash. Priapism, a painful and persistent erection lasting longer than four hours, is a rare but serious potential side effect of many ED meds. This is a medical emergency and requires immediate attention from a healthcare professional to prevent permanent injury.
Talk to your healthcare provider about any prescription drugs or supplements you’re taking to ensure there’s no potential drug interaction before starting Viagra, generic sildenafil, or any other ED drugs. Also discuss any health conditions you may have, such as heart disease or high blood pressure. They’ll work with you to get you on the right medication regimen to improve your sex life and sexual function.
- 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/
- 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). 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., et al. (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
- GoodRx. (2021). Sildenafil. Retrieved on Nov. 23, 2021 from https://www.goodrx.com/sildenafil
- 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., et al. (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/
- Pfizer. (n.d.). Avoid Counterfeit VIAGRA (sildenafil citrate). Retrieved August 25, 2020, from https://www.viagra.com/getting/avoid-counterfeits
- Rhim, H. C., Kim, M. S., Park, Y., Choi, W. S., Park, H. K., Kim, H. G., . . . Paick, S. H. (2019). The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine, 16(2), 223-234. doi:10.1016/j.jsxm.2018.12.002. Retrieved from https://www.jsm.jsexmed.org/article/S1743-6095(18)31362-6/pdf
- 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/
- Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the U.S. 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
- 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/