How to Choose the Right ED Medication

The Four FDA-Approved ED Medications

All work through the same mechanism (PDE5 inhibition) with similar effectiveness, but differ in duration, onset, and cost:

1. Sildenafil (Viagra)

How it works:

• Takes effect: 30-60 minutes
• Duration: 4-6 hours
• Effectiveness: 70-85%
• Food: High-fat meals delay onset

Typical dosing:

• Starting: 50mg
• Range: 25-100mg
• Take on-demand 30-60 min before sex

Cost comparison:

• Brand Viagra: $90-100/dose
• Generic sildenafil: $4-10/dose (telehealth)
• Insurance copay: $10-50/dose

Best for:

• Predictable timing
• First-time ED treatment
• Budget-conscious (generic)
• Don’t want long duration

2. Tadalafil (Cialis)

How it works:

• Takes effect: 30-45 minutes
• Duration: Up to 36 hours
• Effectiveness: 75-85%
• Food: No interaction

Dosing options:

• On-demand: 10-20mg before sex (36-hour window)
• Daily: 2.5-5mg every day (enables spontaneous sex anytime)

Cost comparison:

• Brand Cialis: $90-110/dose (on-demand)
• Generic tadalafil: $6-15/dose (on-demand)
• Daily generic: $60-120/month

Best for:

• Spontaneous/unpredictable timing
• Weekend use (Friday-Sunday)
• Want to avoid timing doses
• Prefer daily medication for readiness

3. Vardenafil (Levitra, Staxyn)

How it works:

• Takes effect: 30-60 minutes
• Duration: 4-5 hours
• Effectiveness: 70-80%
• Food: High-fat meals reduce effectiveness

Typical dosing:

• Starting: 10mg
• Range: 5-20mg
• Take 60 minutes before sex

Cost:

• Generic: $8-15/dose
• Less commonly prescribed

Best for:

• Men who don’t respond to sildenafil
• Need slightly longer than sildenafil but shorter than tadalafil
• Alternative option

4. Avanafil (Stendra)

How it works:

• Takes effect: 15-30 minutes (fastest)
• Duration: 6 hours
• Effectiveness: 70-85%
• Food: Minimal interaction

Typical dosing:

• Starting: 100mg
• Range: 50-200mg
• Take 15-30 min before sex

Cost:

• $15-25/dose (generic available)
• Newer medication

Best for:

• Need quick onset
• Less planning time
• Want middle-ground duration
• Fewer interactions with food/alcohol

How to Choose Your ED Medication

By Timing Needs

Predictable/planned sex: → Sildenafil (cheapest, effective, shorter duration)

Spontaneous/variable timing: → Daily tadalafil 2.5-5mg (always ready)

Weekend plans: → On-demand tadalafil 10-20mg (36-hour window)

Need fast onset: → Avanafil (works in 15-30 min)

By Budget

Most affordable:

1. Generic sildenafil: $4-10/dose through telehealth platforms (Hims, BlueChew, Ro)
2. Generic tadalafil on-demand: $6-15/dose
3. Generic tadalafil daily: $60-120/month ($2-4/day)

Higher cost:

• Brand name Viagra/Cialis: $90-110/dose
• Avanafil: $15-25/dose
• Vardenafil: $8-15/dose

Cost-saving strategies:

• Use telehealth (Hims, Ro, BlueChew) for lowest generic prices
• Ask about compounded versions (even cheaper)
• Check GoodRx for pharmacy discounts
• Consider daily tadalafil vs multiple on-demand doses
• Start with sildenafil (cheapest effective option)

By Relationship Pattern

New relationship, unpredictable: → Daily tadalafil (removes pressure, always ready)

Established relationship, scheduled: → Sildenafil on-demand (plan ahead, save money)

Long-distance relationship, weekend visits: → Tadalafil 10-20mg Friday (covers through Sunday)

Multiple times per week: → Daily tadalafil (better value than multiple on-demand doses)

By Side Effect Profile

All medications have similar side effects:

• Headache: 10-16%
• Flushing: 10-13%
• Nasal congestion: 4-10%
• Indigestion: 3-9%
• Back pain: 2-12% (slightly more with tadalafil)

If one causes problems:

• Try different medication (individual tolerance varies)
• Lower the dose
• Take with food (except tadalafil already food-independent)
• Stay hydrated
• Avoid alcohol

By Other Medications

Taking alpha-blockers (prostate):

• Tadalafil 2.5-5mg daily is safest
• Wait 4 hours between alpha-blocker and on-demand ED medication
• Tell your provider

Taking nitrates (heart):

• CANNOT use any ED medication (dangerous blood pressure drop)
• Includes nitroglycerin, isosorbide
• Also avoid recreational poppers (amyl nitrite)

Other heart medications:

• Usually safe, but tell provider about all medications
• May need dose adjustments

Brand vs Generic: The Truth

Effectiveness

No difference:

• Same active ingredient
• Same absorption rate
• Same blood levels
• Same FDA standards
• 70-85% success rate for both

FDA requirements for generics:

• Bioequivalent (80-125% of brand name blood levels)
• Same manufacturing standards (cGMP)
• Same purity standards
• Rigorous testing

Cost Difference Explained

Brand name:

• Marketing costs
• Brand recognition
• Patent protections (expired)
• $90-100/dose

Generic:

• No marketing needed
• Multiple manufacturers compete
• FDA-approved since 2017 (sildenafil)
• $4-10/dose

You’re paying for the name, not better quality.

When Brand Might Be Preferred

Rarely necessary, but some choose brand for:

• Insurance covers brand but not generic (uncommon)
• Personal preference/trust in brand
• Specific inactive ingredients (allergies)

For 98% of men, generic is identical in every way that matters.

On-Demand vs Daily Dosing

On-Demand Dosing

How it works:

• Take 30-60 minutes before sex
• Higher dose (sildenafil 50-100mg, tadalafil 10-20mg)
• Effective for 4-36 hours depending on medication

Best for:

• Infrequent sex (1-2x/week or less)
• Predictable timing
• Lower monthly cost
• Don’t want daily medication

Cost example:

• 4 times/month: $16-40 (generic sildenafil)
• 8 times/month: $32-80

Daily Low-Dose

How it works:

• Take small dose (tadalafil 2.5-5mg) same time daily
• Always ready for spontaneous sex
• No timing needed
• Steady medication level

Best for:

• Frequent sex (3+/week)
• Unpredictable timing
• Want spontaneity
• Don’t like planning/timing

Cost:

• $60-120/month through telehealth
• $2-4/day

Considerations:

• Only tadalafil approved for daily use
• Takes 4-5 days to reach steady levels
• Must take every day (not as-needed)

Which Saves Money?

On-demand is cheaper if:

• Sex 1-2 times/week or less
• Predictable schedule
• Don’t mind timing

Daily is cheaper if:

• Sex 3+ times/week
• Multiple rounds in 36 hours
• Want readiness for spontaneous opportunities

Example:

• On-demand: 12 times/month = $48-120
• Daily: Same month = $60-120
• Daily wins at 3+/week frequency

Common Scenarios

First-Time User

Recommendation: Generic sildenafil 50mg

Why:

• Lowest cost to try ($4-10)
• Well-studied (longest track record)
• Predictable 4-6 hour duration
• Easy to adjust dose up/down
• Can switch to others if needed

How to start:

• Order through telehealth (Hims, Ro, BlueChew)
• Try 50mg first time
• Take on empty stomach or light meal
• Plan 1 hour before sex
• Adjust next time based on results

Established User, Want Spontaneity

Recommendation: Daily tadalafil 5mg

Why:

• Always ready (no timing)
• Removes performance pressure
• Better for relationship intimacy
• Cost-effective for frequent sex

How to switch:

• Stop on-demand medication
• Start daily tadalafil
• Takes 4-5 days for full effect
• Can use on-demand dose while starting
• After 1 week, fully effective

Weekend Warrior

Recommendation: Tadalafil 10-20mg Friday evening

Why:

• One dose covers Friday-Sunday
• Multiple sessions possible
• No timing stress
• Cost-effective

How to use:

• Take Friday evening (dinner time)
• Effective through Sunday morning
• Can have sex multiple times
• Only pay for one dose

Budget-Conscious

Recommendation: Generic sildenafil from telehealth

Where to get:

• BlueChew: $20/month (4 doses of 30mg)
• Hims: $44/month (8 doses)
• Ro: $4-6/dose
• GoodRx: $6-10/dose at pharmacy

Strategies:

• Start with lowest effective dose
• Use compounded options
• Compare telehealth platforms
• Consider splitting higher-dose pills (ask provider)

Effectiveness Expectations

Success Rates

70-85% of men respond to ED medications

What “works” means:

• Achieve erection sufficient for sex
• Maintain erection through completion
• Satisfaction with firmness

Why 15-30% don’t respond:

• Severe vascular damage
• Severe nerve damage
• Hormonal issues (low testosterone)
• Psychological factors
• Need different treatment

How Long Until It Works

First dose:

• 60% work on first try
• 25% need dose adjustment
• 15% need different medication

After optimization:

• 85%+ find successful option
• May take 2-3 tries to optimize

Timeline:

• Try medication 4-6 times before giving up
• Each use helps reduce anxiety (improves results)
• Adjust dose after 2-3 attempts

Improving Success Rates

Take consistently:

• Anxiety decreases with familiarity
• Body adjusts to medication
• Confidence improves outcomes

Optimize conditions:

• Empty or light stomach (except tadalafil)
• Allow full onset time
• Limit alcohol (1-2 drinks max)
• Reduce stress/anxiety
• Foreplay enhances effectiveness

Combine with lifestyle:

• Exercise (improves blood flow)
• Healthy diet
• Quit smoking
• Manage stress
• Address relationship issues

Side Effects and Management

Common Side Effects (10-15%)

Headache:

• Most common (10-16%)
• Usually mild, temporary
• Take with food, stay hydrated
• OTC pain reliever if needed

Flushing:

• Facial redness, warmth
• Lasts 1-2 hours
• Normal response (increased blood flow)
• Decreases with regular use

Nasal congestion:

• Stuffy nose
• Temporary
• Nasal decongestant safe to use

Indigestion:

• Mild stomach upset
• Take with light meal
• Antacids safe to use

Less Common Side Effects

Back pain:

• More common with tadalafil (2-12%)
• Usually mild
• NSAIDs help

Visual changes:

• Blue tinge to vision (rare, <2%)
• More common with sildenafil/vardenafil
• Temporary, harmless
• Tells you medication is working

Muscle aches:

• Rare (<2%)
• Temporary
• NSAIDs help

When to Get Medical Help

Call provider if:

• Erection lasting >4 hours (priapism)
• Sudden vision or hearing loss
• Severe dizziness or chest pain
• Allergic reaction (rash, difficulty breathing)

These are rare (<1%) but serious.

Getting Your Medication

Telehealth Platforms (Easiest, Cheapest)

Popular options:

• Hims: $44-95/month, 2-3 day shipping, sildenafil or tadalafil
• Ro: $4-12/dose, flexible plans, daily or on-demand
• BlueChew: $20-120/month, chewable tablets, budget-friendly
• Lemonaid: $2/pill + $25 consultation, good prices

Process:

1. Online questionnaire (5-10 min)
2. Provider review (24-48 hours)
3. Prescription sent to pharmacy
4. Delivered to your door (2-5 days)

Advantages:

• Cheapest generic prices
• Convenient, private
• Quick turnaround
• Flexible subscriptions

Local Pharmacy

Cost:

• Generic sildenafil: $10-20/dose (GoodRx)
• Generic tadalafil: $15-30/dose
• Brand name: $90-110/dose

Insurance:

• Copay: $10-50 typical
• Many plans cover ED medications
• May require prior authorization

Process:

1. In-person or telehealth doctor visit
2. Prescription sent to your pharmacy
3. Pick up same/next day

Insurance Coverage

Most plans cover:

• Generic ED medications (4-6 doses/month typical)
• Requires doctor’s prescription
• Copay $10-50

Prior authorization:

• Some plans require extra approval
• Provide medical justification
• Takes 1-3 days

Limitations:

• Monthly limits (4-8 doses typical)
• May not cover daily dosing
• Higher copay for brand vs generic

Making Your Decision

Start Here:

1. Answer these questions:

   • How often do you have sex? (affects on-demand vs daily)
   • Is timing predictable? (affects which medication)
   • What’s your budget? (affects brand vs generic, platform)
   • Any other medications? (affects safety considerations)

2. Choose starting option:

   • Most men: Generic sildenafil 50mg on-demand
   • Spontaneous sex: Daily tadalafil 5mg
   • Weekend pattern: Tadalafil 10-20mg on-demand
   • Budget-focused: BlueChew or Hims generic

3. Give it a fair trial:

   • Try 4-6 times before changing
   • Adjust dose if needed
   • Switch medications if no results
   • Combine with lifestyle changes

4. Optimize based on results:

   • Works but side effects → lower dose
   • Doesn’t work → increase dose or switch medication
   • Works great → stay with it
   • Timing issues → switch to daily or longer-lasting

Quick Decision Tree:

Need spontaneity? → Daily tadalafil 5mg Predictable 1-2x/week? → Generic sildenafil 50mg Weekend plans only? → Tadalafil 10-20mg Friday Tightest budget? → BlueChew generic subscription Want fastest onset? → Avanafil 100mg Long duration preferred? → Tadalafil (36 hours)

The Bottom Line

All FDA-approved ED medications work effectively (70-85% success) through the same mechanism—choice comes down to personal preference, timing needs, and budget.

For most men starting out:

• Try generic sildenafil 50mg first (cheapest, effective, adjustable)
• Use telehealth for best prices ($4-10/dose vs $90+ brand)
• Give it 4-6 tries before switching
• Adjust dose or try tadalafil if needed

For spontaneous/frequent sex:

• Daily tadalafil 5mg removes all timing concerns
• Always ready for sex anytime
• Best relationship quality for active couples

Generic vs brand name:

• Zero effectiveness difference
• Same FDA standards and ingredients
• 90% cost savings with generics
• No reason to pay brand prices

The right choice is the one that:

• Fits your relationship pattern
• Fits your budget
• Causes minimal side effects
• Gives you confidence

Try one, optimize it, and don’t overthink it. The best medication is the one you’ll actually use.

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This guide provides general information. Consult healthcare providers for medical advice tailored to your health history. Never combine ED medications with nitrates. Effectiveness rates from clinical trials and real-world studies. Last updated: January 2025.