How To Talk to Your Doctor About Erectile Dysfunction Medications

Male sexual dysfunction affects up to one third of men, which includes decreased libido (no interest in sex), erectile dysfunction (ED), and problems ejaculating (including premature ejaculation). If you’d like to start a conversation with your doctor about any of these topics to see if an ED prescription is right for you, here are some important considerations to think about.

Do I need to see a doctor to find out why I have ED?

A basic check up is never a bad idea. Your doctor can test your early morning testosterone levels, review your medications, and take a close look at certain habits like drinking more than three glasses of alcohol or smoking more than 10 cigarettes per day—all of which may affect your risk for ED.

What are the available ED medication options out there?

First-choice therapies for ED are the phosphodiesterase-5 (PDE5) inhibitors, sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis), and Stendra (avanafil). These medications are equally effective.

But, if there are any differences, these are it: The effects of tadalafil (Cialis) last longer than others, and Stendra and the dissolvable tablet, Staxyn, start working sooner.

Who should avoid taking ED meds?

The PDE5 inhibitors listed above should not be taken by those on nitrates (e.g., nitroglycerin, isosorbide) and should be used cautiously by those taking alpha-adrenergic blockers (e.g., terazosin, prazosin, and doxazosin) because of a risk of low blood pressure.

What’s the cheapest ED drug?

Viagra is now available as the affordable generic drug, sildenafil, and a 100 mg tablet is the same price as a 25 mg or 50 mg tablet, so you can break the 100 mg tablet in half and save yourself some money. Sildenafil should be taken on an empty stomach about 1 hour before sexual activity. Start with 50 mg and increase to 100 mg if you do not see the results you are hoping for. Sildenafil lasts approximately 4 hours.

Doc, tell me about Levitra (vardenafil).

The Levitra generic, vardenafil, has a similar side effect profile and lasts as long as the Viagra generic, sildenafil. Vardenafil is available in 10 mg and 20 mg doses.

You can also try the new rapid-onset disintegrating vardenafil tablet called Staxyn, which is more expensive but works quickly. And unlike sildenafil, you can take it on a full stomach.

What about Cialis (tadalafil)?

Tadalafil, or generic Cialis, is as effective as sildenafil (Viagra) and vardenafil (Levitra), but it lasts longer. Because of this, tadalafil is more expensive than sildenafil. Plus, you can start on tadalafil at 10 mg, and then decrease to 5 mg or increase to 20 mg, if needed.

A lower dose of tadalafil, 2.5 mg or 5 mg a day, can be taken daily and is as effective as taking higher doses on an as-needed basis, but it’ll be expensive. [PRO TIP: A daily dose of tadalafil is approved to treat lower urinary tract symptoms (LUTS) due to a large prostate (benign prostatic hypertrophy or BPH), so your doctor can try a prior authorization to get insurance to cover this option for you.]

What’s the newest ED medication on the market?

Stendra, approved in 2012, is the only ED medication approved for 15 minute onset of action (and can be taken with food). There is no generic form of Stendra and it’s expensive, so it’s probably not worth the cost.

What are the most common side effects of ED medications?

Flushing, headaches, and nasal congestion are common side effects of all ED medications.

Should I just order these ED meds online or from a Canadian pharmacy?

No. Medications ordered online or from Canada are often unregulated and contain ineffective, expired, and even harmful ingredients. Remember that safety is your number one priority. Always check GoodRx for discounts on your ED medications, and to make them even more affordable, consider choosing generic options and splitting the pills.

Hope this helps.

Dr O.

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