Your essential guide to the right ED medication

Selecting an erectile dysfunction that works for you is really important, therefore, being informed about the most reliable treatments, brands and products is essential.

Published: Tuesday 03 March 2020



Erectile dysfunction (ED) is a common condition, it is prevalent in more than 50% of men over the age of 40[1]. There are many ED treatments available that are clinically proven to be effective at treating erectile dysfunction. Selecting an erectile dysfunction treatment that works for you is really important, therefore, being informed about the most reliable treatments, brands and products is essential for a healthy sex life.

What is the most recommended form of ED treatment?

Oral prescription medication is regarded as the go-to treatment or ‘first line therapy’ to treat erectile dysfunction[2]. The efficacy of oral prescription medication has been rigorously tested and consolidated through clinical research. A recent study concluded that collectively, oral prescription medication offers efficacy, tolerability and safety in the treatment of ED[3]. An extensive overview conducted in a landmark study investigating the use of oral medication to treat ED, highlighted that across 16 trials, successful erections were achieved in up to approximately 90% of participants (versus 35.5% of those taking a placebo) and successful sexual intercourse was experienced by approximately 70% of participants (versus 35.0% of those taking a placebo)[4].

How do oral ED medications work?

Following arousal, the brain activates increased blood flow to the penis, resulting in an erection. In order for an erection to subside, an enzyme called phosphodiesterase type 5 (PDE-5) stimulates smooth muscle to constrict blood vessels, reducing blood flow and causing the penis to return to it’s normal size[5]. In men without ED, the regulation of increased and decreased blood flow is sufficient to sustain an erection long enough for sexual activity.

The active ingredients in ED medications are collectively referred to as PDE-5 inhibitors, which work by preventing the constriction of blood vessels, and blood flow to the penis following sexual arousal is therefore maintained for longer and an erection is sustained for longer. For an erection to be achieved and maintained, the man needs to be sexually stimulated or aroused for the drug to work properly.

Active ingredients and brands

Well known PDE-5 inhibitors consist of; Sildenafil citrate, Tadalafil, Avanafil and Vardenafil. Oral ED treatments with these active ingredients are sold in their generic, non-branded version; Sildenafil (Viagra), Tadalafil (Cialis), Avanafil (Spedra) and Vardenafil (Levitra). Oral ED treatments are also sold by brands, although they are medically equivalent, they are typically more expensive; Viagra (Sildenafil), Cialis (Taldalafil), Spedra (Avanafil) and Levitra (Vardenafil). You can also purchase Viagra Connect which has the same active ingredient as Viagra but is a non-prescription equivalent.

How do you know which ED Medication to choose?

Due to the wide range of ED medications available, working out which one is right for you is important. The factors to consider consist of; frequency of use, dosage strength, duration for medication to become active, medication activity time and brand versus non-brand.

Active Ingredient Strengths sold Active time Duration Legal
Viagra Sildenafil citrate 25mg, 50mg, 100mg 30 - 60 min 4 hours Yes
Generic Sildenafil Sildenafil citrate 25mg, 50mg, 100mg 30 - 60 min 4 hours Yes
Spedra Avanafil 50mg, 100mg, 200mg 15-30 min 6 hours Yes
Levitra Vardenafil 5mg, 10mg, 20mg, 10mg orodispersible 25-60 min 4-5 hours Yes
Generic Vardenafil Vardenafil 5mg, 10mg, 20mg 25-60 min 4-5 hours Yes
Cialis Tadalafil 10mg, 20mg 30 min 36 hours Yes
Generic Tadalafil Tadalafil 10mg, 20mg 30 min 36 hours Yes
Cialis Daily Tadalafil 2.5mg, 5mg Continuous Continuous Yes
Generic Tadalafil Daily Tadalafil 2.5mg, 5mg Continuous Continuous Yes
Kamagra Sildenafil citrate 25mg, 50mg, 100mg 30 min - 1 hour 4 hours No
Active Ingredient Strengths sold
Viagra Sildenafil citrate 25mg, 50mg, 100mg
Generic Sildenafil Sildenafil citrate 25mg, 50mg, 100mg
Spedra Avanafil 50mg, 100mg, 200mg
Levitra Vardenafil 5mg, 10mg, 20mg, 10mg orodispersible
Generic Vardenafil Vardenafil 5mg, 10mg, 20mg
Cialis Tadalafil 10mg, 20mg
Generic Tadalafil Tadalafil 10mg, 20mg
Cialis Daily Tadalafil 2.5mg, 5mg
Generic Tadalafil Daily Tadalafil 2.5mg, 5mg
Kamagra Sildenafil citrate 25mg, 50mg, 100mg

1. Frequency of use (daily or on-demand)

It is important to consider whether you want to take daily ED medication which may be more practical for intercouse that may not be planned (Generic Tadalafil and the Branded version, Cialis can be taken daily) or on-demand medication, which may be better suited to planned sexual intercourse. Furthermore, it’s important to acknowledge that Tadalafil (daily ED medication) can take up to 5 days to build up in the body. If you anticipate a frequent use of Tadalafil (i.e., at least twice weekly), a once daily dose of either 2.5mg or 5mg of Tadalafil might be suitable for you.

2. Strength

The strength of the medication is also important to consider, across brands different strengths are available, typically consisting of: 2.5mg, 5mg, 10mg, 25mg, 50mg, 100mg and 200mg. Daily versions have lower strength dosages of either 2.5mg or 5mg whilst non-daily dosages are typically stronger. But which strength do you need?

Research investigating the efficacy of increased ED medication dosage strength revealed that whilst efficacy is dose dependent, the differences are small[6]. Initially, selecting a moderate strength dose may be worthwhile to see if you require a stronger dose.

3. Duration for medication to become active

Knowing the duration time for the ED medication to become active in on-demand products is also important. The action time can vary, but typically takes between 15 - 60 minutes depending on the medication selected. Daily dose medications do not have an action time as they are active all the time following continued use.

4. Duration the medication is active for

This refers to how long the medication lasts in the body and the amount of time that there is potential for an erection to be achieved, it does not refer to how long you have an erection for. On-demand oral ED medications remain active for a specific period of time depending on the brand/active ingredient; typically the duration ranges between 4 - 36 hours. The range of medication durations provides a varied choice and is therefore subject to preference and perceived practicality.

5. Branded or non-branded

Oral ED medications are either sold as the branded version or generic version. An example of this is the well-known brand Viagra, which contains the active ingredient Sildenafil citrate. Sildenafil citrate is sold in its generic form, Sildenafil, where it is medically equivalent to Viagra and just as effective[7]. However, there is a considerable difference in price, where Viagra is significantly more expensive than generic Sildenafil. This significant difference in price between branded and generic versions is evident across a range of ED medications.

Although the tablet, packaging or name may be different for branded versions, both branded and generic versions are safe to use, medically equivalent and regulated in the same way by the MHRA (Medicines and Healthcare products Regulatory Agency).

6. Other factors to consider

Selecting an ED medication may be influenced by having a pre-existing health condition. Levitra (Vardenafil) is particularly effective at treating erectile dysfunction for those who have diabetes (type I and type II), and may offer more effective results compared to use of Viagra (Sildenafil)[8].

It’s also important to consider how you can positively impact your ED; ensuring regular exercise, reducing BMI, stopping smoking and reducing alcohol intake are all effective ways to improve the success of ED treatment[9].

Whilst oral ED medications are safe and strictly regulated, just like any form of medication, be sure to consider possible side effects and refer to the product information leaflet.

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