Medicines that you take by mouth are referred to as oral medications. These types of medications are typically considered the primary treatment option for men experiencing difficulties in achieving or maintaining an erection, a condition known as erectile dysfunction (ED). The oral medications available for managing ED are generally effective and tend to cause very few side effects when taken as directed.

The four main oral medications prescribed for erectile dysfunction include:

• Avanafil (Stendra).
• Sildenafil (Viagra).
• Tadalafil (Cialis).
• Vardenafil.

These oral medications are classified as PDE5 inhibitors. Their primary action is to enhance the effects of a natural substance the body produces that relaxes muscles in the penis, known as nitric oxide. By increasing the levels of nitric oxide, these medications improve blood flow to the penis, facilitating an erection in response to sexual stimulation.

How oral medicines differ

Each of the four oral medications for ED has a unique chemical structure. These subtle variations can influence how quickly each medication takes effect, how long its effects last, and the potential side effects associated with its use. It is important to consult with your doctor or healthcare provider to determine which option may be most suitable for your individual needs, taking into account your health history and any other medications you may be taking.

• Sildenafil (Viagra). This medication is most effective when taken on an empty stomach approximately one hour prior to sexual activity. If taken after a high-fat meal or in conjunction with alcohol, the absorption of the drug may be delayed. The duration of its effectiveness typically ranges from 4 to 5 hours, and may last longer in individuals with mild to moderate cases of erectile dysfunction.
• Vardenafil. This medication is also recommended to be taken on an empty stomach about an hour before engaging in sexual activity. Similar to sildenafil, consuming a high-fat meal or alcohol can impede the body's ability to absorb it rapidly.

  Vardenafil generally has a duration of action of approximately 4 to 5 hours, with potential extended effects for those with mild to moderate ED. A new formulation that dissolves on the tongue may act more quickly than the traditional pill form.

• Tadalafil (Cialis). This medication can be taken with or without food, one hour before sex, and its effects can last up to an impressive 36 hours. This allows for more spontaneous sexual activity. It can be prescribed in a lower daily dose or in a higher dose as needed for performance.
• Avanafil (Stendra). This medication offers flexibility as it can be taken with or without food approximately 30 minutes prior to sexual intercourse. Its action lasts 4 to 5 hours, and again may be prolonged for individuals with mild to moderate ED.

While all these medications are effective for treating ED, the choice of which to use should be made in consultation with a healthcare professional. Discuss your preferences related to factors such as cost, convenience, duration of effects, and side effects. Generic options for sildenafil, vardenafil, and tadalafil are available, which can provide additional cost savings.

When oral medications might not be safe

It is crucial to consult with your healthcare provider before beginning any medication for erectile dysfunction. Oral ED medications may not be effective or could pose risks if you are also taking certain medications, including:

• Nitrate medications. These are often prescribed for managing chest pain associated with angina. Examples include nitroglycerin (Nitro-Dur, Nitrostat, among others), isosorbide mononitrate (Monoket), and isosorbide dinitrate (Bidil).
• Alpha-blockers. These drugs are frequently used to treat conditions like benign prostatic hyperplasia or male pattern baldness and include dutasteride (Avodart, Jalyn) and finasteride (Propecia, Proscar).
• Medicines that inhibit an enzyme called CYP3A4. Examples of these medications include itraconazole (Sporanox, Tolsura), ketoconazole (Extina, Ketozole, and more), and ritonavir (Norvir).

Additionally, using oral medications for ED may not be advisable if you have:

• Severe low blood pressure, also referred to as hypotension, or uncontrolled high blood pressure, known as hypertension.
• Severe liver disease that could impair drug metabolism.
• Kidney disease that necessitates treatment through dialysis.
• Recent heart or vascular complications, including a heart attack, stroke, or a significant heart rhythm disorder in the past six months.
• Inherited eye diseases that could affect the retina.

Side effects

The side effects associated with oral ED medications are frequently mild and manageable. Commonly reported side effects include:

• Facial flushing or warmth.
• Headaches.
• Gastrointestinal disturbances like upset stomach.
• Visual disturbances, which may include a blue tinge to vision, increased sensitivity to light, or blurred vision.
• Nasal congestion or a runny nose.
• Lower back pain.
• A sensation of dizziness.

In rare instances, more serious side effects can occur, such as:

• Hearing or vision loss. Some patients have reported sudden hearing or vision impairment after taking these medications, although it remains uncertain whether the medications directly caused these effects or whether they were related to underlying health conditions. If you experience sudden changes in hearing or vision while on oral ED medication, seek medical attention immediately.
• Prolonged erection. Known as priapism, this condition is characterized by an erection that lasts longer than four hours and can be very painful. It is critical to seek prompt medical treatment to prevent potential harm to the penis.

Buying oral erectile dysfunction medications online

The market for erectile dysfunction treatments is substantial, and unfortunately, scams are prevalent online. If you decide to purchase medications over the internet, consider the following precautions:

• Ensure the pharmacy is legitimate. Avoid ordering from an online pharmacy that does not provide a valid phone number, physical address, or if their prices seem suspiciously low. Additionally, pharmacies that do not require a prescription or lack a licensed pharmacist available for consultation should be approached with caution. Always verify the authenticity of online pharmacies to avoid counterfeit products that can be dangerous or ineffective. In the U.S., the National Association of Boards of Pharmacy can provide information on whether an online pharmacy is properly licensed. If you reside outside the U.S., look for guidance from local pharmacy regulatory agencies.
• Verify your prescription and dosage. When ordering, ensure that the medicines you receive match the prescription from your healthcare provider in terms of type and dosage. Pay careful attention to the medication dosage during both ordering and delivery to ensure safety and efficacy.
• Avoid “herbal Viagra.” Steer clear of products that claim to be a herbal or nonprescription equivalent of oral medications for ED. These substitutes are often ineffective, and some may contain harmful ingredients.

June 24, 2023

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