Sildenafil and Alternatives: Comparison of ED Drugs

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Written By Julie Ingram
Comparison of Sildenafil with Other Similar Drugs used for ED Treatment

Erectile Dysfunction (ED) is a common condition in men or Assigned Males at Birth (AMAB). It can impact the quality of life for many men.

Since its approval by FDA in 1998, Sildenafil also known by its brand name Viagra has revolutionized ED treatment. It is a well-known and widely prescribed choice.

However, there are other Erectile Dysfunction medicines also available on the market. Most of these medicines have mechanisms of action similar to Sildenafil. 

In this article, we will explore these ED medications and compare Sildenafil and its counterparts. 

What other drugs are used for ED treatment

Although Sildenafil (Viagra) is the most prescribed ED medicine, other alternatives are also available.

They are all FDA-approved medications for ED treatment. 

Each of those alternatives has its unique benefits and characteristics. These include: 

They all belong to the same class of medications known as Phosphodiesterase type 5 (PDE5) inhibitors.

All of these medications work by relaxing the blood vessels. 

This relaxation improves the blood flow to the penile region, facilitating the erection process.

To understand how ED pills work, delve into the working of Viagra in this articleScience Behind the Magic Pill: How Does Viagra Work

Comparison of all ED Medications

A simple chart comparing the key features of Sildenafil, Tadalafil, Vardenafil, and Avanafil:

Drug NameSildenafilAvanafilTadalafilVardenafil
Approval Year1998201220032003
Onset of Action30-60 minutes15-30 minutes30-45 minutes25-60 minutes
Duration of Effect4-5 hours6-12 hoursUp to 36 hours4-5 hours
Efficacy Rate70-80%Approximately 80%Approximately 80%Approximately 80%
Common Side EffectsHeadache, flushing, dyspepsia, nasal congestionHeadache, flushing, nasal congestionHeadache, dyspepsia, back pain, myalgia, nasal congestionHeadache, flushing, dyspepsia, nasal congestion
ConsiderationsEffect can be delayed by a high-fat mealRapid onset may provide advantage for some; less affected by food intakeCan be taken daily; not significantly affected by foodEffect can be delayed by a high-fat meal
Treats Pulmonary Arterial HypertensionYesNoYesNo
Available Doses25 mg, 50 mg, 100 mg50 mg, 100 mg, 200 mg2.5 mg, 5 mg, 10 mg, 20 mg5 mg, 10 mg, 20 mg
Method of TakingOral, taken as needed, around 1 hour before sexual activityOral, taken as needed, 15-30 minutes before sexual activityOral, can be taken daily or as needed, at least 30 minutes before sexual activityOral, taken as needed, around 1 hour before sexual activity

Want to explore the differences between Sildenafil and its each alternative seperately? Look no further—these articles have you covered:
Tadalafil vs Sildenafil – Which ED Pill Reigns Supreme
Vardenafil vs Sildenafil: A Head-to-Head Comparison
Sildenafil vs Avanafil: Which One to Choose

The side effects listed are the most common ones. This table does not include all potential side effects. Also, the efficacy rates are general estimates and can vary between individuals.

Which ED medication is the best

The “right” ED medication for you depends on numerous individual factors. These factors include

  • Overall health
  • Lifestyle
  • Specific ED symptoms
  • Presence of other medical conditions
  • Current medications

The right medication also depends on some personal preference as well. These include how fast you want your medication to work or how long you want it to be effective.

Another important factor while deciding right ED pill is the number of side effects it has. 

While your doctor will decide the right pill for you, we will discuss some of these in detail to help you better understand.

The quickest onset of action

Taking pillSource: AndreyPopov_from_Getty_Images
Taking pill

Among all the ED medications, Avanafil starts working the fastest. 

Clinical studies indicate that Avanafil can start working as quickly as 15 minutes after taking it orally. This makes Avanafil a suitable choice for those seeking immediate effects.

Sildenafil, Tadalafil, and Vardenafil also work effectively but generally take longer to start working. 

Sildenafil start working within 30 to 60 minutes. Vardenafil takes same time as Sildenafil. Tadalafil typically starts working within 30 to 45 minutes.

It’s important to remember that the onset of action can vary among individuals. It depends on various factors such as metabolic rate, overall health, and the food in the stomach.

Learn why these ED medications take time to become effective by reading these articles:
How Long Does It Take For Tadalafil to Start Working
Unlocking the Timing: How Long Does Sildenafil Take to Work

Duration of effects

Among the four ED medications, Tadalafil has the longest duration of action. Tadalafil can last up to 36 hours, earning it the nickname “The Weekend Pill.”

Vardenafil and Sildenafil last for about 4-5 hours. Avanafil lasts around 6 to 7 hours.

However, the actual duration can vary among individuals. It depends on factors like overall health, age, metabolism, and other medications they may be taking.

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Number of side effects

All ED medicines have some side effects. Usually, they are very mild if taken properly as the doctor advises.

Among the four ED medications available Avanafil has the least side effects. However, its generic version is not available.

Even though Avanafil has the least number of side effects, Sildenafil is usually the first line of treatment that a doctor prescribes. 

Sildenafil (Viagra) is the oldest and most researched medication for treating ED. 

Sildenafil or Viagra was discovered in 1988 by Pfizer. Since then it has been widely used and has most clinical studies. 

Clinical studies help doctors better understand risk factors and minimize them. Since Sildenafil has been tested in more clinical studies, it can be the safest option. 

Explore these articles to understand the side effects of Sildenafil and Tadalafil in detail.
Navigating the Potential Side Effects of Sildenafil
Side Effects of Tadalafil and How To Manage Them

Remember, clinical studies alone do not make it safer. They only help to understand its effect and risks. Always consult a doctor and use medications only as advised.


Sildenafil (Viagra) is the first approved, most prescribed, and most studied medication for ED. 

However, there are other medications available for the treatment of ED. These include Avanafil, Tadalafil, and Vardenafil.

All of these medications are taken orally. Sildenafil and Tadalafil can be taken almost 30 minutes before having sex. Vardenafil and Avanafil must be taken 1 hour before sexual activity.

If you want spontaneity in your sexual activity, Tadalafil might be the preferred choice. It has an extended duration of action. 

If a quick onset of action is more important, Avanafil could be the right choice.

Sildenafil, on the other hand, is the oldest and has the most clinical research.

Which ED pill to take from Sildenafil and alternatives depends on the individual’s specific need. Only a doctor can decide the “right” ED pill for you. 

Frequently Asked Questions

Can I take ED medication if I have other health conditions?

Certain health conditions can interact with ED medication. These include heart, low blood pressure, and liver or kidney disease. 

It’s essential to discuss your full medical history with your healthcare provider.

Are there natural alternatives to ED medications?

Some people find improvement with lifestyle changes. These include ED exercises, a healthy diet, reduced alcohol intake, and quitting smoking. 

Can I combine different ED medications for better results?

No, you should never combine different ED medications. It will increase the risk of side effects. It can cause interaction and severe health problems. Following your doctor’s directions when taking ED medication is always best.

Are ED medications safe to use in the long term?

Most ED medications like Tadalafil are considered safe for long-term use. Their safety can depend on individual health factors. Long-term use should always be discussed with a healthcare provider.

How can I regain erectile strength?

Lifestyle changes may help reduce ED symptoms. Eat a healthy diet, limit alcohol consumption, and manage conditions such as high blood pressure or diabetes.

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