From Prescription Medications to OTC Supplements: Which Viagra Alternatives Actually Work?

If you’re one of the 30 million people in the U.S. affected by erectile dysfunction (ED), it’s good to know all your treatment options. Viagra (sildenafil) is a popular choice, but it’s not the only treatment available, and it isn’t the best choice for everyone. But what prescription and over-the-counter (OTC) Viagra alternatives are available? And do supplements for erectile dysfunction actually work?

Keep in mind that when it comes to ED, there’s not one best treatment. Everyone responds differently, and each option comes with its own pros and cons. Here, we’ll discuss which Viagra alternatives are worth trying and which ones you may want to think twice about.

1. Prescription Viagra alternatives

Here are some other medications that can be prescribed for ED. 

Oral PDE5 inhibitors: Cialis, vardenafil, and Stendra

Viagra is a phosphodiesterase-5 (PDE5) inhibitor. PDE5 inhibitors work by relaxing smooth muscles and increasing blood flow to the penis. Other PDE5 inhibitors include Cialis (tadalafil), vardenafil, and Stendra (avanafil). 

PDE5 inhibitors are considered equally effective, but there are key differences between them. For example, Stendra works quickly, and you can take it when needed. Cialis lasts longer and is safe to take daily. The best choice for you will be based on your lifestyle and individual needs.

But if you’ve been told to avoid Viagra because of health conditions or potential interactions with other medications you’re taking, other PDE5 inhibitors likely aren’t a safe alternative. All PDE5 inhibitors carry similar risks and interactions. It’s best to check with your healthcare team to make sure a PDE5 inhibitor is a safe option for you.

Good to know: PDE5 inhibitors and nitrate medications are dangerous to take together. The combination can cause your blood pressure to become dangerously low, which in some cases is deadly. It’s recommended to separate nitrates and PDE5 inhibitors by at least 24 to 48 hours.

Alprostadil injections: Caverject and Edex

Alprostadil (Caverject, Edex) is an injectable medication that treats ED. It’s injected into the base of the penis to relax muscles and widen blood vessels. This allows for more blood flow to the penis, which can help you get an erection. 

Alprostadil works fast (within 5 to 20 minutes) and can be very effective for treating ED. But the injection location makes it less popular than other options. About one-third of people experience penile pain from the injection.

Before starting alprostadil, you’ll need injection training at your prescriber’s office. Proper injection technique is important to prevent scar tissue (penile fibrosis). Alprostadil also shouldn’t be injected more than 3 times a week. 

Alprostadil is available under three brand names: Caverject, Caverject Impulse, and Edex. All three have different packaging and instructions. Be sure to follow your prescriber’s instructions carefully.

EXPERT PICKS: WHAT TO READ NEXT

• Can medications cause ED? Yes. Over 100 different medications can cause erectile dysfunction. Learn which medications are the most likely culprits.

• Wondering if you have ED? Take this quiz to find out.

• What are the worst foods for ED? Learn which foods can contribute to erectile dysfunction, and what to eat to help prevent it.

Compounded injections: BiMix, TriMix, and QuadMix

These injectable Viagra alternatives are prescription-only, but they aren’t commercially made. Instead, they’re compounded, which means they must be made at a specialized compounding pharmacy. These compounded medications aren’t FDA-approved, but they’re still considered effective ED treatments. 

Typical combinations are:

• BiMix (papaverine, phentolamine)

• TriMix (papaverine, phentolamine, alprostadil)

• QuadMix (papaverine, phentolamine, alprostadil, atropine)

Papaverine and the other medications included in these compounds are vasodilators. Like alprostadil, they’re injected into the penis to relax blood vessels and increase blood flow. Your prescriber will tailor which medications and doses work best for you. 

Compared to alprostadil alone, TriMix and QuadMix may work better, cost less on average, and be less painful to inject. But these compounded formulations may be more likely to cause priapism — a painful erection that won’t go away. And they can also be harder to obtain, since they can only be made by specialized compounding pharmacies.

2. OTC herbs and supplements

Some over-the-counter (OTC) herbs and dietary supplements claim to be Viagra alternatives for ED. But these products aren’t regulated by the FDA, and there often isn’t much data about their safety or efficacy. 

Here’s what we know about a few popular supplements people take for ED. 

L-arginine

L-arginine is an amino acid found in foods such as red meat and dairy. The body turns L-arginine into nitric oxide. Nitric oxide widens blood vessels and increases blood flow.

Health experts rate 2.5 g to 5 g of L-arginine as “possibly effective” for treating ED. A few studies have shown that it might be helpful for mild to moderate ED. But L-arginine doesn’t seem to help with severe ED or ED that’s caused by issues other than blood flow. And it seems to work better when taken with a PDE5 inhibitor, such as Viagra.

L-arginine may not be safe for everyone. For example, it can be dangerous if taken too soon after a heart attack. And you may need to avoid it if you have kidney problems or take medications for high blood pressure or diabetes. Talk to a healthcare professional first before trying it.

Ginseng

Ginseng is an herbal supplement that’s often promoted as an adaptogen — a type of herb that helps your body deal with stress.

Ginseng is thought to help with ED by increasing the release of nitric oxide. It may also enhance sexual arousal. But there’s not a lot of evidence that ginseng actually works. There are a few low-quality studies that show it might work slightly better than a placebo for some people. But there are no studies comparing it to proven ED treatments.

Short-term ginseng use (up to 6 months) appears to be safe for most people. But keep in mind that ginseng has a lot of drug interactions, including some antidepressants, blood thinners, and blood pressure medications. Check with your healthcare team before taking it.

Yohimbine

Yohimbine is an herbal supplement that comes from the bark of the African Yohimbe tree. It was used historically as an aphrodisiac, but these days you can find it marketed for anything from ED to weight loss.

Although it’s been around longer than Viagra, we still don’t know a lot about yohimbine. A few studies have shown that it might be helpful for ED. But yohimbine likely works best when it’s combined with PDE5 inhibitors or other supplements, such as L-arginine.

There are some risks with yohimbine. Because most supplements aren’t regulated, they often contain different amounts of yohimbine than stated on the label. The products may even contain illicit PDE5 inhibitors, too. High doses of yohimbine can cause a rapid heart rate and anxiety. Plus, it’s been associated with heart attacks and seizures. 

Because of its unreliable potency and side effects, yohimbine is restricted or banned in many countries.

Horny goat weed

Horny goat weed (Epimedium) is an herbal supplement used in traditional Chinese medicine as an aphrodisiac. It contains phytoestrogens (plant estrogens) and is often promoted to help with conditions related to blood flow or hormones. Despite its name, there is no reliable evidence that horny goat weed helps treat ED (or any health condition).

Health experts rate horny goat weed as possibly safe when taken orally. But it can interact with several medications, including blood thinners and blood pressure medications. Before trying this herb, it’s best to ask a pharmacist to review your medication list.

DHEA

Dehydroepiandrosterone (DHEA) is a hormonal supplement. Your body makes DHEA naturally, but levels tend to go down with age. DHEA is converted into sex hormones, such as testosterone or estrogen. A few studies have looked at whether boosting low DHEA with supplements can help with ED. But the results are mixed, and it’s still unclear what role DHEA plays in ED (if any).

Health experts rate DHEA as possibly safe for most people. But it’s important not to take more than 50 mg to 100 mg of DHEA a day or to take it for a long period of time. Doing so can increase your risk of serious side effects, including some types of cancer. DHEA also interacts with some health conditions and medications. It’s best to talk to a healthcare professional before trying DHEA. 

3. Devices

There are also ED treatments that don’t involve medication. These include devices you can use as needed to increase or maintain blood flow, such as vacuum pumps and tension rings. Surgery is another option, although it’s more invasive. This can involve implanting an inflatable or shapeable device into the penis.

There’s also been more recent interest in electrical stimulation and low-intensity shockwave therapy for ED. While not FDA-approved for ED, these treatments seem to be effective and are gaining popularity in clinical practice.

4. Lifestyle changes

There are lots of reasons that ED happens. Making changes to improve your physical and mental health is a good place to start to help manage your symptoms.

Physical health

Healthy blood vessels play an important role in achieving and maintaining an erection. ED may be an early sign that your cardiovascular health needs improvement. Healthy lifestyle habits to improve your heart health include:

• Maintain or work toward your target body weight

• Eat a balanced diet

• Exercise regularly

• Quit smoking

• Avoid heavy drinking

• Control blood glucose (sugar) levels

• Keep your blood pressure in your target range

• Manage high cholesterol

Physical therapy, such as pelvic floor exercises, can also help improve ED symptoms over time. Your primary care provider can help connect you with someone trained in this type of therapy.

Mental health

Mental health also plays a role in ED. In fact, you’re almost five times more likely to experience ED if you’re living with depression. Other mental health factors, such as stress, relationship problems, and performance anxiety, can also contribute to ED. 

Treatments such as sex therapy or couples therapy can help improve your mental health, as well as your ED symptoms.

Good to know: It’s a common belief that all antidepressants cause sexual side effects. But leaving depression untreated can raise your risk for chronic health conditions, including ED. And some antidepressants have a lower risk of sexual side effects than others. Your prescriber can work with you to find a mental health treatment that doesn’t interfere with your sex life.

Frequently asked questions

Why trust our experts?

Written by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Our editorial standards

Meet our experts