Best ED Medications: Viagra vs. Cialis vs. Other Popular Options

Viagra and Vybrique (sildenafil)

Viagra was the first major medication the FDA approved for ED. It’s been available in the U.S. since 1998. Vybrique is a new brand-name version of sildenafil that comes as a dissolvable oral film. It was FDA approved in February 2026.

For occasional use, most people start with sildenafil tablets. The tablets are often prescribed for mild or moderate symptoms. Vybrique may be a better option for people who have difficulty swallowing pills. 

Here are key points to keep in mind if you’re considering taking sildenafil:

• How to take it: You should take sildenafil on an empty stomach. If you really need to eat, then try waiting at least 1-2 hours after your meal before you take a dose. And opt for a light, low-fat meal. Fatty meals and alcohol can slow down the time it takes for sildenafil to start working — by about 1 hour for Viagra and 1.5 hours for Vybrique.

• How fast it works: Sildenafil can start to take effect in as little as 30 minutes. But it may take up to 2 hours to feel the peak effects of the tablets. And it may take up to 5 hours with the oral film. Both forms can keep working for up to 8 hours.

• The typical dose: The typical starting dosage of sildenafil is one 50 mg tablet or film taken 30 minutes to 4 hours before sex, as needed. If you’re having side effects, your dose may be lowered to 25 mg. If your dose isn’t working well enough, it can be increased to 75 mg if you’re taking the oral film or 100 mg if you’re taking the tablets.

Cialis (tadalafil)

Cialis is different from Viagra and other ED medications because it lasts much longer. You can also take it on a daily basis. For this reason, Cialis may be a better fit than Viagra or Vybrique for regular use. It’s especially helpful for people who don’t respond as well to medications that are only taken “on demand.” 

Here are key points to keep in mind if you’re considering taking Cialis:

• How to take it: Food doesn’t affect Cialis. You can take it just when you need it or regularly — every day — if needed.

• How fast it works: Cialis can start working in as quickly as 30 minutes, but you may have to wait up to 2 hours for it to be fully effective. The effects of Cialis can last for up to 36 hours, helping you with erections at any point in that time period.

• The typical dose: The typical starting dosage of Cialis for occasional use is one 10 mg tablet taken at least 30 minutes before sex. Your dose may be lowered to 5 mg or increased to 20 mg depending on how you respond. The daily dose for regular use ranges from 2.5-5 mg.

Vardenafil (formerly Levitra and Staxyn)

Generic vardenafil was previously sold under the brand names Levitra and Staxyn, but those brands have been discontinued. Vardenafil can work for up to 5 hours, so it may be a good fit for people looking for an option that may last longer than Viagra but not as long as Cialis. 

Here are some points to keep in mind if you’re considering taking vardenafil:

• How to take it: Vardenafil can be taken with or without food. But high-fat foods can delay vardenafil's absorption and lower its effectiveness. Two food studies showed that a high-fat meal could lower the effects of vardenafil by up to 50%. Ideally, try to wait 1-2 hours after eating before you take it. If that’s not possible, stick to a light, low-fat meal. You can take it as needed for occasional ED symptoms.

• How fast it works: Vardenafil can start working in as quickly as 15 minutes, but you may have to wait 1 hour to experience its peak effects. 

• The typical dose: The typical starting dosage of vardenafil is one 10 mg tablet taken about 1 hour before sex. Your dose may be lowered to 5 mg or increased to a maximum of 20 mg. Vardenafil is available as a traditional pill that you swallow and a rapidly dissolving pill (which works faster).

Stendra (avanafil)

Stendra is a newer ED medication that works similarly to sildenafil, tadalafil, and vardenafil. Out of all the PDE5 inhibitors for ED, Stendra works the fastest. And its effects typically last for a shorter time span. It’s helpful for people who want a fast-acting “on demand” pill but don’t want the effects to last most of the day. 

Here are some things to keep in mind if you’re considering taking avanafil:

• How to take it: Avanafil comes in pill form and it’s not affected by food. You can take it as needed for occasional ED symptoms.

• How fast it works: Avanafil works a little faster on average than other ED medications. The usual starting dose of 100 mg works within 15 minutes. With a lower dose, you’ll need to wait about 30-45 minutes.

• The typical dose: The recommended starting avanafil dosage is 100 mg taken 15 minutes before sex, as needed. But doses can range from 50-200 mg.

** Based on T½ data, which indicates how long it takes the medication to leave the body

Heart safety

PDE5 inhibitors are generally safe for the heart, and most people with heart conditions can take them. But there are two potentially serious issues to know about:

1. All PDE5 inhibitors can lower your blood pressure. This may be a problem if you also take a blood pressure medication. A sudden drop in blood pressure can make you feel dizzy, fall, black out, or even cause more serious heart issues.

2. Nitrate medications can have dangerous interactions with PDE5 inhibitors. Nitrate medications, like nitroglycerin (Nitrostat), are commonly given to people with heart conditions such as angina and high blood pressure. If you take a nitrate medication, you should never take ED medications.

Interactions

ED medications are metabolized (broken down) by an enzyme in your body called CYP3A4. Certain medications and substances can block this enzyme, causing PDE5 inhibitors to build up in the body. You are more likely to experience side effects or toxic levels if this happens.

Several medications — such as ketoconazole, verapamil, and erythromycin — can cause this interaction. Even grapefruit juice can be a culprit. Talk with your healthcare team to find out if there are certain medications or foods you should avoid while taking an ED medication.

Liver or kidney disease

PDE5 inhibitors are processed through both your liver and kidneys. If you have mild to moderate liver or kidney disease, your prescriber may need to lower your dose of ED medication. If your condition is severe, they may want you to avoid PDE5 inhibitors altogether. Speak with your healthcare team to see if PDE5 inhibitors are safe for you to take.

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