Key Takeaways
- PDE5 inhibitor tablets (sildenafil, tadalafil, avanafil, vardenafil) are effective in 60–70% of men and differ primarily in onset speed, food sensitivity, and duration.
- Tadalafil lasts up to 36 hours (or can be taken as a low-dose daily tablet for continuous spontaneity), while avanafil acts in as little as 15 minutes.
- Men who take nitrate heart medications must never use PDE5 inhibitors; topical gels, alprostadil creams, or non-drug devices provide alternatives under medical guidance.
Most people associate erectile dysfunction (ED) treatment with sildenafil (Viagra), yet modern clinical options span fast-acting tablets, 36-hour or once-daily pills, topical gels, oral sprays, and medical devices. Comparing how quickly each works and how long it lasts helps match treatment to your health and lifestyle (1,11).
Side-by-side comparison of ED treatments
| Treatment | Active / Brand | Format | Typical Onset | Duration | Key Advantage |
|---|---|---|---|---|---|
| Sildenafil | Generic, Viagra | Tablet | 30–60 min | 4–6 hours | Well-established on-demand standard (25mg–100mg) (2). |
| Tadalafil | Generic, Cialis | Tablet | 30–60 min | Up to 36 hours | Longest window (‘weekend pill’) or continuous 2.5–5mg daily option (3). |
| Avanafil | Generic, Spedra | Tablet | ~15 min | Up to 6 hours | Fastest-acting oral PDE5 tablet (4). |
| Vardenafil | Generic, Levitra | Tablet | 30–60 min | 4–5 hours | Less affected by meals; well studied in men with diabetes (5). |
| Eroxon Stimgel | Topical gel | Gel | ~10–15 min | Up to 1 hour | Non-prescription nerve-stimulating cooling/warming gel (6). |
| Vitaros | Alprostadil | Cream | 5–30 min | 1–2 hours | Prescription local vasodilator for men avoiding oral PDE5 tablets (7). |
| Hezkue Spray | Sildenafil | Oral spray | 15–30 min | 4–5 hours | Mint oral spray for men who dislike swallowing pills (8). |
| Alprostadil Injection | Caverject | Injection | 5–20 min | ~1 hour | Second-line option effective even when tablets fail (9). |
| Vertica | Radiofrequency | Device | Gradual | Long-term | Drug-free home RF device used 2–3x weekly (10). |
How to choose the right option safely
PDE5 inhibitor tablets work in 60% to 70% of men by enhancing nitric-oxide-mediated blood flow during arousal, sharing mild side effects such as flushing, headache, nasal congestion, or indigestion (1,11).
- Want spontaneity or frequent intimacy? Daily low-dose tadalafil (5mg) or weekend tadalafil (10–20mg) removes clock-watching (3).
- Want occasional, predictable support? Generic sildenafil taken on an empty stomach 45–60 minutes beforehand is cost-effective and reliable (2).
- Important cardiac safety check: Men taking nitrates (for angina), nicorandil, or riociguat must never take sildenafil, tadalafil, vardenafil, or avanafil due to dangerous blood-pressure drops. Always complete a thorough clinical screening and check cardiovascular health markers (blood pressure, lipids, HbA1c), since ED can be an early vascular warning sign.
References
- National Institute of Diabetes and Digestive and Kidney Diseases. Erectile dysfunction.
- U.S. Food and Drug Administration. Viagra (sildenafil) prescribing information.
- U.S. Food and Drug Administration. Cialis (tadalafil) prescribing information. 2025.
- U.S. Food and Drug Administration. Stendra (avanafil) prescribing information. 2025.
- U.S. Food and Drug Administration. Levitra (vardenafil) prescribing information. 2025.
- Eroxon Clinical Overview. Topical ED Gel Evidence.
- U.S. Food and Drug Administration. Alprostadil (Caverject) prescribing information.
- Product manufacturer. Hezkue (sildenafil) oromucosal spray — prescribing information. 2025.
- U.S. Food and Drug Administration. Caverject (alprostadil) injection prescribing information. 2025.
- Vertica Labs. Radiofrequency ED Clinical Research. 2025.
- Andersson KE. PDE5 inhibitors – pharmacology and clinical applications 20 years after sildenafil discovery. Br J Pharmacol. 2018;175(13):2554–2565.
