Viagra and Cialis may be ineffective or dangerous based on your health history and current medications.
Some of the most common chronic conditions affecting older adults—including high blood pressure, high cholesterol, heart disease, and diabetes—can damage penile blood vessels and nerves, leading to new or worsening ED that doesn’t respond to Viagra or Cialis. (
3
,
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) Fortunately, several other ED treatments are available, including penile injections, vacuum erection devices, and a discreet penile prosthesis. (
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)
ED can also appear as one of the first symptoms of cardiovascular disease, hypertension, anxiety, and other chronic health concerns. (
6
) If you haven’t had a physical exam within the last year, don’t try to get ED medication online. Visit your doctor in person to ensure underlying conditions are diagnosed and treated alongside ED.
Viagra and Cialis shouldn’t be taken with some of the medications that are used to treat chest pain, high blood pressure, or lower urinary tract symptoms. Viagra should also be avoided in men taking protease inhibitors—a specific class of medications used to treat HIV.
Combining nitrates or alpha-blockers with ED pills may cause a severe, life-threatening drop in blood pressure, which can be associated with feeling dizzy, fainting, falling, and even death.
This is not a complete list of medications that could interact badly with Viagra and Cialis. Talk to your provider about everything you take—including recreational drugs—when discussing potential ED treatments.
Cialis and Viagra also shouldn’t be taken by people with low resting blood pressure, uncontrolled high blood pressure, inherited disorders of the eye or retina, recent heart attack or stroke, or uncontrolled heart disease.
Dietary supplements
Dietary supplements, sometimes called “food supplements” or simply “supplements,” can add vitamins, minerals, proteins, oils, or herbs to your diet.
In a survey of men with ED who have tried ED treatments online, 37% of respondents shared that they took supplements for their sexual health. Some supplements have research supporting their effects on certain groups of people with ED. However, the American Urological Association (AUA) does not recommend any supplements for treating ED, stating that these treatments are “either ineffective, not safe, or lack a sufficient body of evidence” for a general recommendation. (
7
)
The
Food & Drug Administration (FDA) does not approve supplements
for their safety or effectiveness. It’s important to talk to your healthcare provider to see if any supplements are appropriate for you.
L-carnitine
L-carnitine is an amino acid, a building block of protein. (
8
) Preliminary studies have shown that supplemented propionyl-L-carnitine, a form of L-carnitine, can improve ED symptoms in men with diabetes who take Viagra (sildenafil). (
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) Propionyl-L-carnitine combined with acetyl-L-carnitine, another form of L-carnitine, has been shown to improve the effectiveness of Viagra (sildenafil) in men who experienced ED after prostate surgery. (
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)
Forms of L-carnitine have been studied for heart conditions, nervous system damage, and thyroid disorders. Its side effects are generally mild, but high doses can cause diarrhea. People with heart, liver, or kidney disease may be at risk of side effects from taking L-carnitine, and they should especially talk to their doctor before taking it.
-
Cost:
$4–$47 per month online, from health food stores, or at a pharmacy -
Covered by insurance:
No
L-arginine
L-arginine is another amino acid that has been studied to support people with ED. A meta-analysis of 10 clinical trials found that L-arginine helped with erectile function, and it may be helpful for cases of mild to moderate ED. (
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)
L-arginine, like L-carnitine, can cause gastrointestinal problems at high doses and can lower blood pressure. It can also increase the risk of bleeding and worsen asthma. (
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)
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Cost:
$6–$42 per month online, from health food stores, or at a pharmacy -
Covered by insurance:
No
Dehydroepiandrosterone sulfate (DHEA-S)
DHEA is a hormone produced by the body and DHEA-S is the form of DHEA in dietary supplements. It’s the precursor to several hormones, including testosterone, and it may help people with ED through this mechanism. Studies have shown that DHEA levels in the body can decrease with age, but more studies are needed to confirm its effect on people with ED. (
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)
There isn’t enough information about the long-term safety of the supplement DHEA-S. (
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) People with hormone-related cancers such as breast, prostate, and testicular cancer, liver disease, and diabetes should not take DHEA-S. According to some experts, DHEA-S may also cause symptoms of mania or irritability in people with a history of depression or bipolar disorder. (
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)
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Cost:
$3–$51 per month online, from health food stores, or at a pharmacy -
Covered by insurance:
No
Dangerous dietary supplements
There are many dietary supplements marketed as “natural Viagra” or “herbal Viagra” to treat ED. These formulations can look like a blend of vitamins and minerals, but we caution against any formulation that comes with claims of male sexual enhancement.
“Gas station pills” are dubious dietary supplements that can be found outside of health care settings, like at a gas station, convenience store, or online, instead of on the shelves of a pharmacy. Among our Reviews Team’s ED survey respondents, 78% had tried a “gas station pill” at least once before seeking online ED treatment. This is concerning because the FDA frequently warns consumers about sexual enhancement OTC products tainted with ingredients not listed on the label. (
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) Hidden ingredients can pose a risk to people with certain medical conditions or who take medications that can interact with the product. The hidden ingredients in these “gas station pills” are often the active ingredients in the prescription medication used to treat ED (e.g., sildenafil and tadalafil).
A study on ED supplements found that 70% of tested products contained undeclared ingredients. (
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) What’s more, the products that were found to contain unlisted sildenafil, the active ingredient in the drug Viagra, had doses above the maximum recommended dose of the medication. Having unknown or large doses of any drug increases the risk of overdose or side effects.
Pros
Available over the counter at most stores and pharmacies
Cons
Lack of research on their safety and efficacy
Generally not covered by private insurance plans, FSA funds, or HSA funds
Possibility of unsafe and undeclared ingredients in some formulations
Herbal supplements
Herbal supplements are dietary supplements primarily made of medicinal herbs that can have certain effects on the body. Herbs like ginseng, ginkgo, yohimbine, and horny goat weed have some research on their effects on ED. However, herbal products require more caution around interactions and side effects because these plants often have multiple effects on the body.
We summarize the research on a few popular botanical herbs that can be found in herbal ED supplements.
Ginseng (
Panax ginseng
)
Ginseng, specifically Korean red ginseng, is typically used in traditional Chinese and Asian medicine. A 2021 review of available studies found that ginseng had a minimally positive effect on ED and a low side effect profile. (
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) The review also found that men who took ginseng expressed that ginseng improved their ability to have intercourse.
Side effects of ginseng include diarrhea, nausea, insomnia, headaches, and hypertension. (
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) The herb can interact with caffeine, blood thinners, diabetes medications, and some psychiatric medications (such as phenelzine). You should not take ginseng if you have high blood pressure, are experiencing asthma or infections, or have nosebleeds.
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Cost:
$6–$48 per bottle online, from health food stores, or at a pharmacy -
Insurance coverage:
No
Ginkgo (
Ginkgo biloba
)
Ginkgo is an herb associated with supporting circulation and memory. (
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) Because of its possible effects on improving circulation, the herb may be found in ED supplements. A review of the research on ginkgo found that its extract has no positive effects on male sexual function. (
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)
Headaches and digestive symptoms are the most common side effects of taking ginkgo. Ginkgo interacts with many medications, including seizure medications, antidepressants, and blood pressure medications. It also interacts with blood-thinning drugs and may increase the risk of prolonged bleeding if taken before surgeries or dental procedures. People who have epilepsy or have diabetes are cautioned against taking ginkgo.
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Cost:
$5–$39 per bottle online, from health food stores, or at a pharmacy -
Insurance coverage:
No
Tongkat Ali (
Eurycoma longifolia
)
Tongkat Ali, sometimes called longjack or Malaysian ginseng, is a plant native to Southeast Asia that’s traditionally used as an aphrodisiac. A review of studies on Tongkat Ali extracts found a possible clinical benefit on erectile function, but more studies are needed to have a clearer answer. (
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) One clinical trial found that Tongkat Ali improved erectile function in men who had lower testosterone levels due to aging. (
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) “Tongkat Ali can work by lowering SHBG and raising testosterone levels,” adds Dr. Paulvin.
Tongkat Ali can cause side effects such as insomnia, irritability, and restlessness. (
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) Because of its possible effects on testosterone levels, people with prostate cancer, breast cancer, diabetes, heart disease, sleep apnea, or kidney disease are cautioned against using it.
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Cost:
$10–$45 per bottle online, from health food stores, or at a pharmacy -
Insurance coverage:
No
Yohimbe (
Pausinystalia yohimbe
)
Yohimbe is a tree native to parts of Africa, and its bark has been used as an aphrodisiac. (
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) The active ingredient in Yohimbe bark, yohimbine, can also be found as a prescription drug. (
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) A review of the studies on yohimbine shows that it can improve erectile function in people with ED. (
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) However, the National Center for Complementary and Integrative Health (NCCIH) warns that the amount of active ingredient in supplements with Yohimbe can vary and may not have the same effects as the prescription extract version. (
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)
However, it’s important to note that Dr. Paulvin warns that this supplement can have serious high blood pressure and cardiac side effects.
Yohimbe has been associated with serious side effects such as heart attacks and seizures. It may also cause stomach problems, anxiety, and high blood pressure. Yohimbe can interact with medications like phenelzine (Nardil) and tranylcypromine (Parnate).
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Cost:
$4–$22 per bottle online, from health food stores, or at a pharmacy -
Insurance coverage:
No
Horny goat weed (
Epimedium species
)
Horny goat weed is used in traditional Chinese medicine to support ED. However, there’s not much research to summarize its effects on humans.
Taking horny goat weed can cause minor side effects like abdominal discomfort and nausea. (
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) The herb can interact with certain medications, including blood pressure drugs and blood thinners.
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Cost:
$6–$31 per bottle online, from health food stores, or at a pharmacy -
Insurance coverage:
No
Maca (
Lepidium meyenii
)
Maca root is commonly used in Peruvian traditional herbal medicine. (
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) There is limited evidence for maca’s effect on erectile function in men with mild ED. (
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)
Maca isn’t recommended for hormone-sensitive conditions such as breast cancer. (
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) There currently aren’t any known, published interactions between maca and any medications.
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Cost:
$7–$49.69 per package online, from health food stores, or at a pharmacy -
Insurance coverage:
No
Pros
May improve erectile function, according to small studies
Conveniently available OTC
Cons
Not enough strong evidence to support any herb’s effects on ED
May have unknown levels of active ingredients
Likely to interact with certain medications
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