Oral Treatment Options for ED

At Maze Men’s Health, oral medications are often the first and most effective treatment for Erectile Dysfunction (ED). The four FDA-approved options — Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and Stendra (avanafil) — belong to a class of drugs known as phosphodiesterase type 5 (PDE5) inhibitors. These medications enhance natural erections by improving blood flow to the penis. When a man is sexually aroused, nitric oxide signals the blood vessels in the penis to relax and fill with blood; PDE5 inhibitors strengthen this process by blocking the enzyme that reverses it. The result: firmer, longer-lasting erections in response to arousal — not artificial stimulation.

Each medication works slightly differently in timing, duration, and side effect profile. Viagra (sildenafil) is the most well-known and often the strongest, typically taken one hour before sex on an empty stomach for best absorption. Its effects last about 4–6 hours. Cialis (tadalafil) is the longest-acting ED medication — it can last up to 36 hours — making it ideal for men who prefer spontaneity or daily low-dose use. It’s also FDA-approved for men with benign prostatic hyperplasia (BPH) or urinary symptoms, offering additional benefits beyond sexual performance. Levitra (vardenafil) provides similar effectiveness to Viagra but with slightly fewer side effects, while Stendra (avanafil) is the fastest-acting, taking effect in as little as 15 minutes and often better tolerated for men with sensitive stomachs or who wish to take it closer to sexual activity.

Many of these medications are now available in affordable generic forms, including sildenafil and tadalafil, which can cost as little as $4–$7 per dose through traditional or compounding pharmacies. For men who prefer alternative delivery methods, compounding pharmacies can prepare troches (dissolvable tablets), sublingual versions, or capsules to fit individual needs. At Maze, our clinicians help patients identify the right medication, dose, and timing to achieve the best results while minimizing side effects such as headache, flushing, or nasal congestion.

While oral ED medications are effective for approximately 70% of men, they aren’t suitable for everyone. They cannot be taken by men who use nitrates, have unstable heart disease, or suffer from certain cardiovascular conditions. During your comprehensive evaluation, Michael A. Werner, M.D., and his team will assess your heart health, hormones, and overall medical history to ensure safe and optimal treatment. For men who don’t respond to pills or who experience side effects, Maze offers additional advanced therapies including penile injections, low-intensity shockwave therapy (LiSWT), Platelet-Rich Plasma (PRP) treatments, and penile implants.

Our goal is to help every man — whether in Westchester, New York City, Connecticut, or New Jersey — find the most effective, evidence-based solution for his specific needs. At Maze, we don’t just treat symptoms; we treat the whole person, restoring function, confidence, and quality of life.