ED Medications List: Pills, Injections, Suppositories and Compounded Options
Tablets are only part of the list. Here is every form, how the label says to take it, and who must not.
Men's Health Weekly staff ·
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The quick answer
- ED medicines come as four oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil), alprostadil injections, a urethral suppository, and non-approved compounded products.12
- Label timing differs: about 1 hour for sildenafil and vardenafil, as early as about 15 minutes for avanafil, and effects up to 36 hours after as-needed tadalafil.3456
- Nitrates in any form are contraindicated with the PDE5 tablets, and alpha-blockers call for caution.345
- The Caverject label reports penile pain in 37% and a prolonged erection in 4% of patients treated, and its first doses are given in the clinician's office.7
The prescription medicines for erectile dysfunction fall into four groups: oral PDE5 inhibitor tablets (sildenafil, tadalafil, vardenafil, avanafil), injections into the penis (alprostadil), a urethral suppository (alprostadil), and compounded products that are not FDA-approved. The NIDDK lists PDE5 inhibitors first and describes injectable medicines and suppositories as options that can enhance erections.1 The list below gives each one with the facts its FDA label states: how it is taken, when, and what rules out its use.
What are the ED medications on the market?
| Medicine (brand) | Form | How the label says to take it |
|---|---|---|
| Sildenafil (Viagra) | Tablet | Usual dose 50 mg about 1 hour before sexual activity, anywhere from 30 minutes to 4 hours; once a day at most; 25 mg or 100 mg by tolerance3 |
| Tadalafil (Cialis) | Tablet | As needed: 10 mg before sexual activity, adjusted to 5 or 20 mg; improved erectile function compared with placebo up to 36 hours after a dose. Once daily: 2.5 mg, may rise to 5 mg6 |
| Vardenafil (Levitra) | Film-coated tablet | 10 mg about 60 minutes before sexual activity, adjusted to 5 or 20 mg; once a day at most4 |
| Vardenafil orally disintegrating tablet | Dissolves on the tongue | 10 mg, about 60 minutes before sexual activity, taken without liquid; not interchangeable with the Levitra 10 mg tablet because exposure is higher8 |
| Avanafil (Stendra) | Tablet | 100 mg as early as about 15 minutes before sexual activity; 200 mg or 50 mg by tolerance; once a day at most5 |
| Alprostadil (Caverject, Edex) | Injection into the side of the penis | Dose set in the clinician's office, then no more than 3 times weekly with at least 24 hours between doses79 |
| Alprostadil urethral suppository | Solid piece placed in the urethra | The NIDDK says a health care professional teaches how to insert it; we did not find a current DailyMed label for it1 |
All four tablets need sexual stimulation to produce an erection, and each label sets a once-a-day limit for as-needed use.345 Tadalafil is the exception in format: it also comes as a once-daily tablet taken at about the same time every day regardless of sexual activity.6
How do the four ED pills differ?
They share a mechanism and a set of safety limits, and differ mainly in timing and food effects. Sildenafil and vardenafil are labeled for about an hour before sex, avanafil as early as about 15 minutes, and tadalafil for as-needed use or daily use.3456 Food matters for sildenafil: after a high fat meal its absorption slows, with a mean delay of 60 minutes in reaching peak levels and a mean 29% lower peak.3 Vardenafil film-coated tablets showed an 18% to 50% lower peak after high-fat meals in the label's food studies.4 Our comparison of which ED pills are FDA-approved and in which forms covers the tablets and their generics in more detail.
Which one a man is given depends on his other medicines, his heart and liver and kidney health, and how he wants to use it. The labels do not rank the four against each other, and we found no head-to-head trial in this run that would let us say one is better.
Who cannot take them?
Nitrates in any form are contraindicated with these tablets: Viagra's label says sildenafil potentiates the blood pressure lowering effect of nitrates, and the Levitra label contraindicates nitrates and nitric oxide donors.34 The Stendra label says the same.5 Alpha-blockers call for caution, with lower starting doses in some cases (Stendra starts at 50 mg in men on stable alpha-blocker therapy).5 A man on any heart medicine should name it at the visit. An erection lasting more than 4 hours is an emergency for every group in this article.3
What are the injections and suppositories like?
Alprostadil is a different kind of medicine: Caverject is a prostaglandin E1 agonist injected into the penis, and the first injections are given in the clinician's office so the dose can be titrated to the lowest effective one.7 The patient must be trained in self-injection before using it at home, and the label asks for a check-up every 3 months.7 Edex's label says an erection can be expected within 5 to 20 minutes and states a goal of an erection lasting no longer than 1 hour.9
| Reported in the labels | Caverject | Edex |
|---|---|---|
| Penile pain | 37% of patients in studies up to 18 months7 | 31% after Edex vs 9% after placebo in placebo-controlled studies9 |
| Erection longer than 4 hours | 4%7 | 4% of all patients treated up to 24 months; 3% vs under 1% on placebo in placebo-controlled studies9 |
| Penile fibrosis | 3% overall; 7.8% in one self-injection study of up to 18 months7 | See label9 |
| Not for men with | Sickle cell disease or trait, multiple myeloma, leukemia, penile fibrosis conditions such as Peyronie's disease, or penile implants7 | The same list of conditions9 |
These are separate studies with different designs, so the columns should not be read as a head-to-head comparison. Injections suit some men when tablets are contraindicated or have not been enough, which is a decision for a urologist or another prescriber.
What about compounded ED medicines?
Compounded ED products, such as sublingual combinations of the tablet ingredients, are made by a pharmacy for an individual patient and are not on the approved list above. The FDA says compounded drugs are not FDA-approved and that the agency does not verify their safety, effectiveness or quality before they are marketed.2 The Viagra label also says the safety and effectiveness of combining sildenafil with other ED treatments have not been studied.3 That is not a reason for or against any single product, but it is why the label tables above cannot be applied to a combination.
Sponsored: Quattro from Vea Health, one compounded route
This section is sponsored: we have a financial relationship with Vea Health. It is one online option and is not ranked against the approved medicines above.
Vea Health describes Quattro as a compounded sublingual dose combining sildenafil, tadalafil, vardenafil and apomorphine, prescribed only after a licensed clinician reviews your health history, with no charge unless a clinician approves the prescription.10 It is made by a state-licensed 503A pharmacy for an individual patient, so it is not FDA-approved, and its strengths are not listed on the page we loaded. Because it contains three PDE5 inhibitors, the nitrate and alpha-blocker limits on the labels above are the questions a prescriber has to settle first.34
How do you choose between them?
Start with the cause and the check-up; our guide to who to see for ED and what they should check explains the visit. Then the choice usually turns on four things: heart and nitrate history, how soon before sex you want to take it, whether you want a daily option, and whether tablets are suitable at all. For the wider picture of lifestyle steps and when medicine is added, see how to fix ED in order.
Ordering any of these online is a prescription decision. The NIDDK advises talking with a health care professional before ordering ED medicines online.1
Bottom line
There are four approved tablets, two approved injections, an approved suppository, and compounded options that carry no FDA approval. Each label states its own timing and its own list of people who must not use it. Take the list to a prescriber with your medicine and heart history, and expect them to pick from it rather than the reverse.
Your questions
What are the main ED medications?
Four oral tablets: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Stendra). Alprostadil is the other approved type, given by injection into the penis or as a urethral suppository.
Which ED medication starts fastest?
Per the labels, Stendra (avanafil) can be taken as early as about 15 minutes before sexual activity, against about 60 minutes for vardenafil and about 1 hour for sildenafil. The labels do not rank them against each other.
Are there ED medications that are not pills?
Yes. Alprostadil is injected into the side of the penis (Caverject, Edex) and also comes as a urethral suppository. The NIDDK says both can enhance erections.
Who should not take ED pills?
Men taking nitrates in any form should not use them, per the sildenafil, vardenafil and avanafil labels. Men on alpha-blockers need caution, and a clinician should review every medicine you take.
Read next
Part of our guide: Getting ED Treatment: Doctors, Online Prescriptions and FDA-Approved Options
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases. Erectile Dysfunction: Treatment. National Institutes of Health. Accessed October 24, 2026.
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers.
- Pfizer. VIAGRA (sildenafil citrate) prescribing information. DailyMed, U.S. National Library of Medicine.
- LEVITRA (vardenafil hydrochloride) prescribing information. DailyMed, U.S. National Library of Medicine.
- Metuchen Pharmaceuticals. STENDRA (avanafil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Eli Lilly. CIALIS (tadalafil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Pharmacia & Upjohn. CAVERJECT (alprostadil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Alembic Pharmaceuticals. Vardenafil hydrochloride orally disintegrating tablets prescribing information. DailyMed, U.S. National Library of Medicine.
- Endo USA. EDEX (alprostadil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Vea Health. Quattro. Accessed October 22, 2026.
- Dula E, et al. Double-blind, crossover comparison of 3 mg apomorphine SL with placebo and with 4 mg apomorphine SL in male erectile dysfunction. Eur Urol. 2001. PubMed 11464037.