7 Viagra Alternatives — and Which Ones Actually Work According to Healthcare Professionals - GoodRx (2024)

If you’re one of the 30 million people in the U.S. affected by erectile dysfunction (ED), it’s good to know all of your medication options. Viagra (sildenafil) and other phosphodiesterase-5 (PDE5) inhibitors are popular choices. But they don’t work for everyone, and you may need to avoid them if you’re taking certain other medications, like nitrates, or if you have certain health conditions, such as low blood pressure or a recent heart attack or stroke.

The good news is there are Viagra alternatives for ED treatment. Below, we’ll discuss seven Viagra substitutes, including which are worth a try and which ones you may want to think twice about.

1. MUSE

One Viagra alternative is the Medicated Urethral System for Erection, known as MUSE (alprostadil). It’s a small pellet that’s inserted into the opening of your penis. MUSE contains alprostadil, a synthetic form of prostaglandin that relaxes muscles and widens blood vessels in the penis. This allows for more blood flow, which can help you get an erection.

MUSE comes in four different doses and is about 50% to 65% effective. It usually works within 5 to 10 minutes and lasts from 30 to 60 minutes. You can use it up to two times in a 24-hour period.

Common side effects include a burning or aching sensation in the penis. It’s recommended that you use MUSE for the first time under the supervision of a healthcare provider.

2. Caverject

Caverject (alprostadil) contains the same medication as Muse. But the key difference is that you inject Caverject into the base of the penis with a needle.

Caverject usually works within 5 to 20 minutes after injection and lasts no longer than one hour. It’s recommended to use it no more than three times per week.

In studies, Caverject was over 80% effective at treating ED. But the injection makes it less popular than other options. Before starting Caverject, you’ll need injection training at your healthcare provider’s office. And it can be painful — about one-third of people experience penile pain from their injection.

Caverject can also cause penile fibrosis in a small number of people, which can worsen ED symptoms. Using proper injection technique and changing where you inject each time can help lessen this side effect.

Injectable alprostadil is available under three brand names: Caverject, Caverject Impulse, and Edex. All three have different packaging and instructions. Be sure to get clear instructions and training from your healthcare provider.

3. Bimix, Trimix, and Quadmix

Trimix (papaverine, phentolamine, alprostadil) is one of several other injectable ED treatments. Papaverine and the other medications included in these compounds are vasodilators. They work by relaxing blood vessels and increasing blood flow to the penis.

These medications aren’t commercially made. Instead, they’re compounded, which means they must be made at a specialized compounding pharmacy. Your healthcare provider will help tailor which medications and dose work best for you. Typical combinations are:

• Bimix (papaverine, phentolamine)

• Trimix (papaverine, phentolamine, alprostadil)

• Quadmix (papaverine, phentolamine, alprostadil, atropine)

These compounded medications aren’t FDA approved, but they’re still considered effective ED treatments. Compared to Caverject, Trimix and Quadmix may work better, cost less on average, and may be less painful to inject.

But these compounded formulations may be more likely to cause priapism — a painful erection that won’t go away. And they can also be harder to obtain, since they can only be made by specialized pharmacies.

4. L-arginine

L-arginine is an amino acid found in foods like red meat and dairy. The body turns L-arginine into nitric oxide. Nitric oxide widens blood vessels and increases blood flow.

Health experts rate 2.5 g to 5 g of L-arginine as “possibly effective” for treating ED. A few studies have shown that it might be helpful for mild to moderate ED. But it doesn’t seem to be helpful for severe ED or ED that’s caused by issues other than blood flow. And it seems to work better when taken with a PDE5 inhibitor, like Viagra.

Talk to your healthcare provider before trying L-arginine. It may not be safe for everyone. For example, it can be dangerous if taken too soon after a heart attack. And you may need to avoid it if you have kidney problems or take medications for high blood pressure or diabetes.

5. Trazodone

Trazodone is an antidepressant medication that can cause priapism in some people who take it. This caused people to think it might work for ED. But it’s unclear if trazodone is actually an effective ED treatment. Some studies have shown that it doesn’t work better than a placebo. Other studies suggest that it might help at higher doses (150 mg to 200 mg per day).

However, psychological factors can also cause ED. In fact, you’re almost five times more likely to experience ED if you have depression. And since trazodone is used to treat depression, it may be more helpful in people whose ED is more related to a mental cause than a physical one.

Talk to your healthcare provider if you think depression might be causing your ED.

6. Ginseng

Ginseng is an herbal supplement that’s often promoted as an adaptogen — a type of herb that helps your body deal with stress.

Ginseng is thought to treat ED by increasing the release of nitric oxide. It may also enhance sexual arousal. But there’s not a lot of evidence that ginseng actually works. There are a few low-quality studies that show it might work slightly better than a placebo for some people. But there are no studies comparing it to proven ED treatments.

Short-term ginseng use (up to 6 months) appears to be safe for most people. But keep in mind that ginseng has a lot of drug interactions, including some antidepressants, blood thinners, and blood pressure medications.

7. Yohimbine

Yohimbine is an herbal supplement that comes from the bark of the African Yohimbe tree. It was used historically as an aphrodisiac, but these days you can find it marketed for anything from ED to weight loss.

Although it’s been around longer than Viagra, we still don’t know a lot about yohimbine. A few studies have shown that it might be helpful for ED but likely works best when it’s combined with other supplements, like L-arginine.

There are some risks with yohimbine. Most products aren’t regulated, and often contain different amounts of yohimbine than stated on the label. The products may even contain PDE5 inhibitors, too. High doses of yohimbine can cause a rapid heart rate and anxiety. Plus, it’s been associated with heart attacks and seizures. Because of its unreliable potency and side effects, yohimbine is restricted or banned in many countries.

The issue with viagra and nitrates

As mentioned above, nitrates may be one reason you’re not able to take Viagra. Nitrates are a type of medication prescribed to treat angina (chest pain) or help with symptoms of heart failure. They’re vasodilators that work by widening your blood vessels. Common examples include nitroglycerin (Nitrostat) and isosorbide mononitrate (Imdur).

Viagra and nitrates are dangerous to take together. The combination can cause your blood pressure to become dangerously low, which in some cases is deadly. It’s recommended to separate nitrates and PDE5 inhibitors by at least 24 to 48 hours.

Do nitrates help with ED?

Before Viagra, there were a few case reports of people getting an erection from nitrates and other types of vasodilators. It’s possible that if you’re taking nitrates, they may improve your sexual function.

But nitrates have different effects than Viagra on your heart and large arteries. Attempting to take them off-label to try to treat ED is dangerous. Taking nitrates that aren’t prescribed to you could result in headache, confusion, and vomiting. It can also lead to difficulty breathing, coma, and death.

Are there alternatives to medication for ED?

Yes. Vacuum devices and prosthesis surgery are ED treatments that don’t involve medication. Vacuum devices are non-invasive and use suction to help you achieve an erection. Surgery involves implanting an inflatable or shapeable prosthetic into the penis.