Common Side Effects of ED Medications

Stendra also acts quicker in the body than others — some studies showed efficacy in as little as 15 minutes.15 This speed makes Stendra a great treatment choice for men who don’t always know when they’ll want to have sex and are happy to take something shortly beforehand. If this describes you, then we recommend Hims Stendra. Stendra is also our top choice for couples who enjoy morning sex. Tadalafil taken in the morning can sometimes require about an hour before it is fully effective. This experience with tadalafil varies — some men find tadalafil to be effective for a full 36 hours (which would make the prior morning’s dose still effective), while others find its effects wear off in closer to 18 hours. If you are in the latter camp, Stendra will be better for your morning rituals because you can take a dose as you wake up and then be ready for fun in as little as 15 minutes. However, Stendra will cost you significantly more than sildenafil or tadalafil. Hims — our top choice for convenient access to Stendra — offers a monthly subscription for four 100mg Stendra tablets at $210 per month, billed quarterly. If you can afford the cost, this may be the best choice for you. If not, then we’d suggest you explore daily tadalafil. There are three standard dosage options for Stendra: Both the 100mg and 200mg dosages take effect in about 15 minutes. Sublingual dose requires no water to take FDA-approved for use in Parkinson’s patients May cause fainting in a small fraction of users Nausea is a common initial side effect Hard to find outside Rugiet’s blended ED treatment Apomorphine has been used since the 19th century as everything from a sedative to an aid in kicking heroin addiction, and it’s currently FDA-approved for treating Parkinson’s disease. However, multiple studies indicate its potential as a treatment for ED.16 The name can be a source of confusion since most people outside the medical professions would likely hear the “morphine” part and assume opioid properties. But apomorphine doesn’t bind to opioid receptors and is nonaddicting. For Parkinson’s patients, apomorphine is delivered via subcutaneous injection at doses often higher than those used in ED treatment. Studies into its use for Parkinson’s revealed intense nausea as a potential side effect — often to the point that doctors would have to prescribe an antiemetic to deal with nausea and vomiting. ED patients taking apomorphine as a sublingual film — or, in the case of Rugiet, a lozenge — may also experience some nausea, but this appears to decline with regular use.17 Apomorphine appeared on target to become a viable alternative to Viagra in 2000, but the manufacturers behind its two branded forms intended for ED patients pulled it from FDA consideration despite what appeared to be a sure path to approval. They cited the need for further study, particularly into the drug's interaction with nitrates and its potential to cause fainting in less than 0.2% of trial participants. Today, apomorphine remains FDA-approved for Parkinson’s disease but is only prescribed for ED treatment as an off-label use. The only major providers we recommend that offer apomorphine in any form are Rugiet and BlueChew, but they typically combine apomorphine with tadalafil and sildenafil in a lozenge.

Factor	Impact on Tablets	Advice
Smoking	Reduced blood flow	Quit smoking for better results
Alcohol Consumption	Can diminish effectiveness	Limit alcohol intake
Obesity	Impaired blood circulation	Maintain healthy weight
Stress	Affects libido and response	Practice stress-reducing techniques
Exercise	Improves cardiovascular health	Regular physical activity

That lozenge’s sublingual administration may decrease the time it takes to start working. It’s possible to get apomorphine-only lozenges from Rugiet, but they only come in the 3mg dose at a cost of $30 for six doses. If you’re looking for ED medications that aren’t technically PDE5 inhibitors (which sildenafil, tadalafil, and vardenafil all are), this may be a viable route. We’ll discuss these combination offering in our next section, which is all about combination therapies.

• Tadalafil is often preferred for daily use due to longer duration.
• Sildenafil and vardenafil require more precise timing around meals.
• Side effects are usually mild but may include flushing and upset stomach.
• Do not share tablets with others to avoid misuse and health risks.
• Erectile dysfunction can be an early sign of heart disease.
• Consult a healthcare professional if tablets have no effect.
• Avoid grapefruit juice when taking certain ED medications.
• Some medications may lose effectiveness over time; check with a doctor.

May improve outcomes in men resistant to monotherapies Can offer treatment outside of just PDE5 inhibitors May increase the risk of side effects Combination therapies are exactly what they sound like: some combination of commonly prescribed ED medications. Studies have shown that certain combinations can be more effective than a monotherapy on its own.23 As with monotherapies, the exact combination and dosing will be a matter for your physician to prescribe. Combination therapies have become more popular among the providers in this guide. Rugiet was the first to offer multiple drugs in a single product with its lozenges, but Hims and Roman soon followed suit. And BlueChew’s recently developed Max and Gold products combine several ED therapies into a single chewable tablet. Let’s start with Rugiet since it kicked off the combination craze with its product, Rugiet Ready. The specific combinations available to you from Rugiet depend on the results of your doctor’s consultation, but here’s a look at their standard mixes: As you can imagine, combining these three medications theoretically increases the chances that they will work for you quickly and remain active in your system for up to 24-36 hours (as long as tadalafil is one of them). However, side effect risks may also increase as you combine medications.

Can I Use Insurance?

Stendra also acts quicker in the body than others — some studies showed efficacy in as little as 15 minutes.15 This speed makes Stendra a great treatment choice for men who don’t always know when they’ll want to have sex and are happy to take something shortly beforehand. If this describes you, then we recommend Hims Stendra. Stendra is also our top choice for couples who enjoy morning sex. Tadalafil taken in the morning can sometimes require about an hour before it is fully effective. This experience with tadalafil varies — some men find tadalafil to be effective for a full 36 hours (which would make the prior morning’s dose still effective), while others find its effects wear off in closer to 18 hours.

Can you use baking soda for erectile dysfunction treatment?

If you are in the latter camp, Stendra will be better for your morning rituals because you can take a dose as you wake up and then be ready for fun in as little as 15 minutes. However, Stendra will cost you significantly more than sildenafil or tadalafil. Hims — our top choice for convenient access to Stendra — offers a monthly subscription for four 100mg Stendra tablets at $210 per month, billed quarterly. If you can afford the cost, this may be the best choice for you. If not, then we’d suggest you explore daily tadalafil.

Key takeaways

There are three standard dosage options for Stendra: Both the 100mg and 200mg dosages take effect in about 15 minutes. Sublingual dose requires no water to take FDA-approved for use in Parkinson’s patients May cause fainting in a small fraction of users Nausea is a common initial side effect Hard to find outside Rugiet’s blended ED treatment Apomorphine has been used since the 19th century as everything from a sedative to an aid in kicking heroin addiction, and it’s currently FDA-approved for treating Parkinson’s disease. However, multiple studies indicate its potential as a treatment for ED.16 The name can be a source of confusion since most people outside the medical professions would likely hear the “morphine” part and assume opioid properties. But apomorphine doesn’t bind to opioid receptors and is nonaddicting. For Parkinson’s patients, apomorphine is delivered via subcutaneous injection at doses often higher than those used in ED treatment. The obvious downside to Rugiet is its cost.

Product	Dosage	Quantity + Bonus	Price
Viagra Generic	150mg	30 + 2 Pills	72.32€ 68.88€	Buy
Levitra Professional	20mg	60 + 2 Pills	223.11€ 212.49€	Buy
Kamagra Gold	100 mg	20 Pills	86.09€ 81.99€	Buy
Cialis Generic	40mg	270 + 10 Pills	382.19€ 363.99€	Buy
Priligy Generic Dapoxetine	60mg	10 Pills	47.63€ 45.36€	Buy
Cialis Generic	20mg	10 Pills	31.49€ 29.99€	Buy
Cialis Generic	10mg	20 Pills	48.23€ 45.93€	Buy
Kamagra Oral Jelly	100mg	30 + 5 Sachets	136.20€ 129.71€	Buy
Viagra Original	100mg	64 + 4 Pills	264.15€ 251.57€	Buy
Kamagra Polo	100mg	84 + 4 Pills	244.49€ 232.85€	Buy
Kamagra Soft Tabs	100mg	120 + 6 Pills	311.78€ 296.93€	Buy
Kamagra Oral Jelly	100 mg	90 + 8 Sachets	303.56€ 289.10€	Buy
Tadalista Super Active	20mg	90 + 10 Pills	314.14€ 299.18€	Buy
Kamagra Soft Tabs	100mg	12 Pills	57.55€ 54.81€	Buy
Kamagra Gold	100 mg	120 + 6 Pills	330.74€ 314.99€	Buy
Kamagra Gold	50 mg	32 Pills	103.06€ 98.15€	Buy
Cialis Generic	40mg	180 + 10 Pills	277.29€ 264.09€	Buy

You can opt for larger shipments to reduce your cost per dose, and that can save you over 30%, but it results in significant up-front costs. For example, a monthly six-pack of medium strength Ready is $99. To get the best cost per dose, you can get 12 of those six-packs shipped to you quarterly for $799. That’s a lot of savings, but it’s likely cost-prohibitive for man up pills many men. To learn more about Rugiet’s offering, check out our comprehensive review of their services.

• ED tablets can enhance confidence and intimacy.
• Not all men respond equally; some require alternative therapies.
• Psychological side effects like anxiety may decrease after use.
• Age and severity of ED influence medication choice.
• Using tablets without a prescription can be unsafe.
• Some underlying health issues may contraindicate certain medications.
• Combining ED medication with fitness programs improves results.
• Always follow medical advice for long-term erectile health.

Rugiet has also expanded its catalog to include a daily tadalafil combined with DHEA to boost testosterone, but we don’t regard DHEA as a very good option for improving testosterone levels with an OTC treatment. You can also get a combination of tadalafil with either minoxidil or paroxetine to treat hair loss or premature ejaculation concurrently with ED, but both treatments have less tadalafil in them than comparables from Hims. Hims has led the way in the chewable combination space since they introduced their Hard Mints and Sex Chews. Recently, the company has expanded these efforts to introduce several new combination treatments that combine common ED medications with ingredients to treat hair loss, premature ejaculation, and more. Here’s a quick look at some of its simpler combination chewables: Hims also offers more novel combinations that slightly outperform those Rugiet recently added to its catalog. This product combines daily tadalafil (likely as a 2.5mg or 5mg dose) with an unspecified dose of fluoxetine, a prescription selective serotonin reuptake inhibitor (SSRI) that’s been studied for years in the context of premature ejaculation.26 Like Climax Control, this Sex Rx product uses daily tadalafil as its ED-fighting base, combined with oral finasteride and oral minoxidil. It’s unclear at this time if the medication can be delivered with just one of those two hair loss medications, but both have been shown to be very effective as oral treatments.27 Again, this drug combination starts with tadalafil, and Hims has combined it with atorvastatin, a statin designed to reduce your risk of certain cardiovascular events, like myocardial infarction.28 Then there’s Roman’s combination sex chew offering, called Sparks, which is only available as a combination of 22mg tadalafil and 55mg sildenafil for the constant rate of $12/dose.

Recommended reading

Studies into its use for Parkinson’s revealed intense nausea as a potential side effect — often to the point that doctors would have to prescribe an antiemetic to deal with nausea and vomiting. ED patients taking apomorphine as a sublingual film — or, in the case of Rugiet, a lozenge — may also experience some nausea, but this appears to decline with regular use.17 Apomorphine appeared on target to become a viable alternative to Viagra in 2000, but the manufacturers behind its two branded forms intended for ED patients pulled it from FDA consideration despite what appeared to be a sure path to approval. They cited the need for further study, particularly into the drug's interaction with nitrates and its potential to cause fainting in less than 0.2% of trial participants. Today, apomorphine remains FDA-approved for Parkinson’s disease but is only prescribed for ED treatment as an off-label use. The only major providers we recommend that offer apomorphine in any form are Rugiet and BlueChew, but they typically combine apomorphine with tadalafil and sildenafil in a lozenge.

FYI on ED

That lozenge’s sublingual administration may decrease the time it takes to start working. It’s possible to get apomorphine-only lozenges from Rugiet, but they only come in the 3mg dose at a cost of $30 for six doses. If you’re looking for ED medications that aren’t technically PDE5 inhibitors (which sildenafil, tadalafil, and vardenafil all are), this may be a viable route. We’ll discuss these combination offering in our next section, which is all about combination therapies. May improve outcomes in men resistant to monotherapies Can offer treatment outside of just PDE5 inhibitors May increase the risk of side effects Combination therapies are exactly what they sound like: some combination of commonly prescribed ED medications.

Language matters

Studies have shown that certain combinations can be more effective than a monotherapy on its own.23 As with monotherapies, the exact combination and dosing will be a matter for your physician to prescribe. Combination therapies have become more popular among the providers in this guide. Rugiet was the first to offer multiple drugs in a single product with its lozenges, but Hims and Roman soon followed suit. And BlueChew’s recently developed Max and Gold products combine several ED therapies into a single chewable tablet. Let’s start with Rugiet since it kicked off the combination craze with its product, Rugiet Ready. That 22mg tadalafil dose is much higher than we’d recommend for men new to ED medications.

How oral medicines differ

The specific combinations available to you from Rugiet depend on the results of your doctor’s consultation, but here’s a look at their standard mixes: As you can imagine, combining these three medications theoretically increases the chances that they will work for you quickly and remain active in your system for up to 24-36 hours (as long as tadalafil is one of them). However, side effect risks may also increase as you combine medications. The obvious downside to Rugiet is its cost. You can opt for larger shipments to reduce your cost per dose, and that can save you over 30%, but it results in significant up-front costs. For example, a monthly six-pack of medium strength Ready is $99.

ED overview

To get the best cost per dose, you can get 12 of those six-packs shipped to you quarterly for $799. That’s a lot of savings, but it’s likely cost-prohibitive for man up pills many men. To learn more about Rugiet’s offering, check out our comprehensive review of their services. Rugiet has also expanded its catalog to include a daily tadalafil combined with DHEA to boost testosterone, but we don’t regard DHEA as a very good option for improving testosterone levels with an OTC treatment. You can also get a combination of tadalafil with either minoxidil or paroxetine to treat hair loss or premature ejaculation concurrently with ED, but both treatments have less tadalafil in them than comparables from Hims.

Key differences between ED medications

Hims has led the way in the chewable combination space since they introduced their Hard Mints and Sex Chews. Recently, the company has expanded these efforts to introduce several new combination treatments that combine common ED medications with ingredients to treat hair loss, premature ejaculation, and more. Here’s a quick look at some of its simpler combination chewables: Hims also offers more novel combinations that slightly outperform those Rugiet recently added to its catalog. This product combines daily tadalafil (likely as a 2.5mg or 5mg dose) with an unspecified dose of fluoxetine, a prescription selective serotonin reuptake inhibitor (SSRI) that’s been studied for years in the context of premature ejaculation.26 Like Climax Control, this Sex Rx product uses daily tadalafil as its ED-fighting base, combined with oral finasteride and oral minoxidil. It’s unclear at this time if the medication can be delivered with just one of those two hair loss medications, but both have been shown to be very effective as oral treatments.27 Again, this drug combination starts with tadalafil, and Hims has combined it with atorvastatin, a statin designed to reduce your risk of certain cardiovascular events, like myocardial infarction.28 Then there’s Roman’s combination sex chew offering, called Sparks, which is only available as a combination of 22mg tadalafil and 55mg sildenafil for the constant rate of $12/dose. If you’re used to taking such a high dose, this might be a viable product, but there are superior options with more flexible dosing for lower prices from Hims.

What should I know about storage and disposal of this medication?

In that case, we’d recommend starting with Hims, where you can choose between numerous combinations at slightly better prices and more reasonable doses than you’ll find from Roman, BlueChew, or Rugiet. Our testing also confirmed that Rugiet lozenges are susceptible to high temperatures and may melt if left in a hot car or even outside on a hot enough day. That makes them less ideal for certain situations and climates than more durable chews from Hims or Roman. With up to 40% of ED cases proving to be psychological in origin, a large number of men can find relief through mental health care, whether that’s talk therapy, psychiatry, or a combination of the two.44 You can try to find an in-person therapist or psychiatrist, but the industry has largely moved online over the last several years, so we’ll focus this section on teletherapy resources for mental health that can help men address psychogenic ED. While Cerebral is a little more expensive than some excellent competitors, it offers plans for talk therapy, psychiatry (medication access), or both. BlueChew Max combines tadalafil with either sildenafil or vardenafil, depending on your preference, making it a superior choice for men interested in putting those two together without adding apomorphine to the mix. BlueChew Gold expands in the opposite direction, combining the three medications seen in Rugiet Ready and adding oxytocin to the mix. Oral oxytocin boasts some evidence for improving female sexual desire, and its reputation as “the love hormone” implies that these effects could work just as well in men. But there’s not enough science backing this up just yet. That said, as we’ll discuss soon, mental health plays a big role in ED, and oxytocin has been shown to help in cases of anxiety and depression.

• Physical activity increases nitric oxide levels aiding erections.
• Stress and anxiety are common causes of ED needing medication.
• Certain medications for other conditions may affect ED treatment.
• Some ED tablets require prescription based on health history.
• Age-related decline impacts the effectiveness of ED tablets.
• Combining multiple ED medications is not recommended.
• Men should discuss any ongoing health issues with their doctor.
• Proper hydration and sleep contribute to better erectile function.

So, it’s possible that the oxytocin in Gold is there to address potential psychiatric complications around ED, rather than physiological ones.46 Given the current state of available doses, we don’t recommend combination therapies to men who haven’t tried ED medications before. If you discover that a monotherapy can work for you, there’s no reason to add another medication to the picture.

What Lifestyle Changes Can Help With Erectile Dysfunction?

That 22mg tadalafil dose is much higher than we’d recommend for men new to ED medications. If you’re used to taking such a high dose, this might be a viable product, but there are superior options with more flexible dosing for lower prices from Hims. BlueChew Max combines tadalafil with either sildenafil or vardenafil, depending on your preference, making it a superior choice for men interested in putting those two together without adding apomorphine to the mix. BlueChew Gold expands in the opposite direction, combining the three medications seen in Rugiet Ready and adding oxytocin to the mix. Oral oxytocin boasts some evidence for improving female sexual desire, and its reputation as “the love hormone” implies that these effects could work just as well in men.

Watch out for side effects

But there’s not enough science backing this up just yet. That said, as we’ll discuss soon, mental health plays a big role in ED, and oxytocin has been shown to help in cases of anxiety and depression. So, it’s possible that the oxytocin in Gold is there to address potential psychiatric complications around ED, rather than physiological ones.46 Given the current state of available doses, we don’t recommend combination therapies to men who haven’t tried ED medications before. If you discover that a monotherapy can work for you, there’s no reason to add another medication to the picture. If you’ve tried monotherapies and had poor or mixed results at various doses, a combination therapy might be the way to go. If you’ve tried monotherapies and had poor or mixed results at various doses, a combination therapy might be the way to go. In that case, we’d recommend starting with Hims, where you can choose between numerous combinations at slightly better prices and more reasonable doses than you’ll find from Roman, BlueChew, or Rugiet.

What special dietary instructions should I follow?

Our testing also confirmed that Rugiet lozenges are susceptible to high temperatures and may melt if left in a hot car or even outside on a hot enough day. That makes them less ideal for certain situations and climates than more durable chews from Hims or Roman. With up to 40% of ED cases proving to be psychological in origin, a large number of men can find relief through mental health care, whether that’s talk therapy, psychiatry, or a combination of the two.44 You can try to find an in-person therapist or psychiatrist, but the industry has largely moved online over the last several years, so we’ll focus this section on teletherapy resources for mental health that can help men address psychogenic ED. While Cerebral is a little more expensive than some excellent competitors, it offers plans for talk therapy, psychiatry (medication access), or both.