Potency Drugs for Erectile Dysfunction in Comparison


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What sexual enhancers are there?

Potency drugs – also called erection aids – are used to treat erectile dysfunction (ED) in men. A distinction is made between different methods and active ingredients, which help in different ways with erectile dysfunction. In this article, the focus is on the comparison of medicinal sexual enhancers, i.e. Sildenafil ( Viagra ), Tadalafil ( Cialis ) and Co.

Mechanical sexual enhancers

A common mechanical sexual enhancer for erectile dysfunction is the penis pump or vacuum pump. This is placed over the still-flaccid penis before sexual intercourse. By pumping, negative pressure can be generated, through which blood flows into the erectile tissue of the penis. The result is an erection that can be maintained with the help of a cock ring.

Herbal sexual enhancers

Natural sexual enhancers include natural or animal substances that are said to have a potency-enhancing effect. However, the effect of these sexual enhancers should be viewed critically, as they are often marketed by dubious suppliers. Examples of herbal sexual enhancers are special foods, ginseng, the “Spanish fly” or maca powder.

Medicinal sexual enhancers

Drugs for sexual enhancers contain chemical substances that can be used to trigger or maintain an erection. A distinction is made between the active ingredients, which act on the erection in a different way. In particular, the PDE-5 inhibitors avanafil, sildenafil, tadalafil, and vardenafil can be differentiated from the active ingredient alprostadil. But the medicinal sexual enhancers also differ in terms of the method: while some are swallowed in tablet form, others are injected directly into the penis.

PDE-5 inhibitors

The most well-known sexual enhancers are the so-called phosphodiesterase-5 inhibitors, PDE-5 inhibitors for short . This category also includes what is probably the most famous sexual enhancer: Viagra. However, this is just one of many drugs that work through PDE-5 inhibitors. A distinction is made between 4 active ingredients:

➜ Avanafil

➜ Sildenafil

➜ Tadalafil

➜ Vardenafil

These 4 different active ingredients work in a similar way and all show the same effect: A stronger and longer erection. Nevertheless, aspects such as the effects and side effects, the duration of the effect, or the required dose can differ.

In the UK, PDE5 inhibitors generally require a prescription. No wonder, because the active ingredients are often associated with side effects and can even become dangerous under certain conditions or if taken incorrectly.


The active ingredient alprostadil – also known as prostaglandin E1 – is normally injected directly into the penis using the MUSE or SKAT method. There, the active ingredient ensures increased blood flow, which leads to an erection. Like PDE-5 inhibitors, drugs containing the active ingredient alprostadil require a prescription. The reason for this is also the possible effects.³

Difference between drug and drug

An active ingredient is a pharmacologically active substance in a drug. Ergo: The active ingredient is the part of the drug that is responsible for its effectiveness.⁴

Compared to sexual enhancers: intake

‍ The PDE-5 inhibitors avanafil, sildenafil, tadalafil, and vardenafil are taken in tablet form. However, if men have problems swallowing tablets, some active ingredients can also be replaced with melted or chewable tablets. Ideally, the PDE-5 inhibitor is taken on an empty stomach, as the active ingredients may take longer to develop their effects on a full stomach. The PDE-5 inhibitors can be taken as needed, but not more than once a day.

There are two different ways of taking alprostadil: MUSE and SKAT.

➊ With the MUSE (“Medicated Urethral System for Erection”), the active substance is introduced directly into the urethra via a sterile applicator, from where it spreads into the erectile tissue. This application may be carried out no more than twice within 24 hours and no more than seven times per week.

➋ In SKAT (cavernosal autoinjection therapy), an injection solution containing the active ingredient is injected into the penis. This injection must be repeated after 24 hours at the earliest and must not be injected more than three times a week.

Potency: comparison of the dosage

“The dose makes the poison” also applies to sexual enhancers. Because a much too high amount can lead to severe side effects and cause permanent damage. In the right dose, however, sexual enhancers are an effective aid in erectile dysfunction.

The recommended dose of sexual enhancers varies between the active ingredients and should ideally always be discussed with a doctor. It is best to start with a small dosage and gradually increase it depending on the effect.

Microgram = µg, milligram = mg

Compared to sexual enhancers: period until the effect begins

How long it takes for a drug to take effect depends on a number of factors and can vary from time to time and between patients. Nevertheless, it can be said that some active ingredients bring about the result achieved – namely an erection – faster than others do.

Compared to sexual enhancers: duration of action

The active ingredients not only unfold their effect at different speeds but are also broken down at different speeds and have different effects. While the duration of action of the PDE-5 inhibitors also depends on sexual arousal, with the active ingredient alprostadil you can expect an erection of one hour at the right dose.

Compared to sexual enhancers: contraindications

Not everyone should use sexual enhancers for erectile dysfunction. Because under certain conditions – such as special underlying diseases – taking the sexual enhancer can lead to serious side effects and, in extreme cases, be life-threatening. It is therefore important to consult a doctor before reaching for the sexual enhancer, to weigh up the individual risks of taking it, and, if necessary, to adjust the dose.

Contraindications for PDE-5 inhibitors:

  • diabetes
  • Cardiovascular diseases (e.g. severe heart failure, stroke)
  • Hepatic or renal dysfunction
  • very low blood pressure (below 90/50 mmHg).
  • hereditary retinal damage
  • sickle cell anemia, leukemia
  • Experience with permanent erections (priapism)
  • unusual penis shape, narrowing of the foreskin (phimosis)

with avanafil: very high blood pressure (over 100/170 mmHg)

Contraindications for PDE-5 inhibitors:

  • implanted penile prosthesis
  • Cardiovascular diseases (e.g. unstable angina pectoris, cardiac insufficiency)
  • Hardening in the connective tissue of the erectile tissue
  • unusual penis shape, narrowing of the foreskin (phimosis)
  • blood clotting disorders
  • sickle cell anemia, leukemia
  • Experience with permanent erections (priapism)

Potency drug comparison: interactions

In addition to possible underlying diseases, the intake of medication and other substances should also be clarified before resorting to sexual enhancers. The reason is possible interactions between the drugs and the active ingredients of the sexual enhancers, which in the worst case can be life-threatening.

Interactions in PDE-5 inhibitors:

  • Medicines with nitrates or nitrate-related substances, e.g. amyl nitrite (for heart diseases, party drugs like “Rush”)
  • Alpha-1 receptor blockers (for high blood pressure, prostate problems)

➜ When taking sildenafil or vardenafil, there should be a four to six-hour interval between the sexual enhancers and the alpha-1 receptor blocker

  • Medicines such as itraconazole, ketoconazole, and miconazole (for fungal infections), erythromycin, clarithromycin, and telithromycin (for bacterial infections), indinavir, ritonavir and saquinavir (for HIV infections), tacrolimus (after organ transplants)

➜ take the smallest amount of active ingredient here

➜ Do not take Avanafil at all

  • For avanafil: do not take it with riociguat (for pulmonary hypertension).

Interactions with alprostadil:

  • Alpha-1 receptor blockers (for high blood pressure, prostate problems)
  • antihypertensive drugs
  • anticoagulants, e.g. warfarin (if there is a risk of thrombosis)

Compared to sexual enhancers: side effects

As with almost all medicines, there can also be undesirable side effects with potency drugs. While some of these side effects are unpleasant but not dangerous (➊), others must be monitored (➋) or treated immediately by a doctor (➌).

Side effects of PDE-5 inhibitors⁵:

➊ nasal congestion; Nosebleeds, flu-like symptoms, muscle and back pain, nausea, vomiting, diarrhea, abdominal pain

➋ Headache, dizziness, weakness, flushing (reddened face/upper body), rash, burning, and numbness of the skin

➌ severe headache (harbinger of cerebral hemorrhage or stroke); Severe visual disturbances and eye pain, chest pain, palpitations, and shortness of breath (harbinger of a heart attack), permanent erections, life-threatening allergies (severe skin rash, itching, tachycardia, shortness of breath, weakness)

Alprostadil side effects:

➊ Visual disturbances, dry mouth, nausea

MUSE: Burning sensation and feelings of tension in the penis

SKAT: Bruising, itching in the penis, reddened skin

➋ Dropped blood pressure (headache, dizziness), sensory disturbances in the penis and perineum, increased liver values, difficult urination, narrowing of the foreskin, painful erections, inflammation of the glans

MUSE: Burning and bleeding of the urethra, urinary tract infections

SKAT: pain, nodular swellings, and scars

➌ Permanent erections

How the effects or side effects are felt depends on the individual’s circumstances and will determine which drug is preferred over another. So it can happen that a man no longer wants to take medication with sildenafil due to special side effects, but tolerates medication with vardenafil well… And vice versa.

Potency in comparison: packaging size and prices

There is not one drug for every active ingredient, but usually several genetic variants. These generics contain the same active ingredient as the original drug and are only sold under a different name.

Here are some examples:

‍ The
original drugs of the four PDE-5 inhibitors:

  • The drug Viagra contains the active ingredient sildenafil.
  • The drug Cialis contains the active ingredient Tadalafil.
  • The drug Levitra contains the active ingredient vardenafil.
  • The drug Spedra contains the active substance avanafil.

The original drugs with alprostadil:

  • The drug Caverject contains the active ingredient alprostadil.

The drug MUSE contains the active ingredient alprostadil.

Price comparison potency

The price per sexual enhancer varies depending on the active ingredient, the package size, and the dosage of the active ingredient. Irrespective of this, however, there are also strong price differences between the companies. The originals are usually significantly more expensive than the generics.

The costs for sexual enhancers are usually not covered by health insurance.

Package size potency

The range of pack sizes varies depending on the product. As a rule, the smallest pack consists of 4 and the largest of 30 tablets. As with all other products, the price per tablet also varies with the pack size. This means that the larger the pack, the cheaper the individual tablets.

Buy and order sexual enhancers

Many men are ashamed of their erectile dysfunction and are reluctant to see a doctor. However, contact with a doctor is a basic requirement for the purchase of sexual enhancers, as these require a prescription. In addition, EVERYONE should have possible underlying diseases and interactions medically clarified before resorting to sexual enhancers, since the sexual enhancers can be life-threatening if taken incorrectly!

But be careful: On the virtual search for sexual enhancers, you can quickly come across dubious Internet dealers. Here you should definitely remember: If you are offered medicinal potency pills without a medical diagnosis and prescription, then KEEP YOUR FINGERS OFF! Because these products are simply illegal and usually either have no effect at all or pose a serious risk to health. Counterfeit medicines are often of inferior quality and contaminated.

Conclusion: What are the best sexual enhancers?

Which sexual enhancer is best for you individually cannot be generalized. Because every man reacts differently to the various active ingredients: while the effect of an active ingredient is convincing for one person, strong side effects or no effect at all can occur for another.

It is therefore all the more important to slowly approach the active ingredients and to carefully observe the effects and side effects when taking them for the first time and, if necessary, to discuss them with a doctor.

The explanations and lists of possible treatment options are purely informative and do not replace consultation with your doctor or the explanations about the intake, mode of action, and side effects from the product-specific leaflet.

Isabel D White

Isabel D White

Isabel led the Royal Marsden Hospital (London) psychosexual therapy service until 2019. She works in partnership with individuals & couples to explore physical, emotional & relationship factors that contribute to sexual difficulties after cancer. These include: low desire, erection, arousal or orgasmic difficulties, sexual pain & sexual avoidance. She adopts an integrative approach to personalized therapy using psychosexual therapy (sensate focus framework), biomedical management (erectile dysfunction medication & devices, menopause & vaginal health strategies, sexual aids) & psychoeducation.

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