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Erectile dysfunction

The four erection medicines that regulators have actually approved

Four active substances are approved for erectile dysfunction across the US and Europe: sildenafil, tadalafil, vardenafil and avanafil. Everything else sold under the name of an erection pill is either one of those four under a different brand, or it is not a medicine at all.

The differences between them are narrow and specific: how fast they start, how long the effect lasts, whether food matters, and which other drugs they cannot be combined with. Those four questions are what the pages below answer, using the approved product information rather than marketing copy.

Medicines

Erectile dysfunction

  1. SildenafilViagra, Revatio, Viagra ConnectThe first medicine approved for erectile dysfunction, on the market since 1998 and off patent everywhere, which is why it is now the cheapest of the four.Prescription only
  2. TadalafilCialisThe long-acting one, and the only medicine in this category approved both for erectile dysfunction and for an enlarged prostate, including for the two together.Prescription only
  3. VardenafilLevitra, VivanzaThe least prescribed of the four, largely because it sits between sildenafil and tadalafil without doing anything that either does not.Prescription only
  4. AvanafilSpedra, StendraThe newest of the four and the fastest to take effect, sold as Spedra in Europe and Stendra in the United States.Prescription only
  5. AlprostadilMuse, Caverject, VitarosThe option for people the tablets do not work for, given as a pellet into the urethra or an injection rather than swallowed.Prescription only

Comparison

The two labels, side by side

  1. Sildenafil and tadalafil, compared from both labelsThe most common question in this category, and the labels answer most of it. One difference is real and practical, one is a matter of price, and the rest is closer to marketing than to medicine.

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How to get it legally

All four are prescription-only in every country where they are approved. That is not a formality: they lower blood pressure, and combined with nitrates prescribed for heart disease that drop can be fatal. The prescription exists to catch exactly that.

The legal route without a face-to-face appointment is an online clinic: a regulated service where a doctor or prescribing pharmacist reviews a questionnaire, asks follow-up questions if needed, and issues a prescription that a registered pharmacy dispenses. It is the same medicine, from the same supply chain, and in most of Europe it is cheaper than the branded pill was ten years ago.