ED Medication Online: Sildenafil vs. Tadalafil and How to Get a Prescription

Getting ED medication online is legal, private, and common. Erectile dysfunction affects a large share of men at some point, and the two most prescribed medications for it, sildenafil and tadalafil, have been around for decades. What you want is a real medical screening, not just a checkout button, because ED is sometimes the first sign of something bigger.

Why the screening is not a formality

Erections depend on healthy blood vessels. The same problems that narrow arteries in your heart, such as high blood pressure, high cholesterol, diabetes, and smoking, often show up first as trouble getting or keeping an erection. A good online visit asks about your heart, your blood pressure, and your medications for that reason. If you have not had a physical or basic blood work in a while, ED is a good reason to get one.

Sildenafil vs. tadalafil

Both work the same basic way. They block an enzyme called PDE5, which lets more blood flow into the penis when you are sexually aroused. Neither one causes an erection on its own.

• Sildenafil is the active ingredient in Viagra. It usually starts working in 30 to 60 minutes and lasts about 4 hours. A heavy, high-fat meal can slow it down.
• Tadalafil is the active ingredient in Cialis. It usually starts working within 30 minutes to 2 hours and can last up to 36 hours, which means less planning. It can also be prescribed as a low daily dose.

Which one is better depends on your schedule, your other medications, and how your body responds. A physician chooses the medication and dose with you.

Who should not take ED medication

• Anyone taking nitrates, such as nitroglycerin for chest pain. The combination can drop your blood pressure to a dangerous level. This includes recreational "poppers."
• Anyone taking riociguat, a medication for certain lung and blood pressure conditions
• Men who have been told sexual activity is not safe for their heart

If you take alpha blockers for blood pressure or prostate symptoms, the physician needs to know, because the combination can cause dizziness or fainting.

Side effects and when to get help

Common side effects include headache, flushing, a stuffy nose, and indigestion. Tadalafil can also cause back and muscle aches. Get medical help right away for:

• An erection that lasts more than 4 hours
• Sudden loss of vision in one or both eyes
• Sudden loss of hearing or ringing in the ears
• Chest pain, especially during sex

How an online ED visit works

1. You fill out a confidential questionnaire about your symptoms, your heart health, your blood pressure, and every medication and supplement you take.
2. A licensed physician reviews it and may ask follow-up questions.
3. If medication is appropriate, the physician picks sildenafil or tadalafil and a dose. If it is not, they tell you why and what to do instead.
4. Your medication ships in discreet packaging.

Generic, compounded, and brand name

• Brand-name Viagra and Cialis are FDA-approved and the most expensive option.
• FDA-approved generics of both are widely available at retail pharmacies with a prescription.
• Compounded sildenafil and tadalafil are prepared by licensed compounding pharmacies for an individual prescription. The FDA does not review compounded products for safety, effectiveness, or quality.

Our men's health program offers compounded sildenafil and tadalafil prepared by state-licensed 503A pharmacies, with one flat monthly price posted upfront and no membership required. Availability varies by state, and the page lists where each one ships.

Avoid these

• Sites that sell ED pills with no questions asked
• "Herbal" or "natural" male enhancement products. The FDA has repeatedly found these secretly contain sildenafil or tadalafil at unknown doses, which is especially dangerous for men on nitrates.
• Pills shipped from overseas pharmacies with no U.S. prescriber involved

When ED is more than a prescription

If ED came on suddenly, started after a new medication, or comes with low energy and low sex drive, tell the physician. Low testosterone, depression, sleep problems, and medication side effects can all play a role. If you want help with the bigger picture, our membership plans include unlimited visits with licensed providers, and our behavioral health care covers the stress and anxiety side of it.

Questions first? Contact us. If you have chest pain, call 911, and tell the EMS crew if you have taken an ED medication, because it changes which heart medications they can give you.