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Mechanism in brief
PDE5 inhibitors slow down the breakdown of cGMP → blood vessels in the penis remain relaxed → firmer erection during arousal.
Dapoxetine combinations inhibit premature ejaculation and improve erection.
Herbal supplements may stimulate libido or slightly improve blood circulation but are not a substitute for prescription drugs.
Dosage & use
Start low – 50 mg sildenafil or 10 mg tadalafil is sufficient for most starters.
Empty stomach = faster effect – fatty foods can delay absorption by 30 minutes.
Max. 1 dose every 24 hours – never stack two PDE5 inhibitors.
Moderate alcohol consumption – 1–2 drinks is okay; more reduces effectiveness and increases side effects.
Safety & Contraindications
Do not combine with nitrates (angina) or poppers → dangerously low blood pressure.
Pay attention to blood pressure and heart medication; consult a doctor if in doubt.
If you have chest pain, sudden blurred vision or an erection > 4 hours, seek immediate medical help.
Frequently Asked Questions About Types of Erection Pills
1. What types of PDE5 inhibitors are there?
The four most commonly used are sildenafil (Viagra, Kamagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). They differ in lead time and duration of action.
2. How does sildenafil (Viagra) work?
Sildenafil inhibits the enzyme PDE5, which causes the blood vessels in the penis to dilate. Effect begins after 30–60 min and lasts 4–6 hours.
3. What makes tadalafil (Cialis) unique?
Tadalafil has a longer duration of action (up to 36 hours) and can sometimes start after just 15–45 minutes. This allows you to plan more flexibly (“weekend pill”).
4. Why do some men choose vardenafil (Levitra)?
Vardenafil works slightly faster than sildenafil (30–45 min) and is less likely to cause food-related stomach upset in some users.
5. What is avanafil (Spedra) and how quickly does it work?
Avanafil is the fastest PDE5 inhibitor: effect after just 15–30 minutes. It is ideal if you decide to have sex shortly beforehand.
6. Are generic variants equally effective?
Yes. Generic sildenafil, tadalafil and vardenafil contain the same active ingredient and concentration as the brand names, provided they are produced according to GMP standards.
7. Are there non-PDE5 options?
Yes. Alprostadil can be used as an injection or urethral suppository when PDE5 inhibitors do not work. There is also yohimbine, a supplement with mixed evidence.
8. Which side effect differs per type?
General: headache, flushing, stomach upset. Tadalafil can cause back and muscle pain; vardenafil and sildenafil can cause slightly more stomach upset with fatty meals.
9. Can you take an erection pill daily?
Only tadalafil has a maintenance dose (2.5 mg or 5 mg daily). The other PDE5 inhibitors are used occasionally, max. once every 24 hours.
10. How do I choose the right pill?
Choose based on desired flexibility: choose avanafil with short preparation, tadalafil for long term window, sildenafil/vardenafil for standard use.
11. Are there natural alternatives?
Supplements such as L-arginine, Panax ginseng and citrulline may provide mild improvement, but they lack the strong effectiveness of PDE5 inhibitors.
12. When do I switch to an alternative drug?
If PDE5 inhibitors don't work well enough or you have serious side effects, discuss alprostadil injections or vacuum pumps with your doctor as the next step.
Prof. Dr. M. Vermeer is a leading specialist in erectile dysfunction and men's health, working in the Urology Department of the Men's Health Outpatient Clinic. With his extensive expertise and years of experience, he has specialized in the diagnosis and treatment of erectile dysfunction, using an innovative multidisciplinary approach that combines medical science with psychosexual care.
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