Erectile dysfunction (ED) is a common issue for people with diabetes, but several treatments can help. ED pills include Viagra, Cialis, vardenafil, and Stendra.

ED involves difficulty developing and maintaining an erection for sexual activity. The cause may be psychological or physical.

Keep reading to learn more about how ED pills work and which options are most suitable for people with diabetes.

During sexual arousal in males, the brain signals for more blood to flow into the penis, causing an erection. Erectile dysfunction (ED) occurs when a physical or psychological factor impedes this process.

For people with diabetes, ED can occur due to persistently high blood sugar levels, causing damage to the nerves and blood vessels. Damage to certain nerves can reduce sensations in the genitals, while damage to blood vessels in the penis can reduce blood flow to this area. Either type of damage can cause ED.

Pills for ED typically contain phosphodiesterase type 5 (PDE5) inhibitors. These substances block the PDE5 enzymeTrusted Source, which regulates the contraction and relaxation of smooth muscles, such as those within the artery walls. Disrupting this enzyme causes the smooth muscles to relax, dilating the arteries and increasing blood flow. Meanwhile, the veins constrict, causing a blood pressure difference that leads to penile rigidity.

Diabetes can physically or psychologically disrupt sexual functionTrusted Source in both males and females.

In males, a person with diabetes may experience high blood sugar levels that damage the nerves or blood vessels, causing ED. People with diabetes are also more likely to have high blood pressure or cardiovascular disease, and the treatments for these conditions may further increase the risk of ED.

Most people with diabetes can take ED pills. However, talking with a doctor first is essential, as these medications can affect a person’s heart rate and vision. They may also interact withTrusted Source other drugs.

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Best overall: Viagra (sildenafil)

  • Type: PDE5 inhibitor
  • Lasts for: up to 4 hours
  • Form: tablet

Viagra and its generic version, sildenafil, are PDE5 inhibitors. Viagra starts working after about 30 minutes to an hour, and the effects last up to 4 hours.

A doctor can prescribe Viagra in dosages of 25, 50, or 100 milligrams (mg) per day. Low dosages can also treat pulmonary arterial hypertension.

Side effects

Some potential side effects of Viagra include:

In rare cases, Viagra can cause serious side effects, such as chest pain and painful erections lasting several hours.

Price and where to buy

In the United States, Viagra is only available via prescription. Some online retailers include:

Pros

  • available in various forms
  • generally fast response following ingestion
  • can be very affordable per dose
  • Viagra is a well-researched and popular brand-name drug

Cons

  • side effects that can last longer than some other ED pills
  • Viagra is far more expensive than its generic, sildenafil

Best for daily use: Cialis

  • Type: PDE5 inhibitor
  • Lasts for: up to 36 hours
  • Form: tablet

Cialis (tadalafil) is another PDE5 inhibitor for ED. People can take it as needed or daily. Some people take this medication daily to treat both ED and urinary issues associated with prostate enlargement.

It is available in tablet form, and the effects can last up to 36 hours.

Side effects

Cialis can cause side effects, including:

  • hot flashes
  • headaches
  • a stuffy or runny nose
  • cough
  • indigestion
  • arm and leg pain
  • muscle pain

Price and where to buy

Cialis is available via prescription only. Costs vary, depending on the supplier.

  • Hims: This online retailer charges from $958 for a monthly prescription of daily Cialis. Its generic daily form, tadalafil, costs $40 a month. Learn more about Hims.
  • Roman: This company charges $11–$44 per dose for tadalafil and $8 per pill for the daily version. Brand-name Cialis costs $20–$80 per pill.

Pros

  • provides long lasting effects
  • relatively fast-acting
  • suitable for daily use

Cons

  • brand-name Cialis is very expensive from some retailers
  • Cialis and tadalafil are more expensive than Viagra/sildenafil

Best for a coated tablet: Vardenafil

  • Type: PDE5 inhibitor
  • Lasts for: up to 5 hours
  • Form: coated tablet

Vardenafil is another PDE5 inhibitor for ED. People take it 1 hourTrusted Source before sexual activity, and the effects can last up to 5 hours. It was available under the brand-name Levitra, but the manufacturer discontinued production. As such, only its generic version is available.

The medication is available as a coated tablet, which a person can take with food.

Side effects

Potential side effects of vardenafil include:

  • hot flashes
  • headaches
  • a stuffy or runny nose
  • vision problems
  • stomach issues
  • muscle and back pain

Price and where to buy

Vardenafil is available via prescription only and is available at pharmacies. Some insurance policies may cover the costs.

Vardenafil can cost up to $450 for 30 pills. Factors that may affect the cost include the location of the pharmacy and taxes payable based on location.

Pros

  • fast-acting
  • a lower dose can have the same effect as a larger dose of another type of ED pill

Cons

  • more costly than other ED pills
  • effects do not last as long compared to other ED pills
  • the branded version is no longer available

Best for fast action: Stendra

  • Type: PDE5 inhibitor
  • Lasts for: 3–5 hours
  • Form: tablet

Stendra (avanafilTrusted Source) works more quicklyTrusted Source than most other PDE5 inhibitors, taking effect within 15–30 minutes. The effects can last 3–5 hours.

Stendra is available as a tablet that people can take as needed, with or without food. A doctor will determine the appropriate dosage on a case-by-case basis.

Side effects

Stendra can cause side effects, including:

  • hot flashes
  • headaches
  • a stuffy or runny nose
  • vision problems
  • nausea
  • back and muscle pain

Price and where to buy

  • Hims: At this online retailer, Stendra prices start at $53 per dose. Some insurance providers may cover the cost.

Pros

  • fast-acting
  • insurance may cover the cost

Cons

  • effects do not last very long for the cost
  • more expensive per dose than other options

Best for a chewable alternative: BlueChew

  • Type: PDE5 inhibitor
  • Lasts for: 4–6 hours
  • Form: chewable tablet

BlueChew is an online licensed healthcare platform. It provides ED tablets in a chewable form.

To buy BlueChew, a person must either have an existing prescription or complete a medical profile and digital consultation to get a prescription through BlueChew’s medical practitioners. A person can then opt to receive a monthly order of 30 or 45 mg of sildenafil, 6 or 9 mg of tadalafil, or 8 mg of valdenafil.

BlueChew ED pills contain the same active ingredients as those in Viagra and Cialis, which have Food and Drug Administration (FDA) approval. However, the chewable components are not FDA-approved.

BlueChew notes that people should not take sildenafil, tadalafil, or valdenafil if they take medication containing nitrates or guanylate cyclase stimulators for pulmonary hypertension.

Price and where to buy

Monthly BlueChew subscriptions start at $20 and only available through the BlueChew website. All new customers receive a $20 initial credit to apply towards a subscription.

There are four levels of subscriptions available: Active, Busy, Popular, and Pro.

Pros

  • choice of three active ingredients
  • offers regular prescription deliveries to a person’s home
  • affordable
  • chewable tablets may suit those who find swallowing pills difficult

Cons

  • does not state if the pill is allergen-friendly
  • the chewable form of this medication is not FDA-approved

Best injectable alternative: TriMix injection

  • Type: alpha-adrenergic receptor, antispasmodic, and vasodilator mixture
  • Lasts for: up to 1 hour
  • Form: injection

TriMix Injections are an alternative to PDE5 ED pills, combining the active ingredients described below:

  • Papaverine: This drug relaxes the blood vessels. Doctors typically prescribe it to people with circulation issues, but it can also work for ED.
  • Phentolamine: This drug is a vasodilator and alpha-adrenergic receptor, which stopsTrusted Source smooth muscle contraction.
  • Prostaglandin E1: Also known as alprostadil, this is a muscle relaxant and vasodilatorTrusted Source that relaxes the muscles and blood vessels in the penis to increase blood flow and encourage an erection.

A person injects TriMix into the penis, after which an erection can develop within 5–20 minutes and may last up to an hour. A person cannot use the medication more than two times per week.

Side effects

Side effects of TriMix injection can include:

  • moderate pain during injection
  • a small amount of bleeding at the injection site
  • a painful sensation during erection
  • in rare cases, an erection lasting more than 2 hours

Price and where to buy

TriMix injections are available via prescription only at compounding pharmacies. It can cost around $200.

Pros

  • alternative for those unable to use PDE5 medication
  • fast-acting
  • self-administered
  • a single vial can offer up to 25 injections
  • some insurance plans may cover the costs

Cons

  • results do not last as long as other alternatives
  • unsuitable for those who do not like needles
  • people must be comfortable self-injecting the medication
  • only suitable for use twice per week
  • it is expensive

Below is a summary table comparing the ED products in this article:

Where to BuyPriceFeatures Form
Viagra
(sildenafil)		Roman
Lemonaid		starting at $2 per doselasts 4–6 hourstablet (also available as a liquid)
Cialis
(tadalafil)		Hims
Roman		varies depending on supplierlasts up to 36 hourstablet
vardenafilPharmacies$500–$1,600lasts up to 5 hourscoated tablet
Stendra
(avanafil)		Himsstarting at $53 per doselasts up to 5 hourstablet
Chewable sildenafil, tadalafil, or valdenafilBlueChew$20-$120 per month based on the subscription package you choose (as low as $2.60-$4 per dose)lasts up to 6 hourschewable tablet
TriMix InjectionsSelect pharmaciesaverage of $175lasts up to 1 hourinjection

Clinical trialsTrusted Source show that all PDE5 inhibitors improve erectile function, have similar effectiveness, and people with diabetes can use them.

However, results varied depending on the type of erectile dysfunction medication, dose, and any additional medication the participants took. For example, participants who took 25–100 mg of sildenafil daily showed a response rate of 57.7% in erectile function, and 21 men who took 50 mg of sildenafil daily showed an improvement in blood flow.

However, a small number of participants in this clinical trial discontinued taking sildenafil due to experiencing side effects such as headaches, dyspepsia, and flushing.

The same clinical trial also looked at the effectiveness of vardenafil, tadalafil, and avanafil. Researchers reported that 72% of participants who took 20 mg of vardenafil daily showed an improvement in erectile function. Only 13% of the participants reported side effects such as headaches, flushing, and rhinitis. These people were also taking antiarrhythmic drugs, namely procainamide, quinidine-sotalol, or amiodaron.

Of the participants, 53% who took tadalafil at a dose of 2.5–5 mg daily had a positive response rate. Side effects were mild to moderate and included myalgia and back pain. Additionally, tadalafil improved endothelial dysfunction, a condition whereby the large blood vessels on the heart’s surface narrow instead of opening.

Researchers also reported that avanafil showed significant improvements in erectile function in all 390 participants. There were also lower incidences of side effects such as visual disturbances, myalgia, and back pain. However, the researchers recommended that people who have severe liver damage should avoid avanafil.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Learn more.

Medications for ED can cause side effects, and people with diabetes may face additional risks.

For example, PDE5 inhibitors can interact withTrusted Source several other drugs, including nitrate-based medications. Doctors may prescribe these medications to treat high blood pressure, which frequently affects people with diabetes.

Any person with diabetes should speak with a doctor before taking medication for ED.

A person should talk with a doctor before trying any type of ED medication, especially if they have an underlying medical condition or are taking medication of any kind. Some medications can interact with one another, causing dangerous effects.

A person who has begun taking ED medication should consult a doctor if they experience any of the side effects listed above.

A person should also contact a doctor if their ED medication does not produce the desired effects. They will be able to provide alternative suggestions.

Besides medication, the following approachesTrusted Source may help to reduce or stop ED:

  • Making lifestyle changes: This could include quitting smoking, exercising regularly, or losing excess weight.
  • Improving blood sugar: Maintaining healthy blood sugar levels can help long term.
  • Receiving counseling: Psychological therapies can help address any psychological or emotional causes of ED.
  • Changing medications: ED can be a side effect of certain medications. Where possible, a doctor may change the medication type or dosage.
  • Trying devices: Vacuum or pump devices are an alternative to ED medications. These devices use suction to draw blood into the penis. Learn more about the best penis pumps for ED.
  • Surgery: If all other treatments are ineffective, a doctor may recommend surgery to place inflatable or flexible rods into the penis to enable an erection.

Below are some common questions about ED pills and diabetes.

Can you take ED meds with diabetes?

Most ED pills can help a person who has both ED and diabetes. However, a person should speak with a doctor before taking medication for ED, as these drugs can interfere with other medications. They may also affect a person’s vision, blood pressure, and heart rate.

Is Cialis better when you have diabetes?

Cialis does not alter blood sugar levels in people with diabetes. People can also take the medication with insulin.

Cialis contains the active ingredient tadalafil. A 2019 study found that men with diabetes who took tadalafil daily showed significant improvement in their ED.

A person must speak with a doctor before trying any new medication.

Can people with diabetes overcome erectile dysfunction?

Erectile dysfunction can be permanent or may happen only occasionally.

The following lifestyle changes can help improve occasional or intermittent ED:

Permanent ED can occur due to irreversible blood vessel damage from diabetes or other conditions. While no treatments are available to reduce this damage, prescription medications can help improve functionality. If these options are unsuccessful, a person can ask a doctor about alternative therapies, such as vacuum devices or penile implants.

A person with diabetes and ED may benefit from taking ED pills. These medications typically contain PDE5 inhibitors that help promote blood flow to the penis to induce and maintain an erection.

However, a person should talk with a doctor before trying ED pills, as these medications can cause side effects and may interfere with other medications the person is taking.

Anyone who experiences side effects while taking an ED medication should notify a doctor immediately. A person should also seek medical advice if their ED medication is ineffective. A doctor can recommend alternative options, such as injectable medications, vacuum devices, or penile implants.