Erectile Dysfunction Medicines: Uses, Safety & FAQs

Erectile dysfunction (ED) is when a man finds it hard to get or keep an erection firm enough for sex. In India, the tablets most often prescribed for it are prescription medicines called PDE5 inhibitors. They do not create desire or produce an erection on their own; they help an erection happen when you are sexually stimulated. No single tablet suits every man, so your doctor chooses one for you.

ED is trouble getting or keeping an erection firm enough for sex. It is common, and it is not a normal part of getting older. It often points to another problem, because narrowed blood vessels, diabetes and low testosterone can all show up first as ED, so treatment usually starts with a tablet from one family, called PDE5 inhibitors.

Five PDE5 inhibitor tablets are used in India. They work the same way but differ in how fast they act and how long they last. Which one suits you depends on the timing you need.

This page names active ingredients, not brands. Many brands are sold in India, and some products add a second drug for early ejaculation, so check exactly what is printed on your pack.

Sildenafil citrate is listed in Schedule H of the Drugs and Cosmetics Rules, 1945 (entry 453), so it needs a doctor's prescription. The other four are prescription medicines in India too. Udenafil appears in Indian prescribing guidance but is not approved in the United States or Europe.

Think of an erection as a gate that a short-lived chemical signal holds open. The tablet never opens the gate itself; it only stops the gate from closing too soon.

1. The signal: Sexual stimulation makes nerves in the penis release nitric oxide, a gas that starts the chain.
2. The rush: That gas raises a messenger chemical called cGMP, which relaxes the blood vessels and lets blood fill the penis.
3. The closing: An enzyme called PDE5 clears cGMP away, and the erection goes down.
4. The block: PDE5 inhibitors slow that enzyme, so cGMP stays longer and blood stays in the penis.

Without that signal, the tablet cannot produce an erection by itself.

Doctors usually prescribe these tablets for:

• Erectile dysfunction, when erections are rarely firm enough for sex
• ED with urinary symptoms from an enlarged prostate, where daily tadalafil helps both
• ED after prostate surgery, as part of recovery in some men
• Nerve damage from diabetes, spinal injury or multiple sclerosis
• ED linked to low testosterone, where testosterone is treated first and a tablet is added if needed

When a tablet suits you, you get a firmer erection during its working window. How well it works differs from man to man.

They do not raise sex drive, treat infertility or protect you from sexually transmitted infections. They also do not treat the cause behind the ED, so your doctor will look for that separately.

Using a tablet for an occasional off night can hide a heart or diabetes problem that needs attention.

1. Take it only at the dose and schedule your doctor has written.
2. Swallow the tablet with water, with or without food.
3. Keep to one dose a day, unless your doctor has prescribed a daily tablet.
4. Do not combine two different ED medicines.

Your dose depends on your age, your heart and blood pressure, your kidney and liver, and the other medicines you take. The starting doses in the prescribing information are a reference point, not a target.

Men over 65, men with liver or kidney problems, and men already taking an alpha-blocker usually start lower. Never increase the dose on your own. A higher dose does not help when the timing is wrong, but it does make headache, flushing and a drop in blood pressure more likely.

If someone takes too many tablets, they may feel dizzy or faint. Go to the nearest emergency department and carry the pack with you. Call 112 for emergency help, or 108 for an ambulance in most states.

Most of these tablets are taken only when you need one, so there is no schedule to miss. If you take tadalafil every day, take the missed dose when you remember. Skip it if the next dose is close, and never take two doses together.

Most men notice an effect within 15 to 60 minutes of the right dose, depending on the tablet. If nothing happens after several properly timed attempts, do not take more; ask your doctor to review the timing, the dose and whether another option suits you better.

Keep the tablets in their strip in a cool, dry place below 30°C, away from sunlight and damp. Keep them out of reach of children and check the expiry date before use.

Most men take these tablets without trouble. When side effects happen, they are usually mild and fade within a few hours.

Common and mild:

• Headache
• Flushing and a warm face
• Indigestion or heartburn
• A blocked or runny nose
• Back pain and muscle aches
• Blurred vision or a colour tinge to what you see
• Nausea or a rash

Rare but serious (stop the medicine and get help):

• An erection that lasts more than 4 hours
• Sudden loss of vision in one or both eyes
• Sudden loss of hearing, sometimes with ringing in the ears
• Chest pain, breathlessness or fainting during sex
• A sharp fall in blood pressure with dizziness or collapse

Headache, flushing and indigestion are the most common, and they are more likely at higher doses. The colour tinge to vision comes from sildenafil acting briefly on an enzyme in the eye. Back and muscle pain are more typical of tadalafil.

• Anyone who takes nitrates for chest pain, in any form
• Anyone who takes riociguat or vericiguat
• Men whose doctor has said sex is unsafe for their heart
• Anyone allergic to the tablet or its ingredients
• Children and women

Tell your doctor before taking an ED tablet if you have:

• Heart disease, high blood pressure, or a recent heart attack or stroke (sex strains the heart)
• Diabetes (the tablet works less well if your sugar is poorly controlled)
• Kidney or liver disease (the tablet can build up in your blood)
• A curved penis, or Peyronie's disease (the tablet can make the curve worse)
• Sickle cell disease, leukaemia or multiple myeloma (a higher chance of a painful, lasting erection)
• You take an alpha-blocker such as tamsulosin (together they can drop your blood pressure)
• A stomach ulcer or a bleeding disorder (a small risk of bleeding)
• You are over 65 (your doctor usually starts you on a lower dose)

A small drink is usually fine with sildenafil, but heavy drinking makes dizziness and low blood pressure more likely. These tablets can also cause dizziness or blurred vision, so do not drive until you know how yours affects you. Always tell your doctor about every medicine, supplement or home remedy you are using.

A tablet only helps with erections. Get medical help quickly if you have:

• Chest pain, breathlessness or fainting during or after sex — call 112 or 108
• An erection lasting more than 4 hours
• Sudden loss of vision or hearing
• No improvement after several properly timed doses, which is more likely if your ED is caused by diabetes
• ED that began suddenly, or with numbness, thirst or weight loss
• A curved, painful penis, or blood in your urine

If low mood, anxiety or relationship stress is part of the problem, tell your doctor. For free 24×7 mental health support in India, call Tele-MANAS on 14416 or 1800-891-4416.

ED tablets work well for many men, but they are prescription medicines for a reason. The right one depends on your heart, your other medicines and how you want to use it. Get a diagnosis first, take it exactly as prescribed, and expect a mild headache or flush rather than a dramatic change. Most side effects pass within hours, and the warning signs above need urgent care.