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Erectile dysfunction medicines such as sildenafil and tadalafil can make it easier to get and keep an erection by increasing blood flow to the penis. They do not work for everyone, may cause side effects, and can interact dangerously with medicines such as nitrates. Recurrent erection problems can also point to an underlying health issue, so a clinical assessment may matter as much as the choice of treatment.
This overview focuses on PDE-5 inhibitors, especially sildenafil and tadalafil. It draws on UK NHS and NHS Inform patient guidance; availability, prescribing rules and recommended care differ by country. It is general information, not personal prescribing advice. Follow your prescription and the medicine leaflet, and ask a clinician or pharmacist about your own situation.
What erectile dysfunction medicines do
Erectile dysfunction (ED) means repeatedly being unable to get or keep an erection firm enough for sex. Difficulty can happen occasionally with stress, tiredness or alcohol; problems that recur are worth discussing with a GP or another qualified clinician.
Sildenafil, tadalafil, vardenafil and avanafil are PDE-5 inhibitors. They increase blood flow to the penis and can help an erection happen during sexual activity. They do not automatically create an erection or restore sexual desire, and an individual result is not guaranteed. The NHS says treatment can usually help improve ED, but suitability and results depend on the person and the cause.
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What is the difference between sildenafil and tadalafil?
Both medicines are PDE-5 inhibitors, but their general timing and duration differ. These descriptions come from NHS patient guidance and are not individualized dosing instructions.
| Medicine | General timing described by NHS guidance | Duration described by NHS guidance |
|---|---|---|
| Sildenafil | People with ED are usually instructed to take a tablet about an hour before sex. | Not stated in the cited NHS sildenafil guidance. |
| Tadalafil | For some people, use is described about 30 minutes before sex. | Effects can last up to 36 hours. |
Neither option is universally better. The right choice depends on suitability, other medicines, side effects and individual circumstances. Use the timing and instructions on your own prescription and leaflet rather than adjusting how or when you take a medicine based on a general description.
What are the side effects of sildenafil and tadalafil?
Side effects vary by medicine and person. The following are common effects listed in NHS patient guidance; this is not a complete list.
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- Directions: Take 2 tablets, 45 minutes before needed.
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| Medicine | Common side effects described by NHS guidance |
|---|---|
| Sildenafil | Headache, dizziness, stuffy nose, indigestion or nausea, and temporary visual changes. |
| Tadalafil | Headache, flushing, stuffy nose, indigestion, and muscle or back pain. |
NHS guidance also lists possible serious effects, including an allergic reaction, chest pain or other heart symptoms, fainting or seizures, sudden sensory problems, and a prolonged painful erection. For urgent symptoms, follow local emergency guidance and the medicine leaflet.
Can I take erectile dysfunction medicine with nitrates?
Nitrates used for chest pain, including glyceryl trinitrate (GTN), are a key safety concern: NHS guidance says sildenafil and tadalafil are not usually prescribed with them. Other medicines can interact too, including some treatments for blood pressure or pulmonary hypertension, antibiotics, antifungals, HIV, ED or prostate conditions. This is not a complete interaction list.
Before using an ED medicine, tell a clinician or pharmacist about all prescription and non-prescription medicines, supplements and relevant health conditions. They can review your full list against current product information.
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Health factors that may affect suitability
NHS sildenafil guidance describes cautions that may apply with a recent heart attack or stroke, low blood pressure or uncontrolled high blood pressure, liver or kidney problems, certain blood disorders, or previous vision loss linked to reduced blood flow to the optic nerve. NHS tadalafil guidance also flags alcohol-related low blood pressure and grapefruit juice, as well as interacting medicines. These examples are not a complete checklist of who can or cannot take either medicine; suitability requires current product information and professional review.
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ED can have physical, psychological or medicine-related contributors. NHS guidance names high blood pressure, high cholesterol, diabetes, depression or anxiety, hormone problems, stress, tiredness, alcohol and medicine side effects among possible factors. A clinician can consider whether an underlying condition or a medicine may be contributing. Do not stop a prescribed medicine without professional advice; changing it may require a safe alternative.
Assessment can help ensure that treatment addresses more than the symptom and that sexual activity or a particular medicine is appropriate for your health. If erection problems keep happening, discuss them with a GP or qualified clinician rather than relying only on a pill.
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What can you try if tablets are unsuitable or do not help?
NHS guidance describes several possible paths. Which, if any, is suitable depends on the cause and the individual.
- Address a contributing condition or medicine: a clinician can review health problems and consider whether a medicine needs to be changed.
- Lifestyle changes: may be relevant where health or lifestyle factors contribute to ED.
- Counselling or therapy: may help when emotional or mental health factors are involved.
- Vacuum pump: NHS guidance says a vacuum pump encourages blood flow and may be used when medication is unsuitable or does not work.
Buying ED medicines online
The NHS warns that ED medicines bought online may be fake or unregulated, and their ingredients can vary. Its advice about checking pharmacy and care-provider registration applies to the UK. In other countries, check the official register of the relevant national regulator. A regulated source does not replace a medication and health review when one is needed.
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Sources and scope
The medical guidance summarized here comes primarily from NHS patient pages and NHS Inform. The NHS Inform page states that it was updated on 23 September 2026; the NHS tadalafil page states that it was last reviewed on 13 May 2026. The NHS sildenafil guidance available for this overview did not provide a captured last-reviewed date. Medicine labeling and local rules can change, so consult current local guidance and your own medicine leaflet.
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