Medications for Erectile Dysfunction in Los Angeles & San Francisco, CA
Understanding Viagra and Cialis
Medical therapy is a mainstay in the treatment of organic or situational erectile dysfunction. It has given hope to many men who once struggled with the effects of impotence on their mood, relationship and overall quality of life. Dr. Paul Turek has relied on a range of medications to safely and effectively treat patients.
If you have erectile dysfunction, you may be encouraged to learn that a variety of treatment options exist, and Dr. Turek offers the very best that science has to offer. The board-certified urologist and men’s sexual health provider will put your worries and concerns to rest and work with you to find a solution that meets your personal needs.
The treatment that is right for depends on many factors, including your age, medical history, other medications you take, potential side effects, personal preferences and treatment goals.
Oral Medications for Eresctile Dysfunction
When you are sexually aroused, your body releases a chemical called nitric oxide, which relaxes the blood vessels and tissues of your penis. This allows your penis to engorge with blood, resulting in an erection. But an enzyme called phosphodiesterase 5 (PDE5) reverses the function of nitric oxide.
Sildenafil, tadalafil and vardenafil are phosphodiesterase 5 inhibitors, meaning they work by blocking PDE5. The medications will not make you sexually aroused, but they will allow you to get an erection in response to sexual stimulation and help you maintain it long enough for sexual intercourse.
Viagra (sildenafil citrate) is perhaps the best known of the PDE5 inhibitors and produces great results. It takes effect within an hour and lasts three to four hours. It must be taken on an empty stomach to be effective. A newer alternative to sildenafil is vardenafil (Levitra) which has a similar duration of activity but can be taken with food.
Cialis (tadalafil citrate) is longer-acting than Viagra and stays in the bloodstream for a longer time, up to 36 hours. Some men take a small dose of the medication daily so there is always some in their system.
Depending on your personal needs, Dr. Turek may prescribe any one of these medications.
What Are the Side Effects?
Side effects are a common concern with any medication.
Side effects of Viagra (sildenafil) and Levitra (vardenafil) include:
- Headache
- Stuffy or runny nose
- Upset stomach
- Temporary abnormal vision (more common with Viagra)
- Heartburn (more common with Levitra)
- Bloodshot eyes
- Blushing
Side effects of Cialis (tadalafil) are similar and include:
- Headache
- Flushing
- Stuffy or runny nose
- Heartburn
- Back or leg cramps
- Bloodshot eyes
- Muscle pain (back)
Because Cialis remains in your system longer, possible side effects can last longer than those of Viagra or Levitra. It is also important to understand that certain drugs, mainly nitrates used for chest pain and some alpha-blocking drugs used for prostatic enlargement, negatively interact with Viagra and Cialis. Dr. Turek will discuss the potential side effects of Viagra and Cialis and explain the possible interactions. Together, you will determine the best medication to help you get and keep an erection and enjoy improved sexual function.
Learn More about Medications for Erectile Dysfunction
If you are experiencing erectile dysfunction and want to discuss your medical options with Dr. Turek, please request an appointment at The Turek Clinic. Contact us today to schedule your visit.
Comparison of Oral ED Medications
| Medication | Typical Starting Dose* | Onset of Action | Duration of Effect | Food Considerations |
| Sildenafil (Viagra) | 50 mg as needed (range 25–100 mg) | 30–60 minutes | 3–4 hours | Best taken on an empty stomach; high-fat meals delay absorption |
| Vardenafil (Levitra) | 10 mg as needed (range 5–20 mg) | 30–60 minutes | 4–5 hours | Can be taken with food; very high-fat meals may delay onset |
| Tadalafil (Cialis – On Demand) | 10 mg as needed (range 5–20 mg) | 30–60 minutes | Up to 36 hours | May be taken with or without food |
| Tadalafil (Cialis – Daily) | 2.5–5 mg daily | Continuous steady levels | Continuous while taken daily | No food restrictions |
*Dosing is individualized based on age, health status, and response to treatment.
Important Safety Information
Do not take PDE5 inhibitors (Viagra, Cialis, Levitra, or similar medications) if you use nitrates for chest pain (such as nitroglycerin, isosorbide dinitrate, or isosorbide mononitrate) or riociguat. The combination can cause a dangerous and potentially life-threatening drop in blood pressure.
Men who take alpha-blockers for prostate enlargement or high blood pressure should use PDE5 inhibitors with caution and under medical supervision, as the combination can also lower blood pressure.
Alcohol can reduce erectile response and may increase side effects such as dizziness or low blood pressure. Moderation is advised when using ED medications.
Seek immediate medical attention if you experience chest pain, severe dizziness, sudden vision or hearing loss, or an erection lasting longer than four hours (priapism).
Before prescribing medication, Dr. Turek reviews your cardiovascular history and current medications to ensure safe use.
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When Oral Medications Do Not Work
While PDE5 inhibitors are highly effective for many men, they do not work for everyone. If oral medications are ineffective, poorly tolerated, or contraindicated, additional evaluation is recommended.
Next steps may include:
- Hormonal evaluation (including testosterone testing)
- Thorough cardiovascular risk assessment
- Penile injection therapy (intracavernosal or intraurethral therapy)
- Vacuum erection devices
- Consideration of advanced therapies when appropriate
Erectile dysfunction can sometimes signal underlying vascular disease. For this reason, moderate to severe ED warrants broader cardiovascular evaluation.
Dr. Turek tailors next-step therapies based on the underlying cause of dysfunction, overall health, and patient preference.
Investigational and Experimental Therapies
Patients may encounter information about emerging therapies for erectile dysfunction. Based on current American Urological Association (AUA) Guidelines, the following therapies have insufficient
medical evidence of effectiveness and are currently experimental:
- Low-intensity extracorporeal shock wave therapy (ESWT) is considered investigational. (Conditional Recommendation; Evidence Level: Grade C)
- Intracavernosal stem cell therapy is considered investigational. (Conditional Recommendation; Evidence Level: Grade C)
- Platelet-rich plasma (PRP) therapy is considered experimental. (Expert Opinion)
These treatments are not considered standard of care. While early studies suggest possible benefit in select populations, the available data are limited by small sample sizes, inconsistent protocols, short follow-up periods, and a lack of long-term safety data. In addition, optimal dosing, treatment schedules, durability of response, and patient selection criteria have not yet been clearly established.
For the above reasons, these therapies should be approached cautiously and, when appropriate, within research settings. Dr. Turek adheres to evidence-based treatments with proven safety and efficacy and discusses investigational options only within the context of research and clinical trials.
