Comparison
ED medications side by side
All four PDE5 inhibitors work by the same mechanism and perform similarly in trials. Use this table to pick on the dimensions that actually differ.
Medication comparison table
| Attribute | Tadalafil9.0 / 10 | Sildenafil citrate8.4 / 10 | AvanafilUnscored | Vardenafil7.2 / 10 |
|---|---|---|---|---|
| Brand name | Cialis | Viagra | Stendra | Levitra |
| Drug class | PDE5 inhibitor | PDE5 inhibitor | PDE5 inhibitor | PDE5 inhibitor |
| Onset | 30–60 minutes, occasionally up to 2 hours | 30–60 minutes | 100/200 mg: about 15 minutes; 50 mg: about 30 minutes in labeling | 30–60 minutes |
| Duration | Up to 36 hours | 4–6 hours | About 6 hours | 4–8 hours |
| Half-life | ~17.5 hours | ~4 hours | ~5 hours | ~4–5 hours |
| Doses | As needed: 5 mg, 10 mg, 20 mg · Daily: 2.5 mg, 5 mg | 25 mg, 50 mg, 100 mg | 50 mg, 100 mg, 200 mg | 5 mg, 10 mg, 20 mg (plus a 10 mg orally disintegrating tablet) |
| Effect of food | None of clinical significance — food does not meaningfully delay it | A high-fat meal can delay onset by about an hour | May be taken with or without food; a high-fat meal delays peak concentration | A high-fat meal reduces and delays absorption |
| Generic available | Yes | Yes | Yes | Yes |
| Typical cost | Roughly $0.60–$5 per tablet for the generic with a discount card | Roughly $0.50–$4 per tablet for the generic with a discount card | Request a current quote for the exact brand or generic, strength, and quantity | Roughly $1–$8 per tablet for the generic with a discount card |
| Best for | People who dislike timing doses around sex, or who also have benign prostatic hyperplasia. | Anyone starting treatment who wants the lowest cost and the largest body of evidence behind it. | A clinician-led discussion when timing, tolerability, and the current pharmacy quote are important | People for whom sildenafil was ineffective or poorly tolerated, and who don't want tadalafil's long duration. |
Cost figures are ballpark US cash prices with a discount card and move constantly. Confirm current pricing at your own pharmacy.
Also reviewed, but not in this table
These are not PDE5 inhibitors, so comparing them on dose and onset would mislead. Each has its own review.
- Alprostadil — The second-line option that works when pills don't
- Udenafil, mirodenafil, lodenafil — Real drugs, real evidence, and no legal way to get them here
- Yohimbine hydrochloride — What men were prescribed before Viagra — and why they stopped
Quick decision guide
You want the lowest possible cost
Generic sildenafil
You don't want to plan around a pill
Daily low-dose tadalafil
You need it to work fast
Avanafil
Sildenafil tints your vision blue
Avanafil — it's more PDE5-selective
Tadalafil gives you back pain
A shorter-acting option like sildenafil
Pills haven't worked at all
Trimix — the highest success rate there is
Your desire has faded, not just the erections
Get testosterone measured properly first
You take nitrates for your heart
Eroxon or a vacuum device — no drug, no interaction
You want something without a prescription
Eroxon — the only legitimate OTC option
You want to stop paying every month
A vacuum device, bought once
You've genuinely tried everything
A penile implant — but it's permanent
Get emergency help for these
- An erection lasting more than 4 hours — this can cause permanent damage
- Sudden loss of vision or hearing
- Chest pain during or after sex — tell responders you took a PDE5 inhibitor
Where to buy, compared
The medication matters less to your total cost than where you buy it. These are the routes we review.
| Provider | Model | Subscription | Score |
|---|---|---|---|
| CoreAge Rx (4PLAY) | Three-minute online intake form reviewed asynchronously by a US-licensed provider | Auto-refill is opt-in after the first order rather than opt-out | 9.0 |
| SuperHealthy Rx | Online assessment followed by medical-team review | Request the selected current terms | Unscored |
| PlushCare | Scheduled video consultation with a doctor | Advertises a $19.99/month membership in addition to visits | Unscored |
| RedBox Rx | Online assessment reviewed by a licensed provider; video may be required | No membership or subscription fee advertised; available refills ship automatically unless stopped | Unscored |
| Hims | Asynchronous online questionnaire reviewed by a licensed clinician | Yes — recurring subscription is the primary model | 7.4 |
| Ro | Online questionnaire with clinician review; synchronous options for some services | Yes for ongoing supply; some one-time options | 7.0 |
| BlueChew | Online questionnaire reviewed by a licensed clinician | Yes — monthly subscription model | 4.0 |
| Lemonaid Health | Health questionnaire, blood-pressure information, and medical-team review; video may be required | One-time consultation advertised; confirm medication billing and refill terms for the selected order | Unscored |
| Cost Plus Drugs | None — pharmacy only, bring your own prescription | No | 8.4 |
| Sesame Care | A scheduled video appointment with a listed clinician | Compare the selected appointment with any optional Sesame Plus offer | Unscored |
| GoodRx | None for the coupon service — it is a discount tool, not a clinic | No for the free coupons; a paid tier exists with deeper discounts | 8.3 |
| Amazon Pharmacy | None — it is a pharmacy. Amazon offers telehealth separately through One Medical | No, though Prime membership unlocks the better pricing | 7.9 |
| Rex MD | Online Q&A form with clinician review; some conditions and states require an audio or video call | Yes — recurring delivery is the standard model | 7.2 |