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Erectile Dysfunction Drugs

Erectile Dysfunction Drugs Explained: Prescribing. Buying. Taking

Today, our guest expert Milton Mankoff, Ph.D., and Licensed Clinical Social Worker kindly agreed to answer some of the most asked questions of men audience of our web resource on choosing ED drugs, duration of the course, dosages, and buying them.

HumbleSurgical: Drugs for erectile dysfunction are prescription drugs and to get them in a pharmacy you need a prescription from your local doctor. At the same time, many people tend to skip going to a doctor and find ways to buy ED medicines without any prescription. Dr. ManKoff, what do you think? Is a prescription for ED drugs a must-have?

Doctor: It is. At least, at the beginning when you just start your ED treatment. There are some many things to consider that cannot be evaluated by a patient himself.

First of all, these are the causes of your erectile dysfunction. They can be physiological, psychological, and of mixed genesis, when both physical conditions and a patient’s emotional state of mind should be taken into consideration. From my practice as a sexual therapist, the ratio between bodily and mental causes of impotence is about fifty-fifty.

Another thing is that you should tell your doctor about all of your chronic health conditions and medicines you are taking. Many medicines can negatively affect your libido, and your treatment should be balanced wisely in order not to ruin your ongoing therapy and to choose an ED medicine that is not contradictory. It is not a secret that drugs can interact, so choosing ED medicine with the doctor is essential for your safety. Any medications that belong to phosphodiesterase type 5 inhibitors — which includes the most popular and common ED drugs, such as Viagra, Cialis, Levitra, and some others — can dramatically decrease blood pressure and cause syncope. That is why you should talk to the doctor without any doubt. For some people, it can be embarrassing to go to a local doctor. Happily, there are many online services that offer an online appointment with a sexologist.

HumbleSurgical: Doctor Mankoff in your person, we have a professional expert, so can you please give a piece of advice to our audience. First of all, which of existing ED medicines you can recommend better?

Doctor: There is no universal cure and it is always individual. As there are no two similar people, there is no the same treatment. As I already mentioned, most of the contemporary ED drugs are PDE5 blockers used when a cause of erectile dysfunction is in vascular problems. There are no specific indications to choose one or another medication. It is more the matter of doctor’s preferences and patient’s specific features. Sometimes, it takes time to choose the right option.

HumbleSurgical: Can you give us some examples from your practice?

Doctor: Well, I had a 57 y. o. patient who presumably had the vascular condition and one of his friends recommended Cialis that he had been taking for more than one year by the time. Many patients consider Cialis better than Viagra as it starts acting faster and lasts longer. The patient insisted on taking Cialis and got a prescription for a starting dose of 10 mg. But unexpectedly, he has not got the desired effect. After increasing the dose up to 20 mg, it worked better, but he found some unpleasant side effects, such as back pain and headaches.

I suggested him to try Viagra, the oldest treatment for ED with an almost 25-year history. He started from 50 mg and it was effective. Now the patient takes Viagra when needed and quite happy with its effects and not having many side effects. But this example does not prove that Viagra is more effective than Cialis: it just shows that, in different patients, medicines act differently and, often, unpredictable.

HumbleSurgical: Can you tell us more about the recommended dosages. We can see that the dosages of Viagra and Cialis you just mentioned are absolutely different.

Doctor: Yes, they are. Depending on the active ingredient, the drugs have a higher or lower dosage and different ‘starting time’. Thus, for Viagra the recommended dose is 50 mg, for Stendra is 100 mg, and, for Levitra and Staxin is 10 mg. As to Cialis, there are two different types of treatment: you can take it on the daily basis (it issued for daily use in 2.5 mg and 5 mg tablet) or when needed (10 mg or 20 mg). There are some other factors to consider when taking ED medications, such as your diet and alcohol intake. Some of them are recommended on an empty stomach, others can be taken with food, some are more ‘alcohol friendly’, and there is even such medicine as Staxyn that should not be taken with any liquid. You can find a good comparison of the dosages on this website

HumbleSurgical: There are some websites that offer generic ED drugs in larger dosages than the brand medications have. For example, you can find 200mg or 150 mg Viagra. What do you think about this? Is it not dangerous?

Doctor: Normally, generic drug manufacturers produce higher doses for cost saving. Nobody supposes taking higher doses. As far as I know, 200mg Viagra and 40 mg Cialis are intended for splitting.

HumbleSurgical: What do you think about buying generic ED drugs online? Is it safe? Do you recommend it to your patients?

Doctor: I work in the U.S. and follow all the regulations. ED medications are prescription drugs and they are sold in the United States under prescription. And all I can do is to prescribe treatment, whilst my patients can decide where to buy their medicine, taking into account their insurance plans and financial situation. I know a few of my patients who buy medications online and they are quite happy and never complained about poor quality. At the same time, there are many illicit websites and you should be careful when purchasing online. Legitimate pharmacies normally ask for your prescription before selling drugs to you. For example one of the largest US pharmacy services suggests to submit you RX before shopping.

HumbleSurgical: Can you recommend any trusted pharmacy with a service of online prescription?

Doctor: There is no legal possibility of such services. Pharmacies are not accredited to give prescriptions — they only refill them. If a pharmacy claims it provides online prescription service, you are likely to be cheated. Some pharmacies have online consultants who can give you general recommendations or help you choose between a few options but nor more than that. Many services of online appointments with doctors are developing now and it is expected more and more of them in the near future. For example, I can name such well-known websites as and in the US, or in Canada Some of them not only connect you with accredited doctors but also provide an online prescription service and deliver your prescription to your address or to the pharmacy of your choice.

HumbleSurgical: What do you think about self-medication and buying cheaper ED medicines online on one’s own?

Doctor: Self-medication is always dangerous. I will not recommend to increases doses on your own or choose a medicine without a doctor’s assistance. But if you already have a clear treatment plan and doctor’s prescription for medications, why not to try some cheaper options. You just need to be careful when choosing pharmacies.