Over-the-Counter Erectile Dysfunction Pills: What You Need to Know

Having a healthy sex life is an important part of overall well-being, but at some point in their lives, many people who have penises struggle to achieve or maintain an erection long enough to have satisfying intercourse.

This condition, known as erectile dysfunction (ED), can be frustrating and embarrassing, which may make over-the-counter (OTC) ED supplements an attractive option.

Unlike prescription ED pills like Viagra (sildenafil), which can be expensive and require a visit to your healthcare provider, over-the-counter ED pills are usually more affordable and readily available at your local drugstore or for sale online.

These pills may be self-promoted for their effectiveness at improving sexual performance, but they are often unproven, untested, unregulated, and may bring about unwanted side effects.

In this article, we'll review the types of over-the-counter ED pills available, as well as their risks and alternative treatment options.

Over-the-Counter Drugs

Over-the-counter drugs have become popular treatments for ED, despite making unproven claims of enhancing sexual performance.

Some products, like the popular male enhancement nutritional supplement Extenze, contain sildenafil, the active ingredient in Viagra. This undeclared ingredient can interact with nitrates found in some prescription drugs, such as the vasodilator nitroglycerin, and cause blood pressure to fall to dangerous levels.

As a result, the Food and Drug Administration (FDA) does not recommend this supplement, especially for diabetic and hypertensive patients who take nitrates to regulate their blood pressure.

The following OTC dietary supplements and natural remedies have not been well studied but may have some role in the treatment of erectile dysfunction and impotence:

• L-arginine: L-arginine is an amino acid—a building block of protein—that is found naturally in food. It boosts the body's production of nitric oxide, a compound that helps dilate blood vessels. In theory, opening blood vessels should increase blood flow to the penis, facilitating an erection, but study conclusions have been mixed. Still, some companies falsely advertise its effectiveness. L-arginine, sometimes sold under the manufacturing name Hombron, should never be taken with Viagra because it can result in a large and unsafe drop in blood pressure. More research is needed to study its safety and effectiveness.
  
• Dehydroepiandrosterone (DHEA): Some studies suggest that DHEA supplements, which help create sex hormones like testosterone and estrogen, could help with ED, but others have found no evidence of their benefit. 
  
• Ginkgo: Ginkgo biloba may increase blood flow to the penis, which could improve sexual desire and counter ED. However, the National Center for Complementary and Integrative Health (NCCIH) says that there is no solid evidence that ginkgo is beneficial for any health condition. Ginkgo also may cause a slew of side effects, including headaches, dizziness, stomach upset, palpitations, and constipation. Ginkgo should never be taken with Coumadin (warfarin), a blood thinner, or if you have a bleeding disorder. 
  
• Ginseng: Ginseng, or Panax ginseng, may promote the relaxation of the body’s smooth muscles, helping produce an erection, but its primary side effect is insomnia, which increases ED risk. More research needs to be done to clarify its overall effectiveness. 
• Yohimbine: The NCCIH does not endorse yohimbine, which is a traditional aphrodisiac for treatment of ED. Yohimbine may have serious side effects, including heart attack and seizures.
  
• Epimedium grandiflorum: Epimedium grandiflorum, also known as horny goat weed, barrenwort, and bishop's hat, is a traditional remedy for increasing fertility, but there is not enough evidence to support its use for ED. 
  

It's worth noting that none of the OTC supplements listed above is approved by the FDA for ED, but some studies suggest that they may be helpful in treating ED. These substances should never replace standard treatments. You should also consult your healthcare provider before trying any supplement.

Risks

OTC medications should not be combined with standard ED drugs. Store-bought pills are unregulated and unstudied for effectiveness or safety. What's more, some manufacturers make untrue claims or misreport the ingredients in their products. In fact, the FDA has found that nearly 300 products marketed for ED contain excessively high doses or undisclosed ingredients.

In consumer product testing, many OTC supplements have been found to contain bootlegged amounts of prescription medications, including Viagra, Cialis, Levitra, and Stendra. The ingredients in these supplements are not under quality control and may differ from pill to pill, making them particularly dangerous.

These unregulated supplements may also interact with other medications that you are taking, causing an unsafe drop in blood pressure. For example, L-arginine should never be taken with nitrates or alpha-blockers, as the combination can lead to a sudden drop in blood pressure. Therefore, you should never start, replace, or stop medication without first speaking with a healthcare provider.

A Word From Verywell

As we age, our bodies undergo changes such as decreasing testosterone production, which can result in hormone imbalances that affect erections. Other conditions like cardiovascular disease, diabetes, obesity, and work-related stress further compound the problem.

ED can also be caused by an underlying psychiatric or physical issue, such as depression, anxiety, medications for blood pressure or high cholesterol levels, thyroid conditions, or an enlarged prostate/prostate surgery. Additionally, side effects like incontinence may interfere with sexual intercourse and the ability to maintain an erection. The list is endless. 

If you are one of the millions of people trying OTC remedies for erectile dysfunction without success, it may be time to see a healthcare provider or specialist for evaluation. A urologist, for instance, can help you identify the root cause of your ED, create a safe and effective treatment plan, and explain to you why some OTC treatments may not be as effective as they seem.