Over-the-Counter Erectile Dysfunction Pills: As Good As Viagra?

While labels on herbal remedies and supplements sold as over-the-counter erection pills may hint they are just like Viagra (sildenafil) or another erectile dysfunction (ED) drug, their benefits remain largely unproven. Furthermore, most are untested and none have been approved for the treatment of ED by the U.S. Food and Drug Administration (FDA).

Still, these pills have become increasingly popular with consumers. Unlike Viagra and Cialis (tadalafil), they don't require a prescription. They are also less expensive and often include natural ingredients.

If you are considering over-the-counter erection pills for these or other reasons, it's best to review what is known about them, including their potential side effects and risks, first. Read on for a review of six such pills, as well as ways to improve ED without them.

L-Arginine

L-arginine is an amino acid—a building block of protein—that is found naturally in food. Among other things, it boosts the body's production of nitric oxide (NO), a compound that helps dilate (widen) blood vessels. Without NO, the blood vessels in the penis cannot engorge with blood and achieve an erection.

In theory, L-arginine supplements should improve the quality of erections by increasing NO production, but study results have been mixed. There is some evidence, albeit slight, that doses of 1,500 to 5,000 milligrams (mg) may be useful for people with mild to moderate ED.

Even so, it is important to remember that people get plenty of L-arginine from their diet and that NO is only one of the components needed to achieve an erection.

While L-arginine supplements are generally considered safe, they can cause side effects like:

• Headache
• Bloating
• Nausea
• Stomach pain
• Diarrhea
  

L-arginine should not be used in people with gout as it can increase the risk of an attack. It can also cause airway inflammation and should not be used in people with chronic obstructive pulmonary disease (COPD) or poorly controlled asthma.

L-arginine can also cause a drop in blood pressure and should never be used in people who have had a recent heart attack. Similarly, it should be used with caution in people taking high blood pressure medications as it may trigger a steep and sudden drop in blood pressure (hypotension).

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is the most abundant steroid in the human body. It is used to create sex hormones like testosterone, which plays an important role in erections.

In the United States, DHEA is sold as a supplement under the assumption that it can aid with muscle building and athletic performance. Some studies suggest that DHEA supplements can help treat ED by boosting testosterone levels, but others have found no evidence of this.

A 2018 review in the World Journal of Men's Health concluded that DHEA may be of benefit to "healthy, middle-aged, and elderly" males with mild ED but is likely ineffective in those with moderate to severe ED.

The hormonal effects of DHEA can also cause significant side effects, such as:

• Oily skin
• Acne
• Male-pattern hair loss
• Gynecomastia (breast enlargement)
• Shrinkage of the testicles

Ginkgo Biloba

Ginkgo biloba, also known as the maidenhair tree, has been used for centuries as a herbal extract to treat a wide range of medical conditions, including hypertension (high blood pressure).

By decreasing blood pressure, Ginkgo biloba can theoretically improve blood flow to the penis. Others contend that it has an aphrodisiac effect and can increase sexual desire (libido) in both males and females.

To date, 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 biloba may also cause side effects such as:

• Headaches
• Dizziness
• Stomach upset
• Nausea and vomiting
• Heart palpitations (skipped heartbeats)
• Constipation
• Diarrhea
• Anxiety
• Easy bruising
• Nosebleeds

Because Ginkgo biloba can interfere with blood clotting, it should never be taken with blood thinners like Coumadin (warfarin) or if you have a bleeding disorder.

Ginseng

Ginseng (Panax ginseng) is a fragrant root used for culinary purposes as well as a herbal remedy in traditional Chinese medicine.

Ginseng is thought to boost the production of nitric oxide. It is also known to reduce blood pressure, which may improve blood flow to the penis. On top of this, ginseng is thought to have mild stimulatory effects that may increase sexual arousal.

Even so, there is little evidence of a true effect for ED.

Generally considered safe for use, ginseng can nevertheless cause side effects like:

• Headaches
• Nausea
• Nervousness
• Insomnia
• Increased or decreased blood pressure
• Diarrhea
• Rapid heartbeats

Ginseng should also be avoided if you are taking blood thinners and may interfere with immunosuppressant drugs like prednisone and Imuran (azathioprine) used to treat inflammatory and autoimmune diseases.

Yohimbine

Yohimbine (Pausinystalia johimbe) is a herbal remedy made from the bark of an African tree of the same name. Yohimbine acts as an aphrodisiac in some mammals. While some people believe that it has a similar effect on humans, the evidence supporting the claim is weak.

Yohimbine is also popularly used as a dietary supplement for the treatment of ED, where it is thought to increase blood flow to the genitals of both males and females.

Some studies suggest that yohimbine may increase the likelihood of an erection when used alone or in combination with L-arginine. Even so, only around one in every 20 males with ED reported a complete response.

Despite its possible benefits, yohimbine can cause potentially severe side effects, including:

• Anxiety
• Stomach pain
• Nausea and vomiting
• High blood pressure
• Irregular heartbeats

Horny Goat Weed

Horny goat weed (Epimedium grandiflorum) is a traditional herbal remedy that is thought to increase libido, promote fertility, and treat ED.

Horny goat weed contains a plant-based compound known as icarin that works similarly to Viagra and other PDE5 inhibitors by blocking an enzyme that causes blood vessels to constrict (narrow). By doing so, blood vessels in the penis can dilate and engorge with blood.

Because of this effect, some people refer to horny goat weed as "herbal Viagra."

Even so, studies have shown that horny goat weed is a very weak PDE5 inhibitor and that it is largely ineffective in treating people with ED.

Horny goat weed can also cause side effects like:

• Dry mouth
• Increased thirst
• Dizziness or lightheadedness
• Nausea or vomiting
• Nose bleeds
• Easy bruising
• Rapid or irregular heartbeat

Horny goat weed should not be used if you are being treated for arrhythmia (irregular heartbeats) or are on high blood pressure medications or blood thinners.

Treating ED Without Medications

It's important to remember that the above-listed remedies are not approved by the FDA and carry certain health risks. And, while PDE5 inhibitors like Viagra and Cialis are approved by the FDA, they also carry certain risks.

If you are dealing with mild to moderate ED, you may want to embrace certain lifestyle changes to increase your chances of achieving and sustaining an erection without pills. Even if you are currently struggling with ED, making these changes can often reverse or ease the symptoms.

A 2014 study published in the Journal of Sexual Medicine found that of 810 males diagnosed with ED, 42% were able to overcome their condition by making the following heart-healthy changes:

• Losing weight
• Eating a healthy diet
• Exercising regularly
• Drinking less alcohol
• Getting better sleep

These habits not only reduce the risk of heart disease but also have a knock-on effect by lowering blood pressure and improving the dilation of blood vessels in the penis.

Even if you still need a PDE5 inhibitor to achieve an erection, being fit, healthy, and active greatly will increase your response to drugs like Cialis and Viagra.

A Word From Verywell

Over-the-counter erectile dysfunction pills should not be combined with prescription ED drugs. Supplements and herbal remedies are largely unregulated in the United States and often lack evidence of their long-term effectiveness or safety. What's more, some manufacturers make untrue claims or misreport ingredients in their products.

The FDA reported that nearly 300 OTC products marketed for ED contained undisclosed ingredients or potentially harmful doses of their active ingredient. Some were even found to contain significant doses of Viagra or Cialis.

If you decide to try an herbal ED remedy, speak with your healthcare provider to see if it is safe for you, particularly if you have a chronic condition or are taking chronic medications.