Using ED tablets for the first time

All men with erectile dysfunction should consult their regular doctor before obtaining treatment online.

Trial of therapy advice

Start with a low dose, and try medication repeatedly at a low dose to start with.

Find a tablet that works well and take the lowest dose which is effective.

Men who are prone to low blood pressure may feel lightheaded or dizzy after taking medication. This is rare. A few hours after taking a tablet for the first time, as a precaution, avoid situations where it is not possible to sit or lie down.

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Viagra (sildenafil)

Viagra lost its exclusive patent in the UK in June 2013. Viagra is now available legally in the UK under the name sildenafil. Sildenafil is sometimes also known as 'generic Viagra' or 'generic sildenafil'.

There are three strengths of Viagra/sildenafil tablets: 25mg, 50mg and 100mg. Most men should start with 50mg tablets. The maximum dose is 100mg once in 24 hours.

If 50mg tablets do not work after trying them four times, and they are not causing side effects, the dose should be increased to 100mg. The maximum should be tried on eight separate occasions before deciding it is not effective.

Starting on a lower dose, 25mg, is advised if you are prone to side effects, taking other medications that may interact or have liver or severe kidney impairment. It is advised to speak with your usual GP if this applies. Side effects can still be experienced with lower doses but are usually milder.

Viagra/sildenafil needs to be taken at least 45 minutes and preferably one hour before sex. Sexual stimulation is necessary for an erection. Tablets will continue to work for up to 4 hours and they should not be taken more than once in 24 hours. It may take longer to work if taken with food.

Low cost generic sildenafil became available June 2013.

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Cialis (tadalafil)

Cialis comes in four strengths: 2.5mg, 5mg, 10mg and 20mg.

The usual starting dose of Cialis is one 10mg tablet taken about 30 minutes before sexual activity. This can be increased to a maximum of 20mg as a single dose or reduced to 5mg in response to treatment.

Cialis will continue to work for up to 36 hours. It should not be taken more than once in 24 hours. If treatment is needed more than twice a week, daily low dose Cialis should be used (see below).

Cialis should be tried on numerous separate occasions before deciding it is ineffective. Sexual stimulation is required for an erection. Cialis will not cause erections without it. The effectiveness of Cialis is not altered by food.

Cialis lost its patent protection in the UK November 2017 and is now legally available in generic form as tadalafil.

Low dose Cialis

Men who need Cialis/tadalafil more than twice a week should take a daily tablet of 2.5mg or 5mg.

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Vardenafil (generic Levitra)

There are three strengths of Levitra (vardenafil): 5mg, 10mg and 20mg. Most men should start with a single 10mg tablet.

If 10mg is ineffective the dose may be increased to a maximum of 20mg. If 10mg causes side effects the dose should be decreased to 5mg.

The lower 5mg dose should be started if you have liver disease, severe kidney disease or are taking medications that may interact. You should discuss this with your usual GP if you are unsure.

Vardenafil should be taken about 25 minutes to one hour before attempting intercourse. It can be taken with or without food. Its effect may be delayed if taken with meals high in fat. Levitra will work for 4-5 hours and should not be taken more than once in 24 hours.

It should be tried on multiple separate occasions before deciding it is ineffective. Levitra will not work unless arousal is present.

Vardenafil lost its patent protection in the UK October 2018 and is now legally available in generic form as vardenafil. In February 2023 branded Levitra was discontinued by the manufacturer (Bayer).

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Spedra (avanafil)

The recommended dose is 100mg taken as needed approximately 15-30 minutes before sexual activity. Based on individual efficacy and tolerability, the dose may be increased to a maximum dose of 200mg or decreased to 50mg. Sexual stimulation is required for a response to treatment. Spedra will continue to work for around 4 hours and should not be taken more than once in 24 hours.

Onset of action may be delayed up to 1.5 hours, if taken on a full stomach.

Spedra (avanafil) is due to come off patent in 2025 so there may be generic versions produced by other pharmaceutical companies. When these become available we will update our pages so these can be considered.

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