What are the Risks of Taking Over-the-Counter ED Drugs?

When you have a cold, you probably head to the pharmacy to buy cough medicine and throat lozenges. But what about when you can’t get an erection? Can you pop over to the drugstore and buy Viagra® over the counter?

In short, no. There are no safe or effective over-the-counter ED drugs, and taking so-called over-the-counter Viagra substitutes can put your health at risk. Many products misrepresent themselves as “Viagra-like” erectile dysfunction pills. Some may even illegally contain the same active ingredients, but the purity of these ingredients and the quantities used aren’t always verifiable. 

Below, we’ll explain why Viagra and other ED drugs are only available by prescription, how you can access them if you’re experiencing erectile dysfunction (ED), and why over-the-counter Viagra is inferior to brand-name Viagra or its generic version, sildenafil citrate.

Over-the-counter (OTC) medications are relatively affordable and accessible. And they conveniently treat a wide range of ailments. But if you’re hoping to access safe, dependable treatments for erectile dysfunction or other men’s health conditions, you’ll need a prescription for that.

The only way to legally buy Viagra is by first getting a prescription from a healthcare provider.

You might be able to purchase the drug from a walk-in pharmacy abroad, but you can’t buy Viagra over the counter in the U.S. There’s no generic sildenafil OTC, either. 

Over-the-counter products marketed as Viagra alternatives or OTC Viagra aren’t actually Viagra at all.

Some may make some big claims about being able to do things like dilate blood vessels, improve blood flow, or even increase levels of sex hormones. But there isn’t much evidence to corroborate the claim that these over-the-counter Viagra substitutes are effective. Many can’t even be proven safe.

Lots of “online pharmacy” products not only use fake or unproven ingredients, but they’re also often made in unsafe, unsanitary conditions.

You can often find these products behind gas station counters, at local convenience stores, in sex shops, and online. But officially speaking, you can’t get a Viagra pill over the counter.

There’s No Evidence Herbal Viagra or OTC Viagra Works

A majority of these products are just herbal supplements that haven’t been tested or approved by the FDA (U.S. Food and Drug Administration) for ED. For the most part, there’s no proof they provide any real benefits for sexual performance or that they work effectively to treat erectile dysfunction.

And since they’re sold without a prescription, OTC ED meds may be unsafe if you use other types of medication, especially for hypertension (high blood pressure) or heart disease.

That said, concerns over affordability and the perceived hassle of obtaining prescription drugs drive many men with ED to seek out other options — which sometimes include unsafe OTC erectile dysfunction drugs.

And that’s not good.

Two things should worry you about OTC Viagra products: what they say is inside and what they don’t say is inside. 

Questionable Ingredients in Over-the-Counter Viagra

Let’s start with what’s on the ingredients list. Most over-the-counter Viagra substitutes usually contain herbal ingredients, such as horny goat weed, ginseng, or L-arginine.

Overall, there’s very little evidence that these herbal supplements have any real benefits for erections, sexual desire, or general sexual activity. And many ingredients have failed to outperform placebos in clinical trials.

Horny goat weed does contain icariin, a mild phosphodiesterase 5 inhibitor (PDE5 inhibitor). This means it works the same way as Viagra, but it won’t stack up to the efficacy you get from prescription medications. As such, it’s best not to rely on them as a treatment for ED.

Hidden Ingredients in Over-the-Counter Viagra

Besides their lack of efficacy data, it’s especially crucial to avoid over-the-counter alternatives to Viagra due to the large amount of unknown, frequently unlabeled ingredients sometimes used in these products.

This means you face a real risk of experiencing drug interactions if you use them with other prescription medications. Like Spanish fly and other alternative ED remedies, these products are all flash and no substance.

Many non-prescription erectile dysfunction supplement packages have similar disclaimers on their labels. This is what they typically say:

“These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

That’s because the FDA doesn’t regulate these statements in the same way it regulates claims for prescription medications — something that makes them different from the likes of real Viagra.

Some OTC ED pills on the market include:

• Libido Max®

• Male Extra®

• Virectin®

• VigRX Plus®

When shopping for OTC erectile dysfunction remedies, you’ll find several marketed as “male enhancement” pills. 

Many claim to be for more than just the treatment of erectile dysfunction — some also promise to increase stamina, improve libido, and boost testosterone levels.

In a nutshell, they’re billed as over-the-counter ED pills that work fast. But you’re wise to be skeptical.

Libido Max

Supposedly made with natural ingredients like L-arginine, horny goat weed, and yohimbe, Libido Max claims to support blood flow around the body and function as a pleasure booster.

There’s debate about how effective it is, with numerous users giving it mixed reviews due to potential side effects and lack of efficacy.

Male Extra

Manufactured by Marlia Health Innovations in the UK, Male Extra claims to produce larger and harder erections while enhancing sexual ability. 

This male sexual-performance supplement lists natural ingredients, such as pomegranate and L-arginine, which are purported to promote vitality and increased energy.

Although L-arginine may offer some performance benefits, there’s very little clinical research to suggest it has significant effects on erections, bedroom performance, or general sexual desire.

Virectin

Virectin contains L-arginine, tongkat ali, vitamin B3 (niacin), and selenium. It promises to support healthy testosterone levels, boost libido, and enhance drive during sexual activity.

Some of the active ingredients in Virectin may offer mild benefits. But there isn’t any high-quality evidence to suggest it improves sexual arousal or treats issues like erectile dysfunction.

And the vitamins — while nice — aren’t a treatment for ED.

VigRX Plus

Marketed as the world’s “leading male-enhancement product,” VigRX Plus contains red ginseng, saw palmetto, ginkgo biloba, and other ingredients alleged to stimulate sexual activity and help maintain a firm erection.

In one study published in the journal BMC Complementary and Alternative Medicine, researchers found that the herbal product was more effective than a placebo in improving sexual function in men.

However, there’s currently no reliable, high-quality research comparing VigRX to established medications for ED, like sildenafil or other PDE5 inhibitors. 

We mentioned that over-the-counter Viagra and other OTC ED pills aren’t regulated by the FDA in the same way as prescription medications and why that’s potentially dangerous. Now, let’s talk about specific products. 

Brands and Products Red-Flagged By the FDA

Over the years, the FDA has issued numerous health warnings about tainted male enhancement pills. In fact, the government agency posted so many warnings that it maintains a large online database of tainted sexual enhancement products.

Products and brands on the list include:

• Man Up Now®

• Stiff Nights®

• Rock Hard Weekend®

• Duro Extend Capsules for Men®

• Vigor-25®

• Magic Power Coffee®

• Time Out®

• Mr. Magic Male Enhancer®

• Vitalex®

• Xiadafil VIP Tabs®

• ExtenZe®

It’s best to steer clear of these and go with safer, evidence-backed products for ED.

Low-Purity Ingredients

What is it about these products that made the FDA issue a health warning? For many, it was a problem with the purity or safety of the ingredients.

For example:

• Sulfoaildenafil. Man Up Now is made with sulfoaildenafil, a synthetic chemical similar to Viagra’s active ingredient, sildenafil.

• Unknown amounts of sildenafil. An FDA notice against ExtenZe states that the company’s products have been found to contain undeclared amounts of sildenafil.

• Unlisted ingredients. Vimax is another popular supplement for treating erectile dysfunction and other forms of male sexual dysfunction. It’s marketed as a “100% natural product” containing herbal ingredients for enhancing male virility. But like many over-the-counter ED products, Vimax also contains substances not listed on its label, namely prescription ED medications.

• Unregulated tadalafil. In a 2015 notification, the FDA warned consumers that Vimax illegally contains tadalafil, the active ingredient in the ED med Cialis®. Tadalafil can interact with many common medications for treating high blood pressure and chest pain. If you’ve previously had a heart attack or another cardiovascular event, you shouldn’t use it at all without discussing it with a healthcare provider.

Because of these risks, it’s best to avoid any supplements containing unlabeled ingredients and instead stick to proven, FDA-approved treatments prescribed by healthcare professionals.

Poorly Measured Doses

Some over-the-counter erectile dysfunction pills contain more than one active ingredient. This means they may have a higher risk of causing side effects or drug interactions.

Others contain unsafe, poorly measured doses of active ingredients. With some OTC erection pills, potentially harmful ingredients aren’t just improperly listed on the product labels, but they’re often used in unsafe doses.

For instance, the FDA demanded that the manufacturers of Mr. Magic Male Enhancer take the product off the market. Its two main ingredients — illegal sildenafil and sulfoaildenafil — weren’t declared on the list of ingredients.

Potential Interactions

All PDE5 inhibitors currently available to treat erectile dysfunction can cause interactions when used with medications for hypertension and some heart conditions, such as a sudden drop in blood pressure.

To be sure, these issues can also happen with FDA-approved, legally prescribed medications in some cases. But you typically learn about the risks when you speak to a healthcare provider before getting a prescription.

Your healthcare provider can prevent dangerous drug interactions. And unlike the “swallow-it-all” packets the mini-mart attendant hands you, prescriptions are appropriately dosed for patients.

So if you’re considering an “all-natural” over-the-counter alternative to Viagra, our recommendation would be to reconsider.

Men turn to several herbal supplements and natural remedies for ED, better erections, and elevated sexual function. But we have to caution you that the research on the benefits of natural ED treatments is mixed at best.  

Some particular compounds have been shown to improve blood flow and more, including:

• Dehydroepiandrosterone (DHEA)

• L-arginine

• Pycnogenol

• Yohimbe

• Propionyl-L-carnitine (PLC)

Want to see what research has to say about them? Read on. 

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone, or DHEA, is a hormone produced by the adrenal cortex. It’s an important precursor for several sex hormones, including testosterone.

DHEA appears to decline with age, with low levels linked with an elevated risk of erectile dysfunction. Although research findings are inconclusive right now, some studies suggest DHEA may affect receptors that manage blood flow to the penis.

However, there isn’t yet a clear link between DHEA supplementation and improved erections or sexual performance.

L-arginine

Next up on the “Might Work to Help You Get Hard But Probably Not” list is L-arginine. This amino acid is purported to help boost nitric oxide production.

Nitric oxide helps relax smooth muscles in the arteries that supply blood to the penis, so it plays a major role in producing erections.

A meta-analysis published in the Journal of Sexual Medicine looked at 10 randomized controlled trials and found that arginine supplements might provide benefits for men with mild to moderate ED.

Our full guide to L-arginine and erectile dysfunction goes into more detail about how L-arginine works within the body, as well as its potential effects on erectile health. 

Pycnogenol

Pycnogenol is a nutritional supplement derived from French maritime pine bark extract. It may offer similar benefits for erectile dysfunction. In fact, pycnogenol and L-arginine are sometimes used together in natural supplements for ED. 

A study from 2003 looked into the effects of L-arginine and pycnogenol as a combined treatment for erectile dysfunction and found they promoted improvements in sexual function after three months of use.

By the end of the three-month study, 92.5 percent of participants had experienced a normal erection.

These are good signs for sure, but we’re far from establishing a definitive case for pycnogenol.

Yohimbe

Yohimbe is a tree native to Central and Western Africa. Its bark contains yohimbe, an alleged traditional aphrodisiac. But don’t call it the “Viagra tree” just yet.

Though scientific research on yohimbe and erectile dysfunction is mixed overall, some studies have found that it may offer benefits for men with sexual performance issues.

For example, a recent review published in the Turkish Journal of Urology used data from eight studies. It found that yohimbine — the active ingredient in yohimbe — was associated with improved erectile function when used in combination with other treatments.

But the researchers also noted that yohimbe wasn’t fully effective as a treatment for male sexual function issues when used on its own.

Propionyl-L-carnitine (PLC)

Propionyl-L-carnitine, or PLC, is a natural supplement widely promoted for its potential to increase energy levels.

While research on propionyl-L-carnitine on its own isn’t conclusive, several studies suggest it may offer benefits for erectile function when used with ED medications. 

For instance, one study published in the journal Current Medical Research and Opinion found that men with ED — and diabetes — showed larger improvements with propionyl-L-carnitine and sildenafil (the active ingredient in Viagra) than with sildenafil alone.

However, as noted, diabetes was a pre-existing condition for study participants. Additionally, they had already unsuccessfully tried sildenafil by itself. So there’s no way to know if these results would be replicated in a larger trial with otherwise healthy participants.

Other Supplements 

Other supplements that may help increase blood flow and improve sexual function include:

• Ginseng

• Ginkgo biloba

• Rhodiola rosea

• Horny goat weed

Though these remedies may have some promise, it’s important to keep in mind that they aren’t evidence-based medications — nor are they approved by the FDA to treat any type of disease. 

This means they haven’t been thoroughly tested for efficacy and safety like FDA-approved drugs have.

The FDA says Viagra works and that dietary supplements may or may not. What are you going to do with this information?

While over-the-counter alternatives to Viagra might seem appealing, you’ll get better results — and keep yourself safer — by working with a healthcare provider to find the right medication.

If you have erectile dysfunction caused by a physical health issue, using ED medication to improve your erections might be the best option.

These medications work by increasing blood flow to the penis, which can make it easier to get and maintain an erection when you’re sexually aroused. 

Currently, there are several safe and effective FDA-approved medications for treating ED. With a prescription from a medical professional, you can purchase oral ED drugs, such as:

• Sildenafil (the active ingredient in Viagra)

• Tadalafil (Cialis)

• Vardenafil (Levitra®)

• Avanafil (Stendra®) 

Most of these medications are taken as needed before sex. But tadalafil (Cialis) can be used daily to improve erectile function over the long term.

There’s also a prescription injectable medication called alprostadil that’s approved by the FDA for ED. Other compounded medications for ED include BiMix, TriMix, and QuadMix.

Curious about non-prescription treatments? Eroxon is a recently FDA-authorized topical gel for ED that’s available over the counter. It’s rubbed on the head of the penis and stimulates nerves to cause an erection.

We offer several ED medications on our online platform, following a consultation with a licensed healthcare provider. This allows you to quickly and easily access discreetly packaged, FDA-approved medications for ED from home without any awkward visits to your primary care provider’s office.

Aside from medication, there are plenty of non-pharmacological ways to address ED and improve sexual health.

Healthcare professionals can help you identify the underlying cause of your ED and figure out the best type of treatment.

Let’s take a look at each of these in detail.

Physical Health Improvements for ED

Making simple changes to your habits and lifestyle can improve your erections and sexual performance.

You can reduce the severity of ED (or potentially stop it altogether) by exercising regularly, eating a balanced diet, maintaining a healthy weight, quitting smoking, and avoiding excessive alcohol consumption. 

Our guide to naturally protecting your erection can walk you through strategies to get started on your own. 

Mental Health Improvements for ED

ED isn’t all about the physical body — around 40 percent of all ED cases are psychological in origin, according to some research. Stress, anxiety, self-esteem issues, and a poor body image can all cause problems, even if there are no clear physical causes for ED present.

If this feels a little overwhelming, the good news is that you’re not alone. How you feel is normal and very common, and most importantly, it’s treatable. 

If psychological hang-ups are causing you grief in the bedroom — things like PTSD (post-traumatic stress disorder), past trauma, performance anxiety, etc. — talk therapy might help.

Psychotherapy — like cognitive-behavioral therapy (CBT) or sex therapy — with a mental health provider can help you pinpoint your sexual sticking points and grease those bearings.

Devices and Surgery

There are a few potential solutions for ED we haven’t talked about yet.

Vacuum erectile devices, or penis pumps, are also an option to try for those who want a non-prescription way to address ED.

As a last resort, severe cases of ED might be treated with penile implant surgery. This option is typically suggested when other, less invasive treatments have failed.

Is Viagra over the counter? Nope. It’s only available with a prescription. You can’t get generic sildenafil over the counter, either.

Needing help with ED is normal for many men these days, young and old. Unfortunately, feeling comfortable enough to seek help from a medical professional hasn’t been normalized so well.

Before you get roped into the health promises of some shiny packaging at the local bodega, remember you’ve got nothing to be ashamed of. That’s what many of these dangerous products prey on, and they do it profitably.

Here’s what to keep in mind about over-the-counter Viagra:

• ED Solutions are big business. Erectile dysfunction is such a widespread issue for men of all ages, so it’s no wonder there are so many prescription medications and other products out there to treat it. 

• A lot of what you see on shelves won’t work. Many Viagra over-the-counter products marketed online and sold in gas stations, sex stores, and elsewhere aren’t effective. 

• Those OTC products could also be dangerous. Many contain unlabeled ingredients that could be unsafe if used with other medications. As such, if you’re considering trying those gas station pills you saw for sale for just a few dollars, we urge you to reconsider.

Instead of using ineffective and potentially unsafe over-the-counter alternatives, go with an affordable generic medication, like sildenafil or tadalafil.

We offer these medications through an online ED consultation as part of our range of erectile dysfunction treatment options.