ED medication: the practical guide
Erectile dysfunction has the most-studied medication class in modern medicine. PDE5 inhibitors work for ~70-80% of men. The question isn't whether they work, it's which one, what dose, and whether a $40 generic does the same job as a $90 brand.
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Sildenafil (Viagra) vs tadalafil (Cialis)
Sildenafil works in 30-60 minutes, lasts 4-6 hours. Tadalafil works in 30 minutes, lasts 24-36 hours. Tadalafil also has a daily-low-dose option (2.5-5mg) for spontaneity. Generic versions of both are FDA-approved and chemically identical to brand-name.
Telehealth's role
ED is one of the cleanest telehealth use-cases. The history-taking is standardized, the screening for cardiac risk is checklist-able, and there's no physical exam needed for most prescriptions. Async (text-based) programs work fine. Avoid programs that prescribe without any screening, that's a red flag.
Side-effects to expect
Headache (10-15%), flushing, nasal congestion, mild visual changes (sildenafil). Tadalafil more commonly causes back pain or muscle aches. Stop if you have chest pain or sudden vision/hearing loss. Don't combine with nitrates.
Compounded chewables
Brands now offer compounded sildenafil + tadalafil chewables in flavored variants. Cheaper, but not FDA-approved. They work, they're the same APIs, but quality varies by pharmacy. If you go this route, pick a brand that names its pharmacy.