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Ask our medical team for impartial information and advice about any treatment we provide or medical condition that we treat before you buy.

*Prescription medicines are supplied subject to a medical consultation at the discretion of a doctor.

  • With all the different ED treatments available on the market, where do I start?

    The treatments for erectile dysfunction are available in the following strengths:

     ‘As required’ ED treatments

    Viagra 25mg, 50mg & 100mg tablets - the normal starting dose for people who have not taken Viagra before is 50mg. If it is highly effective then the strength should be reduced to the 25mg. If the 50mg strength has been tried on 4 separate occasions and if it doesn't produce the required effects then it can be increased to 100mg (as long as there are no side effects). The 100mg should be tried 8 different attempts before the tablets are deemed to be ineffective. For Viagra to be effective, it needs to be taken 45 minutes to 1 hour before sex. You should never take more than one Viagra tablet in a 24-hour period.

    Viagra is now available legally in the UK under the name sildenafil or generic Viagra; the exclusive patent expired in July 2013. It is medically equivalent and now available at a fraction of the cost.

    Sildenafil 25mg, 50mg & 100mg tablets – follow the same instructions as given above for Viagra tablets, the starting dose is sildenafil 50mg. Remember, these are medically equivalent to Viagra however because they are generic they are available at a significantly reduced price.

    Cialis 10mg & 20mg tablets - the normal Cialis starting dose is 10mg. If it is highly effective then it should be reduced to the 5mg. It should be tried on 4 separate occasions and if it doesn't produce the required effects then it can be increased to the 20mg strength (as long as there are no side effects). The 20mg should be tried 8 different attempts before the tablets are deemed to be ineffective. If more than 2 tablets are needed a week then the 2.5mg or 5mg daily tablets should be considered. It can be taken as little as 30 minutes or up 12 hours before it is needed. The effectiveness of Cialis is not altered with food.

    Levitra 10mg & 20mg tablets - the normal Levitra starting dose is 10mg. It should be tried on 4 separate occasions and if it doesn't produce the required effects then it can be increased to the 20mg strength (as long as there are no side effects). The 20mg should be tried 8 different attempts before the tablets are deemed to be ineffective.

    Spedra 50mg, 100mg & 200mg tablets - the normal Spedra starting dose is 100mg. If it more than effective then the strength should be reduced to the 50mg.If the 100mg strength has been tried on 4 separate occasions and if it doesn't produce the required effects then it can be increased to the 200mg strength (as long as there are no side effects). The 200mg should be tried 8 different attempts before the tablets are deemed to be ineffective. For Spedra to be effective, it needs to be taken 45 minutes to 1 hour before sex.

    Vitaros cream - Vitaros comes in single dose applicators and is the fastest acting of all the ED treatments with none of the side effects associated with the common tablet treatments. It can be more inconvenient to apply and requires fridge storage.

    Daily ED treatments 

    Cialis 2.5mg & 5mg daily tablets – the normal starting dose is 2.5mg daily. This can be increased to 5mg daily if after a number of months the 2.5mg strength is not producing the desired effects. It is important to try to take Cialis Daily at the same time each day and not to supplement your treatment with any ‘as required’ ED tablets or treatments.

    With all of the erectile dysfunction tablet treatments, sexual stimulation is necessary for arousal.

    As we are all individuals, one tablet or brand may work better than another and trying them to find one that suits you is acceptable. Remember to take the lowest possible dose that gives you the effects you are looking for.

As a precaution, avoid situations where it is not possible to sit or lie down a few hours after taking a tablet for the first time.

  • How long do I have to leave between doses?

    You should not take Viagra, Spedra or Levitra in a 24-hour period. You should not take more than one Cialis 10mg or 20mg tablet in a 36-hour period and more than two ‘as required’ Cialis tablets in a week. Do not take more than one Cialis Daily in a 24-hour period.

  • Is one brand of ED treatment more effective than another?

    Cialis, Levitra, Spedra, and Viagra (sildenafil) work in a similar way to produce an erection but there are subtle differences in length of duration and speed of onset.

    Cialis generally has the fastest onset, sometimes within as little as 15 minutes. It also produces the longest effect, up to 36 hours. Is not affected by food and can be taken as little as 30 minutes or up to 12 hours before it is needed.

    Spedra works as quickly as 15 minutes and last up to 6 hours.

    Levitra takes around 30 minutes to produce an erection and lasts a little longer than Viagra - up to 5 hours.

    Viagra takes on average 30 minutes to kick in and continues for around 4 hours. This also applies to Sildenafil tablets.

    We are all different and one type of tablet may work better for you than another. In addition, factors like the amount of alcohol consumed and when and what you ate can alter the effects of the individual treatments. You may wish to try different tablets and see which suits you best. Each treatment should be tried at least 4 - 8 times before deciding if it is effective for you before changing strength or drug.

  • If one of these ED treatments isn't effective, can I try another?

    We are all different and one type of tablets may work better for you than another. You may want to try different tablets and see which suits you the best. Remember to try each treatment multiple times before trying a different strength or drug.

    You should never take different treatments at the same time; leave at least 24 hours between taking any erectile dysfunction treatments (leave 36 hours for Cialis).

  • What are the side effects of Erectile Dysfunction treatment?

    Viagra and the other erectile dysfunction treatments in the same family, are very well tolerated. Any adverse effects that do occur are mostly mild, including:

    • Headaches
    • Flushing
    • Heartburn
    • Nasal congestion

    For a full list of side effects, see each individual treatment page.

  • When do I take my Erectile Dysfunction treatment?

    Sexual stimulation is necessary for an erection when taking any of these tablets. Viagra/sildenafil needs to be taken at least 30 minutes and preferably one hour before sex.

    Cialis can be taken between 30 minutes and 12 hours before sex. Do not take more than one tablet in 36 hours or two tablets in a week. If you need to take more than 2 Cialis tablets a week then the daily dose strengths of 2.5mg or 5mg may be more appropriate for you.

    Levitra should be taken about 25 minutes to 1 hour before attempting intercourse. It can be taken with or without food. Its effect may be delayed if taken with meals high in fat.

    Spedra is taken as needed approximately 30 minutes before sexual activity. Onset of action may be delayed up to 1.5 hours, if taken on a full stomach.

  • If I need more than two Cialis tablets a week, what other options are there?

    Taking more than two tablets of Cialis will lead to a build up in your system. If you need more than two 'as required' tablets a week then we recommend the 2.5mg or 5mg once daily doses of Cialis.

  • Should I avoid grapefruit and grapefruit juice when taking ED tablets?

    Grapefruit and grapefruit juice can reduce the elimination of certain medicines from the body. This may lead to a build up drug in your system. For this reason we advise you avoid grapefruit and grapefruit juice whilst taking erectile dysfunction medication.

  • What do I do if the ED tablet I took didn't work?

    The usual starting dose for erectile dysfunction tablets is
 Viagra 50mg, Sildenafil 50mg, Cialis 10mg, Spedra 100mg or Levitra 10mg. If it has not had the desired effect or didn't last 4 hours then it is important to try again for another 3 separate occasions before moving up to the higher strength. It can take a few attempts at first before you get the desired effect for your treatment.

    If the starting dose was more effective than anticipated then reduce the dose to the lower strength treatment.

    With all the ED treatments arousal is necessary, the tablets will not work without it and the medication will then simply wear off after 4 hours.

    Avoid taking ED medication with a heavy meal/high fat meal. This may delay the onset/ take longer to start working.

    Drinking excessive amounts of alcohol is not recommended as it will impair your ability to achieve an erection and you will not receive the maximum benefits form the medication.

  • Can I cut any of the Erectile Dysfunction treatments in half?

    Both The Independent Pharmacy and the manufacturers of ED treatments do not recommend cutting or breaking any of the ED treatments.


  • If my erection does not subside after 4 hours, what should I do?

    An erection that last for more than 4 hours (known as priapism) needs urgent medical attention. If left untreated, it can cause long-term damage to the penis. It is important to understand that this condition is rare, if you use erectile dysfunction treatments sensibly and as directed there is only a very small risk of this occurring.

  • If I take an ED tablet every time I have sex, will I become addicted to it?

    Viagra and the other erectile dysfunction treatments are not addictive but it is important to bear in mind that by taking this medication you are treating the symptoms and not the underlying cause of the condition. Therefore in the future you may need a higher strength tablet if the underlying condition was to get worse. If the erection difficulties are due to performance anxiety then men may feel unable to perform without them and become psychologically reliant on them as a back up.

  • Will I have to take ED treatments forever?

    The amount of time you need to take erectile dysfunction medications for will depend on the cause of your condition. If it is due to another medical condition such as diabetes, high blood pressure or obesity by changing your lifestyle and getting effective treatment for this condition, you may see a slow improvement in your symptoms of erectile dysfunction.

    Alternatively, if your ED is caused by psychological reasons like anxiety, you may need counseling to overcome the issues at the heart of your condition. Remember that erectile dysfunction treatments treat the symptoms of ED but not the underlying causes.

  • Is Erectile Dysfunction same as impotence?

    Erectile Dysfunction (ED) is the condition when sufficient erection cannot be attained or maintained long enough for normal sexual function. It is commonly referred to as male impotence.

  • Do all men have Erectile Dysfunction?

    Not necessarily. However, one in five men experiences it at some stage in their lives, even though only 10% of those who have it ever seek treatment. It is commonly perceived as lack of virility and loss of manliness, therefore men tend to keep the incidence to themselves and suffer in silence unnecessarily.

  • How does ED occur?

Erectile dysfunction occurs when the blood supply to the penis is reduced. Typically, during an erection, the arteries that bring in the blood are relaxed, allowing more blood to flow in, while the veins that carry the blood away are constricted, reducing the outflow. Sexual stimulation, and associated nerve impulses and hormones, kick start this reaction. Any disruption in this process can result in ED.

  • What are the usual causes of Erectile Dysfunction?

Lifestyle diseases like hypertension, diabetes, atherosclerosis (narrowing of the blood vessels – commonly due to cholesterol) and heart disease that affect blood circulation in general often precipitate erectile dysfunction. Neurological reasons include multiple sclerosis and Parkinson’s’ disease, while hormonal imbalances such as high levels of prolactin and low levels of testosterone also may result in ED. It can be an adverse side effect of certain medications used to for treat allergies, depression, high blood pressure or Parkinson’s disease. Injury to the pelvic area or to nerves that control erection may also be the cause in some cases.

  • So ED is not all in the head?

    This is one of the most damaging misconceptions about erectile dysfunction. According to a University of Maryland Medical Centre report, only 15% of the cases are purely psychological in nature. The causes of the remaining 85% can be traced to some physical problem. Anxiety, unresolved anger and other emotional issues between partners are the usual psychological causes. Depression also may cause impotence.

  • Can Erectile Dysfunction be prevented?

    Whilst all causes of erectile dysfunction may not be preventable, maintaining a healthy lifestyle goes a long way in preventing the physical causes such as hypertension, diabetes, atherosclerosis and heart disease. Smoking, as well as alcohol and drug abuse, are some examples of the other preventable causes. Effective communication between partners also helps.

  • Can Erectile Dysfunction be treated successfully?

Most cases of erectile dysfunction respond to medication. Viagra, or other treatments such as Sildenafil, Cialis and Levitra, help those with ED to achieve erection and maintain it. They are normally taken around and hour before sex and will only work when you become aroused. For most people they are not available from the NHS and must be paid for privately from your local GP or an Online Pharmacy.

  • Is sex counselling and surgery necessary to resolve ED?

    Not in most cases of ED. To identify and resolve psychological causes of ED, sex counselling can help. Surgical correction of physical defects, if any, can resolve ED in some cases. When non-surgical treatment measures are exhausted, surgery to implant a penile prosthesis can be considered to manage the condition.


  • What are the other treatment options for Erectile Dysfunction?

    • Lifestyle changes - Quitting smoking, reducing alcohol intake, getting regular physical exercise, and reducing weight are all that may be necessary to resolve the issue in many cases.
    • Vacuum devices - 
They are applied externally to create a vacuum that helps draw in blood to the penis. A ring is used at the base of the penis to reduce outflow and maintain the erection longer.
    • Referral to other healthcare professionals - 
The case may be referred to an urologist or to neurologist, if necessary. If the condition persists even after the probable physical reasons are ruled out, a psychologist may help resolve the issue.
  • Can I buy ED treatment online?

    Yes, you can buy all available erectile dysfunction treatments online from The Independent Pharmacy. By filling in a consultation for one of our UK prescribers to check and, if appropriate, they can issue with a prescription for the ED treatment of your choice. This prescription is then dispensed by our NHS pharmacy and dispatched to a location of your choice.

  • How do I know the Erectile Dysfunction treatment I receive is not fake?

    All the ED treatments we supply are sourced from the same UK wholesalers used by your local high street pharmacy. We always ensure that the products we supply are of the highest quality and have a UK product licence. Being a registered NHS pharmacy we use the same medicines for our Online Pharmacy service as we supply to our NHS patients. 

  • What other ED treatments are out there?

    There is a wide variety of alternative treatments out there: from pills to injections, so be sure to seek the advice of a medical professional rather than taking matters into your own hands.
    Some sufferers of ED take supplements such as proargi, fatty acids such as Omega-3, citrulline or arginine to combat their ED. Natural remedies like garlic and herbal medicines are also used. These treatments of various dosages are intended to increase the blood flow to the penis.

    Vacuum pumps, either specially designed or intended for DIY penis enlargement or enhancement, are also ways that people treat ED at home. However, as with any condition, you need to consult with a doctor for treatment that will work.

  • Is my ED permanent? Can it come and go?

    Erectile dysfunction can indeed come and go, either with improvements in blood flow following treatment, which then deteriorate again, or with the psychological effects such as stress easing off but later worsening. ED can also strike when you least expect it, or when you overthink it, which can be very frustrating.

  • Does erectile dysfunction affect ejaculation, sperm count and fertility?

    The main symptom of ED is being unable to sustain an erection. Despite this, a man may still have sexual desire and be able to have an orgasm and to ejaculate.

    Erectile dysfunction can cause male infertility because it can interrupt or prevent intercourse. In order to conceive, sperm must travel to a partner's egg during intercourse. Thus, problems that prevent or interrupt intercourse cause an inability to deliver sperm to the egg and lead to infertility.

    In some (but not all) cases, ED may be linked to a low sperm count, low levels of testosterone or difficulty with conception.

  • Can bodybuilding activities and pills cause ED?

    Bodybuilders sometimes regularly use steroids, DMAA (dimethylamylamine) or hormone treatments that can cause or worsen the symptoms of ED.  

  • What other conditions can be linked to ED?

    Cancers and liver conditions, such as Hepatitis C, are often linked with ED online, however no formal trials have been completed.

  • Could my ED be caused by using condoms?

    Many men claim that ED is caused directly by using condoms. While condoms can, in some cases, interfere with arousal and therefore erections, there is no direct link between the two. Erectile dysfunction occurs when an erection is not possible, rather than being caused by a condom. Ensuring that your condoms are the correct fit for you could fix the problem.

Authored By:

A photo of  Andy Boysan

Andy Boysan


Published on: 29-05-2019

Last modified on: 29-05-2019

Reviewed By:

A photo of  Scott McDougall

Scott McDougall


Reviewed on: 29-05-2019

Next review date: 29-05-2021

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