Your ED medication isn’t working. What comes next?
In this article
If sildenafil or tadalafil has not helped, the next step is a review of how you used it, what happened and what might be contributing. One disappointing encounter does not answer every question about treatment. The American Urological Association emphasizes clear instructions and appropriate use when evaluating response to an ED medicine. AUA guideline.
You do not have to keep repeating the same frustrating evening. Nor should you guess at a higher dose, take an extra tablet or add another ED medication. Give your prescriber a useful account of the problem and a chance to adjust the plan.
First, define what “not working” means
Did you notice no change at all? An erection that did not last? Side effects that made sex less appealing? Less worry about timing but the same problem with firmness?
These are different results. It is also worth separating erection difficulty from a loss of desire or difficulty reaching orgasm. A sexual-health assessment can address those as distinct concerns. NIDDK: ED diagnosis.
Write down the name and prescribed instructions, when you took it, what you noticed and any side effects. You do not need to document intimate details you are uncomfortable sharing. A short, factual description is a better starting point than “I must need something stronger.”
Check timing, food and the intended routine
Sildenafil is commonly taken about an hour before sex; a high-fat meal can delay absorption. If the evening involved a large dinner, a late tablet and an expectation of an immediate response, discuss that sequence. Sildenafil prescribing information.
Tadalafil has daily and as-needed schedules. The daily regimen reaches steady-state concentrations over several days, while the as-needed evidence includes a response window extending up to 36 hours. Neither describes an automatic erection. Taking a daily prescription only before sex is not following the same regimen. Tadalafil prescribing information.
Ask your prescriber how long and under what conditions to assess your actual prescription. The daily versus on-demand comparison explains the routines; the sildenafil versus tadalafil guide explains the differences between medicines.
Make room for arousal
These medicines support a response to stimulation. They do not require you to feel an erection while sitting around waiting for proof that the tablet has started working. They also do not create sexual desire. Sildenafil, tadalafil.
Consider whether the experience allowed the kind of touch, time and stimulation you enjoy. If attention kept returning to “is it working yet?”, say that. Our new-partner and performance-anxiety guide explores how to make that conversation less loaded.
If interest itself has changed, start with erections without desire. Adding more erection medication is not a substitute for understanding a different concern.
Revisit health changes and other medicines
An assessment may include your health history, an examination and testing when indicated. Bring changes in symptoms and medications, even if they do not seem connected to sex. NIDDK: evaluation.
Your prescriber may consider whether another medication contributes, whether counseling could help, or whether an underlying condition needs treatment. Do not stop a medicine for another condition yourself. NIDDK: treatment options.
Ask: “Have we checked the likely contributors, or only changed the prescription?” That is particularly useful if a treatment that previously helped no longer does.
More medication is not automatically the next answer
A follow-up can consider a different prescribed dose or routine, another medicine, a vacuum device, injections or other specialist options. The AUA supports discussing the benefits and burdens of the available treatments with the person receiving care. AUA guideline.
Do not self-combine sildenafil and tadalafil or layer extra doses onto a daily schedule. Tadalafil labeling warns against combinations with other PDE5 inhibitors or ED therapies whose combined safety and efficacy have not been established. Prescribing information.
Also check the source. An online seller’s familiar-looking package is not enough to establish legitimacy. FDA recommends checking for a prescription requirement, a licensed pharmacy and access to a pharmacist. FDA online-pharmacy guidance.
Know when to seek help promptly
Seek immediate medical attention for an erection lasting more than four hours, sudden loss of vision or sudden hearing changes. For chest pain, tell emergency clinicians the ED medicine and when you last took it; do not self-treat with nitroglycerin or another nitrate. Sildenafil prescribing information.
For the broader interaction review, read daily tadalafil safety.
Make the next appointment specific
Bring three things: what you used, what happened and what you want to improve. Ask what the next step is testing and when you should check back in. A planned reassessment is more useful than repeating an unsuccessful routine indefinitely.
If you are considering care through AnthologyRX, the plan details below are a starting point for comparing options. Include your previous treatment experience in the assessment so the clinician can take it into account.
Compare the plans at AnthologyRX
All fees are included in the listed plan price. Compare the amount billed and the commitment alongside the monthly equivalent. Compare all sexual-health plan prices, including compounded dissolving tablets.
Tadalafil 5mg Daily
A daily routine that separates taking a tablet from the occasion.
- Strength
- 5 mg
- Total plan quantity
- 90 tablets
- Billed amount
- $117 every 3 months
- Monthly equivalent
- $39 per month
- Commitment
- 3 months
- Monthly option
- $59 billed monthly · 30 tablets total plan quantity
- Fees
- Included in the plan price
Tadalafil 20mg On-Demand
An as-needed option with a longer response window.
- Strength
- 20 mg
- Total plan quantity
- 48 tablets
- Billed amount
- $87 every 3 months
- Monthly equivalent
- $29 per month
- Commitment
- 3 months
- Monthly option
- $49 billed monthly · 16 tablets total plan quantity
- Fees
- Included in the plan price
Sildenafil
An as-needed option taken ahead of sex.
- Billed amount
- $87 every 3 months
- Monthly equivalent
- $29 per month
- Commitment
- 3 months
- Monthly option
- $49 billed monthly
- 25 mg monthly plan
- $49 billed monthly · 10 tablets total plan quantity
- 25 mg quarterly plan
- $87 every 3 months · 30 tablets total plan quantity
- 50 mg monthly plan
- $49 billed monthly · 16 tablets total plan quantity
- 50 mg quarterly plan
- $87 every 3 months · 48 tablets total plan quantity
- Fees
- Included in the plan price
Start with the treatment page to review the plan, then complete the secure assessment. Your clinician reviews your health history and treatment request. Read how care works and the consultation, cancellation and refund policy before you begin.
