A Guide to Non-Prescription Erectile Dysfunction Products

6. Horny Goat Weed
Choosing the Right One for You
In the journals
What other drugs will affect sildenafil?
How to switch to a sildenafil citrate alternatives
2. Dehydroepiandrosterone (DHEA)
Key takeaways

A Double-Blind Crossover Study Evaluating the Efficacy of Korean Red Ginseng in Patients With Erectile Dysfunction: A Preliminary Report. The Journal of Urology, 168(5), 2070-2073. The effectiveness of zinc supplementation in men with isolated hypogonadotropic hypogonadism. Maca (L. meyenii) for improving sexual function: a systematic review. BMC Complementary and Alternative Medicine, 10, 44. Antidepressant-Like Behavioral, Anatomical, and Biochemical Effects of Petroleum Ether Extract from Maca (Lepidium meyenii) in Mice Exposed to Chronic Unpredictable Mild Stress. Safety and efficacy of daily Revactin® in men with erectile dysfunction: a 3-month pilot study. Translational Andrology and Urology, 7(2), 266-273. Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction. FDA warns consumers to avoid certain male enhancement and weight loss products sold through Amazon, eBay and other retailers due to hidden, potentially dangerous drug ingredients. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Intracavernosal sildenafil facilitates penile erection independent of the nitric oxide pathway. Iron and Physical Activity: Bioavailability Enhancers, Properties of Black Pepper (Bioperine®) and Potential Applications. Effect of phosphodiesterase 5 inhibitors on blood pressure. The Cochrane Database of Systematic Reviews, 2019(12). Ashwagandha as a Unique Cause of Thyrotoxicosis Presenting With Supraventricular Tachycardia.

Over-the-counter sildenafil is often produced by small supplement companies.
Check the expiration date before purchasing OTC sildenafil products.
Many OTC options are advertised as natural or herbal supplements.
Use OTC sildenafil responsibly to avoid adverse health effects.
Keep records of purchase and usage for future reference.

Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review. Advances in Nutrition, 12(3), 744-765. Role of Hydrogen Sulfide in the Physiology of Penile Erection.

Country	OTC Availability	Age Restrictions	Notes
UK	Yes	18+	'Viagra Connect' available OTC
USA	No	Prescription only	No OTC availability
Germany	Limited (Certain formulations)	18+	Some low-dose products available OTC
India	Yes	18+	Widely available OTC
Australia	No	Prescription-only	No OTC sales

Association between homocysteine, vitamin B12, folic acid and erectile dysfunction: a cross-sectional study in China. MacKay D., Verma S., & Srivastava S. (2022) Effect of a Polyherbal Dietary Supplement on Semen Characteristics: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? A Clinical Study Report VigRx Plus in Male Sexual Health. Effects of Traditional Chinese Medicine on Sperm Parameters with a Focus on DNA Fragmentation: A Literature Synthesis. Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia: systematic review of randomized controlled trials. Effect of Cordyceps militaris supplementation on sperm production, sperm motility and hormones in Sprague-Dawley rats.

6. Horny Goat Weed

The Journal of Sexual Medicine, 7(2 Pt 1), 743–750. Effects of Panax ginseng on glial cell-derived neurotrophic factor (GDNF) expression and spermatogenesis in rats. Phytotherapy Research: PTR, 25(2), 308–311. Niacin in the Central Nervous System: An Update of Biological Aspects and Clinical Applications. International Journal of Molecular Sciences, 20(4).

Can you take ED meds with diabetes?

Structure/function analyses of human sex hormone-binding globulin: effects of zinc on steroid-binding specificity. The Journal of Steroid Biochemistry and Molecular Biology 85(2-5):195-200. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. International Journal of Impotence Research, 19(6), 564–567. The American Journal of Chinese Medicine, 36(5), 849–859. The effect of Emblica officinalis diet on lifespan, sexual behavior, and fitness characters in Drosophila melanogaster. Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(3), 223–225. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies.

Consumers should avoid buying sildenafil OTC from unverified websites.
Some OTC sildenafil may be packaged as natural or herbal alternatives.
Over-the-counter availability depends on the country’s drug regulations.
OTC sildenafil is intended for occasional use, not daily therapy.
Keep track of dosage instructions even for OTC products.

Lifestyle modifications and erectile dysfunction: what can be expected? Penile traction therapy and Peyronie’s disease: a state of art review of the current literature. Therapeutic Advances in Urology, 5(1), 59-65. The effect of (L-)carnitine on weight loss sildenafil oral jelly 100mg in adults: a systematic review and meta-analysis of randomized controlled trials. Modulation of American ginseng on brainstem GABAergic effects in rats.

Product	Dosage	Quantity + Bonus	Price
Viagra Generic	150mg	360 + 10 Pills	423.48€ 403.31€
Viagra Generic	100mg	10 Pills	28.91€ 27.53€
Kamagra Polo	100mg	180 + 8 Pills	446.52€ 425.26€
Viagra Generic	200mg	270 + 10 Pills	379.76€ 361.68€
Viagra Generic	200mg	20 Pills	61.69€ 58.75€
Viagra Generic	200mg	90 + 6 Pills	170.79€ 162.66€
Kamagra	100mg	180 + 6 Pills	436.79€ 415.99€
Kamagra Oral Jelly	100mg	110 + 9 Sachets	334.87€ 318.92€
Viagra Generic	50mg	360 + 10 Pills	225.33€ 214.60€
Viagra Generic	150mg	90 + 6 Pills	147.18€ 140.17€
Kamagra Oral Jelly	100mg	63 + 7 Sachets	224.18€ 213.50€
Viagra Generic	150mg	20 Pills	55.02€ 52.40€
Viagra Generic	200mg	10 Pills	40.96€ 39.01€
Viagra Generic	25mg	180 + 6 Pills	154.93€ 147.55€

Journal of Ethnopharmacology, 62(3), 215–222.

Choosing the Right One for You

Role of homocysteine in the development of cardiovascular disease. The science of vacuum erectile device in penile rehabilitation after radical prostatectomy. Translational Andrology and Urology, 2(1), 61-66. Zinc status and serum testosterone levels of healthy adults. Nutrition (Burbank, Los Angeles County, Calif.), 12(5), 344–348.

Can I buy Viagra over the Counter?

Sperm quality in men is improved by supplementation with a combination of L-arginine, L-citrullin, roburins and Pycnogenol®. The Journal of Sexual Medicine, 16(2), 223–234. Erectile dysfunction (ED, or impotence) is a condition that causes men to be unable to acquire or maintain an erection. Treatment for erectile dysfunction is aimed at enabling a man to achieve and maintain an erection for sexual intercourse. Certain over-the-counter (OTC) supplements may help with erectile dysfunction, such as: Korean red ginseng (also called panax ginseng) Studies have shown improvements in erections Carnitine (propionyl-L-carnitine) May improve erectile dysfunctionAlso used to enhance the effectiveness of sildenafil (Viagra) Also used to enhance the effectiveness of sildenafil (Viagra) Dehydroepiandrosterone (DHEA) Declines in DHEA are associated with increased incidence of EDDHEA supplements are often promoted to improve sexual health, though more study is needed Declines in DHEA are associated with increased incidence of ED DHEA supplements are often promoted to improve sexual health, though more study is needed Tell your doctor before taking any over-the-counter supplement. Ginsenoside Rg1 improves male copulatory behavior via nitric oxide/cyclic guanosine monophosphate pathway.

Some OTC sildenafil products are marketed as "sexual enhancement" supplements.
Never use OTC sildenafil if you are taking medications containing nitrates.
Always read customer reviews for insight on effectiveness.
OTC sildenafil can be found in health stores or online marketplaces.
Make sure the product has proper certification or approval.

Age Group	Percentage of Users	Gender Distribution	Common Reasons for Use	Notable Comments
18-30	15%	Mostly male	Performance enhancement	Increasing online signals
31-50	45%	Predominantly male	Erectile dysfunction, confidence boost	Stable user base
51+	40%	Mostly male	Age-related ED	Growing acceptance of OTC products

The Journal of Steroid Biochemistry and Molecular Biology 85(2-5):195-200.

In the journals

Use caution with any product that claims to be a non-prescription “herbal Viagra.” Some of these products contain the actual drug, sildenafil, which should only be taken when prescribed by a doctor. They may also contain unlabeled ingredients that can cause serious side effects or interact with other medications you take. In addition to sildenafil (Viagra), medications used to treat erectile dysfunction include: Phosphodiesterase-5 inhibitors Tadalafil (Cialis)Vardenafil (Levitra)Avanafil (Stendra) Testosterone replacement therapy Used when man's testes do not produce sufficient amounts of the hormone testosteroneDoes not work to improve sexual function in men who produce normal amounts of testosterone Used when man's testes do not produce sufficient amounts of the hormone testosterone Does not work to improve sexual function in men who produce normal amounts of testosterone Lifestyle modifications to treat erectile dysfunction may include: Weight loss in men who are obese Talk to your doctor about using different medications to treat hypertension and pain Do not stop taking any prescribed medication without first talking to your doctor Do not stop taking any prescribed medication without first talking to your doctor Psychotherapy and psychoactive medications may be recommended for men who have erectile dysfunction due to depression and/or anxiety. Counseling with a sex therapist may be helpful for men with performance anxiety. Medical treatments used to treat erectile dysfunction may include: Penile self-injection A medication (alprostadil or papaverine) is self-injected into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection A medication (alprostadil or papaverine) is self-injected into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection Intraurethral alprostadil (MUSE) Uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection Uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection Vacuum-assisted erection devices Involves placing the penis into a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penisA rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect Involves placing the penis into a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penis A rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect Penile prostheses Surgically implanted devices that inflate to allow the penis to become erect Surgically implanted devices that inflate to allow the penis to become erect Limited blood flow to the penis Cigarette smokingObesityDiabetesHigh blood pressure (hypertension)AgingPrescription medications, such as antihypertensive medications Neurological causes DiabetesStrokeProstate surgery that damage nerves to the penisPelvic traumaSpinal cord or back injuryMultiple sclerosisDementiaPrevious episodes of prolonged erection (priapism) Prostate surgery that damage nerves to the penis Drugs that affect the nervous system or that lower testosterone levels or inhibit testosterone action NicotineAlcoholOpioidsBlood pressure medications, such as beta-blockersAntidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)SpironolactoneSympathetic blockers such as clonidine, guanethidine, or methyldopaThiazide diureticsKetoconazoleCimetidineRecreational drugs, such as cocaine and heroin Blood pressure medications, such as beta-blockers Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) Sympathetic blockers such as clonidine, guanethidine, or methyldopa Recreational drugs, such as cocaine and heroin Other risk factors Chronic kidney diseasePeripheral neuropathyAutonomic dysfunctionPeripheral vascular diseaseHypogonadismEndocrine disordersBicycling

Penile implants

Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. International Journal of Impotence Research, 19(6), 564–567.

What other drugs will affect sildenafil?

Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(3), 223–225. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Lifestyle modifications and erectile dysfunction: what can be expected? Penile traction therapy and Peyronie’s disease: a state of art review of the current literature.

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Therapeutic Advances in Urology, 5(1), 59-65. The effect of (L-)carnitine on weight loss sildenafil oral jelly 100mg in adults: a systematic review and meta-analysis of randomized controlled trials. Modulation of American ginseng on brainstem GABAergic effects in rats. Journal of Ethnopharmacology, 62(3), 215–222. Ginsenoside Rg1 improves male copulatory behavior via nitric oxide/cyclic guanosine monophosphate pathway. Role of homocysteine in the development of cardiovascular disease. The science of vacuum erectile device in penile rehabilitation after radical prostatectomy. Translational Andrology and Urology, 2(1), 61-66. Zinc status and serum testosterone levels of healthy adults.

How to switch to a sildenafil citrate alternatives

Epimedium extract

BMC Complementary and Alternative Medicine, 10, 44. Antidepressant-Like Behavioral, Anatomical, and Biochemical Effects of Petroleum Ether Extract from Maca (Lepidium meyenii) in Mice Exposed to Chronic Unpredictable Mild Stress. Safety and efficacy of daily Revactin® in men with erectile dysfunction: a 3-month pilot study. Translational Andrology and Urology, 7(2), 266-273. Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction. Nutrition (Burbank, Los Angeles County, Calif.), 12(5), 344–348. Sperm quality in men is improved by supplementation with a combination of L-arginine, L-citrullin, roburins and Pycnogenol®. The Journal of Sexual Medicine, 16(2), 223–234. Erectile dysfunction (ED, or impotence) is a condition that causes men to be unable to acquire or maintain an erection. Treatment for erectile dysfunction is aimed at enabling a man to achieve and maintain an erection for sexual intercourse. Certain over-the-counter (OTC) supplements may help with erectile dysfunction, such as: Korean red ginseng (also called panax ginseng) Studies have shown improvements in erections Carnitine (propionyl-L-carnitine) May improve erectile dysfunctionAlso used to enhance the effectiveness of sildenafil (Viagra) Also used to enhance the effectiveness of sildenafil (Viagra) Dehydroepiandrosterone (DHEA) Declines in DHEA are associated with increased incidence of EDDHEA supplements are often promoted to improve sexual health, though more study is needed Declines in DHEA are associated with increased incidence of ED DHEA supplements are often promoted to improve sexual health, though more study is needed Tell your doctor before taking any over-the-counter supplement. Use caution with any product that claims to be a non-prescription “herbal Viagra.” Some of these products contain the actual drug, sildenafil, which should only be taken when prescribed by a doctor.

2. Dehydroepiandrosterone (DHEA)

FDA warns consumers to avoid certain male enhancement and weight loss products sold through Amazon, eBay and other retailers due to hidden, potentially dangerous drug ingredients. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Intracavernosal sildenafil facilitates penile erection independent of the nitric oxide pathway. Iron and Physical Activity: Bioavailability Enhancers, Properties of Black Pepper (Bioperine®) and Potential Applications. Effect of phosphodiesterase 5 inhibitors on blood pressure.

What is Viagra (Sildenafil Citrate)?

The Cochrane Database of Systematic Reviews, 2019(12). Ashwagandha as a Unique Cause of Thyrotoxicosis Presenting With Supraventricular Tachycardia. Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review. Advances in Nutrition, 12(3), 744-765. Role of Hydrogen Sulfide in the Physiology of Penile Erection. They may also contain unlabeled ingredients that can cause serious side effects or interact with other medications you take. In addition to sildenafil (Viagra), medications used to treat erectile dysfunction include: Phosphodiesterase-5 inhibitors Tadalafil (Cialis)Vardenafil (Levitra)Avanafil (Stendra) Testosterone replacement therapy Used when man's testes do not produce sufficient amounts of the hormone testosteroneDoes not work to improve sexual function in men who produce normal amounts of testosterone Used when man's testes do not produce sufficient amounts of the hormone testosterone Does not work to improve sexual function in men who produce normal amounts of testosterone Lifestyle modifications to treat erectile dysfunction may include: Weight loss in men who are obese Talk to your doctor about using different medications to treat hypertension and pain Do not stop taking any prescribed medication without first talking to your doctor Do not stop taking any prescribed medication without first talking to your doctor Psychotherapy and psychoactive medications may be recommended for men who have erectile dysfunction due to depression and/or anxiety. Counseling with a sex therapist may be helpful for men with performance anxiety.

Key takeaways

Potentially harmful side effects

Effects of Traditional Chinese Medicine on Sperm Parameters with a Focus on DNA Fragmentation: A Literature Synthesis. Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia: systematic review of randomized controlled trials. Effect of Cordyceps militaris supplementation on sperm production, sperm motility and hormones in Sprague-Dawley rats. The American Journal of Chinese Medicine, 36(5), 849–859. The effect of Emblica officinalis diet on lifespan, sexual behavior, and fitness characters in Drosophila melanogaster. Medical treatments used to treat erectile dysfunction may include: Penile self-injection A medication (alprostadil or papaverine) is self-injected into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection A medication (alprostadil or papaverine) is self-injected into the two chambers of the penis that are filled with spongy tissue and blood (corpora cavernosa) to cause an erection by allowing the blood vessels within the penis to expand so the penis swells and stiffens to create a fully rigid erection Intraurethral alprostadil (MUSE) Uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection Uses the same medication (alprostadil) as penile self-injection but instead a man inserts a device with an alprostadil pellet (suppository) into the urethra to create an erection Vacuum-assisted erection devices Involves placing the penis into a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penisA rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect Involves placing the penis into a plastic cylinder and creating a vacuum around the penis to increase blood flow into the penis A rigid ring is placed at the base of the penis to hold the blood inside the penis, keeping it erect Penile prostheses Surgically implanted devices that inflate to allow the penis to become erect Surgically implanted devices that inflate to allow the penis to become erect Limited blood flow to the penis Cigarette smokingObesityDiabetesHigh blood pressure (hypertension)AgingPrescription medications, such as antihypertensive medications Neurological causes DiabetesStrokeProstate surgery that damage nerves to the penisPelvic traumaSpinal cord or back injuryMultiple sclerosisDementiaPrevious episodes of prolonged erection (priapism) Prostate surgery that damage nerves to the penis Drugs that affect the nervous system or that lower testosterone levels or inhibit testosterone action NicotineAlcoholOpioidsBlood pressure medications, such as beta-blockersAntidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)SpironolactoneSympathetic blockers such as clonidine, guanethidine, or methyldopaThiazide diureticsKetoconazoleCimetidineRecreational drugs, such as cocaine and heroin Blood pressure medications, such as beta-blockers Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) Sympathetic blockers such as clonidine, guanethidine, or methyldopa Recreational drugs, such as cocaine and heroin Other risk factors Chronic kidney diseasePeripheral neuropathyAutonomic dysfunctionPeripheral vascular diseaseHypogonadismEndocrine disordersBicycling