Short answer: the tablets that work the same way as Viagra (sildenafil) are tadalafil, taken when needed or as a lower dose once a day, vardenafil and avanafil: the NHS calls all four PDE5 inhibitors. These tablets only work with sexual stimulation. Two tablets are pharmacy medicines, which a pharmacy can supply after a pharmacist consultation without a prescription: Viagra Connect, which is sildenafil 50mg, and Cialis Together, which is tadalafil 10mg (MHRA). Treatments that are not tablets include Eroxon, a gel sold without a prescription as a medical device rather than a medicine; two prescription medicines, alprostadil cream (Vitaros) and alprostadil injections, which a doctor or a specialist clinic starts; vacuum pumps; psychosexual therapy; and, when other treatments have failed, a penile implant (nhs.uk, the British Association of Urological Surgeons and the Vitaros product information, section 4.1). We supply tablets, not gels, creams, injections or pumps.
This guide sets out what the NHS, the British Association of Urological Surgeons (BAUS), the MHRA and each product's UK information say about each option, as of October 2026, and does not rank them: which suits you depends on your health, your other medicines and what you have tried. See all our erectile dysfunction treatments.
What are the alternatives to Viagra?
The alternatives to Viagra are the other tablets that work the same way, two of them pharmacy medicines, and treatments that are not tablets: a gel, a prescription cream, injections, a pellet placed in the tip of the penis, vacuum pumps, talking therapy, treatment for the cause and, when nothing else has worked, an implant.
| Option | What it is | How you get it in the UK |
|---|---|---|
| Tadalafil, vardenafil or avanafil | Tablets that work the same way as sildenafil (PDE5 inhibitors). Tadalafil can also be taken once a day. | On prescription from a GP or sexual health clinic (nhs.uk), or from us after a consultation reviewed by a GPhC-registered pharmacist |
| Viagra Connect or Cialis Together | Branded sildenafil 50mg or tadalafil 10mg, pharmacy medicines | From a pharmacy after a pharmacist consultation, with no prescription (MHRA). We supply both to men aged 18 to 64. |
| Gel (Eroxon) | A gel rubbed onto the head of the penis just before sex: a medical device, not a medicine | Sold without a prescription (its maker). We do not supply it. |
| Cream (alprostadil, Vitaros) | A prescription medicine put into the opening at the tip of the penis 5 to 30 minutes before sex | On prescription from a doctor, who recommends the starting dose; a healthcare professional shows you how to use it (Vitaros product information) |
| Injections (alprostadil) | An injection into the side of the penis, which you are taught to give yourself | From a specialist erectile dysfunction clinic, usually after a GP referral (BAUS) |
| Urethral pellet (MUSE) | A small pellet of alprostadil placed into the tip of the penis with an applicator | From a specialist clinic, where available (BAUS). We found no current UK product information for it. |
| Vacuum pump | A cylinder and pump that draw blood into the penis, with a ring at the base to keep the erection | On the NHS for some men; most buy their own, after advice from a doctor or specialist nurse (nhs.uk, BAUS) |
| Psychosexual or sex therapy | Talking therapy, when erection problems are linked to emotional or mental health problems | Through the NHS, where there can be a long wait, or privately from a member of the College of Sexual and Relationship Therapists or the Institute of Psychosexual Medicine (nhs.uk) |
| Treating the cause | Lifestyle changes, treatment for high blood pressure, high cholesterol or a hormone problem, or a change of medicine | Your GP (nhs.uk, BAUS) |
| Penile implant | A device placed inside the penis in an operation, to make it firm enough for sex | A specialist urologist, when other treatments have not worked (BAUS) |
The usual order, as BAUS sets it out
The British Association of Urological Surgeons describes the order in which the options are usually tried:
Look for a cause. A GP asks about your health, lifestyle and relationships, examines you and arranges routine blood tests: BAUS says these together find most treatable causes. Lifestyle changes, treatment for any cause and, if needed, psychosexual support come in here.
Tablets. If no treatable cause is found, BAUS says tablets are the usual starting treatment for most men: a PDE5 inhibitor such as sildenafil or tadalafil. Your GP then checks how they are working.
A specialist clinic. If tablets do not work, cause side effects or cannot be used, a GP can refer you to an erectile dysfunction clinic, which BAUS says can offer injections into the penis, a small pellet placed in the tip of the penis (MUSE) and vacuum pumps.
An implant. BAUS describes a penile implant as an end stage solution when all other treatment options have failed.
Which other tablets work like Viagra?
Three other medicines work the same way as sildenafil, the medicine in Viagra: tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). The NHS calls these four PDE5 inhibitors, medicines that increase blood flow to the penis, the main treatments for erectile dysfunction. These tablets only work with sexual stimulation. They differ mainly in when you take them before sex, how long the effect can last, and that tadalafil can also be taken once a day. How Viagra works explains the action they share.
Tadalafil, taken when needed
Tadalafil is the medicine in Cialis; taken when needed, it is a 10mg or 20mg tablet. Take it at least 30 minutes before sex. It takes about 30 to 45 minutes to work, and its effect can last more than 24 hours. Take one tablet no more than twice a week, and never more than once in 24 hours. Tadalafil is not affected by food. More on timing in how long tadalafil lasts.
Daily tadalafil
Daily tadalafil is a lower dose, 2.5mg or 5mg, taken every day whether or not you plan to have sex that day. It is for men who expect to have sex at least twice a week. Take one tablet a day, at about the same time each day. The available data does not suggest that taking it every day works better than taking tadalafil when needed. We supply tadalafil for erectile dysfunction only. If you have urinary symptoms, please see your GP.
Vardenafil
Vardenafil is the medicine in Levitra, and comes as 5mg, 10mg or 20mg tablets. Take it 25 to 60 minutes before sex. It takes about 30 minutes to work. Never take more than one tablet in 24 hours. A heavy or high-fat meal can delay how quickly it works.
Avanafil
Avanafil is the medicine in Spedra, and comes as 50mg, 100mg or 200mg tablets. Take the 100mg or 200mg tablet 15 to 30 minutes before sex, or the 50mg tablet about 30 minutes before. The 100mg and 200mg tablets can work in about 15 minutes. It lasts about 6 hours. Never take more than one tablet in 24 hours. A heavy or high-fat meal can delay how quickly it works. Avanafil has not been compared directly with other ED tablets for how quickly it works.
In our consultation: Avanafil needs a blood pressure reading below 170/100. You can choose another treatment, or have your blood pressure checked and come back. If you take erythromycin, aprepitant, diltiazem, fluconazole or verapamil, a stricter limit applies. Take no more than one avanafil tablet in 48 hours.
Do not take two erectile dysfunction medicines together. For a side-by-side look at when to take each one, food, side effects and who should not take them, see sildenafil vs tadalafil.
Not sure which suits you? Answer a few questions about your health and the medicines you take. A GPhC-registered pharmacist reviews every consultation, and if they cannot approve your order, we refund you in full.
Start your consultationCan you get an alternative to Viagra without a prescription?
Yes: Cialis Together, which contains tadalafil 10mg, is a pharmacy medicine, so a pharmacy can supply it after a pharmacist consultation, with no prescription (MHRA, 14 March 2023). The MHRA made Viagra Connect a pharmacy medicine in November 2017, but it contains sildenafil 50mg, the same active ingredient as prescription Viagra, so it is another way to get sildenafil rather than a different medicine (MHRA, 28 November 2017). How the two compare is in Viagra Connect vs prescription sildenafil.
We supply Viagra Connect® and Cialis Together® after a pharmacist consultation: a pharmacy checklist that our pharmacist reviews before your order is sent, for men aged 18 to 64 with erection problems. The MHRA said neither would be sold to men with severe heart or blood vessel disease or a high risk of it, severe kidney failure, liver failure (for Cialis Together, severe liver failure), or who take certain medicines that interact with them, and that those men must stay under a doctor's supervision. Erection problems can be an early sign of heart disease, diabetes or high blood pressure. If you use Viagra Connect, book a check-up with your GP as soon as you can, within 6 months of starting it. Cialis Together's product information gives the same advice (section 4.4). Less common side effects are listed in the leaflet in your pack. Please read it before your first dose.
What is the new gel for erectile dysfunction?
Eroxon is a gel for erectile dysfunction sold without a prescription. It is a class II medical device, not a medicine: its maker says it has no active ingredient, and that its cooling and then warming effect on the head of the penis stimulates blood flow in the penis (Eroxon's instructions for use, section 1, and its website). It is for men aged 18 and over with erectile dysfunction, and it does not work without sexual arousal.
How it is used, from its instructions (section 3): squeeze the whole of one single-dose tube, about a pea-sized amount, onto the head of the penis just before sex, and massage it in for about 15 seconds. You or your partner can apply it. If you are not circumcised, pull the foreskin back before applying it.
Its instructions say not to use it if you are allergic to any of its ingredients, a doctor has told you to avoid sex, you have any disease or deformity of the penis, such as Peyronie's disease, or the skin of your penis is red, sore, damaged or broken (section 2). Sex puts extra strain on the heart, so if you have a heart problem, or think you might, its instructions say to speak to your doctor. They also say to tell your doctor before using it if you have ever had an erection that lasted more than 4 hours, or have a condition that can cause one, such as sickle cell anaemia (section 2). Rarely, it can irritate the skin, with burning, itching or soreness: stop using it if this happens to you or your partner (section 4). It is compatible with latex condoms, not other types, is not a contraceptive and does not protect against sexually transmitted infections. Its instructions also advise a check-up with your doctor within 6 months of starting it, because erection problems can be an early sign of conditions such as heart disease, diabetes or high blood pressure.
Its instructions say nothing about using it with erectile dysfunction tablets, and the tablets' product information says combining them with other treatments for erectile dysfunction has not been studied: tadalafil's, for example, says men should be told not to take it in such combinations (Cialis SmPC, section 4.4). We do not supply Eroxon; a pharmacist can advise you about it.
Do erectile dysfunction creams work?
Alprostadil cream (Vitaros) is a prescription medicine licensed in the UK to treat erectile dysfunction in men aged 18 and over, and its product information reports that in its two main trials it improved scores on an erectile function questionnaire, and success with penetration, more than a dummy cream (placebo) did (Vitaros SmPC, sections 4.1 and 5.1). Individual results vary, and a doctor decides whether it suits you. Alprostadil widens the blood vessels in the erectile tissue of the penis, so more blood flows in (section 5.1).
How the cream is used
A doctor recommends the starting dose, and a healthcare professional shows you how to use it before you use it yourself. You put the cream from one single-use container into the opening at the tip of the penis, without putting the container inside, 5 to 30 minutes before sex, then hold the penis upright for about 30 seconds. Its effect lasts about 1 to 2 hours. Use it no more than 2 or 3 times a week, and no more than once in 24 hours (section 4.2).
Side effects and cautions
Common side effects include burning, pain or redness of the penis, pain in the urethra (the tube urine passes through) and a rash, and a partner can get vaginal burning or irritation (section 4.8). Dizziness and fainting have been reported, so do not drive or do anything hazardous in the 1 to 2 hours after using it (sections 4.4 and 4.7). Rarely, an erection lasts more than 4 hours: get medical help straight away if it does (section 4.4).
Use a condom with a partner who could become pregnant, or who is pregnant or breastfeeding; the cream does not protect against sexually transmitted infections (sections 4.3 and 4.4). It should not be used with tablets such as sildenafil or tadalafil (section 4.5), or by men who have had a heart attack, who faint or get low blood pressure on standing, who have an unstable heart condition or an unstable condition of the blood vessels in the brain, a curved or misshapen penis or an inflamed penis or urethra, or a condition that makes a prolonged erection more likely, such as sickle cell anaemia (section 4.3). We do not supply it: ask your GP.
How do injections for erectile dysfunction work?
An injection of alprostadil into the side of the penis is thought to relax the muscle in its erectile tissue, so blood flows in and an erection follows (Caverject SmPC, section 5.1); BAUS says it can take up to 15 minutes to work fully. Injections are a prescription medicine, started at a specialist erectile dysfunction clinic, usually after a GP referral (BAUS).
A doctor works out your dose step by step, so that the erection lasts no longer than about an hour. Medically trained staff give the injection to begin with, and you are then taught to inject yourself at home (Caverject SmPC, section 4.2; BAUS). Use them no more than once a day and no more than three times a week (section 4.2).
Almost everyone feels some discomfort when injecting, and bruising is common. Pain in the penis is the most frequent side effect, and repeated injections into the same place can leave scarring that makes the penis bend (BAUS; SmPC, sections 4.4 and 4.8). Injections are not suitable with a curved penis or Peyronie's disease, a penile implant, or a condition that makes a prolonged erection more likely, such as sickle cell anaemia, and they should not be used with other treatments for erectile dysfunction, such as sildenafil (sections 4.3 and 4.5). Tell the clinic if you take a blood thinner (BAUS; SmPC, section 4.4).
If an erection lasts more than 4 hours, go to your nearest emergency department straight away and tell them which injection you have had (BAUS).
What is the urethral pellet (MUSE)?
BAUS describes MUSE as a small pellet of prostaglandin (alprostadil) placed into the tip of the urethra, the opening at the tip of the penis, with an applicator. Once the penis is massaged, the medicine is released and helps blood flow in. Some men feel mild burning afterwards, and BAUS describes it as an option for men who would rather not inject. We could not find current UK product information for MUSE (electronic medicines compendium, searched October 2026), so ask the clinic whether it is available.
How does a vacuum pump for erectile dysfunction work?
A vacuum pump draws blood into the penis: you put your penis into a plastic cylinder and pump the air out, and the vacuum fills the penis with blood. You then slide a ring onto the base of the penis to keep the blood in, release the vacuum and take the cylinder off. It takes a few minutes (BAUS).
Never leave the ring on for longer than 30 minutes, because this can cause damage. BAUS describes the side effects as minor: discolouration or bruising, the penis feeling cold or less stable than a natural erection, and some discomfort from the ring, which also stops semen coming out at orgasm; the semen goes back into the bladder and is passed with urine, which does no harm. Tell your doctor if you take a blood thinner or have a blood clotting problem, as a pump may not be suitable.
Some men can have a pump on an NHS prescription, for example men with diabetes, multiple sclerosis or Parkinson's disease, or after surgery or other treatment for prostate cancer; most buy their own. A clinic usually arranges for a specialist nurse or a representative to show you how one works (BAUS), and the NHS advises speaking to a doctor about where to get one. We do not supply them.
Can therapy or exercises help erectile dysfunction?
Yes: when erection problems are linked to emotional or mental health problems, counselling and therapy can help, the NHS says, and healthy lifestyle changes can sometimes help too. A GP can help decide whether psychosexual counselling might help you (BAUS), and the NHS notes there can be a long wait for it.
You can also pay to see a therapist privately. The NHS says sex therapists should be members of the College of Sexual and Relationship Therapists (COSRT) or the Institute of Psychosexual Medicine, and that Relate offers sex therapy for a fee. The COSRT website lets you search for a registered therapist by location or by name.
Losing weight, stopping smoking, drinking less alcohol and exercising can all help. If you cycle more than 3 hours a week, try a break from cycling. Neither the NHS page nor the BAUS page on erectile dysfunction sets out pelvic floor or other specific exercises for erections. The causes, and the checks a GP does, are in what is erectile dysfunction.
Is surgery or shockwave therapy used for erectile dysfunction?
Surgery, usually a penile implant, is for men whose erection problems have not responded to other treatments, and shockwave therapy is not among the treatments the NHS or BAUS pages describe for erectile dysfunction. BAUS says implants are fitted by a small number of surgeons in a limited number of centres, and advises discussing every alternative with a urologist before choosing one.
From the BAUS leaflet on implants: an implant is either two bendable rods that keep the penis firm, or an inflatable device with a small pump in the scrotum that fills cylinders in the penis. It lies inside the body, so it can be felt but not seen, and it does not change your sex drive, feeling or orgasm. It does not make the penis longer or wider in the way a natural erection does. It cannot be undone: removing an implant leaves permanent erectile dysfunction. An implant typically lasts 10 to 15 years before it may need replacing.
BAUS also describes surgery on the arteries, or an angioplasty, for men whose erection problems come from a blocked artery to the pelvis or penis, which usually follows an injury to the pelvis.
Shockwave therapy: when we searched NICE's website on 24 October 2026 we found no NICE guidance on it for erectile dysfunction. If you are thinking about it, ask your GP or a urologist before you go ahead.
Is it safe to buy erectile dysfunction tablets online?
Use a UK-registered pharmacy, the MHRA advises, and never social media, messaging apps or unknown websites. It warns that erectile dysfunction medicines sold that way may contain no active ingredient, the wrong dose, hidden drugs or toxic ingredients, and can be especially dangerous for people with heart disease or high blood pressure, or who take other medicines (MHRA, 13 February 2026).
The MHRA's Criminal Enforcement Unit seized about 19.5 million doses of unlicensed erectile dysfunction medicines from 2021 to 2025. It also advises checking an online pharmacy on the General Pharmaceutical Council's register, speaking to a GP or pharmacist about treatment, and reporting suspicious medicines or websites through the Yellow Card scheme.
QuickCare Pharmacy, the registered pharmacy that dispenses Solira orders, is on that register (GPhC 9013213). See how to check your medicine is genuine. Do not use unlicensed herbal remedies for erections, and do not stop any prescribed medicine unless your doctor tells you to.
What if Viagra or other tablets have not worked?
Try a tablet 4 to 8 times before deciding it does not work, then tell us. When you reorder, we ask how your last tablets worked and whether you had any side effects. If your dose did not work well enough and caused no side effects, the pharmacist can consider the next strength up. If a medicine has not worked after 4 to 8 tries at the highest dose that suits you, your pharmacist may suggest trying a different one. Viagra not working goes through the common reasons.
Our consultation does not supply another tablet if you have already tried the maximum dose of two different erectile dysfunction medicines without success. Please see your GP, who can look for a cause such as low testosterone and may refer you to a specialist. A medicine you take can be the cause too (nhs.uk): see medicines that can cause erectile dysfunction. A specialist clinic can then talk you through injections, vacuum pumps and the other options above (BAUS).