When your ED medicine is not helping.

Start with what actually happened

Write down the medicine and strength you were prescribed, when you used it, what the instructions said, and what happened. Note side effects, meals, alcohol, stress, and any changes in other medicines. Keep these notes for your clinician rather than posting identifying medical information online.

Describe the goal that was missed: getting an erection, keeping it, comfort, or confidence. A precise description is more useful than simply “it failed.”

Check the instructions and expectations

PDE5 inhibitors support erections with sexual stimulation; they do not automatically create desire. Food can delay the onset of sildenafil, and treatment schedules differ between medicines. Your clinician or pharmacist can check whether you understood the instructions for your actual product.

Do not borrow timing directions from a different brand, dosage form, or compounded blend. Our sildenafil and tadalafil comparison explains some general differences, but it cannot replace your prescription label.

The follow-up may revisit the cause

Erection difficulties can involve blood vessels, nerves, hormones, medicines, emotions, or several factors together. Your clinician may reconsider the diagnosis, recommend an examination or tests, review medicines, or discuss counseling and other treatment options.

This does not mean you did anything wrong. A treatment trial is part of a conversation about what helps and what does not. NIDDK describes the elements of an ED evaluation.

Avoid the do-it-yourself “upgrade”

Do not take more than prescribed, take doses closer together, or add a second ED medicine to force a response. Tadalafil labeling advises against combining it with other PDE5 inhibitors. More ingredients do not establish a better result and can create overlapping risks.

A prescriber can discuss whether a different approved medicine, a different approach, or specialist assessment is appropriate. If a compounded combination is proposed, ask what evidence supports it for your situation and how it compares with alternatives.

There are other options to discuss

Depending on the cause and your preferences, care may involve counseling, a vacuum erection device, locally administered medication, or other approaches. See our overview of treatment beyond pills to learn the vocabulary before your appointment.

For an erection lasting longer than four hours, chest pain, or severe symptoms, seek urgent medical care. A routine follow-up is not the right place to wait out an emergency.

Keep reading

• What is an ED oral suspension?
• Your first ED visit, made less awkward.
• The safety conversation comes first.

Browse ED product reviews or compare CoreAge Rx, Ro, Hims, BlueChew, and Rugiet Ready.