Best ED treatment options compared

There isn't one best ED treatment. There's the one that fits your health, your other medicines and the way you actually want sex to go.

At MintRx, the options fall into three groups: FDA-approved generic tablets you swallow, compounded troches that dissolve under your tongue, and Tri-Mix, a compounded injection for when tablets aren't enough. Here's what makes each different, and how to pick a sensible place to start.

ED means trouble getting or keeping an erection firm enough for sex. Blood flow, nerves, hormones, medicines and stress can all play a part. It's also a health signal: the American Urological Association advises that ED is a risk marker for underlying cardiovascular disease, and a large analysis of 25 studies linked ED with a higher risk of later heart and blood vessel events. Treating the erection is fine. It just shouldn't be the only thing that happens, especially if ED is new.

Three kinds of ED treatment, side by side

Compounded doesn't mean bad. It means a pharmacy prepared a formulation that FDA does not verify for safety, effectiveness or quality before it's sold, so results from approved tablets don't automatically carry over. A licensed provider decides whether any of these is right for you.

Sildenafil: the as-needed classic

Sildenafil is a PDE5 inhibitor. It strengthens the blood-flow response that happens with sexual stimulation; it doesn't create an erection on its own or raise desire. The label has you take it about an hour before sex, anywhere from 30 minutes to 4 hours ahead. Follow the timing on your own label.

The practical catch is food. In label studies, a high-fat meal delayed sildenafil's peak level by about an hour, so a big dinner can make it seem slow or unreliable. Common side effects include headache, flushing, indigestion, a stuffy nose and vision changes.

In a network analysis of 82 randomized trials, sildenafil 50 mg showed the greatest effectiveness of the starting doses studied, along with the highest overall rate of side effects. That's a fair summary: dependable, shorter acting, and a little more planning around meals. Ready to start? Here's how getting sildenafil online with a prescription works.

Tadalafil: a longer window, or a daily routine

Tadalafil is also a PDE5 inhibitor, with two different ways to use it. As needed, it improved erectile function for up to 36 hours after a dose in label studies. That's a window for responding to stimulation, not a 36-hour erection, and food doesn't affect how the tablets are absorbed. Daily tadalafil is a lower dose taken every day, so you aren't timing a tablet around sex; blood levels reach a steady state within about five days.

In the same network analysis, tadalafil 10 mg had intermediate effectiveness and the lowest overall side-effect rate. In one randomized crossover trial, 73% of men chose tadalafil over sildenafil when asked which to continue. Preference doesn't make it better for you, but it shows how much timing matters in real life.

One caution: five or more drinks with tadalafil can lower blood pressure and cause dizziness. That isn't a safe-drinking line, so tell your provider what you actually drink. Already on sildenafil? Read can you switch from sildenafil to tadalafil online.

Compounded troches: Mint Mojo, Mint Vibe and the tadalafil troche

A troche is a small medicine that dissolves under your tongue instead of being swallowed. Some people simply prefer that, and Mint Mojo and Mint Vibe combine ingredients that don't come together in any FDA-approved tablet. Dissolving under the tongue doesn't by itself prove faster or stronger results, so follow your label rather than tablet timing.

Mint Mojo combines tadalafil 20 mg with apomorphine 3 mg, which works on dopamine in the brain. In randomized trials, sublingual apomorphine on its own worked modestly better than placebo, and a small crossover trial found it less effective than sildenafil 50 mg. Those studies tested apomorphine alone, not this combination. The pharmacist detail worth knowing: never combine apomorphine with ondansetron or similar anti-nausea medicines, because the apomorphine label reports profound low blood pressure and loss of consciousness with that pairing. Mint Mojo is stored at room temperature.

Mint Vibe combines sildenafil 30 mg, tadalafil 10 mg and oxytocin 100 IU. It already contains two ED medicines, so never add a separate sildenafil or tadalafil tablet unless your prescriber tells you to; the tablet labels note that ED medicine combinations haven't been studied and may lower blood pressure further. Oxytocin is a separate ingredient, not a promise of more desire or a better erection. If you also use oxytocin nasal spray, tell your provider. Keep Mint Vibe refrigerated.

The tadalafil troche is a single-ingredient dissolvable for people who'd rather not swallow a tablet. Let it dissolve fully under your tongue, follow your label, and don't reuse tablet instructions.

Tri-Mix: when tablets aren't enough

Tri-Mix combines papaverine, phentolamine and alprostadil in a compounded injection given into the side of the penis. It works directly in erectile tissue, and the American Urological Association says men with ED should be told about injection therapy, including its benefits, risks and burdens.

Before deciding tablets have failed, check the basics. Was there sexual stimulation? Did a heavy meal slow sildenafil? Was it used as prescribed more than once? A timing problem is different from a treatment that was used correctly and still fell short.

Tri-Mix comes in different concentrations, and a syringe marking doesn't tell you the strength. Keep it refrigerated at 36 to 46°F, use an opened vial within 28 days, and never past the pharmacy-labeled beyond-use date.

Know your plan before your first injection. An erection lasting 4 hours is an emergency: go to the ER even if it doesn't hurt, and sooner if it's painful. If it isn't going down by about 3 hours, start the plan: call MintRx at 866-855-6468, know your nearest ER and line up a ride. Before you request it, read what to ask before requesting a Trimix prescription.

Safety that applies to every option

Anything containing sildenafil or tadalafil, which includes both tablets, Mint Mojo, Mint Vibe and the tadalafil troche, must not be taken with nitrates such as nitroglycerin, recreational 'poppers' or riociguat. The combination can drop blood pressure dangerously.

Tell your provider about heart disease, chest pain, blood pressure medicines, alpha blockers such as tamsulosin, kidney or liver problems, and every prescription, supplement and recreational substance you use. List combination products by their ingredients, not just their names.

Stop and get medical care right away for sudden vision loss or sudden hearing loss. If chest pain starts during or after sex, call emergency services, tell them which ED medicine you took and when, and don't take a nitrate on your own. Not sure something needs a call? Here's when to call the MintRx pharmacy team.

Erections and desire aren't the same problem

A medicine that helps erections doesn't necessarily fix low desire. Before choosing, name the actual concern: getting an erection, keeping it, desire, discomfort or anxiety around sex. That gives your provider a far better starting point than asking for the strongest option.

PT-141 sometimes gets mentioned alongside ED treatments, but it works on desire pathways in the brain rather than blood flow to the penis. If desire is the issue, start with whether compounded PT-141 injection is the same as Vyleesi, and who should discuss PT-141 nasal spray risks with a provider.

How to choose a starting point

• Want something familiar for planned occasions? Ask about sildenafil tablets.
• Want a longer window, or a daily routine so you aren't planning around a pill? Ask about tadalafil tablets.
• Prefer not to swallow a tablet, or curious about a combination? Ask about the troches.
• Used tablets correctly and still not getting enough? Ask about Tri-Mix.

Whatever you choose, bring your medication list, what you've tried, how you used it and what you want to be different. A licensed provider decides whether to prescribe. Your pharmacist helps you use it well after it arrives, from timing and food to side effects and refills. If you want to talk it through first, book a call with a MintRx pharmacist, and see what happens after you start treatment online.

FAQ

Written by Nathan Parker, PharmD

Sources

• Viagra (sildenafil) label, DailyMed
• Cialis (tadalafil) label, DailyMed
• Apomorphine injection label, DailyMed (cited for the anti-nausea interaction only)
• AUA Erectile Dysfunction Guideline
• AUA/SMSNA Acute Ischemic Priapism Guideline
• Chen et al., PDE5 inhibitor network meta-analysis, Eur Urol
• von Keitz et al., tadalafil vs sildenafil preference trial, Eur Urol
• Guillén et al., apomorphine for ED meta-analysis, Arch Sex Behav
• Pavone et al., sublingual apomorphine vs sildenafil, J Urol
• Zhao et al., ED and cardiovascular events meta-analysis, J Sex Med
• FDA, Compounding and the FDA: Questions and Answers

Compounded medicine disclosure

Mint Mojo, Mint Vibe, the tadalafil troche and Tri-Mix are compounded medicines. Compounded medicines are not FDA-approved, and FDA does not verify their safety, effectiveness or quality before they are marketed. Sildenafil and tadalafil tablets are FDA-approved generic medicines.