Counseling patients on ED treatment

In this article:

• ED treatment
• Common questions
• Natural treatments
• When to see a provider

In this article

• ED treatment
• Common questions
• Natural treatments
• When to see a provider

For many men, erectile dysfunction (ED) can be a sensitive topic that doesn’t get enough attention. However, with ED drugs like sildenafil and tadalafil among the most prescribed drugs in 2025, there’s no doubt that more patients are seeking ED treatments.

Since many men may feel uncomfortable discussing treatment with their healthcare provider, they might instead turn to pharmacists. Pharmacists might even become their main point of contact, especially when it comes to instructions for use, side effects, over-the-counter (OTC) products, and potential drug interactions.  

The current state of ED treatments

Erectile dysfunction is one of the most common health problems that men face. In the United States, around 24% of men have an ED diagnosis, with the prevalence increasing with age. Severe cases affect around 5% of younger men but jump to 15% as they get older. About 52% of men older than 40 live with mild to moderate ED. 

ED is often caused by an underlying issue such as heart disease, diabetes, obesity, or metabolic syndrome. However, for many men, mental health problems like depression, anxiety, and stress can also be a key cause of ED. While ED is usually a symptom of a condition, it may also be a warning sign of more serious problems.

Many patients take medication as a first-line option. Vacuum pumps, direct penile injections, and penile implants are potential treatments, but most men with ED first try oral PDE5 inhibitors alongside lifestyle changes. 

Common questions about ED treatment

Patients on ED medications sometimes have questions about timing, food, or drug interactions, and potential side effects. It’s usually convenient for patients to ask these questions while picking up their medication rather than waiting to see their healthcare provider.

How long does my medication take to work?

The amount of time it takes for ED medication to work will depend on the drug. Sildenafil and vardenafil usually start working within 30 to 60 minutes, while avanafil can start working in as little as 15 minutes. Tadalafil starts working within 30 minutes but can take up to two hours to reach its full effect. However, tadalafil is one of the longest-lasting options, with potential effects lasting up to 36 hours. 

Do I need to take it with food?

This is a common question patients might ask when planning a date night or a special occasion with their partner. Patients should know that food can seriously affect how well oral ED drugs are absorbed. For example, eating a high-fat meal with sildenafil or vardenafil can delay absorption and reduce the drug’s effectiveness. Avanafil is more flexible with food, although heavy, high-fat meals could still delay the onset of effects. Tadalafil isn’t affected by food and can be taken with or without meals. 

Can I drink alcohol with this?

Alcohol doesn’t directly interact with PDE5 inhibitors. Drinking in moderation, which means no more than two drinks per day for men, is usually fine. Heavy drinking is a different story, since doing so could increase the risk of low blood pressure and cause symptoms like dizziness and chest pain. For many men, alcohol also makes it harder to get an erection on its own, which can counteract the medication. 

Do I take it right before sex or earlier?

The answer to this question will depend on what the patient is taking, as some drugs work faster than others. For example, avanafil is a fast-acting option that can be taken 15 to 30 minutes before sex. For sildenafil, most patients find that 30 minutes to an hour before sexual activity works best. Tadalafil has the most flexibility, with patients being able to take it anywhere from 30 minutes to several hours before sex. Some patients are on a daily low dose, so they don’t need to time it.

Is this medication safe with my blood pressure medications?

This is one of the most important questions to answer when using ED medication safely. ED medications are not safe with nitrates, such as nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate. Patients should be aware that combining PDE5 inhibitors with nitrates can cause hypotension. Patients taking alpha blockers for blood pressure or prostate problems may also need to be careful for the same reason. Regular blood pressure medications, such as ACE inhibitors or calcium channel blockers, are usually safe with ED medications when taken as prescribed.

Why did it work once but not another time?

ED medications might not work the same every time due to different factors like diet, alcohol consumption, or stress. For example, heavy meals or taking the dose too early or too late can reduce the drug’s effectiveness. If problems with effectiveness keep happening, it’s best for the patient to consult their healthcare provider rather than changing their dosage or treatment on their own. 

These are only some of the questions you might encounter at the pharmacy. No matter the concern, it’s important to listen and be there for patients, especially when they might look up to pharmacists for their opinion. 

Advising on OTC and “natural” ED products in the pharmacy

Because awareness about ED is increasing and the stigma around treatment is getting better, patients may be considering nonprescription products to help treat their ED. Pharmacies now stock different OTC and natural products with claims that they improve ED by boosting testosterone or enhancing performance in the bedroom.

While some patients may report benefits, these supplements are not approved by the FDA to treat ED. They’re also usually supported by small-scale studies or lack any research on benefits, and they may even come with risks of side effects or drug interactions.

OTC medicines and dietary supplements can be enticing for some men who prefer natural options over prescription medication. However, as a pharmacist, it’s sometimes difficult to navigate these conversations since the effectiveness and safety of these products can vary.

In any case, prescription ED medications are still the most reliable treatment option with proven benefits and clear safety risks. If patients want to go the route of natural supplements, pharmacists can first recommend lifestyle changes, such as regular exercise, a nutritious diet, avoiding smoking and alcohol, and managing stress. These strategies can help support overall health, including erectile function, without the risks that come with unregulated supplements. 

When to suggest seeing a provider

While pharmacists can help counsel patients on ED medication uses and side effects, some things need to be further discussed with their prescribing provider. Patients should see their provider if their medication is no longer working for them, or if they’re experiencing new or worsening problems.

For example, patients should see their healthcare provider if they experience:

• Sudden erectile dysfunction that comes on quickly
• Pain during erections
• Erections lasting longer than four hours (priapism)
• A loss of morning erections

Since ED can also indicate deeper underlying health problems, patients may also need to consult their healthcare provider if they experience the following alongside ED:

• Chest pain or heart symptoms
• Uncontrolled high blood sugar levels
• High blood pressure
• Shortness of breath with any kind of activity
• Numbness or tingling in the hands or feet
• Pain or trouble urinating

Most men look for reassurance when ED treatment doesn’t go as expected. In addition to guiding patients on dosages and side effects, pharmacists can recommend a doctor’s visit to help rule out underlying conditions.