Can you get Viagra over the counter? Here’s what to know

In this article:

• Can you get OTC Viagra?
• Prescription Viagra alternatives
• OTC Viagra substitutes

In this article

• Can you get OTC Viagra?
• Prescription Viagra alternatives
• OTC Viagra substitutes

Sildenafil citrate, brand name Viagra, is a pill usually prescribed for erectile dysfunction (ED). It belongs to the drug class phosphodiesterase-5 (PDE-5) inhibitors which work by relaxing vascular smooth muscle and increasing blood flow in the penis to cause erection.

Viagra is a prescription medication, but there are over-the-counter alternatives in use, such as L-arginine, dehydroepiandrosterone, ginseng, and propionyl-l-carnitine supplements, which will be discussed below.

Can you get Viagra over the counter?

No, you cannot purchase Viagra over the counter; it is only available with a prescription. This is due to the risk of adverse effects, as well as the risk of abuse and misuse, as people often use Viagra for recreational purposes.

People who use Viagra recreationally are likely to mix it with illegal substances such as marijuana, ecstasy, methamphetamines, cocaine, and even alkyl nitrites—the combination of Viagra and alkyl nitrites is associated with fatal cardiovascular problems. Recreational Viagra is also a risk factor for priapism (erection lasting over 4 hours). Without immediate medical attention, priapism can cause permanent damage to penile tissue.

Because of these reasons, you cannot get Viagra without consulting your healthcare provider. However, there are some over-the-counter (OTC) supplements marketed as “Viagra alternatives,” but they are not similar to Viagra in efficacy and safety. 

Prescription Viagra alternatives

Viagra can be a safe and effective treatment when not improperly used, but it is not always the best option. While OTC supplements may not have proven efficacy and safety, Viagra alternatives also include prescription medications, which are United States Food and Drug Administration (FDA)-approved for ED. They are not sold over the counter; you need a consultation with your healthcare provider to get them. “Generally, all of the prescription alternatives to Viagra can be effective, but individual response, side effect profile, and personal preference often guide the best choice,” Dr. Carter says.

Prescription alternatives to Viagra include: 

Cialis

“On account of its longer duration (36 hours), Cialis can also be taken daily in a low-dose form for continuous effect. I often prescribe Cialis to my patients who want more sexual freedom and spontaneity,” Dr. Carter says.

Stendra

“Stendra is a more selective PDE5 inhibitor than Viagra. I often prescribe it to my patients who want more spontaneity and fewer side effects compared to Viagra,” Dr. Carter says. 

Levitra

“Levitra is the most potent PDE5 inhibitor. I often prescribe it to my patients who have been dissatisfied with their response to Viagra,” Dr. Carter says. 

Alprostadil 

Alprostadil is a vasodilator that can be injected into the penile shaft or used as a suppository, which is inserted into the urethra. The inconvenience of its dosing mechanism may make it a less popular option.

Viagra OTC substitutes

Viagra OTC substitutes include dietary supplements and herbal remedies. These supplements are not approved by the FDA. “In my opinion, patients should exercise caution when considering natural supplements as substitutes for Viagra. I tell my patients that many over-the-counter products marketed for erectile dysfunction are unregulated and may contain undisclosed prescription drugs or harmful ingredients,” says Jason B. Carter, board-certified urologist and medical adviser at Aeroflow Urology.

Hence, it is always important to check with your healthcare provider before using OTC Viagra substitutes. “I believe it is imperative that men who have erectile dysfunction get evaluated by a physician,” says Philip Werthman, MD, board-certified urologist and director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles, CA.

“I believe men who take over-the-counter supplements miss the opportunity to see a healthcare provider that can diagnose and prevent a more serious disease process that can be cardiovascular, hormonal, or neurologic in nature,” Dr. Werthman says. Determining the root cause of erectile dysfunction can have positive implications for long-term health. Finding and reversing problems like hypertension or low testosterone, which can manifest as erectile dysfunction, has the potential to be highly beneficial. 

L-Arginine

L-arginine is an amino acid produced by the body and also present in dietary proteins. L-arginine is referred to as a physiological substrate for nitric oxide (NO)—a compound known to relax smooth muscles and widen blood vessels in the penis. 

A study found that people on 1,500 to 5,000 mg of L-arginine supplement experienced improvement in erectile dysfunction compared to the placebo group. 

L-arginine supplements stand out because of their natural occurrence, bioavailability when taken orally, and tolerability when used for a long time. However, they may cause side effects, including decreased blood pressure, nausea, and vomiting. Also, people with renal problems may experience increased blood urea nitrogen levels, and the supplement may trigger abdominal cramps and bloating in people with cystic fibrosis.

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is a prohormone produced in the adrenal glands, ovaries, testes, and brain. In target tissues, DHEA is converted into sex hormones such as androstenedione and testosterone.

A 2018 review article published in the World Journal of Men’s Health noted that decreased secretion of DHEA may be a risk factor for erectile dysfunction. But, it also suggested that there is no solid evidence to support that DHEA helps with erections or that it is safe to use, especially over a long time. Using DHEA over a long period or at high doses may be associated with cancer, and short-term use at low doses may lead to side effects such as acne, insomnia, mood changes, headache, and stomach upset.

Ginseng

Ginseng is a popular herb used for various purposes in East Asian countries. Its active ingredient, ginsenosides, may help produce nitric oxide.

In a systematic review evaluating the effects of ginseng on men with mild to moderate difficulty with erections, people taking ginseng reported improvement in their ability to have sexual intercourse, although they did not experience sexual satisfaction. The systematic review also reported “trivial effect on erectile function” compared to a placebo and with little to no side effects. 

Propionyl-L-carnitine

Carnitine is an amino acid produced by the liver, brain, and kidneys, and also obtained from animal protein. “Propionyl-L-carnitine is a derivative of L-carnitine that has been studied for its potential vascular and metabolic benefits. Research suggests it may improve blood flow and enhance nitric oxide activity, which is important for erections,” Dr. Carter says.

“Some studies have shown that, when used in combination with PDE5 inhibitors, it may enhance their effectiveness, especially in men with diabetes or following prostate cancer surgery. While it is not a stand-alone treatment, it can be a helpful adjunct therapy in select patients, particularly those with vascular-related erectile dysfunction,” Dr Carter explains. 

Horny goat weed

A natural compound called icariin (ICA), found in horny goat weed may boost nitric oxide production, as documented in animal studies. Honey goat weed may be safe when used for a short period. Using it in high doses or over a long period may lead to side effects such as severe breathing problems. Additionally, due to blood pressure-lowering effects, it should not be taken with supplements that produce the same response, such as casein peptides, L-arginine, and niacin. 

Gingko

Ginkgo Biloba, popularly known as ginkgo, is a plant rich in antioxidants. According to a systematic review, ginkgo may potentially support sexual processes by increasing blood flow to the genitals, producing nitric oxide, relaxing smooth muscles, and triggering the erectile effects of prostaglandin. However, the review concluded that “ginkgo biloba has limited positive effects on sexual function” with the quality of evidence judged as being low due to the poor nature of studies, small sample size, and other limitations.

Yohimbe

Yohimbe has been traditionally used as an aphrodisiac. According to a 2021 systematic review of eight studies, yohimbine (a component in yohimbe) alone had no significant effects on sexual function but may be beneficial when combined with other supplements. However, it may cause side effects such as irregular heartbeat, blood pressure problems, heart attacks, anxiety, stomach problems, and seizures. 

Eroxon

In 2023, the FDA approved the OTC sale of Eroxon, a topical gel for the treatment of ED. The product is applied to the penis to assist with erectile function. With a SingleCare discount card, a 4-pack of Eroxon gel may cost only $30.

It is important to always seek medical advice from a healthcare professional before using any of these prescription or OTC medications. Depending on your medical history, they will recommend the best and safest option for you.