Erectile Dysfunction

All four molecules belong to the same class and are used for the same problem; they differ mainly in how long they stay active in the body, the forms they come in, and how they interact with food and other medicines. There is deliberately no dose column here — labelled strength is a matter for your prescriber, not a shopping decision.

Swipe the table sideways to see every column.

Duration profiles above are qualitative comparisons drawn from approved product information; they are not a guide to when or how to take anything, and they are not a claim that one option performs better than another. Response varies from person to person. Labelled strength, suitability and any change of medicine are decisions for your prescriber.

1. 1Start with a medical assessment, not a product

   ED can be the first visible sign of cardiovascular disease or undiagnosed diabetes. A prescriber will want to know your blood pressure, your other medicines and your cardiac history before any PDE5 inhibitor is considered. Choosing a product before that assessment gets the order backwards.

2. 2Rule out the absolute blockers first

   If you take nitrates in any form, or the pulmonary hypertension medicine riociguat, PDE5 inhibitors are not an option at all — this is not a caution to weigh up, it is a hard contraindication. Alpha-blockers and some blood pressure medicines need care rather than exclusion. Bring a full list of what you take, including anything bought over the counter.

3. 3Then think about duration and format

   Once a prescriber has confirmed the class is suitable, the practical differences are how long a molecule stays active and what form it comes in. A longer-acting option suits people who dislike planning; a shorter-acting one suits people who prefer a medicine to clear the system quickly. Oral jellies and chewables exist for people who struggle with tablets.

4. 4Review rather than escalate

   If a medicine is not working as expected, the answer is a conversation with your prescriber, not a higher labelled strength or a second product. Sometimes the issue is an interaction, sometimes an untreated underlying cause, sometimes a psychological factor that medicine alone will not resolve.

Put briefly: the class is chosen by a prescriber, and the molecule within the class is chosen with them based on your other medicines, your health history and how long you want a medicine to remain active. Formats — tablet, chewable, effervescent, oral jelly — are a matter of practicality. Combination products containing dapoxetine are only relevant if premature ejaculation has also been assessed. Never combine two products from this range, and never use someone else's medicine.

• Erectile dysfunction — difficulty getting or keeping an erection firm enough for sex
• ED with an identified physical contributor, such as diabetes or high blood pressure, managed alongside treatment of the underlying condition
• ED with a psychological or mixed contributor, usually alongside counselling or relationship support
• ED following prostate surgery or pelvic nerve injury, where a specialist has advised a PDE5 inhibitor is appropriate
• Premature ejaculation — dapoxetine-containing combination products, where a prescriber has judged them suitable
• Situations where a person finds tablets hard to swallow and a prescriber has agreed an oral jelly or chewable form is a reasonable alternative

• Nitrates are an absolute contraindication. PDE5 inhibitors must never be combined with nitrate medicines — glyceryl trinitrate sprays, patches or tablets, isosorbide mononitrate or dinitrate — or with amyl nitrite 'poppers'. The combination can cause a sudden, severe and potentially fatal drop in blood pressure. The same applies to riociguat.
• Seek urgent medical care immediately for an erection that is painful or lasts several hours (priapism), for sudden loss or reduction of vision in one or both eyes, for sudden hearing loss or ringing in the ears, or for chest pain, severe dizziness or fainting during or after sex. In an emergency in Australia, call 000. Tell the treating team what you have taken and do not accept a nitrate.
• If you have heart or blood-vessel disease, a recent heart attack or stroke, uncontrolled blood pressure at either extreme, or a heart rhythm disorder, a prescriber must assess whether sexual activity itself is safe for you before any ED medicine is considered.
• Tell your prescriber about liver or kidney problems, a history of priapism, sickle cell disease, leukaemia, myeloma, an anatomical deformity of the penis, or the inherited eye condition retinitis pigmentosa. Each changes the risk picture.
• Alpha-blockers used for prostate symptoms or blood pressure, some antifungals and antibiotics, HIV protease inhibitors and grapefruit juice can all affect how these medicines behave. Give your prescriber and pharmacist a complete list, including supplements.
• Do not use more than one product from this range at a time, and do not add a PDE5 inhibitor to one already in your system. They act on the same pathway and the risks add up without a corresponding benefit.
• These medicines are for adult men. They are not indicated for women, not for anyone under 18, and not for use as a recreational or performance product by people without erectile dysfunction.
• Alcohol in quantity works against you here — it depresses arousal and compounds the blood-pressure effects. Recreational stimulants combined with PDE5 inhibitors have been linked to serious cardiovascular events.
• Products containing dapoxetine add SSRI-related precautions, including interactions with other antidepressants, with some migraine treatments and with St John's wort, and a documented risk of fainting.
• Always read the patient information leaflet supplied with your medicine, and check the packaging and expiry before use. If anything about the presentation looks different from what you expected, do not use it — ask your pharmacist.

• Check the prescription position first

  Sildenafil, tadalafil, vardenafil, avanafil and dapoxetine are Schedule 4 Prescription Only Medicines in Australia. Any source that frames itself as a way to skip that step is asking you to take on the risk yourself. Have an assessment with a registered Australian prescriber, and keep the record.

• Know what ARTG registration means

  The Australian Register of Therapeutic Goods lists the products the TGA has assessed for supply in Australia. Many international generics are made to Good Manufacturing Practice standards for other markets without being ARTG-registered. That is a meaningful difference and you should understand which you are ordering.

• Inspect the packaging on arrival

  Genuine product arrives in intact manufacturer packaging with a legible batch number and expiry date, an unbroken blister foil, and a patient information leaflet. Spelling errors, smudged printing, missing batch details, loose tablets in a plain bag or a short-dated expiry are all reasons to stop and ask.

• Judge the seller, not just the price

  A verifiable business address, a working contact route, clear pricing in Australian dollars, a stated dispatch and delivery timeframe, a published returns and complaints process, and a privacy policy that explains what happens to your data. A price far below everything else in the market usually reflects something about the product.

• Keep counterfeit risk in mind

  ED medicines are among the most counterfeited products in the world precisely because demand is high and people buy them privately. Counterfeits have been found containing the wrong ingredient, the wrong quantity of the right ingredient, or contaminants. This is the practical reason authenticity checks matter more here than in most categories.

• Report anything that seems wrong

  If a product looks tampered with, or if you have an unexpected reaction, speak to a pharmacist or doctor. Australia has an adverse event reporting system administered by the TGA, and pharmacists can help you use it.

• Orders are dispatched within one business day of payment clearing, with a confirmation email and tracking where available.
• Standard delivery is 2–4 business days Australia-wide, and delivery is free on orders over $150. Remote and regional destinations can add time.
• Everything ships in plain, unbranded outer packaging. Nothing on the outside of the parcel names the product, the category or the contents.
• No product in this range needs cold-chain handling. Store tablets, chewables and jellies below 25°C, in the original packaging, away from direct sunlight, heat and humidity — a bathroom cabinet is one of the worst places in an Australian house for medicine.
• Keep everything out of reach and sight of children, and keep medicines in the blister or sachet they arrived in so the batch and expiry stay readable.
• Do not decant into a pill organiser alongside other medicines, and do not use anything past its expiry date. Ask a pharmacist about safe disposal of unused medicine rather than putting it in household waste.

PDE5 inhibitor

Phosphodiesterase type 5 inhibitor — the drug class all the ED medicines here belong to. It blocks an enzyme involved in relaxing blood vessel walls, which makes blood flow into the penis easier during arousal.

Active ingredient

The molecule that does the pharmacological work — sildenafil, tadalafil, vardenafil, avanafil or dapoxetine. Brand names differ; the active ingredient is what a prescriber and pharmacist actually care about.

Generic medicine

A medicine containing the same active ingredient as an originator brand, made once the original patent has expired. It usually costs much less because the manufacturer has not carried the original development cost.

Bioequivalence

The regulatory standard a generic must meet to be treated as interchangeable with the originator: it has to deliver the active ingredient into the bloodstream to a comparable extent and at a comparable rate.

Schedule 4 (Prescription Only Medicine)

The Australian scheduling classification that means a medicine may only be supplied on the prescription of an authorised health practitioner. All the ED medicines discussed here sit in this category.

ARTG

The Australian Register of Therapeutic Goods — the TGA's register of products assessed for supply in Australia. Registration is the marker of a product that has been through the Australian regulatory process.

Nitrates

Medicines used mainly for angina, such as glyceryl trinitrate and isosorbide mononitrate, plus the recreational inhalants called 'poppers'. They must never be combined with a PDE5 inhibitor.

Priapism

A prolonged, often painful erection that persists without ongoing arousal. It is a medical emergency because sustained lack of blood flow can permanently damage erectile tissue.

Oral jelly

A single-serve sachet of gel containing the medicine, swallowed rather than chewed. It exists for people who find tablets hard to swallow, not as a different or stronger kind of treatment.

Or read the reference page for an individual active ingredient:

For independent, Australian information about the medicines in this range, we point customers to the following bodies. Search for the medicine by name on their sites rather than relying on overseas material.

• Therapeutic Goods Administration (TGA)
• Australian Register of Therapeutic Goods (ARTG)
• Healthdirect Australia
• Australian Commission on Safety and Quality in Health Care
• Pharmaceutical Benefits Scheme (PBS)