How to Get an ED Medication Prescription: What to Expect

How does the prescription process work?

You can get an ED prescription through your primary care clinician, a urologist, or a telehealth service. Whether in person or by video, the visit covers a brief review of your health history, current medications, cardiovascular status, blood pressure, and how long you have had ED.

For most men with straightforward ED — no major cardiac conditions, no nitrate medications — the appointment typically takes 15 to 30 minutes and can result in a same-day prescription 1Ref 1Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW (2018).Erectile Dysfunction: AUA Guideline.Clinical evaluation framework for ED including history, physical exam, and medication review; PDE5 inhibitors as first-line therapy; nitrate contraindication; role of identifying underlying cardiovascular risk in the evaluation. The clinician evaluates whether any underlying condition should be addressed alongside treatment and selects the most appropriate medication 1Ref 1Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW (2018).Erectile Dysfunction: AUA Guideline.Clinical evaluation framework for ED including history, physical exam, and medication review; PDE5 inhibitors as first-line therapy; nitrate contraindication; role of identifying underlying cardiovascular risk in the evaluation.

What does the clinician need to know?

The most important piece of information is your full medication list — especially any nitrate medications (commonly prescribed for angina, such as nitroglycerin) or alpha-blockers (for blood pressure or prostate symptoms). PDE5 inhibitors — the drug class that includes sildenafil and tadalafil — can cause a dangerous drop in blood pressure when combined with nitrates; this combination is an absolute contraindication and must be disclosed before any prescription is written 2Ref 2Dhaliwal A, Gupta M (2023).PDE5 Inhibitors.PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) as first-line FDA-approved treatment for ED; absolute contraindication with nitrates due to severe hypotension; approved indications and dosing.

The clinician will also ask about: - How long the problem has been present and whether it happens in all situations or some - Cardiovascular risk factors (blood pressure, diabetes, smoking, cholesterol) - Symptoms suggesting low testosterone (reduced libido, fatigue, mood changes) - Prior treatments tried and any current ED medications

For men in their 40s or 50s with multiple cardiovascular risk factors, a broader evaluation — including blood pressure check and possibly bloodwork — may be appropriate before prescribing 1Ref 1Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW (2018).Erectile Dysfunction: AUA Guideline.Clinical evaluation framework for ED including history, physical exam, and medication review; PDE5 inhibitors as first-line therapy; nitrate contraindication; role of identifying underlying cardiovascular risk in the evaluation.

What will likely be prescribed?

Several FDA-approved PDE5 inhibitor medications are available for ED 2Ref 2Dhaliwal A, Gupta M (2023).PDE5 Inhibitors.PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) as first-line FDA-approved treatment for ED; absolute contraindication with nitrates due to severe hypotension; approved indications and dosing. They work by increasing blood flow in response to sexual stimulation but differ in how quickly they act, how long they last, and whether they are taken daily or as needed 3Ref 3Pyrgidis N, Mykoniatis I, Haidich AB, Tirta M, Talimtzi P, Kalyvianakis D, Ouranidis A, Hatzichristou D (2021).The Effect of Phosphodiesterase-type 5 Inhibitors on Erectile Function: An Overview of Systematic Reviews.Comparative efficacy of PDE5 inhibitors across multiple ED causes; differences in onset, duration, and dosing between agents; evidence for on-demand versus daily dosing approaches:

• Sildenafil — taken 30 to 60 minutes before sex; effective for 4 to 6 hours
• Tadalafil — available in a daily low-dose form or a higher as-needed dose; as-needed effects can last up to 36 hours
• Vardenafil — similar timing to sildenafil; slightly different side-effect profile
• Avanafil — faster onset (as little as 15 minutes); generally well tolerated

Your clinician will discuss the options and match the right medication and dose to your situation, including any relevant contraindications 1Ref 1Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW (2018).Erectile Dysfunction: AUA Guideline.Clinical evaluation framework for ED including history, physical exam, and medication review; PDE5 inhibitors as first-line therapy; nitrate contraindication; role of identifying underlying cardiovascular risk in the evaluation2Ref 2Dhaliwal A, Gupta M (2023).PDE5 Inhibitors.PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) as first-line FDA-approved treatment for ED; absolute contraindication with nitrates due to severe hypotension; approved indications and dosing.

Is a telehealth visit appropriate for this?

Yes. Telehealth visits for ED prescriptions are legal, clinically appropriate, and widely used. For a straightforward case — a man in general good health without active cardiac conditions — a video visit can accomplish everything an in-person clinic visit can for initial evaluation and prescribing 4Ref 4Novara G, La Falce S, Kungulli A, Crestani A, Valotto C, Zattoni F, Breda A, Gontero P, Ortner G, Pini G, Simeone C, Bartoletti R, Conti A, Ficarra V (2020).Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic?.Telehealth visits in urology are clinically appropriate for history-taking, initial evaluation, behavioral counseling, and prescription management for straightforward cases; systematic review of 45 studies confirming telemedicine utility across urological domains including non-procedural consultations.

Telehealth also makes it easier to ask about something many men find awkward in person. The clinician will still conduct a full history and medication review, confirm there are no contraindications, and tailor the prescription appropriately.

Some cases warrant an in-person evaluation: men with significant cardiac history, uncontrolled blood pressure, or previous ED treatment that has not worked may benefit from a more thorough workup that can include physical examination or bloodwork 1Ref 1Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW (2018).Erectile Dysfunction: AUA Guideline.Clinical evaluation framework for ED including history, physical exam, and medication review; PDE5 inhibitors as first-line therapy; nitrate contraindication; role of identifying underlying cardiovascular risk in the evaluation.