What Is the Best ED Medication for Men Over 60?
Age changes the starting dose and the screening questions more than it changes which pill is on offer. Here is what the age-split trials and labels say.
The short version
- In a pooled analysis of 11,364 men, 80% of men under 65, 69% of those 65 to 74 and 59% of those 75 and older reported improved erections on sildenafil.1
- The sildenafil label says to consider a 25 mg starting dose after 65, and the vardenafil label says to consider 5 mg, because older men have higher drug levels.23
- Tadalafil and avanafil labels report no age-based dose adjustment, though avanafil notes greater sensitivity in some older individuals.45
- Nitrate use, alpha-blockers, kidney function and heart rhythm drugs decide the safe choice more than age does.243
No single ED tablet is the best for every man over 60. Sildenafil, tadalafil, vardenafil and avanafil all carry FDA labels that report no overall difference in safety or effectiveness between older and younger men in their trials.2435 What changes with age is the starting dose, the other medicines in the picture and the health conditions that decide which tablet a prescriber picks. In a pooled analysis of 11,364 men, 59% of men aged 75 and older reported improved erections on sildenafil, against 80% of men under 65.1
This guide sets out what each label says about older men, what the age-specific trials found, and what a good prescriber should ask before choosing.
Do ED tablets still help after 60 or 70?
Yes, in the trials, though the response rate is lower at older ages. The largest age analysis pooled 48 placebo-controlled sildenafil trials. Sildenafil beat placebo in every age group on the International Index of Erectile Function and on a global question asking whether erections had improved. The share of men reporting improvement was 80% under 65, 69% at 65 to 74 and 59% at 75 and older.1 The analysis was authored by Pfizer employees and consultants, so it is industry-run, but it is the biggest age-split dataset available.
An earlier analysis of five sildenafil trials looked at 411 men aged 65 and older, and a separate group of 71 older men with diabetes. Sildenafil improved erectile function in both, and stopping the drug because of side effects was low and comparable to placebo.6
What do the labels say about older men?
Each label addresses age differently, which is why the choice is not purely about which pill is strongest.
| Medicine | What the FDA label says about men 65 and older |
|---|---|
| Sildenafil | Healthy men 65 and older cleared the drug more slowly, with about 84% higher exposure than young men. No overall difference in safety or efficacy in trials, but the label says to consider a 25 mg starting dose.2 |
| Tadalafil | Exposure about 25% higher in healthy older men; no overall differences in efficacy or safety and no dose adjustment for age alone. Diarrhea was reported more often in men 65 and older (2.5%) in as-needed trials.4 |
| Vardenafil | Concentrations 34% (peak) and 52% (total exposure) higher at 65 and older. The trials included more than 834 older men with no differences in safety or effectiveness, but the label says a 5 mg starting dose should be considered.3 |
| Avanafil | Exposure was similar in healthy older and younger men. No dose adjustment for age alone, but the label notes greater sensitivity to medication in some older individuals.5 |
These are label statements from separate programs. They show how each drug behaves in older bodies; they do not rank the drugs against each other.
Which trials were built around older men?
Two studies are worth knowing because they were designed to include older men and men with other conditions.
- Vardenafil dissolving tablet. Two phase III trials were pooled: 701 men, 51% of them 65 or older. The 10 mg tablet beat placebo on every main measure regardless of age, baseline severity, diabetes, high cholesterol or high blood pressure, and older men did about as well as younger men. Side effects were mostly mild to moderate. The authors included employees of the manufacturer.7
- Tadalafil in men with several conditions (MOMENTUS). An open-label study of 155 men with an average age of 65, most with diabetes (72%) and cardiovascular disease (67%). On tadalafil 20 mg as needed, erectile function scores rose by an average of 7.6 points over 12 weeks. Headache (5.2%), flushing (3.9%) and nasal congestion (3.2%) were the most common side effects, and 3% stopped because of them. With no placebo group and Lilly sponsorship, it supports tolerability more than it proves comparative benefit.8
What matters more than age itself?
For most men over 60, the deciding factors are the other medicines and conditions, not the birth year.
- Nitrates. Every PDE5 tablet is contraindicated with nitrates in any form, including nitroglycerin for angina.243 This is the most important screening question.
- Alpha-blockers. Many men take these for an enlarged prostate. The sildenafil and tadalafil labels say to be stable on the alpha-blocker first and to start at the lowest dose.24
- Kidney function. Sildenafil's label suggests considering a 25 mg start in severe renal impairment (creatinine clearance below 30 mL/min). Tadalafil has specific dose limits at that level and for once-daily use.24
- Heart rhythm. Vardenafil should be avoided in men with congenital QT prolongation or on class IA or III antiarrhythmic drugs.3
- Prostate symptoms. Tadalafil also has a label for benign prostatic hyperplasia. A prescriber may weigh that if both problems are present, though the label does not recommend tadalafil together with alpha-blockers for BPH.4
Is daily or as-needed dosing better for older men?
The labels do not name a winner. Tadalafil is the only one with a once-daily ED form.4 Sildenafil, vardenafil and avanafil are taken before sex. Our comparison of sildenafil, tadalafil and vardenafil sets out the timing differences, and the label side effect rates show how the common reactions compare.
What should an older man ask before starting?
- Do I take any nitrate, including a spray or patch for chest pain?
- Is my heart stable enough for sexual activity? The labels tell prescribers to consider cardiovascular status first.23
- Do I take an alpha-blocker or blood pressure medicine?
- Should the starting dose be lower because of my age or my kidney or liver function?
- What should I do if an erection lasts more than four hours, or I lose vision or hearing suddenly?24
A telehealth service can meet these standards only if its screening asks them, which is why our guide to online prescriptions lists what a proper check includes. For named services, see the provider comparison.
What this article does not cover
This guide covers approved oral tablets. Compounded versions are not FDA-approved.9 The trial data are largely industry-sponsored and cannot rank the drugs against each other. Older men with heart disease, kidney disease, or many medicines need an individual assessment from a licensed clinician.
Frequently asked questions
What is the best ED medication for men over 60?
No label or trial names one best drug. Sildenafil, tadalafil, vardenafil and avanafil all report no overall age differences in safety or efficacy, so the choice depends on timing, other medicines and health conditions.
Do ED pills work as well after 65?
Response rates are lower at older ages. In a pooled analysis of 48 sildenafil trials, improved erections were reported by 80% of men under 65, 69% of men 65 to 74 and 59% of men 75 and older, all higher than placebo.
Should older men start with a lower ED dose?
The sildenafil label says to consider a 25 mg starting dose after 65 and the vardenafil label a 5 mg starting dose, because older men have higher drug levels. Tadalafil and avanafil labels do not call for an age-based adjustment.
Is tadalafil safe for men over 65 with other conditions?
In the open-label MOMENTUS study, men averaging 65 years old, mostly with diabetes and heart disease, had headache, flushing and congestion as the most common side effects. Nitrates remain a contraindication.
Can men over 60 take ED pills with blood pressure medicine?
Often, with care. Nitrates are never allowed, and alpha-blockers need a stable dose and a low starting ED dose. A prescriber should review every medicine first.
Related reading
Sources
- Goldstein I, et al. Efficacy and safety of sildenafil by age in men with erectile dysfunction. J Sex Med. 2016. PubMed 27114196.
- Pfizer. VIAGRA (sildenafil citrate) prescribing information. DailyMed, U.S. National Library of Medicine.
- Teva Pharmaceuticals USA. Vardenafil hydrochloride tablets prescribing information. DailyMed, U.S. National Library of Medicine.
- Eli Lilly. CIALIS (tadalafil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Metuchen Pharmaceuticals. STENDRA (avanafil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Wagner G, et al. Sildenafil citrate (VIAGRA) improves erectile function in elderly patients with erectile dysfunction: a subgroup analysis. J Gerontol A Biol Sci Med Sci. 2001. PubMed 11213274.
- Sperling H, et al. Efficacy and safety of an orodispersible vardenafil formulation for the treatment of erectile dysfunction in elderly men and those with underlying conditions: an integrated analysis of two pivotal trials. J Sex Med. 2011. PubMed 20807322.
- Goldstein I, et al. Efficacy and safety of tadalafil in men with erectile dysfunction with a high prevalence of comorbid conditions: results from MOMENTUS. J Sex Med. 2007. PubMed 17233782.
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers.