What Is the Most Effective ED Medication?
The big comparisons do not name one winner. Here is what each measured, why they differ, and what the labels and a preference trial add.
The short version
- All approved ED tablets beat placebo; the differences between them are modest.12
- A 2013 analysis of 118 trials ranked tadalafil first; a 2015 analysis of 82 trials found sildenafil 50 mg had the greatest starting-dose efficacy.12
- A 2026 dose-specific analysis again put sildenafil 100 mg and 50 mg at the top, and two of its authors are Viatris employees.3
- In a 90-man open-label crossover study, 52% preferred tadalafil, 28% sildenafil and 20% vardenafil.4
- Avanafil ranked lower on efficacy in every analysis that included it.125
No analysis has found one ED tablet that is the most effective for every man, and the large comparisons do not agree on a winner. A 2013 analysis of 118 trials ranked tadalafil first, followed by vardenafil.1 A 2015 trade-off analysis found sildenafil 50 mg had the greatest efficacy at starting doses,2 and a 2026 dose-specific analysis again put sildenafil 100 mg and 50 mg at the top.3 All of them agree on the bigger point: the approved tablets all beat placebo, and the differences between them are modest next to the differences between men.
This guide sets out what each analysis measured, why the rankings differ, and what the labels and a preference trial add, so you can see what the evidence supports and what it does not.
What do the four big comparisons find?
Network meta-analyses pool trials that compared drugs with placebo or with each other, then estimate how the drugs rank. Here are the four most cited, in the order they were published.
| Analysis | Size | Which drug ranked highest for efficacy |
|---|---|---|
| Yuan et al., 20131 | 118 trials, 31,195 men | Tadalafil, followed by vardenafil. Tadalafil beat vardenafil on the IIEF erectile function domain by 1.49 points. Avanafil was less effective than both on a global assessment question. |
| Chen et al., 20152 | 82 trials, 47,626 men for efficacy | Sildenafil 50 mg had the greatest efficacy at starting doses but also the highest overall adverse event rate. Tadalafil 10 mg was intermediate. Vardenafil 10 mg and avanafil 100 mg had markedly lower efficacy. |
| Madeira et al., 20215 | 179 trials, 50,620 men | Sildenafil 25 mg had a 98% probability of being the most effective on IIEF and sildenafil 50 mg 80%, with tadalafil 10 mg and 20 mg at 73% and 76%. Avanafil and lodenafil were less effective. |
| Salonia et al., 20263 | 83 trials, 6,029 men | Sildenafil 100 mg (odds ratio 9.06 versus placebo) and 50 mg (7.90), then vardenafil 10 mg (7.78) and tadalafil 20 mg (7.13). Tadalafil 10 mg and avanafil were lower. |
Two of the 2026 authors are Viatris employees, which is worth knowing when reading a ranking that favors one drug.3 The 2021 "probability" figures are rankings from a statistical model, not the share of men who responded, so a 98% probability does not mean 98% of men improved.5
Why do the rankings disagree?
Three reasons come up repeatedly in these papers.
- Different outcomes. One analysis scored the IIEF erectile function domain, another a single global question, another the share of men reaching a normal-range IIEF score above 26.13 A drug can lead on one measure and not another.
- Different doses. Comparing "sildenafil" with "tadalafil" hides whether the arm was 25 mg or 100 mg. The 2015 and 2026 papers compare specific doses, which is why sildenafil 100 mg and tadalafil 10 mg can sit far apart in the same ranking.23
- Few direct comparisons. Most trials compared one drug with placebo. The network method infers drug-versus-drug differences from those separate trials, which assumes the men in them were similar.1
The sensible reading is that sildenafil and tadalafil sit near the top of most rankings, vardenafil is close behind in several, and avanafil is consistently lower. Which of the top two leads depends on how the question is asked.
What do the labels report for each drug?
The FDA labels give each drug's own trial results against placebo. They cannot rank the drugs against each other, because the trials differ, but they show how large the effect is.
- Sildenafil (Viagra). On a global improvement question, 57% of men on Viagra reported improved erections versus 10% on placebo, and diary data showed 48% of attempts at intercourse were successful versus 12%.6
- Tadalafil (Cialis). The as-needed form improved erectile function versus placebo up to 36 hours after dosing. In a 348-man study of 20 mg, at least one successful intercourse was reported by 61% at the 24-hour attempt and 64% at the 36-hour attempt, versus 37% on placebo at both times.7
The placebo figures matter. Between a third and a tenth of men report improvement on a dummy pill, so a drug that "helps" 60% of men is adding about half, not the whole 60%.
Which drug do men prefer when they try several?
One small open-label crossover study in Spain asked 90 men with mild to moderate ED to take sildenafil 100 mg, vardenafil 20 mg and tadalafil 20 mg in turn. Tadalafil was preferred by 52% (47 men), sildenafil by 28% and vardenafil by 20%. The IIEF score favored tadalafil over both of the other drugs.4 Because everyone knew which drug they took and the study was small, this shows preference more than superiority, and the authors themselves describe preference as partly subjective.4
What matters more than the ranking?
For most men the practical differences are timing and tolerability rather than raw efficacy.
| Question | What the evidence says |
|---|---|
| Do you want a long window? | Tadalafil's label describes benefit up to 36 hours after an as-needed dose.7 |
| Is side effect rate the priority? | The 2015 analysis found tadalafil 10 mg had the lowest overall adverse event rate and sildenafil 50 mg the highest.2 |
| Is peak efficacy the priority? | Several analyses put sildenafil at 50 to 100 mg at or near the top.23 |
| Is the first drug not enough? | Dose adjustment or a switch is routine. The labels allow dose changes by a clinician based on efficacy and toleration.67 |
Our guides on which ED medication has the fewest side effects, ED medication for men with diabetes and ED medication for men over 60 apply these differences to specific situations, and the side-by-side comparison covers formats and onset.
What can make any ED pill fail?
Before concluding a drug is not effective, the label-level reasons it may underperform are worth checking with a clinician. The Cialis label's own timing data show the response depends on the dose and how long after dosing sex is attempted,7 and the sildenafil label says the dose may be raised or lowered by a clinician based on effectiveness and toleration.6 Medicines, heart health and low testosterone can also be part of the picture, which is why a screening visit matters more than the choice of brand.
Who should not take these drugs?
Every approved ED tablet is contraindicated with nitrates, and the labels advise considering cardiovascular status before sexual activity.678 Combinations with alpha-blockers need dose care. Whichever drug tops a table, a clinician who knows your medicines should prescribe it. If you are comparing prescribers, our provider comparison lays out what to look for, and avoid "male enhancement" products that claim to be stronger.
What this article does not cover
This guide covers approved oral tablets. Compounded versions are not FDA-approved.9 The label figures come from company-sponsored trials in different populations and cannot rank the drugs against each other, and the network analyses combine trials of differing designs and doses. Efficacy rankings describe groups of men, not what any one man will experience.
Frequently asked questions
What is the most effective ED medication?
No single tablet is proven best. A 2013 analysis ranked tadalafil first, while 2015 and 2026 analyses put sildenafil at 50 to 100 mg at the top. All approved tablets beat placebo.
Is Viagra or Cialis more effective?
Rankings differ by analysis and outcome. Cialis led in a 2013 analysis and a 90-man preference study, while sildenafil led in 2015 and 2026 analyses. The Cialis label reports benefit up to 36 hours after an as-needed dose.
Is vardenafil stronger than sildenafil?
Not clearly. Vardenafil 10 mg ranked close to sildenafil in a 2026 analysis but showed markedly lower global efficacy than sildenafil 50 mg in a 2015 analysis.
Why do analyses disagree on the best ED pill?
They measure different outcomes, compare different doses, and mostly infer drug-versus-drug differences from placebo trials.
What is the most popular ED medication?
Popularity is not measured in these trials. In one small preference study, 52% of men chose tadalafil, 28% sildenafil and 20% vardenafil.
Related reading
- What Is the Best ED Medication for Men With Diabetes?
- What Is the Best ED Medication for Men With High Blood Pressure?
- What Is the Best ED Medication for Men Over 60?
- Can Online Doctors Prescribe Viagra?
- The best ED treatments of 2026, compared side by side
- Sildenafil vs tadalafil vs vardenafil: how they differ
Sources
- Yuan J, et al. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. Eur Urol. 2013. PubMed 23395275.
- Chen L, et al. Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis. Eur Urol. 2015. PubMed 25817916.
- Salonia A, et al. A comparative evaluation of on-demand phosphodiesterase-5 inhibitor efficacy in erectile dysfunction treatment: a systematic review and network meta-analysis of double-blind, placebo-controlled, randomized trials. J Sex Med. 2026. PubMed 42296271.
- Tolrà JR, et al. Prospective, randomized, open-label, fixed-dose, crossover study to establish preference of patients with erectile dysfunction after taking the three PDE-5 inhibitors. J Sex Med. 2006. PubMed 16942534.
- Madeira CR, et al. Efficacy and safety of oral phosphodiesterase 5 inhibitors for erectile dysfunction: a network meta-analysis and multicriteria decision analysis. World J Urol. 2021. PubMed 32388784.
- Pfizer. VIAGRA (sildenafil citrate) prescribing information. DailyMed, U.S. National Library of Medicine.
- Eli Lilly. CIALIS (tadalafil) prescribing information. DailyMed, U.S. National Library of Medicine.
- Teva Pharmaceuticals USA. Vardenafil hydrochloride tablets prescribing information. DailyMed, U.S. National Library of Medicine.
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers.