What to do if your ED medication isn’t working

Tried an ED medication and found it didn't do much? You're far from the only one. Erectile dysfunction (ED) medication doesn't work for everyone straight away, and there's usually a reason behind it, whether that's how you're taking it, what else is going on with your health, or simply needing more than one attempt.

This guide covers the most common reasons ED medication isn't working, what's worth checking before you give up on it, and the other options available if tablets aren't the right fit for you.

A disappointing first try is common, and it's rarely the final word on whether treatment can work for you.

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How ED medication is meant to work

Erectile dysfunction, also called impotence, is when you struggle to get or keep an erection firm enough for sex.¹ It's common, especially over 40, and on its own it's usually nothing to worry about.

Most ED tablets are PDE-5 inhibitors. They work by relaxing the blood vessels in your penis, so more blood can flow in when you're aroused. That's the part worth remembering: these medications do not create arousal on their own. You still need to be turned on for them to work.

Timing and duration vary between the four main tablets:

• Sildenafil (Viagra) - usually taken around an hour before sex; effects typically last a few hours.
• Tadalafil (Cialis) - can be taken as a one-off dose around 30 minutes before sex, with effects lasting up to 36 hours.²
• Vardenafil (Levitra) - similar timing to sildenafil, usually effective for around 4 to 5 hours.
• Avanafil (Spedra) - the fastest acting of the four, often working within 15 to 30 minutes.

Think of these tablets as support, not a switch. You still need to feel turned on for anything to happen.

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Common reasons your ED medication isn't working

If your ED medication hasn't worked the way you hoped, it's worth ruling a few things out before deciding it isn't for you.

Often it's how or when the tablet is taken, not the medicine itself, that's holding it back.

You're not giving it enough time, or enough arousal

These tablets need sexual stimulation to work. No stimulation, no effect, however much you've taken.¹ Give the tablet time to kick in, too. Most take 30 to 60 minutes, and it can take longer if you've eaten a big meal beforehand.

You've eaten a heavy meal

A large, fatty meal slows down how quickly sildenafil and similar tablets are absorbed. Try taking your dose on an empty stomach, or at least a couple of hours after eating, for the best chance of it working on time.

You've only tried it once or twice

One disappointing attempt doesn't mean a medication doesn't work for you. Many prescribers recommend giving a tablet several goes, not just one or two, including a few at your highest prescribed dose, before ruling it out.

You're on the wrong dose

If you started on the lowest dose "just to try it", that might be why it's not doing much. Your prescriber can only get the dose right if they know how you got on, so tell them if it hasn't worked and ask about adjusting it.

Do not take extra tablets or change your dose on your own if it isn't working.

Something else could be getting in the way

A few other things can stop ED medication working as well as it should:

• An underlying health condition - diabetes, high blood pressure, high cholesterol and low testosterone can all affect how well ED tablets work, or cause ED in the first place.¹ If it came on gradually alongside other symptoms like low energy or reduced libido, it's worth asking your GP about a testosterone check. Our guide to ED and testosterone goes into this in more depth.
• Other medications - some antidepressants, blood pressure medicines and prostate medicines (alpha-blockers) can interact with ED tablets or contribute to ED as a side effect. Always tell your prescriber about everything else you're taking.
• Stress, anxiety or relationship worries - ED medication increases blood flow, but it will not resolve performance anxiety or relationship stress by itself. If this feels like the bigger issue, ask your GP about a referral for counselling or psychosexual therapy, alongside or instead of medication.
• Alcohol and grapefruit juice - drinking too much alcohol makes it harder to get an erection, and grapefruit juice can affect how sildenafil and tadalafil are broken down in your body. Best avoided around the time you take your dose.²

ED that doesn't respond to tablets can be an early sign of another health condition, so it's worth getting checked.

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Other options if tablets aren't right for you

If you've ruled out the common causes and your ED medication still isn't giving you the result you want, there are other options worth discussing with your prescriber.

Tablets aren't the only route. Some options don't rely on timing or arousal in the same way.

Tadalafil Daily

Rather than taking a tablet each time, Tadalafil Daily is a low dose taken at the same time every day. It keeps a steady level of the medication in your system, so you don't need to plan sex around it or wait for it to kick in.³ It can suit you well if timing or performance anxiety has been part of the problem.

Vacuum pump

A vacuum pump draws blood into the penis to create an erection, then a ring at the base helps maintain it. It's a non-medical option that can be used on its own or alongside ED medication.

Alprostadil injection or suppository

If tablets aren't suitable, or haven't worked, alprostadil can be injected into the penis or inserted as a suppository. Both work directly on the blood vessels rather than relying on arousal in the same way. Your prescriber can talk you through whether either is appropriate for you.

Penile implants

This is a surgical option, usually only considered after other treatments have been tried and haven't worked. It's a bigger decision, and your GP or a urologist can advise whether it's worth exploring.

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Lifestyle changes that can help

Your day-to-day habits can affect how well ED medication works, and sometimes they're the underlying cause of ED itself.

Eat well. A diet built around vegetables, lean protein, wholegrains and healthy fats supports the blood flow an erection depends on.

Move more. Regular exercise improves circulation and helps manage weight, both linked to ED.¹

Watch how much you cycle. Cycling for more than 3 hours a week has been linked to erection problems in some men, so it's worth a mention if you're a keen cyclist.¹

Quit smoking. Nicotine narrows blood vessels, including the ones that matter here.

Cut back on alcohol. Heavy drinking makes erections harder to achieve, not easier.

Many of the habits that protect your heart also protect your erections.

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When should you see a GP?

Speak to a GP or pharmacist if:

• Your ED medication still is not working after several attempts and adjustments to dose or timing
• Your erection problems started suddenly, or alongside other symptoms like low energy or reduced libido
• You take nitrate medication for angina or chest pain. Do not take ED medication if you are taking nitrates, as combining the two can cause a dangerous drop in blood pressure.²
• You get an erection that lasts longer than 4 hours. This needs urgent medical attention.²

If you bought ED medication without a prescription, it's also worth having a check-up within 6 months, as erection problems can sometimes be an early sign of other health conditions such as diabetes or heart disease.²

Never take ED tablets alongside nitrate medicines for angina or chest pain.

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References

1. NHS. Erection problems (erectile dysfunction). NHS; 2023. nhs.uk
2. NHS. Sildenafil (Viagra): a medicine for erection problems. NHS; 2026. nhs.uk
3. NHS. Tadalafil. NHS; 2026. nhs.uk

This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.