Viagra Alternatives that may be used alone or together with the pharmaceutical impotence drug
August 29 2018  by
Ray Sahelian, M.D.

Anyone who wishes to enhance their sexual performance or find a natural Viagra alternative has many options to choose from. There are pharmaceutical sex pills and natural Viagra alternatives, often called an aphrodisiac. Although many people are skeptical that natural Viagra alternatives work, I am 100 percent convinced that they do have a significant effect on sexual enjoyment, stamina, erection and performance. This impotence pill is very popular, and its cousins Levitra and Cialis are also quite popular.

   Viagra works very well in most users to improve vasodilation (dilation of blood vessels) and increase erection quality. However, some people prefer to use natural herbs since these herbs address the issue of libido and genital sensation which Viagra is not able to do. Some people like to take aphrodisiac herbs for general sexual enhancement, and then take Viagra on the day they plan to have sexual activity. We do not suggest using sexual herbs the same day as Viagra since unexpected side effects may occur. If you do use aphrodisiac herbs, your dose of Viagra may be half as much since the herbs already have made a positive influence of your sexual function and erectile potential.

What about natural Viagra alternatives, how effective are they, are they a substitute for the medications, can they be taken together?
There are quite a number of herbal and natural Viagra alternatives that I consider to have aphrodisiac qualities. In fact, I am personally familiar with several dozen. Some of my favorites herbs are included in Passion Rx. You could also read a comprehensive book called Natural Sex Boosters which devotes a chapter to each nutrient and herb.
As medical science has given us a greater understanding of human sexuality and our own chemical processes that put us in the mood, research has uncovered how some well-known and not so well-known natural Viagra alternatives actually work with our body chemistry to lead to arousal and excitement. Various substances of animal and plant origin have now been identified, allowing for testing and scientific understanding of their chemical composition and mechanisms of action.

Herbal enhancers are not a precise natural Viagra alternative in the sense that they do not work exclusively as a phosphodiesterase type 5 inhibitor. Rather, the dozens of compounds in these plants and herbal blends have an influence on a number of natural chemical processes in the body and brain that influence sexuality.

The potent herbal extracts that increase libido include ashwagandha, catuaba, cnidium monnieri, coleus forskohlii, epimedium, maca, mucuna pruriens, muira puama, passion flower, pfaffia paniculata, rhodiola, shilajit, tribulus terrestris, tongkat ali. Passion Rx is also available with yohimbe. These herbs can be taken together with lower dosages of prescription ED drugs.

Q. Thank you for your videos and advice, they are very informative and practical. Is it safe to take prescription Viagra if your cycling on tongkat Ali? Also do you feel tongkat could cause hair loss?
   A. I have no reason to believe tongkat ali causes hair loss. Since it takes two or three days for tongkat ali to work, it can be taken two or three days in a row and then on the day of sexual activity, one can stop the herbal aphrodisiac and instead take Viagra, perhaps a little lower dose than usual.

Impotence drugs currently available on the market
Viagra, Levitra, and Cialis. Viagra is not just for old men. The blockbuster impotence pill is being used by a growing number of men under the age of 55. The study of more than 5 million insured adults from 1998 to 2002 found the fastest-growing segments of users was men aged 18 to 55 years. And fewer of these men are using Viagra because they need to for impotence. These findings suggest increased use of this prescription medication as an enhancement or recreational agent. However, most Viagra users are over 56.

Viagra (sildenafil), approved by the FDA in 1998, has been the most popular sex pill for the treatment of erectile dysfunction. Viagra works very well in dilating blood vessels in the genital region leading to an erection or increased blood flow to the vaginal tissues, however this blue sex pill does little to directly increase libido or sexual arousal. The effect of Viagra is often noticed within an hour after taking a pill of 50 or 100 mg, and ease of erection may last up to 12 hours. Side effects of Viagra include headache, flushes, nasal congestion or runny nose, malaise, nausea, changes in blood pressure, irregular heart beats, visual disturbances including rare cases of blindness, and chest pain. Viagra may cause stickiness of blood platelets.
Trimetazidine, a drug that prevents heart-related chest pain, is a better choice than "nitrate" drugs, such as Nitro-DUR and Isordil, for men with heart disease who are taking sildenafil. There have been concerns about dangerously low blood pressure when Viagra is combined with nitrates, yet many men with heart disease are currently seeking treatment for erectile dysfunction.

Liver damage
Eur Rev Med Pharmacol Sci. 2017. Sildenafil-associated hepatoxicity: a review of the literature. In the last decade, some cases of Viagra-associated liver damage have been reported.

Viagra and fertility
Laboratory studies conducted at Queen's University Belfast, UK suggest that taking the erectile dysfunction drug Viagra may negatively affect sperm function and possibly male fertility. Dr. David R. J. Glenn observed that exposure of cultured sperm to Viagra, compared to no exposure, led to a "sustained enhancement of motility," both in numbers of progressively motile sperm and their velocity. Exposure to Viagra -- at concentrations equivalent to the average maximum total blood concentration present 30 minutes after a single oral dose of 100 milligrams -- also caused a premature "acrosome reaction." Acrosomes are structures that cover the head of the sperm and contain a variety of enzymes that help the sperm penetrate the outer membrane of the egg. Fertility and Sterility, May 2007.

Hearing loss
Men who take Pfizer's sildenafil or similar drugs for erectile dysfunction increase their chances of hearing impairment. A study, based on a national sample of American men over 40, found that slightly more than one in six of those who did not take Viagra-like drugs -- for instance, Eli Lilly's Cialis -- were deaf or hard of hearing. Among those who took the drugs, however, almost one in three had hearing loss, Gerald McGwin, an epidemiologist at the University of Alabama at Birmingham School of Public Health says even after accounting for other factors linked to hearing loss, hard-of-hearing men still had twice the odds of taking Viagra. Drug makers already include a "black box" warning about potential hearing loss on these products. Archives of Otolaryngology -- Head & Neck Surgery, 2010.

Use for PTSD not effective
Sildenafil, aka Viagra, does not benefit vets who have erectile dysfunction (ED) related to post-traumatic stress disorder. Viagra is often effective for ED related to various causes -- including heart disease, high blood pressure and diabetes. But studies indicate that as many of half of men who try the medication do not respond adequately. Iranian researchers looked at whether Viagra was helpful for combat veterans who were suffering from post-traumatic stress disorder (PTSD) as well as ED. Dr. Mohammad Reza Safarinejad, of Shahid Beheshti University Research Center in Tehran found that the drug appeared no more effective than placebo pills at improving the men's sexual function: 10 percent of Viagra patients reported normal erectile function by the study's end, compared with 8 percent of men given a placebo, or dummy pill. Dr. Mohammad Reza Safarinejad, of Shahid Beheshti University Research Center in Tehran says that while about half of people with PTSD recover completely in a few months, many others have symptoms that become chronic and debilitating. BJU International, 2009.

Natural Viagra Alternative Update
As many as half of the Viagra anti-impotence pills sold on the Internet could be counterfeit. British scientists analyzed samples of Viagra sold on web sites and found that some of the little blue pills contained different components or less of the active ingredient than the top-selling drug made by pharmaceutical giant Pfizer Inc.

Study links impotence drugs to eye damage risk, Optic nerve problems more likely in people with a history of heart disease
Impotence drugs such as Viagra and Cialis can increase the risk of eye damage in men who have a history of heart disease or high blood pressure. Scientists at the University of Alabama in Birmingham found that men who had suffered a heart attack were 10 times more likely to have optic nerve damage if they had been taking leading anti-impotence pills. “For patients with a history of myocardial infarction (heart attack), we did observe a strong and statistically significant association suggestive of a link between the use of Viagra and/or Cialis and an increased risk of NAION,” Dr. Gerald McGwin, who headed the study, said in a report in the British Journal of Ophthalmology. Non-arteritic anterior ischaemic optic neuropathy (NAION), is the most common cause of acute optic nerve disease in people over 50 years old. It can cause permanent loss of vision in one or both eyes. Viagra, made by Pfizer Inc and Eli Lilly and Co.’s Cialis, are leading impotence treatments. McGwin and his team questioned 76 men, half of whom suffered from NAION, who were treated at a specialist eye clinic in the United States, about their smoking and drinking habits and use of anti-impotence pills. Tens of millions of men have used Viagra and Cialis since the treatments were launched. In May, the Food and Drug Administration in the United States said it had received more than 40 reports of NAION involving impotence drugs but had not determined whether the treatments were responsible.

I found your website by browsing the internet on the search for a safe treatment option for my erectile dysfunction (ED) combined with reduced libido. When reading the text on your website I became the impression, that you are dealing very reliably and in a reputable way with everything by always showing both sides of the coin and not simply praising your own products and trying to sell them. So I believe, your response on my inquiry below will be as reputable and reliable as well, and will very much help me in finding and making the right decision.I am a 55 year-old male. I lost my wife to breast cancer 11 years ago, and when I found a new girl-friend (or better “lady-friend” in my age…) in 2011 I had to learn, that I became fully unable to build up an erection. This was never a problem in younger years, but as the last time I had sexual intercourse with my wife was very long ago. The first option I tried were the well-known PDE5 inhibitors Viagra, Levitra and Cialis, but only Levitra showed a slight effect. Viagra and Cialis didn’t work at all on my penis, and with Viagra I ran into many side effects like severe headache, congested nose and the like.When drilling deeper into the root cause, physicians detected quite a lot of so-called venous leakages in my penis and pelvis and recommended me a penile implant to “re-install” the erectibility of my penis. As this is an act of surgery and also a “one-way ticket”, I refrained from this option and underwent two rounds of therapeutic embolization of the Plexus Santorini and the veins through which the blood flew out of my penis instead. This helped me a bit, but on Monday this week new venous leakages have been detected, and an Alprostadil (prostaglandin) injection (25 µg) into my penis led to only a minute erection (if any…). In any case this “erection” was never sufficient to have intercourse with it….On the other hand I am still able to climax and ejaculate, and the feeling of my orgasm is still very strong. Is there any help and support you can offer me with dietary supplements, herbal extracts and the like to get a treatment of this (psychically very demanding) situation?
   A. This is a difficult condition to treat but sometimes trial and error with different herbal alternatives, such as tongkat ali, or catuaba, could help. But if there is little response to the ED medications, it is difficult to predict whether the herbs will be effective.

Warning labels
Viagra: “Less common side effects that may occur are temporary changes in color vision (such as trouble telling the difference between blue and green objects or having a blue color tinge to them), eyes being more sensitive to light or blurred vision.”
Cialis: “may uncommonly cause ... vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.”
Levitra: “may uncommonly cause ... vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.”

Viagra and vision lawsuit
A Houston man filed a lawsuit in June 2005 in federal court against Pfizer, claiming he suffered blindness after taking its best-selling erectile dysfunction drug Viagra. James Thompson filed the civil suit against Pfizer in the U.S. District Court for the Southern District of Texas on Tuesday and is seeking more than $75,000 for his vision loss. He is also seeking class-action status because it has been estimated that since 1998, 23 million people have taken the erectile dysfunction drug Viagra, the trade name for sildenafil.

Q. I am a retired police pilot (helicopter and fixed-wings) and have been able to maintain my FAA Medical since 1967.  Once, while investigating the first occurrence of tinnitus with sudden hearing loss in 2003 an MRI was taken to rule out a tumor, and only disclosed an image of an old infarct in my right lobe. I never have had any signs or symptoms of a stroke, so this was a total shock to me. Repeat MRIs showed no change, but the neurologist (and a second neurologist) strongly cautioned me against using Viagra drug for my quest to reverse erectile dysfunction. The tinnitus repeated during 2003, but suddenly stopped; I finally renewed my medical and have been getting mountain flying training, no problems. I have tried Viagra erectile dysfunction drug three times prior to this ear investigation, there was one obvious positive result, one probable, but I discontinued use due to a long-term psychological resistance to intercourse, which now seems to be slowly reversing with extensive counseling. Now I am willing to try another approach, and need to know if Passion Rx has any related side effects that the FAA could object to when renewing my medical in the future. If Passion Rx is truly safe, a lot of old-fart pilots should be customers, especially the airline types, with all those cabin attendants hanging around. No, I am not a member of the "Mile-High Club."
   A. None of the herbs in Passion Rx are tested in drug tests, and we have no reason the FAA would object to any of the herbs. Passion Rx without yohimbe may be a good option since it yohimbe sometimes causes mild visual changes for a couple of hours whereas Passion Rx without yohimbe actually can improve vision. The use of an erectile dysfunction drug causes blurred vision for several hours. Actually, some people have had permanent vision loss using Viagra, Cialis, Levitra erectile dysfunction drugs. Passion Rx also improves alertness. It would be a good idea, if your doctor approves, to use only half a capsule of Passion Rx until you get a good sense of how it works for you.

Natural Viagra alternative questions
Q. Would you consider horny goat weed a natural Viagra alternative?
   A. I still have not come across any single herb that is as good in enhancing an erection and a good natural Viagra alternative and quick acting except perhaps for yohimbe which has unpleasant side effects in high dosages.

Q. I'm an Italian man 70 y.o. My question is: is it possible to take Viagra together with Passion Rx ??
   A. We suggest using Passion Rx the day before, but not the same day as Viagra.

Q.  I just ordered some Passion Rx as natural Viagra alternative and had a question. I know if you are taking Viagra or something and have a heart attack they need to know you are taking it because being given nitroglyceren while taking Viagra could be fatal. Is there a similar danger with Passion Rx? I don't plan on having a heart attack but if I did do I need to tell the hospital staff I'm taking this natural alternative.
   A. We are not aware of an association between Passion Rx and nitroglycerin. Viagra is a single substance that works directly to dilate blood vessels and hence it's potential risk for problems with nitroglycerin. Passion Rx has about 2 dozen herbs and nutrients. Each herb has dozens of different substances in it.

Q. Is arginine a natural alternative to Viagra since it converts into nitric oxide?
   A. I personally do not consider arginine to be a natural alternative to Viagra since, even though it may convert into nitric oxide, the effects are short lived.

Q. I would like to buy a Viagra alternative but I am not sure which one will work for me.
   A. It is impossible to predict which herb or herbal combination is best suited for a person without trial and error. If you would like to buy a Viagra alternative, try tongkat ali, LJ100, mucuna pruriens, or better yet a combination of several herbs found in Passion Rx.

Q. Can passion Rx with Yohimbe be taken with Viagra? Can you continue to use Viagra and take Passion Rx?
   A. We suggest not taking them the same day. Passion Rx can be taken 2 days or 1 day before using Viagra, but not the same day as Viagra.

Q. I am looking for a Viagra alternative. I am in good health, albeit overweight. I currently weigh about 250 and should weigh in the 215 – 220 range, based on I feel and look. medical charts for height would have me in the 185 – 190 range. Not going to happen. I was born in1944 (62 years old). At approximately age 52 I started having erectile dysfunction symptoms. I went to a clinic which was pushing growth hormones and medicines which allegedly reversed aging. Very expensive and I couldn’t afford to even try their solutions. I did get a prescription for Viagra. The Viagra has always work for me, but I have an uncomfortable feeling in my eyes (usually the right one) I worry that the Viagra could be doing permanent damage to my sight. I have in the past been noted to have borderline high blood pressure, however that symptom has not been present since I moved from Florida to El Paso. This could be a reduction in stress and it could be partly due to the medicines I am currently taking. In November 2006 I went to the emergency clinic at Fort Belvoir with what I thought was bronchitis or possibly pneumonia. As it turns out I was in Atrial Fibrillation and that was the real cause of my symptoms. In the hospital they put me on Diltiazem Inter venous to reduce heart rate. The heart self corrected out of Afib to a regular heart beat. In March 2007 the doctor I am currently seeing prescribed Zocor for my cholesterol level. Currently Meds: Coumadin (warafin) – 7.5 per day six days 10 on 7th day. Purpose is to thin blood thus preventing a possible clot in case of another Atrial fibrillation event. Diltiazem ( tiazac ) – 240 mg. which were prescribed in November after I had an fairly serious Atrial fibrillation event. Zacor – 10 mg. to lower my cholesteral. 1. I have taken Viagra in the past I get a feeling that I would describe as an uncomfortable pressure in the eyes (especially the right eye). I'm worried that this could be, or could in the future case permanent damage. The cardiologist at William Beaumont saw no danger to my heart from using Viagra. Internet research confirms his opinion. However the eye sight is a different story. Coumadin and / or Dilitiazen seems to effect my energy level and leaves me with diet considerations that don't please me. Why not just a aspirin regiment to keep the blood thin enough to reduce the odds of a clot in case of another Atrial fibrillation? Coumadin reduces my food options. Many minerals and supplements that I could take in the past have been removed. This may be the answer to the energy level issue. Zocor affects the liver. As a recovering alcoholic (sober since April 1979) I can't imagine that would be an acceptable side effect. The doctor I've been seeing says that we can monitor for damage. I'd rather come up with a stricter diet and use supplements. Can my current prescription medicines be safely replaced with natural supplements, minerals, diet etc? Is there a natural viagra alternative to use? With the current meds in my system what are the potential side effects with ED product Passion-Rx Yohimbe?
   A. We appreciate your email. However, we can't make any medical decisions for you, that is the role of your doctor. Also, we would not recommend Passion Rx for anyone who has a heart condition.

Q. I have read about Passion Rx for ED. I have also read about Viagra and the possibility of eye problems associated with it's use. The specific eye problem is NAION. Is there any data about Passion Rx and eye problems associated with it since it is an herbal product.
   A. The composition of Passion Rx is 100 percent different than Viagra or other ED drugs. There is no risk for eye damage from Passion Rx and no risk for NAION.

Q. I have read the ingredients in Passion Rx and I have seen the same ingredients in other formulas or just slightly different. What makes this product work so well, and other products that I have tried, not work so well. The ingredients you have in this product have been around for a long time. If the ingredients are that potent wouldn’t customers try more of this product than Viagra?
   A. There are many factors that influence the effectiveness of a sexual enhancing product. The ingredients, whether they are just the powders or concentrated extracts, the amounts of the ingredients, the quality of the raw material, etc. Also, the product may not work well if the dosages are too high or too low. Viagra works rather quickly and many people want a quick effect and prefer a drug. Viagra only works for erection enhancement, not for sensation or libido. Passion Rx works in a more comprehensive manner and supports many aspects of the sexual response, but it does not work in an hour like Viagra. Normally it takes a few days for the full benefits to be noticed.

Q. I also take Viagra. Will it be safe if I also took the Passion Rx. Also, is this a natural herb and are there any side effects. Is it also approved by the FDA.
   A. We don't recommend taking Viagra and passion the same day, passion can be taken for the 2 previous days and less of a Viagra dose can be used on the day of activity. All the ingredients in Passion Rx are approved by the FDA. This is an all natural formula with herbs. Yes, there are side effects, see the link above for Passion Rx.

I have had prostate cancer and 1 nerve bundle removed. Viagra helps me achieve an erection. Which of your products would you recommend?
    We can't make any specific recommendations, but you may wish to read our page regarding treatment of impotence.

I had a radical prostatectomy several years ago with my surgeon using the Da Vinci procedure. I had Gleason 5, with positive margins on the left lobe only. No cancer on the right lobe of the prostate. I have had undetectable PSA ever since. My blood serum testosterone is about 450. I am now 66 y/o. I am extremely wary of any testosterone product. I use Viagra, and have a satisfactory response. I rarely have an orgasm, and when I do, it isn’t very good. Is the Tongkat Ali an appropriate herb for me? I am looking at a product from LifeForce Energy, that has 100 mg of Tongkat Ali with Maca Root (400 mg). Also Niacin and Zinc are in the compound. Recommended dosage 2 capsules daily. If that is not the right product for me, if indeed any is given my cancer history, is there one that would be?
   A. I am not aware of any of the herbs used for libido improvement and ED to be contraindicated in those who have a history of prostate cancer.

Maybe you can help me. I am looking into Viagra alternatives. I see several natural products on the market, but I don't want anything with Yohimbe. Also, it seems that the FDA has banned herbal supplements with sildenafil or like substances in them and there is alot of noise on the web about this. My first question is: do herbal aphrodisiacs and libido boosters like Safed Musli, ashwagandha, maca, tongkat ali, tribulus terrestris extract, Smilax Extract, or Shilajit naturally contain any sildenafil-like substances? My second question is: are there any herbs that contain sildenafil-like substances? My last question is: is there a place I can get a list of US and/or European approved herbal substances that might be used as Viagra alternatives?
    I am not aware of any of these herbs containing substances that are chemically similar to sildenafil. I am not aware of any official list of herbal substances that are listed as such. You may consider reading a book called Natural Sex Boosters that reviews the benefits of aphrodisiac herbs.