Alternatives to Tadalafil If You Can't Fill Your Prescription

Alternatives to Tadalafil If You Can't Fill Your Prescription

If you've been prescribed Tadalafil (the generic form of Cialis) and can't fill your prescription — whether it's out of stock, too expensive, or not covered by your insurance — you're probably wondering what other options are available.

The good news: Tadalafil is not your only choice. There are several other FDA-approved medications in the same drug class that work in a similar way. In this article, we'll explain how Tadalafil works, then walk you through the best alternatives so you can have an informed conversation with your doctor.

What Is Tadalafil and How Does It Work?

Tadalafil is a PDE5 inhibitor — a type of medication that works by blocking an enzyme called phosphodiesterase type 5. This enzyme normally breaks down a chemical called cGMP, which is responsible for relaxing smooth muscle and increasing blood flow.

By blocking PDE5, Tadalafil allows cGMP to build up, which:

• Increases blood flow to the penis during sexual stimulation (for erectile dysfunction)
• Relaxes smooth muscle in the prostate and bladder (for BPH)
• Reduces blood pressure in the lungs (for pulmonary arterial hypertension)

What makes Tadalafil unique compared to other PDE5 inhibitors is its long duration of action — up to 36 hours. This is why it's sometimes called "the weekend pill." It's also the only PDE5 inhibitor approved for daily use at low doses (2.5 mg or 5 mg).

For a more detailed explanation, see our article on how Tadalafil works.

Alternative 1: Sildenafil (Generic Viagra)

Sildenafil is the most well-known erectile dysfunction medication in the world. Originally marketed as Viagra by Pfizer, generic Sildenafil has been available since 2017 and is very affordable.

Key facts about Sildenafil:

• How it works: Same mechanism as Tadalafil — blocks PDE5 to increase blood flow
• Duration: 4-6 hours (shorter than Tadalafil's 36 hours)
• Doses: 25 mg, 50 mg, 100 mg — taken as-needed about 30-60 minutes before sexual activity
• Food interactions: High-fat meals can delay its effectiveness; best taken on an empty stomach
• Cost: Generic Sildenafil is very affordable — often $3-$15 for 30 tablets with a discount coupon
• Best for: Patients who only need occasional ED treatment and prefer a lower-cost option

The main downside compared to Tadalafil is the shorter duration and the need to time it around meals.

Alternative 2: Vardenafil (Levitra / Staxyn)

Vardenafil is another PDE5 inhibitor that's been available for over two decades. It's sold under the brand names Levitra (tablet) and Staxyn (orally disintegrating tablet).

Key facts about Vardenafil:

• How it works: Same PDE5 inhibition mechanism
• Duration: 4-6 hours, similar to Sildenafil
• Doses: 5 mg, 10 mg, 20 mg — taken as-needed about 60 minutes before sexual activity
• Food interactions: High-fat meals can reduce effectiveness
• Unique feature: Staxyn (orally disintegrating tablet) dissolves on the tongue — no water needed
• Cost: Generic Vardenafil is moderately priced — typically $15-$50 for 30 tablets with a coupon
• Best for: Patients who want an alternative to Sildenafil with a slightly different side effect profile

Alternative 3: Avanafil (Stendra)

Avanafil is the newest PDE5 inhibitor on the market. It's sold under the brand name Stendra and was approved by the FDA in 2012.

Key facts about Avanafil:

• How it works: PDE5 inhibitor, same class as Tadalafil
• Duration: About 6 hours
• Onset: Can work in as little as 15 minutes — the fastest of all PDE5 inhibitors
• Doses: 50 mg, 100 mg, 200 mg — taken as-needed 15-30 minutes before sexual activity
• Food interactions: Can be taken with or without food (less affected by meals than Sildenafil or Vardenafil)
• Cost: Brand-name Stendra is more expensive — typically $40-$70 per tablet; generic availability is limited
• Best for: Patients who need fast onset and don't want to plan around meals

How Do These Alternatives Compare to Tadalafil?

Here's a quick comparison to help you and your doctor decide:

• Longest lasting: Tadalafil (up to 36 hours)
• Fastest acting: Avanafil (as fast as 15 minutes)
• Most affordable: Sildenafil (often under $15 for 30 tablets with a coupon)
• Daily dosing option: Only Tadalafil is approved for daily use
• Least food interaction: Tadalafil and Avanafil

All four medications are contraindicated with nitrates (such as nitroglycerin) and should not be taken with Riociguat. Make sure to tell your doctor about all medications you take. Read more in our Tadalafil drug interactions article.

What About Non-Medication Alternatives?

If PDE5 inhibitors aren't right for you — or if your doctor recommends exploring other options — there are non-medication treatments for ED:

• Vacuum erection devices (penis pumps) — mechanical devices that create an erection using negative pressure
• Penile injections (Alprostadil/Caverject) — medication injected directly into the penis
• Urethral suppositories (MUSE) — a small pellet inserted into the urethra
• Lifestyle changes — exercise, weight loss, quitting smoking, and reducing alcohol can improve ED symptoms
• Therapy — psychological counseling may help if ED has an emotional or psychological component

Always discuss these options with your healthcare provider before making any changes to your treatment plan.

Final Thoughts

If you can't find or afford Tadalafil, you're not out of options. Sildenafil, Vardenafil, and Avanafil are all effective PDE5 inhibitors that may work well for you. Talk to your doctor about which alternative makes the most sense based on your health, lifestyle, and budget.

In the meantime, you can use Medfinder to check if Tadalafil (or any of these alternatives) is available at a pharmacy near you. And for tips on reducing your out-of-pocket costs, check out our article on how to save money on Tadalafil.