Contents
If Viagra isn’t working the way it used to—or never worked as well as you expected—you’re not alone. Erectile dysfunction (ED) is common, especially among men in their 40s and 50s, and treatment effectiveness can change over time.
The good news is that Viagra isn’t the only solution. When sildenafil stops working, there are several evidence-based options that address both the physical and mental components of erections.
This guide explains why Viagra may stop working and outlines five proven options to help you find a more effective, personalized ED treatment plan.
Erectile Dysfunction: A Simple Definition
Erectile dysfunction (ED) means regularly being unable to get or maintain an erection firm enough for sex.
ED becomes more common with age, but it is not an inevitable part of aging. Blood flow, nerve function, hormones, mental health, medications, and lifestyle factors all influence erections—and many of these contributors are treatable.
Understanding ED Treatment Options
Why Viagra May Not Be Working Anymore
Before changing treatments, it’s important to understand why Viagra may not be effective. ED medications don’t create spontaneous erections—they enhance the body’s natural response to sexual stimulation.
Common reasons Viagra doesn’t work
Incorrect timing before sex
Taking it with a heavy or high-fat meal
Alcohol use
Dose that’s too low
Worsening blood vessel health
Nerve damage (diabetes, surgery, neurologic conditions)
Low testosterone
Medication interactions
Performance anxiety or stress
Smoking or metabolic disease
Many men assume Viagra has “stopped working” when the issue is actually how it’s taken or an underlying condition that hasn’t been addressed.
What to Do First If Viagra Doesn’t Work
Before abandoning oral medication, clinicians often recommend:
Taking sildenafil on an empty stomach
Waiting 30–60 minutes before sexual activity
Limiting alcohol
Trying the medication multiple times
Reviewing dose and timing with a healthcare provider
If results remain inconsistent, switching strategies is often effective.
Option 1: Optimize or Switch PDE5 Inhibitors
Viagra is only one medication in the PDE5 inhibitor class.
PDE5 inhibitors relax blood vessels and improve blood flow to help produce firmer erections. Options include sildenafil, tadalafil, vardenafil, and avanafil.
Different medications suit different needs:
Sildenafil: onset 30–60 minutes, lasts ~4–6 hours
Avanafil: onset as fast as 15 minutes
Tadalafil: lasts up to 36 hours
It’s common—and medically appropriate—to try more than one PDE5 inhibitor, as individual response varies.
Safety note: PDE5 inhibitors should never be used with nitrate medications.
blog/erectile-dysfunction/erection-pills-what-they-are-how-common-options-work-and-a-faster-alternative
Option 2: Daily Low-Dose Tadalafil for Spontaneity
For men who dislike planning intimacy around a pill, daily tadalafil offers continuous readiness.
Daily tadalafil typically involves 2.5–5 mg taken once per day and may be ideal if you:
Have sex multiple times per week
Want spontaneity
Experience performance anxiety
Also have benign prostatic hyperplasia (BPH)
Side effects are usually mild but should be monitored with long-term use.
Option 3: Use Generic ED Medications or Subscription Care
Cost and access play a major role in treatment consistency.
Generic ED medications contain the same active ingredients as brand-name drugs at a significantly lower cost. Subscription-based care can further improve adherence by simplifying refills, follow-ups, and ongoing optimization.
This approach makes ED treatment more sustainable for many men.
Option 4: Try a Combination ED Medication That Boosts Arousal in the Brain
If Viagra doesn’t work reliably, the issue may not be blood flow alone. Many men experience ED due to a mix of physical and neurological factors, including delayed arousal or performance anxiety.
Combination ED therapy pairs a PDE5 inhibitor with apomorphine, a medication that works in the brain to stimulate sexual arousal.
How apomorphine helps
Apomorphine activates dopamine pathways involved in:
Sexual desire
Arousal signaling
Initiating the erection response
By addressing the brain-based component of arousal, it helps trigger the physical response that PDE5 inhibitors then enhance through improved blood flow.
Why combination therapy may work when Viagra doesn’t
Targets both mental arousal and physical circulation
Can reduce anxiety-related ED
May improve onset speed and reliability
Helpful for men who feel interested but struggle to “get started”
Example: Rugiet Ready
One example of this approach is Rugiet Ready, which combines sildenafil and tadalafil with apomorphine in a fast-dissolving sublingual formulation.
Key characteristics:
Works through both the brain and body
Faster onset due to sublingual absorption
Longer duration from tadalafil
Designed for men with an incomplete response to standard ED pills
Combination therapy should always be prescribed and monitored by a licensed clinician.
Option 5: Penile Injection Therapy
When oral medications—alone or in combination—fail to deliver reliable results, injections are among the most effective ED treatments available.
Intracavernosal injection therapy involves injecting medication directly into the side of the penis to trigger an erection.
What to expect:
Erection in 5–15 minutes
High reliability, even when pills don’t work
Useful for more severe or vascular-related ED
Requires instruction and comfort with self-injection
Medical supervision is essential to ensure proper dosing and to minimize side effects such as penile pain or prolonged erections.
Other ED Treatment Options
For men who do not respond to PDE5 inhibitors—either alone or in compounded combinations—there are additional clinically recognized therapies that may be appropriate.
These include options such as:
Intraurethral alprostadil suppositories, which deliver medication locally without injections
Vacuum erection devices (VEDs), which use mechanical suction to draw blood into the penis
Other device-based or procedural therapies recommended on a case-by-case basis
A licensed healthcare provider can help determine whether these options are appropriate based on your medical history, preferences, and prior treatment response.
When ED Medications Fail Due to Arousal, Not Blood Flow
For some men, erectile dysfunction isn’t caused by circulation problems alone. Even when blood flow is adequate, erections may still be unreliable if the brain signals that initiate arousal are weak or delayed.
In these cases, clinicians may consider combination ED therapy that addresses both:
Blood flow, using PDE5 inhibitors
Arousal signaling in the brain, using medications such as apomorphine
Apomorphine works on dopamine pathways involved in sexual desire and arousal, helping initiate the erection response that blood-flow medications then support. This approach may be particularly helpful for men who:
Feel mentally interested but struggle to become fully aroused
Experience performance anxiety
Have inconsistent results with standard ED pills
One example of this approach is Rugiet Ready, which combines PDE5 inhibitors with apomorphine in a formulation designed to support both the brain and body aspects of erections.
Questions and Answers About ED When Viagra Isn’t Working
Is erectile dysfunction normal in your 40s and 50s?
ED becomes more common with age, but it is not inevitable. Many men in their 40s and 50s experience ED due to treatable factors such as circulation issues, hormone changes, stress, or medication effects.
How many times should I try Viagra before deciding it doesn’t work?
Clinicians often recommend trying Viagra several times under the right conditions—correct dose, empty stomach, and proper timing—before concluding it’s ineffective.
Why does Viagra work sometimes but not others?
Inconsistent results are often due to food intake, alcohol use, stress, fatigue, anxiety, or underlying health conditions that affect blood flow or nerve signaling.
Does ED medication still require sexual arousal?
Yes. ED medications do not cause automatic erections. Sexual stimulation is still required for them to work.
Can anxiety cause Viagra to stop working?
Yes. Performance anxiety can interfere with the brain signals needed to initiate an erection, which may limit the effectiveness of blood-flow medications alone.
When should I see a doctor if Viagra isn’t working?
You should see a healthcare provider if ED is persistent, worsening, or affecting quality of life—especially since ED can be an early sign of cardiovascular or metabolic conditions.
Final Takeaway
If Viagra isn’t working, it doesn’t mean you’re out of options. ED treatment is most effective when it’s personalized, addresses both the mind and body, and evolves as your health changes.
Working with a clinician to optimize medication choice, dosing, and delivery method can often lead to better, more reliable results.
