# Taking ED pills without ED: what the labels and studies say > Not in the way many men expect. In a small placebo-controlled trial, sildenafil did not improve erections in young men without ED. The bigger risks come from mixing: poppers with sildenafil or tadalafil can drop blood pressure dangerously, and surveys link recreational use with illicit drug use and lower confidence in unaided erections. _Last updated: 2026-10-18_ --- **In short:** sildenafil (Viagra) is approved to treat erectile dysfunction, and tadalafil (Cialis) is approved for erectile dysfunction and for symptoms of an enlarged prostate ([Viagra prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501); [Cialis prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895), DailyMed). Some men without ED take them anyway, hoping for a stronger or longer erection; in one US student survey, most got the pills from a friend ([Harte and Meston 2011](https://pubmed.ncbi.nlm.nih.gov/20358273/)). The small trials that tested this in healthy men found little or no change in erections compared with a placebo. The risks are more concrete: a dangerous blood pressure drop when the pill meets "poppers," stimulants that carry heart risks of their own, and, in surveys, a link between recreational use and lower confidence in erections without a pill. This page sets out what the labels, FDA and the published studies say. Evidence level: two small placebo-controlled trials in healthy men plus several cross-sectional surveys, which can show links but not cause. ## Do ED pills change erections in men without ED? Probably very little. In a randomized, double-blind trial of 60 healthy men aged 20 to 40 with no reported ED, a single sildenafil tablet taken at home produced no difference in reported erection quality compared with a placebo: 12 of 30 men on sildenafil and 10 of 30 on placebo reported an improvement ([Mondaini et al., Int J Impot Res 2003](https://pubmed.ncbi.nlm.nih.gov/12904810/)). The authors concluded that sildenafil does not improve erections in young healthy men and advised against recreational use. A second small crossover trial in 20 healthy volunteers measured erections with ultrasound and found no change with sildenafil compared with placebo ([Aversa et al., Hum Reprod 2000](https://pubmed.ncbi.nlm.nih.gov/10611201/)). Both trials did report one difference: the recovery time before another erection after ejaculation was shorter on sildenafil, as reported by the men in the first trial and as measured by the researchers in the second. These were single-dose studies in small groups, so they do not show that the effect is reliable, lasting or safe to chase. ## Why would an ED pill do little for a man without ED? Because the pills do not create an erection on their own. They block an enzyme called PDE5 that breaks down part of the body's own erection signal, so that signal lasts longer once sexual stimulation has started it. The Viagra label states that sildenafil "has no effect in the absence of sexual stimulation," and the Cialis label says the same of tadalafil ([Viagra prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501); [Cialis prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895), DailyMed). If that signal already works well, there is little for the pill to add. The Cialis patient leaflet also states that the drug does not increase a man's sexual desire. Our explainer on [how ED medicines work](/how-ed-medications-work/) covers the mechanism in more detail. ## How common is recreational use of ED pills? It is a minority habit, but not a rare one, and the surveys keep finding the same companions: other drugs and riskier sex. All of the studies below are cross-sectional surveys, so they show what tends to go together, not what causes what. | Study | Who was surveyed | What it found | | ------------------------------------------------------------------------------------ | ----------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | [Harte and Meston, Arch Sex Behav 2011](https://pubmed.ncbi.nlm.nih.gov/20358273/) | 1,944 US undergraduate men | 4% had used an ED pill recreationally at some point and 1.4% were current users; many of those users reported mixing it with illicit drugs, and two thirds got the pills mainly from a friend | | [Mitchell et al., Sex Transm Infect 2016](https://pubmed.ncbi.nlm.nih.gov/26092974/) | National probability sample in Britain, ages 16 to 74 | 12.9% of men had ever used medicine to help sexual performance; use was linked with alcohol, recreational drugs and unsafe sex, and the link with unsafe sex held after accounting for erection difficulties | | [Hammoud et al., J Sex Med 2017](https://pubmed.ncbi.nlm.nih.gov/28583339/) | 2,250 gay and bisexual men in Australia | Use in the previous 6 months was linked with illicit drug use and higher sexual risk; weekly users were more likely than less frequent users to have severe anxiety | ## What are the risks with poppers? Status: Not FDA-approved for ED in the US (applies to nitrite "poppers," which FDA calls unapproved products). Source: FDA, FDA Advises Consumers Not to Purchase or Use Nitrite "Poppers," and FDA Consumer Update on nitrite poppers, checked 2026-10-18. This is the most dangerous combination on the page. "Poppers" are nitrite liquids, such as amyl nitrite and butyl nitrite, sold in small bottles and often marketed as cleaners, nail polish removers or air fresheners ([FDA Consumer Update](https://www.fda.gov/consumers/consumer-updates/ingesting-or-inhaling-nitrite-poppers-can-cause-severe-injury-or-death)). The Viagra and Cialis labels both forbid them: the Viagra label contraindicates sildenafil with "organic nitrates or organic nitrites in any form" because sildenafil strengthens their blood-pressure-lowering effect, and the Viagra and Cialis patient leaflets name poppers directly ([Viagra prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501); [Cialis prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895), DailyMed). The Viagra label adds that it is unknown when, after a dose, nitrates could be given safely. Poppers carry their own risks even without a pill. FDA advises consumers not to buy or use them at all, and says it has seen more reports of deaths and hospitalizations after people inhaled or swallowed them, with problems including severe headaches, dizziness, trouble breathing, extreme drops in blood pressure, a blood oxygen disorder called methemoglobinemia, and brain death ([FDA advisory, June 2021](https://www.fda.gov/food/alerts-advisories-safety-information/fda-advises-consumers-not-purchase-or-use-nitrite-poppers)). FDA describes poppers as unapproved products that have not been evaluated for safe use and lists seizures, irregular heart rhythm, coma and death among the possible harms ([FDA Consumer Update](https://www.fda.gov/consumers/consumer-updates/ingesting-or-inhaling-nitrite-poppers-can-cause-severe-injury-or-death)). Our page on [nitrates and ED medicines](/nitrates-and-ed-medications/) explains the nitrate rule in full. ## What are the risks with stimulants such as cocaine or methamphetamine? The worry is the heart, and the evidence on erections points the wrong way. The National Institute on Drug Abuse (NIDA) says cocaine raises heart rate and blood pressure, narrows blood vessels, and is linked with stroke and with damage to the heart muscle, and that chest pain resembling a heart attack sends many users to the emergency room ([NIDA, Cocaine](https://nida.nih.gov/research-topics/cocaine)). NIDA lists rapid and irregular heartbeat, higher blood pressure, stroke and decreased sexual function in men among the effects of methamphetamine ([NIDA, Methamphetamine](https://nida.nih.gov/research-topics/methamphetamine)). The Viagra and Cialis labels say sexual activity itself carries some cardiac risk for men with heart disease, and that ED treatments should not generally be used by men for whom sexual activity is inadvisable because of their heart ([Viagra prescribing information, section 5.1](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501); [Cialis prescribing information, section 5.1](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)). Neither label mentions cocaine or methamphetamine, so the labels offer no safety information on the pairing. On erections, a study of 1,159 men who used amphetamine, recruited at a drug treatment center in Taiwan, found ED in 29.3% of them, compared with 11.9% of 211 age-matched men who did not; the study shows a link, not proof that the drug caused it ([Chou et al., J Sex Med 2015](https://pubmed.ncbi.nlm.nih.gov/26147855/)). ## What about alcohol? The Cialis label explains that alcohol and tadalafil both widen blood vessels mildly, so together they can lower blood pressure more than either alone, and it warns that heavy drinking with tadalafil can raise the chance of dizziness, a faster heart rate, headache and a drop in blood pressure on standing ([Cialis prescribing information, section 5.9](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)). That matters most in the same settings the surveys describe, where alcohol and other drugs are often used together. Our page on [sildenafil and alcohol](/sildenafil-and-alcohol/) covers what the labels say for each drug. ## Can relying on a pill feed anxiety? One survey suggests it might, though it cannot prove it. In a survey of 1,207 young US college men, those who used ED pills recreationally had erectile function scores similar to non-users but reported lower confidence in their erections and lower overall sexual satisfaction. More frequent use went with lower confidence, and lower confidence went with weaker erectile function ([Harte and Meston, J Sex Med 2012](https://pubmed.ncbi.nlm.nih.gov/22568639/)). The authors raised the possibility that recreational use could feed ED rooted in worry rather than blood flow, but a single survey at one point in time cannot show which came first. If nerves are the real reason for reaching for a pill, that is worth knowing, because worry about erections has its own approaches. Our guides to [ED versus performance anxiety](/ed-vs-performance-anxiety/) and [overcoming performance anxiety](/overcoming-performance-anxiety/) cover what helps. ## Do ED pills protect against sexually transmitted infections? No. Both the Viagra and Cialis labels state that the drug offers no protection against sexually transmitted diseases, including HIV ([Viagra prescribing information, section 5.9](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501); [Cialis prescribing information, section 5.13](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)). This matters because the surveys above link recreational use with more sexual partners ([Harte and Meston 2011](https://pubmed.ncbi.nlm.nih.gov/20358273/)) and with unsafe sex, defined as two or more partners and no condom use in the past year ([Mitchell et al. 2016](https://pubmed.ncbi.nlm.nih.gov/26092974/)). ## Where do pills taken without a prescription come from? Most often from a friend: in the US student survey, two thirds of recreational users got the pills mainly from a friend and about 1 in 8 from the internet ([Harte and Meston 2011](https://pubmed.ncbi.nlm.nih.gov/20358273/)). Both routes skip the safety check the labels build in. The Cialis patient leaflet says the drug "must be used only under a healthcare provider's care" ([Cialis prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)), and the Viagra label says an ED evaluation should look for underlying causes, while its patient leaflet tells men to ask their doctor whether their heart is healthy enough for sex ([Viagra prescribing information, section 5.1](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501)). A pill from an unknown source may also not be what it claims. In one notice, FDA testing found that a product sold for sexual enhancement contained both sildenafil and tadalafil without listing them ([FDA public notification, December 2020](https://www.fda.gov/drugs/medication-health-fraud/public-notification-triple-supremezen-extreme-3500-contains-hidden-drug-ingredients)); our page on [FDA warnings about tainted supplements](/fda-tainted-supplement-warnings/) tracks others like it. Taking a pill like that next to a prescribed one can mean [combining ED medicines](/combining-ed-medications/) without knowing it, and our guide to [getting ED treatment online safely](/getting-ed-treatment-online-safely/) explains how to spot a legitimate service. Never take any ED medicine with poppers or with nitrate medicines such as nitroglycerin. Call 911 or go to an emergency room for chest pain, fainting, trouble breathing or a seizure. Get emergency care for an erection lasting more than 4 hours, because untreated priapism can cause permanent damage. ## When should you talk to a clinician? If you are using ED pills without a prescription, or wondering whether you need one, a short conversation with a clinician is the safer route. Bring up any heart symptoms, every medicine and supplement you take, and any use of poppers, stimulants or alcohol, since the labels and FDA warn about poppers and heavy drinking and NIDA describes heart risks from stimulants ([Viagra prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501); [Cialis prescribing information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895); [NIDA, Cocaine](https://nida.nih.gov/research-topics/cocaine)). If the real concern is confidence or worry, say so; it can be addressed directly. Habits such as drinking less and avoiding drugs also feature in our overview of [lifestyle and ED](/lifestyle-and-ed/). ## Sources 1. [Viagra (sildenafil citrate) prescribing information, Pfizer, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0b0be196-0c62-461c-94f4-9a35339b4501) 2. [Cialis (tadalafil) prescribing information, Eli Lilly and Company, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895) 3. [U.S. Food and Drug Administration. FDA Advises Consumers Not to Purchase or Use Nitrite "Poppers." June 2021](https://www.fda.gov/food/alerts-advisories-safety-information/fda-advises-consumers-not-purchase-or-use-nitrite-poppers) 4. [U.S. Food and Drug Administration. Ingesting or Inhaling Nitrite "Poppers" Can Cause Severe Injury or Death. Consumer Update](https://www.fda.gov/consumers/consumer-updates/ingesting-or-inhaling-nitrite-poppers-can-cause-severe-injury-or-death) 5. [Mondaini N, et al. Sildenafil does not improve sexual function in men without erectile dysfunction but does reduce the postorgasmic refractory time. Int J Impot Res. 2003](https://pubmed.ncbi.nlm.nih.gov/12904810/) 6. [Aversa A, et al. Effects of sildenafil (Viagra) administration on seminal parameters and post-ejaculatory refractory time in normal males. Hum Reprod. 2000](https://pubmed.ncbi.nlm.nih.gov/10611201/) 7. [Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav. 2011](https://pubmed.ncbi.nlm.nih.gov/20358273/) 8. [Harte CB, Meston CM. Recreational use of erectile dysfunction medications and its adverse effects on erectile function in young healthy men: the mediating role of confidence in erectile ability. J Sex Med. 2012](https://pubmed.ncbi.nlm.nih.gov/22568639/) 9. [Hammoud MA, et al. Off-label use of phosphodiesterase type 5 inhibitor erectile dysfunction medication to enhance sex among gay and bisexual men in Australia: results from the FLUX study. J Sex Med. 2017](https://pubmed.ncbi.nlm.nih.gov/28583339/) 10. [Mitchell KR, et al. Medicated sex in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles. Sex Transm Infect. 2016](https://pubmed.ncbi.nlm.nih.gov/26092974/) 11. [Chou NH, Huang YJ, Jiann BP. The impact of illicit use of amphetamine on male sexual functions. J Sex Med. 2015](https://pubmed.ncbi.nlm.nih.gov/26147855/) 12. [National Institute on Drug Abuse. Cocaine](https://nida.nih.gov/research-topics/cocaine) 13. [National Institute on Drug Abuse. Methamphetamine](https://nida.nih.gov/research-topics/methamphetamine) 14. [U.S. Food and Drug Administration. Public Notification: Triple SupremeZen Extreme 3500 contains hidden drug ingredients. December 2020](https://www.fda.gov/drugs/medication-health-fraud/public-notification-triple-supremezen-extreme-3500-contains-hidden-drug-ingredients) --- _Affiliate disclosure: some links on the web version of this site go to Bodybuilding Peptides (trybbpeptides.com), an affiliate destination, and we may earn a commission if you buy there. Our coverage is independent of that relationship. Details: https://theedreport.com/affiliate-disclosure/_