Most people, if you asked them to name a prescription erectile dysfunction treatment, would provide the same answer:

Viagra, or the ‘blue pill’.

Over the past few years it’s the item which has become most closely associated with the condition. But recently, several other products have become available, some even producing faster or (according to some) more potent results.

And these aren’t just pills, like Cialis, Levitra, and more recently, Spedra. Now you can buy urethral suppositories, injections, creams, and even chewable tablets.

It goes without saying that not everyone likes using standard tablets, so we thought we would put together a brief guide to the alternatives:

  1. MUSE
  2. Caverject
  3. Vitaros
  4. Nipatra


Manufactured by Japanese firm MEDA Pharmaceuticals, MUSE is one of, if not technically the quickest-acting prescription medication for erectile dysfunction.

It’s also been around for longer than you think; released in 1997, MUSE was approved for ED around the same time as Viagra.

So why isn’t it as well known as its blue pill counterpart?

The most likely reason is the method of application which, although relatively simple, isn’t quite as convenient and discreet as swallowing a pill with a glass of water.

MUSE is what’s known as a urethral suppository, which means that it is inserted into the opening at the tip of the penis.

It may sound painful, but most people find that it causes little more than mild discomfort at first, before becoming more accustomed to use. Following application, the penis is ‘rolled’ between open hands to allow the solution to circulate.

Perhaps the main advantage of this medicine is the speed of its activity. Users will experience the benefits within 5-10 minutes, while Spedra, the quickest available pill, can take as long as 15-30 minutes to work.

One 1997 study carried out by urologists at the University of Southern California into the effectiveness of urethrally-inserted alprostadil found that around two thirds of men using it experienced erections strong and consistent enough for sex; while less than one fifth exhibited satisfactory results after using a placebo.

Another investigation conducted in London a year later produced similar results, with 64 per cent noting improved erectile potency.

When measured against ED pills, MUSE doesn’t do too badly. This level of effectiveness is comparable to the lowest dose of Viagra (25mg), which has been found to produce sufficient results in 63 per cent of users.

The main drawback of MUSE then, when measured next to ED pills, is its duration of function. Whereas Viagra and Levitra will remain active for up to four or five hours, the effects of MUSE begin to wear off within just one hour.

MUSE Box Front

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Like MUSE, this item also contains alprostadil, which is a synthetic version of a type of chemical called a prostaglandin.

It is injected into the base of the penis, and as a localised treatment produces much quicker results than most tablets on average; in around 5 to 20 minutes.

Caverject is available to buy in two forms. The vials version comes as a powder, which is then mixed with a liquid which is also supplied; whereas the dual chamber version is sold pre-mixed.

It is also made by Pfizer, the same people who developed Viagra.

Again, as an injection, it is not as discreet as taking a pill, but it may be just as potent.

One study conducted by Saudi scientists and published in the British Journal of Urology International, found that intracavernous injection of alprostadil produced erections in more men (90 per cent) than in those using a urethral delivery method, such as with MUSE (60 per cent), although more discomfort was reported.

In fact, Penile pain is among the more commonly reported side effects for Caverject.

For many, the thought of self-administering an injection into the penis can be a fairly daunting one, with the very careful administration required potentially putting some users off. But like MUSE, it becomes easier to use once the user has become accustomed to it.

Perhaps, once again, one of the main shortcomings of Caverject in comparison to tablets is its length of activity. The effects begin to wear off within one hour. But for some, this is a viable trade-off for the speed at which it gets to work.

Caverject Vials Box Front

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The third and final alprostadil product on our list is Vitaros, which a cream made by Takeda Pharmaceuticals.

It is applied to the penis in a similar way to MUSE, through the use of a plunger. Following application, the penis is held upright to facilitate the absorption of the cream, and its window of activity begins from 5-30 minutes.

One of the most appealing traits of Vitaros is its relative easiness when it comes to application, and its reduced capacity for interactions with other medicines.

A recent clinical review stated that the higher dose of Vitaros had an 83 per cent success rate, more or less putting it on level pegging with the 100mg dose of Viagra, at 82 per cent.

So with its high rate of sufficiency and simplicity to apply, does Vitaros have any disadvantages?

Yes. As a prostaglandin it does not stay active for as long as PDE5 inhibitor drugs.

The good news, however, is that it may be slightly longer-lasting than MUSE and Caverject in some cases, lasting for up to two hours instead of one.

In addition to being easier to apply, it is also more discreet, and likely won’t take as long to prepare as the injection.

On the other hand, while it is quicker to react in the body than most pills on average, it may be a little slower than its prostaglandin stablemates, taking up to half an hour to work.

Vitaros Front

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This chewable form of erectile dysfunction pill made by Mercury Pharma is likely the most discreet of all the products on this list, and the easiest to take.

It contains exactly the same active ingredient as Viagra, a PDE5 inhibitor called sildenafil, and works in a likewise manner.

Unlike the solid tablet version, it doesn’t need to be taken with water.

Clinical trials have identified that the duration of onset for the drug is around 25 minutes on average, making it slower than the non-tablet items listed above.

This is because the medication, like regular pills, is taken orally and needs to be digested by the body; whereas drugs like Caverject, MUSE and Vitaros by being applied directly to the penis, are taken up into the bloodstream quickly, and get to work more or less straight away.

One area in which Nipatra is comfortably ahead though, is in its duration of activity, which can be up to five times that of the other products described here.

Nipatra 100Mg Front

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The product you choose depends on what you’re looking to get out of it.

If you’re in a long term relationship, discretion may not be a priority, and you may simply be seeking the quickest drug; in which case, MUSE could be the right choice.

For added potency, Caverject may be preferable for people comfortable using needles; whereas those who want speed and simplicity of use might go for Vitaros.

Users who aren’t too fussy about speed but are looking for discretion may find Nipatra the most suitable of all the treatments on the market.

Medical history and the use of other treatments is also a major factor.

As a tablet, Nipatra is subject to the same interactions as other PDE5 inhibitors; however, applied methods such as MUSE, Caverject and particularly Vitaros, generally carry a lower risk of interactions because they do not remain active for as long and spend less time in the body.

If you are looking for an easy to use erectile dysfunction solution and are not sure where to begin, your doctor will be able to provide further guidance.

Product MUSE Caverject Vitaros Nipatra
Price* £45 £37 £65 £60
Made by MEDA Pfizer Takeda Mercury
Active ingredient Alprostadil Alprostadil Alprostadil Sildenafil
Type Urethral suppository Injection Urethral cream Chewable tablet
Released 1997 2000 2013 2012
How quick is it?** 5-10 minutes 5-20 minutes 5-30 minutes 30-60 minutes
How long does it remain active for?*** 30-60 minutes Up to 60 minutes 1-2 hours Up to 5 hours
Dosages available 250, 500 or 1000 micrograms 5, 10, 20 or 40 micrograms 2 or 3mg per gram 25, 50 or 100mg
Taken On demand On demand On demand On demand
Available over the counter No No No No
Can I take it and drink alcohol? Not recommended Not recommended Not recommended Not recommended
Can I take it with food? Yes. Yes. Yes. Large meals may increase the response time.
Will I be able to drive after taking it? Yes, provided you experience no side effects. Yes, provided you experience no side effects. Yes, provided you experience no side effects. Yes, provided you experience no side effects.
Unique characteristic Speedy solution, gets to work in 10 minutes or less. Gets to work  quickly and application method gives it added potency. Fast working treatment which is very simple to administer. Chewable version of Viagra is easier for some then regular tablets.
Find it on Get MUSE Get Caverject Get Vitaros Get Nipatra

 * - Prices taken from Prices for MUSE and Caverject are for one dose or single-use applicator. Prices for Nipatra and Vitaros are for four individual doses.

** - Duration before sex which the patient information leaflet instructs the user to take it.

*** - On average, taken from manufacturer website.

+ - This is not comprehensive information. More details on side effects, prohibitive conditions and the effects of other medicines can be found on the respective product page or the patient information leaflet.