Two topical products stand out for treating erectile dysfunction: alprostadil cream, a prescription medication, and Eroxon (MED3000), the first over-the-counter gel cleared by the FDA for ED. Which one works best depends on the severity of your ED, whether you want a prescription option, and how you weigh effectiveness against side effects.
Eroxon: The First Over-the-Counter Option
Eroxon is a non-medicated topical gel that received FDA clearance as a Class II medical device for treating erectile dysfunction in adults aged 22 and older. It’s available without a prescription, which makes it the most accessible topical ED treatment on the market. The gel is applied directly to the tip of the penis and works by creating a physical cooling-then-warming sensation that stimulates blood flow.
In two clinical trials, roughly 60% of patients using Eroxon achieved clinically meaningful improvements in erectile function scores. Speed is one of its strongest selling points. In one study, about 60% of users achieved an erection in under 10 minutes. A second trial showed a lower but still notable rate of 45% reaching that same benchmark. Because Eroxon contains no active drug, its side effect profile is mild compared to prescription alternatives, mostly limited to temporary local sensations from the gel itself.
The trade-off is that Eroxon tends to work best for mild to moderate ED. Men with more severe erectile dysfunction may not get enough of a response from a non-medicated product alone.
Alprostadil Cream: The Prescription Option
Alprostadil is the only prescription topical cream approved specifically for ED. Sold under the brand name Vitaros in some markets, it contains a synthetic version of a naturally occurring fatty acid that directly relaxes smooth muscle in penile blood vessels, increasing blood flow without requiring the arousal-dependent pathway that oral pills like sildenafil rely on. You apply a small amount to the tip of the penis using a pre-filled applicator.
Alprostadil cream is more potent than Eroxon, but that potency comes with a higher rate of side effects. In clinical trials, 67% of men using the cream reported adverse events compared to 12% on placebo. The most common issues were localized and temporary: burning, pain, and redness at the application site. About 6.5% of female partners also experienced vaginal burning or irritation during intercourse, compared to 3% with placebo. Despite these numbers, only 3 to 4% of trial participants stopped using the cream because of side effects, suggesting most men found the discomfort manageable.
One serious risk to be aware of: alprostadil can cause a prolonged erection lasting more than four hours. This is a medical emergency that requires treatment to prevent permanent tissue damage. The cream also should not be combined with oral ED medications like sildenafil or tadalafil, because the combination could create dangerous cardiovascular effects.
How Topical Treatments Work Differently From Pills
Oral ED medications work indirectly. They block an enzyme that breaks down a chemical messenger involved in erections, so when you become sexually aroused and your body releases nitric oxide, more of that signal stays active for longer. The key detail: you still need arousal for the pill to work.
Topical treatments take a more direct route. Alprostadil acts locally on blood vessel walls to cause them to relax and widen, pulling blood into erectile tissue regardless of arousal signals from the brain. Eroxon uses a physical mechanism (temperature change) rather than a chemical one to stimulate local blood flow. Both approaches bypass the digestive system entirely, which means faster onset and fewer whole-body side effects like headaches or flushing that oral medications commonly cause.
Nitroglycerin Gel: A Less Common Alternative
Nitroglycerin, a compound long used to treat chest pain by widening blood vessels, has also been studied as a topical ED treatment. When a 2% nitroglycerin paste was applied to the penile shaft in a placebo-controlled study, 18 out of 26 subjects showed a significant increase in penile blood flow, confirmed by ultrasound measurements of the cavernous arteries. A more refined formulation called MED2005 was tested in a randomized crossover trial published in The Journal of Sexual Medicine.
Nitroglycerin-based gels are not widely available as a standard ED treatment, and they carry risks for anyone taking nitrate medications for heart conditions. The combination can cause a dangerous drop in blood pressure. Still, for men who don’t respond well to other options, it’s worth discussing with a prescriber.
Choosing Between Them
Your choice comes down to a few practical factors:
- Severity of ED: Mild to moderate cases may respond well to Eroxon. More significant erectile dysfunction is more likely to need alprostadil or a prescription treatment.
- Convenience: Eroxon requires no prescription, no doctor visit, and no refrigeration. Alprostadil requires a prescription, and some formulations need specific storage conditions, with certain versions requiring refrigeration between 36°F and 46°F until dispensed.
- Side effects: If you or your partner are sensitive to irritation, Eroxon’s non-medicated formula is the gentler choice. Alprostadil’s local burning and discomfort are common enough that two out of three users experience some reaction.
- Speed: Both work faster than oral medications. Eroxon can produce results in under 10 minutes for many users. Alprostadil also acts within minutes of application.
- Other medications: If you already take nitrates for heart disease, nitroglycerin-based options are off the table. If you use oral ED pills, alprostadil cream should not be added on top of them.
No safety data exists for alprostadil cream use beyond nine months, so long-term users should have regular check-ins with their prescriber. There are also no safety data for its use during oral or anal sex.
For most men starting out, Eroxon offers a low-risk way to see if a topical approach works before moving to a prescription product. If it falls short, alprostadil cream provides a stronger pharmacological effect with the trade-off of more noticeable side effects.