BlueChew Side Effects

Erectile dysfunction (ED) affects many people — likely a third of men.1 It becomes more common with age, yet 5% of men under 40 are unable to get an erection.2 As you explore your options for ED treatment, you’ll naturally want to know whether treatments are effective, safe, and affordable. These bedrock considerations overwhelmingly shape our regard for any medical treatment. But there are layers to the subject of safety; a treatment can be generally safe while also possibly causing mild side effects in a broad group of people. And what one person considers a minor nuisance may be a deal-breaker for another.

One provider of ED medications — BlueChew — has understandably attracted a lot of attention over the past several years. For some people, BlueChew’s ED medications are a non-starter — unsafe or unsuitable for underlying health reasons, as determined by a consulting medical professional. If you’re considered a good candidate for treatment, it means that you will be able to access some of the most effective, safe, and affordable ED treatments available. But that doesn’t mean you won’t experience a side effect, or maybe more than one.

So, what are BlueChew’s side effects? Are they exactly the same for each treatment option? What about the likelihood of experiencing them? And does dosage affect the likelihood?

Because so many people have asked us for clarification about the potential side effects of BlueChew, we’ve created this comprehensive guide to shed more light on this important subject. If you’re going to begin a new medication like the ones BlueChew offers, you should definitely know what side effects you could encounter — and when those side effects should prompt you to speak to a doctor.

Thankfully, BlueChew side effects are usually mild, but the likelihood and nature of possible side effects varies by medication and is affected by dose. We’ll break it all down so that you can proceed in confidence or explore alternative treatment options.

BlueChew entered the landscape as a unique company — the first to provide chewable prescription treatments for ED online. Initially, this meant compounded versions of the active ingredients in Viagra and Cialis, which are sildenafil and tadalafil, respectively. But later, BlueChew introduced a third option: chewable vardenafil, the active ingredient in Levitra. BlueChew offers ED prescriptions through an online portal, allowing you to have medication delivered straight to your door wherever you live in the United States (as long as that isn’t North Dakota), without any physical doctor’s visit or trip to a pharmacy.

While it may have been the first, BlueChew is no longer the only company to do all of this. It’s among a widening group of providers offering compounded forms of well-studied prescription ED medications. These compounded drugs have the same therapeutic potency as traditional, brand-name pills. Dosages do vary from company to company, which is something we’ll outline later in this guide since it can affect the likelihood of side effects.

BlueChew offers the following prescription treatments:

• Sildenafil (active ingredient in Viagra)
• Tadalafil (active ingredient in Cialis)
• Vardenafil (active ingredient in Levitra)

The company recently introduced a daily version of its tadalafil chew. (Previously, only an as-needed version of tadalafil was available.) The main difference between daily and as-needed tadalafil prescriptions tends to be dosage, though BlueChew’s daily chew does include supportive supplemental ingredients. Some of these, such as vitamin D and folic acid, are even present at levels that studies indicate could be beneficial for men trying to address ED.37 38

Only a medical professional — like the kind affiliated with BlueChew or its competitors, or a doctor you’d see in a traditional office — can determine if you’re a safe and suitable candidate for these medications. If you are, it means the medical professional has reviewed pertinent details about your medical history, health, and current medications and concluded that using one of these medications will likely help address your ED symptoms without posing a serious risk to your health.

But if you are approved, it does not guarantee you’ll experience no side effects. In fact, side effects are not uncommon. Thankfully, they tend to be very mild, with few people discontinuing treatment because of them. In our surveying the landscape of available ED treatments — prescription medications, over-the-counter options like supplements, and various devices you’d use at home or in a clinical setting — none currently offer the same combination of effectiveness, safety, affordability, and convenience as the treatments BlueChew offers.

To understand why BlueChew’s ED medications would cause side effects and also why those side effects would vary from drug to drug, it’s useful to know a few basic details of how the medications work. Warning: it’s a bit complicated!

All of BlueChew’s medications are PDE5 inhibitors, a class that also includes relative newcomer avanafil (Stendra), which BlueChew does not yet offer. PDE5 stands for “phosphodiesterase type 5.” (You can see why people use the abbreviation.) Phosphodiesterases are a superfamily of enzymes that act as regulators of signals being sent within cells. As the number in PDE5 would suggest, there are numerous families of phosphodiesterase that have been identified — 11, to be precise (PDE1 through PDE11) — and they all have different effects on the human body.3 Scientists further divide these families into subtypes and splice variants.

As BlueChew’s medications are all PDE5 inhibitors, they all temporarily prevent PDE5 from doing what it normally would do in your body… which makes it useful to understand what PDE5 ordinarily does.

What does PDE5 ordinarily do?

You may or may not have heard of the chemical, nitric oxide (NO). Some people take dietary supplements to increase NO in their bodies, typically with goals involving exercise performance, sexual performance, or general cardiovascular health. This is because NO, vascularly downstream of where it is released in the body, causes the conversion of GTP (guanosine triphosphate) into cGMP (cyclic guanosine monophosphate). cGMP relaxes the smooth muscles in the walls of blood vessels, which is what causes them to widen — something called vasodilation.4 So, NO can promote increased blood flow.

When it is released vascularly upstream from the spongy tissues of the penis, NO leads to more cGMP in those tissues, which enables the increase in blood flow and accumulation of blood there, causing an erection.5 What causes an erection to stop, meanwhile, is PDE5; when the body feels that it’s time for an erection to end, PDE5 is released to bind to the cGMP, causing smooth muscles in the blood vessels to return to normal.6 This means less blood flow to the penis, and the erection goes away.

Inhibiting PDE5 is an effective way to allow many (but not all) men with ED to get erections strong enough for the sexual activity they want. And the reason these treatments don’t cause spontaneous erections is that arousal is still necessary for the brain to signal to the cavernous nerve (a nerve in the penis) to release NO there.6 (Remember, NO has the aforementioned effects vascularly downstream of where it is released.)

Can these drugs affect other PDE enzymes aside from PDE5s?

None of the PDE5 medications that BlueChew offers are completely selective for PDE5. In other words, they can inhibit other families of PDE as well. To the limited extent that they do collaterally inhibit other PDE families, they can produce different side effects corresponding to those PDE families and what their normal jobs are in our bodies. And while all three of the medications share a small set of common potential side effects — headache, nasal congestion, and dyspepsia — most adverse side effects happen because of the medications inhibiting other PDE families aside from PDE5.35

Sildenafil and vardenafil collaterally inhibit PDE1 and PDE6. Tadalafil, meanwhile, doesn’t cause that kind of collateral effect, but it does collaterally inhibit PDE11.6 This provides some explanation for why these medications differ in the side effects they're most likely to cause.

BlueChew’s sildenafil comes in either 30mg or 45mg doses. As the active ingredient in Viagra, sildenafil is probably the most common and certainly the longest-studied ED medication on the market today. It’s the one that started them all, the only one introduced in the 20th century; if you’re old enough, you may remember Bob Dole as a spokesman for it following his presidential campaign in the late ‘90s. Like vardenafil, sildenafil is an as-needed medication. You’ll take it 30-60 minutes before sexual activity may occur, and after that waiting period, the medication will be effective for a period of 4-6 hours.

On the one hand, the fact that it’s the longest-studied ED medication can give people some peace of mind, and it’s still the first path that many prescribing doctors explore with patients. On the other hand, years of research also reveal that sildenafil seems capable of causing certain side effects that a couple newer options like vardenafil and avanafil likely won’t. Avanafil — the active ingredient in Stendra and the newest PDE5 for ED — is a relatively costly medication offered by Hims but not BlueChew. It’s the most selective PDE5 inhibitor and less likely to cause side effects.7

Sildenafil’s most common side effects are mild and include:8

• Headache
• Flushing of the face and skin
• Nasal congestion
• Acid reflux (heartburn)
• Dyspepsia (discomfort in the upper abdomen caused by stomach upset)
• Vision changes (such as a blue-green tint, temporarily blurred vision, or difficulty with color perception)

Side effects involving vision disturbances arise due to the fact that sildenafil also collaterally inhibits PDE6. Of course, this isn’t the purpose of taking sildenafil; the goal is to inhibit PDE5 in order to facilitate erections. PDE6 isn’t associated with erections but, instead, with certain visual processing pathways. People who experience vision-related side effects often successfully avoid them in the future by switching to tadalafil. Switching to vardenafil sometimes solves this problem as well; though vardenafil also weakly inhibits PDE6, research indicates that men who experience vision-related side effects from sildenafil may avoid those side effects when using vardenafil.9

Also, these mild visual changes are not to be confused with a very rare but serious side effect (described later) involving total loss of vision in one or both eyes. It’s rare, but if it happens, seek medical attention.

Whereas sildenafil and vardenafil are similar in molecular structure, tadalafil (the active ingredient in Cialis) is quite different from them.3 There’s a waiting period of about 30-60 minutes before a dose starts working, but tadalafil is a much longer-acting drug than either sildenafil or vardenafil. Because tadalafil remains active for 18-36 hours, it can be prescribed either as an as-needed medication or a once-daily medication. As-needed BlueChew tadalafil comes in 6mg or 9mg doses, while daily tadalafil from BlueChew is 9mg. Tadalafil is a longer-acting drug than either of BlueChew’s other treatments.

Despite its differences, as it’s a PDE5 inhibitor, tadalafil is capable of causing several of the same side effects as the two other BlueChew medications. The most common side effects of tadalafil are mild and include:11

• Headache
• Dyspepsia (discomfort in the upper abdomen caused by stomach upset)
• Back and muscle pain
• Nasal congestion, runny nose, and/or sneezing

Notice that this list differs from sildenafil’s side effects in a couple meaningful ways. First, visual side effects aren’t likely to occur with tadalafil because tadalafil doesn’t inhibit PDE6. But unlike sildenafil, tadalafil may cause back pain and muscle aches. This is owing to the fact that tadalafil inhibits PDE11 — something that sildenafil and vardenafil do not do.10 If you’re already susceptible to back pain, this might make you prefer those other two medications rather than tadalafil. Though the majority of people do not experience anything but potentially mild side effects, 2-3% do contend with more significant back pain and myalgia.12

Likelihood of side effects

You might look at these lists of side effects and conclude that, since its list is shorter, BlueChew tadalafil doesn’t pose the same risk of side effects as the other BlueChew medications. However, studies indicate that tadalafil users experience side effects at least as often as users of other PDE5 inhibitors.3 And tadalafil, particularly at higher doses, can produce side effects that last longer than those of sildenafil or vardenafil.23

Research suggests that 53% of tadalafil users may experience side effects in the first year of treatment, while that number rises to 73% by the end of year two. However, these side effects are mild, and only 10% of users considered the side effects consistent enough to bother them.13 The likelihood of side effects from BlueChew tadalafil will be quite similar.

Like sildenafil, vardenafil is taken on an as-needed basis. If you know that you’ll be engaging in sex, you’d chew a BlueChew vardenafil dose 30-60 minutes ahead of time in order for it to provide effective treatment for 4-6 hours.

Vardenafil has a very similar side effects profile to sildenafil. However, along with tadalafil, vardenafil was developed about a half-decade after sildenafil appeared on the market. Compared to sildenafil, it is more selective in inhibiting PDE5.9

Side effects of vardenafil tend to be mild, as with the other two BlueChew medications, and most commonly may include:14

• Headache
• Dyspepsia
• Facial flushing
• Nasal congestion, runny nose, and/or sneezing

Vardenafil does still collaterally inhibit PDE6 but doesn’t do so to the extent that sildenafil does, so its likelihood of causing visual side effects is lower.9 This often makes it a good alternative for people who want to discontinue sildenafil due to changes in color perception.

Side effects of BlueChew vardenafil will be much the same as those of brand-name Levitra or Staxyn but with possible added side effects from the peppermint that BlueChew includes for flavor. Peppermint may trigger heartburn symptoms in those who suffer from GERD because it relaxes the lower esophageal sphincter.15

As described above, the vast majority of BlueChew side effects are mild. In very rare cases, however, PDE5 medications may cause side effects that would require swift medical attention. If you experience any of the following side effects, you should seek medical attention immediately:

Again, these side effects are rare, thankfully. At the time of a particular review of literature in 2008 — a decade after Viagra hit the market and a half-decade since Cialis and Levitra had entered it — there had been only one documented case of priapism caused by tadalafil and only a few documented cases caused by sildenafil; there was just as much evidence of this class of drugs alleviating recurrent priapism as there was evidence of the drugs causing priapism as a side effect.18 And in the case of hearing loss, more research is certainly needed; a review of the literature published in 2019 concluded that research up to that time was inconclusive, with some data suggesting risk and other data suggesting that PDE5s were actually otoprotective (protective of hearing) rather than somehow ototoxic.36

You’re far likelier to experience bothersome side effects than dangerous ones. And if you do encounter common side effects that rise to a level of severity or frequency that bothers you, talk to your prescribing medical professional. If you work with BlueChew, you’d want to share your negative experience through their patient portal so that the medical professionals can reassess your dosage or medication and potentially propose an alternative treatment path that wouldn’t cause those unpleasant side effects.

Contraindications and associated risks

BlueChew’s medications are available only via prescription by one of BlueChew’s affiliated medical professionals. If you take certain medications already or have underlying cardiovascular conditions, prescription ED medications can be downright dangerous to you. For instance, if you take a nitrate-containing medication (like nitroglycerin), that is a contraindication to using PDE5 inhibitors like sildenafil, tadalafil, and vardenafil. Using both can cause possibly deadly low blood pressure (hypotension).35

If you have preexisting hypotension or take medications like alpha-blockers to treat high blood pressure, the prescribing doctor would need to decide whether it’s safe for you to take PDE5 inhibitors. Doing so may also cause dangerously low blood pressure, symptoms of which can include:

• Dizziness
• Weakness
• Fainting
• Tiredness
• Physical instability

But hypotension doesn't always cause noticeable symptoms, despite the risks to your health.

Those with chronic kidney disease may not be suitable candidates for prescription ED medication, though the prescribing medical professional will be able to determine whether your circumstances contraindicate using them.

All of this underscores the importance of being thorough in your description of medications and existing health conditions when you consult with the doctor — something perhaps even more important in an online consultation scenario. Prescribing medical professionals will be able to determine whether you’re a safe candidate for the treatments that BlueChew offers, but only if they have enough information about your underlying health and current use of medications.

Your likelihood of experiencing side effects may be higher or lower depending on differences in the dosage of the active ingredients. Studies examining the effectiveness and safety of tadalafil, sildenafil, and vardenafil at different dosages reveal that side effects are more common at higher doses.3

Given that dosage appears to play a direct role in the likelihood of side effects — with higher doses increasing the chances of side effects — what does this mean for BlueChew side effects in particular?

BlueChew side effect risks compared to those with other providers

Here’s a quick comparison of BlueChew’s dosages and those of its competitors. And note: competitors Hims and Roman both offer brand-name Viagra and Cialis in addition to the compounded versions whose doses you’ll find in the chart below.

How could this factor into your decision-making and comfort levels when it comes to risk of side effects? Let’s break it down further by medication.

Ultimately, from strictly a safety standpoint, BlueChew strikes us as a good starting place for people new to PDE5 medications, particularly when exploring the following options:

• Sildenafil
• As-needed tadalafil
• Vardenafil

We’ve compared ED treatment options for years to help men decide, and we draw this conclusion for a few compelling reasons:

1. The dosages for each of these scenarios are either below or very close to the common entry points in terms of strength, which helps you keep your risk of side effects relatively low. If the lower dose works for you, that’s excellent; generally, the best dose of any prescription is going to be the lowest effective dose.
2. BlueChew offers a level of convenience rivaled only by competing online providers — and only if they are providing compounded versions that don’t require a glass of water. In the case of these three treatment paths, BlueChew offers the best compounded options at this time.
3. BlueChew is the only place that lets you try one of these medications for free (only paying the small shipping fee), as long as their medical professionals determine that you’re a safe candidate for trying one of these PDE5 medications. We know of no easier and more affordable way to see if one of these medications works well for you.

Given that some side effects are universal among PDE5 medications, while others are unique to one or a couple of them, here is a handy chart that hopefully enables easier comparison of the likeliest possible side effects:

When it comes to likelihood, numerous studies into these drugs broadly agree that:

1. Most men won’t experience anything beyond mild side effects.
2. Side effects are more likely to occur at higher doses.

How likely are the likeliest side effects?

One large study conducted in 2009 compared the frequency and duration of various side effects caused by sildenafil, vardenafil, and tadalafil among a group of over 400 men who were given the maximum doses of one of those three drugs. The chart below shows the rates of specific side effects experienced with each drug at a maximum dose. It found that:23

• The vast majority of participants didn’t wish to discontinue the medications.
• Most side effects were mild.
• Between one third and one half of participants experienced side effects, depending on the medication (with vardenafil users experiencing side effects 33% of the time, sildenafil users experiencing them 43% of the time, and tadalafil users experiencing them 46% of the time).
• When they occurred, side effects for tadalafil users tended to last longer than other drugs.

It’s important to remember that this was a study of what might happen at the maximum dosage levels, whereas BlueChew medications are not offered at these maximum levels. Other studies looking at ranges of doses show that rates of side effects tend to increase at higher dosage levels (as described earlier) and that doses more akin to what BlueChew provides tend to yield lower rates of side effects. A 2006 review of clinical evidence — after sildenafil had been on the market for eight years — showed this rate of side effects when a broad spectrum of dosage levels was taken into consideration:22

Other reviews of clinical practice show that the rate of side effects for sildenafil at 50mg (a rate of 20%) is about one-third the rate seen at 150mg.20 And meanwhile, several double-blind studies of vardenafil showed that vardenafil, at doses closer to BlueChew’s, does not bring a risk of back pain (which is consistent with the fact that it doesn’t inhibit PDE11 as tadalafil does).21

In order to formulate its chewable meds, BlueChew includes a short list of inactive ingredients as well. These collectively amount to less than a gram of each tablet. With the exception of the peppermint and mint of the BlueChew vardenafil chews possibly aggravating GERD symptoms, the likelihood of experiencing side effects from any of these seems very low.

The inactive ingredients vary a bit from BlueChew medication to medication since some of them provide flavor to the chewables. All of the chewables, regardless of active ingredient, contain:

In terms of inactive ingredients for the purpose of flavoring, BlueChew’s products variably contain:

• Natural flavoring (fruit punch in sildenafil and tadalafil only)
• Xylitol (vardenafil only)
• Mint (vardenafil only)
• Peppermint (vardenafil only)

Xylitol poses no apparent risk of side effects.33 However, because of the connection between peppermint and reflux symptoms for some who suffer from GERD, those with GERD may wish to avoid the risk of any unwanted heartburn side effects from the peppermint added to BlueChew vardenafil chews.15 34 If you have GERD or hiatus hernia and have observed that peppermint or mint exacerbates your reflux symptoms, you’d be better off opting for BlueChew sildenafil or tadalafil — depending on what a prescribing medical professional concludes, of course — or choosing a more traditional form of vardenafil that isn’t minty.

The PDE5 treatments available from BlueChew are available only by prescription for good reasons: they would pose an unacceptable health risk to some people, and for the rest of us, they may cause side effects that are disruptive enough that it’s important for a doctor to be involved in making adjustments to dosage or proposing a different PDE5 medication entirely. But thankfully, the medications in BlueChew have been widely used for decades, so there’s a long track record to study. It reveals that, for the vast majority of people prescribed these medications, they cause only mild to moderate side effects — the kind that seldom discourage people from using them if the treatment is working.