What Is Sildenafil?
Sildenafil is a prescription medicine used to treat erectile dysfunction, which means difficulty achieving or maintaining an erection firm enough for satisfactory sexual activity.
It is the active ingredient originally developed and marketed in the ED medicine Viagra.
Generic sildenafil medicines have subsequently been authorised in Europe. EMA describes products such as Sildenafil Teva, Sildenafil Actavis and Sildenafil ratiopharm as generic medicines developed to be equivalent to Viagra.
Common tablet strengths include:
- 25mg
- 50mg
- 100mg
Sildenafil does not automatically cause an erection. Sexual stimulation is still necessary.
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How Does Sildenafil Work?
Sildenafil is a phosphodiesterase type 5 inhibitor, more commonly called a PDE5 inhibitor.
During sexual stimulation, the body produces a chemical messenger known as cyclic guanosine monophosphate (cGMP).
cGMP helps smooth muscle in the erectile tissue relax, allowing more blood to enter the penis.
An enzyme called PDE5 normally breaks cGMP down.
Sildenafil inhibits PDE5, which allows the effects of cGMP to continue for longer.
This can improve blood flow and help support a natural erection during sexual stimulation.
Sildenafil does not:
- automatically produce an erection;
- increase sexual desire directly;
- act as an aphrodisiac;
- directly increase testosterone; or
- work without sexual stimulation.
What Is Erectile Dysfunction?
Erectile dysfunction is the inability to get or maintain an erection sufficient for satisfactory sexual performance.
It can happen occasionally or become a persistent problem.
Potential contributing factors include:
- cardiovascular disease;
- diabetes;
- obesity;
- high blood pressure;
- high cholesterol;
- smoking;
- excessive alcohol consumption;
- some prescription medicines;
- stress;
- anxiety;
- depression; and
- relationship or performance concerns.
Persistent ED can sometimes be associated with underlying cardiovascular or metabolic problems, so repeated symptoms should not simply be ignored.
Who May Be Suitable for Sildenafil?
Sildenafil is indicated for adult men with erectile dysfunction.
Whether it is appropriate depends on factors such as:
- cardiovascular health;
- current medicines;
- blood pressure;
- kidney function;
- liver function;
- previous ED treatment;
- eye conditions; and
- other medical history.
An appropriate consultation helps determine whether sildenafil or another ED treatment is suitable.
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How Do You Take Sildenafil?
The usual recommended starting dose is:
50mg taken as needed approximately one hour before sexual activity.
Depending on effectiveness and tolerability, the dose may be:
- reduced to 25mg; or
- increased to a maximum of 100mg.
The maximum recommended dosing frequency is once per day.
Always follow the dose prescribed for you.
Do not take more sildenafil simply because the medicine did not work as expected on one occasion.
What Sildenafil Strength Should I Take?
The most appropriate strength depends on individual response, side effects and medical circumstances.
Sildenafil 25mg
25mg is the lower standard strength.
EMA guidance for generic sildenafil notes that patients with reduced liver function or severely reduced kidney function should generally start with 25mg.
A lower dose may also be considered where medicine interactions or side effects make a reduced dose more appropriate.
Sildenafil 50mg
50mg is the usual recommended starting dose for many adult men with ED.
Sildenafil 100mg
100mg is generally the maximum recommended dose.
It may be considered if 50mg does not provide an adequate response and the higher dose is medically suitable.
A higher strength does not guarantee a better result and can increase the likelihood of side effects.
How Long Before Sex Should I Take Sildenafil?
Sildenafil is generally taken approximately one hour before sexual activity.
The exact response can vary.
Factors that may influence onset include:
- whether you have recently eaten;
- the amount of fat in a meal;
- alcohol;
- individual metabolism;
- other medicines; and
- sexual stimulation.
Does Food Affect Sildenafil?
Yes.
EMA information states that taking sildenafil with food can delay the onset of activity compared with taking it without food.
A particularly large or fatty meal may therefore mean that it takes longer for sildenafil to become effective.
A delayed response does not necessarily mean the medicine has failed.
Does Sildenafil Work Without Sexual Stimulation?
No.
Sexual stimulation is required for sildenafil to work effectively.
The medicine supports the normal erectile-response pathway rather than causing an erection independently.
How Effective Is Sildenafil?
Sildenafil has been extensively studied.
In the original Viagra clinical programme, EMA reports that the percentages of patients saying treatment improved their erections were:
- 62% with 25mg
- 74% with 50mg
- 82% with 100mg
compared with 25% with placebo.
These are group-level trial results, not guarantees for individual patients.
Treatment response depends on factors such as:
- the underlying cause of ED;
- correct timing;
- dose;
- sexual stimulation;
- cardiovascular health;
- alcohol;
- other medicines; and
- psychological factors.
What If Sildenafil Does Not Work?
Sildenafil may not work as expected every time.
Possible reasons include:
- insufficient sexual stimulation;
- taking it after a heavy meal;
- incorrect timing;
- excessive alcohol;
- anxiety;
- an unsuitable dose;
- another medicine; or
- an underlying medical cause of erectile dysfunction.
Do not exceed the prescribed dose or take more than one dose per day.
If sildenafil repeatedly does not work, discuss the problem with an appropriate healthcare professional.
What Are the Common Side Effects of Sildenafil?
Common sildenafil side effects can include:
- headache;
- flushing;
- indigestion;
- nasal congestion;
- dizziness;
- nausea;
- blurred vision; and
- altered colour vision.
Not everyone experiences side effects.
Higher doses may increase the likelihood of some adverse effects.
Always read the current patient information supplied with your specific sildenafil product.
What Serious Sildenafil Side Effects Should I Know About?
Seek urgent medical attention if you experience serious or unusual symptoms such as:
- chest pain;
- severe dizziness or collapse;
- sudden significant loss of vision;
- sudden hearing problems;
- severe allergic symptoms; or
- an erection that is prolonged or painful.
A prolonged erection can damage penile tissue and should not be ignored.
Can Sildenafil Be Taken With Nitrates?
No.
Sildenafil must not be taken with nitrate medicines used for conditions such as angina.
Combining sildenafil with nitrates can cause a potentially dangerous fall in blood pressure.
Sildenafil also must not be combined with guanylate cyclase stimulators such as riociguat.
Always disclose every medicine you use during your consultation.
Who Should Not Take Sildenafil?
Sildenafil is not appropriate for everyone.
Situations that can make treatment unsuitable include:
- nitrate medicine use;
- certain serious cardiovascular conditions;
- situations where sexual activity is medically inadvisable;
- previous certain forms of vision loss such as NAION;
- significant hypotension;
- recent heart attack or stroke;
- severe liver disease; and
- some hereditary retinal disorders.
Other precautions and interactions may also apply.
Does Sildenafil Interact With Other Medicines?
Yes.
Sildenafil can interact with several types of medication.
Particular attention may be required with:
- nitrates;
- riociguat;
- alpha-blockers;
- some HIV medicines;
- certain antifungal medicines;
- some antibiotics;
- blood-pressure medicines; and
- other ED medicines.
Always disclose all prescription medicines, non-prescription products and supplements.
Can I Drink Alcohol With Sildenafil?
Moderate alcohol consumption may not necessarily prevent sildenafil from working.
However, excessive alcohol can:
- worsen erectile dysfunction;
- reduce sexual performance;
- increase dizziness;
- contribute to blood-pressure effects; and
- make treatment less reliable.
Limiting alcohol can therefore improve both sexual health and treatment response.
Does Sildenafil Increase Sex Drive?
No.
Sildenafil helps the physical erectile response, but does not directly increase libido.
A man can therefore have erectile dysfunction and low sexual desire for different reasons.
If reduced libido is the main problem, further assessment may be appropriate.
Does Sildenafil Increase Testosterone?
No.
Sildenafil is not testosterone replacement therapy.
It acts on the PDE5/cGMP pathway involved in blood flow to erectile tissue.
Is Generic Sildenafil the Same as Viagra?
Generic sildenafil and Viagra contain the same active ingredient: sildenafil.
EMA describes authorised generic sildenafil medicines as being developed to be similar to the reference medicine Viagra.
Generic Sildenafil
- Contains sildenafil
- Commonly available in 25mg, 50mg and 100mg
- Usually less expensive
- May differ in manufacturer, tablet appearance and inactive ingredients
Viagra
- Original branded sildenafil medicine
- Same active ingredient
- Available in 25mg, 50mg and 100mg tablets
Sildenafil vs Cialis
Both are PDE5 inhibitors but contain different active ingredients.
Sildenafil
- Taken on demand
- Usually around one hour before sexual activity
- Common strengths include 25mg, 50mg and 100mg
Cialis
- Contains tadalafil
- Longer duration of action
- Can also be prescribed as a lower-dose once-daily treatment
Sildenafil vs Spedra
Sildenafil and Spedra are different PDE5 inhibitors.
Sildenafil
Usually taken around one hour before sexual activity.
Spedra
Contains avanafil and is generally taken closer to anticipated sexual activity.
Sildenafil vs Vardenafil
Sildenafil and vardenafil belong to the same PDE5 inhibitor class but are different medicines.
Vardenafil is the active ingredient used in Levitra.
They differ in:
- dosing;
- timing;
- metabolism;
- interactions;
- strengths; and
- individual response.
Sildenafil vs Hezkue Oral Spray
Both contain sildenafil.
Sildenafil Tablets
- Solid oral tablet
- Common strengths: 25mg, 50mg and 100mg
Hezkue
- Liquid sildenafil suspension
- Administered using a measured oral spray pump
- Provides flexible dosing through multiple actuations
The active ingredient is the same, but the delivery method differs.
View Hezkue Sildenafil Oral Spray
Sildenafil vs VaxAid Deluxe
The two treatments use completely different approaches.
Sildenafil
- Prescription medicine
- PDE5 inhibitor
- Requires sexual stimulation
VaxAid Deluxe
- Drug-free vacuum erection device
- Uses negative pressure to increase penile blood flow mechanically
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