Mechanism of Action: How Sildenafil Works

Patients thus taking the drug may experience colorvision abnormalities. Some complained of blurriness and loss of peripheral vision.

Side Effect	Frequency	Severity	Notes
Headache	Very common	Mild to moderate	Usually transient
Flushing	Common	Mild	Due to vasodilation
Dyspepsia	Common	Mild	Indigestion
Nasal Congestion	Less common	Mild	Sinus tissues affected

In July 2005, the US Food and Drug Administration (FDA) updated labeling for tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra) to reflect a small number of post-marketing reports of sudden vision loss, while acknowledging that "...it is not possible to determine whether these oral medicines for erectile dysfunction were the cause of the loss of eyesight or whether the problem is related to other factors such as high blood pressure or diabetes, or to a combination of these problems.

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Tentative evidence suggests that sildenafil may help males who experience antidepressant-induced erectile dysfunction. While sildenafil improves some markers of disease in people with pulmonary arterial hypertension, it does not appear to affect the risk of death or serious side effects. Sildenafil and other PDE5 inhibitors are used off-label to alleviate vasospasm and treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon;[9][21] these drugs have moderate efficacy for reducing the frequency and duration of vasospastic episodes. [9] As of 2016,[update] their role more generally in Raynaud's was sildenafil 200 mg not clear. Sildenafil has shown some potential for improving exercise performance at high altitudes. "[25] A careful review of pooled data from clinical trials containing well documented information about the dose and duration of exposure to the drug for a large number of patients, yields no evidence for an increased risk of non-arteritic anterior ischemic optic neuropathy or other adverse ocular events associated with PDE5 inhibitor use.

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Rare but serious adverse effects found through postmarketing surveillance include prolonged erections, severe low blood pressure, myocardial infarction (heart attack), ventricular arrhythmias, stroke, increased intraocular pressure, and sudden hearing loss. [4] In October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including sildenafil, required a more prominent warning of the potential risk of sudden hearing loss. Care should be exercised by people who are also taking protease inhibitors for the treatment of HIV infection.

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Sildenafil acts by blocking phosphodiesterase 5 (PDE5), an enzyme that promotes breakdown of cGMP, which regulates blood flow in the penis. [8] It requires sexual arousal to work, and does not by itself cause or increase sexual arousal. [8] It also results in dilation of the blood vessels in the lungs. Pfizer originally discovered the medication in 1989 while looking for a treatment for angina. [11] It was approved for medical use in the United States and in the European Union in 1998.

Usual Adult Dose for:

[5][8][11][12] In 2023, it was the 151st most commonly prescribed medication in the United States, with more than 3 million prescriptions. [13][14] It is available as a generic medication. [15][16] In the United Kingdom, it is available as a pharmacy medicine. The primary indication of sildenafil is treatment of erectile dysfunction (inability to sustain a satisfactory erection to complete sexual intercourse). Its use is now one of the standard treatments for erectile dysfunction, including for males with diabetes mellitus. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects. Those using protease inhibitors are recommended to limit their use of sildenafil to no more than one 25 mg dose every 48 hours.

What special dietary instructions should I follow?

It is not known if sildenafil citrate passes into your breast milk or if it could harm your baby. •Ritonavir (Norvir ®) or other medicines used to treat HIV infection •Take sildenafil tablets exactly as your doctor tells you. •low blood pressure.Low blood pressure may cause you to feel faint or dizzy. •more shortness of breath than usual.Tell your doctor if you get more short of breath after you start sildenafil tablets. •decreased eyesight or loss of sight in one or both eyes (NAION).If you notice a sudden decrease or loss of eyesight, talk to your doctor right away.

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•sudden decrease or loss of hearing.If you notice a sudden decrease or loss of hearing, talk to your doctor right away. It is not possible to determine whether these events are related directly to this class of oral medicines, including sildenafil , or to other diseases or medicines, to other factors, or to a combination of factors. •heart attack, stroke, irregular heartbeats, and death.Most of these happened in men who already had heart problems. •erections that last several hours.If you have an erection that lasts more than 4 hours, get medical help right away. •Sildenafil Tablets comes in child-resistant package. [4] Other drugs that interfere with the metabolism of sildenafil include erythromycin and cimetidine, both of which can also lead to prolonged plasma half-life levels.

• The medication may interact with antibiotics like erythromycin.
• Patients with eye disorders should consult their doctor before use.
• Sildenafil citrate tablets are often used recreationally as well.
• Overuse or misuse can lead to health complications.

The use of sildenafil and an α1 blocker (typically prescribed for hypertension or for urologic conditions, such as benign prostatic hypertrophy) at the same time may lead to low blood pressure, but this effect does not occur if they are taken at least 4 hours apart.

Patient Group	Typical Dose	Special Considerations
Adult Men	150 mg as needed	Take 30-60 minutes before activity
Elderly Patients	75-150 mg based on response	Start at lower dose, monitor side effects
Patients with Liver impairment	Lower dose advised	Adjust based on hepatic function

Concomitant use of nitric oxide donors, organic nitrites and nitrates,[30] such as: nitroglycerinisosorbide mononitrateisosorbide dinitratesodium nitroprussidealkyl nitrites (commonly known as "poppers") Concomitant use of soluble guanylyl cyclase stimulators, such as riociguat Sildenafil should not be used if sexual activity is inadvisable due to underlying cardiovascular risk factors. Sildenafil's popularity with young adults has increased over the years.

• Be aware of the signs of adverse reactions like chest pain.
• Do not use sildenafil if you are taking medications for heart issues.
• The medication does not cause sexual arousal; stimulation is needed.
• Use only the prescribed dose, especially at high levels like 150 mg.

[32] Sildenafil's brand name, Viagra, is widely recognized in popular culture, and the drug's association with treating erectile dysfunction has led to its recreational use.

• Sildenafil 150 mg is considered a high dose for most users.
• Overdose can cause severe hypotension or cardiovascular issues.
• Use caution when taking other medications affecting blood pressure.
• Sildenafil should be taken only as prescribed by a healthcare provider.

[33] The reasons behind such use include the belief that the drug increases libido, improves sexual performance,[33] or permanently increases penis size.

• Sildenafil 150 mg can be part of a treatment plan for ED.
• Do not combine sildenafil with other erectile dysfunction drugs.
• Side effects should be reported to a healthcare provider promptly.
• Always check for allergies to sildenafil or related compounds.

[34] Studies on the effects of sildenafil when used recreationally are limited, but suggest it has little effect when used by those who do not have erectile dysfunction.

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You too can be free from having to worry about something like this, and you may enjoy a new awareness of life by experiencing enduring and better sex. Sildenafil, sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. [4][8] It is also sometimes used off-label for the treatment of certain symptoms in secondary Raynaud's phenomenon. [9] It is unclear if it is effective for treating sexual dysfunction in females. [8] It can be taken sildenafil generic orally (swallowed by mouth), intravenously (injection into a vein), or through the sublingual route (dissolved under the tongue).

Pulmonary hypertension

[8][10] Onset when taken orally is typically within twenty minutes and lasts for about two hours. Common side effects include headaches, heartburn, and flushed skin. [8] Caution is advised in those with cardiovascular disease. [8] Rare but serious side effects include vision problems, hearing loss, and prolonged erection (priapism) that can lead to damage to the penis. [8] Sildenafil should not be taken by people on nitric oxide donors such as nitroglycerin, as this may result in a serious drop in blood pressure. [35] This study also noted a significant placebo effect in the control group.

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However, its overall efficacy is not clear. Sildenafil has been studied for high-altitude pulmonary edema (HAPE), but its use is currently not recommended for that indication. In clinical trials, the most common adverse effects of sildenafil use included headache, flushing, indigestion, nasal congestion, and impaired vision, including photophobia and blurred vision. [4] Some sildenafil users have complained of seeing everything tinted blue (cyanopsia). [24] This cyanopsia can be explained because sildenafil, while selective for PDE5, does have some affinity for PDE6, which is the phosphodiesterase found in the retina.