5 WARNINGS AND PRECAUTIONS
If you have stable heart disease, you can generally still take sildenafil, but your blood pressure should be monitored and in some cases, an exercise stress test might be administered prior to starting sildenafil. Men with significant coronary artery disease or with valvular narrowing's in the heart caused by aortic valve stenosis or hypertrophic obstructive cardiomyopathy (or HOCM) should not use sildenafil.
Side Effects
American Journal of Cardiology, 84(5), 11N–17N. Our friendly customer care team is standing by for support. This content is intended for counseling purposes only. This content is informational/educational and is not intended to treat or diagnose any disease or patient. No claims are made as to the safety or efficacy of mentioned preparations.
How Sildenafil Works to Treat ED
The compounded medications featured in this content have been prescribed and/or administered by prescribers who work with Wedgewood Pharmacy. You are encouraged to speak with your prescriber as to the appropriate use of any medication. Wedgewood Pharmacy's compounded veterinary preparations are not intended for use in food and food-producing animals. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them.
Frequently Asked Questions
[1][2][4][5][7][8][10][24][27][33][41][56][57][67][91][131] Brand Name: Vybrique, ViagraClasses: Phosphodiesterase Type 5 Inhibitors (24:08.12), Phosphodiesterase type 5 inhibitors (48:48.24) Sildenafil citrate (Viagra® and generic equivalents) is used orally for the treatment of erectile dysfunction (ED, impotence). [1][4][6][7][8][9][10][25][33][34][67][81][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][142][143][144][189] A thorough medical, sexual and psychosocial history, physical examination, and selective laboratory testing should be undertaken to diagnose ED, determine potential underlying causes, exclude potentially reversible or treatable causes (e.g., hypogonadism with inadequate testosterone replacement, hyperprolactinemia, drug-induced dysfunction, dyslipidemias, alcoholism, other substance abuse, hypertension, thyroid disease, cardiovascular or cerebrovascular disease, neurologic disease, adrenal dysfunction, psychologic dysfunction, marital discord, smoking), and identify appropriate treatment in conjunction with or prior to initiating vasoactive therapy (e.g., PDE 5 type inhibitor). [12][28][30][31][57][65][66][70][78][83][94][144][145][160][161][189][601][602][603] A review of the patient's current drug regimens should be conducted to detect possible drug-induced ED (e.g., certain antihypertensive, antidepressant, antipsychotic, or antiarrhythmic agents); it may be possible to substitute alternative drug(s) that lessen the risk of such dysfunction. [12][28][70][81][118][144][161][602][603] In instances where substitution therapy is not feasible, concomitant vasoactive therapy with a PDE 5 type inhibitor may promote patient compliance by counteracting ED as an adverse effect. [12][28][70][81][118][144][161][602][603] Efficacy of sildenafil is variable in patients with ED, in part depending on the underlying etiology, severity, and dose employed, but the drug generally appears to be effective in restoring sexual function to an acceptable level in the majority of treated men. In some cases men with eye problems such as retinitis pigmentosa, extra caution should be taken since the drug can have visual side effects. (11) Any man taking sildenafil for erectile dysfunction should be aware that drug interactions are one of the more important factors when deciding on whether the medication can be used safely and what dosage is safe. Nitrates can cause issues with blood pressure, alpha blockers can increase the risk of dizziness, CYP3A4 inhibitors such as ketoconazole, erythromycin, or ritonavir can slow the breakdown of the certain medications such as sildenafil in the blood and in these situations, your doctor will discuss whether sildenafil is safe and if so, what the safe dose and administration routine (eg daily or every second day) are. Grapefruit juice is a mild inhibitor of an enzyme known as CYP3A4 and can increase the risk of side effects with sildenafil as this medication is metabolized by CYP3A4 Whether you’re taking 25mg or 100mg, always tell your doctor about any other medications you’re taking, even if they’re over the counter. There is no perfect dosage of sildenafil for every man.
| Side Effect | Frequency | Severity | Management Suggestions |
|---|---|---|---|
| Headache | Common | Mild | Analgesics, hydration |
| Visual disturbances | Less common | Mild-moderate | Discontinue use if persistent |
| Dizziness | Common | Mild | Sit or lie down, avoid driving |
| Priapism | Rare | Severe | Seek immediate medical attention |
| Hearing loss | Very rare | Severe | Discontinue medication, seek help |
50mg is the most prescribed dose, but depending on the factors discussed in this article there may be a better dose for you based on your specific medical background and needs.FYI: Erectile dysfunction can be a side effect of common hair loss medications like finasteride. If you're also struggling with hair loss and are worried about how treatment could affect performance, you may want to consider topical finasteride. For most healthy adults, the recommended starting sildenafil dosage is 50 mg taken about 30–60 minutes before sexual activity. Depending on your response and side effects, a doctor may adjust your sildenafil citrate dosage down to 25 mg or up to 100 mg Standard tablets for erectile dysfunction are 25 mg, 50 mg, and 100 mg. A sildenafil 20 mg dosage is primarily manufactured for pulmonary hypertension (Revatio). While 20 mg may help some men—especially in sublingual forms—many patients need higher doses for consistent results Sildenafil is generally intended for on‑demand use, not as a sildenafil daily dosage. Unlike tadalafil, there is no FDA‑approved daily sildenafil regimen.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Viagra Generic | 200mg | 120 + 8 Pills | 204.80€ 195.05€ | |
| Viagra Generic | 100mg | 30 + 4 Pills | 60.91€ 58.01€ | |
| Kamagra Oral Jelly | 100mg | 30 + 5 Sachets | 136.20€ 129.71€ | |
| Viagra Generic | 50mg | 120 + 6 Pills | 129.64€ 123.47€ | |
| Kamagra Oral Jelly | 100mg | 90 + 8 Sachets | 303.56€ 289.10€ | |
| Kamagra Oral Jelly | 100mg | 63 + 7 Sachets | 224.18€ 213.50€ | |
| Kamagra Soft Tabs | 100mg | 12 Pills | 57.55€ 54.81€ | |
| Viagra Generic | 100mg | 180 + 8 Pills | 199.37€ 189.88€ | |
| Viagra Generic | 100mg | 120 + 6 Pills | 149.50€ 142.38€ | |
| Viagra Generic | 25mg | 10 Pills | 25.19€ 23.99€ | |
| Kamagra Polo | 100mg | 12 Pills | 60.21€ 57.34€ | |
| Kamagra Polo | 100mg | 84 + 4 Pills | 244.49€ 232.85€ |
Taking it more than once in 24 hours can increase the risk of side effects and should be avoided unless prescribed by your doctor to be used that way. Exceeding the maximum dosage for sildenafil (more than 100 mg in 24 hours) does not improve erections and raises the risk of severe headaches, dizziness, low blood pressure, vision changes, and priapism (a prolonged erection requiring emergency care). Seek medical attention if you exceed the recommended daily maximum of 100mg in one day. Both doses work by improving blood flow, but the sildenafil 100 mg dosage is usually prescribed if 50 mg is not effective.
8.7 Hepatic Impairment
If you have stable heart disease, you can generally still take sildenafil, but your blood pressure should be monitored and in some cases, an exercise stress test might be administered prior to starting sildenafil. Men with significant coronary artery disease or with valvular narrowing's in the heart caused by aortic valve stenosis or hypertrophic obstructive cardiomyopathy (or HOCM) should not use sildenafil. In some cases men with eye problems such as retinitis pigmentosa, extra caution should be taken since the drug can have visual side effects. (11) Any man taking sildenafil for erectile dysfunction should be aware that drug interactions are one of the more important factors when deciding on whether the medication can be used safely and what dosage is safe. Nitrates can cause issues with blood pressure, alpha blockers can increase the risk of dizziness, CYP3A4 inhibitors such as ketoconazole, erythromycin, or ritonavir can slow the breakdown of the certain medications such as sildenafil in the blood and in these situations, your doctor will discuss whether sildenafil is safe and if so, what the safe dose and administration routine (eg daily or every second day) are.
How Viagra Facilitates an Erection
Grapefruit juice is a mild inhibitor of an enzyme known as CYP3A4 and can increase the risk of side effects with sildenafil as this medication is metabolized by CYP3A4 Whether you’re taking 25mg or 100mg, always tell your doctor about any other medications you’re taking, even if they’re over the counter. There is no perfect dosage of sildenafil for every man. 50mg is the most prescribed dose, but depending on the factors discussed in this article there may be a better dose for you based on your specific medical background and needs.FYI: Erectile dysfunction can be a side effect of common hair loss medications like finasteride. If you're also struggling with hair loss and are worried about how treatment could affect performance, you may want to consider topical finasteride. For most healthy adults, the recommended starting sildenafil dosage is 50 mg taken about 30–60 minutes before sexual activity.
Is 20 or 25mg Sildenafil Enough for ED?
Depending on your response and side effects, a doctor may adjust your sildenafil citrate dosage down to 25 mg or up to 100 mg Standard tablets for erectile dysfunction are 25 mg, 50 mg, and 100 mg. A sildenafil 20 mg dosage is primarily manufactured for pulmonary hypertension (Revatio). While 20 mg may help some men—especially in sublingual forms—many patients need higher doses for consistent results Sildenafil is generally intended for on‑demand use, not as a sildenafil daily dosage. Unlike tadalafil, there is no FDA‑approved daily sildenafil regimen. Taking it more than once in 24 hours can increase the risk of side effects and should be avoided unless prescribed by your doctor to be used that way. Studies show a higher response rate at 100 mg, but also a greater chance of side effects. Doctors typically start at 50 mg and only increase to 100 mg if needed. Physician-Scientist; Founder, Director, and Chief Executive OfficerXYON: Founder, Director, and CEOEducationDoctorate of Medicine (MD) — University of Cape Town, South Africa — 1991Genetics (PhD) — University of Amsterdam, The Netherlands — 1998Internal Medicine (Postgraduate Fellowship) — University of British Columbia (UBC), Canada — 2001Academic & Clinical AppointmentsClinical Assistant Professor, Division of General Internal Medicine — University of British ColumbiaAssociate Member, Division of Cardiology, Department of Medicine — University of British ColumbiaFaculty — Providence Health Care Heart and Lung Institute B., Ströberg, P., Lee, S. W., Park, N. C., Kim, S.-W., Tseng, L.-J., Collins, S., & Stecher, V. J. Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: Effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt. The Journal of Sexual Medicine, 6(10), 2826–2835. Sildenafil: A review of its use in erectile dysfunction. Effects of two different dosages of sildenafil on patients with erectile dysfunction. American sildenafil oral jelly 100mg Journal of Men’s Health, 11(3), 747–757.
4.1 Nitrates
[1][7][8][9][10][25][33][34][65][76][81][101][104][105][126][127][131][142][143][144] The erectile response generally increases with increasing sildenafil dose and plasma drug concentration, with response becoming greater at 50- and 100-mg doses than at 25 mg.[1][8][9][33][126][130][131][155] Analyses of subgroups of patients with ED indicate that efficacy of sildenafil is not affected by race or age, duration of ED, or duration of select underlying disease states (e.g., diabetes mellitus), and the drug has been effective in a broad range of patients with ED, including those with a history of coronary artery disease (e.g., coronary artery bypass graft [CABG]), hypertension, other cardiac disease (including ischemic heart disease), peripheral vascular disease, type 1 or 2 diabetes mellitus, depression, radical prostatectomy, prostate brachytherapy, transurethral resection of the prostate (TURP), spina bifida, spinal cord injury, and in patients taking antidepressants, antipsychotics, diuretics, and antihypertensive agents. [1][25][30][33][34][93][101][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][144] Pooled data from numerous fixed-dose and flexible-dose studies in men with ED secondary to a broad spectrum of organic and psychogenic causes showed increases in mean rates of successful intercourse (total successes divided by total attempts) to about 66-69% in those receiving sildenafil compared with about 20-22% for placebo. Erectile response to sildenafil is better in patients whose erectile function is less impaired at treatment initiation (e.g., those with some spontaneous successful intercourse, with partial erections, with erections during sleep, or with psychogenic causes). Urologist recommends daily Viagra to prevent impotence.
- Sildenafil 200 mg is a powerful treatment requiring careful medical evaluation.
- It is not a cure but helps manage symptoms of erectile dysfunction.
- Patients should keep track of medication reactions and report to their doctor.
- Do not mix sildenafil with alcohol, cigarettes, or recreational drugs.
- Avoid heavy or fatty meals close to the time of intake.
- Always use medication as directed to prevent health complications.
Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. Oral sildenafil in the treatment of erectile dysfunction. The New England Journal of Medicine, 338(20), 1397–1404. A prospective study of the beneficial effects of dose optimization and customized instructions on patient satisfaction with sildenafil citrate (Viagra) for erectile dysfunction. International Journal of Impotence Research, 18(5), 389–394. Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose.
Medical Alternatives and Supplements
International Journal of Urology, 11(11), 989–993. Sex, erectile dysfunction, and the heart: A growing problem. Phosphodiesterase‑5 (PDE5) inhibitors in the management of erectile dysfunction.
Therapeutic category/Drug classification
Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A.
What are the most common side effects of sildenafil?
Oral sildenafil in the treatment of erectile dysfunction. The New England Journal of Medicine, 338(20), 1397–1404. A prospective study of the beneficial effects of dose optimization and customized instructions on patient satisfaction with sildenafil citrate (Viagra) for erectile dysfunction. International Journal of Impotence Research, 18(5), 389–394. Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose.
Antihypertensive and α-Adrenergic Blocking Agents
International Journal of Urology, 11(11), 989–993. Sex, erectile dysfunction, and the heart: A growing problem. Phosphodiesterase‑5 (PDE5) inhibitors in the management of erectile dysfunction. Pharmacy and Therapeutics, 38(7), 407–419. Cardiovascular effects of sildenafil citrate and recommendations for its use. Pharmacy and Therapeutics, 38(7), 407–419. Cardiovascular effects of sildenafil citrate and recommendations for its use. American Journal of Cardiology, 84(5), 11N–17N. Our friendly customer care team is standing by for support. This content is intended for counseling purposes only. This content is informational/educational and is not intended to treat or diagnose any disease or patient. No claims are made as to the safety or efficacy of mentioned preparations. The compounded medications featured in this content have been prescribed and/or administered by prescribers who work with Wedgewood Pharmacy. You are encouraged to speak with your prescriber as to the appropriate use of any medication.
- Sildenafil 200 mg is not recommended for women or children.
- Overuse can lead to serious cardiovascular problems.
- The medication should be part of a comprehensive treatment plan.
- Use caution if combining sildenafil with other ED medications.
- Inform your healthcare provider of all health conditions before use.
- Ensure correct timing to maximize the drug's effectiveness.
Wedgewood Pharmacy's compounded veterinary preparations are not intended for use in food and food-producing animals. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. [1][2][4][5][7][8][10][24][27][33][41][56][57][67][91][131] Brand Name: Vybrique, ViagraClasses: Phosphodiesterase Type 5 Inhibitors (24:08.12), Phosphodiesterase type 5 inhibitors (48:48.24) Sildenafil citrate (Viagra® and generic equivalents) is used orally for the treatment of erectile dysfunction (ED, impotence).
- Sildenafil 200 mg should not be used with recreational drugs like ecstasy.
- Always consult a doctor if you notice vision changes or hearing loss.
- The medication may cause flushing, indigestion, or nasal stuffiness.
- It is crucial to stay hydrated when using sildenafil.
- Women using sildenafil should seek medical advice before use.
- Proper lifestyle changes can enhance erectile function alongside medication.
[1][4][6][7][8][9][10][25][33][34][67][81][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][142][143][144][189] A thorough medical, sexual and psychosocial history, physical examination, and selective laboratory testing should be undertaken to diagnose ED, determine potential underlying causes, exclude potentially reversible or treatable causes (e.g., hypogonadism with inadequate testosterone replacement, hyperprolactinemia, drug-induced dysfunction, dyslipidemias, alcoholism, other substance abuse, hypertension, thyroid disease, cardiovascular or cerebrovascular disease, neurologic disease, adrenal dysfunction, psychologic dysfunction, marital discord, smoking), and identify appropriate treatment in conjunction with or prior to initiating vasoactive therapy (e.g., PDE 5 type inhibitor). [12][28][30][31][57][65][66][70][78][83][94][144][145][160][161][189][601][602][603] A review of the patient's current drug regimens should be conducted to detect possible drug-induced ED (e.g., certain antihypertensive, antidepressant, antipsychotic, or antiarrhythmic agents); it may be possible to substitute alternative drug(s) that lessen the risk of such dysfunction. [12][28][70][81][118][144][161][602][603] In instances where substitution therapy is not feasible, concomitant vasoactive therapy with a PDE 5 type inhibitor may promote patient compliance by counteracting ED as an adverse effect. [12][28][70][81][118][144][161][602][603] Efficacy of sildenafil is variable in patients with ED, in part depending on the underlying etiology, severity, and dose employed, but the drug generally appears to be effective in restoring sexual function to an acceptable level in the majority of treated men.
5.8 Effects on Bleeding
Exceeding the maximum dosage for sildenafil (more than 100 mg in 24 hours) does not improve erections and raises the risk of severe headaches, dizziness, low blood pressure, vision changes, and priapism (a prolonged erection requiring emergency care). Seek medical attention if you exceed the recommended daily maximum of 100mg in one day. Both doses work by improving blood flow, but the sildenafil 100 mg dosage is usually prescribed if 50 mg is not effective. Studies show a higher response rate at 100 mg, but also a greater chance of side effects. Doctors typically start at 50 mg and only increase to 100 mg if needed.
How long does it take for these medications to work?
Physician-Scientist; Founder, Director, and Chief Executive OfficerXYON: Founder, Director, and CEOEducationDoctorate of Medicine (MD) — University of Cape Town, South Africa — 1991Genetics (PhD) — University of Amsterdam, The Netherlands — 1998Internal Medicine (Postgraduate Fellowship) — University of British Columbia (UBC), Canada — 2001Academic & Clinical AppointmentsClinical Assistant Professor, Division of General Internal Medicine — University of British ColumbiaAssociate Member, Division of Cardiology, Department of Medicine — University of British ColumbiaFaculty — Providence Health Care Heart and Lung Institute B., Ströberg, P., Lee, S. W., Park, N. C., Kim, S.-W., Tseng, L.-J., Collins, S., & Stecher, V. J. Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: Effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt.
Can these medications be used together?
The Journal of Sexual Medicine, 6(10), 2826–2835. Sildenafil: A review of its use in erectile dysfunction. Effects of two different dosages of sildenafil on patients with erectile dysfunction. American sildenafil oral jelly 100mg Journal of Men’s Health, 11(3), 747–757. Urologist recommends daily Viagra to prevent impotence. [1][7][8][9][10][25][33][34][65][76][81][101][104][105][126][127][131][142][143][144] The erectile response generally increases with increasing sildenafil dose and plasma drug concentration, with response becoming greater at 50- and 100-mg doses than at 25 mg.[1][8][9][33][126][130][131][155] Analyses of subgroups of patients with ED indicate that efficacy of sildenafil is not affected by race or age, duration of ED, or duration of select underlying disease states (e.g., diabetes mellitus), and the drug has been effective in a broad range of patients with ED, including those with a history of coronary artery disease (e.g., coronary artery bypass graft [CABG]), hypertension, other cardiac disease (including ischemic heart disease), peripheral vascular disease, type 1 or 2 diabetes mellitus, depression, radical prostatectomy, prostate brachytherapy, transurethral resection of the prostate (TURP), spina bifida, spinal cord injury, and in patients taking antidepressants, antipsychotics, diuretics, and antihypertensive agents. [1][25][30][33][34][93][101][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][144] Pooled data from numerous fixed-dose and flexible-dose studies in men with ED secondary to a broad spectrum of organic and psychogenic causes showed increases in mean rates of successful intercourse (total successes divided by total attempts) to about 66-69% in those receiving sildenafil compared with about 20-22% for placebo. Erectile response to sildenafil is better in patients whose erectile function is less impaired at treatment initiation (e.g., those with some spontaneous successful intercourse, with partial erections, with erections during sleep, or with psychogenic causes).