Other means of assessing efficacy were an

Warnings & Precautions

People with HIV/AIDS: If you have human immunodeficiency virus (HIV/AIDS), consult you pharmacist. Phosphodiesterase inhibitors such as sildenafil can significantly impede the efficacy of some antiretroviral medications. Other conditions: People with dehydration, left-heart diseases and certain abnormalities of the body’s nervous system function should use sildenafil with caution. Sildenafil isn’t recommended for people with pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis. Don’t take sildenafil with nitrates or nitric oxide donors because your systemic blood pressure could drop to unsafe levels.

Possible Side Effects of Sildenafil

Use caution when drinking alcoholic beverages or taking anti-hypertension or blood pressure-lowering medications. Sildenafil is broken down predominantly by an enzyme called CYP3A in sildenafil oral solution the liver. Significant interactions can occur with medications that affect this enzyme pathway. Simultaneous use of bosentan and sildenafil can increase bosentan in blood and decrease sildenafil levels. It’s not known whether those changes are clinically significant. event log, in which we asked the men

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to record the date and dose of

More about sildenafil

Men were excluded if they had penile anatomical defects, a primary diagnosis of another sexual disorder (e.g., premature ejaculation), spinal cord injury, any major psychiatric disorder not well controlled with treatment, poorly controlled diabetes mellitus, active peptic ulcer disease, a history of alcohol or substance abuse, major hematologic, renal, or hepatic abnormalities, or a recent (within the previous six months) stroke or myocardial infarction or if they were receiving nitrate therapy. Other erectile-dysfunction therapies were discontinued at the time of screening (four weeks before the subjects received the study medication). Sildenafil (Viagra) and an identical-looking placebo were supplied by Pfizer. The men were instructed to take a dose approximately one hour before planned sildenafil 100 mg tab sexual activity but not more than once daily. The protocols were approved by the institutional review board at each center, and all the men gave written informed consent. medication taken, the presence of sexual stimulation, the

Metrics & Citations

Using sildenafil with epoprostenol can reduce sildenafil levels in the blood. Using sildenafil with beta blockers (a heart or blood pressure medicine) can increase sildenafil levels. We evaluated the efficacy and safety of sildenafil, administered as needed in two sequential double-blind studies of men with erectile dysfunction of organic, psychogenic, or mixed causes. In a 24-week dose–response study, 532 men were treated with oral sildenafil (25, 50, or 100 mg) or placebo. In a 12-week, flexible dose-escalation study, 329 different men were treated with sildenafil or placebo, with dose escalation to 100 mg based on efficacy and tolerance.

Are you currently using Sildenafil (Viagra, Revatio)?

After this dose-escalation study, 225 of the 329 men entered a 32-week, open-label extension study. We assessed efficacy according to the International Index of Erectile Function, a patient log, and a global-efficacy question. In the dose–response study, increasing doses of sildenafil were associated with improved erectile function (P values for increases in scores for questions about achieving and maintaining erections were <0.001). For the men receiving 100 mg of sildenafil, the mean score for the question about achieving erections was 100 percent higher after treatment than at base line (4.0 vs. 2.0 of a possible score of 5). hardness of erections (graded on a four-point

• Sildenafil is a medication used to treat erectile dysfunction in men.
• It works by increasing blood flow to the penis during arousal.
• Sildenafil is commonly sold under the brand name Viagra.
• The typical dose ranges from 25 mg to 100 mg, taken before sexual activity.
• It usually takes about 30 to 60 minutes to work after ingestion.
• Sildenafil's effects can last for up to 4-6 hours.
• It can cause side effects like headaches, flushing, and nasal congestion.
• Sildenafil should not be used with nitrate medications due to risk of dangerous drops in blood pressure.
• It is available by prescription from a healthcare provider.
• Do not take sildenafil more than once a day to avoid adverse effects.

scale), and whether sexual intercourse was successful, and

Related/similar drugs

We assessed efficacy by using the responses to question 3 (frequency of penetration) and question 4 (maintenance of erections after penetration) of the 15-question International Index of Erectile Function, a validated, multidimensional, self-administered questionnaire used for the clinical assessment of erectile dysfunction and treatment outcomes in clinical studies.11 The responses to these two questions pertaining to the ability to achieve and maintain an erection sufficient for sexual intercourse, as described in the definition of erectile dysfunction,1 were rated on a scale of 1 (almost never or never) to 5 (almost always or always). A score of 0 indicated no attempt at sexual intercourse. The mean score for each of the two questions was 4.3 for 109 normal men, 31 to 86 years old, with an age distribution similar to that of the men with erectile dysfunction (unpublished data). Efficacy was also assessed on the basis of the scores for the five separate response domains of male sexual function of the International Index13: erectile function (questions 1 through 5 and 15; possible total score, 1 to 30); orgasmic function (questions 9 and 10; possible total score, 0 to 10); sexual desire (questions 11 and 12; possible total score, 2 to 10); intercourse satisfaction (questions 6, 7, and 8; possible total score, 0 to 15); and overall satisfaction (questions 13 and 14; possible total score, 2 to 10). The domain scores were computed by adding the scores for the individual questions in each domain. a global-efficacy question (“Did the treatment improve your

Information & Authors

In the last four weeks of treatment in the dose-escalation study, 69 percent of all attempts at sexual intercourse were successful for the men receiving sildenafil, as compared with 22 percent for those receiving placebo (P<0.001). The mean numbers of successful attempts per month were 5.9 for the men receiving sildenafil and 1.5 for those receiving placebo (P<0.001). Headache, flushing, and dyspepsia were the most common sildenafil citrate tablets 50mg adverse effects in the dose-escalation study, occurring in 6 percent to 18 percent of the men. Ninety-two percent of the men completed the 32-week extension study. Oral sildenafil is an effective, well-tolerated treatment for men with erectile dysfunction.

Platelet-aggregation Inhibitors

Erectile dysfunction, the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance, is estimated to affect up to 30 million men in the United States.1 The disorder is age-associated,1–3 with estimated prevalence rates of 39 percent among men 40 years old and 67 percent among those 70 years old.2 The available treatments include vacuum-constriction devices; intracavernosal injections of vasoactive agents, including alprostadil (prostaglandin E1)4; transurethral delivery of alprostadil5; implantation of penile prostheses; and venous or arterial surgery. No effective oral therapy for erectile dysfunction is currently available.6 Normal penile erection depends on the relaxation of smooth muscles in the corpora cavernosa. In response to sexual stimuli, cavernous nerves and endothelial cells release nitric oxide, which stimulates the formation of cyclic guanosine monophosphate (GMP) by guanylate cyclase.7–9 The mechanism by which cyclic GMP stimulates relaxation of the smooth muscles remains to be elucidated. Sildenafil is a selective inhibitor of cyclic-GMP–specific phosphodiesterase type 5, the predominant isozyme metabolizing cyclic GMP in the corpus cavernosum.10 By selectively inhibiting cyclic-GMP catabolism in cavernosal smooth-muscle cells,11 sildenafil would be expected to restore the natural erectile response to sexual stimulation but not cause erections in the absence of such stimulation. Sildenafil is rapidly absorbed, with maximal plasma concentrations occurring within one hour after oral administration and a mean terminal half-life of three to five hours.10 In a placebo-controlled pilot study of 12 men, sildenafil significantly improved the erectile response during visual sexual stimulation.10,12 We therefore undertook two studies to evaluate in a home setting the efficacy and safety of sildenafil in men with erectile dysfunction. erections?”), with a response of yes or no. The end points of the International

Drug Interactions

In two sequential studies, we studied a total of 861 men 18 years of age or older with a clinical diagnosis of erectile dysfunction (as defined previously1) of six months' duration or longer at 37 centers in the United States. Each man had to be in a stable relationship with a female partner that had begun at least six months earlier. The cause of erectile dysfunction was determined from the medical history, physical examination, and other diagnostic procedures, including a test involving the intracavernosal injection of a vasoactive drug (done in 31 percent of the men), a RigiScan test of nocturnal penile tumescence (26 percent), penile duplex ultrasonography (21 percent), and endocrine testing (21 percent). On the basis of these evaluations, the men were classified as having organic, psychogenic, or mixed erectile dysfunction. Of the 861 men studied, 605 (70 percent) were judged to have organic erectile dysfunction, 99 (11 percent) to have psychogenic erectile dysfunction, and 157 (18 percent) to have mixed erectile dysfunction. Index quantified the magnitude of the response,

What special dietary instructions should I follow?

There are no adequate and well-controlled human studies. In clinical practice, sildenafil is commonly used for pregnant and lactating women with severe PAH, as the risk of untreated or undertreated PAH is higher than the risk of adverse effects from sildenafil. Children and teens: Clinical trials of sildenafil for pediatric PAH patients have been small and part of studies with a wide range of ages and diseases. Generally, sildenafil seems safe and effective for pediatric patients. The treatment algorithm from the sixth World Symposium on Pulmonary Hypertension recommended PDE5 inhibitors for pediatric patients.

The Bottom Line

People with liver disease: People with mild to moderate liver disease don’t need to adjust their sildenafil doses. Severe liver disease hasn’t been studied. People with kidney disease: People with kidney disease don’t have to adjust their dosage. People with sickle cell disease: People with PH related to sickle cell disease can develop a serious condition known as vaso-occlusive crisis. Sildenafil’s effectiveness for PH related to sickle cell anemia hasn’t been established. and the global-efficacy question and the

Condition	Risk	Recommendation
Nitrate use	Severe hypotension	Do not take with nitrates
Heart Disease	Cardiovascular risk	Consult doctor before use
Kidney or Liver impairment	Altered drug metabolism	Dosage adjustment recommended
Retinitis Pigmentosa	Vision issues	Use with caution

event log provided qualitative assessments of efficacy.

• Sildenafil can sometimes cause flushing and nasal congestion.
• It is not a cure for erectile dysfunction, only a treatment option.
• Psychological factors can also affect erectile performance alongside medication.
• Sildenafil may sometimes interact with foods that contain high fat content.
• Regular exercise and stress management can complement treatment with sildenafil.
• The medication should be stored safely out of children's reach.
• Reporting side effects to a healthcare provider is important for safety.
• Sildenafil is typically started at a low dose, gradually increased if needed.
• It is important to follow the prescribed timing for medication intake.
• Discontinuing sildenafil should be discussed with a healthcare professional.