Sildenafil is a tablet that helps you get and keep an erection strong enough for sex. It’s better known as Generic Viagra.

What Is Sildenafil?

Put simply, sildenafil is the OG prescription ED treatment. The generic version of Viagra, sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor, which essentially works to sustain dilation and blood flow within your penis, resulting in better, firmer erections. 

Unlike tadalafil (Cialis®) for instance, which can work for a day or more, sildenafil is a sort of pre-game solution to the problem, like carbo loading for your erections. It’s best taken when the action is going to take place within a few (up to 4) hours, according to the National Library of Medicine.

It’s a great option for men with ED, and about 70 percent of men respond well to PDE5 inhibitors, according to Harvard Medical School. But it’s largely dependent on your causes. The best results come for men with “no identifiable organic cause”—they see approximately a 90 percent success rate. 

How Does Sildenafil Work?

Before we get into the specifics of sildenafil doses, it’s important to explain how sildenafil works as a treatment for erectile dysfunction.

Sildenafil was the first oral medication approved to treat ED. It came onto the market in 1998 as Viagra. In the decades since it first appeared, it’s also become available as a generic drug and is one of the most widely used prescription medications in the United States.

Sildenafil is part of a class of medications referred to as phosphodiesterase-5 (PDE5) inhibitors, or PDE5 inhibitors. It works by blocking the actions of cGMP-specific phosphodiesterase type 5 — an enzyme that controls the flow of blood to certain types of tissue in your body.

Erections are all about blood flow. When you’re sexually aroused, your nervous system signals to the muscles of your penis. As these muscles relax, blood flows to the corpora cavernosa — a pair of sponge-like masses of erectile tissue that allow you to get an erection.

PDE5 is responsible for regulating blood flow to your penis. By blocking the effects of PDE5 on blood flow, sildenafil improves the supply of blood to the erectile tissue in your penis and makes it easier to get and stay hard.

As blood flows in, the tunica albuginea — a type of membrane that surrounds the erectile tissue of your penis — contracts, trapping blood inside your erectile tissue and allowing you to maintain an erection during sex.

Although sildenafil can improve blood flow to your penis and make getting hard easier, it doesn’t cause you to feel sexually aroused or have any impact on your sex drive.

It also doesn’t cause spontaneous erections. For sildenafil to work, you’ll still need to have some form of sexual stimulation.

What dosage of Sildenafil is right for me?

Sildenafil tablets come in 20mg, 25mg, 50mg and 100mg doses. So doctors have a little more range with Sildenafil dosages than they do with other ED drugs.

If you’re taking it for the first time, you’ll normally start on Sildenafil 50mg. If you take this dose and it works well but you get mild side effects, a doctor will suggest lowering your dose to 25mg.

Men taking Sildenafil pills for the first time but who also have risk factors that make them more prone to side effects (like diabetes for example) may be recommended Sildenafil 20mg or 25mg to start with.

Sildenafil 100mg is only for when you’ve tried 50mg and it hasn’t been strong enough. A doctor may even suggest upping your Sildenafil dose to 60mg or 80mg before going up to 100mg.

How You Take Sildenafil

We probably don’t need to tell you this, but you can’t go taking five of these and hoping for some sort of Hulk-esque super erection. Nobody’s going to turn green and become unstoppable, get it? It’ll quite possibly turn other colors and become non-functional.

Once taken, sildenafil takes between 30 to 60 minutes to activate, and lasts for around four hours.

According to the FDA, doses range between 25mg and 100 mg, and those should be taken as needed ahead of planned performance. As much as sildenafil is a great option for giving you some control of your love life, if your sex life is unpredictable, you may be better served with a daily option, like tadalafil.

Sildenafil vs Viagra: What’s the difference?

It’s a question that gets asked a lot. The main difference between a generic (Sildenafil) and a branded medicine (Viagra) is that a branded drug is one pharma company’s baby. When a lab discovers a drug, there is normally a period of exclusivity, where only that lab can legally produce and market the drug before other labs can make their own versions (generics).

Viagra is a Pfizer drug. They launched it in 1998 and still own the rights to the name today. But in 2013, this exclusivity on the drug itself expired, so other labs were free to produce it as a generic (Sildenafil).

There are a few different versions of Sildenafil marketed by different pharma companies (for example Sildenafil Teva and Sildenafil Actavis) and Pfizer even have their own version of it too.

Viagra and Sildenafil pills look different, and come in different packaging. But clinically, the drugs are the same. Sildenafil should work just as well as its branded daddy.

Sildenafil Side Effects and Drug Interactions

Like most medications, sildenafil can have some potentially negative drug interactions. The most commonly reported for PDE5 blockers like sildenafil are complications related to blood pressure (particularly when taken with alpha blockers). 

PDE5s, because of how they interact with blood vessels, can be used to treat hypertension, which sounds like a double benefit but is actually the main reason it’s important to disclose other medications before taking sildenafil. 

Doubling up on the blood medications could result in a lot of issues, particularly if you have high blood pressure.

Commonly reported side effects included mild issues like indigestion, back pain, headache, muscle pain, flushing, stuffy nose or abnormal vision. Stop the medication immediately and seek emergency assistance if your vision becomes abnormal.

You should not take sildenafil alongside other PDE5 inhibitors—it can cause really inconvenient problems, like death. Seriously, this is how you could stop your own heart. Don’t take two ED drugs simultaneously. And if you’re taking any other blood pressure meds, talk to your healthcare provider before starting sildenafil. This includes PDE5s inhibitors, as well as alpha-blockers and antihypertensive medications. 

According to additional FDA data, alcohol consumption alongside PDE5 inhibitors can cause complications. And if you’re taking nitrates, DO NOT take sildenafil or any of these drugs.

There are also some rare side effects to be on the lookout for, that do occasionally happen. They include renal impairment, sudden hearing loss, and priapism (prolonged erection). According to the FDA, “If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result.” If your erection lasts more than four hours, get medical assistance.

Other Considerations

As much as ED might seem like a problem solved, there’s no guarantee sildenafil is going to be your magic pill, particularly if the cause of your particular ED isn’t physiological. It’s hard to do, but you might want to take a moment in addressing this problem to ask yourself whether something else might be at play—something psychological. 

Anxiety and depression can play a role in creating performance issues, and if you think this might be your problem go ahead and consult a healthcare professional, but consider asking for a referral to a psychiatrist or mental health professional, to examine other treatment options. Sildenafil might be one of several tools that end up making a more complex solution to your particular problem with ED.

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ED,

Last Update: 30 March 2024