Sildenafil

Sildenafil is prescribed to adult men with erectile dysfunction (ED), which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. Sildenafil is the generic version of Viagra. Sildenafil works by increasing blood flow to the penis. Sildenafil is available in 25mg, 50mg, and 100mg tablets.

Read our 101 guide to sildenafil (Viagra).

The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. The dose may be increased to 100 mg or decreased to 25 mg based on effectiveness and tolerability. The maximum recommended dose is 100 mg. The maximum recommended dosing frequency is once per day. If Sildenafil is taken with food, the onset of activity may be delayed compared to the fasted state.

Tolerated well by many patients. However, like all medicines, sildenafil can cause some side effects. The most common side effects of sildenafil and methods of overcoming them include:

• Headaches: Drink plenty of water and stay hydrated. Take some painkillers if your headache persists the following day. If your headache is not usual, then immediately consult The Family Chemist.
• Flushing: try to cool down by drinking cold water, turning on a fan or opening a window. Avoid alcohol, as this can make flushing worse. It may also help to lie down and rest after.
• Indigestion: You can take Sildenafil after food to lower the risk of indigestion. However, the effects may take slightly longer. You can consider taking antiacids or alginates to lower the risk; however, if indigestion persists, try an alternative ED tablet.
• Nasal congestion: Consider adding some aromatherapy in the room to help with nasal congestion and to set the mood right.
• Dizziness: Lie down and take it easy. Avoid sudden movements or jumping up. The effects should only last for a short period of time.
• Muscle pain: consider asking your partner for a massage to add to the sexual arousal and a stronger enhanced erection.

Stop taking sildenafil if:

• Experience vision changes such as blurred vision, sensitivity to light or sudden vision loss.
• Sudden decrease or loss of hearing.
• Long-lasting and painful erections which can cause permanent damage to the penis.
• Low blood pressure.

Please visit the patient information leaflet for Sildenafil for a full list of side effects.

Men with erectile dysfunction should consult their doctor to rule out secondary causes. Patients who have experienced a stroke or severe heart disease should not take sildenafil, as this can precipitate the condition. Sildenafil also interacts with many medications and may not be suitable to take. For example, patients taking isosorbide nitrate or glyceryl nitrate spray for angina.

Do not take Sildenafil:

• If you are allergic to sildenafil or any other ingredients of this medicine.
• If you are taking medicines called nitrates, the combination may lead to a dangerous fall in your blood pressure. Tell your doctor if you are taking any of these medicines often given to relieve angina pectoris (or “chest pain”). If you are not sure, ask your doctor or pharmacist.
• If you are using any of the medicines known as nitric oxide donors, such as amyl nitrite (“poppers”), the combination may also lead to a dangerous fall in your blood pressure.
• If you are taking riociguat. This drug treats pulmonary arterial hypertension (i.e., high blood pressure in the lungs) and chronic thromboembolic pulmonary hypertension (i.e., high blood pressure in the lungs secondary to blood clots). PDE5 inhibitors, such as Sildenafil, have been shown to increase the hypotensive effects of this medicine. If you are taking riociguat or are unsure, tell your doctor.
• If you have a severe heart or liver problem.
• If you have recently had a stroke or a heart attack, or if you have low blood pressure.
• If you have certain rare inherited eye diseases (such as retinitis pigmentosa).
• If you have ever had loss of vision due to non-arteritic anterior ischaemic optic neuropathy (NAION)

Talk to The Family Chemist clinician or doctor:

• if you have sickle cell anaemia (an abnormality of red blood cells), leukaemia (cancer of blood cells), multiple myeloma (cancer of bone marrow)
• If you have a deformity of your penis or Peyronie’s Disease.
• if you have problems with your heart. Your doctor should carefully check whether your heart can take the additional strain of having sex.
• if you currently have a stomach ulcer, or a bleeding problem (such as haemophilia).
• if you experience sudden decrease or loss of vision, stop taking Sildenafil
  and contact your doctor immediately.

• You should not use Sildenafil with any other oral or local treatments for erectile dysfunction.
• You should not use Sildenafil with treatments for pulmonary arterial hypertension (PAH) containing sildenafil or any other PDE5 inhibitors.
• You should not take Sildenafil if you do not have erectile dysfunction.
• You should not take Sildenafil if you are a woman.
• You should tell your doctor if you have kidney or liver problems. Your doctor may decide on a lower dose for you.

The main active ingredient in Viagra/ generic Sildenafil is called Sildenafil Citrate. This ingredient predominantly raises the amount of blood that flows to the penis.

Sildenafil blocks the breakdown of cGMP from degradation by an enzyme called phosphodiesterase type 5 (PDE5). Nitric Oxide (a vasodilator) binds to the receptors in the penis, resulting in increased levels of cGMP, leading to smooth muscle relaxation and increased blood flow into the spongy tissue of the penis, causing an erection. PDE5 degrades cGMP. Sildenafil is a potent and selective inhibitor of PDE5.

Please note that this medication will not resolve the fundamental cause of Erectile Dysfunction. You will need to be sexually aroused, and your penis must be stimulatedfor Sildenafil to work to its full effect, as the medication alone will not cause an erection.

For the best results and effect of Sildenafil, it is recommended to take it on an empty stomach. This is so the Sildenafil can be fully absorbed into the bloodstream as some foods, particularly fatty foods, can make it harder to enter the system and work quickly.

Although Sildenafil takes around 30 minutes to start taking effect, it peaks approximately 60 minutes after taking it. Depending on several factors, it can last up to 4 hours in your bloodstream.

Some factors that affect how long sildenafil lasts include the dosage you have taken, your weight and age, your mindset at the time, and whether you have taken it on an empty stomach.

Read our blog on how long Sildenafil makes you last.

The maximum dosage of Sildenafil that should be used in a 24-hour day is one tablet. You should not exceed this amount. If one tablet is not working for you, you must return to The Family Chemist clinician to discuss other options or different dosage amounts.

Sildenafil isn’t always guaranteed to work the first time. Therefore, it should be taken at least 6-8 times to see if it is the right drug for you.

You can drink alcohol whilst taking Sildenafil, but it is recommended to only drink in moderation. Excess drinking of alcohol can contribute to Erectile Dysfunction. Alcohol interferes with the messengers in the brain that tell the penis to fill with blood. According to a study consuming alcohol dampens your central nervous system and slows down the communication between the brain and the penis. Alcohol is a diuretic, increasing urination and making you feel dehydrated. Dehydration leads to a release of the hormone angiotensin, which narrows blood vessels and can limit blood flow to the penis.

Another study found that alcohol can lead to a drop in circulating testosterone. Testosterone deficiency mimics nitric oxide production, the key to vasodilatation and increased blood flow to your penis.

This means that the high levels of alcohol can make the Sildenafil not work as effectively and cancel out the effect it may have on your ED.

Before driving, you should assess whether you are fit to do so. This is because one of the common side effects of Sildenafil is dizziness, but not all men experience this. If you do not have any symptoms like this, then you are safe to drive.

Sildenafil and Viagra have the same effect. Sildenafil is the key element in both of them, but the benefit of Sildenafil is the cost of it as it is cheaper. The difference between them is that Sildenafil is the unbranded version of Viagra, but they both work similarly.

No, Viagra and sildenafil are pharmacologically the same. Viagra is the brand name of Sildenafil. The pharmacokinetic data and pharmacological response are the same; therefore, the cautions, contraindications and adverse reactions are the same.

Sildenafil can be purchased as a prescription-only medicine at 25mg and 100mg strengths. Sildenafil 50mg is available over the counter as Viagra Connect. Viagra Connect is the same as Sildenafil medically. However, you pay for the brand, which is significantly more expensive than sildenafil. You will have to have a short consultation before being prescribed Sildenafil. The Family Chemist consultation is short and easy to follow, ensuring that taking Sildenafil is safe and effective. Contact the clinician at 0115 850 1944 or [email protected] for further advice. The order is dispensed by our in-house pharmacy and sent using discreet packaging. Also, don’t forget to subscribe to our newsletter for special, unique discounts and information.

Sildenafil is not safe to take with recreational drugs. They have not been tested in studies and have no evidence behind their combined use. Sildenafil is particularly dangerous with:

• Poppers (amyl nitrate)
• Stimulants like MDMA (ecstasy) or cocaine
• Hallucinogens like LSD
• Legal highs or novel psychoactive substances like mephedrone.

First, we recommend using Sildenafil on at least eight occasions before ruling out its effectiveness. However, if you suffer from side effects, then it may be worth trying another ED tablet like Tadalafil. Tadalafil is longer-acting and can be used daily at lower doses if you have regular sex. If tadalafil doesn’t suit you, you can try Vardenafil or Avanafil. After exhausting all tablets, it may be worth revisiting the GP and considering tackling the secondary causes, for example, stress and anxiety that may be causing erectile dysfunction.

There is an alternative cream called Vitaros available from The Family Chemist, which may provide some benefit over ED tablets. Read all about it here.

Since the patent expired for Viagra, many “generic” companies have replicated Sildenafil which has led to a massive reduction in price. It is essential to note that the brand for sildenafil is Viagra. However, Pfizer manufactures it. The drug’s name Viagra is Sildenafil. Sildenafil is manufactured by many well-respected companies such as Teva, Actavis, Accord, Mylan and many others. We at The Family Chemist predominantly use the highly popular and effective TEVA manufacturer; however, we can source others if requested.

Sildenafil can remain in your bloodstream for up to 12 hours. However, patients will experience the main effects of sildenafil within 4 hours of taking the tablet. This is because the peak concentration in the blood is usually achieved within 1 hour of taking the tablet. After 4 hours, the concentrations are not high enough to provide you with any benefit. However, some patients may report that they can still feel the effects due to individualised pharmacokinetic responses.

The effects of food can dampen the effects of sildenafil. This is backed by a study highlighting its effects. As you can see from the tablet below, sildenafil concentrations peak much higher when taken on an empty stomach than in patients who have eaten. Food slowed the rate but minimally affected the extent of drug absorption.

Figure 1: Mean plasma concentration profiles of sildenafil following oral (○) and intravenous (•) administration of 50-mg sildenafil.

Sildenafil was synthesised by chemists at Pfizer. They patented the drug and called it Viagra. During this time, no other pharmaceutical company could manufacture the drug. In 1996, Sildenafil was the first oral treatment approved to treat erectile dysfunction, and Pfizer dictated the prices. Pfizer has chosen to keep their prices high as they still have a large market of loyal men purchasing the brand.

The ability to achieve a penile erection is dependent on several factors. After careful evaluation of many studies, the onset of action following the administration of sildenafil was achieved after the following:

12 minutes: Early erections. 30% of the patients in the study found they received significant penile rigidity after administering sildenafil.

27 minutes: Average response: Most men experience enhanced erections following oral administration of sildenafil.

57 minutes: Peak erections: The maximum effect of sildenafil was seen.

4 hours: Half-life: patients will commonly start seeing the effects of sildenafil wearing off.

12 hours: Still going: A study found a significant proportion of men with ED may still experience the lasting effects of sildenafil.

You can buy sildenafil safely over the internet. But be careful, as many websites sell fake medicines or medicines not licensed by MHRA in the UK. The Family Chemist is registered with the General Pharmaceutical Council (GPhC) and only supplies UK-licensed medicines sourced from UK MHRA-licensed pharmaceutical wholesalers.

The Family Chemist recommends reading medical information provided throughout the FAQs from trusted websites such as The Family Chemist and NHS and consulting The Family Chemist clinician or doctor before purchasing prescription-only medicine.

Under the banner of “Choose Self Care for Life” the aim is to engage and empower people to better look after their own health. Whether it is about self-treatable conditions, long term conditions, or lifestyle choices to ensure better physical health and mental wellbeing, this week raises awareness of the huge benefits of people looking after themselves better. The results of this UK study suggest that men are capable of using written sildenafil patient education materials to assess their suitability for treatment with 50 mg sildenafil accurately.

The choice of treatment depends of the frequency of sexual intercourse and response to treatment. Sildenafil, Avanafil and Vardenafil are short acting drugs and are suitable for occasional use when required. Tadalafil is a longer acting drug which can be used when required, but can also be used as a regular lower daily dose to allow for spontaneous sexual activity or in those who have frequent sexual activity.

Yes, some manufacturers score their sildenafil tablets to allow you to cut them into half or quarters. The Family Chemist provides a pill cutter if you ask for it using our contact form, which can help cut the sildenafil in half. If you do cut your sildenafil tablets in half, be sure to keep them in a closed container outside of direct light and use them soon. Do not store your split tablets for extended times, as they can be exposed to moisture and become ineffective.

Sildenafil is safe to take for a long time. There do not seem to be any lasting harmful effects from taking sildenafil for many months and years. The effects of sildenafil can vary from time to time as achieving an erection depends on many factors, including food, alcohol, arousal, weight, and comorbidities such as high blood pressure or diabetes. You should consult your doctor if there has been a change to your medical history or if the usual dose of sildenafil repeatedly fails to help you maintain an erection.

No, ED tablets taken together can significantly increase the risk of dangerous and toxic side effects. They can increase the risk of falls, fainting, cardiac arrests, tachycardia and prolonged, painful erections, causing permanent damage to the penis.

The safe method would be to try an ED treatment at a middle dose, and if it’s ineffective, work your way up to the maximum tolerated dose and try the dose at least eight times with at least 24 hours between each dose. Try another ED medicine if you find the ED treatment intolerable or ineffective. Leave at least 24 hours between doses and sometimes more if taking tadalafil.