Is sildenafil (Viagra) safe for daily use?

From the Guidelines

Sildenafil is not typically recommended for daily use for most people, but it may be prescribed for specific situations under close medical supervision. The standard approach is to use it on an as-needed basis, usually no more than once per day. However, there are specific situations where daily low-dose sildenafil may be prescribed, particularly for pulmonary arterial hypertension (typically 20mg three times daily) or in certain cases of erectile dysfunction under close medical supervision (usually 5-20mg daily) 1.

Key Considerations

• Daily use increases the risk of side effects including headaches, flushing, indigestion, nasal congestion, visual disturbances, and potentially more serious cardiovascular effects.
• Sildenafil works by inhibiting an enzyme called phosphodiesterase type 5, which increases blood flow to certain tissues.
• Long-term daily use hasn't been extensively studied for erectile dysfunction.
• Before considering daily sildenafil, you should have a thorough medical evaluation, as underlying conditions like diabetes, heart disease, or high blood pressure may need treatment.
• Never take sildenafil without a prescription, and always inform your doctor about all medications you're taking to avoid dangerous interactions, especially with nitrates.

Important Factors to Discuss with Your Doctor

• Underlying medical conditions that may affect the safety and efficacy of sildenafil.
• Potential interactions with other medications.
• The appropriate dosage and frequency of use for your specific situation.
• Regular monitoring of your condition and adjustment of treatment as needed.

Recent Studies

A study published in 2011 found that daily use of 2.5 and 5 mg tadalafil for 12 weeks was well tolerated and significantly improved erectile dysfunction in diabetic men 1. However, this study lacked an on-demand treatment arm, and more research is needed to fully understand the effects of daily sildenafil use.

Conclusion is not allowed, so the answer ends here.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Sildenafil Safety for Daily Use

• The safety of sildenafil for daily use has been evaluated in several studies 2, 3, 4, 5, 6.
• According to a study published in 2002, the use of sildenafil is extremely safe in the absence of contraindications, with common side effects including headache, flushing, and dyspepsia 2.
• A 2019 study found that regular use of sildenafil has a therapeutic effect similar to that of tadalafil, without more adverse effects 3.
• Another study published in 2002 noted that sildenafil has proven to be a very effective medicinal product, with a success rate of 82% in patients with erectile dysfunction, and no deducible evidence of an increase in mortality rate among sildenafil users compared to the general population 4.
• A 2016 study assessed the efficacy and safety of sildenafil in men with erectile dysfunction, and found that it is an effective and well-tolerated treatment regardless of patient age, including men at least 75 years old 5.
• In terms of drug attributes, a 2006 study found that men with erectile dysfunction preferred tadalafil over sildenafil due to its ability to get an erection long after taking the medication and firmness of erections 6.

Contraindications and Precautions

• Sildenafil is contraindicated in patients with unstable angina pectoris, and its use necessitates caution in cardiac failure and when used within six months of acute myocardial infarction and stroke 2.
• The co-administration of sildenafil with organic nitrates is unsafe, and relative contraindications include uncontrolled hypertension and impaired cardiac reserve 2.
• Men taking nitrate therapy or nitric oxide donors, and those with severe cardiac failure, unstable angina, or recent stroke or myocardial infarction, should be excluded from sildenafil treatment 5.

Adverse Effects

• Common adverse effects of sildenafil include headache, flushing, and dyspepsia 2, 5.
• A 2019 study found that adverse reactions were mild and showed no statistically significant difference in incidence rate among patients taking sildenafil regularly, sildenafil on-demand, or tadalafil regularly 3.
• A 2006 study found that tadalafil and sildenafil were well tolerated, with 12 (3.3%) patients discontinuing due to an adverse event 6.