From the Guidelines
For elderly males, the recommended starting dose of sildenafil (Viagra) is 25 mg taken approximately one hour before sexual activity, with a maximum frequency of once daily. This recommendation is based on the evidence that higher doses of sildenafil are associated with improved erectile function, but also with a greater risk of adverse effects 1. The dose may be increased to 50 mg or 100 mg based on effectiveness and tolerability, but this should be done under medical supervision. It is essential to consider the potential for decreased drug clearance in older individuals, which can lead to higher blood levels and increased risk of side effects.
Some key points to consider when prescribing sildenafil to elderly males include:
- Taking the medication on an empty stomach or after a light meal for optimal absorption, as high-fat meals can delay its onset of action
- Being aware of potential drug interactions, particularly with nitrates (absolutely contraindicated) and alpha-blockers (require careful dosing separation)
- Monitoring for side effects including headache, flushing, dyspepsia, and visual disturbances, which may be more pronounced in older individuals due to age-related changes in drug metabolism and elimination.
Overall, the goal is to balance the benefits of improved erectile function with the potential risks and side effects, particularly in elderly males who may be more susceptible to these effects due to age-related changes.
From the FDA Drug Label
The recommended dose of sildenafil tablets is 20 mg three times a day (TID). In patients with PAH, however, the ratio of the metabolite to sildenafil is higher. Geriatric Patients Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, resulting in approximately 84% and 107% higher plasma concentrations of sildenafil and its active N-desmethyl metabolite, respectively, compared to those seen in healthy younger volunteers (18-45 years)
The regular dosing of Sildenafil (Viagra) for an elderly male is 20 mg three times a day. However, due to reduced clearance in geriatric patients, the plasma concentrations of sildenafil and its active metabolite may be higher compared to younger volunteers 2.
From the Research
Recommended Dosing of Sildenafil (Viagra) for Elderly Males
- The recommended dosing of Sildenafil (Viagra) for elderly males typically starts at a lower dose due to potential health complications and interactions with other medications 3, 4.
- A common starting dose for elderly patients is 25mg, which can be adjusted based on efficacy and tolerability 3, 4.
- The maximum dose for elderly males is 100mg, taken as needed, no more than once daily 3, 5.
Considerations for Elderly Males
- Elderly males are more likely to have concomitant medical problems, such as cardiovascular disease, which may require caution when taking Sildenafil 5, 4.
- The efficacy and safety of Sildenafil in elderly males have been demonstrated in several studies, with improvements in erectile function and overall sexual experience 4, 6.
- Common adverse events associated with Sildenafil in elderly males include headache, flushing, and dyspepsia, which are typically mild to moderate in severity 3, 4, 6.
Study Findings
- A study published in 2004 found that Sildenafil was efficacious and well-tolerated in elderly males with erectile dysfunction, with significant improvements in erectile function and overall sexual experience 4.
- Another study published in 2001 found that Sildenafil improved erectile function in elderly patients with erectile dysfunction, including those with diabetes 6.
- A study published in 1999 found that Sildenafil was effective in improving erections and allowing successful penetrative sexual intercourse in men with erectile dysfunction, regardless of age 3.