What is the use of Sildenafil (Viagra)?

From the Guidelines

Viagra (sildenafil) is a highly effective treatment for erectile dysfunction (ED) in men, with high-quality evidence showing significant improvements in sexual intercourse and erectile function compared to placebo 1.

Key Points

• The typical starting dose of Viagra is 50mg taken approximately one hour before sexual activity, with doses ranging from 25mg to 100mg depending on individual response and tolerability.
• Improvement in erectile function is related to higher doses for sildenafil and vardenafil, but not tadalafil 1.
• Common side effects include headache, flushing, indigestion, nasal congestion, and visual disturbances.
• Viagra is contraindicated in patients taking nitrates for chest pain, and caution should be exercised in patients with cardiovascular disease, liver or kidney problems, or a history of stroke 1.

Treatment Recommendations

• The American College of Physicians recommends initiating therapy with a PDE-5 inhibitor, such as Viagra, in men who seek treatment for ED and do not have a contraindication to PDE-5 inhibitor use 1.
• The choice of a specific PDE-5 inhibitor should be based on individual patient preferences, including ease of use, cost of medication, and adverse effects profile 1.

Important Considerations

• High-quality evidence indicates that all PDE-5 inhibitors, including sildenafil, vardenafil, and tadalafil, improve erections and sexual intercourse compared to placebo 1.
• The incidence of adverse events does not significantly differ among the various PDE-5 inhibitors, but higher doses are associated with a greater risk for adverse effects 1.

From the FDA Drug Label

Sildenafil tablets are a prescription medicine used in adults to treat pulmonary arterial hypertension (PAH). Sildenafil tablet contains the same medicine as sildenafil citrate tablets, 25 mg, 50 mg and 100 mg, which are used to treat erectile dysfunction (impotence). Do not take sildenafil tablets, 20 mg with sildenafil citrate tablets, 25 mg, 50 mg and 100 mg or other PDE-5 inhibitors.

The drug sildenafil is used to treat pulmonary arterial hypertension (PAH) and erectile dysfunction. However, the dosage and usage for these conditions differ. For PAH, the dosage is 20 mg, three times a day, while for erectile dysfunction, the dosage is 25 mg, 50 mg, or 100 mg. It is essential to note that patients should not take both sildenafil tablets (20 mg) and sildenafil citrate tablets (25 mg, 50 mg, and 100 mg) or other PDE-5 inhibitors simultaneously 2.

From the Research

Overview of Viagra

• Viagra, also known as sildenafil, is an oral therapy for erectile dysfunction of a broad range of causes 3
• It works by selectively inhibiting phosphodiesterase type 5, allowing corpus cavernosum smooth muscle to relax, potentiating erections during sexual stimulation 3

Efficacy and Safety

• Sildenafil is an effective oral treatment in men with erectile dysfunction, significantly superior to placebo in improving erections and allowing successful penetrative sexual intercourse 3
• The efficacy of sildenafil was not affected by patient age (> or < or =65 years) or by antihypertensive or antidepressant medications 3
• Common adverse events associated with sildenafil were transient and mild or moderate and included headache, flushing, dyspepsia, nasal congestion and abnormal vision 3
• Sildenafil is extremely safe provided the drug is taken under proper conditions, with the most common side effects being headache, flushing, and dyspepsia 4

Age and Efficacy

• Sildenafil is an effective and well-tolerated treatment for erectile dysfunction regardless of patient age, including men at least 75 years old 5
• The percentage of men reporting improved erections on the global assessment question was statistically significantly higher with sildenafil vs placebo for all age subgroups 5

Treatment Considerations

• Phosphodiesterase type 5 (PDE5) inhibitors, including sildenafil, are recognized as efficacious and well tolerated, and are the first-line treatment for ED 6
• The choice of PDE5 inhibitor should be based on individual patient factors, including clinical, demographic, and relational factors 6
• PDE5 inhibitors are safe and effective in most patient populations, including men with ischemic cardiovascular disease or those receiving anti-hypertensive agents, and men with diabetes or those who have undergone nerve-sparing retropubic radical prostatectomy 7