Sildenaﬁl Sildenaﬁl is an oral medication for treatment of erectile dysfunction that has been available since 1998. Sildenaﬁl does not produce erections, but it improves erections already produced by sexual stimulation. Foreplay is an essen- tial component for the erection. Sildenaﬁl works by inhibiting the enzyme responsible for relaxing an erection by breaking down a chemical called cyclic guanosine monophosphate (cGMP). The action of sildenaﬁl in the body increases the levels of cGMP, relaxing the smooth muscles in the penis and increasing blood ﬂow into the penis.
Sildenaﬁl is absorbed and processed rapidly by the body. It must be taken a half hour to an hour before sexual intercourse and should not be used more than once a day.
Warning: Sildenaﬁl must not be taken by men who are using nitrates, which are medications taken for chest pain and high blood pressure. Men who are using nitrates who then take sildenaﬁl risk dangerously low blood pressure and stroke.
Overall, studies have shown that sildenaﬁl is effective for about 50 to 75 per- cent of men being treated for erectile dysfunction. Effectiveness rates vary depending on the cause of the problem, but the drug has produced positive results for a range of men under treatment, including those with diabetes (57 percent) and spinal cord injuries (83 percent), as well as men who have had a radical prostatectomy (43 percent).
Sildenaﬁl has few major side effects, but minor side effects include head- aches, ﬂushing, indigestion, and blue-green color vision deﬁciency. Sildenaﬁl is available only with a doctor’s prescription.
Is Sildenaﬁl for You?
What it is
Sildenaﬁl is a prescription medication that is used to treat erectile dysfunction. It is the ﬁrst oral medication for this purpose approved by the US Food and Drug Admin- istration.
What it is not
Sildenaﬁl is not an aphrodisiac. It will not arouse or increase sexual desire. It is not a means to improve erections in men who do not have erectile dysfunction. It is not a chem- ical substitute for working on a relationship.
How it works
Sildenaﬁl blocks an enzyme in the penis that naturally breaks down a chemical called cGMP, which is produced during sexual stimulation and plays an important role in creat- ing and sustaining normal erections. cGMP allows smooth muscle in the penis to con- tract, allowing more blood to enter the penis and producing a ﬁrmer erection. The longer cGMP remains in the penis, the better the chance of reaching and maintaining an erection. Sildenaﬁl allows more cGMP to remain in the penis, but it does not increase the body’s
production of the chemical. This is why sexual arousal is necessary in the ﬁrst place—to produce some cGMP.
How sildenaﬁl should be taken
Sildenaﬁl comes in three dosages: 25-, 50-, and 100-milligram (mg) tablets. The med- ication can be taken on an empty stomach about 1 hour before sexual intercourse, although it may work from 30 minutes up to 4 hours after the tablet is swallowed. Physi- cians usually prescribe a home trial of 50-mg tablets. If side effects develop, a lower dosage may be tried. If the response is not adequate and there are no side effects, dosage may be increased to 100 mg. Older men and those with liver or kidney failure may begin with the 25-mg tablets.
Note: Only one tablet a day should be taken. Taking more than 100 mg a day will not signiﬁcantly improve the erection response and will only increase the likelihood of having side effects.
What side effects are known?
Headache is the most common side effect (about 16 percent of men taking sildenaﬁl). A drop in blood pressure and facial ﬂushing occur in about 10 percent of men who are using the drug. Indigestion occurs in 7 percent and nasal congestion in 4 percent. About 3 percent report some visual disturbance (blurred vision, increased light sensitivity, or see- ing a bluish tinge on objects). None of these side effects is severe, and most are described as mild. Very few men stop taking the medication because of the side effects.
What medications should not be taken with sildenaﬁl?
Men taking any type of organic nitrate medication or medications containing nitrates should not take sildenaﬁl. Nitrate-containing medications include a number of vasodilator drugs, such as nitroglycerin. Certain street drugs, such as amyl nitrate, also will cause problems if taken with sildenaﬁl.
How much does sildenaﬁl cost, and will insurance cover it?
The cost at most pharmacies is about $8 to $10 a pill. Some insurance prescription drug plans cover the cost, but others do not. Some insurance plans reimburse for only a few pills a month. Contact your insurance provider directly for details on coverage.
How do I obtain sildenaﬁl?
Because of the side effects and contraindications of sildenaﬁl, you should see your physician for an examination. If the doctor determines that the drug is likely to help you, he or she will write a prescription.
Warning: Because of the popularity of and demand for sildenaﬁl, some Web sites are offering prescriptions to men without obtaining sufﬁcient medical information about them. People who order the drug directly over the Internet, without a physician’s exami- nation or a review of their medical history, are putting themselves at risk for dangerous side effects or even death. Men who have other medical problems, especially heart dis- ease, or who have not been sexually active should check with their physician before resuming sexual activity.