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About Viagra

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Key facts

  • Viagra is used to treat erectile dysfunction (ED) in men.
  • ‘Viagra’ is a brand name, the active ingredient is ‘sildenafil’.
  • Starting dose is one 50mg tablet in 24 hours. Depending on results, adjust to 25mg or 100mg.
  • Take 30-60 minutes before sexual activity, usually lasts for 4 hours.
  • Large meals, fatty food, alcohol, and grapefruit can affect efficacy.
  • Studies show sildenafil is an effective and well-tolerated treatment for erectile dysfunction regardless of patient age, including men at least 75 years old.
  • See below for full list of side effects, cautions, and interactions with other drugs.

How does Viagra work?

Viagra works by increasing blood flow to the penis which helps men get and sustain an erection long enough for sex.

The active ingredient in Viagra is sildenafil, which is known medically as a PDE5 inhibitor. Sildenafil inhibits (blocks) an enzyme which regulates blood flow in the penis. PDE5 inhibitors multiply the natural process of arousal and increase blood flow to the penis in situations of sexual stimulation. Sildenafil helps to achieve an erection but relies on natural arousal as a trigger. It, and other PDE55 inhibitors such as tadalafil, vardenafil, and avanafil, support sexual relations when erections are failing.

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How to take

The usual first starting dose of Viagra is one 50mg tablet, for men who have not used Viagra before, although men over the age of 65 years would normally start on the lowest dose tablet (25mg).

Viagra works in 30 to 60 minutes after it is taken and usually remains active for 4 hours.

If 50mg strength of tablet is highly effective subsequent doses may be reduced down to one 25mg tablet. If a 50mg tablet is ineffective, or the duration of activity is less than 4 hours, the dose can be increased to one 100mg tablet. Do not take Viagra more than once per day, or more than 100mg dose.

Arousal is required for the treatment to work. Viagra is most likely to be suitable if taken in situations where sexual arousal is expected within an hour or two of taking the tablet. Without sexual arousal there will be no benefit and the effect of the tablet will simply wear off after about 4 hours.

Avoid large meals, meals high in fat, excessive alcohol, and grapefruit as these can affect Viagra’s efficacy (effectiveness).

 

Do not take more than 1 dose or more than 100mg in 24 hours, or combine with other erectile dysfunction tablets.


Does it work every time?

A trial of treatment should be repeated at least 4 times before deciding whether Viagra is working and before requesting a change of dosage or change to another ED medication. As with any treatment, there are times when Viagra might not work and may not improve or overcome the underlying cause of erectile dysfunction.

Satisfactory erections require the following:

  • Adequate blood supply
  • Arousal
  • Healthy nervous system

If erectile dysfunction is the result of spinal injury or operation, nerves might be damaged. In this case Viagra may help a little but other measures, such as injections or stiffening aids, may be required.

Other causes of erectile dysfunction may require specialist treatment apart from tablets.Some men, whose erectile dysfunction has psychological causes, may benefit from counselling.

Are there any side effects?

Viagra is remarkably well tolerated and free from significant side effects in the vast majority of men who take it. Viagra increases blood flow which can have adverse affects on other parts of the body, although these are usually mild. Most men who experience side effects carry on using Viagra regardless.

Slightly over 1% of men taking Viagra notice a bluish or yellowish discolouration of their vision. This is not in itself a cause for concern, and usually does not interfere with normal activity. It wears off after a few hours.

The most commonly reported adverse reactions in clinical studies were:

  • Headache is very common and can be treated with simple painkillers such as paracetamol.
  • Flushing (redness of the skin, typically over the cheeks or neck).
  • Indigestion (dyspepsia) – can be treated with indigestion remedies.
  • Visual disorders/distortion.
  • Nasal congestion – can be treated with menthol or eucalyptus inhalers.
  • Dizziness – if affected it is recommended not to drive or operate machinery.

In the rare event of serious side effects seek immediate medical advice. This applies particularly to chest pains (possibly heart attack), loss of vision, and prolonged and painful erection.

Priapism is the medical name for prolonged painful erections which have the potential to cause permanent damage to the penis. Priapism is rare. A sustained erection of more than 4 hours requires immediate emergency medical attention.

Warnings

During the assessment process with Dr Fox men are required to complete an erectile dysfunction questionnaire to determine if Viagra tablets are suitable.

Men with the following conditions should not take Viagra without further assessment from their GP:

  • Taking medicines called nitrates (often given for chest pain)
  • Taking or intend to take amyl nitrite (‘poppers’)
  • Taking riociguat (to treat high blood pressure in the lungs)
  • Low or high blood pressure
  • Allergies or reactions to past ED treatments
  • Recent heart attack (within 6 weeks) or suffer from angina (heart pain on exertion) or any form of heart disease
  • History of strokes or mini-strokes (transient ischaemic attack)
  • History of vision problems caused by circulation problems
  • History in the family of rare degenerative eye disease
  • Serious kidney (renal) or liver disease
  • Peyronie’s disease – angulation or deformity of the penis
  • Leukaemia, multiple myeloma or sickle cell disease
  • Bleeding disorders (such as haemophilia)
  • Current active stomach ulcers (peptic ulcer or gastric ulcer)
  • Lactose intolerant (Viagra tablets contain lactose)

We cannot supply Viagra to men who have any of the above conditions.

Recreational misuse

Viagra is sometimes used for recreational rather than therapeutic purposes. If Viagra is taken in this way, particularly in combination with non-prescribed drugs, there is an increased risk of significant side effects, some of which may be serious.

Also see FAQ below what are the risk of taking Viagra with recreation or illegal drugs?

Patient information leaflet

The ‘Patient Information Leaflet’ supplied with the medication must be read before taking Viagra tablets.

Viagra Connect

Viagra – the little blue pill recognised across the world – changed the face of erectile dysfunction treatment when it was launched by Pfizer in 1998. With its relatively few side effects, ease of use and proven effectiveness, it is little wonder the drug has become so popular.

Viagra was under patent protection in the UK until June 2013, after which legal cheaper versions of generic Viagra have been made available under its medical name sildenafil.

In November 2017 the UKs medicines regulator, the MHRA, approved an application by Pfizer to reclassify its sildenafil 50mg to a ‘P’ medicine (available without prescription) which is sold as a new product called Viagra Connect.

Why do men get erectile dysfunction?

Many factors can contribute to erectile dysfunction (also known as impotence). Lifestyle choices, such as excessive drinking, smoking, illegal drug use, as well as obesity and stress, can all have an impact on erections. Erectile dysfunction can also be a symptom of underlying health problems such as atherosclerosis (narrowing of the arteries), heart disease, and diabetes, amongst others.

Men suffering from erectile dysfunction should inform their GPs who will undertake an assessment, possibly perform tests, and provide advice. GPs are trained to deal with ED and are sympathetic to any embarrassment it may cause.

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