Information
What is Sildenafil?
Sildenafil was the first drug discovered to treat erectile dysfunction, a condition that affects roughly 52% of men in some form.
It was originally intended for use in angina, a type of chest pain caused by a lack of blood flowing to the heart muscle. During clinical trials in the 1990's however, it was found that men who took sildenafil were getting erections. It appeared that the blood vessels were dilating in the penis, and not in the heart and thus, Viagra was born.
The FDA approved Viagra, which is the branded form of sildenafil for erectile dysfunction in 1998. Manufactured by Pfizer, the company's patent expired in 2020. This meant other manufacturers could now formulate their own non-branded or generic Viagra, known simply as Sildenafil.
What is Erectile Dysfunction?
To understand erectile dysfunction (ED), firstly we need to understand how an erection works. When a man is sexually aroused, nerves release chemicals that increase blood flow into the penis. The penis contains spongy muscle tissue which relaxes and traps this blood. The increase in blood pressure here makes the penis firm, leading to an erection.
Post orgasm, another set of nerves causes this spongy muscle to essentially squeeze the blood out of the penis and back into circulation, leading to the erection subsiding.
Erectile dysfunction is when you are unable to achieve an erection or unable to maintain it long enough for sex. You may still be able to get an erection at other times such as waking up but specifically when the erection cannot be achieved for sex, is when erectile dysfunction is suspected.
It is not uncommon for most men to occasionally fail to keep an erection, due to tiredness, stress or drinking too much alcohol and is usually nothing to worry about. It may also be a side effect of certain medicines.
If ED occurs more often, it usually indicates an underlying health condition such as high blood pressure, high cholesterol or diabetes. All of these conditions can interfere with blood flow which we know is paramount to achieving an erection.
Normal sex requires the mind and body to work in tandem with one another so any emotional issues such as depression, anxiety, stress, performance anxiety or hormonal problems can also lead to ED.
Sex plays an important role in supporting relationships and overall health and well-being. It can offer physical and psychological health benefits such as improving sleep, lowering stress, anxiety, blood pressure, and heart disease and boosting immune function.
Sex is important towards maintaining a healthy relationship by increasing intimacy and boosting happiness.
As it can play such an important role in our lives, it is important to address therefore sexual issues such as ED which can affect not only men but also their sexual partner.
Key Features of Sildenafil Tablets
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A cheaper alternative to the well-known Viagra, but equally as effective.
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Helps increase blood flow to the penis when sexually excited, making it easier to get an erection.
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Some men report achieving an erection as quickly as 12 minutes.
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The effects can last for up to 4 hours
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Can be purchased discreetly from Quick Meds with next-day delivery.
How Sildenafil Tablets Help with ED
Sildenafil belongs to a class of medicines called phosphodiesterase (PDE) inhibitors, specifically PDE-5. PDE-5 is an enzyme found in the walls of blood vessels which affects blood flow. By inhibiting this enzyme, blood vessels relax which in turn helps with increasing blood flow. Sildenafil will not work without sexual stimulation or arousal.
A study carried out assessing sildenafil found, on average it takes 12 minutes to achieve an erection rigid enough for penetration but for most patients within 30 minutes. The duration of action was found to be 4 hours.
Another study investigated the effectiveness of sildenafil 100mg tablets at 12 hours after taking a dose. It found sildenafil remains clinically active after 12 hours.
A clinical study performed summarised after 12 weeks of treatment, between 47% and 87% of patients indicated sildenafil treatment improved their erections when compared to placebo.
The same study assessed satisfaction and quality of life. Patients and their partners reported higher levels of satisfaction after sildenafil treatment. It also improved self-esteem, confidence, sexual satisfaction and relationship satisfaction compared to patients taking placebo.
Other medications available to treat ED are Tadalafil, Avanafil and Vardenafil. Like Sildenafil, these are all PDE-5 inhibitors and therefore work in the same way but all have slight differences.
Sildenafil starts working within 30 minutes post-dose, can last up to 4 hours and serious side effects are rare. Sildenafil is unsuitable for patients with severe blood pressure control and must be used with caution in patients with severe liver conditions or sickle cell anaemia. Possible side effects include a stuffy nose, hot flashes, headaches, nausea and chest pains.
Tadalafil is the longest-lasting PDE-5 lasting up to 36 hours. With Tadalafil, patients have the flexibility of taking a lower daily dose for a long-term solution as opposed to just taking a tablet before sexual intercourse. Some research has indicated patients taking tadalafil have an increased confidence compared to patients taking sildenafil. Tadalafil can however interact with certain common blood pressure medications. It carries the same side effect profile as sildenafil.
Avanafil is the fastest-acting PDE-5 which can start working within 15 mins of taking. Its effects can last up to 6 hours and some research has indicated avanafil is more effective than sildenafil. Avanafil is currently only available as the branded form Spedra, making it more expensive than other drugs.
Vardenafil has a similar effectiveness to sildenafil and there are no major advantages of vardenafil compared to other ED drugs. It can take longer to work, necessitating the need to take it 1 hour before sexual intercourse. It is, however, available in a generic form, making it a cheaper alternative to Avanafil.
Generic Sildenafil vs. Viagra: Understanding the Difference
Both sildenafil and Viagra are licensed treatments for ED. The drug contained within both is sildenafil citrate and there are no differences in how they work.
The main difference between the two products is the cost where Viagra carries a higher price tag than its non-branded or generic alternative. The tablets look different as Viagra, also commonly referred to as the blue pill, is a blue diamond-shaped tablet. Non-branded Viagra may be blue or white and are rounded tablets.
Generic drugs are almost always cheaper than their branded counterparts, but importantly are exactly the same. There is no reason for a branded product to be superior to the generic. Generic medicines are also more readily available as many different companies manufacture them whereas branded medicines can only be manufactured by their own company.
In the instance of Viagra, the main differences are again, the price and the look of the tablets. Some patients may even prefer sildenafil tablets over Viagra due to not being able to tolerate their blue colouring.
Long-Term Use and Safety
Sildenafil can safely be taken for a long time. Studies have not shown any lasting effects from taking sildenafil for months or even years. However it is important to note that sildenafil is not a daily tablet, it should only be taken when needed for sexual intercourse.
Sildenafil is an effective erectile dysfunction treatment but is not a cure. Whilst it can safely be taken for years, patients should not depend on it.
A clinical study carried out in 979 men taking sildenafil 100mg tablets for 4 years found that 3.8% of the men had 1 or more adverse effects that led to a change in dosage. 94% of the participants reported satisfaction with the treatment. Overall, there was a low incidence of adverse effects.
How to Take Sildenafil 100mg Safely
The starting dose of Sildenafil tablets is one 50mg tablet approximately 1 hour before anticipated sexual activity. No more than 1 tablet should be taken per day. Taking too much sildenafil can lead to unwanted effects and will not work more effectively.
Some patients may need to start at a lower dose of 25mg if they are taking other medication. Patients with liver or kidney disease may also need to be started at 25mg.
This dose can be increased to sildenafil 100mg tablets depending on the response. Sildenafil tablets are best taken on an empty stomach as the presence of food delays its onset of action.
To ensure sildenafil works the way it is intended to, there must be sexual stimulation.
You cannot take more than one sildenafil tablet per day. Sildenafil is taken before sexual activity so there may be days when you do not need to take it.
As sildenafil tablets require stimulation and can take up to 30 minutes to start working, it is important to follow the instructions on the packaging and not take an extra dose.
If you take more than you should, sildenafil tablets will not help you achieve an erection sooner or work more effectively. It will however put you at an increased risk of serious side effects such as low blood pressure, headaches, a blocked nose or changes to your vision.
Precautions and Contraindications
Most men over 18 can safely take sildenafil tablets. However, sildenafil may not be suitable if you have a stomach ulcer, a deformity of the penis (Peyronie's disease) or have sickle cell anaemia, leukaemia or multiple myeloma.
Sildenafil must not be taken by patients who have ever had an allergic reaction to sildenafil citrate or any other medication. Patients who have been advised to avoid sexual intercourse or who have a loss of vision due to non-arteritic anterior ischemic optic neuropathy (NAION) must also not take sildenafil tablets.
Sildenafil is contraindicated in patients with severe liver impairment, low blood pressure (hypotension), who have recently had a heart attack or stroke or who have a known hereditary disorder of the eyes called retinitis pigmentosa.
Patients suffering from an existing heart medical condition must be reviewed by a GP before initiating ED treatment. This is because there is potential for cardiac risk associated with sexual activity.
Certain medications can interact with sildenafil. If you are using nitrates to treat angina, alpha-blockers such as losartan for blood pressure, or riociguat used for pulmonary hypertension you cannot take sildenafil tablets. This is because the combination can lead to a sudden decrease in blood pressure.
Taking nitric oxide donors such as amyl nitrate or poppers with sildenafil can potentially lead to a dangerous effect on our hearts.
Side Effects of Sildenafil and Managing Them
As with all medicines, sildenafil can cause side effects. Most of these are mild but there are also some rare effects as well. The side effects may be temporary, but in some cases may last longer, in which case you should seek medical attention.
The most common side effects are nasal congestion, blurred vision, headache and flushing. Other side effects include nausea, back or muscle pain, fever, dizziness, nosebleeds or a mild allergic reaction. These will occur in some patients, usually the first time they use sildenafil.
These common side effects can be managed by ensuring you
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Drink plenty of fluids and reduce alcohol intake to reduce the risk of headaches.
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Avoid spicy food to help with nausea.
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Dut down on caffeinated drinks and alcohol to help with facial flushing.
More serious side effects include severe low blood pressure, cardiovascular problems, vision loss, hearing loss or a severe allergic reaction.
If any of these serious side effects occur or if you have a prolonged or painful erection lasting more than 2 hours, you should seek immediate medical attention.
If you experience chest pain during or after sex and you are taking nitrates, seek immediate medical attention.
Buy Sildenafil Online Safely
You can buy sildenafil online but it is important to know how to identify a legitimate online pharmacy to ensure the medication you are being supplied is safe and fit for use.
All pharmacies in the UK, including online pharmacies must be registered with the General Pharmaceutical Council (GPhC). Look out for registration details on their website.
Additionally, the healthcare professional giving you medical advice must also be registered with the relevant governing body. Pharmacists are registered with the GPhC and doctors with the General Medical Council (GMC). Ask the healthcare professional for their registration number which can then be verified on the GMC and GPhC websites respectively.
Sildenafil 100mg tablets and Viagra are both prescription-only medicines which means they can only be supplied in accordance with a valid prescription. Prescriptions can be authorised by your own doctor or pharmacist prescriber.
If you intend to buy online, the online pharmacy should ask you to fill out a short consultation with all your details including a medical history. You may be asked to book a telephone consultation to discuss these responses and once this has been reviewed, the prescriber will decide the safest sildenafil dosage for you to start at.
It is important to answer all questions honestly about your health to ensure the prescribed product is safe for you to take.
A pharmacy-only version of sildenafil 50mg tablets known as Viagra Connect can now be purchased from a registered pharmacy without a prescription.
Unfortunately, counterfeit medicines are increasing in the UK. With popular products such as Viagra and sildenafil, it is important to know how to spot if a medicine is fake.
These counterfeit erectile dysfunction medicines may contain no active ingredient, the wrong ingredient, or the right ingredient at the wrong dose. It may even contain something drastically different to what it says it contains. In any case, patient safety can potentially be compromised.
Except for Viagra Connect, all other forms of Viagra and non-branded sildenafil are prescription only, so you should only ever look to obtain these on a prescription from a registered pharmacy. If a website is looking to sell you these medicines with no consultation with a prescriber, it is potentially counterfeit.
If you are ever in doubt, speak to your local pharmacist who can help you identify the legitimacy of the medication you have.
Start your ConsultationWhy Choose Quick Meds for Your ED Treatment Needs
Quick Meds offers a range of services in addition to NHS prescriptions. We have a team of GPhC-registered pharmacists trained to provide the highest level of care and professionalism.
Our in-house prescribers are accredited and trained to the highest standard. They are equipped to prescribe sildenafil online and many other treatments on a private prescription via our online service.
Details of our accreditation are available to view on our website.
Here at Quick Meds, patient safety and satisfaction is our utmost priority. Our dedicated team of pharmacists are ready to answer any questions you may have about your treatment or the service.
All treatments provided via our private prescription service include an online consultation on our website. This is reviewed by our clinicians who will usually follow up with a phone call to ensure the treatment to be prescribed is safe and effective for its intended purpose. This is the opportunity for patients to ask any questions they have about the treatment or the service provided.
All medicine is packaged with the patient information leaflet supplied providing you with all the information you need to safely take your medicine and is packaged discreetly. Following dispatch and delivery, we offer ongoing medication support, how to manage any concerns and how to get the most out of your treatment.
Insights and Latest Research
Many alternative treatments are currently being researched to help treat erectile dysfunction.
Stem cell therapy where stem cells are injected into the penis to help reduce inflammation and improve blood flow is being researched and shows promising results.
A vascular stent, operating similarly to a coronary stent in heart disease may help to treat ED by improving blood flow. A few trials with stents have shown good results but more data is needed to assess long-term safety and efficacy.
References
- https://www.medicalnewstoday.com/articles/list-of-pde5-inhibitors#what-they-are
- https://www.nhs.uk/conditions/angina/
- https://qz.com/1070732/viagras-famously-surprising-origin-story-is-actually-a-pretty-common-way-to-find-new-drugs
- https://www.medicalnewstoday.com/articles/generic-viagra#uses
- https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
- https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed))
- https://www.healthline.com/health/how-common-is-ed#prevalence
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874251/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699643/#
- https://www.medicalnewstoday.com/articles/what-is-the-most-effective-pill-for-ed#list-of-ed-pills
- https://www.medicalnewstoday.com/articles/generic-viagra#generic-vs-branded
- https://www.nhs.uk/medicines/sildenafil-viagra/how-and-when-to-take-sildenafil/
- https://www.nhs.uk/medicines/sildenafil-viagra/who-can-and-cannot-take-sildenafil/)
- https://www.medicines.org.uk/emc/product/11741/smpc
- https://www.nhs.uk/medicines/sildenafil-viagra/side-effects-of-sildenafil/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387281/
- https://www.pharmacyregulation.org/standards/guidance/buying-medicines-safely-online
- https://www.ox.ac.uk/news/science-blog/detecting-counterfeit-medicines
- https://www.nhs.uk/medicines/sildenafil-viagra/common-questions-about-sildenafil/
- https://www2.hse.ie/living-well/alcohol/health/effects-on-your-body/sex-life-fertility/
- https://www.everydayhealth.com/heart-health/viagra-and-cialis-may-cut-risk-of-early-death-from-heart-disease/
- https://www.healthline.com/health/drugs/viagra#uses
- https://www.viagraconnect.co.uk/en-gb/what-is-viagra-connect/how-does-viagra-connect-work
- https://www.healthline.com/health/erectile-dysfunction/how-long-does-viagra-last#starting-point
FAQs
Is sildenafil as strong as Viagra?
Both sildenafil and Viagra contain the same active ingredient, sildenafil citrate. Both are as effective as each other in the same strength. i.e. sildenafil 100mg tablets are as strong as Viagra 100mg tablets.
How many hours does sildenafil last?
Sildenafil tablets can last up to 4 hours. This does not mean you would have an erection for 4 hours but rather it can help achieve an erection within the 4 hours of taking sildenafil. It is important to note Viagra or sildenafil does not work if there is no sexual stimulation.
Can you drink alcohol whilst taking sildenafil?
You can drink alcohol whilst taking sildenafil but it is important to note that drinking large amounts can make it harder to achieve or maintain an erection.
Is sildenafil good for the heart?
A recent study published in January 2023 observed that men who regularly take ED medicines had lower rates of heart failure, heart attack, unstable angina and stroke. This suggests sildenafil is good for the heart.
Why is sildenafil so much cheaper than Viagra?
Viagra or the blue pill is essentially a branded form of sildenafil. Both contain the same active ingredient. Pfizer, the company that makes Viagra no longer holds the exclusive rights to the formula. This allows other drug manufacturers to manufacture the drug and offer it at a competitive price.
Does sildenafil keep you hard after ejaculating?
Yes, sildenafil may keep you hard after ejaculating as its effects can last up to 4 hours. This can vary from patient to patient but it is important to consult your doctor or pharmacist if your erection lasts longer than 4 hours.
Can I buy sildenafil over the counter?
Sildenafil citrate is available over the counter as a pharmacy medicine under the brand Viagra Connect. This formulation is available as a 50mg tablet only and does not need a prescription. You do still need to have a short discussion with a pharmacist, however, to assess suitability.
How long can the average man stay erect with 100mg of sildenafil?
On average, sildenafil lasts for 2-3 hours before the effects start to subside, but the effects can last for up to 4 hours post-dose.
Can you take 2 sildenafil tablets at once?
You should only ever take one sildenafil tablet per day. To ensure it works, you need to be sexually stimulated. If you are taking 25mg or 50mg tablets, you may need an increased dose to a maximum dose of 100mg daily. Doses higher than 100mg will not make the drug more effective and may lead to unwanted effects. Speak to your doctor or pharmacist prescriber to discuss which dose is suitable for you.
Does crushing sildenafil make it work faster?
Both sildenafil and Viagra must be swallowed whole. You cannot split sildenafil tablets and they are not designed to be crushed or chewed. Doing so does not make the drug work faster.
What should you avoid when taking sildenafil 100mg tablets?
You can eat or drink normally whilst taking sildenafil although the presence of food may delay the tablet from working. Excessive alcohol consumption may also affect your ability to achieve an erection.
You should avoid using nitric oxide donors or 'poppers' with sildenafil as the combination can lead to dangerous effects on the heart. Sildenafil has not been tested extensively with recreational drugs so these must also be avoided.
If you are using nitrates to treat angina, alpha-blockers such as losartan for blood pressure, or riociguat used for pulmonary hypertension you cannot take sildenafil tablets. This is because the combination can lead to a sudden decrease in blood pressure. Speak to your doctor or pharmacist prescriber to discuss alternative ed treatments available for you.
Can you take sildenafil 3 days in a row?
Yes, you can take sildenafil on consecutive days. It is important to stick to a maximum dose of 100mg daily and no more than once per day.