The revolutionary pill
Viagra – the little blue pill recognised across the world – has changed the face of erectile dysfunction treatment since its market release by Pfizer in 1998. With its relatively few side effects, ease of use and its 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 (sildenafil) have been made available.
What does it do?
The active ingredient in Viagra/sildenafil is sildenafil citrate, which is known medically as a PDE5 inhibitor. Viagra/sildenafil inhibits 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. Viagra/sildenafil helps to achieve an erection but relies on natural arousal as a trigger. It, and other PDE5 inhibitors, support sexual relations when erections are failing.
Why do men get erectile dysfunction?
Many factors can contribute to impotence (erectile dysfunction). Lifestyle choices, such as excess 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, 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.
Viagra is a well known and widely used drug. Side effects are normally not troublesome. Onset of action tends to be reliable and predictable. Viagra/sildenafil normally starts to work 30 to 60 minutes after it is taken and usually remains active for in the region of 4 hours.
Other erectile dysfunction drugs, Cialis, Levitra and Spedra, work in a similar way, with similar side effects. Viagra/sildenafil was the first drug in this class to become widely prescribed.
Does it work every time?
As with any treatment, there are times when Viagra/sildenafil might not work and may not improve or overcome the underlying cause of erectile dysfunction. Satisfactory erections require the following:
Adequate blood supply
Healthy nervous system
If erectile dysfunction is the result of spinal injury or operation, nerves might be damaged. In this case Viagra/sildenafil 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.
A GP should always be informed.
Sildenafil (generic Viagra), Cialis, Levitra and Spedra are alternative oral tablet treatments for erectile dysfunction and are also available to buy online in various strengths and pack sizes after completing the same medical consultation.
Dr Fox also supplies Vitaros cream, a non-tablet treatment for ED.
Taking Viagra/sildenafil for the first time
The usual first starting dose of Viagra is one 50mg tablet. If this strength of tablet is highly effective subsequent doses might 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.
A trial of treatment should be repeated a number of times before deciding whether Viagra/sildenafil is working and before requesting a change of dosage or change to another ED medication. Viagra/sildenafil is most likely to be suitable if taken in situations where arousal is expected within an hour or two of taking the tablet. Arousal is required for the treatment to work. Without it there will be no benefit and the effect of the tablet will simply wear off after about 4 hours.
photo of Viagra 25mg pack
Reduced dose recommended when 50mg starting dose is highly effective.
photo of Viagra 50mg pack
Starting dose usually recommended for most men taking Viagra for the first time.
photo of Viagra 100mg pack
High strength dose for when 50mg is insufficient, or erection lasts less than 4 hours.
Viagra/sildenafil is sometimes used for recreational rather than therapeutic purposes. If Viagra/sildenafil 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.
Viagra/sildenafil is remarkably well tolerated and free from significant side effects in the vast majority of men who take it.
Slightly over 1% of men taking Viagra/sildenafil 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, flushing, dyspepsia, visual disorders, nasal congestion, dizziness, and visual colour distortion.
In the rare event of serious side effects men should seek immediate medical advice. This applies particularly to chest pains (possibly cardiac), loss of vision, and prolonged and painful erection.
Further detailed information about the side effects of Viagra/sildenafil.
Prolonged painful erections
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 medical attention.
When not to take
During the assessment process at Dr Fox men are required to complete an erectile dysfunction questionnaire to determine if tablets are suitable.
Men should not take Viagra without further assessment from their GP when the following apply:
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)