Viagra® and Sildenafil: 9 Facts Your Doctor Wants You to Know

There’s no short­age of infor­ma­tion online about erec­tile dys­func­tion (ED). The prob­lem is that a lot of it isn’t accu­rate — and some of it is being sold to you.

ED is far more com­mon than most men assume. Research sug­gests that between 30 and 50 mil­lion men in the Unit­ed States have ED, and about 40% of men are affect­ed by age 40. One of the main­stays of treat­ment is oral med­ica­tion. Via­gra®, or its gener­ic, silde­nafil, remains the most rec­og­nized name on the market.

At Duly Health and Care, our sub­ur­ban-based com­pre­hen­sive care mod­el means the pri­ma­ry care physi­cian who man­ages your blood pres­sure and the urol­o­gist who treats your ED can work from the same chart, in the same net­work, often in the same com­mu­ni­ty. That mat­ters more with ED than most men realize.

Here’s what’s actu­al­ly true about Viagra®.

1. Not every man can or should take Viagra®

Before start­ing silde­nafil, tell your doc­tor if you:

• Take nitrates in any form, includ­ing nitro­glyc­erin (this com­bi­na­tion can drop your blood pres­sure to dan­ger­ous levels)
• Take rio­ciguat or anoth­er guany­late cyclase stimulator
• Have had a heart attack, stroke or heart fail­ure in the last six months
• Have low blood pres­sure, uncon­trolled high blood pres­sure, chest pain or a his­to­ry of vision loss from optic nerve problems
• Have liv­er or kid­ney disease

Bring a full list of your med­ica­tions and sup­ple­ments to the con­ver­sa­tion. Cer­tain antibi­otics, anti­fun­gals and HIV med­ica­tions can raise silde­nafil lev­els in your blood and increase your risk of side effects.

2. Tim­ing mat­ters — but you have more flex­i­bil­i­ty than you think

The typ­i­cal rec­om­men­da­tion is to take silde­nafil about one hour before sex­u­al activ­i­ty. It can be tak­en any­where from 30 min­utes to four hours before­hand, which gives you a rea­son­able win­dow to work with.

3. Once a day is the limit

The max­i­mum rec­om­mend­ed dos­ing fre­quen­cy is one dose per 24 hours. Tak­ing more won’t improve results — it only increas­es your risk of side effects.

4. A heavy meal can slow it down

You may have read that you need to fast for two hours first. That’s not accu­rate. Silde­nafil can be tak­en with or with­out food. What’s true is that a high-fat meal — think a cheese­burg­er and fries — can delay how quick­ly the med­ica­tion starts work­ing. If you’re plan­ning ahead, a lighter meal is the bet­ter choice.

5. There’s more than one dose

Your physi­cian may adjust your dose up or down depend­ing on how you respond and tol­er­ate it. That adjust­ment is a nor­mal part of the process — not a sign that some­thing is wrong.

6. It may not work the first time

Silde­nafil isn’t a switch. It requires sex­u­al stim­u­la­tion to pro­duce an erec­tion, and many men need sev­er­al attempts before they know whether a giv­en dose works for them. Give it a few tries before draw­ing con­clu­sions, and tell your physi­cian what you expe­ri­enced — dose, tim­ing and tech­nique can all be adjusted.

7. Know which side effects are rou­tine and which are emergencies

Com­mon side effects, which are usu­al­ly mild and temporary:

• Headache
• Flush­ing
• Indi­ges­tion
• Stuffy or run­ny nose
• Dizzi­ness
• Mus­cle aches
• Nau­sea
• Changes in vision, such as a blue tinge or light sensitivity

8. ED can be an ear­ly warn­ing sign of some­thing bigger

This is the part most men miss. ED often shares its root caus­es with car­dio­vas­cu­lar dis­ease — it’s close­ly linked to dia­betes, high blood pres­sure, heart dis­ease and phys­i­cal inac­tiv­i­ty. For some men, ED is the first symp­tom that brings an undi­ag­nosed con­di­tion to light.

A pre­scrip­tion alone treats the symp­tom. A full workup — blood pres­sure, blood sug­ar, cho­les­terol, hor­mone lev­els, med­ica­tion review — treats the per­son. That’s the advan­tage of com­pre­hen­sive care close to home: one vis­it can start both conversations.

9. Skip the gas sta­tion pills and unver­i­fied online sellers

Silde­nafil requires a pre­scrip­tion in the Unit­ed States for good rea­son. The FDA has repeat­ed­ly iden­ti­fied sup­ple­ments mar­ket­ed for ​“male enhance­ment” that secret­ly con­tain silde­nafil or sim­i­lar com­pounds — unla­beled, unmea­sured and poten­tial­ly dan­ger­ous if you take nitrates or have heart dis­ease. If a prod­uct promis­es pre­scrip­tion-strength results with­out a pre­scrip­tion, that’s the warn­ing sign.

Via­gra® isn’t your only option

Silde­nafil is one of sev­er­al PDE5 inhibitors, along­side tadalafil, var­de­nafil and avanafil, each with a dif­fer­ent dura­tion and dos­ing rhythm. Beyond oral med­ica­tion, treat­ment may include address­ing under­ly­ing con­di­tions, adjust­ing med­ica­tions that con­tribute to ED, coun­sel­ing, vac­u­um devices, injectable ther­a­py or sur­gi­cal options.

You don’t have to fig­ure out which is right for you on your own. Talk with a Duly pri­ma­ry care physi­cian or a Duly urol­o­gist about what’s actu­al­ly dri­ving your symp­toms and which treat­ment fits your health history.

Talk to a Duly pri­ma­ry care physician

Fre­quent­ly asked ques­tions about Via­gra® and sildenafil

How long does Via­gra® take to work?

Most men take silde­nafil about one hour before sex­u­al activ­i­ty, though it can be tak­en any­where from 30 min­utes to four hours before­hand. A high-fat meal can delay how quick­ly it starts working.

Can I take Via­gra® every day?

The max­i­mum rec­om­mend­ed dos­ing fre­quen­cy is one dose per 24 hours. Tak­ing more won’t improve results and increas­es your risk of side effects.

Do I have to take Via­gra® on an emp­ty stomach?

No. Silde­nafil can be tak­en with or with­out food. A high-fat meal may delay how quick­ly the med­ica­tion begins work­ing, so a lighter meal is the bet­ter choice when you’re plan­ning ahead.

Is erec­tile dys­func­tion a sign of heart problems?

It can be. ED shares many of its under­ly­ing caus­es with car­dio­vas­cu­lar dis­ease and is close­ly linked to dia­betes, high blood pres­sure, heart dis­ease and phys­i­cal inac­tiv­i­ty. For some men, ED is the first symp­tom that leads to an undi­ag­nosed con­di­tion being found.

Do I need a pre­scrip­tion for Via­gra® or sildenafil?

Yes. Silde­nafil requires a pre­scrip­tion in the Unit­ed States because it has sig­nif­i­cant inter­ac­tions with nitrates and oth­er med­ica­tions that must be reviewed before treat­ment begins. Over-the-counter prod­ucts promis­ing sim­i­lar results have been found by the FDA to con­tain hid­den drug ingredients.