VIAGRA (sildenafil citrate), an oral therapy for erectile dysfunction, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).

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Sildenafil, sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension.  It is unclear if it is effective for treating sexual dysfunction in women.  It is taken by mouth or by injection into a vein.[8] Onset is typically within 20 minutes and lasts for about 2 hours.

Common side effects include headaches, heartburn, and flushed skin. Caution is advised in those with cardiovascular disease. Rare but serious side effects include a prolonged erection (priapism) that can lead to damage to the penis, vision problems, and hearing loss. Sildenafil should not be taken by people on nitrates such as nitroglycerin (glycerin trinitrate), as this may result in a serious drop in blood pressure. Sildenafil should not be taken within four hours of taking an alpha one antagonist.

Sildenafil acts by blocking phosphodiesterase 5 (PDE5), an enzyme that promotes breakdown of cGMP, which regulates blood flow in the penis. It requires sexual arousal, however, to work. It also results in dilation of the blood vessels in the lungs.

Pfizer originally discovered the medication in 1989 while looking for a treatment for heart-related chest pain. It was approved for medical use in the United States and in the European Union in 1998. In 2017, it was the 217th most commonly prescribed medication in the United States, with more than two million prescriptions.

In 2017, it became available as a generic medication after final patents by Pfizer expired. In the United Kingdom, it is available over the counter. Most of the Active Pharmaceutical Ingredient (API) in Sildenafil, Sildenafil citrate, is produced in Pfizer’s Ringaskiddy complex, County Cork, which is Pfizer’s largest production facility outside of the United States.

Sildenafil citrate is designated chemically as 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo[4,3d]pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]-4-methylpiperazine citrate and has the following structural formula:

Sildenafil citrate is a white to off-white crystalline powder with a solubility of 3.5 mg/mL in water and a molecular weight of 666.7. Sildenafil is the active ingredient in Viagra, which is nicknamed the little blue pill. Sildenafil, in doses ranging between 25mg and 100mg, has been FDA approved to treat erectile dysfunction.

VIAGRA is formulated as blue, film-coated rounded-diamond-shaped tablets equivalent to 25 mg, 50 mg and 100 mg of sildenafil for oral administration. In addition to the active ingredient, sildenafil citrate, each tablet contains the following inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and FD & C Blue #2 aluminum lake.

Your physician, based on the information you share with them (including your preference and previous use of the medication), will recommend a starting dose. They can also work with you to increase or decrease your dose based on effectiveness and toleration (i.e., titrate your dose). This enables you to achieve the desired effect while taking the least amount of medication.

Sildenafil (Viagra), Cialis, and Levitra are part of a “family” of drugs called PDE-5 inhibitors. You can read more about how they work here.

It is recommended that several attempts are made using the recommended starting dose before adjusting. Several factors can affect the efficacy of sildenafil citrate, including sexual stimulation, and what you eat and drink at the time.

There are several documented reasons why a 100mg dose may be better for the patient:

1. Efficacy. Sildenafil and other Phosphodiesterase type 5 (PDE5) drugs work by increasing blood flow to the penis. Though the 100mg effects do not last longer than a lower dosage, the higher concentration does have a more profound effect. However, it is not a good idea to use a higher strength tablet than you really need. Side effects are more likely at higher doses.
2. Satisfaction with treatment. Naturally a stronger tablet has a better chance of achieving desired results – achieving and maintaining an erection hard enough for sexual intercourse. This in turn results in not only physical but emotional satisfaction, helping couples in their relationships and improving the man’s self-esteem.
3. Reduced anxiety. A number of factors go into the success of an ED medication, and they are not guaranteed to work every time. This uncertainty can lead to a great deal of anxiety for couples who have already had to deal with the frustration of erectile dysfunction – not knowing if they should again get their hopes up for a successful sexual encounter only to be disappointed. The higher dose can therefore have a positive psychological effect, helping men and their partners to feel more confident about having sex.

HOW Viagra WORKS?

Sildenafil lasts up to 8 hours, which means it is in and out of your system faster than Cialis, which can last up to 36 hours. Some people prefer Sildenafil because if they experience side effects, even if minor, they would rather not experience them for up to 36 hours. On the other hand, some people prefer Cialis mainly because it lasts an extended period of time.

The manufacturers of Viagra recommend taking Viagra one hour before having sex. However, studies have suggested that it could start working even sooner than that. Some men were able to achieve an erection just 12 minutes after taking Viagra, although this wasn’t conclusively proven to be due to Viagra. And while the maximum concentration of sildenafil in the blood isn’t reached until about an hour after taking it (and is potentially delayed by an additional hour if taken with food), it took a median of 27 minutes (with a range of 12–70 minutes) for men taking sildenafil to begin experiencing erections.  This was 23 minutes sooner than the median time of 50 minutes experienced by those who took a placebo.

The half-life of Viagra in the body is about four hours, meaning that every four hours after taking it, there’s only half as much of the drug left. However, even 10 to 12 hours after taking Viagra, men could still often achieve erections hard enough for penetration, though of a shorter duration. By 24 hours, all traces of Viagra in the blood are practically gone.

Another reason some people prefer Sildenafil, compared to Levitra, is because it has fewer conflicting medications and functions very similarly in terms of absorption.

It comes down to your personal preference and response to the medication. Please consult with your physician if you have any questions.

Why is Viagra prescribed?

Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Sildenafil (Revatio) is used to improve the ability to exercise in adults with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness). Children should not usually take sildenafil, but in some cases, a doctor may decide that sildenafil (Revatio) is the best medication to treat a child’s condition. Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily.

If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. Sildenafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV).

How should Viagra be used?

Sildenafil comes as a tablet and suspension (liquid; Revatio only) to take by mouth.

If you are taking sildenafil to treat erectile dysfunction, follow your doctor’s directions and the guidelines in this paragraph. Take sildenafil as needed before sexual activity. The best time to take sildenafil is about 1 hour before sexual activity, but you can take the medication any time from 4 hours to 30 minutes before sexual activity. Sildenafil usually should not be taken more than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take sildenafil less often. You can take sildenafil with or without food. However, if you take sildenafil with a high-fat meal, it will take longer for the medication to start to work.

If you are taking sildenafil to treat PAH, follow your doctor’s directions and the guidelines in this paragraph. You will probably take sildenafil three times a day with or without food. Take sildenafil at around the same times every day, and space your doses about 4 to 6 hours apart.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sildenafil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the liquid well for 10 seconds before each use to mix the medication evenly. Use the oral syringe provided with your medication to measure and take your dose. Follow the manufacturer’s directions to use and clean the oral syringe. Do not mix the liquid with other medications or add anything to flavor the medication.

If you are taking sildenafil for erectile dysfunction, your doctor will probably start you on an average dose of sildenafil and increase or decrease your dose depending on your response to the medication. Tell your doctor if sildenafil is not working well or if you are experiencing side effects.

If you are taking sildenafil for PAH, you should know that sildenafil controls PAH but does not cure it. Continue to take sildenafil even if you feel well. Do not stop taking sildenafil without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking sildenafil,

• tell your doctor and pharmacist if you are allergic to sildenafil, any other medications, or any of the ingredients in sildenafil products. Ask your pharmacist for a list of the ingredients.
• do not take sildenafil if you are taking or have recently taken riociguat (Adempas) or nitrates (medications for chest pain) such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others). Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your doctor if you are not sure whether any of your medications contain nitrates.
• do not take street drugs containing nitrates such as amyl nitrate and butyl nitrate (‘poppers’) while taking sildenafil.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax, in Jalyn), and terazosin; amlodipine (Norvasc, in Amturnide, in Tekamlo); certain antifungals such as itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral); anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven); certain barbiturates such as butalbital (in Butapap, in Fioricet, in Fiorinal, others) and secobarbital (Seconal); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal LA, InnoPran); bosentan (Tracleer); cimetidine ; efavirenz (Sustiva, in Atripla); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors including amprenavir (Agenerase; no longer available in the U.S.), atazanavir (Reyataz, in Evotaz), darunavir (Prezista, in Prezcobix), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), and tipranavir (Aptivus); nevirapine (Viramune); other medications or devices to treat erectile dysfunction; medications for high blood pressure; certain medications for seizures including carbamazepine (Carbatrol, Epitol, Tegretol, others), phenobarbital, and phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane, in Rifamate, in Rifater). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with sildenafil, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor what herbal products you are taking or plan to take, especially St. John’s wort.
• tell your doctor if you smoke, if you have ever had an erection that lasted for several hours, and if you have recently lost a large amount of body fluids (dehydration). This can happen if you are sick with fever, diarrhea, or vomiting; sweat a lot; or do not drink enough liquids. Also tell your doctor if you have or have ever had pulmonary veno-occlusive disease (PVOD; blockage of veins in the lungs); a stomach ulcer; heart, kidney, or liver disease; a heart attack; an irregular heartbeat; a stroke; chest pain; high or low blood pressure; high cholesterol; a bleeding disorder; blood circulation problems;blood cell problems such as sickle cell anemia (a disease of the red blood cells), multiple myeloma (cancer of the plasma cells), or leukemia (cancer of the white blood cells); conditions affecting the shape of the penis (e.g., angulation, cavernosal fibrosis, or Peyronie’s disease); or diabetes. Also tell your doctor if you or any of your family members have or have ever had an eye disease such as retinitis pigmentosa (an inherited eye condition that causes loss of vision) or if you have ever had sudden severe vision loss, especially if you were told that the vision loss was caused by a blockage of blood flow to the nerves that help you see.
• if you are a woman and you are taking sildenafil to treat PAH, tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking sildenafil, call your doctor.
• if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking sildenafil.
• if you are taking sildenafil to treat erectile dysfunction, tell your doctor if you have ever been advised by a healthcare professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity. Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain, dizziness, or nausea during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise.
• tell all your healthcare providers that you are taking sildenafil. If you ever need emergency medical treatment for a heart problem, the healthcare providers who treat you will need to know when you last took sildenafil.

What special dietary instructions should I follow?

Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.

What should I do if I forget a dose?

If you are taking sildenafil for erectile dysfunction, you are unlikely to miss a dose since this medication is taken as needed, not on a regular dosing schedule.

If you are taking sildenafil for PAH, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

• How do I Take Viagra for the Best Results?
• Viagra Precaution for Pregnancy and Breastfeeding
• What Are the Differences Between Cialis and Viagra?
• The factors that affect how long Viagra lasts?
• Can I buy Viagra over the counter?
• Where to buy Viagra ?
• Does Viagra make you last longer?
• How quickly does Viagra work?
• How long does Viagra last?
• How do you know if you need Viagra?
• Professional information for Viagra
• Viagra expiration, storage, and disposal
• Is there a “female Viagra”?
• Is Viagra OK for Women ?
• Does Viagra work to treat ED?
• How does Viagra work?
• What should I know about storage and disposal of Cialis?
• What is the Pros and cons of Cialis (tadalafil) ?
• What are the risks and warnings for Cialis (tadalafil)?
• How long does Cialis (tadalafil) last?
• Is Tadalafil as Good as Cialis?
• How should I take Cialis for the best results?
• What can not Cialis do ?
• What Should I Avoid While Taking Cialis?
• What is the distanges of taking Cialis ?
• What is the advantages of taking Cialis ?
• Cialis is not right for everyone
• How does Cialis work?
• How will Cialis be supplied?
• Can Cialis be used with other treatments for impotence?
• How Common is ED (Erectile Dysfunction)?
• Who should not take Cialis?
• Is Cialis right for me?
• What important information should you know about Cialis?
• Are there any side effects with Cialis?

What side effects can Viagra cause?

Sildenafil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• • • headache
    • heartburn
    • diarrhea
    • flushing (feeling of warmth)
    • nosebleeds
    • difficulty falling asleep or staying asleep
    • numbness, burning, or tingling in the arms, hands, feet, or legs
    • muscle aches
    • changes in color vision (seeing a blue tinge on objects or having difficulty telling the difference between blue and green)
    • sensitivity to light

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• sudden severe loss of vision (see below for more information)
• blurred vision
• sudden decrease or loss of hearing
• ringing in ears
• dizziness or lightheadedness
• fainting
• chest pain
• worsening shortness of breath
• erection that is painful or lasts longer than 4 hours
• itching or burning during urination
• rash

Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil. The vision loss was permanent in some cases. It is not known if the vision loss was caused by the medication. If you experience a sudden loss of vision while you are taking sildenafil, call your doctor immediately. Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.

There have been reports of heart attack, stroke, irregular heartbeat, bleeding in the brain or lungs, high blood pressure, and sudden death in men who took sildenafil for erectile dysfunction. Most, but not all, of these people had heart problems before taking sildenafil. It is not known whether these events were caused by sildenafil, sexual activity, heart disease, or a combination of these and other causes.

Talk to your doctor about the risks of taking sildenafil.

Some patients experienced a sudden decrease or loss of hearing after they took sildenafil or other medications that are similar to sildenafil. The hearing loss usually involved only one ear and did not always improve when the medication was stopped. It is not known if the hearing loss was caused by the medication. If you experience a sudden loss of hearing, sometimes with ringing in the ears or dizziness, while you are taking sildenafil, call your doctor immediately. If you are taking sildenafil (Viagra) for erectile dysfunction, do not take any more doses of sildenafil (Viagra) or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor. If you are taking sildenafil (Revatio) for PAH, do not stop taking your medication until you talk to your doctor.

Sildenafil may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Information on Viagra dosages

The appropriate dosage of Viagra may vary between people. Your doctor will be able to determine the right dosage for you.

The number of doses taken daily depends on why Viagra is being used. Viagra is taken orally.

For use in erectile dysfunction:

• • Adults ages up to 64 years old typically take 50 milligrams (mg) 1 hour before sexual intercourse, no more than once a day.
  • For adults ages 65 and older using Viagra for erectile dysfunction, or for those with cirrhosis or severe renal impairment, the average dose is 25 mg as a single dose, taken 1 hour before sexual intercourse, but no more than once a day.

Viagra may also be taken between 30 minutes to 4 hours prior to sexual intercourse.

Your doctor may adjust your dosage to meet your needs.

Viagra may also be used for pulmonary arterial hypertension. When used for this purpose, the average dose is 5 to 20 mg of Viagra taken 3 times a day. The doses of Viagra should be taken between 4 to 6 hours apart when used for pulmonary arterial hypertension.

Age	Dosage	When to take
Adults ages up to 64 years old	50 mg, no more than once a day	1 hour prior to sexual intercourse (alternatively, may also be taken between 30 minutes and 4 hours prior to sexual intercourse)
Adults ages 65 and older, or with cirrhosis or severe renal impairment	25 mg, no more than once a day	1 hour prior to sexual intercourse (alternatively, may also be taken between 30 minutes and 4 hours prior to sexual intercourse)

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension at room temperature or in a refrigerator, but do not freeze it. Dispose of any unused suspension after 60 days.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community.

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

• • • Revatio®
    • Viagra®

Cialis vs. Viagra

Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate.

Both Viagra and Cialis can be taken 30 minutes before sexual activity. However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it.

The fact that it comes in a low-dose (2.5 mg) version also means that Cialis can be taken every day. A daily dose will ensure that the drug’s always in your system.

If you take Cialis, there’s a chance of limb pain. This side effect isn’t associated with any other oral ED drugs.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Viagra Drug interactions

Each drug comes with the risk of drug interactions. Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions.

All four of these drugs interact with:

• • • nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat)
    • certain blood pressure drugs, such as calcium channel blockers
    • alpha blockers, which can treat high blood pressure or an enlarged prostate
    • certain pulmonary hypertension drugs, such as riociguat (Adempas)
    • protease inhibitors, a class of HIV drugs
    • antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox)
    • antibacterial drugs, such as clarithromycin (Biaxin)

Drinking excessive amounts of alcohol while on any PDE5 inhibitor should be avoided, and you shouldn’t combine different ED drugs.

Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital.

For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.

Do not take VIAGRA if you:

• • take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
  • are allergic to sildenafil, as contained in VIAGRA and REVATIO, or any of the ingredients in VIAGRA

Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate medical help.

VIAGRA can cause serious side effects. Rarely reported side effects include:

• • an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, priapism can permanently damage your penis
  • sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
  • sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away

Before you take VIAGRA, tell your healthcare provider if you:

• • have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
  • have had heart surgery within the last 6 months
  • have pulmonary hypertension
  • have had a stroke
  • have low blood pressure, or high blood pressure that is not controlled
  • have a deformed penis shape
  • have had an erection that lasted for more than 4 hours
  • have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
  • have retinitis pigmentosa, a rare genetic (runs in families) eye disease
  • have ever had severe vision loss, including an eye problem called NAION
  • have bleeding problems
  • have or have had stomach ulcers
  • have liver problems
  • have kidney problems or are having kidney dialysis
  • have any other medical conditions

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects. Especially tell your healthcare provider if you take any of the following:

• • medicines called nitrates
  • medicines called guanylate cyclase stimulators such as Adempas (riociguat)
  • medicines called alpha-blockers, such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA with alpha-blockers can lead to a drop in blood pressure or to fainting
  • medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase), or atazanavir sulfate (Reyataz)
  • some types of oral antifungal medicines, such as ketoconazole (Nizoral) and itraconazole (Sporanox)
  • some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin
  • other medicines that treat high blood pressure
  • other medicines or treatments for ED
  • VIAGRA contains sildenafil, which is the same medicine found in another drug called REVATIO. REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])

VIAGRA does not protect against sexually transmitted diseases, including HIV.

The most common side effects of VIAGRA: headache; flushing; upset stomach; abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision; stuffy or runny nose; back pain; muscle pain; nausea; dizziness; rash.

What are the main differences between Cialis and Viagra?

Cialis is the brand-name drug for tadalafil. It was FDA-approved in 2003 and is used to treat erectile dysfunction and benign prostatic hyperplasia (BPH). Cialis can be taken as needed before sexual activity or once daily with effects lasting up to 36 hours. Cialis reaches maximum levels in the body between 30 minutes and 6 hours after taking it. It can be taken with food or on an empty stomach.

Viagra, also known by its generic name sildenafil, was approved by the FDA in 1998 and is a popular drug made by Pfizer to treat ED. Brand name Viagra is only indicated for erectile dysfunction. It is taken as needed before sexual activity with maximum levels of the drug reached within 30 minutes to 2 hours after taking it. Eating a high-fat meal with Viagra may reduce the absorption of the drug.

Main differences between Cialis and Viagra
	Cialis	Viagra
Drug class	Phosphodiesterase type 5 (PDE5) inhibitor	Phosphodiesterase type 5 (PDE5) inhibitor
Brand/generic status	Generic version available	Generic version available
What is the generic name? What is the brand name?	Tadalafil Cialis	Sildenafil Viagra
What form(s) does the drug come in?	Oral tablet	Oral tablet
What is the standard dosage?	Erectile dysfunction: 10 mg oral tablet before sexual activity Once-daily use for ED: 2.5 mg oral tablet by mouth daily BPH or BPH with ED: 5 mg oral tablet daily at the same time every day	Erectile dysfunction: 50 mg oral tablet before sexual activity
How long is the typical treatment?	As needed	As needed
Who typically uses the medication?	Adult men aged 18 years and older	Adult men aged 18 years and older

Conditions treated by Cialis vs. Viagra

Cialis is primarily used to treat ED. However, it is also approved to treat signs and symptoms from an enlarged prostate also called benign prostatic hyperplasia (BPH). Tadalafil, the active ingredient in Cialis, is available as Adcirca, which is used to treat pulmonary arterial hypertension (PAH), or high blood pressure in the lungs. Cialis can also be used off-label for Raynaud’s phenomenon, a rare blood vessel disorder.

Viagra is only FDA-approved to treat ED. Sildenafil citrate, the active ingredient in Viagra, is also manufactured as Revatio to treat pulmonary arterial hypertension (PAH). Viagra is sometimes used off-label to treat Raynaud’s phenomenon and female sexual arousal disorder.

Both Cialis and Viagra have also been prescribed to treat the different problems surrounding ED. For instance, Viagra may also help men who experience early ejaculation so they can have better control. Cialis has been shown to help men experiencing other sexual dysfunctions involving ejaculatory and orgasmic functions.

Condition	Cialis	Viagra
Erectile dysfunction (ED)	Yes	Yes
Benign prostatic hyperplasia (BPH)	Yes	No
Raynaud’s phenomenon	Off-label	Off-label
Female sexual arousal disorder	No	Off-label

Is Cialis or Viagra more effective?

Compared to placebo or using no medication, both Cialis and Viagra are effective at treating erectile dysfunction. Most of the differences between the two drugs have to do with how long the drug lasts, how it is taken, and the medical history of the person taking it.

Although they are both effective, Cialis may be preferred for its once-daily dosing and it’s used for treating BPH. Viagra may be preferred for its shorter half-life for those who only use it sparingly as needed.

In a meta-analysis pooling 16 different trials and analyzing over 5000 patients, Cialis and Viagra showed similar effectiveness and safety. These results were based on the International Index of Erectile Function (IIEF)-EF scale which is widely used to assess erectile function. Both drugs had similar incidences of side effects. However, those taking Cialis experienced improved sexual confidence and preferred it over Viagra due to feeling less pressure about planning with its longer-acting effects.

Another trial showed that the active ingredients in Cialis and Viagra were comparable in effectiveness. There were no significant differences between the two drugs. Cialis, however,  was suggested to offer more flexibility with its longer half-life.

If you have ED, it’s important to consult a doctor to determine which treatment option may be best for you. One medication may be more effective or preferred over the other depending on your situation.

Brand name Cialis is not typically covered by Medicare and most insurance plans. Some plans may cover generic tadalafil. The average retail cost of generic tadalafil is $275 for thirty 2.5 mg tablets. With a SingleCare coupon, you can receive a discount and pay around $90-180 depending on the pharmacy.

Brand name Viagra is not usually covered by Medicare and most insurance plans. Check your insurance plan as some plans may cover generic sildenafil. The average retail cost of generic sildenafil range from $140 or nearly $400. SingleCare can help you lower this cost to about $75-140 for generic sildenafil.

	Cialis	Viagra
Typically covered by insurance?	No	No
Typically covered by Medicare?	No	No
Standard dosage	2.5 mg tablets (supply of 30)	25 mg tablets (supply of 30)
Typical Medicare copay	$275	$140-400
SingleCare cost	$90-180	$75-140

Common side effects of Cialis and Viagra

Cialis and Viagra share several common side effects such as headache, indigestion, muscle pain, back pain, and nasal congestion. Both ED medications can also cause some degree of flushing, which is a warm feeling with a blushed skin tone, especially on the face. These side effects are due to the vasodilator effects of these drugs which relax smooth muscles in the blood vessels to increase blood flow.

In addition to these side effects, Cialis may also cause some pain in the limbs. Other side effects of Viagra include abnormal changes in vision, nausea, dizziness, and rash. Serious side effects of Cialis and Viagra can include cardiovascular, or heart, complications such as heart attack, stroke, cerebrovascular hemorrhage, palpitations, and arrhythmias especially if taken with certain other drugs (see Drug Interactions).

	Cialis *10 mg tablet		Viagra *50 mg tablet
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Headache	Yes	11%	Yes	21%
Indigestion	Yes	8%	Yes	9%
Muscle pain	Yes	4%	Yes	2%
Back pain	Yes	5%	Yes	4%
Nasal congestion	Yes	3%	Yes	4%
Flushing	Yes	3%	Yes	19%
Pain in the arms or legs	Yes	3%	No	–
Abnormal vision	Yes	<0.1%	Yes	2%
Nausea	Yes	<1%	Yes	3%
Dizziness	Yes	<2%	Yes	4%
Rash	Yes	<2%	Yes	2%

*Consult a doctor or pharmacist for all possible side effects.

PDE5 inhibitors like Cialis and Viagra have similar drug interactions. Cialis and Viagra should not be used with any medication that can decrease blood pressure. These medications include nitrates, alpha blockers, antihypertensives (blood pressure lowering drugs), and riociguat. Taking these medications together can cause dangerously low blood pressure.

Cialis and Viagra are both processed in the liver. Therefore, they should not be used with medications that alter the function of certain enzymes. CYP3A4 inhibitors, such as certain antibiotics, antifungals, and HIV protease inhibitor drugs, can increase the level of Cialis and Viagra in the body. CYP3A4 inducers, such as certain anticonvulsants like phenytoin or carbamazepine as well as an antibiotic called rifampin can decrease the effectiveness of Cialis and Viagra.

Cialis and Viagra should also be avoided with alcohol and grapefruit juice. Consuming alcohol or grapefruit juice may increase the side effects of ED medications.

Drug	Drug Class	Cialis	Viagra
Nitroglycerin Isosorbide dinitrate Isosorbide mononitrate Amyl nitrate Amyl nitrite Butyl nitrate	Nitrate	Yes	Yes
Riociguat	Guanylate cyclase stimulator	Yes	Yes
Doxazosin Tamsulosin Terazosin Prazosin Alfuzosin	Alpha blocker	Yes	Yes
Amlodipine Enalapril Lisinopril Metoprolol Losartan Valsartan	Antihypertensive	Yes	Yes
Erythromycin Clarithromycin Telithromycin Rifampin	Antibiotic	Yes	Yes
Ketoconazole Itraconazole	Antifungal agent	Yes	Yes
Ritonavir Atazanavir Darunavir Indinavir Lopinavir Saquinavir	Protease inhibitor	Yes	Yes
Phenytoin Carbamazepine	Anticonvulsant	Yes	Yes

*This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.

Warnings of Cialis and Viagra

ED drugs like Cialis and Viagra may cause heart complications such as heart attack, stroke, and arrhythmias, especially in those with heart health conditions. Cialis and Viagra can also cause changes in blood pressure when used with other blood pressure medications.

Prolonged erections lasting longer than 4 hours are possible with ED medications. Erections that are painful and last longer than 6 hours indicate a condition called priapism. If you experience these adverse effects, seek medical attention immediately.

Although rare, Cialis and Viagra can cause abnormal changes in vision or hearing. In more serious cases, these drugs can cause sudden hearing or vision loss.

Cialis and Viagra are not FDA approved for women or children younger than 18 years old.

Cialis and Viagra do not protect against sexually transmitted diseases (STDs). Consider other protective measures to prevent STDs.

Serious adverse effects may be more common in counterfeit ED drugs. Counterfeit Viagra may contain other ingredients or incorrect amounts of the active ingredient. Counterfeit drugs are not approved by the FDA. Make sure you are getting safe and effective drugs from a reliable source.

Frequently asked questions about Cialis vs. Viagra

What is Cialis?

Cialis, also known by its generic name tadalafil, is a prescription drug used for erectile dysfunction (ED). It can also treat men with an enlarged prostate, or benign prostatic hyperplasia (BPH). Cialis can be taken as needed or once daily with effects lasting up to 36 hours.

What is Viagra?

Viagra is also known by its generic name sildenafil. It is prescribed for erectile dysfunction (ED). Viagra is usually taken as a 50 mg tablet 30 minutes to 4 hours before sexual activity. It should be avoided with a high-fat meal which can reduce its absorption.

Are Cialis and Viagra the same?

Cialis and Viagra are in the same class of drugs called phosphodiesterase 5 (PDE5) inhibitors. However, they are not the same. Cialis contains tadalafil and Viagra contains sildenafil. They also have some different side effects and uses.

Is Cialis or Viagra better?

Cialis and Viagra are both effective for ED. Cialis may be preferred for its once-daily dosing and longer-lasting effects. If you experience erectile dysfunction and are looking for treatment, there are many doctors and specialists who can assess your ED and help you find the best option for your sex life.

Can I use Cialis or Viagra while pregnant?

No. Cialis and Viagra are not indicated for pregnant women. While some off-label uses have been reported for female sexual arousal disorder, women who are pregnant should not be taking ED medications.

Can I use Cialis or Viagra with alcohol?

It is not recommended to use Cialis or Viagra with alcohol. Alcohol can increase side effects such as dizziness and headache. Drinking alcohol with these drugs may result in low blood pressure.

How long does it take for Cialis to peak?

According to the FDA label, maximum levels of Cialis in the body are reached within 30 minutes and 6 hours after taking a single dose. Taking Cialis with or without food does not affect its absorption.

Does Cialis make you last longer?

Cialis does not affect your ability to last longer. It is used to help get and maintain an erection for sexual activity. Sexual stimulation or arousal is required for an erection with Cialis.

Can Viagra and Cialis be taken together?

Viagra and Cialis should not be taken together. Because they act in similar ways, taking them together can increase the risk of adverse side effects.