Viagra and health: Beyond ED

N Engl J Med 1992;326:90-94 Andersson, K-E, Wagner, G. Physiology of penile erection. The role of nitric oxide in the physiology of erection. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction.

Information & Authors

[1][7][8][9][10][25][33][34][65][76][81][101][104][105][126][127][131][142][143][144] The erectile response generally increases with increasing sildenafil dose and plasma drug concentration, with response becoming greater at 50- and 100-mg doses than at 25 mg.[1][8][9][33][126][130][131][155] Analyses of subgroups of patients with ED indicate that efficacy of sildenafil is not affected by race or age, duration of ED, or duration of select underlying disease states (e.g., diabetes mellitus), and the drug has been effective in a broad range of patients with ED, including those with a history of coronary artery disease (e.g., coronary artery bypass graft [CABG]), hypertension, other cardiac disease (including ischemic heart disease), peripheral vascular disease, type 1 or 2 diabetes mellitus, depression, radical prostatectomy, prostate brachytherapy, transurethral resection of the prostate (TURP), spina bifida, spinal cord injury, and in patients taking antidepressants, antipsychotics, diuretics, and antihypertensive agents. [1][25][30][33][34][93][101][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][144] Pooled data from numerous fixed-dose and flexible-dose studies in men with ED secondary to a broad spectrum of organic and psychogenic causes showed increases in mean rates of successful intercourse (total successes divided by total attempts) to about 66-69% in those receiving sildenafil compared with about 20-22% for placebo. Erectile response to sildenafil is better in patients whose erectile function is less impaired at treatment initiation (e.g., those with some spontaneous successful intercourse, with partial erections, with erections during sleep, or with psychogenic causes). [1][33][105][145] In one flexible-dose study (dosage titration and maintenance up to 100 mg), mean scores for number of successful penetrations returned to normal in a subgroup of patients with psychogenic causes of ED; however, mean scores for maintenance of erections during intercourse in these men were lower than in untreated healthy men. [33][34] In a study in men with ED secondary to radical prostatectomy receiving fixed-dose sildenafil (100 mg), response to therapy was greatest in those who had undergone bilateral-nerve-sparing surgery than in those who had undergone unilateral or non-nerve-sparing procedures.

What do I do if my child misses a dose?

[104][127] Pooled data from various clinical trials indicate that sildenafil improved the erections of 43% of patients with ED secondary to radical prostatectomy compared with 15% of those receiving placebo. [1][104] A pooled analysis of 10 placebo-controlled studies of men with severe ED (organic etiology in 60%, psychogenic in 15%, and mixed in 25% of patients) treated with sildenafil (50-100 mg in fixed- or flexible-dose studies) indicated that 48% of the patients usually had erections sufficient for intercourse (score of 4, with 0 being unsuccessful and 5 being almost always successful) after treatment with sildenafil, compared with 8% of those receiving placebo. [76][127] In several randomized, double-blind, placebo-controlled studies in patients receiving sildenafil (flexible doses up to 100 mg or fixed doses ranging from 10-100 mg for 12 weeks) for the treatment of ED attributed to complications of diabetes mellitus, complications of spinal cord injury, or psychogenic causes, 48, 59, or 70% of all attempts at intercourse were successful, respectively, compared with 12, 13, or 29% of all attempts in those receiving placebo. [1][7][8][9][10][25][33][93] In these studies, sildenafil improved several aspects of sexual function including frequency, firmness, and maintenance of erection; frequency of orgasm; satisfaction and enjoyment of intercourse; and overall relationship satisfaction. [1][8][9][33][94][107][130][131][142] Pooled data from fixed- and flexible-dose studies indicate that sildenafil (50 or 100 mg) has no effect on sexual desire (i.e., rates of attempted intercourse, which averaged about 2 per week), but the rate of success increased to an average of 1.3 events per patient per week from 0.4 events per week with placebo. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996;78:257-261 Rosen, RC, Riley, A, Wagner, G, Osterloh, IH, Kirkpatrick, J, Mishra, A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

• Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor.
• The drug was first approved by the FDA in 1998.
• It can be purchased online but requires a prescription in most countries.
• Generic versions of sildenafil are typically cheaper than brand-name Viagra.
• Proper storage involves keeping it at room temperature away from moisture.
• Sildenafil does not protect against sexually transmitted diseases.
• Lifestyle changes like exercise and healthy eating can enhance results.
• Combining sildenafil with other ED treatments should be discussed with a doctor.
• It's important to inform your doctor about all medications you take.
• Sildenafil is not an aphrodisiac and requires sexual stimulation to work.

Riley, AJ, Athanasiadis, L. Impotence and its non-surgical management.

• Sildenafil is a medication used to treat erectile dysfunction in men.
• It works by increasing blood flow to the penis during arousal.
• Sildenafil is commonly sold under the brand name Viagra.
• The typical dose ranges from 25 mg to 100 mg, taken before sexual activity.
• It usually takes about 30 to 60 minutes to work after ingestion.
• Sildenafil's effects can last for up to 4-6 hours.
• It can cause side effects like headaches, flushing, and nasal congestion.
• Sildenafil should not be used with nitrate medications due to risk of dangerous drops in blood pressure.
• It is available by prescription from a healthcare provider.
• Do not take sildenafil more than once a day to avoid adverse effects.

Br J Clin Pract 1997;51:99-103 Any commercial reuse of NEJM Group content requires permission. From the Department of Urology, Boston University Medical Center, Boston (I.G. ); the Department of Urology, University of California, San Francisco (T.F.L. ); the Department of Urology, University of Southern California, Los Angeles, and the Male Clinic, sildenafil white Santa Monica, Calif. (H.P.-N.); the Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, N.J.

); the Department of Urology, University of Virginia, Charlottesville (W.D.S. Select the format you want to export the citation of this publication. Multi-view semi-supervised adversarial attention network for drug repurposing, Computer Methods and Programs in Biomedicine, 282, (109406), (2026). Multi‐Target Mechanisms of Moroccan Aphrodisiac Plants: An Integrative Computational and Phytochemical Investigation, Food Science & Nutrition, 14, 5, (2026).

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

From the Department of Urology, Boston University Medical Center, Boston (I.G. ); the Department of Urology, University of California, San Francisco (T.F.L. ); the Department of Urology, University of Southern California, Los Angeles, and the Male Clinic, sildenafil white Santa Monica, Calif. (H.P.-N.); the Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, N.J. ); the Department of Urology, University of Virginia, Charlottesville (W.D.S.

Last Reviewed Date

Select the format you want to export the citation of this publication. Multi-view semi-supervised adversarial attention network for drug repurposing, Computer Methods and Programs in Biomedicine, 282, (109406), (2026). Multi‐Target Mechanisms of Moroccan Aphrodisiac Plants: An Integrative Computational and Phytochemical Investigation, Food Science & Nutrition, 14, 5, (2026). Artificial intelligence in drug research and development: a review of methods and applications in drug repurposing, Briefings in Bioinformatics, 27, 3, (2026). Endocrine-metabolic crosstalk in erectile dysfunction: mechanistic insights and therapeutic implications, International Journal of Impotence Research, (2026). Artificial intelligence in drug research and development: a review of methods and applications in drug repurposing, Briefings in Bioinformatics, 27, 3, (2026).

Non-medical use

[1][8][33][131] In part, the absence of an effect on sexual desire may be attributed to the fact that men enrolling in ED studies generally have a near-normal level of sexual desire upon study entry. [33][107][130][131] Improvement in erectile function sufficient for successful intercourse can be achieved with sildenafil in a substantial percentage of patients with ED, and the strength and duration of erection achieved with the drug in such patients approached those achieved in untreated healthy men. Sildenafil also has been effective in a limited number of men with temporary ED associated with the stress of providing a sperm sample (e.g., for intrauterine insemination or in vitro fertilization during assisted reproduction). [143] In men with a history of such temporary dysfunction, planned use of sildenafil for subsequent attempts at obtaining a sperm specimen may improve attainment of an erection adequate for self-stimulated ejaculation. While most males with ED respond to oral sildenafil therapy, treatment failures do occur; pooled data from various placebo-controlled, dose-response, or open-label studies (25-100 mg for 6-12 months) indicate that up to 5% of patients discontinued therapy because of lack of effectiveness. Endocrine-metabolic crosstalk in erectile dysfunction: mechanistic insights and therapeutic implications, International Journal of Impotence Research, (2026). Therapeutic applications of phosphodiesterase inhibitors in male reproductive health: narrative review, Sexual Medicine Reviews, 14, 2, (2026).

Chemical synthesis

N Engl J Med 1992;326:90-94 Andersson, K-E, Wagner, G. Physiology of penile erection. The role of nitric oxide in the physiology of erection. Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Sildenafil, a novel effective oral therapy for male erectile dysfunction.

What are some side effects that I need to call my child’s doctor about right away?

Br J Urol 1996;78:257-261 Rosen, RC, Riley, A, Wagner, G, Osterloh, IH, Kirkpatrick, J, Mishra, A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Riley, AJ, Athanasiadis, L. Impotence and its non-surgical management. Br J Clin Pract 1997;51:99-103 Any commercial reuse of NEJM Group content requires permission. Oral suspension versus tablet sildenafil for erectile dysfunction: a prospective multicenter comparative study on patient satisfaction, International Journal of Impotence Research, (2026). Low‐intensity shockwave therapy for erectile dysfunction: An abridged Cochrane review, BJU International, 137, 6, (949-957), (2026). Current state of the problem, Andrology and Genital Surgery, 25, 4, (33-40), (2026). Emerging Trends and Research Focus in Erectile Dysfunction Treatment: A 1993–2023 Bibliometric Analysis, Andrologia, 2026, 1, (2026).

• Sildenafil is available in different strengths to tailor treatment.
• It is often used in clinical settings for ED diagnosis and management.
• Men taking sildenafil should avoid heavy meals shortly before dosing.
• The drug's effectiveness can be influenced by age and overall health.
• Combining sildenafil with recreational drugs can be dangerous.
• Some users report that sildenafil enhances spontaneous sexual activity.
• It is important to only use sildenafil that has been prescribed by a healthcare provider.
• The medication’s cost varies based on brand, dosage, and pharmacy.
• Sildenafil may cause transient eye color changes due to blood vessel effects.
• Patients should keep track of dosage and side effects experienced.

[1][2][4][5][7][8][10][24][27][33][41][56][57][67][91][131] Brand Name: Vybrique, ViagraClasses: Phosphodiesterase Type 5 Inhibitors (24:08.12), Phosphodiesterase type 5 inhibitors (48:48.24) Sildenafil citrate (Viagra® and generic equivalents) is used orally for the treatment of erectile dysfunction (ED, impotence). [1][4][6][7][8][9][10][25][33][34][67][81][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][142][143][144][189] A thorough medical, sexual and psychosocial history, physical examination, and selective laboratory testing should be undertaken to diagnose ED, determine potential underlying causes, exclude potentially reversible or treatable causes (e.g., hypogonadism with inadequate testosterone replacement, hyperprolactinemia, drug-induced dysfunction, dyslipidemias, alcoholism, other substance abuse, hypertension, thyroid disease, cardiovascular or cerebrovascular disease, neurologic disease, adrenal dysfunction, psychologic dysfunction, marital discord, smoking), and identify appropriate treatment in conjunction with or prior to initiating vasoactive therapy (e.g., PDE 5 type inhibitor). [12][28][30][31][57][65][66][70][78][83][94][144][145][160][161][189][601][602][603] A review of the patient's current drug regimens should be conducted to detect possible drug-induced ED (e.g., certain antihypertensive, antidepressant, antipsychotic, or antiarrhythmic agents); it may be possible to substitute alternative drug(s) that lessen the risk of such dysfunction. [12][28][70][81][118][144][161][602][603] In instances sildenafil spray where substitution therapy is not feasible, concomitant vasoactive therapy with a PDE 5 type inhibitor may promote patient compliance by counteracting ED as an adverse effect. [12][28][70][81][118][144][161][602][603] Efficacy of sildenafil is variable in patients with ED, in part depending on the underlying etiology, severity, and dose employed, but the drug generally appears to be effective in restoring sexual function to an acceptable level in the majority of treated men.

Are There Any Downsides to Combination Therapy?

Therapeutic applications of phosphodiesterase inhibitors in male reproductive health: narrative review, Sexual Medicine Reviews, 14, 2, (2026). Oral suspension versus tablet sildenafil for erectile dysfunction: a prospective multicenter comparative study on patient satisfaction, International Journal of Impotence Research, (2026). Low‐intensity shockwave therapy for erectile dysfunction: An abridged Cochrane review, BJU International, 137, 6, (949-957), (2026). Current state of the problem, Andrology and Genital Surgery, 25, 4, (33-40), (2026). Emerging Trends and Research Focus in Erectile Dysfunction Treatment: A 1993–2023 Bibliometric Analysis, Andrologia, 2026, 1, (2026).

Effective treatments, trusted by over 500,000 men

[1][2][4][5][7][8][10][24][27][33][41][56][57][67][91][131] Brand Name: Vybrique, ViagraClasses: Phosphodiesterase Type 5 Inhibitors (24:08.12), Phosphodiesterase type 5 inhibitors (48:48.24) Sildenafil citrate (Viagra® and generic equivalents) is used orally for the treatment of erectile dysfunction (ED, impotence). [1][4][6][7][8][9][10][25][33][34][67][81][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][142][143][144][189] A thorough medical, sexual and psychosocial history, physical examination, and selective laboratory testing should be undertaken to diagnose ED, determine potential underlying causes, exclude potentially reversible or treatable causes (e.g., hypogonadism with inadequate testosterone replacement, hyperprolactinemia, drug-induced dysfunction, dyslipidemias, alcoholism, other substance abuse, hypertension, thyroid disease, cardiovascular or cerebrovascular disease, neurologic disease, adrenal dysfunction, psychologic dysfunction, marital discord, smoking), and identify appropriate treatment in conjunction with or prior to initiating vasoactive therapy (e.g., PDE 5 type inhibitor). [12][28][30][31][57][65][66][70][78][83][94][144][145][160][161][189][601][602][603] A review of the patient's current drug regimens should be conducted to detect possible drug-induced ED (e.g., certain antihypertensive, antidepressant, antipsychotic, or antiarrhythmic agents); it may be possible to substitute alternative drug(s) that lessen the risk of such dysfunction. [12][28][70][81][118][144][161][602][603] In instances sildenafil spray where substitution therapy is not feasible, concomitant vasoactive therapy with a PDE 5 type inhibitor may promote patient compliance by counteracting ED as an adverse effect. [12][28][70][81][118][144][161][602][603] Efficacy of sildenafil is variable in patients with ED, in part depending on the underlying etiology, severity, and dose employed, but the drug generally appears to be effective in restoring sexual function to an acceptable level in the majority of treated men. [1][7][8][9][10][25][33][34][65][76][81][101][104][105][126][127][131][142][143][144] The erectile response generally increases with increasing sildenafil dose and plasma drug concentration, with response becoming greater at 50- and 100-mg doses than at 25 mg.[1][8][9][33][126][130][131][155] Analyses of subgroups of patients with ED indicate that efficacy of sildenafil is not affected by race or age, duration of ED, or duration of select underlying disease states (e.g., diabetes mellitus), and the drug has been effective in a broad range of patients with ED, including those with a history of coronary artery disease (e.g., coronary artery bypass graft [CABG]), hypertension, other cardiac disease (including ischemic heart disease), peripheral vascular disease, type 1 or 2 diabetes mellitus, depression, radical prostatectomy, prostate brachytherapy, transurethral resection of the prostate (TURP), spina bifida, spinal cord injury, and in patients taking antidepressants, antipsychotics, diuretics, and antihypertensive agents.

[1][25][30][33][34][93][101][102][104][105][107][108][112][118][126][127][128][129][130][131][132][133][134][140][144] Pooled data from numerous fixed-dose and flexible-dose studies in men with ED secondary to a broad spectrum of organic and psychogenic causes showed increases in mean rates of successful intercourse (total successes divided by total attempts) to about 66-69% in those receiving sildenafil compared with about 20-22% for placebo. Erectile response to sildenafil is better in patients whose erectile function is less impaired at treatment initiation (e.g., those with some spontaneous successful intercourse, with partial erections, with erections during sleep, or with psychogenic causes). [1][33][105][145] In one flexible-dose study (dosage titration and maintenance up to 100 mg), mean scores for number of successful penetrations returned to normal in a subgroup of patients with psychogenic causes of ED; however, mean scores for maintenance of erections during intercourse in these men were lower than in untreated healthy men. [33][34] In a study in men with ED secondary to radical prostatectomy receiving fixed-dose sildenafil (100 mg), response to therapy was greatest in those who had undergone bilateral-nerve-sparing surgery than in those who had undergone unilateral or non-nerve-sparing procedures. [104][127] Pooled data from various clinical trials indicate that sildenafil improved the erections of 43% of patients with ED secondary to radical prostatectomy compared with 15% of those receiving placebo.

[1][104] A pooled analysis of 10 placebo-controlled studies of men with severe ED (organic etiology in 60%, psychogenic in 15%, and mixed in 25% of patients) treated with sildenafil (50-100 mg in fixed- or flexible-dose studies) indicated that 48% of the patients usually had erections sufficient for intercourse (score of 4, with 0 being unsuccessful and 5 being almost always successful) after treatment with sildenafil, compared with 8% of those receiving placebo. [76][127] In several randomized, double-blind, placebo-controlled studies in patients receiving sildenafil (flexible doses up to 100 mg or fixed doses ranging from 10-100 mg for 12 weeks) for the treatment of ED attributed to complications of diabetes mellitus, complications of spinal cord injury, or psychogenic causes, 48, 59, or 70% of all attempts at intercourse were successful, respectively, compared with 12, 13, or 29% of all attempts in those receiving placebo. [1][7][8][9][10][25][33][93] In these studies, sildenafil improved several aspects of sexual function including frequency, firmness, and maintenance of erection; frequency of orgasm; satisfaction and enjoyment of intercourse; and overall relationship satisfaction. [1][8][9][33][94][107][130][131][142] Pooled data from fixed- and flexible-dose studies indicate that sildenafil (50 or 100 mg) has no effect on sexual desire (i.e., rates of attempted intercourse, which averaged about 2 per week), but the rate of success increased to an average of 1.3 events per patient per week from 0.4 events per week with placebo. [1][8][33][131] In part, the absence of an effect on sexual desire may be attributed to the fact that men enrolling in ED studies generally have a near-normal level of sexual desire upon study entry. [33][107][130][131] Improvement in erectile function sufficient for successful intercourse can be achieved with sildenafil in a substantial percentage of patients with ED, and the strength and duration of erection achieved with the drug in such patients approached those achieved in untreated healthy men. Sildenafil also has been effective in a limited number of men with temporary ED associated with the stress of providing a sperm sample (e.g., for intrauterine insemination or in vitro fertilization during assisted reproduction).

More about sildenafil

[143] In men with a history of such temporary dysfunction, planned use of sildenafil for subsequent attempts at obtaining a sperm specimen may improve attainment of an erection adequate for self-stimulated ejaculation. While most males with ED respond to oral sildenafil therapy, treatment failures do occur; pooled data from various placebo-controlled, dose-response, or open-label studies (25-100 mg for 6-12 months) indicate that up to 5% of patients discontinued therapy because of lack of effectiveness.