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What is this medication?

Sildenafil, Viagra/Revatio

Sildenafil/Viagra/Revatio is indicated for treatment of erectile dysfunction or organic, psychogenic, or mixed etiology.

How does this medication work? 

Sildenafil/Viagra/Revatio enhances the physiological erectile response following sexual arousal through the potentiation of nitric oxide effects on vascular smooth muscle.  Nitric oxide is released into the corpus cavernosum in response to sexual stimulation.  This stimulates the production of cGMP, leading to smooth muscle relaxation and subsequently vasodilation and erection of the penis.  Sildenafil/Viagra/Revatio selectively inhibits cGMP for PDE5 which is the main enzyme that metabolizes cGMP in the penis, thus enhancing the erectile response of the penis.

How should I take this medication? 

Erectile dysfunction:
Take 50mg once daily as needed; can be taken 1 to 4 hours before sexual activity.  Reduce the dose down to 25mg if you experience any side effects.  May increase the dose to a maximum daily dose of 100mg if not satisfied with erectile response to sexual stimulation.

High-altitude pulmonary edema:
Prevention: May use Sildenafil/Viagra/Revatio as an adjunct therapy during gradual ascent in high-risk individuals (i.e. history of high-altitude pulmonary edema).

Take 50mg every 8 hours starting the day of ascent and continue for 3 to 5 days after reaching the maximal altitude.  

Pulmonary artery hypertension:
Take 20mg every 8 hours.  Can slowly increase the dose in 20mg increments to a maximum dose of 80mg every 8 hours daily.

Raynaud’s disease:
Take 20mg once to twice daily; may increase to 20mg three times daily if the lower doses are ineffective.

How to Take (Sildenafil/Viagra/Revatio): Do not split the tablet; take the entire tablet and swallow whole on an empty stomach.  When used as needed, take at least 60 minutes prior to sexual activity.   

You Need to Avoid (Sildenafil/Viagra/Revatio): avoid large amounts of grapefruit and its juice (CYP3A4 inhibitor) and alcohol which may enhance the hypotensive effect.

What should I watch for while using this medication?

Use with caution or avoid in persons with increased susceptibility to vasodilators including those with aortic stenosis, cardiomyopathy, and impaired autonomic control of blood pressure.

Use with caution in persons who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last six months.

Use with caution in persons with resting hypotension (blood pressure under 90/50) or hypertension (blood pressure 170/110).

Use with caution in persons with heart failure or coronary artery disease.

If You Experience Chest Pain (Sildenafil/Viagra/Revatio): Seek medical attention immediately.

If You Experience Hearing Loss (Sildenafil/Viagra/Revatio): If you experience a sudden decrease or loss in hearing.  Seek medical attention.

If Your Penile Erection Does Not Go Down (Sildenafil/Viagra/Revatio): Painful erections lasting > 6 hours is known as priapism and is rare.  However, if your erection lasts longer than > 4 hours, seek medical condition.  Certain medical conditions such as sickle cell anemia, multiple myeloma and leukemia have been associated with a higher risk of priapism.

If You Experience Vision Loss (Sildenafil/Viagra/Revatio): Vision loss is rare but may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION).  Please seek medical attention immediately for any sudden loss of vision in one or both eyes.  Risk factors for NAION include coronary artery disease (CAD), diabetes, hypertension, hyperlipidemia, smoking and > 50 years of age.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed.  Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication? 

Well tolerated, most side effects are transient and mild to moderate in nature.  However, adverse effects such as flushing, diarrhea, myalgia and visual disturbances can increase with doses greater than 100mg every 24 hours.  The most common side effects include:


Cardiovascular: Flushing (10% to 19%)

Central Nervous System: Headache (16% to 46%)

Gastrointestinal: Dyspepsia (3% to 17%)

Ophthalmic: Visual disturbances (2% to 11%; including vision color changes, blurred vision, and photophobia)

Respiratory: Epistaxis (9% to 13%)