Pretty much every adult on the planet knows what Viagra is thanks to the endless number of cheesy commercials that hit our TVs in the late 90s.
Or maybe you know it as the “little blue pill.” What seemed like a miracle drug for those suffering from erectile dysfunction was unfortunately out of reach for many people due to the high cost of about 60 dollars per pill.
Although Viagra has been around for more than two decades, a generic version form of the drug didn’t become available until December 2017, bringing prices way down.
Today, sildenafil, better known as generic Viagra, is used to treat a variety of health conditions and is highly affordable.
The medication is most commonly used to treat erectile dysfunction, which affects more than 30 million men in the United States alone.
What is sildenafil?
The name “sildenafil” might not have the same ring to it that Viagra does, but it performs exactly the same functions.
Sildenafil is sold under two brand names (Viagra and Revatio), and has been manufactured by numerous companies since December 2017 when it went generic.
Sildenafil is used to treat a variety of conditions depending on its dosage, and it is sold in a variety of dosages depending on the conditioned to be treated.
What is sildenafil used to treat?
Of course, we all know that Viagra and its generic forms are used to treat erectile dysfunction in men.
After all, that’s what made it one of the most famous drugs in the world. However, sildenafil was originally developed to treat chest pain and angina.
Patients treating their chest pain and angina observed that they were having more erections, and doctors began using the medication to treat erectile dysfunction.
Today, sildenafil is primarily used to treat high blood pressure, pulmonary arterial hypertension, and erectile dysfunction.
When prescribed at a 20 mg dose, sildenafil is used to treat high blood pressure and pulmonary hypertension; erectile dysfunction is treated with doses of 20 mg, 40 mg, 60 mg, 80 mg, or 100 mg, depending on the patient.
In some cases, it is also used to treat Raynaud’s Phenomenon, a condition that causes discoloration in the extremities due to a diminished blood supply in local tissues after exposure to changes in temperature.

What is erectile dysfunction and what causes it?
Erectile dysfunction, often called ED, occurs when a man has difficulty getting and/or keeping an erection long enough for sex.
It happens when not enough blood flows to the penis, preventing an erection.
Approximately 30 million men in the U.S. suffer from ED, and it can affect people only occasionally or every time they try to have sex.
There are many different medical conditions that can cause ED, including depression, diabetes, heart disease, high blood pressure, high cholesterol, obesity, prostate cancer treatment, and spinal cord injury.
Lifestyle and psychological factors, like smoking, drinking alcohol, and stress, can also contribute to ED. Some medications, including those used to treat high blood pressure, heart disease, and depression, can also cause ED.
Some of the conditions that can cause ED are preventable and benefit from lifestyle changes. If you’re looking for ways to improve your circulation without medication, you can try:
- Finding more ways to stay active
- Managing your weight by eating whole foods and reducing portion sizes
- Drinking less alcohol
- Quitting smoking
- Reducing stress in your daily life
If you’re experiencing ED, you should know that you’re not alone and it is not your fault. Your doctor can help you effectively treat your symptoms.
How does sildenafil treat erectile dysfunction?
Sildenafil treats erectile dysfunction by increasing blood flow to the penis, allowing men to get and keep an erection that is hard enough for sexual intercourse.
Fortunately, it only works when you are sexually stimulated, so there’s no need to worry about an errant erection happening at an inconvenient time.
What does sildenafil cost?
When Viagra was first released, everyone was clamoring to get their hands on this “miracle drug.”
With only one manufacturer, Pfizer, allowed to produce Viagra, patients regularly paid 60 dollars per pill. Following the launch of generic Viagra in December 2017, Pfizer and fellow manufacturer Teva Pharmaceuticals priced sildenafil at approximately 30 dollars per pill, cutting the cost in half.
Today, more manufacturers have begun producing sildenafil, making the medication available to patients at prices as low as four dollars per pill.
That’s a cost savings of over 90 percent compared to the price of Viagra just a few short years ago!
Generic Viagra is covered by most Medicare and insurance plans, but patients can often save even more by using pharmacy discount cards or paying cash.
Since turning generic, sildenafil has become downright affordable for the majority of people.
What are the benefits of using sildenafil?
Let’s start with the obvious: using sildenafil can offer relief from the medical conditions you or your spouse are facing, including high blood pressure, pulmonary hypertension, Raynaud’s Phenomenon, and erectile dysfunction.
Whether you use Viagra or generic sildenafil, you’ll be able to successfully manage your condition. However, as previously established, sildenafil will offer the same results for a fraction of the price of the brand name medication.
Many patients often reject the idea of using generic drugs because they are concerned about the quality and ingredients included in the generic form. After all, how can medications vary so wildly in cost if they are exactly the same?
One thing that is important to know about generic medications is that they are required to undergo the same rigorous testing as brand name medications prior to being sold.
Each generic medication, including sildenafil, must be approved by the FDA.
The regulations for prescription medications require that the same active ingredients that are used in brand name medications also be used in their generic equivalents.
That means that the only differences between the two medications are some of the inactive ingredients (ingredients that do not affect treatment) and cosmetic details like color, shape, and size of the medication.
Another benefit of sildenafil is that it comes in slightly smaller dosages than Viagra, allowing your doctor to more precisely pinpoint the level of treatment you need. Viagra is sold in 25 mg and 50 mg pills, while sildenafil comes in 20 mg tablets.
Therefore, rather than being limited to treatment options of 25 mg, 50 mg, and 100 mg, as you would be with Viagra, doctors are able to offer 20 mg, 40 mg, 60 mg, 80 mg, and 100 mg treatments of sildenafil.
Some patients find that they are able to experience the desired results at a lower dose without side effects like headaches and nausea.
Using sildenafil allows doctors to make modifications to dosages more easily since the medication is sold in 20 mg tablets. Why take (and pay for) more medication than you need?
The more flexible dosing of sildenafil also allows patients to occasionally take more medication than they might otherwise in a situation that causes anxiety, such as performance anxiety with a new partner or additional stress resulting in reduced sexual desire.
How do I know which dose of sildenafil I should take?
Sildenafil comes in tablets containing 20 mg of the medication, but prescriptions are written for patients at a variety of dosages; in situations requiring a higher dose than 20 mg, the patient would take multiple pills.
The appropriate treatment dose of sildenafil for you will depend on several factors, including the condition being treated, your age, height, and weight, and the severity of your condition.
High blood pressure and pulmonary atrial hypertension are generally treated with a 20 mg dose, while treating erectile dysfunction or cialis can be treated with dosages ranging from 20 to 100 mg.
Your doctor will prescribe you with the dosage level right for you, but the starting dose for treatment of erectile dysfunction is typically 50 mg. Your doctor may start you at a dose higher or lower than this initially based on your needs.
As you might remember from those late-90s commercials, Viagra and its generic forms can sometimes cause erections that last up to four hours, so you may need to do some experimenting to find the dose that works best for you.
How do I use sildenafil to treat sexual dysfunction?
While there are many medications that can be simply taken right before bed or upon waking up, sildenafil isn’t one of those when it is used to treat sexual dysfunction.
Although it can be hard to time these sorts of things, sildenafil is generally recommended to be taken about one hour prior to any sexual activity.
Rest assured that you can take sildenafil as long as four hours and as little as 30 minutes prior to sexual activity and you’ll still receive the desired effect.
It’s important not to take sildenafil more often than once every 24 hours, and some patients will be able to take it less frequently based on their medical history or other medications they may be taking.
If your sildenafil seems to be working more slowly than usual, it may be because you have recently eaten a high-fat meal. Sildenafil can be taken with or without food, but the digestion of a large amount of fats will delay the medication’s effects.
Are there any side effects I should be aware of?
Like any medication, there are common side effects associated with the use of Viagra and its generic forms. The side effects most commonly associated with sildenafil are:
- 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
- Sensitivity to light
Other rarely reported, but serious side effects requiring immediate medical attention include:
- Priapism – erections lasting longer than four hours
- Sudden vision loss in one or both eyes, which is a symptom of a serious eye problem called non-arteric anterior ischesmic optic neuropathy (NAION)
- Sudden hearing decrease, hearing loss, or ringing in the ears
- Dizziness or lightheadedness
- Fainting
- Chest pain
- Worsening shortness of breath
- Itching or burning during urination
- Rash
- Heart attack
- Stroke
- Irregular heartbeat
- Bleeding in the brain or lungs
- High blood pressure
- Death
Who should not take sildenafil?
While sildenafil is generally considered a safe medication, there are certain groups of people who should not take sildenafil and who may be prone to a higher risk of dangerous side effects.
People taking medications called nitrates, which are often prescribed for chest pain, or guanylate cyclase stimulators such as Adempas (riociuguat) for pulmonary hypertension, could experience an unsafe drop in low blood pressure if taking sildenafil. Additionally, people who are allergic to sildenafil or any of its ingredients should not take the medication.
Rare side effects such as heart attack, stroke, irregular heartbeat, and death have occurred in men taking sildenafil citrate. Most, but not all, of these patients had a previous history of heart problems prior to taking the medication.
It is unknown whether sildenafil causes or contributes to the possibility of experiencing heart attack, stroke, irregular heartbeat, and death, but men with an existing history of heart issues should talk to their doctors about their medical history prior to taking sildenafil.
How do I know if sildenafil is right for me?
Sildenafil can only be prescribed by a doctor, so your first step is to talk to your healthcare provider about symptoms you are experiencing.
Your doctor will evaluate your medical history, your list of current medications, and talk to you about your lifestyle prior to prescribing sildenafil.
References and Sources:
Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group Page
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Chris is one of the Co-Founders of Pharmacists.org. An entrepreneur at heart, Chris has been building and writing in consumer health for over 10 years. In addition to Pharmacists.org, Chris and his Acme Health LLC Brand Team own and operate Diabetic.org and the USA Rx Pharmacy Discount Card powered by Pharmacists.org.
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