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Erectile dysfunction (ED) is a common men’s health issue occurring in as many as a third of men over the age of twenty-five. The textbook definition of ED is: the inability to obtain or maintain a firm erection for satisfactory sexual activity (Basson et al). ED can be a result of many things including diabetes, insufficient mental arousal, antidepressant medications, etc. 

While it is important to find the root cause, and treat it, there are treatment options available. The erectile dysfunction medication Viagra (Sildenafil), or “the blue pill”, being one of them. Sildenafil is a Phosphodiesterase-5 (PDE-5) inhibitor that works by blocking the site that causes your erection to terminate — hence allowing your erection to last longer. 

Sildenafil has been extensively studied, is approved by the FDA/ Health Canada and is marketed as a safe and effective treatment for ED when used as prescribed. It is available as a brand (Viagra) and generic (Sildenafil) option in 25mg, 50mg and 100mg tablets. Sildenafil should be taken 30-60 minutes prior to sexual activity. 

Sildenafil should be started at a lower dose of 25mg in patients over the age of 65, patients using CYP3A4 inhibitors (like grapefruit and verapamil) and in patients with renal or liver problems. 

Sildenafil’s onset of action can be as early as 15 minutes and duration of action can be as long as 12 hours. However, it is important to note that it should be used on an as needed basis; it is not meant for daily use.

Some things to consider when using Sildenafil as a treatment for erectile dysfunction are:

  • Absorption is delayed by high fat meals
  • Efficacy depends on mental arousal 
  • It is contraindicated with nitrates
    • Avoid use of Sildenafil within 48 hours of short acting nitrates
    • Avoid use of Sildenafil for a minimum of 5 days after stopping long-acting nitrates
  • It may lower blood pressure especially if used with some types of blood pressure lowering medication 

Several studies exploring the safety profile of ED treatments, such as Sildenafil, found that PDE-5 inhibitors improve erectile function and have similar efficacy and safety profiles. However, like with any medication, side effects may occur. Side effects include headaches, flushing, dyspepsia, nasal congestion, visual disturbances, dizziness and a skin rash. 

Serious side effects such as priapism (a prolonged erection lasting more than 4 hours after stimulation has ended) which can result in permanent damage to your penis if not treated immediately as well as sudden loss of vision or hearing can also occur in rare cases.

Considering the safety profile of ED medication, it is obvious why millions of men all around the world rely on them for sexual function. Be sure to use it as prescribed and to discuss whether or not ED medication such as Sildenafil is right for you with your doctor and pharmacist if you want to learn more.

Sources:

  1. Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet 2007;369(9559):409-24.
  2. Bella AJ, Lee JC, Carrier S, Bénard F, Brock GB. 2015 CUA Practice guidelines for erectile dysfunction. Can Urol Assoc J. 2015 Jan-Feb;9(1-2):23-9. doi: 10.5489/cuaj.2699. PMID: 25737750; PMCID: PMC4336024.
  1. Tsertsvadze A, Fink HA, Yazdi F, MacDonald R, Bella AJ, Ansari MT, Garritty C, Soares-Weiser K, Daniel R, Sampson M, Fox S, Moher D, Wilt TJ. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Ann Intern Med. 2009 Nov 3;151(9):650-61. doi: 10.7326/0003-4819-151-9-200911030-00150. PMID: 19884626.
  2. Nehra A. Erectile dysfunction and cardiovascular disease: efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions. Mayo Clin Proc. 2009 Feb;84(2):139-48. doi: 10.1016/S0025-6196(11)60822-7. PMID: 19181648; PMCID: PMC2664585.
Mina Rizk, R.Ph. MPharm

Mina Rizk, R.Ph. MPharm

Mina is a licensed pharmacist in Ontario and British Columbia, operating with his Master’s degree in Pharmacy from the UK. He has a wealth of experience in operating and practicing in community pharmacies, making him well-versed in the healthcare space.

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