11 DESCRIPTION
The effects of sildenafil become evident when you are sexually stimulated or aroused. You should not have an erection for four hours - a prolonged and painful erection (priapism) is a surgical emergency, and you should seek urgent medical attention should this happen. Most people feel the effect of sildenafil in 45 minutes or so. You’ll need to have sexual stimulation or feel sexually aroused to get an erection. If nothing happens, or if not enough happens, you should inform your doctor.
Society and culture
Mechanism of Action
You may experience side effects, and some are more common than others You may experience side effects, and some are more common than others Sildenafil may cause side effects which include dizziness and altered vision. You should be aware of your personal reaction to sildenafil before you drive or operate heavy machinery whilst taking it. Sildenafil may cause side effects which include dizziness and altered vision. you experience any sudden decrease or loss of vision; you experience any sudden decrease or loss of vision; you experience any allergic reaction, such as wheeze, breathing difficulties, or swelling around the eyes or airways; you experience any allergic reaction, such as wheeze, breathing difficulties, or swelling around the eyes or airways; (If you are on nitrate medications for chest pain, do not take them.) (If you are on nitrate medications for chest pain, do not take them.) Severe side effects are rare, but they do happen. If you do experience any of the above severe side effects, you should seek urgent medical attention. Handled correctly, sildenafil citrate is a generally safe and effective way to treat erectile dysfunction.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Viagra Generic | 200mg | 20 Pills | 61.69€ 58.75€ | |
| Kamagra | 100mg | 12 Pills | 55.64€ 52.99€ | |
| Viagra Generic | 50mg | 120 + 6 Pills | 129.64€ 123.47€ | |
| Kamagra | 100mg | 60 + 4 Pills | 201.34€ 191.75€ | |
| Viagra Generic | 100mg | 270 + 10 Pills | 270.47€ 257.59€ | |
| Viagra Generic | 25mg | 60 + 4 Pills | 71.99€ 68.56€ | |
| Viagra Generic | 200mg | 270 + 10 Pills | 379.76€ 361.68€ | |
| Kamagra | 100mg | 120 + 6 Pills | 330.74€ 314.99€ | |
| Kamagra Soft Tabs | 100mg | 32 Pills | 120.11€ 114.39€ | |
| Viagra Generic | 25mg | 90 + 6 Pills | 105.03€ 100.03€ | |
| Kamagra Soft Tabs | 100mg | 12 Pills | 57.55€ 54.81€ | |
| Kamagra Polo | 100mg | 84 + 4 Pills | 244.49€ 232.85€ |
But you should always read the Patient Information Leaflet before taking it. To find out more, book a consultation with one of our clinicians. The prescribing information for sildenafil citrate (VIAGRA, Pfizer, New York, NY, USA) recommends flexible dosing (50 mg initially, adjusted to 100 or 25 mg based on effectiveness and tolerability) in most men with erectile dysfunction (ED). In many men, however, 100 mg may be the most appropriate initial dose because it would reduce the need for titration and could prevent discouragement and treatment abandonment should 50 mg be insufficient. Results of two previously published double-blind, placebo-controlled sildenafil trials of similar design except for a fixed-dose vs flexible-dose regimen were analyzed. Relative to the flexible-dose, approximately one-third more men were satisfied with an initial and fixed dose of 100 mg. In addition, tolerability was similar, and improvements from baseline in outcomes on validated, ED-specific, patient-reported questionnaires were either similar (erectile function and the percentage of completely hard and fully rigid erections) or greater (emotional well-being and the overall sexual experience). The similarity sildenafil online ireland in outcomes is not surprising given that almost 90% of the men in the flexible-dose trial titrated to 100 mg after 2 weeks. These data suggest prescription of an initial dose of 100 mg for men with ED, except in those for whom it is inappropriate. For most men with erectile dysfunction (ED), the prescribing information for sildenafil citrate (VIAGRA, Pfizer) recommends an initial dose of 50 mg, increased to 100 mg or decreased to 25 mg based on effectiveness and tolerability (flexible dose).1 However, 100 mg sildenafil produced optimal erection hardness (fully hard and rigid) in a substantial proportion of men with ED.2 In addition, in dose-optimization studies3, 4 and at the end of double-blind, placebo-controlled (DBPC) treatment in recent reports of flexible-dose trials,5, 6 100 mg was the dose that was used by most men.
6.1 Clinical Trials Experience
Thus, the 100-mg dose may provide some additional benefit beyond that achieved with the 50-mg dose and may be the most appropriate choice for initiation of therapy in many men. This report assesses erection hardness, erectile function, emotional well-being, satisfaction (disease related and treatment related) and the overall sexual experience in men treated with 100 mg fixed-dose sildenafil and in men treated with flexible-dose sildenafil (50 and 100 mg), using data from two DBPC trials that were similarly designed except for a fixed-dose vs flexible-dose regimen.7, 8 The objective was to assess the efficacy and tolerability of an initial dose of sildenafil 100 mg relative to the flexible-dosage regimen recommended in the prescribing information. One trial was a multinational (Republic of Korea, Russian Federation, Spain and Sweden), parallel-group, randomized (1:1:1) DBPC trial of fixed-dose sildenafil (50 or 100 mg) or placebo administered on demand over an 8-week treatment period.7 The other trial was a multicenter (United States), parallel-group, randomized (1:1) DBPC trial of flexible-dose sildenafil (50 or 100 mg) administered on demand over a 10-week treatment period.8 In both trials, ⩽1 dose of study medication was to be taken per day. Details of the patients and methods of the two trials have been published previously.7, 8 As described previously,7, 8 several efficacy assessments were conducted, including the Erection Hardness Score (EHS9), the International Index of Erectile Function (IIEF),10 the Self-Esteem And Relationship (SEAR) questionnaire,11, 12, 13 the Sexual Experience Questionnaire (SEX-Q),14 the Quality of Erection Questionnaire,15 the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)16 and three global efficacy assessment questions.
What other information should I know?
The effects of sildenafil become evident when you are sexually stimulated or aroused. You should not have an erection for four hours - a prolonged and painful erection (priapism) is a surgical emergency, and you should seek urgent medical attention should this happen. Most people feel the effect of sildenafil in 45 minutes or so. You’ll need to have sexual stimulation or feel sexually aroused to get an erection. If nothing happens, or if not enough happens, you should inform your doctor.
Pulmonary Arterial Hypertension
You may experience side effects, and some are more common than others You may experience side effects, and some are more common than others Sildenafil may cause side effects which include dizziness and altered vision. You should be aware of your personal reaction to sildenafil before you drive or operate heavy machinery whilst taking it. Sildenafil may cause side effects which include dizziness and altered vision. you experience any sudden decrease or loss of vision; you experience any sudden decrease or loss of vision; you experience any allergic reaction, such as wheeze, breathing difficulties, or swelling around the eyes or airways; you experience any allergic reaction, such as wheeze, breathing difficulties, or swelling around the eyes or airways; (If you are on nitrate medications for chest pain, do not take them.) (If you are on nitrate medications for chest pain, do not take them.) Severe side effects are rare, but they do happen. If you do experience any of the above severe side effects, you should seek urgent medical attention.
Dose pédiatrique
Handled correctly, sildenafil citrate is a generally safe and effective way to treat erectile dysfunction. But you should always read the Patient Information Leaflet before taking it. To find out more, book a consultation with one of our clinicians. The prescribing information for sildenafil citrate (VIAGRA, Pfizer, New York, NY, USA) recommends flexible dosing (50 mg initially, adjusted to 100 or 25 mg based on effectiveness and tolerability) in most men with erectile dysfunction (ED). In many men, however, 100 mg may be the most appropriate initial dose because it would reduce the need for titration and could prevent discouragement and treatment abandonment should 50 mg be insufficient. Except for the global efficacy assessment questions, all assessment tools are validated, and a higher score indicates better outcome. Safety data included all adverse events (AE) reports from the original trials.
| Contraindication | Reason | Alternatives |
|---|---|---|
| Concurrent Nitrate Use | Risk of severe hypotension | Use other ED treatments |
| Cardiovascular Instability | May exacerbate underlying conditions | Consult cardiologist |
| Hypersensitivity Reactions | Allergic response | Discontinue use |
| Severe Liver Impairment | Altered drug metabolism | Lower dose or avoid |
In this study, analyses were conducted on data from the intent-to-treat population for each study, which was defined as men who took at least one dose of study medication and who provided sufficient efficacy data for at least one efficacy analysis. Treatment effects were estimated using least square means from an analysis of covariance model for change scores from baseline to DBPC end of treatment on the IIEF, SEAR and SEX-Q, and the end-of-treatment EDITS Index score. The model used terms of baseline value, treatment group, investigator site and prognostic factors (age, ED duration, ED etiology) with P values calculated at the 5% significance level for the test of treatment group differences. Logistic regression (terms of treatment group, age, ED duration and ED etiology) was used to analyze the proportion of men who were satisfied with treatment (dichotomized EDITS score). The percentages of EHS 3, EHS 4 and EHS 3 or 4 erections based on all of the event log data since the previous visit were analyzed as clustered binomial data using a logistic regression (terms for baseline percentage, treatment group, age, ED duration and ED etiology), with a scale adjustment for overdispersion (estimated by Williams method) and model; treatment effects were estimated using predicted percentages from the model.
Proper Use
Results of two previously published double-blind, placebo-controlled sildenafil trials of similar design except for a fixed-dose vs flexible-dose regimen were analyzed. Relative to the flexible-dose, approximately one-third more men were satisfied with an initial and fixed dose of 100 mg. In addition, tolerability was similar, and improvements from baseline in outcomes on validated, ED-specific, patient-reported questionnaires were either similar (erectile function and the percentage of completely hard and fully rigid erections) or greater (emotional well-being and the overall sexual experience). The similarity sildenafil online ireland in outcomes is not surprising given that almost 90% of the men in the flexible-dose trial titrated to 100 mg after 2 weeks. These data suggest prescription of an initial dose of 100 mg for men with ED, except in those for whom it is inappropriate.
Raynaud's phenomenon
For most men with erectile dysfunction (ED), the prescribing information for sildenafil citrate (VIAGRA, Pfizer) recommends an initial dose of 50 mg, increased to 100 mg or decreased to 25 mg based on effectiveness and tolerability (flexible dose).1 However, 100 mg sildenafil produced optimal erection hardness (fully hard and rigid) in a substantial proportion of men with ED.2 In addition, in dose-optimization studies3, 4 and at the end of double-blind, placebo-controlled (DBPC) treatment in recent reports of flexible-dose trials,5, 6 100 mg was the dose that was used by most men. Thus, the 100-mg dose may provide some additional benefit beyond that achieved with the 50-mg dose and may be the most appropriate choice for initiation of therapy in many men. This report assesses erection hardness, erectile function, emotional well-being, satisfaction (disease related and treatment related) and the overall sexual experience in men treated with 100 mg fixed-dose sildenafil and in men treated with flexible-dose sildenafil (50 and 100 mg), using data from two DBPC trials that were similarly designed except for a fixed-dose vs flexible-dose regimen.7, 8 The objective was to assess the efficacy and tolerability of an initial dose of sildenafil 100 mg relative to the flexible-dosage regimen recommended in the prescribing information. One trial was a multinational (Republic of Korea, Russian Federation, Spain and Sweden), parallel-group, randomized (1:1:1) DBPC trial of fixed-dose sildenafil (50 or 100 mg) or placebo administered on demand over an 8-week treatment period.7 The other trial was a multicenter (United States), parallel-group, randomized (1:1) DBPC trial of flexible-dose sildenafil (50 or 100 mg) administered on demand over a 10-week treatment period.8 In both trials, ⩽1 dose of study medication was to be taken per day. Details of the patients and methods of the two trials have been published previously.7, 8 As described previously,7, 8 several efficacy assessments were conducted, including the Erection Hardness Score (EHS9), the International Index of Erectile Function (IIEF),10 the Self-Esteem And Relationship (SEAR) questionnaire,11, 12, 13 the Sexual Experience Questionnaire (SEX-Q),14 the Quality of Erection Questionnaire,15 the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)16 and three global efficacy assessment questions.
Dosage Forms & Strengths
Except for the global efficacy assessment questions, all assessment tools are validated, and a higher score indicates better outcome. Safety data included all adverse events (AE) reports from the original trials. In this study, analyses were conducted on data from the intent-to-treat population for each study, which was defined as men who took at least one dose of study medication and who provided sufficient efficacy data for at least one efficacy analysis. Treatment effects were estimated using least square means from an analysis of covariance model for change scores from baseline to DBPC end of treatment on the IIEF, SEAR and SEX-Q, and the end-of-treatment EDITS Index score. The model used terms of baseline value, treatment group, investigator site and prognostic factors (age, ED duration, ED etiology) with P values calculated at the 5% significance level for the test of treatment group differences. Pearson correlations were computed between the SEX-Q change from baseline scores and all other outcomes (change from baseline or end of treatment); 95% confidence intervals for the correlation coefficient were constructed using Fisher's Z-transformation. In both trials, each treatment group comprised sildenafil from canada ∼100 men, most of whom had ED that was of organic or mixed etiology and that was mild to moderate in severity (Table 1). At week 2, 88% (92/104) of patients randomized to flexible-dose sildenafil and 92% (97/105) randomized to flexible-dose placebo increased their dose from 50 mg to 100 mg; at the end of the DBPC treatment, 87% (90/104) and 92% (97/105), respectively, remained on the higher dose. During the DBPC phase of each trial, patients in each treatment group received an average of seven or eight doses per month.
| Parameter | Value | Notes |
|---|---|---|
| Absorption Time | 30-60 minutes | Prompt onset after oral ingestion |
| Peak Plasma Levels | 60 minutes | Max concentration reached |
| Bioavailability | 40% | Due to first-pass metabolism |
| Metabolic Pathway | Liver (CYP3A4) | Hepatic metabolism primarily |
| Excretion | Mainly feces, minor urine | Elimination half-life approx. 4 hours |
Across both trials, only one man discontinued sildenafil (flexible dose) because of lack of efficacy and only two men discontinued sildenafil because of treatment-related AEs: moderate dyspepsia (100-mg fixed dose) and moderate headache (100-mg flexible dose).
What special precautions should I follow?
Logistic regression (terms of treatment group, age, ED duration and ED etiology) was used to analyze the proportion of men who were satisfied with treatment (dichotomized EDITS score). The percentages of EHS 3, EHS 4 and EHS 3 or 4 erections based on all of the event log data since the previous visit were analyzed as clustered binomial data using a logistic regression (terms for baseline percentage, treatment group, age, ED duration and ED etiology), with a scale adjustment for overdispersion (estimated by Williams method) and model; treatment effects were estimated using predicted percentages from the model. Pearson correlations were computed between the SEX-Q change from baseline scores and all other outcomes (change from baseline or end of treatment); 95% confidence intervals for the correlation coefficient were constructed using Fisher's Z-transformation. In both trials, each treatment group comprised sildenafil from canada ∼100 men, most of whom had ED that was of organic or mixed etiology and that was mild to moderate in severity (Table 1). At week 2, 88% (92/104) of patients randomized to flexible-dose sildenafil and 92% (97/105) randomized to flexible-dose placebo increased their dose from 50 mg to 100 mg; at the end of the DBPC treatment, 87% (90/104) and 92% (97/105), respectively, remained on the higher dose.
Sildenafil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
During the DBPC phase of each trial, patients in each treatment group received an average of seven or eight doses per month. Across both trials, only one man discontinued sildenafil (flexible dose) because of lack of efficacy and only two men discontinued sildenafil because of treatment-related AEs: moderate dyspepsia (100-mg fixed dose) and moderate headache (100-mg flexible dose). Sildenafil, whether initiated at a fixed dose of 50 or 100 mg, or initiated at a dose of 50 mg and titrated as needed up to 100 mg, was significantly more effective than placebo (Table 2). The 100-mg fixed dose was significantly more effective than the 50-mg fixed dose in improving the IIEF Overall Satisfaction domain score; the SEAR Sexual Relationship Satisfaction domain, Overall Relationship Satisfaction subscale and Total scores; all SEX-Q domain scores; and the SEX-Q total score (Table 2). In addition, the EDITS Index was significantly higher in the fixed-dose sildenafil 100-mg group vs the fixed-dose sildenafil 50-mg group, although the difference between the dosage groups in the estimated percentage of men who were satisfied with sildenafil treatment (dichotomized EDITS scores: 93 vs 88%) was not statistically significant (Table 2).
Dose adulte
For the fixed-dose sildenafil 100-mg group relative to the flexible-dose sildenafil group (Table 2), there was a similar improvement from baseline in the percentage of EHS 4 erections (33 and 35%, respectively), EHS 3 or 4 erections (36 and 35%, respectively) and IIEF scores (⩽1 point difference between the groups across IIEF domains). However, for the fixed-dose sildenafil 100-mg group relative to the flexible-dose sildenafil group there was a greater improvement from baseline in SEAR scores (8–16 point difference between the groups across SEAR components) and in SEX-Q scores (3–7 point difference between the groups across SEX-Q domains), a greater least square mean±s.e. EDITS Index (78.4±2.0 and 66.5±3.3, respectively), and a larger estimated percentage of men who were satisfied with sildenafil treatment (dichotomized EDITS scores: 93 vs 69%). The SEX-Q total score, which assesses the sexual experience overall in the domains of erection, individual satisfaction and couples satisfaction, correlated positively with all other outcomes in both trials (Table 3). Sildenafil, whether initiated at a fixed dose of 50 or 100 mg, or initiated at a dose of 50 mg and titrated as needed up to 100 mg, was significantly more effective than placebo (Table 2). The 100-mg fixed dose was significantly more effective than the 50-mg fixed dose in improving the IIEF Overall Satisfaction domain score; the SEAR Sexual Relationship Satisfaction domain, Overall Relationship Satisfaction subscale and Total scores; all SEX-Q domain scores; and the SEX-Q total score (Table 2). In addition, the EDITS Index was significantly higher in the fixed-dose sildenafil 100-mg group vs the fixed-dose sildenafil 50-mg group, although the difference between the dosage groups in the estimated percentage of men who were satisfied with sildenafil treatment (dichotomized EDITS scores: 93 vs 88%) was not statistically significant (Table 2). For the fixed-dose sildenafil 100-mg group relative to the flexible-dose sildenafil group (Table 2), there was a similar improvement from baseline in the percentage of EHS 4 erections (33 and 35%, respectively), EHS 3 or 4 erections (36 and 35%, respectively) and IIEF scores (⩽1 point difference between the groups across IIEF domains).
- Sildenafil 100 mg can be used for pulmonary arterial hypertension in some cases.
- It is not intended for use in women or children.
- Regular use of sildenafil does not cure erectile dysfunction but manages symptoms.
However, for the fixed-dose sildenafil 100-mg group relative to the flexible-dose sildenafil group there was a greater improvement from baseline in SEAR scores (8–16 point difference between the groups across SEAR components) and in SEX-Q scores (3–7 point difference between the groups across SEX-Q domains), a greater least square mean±s.e. EDITS Index (78.4±2.0 and 66.5±3.3, respectively), and a larger estimated percentage of men who were satisfied with sildenafil treatment (dichotomized EDITS scores: 93 vs 69%). The SEX-Q total score, which assesses the sexual experience overall in the domains of erection, individual satisfaction and couples satisfaction, correlated positively with all other outcomes in both trials (Table 3).
- The onset of action for sildenafil citrate 100 mg is typically within 30 minutes.
- Effects can last for up to 4-6 hours, providing a window for sexual activity.
- Individual response to the drug varies based on health and dosage.