Quick a gist of the main points and Wrap Up

Sildenafil (sildenafil citrate) is commonly prescribed in Australia to treat erectile dysfunction in adult men. It comes in several tablet strengths and has a distinct formulation when used for pulmonary arterial hypertension; do not swap products intended for different conditions without professional advice. For legal and supply details see Australian Legal and Supply Requirements.

Standard oral strengths available in community practice include 25 mg, 50 mg and 100 mg. Sildenafil requires sexual stimulation to work and should not be viewed as an aphrodisiac or a performance enhancer for sports; athletes should review the guidance in Safety precaution list and Alerts.

Mechanism of its action

Sildenafil promotes erectile function by inhibiting phosphodiesterase type 5 (PDE5). During sexual arousal nitric oxide elevates cyclic GMP in penile tissue, causing smooth muscle relaxation and increased blood flow. By reducing the breakdown of cyclic GMP, sildenafil helps sustain that relaxation and supports the development and maintenance of an erection when stimulation is present.

It will not produce an erection spontaneously without sexual arousal.

Who Can Use Sildenafil

Appropriate candidates include:

• Adult men with erectile dysfunction after clinical assessment.
• People with pulmonary arterial hypertension who must use the product and schedule licensed for that indication and follow specialist instructions rather than using ED tablets.
• Cases outside standard indications, such as women or adolescents, require specialist review; see Use is contraindicated in these cases and Avoidance for important restrictions.

Dosage and Administration

A common starting dose for erectile dysfunction is 50 mg taken approximately 30 to 60 minutes before sexual activity. Some men notice effects in as little as 15 minutes in addition to the action typically persists for up to four hours.

• Adjustments: depending on tolerability and effect the dose can be lowered to 25 mg or increased to 100 mg. Do not take more than one dose in twenty four hours.
• Food: a large fatty meal can slow absorption and delay onset, so taking the tablet on an emptier stomach may speed effect for some people.
• Grapefruit and grapefruit juice may raise drug levels and should be avoided around dosing.
• Avoid drinking large amounts of alcohol before dosing as alcohol can reduce the ability to achieve an erection and increase dizziness or fainting.

People with significant liver or kidney disease, or those on alpha-blockers or strong CYP3A4 inhibitors, are often started on a lower dose such as 25 mg. Discuss adjustments with your prescriber; see Medicines Meetings and social interpersonal dialogue and exchanges influence perceptions and decisions. and Advice for a survey of the main points of the the networked exchange of ideas.

Workplace recommended safety protective measures and Alerts

Before you commence sildenafil, inform your prescriber about any drug allergies, heart conditions, blood pressure issues, eye problems, or prior episodes of prolonged erections.

• Older adults may experience more pronounced drops in blood pressure, dizziness or visual changes.
• Seek specialist assessment if you have anatomical penile abnormalities, bleeding disorders, active peptic ulcers, retinitis pigmentosa, or a history of priapism.
• If you develop chest pain during sexual activity stop and seek urgent medical care.
• Report any sudden loss or change in vision or hearing immediately for urgent review.

Sporting note: sildenafil is not presently listed as prohibited by the World Anti-Doping Agency, but rules may change. Athletes should consult Sport Integrity Australia and a sports physician before using sildenafil. See supply rules at Australian Legal and Supply Requirements.

Inadvisable tips and Avoidance

Do not take sildenafil if any of the following apply:

• You are using nitrate medicines (for example glyceryl trinitrate or isosorbide mononitrate) or recreational nitrites (so called poppers). Combining these with sildenafil can cause a severe and dangerous drop in blood pressure.
• You are prescribed riociguat or other soluble guanylate cyclase stimulators.
• You are already using another PDE5 inhibitor or other erectile dysfunction medication unless supervised by a clinician.
• You have recently experienced a major cardiac event or have been advised by a clinician to avoid sexual activity for cardiac reasons.
• There is a prior history of non-arteritic anterior ischemic optic neuropathy potentially linked to PDE5 inhibitors.
• You are under 18 years old for the ED indication, or you are a woman seeking ED treatment without specialist oversight.

Typical peripheral effects and Signs to Watch

Many people tolerate sildenafil without problems. Reactions that are widely common and mild include:

• Head pain with facial flushing
• Upset stomach or heartburn
• Blocked nose
• A sense of dizziness or feeling unsteady
• Unformed stools and diarrhoea

Less frequent but clinically notable effects:

• Visual disturbances such as a blue tinge, blurred vision or increased light sensitivity
• Backache or muscle discomfort
• Dermal irritation and rash or hypersensitivity reactions

Seek fast medical help for severe dehydration chest pain, fainting, a painful erection lasting longer than four hours, sudden loss of vision or sudden loss of hearing. For guidance on accidental overconsumption consult Overdose and Emergency Needs Response or contact the Poisons Information Centre situated in Australia.

Pharmacokinetic Drug Social the interactional flow among participantss create context for decisions. and Advice

Tell your prescriber and pharmacist about every prescription, over the counter and complementary medicine you take. Major intercommunications between people can shape outcomes. include:

• Absolute contraindication: nitrates and recreational nitrites.
• Do not mingle with riociguat or related agents.
• Exercise caution with alpha-blockers (for example tamsulosin or doxazosin) because of additive blood pressure lowering.
• Strong CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole, itraconazole and clarithromycin increase sildenafil exposure and may require dose reduction or avoidance.
• Grapefruit products increase sildenafil levels and should be avoided near dosing.
• Concurrent antihypertensives or alcohol can increase the risk of symptomatic hypotension.

Routine Use and Omitted medication dose Advisory

For erectile dysfunction, sildenafil is taken as needed coupled with there is no standard daily schedule, so there is no usual the dose was omitted procedure. The formulation for pulmonary arterial hypertension is taken regularly according to a prescribers instructions; do not double doses after a missed tablet without clinical advice.

Never exceed one sildenafil dose in any 24 hour period. Repeated overdosing raises the likelihood of serious damaging effects.

OD and Urgent Medical Emergency Response

If an an overdose is suspected obtain immediate emergency help or contact the Poisons Information Centre. Symptoms suggesting an overdose include severe dizziness, fainting, persistent nausea, marked visual disturbance, chest pain, arrhythmia or a sustained painful erection. Prompt medical assessment is necessary for severe signs.

Secure flexible storage options adapt to changing needs. and Handling Framework

• Store at typical room temperature, about 20 to 25 degrees Celsius.
• Keep tablets in their original packaging to protect from moisture and strong light.
• Do not store in bathrooms or areas with excessive humidity.
• Keep pills and bottles out of sight and reach for kids and animals.

Backup options and Comparative Therapies

Other PDE5 inhibitors and non drug approaches may suit particular preferences or clinical situations. Choice depends on onset, duration, incidental effects, the networked exchange of ideass span conversations, gestures, and feedback. and cost. Initiate a talk with your prescriber about alternate options.

• Tadalafil (Cialis) typically has a much longer duration, sometimes up to 36 hours, and there are low daily dose options for some patients.
• Vardenafil (Levitra) has a clinical profile similar to sildenafil and is available in some orodispersible forms.
• Avanafil (Spedra) medication can offer a quicker onset for some users and may act in about 15 minutes.
• Generic sildenafil contains the same active drug as Viagra and is usually cheaper per tablet than the brand product.

Non pharmacological strategies include lifestyle changes such as weight loss, smoking cessation, tighter control of diabetes and hypertension, psychological therapies, vacuum erection devices and urology referral for structural problems. See cost comparisons at Prices and Cost Comparison (AUD).

Prices and Cost Comparison (AUD)

Retail prices vary by brand, strength, pack size as well as the pharmacy. The numbers below are approximate private prices observed in Australian pharmacies and selected online suppliers, shown in Australian dollar value.

• Generic sildenafil 100 mg: about AUD 1.50 to AUD 4.00 per tablet depending on quantity and discounts.
• Brand Viagra 100 mg: approximately AUD 15 to AUD 30 per tablet when paid privately.
• Generic tadalafil 20 mg: about AUD 2.00 to AUD 6.00 per tablet.
• Brand Cialis 20 mg: roughly AUD 15 to AUD 25 per tablet.
• Vardenafil 20 mg (brand or generic): approximately AUD 10 to AUD 20 per tablet.
• Avanafil 200 mg (Spedra) typically costs about AUD 15 to AUD 30 per tablet.

Most ED medicines are not subsidised by the Pharmaceutical Benefits Scheme for this indication, so expect to pay privately unless you qualify for a special arrangement. Ask your pharmacist about generics, bulk purchase discounts and any dispensing fees that will affect final cost.

Australian Legal and Supply Requirements

Key regulatory points for Australia:

• Scheduling: Sildenafil for erectile dysfunction is a prescription-only medicine (Schedule 4) under the Poisons Standard, so a valid prescription is required.
• Supply: You must obtain a lawful prescription from an Australian registered prescriber to collect sildenafil at an Australian pharmacy. Telehealth prescriptions are acceptable when they comply with current regulations.
• Advertising: Direct to consumer advertising of prescription medicines is restricted under the Therapeutic Goods Act and related advertising codes.
• Personal importation: Importing a medicine for personal use may be permitted for limited supplies with an appropriate prescription and adherence to Therapeutic Goods Procedures for administration guidance, but customs and biosecurity requirements still apply.
• Sporting considerations: Sildenafil is not currently banned by WADA, but athletes should confirm status with Sport Integrity Australia please check before use.

Always obtain medicines through regulated channels and follow prescribers instructions. For further links and support see Further Notes and Resource Materials.

Further Source Materials and Comments

For personalised advice consult your doctor, specialist or pharmacist. Useful topics to review with them include:

• Your full medical history and all current medicines and supplements
• Which starting dose is appropriate and how to adjust safely
• Cost considerations, generic different avenues and pharmacy fees
• When to seek urgent care for negative pharmacologic effects

Pocket guides on this page: a high level snapshot of the content and summary, administration procedures for dosing and legal and supply requirements.