Sildenafil

Sildenafil is the name of the active medical ingredient in Viagra.  It also comes in the same strengths and dosages as Viagra, therefore Sildenafil and Viagra will have identical effects. Sildenafil is used to treat erectile dysfunction (ED) and has proven to be extremely effective in ameliorating the effects ED enabling men to achieve stronger erections and last longer during penetrative sex.

Most erectile dysfunction treatments including Sildenafil (Viagra) belong to a class of medications known as PDE-5 (Phosphodiesterase 5) inhibitors. PDE-5 inhibitors, will only work if the individual who has taken the medication is sexually aroused.

Alternatives to Sildenafil in this medication class are Cialis, Spedra and Levitra.

What are the benefits of Sildenafil?

Sildenafil is a treatment for adult men with erectile dysfunction, sometimes known as impotence.

• Sildenafil CAN also help improve sexual confidence
• Sildenafil CAN be used in men with cardiovascular (heart) disease
• Has a long-established use for erectile dysfunction

Sildenafil enhances the flow of blood into the blood vessels of the penis facilitating an erection.

An erection is initiated when sexual arousal stimulates centres within the brain thereby increasing levels of a chemical called nitric oxide.

This in turn activates the production of cyclic guanosine monophosphate (cGMP) throughout the body. Within the penis, cGMP relaxes the penile vessel walls allowing the arteries to fill with blood, this then produces an erection.

In cases of erectile dysfunction, men have a defective cGMP pathway and an enzyme called PDE-5 responsible for the degradation of cGMP is hyperactive. This prevents cGMP functioning as it should thereby reducing blood flow to the penis.

Sildenafil citrate is a PDE-5 enzyme inhibitor i.e. it blocks activity, this allows the cGMP to last longer within the bloodstream and function correctly. Adequate concentrations of cGMP within the body allows the penile vessels to dilate and take in more blood, thereby facilitating a stronger erection.

What if Sildenafil doesn’t work?

• Ensure that you are taking the correct strength. The dosage you are taking may not be enough. If you are on the lower dosages of 25mg or 50mg please discuss with your doctor to change your dosage if appropriate.
• Sildenafil is not a continual medication, for it to work you must be sexually aroused.
• Certain other medication, some foods and drinks may reduce the effect of Sildenafil. Heavy ‘fatty’ meals taken with your tablet or consumption of alcohol will have some impact on the effectiveness of your tablet.

Can women have Sildenafil?

It currently is licensed for ONLY men. We will only consider providing Sildenafil to men over 18years of age.

How to make Sildenafil the most effective 1. Avoid taking Sildenafil with a large ‘fatty’ meal as this can slow down the absorption of Sildenafil therefore taking longer to work.

2. It is best to take Sildenafil on an empty stomach.

3. Limit alcohol consumption, this can affect absorption of Sildenafil and also alter your blood pressure as well as increase side effects such as dizziness.

4. Avoid ingesting milk, watermelon and grapefruit juice at the same time as your tablet.

5. Swallow the tablet whole, crushing the tablet can degrade and reduce the effectiveness of the active ingredient.

If you are not benefiting from Sildenafil despite having already increased your dosage and have followed all of the advice listed above, it is recommended you consult your doctor.

How long does it last?

Sildenafil lasts upto 4 hours in the bloodstream ( optimal plasma concentration) and its effects wear off after that period. It starts working after 30-60minutes in most men and is most effective within the first 2 hours.

Dosages Sildenafil can be prescribed in varying strengths of 25mg, 50mg and 100mg. All of these are available from the Access Doctor website.

Low strength Sildenafil 25mg tablets are recommended for men over 65 years of age and those that are sensitive to the effects of sildenafil.

Standard strength Sildenafil 50mg tablets is the usual starting recommended dose by the doctor.

Higher strength Sildenafil 100mg tablets are the maximum recommended dosage. It is usually only recommended by the doctor after men have not achieved adequate benefits with the standard strength capsules.

Sildenafil tablets are only licensed and suitable for males over the age of 18 who suffer with erectile dysfunction.

Sildenafil is not suitable for woman and those under the age of 18years.

Sildenafil may be unsuitable for those who identify with any of the following, it is recommended they consult a doctor who can assess suitability in such cases:

• Have liver or kidney disease
• Have cardiovascular disease e.g. heart problems (heart disease, myocardial infarction) or stroke
• Have chest pain symptoms
• Suffered a stroke within the past 6 months
• Have low blood pressure
• Have sickle cell anaemia
• Have intolerance to galactose
• Have deformity to the penis eg Peyronie’s disease or damage to the penis
• Are already on nitrate medication e.g. GTN spray It is vital you state all the information as to the best of your knowledge regarding you past medical history and current medical conditions when completing our consultation, this helps our doctors make safe decisions and provide you with the best treatment options.
• Please read the patient information leaflet for other risk factors.

Sildenafil is known to interact with certain other medications. It is vital to be cautious when taking Sildenafil concurrently with some medications, foods and beverages:

Grapefruit and grapefruit juice, these can increase the level of sildenafil within the body and cause significant reductions of blood pressure.

Alcohol consumption can exacerbate some side effects such as dizziness and flushing.

Blood pressure medication can compound the blood pressure reducing effects.

Nitrates can lower blood pressure and cause flushing.

Can Sildenafil lower blood pressure?

Sildenafil was initially invented and went to clinical trials for the purposes of high blood pressure, studies have shown that taking Sildenafil reduces systolic blood pressure by between 8 to 10 mg Hg, however, it has never been approved or licensed for use in systemic hypertension. It is used to treat Pulmonary artery Hypertension (pulmonary hypertension).

Caution should be used in using Sildenafil with anti-hypertensives, they should be avoided with a specific class of anti-hypertensives called alpha-blockers and medications containing nitrates or their derivatives, in such cases your blood pressure may become dangerously low.

Sildenafil is safe to use with many heart medications. Always inform your doctor of any other medications you are taking, before starting Sildenafil.

During your consultation, please list all your blood pressure medications such as Ramipril, Amlodipine and Bendroflumethiazide.

Side effects can occur with all medications. If you are sensitive to PDE-5 inhibitors you may experience the following side effects:

• headaches.
• feeling sick.
• hot flushes, including facial flushing.
• indigestion.
• a colour tinge to your vision or blurred vision.
• stuffy nose.
• dizziness.

As your body gets use to the medication and the dose, these usually subside. If you get persistent side effects stop taking the medication and seek advice from your doctor.

As mentioned previously, Viagra is Pfizer’s branded medication, it contains the active ingredient Sildenafil.  Sildenafil is therefore the active agent in both Viagra and generic Sildenafil.  They also come in similar size packs and strengths.

All three Pde5 Inhibitors and work by the same mechanism. It must be stated that all are highly effective, the only difference is in the duration of action each drug has. The activity is as follows: Sildenafil (Viagra) (4Hours), Levitra (4-5 hours) and Cialis (36 hours). Sildenafil is most suitable if sexual activity will happen within a few hours, its effects wear off after that.

The combination of ED tablets is potentially dangerous, it will lead to overdose and side-effects. Combination should not be used under any circumstances. If you are not benefiting from one type of medicine, the dose can be adjusted or a different ED treatment advised.

Sildenafil is safe with most other medicines, the ONLY exception being a group of medicines called Nitrates. Nitrates in combination with Sildenafil can lead to a dangerous drop in your blood pressure. Please complete a full list of all your current medications when completing the online consultation, this will help our doctors safely prescribe you Sildenafil.

Although the likelihood of ED increases with age, this is not necessarily inevitable. There are many other causes of ED.

Identify the treatment, strength and quantity you wish to order: Click Select treatment. Complete the Two stage consultation and then fill out the payment details.

Once approved, you will receive your treatment delivered Free for the Next Day.

This is not the case. There is no clinical evidence to suggest you become tolerant to the effects of Sildenafil, we have prescribed the same dose of Sildenafil to men over many years without the need to increase it. However, if there are underlying medical or environmental factors which are not controlled, the dosage may need to be increased.

Yes, most doctors offer this service. The cost varies from 10-30 pounds. Our cost is all inclusive and much cheaper.

Sildenafil is a generic medicine, this means, it can be produced by many manufacturers, this leads to a reduction in cost. Viagra is a brand produced by Pfizer (a large pharmaceutical company). Some men still prefer the Brand Viagra and it is still a highly popular medicine.

Pharmacies use different formulas to calculate the price of private prescriptions, they also buy drugs at different wholesale prices. AccessDoctor guarantee to be the cheapest on this product like for like (all-inclusive price).

There is no difference between Viagra and Sildenafil in any way.

I find the many different Sildenafil brands confusing

The patent for Sildenafil Viagra had has expired, for this reason, many companies can produce Sildenafil as a generic medicine. This is a very popular product. We stock many different Sildenafil brands including Pfizer, Teva, Torrent, Dr Reddys, Bristol Labs, Zentiva, Sandoz, Mylan, Accord, Actavis. We cannot guarantee the brand you will receive.

There are many causes of ED. It is important our Doctors identify the cause; some causes may be reversible and do not need any treatment. Sildenafil is also a prescription only medicine, this means it can only be prescribed by a doctor.

Community pharmacies are able to sell Viagra Connect without the need for a Doctors prescription. However, this is very expensive and the pharmacy environment is often not very private. Order online from AccessDoctor for a confidential, discreet and fast service.

The usual dose is 50mg. This is dose we recommend.

The dose can be increased to the higher dose of 100mg or reduced to 25mg dependent on the effects.

For sildenafil to work properly, you’ll need to be sexually excited. Take one tablet 4 hours before sexual activity.

It is dangerous to take Sildenafil with illicit drugs. Taking Sildenafil and Cocaine together increases the risk of priapism. This is a painful condition that may need surgery. Priapsim is a painful erection lasting more than 2 hours and if not treated can cause permanent penile damage.

The risks of heart disease and stroke are also significantly increased.

Any ED medication taken with amyl nitrate (‘poppers’) can lead to a dangerous state known as hypotension (severe drop in your blood pressure).

We are a regulated online pharmacy. We are registered and regulated by both the GPhC and the MHRA.

Many factors are related to impotence, please see the FAQ on ED.

Men suffering from ED should consult their own doctor, this is so they can identify the underlying cause for their ED.

If you have benefited from Sildenafil previously:

There is no evidence to suggest that your become becomes tolerant (use) to Sildenafil. If your usual dose does not work, this may simply be due to timing. Ensure you are taking the medication 4 hours before sexual activity. If you have not seen any benefits repeatedly, even after closely following time intervals, please consult your own doctor. There may be underlying health reasons to explain this.

If you have just started for the first time:

Sildenafil 50mg is the starting dose, it is advisable to increase the strength to 100mg if 50mg does not work.

If there is no benefit with 100mg, please consult your own doctor, there may be underlying health issues that need addressing.

Alcohol in known to exacerbate the symptoms of ED. It is not recommended for you to drink alcohol when taking Sildenafil because, heavy volumes of alcohol consumption can reduce your blood pressure, this will have a negative synergetic effect with the known side effects of Sildenafil potentially leading to a severe drop in your blood pressure.

Should Sildenafil be taken on an empty stomach?

High fat meals or very large meals can reduce the time sildenafil enters the blood stream and reaches its maximum concentration. When taken on an empty stomach the effects take only 30-45 minutes, this is delayed to upto 90minutes if taken with heavy fatty meals.

The blood flow into the penis increases during sexual arousal. This precipitates an erection. Sildenafil belongs to a class of drugs known as PDE5 inhibitors. This leads to smooth muscle relaxation. The smooth muscle relaxation facilitates blood flow into the penis.  This inhibition of the protease inhibitors dilates penile blood vessels and increases flow.

You should not be taken more than once every 24 hours. If you suffer from specific health conditions or are on other medications you may be advised by your doctor to take it less frequently.

Sildenafil is the first drug used for ED and has the largest clinical follow up. It’s side-effects are minimal compared to other medicines.

It can be effective in as little as 30minutes

Effects last for 4 hours

Only kicks in when there is a sexual stimulus

Walking

According to one study, 30minutes of walking per day reduced the risk of ED by 41%.

Diet

A diet rich in natural foods like fruit, vegetables, whole grains, and fish as opposed to processed foods and red meat decreased the likelihood of ED.

Maintain good vascular health

• These conditions destroy your blood vessels.
• High blood pressure
• high blood sugar, high cholesterol
• high triglycerides
• Poor penile blood flow is a major cause for ED.

Control your weight

Did you know:  a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist!

Pelvic floor exercises

Pelvic floor muscles enhance rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein.

• Lifestyle
• quitting smoking
• losing weight
• limiting alcohol