Viagra: Benefits, Safety, Dosage, & Alternative Options to be Aware of

Viagra is the brand name for sildenafil citrate. It’s used to treat erectile dysfunction (impotence) in men. 

There are dozens of medications used to treat erectile dysfunction, but none as famous as viagra. 

There are a few good reasons for this. 

Viagra was the first erectile dysfunction drug on the market and has consistently proven itself to be one of the most reliable and well-tolerated treatment options available. 

In this guide, we’ll cover everything you need to know before you start taking Viagra. We’ll discuss how it works, how much to take, when to avoid Viagra, and what to do if you experience side effects. 

Let’s dive straight in. 

What is Viagra?

Viagra is a prescription drug used to treat erectile dysfunction.

This little blue pill works as a smooth-muscle relaxant and vasodilator with a particularly strong affinity for the muscles at the base of the penis. By relaxing these muscles, blood can flow freely into the corpora cavernosa, which is necessary to form an erection. 

Viagra has changed the lives of tens of millions of men over the years by giving them back their virility.

Some women also use Viagra to improve sexual performance and pleasure by improving blood flow to the corpora cavernosa in the clitoris — but this use is considered off-label, and Viagra has not yet been proven safe for use in women (more on this in the research section).

What’s the Dose of Viagra?

Viagra comes in three dosage forms: 

  1. 25 mg — 72% effectiveness
  2. 50 mg — 80% effectiveness
  3. 100 mg — 85% effectiveness

Most men find the 50 mg pills sufficient, and this is the dose most commonly prescribed. It’s strong enough to provide results for the majority of men, yet weak enough to reduce the chances of experiencing side effects. 

Some people have shown tolerance to Viagra, primarily if used over long periods. If this happens to you, your doctor may prescribe the 100 mg pills instead. 

The maximum dose of Viagra is one pill per day. If you find Viagra isn’t working for you, speak with your doctor about getting a prescription for a higher dose. Never take more than one tablet in a 24-hour period. 

How Long Does it Take for Viagra to Kick In?

The effects of Viagra will start to kick in about 30 – 60 minutes after you take it. In some cases, Viagra can take as long as 2 hours before it starts to work, so if it’s your first time using the drug, try to remain patient. 

Even with Viagra, you still need to be sexually aroused to experience an erection. Viagra will not trigger an erection on its own. The drug only works to eliminate physical barriers stopping you from experiencing an erection while aroused and is not a sexual stimulant. 

It’s important to take other measures to improve your erection, such as eating a healthy diet, exercising regularly, and practicing foreplay before engaging in sexual activity. 

How Long Does Viagra Last? 

Once Viagra kicks in, the effects last an average of 3 hours. 

In some cases, Viagra will last much longer. It’s common for users to report improvements in their erection up to 24 hours after taking the pill. 

How Much Does Viagra Cost?

The original Viagra, made by Pfizer, costs around $70 per tablet when ordered in packs of 10.  

The patent for the drug expired recently (2019), allowing other manufacturers to start producing generic (non-name-brand) versions of the drug. These medications are much cheaper since the company doesn’t need to recoup any money on research and development. 

Generic sildenafil costs between $6 and $35 per pill. 

The History of Viagra — From Heart Medicine to Boner Pill

Like many important discoveries, the erection-supportive benefits of Viagra was discovered by accident. 

The drug began as a potential heart medication in 1989. Two researchers (Peter Dunn and Albert Wood) working for the pharmaceutical giant Pfizer created a drug called UK-92480 (the classified name used to conceal the secret research chemical from other pharmaceutical companies). 

They believed the new drug could treat high blood pressure and angina (partial occlusion of coronary arteries). 

For the first half of the 1990s, clinical testing was done to explore the effects of UK-92480 for treating heart disease — the results were disappointing. 

Throughout the trial, study participants reported increased erections for several days after using the medication. This feedback, combined with a lack of results in the heart studies, prompted Pfizer to shift gears and focus on the potential for UK-92480 to treat erectile dysfunction instead. 

The results of these studies were nothing short of amazing, and the drug was later patented in 1996. This was when the true chemical name of UK-92480 was first mentioned publically — sildenafil citrate.

It was two years later in 1998 that the FDA finally approved the drug, and Pfizer’s marketing engine could switch into high gear to start promoting the drug. 

Viagra was dubbed “the hottest new drug in history” by Newsweek the same year it was released. Even presidential nominee Bob Dole was brought on by Pfizer to promote the new medication. 

Reporting by the Telegraph UK claimed the drug was even used by the CIA to improve relations with the Taliban in Afghanistan. 

Viagra held nearly 45% of the entire market share for erectile dysfunction medications until 2019 when the patent finally expired. The company has earned tens of billions of dollars since the drugs’ initial debut in 1998 and continues to earn hundreds of millions every year. 

Today, Viagra is no longer protected from generic manufacturers. This means you can buy sildenafil citrate from other manufacturers such as Teva Pharmaceuticals, Aurobindo, Cambia, and others. Generics are bad for business but good for the public using drugs. It dramatically increases competition and drives down the price of the drug substantially. 

Who Should Take Viagra?

Viagra is prescribed for men experiencing difficulties achieving or maintaining an erection. 

Pfizer came out with a scoring system to help men and their doctors determine when Viagra should be used: 

  • Grade 1 — Penis size increases but is not hard
  • Grade 2 — Penis is hard, but not hard enough for penetration
  • Grade 3 — Penis is hard enough for penetration, but not completely hard
  • Grade 4 — Penis is completely hard and rigid

Viagra has the most significant impact on men categorized into grades 1 and 2, but can also help men with grade 3 experience a fuller erection. 

The most common reasons doctors prescribe Viagra is for erectile dysfunction caused by medications, diabetes, obesity, Parkinson’s disease, Peyronie’s disease, sleep disorders, and low testosterone (often a side-effect of age). 

Studies have shown that Viagra can promote erection in difficult-to-treat patients experiencing impotence as well — including spinal cord injuries (83%) [1], radical prostatectomy (43%) [2], and depression (73%) [3]. 

Is Viagra Safe? 

While Viagra is generally regarded as safe, there are a few specific cases where it can become dangerous, and there are several well-known side effects to know about.  

Misuse of this drug is the most common cause of side effects. 

Learn when Viagra becomes dangerous and what potential side effects you should expect. 

The Most Common Side Effects of Viagra

  • Headaches (21% of users)
  • Flushing (19% of users)
  • Indigestion (9% of users)
  • Vision Loss (2% of users)
  • Nasal Congestion (4% of users)
  • Back Pain (4% of users)
  • Dizziness (4% of users)
  • Nausea (3% of users)
  • Rash (2% of users)
  • Muscle Pain (2% of users)

Rare, But Severe Side Effects of Viagra

The potential danger Viagra poses to some people is the main reason why this drug is listed as prescription-only. 

Doctors will weigh the risk of using Viagra and cross-check your medications to reduce the chances of a negative interaction.

1. Prolonged Erection

A prolonged erection is characterized as an erection lasting 4 hours or longer. While this symptom isn’t immediately dangerous, it can lead to the more severe form — priapism — if left unchecked for too long. 

2. Priapism

Priapism is described as a prolonged and painful erection lasting more than 6-hours. This is a much more severe condition than many people realize. Priapism can lead to permanent damage to the penile tissue and result in permanent impotence. 

3. Hypersensitivities & Allergic Reactions

A small percentage of users experience a severe rash after taking Viagra. Some people have reactions to Viagra that cause swelling in the face and throat — leading to difficulty breathing. 

4. Cardiovascular Disease

Patients with underlying heart disease may experience a worsening of symptoms that can become life-threatening. Changes to blood pressure, combined with increased physical exertion during sexual activity, can strain the cardiovascular system and induce angina or coronary artery blockage. 

5. Vision Loss

Non-arteritic anterior ischemic optic neuropathy (NAION) has been reported in a small number of people after using Viagra. This condition involves a loss of blood flow to the optic nerve of the eye, which can lead to permanent vision loss if not treated immediately. 

6. Hearing Loss

A sudden loss or reduction in hearing has been reported in a small number of Viagra users. The cause of this effect is not well understood, which makes it hard to predict. 

If you experience any change in hearing after taking Viagra, contact your doctor immediately. 

Viagra & Negative Drug Interactions

Most of the dangers of using Viagra come from negative side effects caused by mixing the drug with other medications. 

Your doctor will take any of your current medications into account before prescribing Viagra. Some medications may need to be changed before you can begin. 

  • Nitrates — angina and coronary artery disease treatment
  • Guanylate Cyclase (GC) Stimulators — pulmonary hypertension treatment
  • Anti-Hypertensive Medications — such as alpha-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and angiotensin II receptor blockers
  • CYP3A4 inhibitors — such as ritonavir, ketoconazole, itraconazole, erythromycin, and others) 

Who Should Avoid Using Viagra?

Viagra isn’t suitable for everyone — which is why this drug can only be ordered with a written prescription from your doctor. A GP should first rule out potential risks of using the drug.

Here are a few examples of people who should avoid using Viagra altogether:

  1. Patients with severe heart disease or heart valve failure
  2. Patients with a history of NAION or “crowded” optic disc
  3. Patients diagnosed with retinitis pigmentosa
  4. Patients taking any of the contraindicated medications listed in the previous section
  5. Patients with a history of sildenafil hypersensitivity
  6. Patients with a history of priapism
  7. Patients with severe kidney disease
  8. Patients with certain blood disorders (hemophilia, leukemia, sickle-cell anemia)

How Does Viagra Work?

In order to discuss how Viagra works, we need to briefly cover what causes an erection, and what goes wrong in patients with erectile dysfunction. 

An erection begins in the brain. A primitive region of the brain called the limbic system triggers a cascade of effects that stimulate arousal. Something you see, smell, touch, or hear can all trigger the arousal process. 

A signal is sent from the brain to the blood vessels in the penis. The arteries at the base of the penis relax, allowing blood to flow into a specialized tissue called the corpora cavernosa. This region is designed to trap the blood, increasing the size and rigidity of the penis to produce an erection. 

Men may experience problems dilating the blood vessels that allow blood to flow into the penis. This can come as a side effect of medications, heart disease, lowered testosterone levels, or other underlying health conditions. 

Viagra works by improving the body’s ability to dilate the blood vessels in the penis to fill the corpora cavernosa with blood. 

The active ingredient in Viagra (sildenafil) is classified as a PDE5 inhibitor. PDE5 is short for phosphodiesterase type 5 — which is an enzyme that breaks down a compound called cyclic-GMP (cGMP) in the smooth muscle tissue. 

cGMP is critical for the dilation of blood vessels in the penis, as well as other vascular tissues like the eyes and ears.  

By blocking the breakdown of cGMP in the penis, Viagra and other PDE5 inhibitors are able to dramatically increase the ability for blood to flow into the penis to make it easier to have an erection. 

What Happens if a Woman Takes Viagra?

Ever since the release of Viagra in 1998, researchers and the public alike have been questioning whether the wonder drug could be used to improve sexual function in women too. 

In an episode of Sex and the City titled “The Man, the Myth, the Viagra,” one of the main characters, Samantha, take Viagra to experience a more explosive orgasm.

This episode prompted a lot of discussion about whether or not the benefits of Viagra extend to women. 

After extensive research, studies have shown that while Viagra is well-tolerated by women, only one in five women will experience any notable improvement in sexual pleasure after using Viagra [6]. 

The problem with women using the drug is that there are no approved medical reasons for taking it, so it’s difficult to find a doctor who will prescribe the drug. In fact, based on this protocol, it would be unethical for any doctor to prescribe women viagra — at least for the purposes of improving sexual stimulation. 

Taking Viagra without first discussing it with a doctor can lead to severe consequences. 

Medical Research Involving Viagra

Pfizer has invested millions of dollars in research for its blockbuster drug Viagra. Other third-party researchers have also published unbiased studies on the drug to explore its efficacy and safety. 

Here’s a summary of some of the most prominent research on Viagra over the years:

Study #1: Clinical safety of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction

This study summarizes phase II and phase III clinical trials conducted by Pfizer that earned their new drug FDA approval. The studies involved over 5700 patients. 3700 were given sildenafil (Viagra), and 2000 were given a placebo. 

The study found that heart attacks (the most concerning the risk of the drug) were increased slightly in the Viagra group from 1.4/100 patient-years in the placebo group to 1.7/100 patient-years in the treatment group. 

The study also found that discontinuation of the drug due to side effects was very comparable from the placebo control group (2.3%) to the treatment group (2.5%). 

The study concluded that Viagra was an effective and well-tolerated treatment for erectile dysfunction. 

Study #2: Oral Sildenafil in the Treatment of Erectile Dysfunction

This clinical trial involved 532 men diagnosed with erectile dysfunction. There were three treatment groups (25 mg, 50 mg, and 100 mg Viagra tablets), and a placebo control group. 

The study took place over 24 weeks, with an additional 12-week extension for some men. The extension allowed researchers to follow the changes when the dose was increased after the initial study period. Men that took lower doses were given a larger 100 mg dose in the final 12 weeks to assess any changes. 

At the end of the study, researchers reported that nearly 70% of all attempts at sexual intercourse were successful in the men receiving Viagra. In the placebo-control group, only 22% of the attempts were successful. 

The study also found that the higher doses of Viagra showed more significant improvement in symptoms, with only a minor increase in the likelihood of developing side effects. 

Study #3: Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction

This independent study published in 1999 by researchers at Columbia University explored the effects of Viagra on sexual function in women. 

It was one of the first studies to explore the effects of the drug on women. 

The study consisted of 30 post-menopausal women. 

Researchers tracked changes in lubrication, orgasm, and clitoral sensitivity to see what effect Viagra had on the female reproductive organs. The findings showed improvement in all three metrics — 23.2%, 7.4%, and 31.3%, respectively. 

Only 18% of the patients in this study reported significant improvement after using Viagra. 

This study showed that Viagra was well-tolerated in females, but offers little improvement in sexual function. This outweighs the potential risks of using the drug. 

Viagra Alternatives

Viagra isn’t the only treatment option for erectile dysfunction. There are several prominent medications doctors may prescribe for this condition that work similarly to Viagra. The closest is a drug called vardenafil (sold under the brand names Levitra and Vivanza). 

Additionally, generic forms of Viagra made by manufacturers around the world are also available on the open market. 

Here are some of the most prominent Viagra alternatives:

  • Avanafil (Stendra)
  • Mirodenafil (Mvix)
  • Tadalafil (Cialis)
  • Udenafil (Zydena)
  • Vardenafil (Levitra, Staxyn, and Vivanza)

Are There any Natural Alternatives to Viagra? 

While nothing in the natural world offers the specificity and potency of prescription ED medications, some natural substances can be used to provide similar results. 

Here are some of the most common natural Viagra options to consider: 

  • Red Ginseng (Panax quinquefolium)
  • L-Arginine (An Amino acid)
  • Yohimbe (Pausinystalia johimbe)
  • Muira puama (Ptychopetalum olacoides)
  • Catuaba (Trichilia catigua)

Where to Buy Viagra in 2023

Viagra is a prescription medication in the United States and most other countries around the world. This means the only way to get a bottle of Viagra for yourself is to visit your GP and request a prescription. 

Your doctor will assess any underlying medical conditions and determine if your medications could make Viagra dangerous to your health. 

Once you have your prescription, you can visit any local pharmacy to order Viagra or a cheaper generic form of the drug. 


References

  1. Derry, F., Hultling, C., Seftel, A. D., & Sipski, M. L. (2002). Efficacy and safety of sildenafil citrate (Viagra®) in men with erectile dysfunction and spinal cord injury: a review. Urology, 60(2), 49-57.
  2. Meyer, J. P., Gillatt, D. A., Lockyer, R., & Macdonagh, R. (2003). The effect of erectile dysfunction on the quality of life of men after radical prostatectomy. BJU international, 92(9), 929-931.
  3. Nurnberg, H. G., Seidman, S. N., Gelenberg, A. J., Fava, M., Rosen, R., & Shabsigh, R. (2002). Depression, antidepressant therapies, and erectile dysfunction: clinical trials of sildenafil citrate (Viagra®) in treated and untreated patients with depression. Urology, 60(2), 58-66.
  4. Morales, A., Gingell, C., Collins, M., Wicker, P. A., & Osterloh, I. H. (1998). Clinical safety of oral sildenafil citrate (Viagra TM) in the treatment of erectile dysfunction. International Journal of Impotence Research, 10(2), 69-73.
  5. Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. (1998). Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 338(20), 1397-1404.
  6. Kaplan, S. A., Reis, R. B., Kohn, I. J., Ikeguchi, E. F., Laor, E., Te, A. E., & Martins, A. C. (1999). Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction. Urology, 53(3), 481-486.

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