Sildenafil is the active ingredient in Viagra and is available in a generic, unbranded tablet. Sildenafil and Viagra are medically equivalent but Sildenafil is available at a much lower cost. Generic medicines contain the same active ingredient and are equally effective and medically equivalent as the branded products but are available at a lower price. Generic manufacturers have to demonstrate that they are medically identical to the branded product - i.e. they offer the same quality, strength, stability and effectiveness. Visit our Generic Medicine FAQ for more information. The recommended starting dose for sildenafil is one 50mg tablet taken 1 hour before sexual activity. Brands / Synonyms Revatio; Sildenafil Viagra; Viagra; Viagra Indications For the treatment of erectile dysfunction Pharmacology Sildenafil is used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH). Part of the physiological process of erection involves the release of nitric oxide (NO) in the corpus cavernosum. This then activates the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophosphate (c GMP), leading to smooth muscle relaxation in the corpus cavernosum, resulting in increased inflow of blood and an erection. Sildenafil is a potent and selective inhibitor of c GMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of c GMP in the corpus cavernosum. This means that, with Sildenafil on board, normal sexual stimulation leads to increased levels of c GMP in the corpus cavernosum which leads to better erections. Without sexual stimulation and no activation of the NO/c GMP system, Sildenafil should not cause an erection. Mechanism of Action Sildenafil inhibits the c GMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of c GMP in the corpus cavernosum located around the penis. 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Rare but serious adverse effects found through postmarketing surveillance include prolonged erections, severe low blood pressure, myocardial infarction (heart attack), ventricular arrhythmias, stroke, increased intraocular pressure, and sudden hearing loss. Care should be exercised by people who are also taking protease inhibitors for the treatment of HIV infection. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects. Those using protease inhibitors are recommended to limit their use of sildenafil to no more than one 25 mg dose every 48 hours. blocker (typically prescribed for hypertension or for urologic conditions, such as benign prostatic hypertrophy) at the same time may lead to low blood pressure, but this effect does not occur if they are taken at least 4 hours apart. Sildenafil relaxes muscles of the blood vessels and increases blood flow to particular areas of the body. Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as "poppers". Taking sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure. Some medicines can cause unwanted or dangerous effects when used with sildenafil. Tell your doctor about all your current medicines, especially riociguat (Adempas). Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. 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