GUEST POST: How to take Viagra (sildenafil) – and get the best results
by Dr Deborah Lee, Dr Fox Online Pharmacy
Viagra (sildenafil) – ‘the little blue tablet ‘ – has been available in the UK for over 25 years. Viagra is the brand name. The drug name is sildenafil. In this post I will continue calling it Viagra for simplicity.
3.5 million prescriptions were issued by the NHS in 2023-2024. However, in addition, many men take it privately, having purchased it online. Internet pharmacies offer a quick and discreet way to obtain Viagra without the embarrassment and anxiety of needing to see a GP.
But there are many questions. Does Viagra work? How should a man take Viagra? What if it’s not effective? What else is important? What to do if Viagra fails? What are the pitfalls of buying Viagra online?
I’m going to answer all these questions, so read on and find out below.
What is Viagra?
Viagra is a type of medicine known as a phosphodiesterase -5 inhibitor (PDE5i). It is used in men to improve the quality of an erection, to make the erection hard enough to have vaginal penetration.
How does Viagra work?
The penis becomes erect when blood vessels inside it become dilated and engorged with blood. The spongy tissue that runs along the middle of the penis – the corpora cavernosa – are lined by smooth muscle cells. This smooth muscle needs to relax to allow enough blood to fill the tissue space to make the penis hard and rigid.
Smooth muscle relaxes under the action of a peptide called cyclic GMP (c-GMP). C-GMP is broken down by the enzyme, PDE-5. Viagra inhibits PDE-5 – meaning c-GMP levels stay higher for longer, helping maintain a good erection for a longer time period.
How to take Viagra
It’s vital to understand how to take Viagra and take it as directed. Many misunderstandings exist about how to take it. Some of the early trials of Viagra quoted a success rate of 90%. However, more recently, many men have found that it is not having the desired effects. This could be for many reasons, but the good news is that things can be improved. For example, in one trial, 55% of men who were unhappy with their experience with Viagra achieved success after re-education and counselling. Have a look at the following tips.
Tips on how to take Viagra
- Take Viagra 30-60 minutes before you plan to have sex. Most men start with a 50 mg dose. In some circumstances, you may be advised to start with the lowest dose of 25 mg. Take it on an empty stomach – so you should not have eaten anything for 4 hours before taking it. Do not crush the tablet; swallow it whole with water.
- Viagra takes on average 60 minutes to be effective, but this varies from 30 minutes to 2 hours. Don’t try too early – give it time to be absorbed into the bloodstream. You won’t miss the boat! It lasts for 4 hours, so there is plenty of time.
- You do need sexual stimulation – it’s not a magic pill! Unless this happens, you won’t develop an erection. Some research shows it works best if you involve your partner in the decision to take Viagra.
- You must not take Viagra with heart medication such as nitrates (such as nitroglycerine – GTN, isosorbide mononitrate and isosorbide dinitrate), alpha blockers (such as doxazosin and prazosin), antifungal medications (such as itraconazole and ketoconazole), or the antibiotics erythromycin and clarithromycin. Never take any other ED drugs at the same time as Viagra. Also, avoid grapefruit juice, which can interact with the breakdown of Viagra and cause higher blood levels.
- You can drink 2-3 units of alcohol with Viagra, but it’s not sensible to drink heavily.
- Anxiety affects the efficacy of Viagra. Try to stay calm and focused. Viagra has a great track record. If you can relax, Viagra has the best chance of helping you.
- Always read the Patient Information Leaflet (PIL) before taking Viagra.
What if Viagra doesn’t work
Men often find they need to try several times before they are successful with Viagra. If you take it and it fails, try again with careful adherence to the above advice. Research suggests you need to try as many as 6 times before accepting that Viagra isn’t working for you.
Do not increase the dose without speaking to your GP or healthcare provider. 100 mg is the highest dose.
If you’ve tried several times at the highest dose, it’s time to consider alternatives. There are four different PDE5i’s, all of which have slightly different advantages and disadvantages.
- Cialis (tadalafil) – The effects last for 36 hours, hence it has been termed ‘the weekend pill’ – you can take it on Saturday and it’s still working on Sunday! You can also take a low dose of Cialis every day, meaning you can be spontaneous about having sex.
- Levitra (vardenafil) – This is 10 times more potent than Viagra. It’s also more tissue selective, so it may have fewer side effects.
- Spedra (avanafil) – This is faster-acting than the other PDE5is. It has been shown to work within 15 minutes of taking it. It may also cause fewer side effects.
Viagra side effects
Side effects can occur, and these include headache, facial flushing, stuffy nose, dizziness and nausea. These are usually mild and self-limiting.
More serious side effects are rare but can occur. NAION (Non-arteritic anterior ischemic optic neuropathy) can cause sudden loss of vision. Priapism is a painful erection that fails to disappear after 4 hours. This is a medical emergency, and you need to phone 999 or get to A&E without delay.
What other health issues are important?
When you buy Viagra, the doctor or pharmacist will ask questions to assess your suitability for Viagra. High blood pressure, heart disease and diabetes are linked to ED. Also smoking, obesity, drug and alcohol use, and lack of physical exercise. You must answer these questions honestly.
You will not be suitable for Viagra if you have had a recent stroke or heart attack, or have unstable angina or heart failure. Also, for anyone taking nitrates. Your doctor can offer some alternative options, such as prostaglandin E1.
You can help improve your erectile function by addressing each of the lifestyle factors above. Stopping smoking, losing weight, reducing your alcohol intake and taking more regular exercise. Doing this will improve your tissue oxygenation, lower your blood pressure, and improve the health of your artery walls.
How to buy Viagra safely online
The internet is full of fake medicines, which can be dangerous. More than £30 million worth of fake medicines were seized by the MRHA in 2023. Fake Viagra, when tested in a lab, was found to contain paint, talcum powder, printer ink and amphetamines. Always obtain Viagra from a reliable source.
Look for a trusted online pharmacy, which must be registered with the General Pharmaceutical Council and the Care Quality Commission. Prescribing doctors must be registered with the General Medical Council.
Check your medication carefully when it arrives. Look at the packaging for any inconsistencies. Check the expiry date and see that none of the seals have been broken. If you are concerned, report this to the MRHA and don’t take it.
Final thoughts
Viagra can be a lifeline. It is reported to have saved many marriages! However, it does need to be taken carefully. Plus, don’t forget the underlying health conditions that may be related to ED. For some, ED can be a wake-up call that it’s time to do something about improving their health.
Refs:
https://pubmed.ncbi.nlm.nih.gov/12006106
https://pubmed.ncbi.nlm.nih.gov/12414331
https://www.gov.uk/government/news/illegal-medicines-worth-more-than-30-million-seized-in-the-uk-in-2023