How to Take Sildenafil for Erectile Dysfunction

Your healthcare provider just prescribed sildenafil (generic Viagra®) for your erectile dysfunction (ED) symptoms. Awesome! We’re glad to hear you’ve got a treatment. 

You’re probably excited to get your mojo back. But it’s also understandable if your head is swimming with questions.

Like other PDE5 inhibitors, sildenafil is a safe and proven treatment for ED — if used as directed. It’s been FDA-approved since 1998, after all.

PDE5 is short for phosphodiesterase type 5, and it’s an enzyme that’s part of a pathway that impacts blood flow to the penis. PDE5 inhibitors work by inhibiting the action of the enzyme, improving blood flow to your member…and tada — erection!

So, what should you know before taking it? We’ll dig into how to use sildenafil for ED, what to do if you miss a dose and which side effects and interactions to be aware of.

Like any medication, following your healthcare provider’s medical advice is crucial. And yet, it’s not always easy to remember complicated dosing guidelines.

Let’s break it down in simple-to-understand terms.

Typical Sildenafil Dosage

Healthcare providers can prescribe sildenafil tablets in different doses. The most common are:

• 25 milligrams

• 50 milligrams

• 100 milligrams

A typical starting dose of sildenafil is 50 milligrams, which you’d take 30 minutes to four hours before sexy time.

Your provider may adjust your dosage depending on your needs and how you respond to the medication.

It’s also possible to be prescribed doses in multiples of 20 mg, including 20 mg, 40 mg, 60 mg and 80 mg. In these cases, the tablets you have would actually be the generic form of Revatio, a medication that has the same active ingredient as Viagra but is FDA approved for a different condition (although it can be prescribed off label for ED).

When to Take Sildenafil

Unlike some other ED meds, you don’t take sildenafil every day. Instead, you’ll pop one as needed before sexual activity — at least about 30 minutes to an hour before, in most cases. And you shouldn’t take it more than once a day.

Just so you’re aware, the effects typically last up to four hours.

What Foods to Avoid Before Taking Sildenafil

Some meds can upset your stomach if you don’t take them with food. That’s not the case with sildenafil. You can take this ED medication with or without food.

Having said that, high-fat meals can impact the absorption of sildenafil and lead to (literally) flimsy results.

Grapefruit juice can also mess with how the body processes sildenafil. So if you’re a half-grapefruit in the a.m. kinda guy, mention that to your healthcare provider.

What to Do If Sildenafil Doesn’t Work

Your daily dosage should never exceed 100 milligrams — that’s bad-news territory. Not getting results from a 100-milligram dose of sildenafil? Don’t try to take more.

If you’re wondering why sildenafil isn’t helping with your lackluster erections, it might be that you need:

• A different dose

• A different ED medication

• Another kind of treatment altogether (like therapy for psychological ED)

• To better address underlying causes of ED

Additionally, taking sildenafil too early (we’re talking more than a few hours before having sex) won’t produce the effects you’re looking for. Your erection is likely to wear off by the time the moment strikes.

Yeah, that means you have to do a bit of sex planning when taking sildenafil. But you might be surprised at how sexy the anticipation can be — for you and your partner. 

Can I Take Expired Sildenafil?

Avoid taking sildenafil if it’s expired. According to the FDA (U.S. Food and Drug Administration), this is why you should skip taking and safely dispose of expired meds:

• They might be less effective.

• They might be harboring bacteria (ew).

• Their chemical composition could be altered, making them unsafe.

How can you tell if meds are expired? Check the label for a date, likely next to the abbreviation “Exp.”

Want more tips on how to get the most out of sildenafil? Read our guide on how to take Viagra for best results.

Good news! It doesn’t really matter if you forget to take sildenafil because it’s designed for you to take it as you need it.

But be careful about accidentally doubling up on doses. Missing a dose before sex is no big deal — it might just impact the quality of your erection. However, forgetting you already took sildenafil and taking another dose within 24 hours can lead to complications if you go over 100 milligrams.

More on that below.

When taking any new drug, you should be aware of the potential side effects. 

The most common side effects of sildenafil include:

• Headaches 

• Flushing

• Stomach upset

• Nasal congestion

• Muscle and back pain

• Nausea 

• Rash

• Dizziness

• Blurred vision

Most of these mild side effects will go away on their own as your body adapts to taking sildenafil.

But sildenafil also comes with some more rare but potentially serious side effects like:

• Sudden loss of vision (potentially a sign of non-arteritic anterior ischemic optic neuropathy or NAION)

• Loss of hearing

• Allergic reaction 

• Priapism (an erection lasting longer than four hours)

If you experience any of these symptoms after taking sildenafil, seek immediate medical attention.

And FYI: Even mild side effects can impact your life. If you get an upset stomach every time you take sildenafil, talk with a healthcare professional. They may recommend changing your dose or switching medications altogether. 

Read more about potential sildenafil reactions in our sildenafil side effects guide.

Another thing: Sildenafil isn’t right for everyone. It might be dangerous to use sildenafil if you have certain medical conditions or take certain drugs.

Here’s what to consider:

• Heart problems. If your healthcare provider told you not to engage in sexual activity because of a heart condition (like a history of heart attack, heart disease, heart failure, angina or arrhythmia, also known as an irregular heartbeat), it’s probably best to abstain from sex and sildenafil.

• Taking medications for high blood pressure. Using sildenafil when you take medications for high blood pressure or pulmonary arterial hypertension could cause a dangerous, potentially life-threatening dip in blood pressure. Avoid taking sildenafil with nitrates, alpha-blockers or other blood pressure meds like riociguat.

• Priapism risk. If you have a condition — like sickle cell anemia, leukemia, Peyronie’s disease or multiple myeloma — that puts you at higher risk of priapism, you should avoid sildenafil.

• Retinitis pigmentosa. There’s not enough available data to say whether it’s safe for people with this eye disease to take sildenafil.

• Recreational drug use. Sildenafil can interact with the nitrites found in certain recreational drugs popularly known as “poppers,”, causing a dangerous drop in blood pressure.

• Other PDE5 inhibitors. Don’t mix sildenafil with other ED drugs, like Cialis®, Levitra®, Revatio® (another brand name for sildenafil) or Stendra®. This can put you at risk for low blood pressure. More of something isn’t always better! 

• Other drugs. Aside from heart medications and other PDE5 inhibitors, taking sildenafil with ritonavir, ketoconazole, itraconazole or clarithromycin (an antibiotic) can increase the concentration of sildenafil in your body and make you more likely to experience side effects.

• Supplements. Talk with a healthcare professional before mixing sildenafil with supplements, which aren’t regulated in the same way as prescription drugs.

Learn more about health and drug interactions in our sildenafil interactions guide.

If you’re living with ED symptoms, you’re not alone. ED affects millions of men worldwide. 

Sildenafil can make it easier to get and keep an erection so you can enjoy a fulfilling sex life.

Here’s what to remember when taking sildenafil for ED:

• Take it at least 30 to 60 minutes and no more than four hours before sexual stimulation. Also, avoid high-fat foods or meals that can slow absorption.

• Don’t mix sildenafil with medications that can cause dangerous interactions. Unsure whether your meds are safe to combine with sildenafil? Ask a healthcare professional. 

• Combine sildenafil with healthy habits. Regular exercise, a balanced diet and quality sleep can maximize your overall health and sexual well-being.

• There are alternative treatments if it doesn’t work for you. Other oral erectile dysfunction medications include tadalafil (generic for Cialis), avanafil (Stendra), vardenafil and hard mints chewable ED meds. Your healthcare provider might also recommend adjusting your sildenafil dosage.

Ready to find an erectile dysfunction treatment that works for you? Consult with one of our online providers to learn more about your options.