Brand Viagra ( Sildenafil Citrate )

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Brand Viagra (sildenafil citrate) is the original, innovative oral treatment for erectile dysfunction (ED), manufactured by Pfizer. It belongs to the phosphodiesterase type 5 (PDE5) inhibitor class. When taken as needed and combined with sexual stimulation, sildenafil works by relaxing the smooth muscles and widening the blood vessels in the penis, which increases blood flow and helps to produce and maintain a firm erection sufficient for satisfactory sexual activity. Brand Viagra is available in two standard strengths: 50 mg and 100 mg.

Usual adult dose: The recommended starting dose for most patients is 50 mg taken orally as needed, approximately one hour before anticipated sexual activity. Based on efficacy and tolerability, the dose may be increased to a maximum of 100 mg or decreased to 25 mg (using a scored tablet). The maximum recommended dosing frequency is once daily. A high‑fat meal may delay the onset of action, so taking the tablet on an empty stomach or after a light meal is best.

Dosage form: Oral film‑coated tablets: 50 mg (blue, rounded‑diamond‑shaped, debossed with “Pfizer” and “VGR 50”) and 100 mg (blue, rounded‑diamond‑shaped, debossed with “Pfizer” and “VGR 100”).

Onset of action: Peak plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) under fasting conditions. Many men notice an improvement in erectile function in as little as 30 minutes. Sexual stimulation is required for an erection to occur.

Duration of action: The ability to achieve an erection in response to sexual stimulation is maintained for up to 4 to 6 hours after a dose. The elimination half‑life of sildenafil and its active metabolite is approximately 4 hours.

Alcohol recommendation: Alcohol consumption should be limited or avoided while taking Brand Viagra. Drinking alcohol can temporarily reduce the ability to get an erection and may increase the risk of side effects such as headache, dizziness, flushing, and a drop in blood pressure.

Most common side effects: Headache (16%), facial flushing (10%), dyspepsia (indigestion, 7%), nasal congestion (4%), dizziness (3%), and visual disturbances (e.g., blue‑tinged vision, increased sensitivity to light, blurred vision; 3%). These effects are generally mild to moderate and temporary. A prolonged and painful erection lasting more than 4 hours (priapism) is a rare but serious side effect requiring immediate medical attention. Sudden vision loss and sudden hearing loss have also been reported rarely.

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General Information about Brand Viagra (Sildenafil Citrate)

• INN (International Nonproprietary Name): Sildenafil Citrate
• Brand names available in Canada: Viagra® (Pfizer Canada Inc.) is the original brand‑name product. It is available as film‑coated tablets in 25 mg, 50 mg, and 100 mg strengths. Generic sildenafil tablets are also widely available. Our pharmacy dispenses the authentic Pfizer brand as prescribed.
• ATC code: G04BE03 (urologicals, drugs used in erectile dysfunction)
• Dosage forms and strengths: Oral film‑coated tablets: 50 mg and 100 mg of sildenafil citrate. The 25 mg tablet is also available. All strengths are blue and rounded‑diamond‑shaped with distinctive debossing.
• Manufacturers in Canada: Pfizer Canada Inc. (Brand Viagra).
• Registration status in Canada: Approved by Health Canada. Marketed (DINs: 02230918 for Viagra 25 mg, 02230919 for Viagra 50 mg, 02230920 for Viagra 100 mg). First approved in 1999.
• OTC / Rx classification: Prescription only (Rx). Sildenafil is a Schedule I drug under the Controlled Drugs and Substances Act and requires a valid prescription from a licensed Canadian healthcare professional.

Mechanism of Action and Pharmacology

Sildenafil citrate is a potent and selective inhibitor of cyclic guanosine monophosphate (cGMP)‑specific phosphodiesterase type 5 (PDE5). During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum of the penis. Nitric oxide activates the enzyme guanylate cyclase, which increases the intracellular concentration of cGMP. This leads to relaxation of the smooth muscle in the penile arteries and the corpus cavernosum, allowing blood to flow in and produce an erection. PDE5 normally breaks down cGMP, terminating the erectile response. By inhibiting PDE5, sildenafil allows cGMP to accumulate and persist, significantly enhancing and prolonging the erection in the presence of sexual stimulation. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum smooth muscle without sexual stimulation.

Sildenafil is rapidly absorbed after oral administration, with peak plasma concentrations reached within 30 to 120 minutes (median 60 minutes) under fasting conditions. The absolute bioavailability of oral sildenafil is approximately 40%. Food, particularly a high‑fat meal, delays absorption and reduces peak concentration. Sildenafil is metabolized primarily by the cytochrome P450 isoenzyme CYP3A4 (major route) and CYP2C9 (minor route), to an active N‑desmethyl metabolite that possesses approximately 50% of the pharmacologic activity of the parent drug. The elimination half‑life of sildenafil and its active metabolite is approximately 4 hours. Sildenafil is excreted as metabolites predominantly in the faeces (80%) and to a lesser extent in the urine (13%).

Indications

• Treatment of erectile dysfunction (ED), which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. Brand Viagra is effective for ED of various aetiologies, including organic, psychogenic, and mixed causes. It is only active when there is adequate sexual stimulation.
• Not indicated for use in women or in children and adolescents under 18 years of age.

Important Warnings and Precautions

At‑risk groups

• Pregnancy and breastfeeding: Brand Viagra is not indicated for use by women. There are no adequate and well‑controlled studies of sildenafil in pregnant or breastfeeding women.
• Paediatrics (< 18 years): Sildenafil is not approved for use in children or adolescents for the treatment of erectile dysfunction.
• Elderly: No dose adjustment is required based on age alone. However, elderly patients may be more sensitive to the vasodilatory effects of sildenafil, and the risk of orthostatic hypotension may be increased. A lower starting dose of 25 mg may be considered.
• Cardiovascular disease: Sexual activity carries a degree of cardiac risk for patients with pre‑existing cardiovascular disease. Sildenafil has vasodilatory properties and can cause mild and transient decreases in blood pressure. It is contraindicated in patients with severe cardiovascular disease, including unstable angina, severe heart failure, and recent myocardial infarction or stroke (within the last 6 months).
• Use with nitrates: Sildenafil potentiates the hypotensive effects of nitrates and nitric oxide donors (e.g., nitroglycerin, isosorbide mononitrate, amyl nitrate). Concomitant use is absolutely contraindicated and can lead to a life‑threatening drop in blood pressure. Patients must be counselled not to take Viagra with any form of nitrate medication.
• Use with guanylate cyclase stimulators: Concomitant use of sildenafil with riociguat (Adempas®) is contraindicated due to the risk of severe hypotension.
• Priapism: Prolonged erection (longer than 4 hours) has been reported rarely with PDE5 inhibitors. This is a medical emergency that can lead to permanent penile tissue damage and impotence. Men who experience an erection lasting more than 4 hours should seek immediate medical attention.
• Vision loss: Non‑arteritic anterior ischaemic optic neuropathy (NAION), a cause of sudden vision loss, has been reported rarely. The risk may be increased in patients with a small cup‑to‑disc ratio, those with hypertension or diabetes, and smokers. Men who experience sudden vision loss should stop the drug and seek immediate medical care.
• Hearing loss: Sudden decrease or loss of hearing has been reported. Patients should discontinue sildenafil and seek prompt medical attention if this occurs.
• Renal impairment: No dose adjustment is required in mild to moderate renal impairment. In patients with severe renal impairment (creatinine clearance < 30 mL/min), a starting dose of 25 mg is recommended; higher doses should be used with extreme caution.
• Hepatic impairment: The metabolism of sildenafil is reduced in patients with hepatic impairment (e.g., cirrhosis). A starting dose of 25 mg is recommended. Higher doses should be used only with careful titration and monitoring.
• Anatomical deformation of the penis: Use with caution in patients with anatomical deformation (e.g., Peyronie’s disease, angulation, cavernosal fibrosis) or conditions predisposing to priapism (e.g., sickle cell anaemia, multiple myeloma, leukaemia).
• Allergy: Do not take Brand Viagra if you have a known hypersensitivity to sildenafil citrate or any of the tablet’s excipients.

Driving and alcohol

Sildenafil may cause dizziness, blurred vision, or altered colour perception. Patients should be aware of how they react to the medication before driving or operating heavy machinery. Alcohol consumption should be limited, as it may impair the ability to achieve an erection, lower blood pressure, and worsen the side effects of sildenafil such as headache and dizziness.

Dosage Instructions

• Standard adult dose: The recommended starting dose is 50 mg taken orally as needed, approximately one hour before sexual activity. Based on efficacy and tolerability, the dose may be increased to a maximum of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once daily. For patients who find the 100 mg dose too strong, or who have risk factors for adverse effects, the 50 mg dose is often sufficient. The tablets are scored and can be divided to achieve a 25 mg dose if prescribed.
• Patients with renal or hepatic impairment, or those taking CYP3A4 inhibitors or alpha‑blockers: A starting dose of 25 mg is recommended; the 100 mg dose may be contraindicated or used only with specialist guidance.
• Administration: Swallow the tablet whole with a glass of water. For a faster onset, take on an empty stomach or after a light meal. A high‑fat meal can significantly delay absorption and reduce peak effect. Sexual stimulation is required for an erection to occur. Do not take more than one dose per day.
• Missed dose: Brand Viagra is taken as needed, not on a fixed daily schedule, so a missed dose is not applicable.

Side Effects and Contraindications

• Very common side effects (≥ 10%): Headache (16%) and flushing (10%).
• Common side effects (1‑10%): Dyspepsia (7%), nasal congestion (4%), dizziness (3%), and visual disturbances (colour tinge, increased sensitivity to light, blurred vision; 3%). At the 100 mg dose, the frequency of these effects is slightly higher than at 50 mg.
• Uncommon but serious side effects: Priapism, sudden vision loss (NAION), sudden decrease or loss of hearing, and serious cardiovascular events (myocardial infarction, stroke, ventricular arrhythmia) occurring in temporal association with sexual activity and sildenafil use. Hypotension and syncope have also been reported.
• Contraindications: Concomitant use of organic nitrates in any form, or nitric oxide donors (e.g., amyl nitrite). Concomitant use of riociguat. Known hypersensitivity to sildenafil citrate or any component of the product. Severe cardiovascular disease or conditions in which sexual activity is inadvisable. Recent myocardial infarction (within 6 months) or stroke. Severe hepatic impairment. The contraindications apply regardless of the dose strength.

Drug Interactions

• Nitrates and nitric oxide donors — contraindicated: See warnings.
• Guanylate cyclase stimulators — contraindicated: Riociguat.
• Alpha‑blockers: Additive hypotension; start sildenafil at 25 mg, and avoid the 100 mg dose until the patient has been stable on the alpha‑blocker.
• Potent CYP3A4 inhibitors (e.g., ritonavir, ketoconazole): Significantly increase sildenafil levels; maximum dose is 25 mg, not more than once every 48 hours with ritonavir. The 100 mg dose is contraindicated with these inhibitors.
• Moderate CYP3A4 inhibitors (e.g., erythromycin, clarithromycin): May increase sildenafil exposure; monitor for side effects, consider a lower dose.
• Antihypertensives: Additive blood‑pressure‑lowering effect; monitor.
• Alcohol: Increases risk of hypotension and headache; limit intake.

Practical Advice

• Administration: Take Brand Viagra exactly as prescribed. For best results, take on an empty stomach. The medication works only with sexual stimulation. Do not exceed one dose per day.
• Monitoring: No routine laboratory monitoring is required. Medical evaluation is recommended before starting ED therapy, especially at the 100 mg dose. Seek immediate attention for priapism, vision or hearing loss, or chest pain.
• Storage: Store at room temperature (15‑30 °C) in a dry place. Keep out of reach of children.
• Lifestyle: Address underlying health factors (smoking, alcohol, weight, diabetes, hypertension). Do not combine with other PDE5 inhibitors.
• Emergency: Priapism (> 4 hours) or sudden vision/hearing loss requires emergency care. Inform all healthcare providers of sildenafil use before any treatment, especially if nitrates are being considered for chest pain.

Alternative Medications

• Tadalafil (Cialis®): A PDE5 inhibitor with a much longer duration of action (up to 36 hours), available as a tablet for daily or on‑demand use. In Canada, it is available as a brand name and generic. It is less affected by food intake.
• Vardenafil (Levitra®): Another PDE5 inhibitor, available as an oral tablet with a duration similar to sildenafil. A generic version is available. Levitra is also available in an orally disintegrating tablet formulation.
• Avanafil (Stendra®): A fast‑acting PDE5 inhibitor that can start working in as little as 15 minutes. It is available as a brand‑name prescription drug in Canada.
• Alprostadil (Caverject®): An injectable or intraurethral pellet that stimulates an erection directly by relaxing penile smooth muscle. It is used when oral PDE5 inhibitors are ineffective or contraindicated.
• Non‑pharmacological options: Vacuum erection devices (VEDs), penile implants, and psychological counselling for psychogenic ED are alternatives or adjuncts to drug therapy.

Clinical Efficacy

Brand Viagra has been proven effective for the treatment of erectile dysfunction in numerous double‑blind, placebo‑controlled clinical trials. At the 50 mg dose, approximately 74% of men report improved erections, and at the 100 mg dose, about 82% experience improvement, compared with 24% on placebo. Response rates are higher in men with psychogenic ED. The clinical evidence for Brand Viagra is the most extensive of any PDE5 inhibitor, with over two decades of post‑marketing experience confirming its efficacy and safety profile. The 50 mg dose is an effective starting point for most men, while the 100 mg dose provides the maximum therapeutic effect for those who need it. Both strengths have a well‑characterised, manageable side‑effect profile.

Important:

Brand Viagra (sildenafil citrate) is a prescription medication that should be used only under the supervision of a qualified healthcare professional. The most critical safety warning is that sildenafil must never be taken with any form of organic nitrate (e.g., nitroglycerin, isosorbide mononitrate, “poppers”) as this combination can cause a severe, sudden, and potentially fatal drop in blood pressure. This contraindication applies to all doses. If you experience chest pain or an erection lasting longer than 4 hours, stop using the medication and seek emergency medical attention immediately. The 100 mg dose is the maximum approved dose; do not exceed one tablet per day. It is not suitable for patients with severe kidney or liver problems, or for those taking certain medications (e.g., ritonavir, ketoconazole). Sexual activity carries a risk to the heart in patients with pre‑existing cardiovascular disease. If you are taking alpha‑blockers, you should be stable on that therapy before starting sildenafil, and the dose of sildenafil should be reduced. Do not drink large amounts of alcohol. This product is for adult men and is not intended for use by women or children. If you experience sudden vision or hearing loss, seek immediate medical attention. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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