The molecule that set the standard, prescribed like it matters.
Sildenafil contains the same active ingredient as Viagra and is prescribed as the FDA-approved generic after clinician review, then dispensed by a licensed US pharmacy.
About 10 minutes. No charge unless your clinician approves.
Decades of evidence, in one small tablet.
Sildenafil did not become the reference point for erectile-dysfunction treatment because it was first. It stayed the reference point because the evidence and clinical experience held up.
It is a PDE5 inhibitor, which means it helps preserve the signaling that relaxes blood vessels in the penis during arousal. The distinction matters: sildenafil does not manufacture desire or create an erection in the absence of sexual stimulation. It improves the vascular response when arousal is already present.
Nearly three decades of use have made the molecule unusually well characterized. Clinicians know its common side effects, its important interactions, and the situations where it does not belong, especially nitrate use and certain cardiovascular contexts. That depth of knowledge gives your provider a clinically valuable foundation for the prescribing decision.
Decades of clinical use have made sildenafil deeply familiar to prescribers. Licensed clinician review and licensed pharmacy fulfillment keep that experience connected to a careful prescribing relationship from the first dose forward.
Read the evidence →For men who want the deepest evidence first.
The First Prescription
You want to begin with the category’s best-known reference point rather than the newest formulation. Sildenafil gives your clinician decades of clinical experience to work from.
The Occasional User
You want treatment when it is relevant, not a medication in your routine every day. Sildenafil is built around an on-demand pattern.
The Evidence-First Patient
You care less about novelty than about knowing what a medication does, what it does not do, and where the risks are already well mapped.
Describe your pattern honestly in the assessment. A licensed provider reviews your history and determines the right starting dose, or whether to start at all.
This might not be the right fit if:
- Any use of nitrate medications, including nitroglycerin and isosorbide; combining sildenafil with nitrates can cause a dangerous drop in blood pressure
- Recent heart attack or stroke, or cardiac status your provider considers unstable
- Severe hypotension, or blood pressure that is not adequately controlled
- Alpha-blocker therapy requires provider caution around dosing and timing
- History of non-arteritic anterior ischemic optic neuropathy or certain retinal conditions, at your provider’s discretion
Your intake screens for all contraindications. Every candidate is evaluated by a licensed clinician before any prescription is issued. No prescription is issued without clearance.
Sildenafil, prescribed with care.
FDA-approved generic medication. Prescribed by a licensed provider after clinical review.
- Licensed clinician review of cardiovascular history and current medications
- Sildenafil prescribed only when the provider determines it is appropriate
- Practical use and interaction guidance supplied as part of the plan
- Ongoing access for response, tolerability, and treatment changes
Prescription issued subject to provider judgment. Results vary. Not a guarantee of outcomes.
*Price reflects a 3 month commitment. Other billing options are shown at checkout.
More in Sexual Vitality.
Tadalafil + Sildenafil RDT
Two timing profiles. One individualized prescription.
A clinician-selected compounded rapid-dissolve tablet that brings two familiar timing profiles into one individualized prescription.
Sildenafil / Tadalafil / Oxytocin ODT
When blood flow is only part of the picture.
A compounded three-part prescription for cases where vascular response may not be the only layer worth evaluating.
Tadalafil 5mg Daily
Ready when the moment is. Without timing the moment.
Once-daily tadalafil uses the same active ingredient as Cialis, prescribed as the FDA-approved generic, to move treatment out of the immediate moment. (Generic for Cialis (daily).)
What the research shows
69 percent of intercourse attempts succeeded on sildenafil versus 22 percent on placebo.
The detail
In the two sequential double-blind registration studies, 532 men were randomized to sildenafil 25, 50 or 100 mg or placebo in a 24-week dose-response study, and 329 different men entered a 12-week flexible dose-escalation study. In the last four weeks of the dose-escalation study, 69 percent of all attempts at sexual intercourse were successful on sildenafil compared with 22 percent on placebo, and the mean number of successful attempts per month was 5.9 versus 1.5.1
Across causes of erectile dysfunction, more men reported improved erections than on placebo.
The detail
In a 12-week randomized, double-blind, placebo-controlled fixed-dose trial in 514 men whose erectile dysfunction was organic in 32 percent of cases, psychogenic in 25 percent and mixed in 43 percent, sildenafil significantly increased the ability to achieve and maintain erections at all three doses, and 67 to 86 percent of men across the sildenafil groups reported improved erections compared with 24 percent on placebo.2
In men with diabetes, 56 percent reported improved erections versus 10 percent on placebo.
The detail
In a 12-week multicenter randomized, double-blind, placebo-controlled trial in 268 men with diabetes of about 12 years duration and erectile dysfunction of about 5.6 years, 56 percent of men on sildenafil reported improved erections compared with 10 percent on placebo, and 61 percent versus 22 percent had at least one successful attempt at intercourse.3
Pooled across trials, successful intercourse attempts were higher on sildenafil than placebo.
The detail
In a systematic review and meta-analysis of 27 randomized trials covering 6659 men, results pooled from 14 parallel-group flexible-dose trials showed a higher percentage of successful intercourse attempts on sildenafil than on placebo, 57 percent versus 21 percent, weighted mean difference 33.7, 95 percent confidence interval 29.2 to 38.2, and a greater proportion of men with at least one intercourse success during treatment, 83 percent versus 45 percent, relative benefit increase 1.8, 95 percent confidence interval 1.7 to 1.9.4
Sildenafil 50 mg led the starting doses on efficacy and on adverse events alike.
The detail
In a network meta-analysis of 82 randomized trials covering 47,626 patients, sildenafil 50 mg had the greatest efficacy of the starting doses compared, and also the highest overall rate of adverse events; tadalafil 10 mg had intermediate efficacy with the lowest overall adverse-event rate. The comparison is a trade-off between the two, not a ranking on efficacy alone.5
What it does not show
The trials measured intercourse-attempt success, not sexual desire.
The detail
The endpoints are self-reported intercourse-attempt success and questionnaire scores, collected over 12 to 24 weeks in men who had a partner and were attempting intercourse. They establish that erections adequate for intercourse become more frequent. They do not establish an effect on sexual desire, and the FDA-approved labeling states that sildenafil at recommended doses has no effect in the absence of sexual stimulation.146
Placebo did not do nothing: 45 percent of men on placebo recorded at least one success.
Nothing establishes that sildenafil treats the underlying cause, or that benefit persists after stopping.
The detail
The FDA-approved labeling describes 21 randomized, double-blind, placebo-controlled trials of up to six months in more than 3000 men aged 19 to 87. That programme establishes an effect while the medication is being taken. It does not establish that sildenafil treats the underlying cause of erectile dysfunction, or that any benefit persists once treatment stops.6
No best drug for an individual, and combinations with other treatments are not recommended.
The detail
The class evidence does not name a best drug for an individual, and it does not extend to stacking. In the network meta-analysis the highest-efficacy starting dose was also the highest-adverse-event starting dose. Separately, the labeling states that the safety and efficacy of combinations of sildenafil with other PDE5 inhibitors or with other treatments for erectile dysfunction have not been studied and that such combinations are not recommended.56
- Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction Sildenafil… N Engl J Med. 1998.
- Montorsi F, McDermott TE, Morgan R, Olsson A, Schultz A, Kirkeby HJ, Osterloh IH. Efficacy and safety of fixed-dose oral sildenafil in the treatment of… Urology. 1999.
- Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes… JAMA. 1999.
- Fink HA, Mac Donald R, Rutks IR, Nelson DB, Wilt TJ. Sildenafil for male erectile dysfunction: a systematic review and… Arch Intern Med. 2002.
- Chen L, Staubli SE, Schneider MP, Kessels AG, Ivic S, Bachmann LM, Kessler TM. Phosphodiesterase 5 inhibitors for the treatment of erectile… Eur Urol. 2015.
- FDA-approved prescribing information, VIAGRA (sildenafil citrate) tablets, Pfizer Laboratories Div Pfizer Inc, label published February 2026.DailyMed
Do not use if you have
- Nitrates in any form or riociguat, because the combination can drop blood pressure dangerously
Serious risks
- An erection lasting longer than four hours needs emergency care, because untreated priapism can cause permanent penile tissue damage
- Sudden loss of vision in one or both eyes, or a sudden decrease or loss of hearing, means stopping the medication and seeking medical attention immediately
Commonly reported
- Headache
- Flushing
- Indigestion
- Nasal congestion
- A temporary change in color vision, usually a blue tinge or trouble telling blue from green
These are the effects reported most often, and they were reported more frequently at higher doses in the trials behind the label. Two less common problems are the reason the labeling is emphatic. Alpha-blockers, other blood-pressure medicines, recent cardiac events and the cardiac demand of sexual activity itself are all part of the review before it is prescribed. Sildenafil is an FDA-approved generic dispensed by a licensed US pharmacy, and whether it is appropriate, and at what dose, is a decision your clinician makes from your full intake.
Asked and answered.
You are not charged, and you are not left guessing. Your clinician explains the reasoning and, where it helps, what a better path might look like. Reviews are typically completed in under 24 hours.
Yes. Sildenafil contains the same active ingredient as Viagra and is prescribed here as the FDA-approved generic. A licensed clinician determines whether it fits and which dose is appropriate.
Common effects include headache, flushing, nasal congestion, and indigestion. Sildenafil can also cause visual changes. An erection lasting more than four hours or sudden vision or hearing loss requires urgent medical attention. Nitrates are a major contraindication and are screened during review.
Any time, before your renewal date. No phone calls required.