For treatment of pulmonary arterial hypertension:For oral dosage forms (suspension or tablets):Adults—20 milligrams (mg) 3 times a day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 80 mg 3 times a day.Children 1 year of age and older weighing 45 kilograms (kg) or more—20 mg 3 times a day.

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Use of sildenafil oral film is not indicated for use in the pediatric population. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of sildenafil in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving sildenafil. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

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Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. However the dose is usually not more than 40 mg 3 times a day.Children 1 year of age and older weighing 20 to 45 kg—20 mg 3 times a day.Children 1 year of age and older weighing 20 kg or less—10 mg 3 times a day.Children younger than 1 year of age—Use and dose must be determined by your doctor. For oral dosage forms (suspension or tablets):Adults—20 milligrams (mg) 3 times a day. Adults—20 milligrams (mg) 3 times a day.

Product	Dosage	Quantity + Bonus	Price
Viagra Generic	100mg	30 + 4 Pills	60.91€ 58.01€
Viagra Generic	100mg	20 Pills	45.58€ 43.41€
Kamagra Soft Tabs	100mg	84 + 4 Pills	233.05€ 221.95€
Viagra Generic	50mg	270 + 8 Pills	198.48€ 189.03€
Viagra Generic	200mg	120 + 8 Pills	204.80€ 195.05€
Kamagra	100mg	84 + 6 Pills	264.44€ 251.85€
Kamagra Oral Jelly	100mg	90 + 8 Sachets	303.56€ 289.10€
Viagra Generic	150mg	180 + 10 Pills	236.46€ 225.20€
Kamagra	100mg	360 + 6 Pills	839.95€ 799.95€
Viagra Generic	25mg	270 + 8 Pills	184.26€ 175.49€
Viagra Generic	50mg	60 + 4 Pills	83.93€ 79.93€
Kamagra Soft Tabs	100mg	12 Pills	57.55€ 54.81€
Viagra Generic	150mg	270 + 10 Pills	326.61€ 311.06€
Kamagra Oral Jelly	100mg	63 + 7 Sachets	224.18€ 213.50€
Kamagra	100mg	12 Pills	55.64€ 52.99€
Kamagra Soft Tabs	100mg	60 + 4 Pills	180.59€ 171.99€
Viagra Generic	100mg	10 Pills	28.91€ 27.53€

However, the dose is usually not more than 80 mg 3 times a day. Children 1 year of age and older weighing 45 kilograms (kg) or more—20 mg 3 times a day.

Before Using

Adults up to 65 years of age—50 milligrams (mg) as a single dose no more than once a day, 1 hour before sexual intercourse. Your doctor may adjust your dose if needed. Adults 65 years of age and older—25 mg as a single dose no more than once a day, 1 hour before sexual intercourse. For oral dosage form (film):Adults up to 65 years of age—50 milligrams (mg) as a single dose no more than once a day, 1 hour before sexual intercourse. Your doctor may adjust sildenafil 60mg your dose as needed. However the dose is usually not more than 40 mg 3 times a day. Children 1 year of age and older weighing 20 to 45 kg—20 mg 3 times a day.

Brand Name	Recommended Dose	Timing Before Sexual Activity	Max Daily Dose	Note
Sildenafil Max	50 mg	30-60 minutes	100 mg	Take on an empty stomach for faster effect
Virexol	25 mg	30 minutes	50 mg	Do not exceed twice daily
PowerErect	100 mg	15-30 minutes	100 mg	Use with caution in elderly patients
Erosol	50 mg	30-60 minutes	100 mg	Can be taken with or without food

Children 1 year of age and older weighing 20 kg or less—10 mg 3 times a day. Children younger than 1 year of age—Use and dose must be determined by your doctor.

Proper Use

This medicine comes with a patient information leaflet. Read and follow these instructions carefully before you start using sildenafil and each time you get a refill of your medicine. Ask your doctor if you have any questions. You may take this medicine with or without food. Place the film on top of your tongue.

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It will dissolve in your mouth and can be swallowed with saliva without using water or other liquids. Shake the bottle well for at least 10 seconds before each use. Remove the cap by pushing it down and twisting it counter-clockwise. Push the plunger of the syringe, then insert the tip into the bottle while holding the bottle upright on a flat surface. Slowly pull back the plunger until the required dose. For oral dosage forms (suspension or tablets): If you miss a dose of this medicine, take it as soon as possible.

Prepare for your visit

If you see air bubbles in the syringe, repeat the steps. Place the tip of the syringe into you or your child's mouth and point it towards the cheek. This medicine usually begins to work for erectile dysfunction within 30 minutes after taking it. It continues to work for up to 4 hours, although its action is usually less after 2 hours. Use only the brand of this medicine that your doctor prescribed.

Reduce smoking and alcohol intake

Different brands may not work the same way. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Sildenafil can cause side effects like dizziness and headaches.
Always check for allergic reactions before use.
OTC options should be used with caution in high-risk groups.
Be skeptical of claims promising instant results.
Use according to the recommended dose to prevent side effects.
OTC sildenafil may be included in online "male enhancement" products.
Consult reviews and user feedback before purchasing.
Beware of extra charges or hidden fees in OTC purchases.
Keep track of your body's response to medication.
Avoid alcohol to reduce side effects when using sildenafil.
Seek medical help if severe adverse reactions occur.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep out of the reach of children.

Health A - Z

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For treatment of erectile dysfunction:For oral dosage form (tablets):Adults up to 65 years of age—50 milligrams (mg) as a single dose no more than once a day, 1 hour before sexual intercourse. Alternatively, the medicine may be taken 30 minutes to 4 hours before sexual intercourse. Your doctor may adjust your dose if needed.Adults 65 years of age and older—25 mg as a single dose no more than once a day, 1 hour before sexual intercourse.

SILDENAFIL CITRATE

Your doctor may adjust your dose if needed.Children—Use is not recommended.For oral dosage form (film):Adults up to 65 years of age—50 milligrams (mg) as a single dose no more than once a day, 1 hour before sexual intercourse. Your doctor may adjust your dose as needed.Adults 65 years of age and older—25 mg as a single dose no more than once a day, 1 hour before sexual intercourse. Your doctor may adjust your dose as needed.Children—Use is not recommended. For oral dosage form (tablets):Adults up to 65 years of age—50 milligrams (mg) as a single dose no more than once a day, 1 hour before sexual intercourse. Your doctor may adjust your dose if needed.Children—Use is not recommended. Do not keep outdated medicine or medicine no longer needed.

Reaction variability means sildenafil effects differ among individuals.
OTC sildenafil may be less effective than prescription versions.
Some brands claim OTC sildenafil is natural or herbal.
Always verify the ingredient list and active components.
Regular blood pressure monitoring is recommended with use.
OTC sildenafil is often packaged for convenience and privacy.
Side effects may include indigestion, back pain, and dizziness.
The drug is contraindicated in patients with certain eye disorders.
It is essential to understand the legal status in your country.
Use caution with other medications that affect blood flow.
Always purchase from reputable sources to avoid counterfeit products.

Ask your healthcare professional how you should dispose of any medicine you do not use. Store mixed oral liquid in the refrigerator.

Brand Name	Dosage (mg)	Ratings (out of 5)	Available Forms	Price Range (USD)
Sildenafil Max	50	4.2	Tablets, Chewables	10 - 20
Virexol	25	3.8	Tablets	8 - 15
PowerErect	100	4.5	Sublingual Tabs	20 - 30
Erosol	50	4.0	Capsules	12 - 22

Throw away any unused mixed Revatio® oral liquid after 60 days.

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Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.

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Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially: Abnormal penis, including a curved penis or birth defects of the penis—Chance of problems occurring may be increased and this medicine should be used with caution in these patients. It is important that you tell all of your doctors that you take sildenafil. If you need emergency medical care for a heart problem, it is important that your doctor knows when you last took sildenafil.

Country	OTC Availability	Regulations Summary	Date of Legal Change	Notes
USA	No	Prescription required, OTC status not approved	N/A	FDA approved for prescription use
UK	Yes	Sold as a supplement in some stores, regulated as medication in pharmacies	2020	Limited to specific brands
Australia	No	Prescription only	N/A	Strict regulation
Germany	Yes	Over-the-counter sale available in pharmacies	2018	Age restrictions apply

Do not use this medicine if you are also using a nitrate medicine, often used to treat angina or high blood pressure. Some illegal ("street") drugs called "poppers" (such as amyl nitrate, butyl nitrate, or nitrite).

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Arrhythmia (irregular heartbeat, within the last 6 months) or Blood vessel problems (eg, aortic stenosis, idiopathic subaortic stenosis) or Heart attack (within the last 6 months) or Retinitis pigmentosa (an inherited eye disorder) or Stroke (within the last 6 months)—Should not be used in patients with these conditions. Crowded disc or low cup to disc ratio in the eye (an eye disorder) or Hyperlipidemia (high fats in the blood) or Non-arteritic anterior ischemic optic neuropathy or NAION (serious eye condition), history of or Retinitis pigmentosa (an inherited eye disorder) or Smoking—May increase the chance for a serious side effect in the eye called NAION. Stomach ulcer, or history of or—Chance of problems occurring may be increased. It is not known if the medicine is safe for use in these patients. The effects may be increased because of slower removal of the medicine from the body.

How to get a lab test

Sickle-cell anemia (blood disorder)—Sildenafil should be used with caution in these patients as problems with prolonged erection of the penis may occur. Pulmonary arterial hypertension (high blood pressure in the lungs) or Pulmonary veno-occlusive disease or PVOD (a type of lung disease)—Use with caution. Use sildenafil sildenafil spray exactly as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. If too much is used, the chance of side effects is increased. Do not use this medicine if you also use riociguat (Adempas®). If you will be taking this medicine for pulmonary arterial hypertension, your doctor will want to check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. If you take sildenafil for pulmonary arterial hypertension, do not take Viagra®, Vibrique™ or other PDE5 inhibitors, including tadalafil (Cialis®) or vardenafil (Levitra®).

Sildenafil's patent expired, leading to generic OTC options.
OTC sildenafil may have different dosing guidelines.
Be aware of expiry dates on over-the-counter products.
Pharmacists can provide advice on safe use of OTC sildenafil.
Some OTC products include additional herbal ingredients.
OTC sildenafil is often marketed as a libido booster.
Consult a healthcare provider before beginning OTC treatment.
It's essential to distinguish between authorized and illegal sales.
OTC sildenafil is not suitable for minors.
Keep sildenafil out of reach of children.
Proper storage ensures medication potency over time.

Mit Fernheiler Hans-Ulrich BURKHARD

Sildenafil Alternatives Available Over the Counter