Over-the-counter Viagra and Viagra alternatives: what are my options?
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Needing a little help to get an erection isn’t uncommon. One study estimated that nearly 20% of men over 20 in the United States experience erectile dysfunction (ED) at some point in their lives, and that number generally goes up with age (Selvin, 2007).
Despite how common erectile dysfunction is, many people don’t want to talk about it—even with their healthcare providers. One large study estimated that only around 60% of men who experience ED seek help from a medical professional for their condition (Rosen, 2004).
It’s no wonder so many people seek out pills like Viagra over-the-counter (OTC). While many are curious about the best OTC ED pills, you can’t get erectile dysfunction drugs like Viagra over-the-counter. However, many other safe options are available to you. Read on to learn more about ED treatment options.
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Can you get over-the-counter Viagra?
The short (and probably disappointing) answer is no. You can’t get prescription-only ED medications like Viagra over-the-counter. Since 2017, Viagra has been available over-the-counter in the United Kingdom, but there are currently no public efforts to do the same in the US (Bulik, 2017). However, that doesn’t mean getting the treatment you need is difficult. It’s easier than ever to get ED medications safely and discreetly.
Viagra is the most well-known drug for treating erectile dysfunction, but it’s by no means the only option available. It’s part of a class of drugs called PDE-5 inhibitors, which includes:
-
(generic: sildenafil; see Important Safety Information) (generic: tadalafil; see Important Safety Information) (generic: vardenafil) (generic: avanafil)
These drugs can help treat ED by improving blood flow to the penis, allowing for harder, longer-lasting erections. The US Food and Drug Administration (FDA) requires a prescription for all of these medications, including the brand name and generic versions.
Warnings, risks, and side effects
You might see some sources online claiming to offer OTC Viagra. Steer clear. Viagra is one of the most counterfeited drugs in the world. Pfizer, the company that makes brand-name Viagra, has found dangerous substances like printer ink, amphetamines (“speed”), and metronidazole (an antibiotic) in these counterfeit Viagra pills (Pfizer, n.d.).
Viagra and other erectile dysfunction medications come with a risk of potentially dangerous side effects and drug interactions, which is why medical advice from your healthcare provider is essential.
The possible side effects of Viagra and other PDE-5 inhibitors include headache, flushing, upset stomach, vision changes, low blood pressure, stuffy or runny nose, muscle pain, nausea, dizziness, or rash. Priapism, a painful and persistent erection lasting longer than four hours, is a rare but serious potential side effect of ED meds. It’s a medical emergency requiring immediate attention from a healthcare professional to prevent permanent injury (FDA, 2014-b).
Is erectile dysfunction reversible? In most cases, it’s treatable
5 potential over-the-counter Viagra substitutes
While you can’t get the “real deal” over-the-counter, there are some viagra alternatives available OTC that are advertised as treatments for ED. Certain supplements marketed as “natural Viagra” include horny goat weed, red ginseng, yohimbine, l-arginine, and DHEA.
It’s important to note that studies have not directly compared these herbal supplements and prescription erectile dysfunction drugs such as Viagra. Some of these herbal remedies do show promise for improving erections, though. Here’s what you need to know about them:
Red ginseng or Korean ginseng
A study published in 2018 examined 24 different controlled trials with more than 2,000 participants. They concluded that Korean red ginseng might be an effective erectile dysfunction treatment but called for further research to verify their findings (Borrelli, 2018).
Horny goat weed
The effects of this dietary supplement haven’t been tested for treating ED in humans, so we don’t know for sure that it works. However, horny goat weed contains a compound called icariin, which inhibits PDE-5, just like Viagra, Levitra, and Cialis, making it a promising option for treating erectile dysfunction (Dell’Agli, 2008).
Yohimbe/yohimbine
Studies on using yohimbine to treat ED in humans are limited. One study suggests that yohimbe may help men with mild erectile dysfunction successfully achieve and maintain an erection long enough to have sex. More research is needed since this study only included 18 participants (Guay, 2002).
How to talk to your partner about erectile dysfunction
L-arginine
This amino acid has been shown to lower blood pressure by boosting the production of nitric oxide in the body, a chemical that plays an essential role in erections. In fact, some research suggests the supplement may be as effective for treating high blood pressure as lifestyle changes such as diet and exercise (Khalaf, 2019). The research on l-arginine for ED is not as clear, but some small studies have shown that it may make it easier to get an erection or make sex more satisfying, at least when compared to a placebo (Rhim, 2019).
DHEA (dehydroepiandrosterone)
DHEA is a hormone produced by your body that helps make sex hormones like estrogen and testosterone. Although taking supplements containing DHEA can boost levels of DHEA in the body, studies have found they don’t significantly impact testosterone levels and may even increase estrogen levels (Kovac, 2015). High estrogen levels may be associated with erectile dysfunction (Zuniga, 2019).
Bottom line? DHEA probably isn’t a slam dunk for treating your ED. You’re better off asking a healthcare provider about prescription options.
Where to get Viagra safely and discreetly
While you can’t get Viagra or other PDE-5 inhibitors OTC, these medications are easy to get if you have a prescription, so don’t be afraid to discuss your options with a healthcare provider. It’s easier than ever to get ED meds online, shipped discreetly to your home. Some companies offer specific brands, generic versions only, or a combination.
It’s worth knowing about the generic version since there can be a serious price difference between Viagra and its generic alternative (GoodRx, 2021).
Sildenafil is the active ingredient in Viagra and “generic Viagra,” but it’s also used for treating conditions other than ED. Revatio (see Important Safety Information), for example, is also sildenafil, but it comes in different doses than Viagra and is used to treat a lung condition called pulmonary arterial hypertension (PAH) (Barnett, 2006). Generic versions of Revatio may be prescribed off-label to treat ED since sildenafil is the active ingredient.
Viagra and generic Viagra come in three doses: 25 mg, 50 mg, and 100 mg (FDA, 2014-b). But PAH medications like Revatio used off-label to treat ED expand the dosages available. In addition to the 20 mg dose Revatio comes in, it can also be prescribed in 40 mg, 60 mg, 80 mg, and 100 mg doses (FDA, 2014-a).
The recommended starting dose for men with ED is 50 mg of sildenafil, though your care provider might up your dose to 100 mg if 50 mg doesn’t do the trick or lower your dose to 25 mg if you find that 50 mg causes intolerable side effects.
Different types of penis pumps for erectile dysfunction
Viagra alternatives: cock rings and penis pumps
In addition to erectile dysfunction drugs like Viagra and other supplements, products like cock rings and penis pumps can help you get and keep an erection during sex.
A cock ring is a band you wear around your penis. It works by restricting blood flow out of the penis, which can help you maintain a firmer erection. A penis pump, or vacuum constriction device (VCD), uses a vacuum pump to pull blood into the penis. A cock ring can be used to maintain an erection once the penis is erect.
Whatever method you choose to treat erectile dysfunction, ED is a common problem and nothing to be ashamed of. Talk to your healthcare provider about any prescription drugs or supplements you’re taking to ensure there’s no potential drug interaction before starting Viagra, generic sildenafil, or any other ED drugs. Also discuss any health conditions you may have, such as heart disease or high blood pressure. They’ll work with you to get you on the right medication regimen to improve your sex life and sexual function.
References
- Barnett, C. F. & Machado, R. F. (2006). Sildenafil in the treatment of pulmonary hypertension. Vascular Health and Risk Management, 2(4), 411–422. doi: 10.2147/vhrm.2006.2.4.411. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994020/
- Borrelli, F., Colalto, C., Delfino, D. V., et al. (2018). Herbal dietary supplements for erectile dysfunction: A systematic review and meta-analysis. Drugs,78(6), 643-673. doi:10.1007/s40265-018-0897-3. Retrieved from https://link.springer.com/article/10.1007/s40265-018-0897-3
- Bulik, B. (2017). OTC Viagra: Pfizer snags nod for nonprescription sales of the little blue pill for men in the U.K. Retrieved on Aug. 25, 2020 from https://www.fiercepharma.com/marketing/otc-viagra-pfizer-snags-nod-for-non-prescription-sales-uk
- Dell’Agli, M., Galli, G. V., Cero, E. D., et al. (2008). Potent inhibition of human phosphodiesterase-5 by icariin derivatives. Journal of Natural Products,71(9), 1513-1517. doi:10.1021/np800049y. Retrieved from https://pubs.acs.org/doi/10.1021/np800049y
- Dhaliwal, A. & Gupta, M. (2022). PDE5 inhibitor. StatPearls. Retrieved on Aug. 17, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK549843/
- Food and Drug Administration (FDA-a). (2014). REVATIO (sildenafil) label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021845s011,022473s004,0203109s002lbl.pdf
- Food and Drug Administration (FDA-b). (2014). VIAGRA (sildenafil citrate) label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf
- Guay, A. T., Spark, R. F., Jacobson, J., et al. (2002). Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial. International Journal of Impotence Research,14(1), 25-31. doi:10.1038/sj.ijir.3900803. Retrieved from https://www.nature.com/articles/3900803
- GoodRx. (2021). Sildenafil. Retrieved on Nov. 23, 2021 from https://www.goodrx.com/sildenafil
- Khalaf, D., Krüger, M., Wehland, M., et al. (2019). The effects of oral l-arginine and l-citrulline supplementation on blood pressure. Nutrients,11(7), 1679. doi:10.3390/nu11071679. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683098/
- Kovac, J. R., Pan, M., Arent, S., & Lipshultz, L. I. (2015). Dietary adjuncts for improving testosterone levels in hypogonadal males. American Journal of Men’s Health,10(6), NP109-NP117. doi:10.1177/1557988315598554. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1557988315598554#_i7
- Loran, O. B., Ströberg, P., Lee, S. W., et al. (2009). ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt. The Journal of Sexual Medicine,6(10), 2826-2835. doi:10.1111/j.1743-6109.2009.01428.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19817982/
- Pfizer. (n.d.). Avoid Counterfeit VIAGRA (sildenafil citrate). Retrieved on Aug. 17, 2022 from https://www.viagra.com/en/avoid-counterfeits
- Rhim, H. C., Kim, M. S., Park, Y., et al. (2019). The potential role of arginine supplements on erectile dysfunction: A systematic review and meta-analysis. The Journal of Sexual Medicine, 16(2), 223-234. doi:10.1016/j.jsxm.2018.12.002. Retrieved from https://www.jsm.jsexmed.org/article/S1743-6095(18)31362-6/pdf
- Rosen, R. C., Fisher, W. A., Eardley, I., et al. (2004). The multinational Mens Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Current Medical Research and Opinion, 20(5), 607–617. doi:10.1185/030079904125003467. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15171225/
- Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the U.S. The American Journal of Medicine,120(2), 151-157. doi:10.1016/j.amjmed.2006.06.010. Retrieved from https://www.amjmed.com/article/S0002-9343(06)00689-9/fulltext
- Zuniga, K. B., Margolin, E. J., Fazio, A. D., et al. (2019). The association between elevated serum oestradiol levels and clinically significant erectile dysfunction in men presenting for andrological evaluation. Andrologia,51(9), E13345. doi:10.1111/and.13345. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31317572/
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Important Safety Information for Sildenafil (Viagra)
What are the most important things I need to know about VIAGRA® (sildenafil citrate) 25 mg, 50 mg, and 100 mg tablets and generic VIAGRA®?
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.
- VIAGRA® and generic VIAGRA® can cause serious side effects. Serious, but rare, side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis.
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
- sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away
Who should not take VIAGRA® or generic VIAGRA®?
Do not take VIAGRA® or generic VIAGRA® if you:
- Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
- Are allergic to sildenafil, as contained in VIAGRA® and REVATIO®, or any of the ingredients in VIAGRA® or generic VIAGRA® tablets.
- Are a women or a child
When should I call my primary provider?
Call your primary provider right away if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both eyes
- Experience a sudden decrease in or loss of hearing
- Experience chest pain, dizziness, or nausea during sex
- Take too much Viagra or sildenafil citrate
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What are the most common side effects of VIAGRA® and generic VIAGRA®?
The most common side effects are:
- headache
- flushing
- upset stomach
- abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
- stuffy or runny nose
- back pain
- muscle pain
- nausea
- dizziness
- rash
What should I tell my Roman-affiliated provider before taking VIAGRA® and generic VIAGRA®?
Before you take VIAGRA® or generic VIAGRA® , tell your healthcare provider if you:
- Have or have had heart problems such as a heart attack,irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- Have had heart surgery within the last 6 months
- Have pulmonary hypertension
- Have had a stroke
- Have low blood pressure, or high blood pressure that is not controlled
- Have a deformed penis shape
- Have had an erection that lasted for more than 4 hours
- Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including an eye problem called NAION
- Have bleeding problems
- Have or have had stomach or intestinal ulcers
- Have liver problems
- Have kidney problems or are having kidney dialysis
- Have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators such as Adempas® (riociguat)
- Medicines called alpha-blockers such as Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), Jalyn® (dutasteride and tamsulosin HCl), or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA® with alpha-blockers can lead to a drop in blood pressure or to fainting
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir®), indinavir sulfate (Crixivan®), saquinavir (Fortovase® or Invirase®), or atazanavir sulfate (Reyataz®)
- Oral antifungal medicines, such as ketoconazole (Nizoral®) and itraconazole (Sporanox®)
- Antibiotics, such as clarithromycin (Biaxin®), telithromycin (Ketek®), or erythromycin
- Other medicines that treat high blood pressure
- Other medicines or treatments for ED
- VIAGRA® contains sildenafil, which is the same medicine found in another drug called REVATIO®. REVATIO® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA® should not be used with REVATIO® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What is the FDA-approved use of VIAGRA® and generic VIAGRA®?
VIAGRA® (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Roman-affiliated doctors may prescribe VIAGRA® or generic VIAGRA® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment. While this is not an FDA-approved use of the drug, the American Urological Association has included the use of sildenafil citrate in the treatment of PE in its Guideline on the Pharmacologic Management of Premature Ejaculation.
You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see the full Prescribing Information for complete safety information.
Product names referenced herein are trademarks of their respective owners.
Important Safety Information for Tadalafil (Cialis)
What Is The Most Important Information I Should Know About CIALIS® (tadalafil) and generic CIALIS®?
- CIALIS® and generic CIALIS® can cause serious side effects. Serious, but rare, side effects include:
- An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
- Changes in vision. Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
- Sudden decrease or loss of vision. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS® and generic CIALIS®) reported a sudden decrease or loss of vision in one or both eyes. It is uncertain whether PDE5 inhibitors directly cause the vision loss. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS® and generic CIALIS®, and call a healthcare provider right away.
- Sudden loss or decrease in hearing. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS® and generic CIALIS®. It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors. If you experience these symptoms, stop taking CIALIS® and generic CIALIS® and contact a healthcare provider right away.
- ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.
- CIALIS® and generic CIALIS® help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Some form of sexual stimulation is needed for an erection to happen with CIALIS® or generic CIALIS®.
- CIALIS® and generic CIALIS® do not:
- Cure ED
- Increase a man’s sexual desire
- Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
- Serve as a male form of birth control
- Take CIALIS® or generic CIALIS® exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Do not change your dose or the way you take CIALIS® or generic CIALIS® without talking to your healthcare provider.
Who Should Not Take CIALIS® or generic CIALIS®?
Do not take CIALIS® or generic CIALIS® if you:
- Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
- Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
- Take any medicines called “nitrates”
- Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite
- Take any medicines called guanylate cyclase stimulators, such as riociguat
- Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients
When should I call my primary provider?
Call your primary provider right away if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both of your eyes
- Experience a sudden decrease or loss hearing
- Take too much CIALIS® or generic CIALIS®
- Have an allergic reaction to CIALIS® or generic CIALIS®
- Symptoms of an allergic reaction may include:
- Rash
- Hives
- Swelling of the lips, tongue, or throat
- Difficulty breathing or swallowing
Call your healthcare provider or get help right away if you have any of the symptoms of an allergic reaction listed above.
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What Should I Tell My Roman-affiliated Provider Before Taking CIALIS® and generic CIALIS®?
Tell your Roman-affiliated provider about all your medical problems, including if you:
- Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. You should not take CIALIS® and generic CIALIS® if your healthcare provider has told you not to have sexual activity because of your health problems.
- Have pulmonary hypertension
- Have low blood pressure or have high blood pressure that is not controlled
- Have had a stroke
- Have liver problems
- Have kidney problems or require dialysis
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including a condition called NAION
- Have stomach or intestinal ulcers
- Have a bleeding problem
- Have a deformed penis shape or Peyronie’s disease
- Have had an erection that lasted more than 4 hours
- Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia
Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators, such as riociguat (Adempas®), used to treat pulmonary hypertension
- Medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), 4 Jalyn® (dutasteride and tamsulosin HCl) or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS® or generic CIALIS® is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
- Other medicines to treat high blood pressure (hypertension)
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir® , Kaletra® )
- Oral antifungals such as ketoconazole (Nizoral® ), itraconazole (Sporanox® )
- Antibiotics such as clarithromycin (Biaxin® ), telithromycin (Ketek® ), erythromycin (several brand names exist. Please consult your healthcare provider to determine if you are taking this medicine).
- Other medicines or treatments for ED.
- Tadalafil is also marketed as ADCIRCA® for the treatment of pulmonary arterial hypertension. Do not take both CIALIS® or generic CIALIS® and ADCIRCA®. Do not take sildenafil citrate (Revatio®, Viagra®) with CIALIS® or generic CIALIS®.
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What are the most common side effects of CIALIS® or generic CIALIS®?
The most common side effects with CIALIS® and generic CIALIS® are:
- Headache
- Indigestion
- Back pain
- Muscle aches
- Flushing
- Stuffy or runny nose
What is the FDA-approved Use of CIALIS® and generic CIALIS®?
CIALIS® and generic CIALIS® are prescription medicines used to treat erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both.
Roman-affiliated doctors may prescribe CIALIS® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.
You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see the full Prescribing Information for complete safety information.
Important Safety Information for Sildenafil (Revatio)
This Important Safety Information has been adapted from the Prescribing Information for REVATIO®.
What are the most important things I need to know about sildenafil 20 mg tablets?
- Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.
- Sildenafil can cause serious side effects. Serious, but rare, side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking sildenafil and call your healthcare provider right away if you have any sudden vision loss
- sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking sildenafil and contact a doctor right away
Who should not take sildenafil?
Do not take sildenafil if you:
- Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
- Are allergic to sildenafil, as contained in VIAGRA® and REVATIO®, or any of the ingredients in generic sildenafil citrate tablets.
- You’ve ever had blockage of veins in your lungs, which is called pulmonary veno-occlusive disease
- Are a women or a child
Sildenafil contains the same medicine as VIAGRA® (sildenafil citrate), which is used to treat erectile dysfunction (impotence) and REVATIO®, which is used to treat pulmonary hypertension. Do not take sildenafil with VIAGRA, REVATIO, or other PDE5 inhibitors.
When should I call my primary provider?
Call your primary provider if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both eyes
- Experience a sudden decrease in or loss of hearing
- Take too much sildenafil citrate
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What are the most common side effects of generic sildenafil citrate?
The most common side effects are:
- Headache
- Flushing
- Upset stomach
- Abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
- Stuffy or runny nose
- Back pain
- Muscle pain
- Nausea
- Dizziness
- Rash
- Trouble sleeping
- Fever
- Respiratory infection
- Nausea
- Vomiting
- Bronchitis
- Pharyngitis
What should I tell my Roman-affiliated provider before taking sildenafil citrate?
Before you take sildenafil citrate, tell your healthcare provider if you:
- Have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- Have had heart surgery within the last 6 months
- Have pulmonary hypertension
- Have had a stroke
- Have low blood pressure, or high blood pressure that is not controlled
- Have a deformed penis shape
- Have had an erection that lasted for more than 4 hours
- Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including an eye problem called NAION
- Have bleeding problems
- Have or have had stomach or intestinal ulcers
- Have liver problems
- Have kidney problems or are having kidney dialysis
- Have any problem with the shape of your penis or Peyronie’s disease
- Have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Sildenafil may affect the way other medicines work, and other medicines may affect the way sildenafil works, causing side effects.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators such as Adempas® (riociguat)
- Medicines called alpha-blockers such as Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), Jalyn® (dutasteride and tamsulosin HCl), or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA® with alpha-blockers can lead to a drop in blood pressure or to fainting
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir®), indinavir sulfate (Crixivan®), saquinavir (Fortovase® or Invirase®), or atazanavir sulfate (Reyataz®)
- Oral antifungal medicines, such as ketoconazole (Nizoral®) and itraconazole (Sporanox®)
- Antibiotics, such as clarithromycin (Biaxin®), telithromycin (Ketek®), or erythromycin
- Other medicines that treat high blood pressure
- K antagonists (like coumadin or warfarin)
- Other medicines or treatments for ED
- Sildenafil is the same medicine found in VIAGRA® and REVATIO®. REVATIO® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA® should not be used with REVATIO® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What is the FDA-approved use of sildenafil citrate 20 mg tablets?
Sildenafil citrate 20 mg tablets are the generic version of REVATIO®, prescription medicine used to treat pulmonary hypertension. Sildenafil citrate is also the active ingredient in VIAGRA® (sildenafil citrate 25 mg, 50 mg, and 100 mg tablets), which is FDA approved to treat erectile dysfunction (ED).
Roman-affiliated doctors may prescribe sildenafil citrate 20 mg tablets for the treatment of ED or premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.
Please see the Prescribing Information for complete safety information.
Product names referenced herein are trademarks of their respective owners.
