Medically reviewed by Thomas Fischer (Pharmacist). This article was written according to medical standards. More Info

Medically reviewed by Thomas Fischer (Pharmacist)More Info

Viagra is the brand name of Sildenafil. It is used as a treatment for the medical condition in men referred to as erectile dysfunction. It is a phosphodiesterase five inhibitor. It is a very well known medication often called the ‘little blue pill.’

What Exactly Is Viagra?

Viagra is a medication aimed at assisting with impotence. It is readily available with a prescription from a doctor or medical health professional. The reason it requires a prescription is that there are certain risks involved with using this medication. These risks include:

A doctor or medical health professional will be able to weigh the benefits of the medication against these risks for a patient, depending on the patient’s unique health conditions. Some contra-indications of Viagra are:

Viagra

Some of the most common side-effects of Viagra are:

All these factors need to be taken into account before it can be deemed appropriate for a patient to take Viagra. The doctor will analyze the patient’s medical profile and then make a decision on whether or not the little blue pill is the appropriate solution for the patient’s erectile dysfunction problem.

Viagra is generally a safe medication for male patients to use as a treatment for erectile dysfunction. It is even allowed to be taken by patients who have diabetes mellitus. The dosage amount that a doctor or medical health professional approves is generally sufficient. The aim is for a patient to obtain a quality erection and sustain it long enough to complete intercourse.

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The Story Behind The Little Blue Pill

Viagra is a popular medication and widely used for the treatment of erectile dysfunction in male patients. It is usually referred to as ‘The Little Blue Pill’ in social circles. As famous as this medication may be, not everyone knows the story of how Viagra came to be the most popular treatment of erectile dysfunction.

It all began in a research facility in England. The Pfizer Pharmaceutical Chemists were trying to find a treatment for hypertension and angina pectoris by using Sildenafil. Hypertension is an ailment of high blood pressure.

Pfizer

Angina pectoris is an ailment affecting the heart where there is usually not enough blood flowing to the heart muscle. Both of these conditions did not relate to the problem of erectile dysfunction in male patients.

As with all new medicines, Sildenafil needed to undergo clinical trials in order for the medication to be approved. During phase one of the clinical trials, it was discovered that Sildenafil had minimal effect in the treatment of angina. It was noted, however, that Sildenafil could induce erections. This became one of the most well-known drug repositions. Pfizer patented the drug under the brand name Viagra in 1996 and marketed it as a medication for treating erectile dysfunction in male patients. 

The FDA approved Viagra as an erectile dysfunction medication in March 1998. This was a remarkable feat, as Viagra was now the first approved oral treatment for the problem of erectile dysfunction in the USA. It was put on the market later that year and became a financial success. The sales would exceed $1 billion in the early 2000s. It jested that Viagra was the little blue pill that was discovered by accident.

What Does Viagra Look Like?

Viagra is very easy to identify. It is blue in color and has a distinctive rounded-diamond shape. It is film-coated and has markings debossed on either side of each tablet. On one side of the tablet, the word Pfizer is debossed. 

Viagra

On the other side of the tablet, the letters VGR, and the dosage strengths are indicated. Thus it may read as VGR 25, VGR 50, and VGR 100. Viagra usually comes in bottles of 30 or bottles of 100 tablets.

How Viagra Works?

Viagra is a very powerful medication. The active ingredient in Viagra is Sildenafil. Sildenafil is also used to treat pulmonary arterial hypertension. It is a phosphodiesterase five inhibitor(PDE5). It works by blocking an enzyme and thus maintains persistent levels of cGMP. The enzyme that the PDE5 blocked is called phosphodiesterase. 

The action of blocking this enzyme and maintaining persistent levels of cGMP ultimately results in regulated blood flow to the penis. It is, however, still necessary for the patient to be sexually stimulated or aroused in order for Viagra to have an effect.

sildenafil working

Viagra cannot cause actual feelings of arousal. It can, however, assist the patient in obtaining an erection once they are already aroused or sexually stimulated. Viagra also causes the dilation of blood vessels in the lungs. This action leads to a decrease in pulmonary blood pressure to the heart and improves its function. This is how Sildenafil assists with pulmonary arterial hypertension.

Viagra is available to patients in a tablet form. The tablet doses are available in 25mg, 50mg, and 100mg. It is recommended that the dosage be limited to one tablet a day. It should be taken anything from 30 minutes to an hour before anticipated sexual activity. The reason for this is that the time it takes for Viagra to be effective may vary from patient to patient.

Can A Patient Become Addicted To Viagra?

Viagra is a prescription medication with the active ingredient being Sildenafil. Sildenafil does not have the addictive properties that some other prescription medications have. With most prescription medicines, patients run the risk of drug dependence or addiction. This is part of the reason why the sale of such medication is controlled and requires a prescription from a doctor or medical health professional.

Becoming dependent on a prescription medication occurs either accidentally or deliberately. A deliberate dependence occurs when a person actively seeks to obtain a medication that they do not have a medical need for. Once it is obtained, it is then abused. When a patient accidentally becomes addicted, the following occurs:

A doctor or medical health professional prescribes a medication for a valid health reason. The medication is potentially addictive. Even though the patient is using the medication for a health reason, the patient becomes dependent on the medication.

Red flags are usually that the patient requires a higher dosage, and that when the patient stops using the medication, they experience withdrawal symptoms. Sildenafil does not affect the pathways in the brain that trigger addiction. There is, however, the issue of ‘psychological addiction,’ which is different from an actual addiction. 

This occurs when a patient convinces themself that they can not perform as effectively without the medication. This type of addiction does not have any real withdrawal symptoms and can occur with any type of medication.

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Clinical Trials & Tests For Viagra

The clinical trials for Sildenafil proved to be better for assisting with erections than angina, which it was originally researched for. Due to this, further testing needed to be done before the company could begin marketing the drug as an effective remedy for erectile dysfunction.

The tests for Viagra to assist with erections were evaluated in 21 trials. These were randomized trials that were double-blind and placebo-controlled. The doses used in these trials were 25mg, 50mg, and 100mg, respectively.

These studies were conducted over a period of up to six months. Some of the studies designs for these were:

In all 21 cases, Viagra showed an improvement with regards to erectile dysfunction in comparison to the placebo. The effectiveness of the product was established by means of a questionnaire. This questionnaire is referred to as the international index of erectile function.

Primary study endpoints from this questionnaire were about the ability to achieve erections and the maintenance thereof post penetration. Other aspects that were questioned were those relating to orgasm satisfaction with intercourse, sexual desire, and general sexual satisfaction.

Over five years, Viagra was administered to more than 3000 patients. These patients experienced erectile dysfunction of different etiologies. To ensure that the patients were diverse, the ages of the patients ranged from 19 to 87.

One study that Viagra undertook was a random double-blind placebo control study with flexible dosages, particularly aimed at patients with diabetes mellitus. Patients with diabetes mellitus that was attributed to erectile dysfunction were started on a 50mg dosage of the medication. They were permitted to either increase their dosage to 100mg or decrease it to 25mg.

By the end of the study, all of the patients were receiving either 50mg or 100mg of Viagra. The improvements for successful erections and penetration, as well as the maintenance of erection, was significant. The difference between the Viagra and the placebo could easily be observed. 

Patients could answer the questions categorically, rating their answers from zero to five. Answering zero to a question would mean no attempt at intercourse or sexual activity, whereas five would mean always. An optional questionnaire was also made available for partners.

Viagra In Different Forms

Viagra is well known in its tablet form as the little blue diamond-shaped pill. Its dosage options are just as well known. The active ingredient in Viagra is Sildenafil. Sildenafil has also become available for treating erectile dysfunction in forms other than tablet form.

These include spray form, powder form, and even in the form of a cream. The article thus far has primarily focused on Viagra in its traditional tablet form.

Viagra In Tablet Form

Viagra pills are the conventional and most popular way of using the medication. It is a film-coated tablet in three dosage options that is taken an hour prior to sexual activity.

Viagra

Viagra In Spray Form

The active ingredient in Viagra is Sildenafil. Researchers have discovered that using Sildenafil as an oral spray may be a solution to the problem of premature ejaculation. Evidence is not yet conclusive, although there are already unverified products on the market that claim to do this.

Viagra In Powder Form

This is basically Sildenafil citrate. It is a crystalline powder that is white. It is available for sale online in this powder form. There is no FDA approval for consuming Sildenafil for erectile dysfunction in this way.

Viagra Cream

This is a topical cream that contains the same active ingredient as Viagra (Sildenafil). It is still in the stage of clinical trials. It is claimed that it will take effect within five minutes after applying to the penis. The research shows that although the cream works pretty fast, its effects only last for 30 minutes.

References:
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  2. VIAGRA- sildenafil citrate tablet, film coated . Pfizer Laboratories Div Pfizer Inc. URL: http://labeling.pfizer.com/showlabeling.aspx?id=652 
  3. U.S. Food and Drug Administration. VIAGRA® (sildenafil citrate) Tablets. URL: https://www.accessdata.fda.gov.
  4. Kim AA, Kent CK, & Klausner JD. Increased risk of HIV and sexually transmitted disease transmission among gay or bisexual men who use Viagra, San Francisco 2000-2001. AIDS. 2002 Jul 5;16(10):1425-8.
  5. Guimarães AC, Malachias MV, Coelho OR, Zilli EC, Luna RL. Use of sildenafil in patients with cardiovascular disease. Arq Bras Cardiol. 1999;73(6):515-26. doi:10.1590/S0066-782X1999001200006. URL: https://www.scielo.br
  6. Huang SA, Lie JD. Phosphodiesterase-5 (PDE5) inhibitors In the management of erectile dysfunctionP T. 2013;38(7):407-19. URL: https://www.ncbi.nlm.nih.gov