Viagra vs. Sildenafil



What is Sildenafil?
Sildenafil is the active component in Viagra, but it is also in another drug called Revatio;
So, Sildenafil is both Viagra and something else, Revatio. The Sildenafil in Viagra is made in 3 doses (25 mg, 50 mg, and 100 mg) and is used for the treatment of Erectile Dysfunction (ED). The Sildenafil in Revatio comes only in a 20 mg dose and, in that dose, has been approved for the treatment of Pulmonary Hypertension.
Sildenafil is the generic name of the chemical in both those medications, but only Revatio has been approved for use as a generic medication. So, there is an inexpensive Sildenafil in the 20 mg tablet, but not an inexpensive generic of the 25, 50,100 mg tablets.
Physicians have access to Sildenafil and can write it for any reason, not just to treat pulmonary hypertension, but when they use it to treat ED, it is considered “off label” use–even though it is exactly the same medication as in Viagra. This means that, while sildenafil is in pharmacies, only the generic 20 mg tablet is available for doctors and patients to use as an “off label” generic medication for the treatment of ED.

Soon, a generic form of Viagra will be released and, in practical terms, that means that sildenafil will be available not just as 20 mg tablets, but in 25 mg, 50 mg, and 100 mg tablets as a generic and, when written in those doses, will not be considered “off label” use. However, in those dosages the cost will be far greater than the 20 mg sildenafil presently available at pharmacies.



What does this mean for patients? To review, Viagra, which is Sildenafil, has been approved “for the treatment of erectile dysfunction (ED), including ED patients with diabetes mellitus or following radical prostatectomy.” (PDR) Viagra is available in doses of 25 mg, 50 mg, and 100 mg. However, generic Sildenafil comes only in one size, 20 mg. The FDA approved Sildenafil in the low 20 mg dose for pulmonary hypertension, but since it is the same medication as in Viagra, and only a fraction of the cost, many patients work with their healthcare providers to use sildenafil “off-label” for erectile dysfunction (ED). Many find the cost of the brand sildenafil (Viagra) so high they cannot start the medication nor continue its use.

Most physicians who prescribe Viagra (Sildenafil) start patients on the 50 mg dose and either raise or lower the dose as warranted. One of the benefits of using sildenafil in the 20 mg dose is that you and your healthcare provider can raise or lower the dose more carefully.

A physician might write a prescription for a patient to take 2 of the 20 mg tablets of sildenafil (a 40 mg dose) one hour before sexual activity. Based on effectiveness and tolerance, the physician and patient may find it is appropriate to increase the dose to 60 mg (3 tablets), 80 mg (4 tablets), or the maximum 100 mg (5 tablets). On the other hand, a patient may find that a 20 mg dose (1 tablet) gives the effect he wants. At that dose it may even avoid an annoying side effect. Such fine shifts are not possible with brand sildenafil (Viagra). A physician can only jump from 50 mg to 100 mg if an increase is needed, or drop from 50 mg to 25 mg if a decrease is warranted. These are big jumps in dosages by comparison.

One of the other appealing aspects of the 20 mg tablet (besides the lower cost), is that patients can often adjust the dose with guidance from their healthcare provider based on factors not usually considered. They may find that a 20 mg dose is fine most of the time but that, on occasion, a 40 mg dose gives the man a bit more of what he wants (or a partner wants).

It could be that anxiety becomes an issue with a new relationship or stress at work proves to be more of a distraction than in the past. These issues can interfere with “erotic focus” or “awareness of sensory experience.” Basically, it can take someone out of “the moment” making maintaining an erection a bit more of a challenge. Anything that reduces anxiety is helpful. Moreover, the ability to achieve a robust erection initially supports a positive feedback mechanism that allows a man to focus on his, and his partner’s, experience and not worry about the process.

The ability to use small incremental shifts in dosages allows for continued sexual activity while underlying issues are approached without being clouded by concerns about losing sexual intimacy.