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[71][72] In 2008, the FDA forced Pfizer to remove Viva Cruiser, an advergame for Viagra, from appearing on Forbes, after the game failed to disclose risk information about the drug. In February 2007, it was announced that Boots, the UK pharmacy chain, would try over-the-counter sales of Viagra in stores in Manchester, England.

• Contraindicated in patients with severe hepatic impairment (liver disease).
• Dose adjustment may be needed for those with severe renal impairment.
• Use with caution in patients with anatomical penile deformity or Peyronie's.
• Avoid use in patients with a history of retinitis pigmentosa (eye condition).
• Can cause serious cardiovascular events in those with pre-existing heart disease.
• Sexual activity itself poses a cardiac risk; a cardiac stress test may be advised.
• May prolong the QT interval; caution with other QT-prolonging drugs.
• Contains lactose; patients with rare lactose intolerance should be cautious.
• The tablet should be swallowed whole with a glass of water.

Males between the ages of 30 and 65 would be eligible to buy four tablets after a consultation with a pharmacist.

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Sublingual use of sildenafil for erectile dysfunction results in an average onset of action of 15 minutes and lasting for an average of 40 minutes. The preparation steps for synthesis of sildenafil are:[54] Methylation of 3-propylpyrazole-5-carboxylic acid ethyl ester with hot dimethyl sulfate Hydrolysis with aqueous sodium hydroxide (NaOH) to free acid Carboxamide formation with refluxing thionyl chloride/NH4OH Reduction of nitro group to amino group Sildenafil (compound UK-92,480) was synthesized by a group of pharmaceutical chemists led by Simon Campbell[55] working at Pfizer's Sandwich, Kent, research facility in England. It was initially studied for use in hypertension (high blood pressure) and angina pectoris (a symptom of ischaemic heart disease). [56] The first clinical trials were conducted in Morriston Hospital in Swansea. [57] Phase I clinical trials under the direction of Ian Osterloh suggested the drug had little effect on angina, but it could induce marked penile erections.

Raynaud's phenomenon

[58][59] Pfizer therefore decided to market it for erectile dysfunction, rather than for angina; this decision became an often-cited example of drug repositioning. [60][61] The drug was patented in 1996, approved for use in erectile dysfunction by the FDA on 27 March 1998, becoming the first oral treatment approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year. [62] It tadapox tablets soon became a great success: annual sales of Viagra peaked in 2008 at US$1.934 billion. In the US, even though sildenafil is available only by prescription from a doctor, it was advertised directly to consumers on TV (famously being endorsed by former United States Senator Bob Dole and football star Pelé). Numerous sites on the Internet offer Viagra for sale after an "online consultation", often a simple web questionnaire. [75] In 2017, the Medicines and Healthcare products Regulatory Agency (MHRA) enacted legislation that expanded this nationwide,[76] allowing a particular branded formulation of Sildenafil, Viagra Connect (50 mg), to be sold over the counter and without a prescription throughout the UK from early 2018.

Product	Dosage	Quantity + Bonus	Price
Kamagra Oral Jelly	100 mg	90 + 8 Sachets	303.56€ 289.10€	Buy
Cialis Generic	5mg	90 + 6 Pills	115.91€ 110.39€	Buy
Cialis Generic	2.5mg	120 + 6 Pills	128.93€ 122.79€	Buy
Levitra Generic	40mg	60 + 4 Pills	162.37€ 154.64€	Buy
Cialis Generic	20mg	120 + 8 Pills	188.15€ 179.19€	Buy
Viagra Generic	150mg	360 + 10 Pills	423.48€ 403.31€	Buy
Levitra Generic	40mg	180 + 10 Pills	405.06€ 385.77€	Buy
Kamagra Polo	100mg	32 Pills	125.88€ 119.89€	Buy
Cialis Generic	10mg	20 Pills	48.23€ 45.93€	Buy
Viagra Oral Jelly	100mg	21 Sachets	78.66€ 74.91€	Buy
Super Kamagra	160 mg	4 Pills	41.99€ 39.99€	Buy
Viagra Generic	25mg	180 + 6 Pills	154.93€ 147.55€	Buy
Cialis Professional	20mg	60 + 2 Pills	183.83€ 175.08€	Buy
Cialis Soft Tabs	20mg	10 Pills	39.03€ 37.17€	Buy
Super Kamagra	160 mg	12 Pills	101.10€ 96.29€	Buy
Priligy Generic Dapoxetine	60mg	10 Pills	47.63€ 45.36€	Buy
Levitra Professional	20mg	20 Pills	101.00€ 96.19€	Buy

While the sale remains subject to a consultation with a pharmacist, the other restrictions from the trial have been removed, allowing customers over the age of 18 to purchase an unlimited number of pills.

Aspect	Positive Feedback	Negative Feedback	Comments
Effectiveness	Notable improvement in erectile strength	Possible side effects at high doses	Effect varies among individuals
Onset of Action	Usually fast, within 30-60 mins	Sometimes delayed	Depends on food intake and metabolism
Duration	Up to 4-6 hours	May be shorter in some users	varies with dose and health status
Ease of Use	Easy to swallow tablets	None reported	Recommended to take with water
Overall Satisfaction	Mostly positive reviews	Some report side effects	Should be used responsibly

In May 2013, Pfizer, which manufactures stay hard pills Viagra, told the Associated Press they will begin selling the drug directly to people on its website.

• PDE5 inhibitors like sildenafil are first-line oral ED treatments.
• Can improve confidence and sexual relationship satisfaction when effective.
• May be used off-label for pulmonary arterial hypertension (Revatio is different).
• Recreational use without medical need is dangerous and not advised.
• Ensure the pharmacy is verified when purchasing online for authenticity.
• A trial dose under medical supervision may be recommended initially.
• Delayed onset is possible if taken with a large meal, especially fatty foods.
• It is not a hormonal treatment and does not affect testosterone levels.
• Temporary muscle aches and nasal congestion are possible side effects.

Pfizer's patents on Viagra expired outside the US in 2012; in the US they were set to expire, but Pfizer settled litigation with each of Mylan and Teva which agreed that both companies could introduce generics in the US in December 2017.

What is Fildena 120 mg?

The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and increased penile response to sexual stimulation. [49][51] Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection. Other drugs that operate by the same mechanism include tadalafil (Cialis) and vardenafil (Levitra). Sildenafil is broken down in the liver by hepatic metabolism using cytochrome p450 enzymes, mainly CYP450 3A4 (major route), but also by CYP2C9 (minor route) hepatic isoenzymes. The major product of metabolisation by these enzymes is N-desmethylated sildenafil, which is metabolised further.

Available Options

This metabolite also has an affinity for the PDE receptors, about 40% of that of sildenafil. Thus, the metabolite is responsible for about 20% of sildenafil's action. Sildenafil is excreted as metabolites predominantly in the feces (about 80% of administered oral dose) and to a lesser extent in the urine (around 13% of the administered oral dose). If taken with a high-fat meal, absorption is reduced; the time taken to reach the maximum plasma concentration increases by around one hour, and the maximum concentration itself is decreased by nearly one-third. When taken orally, sildenafil for erectile dysfunction results in an average time to onset of erections of 27 minutes (ranging from 12 to 70 minutes). [79][80] In December 2017, Pfizer released its own generic version of Viagra.

• Fildena 120 is a medication used to treat erectile dysfunction in men.
• It contains Sildenafil Citrate, the same active ingredient as Viagra.
• The '120' denotes the dosage in milligrams of Sildenafil.
• Fildena 120 helps increase blood flow to the penis.
• It is available by prescription and should be used under medical guidance.
• The medication typically works within 30-60 minutes after intake.
• It is recommended to avoid high-fat meals; they can delay its effectiveness.
• Possible side effects include headache, dizziness, and flushing.

As of 2018[update], the US Food and Drug Administration has approved fifteen drug manufacturers to market generic sildenafil in the United States. Seven of these companies are based in India.

Precautions & Warnings

Viagra and other products for sexual dysfunction, termed sexuopharmaceuticals, proliferated new types of specialised marketing for such products. [66] Viagra and similar prescription pharmaceuticals were promoted by images in media to the extent of becoming a cultural icon, at the time a relatively new phenomenon known to be permitted only in the United States and New Zealand and which is believed to have significantly contributed to norms regarding male sexuality. [67] One author notes that although the effect of Viagra is only limited to penile blood vessels, advertisements routinely use imagery of couples hugging, smiling and dancing, with the author claiming that pharmaceutical companies were deceptive in the use of such advertisements. In 2000, Viagra sales accounted for 92% of the global market for prescribed erectile dysfunction pills. [69] By 2007, Viagra's global share had plunged to about 50%[70] due to several factors, including the entry of Cialis and Levitra, along with several counterfeits and clones, and reports of vision loss in people taking PDE5 inhibitors. The patent for Pfizer's Viagra sildenafil to treat erectile dysfunction expired in April 2020. In 2026 a chocolate syrup called Boner Bears from Lockout Supplements was recalled through the FDA because of it containing Sildenafil as an undisclosed ingredient. Counterfeit Viagra, despite generally being cheaper,[88] can contain harmful substances or substances that affect how Viagra works, such as blue printer ink, amphetamines, metronidazole, boric acid, and rat poison. Viagra is one of the world's most counterfeited medicines.

Side Effect	Severity	Commonality	Notes
Headache	Mild to moderate	Common	Usually subsides within hours
Flushing	Mild	Common	Redness of face and neck
Dizziness	Mild to severe	Less common	Be cautious while driving
Visual disturbances	Rare	Rare	Blurred vision, color perception change
Priapism	Emergency, sustained erection	Very rare	Needs immediate medical attention

[90][91] According to a 2012 Pfizer study, around 80% of sites claiming to sell Viagra were selling counterfeits.

Country	Legal Status	Prescription Requirement	Notes
India	Prescription medication	Yes	OTC sometimes available in informal markets
USA	Prescription-only	Yes	FDA approved for ED
UK	Prescription required	Yes	Controlled medication
Australia	Prescription-only	Yes	Regulations vary by state
Canada	Prescription-only	Yes	Classified as a prescription drug

An October 2023 release stated that erectile dysfunction medicines were the most seized drugs by the Interpol[92] accounting for 22% of seizures. In 1992, Pfizer filed a patent covering the substance sildenafil and its use to treat cardiovascular diseases.

• Clinical trials showed improvement in erectile function in up to 84% of men.
• The International Index of Erectile Function (IIEF) is a common assessment tool.
• Fildena 120 is part of the "Super P-Force" combo when mixed with dapoxetine.
• Dapoxetine is for premature ejaculation; combined use requires specific prescription.
• Sublingual or chewable versions of sildenafil are not standard for Fildena.
• The medication does not protect against sexually transmitted infections (STIs).
• Not intended for use by individuals with normal erectile function.
• Can be part of a comprehensive ED treatment plan including lifestyle changes.
• Disposal should follow local guidelines, not via household trash or wastewater.

[96] This would be marketed as Revatio.

How does Fildena 120 work for ED?

The US Food and Drug Administration (FDA) has banned numerous products claiming to be Eurycoma longifolia that, in fact, contain only analogs of sildenafil. [44][45][46] Sellers of such fake herbals typically respond by just changing the names of their products. Sildenafil and/or N-desmethylsildenafil, its super p force online major active metabolite, may be quantified in plasma, serum, or whole blood to assess pharmacokinetic status in those receiving the drug therapeutically, to confirm the diagnosis in potential poisoning victims, or to assist in the forensic investigation in a case of fatal overdose. Nitric oxide (NO) in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of cGMP, leading to smooth muscle relaxation (vasodilation) of the intimal cushions of the helicine arteries. This smooth muscle relaxation leads to vasodilation and increased inflow of blood into the spongy tissue of the penis, causing an erection.

4. Is taking Fildena 50 Mg every day an option?

[49] Robert F. Furchgott, Ferid Murad, and Louis Ignarro won the Nobel Prize in Physiology or Medicine in 1998 for their independent study of the metabolic pathway of nitric oxide in smooth muscle vasodilation. The molecular mechanism of smooth muscle relaxation involves the enzyme CGMP-dependent protein kinase, also known as PKG. This kinase is activated by cGMP and it phosphorylates multiple targets in the smooth muscle cells, namely myosin light chain phosphatase, RhoA, IP3 receptor, phospholipase C, and others. [50] Overall, this results in a decrease in intracellular calcium and desensitizing proteins to the effects of calcium, engendering smooth muscle relaxation. The patent was published in 1993 and expired in 2012. The patent on Revatio (indicated for pulmonary arterial hypertension rather than erectile dysfunction) expired in late 2012. Generic versions of this low-dose form of sildenafil have been available in the US from a number of manufacturers, including Greenstone, Mylan, and Watson, since early 2013.

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The 2007 Ig Nobel Prize in aviation went to Patricia V. Agostino, Santiago A. Plano, and Diego A. Golombek of Universidad Nacional de Quilmes, Argentina, for their discovery that sildenafil helps treat jet lag recovery in hamsters. Professional athletes have been documented using sildenafil, believing the opening of their blood vessels will enrich their muscles.

– What Should You Avoid While Taking Fildena Professional 100 Mg (Sildenafil Citrate)?

In turn, they believe it will enhance their performances. Acetildenafil and other synthetic structural analogs of sildenafil which are PDE5 inhibitors have been found as adulterants in a number of "herbal" aphrodisiac products sold over-the-counter. [41] These analogs have not undergone any of the rigorous testing that drugs like sildenafil have passed, and thus have unknown side-effect profiles. [42] Some attempts have been made to ban these drugs, but progress has been slow so far, as, even in those jurisdictions that have laws targeting designer drugs, the laws are drafted to ban analogs of illegal drugs of abuse, rather than analogs of prescription medicines. However, at least one court case has resulted in a product being taken off the market.