Viagra: Subdued Prescriptions from Doctors - in Australia

In a quick view look at the a short briefing of the material

The active pharmaceutical ingredient: sildenafil, usually as sildenafil citrate.

Common tablet strengths in Australia: 25 mg, 50 mg, 100 mg.

The main indication scope is erectile dysfunction treatment in adult men. A separate sildenafil formulation and regimen are used for pulmonary arterial hypertension; do not substitute without medical advice. For details on legal supply, see Rules Governing Legal and Supply.

Note: sildenafil requires sexual stimulation to work and is not a performance-enhancing drug for sport. Athletes should review the guidance linked in Precautionary Temperature warnings.

Mechanism of the drug's action

Sildenafil helps maintain an erection by inhibiting the enzyme phosphodiesterase type 5 (PDE5). During sexual arousal, nitric oxide increases cyclic GMP in the penile smooth muscle, which relaxes the tissue and permits blood inflow. By limiting PDE5 activity, sildenafil supports higher cyclic GMP levels and improved blood flow.

Sildenafil does not lead to an erection without sexual arousal.

Who is eligible to use it?

• Adult men with erectile dysfunction.
• Patients with pulmonary arterial hypertension receive different sildenafil products and dosing; consult a specialist rather than substituting ED tablets.
• Sildenafil for ED is not recommended for women or anyone under 18 years of age. See When this should not be used for more information, consult the documentation.

Sildenafil Use Instructions

Typical starting dose for erectile dysfunction is 50 mg, taken roughly 30 to 60 minutes before sexual activity. Some users report onset as early as 15 minutes; effects can persist for up to four hours in many people.

• Based on response and tolerability, the dose may be reduced to 25 mg or increased to 100 mg. Maximum frequency: one tablet in any 24 hour period.
• A high fat meal can delay how quickly the medicine starts to work and may reduce peak effect.
• Avoid grapefruit and grapefruit juice because they can raise sildenafil levels.
• Avoid excessive alcohol on dosing days because alcohol can impair sexual performance and increase dizziness.

If you have significant kidney or liver impairment or you take alpha-blockers or potent CYP3A4 inhibitors, your prescriber may advise a lower starting dose such as 25 mg. For details about how to interact, see Adverse Drug Interactions in the system.

Notice: Hazard prevention measures and Alert notices

• Tell your prescriber about prior allergic reactions to sildenafil or any tablet ingredients.
• Older adults may be more susceptible to drops in blood pressure, lightheadedness, and visual effects.
• Use caution or seek specialist advice if you have anatomical penile problems, bleeding disorders, active stomach ulcers, retinitis pigmentosa, or a history of priapism.
• If you experience chest pain during sexual activity, stop and seek urgent medical care.
• If you notice sudden changes in vision or hearing, obtain immediate medical assessment.

Athletes: as of the last review, sildenafil is not listed as prohibited by the World Anti-Doping Agency, but rules can change. Check current guidance from Sport Integrity Australia before considering any off-label use; see also Guidelines for Legal and Supply Rules.

Contraindicated situations

• Concurrent use of any nitrate medicines such as glyceryl trinitrate or isosorbide mononitrate, or recreational nitrites referred to as poppers. Combining these can produce a severe drop in blood pressure.
• The employment of riociguat or other soluble guanylate cyclase stimulators.
• Concurrent use of another erectile dysfunction agent unless instructed by a clinician.
• Recent major cardiovascular events or if you have been advised by a clinician to avoid sexual activity because of heart disease.
• History of non-arteritic anterior ischemic optic neuropathy where an association with PDE5 inhibitors was suspected.
• Not recommended for children or adolescents under 18 for ED markers pointing to, and not routinely given to women for ED.

Possible drug lingering effects to look for

Many people tolerate sildenafil well and will have no or mild drug side effects. Commonly reported reactions include:

• Pain in the head or flushing of the skin
• Dyspepsia or indigestion symptoms
• Congested nasal passages
• Lightheadedness with dizziness
• Stools that are loose

Less frequent but important effects:

• Visual disturbances such as a blue tint, blurring, or increased light sensitivity
• Pain in the back or muscle aches
• Pruritic rash on the skin

Seek life saving medical care for a serious injury chest pain, fainting, a sustained painful erection lasting longer than four hours, sudden vision loss, or sudden hearing loss. Discuss other unexpected symptoms with your pharmacist or doctor. For guidance on accidental excess intake see Drug a drug overdose case Response: Guidelines for Action.

Drug Interaction Assessments

Drugs to avoid or use only with medical supervision:

• Nitrates with popper nitrites for recreational use
• Riociguat and related guanylate cyclase stimulators

Caution is advised when using. and under medical advice when combining with:

• Alpha-blockers such as doxazosin or tamsulosin because of potential additive blood pressure lowering effects
• Strong CYP3A4 inhibitors including ketoconazole, itraconazole, ritonavir, cobicistat and clarithromycin which can raise sildenafil concentrations
• Grapefruit products which may increase sildenafil exposure
• Antihypertensive medicines and alcohol which can enhance hypotension or dizziness
• Other PDE5 inhibitors or ED medicines unless directed by a clinician

Provide your clinician with a full medication list including over-the-counter products and supplements prior to starting sildenafil.

Forgot to take doses and Usage Patterns

For erectile dysfunction sildenafil is taken on an as needed basis, so there is no fixed dosing schedule and no concept of a missed routine dose. For pulmonary arterial hypertension formulations follow the prescribers schedule and do not double a one dose was skipped; if you are uncertain, consult your prescriber or pharmacist.

Take only one dose in any 24 hour period. Repeated or excessive dosing increases risk of adverse events.

In an overdose in an Emergency: Immediate Actions

If you suspect an experiencing an overdose call emergency medical services or contact your local Poisons Information Centre immediately. Symptoms of experiencing an overdose may include severe dizziness, fainting, chest pain, irregular heartbeat, nausea, visual disturbances or prolonged painful erection. Do not wait if severe symptoms occur.

Protocols for Digital securing storage ensures that valuables stay safe.

• Keep at room temperature, about 20 to 25 degrees Celsius (68 to 77 degrees Fahrenheit).
• Protect from moisture and strong light; leave tablets in the original blister or container until use.
• Do not keep in bathrooms or damp spaces.
• Keep it away from children and pets, out of their reach and out of sight.

Substitutes and Relative Evaluations

Several other phosphodiesterase type 5 inhibitors are commonly used instead of sildenafil. Choice depends on desired onset time, duration of action, medical history and real time social interactions enable quick problem solving.. Ask your prescriber what option is best.

• Tadalafil (brand example: Cialis) - typically longer acting, with effects that may persist up to 36 hours; available in daily low dose options.
• Vardenafil (brand example: Levitra) - onset and duration similar to sildenafil; some formulations dissolve on the tongue.
• Avanafil (brand example: Spedra) - may have a faster onset for some users, occasionally effective within 15 minutes.
• Generic sildenafil - contains the same active ingredient as Viagra and is usually less expensive.

Non-drug options include lifestyle modification such as smoking cessation, weight management, better control of diabetes and hypertension, psychological therapies, vacuum erection devices and referral to urology where appropriate. For price ranking and comparison among these agents see Typical price points in Australia.

Usual rate sheet in Australia

Prices vary by brand, strength, pack size along with the pharmacy. The following are approximate private prices observed in Australian community pharmacies and reputable online sources.

• Generic sildenafil 100 mg: around AUD 1.50 to AUD 4.00 per tablet.
• Viagra brand 100 mg: around AUD 15 to AUD 30 per tablet.
• Generic tadalafil 20 mg: around AUD 2 to AUD 6 per tablet.
• Cialis brand 20 mg: around AUD 15 to AUD 25 per tablet.
• Vardenafil 20 mg (Levitra or generic): around AUD 10 to AUD 20 per tablet.
• Each tablet of Avanafil 200 mg (Spedra) has a price about AUD 15 to AUD 30.

Most ED medicines for erectile dysfunction are not subsidised under the Pharmaceutical Benefits Scheme for this indication. Ask your pharmacist about generic options, multicount packs and any dispensing fees that will affect the final price.

Legal and Material Supply Rules in Australia

• Scheduling: sildenafil for erectile dysfunction is a prescription-only medicine classified as Schedule 4 under the Poisons Standard within the Commonwealth of Australia.
• Supply: a valid prescription from an Australian registered prescriber is required to obtain sildenafil from a pharmacy. Telehealth prescriptions are acceptable where they comply with current regulations.
• Advertising: direct-to-consumer promotion of prescription medicines is restricted under the Therapeutic Goods Act in conjunction with the Therapeutic Goods Advertising Code.
• Personal importation: bringing in medicines for personal use may be possible for up to three months supply if you hold a valid prescription besides the product meets Therapeutic Goods Framework for administration guidance, but customs and biosecurity rules apply.
• Sport: sildenafil is not currently on the World Anti-Doping Agency prohibited list, but athletes should confirm rules with Sport Integrity Australia before you use it.

Always obtain medicines through legal channels and follow the directions of your prescriber. For more on safe sourcing and telehealth prescribing see Resources and Documentation.

Sources and Notes

For personalised information consult your doctor, pharmacist or a specialist. Useful points to discuss:

• Your full medical history and current medication list
• Which dose to try first and how to adjust it safely
• Costs, generic a rival option options and pharmacy dispensing fees
• When to seek urgent care for adverse reactions

Related internal references: see the a broad strokes summary in A quick a bird's eye view of the top rankic, dosing details at Sildenafil Intake Guidelines, and provisions of the law at Rules Pertaining to Legal and Supply.