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Sildenafil , sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension.

Common side effects include headaches , heartburn , and flushed skin. Sildenafil acts by blocking phosphodiesterase 5 PDE 5 , an enzyme that promotes breakdown of cGMP , which regulates blood flow in the penis.

Pfizer originally discovered the medication in while looking for a treatment for heart-related chest pain. The primary indication of sildenafil is treatment of erectile dysfunction inability to sustain a satisfactory erection to complete sexual intercourse.

Its use is now one of the standard treatments for erectile dysfunction, including for men with diabetes mellitus. Tentative evidence suggests that sildenafil may help men who experience antidepressant -induced erectile dysfunction.

While sildenafil improves some markers of disease in people with pulmonary arterial hypertension , it does not appear to affect the risk of death or serious side effects as of [update].

Sildenafil and other PDE5 inhibitors are used off-label to alleviate vasospasm and treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon ; [17] [18] these drugs have moderate efficacy for reducing the frequency and duration of vasospastic episodes.

Sildenafil has been studied for high-altitude pulmonary edema , but its use is currently not recommended for that indication.

In clinical trials , the most common adverse effects of sildenafil use included headache , flushing , indigestion , nasal congestion , and impaired vision, including photophobia and blurred vision.

In July , the FDA found that sildenafil could lead to vision impairment in rare cases, [21] and a number of studies have linked sildenafil use with non-arteritic anterior ischemic optic neuropathy.

Rare but serious adverse effects found through postmarketing surveillance include prolonged erections , severe low blood pressure , myocardial infarction heart attack , ventricular arrhythmias , stroke , increased intraocular pressure , and sudden hearing loss.

Care should be exercised by people who are also taking protease inhibitors for the treatment of HIV infection. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects.

Contraindications include: [4]. Sildenafil should not be used if sexual activity is inadvisable due to underlying cardiovascular risk factors [26].

Sildenafil's popularity with young adults has increased over the years. In one study, a mg dose was shown to cause no significant change in erectile quality, but did reduce the postejaculatory refractory time.

Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs.

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.

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.

However, at least one court case has resulted in a product being taken off the market. The US FDA has banned numerous products claiming to be Eurycoma longifolia that, in fact, contain only analogs of sildenafil.

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.

Furchgott , Ferid Murad , and Louis Ignarro won the Nobel Prize in Physiology or Medicine in for their independent study of the metabolic pathway of nitric oxide in smooth muscle vasodilation.

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.

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 better erections.

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 p enzymes, mainly CYP 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. 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.

There are also mouth spray preparations of sildenafil for faster onset of action. The preparation steps for synthesis of sildenafil are: [49]. Sildenafil compound UK, was synthesized by a group of pharmaceutical chemists 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. The first clinical trials were conducted in Morriston Hospital in Swansea.

Numerous sites on the Internet offer Viagra for sale after an "online consultation", often a simple web questionnaire.

Viagra is also informally known as "vitamin V", "the blue pill", or "blue diamond", as well as various other nicknames. In February , it was announced that Boots , the UK pharmacy chain, would try over-the-counter sales of Viagra in stores in Manchester , England.

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

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 [67] The decision was made, in part, to reduce online sales of counterfeit and potentially dangerous erectile dysfunction treatments.

On 6 May , Pfizer , which manufactures Viagra, told The Associated Press they will begin selling the drug directly to patients on its website.

Pfizer's patents on Viagra expired outside the US in ; 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 on 11 December As of , the U.

Food and Drug Administration has approved 15 drug manufacturers to market generic sildenafil in the United States.

Seven of these companies are based in India. This is likely to lead to dramatic price reductions. Counterfeit Viagra, despite generally being cheaper, [75] 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. There were 2,, prescriptions for Sildenafil in in England, compared with 1,, in In , Viagra Connect, a particular formulation of Sildenafil marketed by Pfizer, became available for sale without a prescription in the UK, [67] in an attempt to widen availability and reduce demand for counterfeit products.

Sildenafil is available as a generic drug in the United States, labelled for pulmonary arterial hypertension.

In the United States, Pfizer received two patents for sildenafil: one for its indication to treat cardiovascular disease marketed as Revatio and another for its indication to treat erectile dysfunction marketed as Viagra.

The substance is the same under both trade names. In , Pfizer filed a patent covering the substance sildenafil and its use to treat cardiovascular diseases.

The patent was published in and expired in The patent on Revatio indicated for pulmonary arterial hypertension rather than erectile dysfunction expired in late Generic versions of this low-dose form of sildenafil have been available in the U.

In , Pfizer filed a patent covering the use of sildenafil to treat erectile dysfunction. This patent was published in and will expire in Teva sued to have the latter patent invalidated, but Pfizer prevailed in an August federal district court case.

In Canada , Pfizer's patent 2,, for Revatio sildenafil used to treat pulmonary hypertension was found invalid by the Federal Court in June , on an application by Ratiopharm Inc.

On 8 November , the Supreme Court of Canada ruled that Pfizer's patent 2,, on Viagra was invalid from the beginning because the company did not provide full disclosure in its application.

The decision, Teva Canada Ltd. Pfizer Canada Inc. It added further: "As a matter of policy and sound statutory interpretation, patentees cannot be allowed to 'game' the system in this way.

This, in my view, is the key issue in this appeal. Manufacture and sale of sildenafil citrate drugs known as "generic Viagra" is common in India , where Pfizer's patent claim does not apply.

Manufacture and sale of sildenafil citrate drugs is common in China , where Pfizer's patent claim is not widely enforced. Sildenafil was reclassified in New Zealand in so it could be bought over the counter from a pharmacist.

It is thought that this reduced sales over the Internet and was safer as men could be referred for medical advice if appropriate. Egypt approved Viagra for sale in , but soon afterwards allowed local companies to produce generic versions of the drug, citing the interests of poor people who would not be able to afford Pfizer's price.

Pfizer's patent on sildenafil citrate expired in Brazil in From Wikipedia, the free encyclopedia. For other uses, see Viagra disambiguation. IUPAC name.

Interactive image. Further information: Counterfeit medications. Retrieved 6 October European Medicines Agency.

British Journal of Clinical Pharmacology. Retrieved 1 December Sexual Medicine Reviews. Retrieved 11 April CBS News. Retrieved 24 November Follow Suit?

Centers for Medicare and Medicaid Services. Respiratory Medicine. Retrieved 5 November Annals of the Rheumatic Diseases.

PDE-5 inhibitors appear to have significant but moderate efficacy in secondary [Raynaud's phenomenon]. Phosphodiesterase inhibitors e. Commonly-used classes of drugs".

Cochrane Database of Systematic Reviews. Food and Drug Administration. Archived from the original on 22 October Drug Safety.

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