ED Pills

How Much Sildenafil is Too Much

August 13, 2021

Medically reviewed by

David Culpepper, MD

There have never been more options available for men dealing with erectile dysfunction.

When Viagra® became the first FDA-approved prescription medication for treating erectile dysfunction in 1998, it was an instant success. Over the years, this medication has proven so effective that other prescription drugs have been developed with the same mechanism of action in order to compete. Levitra® (vardenafil) and Cialis® (tadalafil) were hot on Viagra's heels, approved in 2003, and since 2017 generic sildenafil has been available at much lower prices as a generic form of Viagra. 

The rise of tadalafil (Cialis), vardenafil (Levitra), and their generic forms have all cut into the revenue that Viagra once generated, but sildenafil is still the most popular ED treatment in the U.S.

So how much sildenafil is too much?

What is Erectile Dysfunction? 

Erectile dysfunction is a health condition in which a man is unable to achieve or maintain an erection that's firm enough for penetrative sexual activity. When the penis is not supplied with enough blood, an erection becomes virtually impossible to achieve. 

Erectile dysfunction is a common issue among men, affecting nearly 30 million men in the United States alone. Every guy will experience the occasional erection issue, but many men experience this issue every time they attempt to have sex.

That's when ED becomes a diagnosis.

There are quite a few reasons for a man to experience chronic erectile dysfunction, such as underlying medical conditions, lifestyle factors, and emotional or psychological issues. Some of the most common medical conditions that are known to contribute to erectile dysfunction include:

  • Depression
  • Diabetes
  • Heart disease
  • High blood pressure
  • Obesity
  • Parkinson’s or Peyronie’s disease
  • High cholesterol
  • Enlarged prostate or prostate cancer treatment
  • Spinal cord or pelvic injury

In addition, lifestyle and psychological factors such as smoking, drinking, and stress, may also contribute to erectile dysfunction. Using certain medications, specifically those that are used to treat high blood pressure, heart disease, and depression, are also known to potentially cause erectile dysfunction.

It’s possible to improve or prevent erectile dysfunction with a few lifestyle changes. Some of the most effective lifestyle changes to improve the symptoms of ED include:

  • Getting more exercise, in particular cardiovascular and aerobic exercise
  • Quitting smoking
  • Reducing stress or anxiety in your life
  • Managing weight and increasing fruits and vegetables while reducing refined carbohydrates and sugar
  • Drinking less alcohol

Happy man in glassesWhat is Sildenafil? 

Sildenafil is the active ingredient in Viagra and is also the generic version of the drug.

Sildenafil is sold as two separate drugs and under multiple brand names, both manufactured by the pharmaceutical company Pfizer. Viagra is the well-known brand made specifically for treating erectile dysfunction, while Revatio® is the other brand name under which Pfizer markets sildenafil at a lower dose of 20 mg for treating pulmonary arterial hypertension. 

In December of 2017, Pfizer’s patents for sildenafil were deemed no longer protective, which allowed other companies to begin manufacturing their own versions of sildenafil. These generic versions of sildenafil are now available widely and cost significantly less than the brand name and trademarked Viagra, despite being identical from a chemical or mechanistic standpoint.

Generic drug manufacturers must prove "bioequivalence" of their sildenafil to the U.S. Food and Drug Administration, demonstrating that their new medication works the same way as the original reference drug – in this case, Viagra.

How Much Sildenafil is Too Much? 

Depending on factors such as age, medical history, weight, and severity of the condition, doctors will prescribe different doses of Viagra or sildenafil. Sildenafil comes in tablet form with available doses of 25 mg, 50 mg, and 100 mg. The average starting dose is typically 50 mg, but depending on desired results, a doctor may increase or decrease the prescribed dose. 

It’s important not to take more than the prescribed dose in one day, and taking more will most likely not result in a firmer erection or longer effects. Sildenafil is designed to be taken at a minimum dose, and taking too much of it will increase your risk of experiencing side effects, particularly more dangerous effects.

It is never advised to take more than your prescribed amount per day, and it’s critical not to take more than 100 mg of sildenafil in a 24-hour period.

Is Sildenafil Safe? 

Sildenafil is generally considered to be a safe treatment of erectile dysfunction for those with an appropriate medical history. Since sildenafil is a prescription medication, it will require a doctor reviewing your medical history before prescribing it. 

It’s important to be honest with your doctor about other medications that you may be taking, as sildenafil can interact negatively with several other drugs. Sildenafil interacts dangerously with nitrate medications such as nitroglycerin, isosorbide dinitrate, and amyl nitrate, which are typically prescribed for chest pain. In addition, it will react dangerously with guanylate cyclase stimulators such as Adempas (riociguat), which is used to treat pulmonary hypertension. 

If you are taking any of these medications and also take sildenafil, it’s possible to experience a sudden and severe drop in blood pressure, which could be fatal. 

In addition to these medications, sildenafil is not recommended for people with a history of heart problems. While it’s possible for someone with no history of heart problems to experience some of the more rare side effects like heart attack, stroke, and irregular heartbeat, these potential sildenafil side effects are more common in patients with a previous history or heart issues. 

Are There Side Effects To Taking Sildenafil? 

Just like any medication, there are several potential side effects associated with using sildenafil. Side effects are more likely to occur in people that have difficulty processing sildenafil or in people that are taking higher doses. 

The most common side effects associated with sildenafil include:

  • Back ache or abdominal pain
  • Blurred vision or blue-tinted vision
  • Diarrhea
  • Difficulty falling asleep or staying asleep
  • Flushing of the face or body
  • Headache
  • Heartburn
  • Light sensitivity
  • Muscle aches
  • Nosebleeds
  • Numbness, burning, or tingling in the hands, arms, feet, or legs
  • Runny nose or nasal congestion

Other side effects that are more serious, yet rarely reported, may require you to seek immediate medical attention. These side effects include:

  • Chest pain (angina) or heart attack
  • Dizziness or lightheadedness
  • Elevated or irregular heartbeat
  • Fainting
  • Hearing decrease, hearing loss, or tinnitus (ringing in the ears)
  • High blood pressure or hypertension
  • Itching or burning during urination
  • Priapism, or an erection lasting longer than four hours
  • Prolonged blurry vision
  • Rash
  • Stroke
  • Sudden loss of vision in one or both eyes
  • Worsening shortness of breath

How Does Sildenafil Work? 

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor, which basically means that it helps the smooth muscles of the arteries in the penis stay relaxed for a longer period of time than usual. This helps to increase blood flow into the penis and also works to trap blood in the penis, helping to maintain an erection that is firm enough for sexual activity. 

To achieve this result, sildenafil still requires adequate stimulation and arousal. It's not able to create an erection without the assistance of certain chemicals released by your body during arousal. But, it removes the body's natural braking mechanism, allowing the erection process to get going effectively.

How Long Does Sildenafil Last? 

On average, the effects of sildenafil will last between two to three hours before they start to diminish. It’s possible for sildenafil to last up to five hours or even longer depending on the dose and your metabolism.

Depending how quickly your body metabolizes it, you may be able to get several erections with sildenafil in your body; however, it likely won’t help you last longer in bed. There has been no research to definitively prove if sildenafil can increase how long you can have sex. 

It’s possible for sildenafil to not work again immediately after sex, too.

Normally, it’s difficult to get another erection right after ejaculating because the body isn’t prepared physically. This is known as the refractory period, and it may only last a few minutes but can last as long as a few hours or even days.

How Much Is Too Much Sildenafil?

Sildenafil is prescribed for ED at up to 100 mg in a single dose. It should not be taken at higher doses, and pills should not be mixed to increase the dose beyond 100 mg. This could result in an unsafe drop in blood pressure or worse.

Do not take more than your recommended dose in any 24 hour period.

Sildenafil vs. Other Options

Sildenafil is just one option for treating erectile dysfunction. Over the years several other effective ED meds have hit the market with various pros and cons. 

Sildenafil, the active ingredient in Viagra, is most similar to vardenafil, the active ingredient in Levitra. They both typically take about 30 minutes or so to kick in and will remain in your system for two to four hours. 

Tadalafil, the active ingredient in Cialis, offers a different experience. This drug begins to work after about 30 minutes but will stay in your system for between 24 and 36 hours. It’s for this reason that tadalafil is often preferred when tried head-to-head because its timeframe for intimacy is so much longer than sildenafil, which is taken in the hours before sex. Cialis is sometimes known as "the weekend drug" for this reason.

The Takeaway

Sildenafil is a highly effective treatment for erectile dysfunction, but it’s important not to take more than the prescribed dose. Under no circumstances should you take more than 100 mg in a 24 hour period. The side effects could be dangerous and possibly result in death. 

Sildenafil is one of the most popular treatments for erectile dysfunction under the brand Viagra. It’s important to talk with your doctor about getting your dose right, and if you're taking sildenafil, it’s important not to take more than the recommended dose, whether it's working or not.

If you're curious about trying prescription ED meds like Viagra or sildenafil, Rex MD can help. We help men access clinicians from the comfort of home, for ED meds prescribed online and shipped to your door, if approved.

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Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5531881/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874251/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603624/

https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction

https://www.ncbi.nlm.nih.gov/books/NBK558978/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437061/