ED Pills

Sildenafil Not Working: What's Next?

March 2, 2022

Medically reviewed by

David Culpepper, MD

Sildenafil is the active ingredient in Viagra®, one of the most popular drugs in the world. Tens of millions of men have used sildenafil to successfully manage the symptoms of erectile dysfunction.

However, sildenafil doesn’t work for everyone. It's effective for around 82 percent of men, according to research.

There are several reasons why sildenafil isn’t effective for all men — but for them, there are solutions. Here are a few alternative and complementary options that may help if sildenafil doesn't work for you.

Why Didn’t My Sildenafil Work?

The first things to cover are some of the common reasons why sildenafil doesn’t work for everyone.

The process of achieving an erection is complicated and can be delicate, even when using medication. Just because sildenafil doesn’t work once, that doesn’t necessarily mean it will never work.

If you tried sildenafil and didn’t achieve an erection, there are several factors that could explain why it didn't work.

You Took the Wrong Dose

Sildenafil and Viagra are just like any other drug in that they come in several doses. For Viagra, generic Viagra, and sildenafil are three options available: 25 mg, 50 mg, and 100 mg.

The most common starting dose is 50 mg. This allows your prescribing doctor the opportunity to determine if your dose should be increased or decreased based on your results.

Unless you're already taking the maximum dose of 100 mg, it’s possible that you simply need a higher dose of sildenafil.

It’s important that you stick with your prescription and talk to your doctor before increasing your sildenafil dose on your own. You should never take more than your prescribed dose in a single day.

You Ate a Heavy Meal

For sildenafil to work, it has to be broken down by your digestive system and absorbed into your bloodstream. Eating a heavy meal that contains a high amount of fat––like steak, lasagna, or a cheeseburger––can impact the speed that your body breaks down sildenafil.

If your stomach is full of heavy foods that require a lot of blood to digest, you might experience a weaker, delayed, or shorter erection than you hoped for.

For best results, you should take sildenafil on an empty stomach or after a lighter meal. This advice, in fact, comes straight from sildenafil's FDA-approved prescribing label.

You Weren’t Stimulated Enough

Contrary to popular belief, sildenafil doesn’t automatically supply an erection as soon as the ingredients kick in. Sildenafil and Viagra actually work alongside a chemical that's naturally produced by your body when you're aroused, called nitric oxide.

When you encounter mental or sensory stimulation, you start to become aroused. Your brain will release various chemicals that act as messengers throughout your body and nervous system. Nitric oxide is one messenger that tells the blood vessels in your penis to expand and the muscles to relax. This allows more blood to flow into your penis to create an erection. PDE5 is another messenger enzyme that then helps your body return to normal.

Think of PDE5 like the body's natural braking system on an erection. Remove the brakes, improve your ability to get and maintain an erection. The function of sildenafil is to block this natural PDE5 enzyme that normally regulates blood flow. By blocking the PDE5 enzyme, your body is free to keep the blood flowing to your penis.

But, if you're never properly aroused or stimulated, your body will never release nitric oxide or get the erection process started. No sildenafil or Viagra dose will have an effect on your erections without some stimulation to get things started. Don't take sildenafil and sit in front of the TV waiting for magic to happen.

What Are Some Alternative Options to Sildenafil?

If you're still unable to achieve an erection even after taking a larger dose of sildenafil, taking it on a lighter stomach, or being sufficiently aroused, it's time to discuss additional options.

Other ED Medications Besides Sildenafil (Viagra)

Sometimes, for unknown reasons, one erectile dysfunction medication works better than another for certain men.

Research tells us that men who try more than one ED medication are more likely to be satisfied. In fact, one study showed that when men had access to all three of the most popular medications (Cialis/tadalafil, Viagra/sildenafil, and Levitra/vardenafil), almost all of them achieved treatment success.

If sildenafil hasn't worked for you, ask your doctor (or Rex MD clinician) about switching to another medication.

Lifestyle Changes

One of the best options for reducing the severity of erectile dysfunction is to make a few lifestyle changes to improve general health. Erections rely on a strong and consistent blood flow, so anything that is good for your cardiovascular system is generally good for your erections.

Eating a healthier diet can reduce the risk of developing medical conditions known to cause erectile dysfunction, such as obesity, high blood pressure, and diabetes.
Getting more exercise can help to strengthen your heart, reduce strain, and lower high blood pressure.
Drinking less alcohol can reduce the risk of developing ED due to neurological or vascular damage.
Quitting smoking will significantly lower your chances of dealing with blood clots and the hardened arteries that contribute to high blood pressure and ED.

Vacuum Pumps

Prescription medication isn’t the only way to achieve an erection. Vacuum pumps have been around for decades and are an all-natural alternative to using drugs. They're quite effective for most men.

The way these cylindrical devices work is simple:

Slide the cylinder device over your penis and create a vacuum seal by pressing the base against your skin.
Activate the battery or hand-powered vacuum pump to pull air out of the cylinder.
The device creates a vacuum that will draw blood into your penis.
After a few minutes, you should have enough blood in your penis to create an erection.
Once erect, a release valve breaks the vacuum seal and you remove the device.
Men often slip on a constriction band to help keep blood in the penis and the erection firm.

Erections achieved this way can last 15 minutes and longer. It’s important to note that you should only wear a constriction band for 30 minutes at most. Longer than that can result in permanent nerve damage.

The Takeaway

Although prescription medications are among the most popular and effective treatments for erectile dysfunction, they won’t work for everyone. If you've tried sildenafil and it wasn't effective, there are other options, and the research suggests most men will find success with one of these options.

It’s possible that sildenafil didn't work for you due to any of the reasons listed above. Every person is different, and there's no way to accurately predict how anyone will respond to a single medication.

Rex MD carries all of the most popular medications for ED at affordable prices and delivered to your door, if prescribed. Click here to learn more.