Sildenafil is a prescription medication for erectile dysfunction (ED). It belongs to a class of drugs called PDE5 inhibitors, and it is the same active ingredient found in Viagra®. Bayview compounds sildenafil in three forms: swallowed tablets, troches that dissolve between the cheek and gum, and rapid dissolve tablets (RDT) that dissolve under the tongue, all prepared to the strength your provider orders.
Sildenafil is FDA-approved as a standard oral tablet. The compounded troche and rapid-dissolve forms, and any non-standard strengths, are prepared by a licensed pharmacy and are used off-label. A valid prescription is required, and only your provider can decide whether sildenafil is appropriate for you.
How does it work?
An erection happens when nerve signals and sexual stimulation release nitric oxide in the penis, which raises a messenger called cGMP and relaxes the smooth muscle so blood flows in. An enzyme called PDE5 breaks cGMP back down. Sildenafil blocks PDE5, so cGMP lasts longer and blood flow is easier to achieve and maintain (StatPearls, PDE5 Inhibitors). It does not cause an erection on its own. Sexual stimulation is still needed.
What is it used for?
Sildenafil is prescribed for erectile dysfunction, difficulty getting or keeping an erection firm enough for sex. PDE5 inhibitors are recommended as a first-line treatment for ED when they are not contraindicated (AUA Erectile Dysfunction Guideline). Only a licensed provider can decide whether it is right for you; Bayview Pharmacy does not provide consultations or determine appropriateness, and a valid prescription is required.
How does it compare to other ED treatments?
Sildenafil is one of several PDE5 inhibitors. The main practical difference is how quickly they work and how long they last. The table below is for education only.
| Medication | Onset | Typical duration |
|---|---|---|
| Sildenafil | About 30 to 60 minutes | About 4 to 6 hours |
| Tadalafil | About 30 to 60 minutes | Up to 36 hours |
| Vardenafil | About 30 to 60 minutes | About 4 to 6 hours |
This is for education only and is not a statement that one medication is better or stronger. Your provider selects the medication, form, and dose that are appropriate for you.
How is it used?
Take sildenafil about 30 to 60 minutes before sexual activity, exactly as your provider directs, and no more than once a day unless told otherwise. Sexual stimulation is needed for it to work. A heavy or high-fat meal can slow how quickly a swallowed tablet takes effect. For the compounded forms: place a rapid dissolve tablet (RDT) under the tongue and let it dissolve for one to two minutes before swallowing; dissolve a troche between the cheek and gum. Your provider sets your strength and form.
Side effects & safety
Common side effects include headache, facial flushing, a stuffy or runny nose, indigestion, dizziness, and temporary changes in vision such as a blue tinge or light sensitivity. Tell your provider about your heart health and all medications you take.
Who should not use it?
Sildenafil is not for everyone. Do not use it if you take nitrates or riociguat, or if you are allergic to sildenafil. Talk with your provider first if you have heart or blood-vessel disease, have had a recent heart attack or stroke, have very low or uncontrolled high blood pressure, take alpha-blockers or other blood-pressure medicines, have severe liver or kidney problems, or have a history of priapism or certain eye conditions. Your provider will confirm that sexual activity and this medication are safe for you.
How should it be stored?
Store as directed on your label, at room temperature away from heat and moisture, and keep it out of the reach of children and others. Do not share it, do not use it after the beyond-use date, and dispose of unused medication as directed.
Why is this compounded?
Compounding lets a licensed pharmacy prepare sildenafil in forms and strengths that aren't available off the shelf, troches and rapid dissolve tablets for people who prefer not to swallow a pill, and custom strengths a provider may want. As a 503A compounding pharmacy, Bayview prepares each order under USP standards. Compounded preparations are not FDA-approved.
Clinical details for prescribers
Regulatory status. Sildenafil is not a controlled substance. It is FDA-approved as an oral tablet (Viagra® and generics); compounded troche, rapid-dissolve, and non-commercial strengths are prepared via 503A compounding and are not FDA-approved.
Mechanism & PK. Selective PDE5 inhibitor; potentiates NO-cGMP signaling in the corpus cavernosum with sexual stimulation. Onset ~30 to 60 min, duration ~4 to 6 h; efficacy reduced by high-fat meals. Usual ED dosing 25 to 100 mg ~1 h before activity, max once daily (StatPearls, PDE5 Inhibitors).
Compounded forms available:
- Tablets: 20, 25, 50, 100 mg
- Troches: 25, 50, 100 mg, dissolve between cheek and gum
- Rapid dissolve tablets (RDT): 50, 100 mg, under the tongue, dissolve 1 to 2 min before swallowing
Contraindications / cautions. Absolute contraindication with nitrates and guanylate cyclase stimulators (riociguat); caution with alpha-blockers and antihypertensives, significant cardiovascular disease, hepatic/renal impairment, and predisposition to priapism. Advise patients to seek care for priapism >4 h, sudden vision loss (NAION), or sudden hearing loss (AUA ED Guideline).
Non-controlled; e-prescribe or use the ED Orals order form. Licensed to dispense in RI, MA, CT, NY, NJ, NH, and FL.
This is a prescription compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your provider determines whether it is appropriate and sets the formulation and dose.
