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Sildenafil inhibits PDE5 (phosphodiesterase type 5), preventing the breakdown of cGMP in smooth muscle. This causes vasodilation and increased blood flow — enabling erections in erectile dysfunction and reducing pulmonary artery pressure.
Brand Viagra costs $60–$80+ per pill. Compounded sildenafil provides the same active ingredient at $1–10/dose. Compounding also allows custom doses, combination formulas (sildenafil + tadalafil, sildenafil + oxytocin), and unique delivery routes like troches.
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Sildenafil citrate is a PDE5 inhibitor originally developed by Pfizer for angina, where it was discovered to produce erections as a side effect — leading to the launch of Viagra in 1998.
Now off-patent, compounded sildenafil is widely prescribed as a cost-effective alternative to brand Viagra and Revatio, with the flexibility of custom doses, combination formulas, and unique delivery routes.
Beyond erectile dysfunction, sildenafil is also prescribed for pulmonary arterial hypertension (PAH), Raynaud's phenomenon, and is being studied for female sexual arousal disorder.
PDE5 Inhibition
Sildenafil selectively inhibits phosphodiesterase type 5 (PDE5), which breaks down cGMP in smooth muscle. By blocking PDE5, cGMP accumulates and causes smooth muscle relaxation and vasodilation.
Nitric Oxide Pathway
Sexual stimulation releases nitric oxide (NO), which stimulates cGMP production. Sildenafil amplifies this natural response — it does not work without sexual stimulation.
Pulmonary Effects
In pulmonary arterial hypertension, sildenafil's vasodilatory effects on pulmonary arteries reduce vascular resistance and improve exercise capacity.
Erectile Dysfunction (ED): Primary indication; works within 30–60 minutes
Pulmonary Arterial Hypertension: Reduces pulmonary vascular resistance
Raynaud's Phenomenon: Off-label; reduces vasospasm
Female Sexual Arousal Disorder: Emerging off-label use
ED: 25mg, 50mg, or 100mg taken 30–60 minutes before sexual activity (max once daily)
Pulmonary Hypertension: 20mg three times daily
Sublingual Troche: Often 50mg; faster onset than oral tablet
Starting dose is typically 50mg. Adjust based on efficacy and tolerability.
Common:
Serious (rare):
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