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    Sildenafil , sold as the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension . 3 It is unclear if it is effective for treating sexual dysfunction in women.
    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 . 3 It requires sexual arousal , however, to work.
    Sildenafil has been studied for high-altitude pulmonary edema but its use is currently not recommended for that indication.

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    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.
    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 . 2 In October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including sildenafil, required a more prominent warning of the potential risk of 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.
    Those using protease inhibitors are recommended to limit their use of sildenafil to no more than one 25 mg dose every 48 hours.
    Studies on the effects of viagra when used recreationally are limited, but suggest it has little effect when used by those not suffering from erectile dysfunction.
    In one study, a 25-mg dose was shown to cause no significant change in erectile quality, but did reduce the postejaculatory refractory time . 25 This study also noted a significant placebo effect in the control group.
    Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs.

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