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Highlights
- Viagra and sildenafil are prescription drugs that may cause side effects.
- Most Viagra side effects are mild and temporary.
- Serious side effects are rare but do happen.
- Certain groups of people are at increased risk of experiencing more serious side effects from Viagra and sildenafil.
- Viagra can have both negative and positive long-term effects.
- If you notice sudden and intense side effects after taking an ED pill, call the doctor or go to the ER immediately.
When Viagra hit the market in 1998, it changed the lives of millions of men and couples. Finally — an easy and effective treatment for erectile dysfunction. While “the little blue pill” is safe for most men, sildenafil, the active ingredient in Viagra, can cause side effects and drug interactions. [Español]
What Is Viagra (Sildenafil) and How Does It Work?
Viagra is the brand name of one of several phosphodiesterase-5 inhibitors (PDE5Is) that are used to treat erectile dysfunction. The active ingredient (and generic name for Viagra) is sildenafil.
Sildenafil works by inhibiting an enzyme called PDE5. Without getting too deep into the biochemistry, PDE5 is responsible for reducing blood flow to the erectile tissue. By blocking PDE5, Viagra causes smooth muscles of the blood vessels to relax, which increases blood flow to the penis.
However, it’s important to understand that Viagra doesn’t create sexual desire or arousal. Instead, it helps a man to get an erection when he’s already sexually stimulated.
Viagra is available today in its original form as well as as the generic sildenafil citrate.
How Safe Is Viagra?
Viagra has been available for over two decades and is safe for most men. Before you try it, you must get a prescription from a doctor, who will check to be sure you have no no contraindications, or reasons why you should not take this medication.
As with all prescription medications, the U.S. Food and Drug Administration (FDA) oversees the safety of Viagra. The FDA approved the sales of Viagra based on extensive clinical trials. It continues to monitor the safety of the drug and investigates the causes of side effects to give physicians up-to-date information.
To make sure that medicines continue to be safe to use, the agency operates the MedWatch system, which doctors and patients can use to report any side effects related to Viagra. You can rest assured that should there be a serious safety concern, the FDA will issue an alert or even recall the drug.
As long as you avoid buying fake Viagra from a questionable source — and have a legitimate prescription from a provider who knows your medical history — you can be confident in its safety.
How Are Side Effects Classified?
Like all medications, Viagra can cause a range of side effects, some more severe than others.
The FDA classifies side effects by frequency and by severity. Here are the classifications:
Side Effect Frequency
- Very common: Occur in 1 in 10 people.
- Common: Occur in more than 1 in 100 people.
- Uncommon: Occur in between 1 in 100 and 1 in 1,000 people.
- Rare: Occur in between 1 in 1,000 and 1 in 10,000 people.
- Very Rare: Occur in fewer than 1 in 10,000 people.
Side Effect Severity
- Mild: Usually temporary and may go away on their own or are easily treated.
- Moderate: Cause some discomfort and may impact daily activities.
- Severe: Cause significant discomfort and can be harmful, needing immediate medical attention.
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Very Common Side Effect of Viagra
Headaches
Headaches are the most common side effect of using ED medications, and they happen to 1 out of 10 people, or 10% of people who take Viagra. A Viagra headache usually lasts anywhere from 30 minutes to a few hours, but for people who are prone to migraine or cluster headaches, they may last longer.
If you regularly experience headaches when taking Viagra, try reducing your dose or switching to another ED medication, such as Cialis, Levitra, Staxyn, or Stendra.
Common Side Effects of Viagra and Sildenafil
All medications have side effects, and Viagra is no exception. However, most of the common side effects of Viagra are minor and temporary, and many people use it regularly with no side effects at all.
Most of Viagra’s most common side effects are caused by sildenafil’s mechanism of action. The widening of the blood vessels behind Viagra’s magic isn’t restricted to the veins in the penis; it affects other areas of your body, as well, which can cause side effects like the following, which are all classified as mild.
Flushing
Some Viagra users say that the blushing and redness on the face is intense and their eyes get red and itchy.
Indigestion and Nausea
It’s not clear why sildenafil can cause these symptoms, but they’re likely caused by the same mechanism as the other common side effects — relaxation of the smooth muscles of the blood vessels.
Stuffy Nose
Surprisingly, the spongy tissue in the penis and the nasal erectile tissue have much in common. Some people get a stuffy nose when they are aroused. Viagra can intensify that symptom by increasing nasal congestion.
Uncommon Side Effects of Viagra
Seeing your lady in blue? It may be a harmless side effect of Viagra!
Uncommon side effects affect at least one in one thousand patients. They can include:
Hypotension (Low Blood Pressure)
Taking Viagra may cause a drop in blood pressure. This side effect may be serious or even fatal if a user combines any ED medication with nitrate medications or other drugs or supplements that contain sildenafil. It can also happen when people use Viagra with alcohol or recreational drugs, including amyl nitrate, or “poppers.” This side effect is considered severe.
Dizziness
Anecdotal evidence says that post-Viagra dizziness can last up to four days. This side effect is classified as mild and may be more common with higher doses.
Rash
Skin rash is a less-common side effect of Viagra and is considered a mild reaction that rarely requires treatment.
Urticaria
Also called hives, urticaria is a more severe form of skin rash that’s characterized by red, raised, itchy welts on the skin. While urticaria is considered a mild side effect of Viagra, you should stop taking the medication and contact your doctor. In rare cases, urticaria can be a sign of a more serious allergic reaction, such as anaphylaxis.
Anaphylaxis is a life-threatening allergic reaction that can cause difficulty breathing, swelling of the tongue and throat, and a drop in blood pressure. If you experience any of these symptoms after taking Viagra, you should call 911 immediately.
Visual Disturbances
Some men have sensitivity to light or blurred vision after taking Viagra. Others report a more surprising reaction — their vision takes on a blue tint, a phenomenon called cyanopsia. This happens because Viagra can inhibit other phosphodiesterase inhibitors in the body, including PDE6, which is found in the retina of the eye.
Though disturbing, visual side effects are temporary and appear to be harmless. Of these, sensitivity to light and blue vision are considered mild side effects, while blurred vision is classified as moderate.
Rare Side Effects of Viagra
All of the side effects on this list are classified as severe. Signs of any of these conditions require immediate medical attention.
Hearing Loss
“Viagra deafness” is a real but rare adverse effect. According to a large-scale analysis, men who take sildenafil are at a higher risk of sudden hearing loss in one or both ears.
Priapism
A strong and long-lasting erection is the point of taking Viagra, but sometimes the penis stays hard for too long and becomes painful. If untreated, this condition can lead to permanent damage. If you have an erection that lasts more than four hours, get urgent medical attention, as priapism can cause ED and permanent disfigurement.
Sudden Vision Loss
There seems to be a link between sildenafil and non-arteritic anterior ischemic optic neuropathy (NAION), a condition which leads to vision loss due to poor blood flow to the eye.
Heart Attack
There are isolated cases of men with previously undiagnosed cardiovascular conditions who suffered sudden cardiac death following the use of ED meds. Of course, this is classified as a severe side effect.
Very Rare Viagra Side Effects
Very rare side effects are those that occur in fewer than 1 in 10,000 people. These side effects are unlikely, and they often happen because of dosage issues, individual sensitivity, an underlying health condition, or an interaction with another medication.
These very rare but serious side effects have been reported:
Serious Skin Reactions
Stevens-Johnson Syndrome (SJS)
SJS is a rare but serious skin reaction that can be life-threatening. It causes the skin to blister and peel, and it may affect the mucous membranes as well. The risk of SJS is very low, but it is important to be aware of the signs and symptoms so that you can get medical attention right away if you notice any.
Symptoms may include:
- Fever
- Rash
- Blisters on the skin
- Redness and swelling of the eyes
- Sore throat
- Mouth ulcers
- Painful urination
- Diarrhea
Toxic Epidermal Necrolysis (TEN)
TEN is a rare but more severe form of SJS. The symptoms are the same, but TENS is characterized by more extensive blistering and peeling of the skin. TEN can also be life-threatening and requires immediate medical attention.
Erythema Multiforme
Erythema multiforme is a less severe skin reaction that is characterized by red, often itchy or painful patches on the skin. Erythema multiforme is usually not life-threatening, but it can be a sign of a more serious underlying condition
Photosensitivity
Some people taking Viagra may experience increased sensitivity to sunlight. This can lead to sunburn or other skin reactions. It is important to avoid excessive sun exposure while taking Viagra/sildenafil.
Angioedema
Angioedema is a serious skin reaction. It appears as a swelling beneath the skin, often around the eyes and lips. Angioedema can also affect the throat and airways, which can be life-threatening. If you develop symptoms of angioedema, get immediate medical attention.
Seizures
Epileptic seizures are an extremely rare side effect that has been reported in only a few isolated cases. Interestingly, more recent research studies performed on mice and rats have found that sildenafil may actually help to prevent seizures.
Non-arteritic Anterior Ischemic Optic Neuropathy (NAION)
(NAION) is a rare eye condition that causes sudden and permanent vision loss in one eye. It is thought to be caused by a lack of blood flow to the optic nerve, though we don’t yet know the cause for certain. For every 100,000 men who take sildenafil for a year, about 3 will develop NAION.
The risk of NAION from sildenafil is higher in certain groups of people, including:
- Men over the age of 50
- Men with diabetes
- Men with high blood pressure
- Men who have had a heart attack or stroke
- Men who have a family history of NAION
If you are taking sildenafil and you experience sudden vision loss in one eye, see an eye doctor immediately. There is no cure for NAION, but early treatment may help to improve vision.
It is important to note that the link between sildenafil and NAION is not fully understood. It is possible that sildenafil may trigger NAION in people who are already at risk for the condition. More research is needed to fully understand the link.
How Long Do Viagra Side Effects Last?
The concentration of Viagra in your body is at its peak between 30 and 120 minutes after swallowing the pill. If you’ve taken it with a heavy meal, the absorption time can be longer.
Expect to feel most side effects within an hour or two. They should subside within a few hours.
The common complications, such as headaches, nausea, or flushing, are temporary. Only on a rare occasion do some people experience them for longer. If you find them troublesome, discuss your symptoms with your doctor to make sure you can safely continue using sildenafil.
Duration of the less-common and rare side effects can vary greatly. The best course of action is to contact your doctor if you experience any unusual or worrisome symptoms.
Reducing Viagra Side Effects
Understanding your own body is key to Viagra side effect prevention. If the doctor decides it’s generally safe for you to take sildenafil, it doesn’t mean you won’t have any adverse effects.
Observe your body. If you notice any new or unusual symptoms after taking Viagra, get in touch with a healthcare provider. If you’re new to ED treatments, avoid driving until you know how the medication will affect you.
If Viagra is causing discomfort, the doctor may suggest reducing your dose. If that doesn’t help, there are alternatives to Viagra/sildenafil you can try. Other effective ED medications include Cialis, Levitra, Stendra, and Staxyn.
Your lifestyle choices are a big factor in your Viagra experience. Avoid drinking lots of alcohol or using recreational drugs when on ED medication, as the interactions can be serious or even fatal.
And if you need another good reason to quit smoking, giving up cigarettes will reduce the risk of cardiovascular complications of taking sildenafil.
What To Do in Case of Severe Side Effects
If you suspect Viagra side effects, talk to your doctor right away
If you’re experiencing new or unusual symptoms after taking Viagra or sildenafil, get in touch with a doctor as soon as possible.
If you’re worried that your adverse effects may be life threatening, call 911 or go to the nearest emergency department. Bring all the medication you took that day with you. If you’ve mixed Viagra with other drugs, either prescription or recreational, don’t hide that information from your provider — your life may depend on it.
Long-Term Effects of Using Viagra
In addition to its short-term side effects, Viagra can also potentially cause both negative and positive long-term effects. Here’s the complete run-down.
Possible Negative Long-Term Effects of Viagra
While negative long-term effects of Viagra use are rare, they can happen. Here are the possibilities you should be aware of.
Permanent Vision Loss
NAION, described above, is a sudden and permanent loss of vision in one eye. However, there is a 15% chance that those with the condition will lose vision in the other eye, as well. Individuals with existing heart disease, diabetes, high cholesterol, or certain other eye problems are more at risk.
Cardiovascular Risks
Viagra can lower blood pressure, and when combined with nitrates (often used for heart disease treatment), it can lead to a significant drop in blood pressure, which can be life-threatening. There have been reports of heart attack, stroke, irregular heartbeat, and even death in men taking Viagra. However, it’s worth noting that these men, in many cases, already had heart problems.
Interactions With Other Medications
Long-term sildenafil use often means a higher likelihood of combining Viagra with other medications. This can increase the risk of side effects and interactions.
Dependency and Performance Anxiety
Some users might develop a psychological dependence on Viagra, believing they can’t perform sexually without it. This isn’t a physical addiction but can be a concern if a man feels performance anxiety or a lack of confidence about engaging in sexual activity without the medication.
Tolerance
Some reports suggest that some men can develop a tolerance to Viagra, requiring more of the drug to achieve the same effect. However, more research is needed to prove this conclusively.
Masking Underlying Causes of ED
Long-term use of Viagra without consulting a healthcare provider might mean that underlying causes of ED (such as diabetes, heart disease, or hormonal imbalances) go undiagnosed and untreated.
Possible Positive Long-Term Effects of Viagra
Even though Viagra has been around for many years, the drug still surprises researchers. Viagra was originally developed as a cardiac medication because of its ability to open blood vessels and improve blood flow. This mechanism of action has a positive effect on more than just the penis.
Here are some other uses researchers have found for sildenafil:
Premature Ejaculation
Some studies have investigated the use of sildenafil in combination with other drugs to treat premature ejaculation, though it’s not a primary treatment for this condition.
Pulmonary Hypertension
Sildenafil is used in the management of pulmonary arterial hypertension (PAH) under the brand name Revatio.
Heart Disease Protection
Many people aren’t aware that sildenafil was originally developed as a medication to treat angina, or chest pain. Since then, researchers have found that sildenafil may offer protection against hypertension and other cardiovascular disease because of its ability to relax smooth muscles in blood vessels and improve blood flow throughout the body.
Congestive Heart Failure
Small trials have shown that PDE5Is, including sildenafil, can improve certain measures of heart function, but larger studies are needed to confirm their effectiveness.
Raynaud’s Phenomenon
This is a condition in which the small blood vessels in the fingers and toes constrict, causing pain. Some studies have suggested that sildenafil can reduce the frequency and duration of Raynaud’s attacks, likely due to its ability to dilate blood vessels. However, study limitations mean that more evidence is needed to determine the link with certainty.
Urinary Tract Infections
Daily use of sildenafil may improve urinary tract symptoms for men with prostate problems.
High Altitude Pulmonary Edema (HAPE)
There’s some evidence that sildenafil can be beneficial for those who suffer from HAPE, a condition that can affect climbers at high altitudes. The drug might help improve oxygenation and reduce resistance in the blood vessels of the lungs.
Alzheimer’s Disease
Recent discoveries suggest that PDE5 inhibitors may be useful in the treatment of Alzheimer’s disease.
Lymphatic Malformations
These are rare, non-malignant masses consisting of fluid-filled channels or spaces thought to be caused by the abnormal development of the lymphatic system. There’s preliminary evidence to suggest that sildenafil may reduce the size and impact of these malformations.
Antidepressant-Associated Sexual Dysfunction
Some individuals on certain antidepressants may experience sexual dysfunction as a side effect. Some studies have looked into sildenafil as a potential remedy for these side effects.
Contraindications
Who Should Not Take Viagra
According to the FDA Prescribing Information for this medication, people who use nitrate medications or amyl nitrate “poppers” should not take Viagra or sildenafil. This combination can cause a severe drop in blood pressure.
Who Should Take Viagra With Caution?
Again according to the FDA, if you belong to one of these groups, talk to your doctor about whether phosphodiesterase-5 inhibitors or drugs containing sildenafil are safe for you to use:
- People taking alpha-blockers: If you’re on alpha-blockers (medicines that lower blood pressure), be cautious if adding Viagra. You should already be stable on the alpha-blocker before starting Viagra, and start with the smallest dose of Viagra.
- People who take amlodipine: When Viagra was taken with amlodipine, a medicine for high blood pressure, it caused an additional drop in blood pressure.
- People who take ritonavir or another CYP3A4 inhibitor. Ritonavir, and some other drugs, can greatly increase the effects of Viagra in the body. If taking these, the dose of Viagra should be limited to a small amount every 48 hours.
- People using other erectile dysfunction medications. Combining ED treatments can lead to adverse effects.
- Individuals with certain health conditions. Including severe heart or liver problems, recent stroke or heart attack, low blood pressure, certain rare inherited eye diseases, or those advised against sexual activity due to health reasons.
- People with certain allergic reactions. People who have known allergies to sildenafil or any other ingredients in Viagra.
- Women and children. Viagra is not approved for use in women or children.
- People with priapism or penile deformities. Those with conditions that cause prolonged erections or have deformities of the penis should use Viagra with caution, as it may make these conditions worse.
- People with severe kidney or liver impairment. They may need careful monitoring or dosage adjustments.
Are There Any Other Potential Drug Interactions With Viagra or Sildenafil?
According to Drugs.com, there are 325 medications that have known interactions with Viagra. Of these, 37 are categorized as major and 284 are considered moderate. When referring to medications on the list, keep in mind that the names given here are all generic names; you may know these drugs by their brand names. If in doubt, ask your healthcare provider.
Major Drug Interactions
While Viagra has a proven record of being safe for most men, like any drug, it can interact with other medications and cause issues from severe to simply annoying.
Here is the complete list of major drug interactions with Viagra, according to Drugs.com.
Nitrate vasodilators. These drugs are commonly known as nitrates, drugs that can lower your blood pressure. Because Viagra also lowers blood pressure, combining it with nitrates can lead to an excessive drop in blood pressure that can be serious or potentially fatal.
Many drugs fall into the nitrate classification. Check our list of nitrate medications if you’re unsure if you’re taking one.
Antineoplastic agents (cancer drugs): The interaction between antineoplastic agents and sildenafil can be complex and may involve cardiovascular risks, altered liver metabolism, increased toxicity, and potential changes in drug efficacy. Both types of drugs can affect heart function and are metabolized in the liver, which could lead to increased side effects or reduced effectiveness.
The drugs in this category are:
- adagrasib
- ceritinib
- idelalisib
- lonafarnib
- tucatinib
HIV protease inhibitors (antivirals): Viagra and drugs in this class can interact in a way that leads to elevated levels of sildenafil in the bloodstream. HIV protease inhibitors, such as ritonavir and saquinavir, inhibit the CYP3A4 enzyme in the liver, which is responsible for metabolizing sildenafil. This interaction can increase the risk of sildenafil-related side effects, including low blood pressure, flushing, and priapism (prolonged erection).
- atazanavir
- amprenavir
- boceprevir
- darunavir
- delavirdine
- fosamprenavir
- indinavir
- nelfinavir
- ritonavir
- saquinavir
- telaprevir
Other PDE5 inhibitors (erectile dysfunction medications): Never combine Viagra with another erectile dysfunction medication. This can lead to dangerous drops in blood pressure.
These medications include:
- avanafil (Stendra)
- tadalafil (Cialis)
- vardenafil (Levitra and Staxyn)
- over-the-counter “male enhancement” supplements.*
*While not included in the FDA’s list of drug interactions with Viagra, we’ve included sexual enhancement products here because the FDA has issued warnings that many over-the-counter supplements of this type contain hidden sildenafil or tadalafil. This makes them potentially dangerous for men who have already taken one of these medications.
CYP3A inhibitors (liver enzyme blockers). CYP3A inhibitors and sildenafil can interact in a way that affects the metabolism of sildenafil because both are processed by the CYP3A enzyme in the liver. This interaction can lead to elevated levels of sildenafil in the bloodstream, increasing the risk of side effects such as low blood pressure, flushing, and priapism (prolonged erection).
The medications on this list are:
- cobicistat
- clarithromycin
- erythromycin
- itraconazole
- ketoconazole
- levoketoconazole
- telithromycin
- troleandomycin
- voriconazole
Antidepressants. Antidepressants and sildenafil may interact in ways that increase cardiovascular risks and side effects. Some antidepressants can cause a prolongation of the QT interval, a cardiac event that can lead to arrhythmias, while sildenafil is known to lower blood pressure. What’s more, both types of medication can affect the central nervous system, potentially leading to additive effects like increased drowsiness or impaired judgment.
Currently, nefazodone is the only antidepressant medication on Drug.com’s major interactions list. However, there are a number of antidepressants classified as moderate, so be sure to check the list if you’re taking one.
Soluble guanylate cyclase stimulators (blood vessel relaxers). Both types of medications work to relax blood vessels and improve blood flow, but when used together, they can cause dangerously low blood pressure, dizziness, fainting, or even more severe cardiovascular complications.
- riociguat
- vericiguat
Note that some drugs on this list belong to more than one class. For example, many of the CYP3A inhibitors are also antifungals or antibiotics.
Other Drug Interactions
The Drugs.com Interaction Checker lists 285 moderate interactions with Viagra and 4 minor interactions.
The moderate interactions include drugs from these classes:
- anti-anxiety medications
- antibiotics
- anticholinergics
- anticoagulants
- antidepressants
- antidiabetics
- antidiarrheal
- antiepileptics
- antifungals
- antigout medications
- antihistamines
- antihypertensives
- antimigraine
- antimalarials
- antinausea
- antineoplastics (cancer drugs)
- antiparkinson
- antipsoriatics
- antipsychotics
- antiretrovirals
- antithyroid
- antituberculosis
- antivertigo
- antivirals
- benzodiazepines
- beta blockers
- calcium channel blockers
- corticosteroids
- diuretics
- NSAIDs (non-steroidal anti-inflammatory drugs)
- opioids
- proton pump inhibitors
- statins (cholesterol medications)
Please check the Drug Interactions Checker for all drugs included in the moderate interactions category.
According to Drugs.com, the following drugs can cause minor interactions with sildenafil:
- armodafinil
- dipyridamole
- modafinil
- theophylline
Even if a drug reaction is categorized as minor, it’s important to talk to your doctor about possible effects based on your personal medical history and other medications you’re taking.
Food Interactions
Grapefruit and grapefruit juice can raise the levels of sildenafil in your body and delay the time it takes for Viagra to work. You may want to avoid large quantities of grapefruit while you’re taking this medication.
Check With Your Healthcare Provider
Note that you may still be able to take Viagra or another PDE5 inhibitor while using a medication on these lists. However, you’ll need to stay in close contact with your doctor, who will monitor your condition and may want to adjust your dose.
Can You Overdose on Viagra?
As tempting as it may feel, never take more sildenafil than prescribed. Viagra overdose can have serious consequences and even be fatal. Other complications of Viagra overdose include priapism and permanent retinal damage.
The maximum daily dosage for healthy men is 100 milligrams, but a 50 milligram tablet will do the trick for most. For some patients, physicians recommend starting with 25 milligrams and adjusting as needed.
Also keep in mind that if you have any of the preexisting conditions mentioned above, your tolerance may be lower, so always be aware of the effects Viagra has on your body and have a low threshold to share any concerns with your doctor.
Take Viagra Side Effects Seriously
Sildenafil is the go-to solution for many men with erectile dysfunction — and for good reason. It’s safe to use and well tolerated by most people. Still, side effects are possible and can range from mild to severe. To minimize the risk of Viagra side effects, discuss any new or unusual symptoms with your healthcare provider.
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Anka Grzywacz is a sexologist, reproductive health expert and Certified Sex Coach™. In her online practice she helps busy women and couples solve their intimate problems.