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1. "When to take Viagra (on an empty stomach)"
One hour is the best answer. Here's the official medical information.
1. Dosage Schedules:
take 1 tablet (25mg) by oral route once daily as needed approximately 1
hour before sexual activity
take 2 tablets (50mg) by oral route once daily as needed approximately 1
hour before sexual activity
take 1 tablet (50mg) by oral route once daily as needed approximately 1
hour before sexual activity
take 2 tablets (100mg) by oral route once daily as needed approximately
1 hour before sexual activity
take 1 tablet (100mg) by oral route once daily as needed approximately 1
hour before sexual activity
2. From the Federal Monograph re DOSAGE:
For most men with erectile dysfunction, the recommended initial dose
of sildenafil is 50 mg taken as needed approximately 1 hour before anticipated
sexual activity. Although sildenafil may be taken anywhere from 4 hours
to 30 minutes before sexual activity, peak plasma concentrations usually
are achieved within 1 hour (range: 30–120 minutes) when taken on an
empty stomach; the erectile response is substantially diminished at 4 hours
compared with 2 hours after administration.
Depending on effectiveness and tolerance, the dose subsequently may be increased
to a maximum recommended level of 100 mg or decreased to 25 mg.. It currently
is recommended that the drug be used no more frequently than once daily;
in early studies, more frequent administration (e.g., 3 times daily) was
associated with an increased incidence of certain adverse effects (e.g.,
myalgias). Evidence from dose-ranging studies indicates that erectile response
is greater at 50- or 100-mg doses than at 25 mg.
Because geriatric patients may have age-related decreases in renal function
and both the pharmacologic and adverse effects of sildenafil may
be increased in such patients, consideration should be given to initiating
therapy with the drug at a reduced dose of 25 mg in geriatric men 65 years
of age and older with erectile dysfunction. Dosage titration should be initiated
at 25 mg for patients with hepatic or severe renal impairment with erectile
dysfunction (see Dosage and Administration: Dosage in Renal and Hepatic
Impairment).
Reduced initial sildenafil dosage also is recommended for patients receiving
drugs concomitantly that are potent cytochrome P-450 (CYP) isoenzyme 3A4
inhibitors including certain macrolide anti-infectives (e.g., erythromycin),
azole antifungals (e.g., itraconazole, ketoconazole), or certain antiretrovirals
(human immunodeficiency virus [HIV] protease inhibitors, delavirdine). For
ketoconazole, itraconazole, and erythromycin, the manufacturers recommend
that dosage titration be initiated at 25 mg for the treatment of erectile
dysfunction and if the dose is well tolerated dosage can be titrated upward
cautiously as necessary. The manufacturers of certain other antiretrovirals
(amprenavir, atazanavir, delavirdine, fosamprenavir, indinavir, nelfinavir,
ritonavir, saquinavir, lopinavir in fixed combination with ritonavir, or
tipranavir in combination with low-dose ritonavir) and some experts recommend
that sildenafil be used with caution and at a reduced dosage of no more
than 25 mg once every 48 hours in patients receiving these antiretrovirals.
Maintenance Dosage.
Oral sildenafil self-medication therapy for erectile dysfunction
usually is maintained at the dose that was determined as optimal during
initial dosage titration. The optimal maintenance dose should result in
an erection that is sufficient for intercourse and maintained after penetration.
Adjustments to the initial titrated dose may be required if the underlying
cause of erectile
dysfunction progresses or if erectile
dysfunction improves.
Follow-up monitoring of patients should be performed periodically (e.g.,
initially at 1–3 months and then annually) to determine patient tolerance,
continuing need, and the possible need for dosage adjustment. Data from
a large, open-label study in patients with erectile
dysfunction of no known organic cause indicate that the dose at
the end of a maintenance period (16 weeks) was 25 mg in 11.3% of patients,
50 mg in 29.1% of patients, and 100 mg in 58.1% of patients. In another
clinical trial in patients with impotence as a result of complications of
diabetes mellitus completing the recommended dose titration, no patients
opted to decrease dosage to 25 mg from 50 or 100 mg; at the end of the 12-week
study, 93% of patients were receiving the 100-mg dose and 7% were receiving
the 50-mg dose. At the end of several large, 12-week, flexible-dose escalation
studies with sildenafil (initial dosage of 25–50 mg, then increasing
or decreasing to 100 or 25 mg as tolerated or needed) in men with a broad
spectrum of erectile dysfunction, 79–98% of the patients were taking
50 or 100 mg. Doses exceeding 100 mg once daily are not recommended because
of the increased risk of adverse effects and lack of evidence that such
dosages provide increased efficacy compared with a 100-mg dose. (See Uses:
Erectile Dysfunction.)
Sildenafil has been shown to remain effective for at least 0.5–3
years in controlled and uncontrolled studies. Although such experience suggests
that the drug can be used throughout life in sexually active men if clinically
indicated, the likelihood of contraindications to sildenafil therapy (e.g.,
presence of an underlying cardiovascular disease requiring nitrate therapy)
increases with age; in addition, the possibility that prolonged use of the
drug could mask the progression of a serious underlying disease must be
considered. There currently are no specific limitations to continued sildenafil
therapy based on patient age and/or duration of therapy alone.
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