Efficacy of 1, 5, and 20 mg oral sildenafil in the treatment of adults with pulmonary arterial hypertension: a randomized, double-blind study with open-label extension

Each 30 mL bottle contains a total of 100 mg of sildenafil citrate, delivered in a drop-based dosing format that allows for precise micro-dosing, rapid absorption, and convenient administration—especially for individuals who prefer not to take tablets or who require flexible titration. Compounded by prescription, this formulation is ideal for patients seeking a customized dosing solution to support sexual performance, vascular responsiveness, and in some cases, exercise tolerance or pulmonary vascular conditions under clinical supervision. Concentration: 100 mg total per 30 mL Use: Erectile dysfunction, vascular enhancement, off-label support for pulmonary conditions Storage: Room temperature (20–25°C); refrigerate if directed Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor that works by enhancing the effects of nitric oxide, a natural vasodilator, in vascular smooth muscle. Support sexual arousal response via increased penile blood flow Improve endothelial function and vascular tone in specific medical conditions The drop-based formulation provides a non-tablet alternative, allowing for more individualized and dynamic use, especially in patients with: Preference for rapid titration with fewer side effects Sildenafil inhibits PDE5, an enzyme that breaks down cyclic guanosine monophosphate (cGMP). Improved blood flow to the corpus cavernosum of the penis Enhanced erection quality, rigidity, and duration during sexual stimulation Lowered pulmonary vascular resistance (off-label applications) This action requires sexual arousal to be effective and does not induce spontaneous erections. Especially effective in men with mild-to-moderate ED, age-related vascular decline, or performance anxiety Allows dose customization based on sensitivity or side-effect profile Off-label use in some protocols for pulmonary hypertension, Raynaud’s syndrome, or vascular insufficiency May aid in exercise performance in certain cardiac rehabilitation settings (by prescription only) Integrated into biohacking or anti-aging programs focused on vascular optimization and intimacy health Typical ED Starting Dose: 5–20 mg (1.5–6 mL depending on compounding instructions) taken orally 30–60 minutes before sexual activity Adjustment: May be increased or decreased based on efficacy and tolerability Administration: Use calibrated dropper or oral syringe for accurate measurement Always follow compounding pharmacy or prescriber-specific instructions, as concentration may vary slightly by batch. Sildenafil is well tolerated, especially in liquid form where smaller doses can be administered and titrated. Visual disturbances (blue-tinged vision, light sensitivity) These effects are dose-dependent and generally mild. Hypotension when combined with nitrates or alpha-blockers Cardiovascular events in high-risk patients (rare with appropriate screening) Taking nitrate medications (risk of severe hypotension) History of retinal disorders (e.g., NAION) Known allergy to sildenafil or similar compounds Use caution in patients with liver/kidney disease or those on multiple antihypertensives.

• Sildenafil is available by prescription only in most countries.
• The medication comes in various dosages, typically 25mg, 50mg, and 100mg.
• Adjust dosage as directed by your healthcare provider.

Store in a cool, dry place (room temperature or as labeled) Shake well before each use if suspension-based Use within 30–60 days of opening or per pharmacy guidance Faster absorption and onset than traditional tablets for some users Easier administration for those with pill aversion or dysphagia Supports personalized ED therapy or off-label vascular care Custom-compounded for purity and consistent concentration Sildenafil Drops – 100 mg in 30 mL Oral Liquid provide a convenient, precisely dosed alternative to traditional ED medications. Whether used to manage erectile dysfunction, support vascular function, or enhance sexual wellness, this formulation offers flexibility, discretion, and clinical-grade reliability. Custom-compounded for safety and absorption, it’s an ideal option for patients seeking personalized performance enhancement under medical guidance. Method of Preparation: Calculate the quantity of each ingredient for the amount to be prepared. Mix 50 mL of Ora-Plus with 50 mL of Ora-Sweet for use as the vehicle in this preparation. Obtain the required number of sildenafil citrate tablets or the required quantity of powder and place in a mortar. Pulverize the tablets, if used, to a fine powder. Add a small quantity of the Ora-Plus:Ora-Sweet mixture and mix sildenafil 100 mg tab to a smooth paste. Geometrically, add the remainder of the Ora-Plus:Ora-Sweet mixture to final volume and mix well.

What should I do if I forget a dose?

Stability: A beyond-use date of up to 91 days may be used for this preparation.1-4 Quality Control: Quality-control assessment can include weight/volume, pH, specific gravity, active drug assay, color, rheologic properties/pourability, physical observation, and physical stability (discoloration, foreign materials, gas formation, mold growth).5 Discussion: A number of stability studies have been conducted on oral liquid formulations of sildenafil for pediatric use. From these, it appears that sildenafil is relatively stable in vehicles, with an acidic pH around 4 to 5. Sildenafil for oral suspension at 10 mg/mL (Revatio) is commercially available with a beyond-use date of 60 days after reconstitution. One study involved compounded sildenafil citrate in a citrate-buffered solution (0.1 M, pH 4) and either a syrup excipient (resulting in a suspension) or a sugar-free syrup excipient (resulting in a solution); both had pH values of approximately 4.2. Both the suspension and the solution were slightly pink and fruit-flavored.

Related treatment guides

The suspension demonstrated stability for 91 days at both 4°C and 25°C; however, the solution was stable only for 30 days, possibly related to a nonredispersible sediment at the bottom of the container.3 A study by Nahata and colleagues that involved sildenafil citrate tablets (Revatio 20 mg) with a mixture of 1:1 Ora-Sweet and Ora-Plus at 2.5 mg/mL and pH 4.5-4.7 demonstrated stability of 91 days at both 4°C and 25°C. Also studied was a mixture of 1:7 (1% methyl cellulose:simple syrup) at pH 5.1 to 4.9 that also demonstrated stability of 91 days at both 4°C and 25°C.4 Sildenafil citrate (C22H30N6O4S.C6H8O7, MW 666.70) occurs as a white to off-white, crystalline powder that is soluble 3.5 mg/mL in water. It is formulated as tablets equivalent to 25 mg, 50 mg, and 100 mg of sildenafil for oral administration. The tablets also contain microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hydroxypropyl methylcellulose, titanium dioxide, lactose, triacetin, and FD&C Blue #2 Aluminum Lake.6,7 Ora-Plus is an oral suspending vehicle that accepts dilution of up to 50% or more with water, flavoring agents, or syrups while still retaining its suspending properties. It has a pH of approximately 4.2 and an osmolality of about 230 mOsm/kg. Use: Sildenafil citrate oral liquid has been used to treat pediatric pulmonary arterial hypertension in children in whom the risk-benefit profile of sildenafil is deemed acceptable. Packaging: Package in tight, light-resistant containers.1 Labeling: Keep out of reach of children. Stability: A beyond-use date of up to 91 days may be used for this preparation.1-4 Quality Control: Quality-control assessment can include weight/volume, pH, specific gravity, active drug assay, color, rheologic properties/pourability, physical observation, and physical stability (discoloration, foreign materials, gas formation, mold growth).5 Discussion: A number of stability studies have been conducted on oral liquid formulations of sildenafil for pediatric use.

Product	Dosage	Quantity + Bonus	Price
Viagra Generic	25mg	30 + 4 Pills	47.97€ 45.69€	Buy
Kamagra Polo	100mg	272 + 12 Pills	622.94€ 593.28€	Buy
Kamagra	100mg	180 + 6 Pills	436.79€ 415.99€	Buy
Viagra Generic	200mg	270 + 10 Pills	379.76€ 361.68€	Buy
Kamagra Oral Jelly	100mg	110 + 9 Sachets	334.87€ 318.92€	Buy
Viagra Generic	50mg	20 Pills	40.52€ 38.59€	Buy
Viagra Generic	25mg	270 + 8 Pills	184.26€ 175.49€	Buy
Viagra Generic	100mg	60 + 4 Pills	96.36€ 91.77€	Buy
Viagra Generic	50mg	180 + 8 Pills	158.82€ 151.26€	Buy
Kamagra Polo	100mg	84 + 4 Pills	244.49€ 232.85€	Buy
Kamagra Soft Tabs	100mg	32 Pills	120.11€ 114.39€	Buy
Kamagra	100mg	60 + 4 Pills	201.34€ 191.75€	Buy
Viagra Generic	25mg	90 + 6 Pills	105.03€ 100.03€	Buy
Kamagra Polo	100mg	120 + 6 Pills	327.15€ 311.57€	Buy
Kamagra	100mg	84 + 6 Pills	264.44€ 251.85€	Buy
Viagra Generic	150mg	30 + 2 Pills	72.32€ 68.88€	Buy
Viagra Generic	100mg	180 + 8 Pills	199.37€ 189.88€	Buy

From these, it appears that sildenafil is relatively stable in vehicles, with an acidic pH around 4 to 5.

Material and Methods

Sildenafil for oral suspension at 10 mg/mL (Revatio) is commercially available with a beyond-use date of 60 days after reconstitution. One study involved compounded sildenafil citrate in a citrate-buffered solution (0.1 M, pH 4) and either a syrup excipient (resulting in a suspension) or a sugar-free syrup excipient (resulting in a solution); both had pH values of approximately 4.2. Both the suspension and the solution were slightly pink and fruit-flavored.

This formulation may be used in cases where the risk-benefit profile for a specific pediatric patient is acceptable.

It is a sildenafil 100g thixotropic vehicle with a viscosity of approximately 1,000 cps at 25°C. Ora-Plus contains purified water, microcrystalline cellulose, sodium carboxymethyl cellulose, xanthan gum, carrageenan, sodium phosphate, and citric acid as buffering agents; simethicone as an antifoaming agent; and potassium sorbate and methylparaben as preservatives.8 Ora-Sweet syrup vehicle is a flavoring vehicle for oral extemporaneous preparations. It is flavored with a citrus-berry flavor blend and contains glycerin and sorbitol to prevent cap lock, a problem associated with many syrups. It is buffered to a pH of approximately 4.2 and it has an osmolality of about 3,240 mOsm/kg. Rockville, MD: U.S.

What should I do if I accidentally use too much sildenafil?

Pharmacopeial Convention, Inc; January 2018.2. Extemporaneous sildenafil citrate oral suspensions for the treatment of pulmonary hypertension in children. Design and physicochemical stability studies of paediatric oral formulations of sildenafil. Extended stability of morphine and sildenafil for oral use in infants and young children. Allen LV Jr. The suspension demonstrated stability for 91 days at both 4°C and 25°C; however, the solution was stable only for 30 days, possibly related to a nonredispersible sediment at the bottom of the container.3 A study by Nahata and colleagues that involved sildenafil citrate tablets (Revatio 20 mg) with a mixture of 1:1 Ora-Sweet and Ora-Plus at 2.5 mg/mL and pH 4.5-4.7 demonstrated stability of 91 days at both 4°C and 25°C. Also studied was a mixture of 1:7 (1% methyl cellulose:simple syrup) at pH 5.1 to 4.9 that also demonstrated stability of 91 days at both 4°C and 25°C.4 Sildenafil citrate (C22H30N6O4S.C6H8O7, MW 666.70) occurs as a white to off-white, crystalline powder that is soluble 3.5 mg/mL in water. It is formulated as tablets equivalent to 25 mg, 50 mg, and 100 mg of sildenafil for oral administration.

Original Paper URL

Whether used to manage erectile dysfunction, support vascular function, or enhance sexual wellness, this formulation offers flexibility, discretion, and clinical-grade reliability. Custom-compounded for safety and absorption, it’s an ideal option for patients seeking personalized performance enhancement under medical guidance. Method of Preparation: Calculate the quantity of each ingredient for the amount to be prepared. Mix 50 mL of Ora-Plus with 50 mL of Ora-Sweet for use as the vehicle in this preparation. Obtain the required number of sildenafil citrate tablets or the required quantity of powder and place in a mortar.

How were differences between studies investigated?

Pulverize the tablets, if used, to a fine powder. Add a small quantity of the Ora-Plus:Ora-Sweet mixture and mix sildenafil 100 mg tab to a smooth paste. Geometrically, add the remainder of the Ora-Plus:Ora-Sweet mixture to final volume and mix well. Use: Sildenafil citrate oral liquid has been used to treat pediatric pulmonary arterial hypertension in children in whom the risk-benefit profile of sildenafil is deemed acceptable. Packaging: Package in tight, light-resistant containers.1 Labeling: Keep out of reach of children. The tablets also contain microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hydroxypropyl methylcellulose, titanium dioxide, lactose, triacetin, and FD&C Blue #2 Aluminum Lake.6,7 Ora-Plus is an oral suspending vehicle that accepts dilution of up to 50% or more with water, flavoring agents, or syrups while still retaining its suspending properties.

Dosing & Uses

Standard operating procedure for performing physical quality assessment of oral and topical liquids. Bethesda, MD: American Society of Health-System Pharmacists; 2016:1918-1932.7. To sildenafil citrate chewable tablets comment on this article, contact rdavidson@uspharmacist.com. N Engl J Med 1998;339:59 Oral Sildenafil in the Treatment of Erectile Dysfunction Original Article, N Engl J Med 1998:338;1397 - 1404 . On page 1397, the first sentence of the abstract should have read, “Sildenafil is a potent inhibitor of cyclic guanosine monophosphate hydrolysis in the corpus cavernosum,” not “a potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum,” as printed.

How were the studies combined?

Also, on page 1399, the second sentence under the heading “Results” should have read, “The men in the dose-escalation study had had erectile dysfunction for longer periods,” not “The men in the dose–response study,” as printed. Any commercial reuse of NEJM Group content requires permission. A novel standard‐free detection of adulteration method for sildenafil derivatives in dietary supplements, Biomedical Chromatography, 38, 8, (2024). Duplex ultrasonography and its role in the assessment of male sexual dysfunction, Male Sexual Dysfunction, (91-101), (2016). Vasodilatory and hypoglycaemic effects of two pyrano-isoflavone extractives from Eriosema kraussianum N. It has a pH of approximately 4.2 and an osmolality of about 230 mOsm/kg. It is a sildenafil 100g thixotropic vehicle with a viscosity of approximately 1,000 cps at 25°C. Ora-Plus contains purified water, microcrystalline cellulose, sodium carboxymethyl cellulose, xanthan gum, carrageenan, sodium phosphate, and citric acid as buffering agents; simethicone as an antifoaming agent; and potassium sorbate and methylparaben as preservatives.8 Ora-Sweet syrup vehicle is a flavoring vehicle for oral extemporaneous preparations. It is flavored with a citrus-berry flavor blend and contains glycerin and sorbitol to prevent cap lock, a problem associated with many syrups. It is buffered to a pH of approximately 4.2 and it has an osmolality of about 3,240 mOsm/kg. Rockville, MD: U.S. Pharmacopeial Convention, Inc; January 2018.2. Extemporaneous sildenafil citrate oral suspensions for the treatment of pulmonary hypertension in children.

• Patients with heart conditions should consult a cardiologist before use.
• Sildenafil may cause a temporary drop in blood pressure.
• Do not use sildenafil if you have a history of stroke or heart attack.

Design and physicochemical stability studies of paediatric oral formulations of sildenafil. Extended stability of morphine and sildenafil for oral use in infants and young children. Allen LV Jr. Standard operating procedure for performing physical quality assessment of oral and topical liquids.

Brand Name	Manufacturer	Typical Dosage Form	Price Range (USD)	Notes
Viagra	Pfizer	25, 50, 100 mg	$10-$20 per pill	Most well-known sildenafil brand
Revatio	Pfizer	20 mg (for PAH)	Varies	Approved for pulmonary hypertension
Sildenafil Sandoz	Sandoz (Novartis)	50, 100 mg	Lower cost option	Generic version
Kamagra	Ajanta Pharma	50, 100 mg	Lower cost	Popular generic alternative

Bethesda, MD: American Society of Health-System Pharmacists; 2016:1918-1932.7.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

E. Br. Switching patients with erectile dysfunction from sildenafil citrate to tadalafil: Results of a European multicenter, open-label study of patient preference, Clinical Therapeutics, 25, 11, (2724-2737), (2003). Changing Practice Patterns in Erectile Dysfunction: A Diagnostic Algorithm for the New Millennium, Advances in Renal Replacement Therapy, 6, 4, (314-326), (1999). Applies to the following strengths: 10 mg/mL; 10 mg/12.5 mL; 20 mg; 25 mg; 50 mg; 100 mg; 75 mg TABLETS (Viagra) Initial dose: 50 mg orally once a day, as needed, about 1 hour prior to sexual activity Maintenance dose: May increase to 100 mg or decrease to 25 mg once a day, based on efficacy and tolerability.

Storage and Handling

To sildenafil citrate chewable tablets comment on this article, contact rdavidson@uspharmacist.com. N Engl J Med 1998;339:59 Oral Sildenafil in the Treatment of Erectile Dysfunction Original Article, N Engl J Med 1998:338;1397 - 1404 .

Sign in

Each 30 mL bottle contains a total of 100 mg of sildenafil citrate, delivered in a drop-based dosing format that allows for precise micro-dosing, rapid absorption, and convenient administration—especially for individuals who prefer not to take tablets or who require flexible titration. Compounded by prescription, this formulation is ideal for patients seeking a customized dosing solution to support sexual performance, vascular responsiveness, and in some cases, exercise tolerance or pulmonary vascular conditions under clinical supervision. Concentration: 100 mg total per 30 mL Use: Erectile dysfunction, vascular enhancement, off-label support for pulmonary conditions Storage: Room temperature (20–25°C); refrigerate if directed Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor that works by enhancing the effects of nitric oxide, a natural vasodilator, in vascular smooth muscle. Support sexual arousal response via increased penile blood flow Improve endothelial function and vascular tone in specific medical conditions The drop-based formulation provides a non-tablet alternative, allowing for more individualized and dynamic use, especially in patients with: Preference for rapid titration with fewer side effects Sildenafil inhibits PDE5, an enzyme that breaks down cyclic guanosine monophosphate (cGMP). Improved blood flow to the corpus cavernosum of the penis Enhanced erection quality, rigidity, and duration during sexual stimulation Lowered pulmonary vascular resistance (off-label applications) This action requires sexual arousal to be effective and does not induce spontaneous erections.

Are there reviews from people who had side effects with 50-mg or 100-mg sildenafil tablets?

Especially effective in men with mild-to-moderate ED, age-related vascular decline, or performance anxiety Allows dose customization based on sensitivity or side-effect profile Off-label use in some protocols for pulmonary hypertension, Raynaud’s syndrome, or vascular insufficiency May aid in exercise performance in certain cardiac rehabilitation settings (by prescription only) Integrated into biohacking or anti-aging programs focused on vascular optimization and intimacy health Typical ED Starting Dose: 5–20 mg (1.5–6 mL depending on compounding instructions) taken orally 30–60 minutes before sexual activity Adjustment: May be increased or decreased based on efficacy and tolerability Administration: Use calibrated dropper or oral syringe for accurate measurement Always follow compounding pharmacy or prescriber-specific instructions, as concentration may vary slightly by batch. Sildenafil is well tolerated, especially in liquid form where smaller doses can be administered and titrated. Visual disturbances (blue-tinged vision, light sensitivity) These effects are dose-dependent and generally mild. Hypotension when combined with nitrates or alpha-blockers Cardiovascular events in high-risk patients (rare with appropriate screening) Taking nitrate medications (risk of severe hypotension) History of retinal disorders (e.g., NAION) Known allergy to sildenafil or similar compounds Use caution in patients with liver/kidney disease or those on multiple antihypertensives. Store in a cool, dry place (room temperature or as labeled) Shake well before each use if suspension-based Use within 30–60 days of opening or per pharmacy guidance Faster absorption and onset than traditional tablets for some users Easier administration for those with pill aversion or dysphagia Supports personalized ED therapy or off-label vascular care Custom-compounded for purity and consistent concentration Sildenafil Drops – 100 mg in 30 mL Oral Liquid provide a convenient, precisely dosed alternative to traditional ED medications. On page 1397, the first sentence of the abstract should have read, “Sildenafil is a potent inhibitor of cyclic guanosine monophosphate hydrolysis in the corpus cavernosum,” not “a potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum,” as printed. Also, on page 1399, the second sentence under the heading “Results” should have read, “The men in the dose-escalation study had had erectile dysfunction for longer periods,” not “The men in the dose–response study,” as printed.

Condition	Caution / Notes	Risk Factors
Cardiovascular disease	Use with caution	Heart failure, recent MI
Concomitant nitrate use	Absolute contraindication	Risk of severe hypotension
Severe hepatic impairment	May require dose adjustment	Reduced clearance
Retinitis Pigmentosa	Cautious use	Potential for vision disturbances

Any commercial reuse of NEJM Group content requires permission.

• Always consult a healthcare provider before starting sildenafil.
• Do not exceed the prescribed dose to avoid side effects.
• Sildenafil can interact with nitrates, causing dangerous blood pressure drops.

A novel standard‐free detection of adulteration method for sildenafil derivatives in dietary supplements, Biomedical Chromatography, 38, 8, (2024). Duplex ultrasonography and its role in the assessment of male sexual dysfunction, Male Sexual Dysfunction, (91-101), (2016). Vasodilatory and hypoglycaemic effects of two pyrano-isoflavone extractives from Eriosema kraussianum N. E. Br. Switching patients with erectile dysfunction from sildenafil citrate to tadalafil: Results of a European multicenter, open-label study of patient preference, Clinical Therapeutics, 25, 11, (2724-2737), (2003).

• Common side effects include headache, flushing, and nasal congestion.
• Serious side effects are rare but can include vision changes and priapism.
• Report any severe reactions to your doctor immediately.

Changing Practice Patterns in Erectile Dysfunction: A Diagnostic Algorithm for the New Millennium, Advances in Renal Replacement Therapy, 6, 4, (314-326), (1999). Applies to the following strengths: 10 mg/mL; 10 mg/12.5 mL; 20 mg; 25 mg; 50 mg; 100 mg; 75 mg TABLETS (Viagra) Initial dose: 50 mg orally once a day, as needed, about 1 hour prior to sexual activity Maintenance dose: May increase to 100 mg or decrease to 25 mg once a day, based on efficacy and tolerability.