Blue Sildenafil for Pulmonary Arterial Hypertension (PAH)

Population-based study in the state of Missouri and Los Angeles County, California.

The effects of sildenafil on ocular blood flow. Effects of sildenafil citrate (Viagra) on choroidal congestion.

How successful was Viagra?

Short time influences of sildenafil on visual function (abstract). Zrenner E. No cause for alarm over retinal side-effects of sildenafil. Effect of sildenafil citrate (Viagra) on the ocular circulation. Ermis SS, Inan UU, Samli M, Ozturk F.

Limit Alcohol

Acute effects of sildenafil on Humphrey visual field and intraocular pressure. Optic disk risk factors for nonarteritic anterior ischemic optic neuropathy. Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial. Incidence of nonarteritic anterior ischemic optic neuropathy. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders.

Pupil-sparing third nerve palsy associated with sildenafil citrate (Viagra).

• Sildenafil was first developed by Pfizer in the 1990s as a heart medication before ED use was found.
• The blue sildenafil pill became popular worldwide, especially after the launch of Viagra.
• It is classified as a phosphodiesterase type 5 (PDE5) inhibitor.
• The legality of buying blue sildenafil varies across countries; prescription is recommended.
• Counterfeit blue sildenafil pills are prevalent and potentially dangerous.
• Genuine blue sildenafil should have a clear inscription and proper packaging.
• The medication's onset is typically within 30 to 60 minutes after intake.
• Alcohol consumption can diminish sildenafil's effectiveness or increase side effects.
• Blue sildenafil doesn't protect against sexually transmitted infections.
• Misuse or overdose can cause dangerous health effects, including heart problems.

Central serous chorioretinopathy in a patient taking sildenafil citrate.

• The pill should not be taken with recreational drugs like poppers (amyl nitrite).
• It is effective for many men, but not everyone will experience the same results.
• Can cause temporary tinnitus or ringing in the ears in rare cases.
• The medication is available in some countries over the counter, but not all.
• It is important to avoid driving until you know how it affects you.
• The blue color helps prevent medication errors in healthcare settings.
• Patients with a history of priapism should avoid using sildenafil.

Ophthalmic Surg Lasers Imaging 2004 Mar-Apr;35(2):165-7.35.

Society and culture

The most common side effects of sildenafil include headache, flushing, dyspepsia, nasal congestion and visual disturbances.13 Serious cardiovascular, cerebrovascular and vascular eventsincluding myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertension, subarachnoid and intracerebral hemorrhages, and pulmonary hemorrhageare possible, though rare, side effects.15 The FDA has concluded that it is not possible to determine whether these events are directly related to Viagra, sexual activity, underlying cardiovascular disease, a combination of these factors or other factors.16 Ocular Side EffectsOcular side effects of sildenafil have been well documented. The most prominent: complaints of a bluish tinge to vision, increased light sensitivity and halos.11,17 The incidence of these visual symptoms is infrequent at low doses but may be as high as 50% at 200mg.18 The mechanism for this phenomenon remains unknown. One theory: Sildenafil has up to 10% effectiveness against phosphodiesterase-6, an enzyme localized to the photoreceptors in the retina. This enzyme is important in transduction, the process in which light energy is converted to a neural signal. Because of the action against PDE6, alterations in cGMP within the cone photoreceptors may be responsible for these visual side effects.13 Higher doses of Viagra (>200mg) have been reported to cause transient visual changes, slight electroretinogram changes and subtle color-vision changes.13,19-21 There is no significant evidence that sildenafil affects visual acuity, visual field, IOP or visual evoked potentials.22,23 NAIONMore serious ocular side effects that have irreversible visual complications also have been linked with sildenafil.

Expired, fake and contaminated pills

Since 1999, more than 20 documented cases of nonarteritic anterior ischemic optic neuropathy (NAION) occurred among individuals following sildenafil ingestion.3-9 A disc at riska crowded, small optic nerve head that has a small physiologic cup, abnormal branching of the central vessels and full nerve fiber bundles obscuring the disc marginis the typical optic nerve head seen in NAION and is almost always seen in the fellow eye (figure 4).24 Visual acuity may vary from 20/20 to a marked loss of vision, depending on which part of the optic nerve head is involved. Structural factors of a disc at risk and subsequent alterations to perfusion pressure in the peripheral branches of the posterior ciliary arteries lead to microvascular ischemia.28 This ischemia, which occurs in the capillaries, causes axoplasmic stasis and edema of the optic nerve head. Risk is significantly increased in older patients, as their capillaries often are already compromised, potentially increasing the level of ischemia. The role of sildenafil in NAION is unknown, but reports suggest that the effect on blood pressure through the NO-cGMP pathway may be responsible.3-5,21,22,29-31 Just as NO can regulate blood pressure through vasodilation, NO may also dilate blood vessels around the optic nerve head and influence its perfusion, subsequently interfering with the autoregulation of ocular blood flow.5,22,29-31 The circulation of the optic disc, peripapillary choroid and choroid depends upon the difference in perfusion pressure of the posterior ciliary arteries and IOP.28 If sildenafil accentuates hypotension enough, the perfusion pressure in the posterior ciliary arteries may decrease and cause an oxygen imbalance, and ultimately an ischemic optic nerve head. This is a similar pathophysiological process to that of nocturnal arterial hypotension, which may cause decreased perfusion to the optic disc.32 If the optic nerve head was already predisposed to ischemia by an anatomic disc at risk configuration, it becomes even more plausible that NAION may develop.

What to do if you think you’ve taken too much Viagra

Other Ocular ComplicationsMuch less prevalent yet serious ocular complications possibly associated with sildenafil usage have occurred. These include one reported case of a third-nerve palsy, (presumably from third-nerve ischemia), one reported case of central serous chorioretinopathy, two reported cases of serous macular detachments (presumably from choroidal ischemia), and one reported case of branch retinal artery occlusion (presumably secondary to cardiac ischemia that lead to arrhythmia and subsequent embolus formation).33-37 As with NAION, a hypotensive ischemic event secondary to the NO effect on various organs was suspected in each of these cases. The ocular findings associated with sildenafil usage may have important implications for other anti-ED medications. Recently, two cases of NAION have been reported in individuals after they used Cialis.38,39 Tadalafil acts similarly to sildenafil, but is more specific for PDE5 and lasts up to 36 hours. Although we cannot positively associate tadalafil and NAION based solely on these two cases, they should raise our suspicion. Quiram P, Dumars S, Parwar B, Sarraf D.

What is Viagra?

Nonarteritic ischemic optic neuropathy developing soon after use of sildenafil (Viagra): a report of seven new cases. Sildenafil-associated nonarteritic anterior ischemic optic neuropathy. Anterior ischemic optic neuropathy associated with Viagra. A case of nonarteritic ischemic optic neuropathy (NAION) in a male patient taking sildenafil. Pomeranz H.

Hormonal imbalances

Sildenafil (Viagra) associated NAION: additional cases. 29th buy sildenafil uk Annual North American Neuro-Ophthalmology Society Meeting. Akash R, Hrishikesh D, Amith P, Sabah S. Case report: association of combined nonarteritic anterior ischemic optic neuropathy (NAION) and obstruction of cilioretinal artery with overdose of Viagra. Sildenafil for male erectile dysfunction: a systematic review and meta-analysis.

How does sildenafil work (mechanism of action)?

Montvale, N.J.: Medical Economics 2001:2534-7.16. Food and Drug Administration Joint Clinical Review. Study 148-228: An open, randomized, single oral dose, four-way crossover study to determine the dose proportionality of the pharmacokinetics of sildenafil in healthy male volunteers over the dose range 25mg to 200mg:167-9. Subjective visual halos after sildenafil (Viagra) administration: electroretinographic evaluation. The effects of sildenafil citrate (Viagra) on color discrimination in volunteers and patients with erectile dysfunction (abstract). Viagra-associated serous macular detachment.

• Research indicates that blue sildenafil may improve quality of life for ED sufferers.
• Side effects are usually mild but can sometimes be severe, requiring medical attention.
• The pill's blue color is iconic and recognized worldwide as Viagra-like medication.
• Blue sildenafil can be part of a broader sexual health regimen under medical advice.
• Some users report enhanced confidence and reduced performance anxiety.
• Ensuring the correct dosage is vital to avoid adverse reactions.
• Sildenafil can sometimes cause changes in hearing or ringing in the ears.
• There are ongoing debates about the long-term effects of sildenafil use.
• Lifestyle factors like exercise and diet can influence sildenafil's effectiveness.
• Educational efforts emphasize responsible use to minimize health risks.

Branch retinal artery occlusion; another complication of sildenafil.

• Blue sildenafil refers to a form of sildenafil, often used for treating erectile dysfunction.
• It is usually sold in a distinctive blue pill shape, commonly associated with Viagra.
• Sildenafil works by increasing blood flow to the penis during sexual arousal.
• Blue sildenafil is available by prescription or, in some cases, through unregulated sources.
• Its recommended dosage varies, typically 25mg to 100mg per use.
• Common side effects include headaches, flushing, nasal congestion, and dizziness.
• It should not be taken with nitrates, as it can cause serious blood pressure drops.
• Blue sildenafil may interact with other medications, so consult a healthcare provider first.
• The drug's effects usually last for 4 to 6 hours, depending on the dose and individual.
• Using blue sildenafil irresponsibly can lead to health risks like priapism or cardiovascular issues.

Tadalafil associated with anterior ischemic optic neuropathy.

What SPECIAL DIETARY instructions should I follow?

To date, no such cases have been reported with Levitra, a similar, long-lasting PDE5 inhibitor. The O.D.s RoleAlthough it is sensitive information patients would often rather not discuss with their eye doctors, it is important to ask every male patient about the use of ED medications. By explaining why it is important for you to know and briefly describing the possible ocular complications associated with these medications, patients may be more willing to disclose this information. Pay careful attention to patients who are being treated for ED with one of the PDE5 inhibitors because most are already at a higher risk of developing a vascular event secondary to age. If nothing else, when a patient presents with signs and symptoms of NAION, a complete review of medications, including specific questions regarding sildenafil usage, is imperative.

Drug form and strengths

Inform your patients about the potential risks of sildenafil. Pay particular attention to patients who have a history of monocular NAION as sildenafil usage may increase the risk of NAION in the fellow eye. If you note ocular ischemia in patients taking sildenafil, report it to the National Registry of Drug-Induced Ocular Side Effects ( for further evaluation. Viagra has been a well-known treatment option for men who suffer from erectile dysfunction. O.D.s must be aware of potential adverse ocular side effects, recognize and treat sildenafil-related conditions, and help patients make informed decisions regarding its use.

Natural and over-the-counter alternatives for ED

Dr. Duszak practices at the Philadelphia Veterans Affairs Medical Center, the Nemours Health Clinic in Wilmington, Del., and a private-practice in Philadelphia. He has lectured on the ocular side effects of Viagra. Sexual dysfunction in the United States: prevalence and predictors. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Bollinger K, Lee MS.

Recurrent visual field defect and ischemic optic neuropathy associated with tadalafil rechallenge.

Over a dozen men developed "very intensely" blue vision and other vision changes after taking double the recommended dose of sildenafil, the main ingredient in branded erectile dysfunction treatments like Viagra. In a case study, researchers examined the reports of 17 men who had visited a clinic in Turkey between August 2017 and March 2019, each within 48 hours of taking 100 milligrams of sildenafil.