Sildenafil is the generic form of Viagra — a PDE5 inhibitor used to treat erectile dysfunction. At Bidwell Health, a licensed U.S. nurse practitioner reviews a 10-minute intake, and if appropriate your prescription is sent electronically to your pharmacy the same day. $45 flat for the visit. Generic sildenafil at the pharmacy is typically $0.50–$2 per tablet with a discount card.
Sildenafil is a selective inhibitor of phosphodiesterase type 5 (PDE5) — the enzyme that breaks down cyclic GMP in the smooth muscle of the penis. By blocking PDE5, sildenafil preserves cGMP levels, which allows the smooth muscle to relax and blood to flow into the corpus cavernosum during sexual arousal. It doesn't cause an erection on its own; it enables a normal erectile response when a man is sexually aroused. The FDA DailyMed label is the definitive reference for its mechanism, dosing, and safety.
Pfizer marketed it as Viagra from 1998 through 2017 when the main U.S. patent expired. Since then, multiple manufacturers have produced FDA-approved generic sildenafil — the exact same molecule at the exact same strengths, priced at a small fraction of brand Viagra. A separate lower-dose formulation (Revatio, 20 mg) is approved for pulmonary arterial hypertension. When we refer to "sildenafil" on this page, we mean the 25–100 mg tablets used for ED.
Sildenafil is appropriate for most adult men with erectile dysfunction. The American Urological Association guideline recommends PDE5 inhibitors as first-line therapy for ED in the absence of contraindications. You can be prescribed sildenafil through Bidwell if you:
You do not need bloodwork, a physical exam, or a specialist referral to start sildenafil through telehealth for typical ED. If your history suggests a secondary cause (sudden onset ED after a heart attack, significant cardiac risk factors, features of hypogonadism), the reviewing nurse practitioner may recommend an in-person evaluation instead of prescribing online.
Use caution — not absolute avoidance — if you take alpha-blockers for BPH (separate doses by 4+ hours), have cardiovascular disease that limits exertion, have Peyronie's disease, or have any condition that predisposes to priapism (sickle cell disease, leukemia, multiple myeloma). The NIH StatPearls review is a useful clinical reference for the full safety profile.
| Dose | When to use | Notes |
|---|---|---|
| 25 mg | Older adults, renal/hepatic impairment, drug interactions | Lower starting dose; titrate up if tolerated |
| 50 mg | Most adults, first-time users | Standard starting dose; taken 30–60 min before activity |
| 100 mg | Inadequate response to 50 mg | Maximum recommended dose; not more than once in 24 hours |
Sildenafil is taken as needed, not daily. Take it 30–60 minutes before anticipated sexual activity, preferably on an empty stomach for fastest absorption. A heavy, high-fat meal can delay onset by an hour or more. Grapefruit juice raises sildenafil levels and should be avoided around dosing.
Only one dose per 24 hours. If a full 100 mg dose taken correctly doesn't produce adequate response after 6–8 well-timed attempts, talk to your provider — the answer is usually switching agents (to tadalafil), checking testosterone, or addressing underlying vascular risk factors. More sildenafil is not the answer.
Sildenafil is generally well tolerated. The most common side effects in clinical trials (FDA label data) are:
Serious but rare side effects include priapism (painful erection lasting more than 4 hours — medical emergency, seek care immediately), sudden hearing loss, and NAION (non-arteritic anterior ischemic optic neuropathy). Stop the medication and seek urgent care for sudden vision or hearing loss.
For a deeper breakdown, see our full write-up on sildenafil side effects explained and how long sildenafil lasts.
Sildenafil is one of the best pharmacy deals in the U.S. At cash prices with a discount card (GoodRx, SingleCare, Amazon Pharmacy, or pharmacy-specific programs):
| Strength | Tablets | Typical cash + discount |
|---|---|---|
| 50 mg (generic) | 10 tablets | ~$8–$20 |
| 100 mg (generic) | 10 tablets | ~$10–$25 |
| 50 mg (generic) | 30 tablets | ~$15–$40 |
| Viagra (brand) | 10 tablets | ~$700–$900 |
Branded Viagra is essentially never the right choice for cash-pay patients. Generic sildenafil is therapeutically equivalent per FDA standards and is what almost every U.S. patient now takes. Your $45 Bidwell visit fee covers the clinical review and prescription — the pharmacy fill is separate and priced independently. Check prices on GoodRx before picking up.
Bidwell Health is licensed to prescribe in:
You must be physically located in one of these states at the time of your visit. If you're outside this list, we're adding states — but we can't prescribe until we're licensed in your state.
Yes. Sildenafil is not a controlled substance, so it's routinely prescribed via telehealth after a licensed provider reviews an intake. Bidwell's process takes about 10 minutes to submit and most reviews complete within 1–2 hours during business hours for $45 flat.
At most U.S. pharmacies with a GoodRx coupon, generic sildenafil 50 mg tablets are roughly $0.50–$2 each. A 30-tablet supply commonly runs $15–$40 cash. Branded Viagra still lists $70–$90 per tablet; essentially all cash-pay patients use the generic.
50 mg taken about 60 minutes before sexual activity. Your provider may start at 25 mg if you're older, have kidney or liver impairment, or take interacting medications. The max dose is 100 mg, once in 24 hours.
Half-life is ~4 hours; clinical effect is strongest for 2–4 hours and the window is typically 4–6 hours. It requires sexual arousal to work. If you want a longer window, tadalafil offers 24–36 hours.
Light to moderate drinking is generally okay. Heavy drinking worsens ED on its own and increases sildenafil side effects like headache, flushing, and low blood pressure. Avoid grapefruit juice around dosing — it raises levels.
Yes. Same active ingredient, same strengths, FDA-approved as therapeutically equivalent. The patent expired in 2017 and multiple manufacturers now produce generic sildenafil.
About 70% of men respond. If 100 mg taken correctly doesn't work after 6–8 well-timed attempts, options include switching to tadalafil, checking testosterone, or evaluating cardiovascular risk. Most "non-response" is actually a dosing or timing issue.
Sildenafil doesn't transfer meaningfully through skin contact or ejaculate. It acts on the person who took it. You don't need to tell your partner for safety reasons, though most people do.
Yes, after an initial review confirms you tolerate sildenafil, Bidwell can provide 90-day refills. Some insurers cover generic sildenafil; check with your pharmacy benefit.
Sildenafil is FDA-approved only for men's ED and pulmonary hypertension. Off-label use for female sexual dysfunction exists but is not well supported by evidence. We don't prescribe sildenafil to women.