Yes, Viagra can be safe and effective for older men: age on its own is not a reason to avoid it, and the European label needs no dose change at 65 or over. What decides whether it is safe for a particular man is his heart, his other medicines, and his kidney and liver health (EMA product information). In Australia sildenafil is prescription-only, so those questions are asked before the first script (healthdirect).
Does Viagra work in older men?
Yes, for most. Sildenafil treats erectile dysfunction (ED), which becomes more common as men get older (healthdirect). The studies behind the European label enrolled more than 8,000 men aged 19 to 87, and across them 67% of the older men reported that their erections improved (EMA product information). It works only with sexual stimulation, at any age.
Do older men need a lower dose?
Not because of age alone. The label says dose adjustments are not required at 65 and over, even though healthy volunteers of that age had about 90% higher blood levels of sildenafil than younger men (about 40% higher for the unbound, active part). The usual start is 50mg about an hour before sex, with a range of 25mg to 100mg and one dose a day at most. A 25mg start should be considered for men with severe kidney impairment or liver impairment, men on medicines that slow the breakdown of sildenafil, and men on an alpha-blocker (EMA product information).
Which heart and blood pressure medicines matter?
Nitrates for angina come first: Viagra must never be taken with them, or with guanylate-cyclase stimulators such as riociguat (EMA). healthdirect also lists amyl nitrite and blood pressure medicines as interacting, with the risk of a sudden drop in blood pressure that is hard to treat (healthdirect). Alpha-blockers, used for high blood pressure or prostate problems, need care (Viagra CMI): be stable on the alpha-blocker before starting, and a 25mg first dose should be considered. Men on several heart or blood pressure medicines should consult with a healthcare provider who has their full medicine list before the first dose.
Which conditions rule Viagra out?
The label rules it out for men with severe liver disease, low blood pressure, a recent stroke or heart attack, an inherited eye disease such as retinitis pigmentosa, or past loss of vision from NAION (EMA). ED medicines should also be avoided if sexual activity itself could put you at risk, for example with some heart conditions (healthdirect).
What side effects should older men watch for?
The common ones are headache, facial flushing, a blocked nose and indigestion. Rarer but serious are changes in vision, sudden hearing loss, dizziness or fainting, an allergic reaction and priapism, an erection that will not go down (healthdirect). Dizziness matters more in a man who already takes blood pressure medicines. An erection lasting more than 4 hours needs the nearest hospital emergency department (healthdirect).
Does it work with diabetes, high blood pressure or heart disease?
Often, though less often than when ED has a psychological cause (84% in the same studies). Across the label's studies, men reporting improved erections numbered 59% of those with diabetes, 68% of those with high blood pressure and 69% of those with ischaemic heart disease (EMA product information). These conditions are also causes of ED, so a doctor will usually treat them first (healthdirect).
What else helps besides tablets?
Helping an older man achieve an erection often involves more than just medication. healthdirect names stopping smoking, exercising more, losing weight and eating well as ways to prevent some causes of ED, and counselling or sex therapy, often with a partner, when stress or the relationship plays a part (healthdirect). When tablets do not suit, the alternatives are alprostadil injections into the penis and vacuum erection devices (healthdirect).
Is another tablet better than Viagra for older men?
There is no "best" tablet by age. The PDE5 inhibitors available in Australia are sildenafil (Viagra), tadalafil (Cialis), vardenafil and avanafil (Spedra), all prescription-only (healthdirect). They differ mostly in timing: tadalafil can work for up to 36 hours after a dose, and a 5mg once-a-day form suits men who expect to use it at least twice a week (Cialis CMI). The Levitra brand is not on the Australian register, but generic vardenafil is (ARTG). All of them share the same ban on nitrates.
