Description

Silagra (sildenafil)

Silagra is a generic sildenafil manufactured by Cipla Ltd in India, available in 25 mg, 50 mg, and 100 mg tablets. Cipla is one of the larger Indian pharmaceutical manufacturers and produces several branded generics for the same active ingredient; this is one of them. The drug itself is standard sildenafil citrate.

Dosing

The recommended starting dose is 50 mg, taken approximately one hour before sexual activity. If 50 mg is effective and well-tolerated, there’s no reason to increase the dose. If insufficient, 100 mg is the maximum. Sexual stimulation is required; the drug doesn’t produce an erection without it.

Some patients need to start at 25 mg rather than 50 mg. The clearest case is men who take ritonavir (Norvir) or lopinavir/ritonavir (Kaletra) for HIV — these are strong CYP3A4 inhibitors that substantially raise sildenafil blood levels. A 25 mg starting dose is standard when these drugs are co-prescribed. The same applies to other strong CYP3A4 inhibitors: ketoconazole, itraconazole, erythromycin, saquinavir. Alpha-blockers for blood pressure or BPH also warrant a 25 mg starting dose and careful hemodynamic monitoring.

Duration of effect: 4 to 6 hours. Fatty meals delay absorption and reduce peak concentration. Empty stomach is most predictable. Maximum one dose per 24-hour period.

Nitrates

Sildenafil combined with nitrates — nitroglycerin, isosorbide preparations, amyl nitrite — causes severe blood pressure drops that can be fatal. This is an absolute contraindication regardless of dose, timing, or clinical context.

Contraindications

All nitrates and recreational nitrites (poppers). Recent cardiac events — heart attack, stroke, or cardiac surgery with incomplete recovery. Severe cardiovascular disease. Uncontrolled high or low blood pressure. Kidney or liver disease at significant severity. Retinitis pigmentosa. History of NAION. Bleeding disorders. Peyronie’s disease or other penile structural abnormalities. Hypersensitivity to sildenafil. Men under 18.

Side effects

Headache, facial flushing, nausea, indigestion, back pain, and muscle pain are the most commonly reported. Visual disturbances — blue tint, increased brightness, blurred vision — are dose-dependent and reflect PDE6 involvement in the retina.

Sudden vision loss, sudden hearing loss, chest pain, and syncope are rare but serious and require immediate evaluation.

Priapism — erection lasting more than 4 hours — is a medical emergency. Delay causes permanent damage to erectile tissue regardless of pain level.