Viagra Black

Viagra Black is a sildenafil tablet produced by an overseas generic manufacturer. Sildenafil blocks the enzyme phosphodiesterase type 5 (PDE5), which lets blood vessels in the penis relax and fill when a man is sexually aroused. It does not cause an erection on its own, does not increase desire and is not a contraceptive or protection against infections. The photograph shows the manufacturer's brand pack as supplied. Despite the name, Viagra Black is not made by the company holding the UK licence for Viagra; the only shared feature is the active ingredient.

One strength is listed, 200mg, in packs of 10, 20, 30, 60, 90, 120 or 180 tablets. Pack size reflects how many tablets you receive, not a different dose per tablet.

UK-licensed sildenafil tablets come in 25mg, 50mg and 100mg strengths. According to the SmPC, the usual starting dose for adult men is 50mg taken about an hour before sexual activity, adjusted to 25mg or 100mg depending on response and tolerability. The licensed maximum is 100mg, no more than once in 24 hours. A 200mg tablet is therefore above the maximum recommended dose, and any decision to use part of a tablet or a different product is for a prescriber. No adjustment is needed for age alone, but men with severe kidney problems or with liver impairment may start at 25mg. A heavy meal can delay the effect.

Sildenafil for erectile dysfunction is licensed in the UK as a prescription-only medicine (POM), and a 50mg version is also available as a pharmacy medicine (P) after a pharmacist's assessment. Viagra Black itself holds no UK marketing authorisation; it is an imported generic and there is no UK SmPC or patient leaflet for this brand.

The SmPC rules out sildenafil for men taking nitrates in any form, including glyceryl trinitrate sprays and isosorbide tablets, or recreational amyl nitrite ("poppers"), because blood pressure can fall dangerously. Riociguat is also contraindicated. It should not be used where sexual activity is inadvisable because of heart disease, after a recent stroke or heart attack, with severe liver impairment, low blood pressure (below 90/50 mmHg) or certain inherited eye disorders such as retinitis pigmentosa, or after loss of vision from non-arteritic anterior ischaemic optic neuropathy (NAION).

Ritonavir, some antifungals (ketoconazole, itraconazole) and clarithromycin raise sildenafil levels sharply, and alpha-blockers such as doxazosin can add to its blood-pressure-lowering effect. Common side effects are headache, flushing, indigestion, nasal congestion, dizziness and changes in colour vision or blurred sight; these tend to be more frequent at higher doses. An erection lasting over four hours, or sudden loss of sight or hearing, needs urgent medical help through 999 or A&E.

Erection problems can be an early sign of diabetes, raised cholesterol or heart disease, so a check-up with your GP is worthwhile. Whether sildenafil is suitable and at what dose is for your doctor or prescriber to decide, and that applies equally to Viagra Black.