On sports radio this morning I heard two consecutive advertisements for mail order pharmacies selling generic sildenafil 20 mg to treat erectile dysfunction (ED) as a substitute for Viagra. This is an issue because of the odd patent law in the U.S and the high cost of brand name ED medications. The generic name for the ingredient in Viagra is sildenafil. It has two FDA approved indications. One is for idiopathic pulmonary hypertension, for which a dose of 5-20 mg dose three times daily is recommended. The patent on sildenafil (Branded as Revario for pulmonary hypertension) has expired and generic versions of sildenafil 20 mg are available and FDA approved to treat pulmonary hypertension. Viagra, another brand name for sildenafil, is marketed and FDA approved for treatment of male erectile dysfunction (ED) at doses of 25, 50 and 100 mg to be used 30-60 minutes before erection is desired. Sildenafil is not available as a generic in the U.S. at 25, 50 or 100 mg doses.
$$$: The big issue with use of Viagra is cost. Viagra 100 mg. per GoodRx.com at the least expensive pharmacy option (a membership plan) costs $299.99 for 6 tablets. This is essentially $50./ 100mg dose. Even broken in half and used at 50 mg dose this is $25./ dose. Generic sildenafil 20 mg per GoodRx.com can be purchased #30 tablets for $19.25 (with free coupon, usual cash prices as low as $2-3.00 / tablet)
Physicians are allowed legally to prescribe FDA available medications for “off label” indications as long as they feel that the off label indication treatment is reasonable, a better option than FDA approved options, and that the patient is informed and agrees to the treatment. In the case of sildenafli this is just an issue with available dose options, and a common practice is to prescribe generic sildenafil 20 mg 1-5 tablets in place of Viagra 100 mg 1/2 -1 tablet. If a patient uses 5 of the 20 mg pills at a cost of $3-15 the savings over a 100 mg Viagra tablet that costs $50 is significant.
Use of generic sildenafil in doses from 1-5 tablets in place of brand name Viagra is a very viable option that I have recommended to patients in need of an ED medication.