Research Report: Is 100 mg the Best Starting Dose for Viagra?

Thumbnail image for research_icon.jpgTitle: Sildenafil Citrate 100 mg Starting Dose in Men with Erectile Dysfunction in an International, Double-Blind, Placebo-Controlled Study: Effect on the Sexual Experience and Reducing Feelings of Anxiety About the Next Intercourse Attempts

Source: Journal of Sexual Medicine, 2009, 6:2826-2835

Purpose of Study: Usually, patients are recommended to begin treatment with Viagra at a 50 mg dose. Later, if that doesn't work well, they may be increased to a 100 mg dosage. This is a standard method for administering medicines, since with a higher dose comes an increased risk of side effects. 

Erectile dysfunction, though, isn't just a physical issue it is a psychological one as well. So patients might be disappointed if they try 50 mg and cannot achieve the type of erection they were hoping for. So, it might be psychologically beneficial to instead start at the higher dose of 100 mg to avoid this performance anxiety.

Result of Study: "After treatment with sildenafil 50 mg or 100 mg, men felt less anxiety, and 56.3% of men initiating treated with 100 mg sildenafil felt no anxiety about he next intercourse attempt compared with 38.8% of men initiating treatment at sildenafil 50 mg." In other words, the men who started out at 100 mg were much more confident, with less performance anxiety, than those who started out at 50 mg. 

However, "Although improvements in functional measures were observed in the 100-mg group during the double-blind phase, the improvements were not statistically significant compared with the 50-mg group" In other words, the 100 mg patients didn't show much of a physical difference than the 50 mg patients. But they did show a different psychological reaction. This means that men may be very sensitive to very slight differences in erectile performance. 

Points of Interest: According to this study, most patients begin taking Viagra at 50 mg but then increase to 100 mg. This is an interesting claim, but doesn't align with the feedback we've received from readers of this site, most of whom seem to do well at 50 mg.

Open Questions: This study didn't examine carefully the differences in side effects experienced by the 50 mg and 100 mg groups. This is an important consideration which we'd like to see studied along with the psychological benefits of a higher dose.