Sildenafil Citrate
A potent, selective inhibitor of cGMP-specific phosphodiesterase type 5 (PDE5). While standardly prescribed for ED, functional applications extend to endothelial rehabilitation, pulmonary arterial modulation, and systemic nitric oxide optimization.
Primary Targets
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Corpus Cavernosum Smooth muscle relaxation via NO/cGMP pathway.
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Pulmonary Vasculature Reduction of pulmonary vascular resistance.
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Endothelium (Systemic) Improvement of flow-mediated dilation.
Pharmacokinetics & Timing
Understanding the absorption window is critical for therapeutic efficacy. High-fat meals drastically alter the Tmax and Cmax, a common cause of "treatment failure" in functional protocols.
ABSORPTION LAG
PEAK CONCENTRATION
DURATION WINDOW
Clinical Nuance & Quirks
Cyanopsia
"Blue Vision". Sildenafil has 10% affinity for PDE6 (retina) vs PDE5. High doses may cause transient blue tinge to vision.
Auditory Shift
Rare sudden decrease or loss of hearing, sometimes accompanied by tinnitus and dizziness.
NO Boosters
Synergistic hypotension risk. Patients supplementing heavily with L-Citrulline or Nitrates may experience exaggerated BP drops.
Reflux/GERD
Lower Esophageal Sphincter (LES) is smooth muscle. PDE5i causes relaxation of the LES, exacerbating GERD.
Dosing & Cycles
THE "WASHOUT" PERIOD
Tachyphylaxis (tolerance) to PDE5i is debated but observed in clinical practice. Functional dosing often utilizes "Holidays" to reset NO sensitivity.