Interaction charts on this desk are for reading, not for writing a prescription or filling a bottle. Open the orbit disclaimer
Trace · PDE5 trace
Last reviewed · 9 min read · Updated
Orbit card
| Onset | Fasted 30-120 min |
|---|---|
| Duration | ~4 h window |
| Food | Fix meals before climbing |
| Alcohol | Moderation on every step |
Clinic slang treats 25 mg as 'the low one for nervous patients'. The label treats 25 mg as the dose you use when exposure will be high or blood pressure is already spoken for. Ritonavir: maximum 25 mg in 48 hours because AUC rose about 11-fold. Ketoconazole, itraconazole, saquinavir, erythromycin: consider 25 mg to start. Age over 65, Child-Pugh hepatic impairment, CrCl below 30: consider 25 mg. Stable alpha-blocker: 25 mg.
Climbing those people to 50 or 100 because a friend uses 100 is how syncope gets written up as 'Viagra side effect' instead of 'ignored cap'.
People without those partners still start at 50 mg in many labels, then move to 25 or 100 by effect and tolerability. This desk's SERP lock is the whole 25-100 band. We will not pretend everyone begins at 100.
A step is wasted if the last attempt was after a high-fat dinner, with a second tablet the same night, or with a new azole. Clean the pairing, then change milligrams. The meal orbit is the dinner half of that sentence.
Nitrates and riociguat close the entire ladder. There is no 25 mg exception for a nitroglycerin spray.
Ladder chip
Sildenafil 50 at dusk plus tadalafil 20 at midnight is not a creative 70. It is two labeled products and two hold clocks. Combo strips that print 100/20 (Sildalist-type) skip the ladder and dump both peaks at once.
Vardenafil 2.5-5 the next morning after 100 mg sildenafil is still class stacking if the 24-hour sildenafil window is open.
Daily tadalafil 2.5 plus occasional sildenafil 50 is the hybrid the daily tadalafil trace already refuses. Pick one orbit.
Export 100 mg brands (Suhagra, Fildena, Cenforce) follow this same ladder if the INN is sildenafil. The logo is not a parallel scale.
Labeled maximum is 100 mg. Export 150 or 200 mg strips are not a Caelum step. They are uncharted exposure.
Inadequate response at 100 mg after clean trials is a work-up or a skyline move. It is not a forum titration.
Cardiac status can close the class at any rung. Chest pain on 25 mg is not a reason to try 50 'more carefully'.
Bring the failure log to the sildenafil orbit rather than buying a second brand of 100 mg.
A message that says Viagra not working without the last strength, meal state, and CYP list is how locums write 100 mg onto a ritonavir cap. Paste the four facts: milligrams last used, fasting or fed, booster or azole yes/no, alpha-blocker yes/no.
If the last three failures were after pizza, the locum should open the meal orbit, not the 100 mg box. If the last three were fasting 50 mg with quiet partners, 100 mg is a fair ask.
Age over 65 on the chart is a consider-25 flag. A locum who only sees ED as a lifestyle request will miss it. Put the age and the last eGFR or liver note in the same sentence as the request.
Do not send a photo of a forum 100 mg blister as proof you already 'use' that strength. This desk does not discuss checkout prices or coupons. INN and milligram on a licensed label are the only photo that helps.
After any priapism visit, the next locum must see that event before they restore 100 mg. Restart strength is specialist territory.
Print or screenshot the current blister showing 25, 50, or 100 so the video visit does not guess. Mixed leftover foils from two years are how a 25 mg cap patient swallows 100 mg because the tablets looked similarly blue. Color is not a milligram. If the locum still wants to write 100 mg, they must also write why the 25 mg cap no longer applies - azole stopped, booster gone, alpha-blocker stable with quiet standing pressures - in that same clinic note today also.
Several attempts at 50 mg, fasting or light-meal, one tablet per day, alcohol moderated, no new CYP3A4 partner. Then 100 mg is a reasonable efficacy conversation. One soggy Saturday is not several attempts.
Side effects that already bother at 50 - flushing, dyspepsia, color-tinge, headache - often scale at 100. That is expected pharmacology, not proof of a counterfeit 50.
Do not split the difference by taking 50 at 20:00 and 50 at 23:00. That is 100 mg without a single-peak plan and it still counts as more than one dose in the night.
If 100 mg fasting fails, the next questions are vascular, hormonal, SSRI, and relationship timing - or a skyline switch - not 150 mg from an export blister.
Households that keep a 25 mg starter from an azole month and a leftover 100 mg from last year will grab the wrong foil in the dark. Write the cap reason on a tape strip on the 25 mg bottle - ritonavir, ketoconazole, tamsulosin - so a Saturday does not become an accidental climb.
Splitting a 100 mg tablet to 'make 50' is not a labeled titration method on this desk. Score accuracy is poor and you still need the pairing to be clean. Ask for the strength you are actually supposed to swallow.
Partners who hide a 100 mg 'just in case' in a travel pouch recreate the stack the ladder forbids. One prescriber plan, one strength in the pouch, one swallow.
Hospital discharge that changes an ACE inhibitor or adds a macrolide should trigger a 25 mg conversation even if 100 mg lived in the drawer for years. The drawer does not update DailyMed.
Export 150 or 200 mg strips sold as the next rung after 100 are not a Caelum step. They are uncharted exposure. If 100 mg fasting failed, the work-up starts. The milligram race ends.
New dizziness after a clinic added an ACE inhibitor is a reason to discuss 25 mg, not to push 100 'so at least something works'.
A winter macrolide is a temporary down-step. Write the antibiotic stop date next to the sildenafil strength on the same card.
Priapism risk rises with higher exposure and with stacking. Anyone who needed emergency detumescence does not restart at 100 without specialist advice.
Vision or hearing red flags stop the ladder at whatever step they appeared. They are not '100 mg problems only'.
Write the exact strength dispensed, not 'the blue ones'. 25 and 100 are easy to mix in a drawer.
Record partners that forced 25 mg so a locum does not 'help' by writing 100 next month.
Record whether the last failure was fasting. Otherwise the next clinician climbs for a dinner problem.
Record nitrate counseling with the 24-hour number. Patients who came from tadalafil still say 48 out of habit and then guess.
Ritonavir patients are not waiting to 'earn' 50 mg. The 48-hour cap is pharmacokinetic, not psychological. Food delay does not open 50.
Strong azole courses are temporary caps. When the azole stops, the prescriber may reopen 50 or 100. Patients should not reopen it the evening the cream ends if oral ketoconazole still has days on the script.
Alpha-blocker users who felt nothing at 25 mg still need a standing-pressure log before 50. Orthostasis can appear on the step that 'finally works'.
Hepatic and severe renal starts at 25 mg exist because clearance is reduced. A normal dinner and a normal libido do not restore clearance.
| Trigger | Labeled sildenafil move |
|---|---|
| Ritonavir | 25 mg, not again for 48 h |
| Ketoconazole / itraconazole / erythromycin / saquinavir | Start 25 mg |
| Age >65, severe renal, hepatic impairment | Consider 25 mg |
| Stable alpha-blocker | 25 mg start |
| Nitrate, nitrite, riociguat | No step - closed class |
Caps stay caps. Climbs need fasting attempts and a partner list. File both on the parent orbit. Dinner excuses stay on the meal orbit.
Traces do not authorize a 25-to-100 jump. Prescribers do.
Checked against the current label and reviewed by Dr. Ingrid Bergsson. See Lift, Chart, Peer-pass, Publish.
25-100 pairing thread - educational only. Priapism or chest pain: 112.
Jon M., Kopavogur Friend uses 100. Clinic gave me 25 because of ketoconazole. Ignore them for the weekend?
No. Ketoconazole is a labeled reason to start at 25 mg. Your friend's 100 mg life is not your CYP3A4 life. Finish the azole conversation with the prescriber before any climb. A weekend 100 on ketoconazole is an exposure experiment, not confidence.
Steinunn R., cautious Take 50 at 20:00 and 50 at 23:00 instead of 100 at once?
That is two swallows and a messy peak, still 100 mg of exposure, and it breaks the one-tablet-per-need rhythm. If 100 mg is the plan, one tablet. If 50 is the plan, one tablet. Splitting the night is not a safety feature.
Kolbrun Y., pneumonia follow-up Clarithromycin five more days. Stay at 100 mg I already have?
Clarithromycin is a CYP3A4 inhibitor. Contact the prescriber about a 25 mg hold for the antibiotic window. Do not finish the 100 mg blister 'because it is already paid for' - this desk does not discuss price, only pairing. Chart the stop date.
Ulfur S., doxazosin 25 mg on doxazosin did little. Go to 50 next Friday?
Maybe, if sitting and standing pressures were quiet and the prescriber moves you. Do not self-step. First-dose 50 on an alpha-blocker is how Saturday spots appear. Bring a one-week pressure log to the message.
Anna S., boosted PI 25 mg Friday. Can I take 25 mg Saturday night?
Ritonavir rule is 25 mg in 48 hours, not 25 mg daily. Friday to Saturday night is inside 48 hours. Wait the full interval or ask clinic for a different plan. Food timing does not shorten 48 hours.
Thora V., 68 I used 100 mg at 60. Clinic restarted 25 after a hospital stay. Insulting?
Age plus whatever new medicines the hospital added can justify 25 mg even if 100 was your old habit. Ask which new partner triggered the cap - often an azole, a pressure drug, or a clearance change. Climb later if they clear the pairing, not because the number feels small.
Dagur Z., clean fail Fasting 100 mg, four tries, no nitrate, no booster. Next milligram?
There is no labeled next milligram. Work-up or skyline switch. Export 150-200 mg is not a Caelum step. Bring the log to the sildenafil orbit visit rather than another logo of 100 mg.
Vigdis W., export shop Sildalist 120 instead of stepping Viagra 50 to 100?
Sildalist 120 on this desk is sildenafil 100 plus tadalafil 20, not a PE/dapoxetine strip and not a 'rung' on the Viagra ladder. You skip titration and inherit two hold clocks. See the Sildalist traces and both parent orbits. Do not use it as a DIY 100.
Erla A., color tinge Blue tinge at 50 mg. Is 25 safer or is 100 going to blind me?
Transient color tinge is a known PDE6-adjacent effect and often dose-related. Sudden vision loss is a different emergency - stop and seek care. Do not self-jump to 100 to 'get used to' tinge. Ask clinic whether 25 mg or another agent is the next trial. Tinge alone is not a DIY 100.
Orri F., impatient 50 mg after pizza failed once. Jump to 100 tomorrow after pizza again?
You have not tested 50 mg. You tested 50 mg plus high-fat delay. Read the meal orbit, retry 50 fasting, then discuss 100. Climbing on a dirty pairing wastes the step and the headache.
Rakel Q., fasting trials Three fasting 50 mg nights, partial effect, no new meds. Reasonable to ask for 100?
That is the clean-step pattern the label's 50-to-100 titration assumes. Ask. Mention headache or color-tinge at 50 so they can weigh tolerability. Do not buy an export 100 while you wait and swallow it the same week as 50.
Desk seal Packet for a step-up visit?
Current strength, number of fasting versus fed attempts, CYP3A4 and alpha-blocker list, age and kidney/liver notes you already know, side effects at this rung, and last nitrate counseling date. Parent page: sildenafil orbit. Dinner detail: meal orbit.