What If Viagra Doesn't Work? Check How You Take It First

Viagra (sildenafil) does not work for every man, but a poor result does not mean tablets are finished for you. Often the fix is how you take it: timing, food, alcohol, arousal, dose or too few attempts. If those are right, the next step is a different tablet or a check for an underlying cause.

Run through this checklist first#

Sildenafil only helps blood flow into the penis. It does not create desire, so you still need arousal. Go through these in order.

• Timing: take it 30 to 60 minutes before sex. Taking it 10 minutes before is a common reason for "nothing happened".
• Food: a heavy or fatty meal can delay absorption by about an hour. An empty stomach or light meal works best.
• Alcohol: a drink or two is fine for most men. More than that can blunt erections on its own.
• Arousal: you need sexual stimulation. Without it, the tablet will not do much.
• Dose: sildenafil comes as 25mg, 50mg and 100mg. The maximum is 100mg, and you take no more than 1 tablet in 24 hours.
• Number of attempts: see the next section.

Our guide on how to take Viagra safely and effectively covers the practical details.

How many tries before it counts as not working?#

The first tablet often disappoints. Nerves, a rushed meal or a glass too many can all get in the way. Clinicians commonly suggest at least 4 attempts at a full dose before judging a tablet, and some advise up to 8. Guidance varies, so your prescriber should set the plan.

Try each time with the same checklist. Note the time you took it, what you ate and drank, and how things went. That record helps a pharmacist or doctor see the pattern quickly.

Do not take a second tablet if the first seems slow. Extra tablets mainly add side effects such as headache, flushing and indigestion.

If it never worked, versus if it stopped working#

These are different problems.

It never worked. Look first at technique and dose. If a full dose taken properly 4 or more times still does nothing, a different tablet is reasonable. Some men also have nerve or blood vessel damage that needs a doctor's review.

It worked, then faded. Tolerance is not a recognised cause. Sildenafil does not "wear out". The more likely explanation is that something has changed:

• Your underlying ED has progressed, for example through diabetes or narrowed blood vessels.
• You started a new medicine.
• You have put on weight, started smoking again or are drinking more.
• Your testosterone has dropped.
• Stress or relationship pressure has built up.

Erections depend on healthy blood vessels, nerves and hormones, so ED can be an early sign of heart or circulation problems. That is why a GP will usually check blood pressure, blood sugar (HbA1c), cholesterol and sometimes testosterone. Men aged 40 to 74 in England can also get a free NHS Health Check.

Medicines that can work against you#

Some medicines cause or worsen ED. These include SSRI antidepressants, beta-blockers, thiazide water tablets, finasteride, opioids and anti-androgens. Do not stop any of them yourself. Ask your doctor or pharmacist whether an alternative exists.

Tell them about everything you take, including over-the-counter products.

Which tablet to try next#

All four UK tablets work in a similar way but differ in timing and food effect. Switching needs a pharmacist or prescriber to check it suits you.

Switching can help, but it is not guaranteed. Tadalafil suits men who dislike planning around a tablet, and some find the lack of time pressure helps. See Cialis vs Viagra for a closer comparison.

When stress or anxiety is the real problem#

If you wake with firm erections or can get hard alone but not with a partner, the cause is more likely psychological. Worry about performance creates a loop: one bad night makes the next more tense. Tablets can still help here, but they work best alongside talking about it.

Try telling your partner something simple, such as "I'm anxious about this, and it's not about you." That often lowers the pressure straight away. You can self-refer to NHS Talking Therapies, and a psychosexual therapist can help if anxiety keeps returning. Heavy porn use can also affect arousal with a partner, which we cover in our guide to porn-induced ED.

Safety rules while you troubleshoot#

Never take sildenafil with nitrates (including GTN spray) or nicorandil. This also applies to "poppers" (amyl nitrite). The combination can drop your blood pressure dangerously. Alpha-blockers, some antifungals and HIV medicines also need a pharmacist's check.

Stop the tablet and get urgent help (call 111, or 999 if severe) if you have:

• an erection lasting more than 4 hours
• sudden loss of vision or hearing
• chest pain, collapse or severe breathlessness

Be careful where you buy. Fake ED pills are sold online and can contain the wrong dose or other drugs. Check the pharmacy on the GPhC register, look for the GPhC internet pharmacy logo, and avoid sites that skip a health questionnaire.

Getting the right prescriber to review it#

On the NHS, ED tablets are prescribed to men who meet set criteria, such as diabetes, multiple sclerosis, Parkinson's disease, spinal injury, kidney failure, prostate cancer or pelvic surgery, or severe distress. Other men usually need a private prescription or Viagra Connect (sildenafil 50mg) from a pharmacist.

If you want a clinician to review your dose or suggest a different tablet, Totiva's ED service offers a free online consultation. You pay only if treatment is approved, with sildenafil from £1.37 a tablet and tadalafil from £1.56. Whatever route you choose, ask what dose to try, how many attempts to make, and which checks you should have.

If tablets still fail after a proper trial, other options exist. These include vacuum pumps, alprostadil (injection or urethral pellet) and, in specialist care, implants. A GP or urologist can explain them.