✅ Product Benefits

• Clinically effective PDE5 inhibitor: Enhances nitric oxide–mediated vasodilation in penile tissue, improving erection firmness and duration when sexually stimulated. Also relaxes pulmonary vascular smooth muscle in PAH patients. 

• Flexible dosing: Recommended single dose is 50 mg taken 30 min–1 hour before intercourse. Depending on effectiveness and tolerance, the dose may be adjusted to 25 mg or increased to 100 mg. Not to exceed one dose per 24 hours. Elderly or patients with liver/renal impairment should start at 25 mg. 

• Rapid action & food flexibility: Effective within ~1 hour; can be taken with or without food, but onset may be delayed after high-fat meals. 

• Extremely affordable & widely accessible: Priced around ৳ 15 per tablet (~৳ 120 for a pack of 8). Easily available over the counter in pharmacies across Bangladesh. 

ℹ️ Safety & Precautions

• Contraindications:

  • Concurrent use with organic nitrates or nicorandil (can cause severe hypotension).

  • Known hypersensitivity to sildenafil. 

• Common side effects:

  • Headache, flushing, dyspepsia, nasal congestion, dizziness, insomnia, visual disturbances (e.g. blue/green tint), and rarely rash.

• Key warnings:

  • Use with caution in patients with cardiovascular disease; sexual activity itself carries risk.

  • Potential additive hypotensive effect when used with alpha-blockers; monitor blood pressure. 

• Drug interactions:

  • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, erythromycin) raise sildenafil levels, increasing risk of adverse effects.

  • CYP3A4 inducers (e.g., rifampin) may reduce efficacy.

  • Concomitant use with nitrates may result in life-threatening hypotension. 

• Rare yet serious risks:

  • Priapism (erection lasting >4 hours): seek emergency care immediately.

  • Sudden vision or hearing loss, syncope, hypotension, myocardial ischemia—rare but may occur in high-risk individuals.

• Special populations:

  • Elderly (≥65 years): Start at 25 mg; increased sensitivity to side effects.

  • Hepatic or severe renal impairment (CrCl <30 mL/min): Start at 25 mg.

  • Pregnancy & breastfeeding: Not indicated for women.

  • Pediatric use: Contraindicated in children.

🧾 Usage Quick Facts

💬 Real-World Insights

Reddit users in Dhaka confirm that Niagra is commonly stocked at pharmacies for ED treatment. One user recommends starting with the 25 mg dose and cautions about responsible use to avoid long-term complications.