Revatio vs. Viagra: what’s the difference?

Most people have heard of Viagra (sildenafil), a prescription drug used to treat erectile dysfunction (ED). If you are looking into Viagra and its cost, you may have come across another drug named Revatio. These drugs have the same active ingredient, sildenafil, which may leave you wondering: Is Revatio the same as Viagra, and can it be used for ED?

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Similarities between Revatio and Viagra

Key similarities between Revatio and Viagra include the following:

• Same active ingredient: Both Viagra and Revatio contain sildenafil, which is also known as sildenafil citrate.

• Same drug class and mechanism of action: Revatio and Viagra belong to a class of drugs called phosphodiesterase-5 inhibitors, or PDE-5 inhibitors.

• Same manufacturer: Pfizer is the pharmaceutical company behind both brands. The generic versions, however, are made by different manufacturers.

• Same interaction risks: Revatio and Viagra carry the same drug interaction risks, since they share the same active ingredient.

• Similar side effects: Revatio and Viagra also cause similar side effects. The lists of common side effects are not identical because these lists come from clinical trials in which the medications were studied separately, in different patient populations.

To treat ED, Viagra works by increasing chemicals that relax the smooth muscle in the blood vessels of the penis. This increases blood flow to the penis when sexual stimulation occurs, helping the penis to become and stay erect. Other PDE-5 inhibitors include Cialis (tadalafil), vardenafil, and Stendra (avanafil).

To treat pulmonary arterial hypertension (PAH), Revatio works by increasing chemicals that relax the lung's blood vessels. This allows blood to flow more efficiently within the lungs, lowering blood pressure. Revatio helps improve the ability to exercise (such as climbing stairs) in people with PAH.

Differences between Revatio and Viagra

While Revatio and Viagra have a lot in common, there are some differences, including:

• Approved uses: The US Food and Drug Administration (FDA) approves Revatio to treat PAH, while Viagra is approved to treat erectile dysfunction.

• Forms: Viagra comes only as an oral tablet, but providers may prescribe Revatio as an oral tablet, an oral liquid suspension, or as an injection into the vein.

• Tablet strengths: Revatio tablets come in a 20 mg strength. Viagra comes in three strengths: 25 mg, 50 mg, and 100 mg.

• Dosing: Viagra is typically taken as one dose as needed, one hour before anticipated sexual activity. The maximum dosage of Viagra is one dose per 24 hours. In contrast, Revatio is usually taken three times daily, long-term, for pulmonary hypertension.

• Cost: The costs of Revatio and Viagra vary widely. The cash price depends on the pharmacy, the quantity and strength, and whether a person has an insurance plan that covers the drug. Coupons and discount programs are also available to those eligible.

Viagra is a brand-name prescription medication. The FDA first approved "the little blue pill" in 1998 to treat ED.

ED is the inability to get or keep an erection strong enough to have satisfying sex. It is caused by a lack of blood flow to the penis. Any condition or factor that limits blood flow can lead to ED, including:

• Diabetes

• High blood pressure

• Obesity

• Cigarette smoking

Also, several types of medications commonly cause sexual side effects. For example, antidepressants and blood pressure meds frequently cause ED and low sex drive (libido). Viagra effectively treats ED in up to 70% of men who take it.

Besides ED, Viagra also has off-label uses, meaning healthcare providers can prescribe it for conditions outside of its FDA-approved uses, such as:

• Female sexual arousal disorder, which causes a lack of interest in sex

• Altitude sickness: headache, dizziness, shortness of breath, and other symptoms that occur after traveling to higher altitudes, where the air pressure and oxygen levels are lower

• Raynaud's phenomenon, a condition that causes decreased blood flow to the fingers in response to cold

Revatio is a brand-name prescription drug, approved by the FDA in 2005 to treat symptoms of a condition called pulmonary arterial hypertension (PAH).

A type of hypertension (high blood pressure), PAH is a lung condition that affects the arteries in the lungs. It also affects the heart. Symptoms of PAH get worse over time, especially with physical activity like walking. Symptoms may include:

• Shortness of breath

• Dizziness, which may lead to fainting

• Chest pain or pressure 

• Bluish tint of the lips or skin

• Swelling in the lower legs and abdomen

Revatio is not a cure for PAH, but it can help reduce the severity of these symptoms and improve a person's ability to be physically active.

Can you use Revatio for ED?

A healthcare provider may prescribe Revatio off-label for ED and instruct a person to take it as needed before sexual activity. If a healthcare provider deems it appropriate, this approach is safe.

Keep in mind that 50 mg is the most common dose of sildenafil that works for ED, and Revatio comes in strengths of 20 mg, so multiple tablets may be needed to reach the recommended dose. Taking more sildenafil than a healthcare provider prescribes is not recommended.

The most common side effects of Viagra are usually temporary. They include:

• Headache 

• Flushing (skin reddening)

• Indigestion or upset stomach

• Abnormal vision, such as blue-tinged, distorted, or blurred vision

• Nasal congestion

• Back pain

• Muscle pain

• Nausea

• Dizziness

• Rash

Since the active ingredient in Viagra and Revatio is the same, the most common side effects of Revatio are very similar and can include:

• Nosebleeds

• Headache

• Upset stomach

• Muscle aches and pains

• Flushing 

Less commonly, these medications may cause serious side effects. An erection lasting longer than four hours (priapism), trouble hearing, or sudden vision loss warrants immediate medical attention.

Sildenafil may not be safe for everyone. A healthcare provider may not prescribe this medication for people with certain medical conditions, such as cardiovascular (heart) disease, low blood pressure, vision problems, sickle cell anemia, or a recent heart attack.

Sildenafil (the active ingredient in both Viagra and Revatio) carries serious interaction risks. Revatio, Viagra, and generic sildenafil should not be taken with:

• Nitrates, medications to prevent or treat angina (chest pain), which work by widening blood vessels. Taking nitrates too close to sildenafil may cause a life-threatening drop in blood pressure. (Examples: nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and the recreational drug amyl nitrite, also known as poppers.)

• Soluble guanylate cyclase (sGC) stimulator drugs, which are used to treat PAH. An example is riociguat (Adempas). Combining riociguat and sildenafil may cause an unsafe drop in blood pressure.

Other medications may interact with sildenafil, and a provider may monitor closely or adjust dosage accordingly. Grapefruit and grapefruit juice should also be limited or avoided while taking sildenafil, as the combination may increase the risk of side effects.

There is no better or worse when comparing these two drugs. Which drug is more appropriate depends on several factors, such as the condition being treated. For personalized medical advice, consult a healthcare provider.

The table below summarizes some of the key differences and similarities between Revatio and Viagra:

Revatio and Viagra are different brand-name medications (also available as generics) that have the same active ingredient, sildenafil.

• Revatio is FDA-approved for treating pulmonary arterial hypertension (PAH), while Viagra is FDA-approved for treating erectile dysfunction (ED). 

• Both medications belong to a class of drugs called phosphodiesterase-5 (PDE-5) inhibitors, meaning they have the same mechanism of action, and similar side effects and drug interaction risks.

• Revatio is typically taken in a lower dose three times a day as an ongoing treatment, while Viagra is only taken as needed before sexual activity.

• Some healthcare providers may prescribe Revatio off-label to treat ED, but multiple pills may be needed at once to reach an effective dose.

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