How long can you take Viagra before it doesn't work anymore? Months or Years?

[Fonzie]

Hey guys I am new here and was wondering if you guys could be straight up and honest about this. I may need to get Viagra down the road and I was wondering the cold hard truth.

A few drs have told me that you can be on it the rest of your life and it isn't a drug that you become immune to.

I just don't believe that from what I have read here.

So how long approx. can you expect to be able to take Viagra before you have to move to something else?
I would think you would start at 25mg or similar and then move up until you hit 100mg.
If you start at 25mg can you do that for 3 times a week and for 5 years or do you move up to 50mg sooner?

Any helpful insight would be appreciated. I am trying to get my game plan going and decide how I should handle my new lifes issue.

[bldoink]

I don't think it's that many guys get "immune" to it but that the underlying cause of the ED worsens to the point that pills are no longer effective. Or it could also be that other ED causes develop. A venous leak can get worse such that the effects of the pill can't overcome the leak. Or perhaps you start with a psychogenic ED but later also develop a VL.

[malibog]

You say nothing of your age or history of ED (if any), which might help a bit.

However, overall, I would say bidoink has given accurate information.

[Fonzie]

I intentionally didn't post all of my info because I wanted to save it for another topic and question. I think if I post everything here it will be like having two conversations in one and won't get the questions answered but I am happy to post it so no one feels I am hiding anything.

I will make this more of a summary so I can post my other question with more detail. 41 years old. Always been fine but had cancer that required chemo. Been 3 years and things were ok not perfect but ok. At first took me more time to ejac like 30 mins then it got better and time wasn't near as long. I have been seeing a decline. I work out regularly. 6'4 220lbs, 33 inch waist. No meds of any kind. I get hard but if I dont put it right in it will start to drop. It has been getting worse. About a year ago I could make out for and hour or two and stay hard. Can't lay on my back without it going down. So I think I am on borrowed time so I want to start planning and doing the best I can to make it work as long as I can. It sucks because I am not ready to need meds and have always taken care of myself. Never drank, never smoked, no drugs etc. I eat a super healthy diet and stay active. Quick summary not sure if that will add anything to this question and please don't let this summary muddy the water for this question.

[Robert-CA]

bldoink is right.

Viagra has been in use for more than 20 years, and there have been several long-term studies of its effectiveness.

There is no evidence that the effectiveness decreases with long term use. However, ED symptoms can worsen over time, leading men to things that the drug has lost its effect.

To slow the "progression" of ED, eat a heart-healthy mediterranean diet, get plenty of aerobic exercise, and follow your doctor's health advice. Even then, your ED may continue to worsen. For men who no longer respond to Viagra, there are a number of other treatment options, including Intracavernous Penile Injections, Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT), and penile implants... all of which are discussed elsewhere on this site.

[malibog]

Thank you for additional info Fonzie.

At your age and in the situation you describe, you might well get a very long, successful run with Viagra.

As I outlined in another thread awhile back, I had a bout of essentially psychologically-induced ED in my 40s. It started right around the time Viagra came on the market. I tried it and it worked better than expected. I used it for maybe three years, then realized I no longer needed it. It certainly always worked in that time.

I needed no "support" of any form for about the next 10 years or so. Then, into my 60s, started noticing I did not get as hard as I used to. So I pulled out some unused Viagra that had been sitting around the house for more than 10 years (expiry dates mean little with that stuff) and it worked as well as it had originally.

Now, late 60s, I am noticing I often don't get as hard as I would like. Viagra will still give me an adequate erection, but not an award-winning one as in the past. But I do not think that is due to any kind of increasing immunity or tolerance to the drug. More likely, in my view, due to the effect of getting older. That is why I very recently tried injections and I have found (on the basis of only a couple of tries) that those work well for me. For how long that will be, I have no idea. But seems like a good fix for now, although I am still using Viagra because it still works, just not as well.

Hope this gives you some idea.

[dg_moore]

Worked for me for several (5-8 or so) years, and then fizzled out. Like others, I don't know if it was because the medication became less effective or if the ED became more severe.

[Flavio]

[...]

A few drs have told me that you can be on it the rest of your life and it isn't a drug that you become immune to.

[...]

I don't know, it's hard to say. Everyone is different, reactions may vary a lot.

Cialis stopped working for me after 10 years of regular use. I'm pretty sure my ED didn't get worse because I am still able to have decent erections without medication and avanafil has been working great.

[dtwarren1942]

Viagra worked fine for me for about five years; however, I had to slowly increase the dose from 25 mg to 100 mg until even 100 mg became ineffective. I moved on to Trimix injections which worked well for about three years before becoming ineffective.

I believe my diabetic neuropathy and plaque worsened over the years which caused the medications to become ineffective.

[Simbarn]

What the guys above have said about a tolerance not developing is IMO correct.

A little more in-depth explanation of what is most likely occurring:

PDE5 inhibitors work by assisting the NO pathway to work more effectively. They do this by affecting a particular stage in the chain of events of this pathway. This stage, to make it simple, is not the initial step, but a number of steps afterward. As we age the initial first step can become more dysfunctional or weak. That is the production of endothelial and neuronal nitric oxide. If this first step becomes less pronounced, the effect PDE5 inhibitors have will decline as well, as everything further down the path will be compromised.
Many things in the process of aging affect the health of the endothelium, which are too involved to go into detail here. Not only does the endothelium deteriorate, the amount of smooth muscle which the NO process finally affects to elicit tumescence, gradually declines due to fibrosis and collagen deposition.
Blood vessels in our entire body are affected as well, their ability to expand and contract declines.

There has been no evidence to suggest that PDE5 inhibitors slowly stop inhibiting PDE5 or cause an increase in PDE5 with consistent use.

What has been demonstrated is the slow deterioration in the NO pathway itself, loss of smooth muscle and increase in adrenergic inhibitory tone.
When the deterioration in the NO pathway becomes great enough in the penis and or adrenergic tone is sufficiently amplified, this is when penis injections become necessary in order to sustain an erection. As the vasodilator drugs in these preparations almost bypass the NO pathway and work directly on the smooth muscle, telling it to relax. There is no point inhibiting PDE5 in this process. They may also contain an adrenergic blocker (phentolamine) which helps to inhibit the NA pathway, which has a stronger influence as we age also. So the injections are targeting the smooth muscle directly and also working on another pathway.
PDE5 inhibitors are just targeting the NO pathway and are therefore more suitable to the early stages of progressive erectile dysfunction, or helping psychogenic erectile dysfunction, if the adrenergic influence isn’t too powerful.
One of the possible reasons a particular PDE5 inhibitor stops working is the increase in the sensitivity to norepinephrine in the penis itself. This happens for some men in middle age. A different PDE5 inhibitor may work for a period of time as it may have a stronger influence on the NO pathway until this sensitivity increases further or NO production declines further as well.
Smooth muscle content and health is also a vital component, as mentioned above. When enough of this is lost due to fibrosis and collagen deposition, none of the above preparations will do anything to sustain an erection. It may be time for an implant.

What is also very interesting is the effect that a low dose of PDE5 inhibitors can have if used on a consistent basis with regard to the health of the endothelium, which is very different to the initial intended use of these drugs for inhibiting PDE5. Reversal of some of the damage/deterioration to the endothelium which therefore helps to restore the initial first step! If caught early enough, this may slow the degenerative processes in the penis substantially.
When “early enough ” is, is a very good question.