Q: I am a 46 years old man, married for eight years and suffering from erectile dysfunction. The doctors advised me to take Sildenafil Citrate 100 mg and it proved effective. As per the doctor's advice I tried to decrease the dosage from 100 mg to 50 mg and then to 25 mg. But 25 mg did not work well, so I continued with Sildenafil Citrate 50 mg but not daily. Despite my efforts I could not get rid of this drug. Now after taking this drug for 8 years, I feel headache, flushed face and increased palpitations. Besides, I feel embarrassed when my partner feels inclined but I forbid, because I happened to be without the drug at that moment. Can't I get rid of this drug and live a normal married life? Isn't there any cure to this illness?

A:It appears that the reason of erectile dysfunction, if any, was not investigated. In some cases there can be a cause such as low male hormone levels etc. In such cases, the cause should be treated. In any case, a 50 mg sildenafil (sold under various trade names such as Penegra) is the normal dose; there is no need to lower the dose to 25 mg. Now longer acting tadalafil (sold under various brand names such as Zydalis) 10 mg, 20 mg has become available. In your case this may be preferable because you will not need immediate access. Its duration of action is quite long at least 24 hours and in some cases up to 36 hours. Hence there can be lot of flexibility of initiating sexual activity after taking the tablet. Some patients may experience headache but it is temporary.