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It was initially studied for use in hypertension high blood pressure and angina pectoris a form of ischaemic cardiovascular disease. Phase I clinical trials under the direction of Ian Osterloh suggested that the drug had little effect on angina, but that it could induce marked penile erections Boolell et al 1996. Pfizer therefore decided to market it for erectile dysfunction, rather than for angina. The drug was patented in 1996, approved for use in erectile dysfunction by the FDA on March 27, 1998, becoming the first pill approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year Kling 1998. It soon became a great success: annual sales of Viagra in the period 1999–2001 exceeded  1 billion.  Thousand Oaks Vallejo Palmdale Columbia El Monte Abilene North Las Vegas Ann Arbor Beaumont Waco Independence Peoria Inglewood Springfield Simi Valley Lafayette Gilbert. 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If taken with a high fat meal, there may be a delay in absorption of sildenafil and the peak effect might be reduced slightly as the plasma concentration will be lowered. Phoenix San Diego Dallas  Detroit San Jose Indianapolis Jacksonville Columbus Austin Baltimore Memphis Boston Washington Nashville-Davidson El Paso Seattle Denver Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 PDE5 which is responsible for degradation of cGMP in the corpus cavernosum. The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of cGMP in the corpus cavernosum, resulting in better erections. Without sexual stimulation and no activation of the NO/cGMP system, sildenafil should not cause an erection. Other drugs that operate by the same mechanism include tadalafil Cialis® and vardenafil Levitra®.  Pembroke Pines Salem Pasadena Escondido Sunnyvale Savannah Fontana Orange Naperville Alexandria Rancho Cucamonga Grand Prairie Fullerton Corona Flint Mesquite Hereditary degenerative retinal Los Angeles  disorders including genetic disorders of retinal phosphodiesterases It is usually recommended to start with a dosage Chicago of 50 mg and then lower or raise the dosage as appropriate. The drug is sold in three dosages 25, 50, and 100 mg, all three costing about US 10 per pill. 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