This treatment plan reviews the risks and benefits of the treatment your healthcare provider is recommending. Please make sure to read it and the manufacturer’s insert that comes with the medicine. The manufacturer’s insert contains the full information on interactions, side effects, and other important information you should know about the medicine before you start taking it.


This medicine is designed to improve penile blood flow to help achieve and maintain erections when used as prescribed. It is important to use it only as prescribed and works best in conjunction with overall healthy lifestyle changes.

Please keep the following in mind if you are starting a sildenafil prescription:

  • Sildenafil will not give you a spontaneous erection- sexual stimulation and arousal is important.

  • Don’t come to conclusions about effectiveness until you make at least 4 attempts at sexual activity.

  • Sildenafil peaks 60 minutes after dosing for most people. Some people have longer times to climax, so experimenting with timing can make a big difference.

  • Food has a big impact on the effectiveness of sildenafil. Take sildenafil with a glass of water on an empty stomach.

  • Try the medication by yourself at first. This will allow you to test out how it affects you before testing it with your partner.

Follow Up Plan

When you are ready for a refill you will need to return for a refill visit to help make sure you are on the lowest effective dose and to screen for side effects. You can reach out to a healthcare provider through the Thrones platform at any time you have questions or concerns about this medicine.

Active Ingredients

This medicine contains one of the following active ingredients which are phosphodiesterase type 5 inhibitors (PDE5i). If you are allergic to any of these components, similar components, or any of the others components listed in the manufacturer’s insert do not take the medicine and call or message us immediately.

  • Avanafil

  • Sildenafil

  • Tadalafil

  • Vardenafil


This medicine could cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please stop the medicine and call or message us or see your healthcare provider in-person.

  • Avanafil

  • Sildenafil

  • Tadalafil

  • Vardenafil


Your healthcare provider has evaluated your health history and the specific health information you provided, however if anything changes and you develop or discover that one of these conditions applies to you please stop taking this medicine and call or message us immediately.

  • Anatomical penis deformation

  • Any condition where sex is not recommended

  • Bleeding or clotting disorders

  • Cardiovascular disease

  • Congenital QT prolongation

  • Family history of arrhythmia

  • Kidney problems

  • Liver problems

  • Peptic ulcer disease

Pregnancy and Breastfeeding

Women should not take or handle this medicine.

Side Effects

Emergency Side Effects

This medicine can cause dangerous and potentially life threatening side effects. If any of the emergency side effects listed in the manufacturer’s insert or those below occur, STOP taking the medicine and call 911 or seek immediate medical help.

  • Abdominal swelling

  • Abnormal heartbeat or rhythms

  • Anxiety or agitation

  • Difficulty swallowing or throat swelling

  • Hearing or vision changes

  • Jaundice or yellow skin

  • Severe skin rash or changes

  • Severe weakness or fatigue

  • Shortness of breath or wheezing

Other Side Effects

This medicine can also cause other side effects. If any of the other side effects listed in the manufacturer’s insert or those below happen to you please stop the medicine and call or message us or see your healthcare provider in-person.

  • Anxiety

  • Change in mental status

  • Dizziness

  • Low blood pressure

  • Passing out

Medicines, Supplements, and Foods

Your healthcare provider has evaluated your health history and the specific health information you provided, however if anything changes and you start or discover that you are taking any of the medicines, foods, or supplements listed below call or message us before you take this medicine. Some of these can cause dangerous interactions with the medicine you are being prescribed and your healthcare provider will help you evaluate that risk and decide on the best plan.

  • Alcohol (Ethyl)

  • Alfuzosin

  • Alprostadil

  • Amiodarone

  • Amyl Nitrite (Poppers)

  • Anagrelide

  • Arsenic Trioxide

  • Azithromycin

  • Boceprevir

  • Butalbital

  • Capsaicin

  • Carbamazepine

  • Chloramphenicol

  • Chloroquine

  • Chlorpromazine

  • Cilostazol

  • Ciprofloxacin

  • Citalopram

  • Clarithromycin

  • Cobicistat

  • Cocaine

  • Conivaptan

  • Dabrafenib

  • Dapoxetine

  • Disopyramide

  • Dofetilide

  • Domperidone

  • Donepezil

  • Doxazosin

  • Dronedarone

  • Droperidol

  • Efavirenz

  • Enzalutamide

  • Erythromycin

  • Escitalopram

  • Flecainide

  • Fluconazole

  • Fusidic Acid (Systemic)

  • Haloperidol

  • Ibutilide

  • Idelalisib

  • Indinavir

  • Itraconazole

  • Ketoconazole

  • Levofloxacin

  • Methadone

  • MiFEPRIStone

  • Mitotane

  • Modafinil

  • Molsidomine

  • Moxifloxacin

  • Nefazodone

  • Nelfinavir

  • Nevirapine

  • Nitroprusside

  • Ondansetron

  • Oxaliplatin

  • Oxcarbazepine

  • Papaverine

  • Pentamidine

  • Phenobarbital

  • Phenytoin

  • Pimozide

  • Pioglitazone

  • Posaconazole

  • Prazosin

  • Procainamide

  • Propofol

  • Quercetin

  • Quinidine

  • Rifabutin

  • Rifampicin

  • Riociguat

  • Ritonavir

  • Saint John’s Wort

  • Saquinavir

  • Sevoflurane

  • Silodosin

  • Sotalol

  • Stiripentol

  • Tamsulosin

  • Telaprevir

  • Telithromycin

  • Terazosin

  • Thioridazine

  • Topiramate

  • Troglitazone

  • Vandetanib

  • Vasodilators (Organic Nitrates)

  • Voriconazole


Accurate Information

Your healthcare provider has evaluated the specific health information you provided and is making their recommendations based on it. If you forgot to provide or incorrectly provided that information your healthcare provider may misdiagnose or fail to diagnose conditions that you may have which could affect their recommendation for treatment. If you need to clarify or update any information about your health you can message or call us anytime.

Treatment Failure

This treatment is not 100% effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency call 911 or seek immediate medical help in-person. You may need to seek alternative treatment such as those listed below or in the follow-up plan.

Misdiagnosis or Delayed Diagnosis

There is also a risk that your healthcare provider will misdiagnose or fail to diagnose conditions that you may have which could affect their recommendation for treatment. This risk exists with a doctor in-person as well but they may have additional signs and symptoms to aid their evaluation. The healthcare providers practicing through the Thrones platform use evidence based practice and guidelines as well as clinical decision support to minimize these risks. Here are some other diagnoses that they attempt to rule out:

  • Cardiovascular disease

  • Major anxiety or depression

  • Peyronie’s disease

  • Testosterone deficiency

Accepting or Declining Our Recommendation

Your healthcare provider is recommending this treatment for you because the potential benefits outweigh the risks. You should evaluate this information as well as the manufacturer’s insert, any input from your in-person healthcare team, and any other relevant information to decide if this treatment plan is appropriate for you. You are free to not follow the recommendations from your healthcare provider although there may also be risks associated with no treatment.

Alternative Treatment

Your healthcare provider has based their recommendation on your specific case and medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what has been provided to you. Some treatments may require an in-person exam or procedure which is not available through the platform. Message us or talk to your doctor in-person to discuss alternative treatments. Here are some other treatments or strategies that you might consider:

  • Cognitive behavioral therapy

  • Penile injection therapy

  • Penile re-vascularization surgery

Self Care

  • Drug and alcohol treatment – both drug and alcohol abuse cause worsening of ED, and cause long-term problems

  • Exercise – regular exercise helps with stress, weight loss or maintenance and increases blood flow

  • Quit smoking – if you are a smoker, over-the-counter products may help

  • Therapy – a trained healthcare specialist can assist with talking through any underlying concerns that may be affecting sexual health or relationship issues

  • Weight loss – being overweight can cause or make ED worse