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Sildenafil protects cyclic guanosine monophosphate (cGMP) from degradation by cGMP-specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum.

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Nitric oxide (NO) in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of cGMP, leading to smooth muscle relaxation ( vasodilation ) of the intimal cushions of the helicine arteries.

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Methylation of 3-propylpyrazole-5-carboxylic acid ethyl ester with hot dimethyl sulfate.This metabolite also has an affinity for the PDE receptors, about 40% of that of sildenafil.The chronic need for dialysis (daily with peritoneal dialysis or three or four times per week with hemodialysis).

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