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Other prescription-only erectile dysfunction medicines which are legal in the UK include Spedra , Cenforce and Vidalista. Sildenafil acts by inhibiting cGMP-specific phosphodiesterase type 5 (phosphodiesterase 5, PDE5), an enzyme that promotes degradation of cGMP , which regulates blood flow in the penis. Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs. 33 Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection.
In 2000, Fildena sales accounted for 92% of the global market for prescribed erectile dysfunction pills. 62 As of 2016 branded pills cost about 50 times more than generic ones. 65 Health care providers may prescribe generic sildenafil for erectile dysfunction.
Teva Canada launched Novo-Sildenafil, a generic version of Fildena, on the day the Supreme Court of Canada released its decision. "Sildenafil: an Orally Active Type 5 Cyclic GMP-Specific Phosphodiesterase Inhibitor for the Treatment of Penile Erectile Dysfunction". "Pharmacology and Drug Interaction Effects of the Phosphodiesterase 5 Inhibitors: Focus on ?-Blocker Interactions". 
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