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The objectives of this study were to evaluate the efficacy and tolerability of high dose sildenafil as a salvage therapy for patients refractory to the maximum recommended dose of sildenafil. Fifty four fully evaluated patients with chronic erectile failure ED who had previously failed to respond to a home trial of sildenafil mg with erections suitable for sexual intercourse were studied. Each man was treated at home with sildenafil at escalating doses of up to mg until either maximal response or intolerable adverse effects occurred. Erectile function was quantified using the erectile function domain of the International Index of Erectile Function IIEF before treatment, with sildenafil mg and with viagra 150mg dose of sildenafil and a global efficacy question after 4 weeks of treatment. The mean age of the study group was

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