Fildena Double 200 mg is not suitable as a first-time sildenafil dose. If it contains sildenafil 200 mg, that is twice the usual maximum single dose of 100 mg recommended for erectile dysfunction. Standard guidance generally starts at 50 mg, with adjustment to 25–100 mg depending on effectiveness and side effects. S SW London ICB +1 Taking 200 mg increases the chance of side effects such as: Severe headache or flushing Dizziness and low blood pressure Fast/irregular heartbeat Visual disturbances Nausea Rarely, prolonged erection or serious cardiovascular problems Since you've asked about several sildenafil products (Malegra, Vigora, Silagra, Fildena, Eriacta), don't combine or alternate them within the same 24-hour period. Sildenafil should generally be taken no more than once daily. N nhs.uk For a first-time user, 50 mg is the usual starting dose, provided sildenafil is medically appropriate for you. A doctor may recommend 25 mg or 100 mg depending on your circumstances. If you've already taken Fildena Double 200 mg, tell me when you took it and whether you have any symptoms right now, and I can tell you what to do next.