sildenafil. Thus, the metabolite is responsible for about 20% of sildenafil's action. Sildenafil is excreted as metabolites predominantly in the feces (about 80% of administered oral dose) and to a lesser extent in the urine (around 13% of the administered oral dose). If taken with a high-fat meal, absorption is reduced; the time taken to reach the maximum plasma concentration increases by around one hour, and the maximum concentration itself is decreased by nearly one-third. Route of administration When taken by mouth sildenafil for erectile dysfunction results in an average time to onset of erections of 27 minutes (ranging from 12 to 70 minutes). Under the tongue use of sildenafil for erectile dysfunction results in an average onset of action of 15 minutes and lasting for an average of 40 minutes. There are also mouth spray preparations of sildenafil for faster onset of action. Chemical synthesis The preparation steps for synthesis of sildenafil are: Methylation of 3-propylpyrazole-5-carboxylic acid ethyl ester with hot dimethyl sulfate Hydrolysis with aqueous sodium hydroxide (NaOH) to free acid Nitration with oleum/fuming nitric acid Carboxamide formation with refluxing thionyl chloride/NH4OH Reduction of nitro group to amino group Acylation with 2-ethoxybenzoyl chloride Cyclization Sulfonation to the chlorosulfonyl derivative Condensation with 1-methylpiperazine. History Sildenafil (compound UK-92,480) was synthesized by a group of pharmaceutical chemists led by Simon Campbell working at Pfizer's Sandwich, Kent, research facility in England. It was initially studied for use in hypertension (high blood pressure) and angina pectoris (a symptom of ischaemic heart disease). The first clinical trials were conducted in Morriston Hospital in Swansea. Phase I clinical trials under the direction of Ian Osterloh suggested the drug had little effect on angina, but it could induce marked penile erections. Pfizer therefore decided to market it for erectile dysfunction, rather than for angina; this decision became an often-cited example of drug repositioning. The drug was patented in 1996, approved for use in erectile dysfunction by the FDA on 27 March 1998, becoming the first oral treatment approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year. It soon became a great success: annual sales of Viagra peaked in 2008 at US$1.934 billion. Society and culture Marketing and sales In the US, even though sildenafil is available only by prescription from a doctor, it was advertised directly to consumers on TV (famously being endorsed by former