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Common side effects include headaches, heartburn, and flushed skin. Sildenafil acts by blocking phosphodiesterase 5 PDE 5, an enzyme that promotes breakdown of cGMP, which regulates blood flow in the penis. The primary indication of sildenafil is treatment of erectile dysfunction inability to sustain a satisfactory erection to complete intercourse. Its use is now one of the standard treatments for erectile dysfunction, including for men with diabetes mellitus. Tentative evidence suggests that sildenafil may help men who experience antidepressant -induced erectile dysfunction. Sildenafil and other PDE5 inhibitors are used off-label to alleviate vasospasm and treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon ; these drugs have moderate efficacy for reducing the frequency and duration of vasospastic episodes.