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It is usually used where there is limited response to the 50mg strength. This should only be done on advice of a doctor or pharmacist. If your doctor or pharmacist has instructed you to take 50mg, you can take two 25mg tablets to make up 50mg. You should not take two 25mg tablets at different times on the same day.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. If you experience a sudden loss of vision in one or both eyes, contact your doctor immediately. It is important that you tell all of your doctors that you take sildenafil.
It may well be that your body needs time to adjust to taking the medication, to get an erection. There may also be other factors, including whether you are taking it correctly, your frame of mind and the dosage. Either way, try not to worry, as most of the time, these issues are easily resolved. Viagra is also sometimes used to treat pulmonary hypertension 
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