Sildenafil has proven to efficiently reduce the increase in pulmonary artery pressure provoked by hypoxic pulmonary vasoconstriction. However, its role as a possible factor in increasing exercise performance under hypoxic conditions remains to be demonstrated. The use of sildenafil has increased among mountaineers, not as a high altitude pulmonary edema preventive drug, but as a means that could help to improve performance. Several studies have attempted to address this issue, with conflicting results. Currently, despite the inconclusive data at simulated or real altitude, and with the clear evidence that, in normoxia, sildenafil does not improve performance, this drug is being used (and sometimes overused) by people who climb high peaks. However, such potential performance improvement would depend on the degree of hypoxemia (altitude) and the individual responsiveness to this drug. This paper reviews the current knowledge on this matter.
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