Objective: To evaluate the efficacy of sildenafil citrate and L-arginine in the pregnancies complicated with fetal growth restriction (FGR) in terms of improvement in color Doppler parameters and perinatal outcome. Materials and methods: In this study, we included 218 antenatal patients with FGR. After randomization, 110 women received sildenafil and 108 women L-arginine. Various fetal color Doppler parameters of umbilical artery (UA) and middle cerebral artery (MCA) were studied and followed until delivery, and perinatal outcome was evaluated. Results: There was significant improvement in mean pulsatility index (PI) of the UA and MCA (p < 0.05). The systolic/diastolic (S/D) ratio and cerebroplacental ratio (CPR) also improved to a significant level. Perinatal outcome appears better in sildenafil group as compared with the L-arginine group. Conclusion: Sildenafil citrate, as a vasodilator, has emerged as a potential management option in the treatment of FGR by later normalization in velocimetric profile.