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An aggressive early scrap between Verstappen and title rival Lando Norris initially saw the McLaren driver come off second best.
However, Verstappen was twice penalised for his elbows-out tactics and slipped to sixth at the chequered flag as a result.
Norris meanwhile surged to second with a late charge, while Charles Leclerc slipped to third – the Ferrari driver lucky to finish at all after a wild moment in the final laps.
Oscar Piastri recovered to eighth from 17th on the grid, while Liam Lawson missed out on points and ultimately suffered damage in a late scrap with Franco Colapinto.
A good start for Verstappen saw him go wheel-to-wheel with pole sitter Sainz, with Norris tucking in behind the Red Bull Racing.
Verstappen seized the lead, Sainz taking to the grass at Turn 1 to hold top spot initially before ceding it to the Dutchman.
In the pack, Yuki Tsunoda spun out before the pack reached the corner following contact with Alex Albon, the pair eliminated on the spot.
It drew the Safety Car almost immediately with Verstappen leading from Sainz, Norris, Leclerc, Lewis Hamilton, and George Russell.
Lawson made up ground in the furore to sit 10th while Piastri remained 17th.
The Safety Car was withdrawn as the field started Lap 7, Verstappen jumping through the stadium section in an effort to break the slipstream to Sainz.
He couldn’t manage it, the second-placed Ferrari using DRS to dive underneath at the start of Lap 10 to take the lead.
Norris soon took aim at Verstappen, moving around the outside of Turn 4 where he was elbowed off the road by the Red Bull Racing pilot.
He skipped through the grass and while appearing to give the place back, he was pushed wide again as they navigated Turn 7, the pair leaving the track at Turn 8.
That opened the door for Charles Leclerc to ease through into second, the championship contenders both losing a place in their scrap.
Investigated by the stewards, Verstappen copped a 10-second penalty for forcing Norris off the track at Turn 4. Soon after he was stung again for his antics at Turn 8.
At the bottom end of the top 10, Lawson and Sergio Perez scrapped, at the Turn 4/5 chicane.
Perez dived up the inside but Lawson refused to budge, the Kiwi then maintained the apex at Turn 5, the pair making contact and damaging Perez’s car.
It was an aggressive battle, the local favourite coming off second best and falling backwards with damage.
Piastri was still moving forward, climbing to 12th by Lap 23 and in the wheel tracks of Stroll.
Verstappen pitted at the end of Lap 26, stationary for 24 seconds as he swapped onto the hard tyre, rejoining behind Esteban Ocon.
On Lap 34, Piastri found a way through on Lawson at Turn 4, a move he set up into Turn 1.
With DRS, and the recently-pitted Mercedes of Hamilton in tow, he swept across the road down the front straight to force the RB to go defensive.
When they got to Turn 4, Lawson was vulnerable and lost out to the punchy McLaren, who was followed through by Hamilton.
Neither Lawson nor Piastri had pitted, making the position loss to Hamilton something of a misnomer given the seven-time champ had been in the lane already.
The Antipodean pair boxed after 39 laps, washing the order at the very front of the race.
That saw Sainz more than seven seconds clear of Leclerc, from Norris, Russell, Hamilton, and Verstappen.
The race had settled down, with gaps between the leading contenders while Piastri worked his way back into the points after stopping far later than most.
Lawson was in that situation too, though without the car pace of the McLaren to aid his progress.
He duly found himself stuck just outside the top 10 behind Lance Stroll, before blue flags ruined any chance he had of moving further forward.
In the final stanza, Norris reeled in Leclerc for second as the latter began to struggle for grip.
The pressure was too much and a mistake follow, Leclerc wagging the tail of the car exiting the final corner on Lap 63 – how the Monegasque driver kept the car out of the wall is anyone’s guess.
But it opened the door for Norris to breeze by into second place, and with it three more championship points.
Sainz was too far away however and held on to the lead to win from Norris, with Leclerc pitting in the closing stages to take third with a bonus point for fastest lap.
Then came Hamilton, who cleared Russell after an intense intra-team battle, ahead of Verstappen, Kevin Magnussen, Piastri, Nico Hulkenberg, and Pierre Gasly in the top 10.
Contact with Franco Colapinto in the final laps forced Lawson to box for a new front wing and he came home 16th scant reward for an otherwise fine drive.
Perez brought up the rear after he too stopped hoping for an attempt at fastest lap, but with a damaged car was powerless to deny Leclerc.
In championship terms, Verstappen continues to head the title but his advantage has reduced to 47 points.
McLaren continues to hold the constructors’ championship lead, now with a 29-point margin to Ferrari with Red Bull Racing slumping to third, 54 points away from McLaren.
