Drug Interactions with Sildenafil Citrate
[1]Advise patients of the potential for sildenafil to augment the blood pressure lowering effect of α-adrenergic blocking agents (e.g., doxazosin) and anti-hypertensive medications (e.g., amlodipine) and concomitant administration may lead to symptomatic hypotension in some patients. [1]Inform patients taking sildenafil for erectile dysfunction and with potential for cardiac risk of sexual activity (e.g., patients with preexisting cardiovascular risk factors) to refrain from further activity and seek medical attention immediately if they experience symptoms (e.g., chest pain, dizziness, nausea) upon initiation of sexual activity.
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[1]Inform patients of the risk of symptomatic low blood pressure (e.g., dizziness, lightheadedness, fainting). [1] Monitor blood pressure when administering sildenafil in combination with blood pressure lowering drugs (e.g., α-adrenergic blocking agents). [1]Advise patients to take sildenafil with or without food 1 hour or, if needed, 30 minutes to 4 hours before sexual activity. [1] Inform patients that taking sildenafil with a high-fat meal may cause delayed onset. [1]Advise patient to inform their clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.
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[1]Inform patients of other important precautionary information. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. \* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name © Copyright, 1959-2026, Selected Revisions April 10, 2024. American Society of Health-System Pharmacists®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. [1]Advise patients to seek immediate medical attention for a sudden loss of vision in one or both eyes while taking sildenafil.
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[1] Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including possible permanent loss of vision.
How should this medicine be used?
The American Society of Health-System Pharmacists, Inc. represents that the database provided hereunder as formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty or merchantability and/or fitness for a particular purpose, with respect to such database and specifically disclaims all such warranties and representations. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the database if provided for informational purposes only.
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The entire monograph for a drug should be liquid sildenafil citrate reviewed for a throrough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug in the database. The information contained in the database is not a substitute for medical care or treatment by a licensed health care provider. > endobj 296 0 obj <> endobj 294 0 obj <>stream /This label may not be the latest approved by FDA. [1]Advise patients to seek prompt medical attention in the event of sudden decrease or loss of hearing while taking sildenafil. [1] These events may be accompanied by tinnitus and dizziness.
What should I know about storage and disposal of this medication?
Concom)8.4 (itant adm)8.4 (i)-1.6 (nistration of strong )]TJ -21.32 -1.165 Td [(CYP3A4 inducers, such as rifam)8.4 (p)0.6 (in, is expected to cause greater decreases in plasm)8.4 (a)-0.6 ( levels of )]TJ 0.0011 Tc -0.0011 Tw T* [(sildenaf)4.1 (il. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* [(Single doses of antacid \(m)8.4 (agnesium)8.4 ( hydroxi)-0.8 (de/alum)8.4 (i)-1.6 (num)8.4 ( hydroxide\) did not affect the )]TJ 0.0004 Tc -0.0004 Tw T* [(bioavailability of)3.4 ( VIAGRA. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0008 Tc -0.0008 Tw T* [(Pharm)8.6 (acokinetic data from)8.6 ( patients in clinical trials showed no effect on sildenafil )]TJ 0.0005 Tc -0.0005 Tw T* [(pharm)8.3 (acokinetics of CYP2C9 inhibitors \(such as tolbutam)8.3 (ide, warfarin\), CYP2D6 inhibitors )]TJ 0.001 Tc -0.001 Tw T* (\(such as selective serotonin reuptake inhibitors, tricyclic antidepress\ ants\), thiazide and related )Tj 0.0007 Tc -0.0007 Tw T* [(diuretics, ACE inhibitors, and calcium)8.5 ( channel blockers. The AUC of)3.7 ( the active m)8.5 (etabolite, )]TJ T* [(N-desm)8.5 (ethyl sildenafil, was increased 62% by )]TJ 0.0008 Tc -0.0008 Tw 18.82 0 Td [(loop and potassium)8.6 (-sparing diuretics and 102% )]TJ 0.0007 Tc -0.0007 Tw -18.82 -1.165 Td [(by nonspecific beta-blockers. These effects on the m)8.5 (etabolite are not expected to be of clinical )]TJ 0 Tw T* (consequence.
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)Tj 0 Tc T* ( )Tj /TT1 1 Tf 0.0002 Tc -0.0002 Tw 0 -1.18 TD (Effects of VIAGRA on Other Drugs )Tj /TT2 1 Tf 0.0009 Tc -0.0009 Tw 0 -1.17 TD (In vitro)Tj /TT1 1 Tf 0.0006 Tc -0.0006 Tw ( studies:)Tj /TT0 1 Tf 6.625 0 Td ( Sildenafil is a weak inhibitor of )Tj 0.0002 Tc -0.0002 Tw [(the cytochrom)8 (e)-1 ( P450 isoform)8 (s)-0.6 ( 1A2, 2C9, )]TJ -0.0001 Tc 0.0001 Tw -6.625 -1.23 Td [(2C19, 2D6, 2E1 and 3A4 \(IC50 >)163.9 (150 )]TJ /C2_0 1 Tf 0 Tc 0 Tw 15.145 0 Td <0050>Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 0.575 0 Td [(M\). [1]Advise patients to seek prompt medical attention for an erection that lasts more than 4 hours.
- Be aware of the signs of adverse reactions like chest pain.
- Do not use sildenafil if you are taking medications for heart issues.
- The medication does not cause sexual arousal; stimulation is needed.
- Use only the prescribed dose, especially at high levels like 150 mg.
[1] If it is not treated right away, priapism can permanently damage the penis. [1]Inform patients taking sildenafil for erectile dysfunction that the drug offers no protection against sexually transmitted diseases and patients should use necessary protective measures to guard against such diseases, including the human immunodeficiency virus (HIV). [1]Instruct the patient to seek medical attention immediately if they take too much sildenafil.
| Patient Group | Typical Dose | Special Considerations |
|---|---|---|
| Adult Men | 150 mg as needed | Take 30-60 minutes before activity |
| Elderly Patients | 75-150 mg based on response | Start at lower dose, monitor side effects |
| Patients with Liver impairment | Lower dose advised | Adjust based on hepatic function |
[1]Inform patients of the risk of symptomatic low blood pressure (e.g., dizziness, lightheadedness, fainting). [1] Monitor blood pressure when administering sildenafil in combination with blood pressure lowering drugs (e.g., α-adrenergic blocking agents). [1]Advise patients to take sildenafil with or without food 1 hour or, if needed, 30 minutes to 4 hours before sexual activity. [1] Inform patients that taking sildenafil with a high-fat meal may cause delayed onset. [1]Advise patient to inform their clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses. [1]Inform patients of other important precautionary information. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. \* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name © Copyright, 1959-2026, Selected Revisions April 10, 2024. American Society of Health-System Pharmacists®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. The American Society of Health-System Pharmacists, Inc.
- Sildenafil citrate was originally developed for pulmonary hypertension.
- It is sold under brand names like Viagra and generics.
- The onset of action usually occurs within 30-60 minutes.
- Maximum effects are typically seen within 2 hours of intake.
represents that the database provided hereunder as formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty or merchantability and/or fitness for a particular purpose, with respect to such database and specifically disclaims all such warranties and representations. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the database if provided for informational purposes only. The entire monograph for a drug should be liquid sildenafil citrate reviewed for a throrough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug in the database.
What other information should I know?
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The information contained in the database is not a substitute for medical care or treatment by a licensed health care provider. > endobj 296 0 obj <> endobj 294 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 293 0 obj <> endobj 297 0 obj <> endobj 292 0 obj <>stream /This label may not be the latest approved by FDA.
How should I take sildenafil?
For current labeling information, please visit endstream endobj 293 0 obj <> endobj 297 0 obj <> endobj 292 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 120 0 obj <> endobj 128 0 obj <> endobj 249 0 obj <> endobj 25 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 28 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 31 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 34 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 37 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 314 0 obj <>stream q 1 0 0 1 -8.760315 -1.877228 cm 0 0 612 792 re W n 1 0 0 1 8.760315 1.877228 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.2397 47.6228 Tm ( )Tj 19 -0.005 Td (14)Tj 0.0014 Tc -0.0014 Tw -19 54.94 Td [(sildenaf)4.4 (il C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 118.9797 705.3428 Tm [(ma)-18.2 (x)]TJ 0.0003 Tc -0.0003 Tw 12 0 0 12 132.5997 706.8428 Tm ( and a 210% increase in sildenafil AUC. VIAGRA had no effect on saquinav\ ir )Tj 0.0007 Tc -0.0007 Tw -5.78 -1.165 Td [(pharm)8.5 (acokinetics. Stronger CYP3A4 inhibitors such as ketoconazole or itracona\ zole would be )]TJ 0.0009 Tc -0.0009 Tw 0 -1.165 TD [(expected to have still greater effects, and population data from)8.7 ( patients in clinical trials did )]TJ 0.001 Tc -0.001 Tw T* (indicate a reduction in sildenafil clearance when it )Tj 0.0005 Tc -0.0005 Tw 20.425 0 Td [(was coadm)8.3 (i)-1.7 (nistered with CYP3A4 inhibitors )]TJ 0.0009 Tc -0.0009 Tw -20.425 -1.18 Td [(\(such as ketoconazole, erythrom)8.7 (ycin, or cim)8.7 (etidine\) \(see )]TJ /TT1 1 Tf -0.0011 Tc 0.0011 Tw 22.94 0 Td (DOSAGE AND )Tj -0.0008 Tc 0 Tw -22.94 -1.18 Td (ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc (\). )Tj 0 Tc T* ( )Tj 0.0008 Tc -0.0008 Tw T* [(In another study in healthy m)8.6 (ale volunteers, co)]TJ 0.0009 Tc -0.0009 Tw 18.8 0 Td [(adm)8.7 (i)-1.3 (nistration with the HIV protease inhibitor )]TJ 0.0008 Tc -0.0008 Tw -18.8 -1.165 Td (ritonavir, which is a highly potent P450 inhibito)Tj 0.0004 Tc -0.0004 Tw 19.255 0 Td [(r, at steady state \(500 m)8.2 (g bid\) with VIAGRA )]TJ 0.0008 Tc -0.0008 Tw -19.255 -1.165 Td [(\(100 m)8.6 (g)0.8 ( single dose\) resulted in a 300% \(4-fold\) increase in sildenafil C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 410.9997 579.1628 Tm [(ma)-18.2 (x)]TJ 0.0005 Tc -0.0005 Tw 12 0 0 12 424.6197 580.6628 Tm ( and a 1000% )Tj 0.0006 Tc -0.0006 Tw -30.115 -1.165 Td [(\(11-fold\) increase in sildenafil plasm)8.4 (a)-0.6 ( AUC.
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At 24 )]TJ 0.0009 Tc -0.0009 Tw 20.595 0 Td [(hours the plasm)8.7 (a levels of sildenafil were still )]TJ 0.0006 Tc -0.0006 Tw -20.595 -1.165 Td [(approxim)8.4 (a)-0.6 (tely 200 ng/m)8.4 (L)1.4 (, com)8.4 (p)0.6 (ared to approxim)8.4 (a)-0.6 (tely 5 ng/m)8.4 (L)1.4 ( when sildenafil was dosed )]TJ 0.0009 Tc -0.0009 Tw T* [(alone. This is consistent with ritonavir\222s m)8.7 (ark)]TJ 0.0004 Tc -0.0004 Tw 18.39 0 Td (ed effects on a broad range of P450 substrates. )Tj 0.0005 Tc -0.0005 Tw -18.39 -1.18 Td [(VIAGRA had no effect on ritonavir pharm)8.3 (acokinetics \(see )]TJ /TT1 1 Tf -0.0011 Tc 0.0011 Tw 23.73 0 Td (DOSAGE AND )Tj -0.0008 Tc 0 Tw -23.73 -1.18 Td (ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc (\). )Tj 0 Tc T* ( )Tj 0.0008 Tc -0.0008 Tw T* (Although the interaction between other protease inhibitors and sildenafi\ l has not been studied, )Tj 0.001 Tc -0.001 Tw T* [(their concom)8.8 (itant use is expected to increase sildenafil levels. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0008 Tc -0.0008 Tw T* [(In a study of healthy m)8.6 (ale volunteers, co-adm)8.6 (inistra)-1.1 (tion of sildenafil at steady state \(80 m)8.6 (g)0.8 ( t.i.d.\) )]TJ 0.0005 Tc -0.0005 Tw T* [(with endothelin receptor antagonist bosentan \(a m)8.3 (oderate inducer of CYP3A4, CYP2C9 and )]TJ T* [(possibly of cytochrom)8.3 (e)-0.7 ( P450 2C19\) at steady stat)]TJ 0.0007 Tc -0.0007 Tw 19.875 0 Td [(e \(125 m)8.5 (g)0.7 ( b.i.d.\) resulted in a 63% decrease of )]TJ -19.875 -1.165 Td (sildenafil AUC and a 55% decrease in sildenafil C)Tj -0.0184 Tc 0 Tw 7.98 0 0 7.98 305.4597 397.0628 Tm [(ma)-18.2 (x)]TJ 0.0006 Tc -0.0006 Tw 12 0 0 12 319.0797 398.5628 Tm [(. For current labeling information, please visit endstream endobj 120 0 obj <> endobj 128 0 obj <> endobj 249 0 obj <> endobj 25 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 28 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 31 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 34 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 37 0 obj <>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Type/Page>> endobj 314 0 obj <>stream q 1 0 0 1 -8.760315 -1.877228 cm 0 0 612 792 re W n 1 0 0 1 8.760315 1.877228 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.2397 47.6228 Tm ( )Tj 19 -0.005 Td (14)Tj 0.0014 Tc -0.0014 Tw -19 54.94 Td [(sildenaf)4.4 (il C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 118.9797 705.3428 Tm [(ma)-18.2 (x)]TJ 0.0003 Tc -0.0003 Tw 12 0 0 12 132.5997 706.8428 Tm ( and a 210% increase in sildenafil AUC. VIAGRA had no effect on saquinav\ ir )Tj 0.0007 Tc -0.0007 Tw -5.78 -1.165 Td [(pharm)8.5 (acokinetics. Stronger CYP3A4 inhibitors such as ketoconazole or itracona\ zole would be )]TJ 0.0009 Tc -0.0009 Tw 0 -1.165 TD [(expected to have still greater effects, and population data from)8.7 ( patients in clinical trials did )]TJ 0.001 Tc -0.001 Tw T* (indicate a reduction in sildenafil clearance when it )Tj 0.0005 Tc -0.0005 Tw 20.425 0 Td [(was coadm)8.3 (i)-1.7 (nistered with CYP3A4 inhibitors )]TJ 0.0009 Tc -0.0009 Tw -20.425 -1.18 Td [(\(such as ketoconazole, erythrom)8.7 (ycin, or cim)8.7 (etidine\) \(see )]TJ /TT1 1 Tf -0.0011 Tc 0.0011 Tw 22.94 0 Td (DOSAGE AND )Tj -0.0008 Tc 0 Tw -22.94 -1.18 Td (ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc (\). )Tj 0 Tc T* ( )Tj 0.0008 Tc -0.0008 Tw T* [(In another study in healthy m)8.6 (ale volunteers, co)]TJ 0.0009 Tc -0.0009 Tw 18.8 0 Td [(adm)8.7 (i)-1.3 (nistration with the HIV protease inhibitor )]TJ 0.0008 Tc -0.0008 Tw -18.8 -1.165 Td (ritonavir, which is a highly potent P450 inhibito)Tj 0.0004 Tc -0.0004 Tw 19.255 0 Td [(r, at steady state \(500 m)8.2 (g bid\) with VIAGRA )]TJ 0.0008 Tc -0.0008 Tw -19.255 -1.165 Td [(\(100 m)8.6 (g)0.8 ( single dose\) resulted in a 300% \(4-fold\) increase in sildenafil C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 410.9997 579.1628 Tm [(ma)-18.2 (x)]TJ 0.0005 Tc -0.0005 Tw 12 0 0 12 424.6197 580.6628 Tm ( and a 1000% )Tj 0.0006 Tc -0.0006 Tw -30.115 -1.165 Td [(\(11-fold\) increase in sildenafil plasm)8.4 (a)-0.6 ( AUC. At 24 )]TJ 0.0009 Tc -0.0009 Tw 20.595 0 Td [(hours the plasm)8.7 (a levels of sildenafil were still )]TJ 0.0006 Tc -0.0006 Tw -20.595 -1.165 Td [(approxim)8.4 (a)-0.6 (tely 200 ng/m)8.4 (L)1.4 (, com)8.4 (p)0.6 (ared to approxim)8.4 (a)-0.6 (tely 5 ng/m)8.4 (L)1.4 ( when sildenafil was dosed )]TJ 0.0009 Tc -0.0009 Tw T* [(alone. This is consistent with ritonavir\222s m)8.7 (ark)]TJ 0.0004 Tc -0.0004 Tw 18.39 0 Td (ed effects on a broad range of P450 substrates.
- Sildenafil 150 mg can be part of a treatment plan for ED.
- Do not combine sildenafil with other erectile dysfunction drugs.
- Side effects should be reported to a healthcare provider promptly.
- Always check for allergies to sildenafil or related compounds.
)Tj 0.0005 Tc -0.0005 Tw -18.39 -1.18 Td [(VIAGRA had no effect on ritonavir pharm)8.3 (acokinetics \(see )]TJ /TT1 1 Tf -0.0011 Tc 0.0011 Tw 23.73 0 Td (DOSAGE AND )Tj -0.0008 Tc 0 Tw -23.73 -1.18 Td (ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc (\). )Tj 0 Tc T* ( )Tj 0.0008 Tc -0.0008 Tw T* (Although the interaction between other protease inhibitors and sildenafi\ l has not been studied, )Tj 0.001 Tc -0.001 Tw T* [(their concom)8.8 (itant use is expected to increase sildenafil levels. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0008 Tc -0.0008 Tw T* [(In a study of healthy m)8.6 (ale volunteers, co-adm)8.6 (inistra)-1.1 (tion of sildenafil at steady state \(80 m)8.6 (g)0.8 ( t.i.d.\) )]TJ 0.0005 Tc -0.0005 Tw T* [(with endothelin receptor antagonist bosentan \(a m)8.3 (oderate inducer of CYP3A4, CYP2C9 and )]TJ T* [(possibly of cytochrom)8.3 (e)-0.7 ( P450 2C19\) at steady stat)]TJ 0.0007 Tc -0.0007 Tw 19.875 0 Td [(e \(125 m)8.5 (g)0.7 ( b.i.d.\) resulted in a 63% decrease of )]TJ -19.875 -1.165 Td (sildenafil AUC and a 55% decrease in sildenafil C)Tj -0.0184 Tc 0 Tw 7.98 0 0 7.98 305.4597 397.0628 Tm [(ma)-18.2 (x)]TJ 0.0006 Tc -0.0006 Tw 12 0 0 12 319.0797 398.5628 Tm [(. Concom)8.4 (itant adm)8.4 (i)-1.6 (nistration of strong )]TJ -21.32 -1.165 Td [(CYP3A4 inducers, such as rifam)8.4 (p)0.6 (in, is expected to cause greater decreases in plasm)8.4 (a)-0.6 ( levels of )]TJ 0.0011 Tc -0.0011 Tw T* [(sildenaf)4.1 (il. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* [(Single doses of antacid \(m)8.4 (agnesium)8.4 ( hydroxi)-0.8 (de/alum)8.4 (i)-1.6 (num)8.4 ( hydroxide\) did not affect the )]TJ 0.0004 Tc -0.0004 Tw T* [(bioavailability of)3.4 ( VIAGRA. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0008 Tc -0.0008 Tw T* [(Pharm)8.6 (acokinetic data from)8.6 ( patients in clinical trials showed no effect on sildenafil )]TJ 0.0005 Tc -0.0005 Tw T* [(pharm)8.3 (acokinetics of CYP2C9 inhibitors \(such as tolbutam)8.3 (ide, warfarin\), CYP2D6 inhibitors )]TJ 0.001 Tc -0.001 Tw T* (\(such as selective serotonin reuptake inhibitors, tricyclic antidepress\ ants\), thiazide and related )Tj 0.0007 Tc -0.0007 Tw T* [(diuretics, ACE inhibitors, and calcium)8.5 ( channel blockers.
Usual Adult Dose for Erectile Dysfunction
[1]Advise patients of the potential for sildenafil to augment the blood pressure lowering effect of α-adrenergic blocking agents (e.g., doxazosin) and anti-hypertensive medications (e.g., amlodipine) and concomitant administration may lead to symptomatic hypotension in some patients. [1]Inform patients taking sildenafil for erectile dysfunction and with potential for cardiac risk of sexual activity (e.g., patients with preexisting cardiovascular risk factors) to refrain from further activity and seek medical attention immediately if they experience symptoms (e.g., chest pain, dizziness, nausea) upon initiation of sexual activity. [1]Advise patients to seek immediate medical attention for a sudden loss of vision in one or both eyes while taking sildenafil. [1] Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including possible permanent loss of vision. [1]Advise patients to seek prompt medical attention in the event of sudden decrease or loss of hearing while taking sildenafil.
Raynaud's phenomenon
[1] These events may be accompanied by tinnitus and dizziness. [1]Advise patients to seek prompt medical attention for an erection that lasts more than 4 hours. [1] If it is not treated right away, priapism can permanently damage the penis. [1]Inform patients taking sildenafil for erectile dysfunction that the drug offers no protection against sexually transmitted diseases and patients should use necessary protective measures to guard against such diseases, including the human immunodeficiency virus (HIV). [1]Instruct the patient to seek medical attention immediately if they take too much sildenafil. The AUC of)3.7 ( the active m)8.5 (etabolite, )]TJ T* [(N-desm)8.5 (ethyl sildenafil, was increased 62% by )]TJ 0.0008 Tc -0.0008 Tw 18.82 0 Td [(loop and potassium)8.6 (-sparing diuretics and 102% )]TJ 0.0007 Tc -0.0007 Tw -18.82 -1.165 Td [(by nonspecific beta-blockers. These effects on the m)8.5 (etabolite are not expected to be of clinical )]TJ 0 Tw T* (consequence. )Tj 0 Tc T* ( )Tj /TT1 1 Tf 0.0002 Tc -0.0002 Tw 0 -1.18 TD (Effects of VIAGRA on Other Drugs )Tj /TT2 1 Tf 0.0009 Tc -0.0009 Tw 0 -1.17 TD (In vitro)Tj /TT1 1 Tf 0.0006 Tc -0.0006 Tw ( studies:)Tj /TT0 1 Tf 6.625 0 Td ( Sildenafil is a weak inhibitor of )Tj 0.0002 Tc -0.0002 Tw [(the cytochrom)8 (e)-1 ( P450 isoform)8 (s)-0.6 ( 1A2, 2C9, )]TJ -0.0001 Tc 0.0001 Tw -6.625 -1.23 Td [(2C19, 2D6, 2E1 and 3A4 \(IC50 >)163.9 (150 )]TJ /C2_0 1 Tf 0 Tc 0 Tw 15.145 0 Td <0050>Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 0.575 0 Td [(M\).