Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist

Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi See "What Are Side Effects Associated with Using Sildenafil?” Elicits vasodilatory properties, resulting in mild and transient decreases in blood pressure Use with caution in patients with anatomic deformation of penis (e.g., angulation, cavernosal fibrosis, or Peyronie disease), conditions potentially predisposing to priapism (e.g., sickle cell anemia, multiple myeloma, or leukemia), cardiovascular disease, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, multidrug antihypertensive regimens, retinitis pigmentosa, concomitant use of CYP3A4 inhibitors Pulmonary vasodilators may significantly worsen cardiovascular status of patients with pulmonary veno-occlusive disease Patients taking alpha blocker should be stabilized before starting phosphodiesterase (PDE)-5 inhibitor, which should be initiated at lowest dose; if patient is already taking optimized dose of PDE-5 inhibitor, alpha blocker should be initiated at lowest dose to avoid hypotension Not to be taken with other PDE-5 inhibitors Sudden decrease or loss of hearing, which may be accompanied by tinnitus and dizziness Viagra: Patients should stop sildenafil and seek medical care if a sudden loss of vision occurs in 1 or both eyes, which could be a sign of non-arteritic anterior ischemic optic neuropathy (NAION); use with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION; patients with a ”crowded” optic disc may also be at an increased risk of NAION Viagra: Potential for cardiac risk with sexual activity in patients with preexisting cardiovascular disease; therefore, treatment for erectile dysfunction generally should not be instituted in men for whom sexual activity is inadvisable because of their underlying cardiovascular status May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Revatio: In small, prematurely terminated study of patients with PAH secondary to sickle-cell disease, vaso-occlusive crises requiring hospitalization were more commonly reported by patients who received sildenafil than by those randomized to placebo; effectiveness of sildenafil in PAH secondary to sickle-cell anemia has not been established; the clinical relevance to men treated for erectile dysfunction with sildenafil is not known Revatio: Not for use in children with PAH; increased mortality with increasing doses (hazard ratio 3.5) was observed in randomized, double-blind, placebo-controlled clinical trial of 234 children (1-17 years) with PAH who had mild-to-moderate symptoms at baseline Revatio: Epistaxis occurred in 13% of patients with PAH secondary to connective tissue disease (e.g., scleroderma); this effect was not seen in idiopathic PAH; incidence was also higher in those receiving concomitant PO vitamin K antagonist therapy (9%) than in those not receiving such therapy (2%) Sildenafil may be acceptable for use during pregnancy Either animal studies show no risk but human studies are not available, or animal studies showed minor risks and human studies were done and showed no risk It is unknown whether sildenafil is distributed into breast milk.

• Sildenafil’s development marked a breakthrough in ED treatment.
• It has revolutionized sexual health for many men globally.
• The drug’s mechanism enhances nitric oxide effects.
• Many patients report improved confidence with sildenafil use.
• Research continues on new formulations and delivery methods.
• Public health campaigns promote safe and effective usage.
• Awareness of contraindications reduces health risks.

Sildenafil citrate is a generic prescription drug that widens arteries. Most people recognize it as Viagra, a treatment for erectile dysfunction. Healthcare professionals also use a lower-dose version to treat high arterial blood pressure in the lungs. The dosage form and dosing schedule will depend on the condition being treated. Treats erectile dysfunction or pulmonary arterial hypertension.

Antihypertensive, phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) Antihypertensive, phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) Sildenafil treats erectile dysfunction or pulmonary hypertension (high blood pressure in the arteries to the lungs).

What to avoid

If a dose is missed, take it when remembered but wait at least 30 minutes before attempting sexual activity. For pulmonary hypertension: Take a missed dose as soon as it’s remembered. If it’s almost time for the next dose, skip the missed dose and take the next dose as scheduled. Never take extra sildenafil to compensate for a missed dose. Take a missed dose as sildenafil white soon as it’s remembered.

Side effects and risks

This medicine is not right for everyone. Do not use it if you have had an allergic reaction to sildenafil. Tell any doctor or other healthcare provider who treats you that you are taking sildenafil. The doctor may need to perform regular check-ups and tests to check the effectiveness and side effects of this treatment. Tell your doctor if you are pregnant, breastfeeding, or have: Kidney disease Liver disease Diabetes Bleeding problems Blood problems such as sickle cell anemia Bleeding problems or ulcers Obstruction of the small veins in the lungs (pulmonary veno-occlusive disease) Eye or vision problems Deformed penis shape Tell your doctor if you are pregnant, breastfeeding, or have: Blood problems such as sickle cell anemia Blood problems such as sickle cell anemia Obstruction of the small veins in the lungs (pulmonary veno-occlusive disease) Obstruction of the small veins in the lungs (pulmonary veno-occlusive disease) If sildenafil is prescribed for erectile dysfunction, the prescriber will need to know if you have: Chest pain during sex Heart disease Heart rhythm problems Low blood pressure or uncontrolled high blood pressure Any previous heart attack or stroke Any heart surgery in the last six months Pulmonary hypertension Multiple myeloma Any history of prolonged erections (longer than four hours) If sildenafil is prescribed for erectile dysfunction, the prescriber will need to know if you have: Low blood pressure or uncontrolled high blood pressure Low blood pressure or uncontrolled high blood pressure Any heart surgery in the last six months Any heart surgery in the last six months Any history of prolonged erections (longer than four hours) Any history of prolonged erections (longer than four hours) Make sure the doctor knows if you smoke or not. Tablet 20 mg (for pulmonary hypertension) 25 mg 50 mg 100 mg Oral suspension 10 mg/mL (pulmonary hypertension) Injection 10 mg/12.5 mL (pulmonary hypertension) 10 mg/12.5 mL (pulmonary hypertension) 10 mg/12.5 mL (pulmonary hypertension) For erectile dysfunction: 25–100 mg tablet taken only once daily at least one hour before sexual activity For erectile dysfunction: 25–100 mg tablet taken only once daily at least one hour before sexual activity For pulmonary hypertension: In adults and children 45 lbs or heavier: 20–80 mg taken orally three times daily OR 10 mg intravenous injection three times daily In children weighing less than 44 lbs: 10 mg three times daily In adults and children 45 lbs or heavier: 20–80 mg taken orally three times daily OR 10 mg intravenous injection three times daily In adults and children 45 lbs or heavier: 20–80 mg taken orally three times daily OR 10 mg intravenous injection three times daily In children weighing less than 44 lbs: 10 mg three times daily In children weighing less than 44 lbs: 10 mg three times daily Sildenafil Citrate12.5ml of 10mg/12.5ml vial Your doctor will tell you how much sildenafil to take and how often it can be taken. Your doctor will tell you how much sildenafil to take and how often it can be taken. Sildenafil doses can be taken with or without food. Please read the Patient Information sheet before taking sildenafil. Take the prescribed dose about one hour before anticipated sexual activity. The dose could still work if it’s taken one-half hour to four hours before sexual activity. Sexual stimulation sildenafil 50mg tablet is needed for sildenafil to work. Do not take more than one dose in a 24-hour period. Take or administer the prescribed dose three times a day, four to six hours apart. Sildenafil oral suspension is prescribed for pulmonary hypertension. Please read and follow the Instructions for Use. Do not use sildenafil oral suspension if it’s still in powder form.

• Sildenafil citrate was first approved by the FDA in 1998.
• Its brand name is Viagra, but generic versions are available.
• The drug is available in tablets of various strengths, typically 25-100 mg.
• It can be prescribed for both men and in specific cases, women.
• Proper dosage varies based on health status and response.
• Use caution in patients with heart problems or low blood pressure.
• It is not a hormone or a testosterone booster.

Shake the bottle for at least 10 seconds before measuring a dose.

Use the oral syringe provided with the medicine to measure doses. Do not mix the dose with other liquids or flavorings. The person getting the medicine should be sitting or standing upright. Place the syringe in the mouth against the cheek and squirt the dose into the cheek. Wash the syringe with water and allow it to dry after each use. Store sildenafil oral suspension in the refrigerator. Throw away any unused medicine 60 days after receiving it. Liqrev oral suspension can be kept for 90 days before it must be thrown away.

For erectile dysfunction: If a dose is missed, take it when remembered but wait at least 30 minutes before attempting sexual activity. Do not take two or more doses in any 24-hour period. If a dose is missed, take it when remembered but wait at least 30 minutes before attempting sexual activity. For pulmonary hypertension: Take a missed dose as soon as it’s remembered. If it’s almost time for the next dose, skip the missed dose and take the next dose as scheduled. Never take extra sildenafil to compensate for a missed dose. Take a missed dose as sildenafil white soon as it’s remembered.

What Is Silenafil and How Does It Work?

Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi See "What Are Side Effects Associated with Using Sildenafil?” Elicits vasodilatory properties, resulting in mild and transient decreases in blood pressure Use with caution in patients with anatomic deformation of penis (e.g., angulation, cavernosal fibrosis, or Peyronie disease), conditions potentially predisposing to priapism (e.g., sickle cell anemia, multiple myeloma, or leukemia), cardiovascular disease, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, multidrug antihypertensive regimens, retinitis pigmentosa, concomitant use of CYP3A4 inhibitors Pulmonary vasodilators may significantly worsen cardiovascular status of patients with pulmonary veno-occlusive disease Patients taking alpha blocker should be stabilized before starting phosphodiesterase (PDE)-5 inhibitor, which should be initiated at lowest dose; if patient is already taking optimized dose of PDE-5 inhibitor, alpha blocker should be initiated at lowest dose to avoid hypotension Not to be taken with other PDE-5 inhibitors Sudden decrease or loss of hearing, which may be accompanied by tinnitus and dizziness Viagra: Patients should stop sildenafil and seek medical care if a sudden loss of vision occurs in 1 or both eyes, which could be a sign of non-arteritic anterior ischemic optic neuropathy (NAION); use with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION; patients with a ”crowded” optic disc may also be at an increased risk of NAION Viagra: Potential for cardiac risk with sexual activity in patients with preexisting cardiovascular disease; therefore, treatment for erectile dysfunction generally should not be instituted in men for whom sexual activity is inadvisable because of their underlying cardiovascular status May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Revatio: In small, prematurely terminated study of patients with PAH secondary to sickle-cell disease, vaso-occlusive crises requiring hospitalization were more commonly reported by patients who received sildenafil than by those randomized to placebo; effectiveness of sildenafil in PAH secondary to sickle-cell anemia has not been established; the clinical relevance to men treated for erectile dysfunction with sildenafil is not known Revatio: Not for use in children with PAH; increased mortality with increasing doses (hazard ratio 3.5) was observed in randomized, double-blind, placebo-controlled clinical trial of 234 children (1-17 years) with PAH who had mild-to-moderate symptoms at baseline Revatio: Epistaxis occurred in 13% of patients with PAH secondary to connective tissue disease (e.g., scleroderma); this effect was not seen in idiopathic PAH; incidence was also higher in those receiving concomitant PO vitamin K antagonist therapy (9%) than in those not receiving such therapy (2%) Sildenafil may be acceptable for use during pregnancy Either animal studies show no risk but human studies are not available, or animal studies showed minor risks and human studies were done and showed no risk It is unknown whether sildenafil is distributed into breast milk. Sildenafil citrate is a generic prescription drug that widens arteries. Most people recognize it as Viagra, a treatment for erectile dysfunction. Healthcare professionals also use a lower-dose version to treat high arterial blood pressure in the lungs. The dosage form and dosing schedule will depend on the condition being treated.

What drugs interact with sildenafil?

Treats erectile dysfunction or pulmonary arterial hypertension. Antihypertensive, phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) Antihypertensive, phosphodiesterase type 5 inhibitor (PDE-5 inhibitor) Sildenafil treats erectile dysfunction or pulmonary hypertension (high blood pressure in the arteries to the lungs). Tablet 20 mg (for pulmonary hypertension) 25 mg 50 mg 100 mg Oral suspension 10 mg/mL (pulmonary hypertension) Injection 10 mg/12.5 mL (pulmonary hypertension) 10 mg/12.5 mL (pulmonary hypertension) 10 mg/12.5 mL (pulmonary hypertension) For erectile dysfunction: 25–100 mg tablet taken only once daily at least one hour before sexual activity For erectile dysfunction: 25–100 mg tablet taken only once daily at least one hour before sexual activity For pulmonary hypertension: In adults and children 45 lbs or heavier: 20–80 mg taken orally three times daily OR 10 mg intravenous injection three times daily In children weighing less than 44 lbs: 10 mg three times daily In adults and children 45 lbs or heavier: 20–80 mg taken orally three times daily OR 10 mg intravenous injection three times daily In adults and children 45 lbs or heavier: 20–80 mg taken orally three times daily OR 10 mg intravenous injection three times daily In children weighing less than 44 lbs: 10 mg three times daily In children weighing less than 44 lbs: 10 mg three times daily Sildenafil Citrate12.5ml of 10mg/12.5ml vial Your doctor will tell you how much sildenafil to take and how often it can be taken. Your doctor will tell you how much sildenafil to take and how often it can be taken. Sildenafil doses can be taken with or without food. This medicine is not right for everyone.

What Are Side Effects Associated with Using Sildenafil?

Make sure the doctor knows if you smoke or not. Sildenafil can cause serious problems, particularly at high doses: Heart problems Low blood pressure Prolonged or painful erections Sudden loss of vision in one or both eyes Hearing problems including hearing loss, ringing in the ears, and dizziness Sildenafil can cause serious problems, particularly at high doses: Sudden loss of vision in one or both eyes Sudden loss of vision in one or both eyes Hearing problems including hearing loss, ringing in the ears, and dizziness Hearing problems including hearing loss, ringing in the ears, and dizziness If sildenafil is being used for ED, do not continue having sex if you experience symptoms of heart problems such as chest pain or nausea. If sildenafil is being used for ED, do not continue having sex if you experience symptoms of heart problems such as chest pain or nausea. Sildenafil for ED does not protect you or your partner from sexually transmitted diseases. Because of potentially hazardous drug interactions, sildenafil can never be safely used with: Other PDE-5 inhibitors such as vardenafil or tadalafil The pulmonary hypertension treatment Adempas (riociguat) Nitrates such as nitroglycerin Drugs that enhance sexual performance called “poppers” such as amyl nitrite Because of potentially hazardous drug interactions, sildenafil can never be safely used with: Other PDE-5 inhibitors such as vardenafil or tadalafil Other PDE-5 inhibitors such as vardenafil or tadalafil Drugs that enhance sexual performance called “poppers” such as amyl nitrite Drugs that enhance sexual performance called “poppers” such as amyl nitrite To avoid other drug interactions, make sure the prescriber knows about all prescription drugs, over-the-counter medications, and supplements you use, particularly: Alpha blockers, medicines commonly used to treat enlarged prostate or high blood pressure Other types of blood pressure drugs Other treatments or supplements for erectile dysfunction HIV/AIDS medications called protease inhibitors Azole antifungal drugs such as ketoconazole and itraconazole The antibiotics clarithromycin and erythromycin Amlodipine, bosentan, cimetidine, rifampin To avoid other drug interactions, make sure the prescriber knows about all prescription drugs, over-the-counter medications, and supplements you use, particularly: Alpha blockers, medicines commonly used to treat enlarged prostate or high blood pressure Alpha blockers, medicines commonly used to treat enlarged prostate or high blood pressure Other treatments or supplements for erectile dysfunction Other treatments or supplements for erectile dysfunction Azole antifungal drugs such as ketoconazole and itraconazole Azole antifungal drugs such as ketoconazole and itraconazole Find more detailed information about sildenafil interactions to avoid here.

Professional resources

Do not use it if you have had an allergic reaction to sildenafil. Tell any doctor or other healthcare provider who treats you that you are taking sildenafil.

Administration and Monitoring

Use the oral syringe provided with the medicine to measure doses. Do not mix the dose with other liquids or flavorings. The person getting the medicine should be sitting or standing upright. Place the syringe in the mouth against the cheek and squirt the dose into the cheek. Wash the syringe with water and allow it to dry after each use.

Platelet-aggregation Inhibitors

Store sildenafil oral suspension in the refrigerator. Throw away any unused medicine 60 days after receiving it. Liqrev oral suspension can be kept for 90 days before it must be thrown away. For erectile dysfunction: If a dose is missed, take it when remembered but wait at least 30 minutes before attempting sexual activity. Do not take two or more doses in any 24-hour period. The doctor may need to perform regular check-ups and tests to check the effectiveness and side effects of this treatment.

• Sildenafil citrate is manufactured by several pharmaceutical companies.
• Its chemical formula is C22H30N6O4S.
• It has a half-life of approximately 4 hours in the body.
• The drug enhances nitric oxide activity in the corpus cavernosum.
• It’s important to follow prescribed dosing to avoid adverse effects.
• It is classified as a phosphodiesterase type 5 inhibitor.
• Sildenafil was initially researched for angina before ED use.

Tell your doctor if you are pregnant, breastfeeding, or have: Kidney disease Liver disease Diabetes Bleeding problems Blood problems such as sickle cell anemia Bleeding problems or ulcers Obstruction of the small veins in the lungs (pulmonary veno-occlusive disease) Eye or vision problems Deformed penis shape Tell your doctor if you are pregnant, breastfeeding, or have: Blood problems such as sickle cell anemia Blood problems such as sickle cell anemia Obstruction of the small veins in the lungs (pulmonary veno-occlusive disease) Obstruction of the small veins in the lungs (pulmonary veno-occlusive disease) If sildenafil is prescribed for erectile dysfunction, the prescriber will need to know if you have: Chest pain during sex Heart disease Heart rhythm problems Low blood pressure or uncontrolled high blood pressure Any previous heart attack or stroke Any heart surgery in the last six months Pulmonary hypertension Multiple myeloma Any history of prolonged erections (longer than four hours) If sildenafil is prescribed for erectile dysfunction, the prescriber will need to know if you have: Low blood pressure or uncontrolled high blood pressure Low blood pressure or uncontrolled high blood pressure Any heart surgery in the last six months Any heart surgery in the last six months Any history of prolonged erections (longer than four hours) Any history of prolonged erections (longer than four hours) Make sure the doctor knows if you smoke or not. Make sure the doctor knows if you smoke or not. Sildenafil can cause serious problems, particularly at high doses: Heart problems Low blood pressure Prolonged or painful erections Sudden loss of vision in one or both eyes Hearing problems including hearing loss, ringing in the ears, and dizziness Sildenafil can cause serious problems, particularly at high doses: Sudden loss of vision in one or both eyes Sudden loss of vision in one or both eyes Hearing problems including hearing loss, ringing in the ears, and dizziness Hearing problems including hearing loss, ringing in the ears, and dizziness If sildenafil is being used for ED, do not continue having sex if you experience symptoms of heart problems such as chest pain or nausea. If sildenafil is being used for ED, do not continue having sex if you experience symptoms of heart problems such as chest pain or nausea. Sildenafil for ED does not protect you or your partner from sexually transmitted diseases.

Effectiveness of Sildenafil

Please read the Patient Information sheet before taking sildenafil. Take the prescribed dose about one hour before anticipated sexual activity. The dose could still work if it’s taken one-half hour to four hours before sexual activity. Sexual stimulation sildenafil 50mg tablet is needed for sildenafil to work. Do not take more than one dose in a 24-hour period.

Oral Administration

Take or administer the prescribed dose three times a day, four to six hours apart. Sildenafil oral suspension is prescribed for pulmonary hypertension. Please read and follow the Instructions for Use. Do not use sildenafil oral suspension if it’s still in powder form. Shake the bottle for at least 10 seconds before measuring a dose. Because of potentially hazardous drug interactions, sildenafil can never be safely used with: Other PDE-5 inhibitors such as vardenafil or tadalafil The pulmonary hypertension treatment Adempas (riociguat) Nitrates such as nitroglycerin Drugs that enhance sexual performance called “poppers” such as amyl nitrite Because of potentially hazardous drug interactions, sildenafil can never be safely used with: Other PDE-5 inhibitors such as vardenafil or tadalafil Other PDE-5 inhibitors such as vardenafil or tadalafil Drugs that enhance sexual performance called “poppers” such as amyl nitrite Drugs that enhance sexual performance called “poppers” such as amyl nitrite To avoid other drug interactions, make sure the prescriber knows about all prescription drugs, over-the-counter medications, and supplements you use, particularly: Alpha blockers, medicines commonly used to treat enlarged prostate or high blood pressure Other types of blood pressure drugs Other treatments or supplements for erectile dysfunction HIV/AIDS medications called protease inhibitors Azole antifungal drugs such as ketoconazole and itraconazole The antibiotics clarithromycin and erythromycin Amlodipine, bosentan, cimetidine, rifampin To avoid other drug interactions, make sure the prescriber knows about all prescription drugs, over-the-counter medications, and supplements you use, particularly: Alpha blockers, medicines commonly used to treat enlarged prostate or high blood pressure Alpha blockers, medicines commonly used to treat enlarged prostate or high blood pressure Other treatments or supplements for erectile dysfunction Other treatments or supplements for erectile dysfunction Azole antifungal drugs such as ketoconazole and itraconazole Azole antifungal drugs such as ketoconazole and itraconazole Find more detailed information about sildenafil interactions to avoid here.