known effects on the nitric oxide/cGMP pathway, sildenafil was shown to potentiate the hypotensive effects of nitrates Strong CYP3A inhibitors Viagra: Modify dose; not to exceed single dose of 25 mg/48 hr Revatio: Not recommended Coadministration increases systemic exposure of sildenafil and risk of adverse effects Moderate-to-strong CYP3A inducers Revatio: Modify dose; upward dose titration may be needed if coadministered Coadministration with moderate-to-strong CYP3A inducers (eg, bosentan) decreases the sildenafil exposure and possibly reduces efficacy Other PDE5 inhibitors Avoid Additive adverse effects may occur if coadministered with other PDE5 inhibitors (eg, avanafil, tadalafil, vardenafil) Alpha-blockers or antihypertensives Modify dose/caution Coadministration may increase risk of hypotension Particularly with higher doses used for erectile dysfunction Pregnancy Limited published data from randomized controlled trials, case-controlled trials, and case series do not report a clear association with sildenafil and major birth defects, miscarriage, or adverse maternal or fetal outcomes when sildenafil is used during pregnancy; there are risks to mother and fetus from untreated pulmonary arterial hypertension Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death Lactation Limited published data from a case report describe presence of sildenafil and its active metabolite in human milk; there is insufficient information about effects of sildenafil on breastfed infant and no information on effects of sildenafil on milk production; limited clinical data during lactation preclude a clear determination of risk of drug to an infant during lactationPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Inhibits PDE-5, increasing cyclic guanosine monophosphate cGMP to allow smooth-muscle relaxation Absorption Bioavailability: 40% Peak plasma time: 30-120 min Metabolism Metabolized in liver by CYP3A4 and (in minor amounts) CYP2C9 Metabolites: N-desmethyl metabolite (active; possesses 50% of sildenafil's PDE-5-inhibiting activity) Elimination Half-life: Parent drug, 3-4 hr; active metabolite, 10-70 min Excretion: Feces (80%), urine (13%) IV Administration Revatio: Administer as an IV bolus Oral Administration Viagra May take with or without food Take as needed, about 1 hr before sexual activity; however, may be taken anywhere from 30 minutes to 4 hr before sexual activity The maximum recommended dosing frequency is once daily Revatio May take with or without food Reconstitution of oral suspension Reconstitute bottle contents with water (total volume of 90 mL [60 mL followed by 30 mL]) Refer to prescribing information for detailed instructions Do not mix with any other medication or additional flavoring agent Storage Revatio tablets or IV solution Store at controlled room temperature 20-25°C (68-77°F) Excursions permitted to 15-30°C (59-86°F) Revatio reconstituted oral suspension Store <30°C (86°F) or in a refrigerator between 2-8°C (36-46°F) Do not freeze Discard unused oral suspension after 60 days BRAND FORM. UNIT PRICE PILL IMAGE Viagra oral- 50 mg tabletViagra oral- 100 mg tabletViagra oral- 25 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 100 mg tabletsildenafil oral- 25 mg tabletsildenafil oral- 50 mg tabletsildenafil oral- 25 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationsildenafil oral SILDENAFIL - ORAL (sil-DEN-a-fil) COMMON BRAND NAME(S): Viagra USES: Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction-ED). In combination with sexual stimulation, sildenafil works by increasing blood flow to the penis to help a man get and keep an erection.This drug does not protect against sexually transmitted diseases (such as HIV, hepatitis B, gonorrhea, syphilis). Practice "safe sex" such as using latex condoms. Consult your doctor or pharmacist for more details. HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start taking sildenafil and each time you get a refill. If you have any questions, ask your doctor or pharmacist.To treat erectile dysfunction-ED, take this drug by mouth as directed by your doctor, usually as needed. Take sildenafil at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour before is the most effective). Do not take more than once daily.A high-fat meal may delay how quickly the drug begins to work.The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if your condition does not improve. SIDE EFFECTS: Dizziness, headache, flushing, or stomach upset may occur. Vision changes such as increased sensitivity to light, blurred vision, or trouble telling blue and green colors apart may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Sexual activity may put extra strain on your heart, especially if you have heart problems. If you have heart problems and experience any of these serious side effects while having sex, stop and get medical help right away: severe dizziness, fainting, chest/jaw/left arm pain, nausea.Rarely, sudden decreased vision, including permanent blindness, in one or both eyes (NAION) may occur. If this serious problem occurs, stop taking sildenafil and get medical help right away. You have a slightly greater chance of developing NAION if you have heart disease, diabetes, high cholesterol, certain other eye problems ("crowded disk"), high blood pressure, if you are over 50, or if you smoke.Rarely, a sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness, may occur. Stop taking sildenafil and get medical help right away if these effects occur.In the rare event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before taking sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack or life-threatening irregular heartbeat in the past 6 months, chest pain/angina, heart failure), stroke in the past 6 months, kidney disease, liver disease, high or low blood pressure, dehydration, penis conditions (such as angulation, fibrosis/scarring, Peyronie's disease), history of painful/prolonged erection (priapism), conditions that may increase the risk of priapism (such as sickle cell anemia, leukemia, multiple myeloma), eye problems (such as retinitis pigmentosa, sudden decreased vision, NAION).This drug may make you dizzy or cause vision problems. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, sildenafil should be used only when clearly needed. Since high blood pressure in the lungs is a serious condition that can harm both a pregnant woman and her unborn baby, do not stop this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, talk to your doctor about the benefits and risks of using sildenafil.This medication passes into breast milk in small amounts. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: riociguat, vericiguat.Sildenafil can cause a serious drop in your blood pressure when used with nitrates. A serious drop in blood pressure can lead to dizziness, fainting, and rarely heart attack or stroke. Do not use sildenafil with any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide), recreational drugs called "poppers" containing amyl nitrate, amyl nitrite, or butyl nitrite.If you are also taking an alpha blocker medication (such as doxazosin, tamsulosin) to treat an enlarged prostate/BPH or high blood pressure, your blood pressure may get too low which can lead to dizziness or fainting. Your doctor may start treatment with a lower dose of sildenafil to minimize your risk of low blood pressure.Other medications can affect the removal of sildenafil from your body, which may affect how sildenafil works. Examples include azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin, erythromycin), HIV protease inhibitors (such as saquinavir), mifepristone, rifampin, ritonavir, among others.Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction-ED or pulmonary hypertension (such as tadalafil, vardenafil). OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include severe dizziness, fainting, painful/prolonged erection. NOTES: Do not share this medication with others. MISSED DOSE: Not applicable. STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Information last revised October 2022. Copyright(c) 2023 First Databank, Inc. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs. FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your