Class: Phosphodiesterase Type 5 Inhibitors VA Class: GU900 Chemical Name: 2-Hydroxy-1,2,3-propanetricarboxylate-1-3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo[4,3-d-pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]-4-methyl-piperazine Molecular Formula: C Recommended as one of several treatment options for initial management of PAH in patients with NYHA/WHO functional class II, III, or IV symptoms who are not candidates for calcium-channel blocker therapy or in whom such therapy has failed. (See Specific Drugs under Interactions.) Consider whether patients with underlying cardiovascular disease (e.g., severe left ventricular outflow obstruction, autonomic dysfunction, resting hypotension [BP Although not clear whether such effects are directly related to PDE type 5 inhibitors or to other factors (e.g., patient’s underlying medical condition, concomitant use of other ototoxic drugs), a strong temporal relationship has been observed. Thel-arginine-nitric oxide-cyclic GMP pathway mediates inhibitory nonadrenergic-noncholinergic neurotransmission in the corpus cavernosum of human and rabbit. (See Specific Drugs under Interactions.) Thorough medical history and physical examination recommended to diagnose ED, determine potential underlying causes, exclude potentially reversible or treatable causes, and identify appropriate treatment. Possible hypotensive reaction in patients receiving concomitant antihypertensive therapy, in patients with CHF and a borderline low blood volume and low BP status, and in patients with left-ventricular outflow obstruction. However, FDA states that there may be situations in which the risk-benefit profile may be acceptable in individual children (e.g., when other treatment options are limited and sildenafil can be used with close monitoring). (See Geriatric Patients under Dosage and Administration.) Insufficient data from clinical trials to determine whether geriatric patients with PAH respond differently than younger adults, but other clinical experience has not identified overall differences in response relative to younger patients. In patients stable on an α-adrenergic blocker, initiate sildenafil at lowest recommended dosage for treatment of ED; in those currently receiving sildenafil, initiate α-adrenergic blocker at the lowest dosage Amprenavir, atazanavir, darunavir, fosamprenavir, indinavir, lopinavir/ritonavir, nelfinavir, ritonavir, saquinavir, tipranavir in combination with low-dose ritonavir: Reduce initial sildenafil dose for treatment of ED to 25 mg and do not exceed a single 25-mg dose every 48 hours Nonspecific PDE inhibitors (e.g., dipyridamole, theophylline): Possible increased inotropic effects in cardiac muscle, vascular smooth muscle relaxation, and platelet-aggregation inhibition; risk of cardiotoxicity, hypotensive, or hemorrhagic event after concomitant use not known, but appears unlikely Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. 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). Consult your doctor or pharmacist for more details. 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). A high-fat meal may delay how quickly the drug begins to work. Can you buy cialis dubai Doxycycline calcium Buy female viagra online cheap Sildenafil oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. Consumer information about the medication SILDENAFIL ERECTILE DYSFUNCTION - ORAL Viagra, includes side effects, drug interactions, recommended dosages. Drug Interactions FAQ about this section. Overview. sildenafil. PDE5 inhibitor. Interaction Characteristics CYP2C9 substrate; CYP3A4 substrate; ototoxicity. If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware. If you are at an office or shared network, you can ask the network administrator to run a scan across the network looking for misconfigured or infected devices. Another way to prevent getting this page in the future is to use Privacy Pass. Check out the browser extension in the Firefox Add-ons Store. Revatio PO: 5 mg or 20 mg 3 times daily, administered 4-6 hours apart IV: 2.5-mg or 10-mg bolus 3 times daily if patient is temporarily unable to take PO Recommended PO/IV dose not to be exceeded Adding Revatio to bosentan does not have any beneficial effect on exercise capacity Not to be prescribed to children (1-17 years) for pulmonary arterial hypertension (PAH); this recommendation against use is based on long-term clinical pediatric trial showing that children taking high doses had higher risk of death than children taking low doses and that low doses were not effective in improving exercise ability (see Cautions) Elicits vasodilatory properties, resulting in mild and transient decreases in blood pressure Use with caution in patients with anatomic deformation of penis (eg, angulation, cavernosal fibrosis, or Peyronie disease), conditions potentially predisposing to priapism (eg, 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 Patient 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 initated 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 nonarteritic 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; advise patients to seek immediate medical attention in the event of a sudden loss of vision 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 (eg, 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%) 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 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 lactation The above information is provided for general informational and educational purposes only. 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