Sildenafil User Reviews & Ratings

[1]Advise patients to take sildenafil with or without food 1 hour

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In a clinical trial combining a single dose of sildenafil (50 mg) and aspirin (150 mg), sildenafil did not potentiate the aspirin-induced increase in bleeding time. In an in vitro human platelet study, sildenafil potentiated the antiaggregatory effect of sodium nitroprusside. The possibility that concomitant administration of rifampin, a potent CYP3A4 inducer, could decrease plasma concentrations of sildenafil should be considered. Additive hypotensive effects can occur if riociguat is used concomitantly with PDE type 5 inhibitors. [1][247] In a study in patients with pulmonary arterial hypertension (PAH) who were receiving stable dosages of sildenafil (20 mg 3 times daily), administration of single doses of riociguat resulted in additive hemodynamic effects.

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[247] A high rate of drug discontinuance generally has been observed among patients receiving combination therapy with sildenafil and riociguat; at least one death, possibly related to the combined use of these drugs, has been reported. Because of the risk of hypotension, concomitant use of sildenafil and riociguat is contraindicated. The safety and efficacy of sildenafil in combination with other treatments for ED have not been established, and therefore such combined therapy currently is not recommended by the manufacturer. [67] No pharmacokinetic interaction has been observed between warfarin, a CYP2C9 substrate, and sildenafil. Sildenafil is a selective inhibitor of phosphodiesterases (PDEs), with the greatest selectivity for PDE type 5, the principal isoenzyme of PDE involved in the metabolism of cyclic guanosine monophosphate (cGMP) to GMP in the corpora cavernosa of the penis. or, if needed, 30 minutes to 4 hours before sexual activity.

• Sildenafil 50 mg can be used occasionally or regularly.
• Chewing or breaking the tablet may reduce effectiveness.
• Patient fasting is not necessary but avoid heavy meals.
• Avoid grapefruit juice while taking this medication.
• Keep out of reach of children and pets.
• Emergency: seek medical help if an erection lasts over 4 hours.
• Inform your doctor about any pre-existing health conditions.
• Use caution if you're on any other medication.

[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

Patient Group	Recommended Dosage	Administration Timing	Special Considerations
Adult Men with ED	50 mg as needed	30 to 60 minutes before sexual activity	Adjust based on efficacy and tolerability
Elderly Patients	Same as adults, starting with lower dose	50 mg usually appropriate	Monitor for side effects
Patients with Liver Impairment	Consult healthcare provider	Dose adjustments may be necessary	Increased risk of side effects
Patients on CYP3A4 inhibitors	Lower dose recommended	Due to increased drug levels	e.g., ketoconazole, ritonavir

and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.

• Sildenafil 50 mg tablets should be stored away from moisture.
• Do not alter the dosage prescribed by your doctor.
• Men with optic conditions should exercise caution.
• Be aware of the risk of sudden hearing loss.
• Use only as directed by healthcare providers.
• Keep track of medication expiration dates.
• The drug works best when taken on an empty stomach.
• Always inform your doctor of any new symptoms.

[1]Inform patients of other important precautionary information.

Precaution/Contraindication	Explanation	Recommendations
Use with Nitrates	Can cause severe hypotension	Avoid concomitant use
Cardiac conditions	Potential stress on cardiovascular system	Consult healthcare provider
Recent Stroke or Heart Attack	Increased risk of adverse events	Medical evaluation required
Liver or Kidney Impairment	Altered drug metabolism	Dose adjustments needed
Sensitive to Sildenafil	Allergic reactions or hypersensitivity	Discontinue if adverse reactions occur

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[1][26][67][91][131] Plasma concentrations of the active N-desmethyl metabolite are approximately 40% of those observed with sildenafil, and the metabolite reportedly accounts for about 20% of sildenafil's pharmacologic activity. [1][67][131] The N-demethylated metabolite, the major circulating metabolite, has a phosphodiesterase selectivity profile similar to that sildenafil citrate tablet of sildenafil and an in vitro potency for PDE type 5 of approximately 50% of the parent drug. [1][116][131] Sildenafil is eliminated mainly in the feces as metabolites following oral administration. [1][67][91][116][131] In healthy adults and those with ED, approximately 80% of an oral dose is excreted as metabolites in feces and 13% is excreted in urine. Importance of instructing patients to read the manufacturer's patient information before starting sildenafil therapy and each time their prescription is refilled.

Dosage Forms & Strengths

[1]Instruct patients to avoid contraindicated medications such as regular and/or intermittent use of organic nitrates, organic nitrites (e.g., ''poppers''), and riociguat. [1]Inform patients that sildenafil is marketed for erectile dysfunction (Viagra) and pulmonary arterial hypertension (Revatio®). [1] Advise patients taking Viagra® not to take Revatio® or other PDE type 5 inhibitors. [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. Please refer to the ASHP Drug Shortages Resource Center for

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Sildenafil is rapidly absorbed following oral administration; the mean absolute bioavailability is sildenafil 50g 41% (range, 25-63%). [1][4][56][67][91][116][249] Although studies indicate that more than 90% of an oral sildenafil dose is absorbed from the GI tract, the drug undergoes extensive metabolism in the GI mucosa during absorption and on first pass through the liver, with only about 40% of a dose reaching systemic circulation unchanged. [1][4][56][67][91][116][131][249] Pharmacokinetics of the drug (as determined by peak plasma concentrations or AUC) are dose proportional over the single-dose range of 1.25-200 mg.[1][4][56][91][116][131] Peak plasma concentrations of sildenafil and its active N-desmethyl metabolite are achieved within 30-120 (median: 60) minutes following oral administration in fasting adults. [1][4][91][127][130][249] Administration with a high-fat meal delays GI absorption, with a reduction in peak plasma concentrations of about 29% and a delay in time to peak plasma concentrations of about 60 minutes; the extent of absorption is not affected. Sildenafil appears to be widely distributed in the body.

Recreational use

[1][4][67][116][131] Sildenafil and its major circulating N-desmethyl metabolite are each approximately 96% bound to plasma proteins; protein binding reportedly is independent of plasma concentration. [1][67][91][116][131] Sildenafil is distributed to a limited extent in semen following oral administration, with less than 0.001% of a single dose appearing in semen 90 minutes after dosing in healthy individuals. [1][67] Such concentrations are unlikely to cause any effects in sexual partners exposed to the semen. [67] Plasma sildenafil concentrations appear to decline in a biphasic manner following oral administration, with a terminal elimination half-life of about 4 hours (range: 3-5 hours). [1][4][67][91][116][127][130][131] Sildenafil is metabolized principally via hepatic cytochrome P-450 (CYP) microsomal isoenzymes 3A4 (major route) and 2C9 (minor route). information on shortages of one or more of these preparations.

• Sildenafil 50 mg tablets are used to treat erectile dysfunction.
• The medicine improves blood flow to the penis.
• Take sildenafil 50 mg 30-60 minutes before activity.
• Do not exceed one tablet per 24 hours.
• Common side effects include headache and flushing.
• Avoid consuming high-fat meals before taking it.
• Alcohol may reduce the effectiveness of the medication.
• Consult a doctor if you experience prolonged erections.

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[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. [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.

Sildenafil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

[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. [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 sildenafil 5mg for sale blocking agents). generic (nonproprietary) name © Copyright, 1959-2026, Selected Revisions April 10, 2024.

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[1][2][4][5][7][8][10][24][27][33][41][42][54][56][57][67][87][88][91][131] Sildenafil has no direct relaxant effect on isolated human corpora cavernosa of the penis, but enhances the effect of nitric oxide by inhibiting PDE type 5-mediated hydrolysis of cGMP. [1][2][4][5][7][8][10][33][41][42][127][131] During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpora cavernosa. [1][2][4][56][67][91][131] By selectively inhibiting PDE type 5, sildenafil causes accumulation of cGMP in various tissues. [1][2][4][5][31][33][34][41][42][56][57][67][91][131] Because sildenafil potentiates the accumulation of cGMP rather than stimulating its production, the drug is effective only when cGMP production in the penis is increased by sexual arousal. [34][91][131] Sildenafil at recommended doses has no effect on erectile function in the absence of sexual stimulation.

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[1][4][33][34][91][127][130][131][132] Sildenafil also exhibits some activity against other PDE isoenzymes. [1][4][5][31][44][57][67][87][88] In vitro, sildenafil is about 10 times more active against PDE type 5 than against PDE type 6, greater than 70-80 times more active against PDE type 5 than against PDE type 1, greater than 1000 times more active against PDE type 5 than against PDE types 2 and 4, and 4000 times more active against PDE type 5 than against PDE type 3. [1][4][27][31][45][52][55][57][67][87][88] The duration of erectile responsiveness (i.e., the time period in which adequate sexual stimulation can produce an erection) with oral sildenafil has been reported to be approximately 2 hours, with some penile responsiveness persisting for up to 4 hours after oral administration. [1] In the largest clinical study published to date, the onset and duration of action of oral sildenafil were not reported. [33][34] In most other placebo-controlled studies in which improvement in erection was determined by penile plethysmography, the erectile effect was determined at a fixed time of 60 minutes after an oral dose of the drug. American Society of Health-System Pharmacists®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

Use Case	Description	Typical Dosage	Notes
Erectile Dysfunction	Improve erectile response during sexual activity	50 mg as needed	Taken 30-60 min before activity
Pulmonary Arterial Hypertension	Off-label use to reduce blood pressure in lungs	Under medical supervision	Brand: Revatio
Off-label uses	Possible off-label benefits in other circulatory disorders	Under research	Not generally approved

The American Society of Health-System Pharmacists, Inc.

• Sildenafil 50 mg works best with sexual arousal.
• Do not take it with other ED medications simultaneously.
• Keep hydrated but avoid excessive alcohol intake.
• The drug is not a cure but manages symptoms.
• Some users may experience nasal congestion.
• Stay informed about possible interactions with supplements.
• Do not use expired medication.
• Follow up with your doctor for ongoing assessment.