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3 DOSAGE FORMS AND STRENGTHS

Sildenafil > sildenafil citrate tables


It is advisable to monitor blood

12.1 Mechanism of Action

When administered as a single oral or single intravenous dose, the inhibitory effect of aprepitant on CYP3A4 is weak and did not result in a clinically significant increase in the AUC of a sensitive substrate. Atazanavir: (Major) Sildenafil is contraindicated for use with atazanavir when used for pulmonary arterial hypertension (PAH). If used for erectile dysfunction, the dose of sildenafil should not exceed 25 mg in 48 hours with increased monitoring for adverse reactions during times of coadministration. Concurrent use is expected to substantially increase the sildenafil plasma concentrations and may result in increased associated adverse events including hypotension, syncope, visual changes, and prolonged erection. Atazanavir; Cobicistat: (Major) Sildenafil is contraindicated for use with atazanavir when used for pulmonary arterial hypertension (PAH).

How sildenafil is used

(Major) Sildenafil is contraindicated for use with cobicistat when used for pulmonary arterial hypertension (PAH). Atropine; Difenoxin: (Moderate) Diphenoxylate/difenoxin is a synthetic opiate agonist with a chemical structure similar to that of meperidine. Prolonged erections have been reported in two patients taking sildenafil with dihydrocodeine. In both cases, patients reported erections subsided immediately after orgasm when taking sildenafil alone. Although more data are needed, use caution when prescribing opiate agonists and sildenafil concomitantly. pressure if the combination is necessary.

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Dutasteride; Tamsulosin: (Moderate) Due to the

8.7 Patients with Renal Impairment

Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Chlorpheniramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Cimetidine: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with cimetidine is necessary. Concomitant use may increase sildenafil plasma concentrations. Cimetidine 800 mg caused a 56% increase in plasma sildenafil concentrations when coadministered with sildenafil 50 mg to healthy volunteers.

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Ciprofloxacin: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with ciprofloxacin is necessary; consider a starting dose of 25 mg of sildenafil when prescribed for erectile dysfunction. Clarithromycin: (Major) Coadministration of clarithromycin is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). Cobicistat: (Major) Sildenafil is contraindicated for use with cobicistat when used for pulmonary arterial hypertension (PAH). Codeine; Phenylephrine; Promethazine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Conivaptan: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with conivaptan is necessary; consider a starting dose of 25 mg of sildenafil when prescribed for erectile dysfunction. potential for symptomatic hypotension, patients should be

Warnings & Precautions

(Major) Sildenafil is contraindicated for use with darunavir when used for pulmonary arterial hypertension (PAH). Delavirdine: (Major) Coadministration of delavirdine is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). When sildenafil is used for erectile dysfunction, the dose of sildenafil should not exceed 25 mg in 48 hours. Dexamethasone: (Moderate) Monitor for decreased efficacy of sildenafil if coadministration with dexamethasone is necessary as concurrent use may decrease sildenafil exposure. Dextromethorphan; Diphenhydramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors.

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Dextromethorphan; Guaifenesin; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Dextromethorphan; Quinidine: (Moderate) Sildenafil is metabolized principally by the hepatic isoenzymes CYP3A4 and CYP2C9. Inhibitors of these isoenzymes, such as quinidine, may reduce sildenafil clearance. Increased systemic exposure to sildenafil may result in an increase in sildenafil-induced adverse effects. Diltiazem: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with diltiazem is necessary; consider a starting dose of 25 mg of sildenafil when prescribed for erectile dysfunction. stable on tamsulosin therapy before initiating

Condition Risk Recommendations
Concomitant Nitrate Use Severe hypotension Avoid combination
Cardiac Conditions Risk of myocardial infarction or arrhythmia Consult cardiologist
Severe Liver Impairment Altered drug metabolism Dose adjustment needed
Hypotension (low BP) Further blood pressure reduction Use with caution

therapy with the lowest dose of sildenafil.

5.4 Hearing Loss

Cariprazine: (Moderate) Orthostatic vital signs should be monitored in patients who are at risk for hypotension, such as those receiving cariprazine in combination with antihypertensive agents. Atypical antipsychotics may cause orthostatic hypotension and syncope, most commonly during treatment initiation and dosage increases. Patients should be informed about measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning, or rising slowly from a seated position. Consider a cariprazine dose reduction if hypotension occurs. Cenobamate: (Moderate) Monitor for decreased sildenafil 25mg tablets efficacy of sildenafil if coadministration with cenobamate is necessary as concurrent use may decrease sildenafil exposure.

Vybrique Oral Film

Ceritinib: (Major) Coadministration with ceritinib is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving ceritinib. Chloramphenicol: (Major) Coadministration of chloramphenicol is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving chloramphenicol. Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors.

 

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