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Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational buy sildenafil at walgreens resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. oral suspension (Revatio) 10mg/mL (when reconstituted) Erectile Dysfunction.

1 hr before sexual activity; however, may be taken anywhere from 30 min to 4 hr before sexual activity.

Based on effectiveness and toleration, may increase dose to maximum of 100 mg or decrease to 25 mg.

IV: 2.5-mg or 10-mg bolus TID if patient is temporarily unable to take PO.

Adding Revatio to bosentan does not have any beneficial effect on exercise capacity. Severe (eg, cirrhosis): Consider initial dose of 25 mg.

Mild or moderate (Child-Pugh A or B): Clearance reduced, resulting in increases in AUC (84%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment Severe (Child-Pugh C): Not studied. Mild or moderate (CrCl 30-80 mL/min): No dose adjustment required Severe (CrCl Enter a drug name and sildenafil.

Vaso-occlusive crisis (PAH secondary to sickle-cell anemia) Nonarteritic anterior ischemic optic neuropathy (NAION) Warnings.

Soluble guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension. Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate pathway, PDE5 inhibitors may potentiate the hypotensive effects of nitrates A suitable time interval following PDE5 dosing for the safe administration of nitrates or nitric oxide donors has not been determined.

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. 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%) Pregnancy & Lactation. 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. Controlled studies in pregnant women show no evidence of fetal risk. 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.

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. Uses Side Effects Precautions Interactions Overdose Images Uses Side Effects Precautions Interactions Overdose Images. 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.

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. 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 persist or worsen, 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 your doctor has prescribed this medication because he or she 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.

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. 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.

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, a severe loss of body water (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.

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.

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. A product that may interact with this drug is: riociguat.

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 ritonavir, saquinavir), hepatitis C virus protease inhibitors (such as boceprevir, telaprevir), mifepristone, rifampin, 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). 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.

Store at room temperature away from light and moisture.

The combination of nitrates (and drugs such as nicorandil) with sildenafil is contraindicated.

This combination must be avoided as it can produce significant hypotension and is potentially fatal. The guidance from the Committee on Safety of Medicines (CSM) regarding nitrates and sildenafil states (1): sildenafil and nitrates - it is stated that these should not be used concurrently.

Nitrates are stated as those used for cardiovascular disease, e.g. amyl nitrate sildenafil should sildenafil coupons for walgreens not be used in men for whom sexual activity is inadvisable e.g. patients with severe cardiovascular disorders such as severe heart failure or unstable angina.

The British Heart Foundation have addressed the use of GTN spray and nitrate tablets and phosphodiesterase (PDE5) inhibitors (sildenafil, tadalafil, verdenafil) (2): nitrate therapy is an absolute contraindication to PDE5 inhibitors (1,2,3) combination of nitrates with PDE5 inhibitors can produce unpredictable excess vasodilation, leading to profound hypotension - same risk also applies with nicorandil if hypotension does occur then the patient should be placed in the Trendelenburg position and emergency help sought.

Resuscitation with intravenous fluids should be initiated as soon as possible. GTN spray should not be used within 24 hours of taking sildenafil or vardenafil and within 48 hours of taking tadalafil note though that coital angina is not common and nitrates can often be safely discontinued or substituted in stable patients if a patient has stable angina and erectile dysfunction then a reassessment of the need for nitrates should be undertaken before denying treatment with a PDE5 inhibitor if a patient with CHD (and also taking a PDE5 inhibitor) develops angina during sexual activity, he must discontinue immediately and relax for 5-10 minutes.

If he stands up then this will reduce the preload and may relieve symptoms.

if the angina pain does not resolve after 20-30 minutes the emergency services should be called informing them of the PDE5 inhibitor use - also sex should not be attempted again before the patient has undergone a thorough reassessment (2) The concurrent use of nicorandil and PDE5 inhibitors is also contraindicated (2,3) - this is due to the nitrate component of nicorandil.

although PDE5Is are safe with most antihypertensive agents, coadministration with nitrates or alpha-blockers poses a risk of severe hypotension (4,5) all alpha-blockers can cause vasodilation and orthostatic hypotension, and coadministration with PDE5Is increases the risk of a clinically significant decrease in BP (5) only after patients are on stable alpha-blocker therapy should PDE5Is be initiated, starting with a low dose (5) Referral to specialist is appropriate if severe CVD which makes sexual activity unsafe or a situation when PDE5 inhibitor use contra- indicated (6) from a therapeutical point of view, intracavernous injections of PGE1 (alprostadil) are efficient and safe second line in the treatment of erectile dysfunction in the cardiac population, whatever the origin. No drug interactions with the various treatment used in cardiology, notably derived nitrates, has been reported other treatment options include vacuum devices, insertion of transurethral alprostadil (MUSE), intracavernosal alprostadil (Caverjet) nitrates are contraindicated within 24 hours of sildenafil and vardenafil and within 48 hours of tadalafil. Only after patients are on stable alph-blocker therapy should PDE5Is be initiated, starting with generic viagra soft a low dose potent cytochrome P450 3A4 inhibitors, including erythromycin, clarithromycin, ketoconazole, itraconazole, and HIV protease inhibitors, increase PDE5I plasma concentrations.

PDE5I drug interactions have the potential to cause life-threatening hypotension in patients with coexisting cardiac disease requiring nitrates or alpha blockers (5) "uroselective" alpha-blockers (tamsulosin, alfuzosin) preferentially inhibit alpha 1A and alpha 1D receptors found primarily in the prostate and benefit patients with benign prostatic hypertrophy. Other alpha-blockers (terazosin) are less selective, and some (doxazosin) are used as third-line agents for hypertension because of their higher affinity for alpha -1B receptors, which are abundant in the peripheral vasculature (5) Viagra.

Commonly known as “the little blue pill,” Viagra has raked in billions for pharmaceutical giant Pfizer since its 1998 release. But the erectile dysfunction drug has been linked to serious side effects, including vision and hearing loss, heart complications and melanoma.

By Kristin Compton Edited By Kevin Connolly Medically Reviewed by Laura Koppen, PharmD, BCPS This page features 20 Cited Research Articles.

Board-certified physicians medically review Drugwatch content to ensure its accuracy and quality.

Drugwatch partners with Physicians’ Review Network Inc. PRN is a nationally recognized leader in providing independent medical reviews.

Reviewer specialties include internal medicine, gastroenterology, oncology, orthopedic surgery and psychiatry.

Food and Drug Administration (FDA) approved Viagra (sildenafil) for prescription use in men with erectile dysfunction (or impotence). The medication was originally developed and studied as an anti-hypertensive drug to treat high blood pressure as well as a type of cardiovascular (affecting the heart and blood vessels) disease called angina pectoris. While that effort failed, chemists at pharmaceutical giant Pfizer found that the drug was capable of inducing penile erections within 30 to 60 minutes of use. Pfizer saw an economical advantage with this new discovery and experienced immediate success with Viagra, accumulating about a billion dollars in sales in its first year alone. In 2014, Fox News reported that “over 30 million men suffer from erectile dysfunction,” and it is estimated that approximately 20 million Americans have taken Viagra.

Men’s Health reported around the same time that during the last two or three decades, ED rates have gone up, especially among younger men.

The Journal of Sexual Medicine published results from one study that showed that “one out of every four new ED patients is under 40 years old.” In 2016, the FDA approved the first-ever generic version of Viagra to be manufactured and distributed by Teva, a Pennsylvania-based pharmaceutical company.

Viagra has always been linked to some serious side effects affecting the eyes, ears, penis, heart and blood vessels. A 2014 study published in JAMA Internal Medicine also points to a possible link between the use of sildenafil (the active ingredient in Viagra) and melanoma, the most dangerous form of skin cancer. However, the significance of this link is still unclear.

Viagra is an oral medication used to treat erectile dysfunction (ED) in men. An erection occurs when blood flow increases into the penis, making it expand and become firm.

Two long chambers inside the penis called the corpora cavernosa contain spongy tissue that collects blood flowing into the chambers, creating pressure that results in the expansion of the penis. Viagra, as a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5), works to block certain naturally occurring enzymes in the body, causing blood vessels to relax and enhancing blood flow to the penis. Viagra does not automatically cause an erection; rather, it assists a man with ED in obtaining and keeping an erection when sexually aroused or stimulated. Sildenafil for Pulmonary Arterial Hypertension (PAH) The active ingredient in Viagra can treat other disorders.

Revatio (sildenafil) is prescribed for adults with pulmonary arterial hypertension (PAH).

PAH is a progressive, life-threatening disorder that causes abnormally high blood pressure in the pulmonary artery, which is the blood vessel responsible for carrying

blood

from the heart to the lungs.

Revatio works to improve a patient’s ability to exercise and slow down the progression and worsening of the disease.

Signs and symptoms of this serious health condition can include shortness of breath when active, fainting spells, dizziness, swelling of the ankles or legs, chest pain, and a rapid heart rate. The National Institutes of Health (NIH) defines erectile dysfunction as “a condition in which a man is unable to get or keep an erection firm enough for sexual intercourse.” Signs of erectile dysfunction (ED), sometimes referred to as impotence, may include the ability to get an erection sometimes but not every time, the ability to get an erection that does not last long enough to engage in sexual intercourse, or the inability to get an erection at

any

time. Physical causes for the condition can include nerve damage, artery damage, or damage to the smooth muscles and fibrous tissues in the penis. Certain diseases and health complications can also lead to ED, such as high blood pressure and diabetes. Psychological and emotional disorders, such as anxiety, depression and stress, as well as certain lifestyle choices, such as an unhealthy diet, lack of exercise, drinking in excess and smoking, can cause or exacerbate ED.



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