Never use combination with chronic sildenafil for PAH cobicistatcobicistat will increase

Non-medical use

If you or someone else has used too much sildenafil, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222. For this use, sildenafil is used only when needed. Take it as your healthcare provider recommends, which is usually between 30 minutes to four hours before planned sexual activity. Do not take double or extra doses. For this use, take sildenafil as your healthcare provider recommends, which is usually three times a day.

What Are the Available Sildenafil Dosages?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Ask your healthcare provider if you are unsure what to do after a missed dose. This survey is being conducted by the WebMD marketing sciences department. 50 mg PO ~1 hr before sexual activity; however, may be taken anywhere from 30 min to 4 hr before sexual activity Maximum dosing frequency is once per day Based on effectiveness and toleration, may increase dose to maximum of 100 mg or decrease to 25 mg Indicated for treatment of pulmonary arterial hypertension (PAH) (World Health Organization [WHO] Group I) to improve exercise ability and delay clinical worsening Revatio (PO), Liqrev: 20 mg PO TID; may titrate up to 80 mg TID, if required, based on symptoms and tolerability Revatio (IV): 10 mg IV bolus TID 10-mg IV predicted to provide pharmacologic effect equivalent to 10-mg oral dose Do not exceed recommended PO/IV dose Viagra, VibriqueSevere (eg, cirrhosis): Consider initial dose of 25 mg Severe (eg, cirrhosis): Consider initial dose of 25 mg RevatioMild or moderate (Child-Pugh A or B): No dose adjustment requiredSevere (Child-Pugh C): Not studied Mild or moderate (Child-Pugh A or B): No dose adjustment required Viagra, VibriqueMild or moderate (CrCl 30-80 mL/min): No dose adjustment requiredSevere (CrCl <30 mL/min): Consider initial dose of 25 mg Mild or moderate (CrCl 30-80 mL/min): No dose adjustment required Severe (CrCl <30 mL/min): Consider initial dose of 25 mg RevatioAny severity, including severe (CrCl <30 mL/min): No dose adjustment required Any severity, including severe (CrCl <30 mL/min): No dose adjustment required Indicated in children aged 1-17 years for treatment of pulmonary arterial hypertension (PAH) (WHO Group I) to improve exercise ability and, in pediatric patients too young to perform standard exercise testing, pulmonary hemodynamics thought to underly improvements in exercise 20-45 kg: 20 mg PO TID Maximum dose in pediatric patients not identified Based on experience in adults, dose may be titrated up to 40 mg TID, if required, based on symptoms and tolerability Mild or moderate (Child-Pugh A or B): No dose adjustment required Any severity, including severe (CrCl <30 mL/min): No dose adjustment required ≥65 years: 25 mg PO initially ~1 hr before sexual activity; however, may be taken anywhere from 30 min to 4 hr before sexual activity Maximum dosing frequency is once per day Based on effectiveness and toleration, may increase dose to maximum of 100 mg or decrease to 25 mg Indicated for treatment of pulmonary arterial hypertension (PAH) (World Health Organization [WHO] Group I) to improve exercise ability and delay clinical worsening PO: 20 mg PO TID; may titrate up to 80 mg TID, if required , based on symptoms and tolerability 10-mg IV predicted to provide pharmacologic effect equivalent to 10-mg oral dose Recommended PO/IV dose not to be exceeded Adding Revatio to bosentan does not have any beneficial effect on exercise capacity Clinical trials found no significant difference in response between elderly patients and younger adults; however, cautious dose selection should be considered in elderly because of greater frequency of decreased hepatic, renal, and cardiac function, as well as comorbid conditions and concomitant pharmacotherapy Compared with healthy younger volunteers, healthy elderly volunteers (≥65 years) had reduced clearance of sildenafil, resulting in approximately 84% and 107% higher plasma concentrations of sildenafil and its active N-desmethyl metabolite, respectively atazanaviratazanavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

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When used chronically for PAH, sildenafil is contraindicated for use with cobicistat; if used for erectile dysfunction, do not

Proper Use

If you feel faint or dizzy, lie down. Tell your healthcare provider right away if you have any of the following symptoms of low blood pressure. You may be at higher risk for this if you take a blood thinner medicine. Tell your healthcare provider if you get nosebleeds often while taking sildenafil. If your nosebleed is severe or will not stop after applying pressure, get help right away.

More common

People who are allergic to any of the following should not take sildenafil. Any of the ingredients in the specific product dispensed Your pharmacist can tell you all of the ingredients in the specific sildenafil products they stock. Sildenafil should not be taken while you are using certain other medicines. Before taking sildenafil, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details. exceed sildenafil 25 mg q48hr cobicistat will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Why is this medication prescribed?

Medicines in this group include avanafil (Stendra), sildenafil (Viagra, Revatio, and others), tadalafil (Cialis and others), and vardenafil (Levitra, Staxyn). Use an accurate measuring device to measure your dose of sildenafil oral liquid. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device. Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

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

This will help them determine if sildenafil is right for you. In particular, make sure that you discuss any of the following. Tell your healthcare provider if you have any of the following. Heart problems, such as heart rhythm problems, chest pain, or heart failure Heart attack, stroke, or heart surgery within the past six months High blood pressure that is still too high despite taking medicines for it Peyronie's disease, or a penis with an abnormal curve or shape An erection lasting longer than four hours A blood disorder, such as sickle cell anemia An inherited eye disease called retinitis pigmentosa Vision loss, or a problem with the nerve between your eyes and brain (optic nerve) Health conditions or factors that raise the risk of optic nerve problems, such as diabetes, high cholesterol, smoking, being older than 50, or having a “crowded disc,” which is something an eye doctor may see in an eye exam Pulmonary veno-occlusive disease, a condition where blood vessels in the lungs are blocked It is not known if or how sildenafil could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening

Stronger erections, better sex

Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take sildenafil while breastfeeding. If you take sildenafil after you eat a high-fat meal, such as a burger and fries, it may take longer to start working. Your healthcare provider may recommend limiting or avoiding grapefruit while taking sildenafil. Grapefruit or grapefruit juice can raise sildenafil levels in your body, which can increase the risk of side effects.

Does sildenafil interact with foods or drinks?

There are no known interactions between sildenafil and alcohol. Always tell your healthcare provider about sildenafil pills any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. In particular, make sure that you discuss if you are using any of the following before taking sildenafil. Tell your healthcare provider about all medicines that you take or have recently taken. This may not be a complete list of medicines that can interact with sildenafil. events; contraindication applies to chronic administration of sildenafil for PAH; for ED, not to exceed 25 mg in 48 hr.

• The onset of effect usually occurs within 30 minutes to 1 hour.
• The effects can last up to 4-6 hours, depending on the individual.
• Patients should avoid heavy meals before taking the medication.
• Sildenafil 25 mg is available by prescription only in most countries.

nelfinavirnelfinavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nelfinavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Food Type	Effect on Absorption	Interaction with Alcohol	Clinical Significance
High-fat meals	Delays absorption	No direct interaction	Typically prolongs onset time
Alcohol consumption	No significant effect (modest amounts)	Can enhance side effects like dizziness, hypotension	Moderate intake is generally safe, excessive alcohol can impair efficacy
Light meal	Minimal effect	None	Safe to take with meals

Coadministration contraindicated if sildenafil used for pulmonary arterical hypertension.

GPhC Regulated Pharmacy

Do not take sildenafil unless it has been prescribed to you by a healthcare provider. Do not share sildenafil with other people, even if they have the same condition as you. Keep sildenafil out of the reach of children. If you keep sildenafil oral liquid in a refrigerator, make sure to keep it away from children who also use the refrigerator. Sexual activity can put extra strain on your heart, which may be unsafe for people with certain health problems, such as a recent heart attack.

Pulmonary hypertension

Talk to your healthcare provider to see if your heart is strong enough for sex. If you feel chest pain, dizziness, or nausea sildenafil 12 5 mg during sex, stop and contact your healthcare provider right away. Sildenafil does not protect against sexually transmitted infections, including HIV. Sildenafil belongs to a group of medicines, known as phosphodiesterase-5 (PDE-5) inhibitors, which are used to treat erectile dysfunction or pulmonary arterial hypertension. You should not take more than one PDE-5 inhibitor medicine. Reduce sildenafil dose if used for erectile dysfunction.

• Consult your doctor if you experience vision changes or ringing in ears.
• Sildenafil can interact with nitrates, causing dangerous hypotension.
• Use with caution if you have heart problems or low blood pressure.
• Report any persistent or painful erections lasting over 4 hours.