16 HOW SUPPLIED/STORAGE AND HANDLING

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What happens if I miss a dose?

Do not take more or less of it or take it more often than prescribed by your doctor. Shake the liquid well for 10 seconds before each use to mix the medication evenly. Use the oral syringe provided with your medication to measure and take your dose. Follow the manufacturer's directions to use and clean the oral syringe. Do not mix the liquid with other medications or add anything to flavor the medication. tell your doctor and pharmacist if you are allergic to sildenafil, any other medications, or any of the ingredients in sildenafil tablet or suspension.

Ask your pharmacist for a list of the ingredients. Some medications should not be taken with sildenafil.

In case of emergency/overdose

Exceeding the maximum dosage for sildenafil (more than 100 mg in 24 hours) does not improve erections and raises the risk of severe headaches, dizziness, low blood pressure, vision changes, and priapism (a prolonged erection requiring emergency care). Seek medical attention if you exceed the recommended daily maximum of 100mg in one day. Both doses work by improving blood flow, but the sildenafil 100 mg dosage is usually prescribed if 50 mg is not effective. Studies show a higher response rate at 100 mg, but also a greater chance of side effects. Doctors typically start at 50 mg and only increase to 100 mg if needed.

What should I do if I accidentally use too much sildenafil?

Physician-Scientist; Founder, Director, and Chief Executive OfficerXYON: Founder, Director, and CEOEducationDoctorate of Medicine (MD) — University of Cape Town, South Africa — 1991Genetics (PhD) — University of Amsterdam, The Netherlands — 1998Internal Medicine (Postgraduate Fellowship) — University of British Columbia (UBC), Canada — 2001Academic & Clinical AppointmentsClinical Assistant Professor, Division of General Internal Medicine — University of British ColumbiaAssociate Member, Division of Cardiology, Department of Medicine — University of British ColumbiaFaculty — Providence Health Care Heart and Lung Institute B., Ströberg, P., Lee, S. W., Park, N. C., Kim, S.-W., Tseng, L.-J., Collins, S., & Stecher, V. J. Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: Effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt. Make sure you have discussed any other medications you are currently taking or plan to take before starting sildenafil with your doctor and pharmacist.

How should this medicine be used?

If you are taking sildenafil to treat erectile dysfunction, follow your doctor's directions and the guidelines in this paragraph. Take sildenafil as needed before sexual activity. The best time to take sildenafil is about 1 hour before sexual activity, but you can take the medication any time from 4 hours to 30 minutes before sexual activity. Sildenafil usually should not be taken more than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take sildenafil less often.

6.1 Clinical Trials Experience

You can take sildenafil with or without food. However, if you take sildenafil with a high-fat meal, it will take longer for the medication to start to work. If you are taking sildenafil to treat PAH, you will probably take sildenafil three times a day with or without food. Take sildenafil at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Before starting, stopping, or changing any medications while taking sildenafil, please get the advice of your doctor or pharmacist.

tell your doctor if you are taking street drugs containing nitrates ('poppers') such as amyl nitrate, amyl nitrite, or butyl nitrate while taking sildenafil.

6. Adverse Reactions/Side Effects

American Journal of Cardiology, 84(5), 11N–17N. Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Sildenafil (Liqrev, Revatio) is used to improve the ability to exercise in adults (Liqrev, Revatio) and children 1 year of age and older (Revatio) with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness). Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation.

7.1 Nitrates

This increased blood flow can cause an erection. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily. If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. Sildenafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV). Sildenafil comes as sildenafil citrates a tablet and suspension (liquid) to take by mouth. Your doctor will tell you not to take sildenafil if you are taking street drugs containing nitrates. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take.

• Sildenafil may be less effective in men with certain health conditions like diabetes.
• Be aware of potential vision changes, such as blue-tinted vision.
• Discontinue use and consult a doctor if adverse reactions occur.
• Sildenafil can cause priapism, a painful prolonged erection needing urgent care.
• Safe sexual activity depends on your overall cardiovascular health.

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

What special dietary instructions should I follow?

If you are taking sildenafil for erectile dysfunction, your doctor will probably start you on an average dose of sildenafil and increase or decrease your dose depending on your response to the medication. Tell your doctor if sildenafil is not working well or if you are experiencing side effects. If you are taking sildenafil for PAH, you should know that sildenafil controls PAH but does not cure it. Continue to take sildenafil even if you feel well. Do not stop taking sildenafil without talking to your doctor. you should know that sildenafil is available under the brand names Liqrev, Revatio, and Viagra. You should only be treated with one of these products at a time. The following nonprescription or herbal products may interact with sildenafil: cimetidine (Tagamet HB), St. John's wort. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking sildenafil. Do not start these medications while taking sildenafil without discussing it with your healthcare provider. tell your doctor if you smoke, if you have had heart surgery within the last 6 months, if you have ever had an erection that lasted for more than 4 hours, and if you have recently lost a large amount of body fluids (dehydration).

How to take tablets

The Journal of Sexual Medicine, 6(10), 2826–2835. Sildenafil: A review of its use in erectile dysfunction. Effects of two different dosages of sildenafil on patients with erectile dysfunction. American Journal of Men’s Health, 11(3), 747–757. Urologist recommends daily Viagra to prevent impotence.

Revatio Tablets

Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. This can happen if you are sick with fever, diarrhea, or vomiting; sweat a lot; or do not drink enough liquids. Also tell your doctor if you have or have ever had pulmonary veno-occlusive disease (PVOD; blockage of veins in the lungs); a stomach ulcer; heart, kidney, or liver disease; a heart attack; heart failure; angina (chest pain); an irregular heartbeat; a stroke; chest pain; high or low blood pressure; high cholesterol; a bleeding disorder; blood circulation problems; blood cell problems such as sickle cell anemia (a disease of the red blood cells), multiple myeloma (cancer of the plasma cells), or leukemia (cancer of the white blood cells); conditions affecting the shape of the penis (e.g., angulation, cavernosal fibrosis, or Peyronie's disease); or diabetes. Also tell your doctor if you or any of your family members have or have ever had an eye disease such as retinitis pigmentosa (an inherited eye condition that causes loss of vision) or if you have ever had sudden severe vision loss, especially if you were told that the vision loss was caused by a blockage of blood flow to the nerves that help you see. if you are a woman and you are taking sildenafil to treat PAH, tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

Full Prescribing Information

Oral sildenafil in the treatment of erectile dysfunction. The New England Journal of Medicine, 338(20), 1397–1404. A prospective study of the beneficial effects of dose optimization and customized instructions on patient satisfaction with sildenafil citrate (Viagra) for erectile dysfunction. International Journal of Impotence Research, 18(5), 389–394. Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose.

Less common

International Journal of Urology, 11(11), 989–993. Sex, erectile dysfunction, and the heart: A growing problem. Phosphodiesterase‑5 (PDE5) inhibitors in the management of erectile dysfunction. Pharmacy and Therapeutics, 38(7), 407–419. Cardiovascular effects of sildenafil citrate and recommendations for its use. If you become pregnant while taking sildenafil, call your doctor.

• Sildenafil interacts with nitrate medications, causing dangerous drops in blood pressure.
• Store sildenafil in a cool, dry place away from children.
• 20mg is often recommended as a starting dose for ED treatment.
• Food, especially high-fat meals, can delay its onset of action.
• Regular use can improve erectile response over time if prescribed.

if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking sildenafil. if you are taking sildenafil to treat erectile dysfunction, tell your doctor if you have ever been advised by a healthcare professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity. Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain, dizziness, or nausea during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise.

• A large body of post-marketing surveillance data exists for sildenafil.
• Spontaneous reporting systems have helped identify rare adverse events.
• These include NAION, sudden hearing loss, and serious cardiovascular events.
• The overall benefit-risk profile remains positive for its approved indications.
• Studies continue to monitor long-term safety in chronic users.
• Data is collected on use in special populations, like the elderly.
• Real-world evidence often confirms the findings from controlled trials.
• Pharmacovigilance is ongoing to detect any new or changing safety signals.
• This data is used to update product labeling and inform healthcare providers.
• Patients are encouraged to report any suspected side effects to their doctor or FDA/MedWatch.
• This surveillance is a critical component of ensuring drug safety.

tell all your healthcare providers that you are taking sildenafil. If you ever need emergency medical treatment for a heart problem, the healthcare providers who treat you will need to know when you last took sildenafil.