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Sildenafil Citrate

Sildenafil Citrate is the generic version of Viagra. It is used to treat impotence in men. Sildenafil Citrate increases the bodys ability to achieve and maintain an erection during sexual stimulation. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

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Uses

Sildenafil (sill-DEN-uh-fil) is used to treat male sexual function problems (erection problems).

How to take

This drug is taken by mouth as needed 45 minutes before sexual activity. Depending on how and when the drug works for you, an interval of one-half hour to as much as 4 hours may prove ideal. Before taking Sildenafil, do not eat a very large or high fat meal as it will impair the effectiveness of the medication. Take only as directed, usually half of a 100mg pill once daily as needed. Sildenafil works along with sexual stimulation to help achieve an erection.

Side effects

Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness might occur. If these effects persist or worsen, notify your doctor promptly.

Precaution

Before using this drug, tell your doctor your medical history, including any allergies (especially drug allergies), any penis conditions such as fibrosis/scarring, history of painful/prolonged erection (priapism), sickle cell anemia, blood system cancers (such as leukemia or myeloma), or Peyronie's disease, eye problems (retina diseases). kidney or liver disease, bleeding disorders or active stomach ulcers, heart diseases, stroke or severe high or low blood pressure. Limit alcohol intake, as it may aggravate side effects of this drug. To avoid dizziness and lightheadedness when rising from a seated or lying position, get up slowly. The elderly may be more sensitive to the side effects of this drug, therefore caution is advised in this age group.

Drug interactions

Tell your doctor of all nonprescription and prescription medication you may use, especially any nitrate medications (e.g., nitroglycerin, isosorbide dinitrate), nitroprusside (any "nitric oxide donor" medicines), cimetidine, erythromycin, azole antifungals (e.g., itraconazole, ketoconazole), mibefradil, rifamycins (e.g., rifampin) or high blood pressure medicines.

Storage

Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from light and moisture. Keep this and all medications out of the reach of children.

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VIAGRA is indicated for the treatment of erectile dysfunction.

DOSAGE AND ADMINISTRATION

For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, VIAGRA may be taken anywhere from 4 hours to 0.5 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day.

The following factors are associated with increased plasma levels of sildenafil: age > 65 (40% increase in AUC), hepatic impairment (e.g., cirrhosis, 80%), severe renal impairment (creatinine clearance < 30 mL/min, 100%), and concomitant use of potent cytochrome P450 3A4 inhibitors [ketoconazole, itraconazole, erythromycin (182%), saquinavir (210%)]. Since higher plasma levels may increase both the efficacy and incidence of adverse events, a starting dose of 25 mg should be considered in these patients.

Ritonavir greatly increased the systemic level of sildenafil in a study of healthy, non-HIV infected volunteers (11-fold increase in AUC, see DRUG INTERACTIONS.) Based on these pharmacokinetic data, it is recommended not to exceed a maximum single dose of 25 mg of VIAGRA in a 48 hour period.

VIAGRA was shown to potentiate the hypotensive effects of nitrates and its administration in patients who use nitric oxide donors or nitrates in any form is therefore contraindicated.

When VIAGRA is co-administered with an alpha-blocker, patients should be stable on alpha- blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at the lowest dose (see DRUG INTERACTIONS).

HOW SUPPLIED

VIAGRA® (sildenafil citrate) is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to the nominally indicated amount of sildenafil as follows:

	25 mg	50 mg	100 mg
Obverse	VGR25	VGR50	VGR100
Reverse	PFIZER	PFIZER	PFIZER
Bottle of 30	NDC-0069-4200-30	NDC-0069-4210-30	NDC-0069-4220-30
Bottle of 100	N/A	NDC-0069-4210-66	NDC-0069-4220-66