WHAT IS SILDENAFIL (VIAGRA)?
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Children should not usually take sildenafil, but in some cases, a doctor may decide that sildenafil (Revatio) is the best medication to treat a child’s condition. 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. 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).
How should this medicine be used?
Sildenafil comes as a tablet and suspension (liquid; Revatio only) to take by mouth.
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. 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, follow your doctor’s directions and the guidelines in this paragraph. You will probably take sildenafil three times a day with or without food. Take sildenafil at around the same times every day, and space your doses about 4 to 6 hours apart.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sildenafil exactly as directed. 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.
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.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
Other uses for this medicine
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking sildenafil,
- tell your doctor and pharmacist if you are allergic to sildenafil, any other medications, or any of the ingredients in sildenafil products. Ask your pharmacist for a list of the ingredients.
- do not take sildenafil if you are taking or have recently taken riociguat (Adempas) or nitrates (medications for chest pain) such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others). Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your doctor if you are not sure whether any of your medications contain nitrates.
- do not take street drugs containing nitrates such as amyl nitrate and butyl nitrate (‘poppers’) while taking sildenafil.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax, in Jalyn), and terazosin; amlodipine (Norvasc, in Amturnide, in Tekamlo); certain antifungals such as itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral); anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven); certain barbiturates such as butalbital (in Butapap, in Fioricet, in Fiorinal, others) and secobarbital (Seconal); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal LA, InnoPran); bosentan (Tracleer); cimetidine ; efavirenz (Sustiva, in Atripla); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors including amprenavir (Agenerase; no longer available in the U.S.), atazanavir (Reyataz, in Evotaz), darunavir (Prezista, in Prezcobix), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), and tipranavir (Aptivus); nevirapine (Viramune); other medications or devices to treat erectile dysfunction; medications for high blood pressure; certain medications for seizures including carbamazepine (Carbatrol, Epitol, Tegretol, others), phenobarbital, and phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane, in Rifamate, in Rifater). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with sildenafil, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor what herbal products you are taking or plan to take, especially St. John’s wort.
- tell your doctor if you smoke, if you have ever had an erection that lasted for several hours, and if you have recently lost a large amount of body fluids (dehydration). 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; 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. If you become pregnant while taking sildenafil, call your doctor.
- 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.
- 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.
What special dietary instructions should I follow?
Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.
What should I do if I forget a dose?
If you are taking sildenafil for erectile dysfunction, you are unlikely to miss a dose since this medication is taken as needed, not on a regular dosing schedule.
If you are taking sildenafil for PAH, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Sildenafil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- flushing (feeling of warmth)
- difficulty falling asleep or staying asleep
- numbness, burning, or tingling in the arms, hands, feet, or legs
- muscle aches
- changes in color vision (seeing a blue tinge on objects or having difficulty telling the difference between blue and green)
- sensitivity to light
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- sudden severe loss of vision (see below for more information)
- blurred vision
- sudden decrease or loss of hearing
- ringing in ears
- dizziness or lightheadedness
- chest pain
- worsening shortness of breath
- erection that is painful or lasts longer than 4 hours
- itching or burning during urination
Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil. The vision loss was permanent in some cases. It is not known if the vision loss was caused by the medication. If you experience a sudden loss of vision while you are taking sildenafil, call your doctor immediately. Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.
There have been reports of heart attack, stroke, irregular heartbeat, bleeding in the brain or lungs, high blood pressure, and sudden death in men who took sildenafil for erectile dysfunction. Most, but not all, of these people had heart problems before taking sildenafil. It is not known whether these events were caused by sildenafil, sexual activity, heart disease, or a combination of these and other causes.Talk to your doctor about the risks of taking sildenafil.
Some patients experienced a sudden decrease or loss of hearing after they took sildenafil or other medications that are similar to sildenafil. The hearing loss usually involved only one ear and did not always improve when the medication was stopped. It is not known if the hearing loss was caused by the medication. If you experience a sudden loss of hearing, sometimes with ringing in the ears or dizziness, while you are taking sildenafil, call your doctor immediately. If you are taking sildenafil (Viagra) for erectile dysfunction, do not take any more doses of sildenafil (Viagra) or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor. If you are taking sildenafil (Revatio) for PAH, do not stop taking your medication until you talk to your doctor.
Sildenafil may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension at room temperature or in a refrigerator, but do not freeze it. Dispose of any unused suspension after 60 days.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
What other information should I know?
Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
What is the Difference between Cialis and Viagra ?
Both Viagra and Cialis are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names:
- sildenafil (Viagra)
- tadalafil (Cialis)
About 30 million American men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many men turn to these oral ED medications.
How cialis and viagra work ?
Viagra and Cialis are part of a family of medications called PDE-5 inhibitors. PDE-5 (phosphodiesterase type-5) is an enzyme that’s the bouncer of the reproductive system: It curtails an erection by hustling blood out of the penis (through a chain reaction involving other molecules). Viagra and Cialis work by blocking PDE-5. This maintains elevated levels of a substance known as cGMP, which relaxes smooth muscle and encourages blood vessels to widen. That makes blood flow more freely, including to the penis.
Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate.
Both Viagra and Cialis can be taken 30 minutes before sexual activity. However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it.
The fact that it comes in a low-dose (2.5 mg) version also means that Cialis can be taken every day. A daily dose will ensure that the drug’s always in your system.
If you take Cialis, there’s a chance of limb pain. This side effect isn’t associated with any other oral ED drugs.
Do tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?
Erectile dysfunction (ED) affects up to 50% of men between the ages of 40 and 70 years of age. Sildenafil, vardenafil and tadalafil have all been shown to be similarly effective in the treatment of men with ED of vary etiologies, to have similar adverse effects profiles, and to improve quality-of-life by similar amounts. As these phosphodiesterase 5 (PDE5) inhibitors all increase the hypotensive effects of nitrates, they are not suitable for use in patients taking nitrates for the treatment of ischaemic heart disease. All three inhibitors must be used with caution in patients taking alpha(1)-adrenoceptors antagonists for benign prostatic hyperplasia.
Although nonarteritic anterior ischaemic neuropathy has been reported in some users of the PDE5 inhibitors, there is no conclusive evidence that PDE5 inhibitors cause this rare effect. Tadalafil has a longer half-life than sildenafil or vardenafil, and a longer duration of action than sildenafil and vardenafil. Most preference studies have shown tadalafil to be preferred, but there are serious limitations to some of these studies. One approach to treatment is to give each patient a short- and long-acting agent, and for individuals to decide their preference.
Effectiveness of sildenafil citrate (Viagra) and tadalafil (Cialis) on sexual responses in Saudi men with erectile dysfunction in routine clinical practice.
Satisfaction with the sexual experience is considered important when evaluating the impact of treatments for erectile dysfunction, yet enhanced satisfaction has been infrequently assessed in the sexual trials. We evaluated the efficacy of sildenafil vs. tadalafil, in Saudi men with erectile dysfunction and determined the self-based rating of medicinal preference.
Sildenafil citrate (Viagra) is a potent inhibitor of the electrolytic enzyme type V phosphodiesterase (PDE5), in the corpus cavernosum and therefore increases the penile response to sexual stimulation. Tadalafil (Cialis) is also a PDE5 inhibitor that increases the level of cyclic guanosine monophosphate (cGMP) in cavernous smooth muscle cells. Whereas cGMP is a second messenger for the vasodilator effects of nitric oxide causing smooth muscle relaxation, which in turn leads to penile erection; however the mechanism by which cGMP stimulates relaxation of the smooth muscles remains to be elucidated.
Both sildenafil and tadalafil have a rapid onset with the effectiveness up to 4 hours and 36 hours respectively. In this study subjects treated with 100 mg oral dose of sildenafil / 20 mg tadalafil were found to be associated with higher mean scores for the questions of the International Index of Erectile Function (IIEF). Frequency of penetration and maintenance of erection after sexual penetration and/or during masturbation were found to be enhanced significantly (p<0.001) in both sildenafil/tadalafil treated men. Similarly mean domain of erectile function, orgasmic function, and intercourse satisfaction also showed a significantly positive improvement (p/0.001) in both the treated groups in comparison with their age matched untreated controls.
Interestingly in all the cases, tadalafil group showed considerably greater positive responses than the sildenafil group but within the same significant levels. Strikingly the sexual-desire domain in sildenafil treated men with respect to their aged matched controls
Here are the basic features of each of these drugs:
|What’s the generic name of this drug?||sildenafil||tadalafil|
|Is a generic version available?||Yes||yes|
|What form does it come in?||oral tablet||oral tablet|
|What strengths does it come in?||25 mg, 50 mg, 100 mg||2.5 mg, 5 mg, 10 mg, 20 mg|
|What’s the typical dosage?||50 mg||10 mg (when used as needed); 2.5 mg (when used daily)|
|When do I take it?||30-60 minutes before sex||30 minutes before sex|
|How long does it work?||4 hours||up to 36 hours|
|How do I store it?||Around room temperature, between 68°F to 77°F (20°C to 25°C)||At 25°C (77°F)|
The drugs are available in a variety of doses, ranging from 2.5 milligrams (mg) to 200 mg. All can be taken with or without food. However, taking these drugs after eating a high-fat meal does slow the rate of absorption.
Most of them stay in your bloodstream for about four to five hours. Cialis is the exception, as it remains in your bloodstream for up to 36 hours. The length of time a drug stays in your system may be important if you’re taking other medications.
You shouldn’t take any of these drugs more than once in a 24-hour period.
Are Cialis and Viagra safe to use while pregnant and breastfeeding?
Cialis – Tadalafil is not approved for women and has not been evaluated in women who are breastfeeding.
Viagra- Although extensive testing in animals has demonstrated no negative effects on the fetus, Viagra has not been studied in pregnant women. There is no effect on sperm count or motility of sperm in men.
It is not known whether sildenafil is excreted into breast milk.
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ED Prescription Side Effects
Each drug comes with the risk of drug interactions. Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions.
All four of these drugs interact with:
- nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat)
- certain blood pressure drugs, such as calcium channel blockers
- alpha blockers, which can treat high blood pressure or an enlarged prostate
- certain pulmonary hypertension drugs, such as riociguat (Adempas)
- protease inhibitors, a class of HIV drugs
- antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox)
- antibacterial drugs, such as clarithromycin (Biaxin)
Drinking excessive amounts of alcohol while on any PDE5 inhibitor should be avoided, and you shouldn’t combine different ED drugs.
Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital.
For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.
In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors. In other cases, adjusting your dosage of the medication can reduce the possibility of drug interactions while using PDE5 inhibitors.