Sildenafil citrateProduct ingredient for Sildenafil
Lorlatinib: (Moderate) Monitor for decreased efficacy of sildenafil if coadministration
- Sildenafil is available in various dosages: 25 mg, 50 mg, 100 mg.
- Starting dose depends on individual health and response.
- Dose adjustments should be done under medical supervision.
- Overuse may lead to increased side effects.
- Missing a dose is generally safe; do not double up.
- The drug may be taken with or without food.
- It’s generally recommended to avoid heavy meals before taking.
- Always follow your healthcare provider’s guidance.
with lorlatinib is necessary as concurrent use may decrease sildenafil exposure.
5. Tips
Letermovir is a moderate CYP3A4 inhibitor; however, when given with cyclosporine, the combined effect on CYP3A4 substrates is similar to a strong CYP3A4 inhibitor. Levamlodipine: (Moderate) Monitor for additive hypotension if amlodipine is administered concurrently with sildenafil, as both agents act independently to reduce blood pressure. Levoketoconazole: (Major) Coadministration of ketoconazole is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). Lonafarnib: (Major) Coadministration with lonafarnib is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving lonafarnib. Lumacaftor; Ivacaftor: (Moderate) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as sildenafil.
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If concurrent use of lurasidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as
Society and culture
Lopinavir; Ritonavir: (Major) Coadministration of ritonavir is contraindicated in patients receiving sildenafil for pulmonary arterial hypertension (PAH). Concurrent use substantially increases the sildenafil plasma concentrations and may result in increased associated adverse events including hypotension, syncope, visual changes, and prolonged erection. Ritonavir, a strong CYP3A4 inhibitor, increased the AUC of sildenafil, a sensitive CYP3A4 substrate, by 11-fold in a drug interaction study. Lorcaserin: (Moderate) Lorcaserin is a serotonin 2C receptor agonist, and priapism is a potential effect of 5-HT2C receptor agonism. Because there is little experience with the combination of lorcaserin and medications indicated for erectile dysfunction (e.g., phosphodiesterase inhibitors), combined use should be approached with caution. sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known.
| Use | Evidence Level | Description | Caution |
|---|---|---|---|
| Altitude Sickness | Experimental | Vasodilation might improve oxygenation | Not FDA approved, consult specialist |
| Premature Ejaculation | Anecdotal evidence | Local vasodilation effects may extend ejaculatory latency | Limited data |
| Cold-induced Vasospasm | Off-label | May alleviate symptoms of vasospasm | Requires medical supervision |
Mavacamten: (Moderate) Monitor for decreased efficacy of sildenafil if coadministration with mavacamten is necessary as concurrent use may decrease sildenafil exposure.
- Sildenafil citrate’s patent expiration increased market competition.
- Generics help reduce treatment costs globally.
- Pharmaceutical companies conduct clinical trials regularly.
- Safety monitoring continues post-marketing.
- Adverse event reporting is essential for drug safety.
- Patients should only use approved formulations.
- Counterfeit sildenafil products are a concern.
- Purchase from reputable sources is advised.
Mifepristone: (Major) Coadministration with mifepristone is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH).
Warnings & Precautions
Deaths have been reported in men who were using sildenafil while taking nitrate or nitrite therapy for angina. Idelalisib: (Major) Coadministration of idelalisib is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving idelalisib. Imatinib: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with imatinib is necessary; a dose reduction of sildenafil may be necessary when prescribed for erectile dysfunction. Indinavir: (Major) Sildenafil is contraindicated for use with indinavir when used for pulmonary arterial hypertension (PAH).
Recreational use
In a small pharmacokinetic study, the coadministration of a single dose of sildenafil (25 mg) to patients receiving indinavir (800 mg every 8 hours) resulted in markedly increased sildenafil AUC values (340% increase), as compared to historical controls. In two of the six subjects, prolonged clinical effects of sildenafil were noted for 72 hours after a single dose of sildenafil. Isavuconazonium: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with isavuconazonium is necessary; a dose reduction of sildenafil may be necessary when prescribed for erectile dysfunction. Isocarboxazid: (Moderate) Additive hypotensive effects may be seen when monoamine oxidase inhibitors (MAOIs) are combined with sildenafil. Careful monitoring of blood pressure is suggested during concurrent therapy of MAOIs with sildenafil.
How sildenafil is used
It can be expected that concomitant administration of CYP3A4 enzyme-inducers, such as rifampin, will decrease plasma levels of sildenafil, however, no interaction studies have been performed. Isoniazid, INH; Rifampin: (Minor) Sildenafil is metabolized principally by cytochrome P450 sildenafil pink pill 3A4 and 2C9 enzymes. Itraconazole: (Major) Avoid use of sildenafil for the treatment of pulmonary hypertension during and for 2 weeks after discontinuation of itraconazole treatment. When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving itraconazole. Ivacaftor: (Moderate) Increased monitoring is recommended if ivacaftor is administered concurrently with CYP2C9 substrates, such as sildenafil. When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving mifepristone.
Why choose us as your Sildenafil manufacturer?
Fluconazole: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with fluconazole is necessary; consider a starting dose of 25 mg of sildenafil when prescribed for erectile dysfunction. Fluvoxamine: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with fluvoxamine is necessary; a dose reduction of sildenafil may be necessary when prescribed for erectile dysfunction. In a drug interaction study, coadministration of fluvoxamine increased the sildenafil AUC by 40%. Fosamprenavir: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with fosamprenavir is necessary; consider a starting dose of 25 mg of sildenafil when prescribed for erectile dysfunction. When used for pulmonary arterial hypertension, this combination is listed as a contraindication in the fosamprenavir FDA-approved labeling.
Drugs you should not use with sildenafil
In a drug interaction study, coadministration with a moderate CYP3A inhibitor increased the Cmax and AUC of sildenafil by 160% and 182%, respectively. Glycerol Phenylbutyrate: (Moderate) Monitor for decreased efficacy of sildenafil if coadministration with glycerol phenylbutyrate is necessary as concurrent use may decrease sildenafil exposure. Grapefruit juice: (Moderate) Sildenafil is metabolized via the cytochrome CYP 3A4 isozyme. Grapefruit juice contains a compound that inhibits CYP3A4 in enterocytes in the GI tract. Sildenafil levels may increase; it is possible that sildenafil-induced side effects could also be increased in some individuals.
InChI key
One study has confirmed a potential interaction; sildenafil's AUC increased 23 percent with coadministration of grapefruit juice. Guaifenesin; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Hydantoins: (Moderate) Monitor for decreased efficacy of sildenafil if coadministration with phenytoin is necessary as concurrent use may decrease sildenafil exposure. Sildenafil is a sensitive CYP3A substrate and phenytoin is a strong CYP3A inducer. Consistent with their known effects on the nitric oxide/cGMP pathway, concomitant use of phosphodiesterase inhibitors and nitrates can cause severe hypotension, syncope, or myocardial infarction. Sildenafil is a sensitive CYP3A substrate and mifepristone is a strong CYP3A inhibitor.
- Sildenafil citrate can be combined with lifestyle changes.
- Exercise and weight management improve erectile function.
- Quitting smoking enhances medication effectiveness.
- Reducing alcohol intake minimizes side effects.
- Psychological therapy may support ED treatment.
- Counseling can address underlying emotional issues.
- Regular medical check-ups are recommended.
- Patient education improves safe and effective use.
Mitapivat: (Moderate) Monitor for decreased efficacy of sildenafil if coadministration with mitapivat is necessary as concurrent use may decrease sildenafil exposure.
2. Upsides
Ivosidenib: (Moderate) Monitor for loss of efficacy of sildenafil during coadministration of ivosidenib; a sildenafil dose adjustment may be necessary. Sildenafil is a sensitive substrate of CYP3A4; ivosidenib induces CYP3A4 and may lead to decreased sildenafil concentrations. Ketoconazole: (Major) Coadministration of ketoconazole is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving ketoconazole. Lansoprazole; Amoxicillin; Clarithromycin: (Major) Coadministration of clarithromycin is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH).
Who can use Sildenafil Citrate Tablets?
Lefamulin: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with oral lefamulin is necessary; consider a starting dose of 25 mg of sildenafil when prescribed for erectile dysfunction. Sildenafil is a sensitive CYP3A4 substrate and oral lefamulin is a moderate CYP3A4 inhibitor; an interaction is not expected with intravenous lefamulin. Lenacapavir: (Moderate) Monitor for an increase in sildenafil-related adverse reactions if coadministration with lenacapavir is necessary; consider a starting dose of sildenafil from canada 25 mg of sildenafil when prescribed for erectile dysfunction. Sildenafil is a sensitive CYP3A substrate and lenacapavir is a moderate CYP3A inhibitor. In a drug interaction study, coadministration with a moderate CYP3A inhibitor increased the AUC of sildenafil by 182%.
Does sildenafil interact with foods or drinks?
Lesinurad: (Moderate) Lesinurad may decrease the systemic exposure and therapeutic efficacy of sildenafil; monitor for potential reduction in efficacy. Lesinurad; Allopurinol: (Moderate) Lesinurad may decrease the systemic exposure and therapeutic efficacy of sildenafil; monitor for potential reduction in efficacy. Letermovir: (Major) Monitor for an increase in sildenafil-related adverse reactions if coadministration with letermovir is necessary; a dose reduction of sildenafil may be necessary when prescribed for erectile dysfunction. Concurrent use is not recommended in patients receiving sildenafil for pulmonary arterial hypertension and taking cyclosporine, because the magnitude of the interaction may be amplified. Consider a starting dose of 25 mg of sildenafil for erectile dysfunction in patients receiving letermovir with cyclosporine.