Sildenafil (Viagra) is an effective medication primarily prescribed for the treatment of erectile dysfunction (impotence). This condition, characterized by the inability to achieve or sustain an erection, affects many men at various stages of life. Sildenafil is also known by other brand names such as Liqrev and Revatio, and it serves an additional purpose in treating pulmonary arterial hypertension (PAH). PAH is a serious condition marked by elevated blood pressure in the arteries of the lungs, leading to symptoms such as breathlessness, fatigue, and dizziness, making it difficult for individuals to engage in physical activities. By belonging to the class of medications known as phosphodiesterase (PDE) inhibitors, sildenafil enhances blood flow to the penis during sexual arousal, enabling an erection to occur. In patients with PAH, sildenafil relaxes the vascular walls within the lungs, promoting better blood circulation.
It is essential to note that sildenafil does not cure erectile dysfunction nor does it amplify sexual desire. Moreover, it is ineffective in preventing pregnancy or the transmission of sexually transmitted infections, such as the Human Immunodeficiency Virus (HIV).
Sildenafil is available as oral tablets and also in a liquid formulation for those who prefer it. For optimal effectiveness, especially regarding erectile dysfunction, patients should follow their healthcare provider's recommendations carefully. Typically, sildenafil should be taken about one hour prior to anticipated sexual activity; however, it can be consumed between four hours and 30 minutes before intercourse. As a rule of thumb, sildenafil should not be taken more than once within a 24-hour period. Depending on individual health factors and other medications being used, a healthcare provider may suggest tailored dosing.
The medication can be ingested with or without food, though it is noteworthy that consuming sildenafil alongside a high-fat meal may impede its onset of action, causing a delay.
For those utilizing sildenafil in the context of PAH, the usual dosage involves taking the medication three times daily, maintaining consistent intervals, regardless of meal times.
Always stick to the instructions provided on the medication label, and do not hesitate to reach out to your doctor or pharmacist for clarification on any ambiguous instructions. It is critical to adhere strictly to the prescribed dosage and frequency of sildenafil to ensure safety and efficacy.
When utilizing the liquid form, be sure to shake the bottle thoroughly for 10 seconds prior to each use to ensure an even mixture of the medication. Use the provided oral syringe to measure out your dose accurately, and avoid mixing the liquid with other medications or introducing any flavor additives.
Your healthcare provider may initiate your treatment with a moderate dose of sildenafil for erectile dysfunction and adjust this dose based on how you respond to the treatment regimen. If you find that sildenafil is not working effectively or if you encounter side effects, inform your healthcare provider promptly.
For the management of PAH, it is important to continue taking sildenafil even if your symptoms seem to improve. Never discontinue the medication without consulting your healthcare provider first.
Always request a copy of the patient information leaflet from your pharmacist or doctor for your records.
This medication may be prescribed for various other medical conditions; please consult your healthcare provider or pharmacist for more details on these additional uses.
Before taking sildenafil,
- Disclose to your healthcare provider and pharmacist any known allergies to sildenafil, other medications, or any ingredients present in the sildenafil tablets or liquid formulation. Request a comprehensive list of ingredients from your pharmacist.
- Certain medications are contraindicated with sildenafil. If you take nitrates (prescribed for chest pain) such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), or nitroglycerin (Nitromist, Nitro-Dur, Nitrostat), inform your healthcare provider or pharmacist right away. It is crucial to provide a complete list of all medications you take before starting sildenafil.
- If you are using illegal drugs that contain nitrates (often referred to as 'poppers'), such as amyl nitrite or butyl nitrate, notify your healthcare provider. The use of sildenafil may not be advised under these circumstances.
- Ensure that you inform your healthcare provider of all prescription and over-the-counter medications, vitamins, and dietary supplements you are currently taking or intend to take. Your healthcare provider may need to modify your medication dosages or monitor you closely for potential side effects.
- Be aware that sildenafil is marketed under the brand names Liqrev, Revatio, and Viagra. You should only use one of these brands at one time to avoid confusion.
- Exercise caution with over-the-counter products or herbal supplements that could interact negatively with sildenafil, such as cimetidine (Tagamet HB) and St. John's Wort. Always inform your healthcare provider about these products prior to starting sildenafil, and avoid taking them without prior consultation.
- Advise your healthcare provider if you smoke, have undergone heart surgery within the last six months, have experienced an erection lasting more than four hours previously, or have recently suffered significant fluid loss (dehydration). Symptoms of dehydration can arise from illnesses such as fever, diarrhea, or vomiting, as well as excessive sweating or inadequate fluid intake. Inform your provider if you have, or have had, pulmonary veno-occlusive disease (PVOD), peptic ulcers, or any diseases affecting the heart, kidneys, or liver, including heart attacks, congestive heart failure, angina (chest pain), irregular heartbeat, strokes, and conditions like diabetes.
- If you are a woman taking sildenafil for PAH, notify your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding. Contact your healthcare provider immediately if you become pregnant while using sildenafil.
- Inform your healthcare provider or dentist if you are scheduled for any surgical procedures, including dental work, while taking sildenafil.
- When taking sildenafil for erectile dysfunction, let your healthcare provider know if you have ever been advised against sexual activity due to health concerns, or if you have ever experienced chest pain during sexual activity. Engaging in sexual activity may impose strain on your heart, particularly if you have preexisting heart conditions. Should you experience chest pain, dizziness, or nausea during sexual activity, seek immediate medical attention and refrain from any further sexual activity until instructed otherwise by your healthcare provider.
- Ensure all healthcare providers are aware that you are taking sildenafil, especially in emergency situations where medical staff will need to know when you last took the medication.
Discuss with your healthcare provider the implications of consuming grapefruit or grapefruit juice while taking sildenafil, as these can affect drug metabolism.
If you are using sildenafil for erectile dysfunction, it is unlikely you will miss a dose, as it is intended to be taken as needed rather than on a strict schedule.
If you are on sildenafil for PAH and miss a scheduled dose, take it as soon as you remember. However, if your next dose is nearly due, skip the missed dose and resume your regular medication timetable. Do not take a double dose to make up for a missed one.
Sildenafil may lead to side effects. If any of the following symptoms are severe or persist, notify your healthcare provider:
- Headache
- Stomach upset
- Diarrhea
- Nausea
- Flushing (feeling of warmth)
- Bloody nose
- Numbness, tingling, or burning sensations in various body parts including arms, hands, feet, or legs
- Muscle pain, back pain, or pain in limbs
- Changes in color vision (such as a blue tint to objects, or difficulty distinguishing between blue and green)
- Increased sensitivity to light
- Stuffy or runny nose
Some side effects can be severe. Contact your healthcare provider immediately if you notice any of the following symptoms:
- Sudden loss of vision (see below for more details)
- Blurred vision
- Sudden decrease or loss of hearing
- Tinnitus (ringing in the ears)
- Dizziness or lightheadedness
- Fainting episodes
- Chest pain
- Worsening shortness of breath
- Painful or prolonged erection (lasting more than four hours)
- Skin rash; itching; hives; trouble breathing or swallowing; swelling of the eyes, face, throat, tongue, or lips
Some patients have reported sudden partial or total vision loss following the use of sildenafil or other similar medications. In some isolated cases, this loss has been permanent. The causal relationship between the medication and vision loss remains unclear. If you experience sudden loss of vision while taking sildenafil, seek medical attention immediately. Avoid taking additional doses of sildenafil or similar medications, such as tadalafil (Cialis) or vardenafil (Levitra), until you consult with your healthcare provider.
Reports have also surfaced linking heart attack, stroke, irregular heartbeats, cerebral or pulmonary hemorrhages, hypertension, and sudden death in men using sildenafil for erectile dysfunction. While most of these patients had preexisting heart issues, the direct connection between these events and the medication remains ambiguous. Discuss the potential risks of sildenafil with your healthcare provider.
Moreover, some patients have experienced sudden hearing loss following the use of sildenafil or similar drugs. While the cause remains unknown, it is essential that if you experience sudden hearing loss accompanied by tinnitus or dizziness while on sildenafil, seek medical assistance immediately. If you are taking sildenafil for erectile dysfunction, refrain from taking further doses until you consult your healthcare provider. If the medication is being used for PAH treatment, do not stop it abruptly without consulting your provider first.
Sildenafil may also lead to additional side effects. Reach out to your healthcare provider if you encounter any unusual problems while using the medication.
If you develop a serious side effect, you or your physician can report it through the 'MedWatch' program managed by the Food and Drug Administration (FDA) via the website (https://www.fda.gov/Safety/MedWatch) or by calling 1-800-332-1088.
Store this medication in its original container, securely closed, and out of the reach of children. Keep the tablets at room temperature and protect them from excess heat and moisture (avoid storage in the bathroom). The suspension should be kept at room temperature or in the refrigerator, but do not freeze it. Discard any unused suspension after 60 days.
It is critically important to keep all medications out of the sight and reach of children, as many containers, including weekly pill organizers, eye drops, creams, patches, and inhalers, are not designed to be childproof and may pose a risk of accidental ingestion. To minimize the risk of poisoning, ensure safety caps are used and place medications in a secure area that is out of children's sight and reach. For more detailed safety information, visit https://www.upandaway.org/es/.
Unused medications should also be disposed of properly to avoid accidental ingestion by pets, children, or others. Do not flush medications down the toilet. The most effective method for disposing of medications is through a drug take-back program. Consult your pharmacist or local waste management office for details about medication take-back programs available in your area. For more information on safe disposal methods, visit the FDA's website at https://goo.gl/xRXbPn.
If an overdose occurs, immediately contact poison control at 1-800-222-1222. Additional information can be found at https://www.poisonhelp.org/help. If the individual has collapsed, is experiencing a seizure, is struggling to breathe, or cannot be awakened, call emergency services at 911 without delay.
Ensure you attend all scheduled appointments with your healthcare provider.
Do not share your medication with anyone else. If you have questions regarding prescription refills, consult your pharmacist.
It is essential to keep a comprehensive written list of all medications you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and dietary supplements. Bring this list to every healthcare appointment or hospital admission since this information can be crucial during emergencies.
- Liqrev®
- Revatio®
- Viagra®