It is not possible to determine whether these events are related directly to Viagra, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors (see WARNINGS for further important cardiovascular information).
A review of population subgroups demonstrated efficacy regardless of baseline severity, etiology, race and age.
Since higher plasma levels may increase both the efficacy and incidence of adverse events, a starting dose of 25 mg should be considered (see DOSAGE AND ADMINISTRATION).
Sildenafil and its major circulating N-desmethyl metabolite are both approximately 96% bound to plasma proteins.
Of the twenty subjects who were ultimately assigned to treatment, a total of 13 subjects successfully completed dose period 1, and seven had successfully completed the previous doxazosin study (using Viagra 50 mg).
If you are taking a protease inhibitor, your dose may be adjusted (please see Finding the Right Dose for You).
Store away from heat and direct light.
Avoid drinking alcohol, which can increase some of the side effects of Viagra.
Most, but not all, of these patients had underlying anatomic or vascular risk factors for developing NAION, including but not necessarily limited to: low cup to disc ratio ("crowded disc"), age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia and smoking.
Do not take Viagra if you are taking any nitrate-based drug, including nitroglycerin patches (Nitro-Dur, Transderm-Nitro), nitroglycerin ointment (Nitro-Bid, Nitrol), nitroglycerin pills (Nitro-Bid, Nitrostat), and isosorbide pills (Dilatrate-SR, Isordil, Sorbitrate).
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In the rat pre- and postnatal development study, the no observed adverse effect dose was 30 mg/kg/day given for 36 days.
One-third to one-half of the subjects in these studies reported successful intercourse at least once during a 4-week, treatment-free run-in period.
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In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance.
In the nonpregnant rat the AUC at this dose was about 20 times human AUC.
Viagra demonstrated statistically significant improvement compared to placebo in all 21 studies.
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Tell your doctor about any medicines you are taking.
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Viagra Dosage and Administration For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity.
Most studies assessed the efficacy of Viagra approximately 60 minutes post dose.
Before you start any treatment for erectile dysfunction, ask your doctor if your heart is healthy enough to handle the extra strain of having sex.
Absorption and Distribution Viagra is rapidly absorbed.
If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result.
One patient discontinued the study prematurely due to an adverse event of hypotension following dosing with Viagra 50 mg.
Two of the questions from the IIEF served as primary study endpoints; categorical responses were elicited to questions about (1) the ability to achieve erections sufficient for sexual intercourse and (2) the maintenance of erections after penetration.
Sixty-three percent, 74%, and 82% of the patients on 25 mg, 50 mg and 100 mg of Viagra, respectively, reported an improvement in their erections, compared to 24% on placebo.
Only your doctor can determine if it is safe for you to continue taking Viagra.
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When Viagra 100 mg oral was coadministered with amlodipine, 5 mg or 10 mg oral, to hypertensive patients, the mean additional reduction on supine blood pressure was 8 mmHg systolic and 7 mmHg diastolic.
You may also report side effects at http://www.
It can help many men who have erectile dysfunction get and keep an erection when they become sexually excited (stimulated).
Consideration should be given to the following: - Patients should be stable on alpha-blocker therapy prior to initiating a PDE5 inhibitor.
Following at least 14 consecutive days of doxazosin, Viagra 50mg or matching placebo was administered simultaneously with doxazosin 4 mg (17 subjects) or with doxazosin 8 mg (3 subjects).
At the same time, on-treatment function was better in treated patients who were less impaired at baseline.
There was no effect on sperm motility or morphology after single 100 mg oral doses of Viagra in healthy volunteers.
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An extra patient leaflet is available with Viagra .
Plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil, so that the metabolite accounts for about 20% of sildenafil's pharmacologic effects.
This lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels (see Pharmacodynamics).
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It is not possible to determine whether these events are related directly to Viagra, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors (see WARNINGS for further important cardiovascular information).
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There were highly statistically significant improvements on the two principal IIEF questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) on Viagra compared to placebo.
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This patient had been taking minoxidil, a potent vasodilator, during the study.
Viagra may rarely cause a prolonged, painful erection.
It works by dilating blood vessels in the penis, allowing the inflow of blood needed for an erection.
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In one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent Swan-Ganz catheterization.
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At doses above the recommended dose range, adverse events were similar to those detailed above but generally were reported more frequently.
The man cannot have an erection.
The following factors are associated with increased plasma levels of sildenafil: age >65 (40% increase in AUC), hepatic impairment (e.
Heart attack, stroke, irregular heart beats, and death have been reported rarely in men taking Viagra.
Do not use more of it and do not use it more often than your doctor ordered.
No significant interactions were shown with tolbutamide (250 mg) or warfarin (40 mg), both of which are metabolized by CYP2C9.
Taking Viagra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.
Also use cautiously if you have a genital problem or deformity such as Peyronie's disease.
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Viagra (sildenafil citrate) is formulated as blue, film-coated rounded-diamond-shaped tablets equivalent to 25 mg, 50 mg and 100 mg of sildenafil for oral administration.
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Sildenafil is not indicated for use in women for erectile dysfunction.
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PDE5 inhibitors, including Viagra, and alpha-adrenergic blocking agents are both vasodilators with blood pressure lowering effects.
During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away.
Based on the pharmacokinetic profile of a single 100 mg oral dose given to healthy normal volunteers, the plasma levels of sildenafil at 24 hours post dose are approximately 2 ng/mL (compared to peak plasma levels of approximately 440 ng/mL) (see CLINICAL PHARMACOLOGY: Pharmacokinetics and Metabolism).
Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.
It can help many men who have erectile dysfunction get and keep an erection when they become sexually excited (stimulated).
Before taking Viagra, tell your doctor about all other medications you use for erectile dysfunction, or if you are using any of the following medications: an antibiotic such as clarithromycin (Biaxin), clotrimazole (Mycelex Troche), dalfopristin/quinupristin (Synercid), erythromycin (E.
Following at least 14 consecutive daily doses of doxazosin, Viagra 100 mg or matching placebo was administered simultaneously with doxazosin.
Store at 25°C (77°F); excursions permitted to 15–30°C (59–86°F) [see USP Controlled Room Temperature].
Adverse Reactions CLINICAL TRIALS Viagra was administered to over 3700 patients (aged 19–87 years) during pre-marketing clinical trials worldwide.
Its pharmacokinetics are dose-proportional over the recommended dose range.
If not treated right away, permanent damage to your penis could occur (see How Sex Affects the Body).
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This lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels (see Pharmacodynamics).
The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
Although not all of these side effects may occur, if they do occur they may need medical attention.
Contact your doctor right away if you have an erection that lasts more than 4 hours.
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If you experience a loss of vision in one or both eyes, stop using Viagra and seek medical attention immediately.
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Viagra must be used only under a doctor's supervision.
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The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours.
Renal dialysis is not expected to accelerate clearance as sildenafil is highly bound to plasma proteins and it is not eliminated in the urine.
There were three subjects who had a standing SBP of < 85 mmHg.
On a global improvement question, 83% of patients reported improved erections on Viagra versus 12% on placebo.