Names and pronunciation
(sil-den′a-fill) Revatio, Viagra
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Individual generic drug information
Extracted information for sildenafil only.
(sil-den′a-fill) Revatio, Viagra
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Func. class.: Erectile agent, antihy- pertensive, pulmonary vasodilator
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Chem. class.: Phosphodiesterase type-5 inhibitor
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Do not confuse: Viagra/Allegra
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ACTION: Enhances the effect of nitric oxide (NO) by inhibiting phosphodiester- ase type 5 (PDE5), which is necessary for degrading cGMP in the corpus cavernosum
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USES: Treatment of erectile dysfunc- tion (Viagra); improvement in exercise ability, pulmonary hypertension (Revatio)
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Unlabeled uses: Sexual dysfunction (women); altitude sickness, Raynaud’s disease
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Extracted information for sildenafil only.
CONTRAINDICATIONS: Hyper- sensitivity to this product or nitrates Precautions: Pregnancy, anatomic penile deformities, sickle cell anemia, leukemia, multiple myeloma, retinitis pigmentosa, bleeding disorders, active peptic ulceration, CV/renal/hepatic disease, multiproduct anti- hypertensive regimens, geriatric patients
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SIDE EFFECTS CNS: Headache, flushing, dizziness, transient global amnesia, seizures CV: MI, sudden death, CV collapse, TIAs, ventricular dysrhythmias, CV hemorrhage MISC: Dyspepsia, nasal congestion, UTI, abnormal vision, diarrhea, rash, nonarteritic ischemic optic neuropathy, hearing loss, priapism, sickle cell crisis
Source page 1205
INTERACTIONS Do not use with nitrates, riociguat; fatal fall in B/P Increase: sildenafil levels—cimetidine, erythromycin, ketoconazole, itraconazole, antiretroviral protease inhibitors, tacrolimus Decrease: sildenafil levels—CYP450 inducers, rifampin, barbiturates, bosentan, carBAMazepine, dexamethasone, phenytoin, nevirapine, rifabutin, troglitazone; antacids Decrease: B/P—α-blockers, alcohol, amLODIPine, angiotensin II receptor blockers Drug/Food Increase: product effect—grapefruit Decrease: absorption—high-fat meal
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Extracted information for sildenafil only.
DOSAGE AND ROUTES Erectile dysfunction (Viagra only) • Adult male <65 yr: PO 50 mg 1 hr before sexual activity; may be in- creased to 100 mg or decreased to 25 mg; max frequency 1×/day; use with alpha blockers: space 50-100-mg dose ≥4 hr of alpha blocker • Adult ≥65 yr (male): PO 25 mg as needed about 1 hr before sexual activity Renal/hepatic dose • Adult: PO (Child-Pugh A, B) 25 mg, take 1 hr before sexual activity; max 1×/day; CCr <30 mL/min, 25 mg starting dose Pulmonary hypertension (Revatio only) • Adult: PO 20 mg tid; take 4-6 hr apart; IV BOL 10 mg tid Pulmonary hypertension induced by altitude sickness (unlabeled) • Adult: PO 50 mg 8 hr starting the day before accent and continuing for 5 days after reaching the target altitude or until descent is initiated Anorgasmy in antidepressant therapy/sexual dysfunction in women (unlabeled) • Adult: PO 50 mg 60-90 min before sexual activity
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Available forms: Tabs (Viagra), 25, 50, 100 mg; tabs (Revatio) 25 mg; sol for inj 10 mg/12.5 mL; powder for oral suspen- sion 10 mg/mL (Revatio)
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Administer: • Erectile dysfunction: give approxi- mately 1 hr before sexual activity; do not use more than 1×/day; give on empty stomach for better absorption • Pulmonary hypertension: give 3×/day, 4-6 hr apart IV Push Route • Give undiluted, check that solution is not discolored or precipitate is present, give tid
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Extracted information for sildenafil only.
Assess: • For erectile dysfunction before use (Viagra): question about any failure to achieve erection or failure to maintain intercourse, anorgasmia • Phosphodiesterase type 5 inhibitors with lopinavir/ritonavir (Kaletra): as- sess for hypotension, visual changes, pro- longed erection, syncope; give only 25 mg q48hr and monitor for adverse reactions • Vision loss: any severe loss of vision while taking this or any similar products; products should not be used • Use of organic nitrates that should not be used with this product • MI, sudden death, CV collapse: those with an MI within 6 mo, resting hypoten- sion <90/50, resting hypertension >170/100, fluid depletion should use this product cautiously; may occur right after sexual activity to days afterward • Sickle cell crisis (vasoocclusive cri- sis): when used for pulmonary hyperten- sion; may require hospitalization • Pulmonary hypertension: Cardiac sta- tus, hemodynamic parameters, exercise tolerance in pulmonary hypertension: S B/P, pulse (Revatio)
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Evaluate: • Therapeutic response: decreasing pul- monary hypertension/improved exercise tolerance (Revatio); ability to perform sexually (male) (Viagra)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That product does not protect against sexually transmitted diseases, including HIV • That product absorption is reduced with a high-fat meal, to take on empty stomach for faster action; to take 30 min to 4 hr before sexual activity; peak is 2 hr • That product should not be used with nitrates or soluble guanylate cyclase stimulators (riociguat) (PAH) • That tabs may be split • To notify prescriber immediately and to stop taking product if vision/hearing loss occurs or erection lasts >4 hr • Do not use more than 100 mg in 24 hr • To use only as directed • That color vision may be altered • About cardiac risk: usually in cardiac disease • Pregnancy/breastfeeding: not indi cated for women (Viagra), unknown in PAH, cautious use in breastfeeding (Revatio)
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Extracted information for sildenafil only.
PHARMACOKINETICS Rapidly absorbed; bioavailability 40%; metabolized by P45 CYP3A4, 2C9 in the liver (active metabolites); terminal half- life 4 hr; peak 15-30 min; reduced absorption with high-fat meal; excreted in feces, urine
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Filter the extracted dose blocks for this individual drug.
Erectile dysfunction (Viagra only)
• Adult male <65 yr: PO 50 mg 1 hr before sexual activity; may be in- creased to 100 mg or decreased to 25 mg; max frequency 1×/day; use with alpha blockers: space 50-100-mg dose ≥4 hr of alpha blocker
Candidate age grouping · source pages 1204, 1205
Erectile dysfunction (Viagra only)
• Adult ≥65 yr (male): PO 25 mg as needed about 1 hr before sexual activity Renal/hepatic dose
Candidate age grouping · source pages 1204, 1205
Erectile dysfunction (Viagra only)
• Adult: PO (Child-Pugh A, B) 25 mg, take 1 hr before sexual activity; max 1×/day; CCr <30 mL/min, 25 mg starting dose Pulmonary hypertension (Revatio only)
Candidate age grouping · source pages 1204, 1205
Erectile dysfunction (Viagra only)
• Adult: PO 20 mg tid; take 4-6 hr apart; IV BOL 10 mg tid Pulmonary hypertension induced by altitude sickness (unlabeled)
Candidate age grouping · source pages 1204, 1205
Erectile dysfunction (Viagra only)
• Adult: PO 50 mg 8 hr starting the day before accent and continuing for 5 days after reaching the target altitude or until descent is initiated Anorgasmy in antidepressant therapy/sexual dysfunction in women (unlabeled)
Candidate age grouping · source pages 1204, 1205
Erectile dysfunction (Viagra only)
• Adult: PO 50 mg 60-90 min before sexual activity
Candidate age grouping · source pages 1204, 1205