Label: SILDENAFIL- sildenafil citrate injection, solution

Sildenafil can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. 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. You could be having a serious side effect of sildenafil. Take sildenafil oral film (Vybrique) exactly as your healthcare provider tells you to take it. Your healthcare provider will tell you how much sildenafil to take and when to take it. Take sildenafil by mouth about 1 hour before sexual activity. You may take sildenafil between 30 minutes and 4 hours before sexual activity if needed. Do not take more than once a day.

Parameter	Value	Notes
Absorption Rate	Rapid	Peak plasma levels in ~60 minutes
Bioavailability	Approximately 40%	Due to first-pass metabolism
Half-life	About 4 hours	Time to reduce plasma concentration by half
Metabolism	Liver (primarily via CYP3A4)	Enzymatic breakdown
Excretion	Mainly feces (~80%)	Some via urine (~13%)

If you take too much sildenafil, call your healthcare provider or go to the nearest hospital emergency room right away. Do not remove the film from the pouch unless ready for immediate use. Do not handle the oral film with wet hands.

5.3 Epistaxis

In pulmonary arterial hypertension (PAH), it dilates pulmonary vessels by the same mechanism, reducing pulmonary blood pressure and improving exercise capacity. Sildenafil first gained FDA approval on March 27, 1998. Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as "poppers". Taking sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure. Some medicines can cause unwanted or dangerous effects when used with sildenafil.

Adjusting Your Sildenafil Dosage Over Time

Tell your doctor about all your current medicines, especially riociguat (Adempas). The most common side effects of sildenafil tablets for ED are: Abnormal vision, such as changes in color vision (such as having a blue color tinge) andblurred vision The most common side effects of sildenafil oral film for ED are: Abnormal vision, such as changes in color and blurred vision The most common side effects of sildenafil tablets/ oral suspension, and injection for PAH are: Sildenafil can cause the following serious side effects. If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, priapism can permanently damage your penis. Sildenafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. See the Vybrique Prescribing Information for more information about how to take sildenafil oral film. Take sildenafil exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets.

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Do not change your dose or stop taking this medicine on your own. Take sildenafil tablet or oral suspension 3 times a day, about 4 to 6 hours apart.

Usual Pediatric Dose for Pulmonary Hypertension

Your healthcare provider will tell you how much to take and when to take it. Your healthcare provider may change your dose if needed. You may take sildenafil between 30 minutes to 4 hours before sexual activity if needed. If you take sildenafil after a high-fat meal (such as a cheeseburger and fries), sildenafil may take a little longer to start working. If you accidentally take too much sildenafil, call your doctor or go to the nearest hospital emergency room right away. Take at approximately the same times sildenafil tablet manforce 50 mg every day. Sildenafil oral suspension will be mixed for you by your pharmacist. Do not mix with other medicines or flavorings.

Overdose/Missed Dose

This has occurred in a small number of people taking sildenafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoked or were over 50 years old. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking sildenafil and call your healthcare provider right away if you havesudden vision loss in one or both eyes. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking sildenafil and contact a doctor right away.

Starting Sildenafil: Recommended First-Time Dosage

In addition, heart attack, stroke, irregular heartbeats, and death have happened rarely in people taking sildenafil. Most, but not all, of these people had heart problems before taking this medicine. It is not known if sildenafil caused these problems. Tell all your healthcare providers that you take sildenafil. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took sildenafil. Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). When sildenafil is used for ED, it is used as needed, so you are not likely to miss a dose. If you are taking sildenafil for PAH and you miss a dose, take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. If you take too much sildenafil, call your doctor or go to the nearest hospital emergency room. Drinking alcohol with sildenafil can cause side effects.

Brand/Source	Price per Tablet	Package Size	Cost per Pack	Notes
Brand A	$3.00	30 tablets	$90.00	Trademarked, pharmacy purchase
Generic B	$0.50	60 tablets	$30.00	FDA-approved generic
Online Supplier C	$0.20	90 tablets	$18.00	Bulk purchase, check authenticity
Local Pharmacy D	$1.00	20 tablets	$20.00	Over-the-counter available

Grapefruit juice and products may interact with sildenafil, leading to unwanted side effects.

Condition	Risk Factors	Recommendations
Use with nitrates	Severe hypotension, risk of significant blood pressure drop	Avoid combining, consult healthcare provider
Severe cardiovascular disease	Risk of adverse cardiovascular events	Use only under medical supervision
Liver impairment	Altered metabolism, increased side effects	Dose adjustment or avoid use
Retinitis pigmentosa	Potential for increased visual side effects	Use with caution, consult ophthalmologist

Avoid using any other medicines to treat impotence, such as alprostadil or yohimbine, without first talking to your doctor. Tell your healthcare provider about all the medicines you take, including prescription and over-the-countermedicines, vitamins, and herbal supplements.

5.4 Visual Loss

Stop sexual activity and get medical help right away if you get symptoms such pfizer sildenafil 100 as chest pain, dizziness, or nausea during sex. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease. Sildenafil does not protect you or your partner from getting sexually transmitted diseases, including Human Immunodeficiency Virus (HIV). Sildenafil may cause low blood pressure, which may cause you to feel faint or dizzy. Lie down if you feel faint or dizzy.

Professional resources

Tell your doctor if you get more short of breath after you start sildenafil. More shortness of breath than usual may be due to your underlying medical condition. Do not take Viagra while also taking Revatio. Tell your healthcare provider if you have any side effect that bothers you or does not go away. These are not all of the possible side effects of sildenafil. Sildenafil may affect the way other medicines work, and other medicines may affect the way sildenafil works, causing side effects. Especially tell your healthcare provider if you take: Nitrates for chest pain or heart problems.

• The pill should be swallowed whole with water.
• Use caution if you have liver or kidney disease.
• Synergistic effects can occur with other blood pressure medications.
• Sildenafil is not a sexual stimulant; stimulation is required.
• Always read the patient information leaflet thoroughly before use.

This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate.

• Sildenafil 10mg is available by prescription only.
• Do not exceed the recommended dose to prevent adverse effects.
• Alcohol consumption can increase side effects of sildenafil.
• Sildenafil 10mg may interact with certain medications.
• Patients with heart issues should consult a doctor before use.

Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure Alpha-blockers are sometimes prescribed for prostate problems orhigh blood pressure. In some patients, the use of sildenafil with alpha-blockers can lead to a drop in blood pressure or fainting Other drugs to treat high blood pressure or a prostate disorder Medicines to treat HIV, such as protease inhibitors, such as ritonavir and saquinavir Some types of oral antifungal medicines, such as ketoconazole and itraconazole Some types of antibiotics, such as erythromycin Other medicines that treat high blood pressure Medicines or treatments for ED, such as avanafil (Stendra), tadalafil (Cialis), or vardenafil (Levitra).

• The drug is generally safe when used as prescribed.
• Patients should inform their doctor about all health conditions.
• Sildenafil 10mg is sometimes used to treat high-altitude pulmonary hypertension.
• Do not take sildenafil with heavy or fatty foods for better absorption.
• Store the medication at room temperature away from moisture.

Tell your doctor about all other medications you use for erectile dysfunction.

8.2 Lactation

Have allergies to sildenafil, Viagra, Revatio, Vybrique, or any of the ingredients in the sildenafil formulation you are taking Take other medicines for pulmonary arterial hypertension, such as riociguat (Adempas) Take other medicines for pulmonary arterial hypertension, such as riociguat (Adempas) Take other medicines that lower your blood pressure, such as nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs that also contain nitrates, such as "poppers". To make sure sildenafil is safe for you, tell your healthcare provider about all your medical conditions, including if you have: Or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure Had heart surgery within the last 6 months Low blood pressure, or high blood pressure that is not controlled A physical deformity of the penis (such as Peyronie's disease) Been told you should not have sexual intercourse for health reasons and you are a male Had an erection that lasted for more than 4 hours Problems with your blood cells, such as sickle cell anemia, multiple myeloma, or leukemia Retinitis pigmentosa, a rare genetic (runs in families) eye disease Ever had severe vision loss, including an eye problem called non-arteritic anterior ischemic optic neuropathy (NAION) Kidney problems or are having kidney dialysis Are pregnant or intending to become pregnant (for patients with PAH) Are breastfeeding or intending to breastfeed (for patients with PAH). Sildenafil for ED is not approved for males <18 years old. Sildenafil is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Are vardenafil and sildenafil available over the counter?

Women with pulmonary arterial hypertension should not stop taking sildenafil without talking to their doctor if they discover they are pregnant. It is not known whether sildenafil passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breastfeeding a baby. Women with pulmonary arterial hypertension should not stop taking sildenafil without talking to their doctor. Take sildenafil oral tablets exactly as your healthcare provider tells you canadian sildenafil citrate to take it. Ask your healthcare provider or pharmacist for a list of these medicines if you are not sure. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. Other drugs may interact with sildenafil, including prescription and over-the-counter medicines, vitamins, and herbal products.