Outliers were defined as subjects with a standing systolic blood pressure of <85 mmHg or a decrease from baseline in standing systolic blood pressure of >30 mmHg at one or more timepoints. There were no subjects treated with sildenafil citrate 25 mg who had a standing SBP < 85mmHg. There were three subjects with a decrease from baseline in standing systolic BP >30mmHg following sildenafil citrate 25 mg, one subject with a decrease from baseline in standing systolic BP > 30 mmHg following placebo and two subjects with a decrease from baseline in standing systolic BP > 30 mmHg following both sildenafil citrate and placebo. No severe adverse events potentially related to blood pressure effects were reported in this group.Of the four subjects who received sildenafil citrate 100 mg in the first part of this study, a severe adverse event related to blood pressure effect was reported in one patient (postural hypotension that began 35 minutes after dosing with sildenafil citrate with symptoms lasting for 8 hours), and mild adverse events potentially related to blood pressure effects were reported in two others (dizziness, headache and fatigue at 1 hour after dosing; and dizziness, lightheadedness and nausea at 4 hours after dosing). There were no reports of syncope among these patients.
- Sildenafil citrate tablets are a popular choice for ED treatment worldwide.
- Take the medication on an empty stomach for faster absorption when possible.
- Be aware of signs of overdose, such as dizziness and prolonged erection.
- Do not use sildenafil with other PDE5 inhibitors or similar drugs.
- Any sudden or severe side effects should prompt immediate medical review.
- Consult your healthcare provider before starting sildenafil if on other treatments.
- Store tablets in a secure, dry, and temperature-controlled environment.
- This medication may not be suitable for all men, depending on health status.
For these four subjects, the placebo-subtracted mean maximum decreases from baseline in supine and standing systolic blood pressures were 14.8 mmHg and 21.5 mmHg, respectively. Two of these subjects had a standing SBP < 85mmHg. Both of these subjects were protocol violators, one due to a low baseline standing SBP, and the other due to baseline orthostatic hypotension.Study 2: Sildenafil citrate with DoxazosinIn the second study, a single oral dose of sildenafil citrate 50 mg or matching placebo was administered in a 2-period crossover design to 20 generally healthy males with BPH.
| Condition | Reason | Precaution |
|---|---|---|
| Use with Nitrates | Risk of severe hypotension | Avoid combination entirely |
| Severe Cardiovascular Disease | Increased risk of adverse events | Use with caution; consult healthcare provider |
| Retinitis Pigmentosa | Possible worsening of symptoms | Evaluate risks before prescribing |
| Hypotension (<90/60 mmHg) | Blood pressure drops dangerously low | Monitor blood pressure closely |
Following at least 14 consecutive days of doxazosin, sildenafil citrate 50 mg or matching placebo was administered simultaneously with doxazosin 4 mg (17 subjects) or with doxazosin 8 mg (3 subjects). The mean subject age in this study was 63.9 years.Twenty subjects received sildenafil citrate 50 mg, but only 19 subjects received matching placebo.
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Incidence not known
One patient discontinued the study prematurely due to an adverse event of hypotension following dosing with sildenafil citrate 50 mg. This patient had been taking minoxidil, a potent vasodilator, during the study.For the 19 subjects who received both sildenafil citrate and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 50 mg sildenafil citrate or matching placebo are shown in Figure 3.Figure 3: Mean Standing Systolic Blood Pressure Change from BaselineBlood pressure was measured after administration of sildenafil citrate at the same times as those specified for the first doxazosin study. There were two subjects who had a standing SBP of < 85 mmHg. In these two subjects, hypotension was reported as a moderately severe adverse event, beginning at approximately 1 hour after administration of sildenafil citrate 50 mg and resolving after approximately 7.5 hours. There was one subject with a decrease from baseline in standing systolic BP >30mmHg following sildenafil citrate 50 mg and one subject with a decrease from baseline in standing systolic BP > 30 mmHg following both sildenafil citrate 50 mg and placebo. There were no severe adverse events potentially related to blood pressure and no episodes of syncope reported in this study.Study 3: Sildenafil citrate with DoxazosinIn the third study, a single oral dose of sildenafil citrate 100 mg or matching placebo was administered in a 3-period crossover design to 20 generally healthy males with BPH.
| Guidance Point | Details | Rationale |
|---|---|---|
| Take on an empty stomach or light meal | Absorption is faster without heavy food | Should be taken about 30-60 minutes before activity |
| Do not exceed one tablet in 24 hours | Risk of overdose and side effects | To ensure safe and effective treatment |
| Avoid alcohol consumption during use | Alcohol can increase side effects | Includes dizziness and hypotension |
| Seek medical advice if experiencing painful erections or vision changes | To prevent complications | Rare but serious side effects |
In dose period 1, subjects were administered open-label doxazosin and a single sildenafil oral jelly 100 mg dose of sildenafil citrate 50 mg simultaneously, after at least 14 consecutive days of doxazosin. If a subject did not successfully complete this first dosing period, he was discontinued from the study. Subjects who had successfully completed the previous doxazosin interaction study (using sildenafil citrate 50 mg), including no significant hemodynamic adverse events, were allowed to skip dose period 1. Treatment with doxazosin continued for at least 7 days after dose period 1. Thereafter, sildenafil citrate 100 mg or matching placebo was administered simultaneously with doxazosin 4 mg (14 subjects) or doxazosin 8 mg (6 subjects) in standard crossover fashion. The mean subject age in this study was 66.4 years.Twenty-five subjects were screened. Two were discontinued after study period 1: one failed to meet pre-dose screening qualifications and the other experienced symptomatic hypotension as a moderately severe adverse event 30 minutes after dosing with open-label sildenafil citrate 50 mg.
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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 sildenafil citrate 50 mg).For the 20 subjects who received sildenafil citrate 100 mg and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 100 mg sildenafil citrate or matching placebo are shown in Figure 4.Figure 4: Mean Standing Systolic Blood Pressure Change from BaselineBlood pressure was measured after administration of sildenafil citrate at the same times as those specified for the previous doxazosin studies.
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Outliers were defined as subjects with a standing systolic blood pressure of <85 mmHg or a decrease from baseline in standing systolic blood pressure of >30 mmHg at one or more timepoints. There were no subjects treated with sildenafil citrate 25 mg who had a standing SBP < 85mmHg. There were three subjects with a decrease from baseline in standing systolic BP >30mmHg following sildenafil citrate 25 mg, one subject with a decrease from baseline in standing systolic BP > 30 mmHg following placebo and two subjects with a decrease from baseline in standing systolic BP > 30 mmHg following both sildenafil citrate and placebo. No severe adverse events potentially related to blood pressure effects were reported in this group.Of the four subjects who received sildenafil citrate 100 mg in the first part of this study, a severe adverse event related to blood pressure effect was reported in one patient (postural hypotension that began 35 minutes after dosing with sildenafil citrate with symptoms lasting for 8 hours), and mild adverse events potentially related to blood pressure effects were reported in two others (dizziness, headache and fatigue at 1 hour after dosing; and dizziness, lightheadedness and nausea at 4 hours after dosing). There were no reports of syncope among these patients.
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For these four subjects, the placebo-subtracted mean maximum decreases from baseline in supine and standing systolic blood pressures were 14.8 mmHg and 21.5 mmHg, respectively. Two of these subjects had a standing SBP < 85mmHg. Both of these subjects were protocol violators, one due to a low baseline standing SBP, and the other due to baseline orthostatic hypotension.Study 2: Sildenafil citrate with DoxazosinIn the second study, a single oral dose of sildenafil citrate 50 mg or matching placebo was administered in a 2-period crossover design to 20 generally healthy males with BPH. Following at least 14 consecutive days of doxazosin, sildenafil citrate 50 mg or matching placebo was administered simultaneously with doxazosin 4 mg (17 subjects) or with doxazosin 8 mg (3 subjects). The mean subject age in this study was 63.9 years.Twenty subjects received sildenafil citrate 50 mg, but only 19 subjects received matching placebo.
What is sildenafil used for?
One patient discontinued the study prematurely due to an adverse event of hypotension following dosing with sildenafil citrate 50 mg. This patient had been taking minoxidil, a potent vasodilator, during the study.For the 19 subjects who received both sildenafil citrate and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 50 mg sildenafil citrate or matching placebo are shown in Figure 3.Figure 3: Mean Standing Systolic Blood Pressure Change from BaselineBlood pressure was measured after administration of sildenafil citrate at the same times as those specified for the first doxazosin study. There were two subjects who had a standing SBP of < 85 mmHg. In these two subjects, hypotension was reported as a moderately severe adverse event, beginning at approximately 1 hour after administration of sildenafil citrate 50 mg and resolving after approximately 7.5 hours. There was one subject with a decrease from baseline in standing systolic BP >30mmHg following sildenafil citrate 50 mg and one subject with a decrease from baseline in standing systolic BP > 30 mmHg following both sildenafil citrate 50 mg and placebo. There were three subjects who had a standing SBP of < 85 mmHg.
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The maximum observed decrease in diastolic blood pressure was -17.2 mmHg when sildenafil was co-administered with alcohol versus -11.1 mmHg when alcohol was administered alone. There were no reports of postural dizziness or orthostatic hypotension. The maximum recommended dose of 100 mg sildenafil was not evaluated in this study [ see Drug Interactions (7.5)].Effects of Sildenafil citrate on Cardiac Parameters:Single oral doses of sildenafil up to 100 mg produced no clinically relevant changes in the ECGs of normal male volunteers.Studies have produced relevant data on the effects of sildenafil citrate on cardiac output. In one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent Swan-Ganz catheterization. A total dose of 40 mg sildenafil was administered by four intravenous infusions.The results from this pilot study are shown in Table 3; the mean resting systolic and diastolic blood pressures decreased by 7% and 10% compared to baseline in these patients.
How does sildenafil work (mechanism of action)?
Mean resting values for right atrial pressure, pulmonary artery pressure, pulmonary artery occluded pressure and cardiac output decreased by 28%, 28%, 20% and 7% respectively. Even though this total dosage produced plasma sildenafil concentrations which were approximately 2 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of 100 mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients.In a double-blind study, 144 patients with erectile dysfunction and chronic stable angina limited by exercise, not receiving chronic oral nitrates, were randomized to a single dose of placebo or sildenafil citrate 100 mg 1 hour prior to exercise testing. The primary endpoint was time to limiting angina in the evaluable cohort. The mean times (adjusted for baseline) to onset of limiting angina were 423.6 and 403.7 seconds for sildenafil (N=70) and placebo, respectively. These results demonstrated that the effect of sildenafil citrate on the primary endpoint was statistically non-inferior to placebo.Effects of Sildenafil citrate on Vision:At single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels.
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This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. Subjects in the study reported this finding as difficulties in discriminating blue/green. An evaluation of visual function at doses up to twice the maximum recommended dose revealed no effects of sildenafil citrate on visual acuity, intraocular pressure, or pupillometry.Effects of Sildenafil citrate on Sperm:There was no effect on sperm motility or morphology after single 100 mg oral doses of sildenafil citrate in healthy volunteers.12.3 PharmacokineticsSildenafil citrate is rapidly absorbed after oral administration, with a mean absolute bioavailability of 41% (range 25 to 63%). All three were taking sildenafil citrate 100 mg, and all three reported mild adverse events at the time of reductions in standing SBP, including vasodilation and lightheadedness.
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There were four subjects with a decrease from baseline in standing systolic BP > 30 mmHg following sildenafil citrate 100 mg, one subject with a decrease from baseline in standing systolic BP > 30 mmHg following placebo and one subject with a decrease from baseline in standing systolic BP > 30 mmHg following both sildenafil citrate and placebo. While there were no severe adverse events potentially canada sildenafil related to blood pressure reported in this study, one subject reported moderate vasodilatation after both sildenafil citrate 50 mg and 100 mg. There were no episodes of syncope reported in this study.Effect of Sildenafil citrate on Blood Pressure When Co-administered with Anti-hypertensives:When sildenafil citrate 100 mg oral was co-administered 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.Effect of Sildenafil citrate on Blood Pressure When Co-administered with Alcohol:Sildenafil citrate (50 mg) did not potentiate the hypotensive effect of alcohol (0.5 g/kg) in healthy volunteers with mean maximum blood alcohol levels of 0.08%. The maximum observed decrease in systolic blood pressure was -18.5 mmHg when sildenafil was co-administered with alcohol versus -17.4 mmHg when alcohol was administered alone.
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There were no severe adverse events potentially related to blood pressure and no episodes of syncope reported in this study.Study 3: Sildenafil citrate with DoxazosinIn the third study, a single oral dose of sildenafil citrate 100 mg or matching placebo was administered in a 3-period crossover design to 20 generally healthy males with BPH. In dose period 1, subjects were administered open-label doxazosin and a single sildenafil oral jelly 100 mg dose of sildenafil citrate 50 mg simultaneously, after at least 14 consecutive days of doxazosin. If a subject did not successfully complete this first dosing period, he was discontinued from the study. Subjects who had successfully completed the previous doxazosin interaction study (using sildenafil citrate 50 mg), including no significant hemodynamic adverse events, were allowed to skip dose period 1. Treatment with doxazosin continued for at least 7 days after dose period 1.
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Thereafter, sildenafil citrate 100 mg or matching placebo was administered simultaneously with doxazosin 4 mg (14 subjects) or doxazosin 8 mg (6 subjects) in standard crossover fashion. The mean subject age in this study was 66.4 years.Twenty-five subjects were screened. Two were discontinued after study period 1: one failed to meet pre-dose screening qualifications and the other experienced symptomatic hypotension as a moderately severe adverse event 30 minutes after dosing with open-label sildenafil citrate 50 mg. 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 sildenafil citrate 50 mg).For the 20 subjects who received sildenafil citrate 100 mg and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 100 mg sildenafil citrate or matching placebo are shown in Figure 4.Figure 4: Mean Standing Systolic Blood Pressure Change from BaselineBlood pressure was measured after administration of sildenafil citrate at the same times as those specified for the previous doxazosin studies. There were three subjects who had a standing SBP of < 85 mmHg.
CAUTION & WARNING:
All three were taking sildenafil citrate 100 mg, and all three reported mild adverse events at the time of reductions in standing SBP, including vasodilation and lightheadedness. There were four subjects with a decrease from baseline in standing systolic BP > 30 mmHg following sildenafil citrate 100 mg, one subject with a decrease from baseline in standing systolic BP > 30 mmHg following placebo and one subject with a decrease from baseline in standing systolic BP > 30 mmHg following both sildenafil citrate and placebo. While there were no severe adverse events potentially canada sildenafil related to blood pressure reported in this study, one subject reported moderate vasodilatation after both sildenafil citrate 50 mg and 100 mg. There were no episodes of syncope reported in this study.Effect of Sildenafil citrate on Blood Pressure When Co-administered with Anti-hypertensives:When sildenafil citrate 100 mg oral was co-administered 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.Effect of Sildenafil citrate on Blood Pressure When Co-administered with Alcohol:Sildenafil citrate (50 mg) did not potentiate the hypotensive effect of alcohol (0.5 g/kg) in healthy volunteers with mean maximum blood alcohol levels of 0.08%. The maximum observed decrease in systolic blood pressure was -18.5 mmHg when sildenafil was co-administered with alcohol versus -17.4 mmHg when alcohol was administered alone. The maximum observed decrease in diastolic blood pressure was -17.2 mmHg when sildenafil was co-administered with alcohol versus -11.1 mmHg when alcohol was administered alone. There were no reports of postural dizziness or orthostatic hypotension. The maximum recommended dose of 100 mg sildenafil was not evaluated in this study [ see Drug Interactions (7.5)].Effects of Sildenafil citrate on Cardiac Parameters:Single oral doses of sildenafil up to 100 mg produced no clinically relevant changes in the ECGs of normal male volunteers.Studies have produced relevant data on the effects of sildenafil citrate on cardiac output. In one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent Swan-Ganz catheterization. A total dose of 40 mg sildenafil was administered by four intravenous infusions.The results from this pilot study are shown in Table 3; the mean resting systolic and diastolic blood pressures decreased by 7% and 10% compared to baseline in these patients. Mean resting values for right atrial pressure, pulmonary artery pressure, pulmonary artery occluded pressure and cardiac output decreased by 28%, 28%, 20% and 7% respectively. Even though this total dosage produced plasma sildenafil concentrations which were approximately 2 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of 100 mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients.In a double-blind study, 144 patients with erectile dysfunction and chronic stable angina limited by exercise, not receiving chronic oral nitrates, were randomized to a single dose of placebo or sildenafil citrate 100 mg 1 hour prior to exercise testing. The primary endpoint was time to limiting angina in the evaluable cohort. The mean times (adjusted for baseline) to onset of limiting angina were 423.6 and 403.7 seconds for sildenafil (N=70) and placebo, respectively. These results demonstrated that the effect of sildenafil citrate on the primary endpoint was statistically non-inferior to placebo.Effects of Sildenafil citrate on Vision:At single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. Subjects in the study reported this finding as difficulties in discriminating blue/green.
- The use of sildenafil citrate 50mg is often combined with psychological counseling.
- Alcohol and large meals can delay the medication’s effectiveness.
- Do not use sildenafil if you are pregnant or nursing.
- Patients with severe vision problems should consult their doctor before use.
- Sildenafil may cause flushing, nasal congestion, or diarrhea.
- Discontinuation may be advised if adverse reactions occur.
- Use caution in men over the age of 65, as side effects may increase.
- Always follow the instructions provided by your medical professional.
An evaluation of visual function at doses up to twice the maximum recommended dose revealed no effects of sildenafil citrate on visual acuity, intraocular pressure, or pupillometry.Effects of Sildenafil citrate on Sperm:There was no effect on sperm motility or morphology after single 100 mg oral doses of sildenafil citrate in healthy volunteers.12.3 PharmacokineticsSildenafil citrate is rapidly absorbed after oral administration, with a mean absolute bioavailability of 41% (range 25 to 63%).
- Sildenafil citrate 50mg may cause priapism, a prolonged erection needing medical attention.
- Use with caution in men taking blood pressure medications.
- Check for contraindications: heart disease, stroke history, or liver issues.
- Avoid taking sildenafil with fatty meals to improve absorption time.
- The drug's effectiveness can be reduced if taken with certain drugs.
- Patients should inform their doctor of all medications they are taking.
- The medication does not protect against sexually transmitted infections.
- Follow the prescribed dosage schedule strictly to avoid adverse reactions.
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