How to Take 150 mg Sildenafil Citrate Safely

W)9.3 (h)0.5 (en VIAGRA is taken with a high fat m)8.3 (eal, the rate of absorption is reduced, with )]TJ 0.0008 Tc -0.0008 Tw T* [(a m)8.6 (ean delay in T)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 149.1233 663.1827 Tm [(ma)-18.2 (x)]TJ 0.0005 Tc -0.0005 Tw 12 0 0 12 162.7433 664.6827 Tm [( of 60 m)8.3 (i)-1.7 (nutes and a m)8.3 (ean reduction in C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 361.0433 663.1827 Tm [(ma)-18.2 (x)]TJ 0.0005 Tc -0.0005 Tw 12 0 0 12 374.6633 664.6827 Tm [( of 29%. The m)8.3 (e)-0.7 (an steady state )]TJ 0.0008 Tc -0.0008 Tw -25.96 -1.165 Td [(volum)8.6 (e of distribution \(Vss\) for sildenafil is 105 L, indicating distributi\ on into the tissues.

Further information

Sim)8.7 (ilar values for )]TJ T* [(pharm)8.7 (acokinetic param)8.7 (eters were seen in norm)8.7 (al volunteers and in the patient population, using )]TJ 0.0008 Tc -0.0008 Tw T* [(a population pharm)8.6 (acokinetic approach. )]TJ /TT1 1 Tf 0 Tc 0 Tw 0 -1.18 TD ( )Tj 0.0006 Tc -0.0006 Tw 0 -1.17 TD (Pharmacokinetics in Special Populations )Tj 0.0014 Tc 0 Tw T* (Geriatrics:)Tj /TT0 1 Tf 0.0008 Tc -0.0008 Tw ( Healthy elderly volunteers \(65 years or over\) had a reduced clearance\ of sildenafil, )Tj 0 -1.165 TD [(with free plasm)8.6 (a concentrations approxim)8.6 (ately 40% greater than those seen in healthy younger )]TJ T* (volunteers \(18-45 years\). )Tj 0 Tc 0 Tw T* ( )Tj /TT1 1 Tf 0.0006 Tc -0.0006 Tw 0 -1.18 TD (Renal Insufficiency:)Tj /TT0 1 Tf 0.0008 Tc -0.0008 Tw 8.595 0 Td [( In volunteers with sildenafil oral jelly 100 mg m)8.6 (ild \(CLcr=50-80 m)8.6 (L)1.6 (/m)8.6 (in\) and m)8.6 (oderate )]TJ 0.0007 Tc -0.0007 Tw -8.595 -1.165 Td [(\(CLcr=30-49 m)8.5 (L)1.5 (/m)8.5 (in\) renal im)8.5 (pairm)8.5 (ent, the pharm)8.5 (acokinetics of a single oral dose of VIAGRA )]TJ 0.0009 Tc -0.0009 Tw 0 -1.165 TD [(\(50 m)8.7 (g)0.9 (\) were not altered. In volunteers with severe \(CLcr=<30 m)8.7 (L)1.7 (/m)8.7 (in\) renal im)8.7 (pairm)8.7 (ent, )]TJ 0.0006 Tc -0.0006 Tw T* [(sildenafil clearance was reduced, resulting in approxim)8.4 (a)-0.6 (tely doubling of AUC and C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 470.1233 243.1228 Tm [(ma)-18.2 (x)]TJ 0 Tc 12 0 0 12 483.7432 244.6228 Tm ( )Tj 0.0009 Tc -0.0009 Tw -35.05 -1.165 Td [(com)8.7 (p)0.9 (ared to age-m)8.7 (atched volunteers with no renal im)8.7 (pairm)8.7 (ent. )]TJ /CS0 cs 1 0 0 scn 0 Tc 0 Tw T* ( )Tj 0 g /TT1 1 Tf 0.001 Tc -0.001 Tw 0 -1.18 TD (Hepatic Insufficiency: )Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 9.685 0 Td (In volunteers with hepatic cirrhosis \(Child-Pugh A and B\), sildenafil \ )Tj -9.685 -1.165 Td (clearance was reduced, resulting in increases in AUC \(84%\) and C)Tj -0.0184 Tc 0 Tw 7.98 0 0 7.98 383.8433 187.0227 Tm [(ma)-18.2 (x)]TJ 0.001 Tc -0.001 Tw 12 0 0 12 397.4633 188.5227 Tm [( \(47%\) com)8.8 (p)1 (ared to )]TJ 0.0009 Tc -0.0009 Tw -27.86 -1.165 Td [(age-m)8.7 (atched volunteers with no hepatic im)8.7 (pairm)8.7 (ent.

Before taking sildenafil,

)]TJ 0 Tc 0 Tw 0 -1.165 TD ( )Tj 0.0009 Tc -0.0009 Tw T* [(Therefore, age >65, hepatic im)8.7 (pairm)8.7 (ent and severe renal im)8.7 (pairm)8.7 (ent are associated with )]TJ 0.0006 Tc -0.0006 Tw T* [(increased plasm)8.4 (a)-0.6 ( levels of sildenafil. A starting oral dose of 25 m)8.4 (g)0.6 ( should be considered in )]TJ 0.0011 Tc -0.0011 Tw 0 -1.18 TD (those patients \(see )Tj /TT1 1 Tf -0.0009 Tc 0.0009 Tw 7.6 0 Td (DOSAGE AND ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc 0 Tw 15.98 0 Td (\). )Tj 0 Tc -23.58 -1.165 Td ( )Tj ET /Artifact <>BDC Q q 1 0 0 1 120.6970062 785.2004395 cm /GS1 gs /Fm0 Do Q EMC /Artifact <>BDC q 1 0 0 1 612 773.2004395 cm /GS1 gs /Fm1 Do Q EMC endstream endobj 358 0 obj <>>>/Resources 421 0 R/Subtype/Form>>stream 0 g 0 G 0 i 0 J []0 d 0 j 1 w 10 M 0 Tc 0 Tw 100 Tz 0 TL 0 Tr 0 Ts BT /ArialRoundedMTBold 10 Tf 0 0 1 rg 65.791 -7.9 Td (This ) Tj 22.92 0 Td (label ) Tj 26.055 0 Td (may ) Tj 22.71 0 Td (not ) Tj 18.12 0 Td (be ) Tj 14.692 0 Td (the ) Tj 18.023 0 Td (latest ) Tj 29.595 0 Td (approved ) Tj 48.974 0 Td (by ) Tj 14.17 0 Td (FDA. ) Tj -281.05 -12 Td (For ) Tj 18.96 0 Td (current ) Tj sildenafil 12 5 mg 38.765 0 Td (labeling ) Tj 41.055 0 Td (information, ) Tj 61.25 0 Td (please ) Tj 34.707 0 Td (visit ) Tj 22.299 0 Td ( Tj ET endstream endobj 359 0 obj <>>>/Resources 423 0 R/Subtype/Form>>stream 0 g 0 G 0 i 0 J []0 d 0 j 1 w 10 M 0 Tc 0 Tw 100 Tz 0 TL 0 Tr 0 Ts BT /ArialRoundedMTBold 10 Tf 0 0 1 rg 0 -7.9 Td ( ) Tj ET endstream endobj 423 0 obj <> endobj 424 0 obj <> endobj 422 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 421 0 obj <> endobj 425 0 obj <> endobj 420 0 obj <>stream /This label may not be the latest approved by FDA. )]TJ 0.0009 Tc -0.0009 Tw T* [(Sildenafil and its m)8.7 (ajor circulating N-desm)8.7 (ethyl m)8.7 (etabolite are both approxim)8.7 (ately 96% bound )]TJ 0.0008 Tc -0.0008 Tw T* [(to plasm)8.6 (a proteins.

Protein binding is i)]TJ 0.0007 Tc -0.0007 Tw 15.495 0 Td (ndependent of total drug concentrations.

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For current labeling information, please visit endstream endobj 357 0 obj <> endobj 352 0 obj <>stream q 1 0 0 1 -8.74585 -1.877228 cm 0 0 612 792 re W n 1 0 0 1 8.74585 1.877228 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.2541 47.6228 Tm ( )Tj 19.25 -0.005 Td (2)Tj 0.0007 Tc -19.25 54.94 Td (Studies )Tj /TT1 1 Tf 0.0012 Tc -0.0012 Tw 3.2 0 Td (in vitro)Tj /TT0 1 Tf 0.0006 Tc -0.0006 Tw [( have shown that sildenafil is selective for PDE5. Its effect is m)8.4 (o)0.6 (re potent on )]TJ 0.0002 Tc -0.0002 Tw -3.2 -1.165 Td (PDE5 than on other known phosphodiesterases \(10-fold for PDE6, >80-fold\ for PDE1, )Tj -0.0004 Tc 0.0004 Tw 0 -1.165 TD (>700-fold for PDE2, PDE3, PDE4, PDE7, PDE8, PDE9, PDE10, and PDE11\). Th\ e )Tj 0.0005 Tc -0.0005 Tw T* [(approxim)8.3 (a)-0.7 (tely 4,000-fold selectivity for PDE5 versus PDE3 is im)8.3 (portant because PDE3 is )]TJ 0.0009 Tc -0.0009 Tw T* (involved in control of cardiac contractility. Silden)Tj 0.0005 Tc -0.0005 Tw 20.01 0 Td (afil is only about 10-fold as potent for PDE5 )Tj 0.0006 Tc -0.0006 Tw -20.01 -1.165 Td [(com)8.4 (p)0.6 (ared to PDE6, an enzym)8.4 (e)-0.6 ( found in the retina which is involved in the phototransduction )]TJ 0.0009 Tc -0.0009 Tw T* [(pathway of the retina. This lower selectivity is thought to be the basis\ for abnorm)8.7 (alities related to )]TJ 0.0008 Tc -0.0008 Tw 0 -1.18 TD [(color vision observed with higher doses or plasm)8.6 (a levels \(see )]TJ /TT2 1 Tf 0.0004 Tc 0 Tw 24.81 0 Td (Pharmacodynamics)Tj /TT0 1 Tf 0.001 Tc (\).

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)Tj 0 Tc -24.81 -1.165 Td ( )Tj 0.0005 Tc -0.0005 Tw 0 -1.165 TD [(In addition to hum)8.3 (an corpus cavernosum)8.3 ( sm)8.3 (ooth m)8.3 (u)0.5 (scle, PDE5 is also found in lower )]TJ 0.001 Tc -0.001 Tw T* (concentrations in other tissues including platel)Tj 0.0008 Tc -0.0008 Tw [(ets, vascular and visceral sm)8.6 (ooth m)8.6 (u)0.8 (scle, and )]TJ 0.0007 Tc -0.0007 Tw T* [(skeletal m)8.5 (u)0.7 (scle. The inhibition of PDE5 in these tissues by sildenafil m)8.5 (ay be the basis for the )]TJ 0.0009 Tc -0.0009 Tw T* (enhanced platelet antiaggregatory activity of nitric oxide observed )Tj /TT1 1 Tf 0.0012 Tc -0.0012 Tw 26.825 0 Td (in vitro)Tj /TT0 1 Tf 0.0005 Tc -0.0005 Tw (, an inhibition of )Tj 0.0009 Tc -0.0009 Tw -26.825 -1.165 Td [(platelet throm)8.7 (bus form)8.7 (ation )]TJ /TT1 1 Tf 0.001 Tc -0.001 Tw 11.42 0 Td (in vivo )Tj /TT0 1 Tf (and peripheral arterial-venous dilatation )Tj /TT1 1 Tf 19.265 0 Td (in vivo)Tj /TT0 1 Tf 0 Tc 0 Tw (. )Tj -30.685 -1.165 Td ( )Tj /TT2 1 Tf 0.0007 Tc -0.0007 Tw 0 -1.18 TD (Pharmacokinetics and Metabolism )Tj /TT0 1 Tf 0.0005 Tc -0.0005 Tw 0 -1.155 TD [(VIAGRA is rapidly absorbed after oral adm)8.3 (i)-1.7 (nist)]TJ 0.0008 Tc -0.0008 Tw 19.345 0 Td (ration, with absolute bioavailability of about )Tj 0.001 Tc -0.001 Tw -19.345 -1.165 Td [(40%. Its pharm)8.8 (acokinetics are dose-proportional over the recom)8.8 (m)8.8 (ended dose range. It is )]TJ 0.0008 Tc -0.0008 Tw 0 -1.165 TD [(elim)8.6 (inated predom)8.6 (inantly by hepatic m)8.6 (etabolism)8.6 ( \(m)8.6 (ainly cytochrom)8.6 (e P450 3A4\) and is )]TJ 0.001 Tc -0.001 Tw T* [(converted to an active m)8.8 (etabolite with properties sim)8.8 (ilar to the parent, sildenafil. )Tj 0 Tc 0 Tw -15.495 -1.165 Td ( )Tj 0.0006 Tc -0.0006 Tw T* [(Based upon m)8.4 (easurem)8.4 (ents of sildenafil in sem)8.4 (e)-0.6 (n of healthy volunteers 90 m)8.4 (i)-1.6 (nutes after dosing, )]TJ T* [(less than 0.001% of the adm)8.5 (i)-1.5 (nistered dose m)8.5 (ay appear in the sem)8.5 (en of patients. )]TJ 0 Tc 0 Tw T* ( )Tj /TT1 1 Tf 0.0005 Tc -0.0005 Tw 0 -1.18 TD (Metabolism and Excretion:)Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 11.68 0 Td [( Sildenafil is cleared predom)8.5 (inantly by the CYP3A4 \(m)8.5 (ajor route\) )]TJ 0.0008 Tc -0.0008 Tw -11.68 -1.165 Td [(and CYP2C9 \(m)8.6 (inor route\) hepatic m)8.6 (i)-1.4 (crosom)8.6 (al isoenzym)8.6 (es.

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The m)8.6 (ajor circulating m)8.6 (etabolite )]TJ 0.0009 Tc -0.0009 Tw 0 -1.165 TD [(results f)3.9 (r)-1.1 (om)8.7 ( N-desm)8.7 (ethylation of)3.9 ( sildenaf)3.9 (il, and is itself)3.9 ( f)3.9 (u)0.9 (rther m)8.7 (etabolized. This m)8.7 (etabolite has )]TJ 0.001 Tc -0.001 Tw T* [(a PDE selectivity prof)4 (ile sim)8.8 (ilar to sildenaf)4 (il and an )]TJ /TT2 1 Tf 0.0012 Tc -0.0012 Tw 21.055 0 Td (in vitro)Tj /TT0 1 Tf 0.0004 Tc -0.0004 Tw [( potency for PDE5 approxim)8.2 (a)-0.8 (tely )]TJ 0.0007 Tc -0.0007 Tw -21.055 -1.165 Td [(50% of the parent drug. Plasm)8.5 (a concentrations of this m)8.5 (etabolite are approxim)8.5 (ately 40% of those )]TJ 0.0009 Tc -0.0009 Tw T* [(seen for sildenafil, so that the m)8.7 (etabolite acc)]TJ 0.0007 Tc -0.0007 Tw 17.855 0 Td [(ounts for about 20% of sildenafil\222s pharm)8.5 (acologic )]TJ 0.0001 Tc -0.0001 Tw -17.855 -1.165 Td (effects. )Tj 0 Tc 0 Tw T* ( )Tj 0.001 Tc -0.001 Tw T* [(After either oral or intravenous adm)8.8 (i)-1.2 (nistration, sildenafil is excreted as m)8.8 (etabolites )]TJ 0.0008 Tc -0.0008 Tw T* [(predom)8.6 (inantly in the feces \(approxim)8.6 (ately 80% of adm)8.6 (i)-1.4 (nistered oral dose\) and to a lesser extent )]TJ 0.0009 Tc -0.0009 Tw T* [(in the urine \(approxim)8.7 (ately 13% of the adm)8.7 (i)-1.3 (nistered oral dose\). Sim)8.7 (ilar values for )]TJ T* [(pharm)8.7 (acokinetic param)8.7 (eters were seen in norm)8.7 (al volunteers and in the patient population, using )]TJ 0.0008 Tc -0.0008 Tw T* [(a population pharm)8.6 (acokinetic approach.

• Be aware of the signs of adverse reactions like chest pain.
• Do not use sildenafil if you are taking medications for heart issues.
• The medication does not cause sexual arousal; stimulation is needed.
• Use only the prescribed dose, especially at high levels like 150 mg.

)]TJ /TT1 1 Tf 0 Tc 0 Tw 0 -1.18 TD ( )Tj 0.0006 Tc -0.0006 Tw 0 -1.17 TD (Pharmacokinetics in Special Populations )Tj 0.0014 Tc 0 Tw T* (Geriatrics:)Tj /TT0 1 Tf 0.0008 Tc -0.0008 Tw ( Healthy elderly volunteers \(65 years or over\) had a reduced clearance\ of sildenafil, )Tj 0 -1.165 TD [(with free plasm)8.6 (a concentrations approxim)8.6 (ately 40% greater than those seen in healthy younger )]TJ T* (volunteers \(18-45 years\). )Tj 0 Tc 0 Tw T* ( )Tj /TT1 1 Tf 0.0006 Tc -0.0006 Tw 0 -1.18 TD (Renal Insufficiency:)Tj /TT0 1 Tf 0.0008 Tc -0.0008 Tw 8.595 0 Td [( In volunteers with sildenafil oral jelly 100 mg m)8.6 (ild \(CLcr=50-80 m)8.6 (L)1.6 (/m)8.6 (in\) and m)8.6 (oderate )]TJ 0.0007 Tc -0.0007 Tw -8.595 -1.165 Td [(\(CLcr=30-49 m)8.5 (L)1.5 (/m)8.5 (in\) renal im)8.5 (pairm)8.5 (ent, the pharm)8.5 (acokinetics of a single oral dose of VIAGRA )]TJ 0.0009 Tc -0.0009 Tw 0 -1.165 TD [(\(50 m)8.7 (g)0.9 (\) were not altered. In volunteers with severe \(CLcr=<30 m)8.7 (L)1.7 (/m)8.7 (in\) renal im)8.7 (pairm)8.7 (ent, )]TJ 0.0006 Tc -0.0006 Tw T* [(sildenafil clearance was reduced, resulting in approxim)8.4 (a)-0.6 (tely doubling of AUC and C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 470.1233 243.1228 Tm [(ma)-18.2 (x)]TJ 0 Tc 12 0 0 12 483.7432 244.6228 Tm ( )Tj 0.0009 Tc -0.0009 Tw -35.05 -1.165 Td [(com)8.7 (p)0.9 (ared to age-m)8.7 (atched volunteers with no renal im)8.7 (pairm)8.7 (ent. )]TJ /CS0 cs 1 0 0 scn 0 Tc 0 Tw T* ( )Tj 0 g /TT1 1 Tf 0.001 Tc -0.001 Tw 0 -1.18 TD (Hepatic Insufficiency: )Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 9.685 0 Td (In volunteers with hepatic cirrhosis \(Child-Pugh A and B\), sildenafil \ )Tj -9.685 -1.165 Td (clearance was reduced, resulting in increases in AUC \(84%\) and C)Tj -0.0184 Tc 0 Tw 7.98 0 0 7.98 383.8433 187.0227 Tm [(ma)-18.2 (x)]TJ 0.001 Tc -0.001 Tw 12 0 0 12 397.4633 188.5227 Tm [( \(47%\) com)8.8 (p)1 (ared to )]TJ 0.0009 Tc -0.0009 Tw -27.86 -1.165 Td [(age-m)8.7 (atched volunteers with no hepatic im)8.7 (pairm)8.7 (ent. )]TJ 0 Tc 0 Tw 0 -1.165 TD ( )Tj 0.0009 Tc -0.0009 Tw T* [(Therefore, age >65, hepatic im)8.7 (pairm)8.7 (ent and severe renal im)8.7 (pairm)8.7 (ent are associated with )]TJ 0.0006 Tc -0.0006 Tw T* [(increased plasm)8.4 (a)-0.6 ( levels of sildenafil. A starting oral dose of 25 m)8.4 (g)0.6 ( should be considered in )]TJ 0.0011 Tc -0.0011 Tw 0 -1.18 TD (those patients \(see )Tj /TT1 1 Tf -0.0009 Tc 0.0009 Tw 7.6 0 Td (DOSAGE AND ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc 0 Tw 15.98 0 Td (\). )Tj 0 Tc -23.58 -1.165 Td ( )Tj ET /Artifact <>BDC Q q 1 0 0 1 120.6970062 785.2004395 cm /GS1 gs /Fm0 Do Q EMC /Artifact <>BDC q 1 0 0 1 612 773.2004395 cm /GS1 gs /Fm1 Do Q EMC endstream endobj 358 0 obj <>>>/Resources 421 0 R/Subtype/Form>>stream 0 g 0 G 0 i 0 J []0 d 0 j 1 w 10 M 0 Tc 0 Tw 100 Tz 0 TL 0 Tr 0 Ts BT /ArialRoundedMTBold 10 Tf 0 0 1 rg 65.791 -7.9 Td (This ) Tj 22.92 0 Td (label ) Tj 26.055 0 Td (may ) Tj 22.71 0 Td (not ) Tj 18.12 0 Td (be ) Tj 14.692 0 Td (the ) Tj 18.023 0 Td (latest ) Tj 29.595 0 Td (approved ) Tj 48.974 0 Td (by ) Tj 14.17 0 Td (FDA. ) Tj -281.05 -12 Td (For ) Tj 18.96 0 Td (current ) Tj sildenafil 12 5 mg 38.765 0 Td (labeling ) Tj 41.055 0 Td (information, ) Tj 61.25 0 Td (please ) Tj 34.707 0 Td (visit ) Tj 22.299 0 Td ( Tj ET endstream endobj 359 0 obj <>>>/Resources 423 0 R/Subtype/Form>>stream 0 g 0 G 0 i 0 J []0 d 0 j 1 w 10 M 0 Tc 0 Tw 100 Tz 0 TL 0 Tr 0 Ts BT /ArialRoundedMTBold 10 Tf 0 0 1 rg 0 -7.9 Td ( ) Tj ET endstream endobj 423 0 obj <> endobj 424 0 obj <> endobj 422 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 421 0 obj <> endobj 425 0 obj <> endobj 420 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 357 0 obj <> endobj 352 0 obj <>stream q 1 0 0 1 -8.74585 -1.877228 cm 0 0 612 792 re W n 1 0 0 1 8.74585 1.877228 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.2541 47.6228 Tm ( )Tj 19.25 -0.005 Td (2)Tj 0.0007 Tc -19.25 54.94 Td (Studies )Tj /TT1 1 Tf 0.0012 Tc -0.0012 Tw 3.2 0 Td (in vitro)Tj /TT0 1 Tf 0.0006 Tc -0.0006 Tw [( have shown that sildenafil is selective for PDE5. Its effect is m)8.4 (o)0.6 (re potent on )]TJ 0.0002 Tc -0.0002 Tw -3.2 -1.165 Td (PDE5 than on other known phosphodiesterases \(10-fold for PDE6, >80-fold\ for PDE1, )Tj -0.0004 Tc 0.0004 Tw 0 -1.165 TD (>700-fold for PDE2, PDE3, PDE4, PDE7, PDE8, PDE9, PDE10, and PDE11\). Th\ e )Tj 0.0005 Tc -0.0005 Tw T* [(approxim)8.3 (a)-0.7 (tely 4,000-fold selectivity for PDE5 versus PDE3 is im)8.3 (portant because PDE3 is )]TJ 0.0009 Tc -0.0009 Tw T* (involved in control of cardiac contractility.

• Sildenafil citrate tablets are available in pharmacies with a prescription.
• Do not purchase medications from unverified sources.
• Keep a record of your dosage and any side effects experienced.
• Regular medical check-ups are recommended during treatment.

Silden)Tj 0.0005 Tc -0.0005 Tw 20.01 0 Td (afil is only about 10-fold as potent for PDE5 )Tj 0.0006 Tc -0.0006 Tw -20.01 -1.165 Td [(com)8.4 (p)0.6 (ared to PDE6, an enzym)8.4 (e)-0.6 ( found in the retina which is involved in the phototransduction )]TJ 0.0009 Tc -0.0009 Tw T* [(pathway of the retina.

This lower selectivity is thought to be the basis\ for abnorm)8.7 (alities related to )]TJ 0.0008 Tc -0.0008 Tw 0 -1.18 TD [(color vision observed with higher doses or plasm)8.6 (a levels \(see )]TJ /TT2 1 Tf 0.0004 Tc 0 Tw 24.81 0 Td (Pharmacodynamics)Tj /TT0 1 Tf 0.001 Tc (\). )Tj 0 Tc -24.81 -1.165 Td ( )Tj 0.0005 Tc -0.0005 Tw 0 -1.165 TD [(In addition to hum)8.3 (an corpus cavernosum)8.3 ( sm)8.3 (ooth m)8.3 (u)0.5 (scle, PDE5 is also found in lower )]TJ 0.001 Tc -0.001 Tw T* (concentrations in other tissues including platel)Tj 0.0008 Tc -0.0008 Tw [(ets, vascular and visceral sm)8.6 (ooth m)8.6 (u)0.8 (scle, and )]TJ 0.0007 Tc -0.0007 Tw T* [(skeletal m)8.5 (u)0.7 (scle. The inhibition of PDE5 in these tissues by sildenafil m)8.5 (ay be the basis for the )]TJ 0.0009 Tc -0.0009 Tw T* (enhanced platelet antiaggregatory activity of nitric oxide observed )Tj /TT1 1 Tf 0.0012 Tc -0.0012 Tw 26.825 0 Td (in vitro)Tj /TT0 1 Tf 0.0005 Tc -0.0005 Tw (, an inhibition of )Tj 0.0009 Tc -0.0009 Tw -26.825 -1.165 Td [(platelet throm)8.7 (bus form)8.7 (ation )]TJ /TT1 1 Tf 0.001 Tc -0.001 Tw 11.42 0 Td (in vivo )Tj /TT0 1 Tf (and peripheral arterial-venous dilatation )Tj /TT1 1 Tf 19.265 0 Td (in vivo)Tj /TT0 1 Tf 0 Tc 0 Tw (.

• Alcohol can increase the risk of side effects from sildenafil.
• Taking sildenafil does not protect against sexually transmitted infections.
• Patients should inform their doctor of all medications they take.
• Sildenafil may cause a drop in blood pressure in some cases.

)Tj -30.685 -1.165 Td ( )Tj /TT2 1 Tf 0.0007 Tc -0.0007 Tw 0 -1.18 TD (Pharmacokinetics and Metabolism )Tj /TT0 1 Tf 0.0005 Tc -0.0005 Tw 0 -1.155 TD [(VIAGRA is rapidly absorbed after oral adm)8.3 (i)-1.7 (nist)]TJ 0.0008 Tc -0.0008 Tw 19.345 0 Td (ration, with absolute bioavailability of about )Tj 0.001 Tc -0.001 Tw -19.345 -1.165 Td [(40%. Its pharm)8.8 (acokinetics are dose-proportional over the recom)8.8 (m)8.8 (ended dose range. It is )]TJ 0.0008 Tc -0.0008 Tw 0 -1.165 TD [(elim)8.6 (inated predom)8.6 (inantly by hepatic m)8.6 (etabolism)8.6 ( \(m)8.6 (ainly cytochrom)8.6 (e P450 3A4\) and is )]TJ 0.001 Tc -0.001 Tw T* [(converted to an active m)8.8 (etabolite with properties sim)8.8 (ilar to the parent, sildenafil.

What happens if I miss a dose?

W)9.3 (h)0.5 (en VIAGRA is taken with a high fat m)8.3 (eal, the rate of absorption is reduced, with )]TJ 0.0008 Tc -0.0008 Tw T* [(a m)8.6 (ean delay in T)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 149.1233 663.1827 Tm [(ma)-18.2 (x)]TJ 0.0005 Tc -0.0005 Tw 12 0 0 12 162.7433 664.6827 Tm [( of 60 m)8.3 (i)-1.7 (nutes and a m)8.3 (ean reduction in C)]TJ -0.0184 Tc 0 Tw 7.98 0 0 7.98 361.0433 663.1827 Tm [(ma)-18.2 (x)]TJ 0.0005 Tc -0.0005 Tw 12 0 0 12 374.6633 664.6827 Tm [( of 29%. The m)8.3 (e)-0.7 (an steady state )]TJ 0.0008 Tc -0.0008 Tw -25.96 -1.165 Td [(volum)8.6 (e of distribution \(Vss\) for sildenafil is 105 L, indicating distributi\ on into the tissues. )]TJ 0.0009 Tc -0.0009 Tw T* [(Sildenafil and its m)8.7 (ajor circulating N-desm)8.7 (ethyl m)8.7 (etabolite are both approxim)8.7 (ately 96% bound )]TJ 0.0008 Tc -0.0008 Tw T* [(to plasm)8.6 (a proteins. Protein binding is i)]TJ 0.0007 Tc -0.0007 Tw 15.495 0 Td (ndependent of total drug concentrations. )Tj 0 Tc 0 Tw -15.495 -1.165 Td ( )Tj 0.0006 Tc -0.0006 Tw T* [(Based upon m)8.4 (easurem)8.4 (ents of sildenafil in sem)8.4 (e)-0.6 (n of healthy volunteers 90 m)8.4 (i)-1.6 (nutes after dosing, )]TJ T* [(less than 0.001% of the adm)8.5 (i)-1.5 (nistered dose m)8.5 (ay appear in the sem)8.5 (en of patients.

Antihypertensive and α-Adrenergic Blocking Agents

)]TJ 0 Tc 0 Tw T* ( )Tj /TT1 1 Tf 0.0005 Tc -0.0005 Tw 0 -1.18 TD (Metabolism and Excretion:)Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 11.68 0 Td [( Sildenafil is cleared predom)8.5 (inantly by the CYP3A4 \(m)8.5 (ajor route\) )]TJ 0.0008 Tc -0.0008 Tw -11.68 -1.165 Td [(and CYP2C9 \(m)8.6 (inor route\) hepatic m)8.6 (i)-1.4 (crosom)8.6 (al isoenzym)8.6 (es. The m)8.6 (ajor circulating m)8.6 (etabolite )]TJ 0.0009 Tc -0.0009 Tw 0 -1.165 TD [(results f)3.9 (r)-1.1 (om)8.7 ( N-desm)8.7 (ethylation of)3.9 ( sildenaf)3.9 (il, and is itself)3.9 ( f)3.9 (u)0.9 (rther m)8.7 (etabolized. This m)8.7 (etabolite has )]TJ 0.001 Tc -0.001 Tw T* [(a PDE selectivity prof)4 (ile sim)8.8 (ilar to sildenaf)4 (il and an )]TJ /TT2 1 Tf 0.0012 Tc -0.0012 Tw 21.055 0 Td (in vitro)Tj /TT0 1 Tf 0.0004 Tc -0.0004 Tw [( potency for PDE5 approxim)8.2 (a)-0.8 (tely )]TJ 0.0007 Tc -0.0007 Tw -21.055 -1.165 Td [(50% of the parent drug. Plasm)8.5 (a concentrations of this m)8.5 (etabolite are approxim)8.5 (ately 40% of those )]TJ 0.0009 Tc -0.0009 Tw T* [(seen for sildenafil, so that the m)8.7 (etabolite acc)]TJ 0.0007 Tc -0.0007 Tw 17.855 0 Td [(ounts for about 20% of sildenafil\222s pharm)8.5 (acologic )]TJ 0.0001 Tc -0.0001 Tw -17.855 -1.165 Td (effects. )Tj 0 Tc 0 Tw T* ( )Tj 0.001 Tc -0.001 Tw T* [(After either oral or intravenous adm)8.8 (i)-1.2 (nistration, sildenafil is excreted as m)8.8 (etabolites )]TJ 0.0008 Tc -0.0008 Tw T* [(predom)8.6 (inantly in the feces \(approxim)8.6 (ately 80% of adm)8.6 (i)-1.4 (nistered oral dose\) and to a lesser extent )]TJ 0.0009 Tc -0.0009 Tw T* [(in the urine \(approxim)8.7 (ately 13% of the adm)8.7 (i)-1.3 (nistered oral dose\).