)]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* [(Physicians should advise patients of the potential for VIAGRA to augm)8.4 (ent the blood pressure )]TJ T* [(lowering effect of alpha-blockers and anti-hypertensive m)8.5 (edications. Concom)8.5 (itant )]TJ 0.0005 Tc -0.0005 Tw T* [(adm)8.3 (i)-1.7 (nistration of VIAGRA and an alpha-blocker m)8.3 (a)-0.7 (y lead to sym)8.3 (p)0.5 (tom)8.3 (a)-0.7 (tic hypotension in som)8.3 (e)-0.7 ( )]TJ 0.0006 Tc -0.0006 Tw T* [(patients.
Therefore, when VIAGRA is co-adm)8.4 (inistered with alpha-blockers, patients should be )]TJ 0.001 Tc -0.001 Tw T* (stable on alpha-blocker therapy prior to in)Tj 0.0001 Tc -0.0001 Tw 16.865 0 Td [(itiating VIAGRA treatm)7.9 (e)-1.1 (nt and VIAGRA should be )]TJ 0.001 Tc -0.001 Tw -16.865 -1.165 Td (initiated at the lowest dose. )Tj 0 Tc 0 Tw T* ( )Tj 0.0009 Tc -0.0009 Tw T* (Physicians should discuss with patients the potential cardiac risk of se\ xual activity in patients )Tj 0.0008 Tc -0.0008 Tw T* [(with preexisting cardiovascular risk factors.
Patients who experience sy\ m)8.6 (p)0.8 (tom)8.6 (s \(e.g., angina )]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 308 0 obj <>>>/Resources 331 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 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 309 0 obj <>>>/Resources 333 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 333 0 obj <> endobj 334 0 obj <> endobj 332 0 obj <>stream /This label may not be the latest approved by FDA.
)]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* [(Physicians should advise patients of the potential for VIAGRA to augm)8.4 (ent the blood pressure )]TJ T* [(lowering effect of alpha-blockers and anti-hypertensive m)8.5 (edications. Concom)8.5 (itant )]TJ 0.0005 Tc -0.0005 Tw T* [(adm)8.3 (i)-1.7 (nistration of VIAGRA and an alpha-blocker m)8.3 (a)-0.7 (y lead to sym)8.3 (p)0.5 (tom)8.3 (a)-0.7 (tic hypotension in som)8.3 (e)-0.7 ( )]TJ 0.0006 Tc -0.0006 Tw T* [(patients. Therefore, when VIAGRA is co-adm)8.4 (inistered with alpha-blockers, patients should be )]TJ 0.001 Tc -0.001 Tw T* (stable on alpha-blocker therapy prior to in)Tj 0.0001 Tc -0.0001 Tw 16.865 0 Td [(itiating VIAGRA treatm)7.9 (e)-1.1 (nt and VIAGRA should be )]TJ 0.001 Tc -0.001 Tw -16.865 -1.165 Td (initiated at the lowest dose. )Tj 0 Tc 0 Tw T* ( )Tj 0.0009 Tc -0.0009 Tw T* (Physicians should discuss with patients the potential cardiac risk of se\ xual activity in patients )Tj 0.0008 Tc -0.0008 Tw T* [(with preexisting cardiovascular risk factors. Patients who experience sy\ m)8.6 (p)0.8 (tom)8.6 (s \(e.g., angina )]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 308 0 obj <>>>/Resources 331 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 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 309 0 obj <>>>/Resources 333 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 333 0 obj <> endobj 334 0 obj <> endobj 332 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 331 0 obj <> endobj 335 0 obj <> endobj 330 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 307 0 obj <> endobj 302 0 obj <>stream q 1 0 0 1 -8.141602 -1.487244 cm 0 0 612 792 re W n 1 0 0 1 8.141602 1.487244 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.8584 48.0128 Tm ( )Tj 19 -0.005 Td (11)Tj /C2_0 1 Tf -19 54.875 Td <0078>Tj /TT1 1 Tf 0.46 0 Td ( )Tj /TT0 1 Tf 0.0006 Tc -0.0006 Tw 1.04 0 Td [(Patients with resting hypotension \(BP )-3.4 (<90/50\) or hypertension \(BP >170/110\); )]TJ 0 Tc 0 Tw -1.5 -1.165 Td ( )Tj /C2_0 1 Tf 0 -1.23 TD <0078>Tj /TT1 1 Tf 0.46 0 Td ( )Tj /TT0 1 Tf 0.0009 Tc -0.0009 Tw 1.04 0 Td (Patients with cardiac failure or coronary artery disease causing unstabl\ e angina; )Tj 0 Tc 0 Tw -1.5 -1.165 Td ( )Tj /C2_0 1 Tf T* <0078>Tj /TT1 1 Tf 0.46 0 Td ( )Tj /TT0 1 Tf 0.0009 Tc -0.0009 Tw 1.04 0 Td [(Patients with retinitis pigm)8.7 (entosa \(a m)8.7 (i)-1.3 (nority of)3.9 ( these patients have genetic disorders of)3.9 ( )]TJ 0 -1.165 TD (retinal phosphodiesterases\). )Tj 0 Tc 0 Tw -1.5 -1.165 Td ( )Tj 0.0008 Tc -0.0008 Tw T* [(Prolonged erection greater than 4 hours and priapism)6.7 ( \(painful erections greater than 6 hours in )]TJ 0.0006 Tc -0.0006 Tw T* [(duration\) have been reported infrequently since m)8.4 (a)-0.6 (rket approval of VIAGRA. In the event of an )]TJ 0.0009 Tc -0.0009 Tw T* [(erection that persists longer than 4 hours, the patient should seek im)8.7 (m)8.7 (ediate m)8.7 (edical assistance. For current labeling information, please visit endstream endobj 331 0 obj <> endobj 335 0 obj <> endobj 330 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 307 0 obj <> endobj 302 0 obj <>stream q 1 0 0 1 -8.141602 -1.487244 cm 0 0 612 792 re W n 1 0 0 1 8.141602 1.487244 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.8584 48.0128 Tm ( )Tj 19 -0.005 Td (11)Tj /C2_0 1 Tf -19 54.875 Td <0078>Tj /TT1 1 Tf 0.46 0 Td ( )Tj /TT0 1 Tf 0.0006 Tc -0.0006 Tw 1.04 0 Td [(Patients with resting hypotension \(BP )-3.4 (<90/50\) or hypertension \(BP >170/110\); )]TJ 0 Tc 0 Tw -1.5 -1.165 Td ( )Tj /C2_0 1 Tf 0 -1.23 TD <0078>Tj /TT1 1 Tf 0.46 0 Td ( )Tj /TT0 1 Tf 0.0009 Tc -0.0009 Tw 1.04 0 Td (Patients with cardiac failure or coronary artery disease causing unstabl\ e angina; )Tj 0 Tc 0 Tw -1.5 -1.165 Td ( )Tj /C2_0 1 Tf T* <0078>Tj /TT1 1 Tf 0.46 0 Td ( )Tj /TT0 1 Tf 0.0009 Tc -0.0009 Tw 1.04 0 Td [(Patients with retinitis pigm)8.7 (entosa \(a m)8.7 (i)-1.3 (nority of)3.9 ( these patients have genetic disorders of)3.9 ( )]TJ 0 -1.165 TD (retinal phosphodiesterases\).
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)Tj 0 Tc 0 Tw -1.5 -1.165 Td ( )Tj 0.0008 Tc -0.0008 Tw T* [(Prolonged erection greater than 4 hours and priapism)6.7 ( \(painful erections greater than 6 hours in )]TJ 0.0006 Tc -0.0006 Tw T* [(duration\) have been reported infrequently since m)8.4 (a)-0.6 (rket approval of VIAGRA. In the event of an )]TJ 0.0009 Tc -0.0009 Tw T* [(erection that persists longer than 4 hours, the patient should seek im)8.7 (m)8.7 (ediate m)8.7 (edical assistance. )]TJ 0.0008 Tc -0.0008 Tw T* [(If priapism)8.6 ( is not treated im)8.6 (m)8.6 (ediately, penile tissue dam)8.6 (age and perm)8.6 (anent loss of potency could )]TJ 0.0012 Tc 0 Tw T* (result.
In the following patients: age )Tj 0.001 Tc -0.001 Tw -24.38 -1.165 Td [(>65, hepatic im)8.8 (pairm)8.8 (ent \(e.g., cirrhosis\), severe renal im)8.8 (pairm)8.8 (ent \(e.g., creatinine clearance )]TJ 0.0007 Tc -0.0007 Tw 0 -1.165 TD [(<30 m)8.5 (L)1.5 (/m)8.5 (in\), and concom)8.5 (itant use of potent cytochrom)8.5 (e P450 3A4 inhibitors \(erythrom)8.5 (y)0.7 (cin\), )]TJ T* [(plasm)8.5 (a levels of sildenafil at 24 hours post dose have been found to be 3 to \ 8 tim)8.5 (es higher than )]TJ T* [(those seen in healthy volunteers.
If VIAGRA is prescribed to patients )Tj 0.0006 Tc -0.0006 Tw -11.49 -1.165 Td [(taking ritonavir, caution should be used.
Data from)5.2 ( subjects exposed to high system)8.5 (ic levels of )]TJ 0.001 Tc -0.001 Tw 0 -1.165 TD [(sildenafil are lim)8.8 (ited.
| Parameter | Value | Description |
|---|---|---|
| Absorption | Peak in 30-120 minutes | Time to reach maximum plasma concentration |
| Bioavailability | Approx. 40% | Percentage of dose absorbed into circulation |
| Distribution | Wide tissue distribution | Binds to plasma proteins |
| Metabolism | Liver via CYP3A4 | Main metabolic pathway |
| Excretion | Mainly in feces and urine | Elimination route |
Visual disturbances occurre)]TJ 0.0008 Tc -0.0008 Tw 19.92 0 Td [(d m)8.6 (o)0.8 (re com)8.6 (m)8.6 (only at higher levels of sildenafil )]TJ 0.0006 Tc -0.0006 Tw -19.92 -1.165 Td [(exposure.
Decreased blood pressure, syncope, a)-0.6 (nd prolonged erection were reported in som)8.5 (e )]TJ T* [(healthy volunteers exposed to high doses of sildenafil \(200-800 m)8.4 (g)0.6 (\). To decrease the chance of )]TJ 0.0009 Tc -0.0009 Tw T* [(adverse events in patients taking ritonavir, a decrease in sildenafil do\ sage is sildenafil 25mg tablets recom)8.7 (m)8.7 (ended \(see )]TJ /TT2 1 Tf -0.0006 Tc 0.0006 Tw 0 -1.18 TD (Drug Interactions, ADVERSE REACTIONS )Tj /TT0 1 Tf 0.0003 Tc 0 Tw 19.345 0 Td (and )Tj /TT2 1 Tf -0.0009 Tc 0.0009 Tw (DOSAGE AND ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc 0 Tw 17.675 0 Td (\). )Tj 0 Tc -37.02 -1.165 Td ( )Tj 0 -1.165 TD ( )Tj /TT2 1 Tf -0.0013 Tc 15.6213 Tw 0 -1.18 TD ( PRECAUTIONS )Tj 0.0011 Tc 0 Tw 0 -1.17 TD (General )Tj /TT0 1 Tf 0.0008 Tc -0.0008 Tw 0 -1.155 TD [(The evaluation of erectile dysfunction should include a determ)8.6 (ination of potential underlying )]TJ 0 -1.165 TD [(causes and the identification of appropriate treatm)8.6 (ent following a com)8.6 (p)0.8 (lete m)8.6 (edical assessm)8.6 (ent. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* [(Before prescribing VIAGRA, it is im)8.4 (portant to note the following: )]TJ 0 Tc 0 Tw T* ( )Tj 0.0007 Tc -0.0007 Tw T* [(Caution is advised when Phosphodiesterase Type 5 \(PDE5\) inhibitors are\ co-adm)8.5 (inistered with )]TJ 0.0005 Tc -0.0005 Tw T* (alpha-blockers.
PDE5 inhibitors, including VIAGR)Tj 0.0008 Tc -0.0008 Tw 20.575 0 Td (A, and alpha-adrenergic blocking agents are )Tj 0.0007 Tc -0.0007 Tw -20.575 -1.165 Td [(both vasodilators with blood pressure lowering effects. W)9.6 (h)0.7 (en vasodilators are used in )]TJ T* [(com)8.5 (b)0.7 (ination, an additive effect on blood pressure m)8.5 (ay be anticipated.
In som)8.5 (e patients, )]TJ T* [(concom)8.5 (itant use of these two drug classes can lower blood pressure significant\ ly \(see Drug )]TJ 0.0008 Tc -0.0008 Tw T* [(Interactions\) leading to sym)8.6 (p)0.8 (tom)8.6 (atic hypotension \(e.g. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* (Consideration should be given to the following: )Tj 0 Tc 0 Tw T* ( )Tj 0.0009 Tc -0.0009 Tw T* (- Patients should be stable on alpha-blocker therapy prior to initiating\ a PDE5 inhibitor. Patients )Tj T* [(who dem)8.7 (onstrate hem)8.7 (odynam)8.7 (i)-1.3 (c instability on alpha-blocker therapy alone are at increased risk )]TJ 0.0005 Tc -0.0005 Tw T* [(of sym)8.3 (p)0.5 (tom)8.3 (a)-0.7 (tic hypotension with concom)8.3 (itant use of PDE5 inhibitors. )]TJ 0.0008 Tc -0.0008 Tw T* (- In those patients who are stable on alpha-blocker therapy, PDE5 inhibi\ tors should be initiated )Tj 0.0007 Tc -0.0007 Tw T* (at the lowest dose. )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 304 0 obj <>>>/Resources 337 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 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 305 0 obj <>>>/Resources 339 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 339 0 obj <> endobj 340 0 obj <> endobj 338 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 337 0 obj <> endobj 341 0 obj <> endobj 336 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 303 0 obj <> endobj 298 0 obj <>stream q 1 0 0 1 -8.715576 -1.917297 cm 0 0 612 792 re W n 1 0 0 1 8.715576 1.917297 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.2844 47.5827 Tm ( )Tj 19 -0.005 Td (10)Tj /TT1 1 Tf -0.0011 Tc 13.7061 Tw -19 54.925 Td ( CONTRAINDICATIONS )Tj /TT0 1 Tf 0.0006 Tc -0.0006 Tw 0 -1.17 TD (Consistent with its known effects on the nitric oxide/cGMP pathway \(see\ )Tj /TT1 1 Tf -0.0014 Tc 0 Tw 29.56 0 Td (CLINICAL )Tj 0.0001 Tc -29.56 -1.18 Td (PHARMACOLOGY)Tj /TT0 1 Tf 0.0004 Tc -0.0004 Tw 8.94 0 Td (\), VIAGRA was shown to potentiate the hypotensive effects of nitrates, \ )Tj 0.001 Tc -0.001 Tw -8.94 -1.165 Td [(and its adm)8.8 (i)-1.2 (nistration to patients who are using organic nitrates, either regularly \ and/or )]TJ 0 -1.165 TD [(interm)8.9 (ittently, in any f)4.1 (o)1.1 (rm)8.9 ( is theref)4.1 (ore contraindicated. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0005 Tc -0.0005 Tw T* (After patients have taken VIAGRA, it is unknown when nitrates, if necess\ ary, can be safely )Tj 0.0008 Tc -0.0008 Tw T* [(adm)8.6 (i)-1.4 (nistered. Based on the pharm)8.6 (acokinetic profile )]TJ 0.0006 Tc -0.0006 Tw 20.93 0 Td [(of a single 100 m)8.4 (g)0.6 ( oral dose given to healthy )]TJ 0.0009 Tc -0.0009 Tw -20.93 -1.165 Td [(norm)8.7 (al volunteers, the plasm)8.7 (a levels of sildenafil at 24 hours post dose are approxim)8.7 (ately )]TJ 0.0007 Tc -0.0007 Tw 0 -1.18 TD [(2 ng/m)8.5 (L)1.5 ( \(com)8.5 (pared to peak plasm)8.5 (a levels of approxim)8.5 (ately 440 ng/m)8.5 (L)1.5 (\) \(see )]TJ /TT1 1 Tf -0.0014 Tc 0 Tw 30.995 0 Td (CLINICAL )Tj 0.0004 Tc -0.0004 Tw -30.995 -1.18 Td (PHARMACOLOGY: Pharmacokinetics and Metabolism)Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 24.38 0 Td (\). In som)8.5 (e patients, )]TJ T* [(concom)8.5 (itant use of these two drug classes can lower blood pressure significant\ ly \(see Drug )]TJ 0.0008 Tc -0.0008 Tw T* [(Interactions\) leading to sym)8.6 (p)0.8 (tom)8.6 (atic hypotension \(e.g. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* (Consideration should be given to the following: )Tj 0 Tc 0 Tw T* ( )Tj 0.0009 Tc -0.0009 Tw T* (- Patients should be stable on alpha-blocker therapy prior to initiating\ a PDE5 inhibitor. Patients )Tj T* [(who dem)8.7 (onstrate hem)8.7 (odynam)8.7 (i)-1.3 (c instability on alpha-blocker therapy alone are at increased risk )]TJ 0.0005 Tc -0.0005 Tw T* [(of sym)8.3 (p)0.5 (tom)8.3 (a)-0.7 (tic hypotension with concom)8.3 (itant use of PDE5 inhibitors.
)]TJ 0.0008 Tc -0.0008 Tw T* (- In those patients who are stable on alpha-blocker therapy, PDE5 inhibi\ tors should be initiated )Tj 0.0007 Tc -0.0007 Tw T* (at the lowest dose.
| Country | Status | Notes |
|---|---|---|
| USA | Approved by FDA | Prescription-only medication |
| UK | Prescription required | Manufactured under regulatory standards |
| Canada | Approved for ED and PAH | Prescription-based |
)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 304 0 obj <>>>/Resources 337 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 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 305 0 obj <>>>/Resources 339 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 339 0 obj <> endobj 340 0 obj <> endobj 338 0 obj <>stream /This label may not be the latest approved by FDA. For current labeling information, please visit endstream endobj 337 0 obj <> endobj 341 0 obj <> endobj 336 0 obj <>stream /This label may not be the latest approved by FDA.
)]TJ 0.0008 Tc -0.0008 Tw T* [(If priapism)8.6 ( is not treated im)8.6 (m)8.6 (ediately, penile tissue dam)8.6 (age and perm)8.6 (anent loss of potency could )]TJ 0.0012 Tc 0 Tw T* (result. If VIAGRA is prescribed to patients )Tj 0.0006 Tc -0.0006 Tw -11.49 -1.165 Td [(taking ritonavir, caution should be used. Data from)5.2 ( subjects exposed to high system)8.5 (ic levels of )]TJ 0.001 Tc -0.001 Tw 0 -1.165 TD [(sildenafil are lim)8.8 (ited. Visual disturbances occurre)]TJ 0.0008 Tc -0.0008 Tw 19.92 0 Td [(d m)8.6 (o)0.8 (re com)8.6 (m)8.6 (only at higher levels of sildenafil )]TJ 0.0006 Tc -0.0006 Tw -19.92 -1.165 Td [(exposure. Decreased blood pressure, syncope, a)-0.6 (nd prolonged erection were reported in som)8.5 (e )]TJ T* [(healthy volunteers exposed to high doses of sildenafil \(200-800 m)8.4 (g)0.6 (\).
To decrease the chance of )]TJ 0.0009 Tc -0.0009 Tw T* [(adverse events in patients taking ritonavir, a decrease in sildenafil do\ sage is sildenafil 25mg tablets recom)8.7 (m)8.7 (ended \(see )]TJ /TT2 1 Tf -0.0006 Tc 0.0006 Tw 0 -1.18 TD (Drug Interactions, ADVERSE REACTIONS )Tj /TT0 1 Tf 0.0003 Tc 0 Tw 19.345 0 Td (and )Tj /TT2 1 Tf -0.0009 Tc 0.0009 Tw (DOSAGE AND ADMINISTRATION)Tj /TT0 1 Tf 0.001 Tc 0 Tw 17.675 0 Td (\). )Tj 0 Tc -37.02 -1.165 Td ( )Tj 0 -1.165 TD ( )Tj /TT2 1 Tf -0.0013 Tc 15.6213 Tw 0 -1.18 TD ( PRECAUTIONS )Tj 0.0011 Tc 0 Tw 0 -1.17 TD (General )Tj /TT0 1 Tf 0.0008 Tc -0.0008 Tw 0 -1.155 TD [(The evaluation of erectile dysfunction should include a determ)8.6 (ination of potential underlying )]TJ 0 -1.165 TD [(causes and the identification of appropriate treatm)8.6 (ent following a com)8.6 (p)0.8 (lete m)8.6 (edical assessm)8.6 (ent. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0006 Tc -0.0006 Tw T* [(Before prescribing VIAGRA, it is im)8.4 (portant to note the following: )]TJ 0 Tc 0 Tw T* ( )Tj 0.0007 Tc -0.0007 Tw T* [(Caution is advised when Phosphodiesterase Type 5 \(PDE5\) inhibitors are\ co-adm)8.5 (inistered with )]TJ 0.0005 Tc -0.0005 Tw T* (alpha-blockers. PDE5 inhibitors, including VIAGR)Tj 0.0008 Tc -0.0008 Tw 20.575 0 Td (A, and alpha-adrenergic blocking agents are )Tj 0.0007 Tc -0.0007 Tw -20.575 -1.165 Td [(both vasodilators with blood pressure lowering effects. W)9.6 (h)0.7 (en vasodilators are used in )]TJ T* [(com)8.5 (b)0.7 (ination, an additive effect on blood pressure m)8.5 (ay be anticipated. For current labeling information, please visit endstream endobj 303 0 obj <> endobj 298 0 obj <>stream q 1 0 0 1 -8.715576 -1.917297 cm 0 0 612 792 re W n 1 0 0 1 8.715576 1.917297 cm BT /GS0 gs /TT0 1 Tf 12 0 0 12 63.2844 47.5827 Tm ( )Tj 19 -0.005 Td (10)Tj /TT1 1 Tf -0.0011 Tc 13.7061 Tw -19 54.925 Td ( CONTRAINDICATIONS )Tj /TT0 1 Tf 0.0006 Tc -0.0006 Tw 0 -1.17 TD (Consistent with its known effects on the nitric oxide/cGMP pathway \(see\ )Tj /TT1 1 Tf -0.0014 Tc 0 Tw 29.56 0 Td (CLINICAL )Tj 0.0001 Tc -29.56 -1.18 Td (PHARMACOLOGY)Tj /TT0 1 Tf 0.0004 Tc -0.0004 Tw 8.94 0 Td (\), VIAGRA was shown to potentiate the hypotensive effects of nitrates, \ )Tj 0.001 Tc -0.001 Tw -8.94 -1.165 Td [(and its adm)8.8 (i)-1.2 (nistration to patients who are using organic nitrates, either regularly \ and/or )]TJ 0 -1.165 TD [(interm)8.9 (ittently, in any f)4.1 (o)1.1 (rm)8.9 ( is theref)4.1 (ore contraindicated. )]TJ 0 Tc 0 Tw T* ( )Tj 0.0005 Tc -0.0005 Tw T* (After patients have taken VIAGRA, it is unknown when nitrates, if necess\ ary, can be safely )Tj 0.0008 Tc -0.0008 Tw T* [(adm)8.6 (i)-1.4 (nistered. Based on the pharm)8.6 (acokinetic profile )]TJ 0.0006 Tc -0.0006 Tw 20.93 0 Td [(of a single 100 m)8.4 (g)0.6 ( oral dose given to healthy )]TJ 0.0009 Tc -0.0009 Tw -20.93 -1.165 Td [(norm)8.7 (al volunteers, the plasm)8.7 (a levels of sildenafil at 24 hours post dose are approxim)8.7 (ately )]TJ 0.0007 Tc -0.0007 Tw 0 -1.18 TD [(2 ng/m)8.5 (L)1.5 ( \(com)8.5 (pared to peak plasm)8.5 (a levels of approxim)8.5 (ately 440 ng/m)8.5 (L)1.5 (\) \(see )]TJ /TT1 1 Tf -0.0014 Tc 0 Tw 30.995 0 Td (CLINICAL )Tj 0.0004 Tc -0.0004 Tw -30.995 -1.18 Td (PHARMACOLOGY: Pharmacokinetics and Metabolism)Tj /TT0 1 Tf 0.0007 Tc -0.0007 Tw 24.38 0 Td (\). In the following patients: age )Tj 0.001 Tc -0.001 Tw -24.38 -1.165 Td [(>65, hepatic im)8.8 (pairm)8.8 (ent \(e.g., cirrhosis\), severe renal im)8.8 (pairm)8.8 (ent \(e.g., creatinine clearance )]TJ 0.0007 Tc -0.0007 Tw 0 -1.165 TD [(<30 m)8.5 (L)1.5 (/m)8.5 (in\), and concom)8.5 (itant use of potent cytochrom)8.5 (e P450 3A4 inhibitors \(erythrom)8.5 (y)0.7 (cin\), )]TJ T* [(plasm)8.5 (a levels of sildenafil at 24 hours post dose have been found to be 3 to \ 8 tim)8.5 (es higher than )]TJ T* [(those seen in healthy volunteers.