Sildenafil Safety Information

What Is This Medication?

Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction (ED) in adult men. Sildenafil works by increasing blood flow to the penis during sexual stimulation, helping you achieve and maintain an erection. It does not cause automatic erections and requires sexual arousal to be effective. Sildenafil is the active ingredient originally found in Viagra and is available in various dosages. It is typically taken as needed, approximately 30 to 60 minutes before sexual activity.

Who Should Consider This Treatment?

Sildenafil may be appropriate for adult men experiencing difficulty achieving or maintaining erections sufficient for satisfactory sexual activity. ED can result from a variety of factors including stress, underlying health conditions, medications, or age-related changes. Your healthcare provider will evaluate your medical history, cardiovascular health, and current medications to determine if sildenafil is a safe and appropriate option for you.

Who Should Not Use This Medication?

Do not use sildenafil if you:

• Take nitrates in any form(nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, or recreational nitrates such as amyl nitrite or "poppers"). Combining sildenafil with nitrates can cause a sudden, dangerous drop in blood pressure.
• Take riociguat (Adempas), a medication used to treat pulmonary arterial hypertension
• Have severe cardiovascular disease, including unstable angina, uncontrolled high blood pressure, or recent heart failure
• Have had a heart attack or stroke within the past six months
• Have a known hypersensitivity or allergy to sildenafil or any of its ingredients

Warnings and Precautions

• Sexual activity carries cardiovascular risk. Your provider will assess your cardiac fitness before prescribing sildenafil. If you experience chest pain, dizziness, or nausea during sexual activity, stop and seek medical help.
• Never combine sildenafil with nitrates. This includes prescription nitrate medications and recreational nitrites. This combination can be life-threatening.
• Use caution if you have anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie disease) or conditions predisposing to priapism (sickle cell anemia, multiple myeloma, or leukemia).
• Sildenafil may cause a temporary decrease in blood pressure. Use caution if you are already taking antihypertensive medications.
• Do not take more than the prescribed dose. Taking more sildenafil than prescribed does not improve efficacy and increases the risk of side effects.

Common Side Effects

The most commonly reported side effects include:

• Headache
• Facial flushing (redness or warmth)
• Nasal congestion or runny nose
• Dyspepsia (indigestion or upset stomach)
• Visual disturbances (mild blue tint to vision, increased light sensitivity, or blurred vision)
• Dizziness
• Back pain

These side effects are usually mild and temporary, resolving within a few hours as the medication wears off. If side effects persist or become bothersome, contact your healthcare provider.

Serious Side Effects

Seek immediate medical attention if you experience any of the following:

• Priapism: An erection lasting more than four hours. This is a medical emergency that requires immediate treatment to prevent permanent damage to the penis.
• Sudden vision loss in one or both eyes, which may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION). Discontinue use and seek emergency care immediately.
• Sudden hearing loss or decrease in hearing, with or without ringing in the ears (tinnitus) or dizziness
• Severe hypotension: Sudden drop in blood pressure causing fainting, severe dizziness, or lightheadedness
• Chest pain, irregular heartbeat, or shortness of breath during or after sexual activity
• Seizures or convulsions

Drug Interactions

Tell your healthcare provider about all medications you are taking. Sildenafil has important interactions with several drug classes:

• Nitrates (ABSOLUTE CONTRAINDICATION): Nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and recreational nitrites. This combination can cause fatal hypotension.
• Alpha-blockers (tamsulosin, doxazosin, prazosin): May cause additive blood pressure lowering. Your provider may start sildenafil at a lower dose if you take an alpha-blocker.
• CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, erythromycin, clarithromycin): These medications can increase sildenafil levels in your blood, raising the risk of side effects. Dose adjustment may be required.
• Other PDE5 inhibitors: Do not use sildenafil with tadalafil, vardenafil, or avanafil. Taking multiple PDE5 inhibitors together increases the risk of serious side effects.
• Blood pressure medications: Sildenafil may add to the blood pressure-lowering effects of antihypertensive drugs.

Before Starting Treatment

Before taking sildenafil, inform your healthcare provider if you:

• Have heart disease, a history of heart attack, or irregular heartbeat
• Have high or low blood pressure
• Have a history of stroke
• Have liver or kidney problems
• Have a blood disorder such as sickle cell anemia, multiple myeloma, or leukemia
• Have a bleeding disorder or active peptic ulcer
• Have a physical deformity of the penis
• Have retinitis pigmentosa or a history of vision problems
• Take any medications for blood pressure or prostate conditions

How to Use This Medication

Sildenafil is taken by mouth as a tablet, typically 30 to 60 minutes before sexual activity. It can be taken with or without food, though a high-fat meal may delay the onset of effects. The recommended starting dose is determined by your provider based on your health profile. Do not take more than one dose in a 24-hour period. The effects of sildenafil typically last four to six hours. Alcohol may increase the risk of side effects such as dizziness and low blood pressure, so limit alcohol consumption when taking this medication. Store at room temperature, away from moisture and heat.