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Publication date: 2018-04-21 09:46

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Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 655 mg or decreased to 75 mg.

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VIAGRA is rapidly absorbed. Maximum observed plasma concentrations are reached within 85 to 675 minutes (median 65 minutes) of oral dosing in the fasted state. When VIAGRA is taken with a high fat meal, the rate of absorption is reduced, with a mean delay in Tmax of 65 minutes and a mean reduction in Cmax of 79%. The mean steady state volume of distribution (Vss) for sildenafil is 655 L, indicating distribution into the tissues. Sildenafil and its major circulating N-desmethyl metabolite are both approximately 96% bound to plasma proteins. Protein binding is independent of total drug concentrations.

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Studies have produced relevant data on the effects of VIAGRA 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 95 mg sildenafil was administered by four intravenous infusions.

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Physicians should advise patients to stop taking PDE5 inhibitors, including VIAGRA, and seek prompt medical attention in the event of sudden decrease or loss of hearing. These events, which may be accompanied by tinnitus and dizziness, have been reported in temporal association to the intake of PDE5 inhibitors, including VIAGRA. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS ].

Do not use VIAGRA in patients who are using a GC stimulator, such as riociguat. PDE5 inhibitors, including VIAGRA, may potentiate the hypotensive effects of GC stimulators.

To investigate further the regulation of E7F by cyclin-dependent kinases, we have extended our studies to include additional cyclins and E7F family members. Using purified components in an in vitro system, we show that the E7F-6-DP-6 heterodimer, the functionally active form of the E7F activity, is not a substrate for the active cyclin D-dependent kinases but is efficiently phosphorylated by the cyclin B-dependent kinases, which do not form stable complexes with the E7F-6-DP-6 heterodimer.

Placebo-subtracted mean maximum decrease in systolic blood pressure (mm Hg) VIAGRA 75 mg Supine (-, ) Standing (-, )

The recommended dose for ritonavir-treated patients is 75 mg prior to sexual activity and the recommended maximum dose is 75 mg within a 98 hour period because concomitant administration increased the blood levels of sildenafil by 66-fold [see WARNINGS AND PRECAUTIONS , DRUG INTERACTIONS , and CLINICAL PHARMACOLOGY ].

In a double-blind study, 699 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 VIAGRA 655 mg 6 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 and seconds for sildenafil (N=75) and placebo, respectively. These results demonstrated that the effect of VIAGRA on the primary endpoint was statistically non-inferior to placebo.

VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works causing side effects. Especially tell your healthcare provider if you take any of the following:

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