Sildenafil Citrate interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Additive hypotensive effects may occur when phosphodiesterase-5 (PDE5) inhibitors are used with alcohol, as both are mild systemic vasodilators.

  What to do: Patients taking PDE5 inhibitors should avoid consuming large amounts of alcohol, which may increase the potential for orthostatic signs and symptoms including increase in heart rate, decrease in standing blood pressure, dizziness, and headache.

  5 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. "Product Information. Stendra (avanafil)." Vivus Inc (2012):

• grapefruit juice

  Moderate

  Metabolism

  Coadministration with grapefruit juice may slightly increase the oral bioavailability and delay the onset of action of sildenafil. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

  What to do: It may be advisable to avoid administration of sildenafil with grapefruit juice to prevent potential toxicity and delay in onset of action.

  1 source

  1. Jetter A, Kinzig-Schippers M, Walchner-Bonjean M, et al. "Effects of grapefruit juice on the pharmacokinetics of sildenafil." Clin Pharmacol Ther 71 (2002): 21-29

Conditions

Conditions in which Sildenafil Citrate needs care, as documented in this source.

• Cardiovascular Diseases

  Major

  The use of phosphodiesterase-5 (PDE5) inhibitors is not recommended in patients with preexisting cardiovascular disease for whom sexual activity is inadvisable due to the potential cardiac risk. Physicians should also consider the vasodilatory effect of these drugs and whether they may adversely affect patients with underlying cardio- and/or cerebrovascular conditions, in particular those who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months; those with resting hypotension (BP < 90/50) or hypertension (BP > 170/110); and those with unstable angina associated with cardiac failure or coronary artery disease. There are no controlled clinical data on the safety or efficacy in such patients. Other adverse cardiovascular effects reported include angina pectoris, myocardial infarction, AV block, ventricular arrhythmia, tachycardia, palpitation, hypotension, postural hypotension, syncope, cerebral thrombosis, cerebrovascular hemorrhage, transient ischemic attack, cardiac arrest, heart failure, and hypertension. Many of these events occurred in patients with cardiovascular risk factors and during or shortly after sexual activity.

  19 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. Feenstra J, vanDriePierik RJHM, Lacle CF, Stricker BHC "Acute myocardial infarction associated with sildenafil." Lancet 352 (1998): 957-8
  3. Goldenberg MM "Safety and efficacy of sildenafil citrate in the treatment of male erectile dysfunction." Clin Ther 20 (1998): 1033-48
  4. Zusman RM "Cardiovascular data on sildenafil citrate - Introduction." Am J Cardiol 83 (1999): c1-2
  5. Conti CR, Pepine CJ, Sweeney M "Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease." Am J Cardiol 83 (1999): c29-34
  6. Zusman RM, Morales A, Glasser DB, Osterloh IH "Overall cardiovascular profile of sildenafil citrate." Am J Cardiol 83 (1999): c35-44
  7. Montorsi F, McDermott TED, Morgan R, Olsson A, Schultz A, Kirkeby HJ, Osterloh IH "Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies." Urology 53 (1999): 1011-8
  8. Kloner RA, Zusman RM "Cardiovascular effects of sildenafil citrate and recommendations for its use." Am J Cardiol 84 (1999): n11-7

  Show all 19 sourcesShow fewer sources

  9. Awan GM, Calderon E, Dawood G, Alpert MA "Acute, symptomatic atrial fibrillation after sildenafil citrate therapy in a patient with hypertrophic obstructive cardiomyopathy." Am J Med Sci 320 (2000): 69-71
  10. Kloner RA "Cardiovascular risk and sildenafil." Am J Cardiol 86 (2000): f57-61
  11. Moreira SG, Brannigan RE, Spitz A, Orejuela FJ, Lipshultz LI, Kim ED "Side-effect profile of sildenafil citrate (Viagra) in clinical practice." Urology 56 (2000): 474-6
  12. McMahon CG, Smali R, Johnson H "Efficacy, safety and patient acceptance of sildenafil citrate as treatment for erectile dysfunction." J Urol 164 (2000): 1192-6
  13. Malozowski S, Sahlroot JT "Hemodynamic effects of sildenafil." N Engl J Med 343 (2000): 967-8
  14. Dunn N "Cardiovascular events in users of sildenafil - Paper does not provide any reassurance." Br Med J 323 (2001): 50-1
  15. "Product Information. Levitra (vardenafil)." Bayer (2003):
  16. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  17. Curran M, Keating G "Tadalafil." Drugs 63 (2003): 2203-12; discussion 2213-4
  18. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  19. "Product Information. Stendra (avanafil)." Vivus Inc (2012):

• Kidney Diseases

  Major

  The plasma clearance of phosphodiesterase-5 (PDE5) inhibitors may be decreased in patients with severe renal impairment, resulting in drug accumulation. Therapy with these agents should be avoided in patients with severe renal disease or on renal dialysis. Dose adjustments might be needed based on individual renal assessment and tolerability if used in these patients.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Lung Diseases

  Major

  Sildenafil injection for the treatment of pulmonary arterial hypertension (PAH) should not be used in patients with pulmonary veno-occlusive disease (PVOD) as it may significantly worsen the cardiovascular status of these patients. If signs of pulmonary edema develop during therapy, the possibility of associated PVOD should be considered.

  2 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):

• Alcoholism

  Moderate

  Alcohol consumption may intensify the pressure-lowering effects of mild vasodilators, such as phosphodiesterase 5 (PDE5) inhibitors. Therefore, patients that consume alcohol should be warned to limit alcohol intake while receiving these agents.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Epilepsy

  Moderate

  The use of phosphodiesterase 5 (PDE-5) inhibitors has been associated with seizures. Therapy with these agents should be administered cautiously in patients with preexisting seizure disorders.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Hearing Loss

  Moderate

  Use of phosphodiesterase-5 (PDE5) inhibitors has been associated with sudden decrease or loss of hearing, which may be accompanied by tinnitus or dizziness. Patients with hearing problems should stop taking these agents and seek prompt medical care.

  7 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Levitra (vardenafil)." Bayer (2003):
  3. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  4. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  5. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  6. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  7. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Liver Diseases

  Moderate

  Phosphodiesterase 5 (PDE-5) inhibitors are cleared predominantly by hepatic metabolism. The pharmacokinetic disposition of these agents has not been assessed in patients with severe hepatic impairment. No dosage modification is recommended for patients with mild to moderate hepatic impairment, however, therapy with these agents should not be administered to patients with severe hepatic impairment. In patients with mild hepatic impairment a lower dose of these agents should be used as initial therapy.

  5 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  3. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  4. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  5. "Product Information. Stendra (avanafil)." Vivus Inc (2012):

• Priapism

  Moderate

  Prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours) have been reported during treatment with phosphodiesterase-5 (PDE 5) inhibitors. Priapism may result in penile tissue damage and permanent loss of potency if not treated promptly. These agents should be used cautiously in patients with conditions that may predispose them to priapism such as sickle cell anemia, multiple myeloma, or leukemia, and those with anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie's disease). If an erection persists longer than 4 hours, the patient should seek immediate medical assistance.

  8 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. Kassim AA, Fabry ME, Nagel RL "Acute priapism associated with the use of sildenafil in a patient with sickle cell trait." Blood 95 (2000): 1878-9
  3. "Product Information. Levitra (vardenafil)." Bayer (2003):
  4. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  5. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  6. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  7. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  8. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

• Retinitis Pigmentosa

  Moderate

  Phosphodiesterase-5 (PDE5) inhibitors have been associated with transient impairment of color discrimination (blue/green) and blue- or color-tinged vision. These agents also inhibit phosphodiesterase-6 (PDE6), to a much lesser extent, which is involved in phototransduction in the retina. There are no controlled clinical data on the safety in patients with retinitis pigmentosa, a minority of whom may have genetic disorders of retinal phosphodiesterases. Therapy with these agents should be avoided in such patients.

  15 sources

  1. "Product Information. Viagra (sildenafil)." Pfizer U.S. Pharmaceuticals (2001):
  2. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA "Oral sildenafil in the treatment of erectile dysfunction." N Engl J Med 338 (1998): 1397-404
  3. Goldenberg MM "Safety and efficacy of sildenafil citrate in the treatment of male erectile dysfunction." Clin Ther 20 (1998): 1033-48
  4. Zrenner E "No cause for alarm over retinal side-effects of sildenafil." Lancet 353 (1999): 340-1
  5. Vobig MA, Klotz T, Staak M, BartzSchmidt KU, Engelmann U, Walter P "Retinal side-effects of sildenafil." Lancet 353 (1999): 375
  6. Marmor MF "Sildenafil (Viagra) and ophthalmology." Arch Ophthalmol 117 (1999): 518-9
  7. Montorsi F, McDermott TED, Morgan R, Olsson A, Schultz A, Kirkeby HJ, Osterloh IH "Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies." Urology 53 (1999): 1011-8
  8. Vobig MA "Retinal side-effects of sildenafil." Lancet 353 (1999): 1442

  Show all 15 sourcesShow fewer sources

  9. McMahon CG, Smali R, Johnson H "Efficacy, safety and patient acceptance of sildenafil citrate as treatment for erectile dysfunction." J Urol 164 (2000): 1192-6
  10. "Product Information. Levitra (vardenafil)." Bayer (2003):
  11. "Product Information. Cialis (tadalafil)." Lilly, Eli and Company (2003):
  12. "Product Information. Revatio (sildenafil)." Pfizer U.S. Pharmaceuticals Group (2005):
  13. "Product Information. Adcirca (tadalafil)." United Therapeutics Corporation (2009):
  14. "Product Information. Stendra (avanafil)." Vivus Inc (2012):
  15. "Product Information. Staxyn (vardenafil)." Merck & Co., Inc (2014):

Therapeutic duplication

Drug classes that overlap with Sildenafil Citrate, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• agents for pulmonary hypertensio

  The recommended maximum number of medicines in the 'agents for pulmonary hypertension' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'agents for pulmonary hypertension' category.

  Example product in the source data (US market): Finasteride/tadalafil