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Viagrasildenafilrelaxes muscles found in the walls of blood vessels and increases blood flow to particular areas of the body.

When VIAGRA is co-administered with an alpha-blockerpatients should be stable on alpha-blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at 25 mgsee WARNINGS AND PRECAUTIONSDRUG INTERACTIONSand CLINICAL PHARMACOLOGY

Take VIAGRA exactly as your healthcare provider tells you to take itYour healthcare provider will tell you how much VIAGRA to take and when to take itYour healthcare provider may change your dose if neededTake VIAGRA about 1 hour before sexual activityYou may take VIAGRA between 30 minutes to 4 hours before sexual activity if neededVIAGRA can be taken with or without foodIf you take VIAGRA after a high fat mealsuch as a cheeseburger and french friesVIAGRA may take a little longer to start working Do not take VIAGRA more than 1 time a dayIf you accidentally take too much VIAGRAcall your doctor or go to the nearest hospital emergency room right away.

Although the interaction between other protease inhibitors and sildenafil has not been studiedtheir concomitant use is expected to increase sildenafil levels.

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Do not use VIAGRA in patients who are using a GC stimulatorsuch as riociguatPDE5 inhibitorsincluding VIAGRAmay potentiate the hypotensive effects of GC stimulators.

Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics of CYP2C9 inhibitorssuch as tolbutamidewarfarinCYP2D6 inhibitorssuch as selective serotonin reuptake inhibitorstricyclic antidepressantsthiazide and related diureticsACE inhibitorsand calcium channel blockersThe AUC of the active metaboliteN-desmethyl sildenafilwas increased 62by loop and potassium-sparing diuretics and 102by nonspecific beta-blockersThese effects on the metabolite are not expected to be of clinical consequence.

Cardiovascularsee WARNINGS AND PRECAUTIONSProlonged Erection and Priapismsee WARNINGS AND PRECAUTIONSEffects on the Eyesee WARNINGS AND PRECAUTIONSHearing Losssee WARNINGS AND PRECAUTIONSHypotension when Co-administered with Alpha-blockers or Anti-hypertensivessee WARNINGS AND PRECAUTIONSAdverse Reactions with the Concomitant Use of Ritonavirsee WARNINGS AND PRECAUTIONSCombination with other PDE5 Inhibitors or Other Erectile Dysfunction Therapiessee WARNINGS AND PRECAUTIONSEffects on Bleedingsee WARNINGS AND PRECAUTIONSCounseling Patients About Sexually Transmitted Diseasessee WARNINGS AND PRECAUTIONS

Sildenafil is cleared predominantly by the CYP3A4major routeand CYP2C9minor routehepatic microsomal isoenzymesThe major circulating metabolite results from N-desmethylation of sildenafiland is itself further metabolizedThis metabolite has a PDE selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50of the parent drugPlasma concentrations of this metabolite are approximately 40of those seen for sildenafilso that the metabolite accounts for about 20of sildenafil’s pharmacologic effects.

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