Sildenafil (AKA Viagra®) for Men

How should this medicine be used?

Sildenafil comes as a tablet or gummy to take orally. If you are taking sildenafil to treat erectile dysfunction, follow your provider’s directions and the guidelines. Take sildenafil as needed before sexual activity. The best time to take sildenafil is about 30 min before sexual activity. Sildenafil usually should not be taken more than once every 24 hours. If you have certain health conditions or are taking certain medications, your provider may tell you to take sildenafil less often. You should take sildenafil without food. If you are taking sildenafil for erectile dysfunction, your provider will probably start you on an average dose of sildenafil and increase or decrease your dose depending on your response to the medication. Tell your provider if sildenafil is not working well or if you are experiencing side effects.

What special precautions should I follow?

Before taking sildenafil, tell your provider if you are allergic to sildenafil, any other medications, or any of the ingredients in sildenafil products. Ask your provider for a list of the ingredients if you are allergic to any medications.

Other precautions:

• do not take sildenafil if you are taking or have recently taken riociguat (Adempas) or nitrates (medications for chest pain) such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others). Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your provider if you are not sure whether any of your medications contain nitrates.
• do not take street drugs containing nitrates such as amyl nitrate and butyl nitrate (‘poppers’) while taking sildenafil.
• tell your provider what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax, in Jalyn), and terazosin; amlodipine (Norvasc, in Amturnide, in Tekamlo); certain antifungals such as itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral); anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven); certain barbiturates such as butalbital (in Butapap, in Fioricet, in Fiorinal, others) and secobarbital (Seconal); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal LA, InnoPran); bosentan (Tracleer); cimetidine ; efavirenz (Sustiva, in Atripla); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors including amprenavir (Agenerase; no longer available in the U.S.), atazanavir (Reyataz, in Evotaz), darunavir (Prezista, in Prezcobix), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), and tipranavir (Aptivus); nevirapine (Viramune); other medications or devices to treat erectile dysfunction; medications for high blood pressure; certain medications for seizures including carbamazepine (Carbatrol, Epitol, Tegretol, others), phenobarbital, and phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane, in Rifamate, in Rifater). Your provider may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with sildenafil, so be sure to tell your provider about all the medications you are taking, even those that do not appear on this list.
• tell your provider what herbal products you are taking or plan to take, especially St. John’s wort.
• tell your provider if you smoke, if you have ever had an erection that lasted for several hours, and if you have recently lost a large amount of body fluids (dehydration). This can happen if you are sick with fever, diarrhea, or vomiting; sweat a lot; or do not drink enough liquids. Also tell your provider if you have or have ever had pulmonary veno-occlusive disease (PVOD; blockage of veins in the lungs); a stomach ulcer; heart, kidney, or liver disease; a heart attack; an irregular heartbeat; a stroke; chest pain; high or low blood pressure; high cholesterol; a bleeding disorder; blood circulation problems;blood cell problems such as sickle cell anemia (a disease of the red blood cells), multiple myeloma (cancer of the plasma cells), or leukemia (cancer of the white blood cells); conditions affecting the shape of the penis (e.g., angulation, cavernosal fibrosis, or Peyronie’s disease); or diabetes. Also tell your provider if you or any of your family members have or have ever had an eye disease such as retinitis pigmentosa (an inherited eye condition that causes loss of vision) or if you have ever had sudden severe vision loss, especially if you were told that the vision loss was caused by a blockage of blood flow to the nerves that help you see.
• if you are taking sildenafil to treat erectile dysfunction, tell your provider if you have ever been advised by a healthcare professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity. Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain, dizziness, or nausea during sexual activity, call your provider immediately and avoid sexual activity until your provider tells you otherwise.
• tell all your healthcare providers and dentists that you are taking sildenafil. If you ever need emergency medical treatment for a heart problem, the healthcare providers who treat you will need to know when you last took sildenafil.

What special dietary instructions should I follow?

Talk to your provider about eating grapefruit and drinking grapefruit juice while taking this medicine.

What side effects can this medication cause?

Sildenafil may cause side effects. Tell your provider if any of these symptoms are severe or do not go away:

• headache
• heartburn
• diarrhea
• flushing (feeling of warmth)
• nosebleeds
• difficulty falling asleep or staying asleep
• numbness, burning, or tingling in the arms, hands, feet, or legs
• muscle aches

Some side effects can be serious. If you experience any of the following symptoms, call your provider immediately:

• sudden severe loss of vision (see below for more information)
• blurred vision
• sudden decrease or loss of hearing
• ringing in ears
• dizziness or lightheadedness
• fainting
• chest pain
• worsening shortness of breath
• erection that is painful or lasts longer than 4 hours
• itching or burning during urination
• rash

Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil. The vision loss was permanent in some cases. It is not known if the vision loss was caused by the medication. If you experience a sudden loss of vision while you are taking sildenafil, call your provider immediately. Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your provider.

Some patients experienced a sudden decrease or loss of hearing after they took sildenafil or other medications that are similar to sildenafil. The hearing loss usually involved only one ear and did not always improve when the medication was stopped. It is not known if the hearing loss was caused by the medication. If you experience a sudden loss of hearing, sometimes with ringing in the ears or dizziness, while you are taking sildenafil, call your provider immediately. If you are taking sildenafil for erectile dysfunction, do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your provider. Sildenafil may cause other side effects. Call your provider if you have any unusual problems while you are taking this medication.

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension at room temperature or in a refrigerator, but do not freeze it. Dispose of any unused suspension after 60 days.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information, if you do not have access to a take-back program.

What other information should I know?

• Keep all appointments with your provider.
• Do not let anyone else take your medication. Ask your provider any questions you have about refilling your prescription.
• Do not take more than the prescribed dose.
• It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a provider or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

It is important that you continue to see your regular medical provider for your usual routine health maintenance. We are not replacing your medical provider.