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Also sildenafil citrate 20 mg reviews has been used in women with sildenafil citrate 20 mg reviews sexual dysfunction induced by ssri antidepressants and in women with neurogenic sexual dysfunction (e.g., due to spinal cord injury or multiple sclerosis however, data limited. 227 228, symptomatic management of PAH (WHO group 1 pulmonary hypertension) to improve exercise capacity and delay clinical worsening. Parenteral preparation used for continued treatment in patients with PAH who are temporarily unable to take oral medication. 203 Efficacy established principally in patients with nyha/WHO functional class iiiii PAH (idiopathic or associated with connective tissue diseases). Recommended as one of several treatment options for initial management of PAH in patients with nyha/WHO functional class II, III, or IV symptoms who are not candidates for calcium-channel blocker therapy or in whom such therapy has failed. 242 Individualize choice of therapy; consider factors such as disease severity, route of administration, potential adverse effects and costs of treatment, clinician experience, and patient preference. 242 245 In patients with inadequate response to initial monotherapy, may consider combination therapy with a prostanoid or endothelin-receptor sildenafil citrate 20 mg reviews antagonist (added sequentially). 242 By targeting different pathophysiologic pathways of the disease, such combination therapy may provide additive and/or synergistic benefits. Because increased mortality has been observed in children receiving higher (more effective) dosages of sildenafil, FDA currently does not recommend use of the drug in patients 18 years of age. 203 233 (See Pediatric Use under Cautions.) Whether long-term sildenafil therapy has a beneficial effect on mortality in adults remains to be established. Administer orally about 1 hour (range: 4 hours to 30 minutes) before sexual activity. Administration with a high-fat meal may delay the onset of action. Administer orally (as tablets or oral suspension) without regard to meals. 203 208 If a dose is missed, take missed dose as soon as it is remembered, then resume regular dosing schedule; do not double dose to replace missed dose. 229 To reconstitute powder for oral suspension, tap bottle to release the powder. 203 Add 60 mL of water to the bottle; recap and shake vigorously for at least 30 seconds. 203 Add another 30 mL to bottle, recap and shake for at least 30 seconds; add a total of 90 mL of water to the bottle regardless of dose. 203 The reconstituted suspension (112 mL) contains sildenafil 10 mg/mL. 203 Use provided bottle adapter to fill 2-mL oral syringe (with.5- and 2-mL dose markings) with the reconstituted suspension. 203 May administer by direct IV injection in patients who temporarily cannot take oral medication. 203 Initially, 50 mg as a single dose no more than once daily. Depending on effectiveness and tolerance, increase dosage to a maximum of 100 mg once daily or decrease to 25 mg once daily. Dosages up to 80 mg 3 times daily not more effective than recommended dosage of 20 mg 3 times daily. Mild to moderate hepatic impairment (Child-Pugh class A or B No dosage adjustments necessary. 203 No dosage adjustment needed, even with severe impairment (Clcr 30 mL/minute). 203 Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. 203 Use with caution in the treatment of ED in patients with a recent (within 6 months) MI, stroke, or life-threatening arrhythmia; in patients with resting hypotension (BP 90/50 mm sildenafil tablets 100mg Hg) or hypertension (BP 170/110 mm Hg or in patients with cardiac failure or CAD. Assess cardiovascular and cerebrovascular status (including use of organic nitrates and nitrites) prior to initiating therapy. Symptomatic hypotension may occur in patients receiving concomitant adrenergic blocking agents; hypotension may be severe or fatal in patients receiving an organic nitrate or nitrite concomitantly. (See Specific Drugs under Interactions.) Consider whether patients with underlying cardiovascular disease (e.g., severe left ventricular outflow obstruction, autonomic dysfunction, resting hypotension BP 90/50 mm Hg, fluid depletion) could be adversely affected by sildenafils vasodilatory activity, 203 especially in combination with sexual activity. Use not recommended in patients with pulmonary veno-occlusive disease.
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