En DE FR ES PL
Sildenafil - instructions for use, analogs, reviews and release forms (tablets 25 mg, 50 mg and 100 mg) of the drug for the treatment of impotence, increased erection and increased libido in men and women. Composition

Sildenafil - instructions for use, analogs, reviews and release forms (tablets 25 mg, 50 mg and 100 mg) of the drug for the treatment of impotence, increased erection and increased libido in men and women. Composition

In this article, you can read the instructions for using the drug Sildenafil. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Sildenafil in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Sildenafil analogs in the presence of existing structural analogues. Use to treat impotence, increase erection and increase libido in men and women.Composition of the preparation.

 

Sildenafil - powerful selective inhibitor of cyclo-guanosine monophosphate (cGMP) -specific phosphodiesterase type 5 (PDE-5).

 

Mechanism of action

 

The realization of the physiological mechanism of erection is associated with the release of nitric oxide (NO) in the cavernous body during sexual stimulation. This, in turn, leads to an increase in the level of cGMP, subsequent relaxation of the smooth muscle tissue of the cavernous body and an increase in blood flow.

 

Sildenafil does not have a direct relaxing effect on an isolated cavernous human body, but enhances the effect of nitric oxide (NO) by inhibiting PDE5, which is responsible for the degradation of cGMP.

 

Sildenafil is selective for PDE5, its activity against PDE5 is higher than that of other known isoenzymes of phosphodiesterase: PDE6 - 10-fold; FDE1 - more than 80 times; PDE2, PDE4, PDE7-PDE11 - more than 700 times. Sildenafil is 4000 times more selective for PDE5 than FDES, which is of paramount importance, since FDEZ is one of the key enzymes in the regulation of myocardial contractility.

 

A mandatory condition for the effectiveness of sildenafil is sexual stimulation.

 

Clinical data

 

Cardiac examinations

 

The use of sildenafil in doses up to 100 mg did not lead to clinically significant changes in the ECG in healthy volunteers. The maximum decrease in systolic pressure in the supine position after taking sildenafil in a dose of 100 mg was 8.3 mm Hg. and diastolic pressure is 5.3 mm Hg. Art. A more pronounced, but also transient, effect on blood pressure was noted in patients taking nitrates.

 

In a study of the hemodynamic effect of sildenafil in a single dose of 100 mg in 14 patients with severe ischemic heart disease (more than 70% of patients had stenosis of at least one coronary artery), systolic and diastolic resting pressure decreased by 7% and 6% respectively, and pulmonary systolic pressure decreased by 9%. Sildenafil had no effect on cardiac output and did not interfere with blood flow in the stenotic coronary arteries, and also led to an increase (approximately 13%) of adenosine-induced coronary flow in both stenotic and intact coronary arteries.

 

In a double-blind, placebo-controlled study, 144 patients with erectile dysfunction and stable angina treated with antianginal drugs (except nitrates) were exercising until the angina symptom severity decreased.The duration of the exercise was significantly longer (19.9 seconds, 0.9 - 38.9 seconds) in patients taking sildenafil in a single dose of 100 mg compared to patients receiving a placebo.

 

In a randomized, double-blind, placebo-controlled study, the effect of changing the dose of sildenafil (up to 100 mg) in men (n = 568) with erectile dysfunction and hypertension taking more than two antihypertensive drugs was studied. Sildenafil improved erection in 71% of men compared with 18% in the placebo group. The incidence of adverse effects was comparable to that in the other groups of patients, as well as those taking more than three antihypertensive drugs.

 

Research of visual disorders

 

In some patients, an easy and transient impairment in the ability to distinguish between shades of color (blue / green) was detected 1 hour after taking 100 mg of sildenafil with the Farnsworth-Munssel test 100. After 2 hours after taking the drug, these changes were absent. It is believed that the violation of color vision is caused by the inhibition of PDE6, which is involved in the transmission of light in the retina of the eye.Sildenafil had no effect on visual acuity, contrast perception, electro-retinogram, intraocular pressure, or pupil diameter.

 

In a placebo-controlled, cross-sectional study of patients with proven early age macular degeneration (n = 9), sildenafil in a single dose of 100 mg was tolerated well. There were no clinically significant visual changes assessed by special visual tests (visual acuity, Amsler grating, color perception, color flow modeling, Humphrey perimeter and photostress).

 

Efficiency

 

The efficacy and safety of sildenafil was evaluated in 21 randomized, double-blind, placebo-controlled studies of up to 6 months in 3000 patients aged 19 to 87, with erectile dysfunction of different etiology (organic, psychogenic or mixed). The effectiveness of the drug was assessed globally using the diary of erections, the international index of erectile function (validated questionnaire on the status of sexual function), and a partner survey.

 

The effectiveness of sildenafil, defined as the ability to achieve and maintain an erection,sufficient for a satisfactory sexual intercourse, was demonstrated in all studies conducted and was confirmed in long-term studies lasting 1 year. In studies using a fixed dose, the ratio of patients who reported that the therapy improved their erection was 62% (a dose of sildenafil 25 mg), 74% (a dose of sildenafil 50 mg) and 82% (a dose of sildenafil 100 mg) compared to 25% in the placebo group. Analysis of the international index of erectile function showed that, in addition to improving erection, sildenafil treatment also increased the quality of orgasm, allowing satisfaction from sexual intercourse and general satisfaction.

 

According to generalized data, 59% of patients with diabetes, 43% of patients who underwent radical prostatectomy and 83% of patients with spinal cord injuries (against 16%, 15% and 12% in the placebo group, respectively) were among the patients who reported improvement in erectile dysfunction with sildenafil. ).

 

Composition

 

Sildenafil citrate + excipients.

 

Pharmacokinetics

 

The pharmacokinetics of sildenafil in the recommended dose range is linear.

 

Suction

 

After ingestion, sildenafil is rapidly absorbed. Absolute bioavailability averages about 40% (from 25% to 63%). Sildenafil at a concentration of about 1.7 ng / ml (3.5 nM) suppresses human PDE5 activity by 50%. When taken in combination with fatty foods, the suction rate decreases: Cmax decreases by an average of 29%, and TCmax increases by 60 minutes, but the degree of absorption does not change significantly (the area under the pharmacokinetic concentration-time curve (AUC) decreases by 11%).

 

Distribution

 

The volume of distribution of sildenafil in the equilibrium state averages 105 liters. The association of sildenafil and its main circulating N-demethyl metabolite with plasma proteins is about 96% and does not depend on the total drug concentration. Less than 0.0002% of the dose of sildenafil (an average of 188 ng) was found in the sperm 90 minutes after taking the drug.

 

Metabolism

 

Sildenafil is metabolized mainly in the liver under the action of the cytochrome CYP3A4 isoenzyme (main pathway) and the cytochrome isoenzyme CYP2C9 (minor pathway). The main circulating active metabolite, formed as a result of N-demethylation of sildenafil, undergoes further metabolism.The selectivity of this metabolite against PDE is comparable to that of sildenafil, and its activity in relation to PDE5 in vitro is about 50% of the activity of sildenafil. The concentration of the metabolite in the blood plasma of healthy volunteers was about 40% of the concentration of sildenafil. N-demethyl metabolite undergoes further metabolism; T1 / 2 is about 4 hours.

 

Excretion

 

After oral administration, as well as after intravenous administration, sildenafil is excreted as metabolites, mainly by the intestine (about 80% of the oral dose) and, to a lesser extent, by the kidneys (about 13% of the oral dose).

 

Pharmacokinetics in specific patient groups

 

Elderly patients

 

In healthy elderly patients (over 65 years), the clearance of sildenafil is reduced, and the concentration of free sildenafil in blood plasma is approximately 40% higher than in young (18-45 years). Age does not have a clinically significant effect on the incidence of side effects.

 

Renal impairment

 

In mild (creatinine clearance 50 to 80 ml / min) and moderate (KK 30-49 ml / min) degree of renal insufficiency, the pharmacokinetics of sildenafil after single ingestion at a dose of 50 mg does not change.In severe renal failure (CK less than 30 ml / min), the clearance of sildenafil decreases, which leads to an approximately two-fold increase in AUC (100%) and Cmax (88%), compared with those for normal kidney function in patients of the same age group.

 

Dysfunction of the liver

 

In patients with cirrhosis of the liver (stages A and B according to the Child-Pugh classification), the clearance of sildenafil decreases, which leads to an increase in AUC (84%) and Stach (47%), compared with those for normal liver function in patients of the same age group. The pharmacokinetics of sildenafil in patients with severe impairment of liver function (Stage C according to the Child-Pugh classification) has not been studied.

 

Indications

  • treatment of erectile dysfunction characterized by inability to achieve or maintain an erection penis sufficient for a satisfactory sexual intercourse;
  • pulmonary hypertension.

 

Sildenafil is effective only with sexual stimulation.

 

Forms of release

 

Tablets coated with 25 mg, 50 mg and 100 mg.

 

Instructions for use and reception scheme

 

Inside.

 

The recommended dose for most adult patients is 50 mg about 1 hour before sexual activity. With regard to efficacy and tolerability, the dose can be increased to 100 mg or reduced to 25 mg.The maximum recommended dose is 100 mg. The maximum recommended frequency of application is once a day.

 

Joint use with other drugs

 

When combined with ritonavir, the maximum single dose of Sildenafil should not exceed 25 mg, and the frequency of application is 1 every 48 hours.

 

When combined with cytochrome CYP3A4 isozyme inhibitors (erythromycin, saquinavir, ketoconazole, itraconazole), the initial dose of Sildenafil should be 25 mg. To minimize the risk of postural hypotension in patients taking alpha-adrenoblockers, the use of Sildenafil should be started only after hemodynamic stabilization has been achieved in these patients. It should also consider the desirability of reducing the initial dose of sildenafil.

 

Elderly patients

 

Correction of the dose of Sildenafil is not required.

 

Side effect

  • headache;
  • vasodilation (tides of blood to the skin of the face);
  • dizziness;
  • visual impairment (blurred vision, violation of color vision);
  • chromatopsy (light and transient, mainly changing the perception of color shades);
  • cardiopalmus;
  • rhinitis (nasal congestion);
  • dyspepsia;
  • diarrhea;
  • swelling of the face;
  • shock;
  • asthenia;
  • chills;
  • abdominal pain;
  • chest pain;
  • reactions of hypersensitivity (including skin rash);
  • Stevens-Johnson syndrome;
  • toxic epidermal necrolysis (Lyell's syndrome);
  • drowsiness;
  • insomnia;
  • neuralgia;
  • Neuropathy;
  • tremor;
  • depression;
  • unusual dreams;
  • decreased reflexes;
  • stroke;
  • transient ischemic attack;
  • convulsions, incl. recurrent;
  • tachycardia;
  • increase or decrease in blood pressure;
  • myocardial infarction;
  • atrial fibrillation;
  • ventricular arrhythmia;
  • unstable angina;
  • AV blockade;
  • thrombosis of cerebral vessels;
  • heart failure;
  • ECG disorders;
  • cardiomyopathy;
  • sudden death;
  • fainting;
  • nose bleed;
  • asthma;
  • dyspnea;
  • laryngitis;
  • pharyngitis;
  • sinusitis;
  • bronchitis;
  • increased sputum production;
  • increased cough;
  • vomiting, nausea;
  • dryness of the oral mucosa;
  • glossitis;
  • colitis;
  • dysphagia;
  • gastritis;
  • gastroenteritis;
  • esophagitis;
  • stomatitis;
  • rectal bleeding;
  • gingivitis;
  • Pain in the eyes;
  • redness of the eyes / injection sclera;
  • occlusion of the vessels of the retina;
  • defects in the fields of vision;
  • cataract;
  • Pain in the eyes;
  • vertigo;
  • noise in ears;
  • ear pain;
  • deafness;
  • anemia, leukopenia;
  • gout;
  • unstable diabetes;
  • hyperglycemia;
  • peripheral edema;
  • arthritis;
  • arthrosis;
  • myalgia;
  • rupture of tendons;
  • tenosynovitis;
  • pain in the bones;
  • myasthenia gravis;
  • synovitis;
  • hives;
  • herpes simplex;
  • itching;
  • sweating;
  • skin ulcers;
  • contact dermatitis;
  • exfoliative dermatitis;
  • cystitis;
  • frequent urination;
  • gynecomastia;
  • urinary incontinence;
  • violation of ejaculation;
  • swelling of the genital organs;
  • anorgasmia;
  • prolonged erection and / or priapism.

 

Contraindications

  • hypersensitivity to sildenafil or to any other component of the drug;
  • use in patients receiving continuous or intermittent donators of nitric oxide, organic nitrates or nitrites in any form, since sildenafil enhances the hypotensive effect of nitrates;
  • safety and efficacy of Sildenafil in combination with other treatments for erectile dysfunction have not been studied, so the use of such combinations is not recommended;
  • according to the registered indication, Sildenafil is not intended for use in children under 18 years of age;
  • deficiency of lactase, lactose intolerance, glucose-galactose malabsorption;
  • It is not recommended simultaneous use of sildenafil with ritonavir.

 

Use in children

 

Contraindicated in children and adolescents under the age of 18 years.

 

Application in elderly patients

 

Correction of the dose of Sildenafil is not required.

 

Application in Women

 

Sildenafil is also used today to treat sexual disorders in women (the so-called "women's Viagra"). The drug is effective for stimulating sexual arousal even during menopause (menopause) or after the operation of removing the uterus.

 

To date, Sildenafil has the following effects when applied by women:

  • increases sexual desire and increases libido;
  • strengthens sensuality;
  • reduces the time needed to achieve good sexual arousal;
  • strengthens the production of vaginal lubrication;
  • improves blood flow in the pelvic organs;
  • strengthens sensations from caresses, touches and the most sexual act;
  • makes an orgasm long;
  • eliminates frigidity;
  • strengthens libido in elderly women;
  • increases endurance while making love.

 

Sildenafil acts on the female body in a complex way, because, in addition to enhancing the natural sexual arousal, the drug stimulates the appearance of the desire for the proximity of a man. Increased blood flow in the pelvic organs, as well as in the female genitalia under the influence of Sildenafil, leads to the fact that the erogenous zones become more sensitive, and the sensations during sex are bright and extremely strong. Through the use of the drug, a woman is able to reach orgasm during each sexual act.

 

Natural sexual arousal and the pleasure of intimacy with the use of Sildenafil is enhanced by the intensification of the local blood flow of the genital organs. The increased isolation of vaginal lubrication and increased sensitivity of erogenous zones can be due to intense blood flow to the genital organs.

 

special instructions

 

To diagnose erectile dysfunction, determine their possible causes and choose an adequate treatment, you must collect a complete medical history and conduct a thorough physical examination. Remedies for the treatment of erectile dysfunction should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis,Peyronie's disease), or in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia).

 

Drugs intended for the treatment of erectile dysfunction should not be prescribed to men for whom sexual activity is undesirable.

 

Sexual activity represents a certain risk in the presence of heart disease, so before starting any therapy for erectile dysfunction, the doctor should refer the patient to a cardiovascular system examination. Sexual activity is undesirable in patients with heart failure, unstable angina, suffered in the last 6 months myocardial infarction or stroke, life-threatening arrhythmias, hypertension (blood pressure more than 170/100 mm Hg), or hypotension (blood pressure less than 90/50 mm Hg. st.). In clinical studies, there was no difference in the incidence of myocardial infarction (1.1 per 100 people per year) or cardiovascular death rate (0.3 per 100 people per year) in patients treated with Sildenafil compared with patients , who received a placebo.

 

Cardiovascular complications

 

During the postmarketing use of sildenafil, serious adverse events such as myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, hypertension, and hypotension were reported for the treatment of erectile dysfunction, such as serious cardiovascular complications ), which had a temporary connection with the use of sildenafil. Most of these patients, but not all of them, had risk factors for cardiovascular complications. Many of these adverse events were observed soon after sexual activity, and some of them were noted after taking sildenafil without subsequent sexual activity. It is not possible to establish the presence of a direct link between the observed undesirable phenomena and these or other factors.

 

Hypotension

 

Sildenafil has a systemic vasodilating effect, resulting in a transient decrease in LD, which is not clinically significant and does not lead to any consequences in most patients. Nevertheless,before the appointment of Sildenafil, the physician should carefully evaluate the risk of possible undesirable manifestations of vasodilating action in patients with the corresponding diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as with a rare syndrome of multiple systemic atrophy, manifested severe violation of the regulation of blood pressure from the autonomic nervous system.

 

Since the joint use of sildenafil and alpha-blockers can lead to symptomatic hypotension in selected sensitive patients, the drug Sildenafil should be carefully administered to patients taking a-adrenoblockers. To minimize the risk of postural hypotension in patients taking a-adrenoblockers, the use of Sildenafil should be started only after the stabilization of hemodynamic parameters in these patients has been achieved. It should also consider the desirability of reducing the initial dose of Sildenafil.The doctor should inform patients about what actions should be taken in case of symptoms of postural hypotension.

 

Visual disorders

 

Rare cases of development of anterior non-artery ischemic neuropathy of the optic nerve were noted as a cause of worsening or loss of vision against the background of the use of all PDE5 inhibitors, including sildenafil. Most of these patients had risk factors, such as optic disc excavation, age over 50, diabetes, hypertension, ischemic heart disease, hyperlipidemia and smoking. The causal relationship between the intake of PDE5 inhibitors and the development of anterior non-artery ischemic neuropathy of the optic nerve was not revealed. The physician should inform the patient about the increased risk of developing anterior non-artery ischemic neuropathy of the optic nerve if this condition has already been noted. In the event of a sudden loss of vision, patients should immediately provide the necessary medical care. A small number of patients with hereditary pigment retinitis have genetically determined impairments of the functions of the retina phosphodiesterase.Information on the safety of the use of Sildenafil in patients with pigment retinitis absent, so sildenafil should be used with caution.

 

Hearing Impairment

 

Some post-marketing and clinical studies report cases of sudden deterioration or hearing loss associated with the use of all PDE5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or loss of hearing. The causal relationship between the use of PDE5 inhibitors and sudden deterioration of hearing or loss of hearing is not established. In the event of a sudden deterioration in hearing or hearing loss, taking sildenafil should immediately consult a doctor.

 

Bleeding

 

Sildenafil enhances the antiaggregant effect of sodium nitroprusside, a donator of nitric oxide, on human platelets. Data on the safety of sildenafil in patients with a tendency to bleeding or exacerbation of peptic ulcer of the stomach and duodenum are absent, so the drug Sildenafil in these patients should be used with caution.The incidence of nasal bleeding in patients with PH associated with diffuse connective tissue diseases was higher (sildenafil 12.9%, placebo 0%) than in patients with primary pulmonary hypertension (sildenafil 3.0%, placebo 2.4%). In patients who received sildenafil in combination with a vitamin K antagonist, the incidence of nasal bleeding was higher (8.8%) than in patients who did not take a vitamin K antagonist (1.7%).

 

Application in conjunction with other treatments for erectile dysfunction

 

The safety and efficacy of Sildenafil together with other treatments for erectile dysfunction have not been studied, so the use of such combinations is not recommended.

 

Impact on the ability to drive vehicles and manage mechanisms

 

Against the background of taking sildenafil, there was no adverse effect on the ability to drive a car or other technical means.

 

However, since the use of sildenafil may reduce blood pressure, the development of chromatopsy, blurred vision, and the like. side effects, you should carefully consider the individual effect of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.

 

Drug Interactions

 

The effect of other drugs on the pharmacokinetics of sildenafil

 

The metabolism of sildenafil occurs mainly under the action of cytochrome isoenzymes CYP3A4 (the main pathway) and CYP2C9, so inhibitors of these isoenzymes can reduce the clearance of sildenafil, and inductors, respectively, increase the clearance of sildenafil. There was a decrease in clearance of sildenafil with simultaneous application of inhibitors of the cytochrome isoenzyme CYP3A4 (ketoconazole, erythromycin, cimetidine). Cimetidine (800 mg), a nonspecific inhibitor of the cytochrome isoenzyme CYP3A4, when taken together with sildenafil (50 mg) causes an increase in the concentration of sildenafil in plasma by 56%. A single dose of 100 mg of sildenafil together with Erythromycin (500 mg per day, 2 times a day for 5 days), a specific inhibitor of the cytochrome CYP3A4 isoenzyme, with the achievement of a constant concentration of erythromycin in the blood, leads to an increase in the AUC of sildenafil by 182%.

 

With the simultaneous administration of sildenafil (once 100 mg) and saquinavir (1200 mg per day 3 times a day), the HIV protease inhibitor and the cytochrome CYP3A4 isoenzyme, while achieving a constant saquinavir concentration in the blood, Cmax sildenafil increased by 140%, and the AUC increased by 210%. Sildenafil has no effect on the pharmacokinetics of saquinavir.

 

Stronger inhibitors of the cytochrome isoenzyme CYP3A4, such as Ketoconazole and itraconazole, can cause more severe changes in the pharmacokinetics of sildenafil.

 

Simultaneous use of sildenafil (once 100 mg) and ritonavir (500 mg twice a day), an HIV protease inhibitor and a strong inhibitor of cytochrome P450, with the achievement of a constant concentration of ritonavir in the blood leads to an increase in Cmax sildenafil by 300% (4-fold ), and AUC by 1000% (11 times). After 24 hours, the concentration of sildenafil in the blood plasma is about 200 ng / ml (after a single application of one sildenafil - 5 ng / ml), which is consistent with information on the pronounced effect of ritonavir on the pharmacokinetics of various substrates of cytochrome P450. Sildenafil does not affect the pharmacokinetics of ritonavir. Combined use of sildenafil with ritonavir is not recommended. If sildenafil is taken in the recommended doses of patients receiving simultaneously strong inhibitors of the cytochrome isoenzyme CYP3A4, then the Cmax of free sildenafil does not exceed 200 nM, and the drug is well tolerated.

 

A single dose of antacid (hydroxide / magnesium hydroxide, aluminum) did not affect the bioavailability of sildenafil.

 

Inhibitors of the cytochrome isoenzyme CYP2C9 (tolbutamide, warfarin), cytochrome cYCH2D6 isoenzyme (selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and thiazide-like diuretics, ACE inhibitors and calcium antagonists have no effect on the pharmacokinetics of sildenafil.

 

Azithromycin (500 mg per day for 3 days) does not affect AUC, Cmax Tmax, rate of elimination rate and T1 / 2 sildenafil or its main circulating metabolite.

 

Effect of sildenafil on other drugs

 

Sildenafil is a weak inhibitor of cytochrome P450 -1A2, 2C9, 2C19, 2D6, 2E1 and 3C4 isoenzymes (IC50> 150 μmol). When sildenafil is taken at recommended doses, its Cmax is about 1 μmol, so it is unlikely that sildenafil can affect the clearance of the substrates of these isoenzymes.

 

Sildenafil enhances the hypotensive effect of nitrates both with prolonged use of the latter, and when they are prescribed for acute indications. In this regard, the use of sildenafil in combination with nitrates or donators of nitric oxide is contraindicated.

 

With the simultaneous administration of alpha-adrenoblocker Doxazosin (4 mg and 8 mg) and sildenafil (25 mg,50 mg and 100 mg) in patients with benign prostatic hyperplasia with stable hemodynamics, the mean additional decrease in systolic / diastolic blood pressure in the supine position was 7/7 mm Hg. st., 9/5 mm Hg. and 8/4 mm Hg, respectively, and in the standing position - 6/6 mm Hg, 11/4 mm Hg. and 4/5 mm Hg, respectively. We report rare cases of development in these patients of symptomatic postural hypotension, manifested as dizziness (without syncope). In individual sensitive patients receiving alpha-blockers, simultaneous use of sildenafil can lead to symptomatic hypotension.

 

Signs of significant interaction with tolbutamide (250 mg) or Warfarin (40 mg), which are metabolized by the isoenzyme of cytochrome CYP2C9, have not been identified.

 

Sildenafil (100 mg) does not affect the pharmacokinetics of HIV protease, saquinavir and ritonavir inhibitors, which are substrates of the cytochrome CYP3A4 isoenzyme, at their constant level in the blood. Sildenafil (50 mg) does not cause an additional increase in bleeding time when taking Acetylsalicylic acid (150 mg). Sildenafil (50 mg) does not increase the hypotensive effect of alcohol in healthy volunteers with a maximum blood alcohol concentration of 0.08% (80 mg / dl) on average.

 

In patients with arterial hypertension, there was no evidence of interaction between sildenafil (100 mg) and amlodipine. The average additional decrease in blood pressure in the prone position is 8 mm Hg. (systolic) and 7 mm Hg. (diastolic).

 

The use of sildenafil in combination with antihypertensive drugs does not lead to additional side effects.

 

Analogues of the drug Sildenafil

 

Structural analogs for the active substance:

  • Viagra;
  • Viasan;
  • Vigrande;
  • Vizarsin;
  • Dynamics;
  • Maxigra;
  • Olmax Strong;
  • Revacio;
  • Silafil;
  • Sildenafil Vertex;
  • Sildenafil SZ (North Star);
  • Sildenafil citrate;
  • Taxiere;
  • Tornethis;
  • Erexel.

 

Analogues on the curative effect (means for regulating potency and treating impotence):

  • Alisat;
  • Allikor;
  • Afrodor 2000;
  • Bromocriptine;
  • Vazoton (L-arginine);
  • Verona;
  • Viardot;
  • Viardot forte;
  • Vizarsin;
  • Dynaman;
  • Zidena;
  • The Impaza;
  • Iohimbine;
  • Yohimbe;
  • Carinate;
  • Karinat Forte;
  • Koprivit;
  • Levitra;
  • Muse;
  • Omnadren 250;
  • Optinat;
  • Proviron;
  • Simpletons;
  • Reilis;
  • Cialis;
  • Stalon;
  • Super Yohimbe Plus;
  • Sustanon;
  • Tentex forte;
  • Testalamine;
  • Testis compositum;
  • Tornethis;
  • Tribestan;
  • Himkoline;
  • Edex;
  • Eifitol;
  • Erbisol;
  • Erexel.

Similar medicines:

Other medicines:

Reviews (2):
Guests
Gregory
In my opinion, our products are of special quality. Well, I would not take medicines of Russian manufacture. Accordingly, and for the potency, I also take not our means.
Guests
Ev Boro
Sildenafil. Elegant result! No side effects, sex two hours, with a huge number of female orgasms. Although drinking a man of 25 mg, just super.

Rules for publishing reviews and visitor questions