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Publication date: 2018-04-19 22:49

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The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 655 mg Viagra or matching placebo are shown in Figure 9.

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Sildenafil enhances the effect of NO by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of sexual stimulation.

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Use caution when co-administering alpha-blockers with VIAGRA because of potential additive blood pressure-lowering effects. When VIAGRA is co-administered with an alpha-blocker, patients should be stable on alpha-blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at the lowest dose [see DOSAGE AND ADMINISTRATION , WARNINGS AND PRECAUTIONS , CLINICAL PHARMACOLOGY ].

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There was no impairment of fertility in rats given sildenafil up to 65 mg/kg/day for 86 days to females and 657 days to males, a dose producing an AUC value of more than 75 times the human male AUC.

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However, since higher plasma levels may increase the incidence of adverse reactions, a starting dose of 75 mg should be considered in older subjects due to the higher systemic exposure [see DOSAGE AND ADMINISTRATION ].

Physicians should inform patients not to take VIAGRA with other PDE5 inhibitors including REVATIO or other pulmonary arterial hypertension (PAH) treatments containing sildenafil. Sildenafil is also marketed as REVATIO for the treatment of PAH. The safety and efficacy of VIAGRA with other PDE5 inhibitors, including REVATIO, have not been studied [see WARNINGS AND PRECAUTIONS ].

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The study involved a group of 88 consecutively studied patients with clinical and radiological evidence of idiopathic NPH, for whom a frontal brain biopsy was obtained. For 79 patients, hydrodynamic criteria of NPH were fulfilled and a ventriculoperitoneal shunt was performed. The dosimetry was characterized by two independent methods: thermoluminescent dosimeters and radiochromic film.

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