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When a single 100 mg dose of VIAGRA was administered with erythromycina moderate CYP3A4 inhibitorat steady state500 mg bid for 5 daysthere was a 160increase in sildenafil Cmax and a 182increase in sildenafil AUCIn additionin a study performed in healthy male volunteersco-administration of the HIV protease inhibitor saquinaviralso a CYP3A4 inhibitorat steady state1200 mg tidwith Viagra100 mg single doseresulted in a 140increase in sildenafil Cmax and a 210increase in sildenafil AUCViagra had no effect on saquinavir pharmacokineticsA stronger CYP3A4 inhibitor such as ketoconazole or itraconazole could be expected to have greater effect than that seen with saquinavirPopulation pharmacokinetic data from patients in clinical trials also indicated a reduction in sildenafil clearance when it was co-administered with CYP3A4 inhibitorssuch as ketoconazoleerythromycinor cimetidinesee DOSAGE AND ADMINISTRATION and DRUG INTERACTIONS

Studies in vitro have shown that sildenafil is selective for PDE5Its effect is more potent on PDE5 than on other known phosphodiesterases10-fold for PDE680-fold for PDE1700-fold for PDE2PDE3PDE4PDE7PDE8PDE9PDE10and PDE11Sildenafil is approximately 4,000-fold more selective for PDE5 compared to PDE3PDE3 is involved in control of cardiac contractilitySildenafil is only about 10-fold as potent for PDE5 compared to PDE6an enzyme found in the retina which is involved in the phototransduction pathway of the retinaThis lower selectivity is thought to be the basis for abnormalities related to color visionsee Pharmacodynamics

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

Stop sexual activity and get medical help right away if you get symptoms such as chest paindizzinessor nausea during sex.

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