Sublingual Viagra (Sildenafil)
Class and Category of Drug
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Chemical class: Pyrazolopyrimidinone derivative
Therapeutic class: Antihypertensive (pulmonary arterial), anti-impotence
Pregnancy category: B
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Drug Indications and Dosages
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To treat erectile dysfunction
Tablets
Adults. 50 mg daily, taken 1 hr before sexual activity; increased as prescribed, based on clinical response. Maximum: 100 mgdaily
Dosage Adjustment Initially25 mg for elderly patients, those with hepatic cirrhosis or creatinine clearance less than 30 ml/min/ 1.73 m2, and those taking potent cytochrome P-450 3A4 inhibitors or ritonavir.
Dosage reduced to 25 mg if taken within 4 hr of an alpha blocker. Maximum: 25 mg/48 hr.
To treat pulmonary arterial hypertension in order to improve exercise ability and delay clinical worsening of condition in patients classified as group 1 by the World Health Organization
Tablets
Adults. 20 mg t.i.d.
Intravenous Injection
Adults. 10 mg administered as bolus t.i.d.
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Contraindications of Drug
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Continuous or intermittent nitrate therapy, hypersensitivity to sildenafil or components
Generic Drug Interactions
Drugs
barbiturates, bosentan, carabamazepine, efavirenza, nevirapine, phenytoin, rifabutin, rifampin: Altered plasma level of either drug
cimetidine, erythromycin, itraconazole, ketoconazole, mibefradil: Prolonged sildenafil effect
doxazosin and other alpha-blockers: Increased risk of symptomatic hypotension nitrates: Profound hypotension
protease inhibitors: Increased sildenafil effect rifampin: Decreased sildenafil effect
Foods
high-fat meals: Drug absorption delayed by up to 60 minutes
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Drugs Adverse Reactions
Central Nervous System: Cerebrovascular, intracerebral, or subarachnoid hemorrhage; dizziness; headache; migraine; seizures; syncope; transient global amnesia, transient ischemic attack
Cardiovascular: Heart failure, hypertension, hypotension, myocardial infarction or ischemia, orthostatic hypotension, palpitations, sudden cardiac death, tachycardia, ventricular arrhythmias
4 hours of an alpha blocker, such as doxazosin, because symptomatic orthostatic hypotension can occur. Tell patient to stop taking drug and contact prescriber if vision decreases suddenly in one or both eyes or if he has a loss of hearing, possibly with tinnitus and dizziness.
Advise patient taking sildenafil for erectile dysfunction to seek sexual counseling to enhance the drug's effects. To avoid possible penile damage and permanent loss of erectile function, urge patient to notify prescriber immediately if erection is painful or lasts longer than 4 hours.
Instruct diabetic patient to monitor his blood glucose level frequently because drug may affect glucose control.
Eyes, Ears, Nose, And Throat: Blurred vision; change in color perception; diplopia; epistaxis; hearing loss; increased intraocular pressure; nasal congestion; nonarteritic anterior ischemic optic neuropathy; ocular burning, pressure, redness or swelling; paramacular edema; photophobia; retinal vascular bleeding or disease; tinnitus, visual decrease or temporary vision loss; vitreous detachment
Endocrine: Uncontrolled diabetes mellitus
Gastrointestinal: Diarrhea, indigestion
Genitourinary: Cystitis, dysuria, painful erection, priapism, urinary tract infection
Musculoskeletal: Arthralgia, back pain
Respiratory: Pulmonary hemorrhage, upper respiratory tract infection
Skin: Flushing, photosensitivity
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Nursing Considerations for Generic Drugs
• Use sildenafil cautiously in patients with renal or hepatic dysfunction, elderly patients, and men with penile abnormalities that may predispose them to priapism.
• Also use cautiously in patients with left ventricular outflow obstruction, such as aortic stenosis and idiopathic hypertrophic subaortic stenosis, and those with severely impaired autonomic control of blood pressure because these conditions increase patient's sensitivity to vasodilators such as sildenafil.
• Monitor patient's blood pressure and heart rate and rhythm before and often during therapy.
• Monitor vision, especially in patients over age 50; who have diabetes, hypertension, coronary artery disease, or hyperlipidemia; or who smoke because sildenafil rarely may cause nonarteritic anterior ischemic optic neuropathy that may lead to decreased vision or permanent vision loss.
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