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Table of Contents
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What is sildenafil used for?
In 27 march 1998, Sildenafil had the approval from food and drug administration (FDA) to be used for treatment of erectile dysfunction ED, It also has FDA approval for the treatment of pulmonary hypertension (or what’s known as pulmonary arterial hypertension (PAH)) in adults to improve patient outcomes and exercise tolerability. Sildenafil is also occasionally used for the secondary Reynaud phenomenon which is a female sexual arousal disorder, and as an add-on therapy to the altitude-induced hypoxemia.
How should sildenafil be taken?
In the treatment of erectile dysfunction, Start with 50 mg sildenafil to be taken orally before sexual activity by one hour, doses more than 200 mg show no benefit than 100 mg dose, A lower dosage may be required when sildenafil is used with certain drugs, The onset of action is about 30 minutes, while the duration of the effect lasts up to 18 hours.
In the treatment of PAH, the recommended dosage is 5 mg or 20 mg three times daily, 4 to 6 hours apart.
Sildenafil Warnings and Precautions:
Sildenafil dilates the blood venis so results in decrease in blood pressure all over the body and specifically in penis, so caution must be paid with patients using drugs that lower blood pressure, especially drugs like prazosin, doxazosin and silodosin. Initiate sildenafil at lowest dose in this situation.
Priapism is a prolonged and painful erection that lasts for more than 4 hours, if left untreated may result in damage to the penis, Use sildenafil with caution in patients with anatomical deformation of the penis and with the conditions potentially increase risk of priapism such as sickle cell anemia or multiple myeloma.
Toxicity from sildenafil can result if used with drugs inhibit its breakdown which increase level of sildenafil, for example: using ritonavir with sildenafil increases its level by 11 fold than normal, The recommendation is to use maximum 25 mg of sildenafil in 48 hours with ritonavir.
The combination of sildenafil with the drug bosentan to manage pulmonary arterial hypertension increases the serum concentrations of bosentan and reduces levels of sildenafil. Combining sildenafil with drugs increases breakdown of sildenafil can similarly lead to reduced sildenafil level so these combinations are not recommended with chronic sildenafil dosing as in PAH.
Side Effects
Patients used sildenafil reported that most commonly side effects were:
- Headaches (2%)
- flushing
- Dyspepsia
- nasal congestion
- back pain
- myalgia
- nausea
- Dizziness
- rash
Sildenafil is associated with changes in sight and blurred vision also some cases reported ototoxicity and hearing loss which was reversible in some of these cases.
Pregnancy
No adequate studies for use of sildenafil in pregnancy, studies on animals show low risk of harm, so use with caution.
Sildenafil contraindications
Nitrates increase the hypotensive effect of sildenafil to produce life threatening conditions so co-administration is contraindicated, Nitrates can be safely administered after (24 or more hours) from sildenafil use, Similarly severe hypotension for any reason like dehydration contraindicates the use of sildenafil. Ischemic optic neuropathy and inherited degenerative retinal disorders contraindicate sildenafil use. Discontinuation of sildenafil is recommended if any sight change occurred.
Typically, no regular monitoring is a must with sildenafil. Occasionally patients asked to monitor blood pressure and pulse.
Toxicity
In the healthy subject, Single dose of 800 mg resulted in the same adverse effects of those of lower doses but with high frequency and severity, no antidotes are available for sildenafil toxicity. In case of overdose, patients should call an ambulance and receive supportive care. Visual side effects increased with toxic doses, dialysis doesn’t help with sildenafil toxicity as sildenafil is not excreted renally and highly bound to plasma protein.
Enhancing Healthcare Team Outcomes
Sildenafil is available in the market for two decades. It is a safe option for treatment of ED and PAH, but some barriers to sildenafil use are cost and social stigma surrounding ED.
Sildenafil increases the quality of life of patients as most of the patients with ED suffer from depression, anxiety and decrease in self- esteem.
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