Potent CYP3A4 inducers are expected to cause substantial sildenafil cenforce decreases in sildenafil plasma levels St John's Wort will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels terazosinsildenafil increases effects of terazosin by pharmacodynamic synergism. sildenafil increases effects of terazosin by pharmacodynamic synergism. tovorafenibtovorafenib will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
ritonavirritonavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ritonavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. silodosinsildenafil increases effects of silodosin by pharmacodynamic synergism. sildenafil increases effects of silodosin by pharmacodynamic synergism. St John's WortSt John's Wort will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration of tovorafenib (a weak CYP3A4 inducer) with CYP3A substrates where minimal concentration changes may lead to serious therapeutic failures.
| Use | Description | Approved Since | Notes |
|---|---|---|---|
| Erectile Dysfunction | Enhances blood flow to penis | 1998 | Taken prior to sexual activity |
| Pulmonary Arterial Hypertension (PAH) | Vasodilation of pulmonary vessels | 2005 | Under medical supervision |
| Off-label uses | Varied, not officially approved | - | Consulting healthcare provider |
If unavoidable, monitor patients for loss of efficacy unless otherwise recommended in the CYP3A4 substrate prescribing information. tovorafenib will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
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tucatinibtucatinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
sildenafil increases effects of phentolamine by pharmacodynamic synergism. phenytoinphenytoin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels phenytoin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels prazosinsildenafil increases effects of prazosin by pharmacodynamic synergism. sildenafil increases effects of prazosin by pharmacodynamic synergism.
primidoneprimidone will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels primidone will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels relacorilantrelacorilant increases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration of sildenafil with strong CYP3A4 inhibitors. relacorilant increases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling. tucatinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. acebutololacebutolol increases effects of sildenafil by additive vasodilation. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.
acebutolol increases effects of sildenafil by additive vasodilation. amifostineamifostine increases effects of sildenafil by additive vasodilation. amifostine increases effects of sildenafil by additive vasodilation. aprepitantaprepitant will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. aprepitant will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. armodafinilarmodafinil will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. armodafinil will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
mifepristone will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. mitotanemitotane decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels. mitotane decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nafcillinnafcillin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels nafcillin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Patients receiving indinavir with ritonavir should receive not more than 25 mg of sildenafil for treatment of erectile dysfunction in a 48-hour period, and patients receiving other protease inhibitors should use a lower initial sildenafil dose of 25 mg. Patient taking sildenafil for PAH with ritonavir is not recommended. pentobarbitalpentobarbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels pentobarbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels phenobarbitalphenobarbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels phenobarbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels phenoxybenzaminesildenafil increases effects of phenoxybenzamine by pharmacodynamic synergism. sildenafil increases effects of phenoxybenzamine by pharmacodynamic synergism. phentolaminesildenafil increases effects of phentolamine by pharmacodynamic synergism. artemether/lumefantrineartemether/lumefantrine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
artemether/lumefantrine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. atenololatenolol increases effects of sildenafil by additive vasodilation.
| Manufacturer | Location | Quality Standards | Certification | Notes |
|---|---|---|---|---|
| Pfizer Inc. | USA | Good Manufacturing Practice (GMP), ISO standards | FDA approved | Main producer of branded Viagra |
| Teva Pharmaceuticals | Israel | GMP, ISO certification | Variants of generic sildenafil | Large generic manufacturer |
| Sun Pharmaceutical | India | Quality assurance systems | Regulatory approval in various countries | Known for affordable generics |
atenolol increases effects of sildenafil by additive vasodilation.
ivosidenib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ketoconazoleketoconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration with strong CYP3A4 inhibitors and sildenafil (for pulmonary arterial hypertension) is not recommended. When used for erectile dysfunction, consider reducing initial sildenafil dose of 25 mg in patients also taking a strong CYP3A4 inhibitor and monitor for sildenafil toxicities (eg, dyspepsia, headache, hypotension). ketoconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
lenacapavirlenacapavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Refer to the prescribing information of PDE5 inhibitors for dose recommendations. lenacapavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. levoketoconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. lonafarniblonafarnib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling. lonafarnib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. lopinavirlopinavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. lopinavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. mifepristonemifepristone will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. betaxololbetaxolol increases effects of sildenafil by additive vasodilation. betaxolol increases effects of sildenafil by additive vasodilation. bisoprololbisoprolol increases effects of sildenafil by additive vasodilation. bisoprolol increases effects of sildenafil by additive vasodilation.
| Point | Explanation | Importance | Tips |
|---|---|---|---|
| Take on an empty stomach | Food, especially high-fat meals, may delay effect | Ensures quicker onset | Preferably take 30-60 minutes before activity |
| Do not exceed dose | Risk of side effects or prolonged erections | Safety concern | Stick to prescribed dose |
| Alcohol consumption | May reduce efficacy and increase side effects | Caution advised | Limit alcohol intake during therapy |
| Report side effects | Priapism, vision changes, hearing loss | Critical for patient safety | Contact healthcare provider immediately |
bosentanbosentan will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels bosentan will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels butalbitalbutalbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. butalbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. carbamazepinecarbamazepine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.