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See "Dosage adjustments" just above for details about when a lower dose might be prescribed. 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 (5.7)]. Physicians should warn patients that prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently since market approval of VIAGRA.
In the third study, a single oral dose of VIAGRA 100 mg or matching placebo was administered in a 3-period crossover design to 20 generally healthy males with BPH. In dose period 1, subjects were administered open-label doxazosin and a single dose of VIAGRA 50 mg simultaneously, after at least 14 consecutive days of doxazosin. If a subject did not successfully complete this first dosing period, he was discontinued from the study.
VIAGRA is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to 25 mg, 50 mg, or 100 mg of sildenafil. Tablets are debossed with PFIZER on one side and VGR25, VGR50 or VGR100 on the other to indicate the dosage strengths. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. Sildenafil is a phosphodiesterase type 5 (PDE-5) inhibitor. It blocks the action of the enzyme PDE-5, which destroys cyclic guanosine monophosphate (cGMP). An increase in cGMP levels leads to relaxation of the smooth muscles in the penis and increased blood flow, which contributes to an erection.
Studies show men usually find the same dose will be effective over a period of years. Erectile dysfunction tends to be a slowly progressive condition, increasing with age, however unless there is an underlying medical progression the same dose should produce the same effect. There is a very rare theoretical risk of abnormal heart rhythm if Viagra (sildenafil) is taken at the same time as some other medications - please check this list. Other causes of erectile dysfunction may require specialist treatment apart from tablets. Some men, whose erectile dysfunction has psychological causes, may benefit from counselling. Reduced dose recommended when 50mg starting dose is highly effective.
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