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Brand name: Sildenafil Soft tabs What is the most important information I should know about sildenafil? • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat Nitrolingual Nitro-Dur Nitro-Bid and others) isosorbide dinitrate (Dilatrate-SR Isordil Sorbitrate) and isosorbide mononitrate (Imdur ISMO Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (“poppers”). Taking sildenafil with a nitrate medicine can cause a serious decrease in blood pressure leading to fainting stroke or heart attack. • If you become dizzy or nauseated or have pain numbness or tingling in your chest arms neck or jaw during sexual activity stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Do not take sildenafil more than once a day. Allow 24 hours to pass between doses. • Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. • A small number of patients have had a sudden loss of eyesight after taking sildenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether sildenafil is the actual cause of such vision loss. Sudden vision loss with sildenafil use has occurred most often in people with heart disease diabetes high blood pressure high cholesterol or certain pre-existing eye problems and in those who smoke or are over 50 years old. • Stop using sildenafil and get emergency medical help if you have sudden vision loss. What is sildenafil? • Sildenafil relaxes muscles and increases blood flow to particular areas of the body. • Sildenafil is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. • Sildenafil may also be used for purposes other than those listed here. What should I discuss with my healthcare provider before taking sildenafil? • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat Nitrolingual Nitro-Dur Nitro-Bid and others) isosorbide dinitrate (Dilatrate-SR Isordil Sorbitrate) and isosorbide mononitrate (Imdur ISMO Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (“poppers”). Taking sildenafil with a nitrate medicine can cause a serious decrease in blood pressure leading to fainting stroke or heart attack. • A small number of patients have had a sudden loss of eyesight after taking sildenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether sildenafil is the actual cause of such vision loss. Sudden vision loss with sildenafil use has occurred most often in people with heart disease diabetes high blood pressure high cholesterol or certain pre-existing eye problems and in those who smoke or are over 50 years old. • Before taking sildenafil tell your doctor if you have: heart disease or heart rhythm problems; a recent history (in the past 6 months) of a heart attack stroke or heart rhythm disorder; congestive heart failure; high or low blood pressure; coronary artery disease; liver disease; kidney disease; a blood cell disorder such as sickle cell anemia multiple myeloma or leukemia; a bleeding disorder such as hemophilia; a stomach ulcer; retinitis pigmentosa (an inherited condition of the eye); a physical deformity of the penis (such as Peyronie's disease); or if you have been told you should not have sexual intercourse for health reasons. • If you have any of these conditions you may not be able to use sildenafil or you may need a dosage adjustment or special tests during treatment. • FDA pregnancy category B: This medication is not expected to be harmful to an unborn baby. Do not use sildenafil without telling your doctor if you are pregnant or plan to become pregnant during treatment. • It is not known if sildenafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take sildenafil? • Take sildenafil exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. • Revatio is usually taken three times each day about 4 to 6 hours apart. • Viagra is usually taken only when needed 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day. • Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions. • If you become dizzy or nauseated or have pain numbness or tingling in your chest arms neck or jaw during sexual activity stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Store this medication at room temperature away from moisture and heat. What happens if I miss a dose? • Viagra is used as needed so you are not likely to miss a dose. • If you miss a dose of Revatio take the missed dose as soon as you remember. If it is almost time for your next dose skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? • Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a sildenafil overdose may include chest pain nausea irregular heartbeat and feeling light-headed or fainting. What should I avoid while taking sildenafil? • Avoid drinking alcohol which can increase some of the side effects of sildenafil. • Avoid using other medicines to treat impotence such as alprostadil (Caverject Muse Edex) or yohimbine (Yocon Yodoxin others) without first talking to your doctor. What are the possible side effects of sildenafil? • If you become dizzy or nauseated or have pain numbness or tingling in your chest arms neck or jaw during sexual activity stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Stop using sildenafil and get emergency medical help if you have sudden vision loss. • Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face lips tongue or throat. • Stop using sildenafil and call your doctor at once if you have any of these serious side effects: chest pain or heavy feeling pain spreading to the arm or shoulder nausea sweating general ill feeling; irregular heartbeat; swelling in your hands ankles or feet; shortness of breath; vision changes; feeling light-headed fainting; or penis erection that is painful or lasts 4 hours or longer. • Continue taking sildenafil and talk with your doctor if you have any of these less serious side effects: warmth or redness in your face neck or chest; stuffy nose; headache; upset stomach; or back pain. • Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect sildenafil? • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems including nitroglycerin (Nitrostat Nitrolingual Nitro-Dur Nitro-Bid Minitran Deponit Transderm-Nitro) isosorbide dinitrate (Dilatrate-SR Isordil Sorbitrate) and isosorbide mononitrate (Imdur ISMO Monoket) or recreational drugs such as amyl nitrate or nitrite (“poppers”). • Before taking sildenafil tell your doctor if you are using any of the following medications: bosentan (Tracleer); cimetidine (Tagamet Tagamet HB); an antibiotic such as erythromycin (E-Mycin Eryc Ery-Tab) or clarithromycin (Biaxin); doxazosin (Cardura) prazosin (Minipress) Terazosin (Hytrin); HIV medicines such as amprenavir (Agenerase) tipranavir (Aptivus) darunavir (Prezista) efavirenz (Sustiva) nevirapine (Viramune) indinavir (Crixivan) saquinavir (Invirase Fortovase) lopinavir/ ritonavir (Kaletra) fosamprenavir (Lexiva) ritonavir (Norvir) atazanavir (Reyataz) or nelfinavir (Viracept); an antifungal medication such as itraconazole (Sporanox) or ketoconazole (Nizoral); carbamazepine (Tegretol) phenobarbital (Luminal) or phenytoin (Dilantin); or rifampin (Rifadin Rimactane) or rifabutin (Mycobutin). • If you are using any of these drugs you may not be able to take sildenafil or you may need dosage adjustments or special tests during treatment. • There may be other drugs not listed that can affect sildenafil. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins minerals herbal products and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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