sildenafil citrate

(sill den' ah fill)

Viagra

Pregnancy Category B

Drug class
Impotence drug

Therapeutic actions
Selectively inhibits cGMP-specific phosphodiesterase type 5. The mechanism of penile
erection involves the release of nitric oxide into the corpus cavernosum of the penis
during sexual stimulation. Nitrous oxide activates cGMP, which causes smooth muscle
relaxation, allowing the flow of blood into the corpus cavernosum. Sildenafil prevents the
breakdown of cGMP by phosphodiesterase, leading to increased cGMP levels and
prolonged smooth muscle relaxation, promoting the flow of blood into the corpus
cavernosum.

Indication
• Treatment of erectile dysfunction in the presence of sexual stimulation
• Unlabeled use: Pulmonary hypertension, female sexual dysfunction

Contraindications and cautions

• Contraindicated with allergy to any component of the tablet, contraindicated for
women or children; concomitant use of nitrates.
• Use cautiously with hepatic or renal dysfunction; with anatomical deformation of
the penis; with known cardiac disease (effects of sexual activity need to be
evaluated).

Available forms
Tablets—25, 50, 100 mg

Dosages
ADULTS
50 mg PO taken 1 hr before anticipated sexual activity; range 25–100 mg PO. May be
taken 30 min–4 hr before sexual activity. Limit use to once per day.
PEDIATRIC PATIENTS
Not intended for use in children.
GERIATRIC PATIENTS
For patients > 65 yr, start dose at 25 mg PO.
PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
Patients with hepatic impairment or creatinine clearance < 30 mL/min may have
increased serum levels; start dose at 25 mg PO.

Pharmacokinetics
Route Onset Peak
Oral Rapid 30–120 min
Metabolism: Hepatic; T1/2: 4 hr
Distribution: Not intended for use in women, no clear studies on crossing the placenta or
entering breast milk
Excretion: Feces and urine

Adverse effects
• CNS: Headache, abnormal vision, dizziness, nasal congestion
• CV: Flushing
• GI: Dyspepsia, diarrhea
• Other: Urinary tract infection, rash

Interactions
Drug-drug
• Possible severe hypotension and serious cardiac events if combined with nitrates;
this combination must be avoided
• Possible increased sildenafil levels and effects if taken with cimetidine,
amlodipine, erythromycin, protease inhibitors; monitor patient and reduce dosage
as needed
Drug-food
• Decreased rate of absorption and onset of action if taken with a high-fat meal
• Decreased metabolism and risk of toxic effects if combined with grapefruit juice;
avoid this combination

Nursing considerations
Assessment
• History: Allergy to any component of the tablet; hepatic or renal dysfunction;
with anatomical deformation of the penis, known cardiac disease; concomitant
use of nitrates
• Physical: Orientation, affect; skin color, lesions; P, BP, ECG, renal and hepatic
function tests

Interventions
• Ensure diagnosis of erectile dysfunction and determine underlying causes and
other appropriate treatment.
• Advise patient that drug does not work in the absence of sexual stimulation. Limit
use to once per day.
• Remind patient that drug does not protect against sexually transmitted diseases
and appropriate measures should be taken.
• Advise patient to never take this drug with nitrates; serious and even fatal
complications can occur.
• Advise patients receiving HIV medications that there is an increased risk of
sidenafil-associated adverse drug reactions, including hypotension, visual
changes, and priapism. Do not exceed 25 mg of sildenafil in 48 hr.
Teaching points
• Take this drug 30 min to 4 hr before anticipated sexual activity. The usual timing
is 1 hr. The drug will have no effect in the absence of sexual stimulation.
• Onset of drug effects will be slowed if taken with a high-fat meal; plan
accordingly. Avoid drinking grapefruit juice if using this drug.
• This drug will not protect you from sexually transmitted diseases; use appropriate
precautions.
• Do not take this drug if you are taking any nitrates; serious side effects and even
death can occur.
• These side effects may occur: Headache, dizziness, rash, flushing.
• Report difficult or painful urination, rash, dizziness, palpitations.

Adverse effects in Italic are most common; those in Bold are life-threatening.