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In a study of healthy male volunteerssildenafil100 mgdid not affect the steady state pharmacokinetics of the HIV protease inhibitorssaquinavir and ritonavirboth of which are CYP3A4 substrates.

When a single 100 mg dose of VIAGRA was administered with erythromycina moderate CYP3A4 inhibitorat steady state500 mg bid for 5 daysthere was a 160increase in sildenafil Cmax and a 182increase in sildenafil AUCIn additionin a study performed in healthy male volunteersco-administration of the HIV protease inhibitor saquinaviralso a CYP3A4 inhibitorat steady state1200 mg tidwith Viagra100 mg single doseresulted in a 140increase in sildenafil Cmax and a 210increase in sildenafil AUCViagra had no effect on saquinavir pharmacokineticsA stronger CYP3A4 inhibitor such as ketoconazole or itraconazole could be expected to have greater effect than that seen with saquinavirPopulation pharmacokinetic data from patients in clinical trials also indicated a reduction in sildenafil clearance when it was co-administered with CYP3A4 inhibitorssuch as ketoconazoleerythromycinor cimetidinesee DOSAGE AND ADMINISTRATION and DRUG INTERACTIONS

VIAGRA is rapidly absorbed after oral administrationwith a mean absolute bioavailability of 41range 2563The pharmacokinetics of sildenafil are dose-proportional over the recommended dose rangeIt is eliminated predominantly by hepatic metabolismmainly CYP3A4and is converted to an active metabolite with properties similar to the parentsildenafilBoth sildenafil and the metabolite have terminal half lives of about 4 hours.

An erection lasts for more than 4 hours If you experience chest pains during or after intercourse you experience changes in your vision or hearing Do not operate machinery if you feel dizzy following treatment.

Physicians should advise patients to stop taking PDE5 inhibitorsincluding VIAGRAand seek prompt medical attention in the event of sudden decrease or loss of hearingThese eventswhich may be accompanied by tinnitus and dizzinesshave been reported in temporal association to the intake of PDE5 inhibitorsincluding VIAGRAIt is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factorssee ADVERSE REACTIONS

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