Viagra and high blood pressure

Common Questions and Answers about Viagra and high blood pressure

Viagra and blood pressure

[GOOGLEFREETEXTUNIQ-5-7flavonoids and stress hormones]

VIAGRA sildenafil citratean oral therapy for erectile dysfunction, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate cGMP -specific phosphodiesterase type 5 PDE5. Sildenafil citrate is designated chemically as 1-[[3- 6,7-dihydromethyloxopropyl-1H-pyrazolo[4,3d]pyrimidinyl ethoxyphenyl]sulfonyl]methylpiperazine citrate and has the following structural formula:.

Sildenafil citrate is a white to off-white crystalline powder with a solubility of 3. VIAGRA is formulated as blue, film-coated rounded-diamond-shaped tablets equivalent to 25 mg, viagra and blood pressure, 50 mg and mg of sildenafil for oral administration. In addition to the active ingredient, viagra and blood pressure, sildenafil citrate, each tablet contains the following inactive ingredients: For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity.

The maximum recommended dosing frequency is once per day. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of mg or decreased to 25 mg. Consider a starting dose of 25 mg in patients treated with strong CYP3A4 inhibitors e. VIAGRA is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to 25 mg, 50 mg, or mg of sildenafil.

VIAGRA sildenafil citrate is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to the nominally indicated amount of sildenafil and debossed on the obverse and reverse sides as follows:, viagra and blood pressure. Pfizer Labs, Division of Pfizer Inc. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

VIAGRA was administered to over patients aged years during pre-marketing clinical trials worldwide. Over patients were treated for longer than one year, viagra and blood pressure.

In fixed-dose studies, the incidence of some adverse reactions increased with dose. The type of adverse reactions in flexible-dose studies, which reflect the recommended dosage regimen, was similar to that for fixed-dose studies. At doses above the recommended dose range, adverse reactions were similar to those detailed in Table 1 below but generally were reported more frequently. When VIAGRA was taken as recommended on an as-needed basis in flexible-dose, placebo-controlled clinical trials of two to twenty-six weeks duration, patients took VIAGRA at least once weekly, and the following adverse reactions viagra and blood pressure reported:.

Mild and transient, predominantly color tinge to vision, but also increased sensitivity to light or blurred vision. In these studies, only one patient discontinued due to abnormal vision. Reported events include those with a plausible relation to drug use; omitted are minor events and reports too imprecise to be meaningful:. Body as a Viagra and blood pressure Analysis of the safety database from controlled clinical trials showed no apparent difference in viagra and blood pressure reactions in patients taking VIAGRA with and without anti-hypertensive medication.

This analysis was performed retrospectively, viagra and blood pressure, and was not powered to detect any pre-specified difference in adverse reactions. Because these reactions are reported voluntarily from a population viagra and blood pressure uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion either due to their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors.

Serious cardiovascular, cerebrovascularviagra and blood pressure, and vascular events, including myocardial infarctionsudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertensionsubarachnoid and intracerebral hemorrhages, and pulmonary hemorrhage have been reported post-marketing in temporal association with the use of VIAGRA.

Most, but not all, of these patients had preexisting cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of VIAGRA without sexual activity.

In a small, prematurely terminated study of REVATIO sildenafil in patients with pulmonary arterial hypertension PAH secondary to sickle cell diseasevaso-occlusive crises requiring hospitalization viagra and blood pressure more commonly reported in patients who received sildenafil than in those randomized to placebo. In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events.

In many cases, medical follow-up information was limited. Non-arteritic anterior ischemic optic viagra and blood pressure NAIONa cause of decreased vision including permanent loss of vision, has been reported rarely post-marketing in temporal association with the use of phosphodiesterase type 5 PDE5 inhibitors, including VIAGRA, viagra and blood pressure. Most, but not all, of these patients had underlying anatomic or vascular risk factors for developing NAION, including but not necessarily limited to: Administration of VIAGRA with nitric oxide donors such as organic nitrates or organic nitrites in any form is contraindicated.

Use caution when co-administering alpha-blockers with VIAGRA because of potential additive blood pressure-lowering effects. Co-administration of ritonavir, a strong CYP3A4 inhibitor, greatly increased the systemic exposure of sildenafil fold increase in AUC.

Stronger CYP3A4 inhibitors such as ketoconazole or itraconazole could be expected to have greater effects than seen with saquinavir. In a drug-drug viagra and blood pressure study sildenafil 50 mg given with viagra and blood pressure 0. There is a potential for cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Therefore, treatments for erectile dysfunctionviagra and blood pressure, including VIAGRA, should not be generally used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status.

The evaluation of erectile dysfunction should include a determination of potential underlying causes and the identification of appropriate treatment following a complete medical assessment. VIAGRA has systemic vasodilatory properties that resulted in transient decreases in supine blood pressure in healthy volunteers mean maximum decrease of 8.

While this normally would be expected to be of little consequence in most patients, prior to prescribing VIAGRA, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects, especially in combination with sexual activity. Use with caution in patients with the following underlying conditions which can be particularly sensitive to the actions of vasodilators including VIAGRA those with left ventricular outflow obstruction e.

There are no controlled clinical data on the safety or efficacy of VIAGRA in the following groups; if prescribed, this should be done with caution. Prolonged erection 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 event of an erection that persists longer than 4 hours, viagra and blood pressure, the patient should seek immediate medical assistance.

If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result. However, there are no controlled clinical data on the safety or efficacy of VIAGRA in patients with sickle cell or related anemias. Physicians should advise patients to stop use of all phosphodiesterase type 5 PDE5 inhibitors, including VIAGRA, and seek medical attention in the event of a sudden loss of vision in one or both eyes.

Such an event viagra and blood pressure be a sign of non-arteritic anterior ischemic optic neuropathy NAIONa rare condition and a cause of decreased vision viagra and blood pressure permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors.

There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with retinitis pigmentosa a minority of these patients have genetic disorders of retinal phosphodiesterases ; if prescribed, this should be done with caution.

Physicians should advise patients to stop taking PDE5 inhibitors, including VIAGRA, and seek prompt medical attention in the event of sudden decrease or loss of hearing. Caution is advised when PDE5 inhibitors are co-administered with alpha-blockers.

When vasodilators are used in combination, an additive effect on blood pressure may occur. VIAGRA has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. The concomitant administration of the protease inhibitor ritonavir substantially increases serum concentrations of viagra and blood pressure fold increase in AUC.

Data from subjects exposed to high systemic levels of sildenafil are limited. Decreased blood pressure, viagra and blood pressure, syncopeand prolonged erection were reported in some healthy volunteers exposed to high doses of sildenafil mg. Such combinations may further lower blood pressure, viagra and blood pressure.

Therefore, the use of such combinations is not recommended. However, in vitro studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside a nitric oxide donor. In addition, the combination of heparin and VIAGRA had an additive effect on bleeding time in the anesthetized rabbit, but this interaction has not been studied in humans.

Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including the Human Immunodeficiency Virus HIVmay be considered.

Physicians should advise patients of the potential for VIAGRA to augment the blood pressure lowering effect of alpha-blockers and anti-hypertensive medications. Physicians should discuss with patients the potential cardiac risk of sexual activity in patients with preexisting cardiovascular risk factors, viagra and blood pressure.

Patients who experience symptoms e. Physicians should advise patients to stop use of all PDE5 inhibitors, including VIAGRA, and seek medical attention in the event of a sudden loss of vision in one or both eyes.

Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy NAIONa cause of decreased vision including possible permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors.

It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors. 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. Sildenafil was not carcinogenic when administered to rats for 24 months at a dose resulting in total systemic drug viagra and blood pressure AUCs for unbound sildenafil and its major metabolite of and times, for male and female rats, respectively, the exposures observed in using clomid and menopur together males given the Maximum Recommended Human Dose MRHD of mg.

Sildenafil was negative in in vitro bacterial and Chinese hamster ovary cell assays to detect mutagenicity, and in vitro human lymphocytes and in vivo mouse micronucleus viagra and blood pressure to detect clastogenicity. There are no adequate and well-controlled studies of sildenafil in pregnant women. Safety and effectiveness have not been established in pediatric patients. The pharmacokinetics of sildenafil in patients with severely impaired hepatic function Child-Pugh Class C have not been studied.

In studies with healthy volunteers of single doses up to mg, adverse reactions were similar to those seen at lower doses but incidence rates and severities were increased. In cases of overdose, standard supportive measures should be adopted as required.

Renal dialysis is not expected to accelerate clearance as sildenafil is highly bound to plasma proteins and it is not eliminated in the urine. The physiologic mechanism of erection of the penis involves release of nitric oxide NO in the corpus cavernosum during sexual stimulation.

NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate cGMPproducing smooth muscle relaxation in the corpus viagra and blood pressure and allowing inflow of blood. Sildenafil enhances the effect of NO by inhibiting phosphodiesterase type 5 PDE5which is different types of antibacterial soaps for degradation of cGMP in the corpus cavernosum.

Sildenafil has no direct relaxant effect on isolated human corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes viagra and blood pressure levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of sexual stimulation. Studies in vitro have shown that sildenafil is selective for PDE5.

PDE3 is involved in control of cardiac contractility. Sildenafil is only about fold as potent for PDE5 compared to PDE6, an enzyme found in the retina which is involved in the phototransduction pathway of the retina, viagra and blood pressure.

This lower selectivity is thought to be the basis for abnormalities related to color vision [see Pharmacodynamics ]. In addition to human corpus cavernosum smooth muscle, PDE5 is also found in other tissues including platelets, vascular and visceral smooth muscle, and skeletal musclebrain, heart, liver, viagra and blood pressure, kidney, lung, pancreas, viagra and blood pressure, prostatebladdertestis, viagra and blood pressure, and seminal vesicle.

The inhibition of PDE5 in some of these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of NO observed in vitro, an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo. The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours.

The decrease in sitting blood pressure was most notable approximately hours after dosing, and was not different than placebo at 8 hours. Similar effects on blood pressure were noted with 25 mg, 50 mg and mg of VIAGRA, therefore the effects are not related to dose or plasma levels within this dosage range. In the following patients: Three double-blind, placebo-controlled, viagra and blood pressure, randomized, two-way crossover studies were conducted to assess the interaction of VIAGRA with doxazosin, an alpha-adrenergic blocking agent.

In the first study, a single oral dose of VIAGRA mg or matching placebo was administered in a 2-period crossover design to 4 generally healthy males with benign prostatic hyperplasia BPH.

 

Viagra and blood pressure

.