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Concomitant use of riociguat with PDE5 inhibitors, together with sildenafil, is contraindicated (see part 4.3). In medical research, riociguat has been shown to reinforce the hypotensive results of PDE5 inhibitors. Single doses of antacid (magnesium hydroxide/aluminium hydroxide) did not affect the bioavailability of sildenafil. Cimetidine (800mg), a cytochrome P450 inhibitor and non-specific CYP3A4 inhibitor, caused a 56% enhance in plasma sildenafil concentrations when co-administered with sildenafil (50mg) to wholesome volunteers. In normal healthy male volunteers, there was no proof of an effect of azithromycin (500mg day by day for 3 days) on the AUC, Cmax, Tmax, elimination rate fixed, or subsequent half-life of sildenafil or its principal circulating metabolite.

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The recommended dose is 50 mg taken as wanted roughly one hour before sexual exercise. Any unused product or waste material should be disposed of in accordance with local necessities. In volunteers with mild to reasonable hepatic cirrhosis (Child-Pugh A and B) sildenafil clearance was lowered, leading to increases in AUC (84%) and Cmax (47%) in comparability with age-matched volunteers with no hepatic impairment.

We publish the most up-to-date data for a medication based on its licence history. The complete physique clearance of sildenafil is forty one L/h with a resultant terminal phase half- life of 3-5 h. The N-desmethyl metabolite is additional metabolised, with a terminal half-life of roughly 4 h. There was no effect on sperm motility or morphology after single one hundred mg oral doses of sildenafil in healthy volunteers (see section 4.6).