Adult Dosing
Pulmonary arterial hypertension
- 2.5 mg or 10 mg IV tid
- Note: IV form is given if patient temporarily unable to take PO medication
Pediatric Dosing
[Outline]
- Increased mortality with increasing dose has been observed in pediatric patients with PAH. Use of therapy, especially for chronic use is not recommended in children
- Vasodilatory effects may adversely affect patients with antihypertensive therapy or resting hypotension (BP <90/50), fluid depletion, severe left ventricular outflow obstruction, or autonomic dysfunction. Blood pressure should be monitored when co-administering with blood pressure lowering drugs
- Pulmonary vasodilators may exacerbate cardiovascular status in patients with pulmonary veno-occlusive disease (PVOD). Not recommended in patients with pulmonary veno-occlusive disease (PVOD). If signs of pulmonary edema occur consider possibility of associated PVOD
- Decreased vision or permanent loss of vision may occur in patients treated with erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION). Seek immediate medical attention if sudden loss of vision in one or both eyes occurs while taking PDE-5 inhibitors
- Sudden decrease or loss of hearing accompanied by tinnitus and dizziness may occur in temporal association with the use of PDE-5 inhibitors
- Use cautiously in patients with anatomical penile deformation or with predisposition to priapism. Penile tissue damage and permanent loss of potency may result if priapism is not immediately treated
- Vaso-occlusive crises requiring hospitalization have been reported in patients with pulmonary HTN secondary to sickle cell disease
Cautions: Use cautiously in
- Concurrent ritonavir, ketoconazole and itraconazole (co-administration not recommended)
- MI within 6 months (Safety or efficacy not established)
- Stroke within 6 months (Safety or efficacy not established)
- Life-threatening arrhythmia in last 6 months (Safety or efficacy not established)
- CAD causing unstable angina (Safety or efficacy not established)
- CHF
- Concurrent treatment with antihypertensives or glipizide
- Hpertension (BP > 170/110) (Safety or efficacy not established)
- Patients currently on bosentan therapy
- Hypotension
- Hypovolemia
- Aortic stenosis
- Anatomical deformation of the penis (e.g angulation, cavernosal fibrosis, or Peyronie’s disease)
- Conditions predisposing to priapism (e.g sickle cell anemia, multiple myeloma, or leukemia)
- Autonomic dysfunction
- Retinitis pigmentosa
- Retinal disorders, degenerative
- Bleeding disorder
- PUD, active
- Elderly pts
Pregnancy Category:B
Breastfeeding: It is not known if sildenafil or its metabolites are excreted in human breast milk. Manufacturer advises caution
