SILDENAFIL

Posology Use in adults:

The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. Based on efficacy and tolerability, the dose may be increased to 100 mg or decreased to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended dosing frequency is once per day.

2).

Special populations Elderly patients:

Dosage adjustments are not required in elderly patients (≥ 65 years old).

Patients with renal impairment:

The dosing recommendations described in ‘Use in adults’ apply to patients with mild to moderate renal impairment (creatinine clearance = 30 - 80 ml/min). Since sildenafil clearance is reduced in patients with severe renal impairment (creatinine clearance <30 ml/min) a 25 mg dose should be considered.

Based on efficacy and tolerability, the dose may be increased step-wise to 50 mg up to 100 mg as necessary. g. cirrhosis) a 25 mg dose should be considered. Based on efficacy and tolerability, the dose may be increased step-wise to 50 mg up to 100 mg as necessary.

Paediatric population:

Sildenafil is not indicated for individuals below 18 years of age. 5). In order to minimize the potential for developing postural hypotension in patients receiving alpha-blocker treatment, patients should be stabilized on alpha-blocker therapy prior to initiating sildenafil treatment.

5). Method of administration For oral use.

Summary of the safety profile The safety profile of sildenafil is based on 8691 patients who received the recommended dosing regimen in 67 placebo-controlled clinical studies. The most commonly reported adverse reactions in clinical studies among sildenafil treated patients were headache, flushing, dyspepsia, visual disorders, nasal congestion, dizziness and visual colour distortion.

Adverse reactions from post-marketing surveillance has been gathered covering an estimated period >9 years. Because not all adverse reactions are reported to the Marketing Authorization Holder and included in the safety database, the frequencies of these reactions cannot be reliably determined.

Tabulated list of adverse reactions In the table below all medically important adverse reactions, which occurred in clinical trials at an incidence greater than placebo are listed by system organ class and frequency (very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000).

In addition, the frequency of medically important adverse reactions reported from post-marketing experience is included as not known. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

Table 1:

Medically important adverse reactions reported at an incidence greater than placebo in controlled clinical studies and medically important adverse reactions reported through post-marketing surveillance. System Organ Class Adverse Reactions Immune system disorders Rare Hypersensitivity reactions Nervous system disorders Very common Common Uncommon Rare Not known Headache Dizziness Somnolence, Hypoaesthesia Cerebrovascular accident, Syncope Transient ischaemic attack, Seizure, Seizure recurrence Eye disorders Common Uncommon Not known Visual disorders, visual colour distortion Conjunctival disorders, Eye disorders, Lacrimation Disorders, Other Eye Disorders Non-arteristic anterior ischaemic optic neuropathy (NAION), Retinal vascular occlusion, Visual field defect Ear and labyrinath disorders Uncommon Rare Vertigo, Tinnitus Deafness Vascular disorders Common Rare Flushing Hypertension, Hypotension Cardiac disorders Uncommon Rare Not known Palpitation, Tachycardia Myocardial infraction, Atrial fibrillation Ventricular arrhythmia, Unstable angina, Sudden cardiac death Respiratory, thoracic and mediastinal disorders Common Rare Nasal congestion Epistaxis Gastrointestinal disorders Common Uncommon Dyspepsia Vomiting, Nausea, Dry mouth Skin, subcutaneous and soft tissue disorders Uncommon Not known Skin rash Steven Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) Musculoskeletal and connective tissue disorders Uncommon Myalgia Renal and urinary disorders Uncommon Haematuria Reproductive system and breast disorders Uncommon Haematospermia, Penile haemorrhage Not known Priapism, Prolonged erection General disorders and administration site conditions Uncommon Chest pain, Fatigue Investigations Uncommon Heart rate increased Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

A medical history and physical examination should be undertaken to diagnose erectile dysfunction and determine potential underlying causes, before pharmacological treatment is considered. Cardiovascular risk factors Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity.

1). Prior to prescribing sildenafil, physicians should carefully consider whether their patients with certain underlying conditions could be adversely affected by such vasodilatory effects, especially in combination with sexual activity.

, aortic stenosis, hypertrophic obstructive cardiomyopathy), or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure. 3). Serious cardiovascular events, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of sildenafil.

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

It is not possible to determine whether these events are related directly to these factors or to other factors. Priapism Agents for the treatment of erectile dysfunction, including sildenafil, should be used with caution in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia).

Concomitant use with other treatments for erectile dysfunction The safety and efficacy of combinations of sildenafil with other treatments for erectile dysfunction have not been studied. Therefore the use of such combinations is not recommended.

1. 1), sildenafil was shown to potentiate the hypotensive effects of nitrates, and its co-administration with nitric oxide donors (such as amyl nitrite) or nitrates in any form is therefore contraindicated. g. patients with severe cardiovascular disorders such as unstable angina or severe cardiac failure).

4). • The safety of sildenafil has not been studied in the following sub-groups of patients and its use is therefore contraindicated: severe hepatic impairment, hypotension (blood pressure <90/50 mmHg), recent history of stroke or myocardial infarction and known hereditary degenerative retinal disorders such as retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases).