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  • Cimetidine (800 mg), a cytochrome P450 inhibitor and non-specific CYP3A4 inhibitor, caused a 56% enhance in plasma sildenafil concentrations when co-administered with sildenafil (50 mg) to healthy volunteers.
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Inhabitants pharmacokinetic analysis of clinical study knowledge indicated a reduction in sildenafil clearance when co-administered with CYP3A4 inhibitors (such as ketoconazole, erythromycin, cimetidine). Subsequently, inhibitors of those isoenzymes may scale back sildenafil clearance and inducers of those isoenzymes could improve sildenafil clearance. Caution is suggested when sildenafil is administered to patients taking an alpha-blocker, as the co-administration may result in symptomatic hypotension in a few susceptible people (see part 4.5). Co-administration of sildenafil with ritonavir isn’t suggested (see section four.5). With the exception of ritonavir, for which co-administration with sildenafil is not advised (see section four.4), a beginning dose of 25 mg must be thought of in sufferers receiving concomitant therapy with CYP3A4 inhibitors (see part four.5). Since sildenafil clearance is lowered in patients with hepatic impairment (e.g. cirrhosis) a 25 mg dose must be thought-about.