Label: SILDENAFIL CITRATE- sildenafil tablet, film coated

istradefyllineistradefylline will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

What to Expect After Taking Cobra-120

epoprostenol increases effects of sildenafil by additive vasodilation. erythromycin baseerythromycin base will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consider a starting dose of 25 mg in patients treated with erythromycin. erythromycin base will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. erythromycin ethylsuccinate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Regional issues

erythromycin lactobionateerythromycin lactobionate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. erythromycin lactobionate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. erythromycin stearateerythromycin stearate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. erythromycin stearate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. esmololesmolol increases effects of sildenafil by additive vasodilation. istradefylline will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. itraconazoleitraconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Not recommended during and 2 weeks after itraconazole treatment when sildenafil is used for pulmonary arterial hypertension.

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itraconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Related/similar drugs

fosaprepitantfosaprepitant will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fosaprepitant will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fosphenytoinfosphenytoin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels fosphenytoin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels gepotidacingepotidacin increases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Usual Geriatric Dose for:

If possible, avoid with sensitive substrates that are are extensively metabolized by CYP3A4 and have a narrow therapeutic index. If unable to avoid, monitor or modify substrate dose according to its prescribing information. gepotidacin increases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. grapefruitgrapefruit will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. grapefruit will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. labetalollabetalol increases effects of sildenafil by additive vasodilation. labetalol increases effects of sildenafil by additive vasodilation. lapatiniblapatinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. lapatinib will sildenafil 25mg tablets increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. lesinurad (DSC)lesinurad (DSC) decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

• Overuse of sildenafil 120 mg may result in severe headache and nausea.
• Alcohol can reduce sildenafil effectiveness and worsen side effects.
• Always follow the doctor’s instructions for dosing and timing.
• Sildenafil should be stored away from moisture, heat, and light.
• Do not mix sildenafil with recreational drugs like 'poppers' or stimulants.
• Sudden vision loss is rare but requires immediate medical attention.

lesinurad (DSC) decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. letermovirletermovir increases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. letermovir increases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Common Side Effects	Frequency	Serious Side Effects	Warning Signs	Management Tips
Headache	Common	Sudden vision loss	Vision changes, eye pain	Seek medical attention immediately
Flushing	Common	Priapism (painful erection)	Erections lasting >4 hours	Seek emergency care
Nasal Congestion	Common	Hypotension	Dizziness, fainting	Sit or lie down, hydrate
Indigestion (Dyspepsia)	Occasional	Hearing loss	Sudden deafness or ringing	Discontinue use and consult doctor
Muscle Pain	Less common	Severe allergic reactions	Rash, difficulty breathing	Discontinue and seek help

When amlodipine and sildenafil were used in combination, each agent independently exerted its own blood pressure lowering effect. lorlatiniblorlatinib will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. lorlatinib will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. mavacamtensildenafil increases levels of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify mavacamten dose if coadministered with weak or moderate CYP2C19 inhibitors.

A Practical Choice for Real Results

griseofulvingriseofulvin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. griseofulvin will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. hydrocortisonehydrocortisone will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. hydrocortisone will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. idelalisibidelalisib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Antiretroviral Agents

Coadministration of sildenafil with strong CYP3A4 inhibitors is not recommended. If using Viagra, consider decreasing starting dose. idelalisib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. isoniazidisoniazid will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. isoniazid will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. sildenafil increases levels of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. mavorixaformavorixafor will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor for adverse effects of sensitive CYP3A4 substrates if coadministered with mavorixafor (a weak CYP3A4 inhibitor). mavorixafor will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

• The safety of 120 mg sildenafil is not well-established for all users.
• High-dose sildenafil may cause muscle aches and back pain.
• Alcohol consumption can intensify sildenafil’s side effects.
• Aspirin and blood thinners may increase bleeding risk when combined with sildenafil.
• Patients with heart conditions should seek medical advice before use.
• The drug should not be used in conjunction with other erectile dysfunction medications.

metoprololmetoprolol increases effects of sildenafil by additive vasodilation. metoprolol increases effects of sildenafil by additive vasodilation. miconazole vaginal will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. mitapivatmitapivat decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor patients for loss of therapeutic effect of sensitive CYP3A substrates with narrow therapeutic index when coadministered with mitapivat. mitapivat decreases levels of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

In case of emergency/overdose

esmolol increases effects of sildenafil by additive vasodilation. etravirineetravirine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels etravirine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels fedratinibfedratinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Adjust dose of drugs that are CYP3A4 substrates as necessary.

Who should not take sildenafil?

fedratinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fluconazolefluconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fluconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fosamprenavirfosamprenavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fosamprenavir will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nebivololnebivolol increases effects of sildenafil by additive vasodilation. nebivolol increases effects of sildenafil by additive vasodilation. nefazodonenefazodone will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nefazodone will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nevirapinenevirapine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels nevirapine will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Condition	Risk Factors	Precautionary Notes
Nitrate use (e.g., nitroglycerin)	Risk of severe hypotension	Do not use sildenafil if on nitrates
Cardiovascular disease	Increased risk of adverse events	Consult cardiologist before use
Severe hepatic impairment	Slower drug metabolism	Adjust dosage accordingly
Retinitis pigmentosa	Possible worsening of condition	Use with caution, consult ophthalmologist
Recent stroke or MI	Elevated risk for complications	Avoid use unless cleared by a doctor

Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levels nifedipinenifedipine will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nifedipine will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

• Regular use of 120 mg sildenafil is not recommended without medical supervision.
• Potential interactions include blood pressure medications and certain antibiotics.
• Always check for contraindications before using sildenafil at high doses.
• The safety profile of large doses has not been well studied in women.
• Avoid driving or operating machinery until you know how sildenafil affects you.
• Keep track of side effects to report to your healthcare provider promptly.

nilotinibnilotinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. nilotinib will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. pindololpindolol increases effects of sildenafil by additive vasodilation. pindolol increases effects of sildenafil by additive vasodilation.

Parameter	Values	Comments
Absorption rate	Rapid, peak at 30-120 mins	Dose-dependent
Distribution	Widely distributed, crosses BBB	Volume of distribution ~105 L
Half-life	Approximately 4 hours	Dose-dependent
Clearance	41 L/hr (average)	Liver metabolism main route
Bioavailability	40%	Influenced by food and other meds

posaconazoleposaconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. posaconazole will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. propranololpropranolol increases effects of sildenafil by additive vasodilation.