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Patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of PDE5 inhibitorsPatients should be stable on alpha-blocker therapy prior to initiating a PDE5 inhibitorIn those patients who are stable on alpha-blocker therapyPDE5 inhibitors should be initiated at the lowest dosesee DOSAGE AND ADMINISTRATIONIn those patients already taking an optimized dose of a PDE5 inhibitoralpha-blocker therapy should be initiated at the lowest doseStepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a PDE5 inhibitorSafety of combined use of PDE5 inhibitors and alpha-blockers may be affected by other variablesincluding intravascular volume depletion and other anti-hypertensive drugs.
At single oral doses of 100 mg and 200 mgtransient dose-related impairment of color discrimination was detected using the Farnsworth-Munsell 100-hue testwith peak effects near the time of peak plasma levelsThis finding is consistent with the inhibition of PDE6which is involved in phototransduction in the retinaSubjects in the study reported this finding as difficulties in discriminating blue/greenAn evaluation of visual function at doses up to twice the maximum recommended dose revealed no effects predisone quick delivery. of VIAGRA on visual acuityintraocular pressureor pupillometry.
After either oral or intravenous administrationsildenafil is excreted as metabolites predominantly in the fecesapproximately 80of administered oral doseand to a lesser extent in the urineapproximately 13of the administered oral doseSimilar values for pharmacokinetic parameters were seen in normal volunteers and in the patient populationusing a population pharmacokinetic approach.
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