Treatment of Pulmonary Hypertension with Sildenafil (aka Viagra): Understanding the Recommendations and Potential Complications
Sildenafil, marketed under the brand name Revatio, is a medication commonly used to treat pulmonary hypertension. This condition causes high blood pressure in the arteries of the lungs, making it difficult for the heart to pump blood effectively.
Recommended Dosage
For adults, the recommended dosage of sildenafil for pulmonary hypertension is 20 mg taken orally three times a day. For children aged 1 to 17 years, the maximum dose is also 20 mg three times daily, but dosing is usually adjusted based on the child's weight and should be determined by a pulmonary hypertension specialist.
Precautions
When using sildenafil, it's crucial to exercise caution. Patients with low blood pressure or those on blood pressure-lowering medications may experience more pronounced vasodilation effects, requiring careful blood pressure monitoring.
Avoid using sildenafil in pulmonary veno-occlusive disease (PVOD) due to the risk of pulmonary edema. If sudden hearing or visual impairment occurs, seek immediate medical attention. Sildenafil may cause serious issues in pulmonary hypertension secondary to sickle cell disease, so it should be used with caution in these cases.
Concomitant use with other phosphodiesterase-5 (PDE5) inhibitors should be avoided due to the risk of additive effects. Use with strong CYP3A inhibitors is not recommended as they affect sildenafil metabolism and increase the risk of adverse effects.
Interactions
Sildenafil may interact with certain HIV medications, Bosentan (Tracleer) or epoprostenol (Flolan), and beta-blockers, which may increase a person's blood levels of sildenafil. It's essential to speak with a doctor before taking sildenafil for PH, as they can advise on avoiding harmful drug interactions and adjust the dosage accordingly.
Side Effects and Warnings
Some potentially serious side effects of sildenafil include sudden loss of vision, blurred vision, sudden decrease or loss of hearing, ringing in the ears, dizziness or lightheadedness, fainting, chest pain, worsening shortness of breath, an erection that lasts longer than 4 hours, itching or burning during urination, and rash.
Certain foods, supplements, and other medications can cause dangerous interactions with sildenafil. It is important to avoid taking sildenafil while taking nitrates or nitric oxide donors.
Doctors do not recommend taking sildenafil while pregnant. In a 2017 clinical trial, people with pulmonary arterial hypertension who took 20 mg of sildenafil three times daily showed the largest increase in their 6-minute walking distance.
Sildenafil is a phosphodiesterase inhibitor that blocks the activity of the enzyme, increasing the levels of cAMP and cGMP.
It's important to remember that this article is for informational purposes only and should not replace professional medical advice. Always consult with a healthcare provider before starting any new medication.
[1] National Heart, Lung, and Blood Institute. (2021). Pulmonary hypertension. Retrieved from https://www.nhlbi.nih.gov/health-topics/pulmonary-hypertension
[3] National Institute for Health and Care Excellence. (2019). Sildenafil for pulmonary arterial hypertension. Retrieved from https://www.nice.org.uk/guidance/ta488
- Sildenafil, marketed as Revatio, is a system used to treat a specific medical condition, pulmonary hypertension, which is a disease that affects the cardiovascular system by causing high blood pressure in the lungs' arteries, possibly leading to heart-related issues.
- The recommended dosage for adults with pulmonary hypertension is 20 mg taken orally three times a day, while children's dosage is adjusted based on their weight and determined by a pulmonary hypertension specialist.
- When using sildenafil, patients must exercise caution, especially those with low blood pressure or those on blood pressure-lowering medications, as they could experience more pronounced vasodilation effects.
- Avoid using sildenafil in pulmonary veno-occlusive disease due to the risk of pulmonary edema, and be aware of the risks in pulmonary hypertension secondary to sickle cell disease.
- Sildenafil may interact with various drugs such as certain HIV medications, Bosentan, epoprostenol, and beta-blockers, so it's crucial to discuss these potential interactions with a doctor before taking it.
- It's important to remember that sildenafil is a product of pharmaceutical science, working by blocking the activity of an enzyme (phosphodiesterase-5) to increase the levels of cAMP and cGMP in the body, leading to improved health and wellness in those with pulmonary hypertension. However, always consult with a healthcare provider before starting any new medication.
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