Penegra

Penegra Dosage/Direction for Use

sildenafil

Manufacturer:

Cadila Healthcare

Distributor:

Metro Drug

Marketer:

Zydus Healthcare Phils
Full Prescribing Info
Dosage/Direction for Use
In erectile dysfunction, it is given orally, in a usual dose equivalent to sildenafil 50 mg about one hour before sexual intercourse. The dose may be increased or decreased depending on response. The maximum recommended dose is 100 mg, and sildenafil should not be taken more than once in 24 hours.
An initial dose of no more than 25 mg daily is advised in patients taking sildenafil with inhibitors of cytochrome P450 iso-enzyme CYP3A4; the dose should not exceed 25 mg every 48 hours if given with ritonavir-boosted HIV-protease inhibitors, although such a combination is best avoided entirely.
In patients stabilized on alpha blocker therapy, an initial dose of sildenafil 25 mg should be considered.
To improve exercise ability in pulmonary arterial hypertension, sildenafil is given orally in a dose of 20 mg three times daily. Alternatively, it may be given by intravenous injection in a dose of 10 mg three times daily if the oral route is not possible. Use of sildenafil for pulmonary arterial hypertension is not recommended with potent CYP3A4 inhibitors such as ketoconazole, itraconazole, and ritonavir; use with other potencies of CYP3A4 inhibitor may require a reduction in the sildenafil dose. A dose reduction to 20 mg twice daily orally, or 10 mg twice daily intravenously, should be considered in patients taking sildenafil with medium-potency CYP3A4 inhibitors like erythromycin or saquinavir. A reduction to 20 mg once daily orally, or 10 mg once daily intravenously, is advised in patients taking sildenafil with stronger CYP3A4 inhibitors like clarithromycin, telithromycin, and nefazodone.
Administration in children: Although sildenafil is not indicated for individuals below 18 years of age. The BNFC 2009 suggests a dose of 250 to 500 micrograms/kg given orally every 4 to 8 hours, adjusted according to response up to a maximum of 2 mg/kg every 4 hours for pulmonary arterial hypertension in neonates and children up to 18 years of age. Treatment should be withdrawn gradually in neonates.
Administration in hepatic impairment: Sildenafil clearance is reduced in patients with hepatic impairment. Safety has not been established in patients with severe hepatic impairment (Child-Pugh class C) and its use is contra-indicated in these patients for this reason. For patients with erectile dysfunction recommends an initial oral dose of 25 mg in patients with hepatic impairment. For patients with pulmonary arterial hypertension states that initial dose adjustments are not needed for patients with mild or moderate hepatic impairment (Child-Pugh class A or B); it is recommended that a reduction to 20 mg twice daily orally, or 10 mg twice daily intravenously, should be considered if therapy is not well tolerated.
Administration in renal impairment: Sildenafil clearance is reduced in patients with severe renal impairment. For patients with erectile dysfunction recommends that in these patients, an initial oral-dose of 25 mg should be considered. The dose maybe increased to 50 or 100 mg orally, if needed and tolerated. For patients with pulmonary arterial hypertension states that no dose adjustments are required for patients with renal impairment, including those with severe renal impairment (creatinine clearance less than 30 mL/minute). However,consideration of a reduction to 20 mg twice daily orally, or 10 mg twice daily intravenously, should be considered therapy is not well tolerated.
Benign prostatic hyperplasia: Although not routinely recommended due to a lack of data, sildenafil has been used to treat lower urinary tract symptoms commonly associated with benign prostatic hyperplasia.
Erectile dysfunction: Sildenafil, an inhibitor of phosphodiesterase type-5, is used as an oral therapy for erectile dysfunction. It is effective in erectile dysfunction of psychogenic causes and organic causes such as diabetes mellitus, spinal –cord injury, and prostatectomy.
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