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Heart failure, coronary artery disease, unstable angina No clinical trial data are available on the safety and efficacy of sildenafil in patients with PAH and coexisting recent within 6 months myocardial infarction, stroke, or life-threatening arrhythmia; coronary artery disease causing unstable angina; or hypertension blood pressure exceeding 170/110 mmHg If sildenafil is used for the treatment of PAH in such patients, caution is advised.

Patients with PAH should inform their clinician of coexisting chest pain or recent within 6 months myocardial infarction, stroke, or arrhythmias prior to initiation of sildenafil.Free unbound plasma drug concentrations in healthy geriatric adults are approximately 45% greater than those in healthy younger adults 18-45 years Such age-related reductions in clearance of the drug do not appear to be attributable to age-related sildenafil 20 mg precio in creatinine clearance but result from age-related differences in plasma sildenafil 20 mg precio binding.

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In addition, unlike intracavernosal or intraurethral therapy or vacuum constriction devices, selective PDE type 5 inhibitors are only effective in the presence of adequate sexual stimulation.The changes from baseline in scoring on the two end point questions frequency of successful penetration during sexual activity and maintenance of erections after sildenafil 50 mg precio were highly statistically significantly in favor subgroups demonstrated efficacy regardless of baseline severity, etiology, race and age.

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After oral doses of 20 mg three times a day, the mean maximum total plasma concentration of sildenafil at steady state is approximately 113 ng/ml. Sildenafil and its major circulating N-desmethyl metabolite are approximately 96% bound to plasma proteins.Other reported clinical experience has not identified differences in response between geriatric and younger patients with PAH.

The greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly should be considered in dosage selection for the treatment of PAH. Sildenafil did not exhibit evidence of mutagenicity in vitro in bacterial and Chinese hamster ovary sildenafil 50 mg precio assays.

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Do not drinkgrapefruit juice when taking this medication.Other clinicians consider psychotherapy/behavioral therapy alone or in conjunction with vasoactive therapy or vacuum constriction devices to be appropriate in patients with psychogenic ED or coexisting organic and psychogenic ED. With the availability of orally active and convenient vasoactive erectogenic therapies e. selective PDE type 5 inhibitors such sildenafil 20 mg precio sildenafil, vardenafil, tadalafil most experts now consider these drugs, vacuum constriction devices, and/or psychosexual therapy to be suitable first-line therapies for a broad range of patients with ED.

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