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Prolonged erection greater than 4 hours and priapismpainful erections greater than 6 hours in durationhave been reported infrequently since market approval of VIAGRAIn the event of an erection that persists longer than 4 hoursthe patient should seek immediate medical assistanceIf priapism is not treated immediatelypenile tissue damage and permanent loss of potency could result.

VIAGRA50 mgdid not potentiate the increase in bleeding time caused by aspirin150 mg

In another study in healthy male volunteersco-administration with the HIV protease inhibitor ritonavirwhich is a highly potent P450 inhibitorat steady state500 mg bidwith VIAGRA100 mg single doseresulted in a 3004-foldincrease in sildenafil Cmax and a 100011-foldincrease in sildenafil plasma AUCAt 24 hours the plasma levels of sildenafil were still approximately 200 ng/mLcompared to approximately 5 ng/mL when sildenafil was dosed aloneThis is consistent with ritonavir’s marked effects on a broad range of P450 substratesVIAGRA had no effect on ritonavir pharmacokineticssee DOSAGE AND ADMINISTRATION and DRUG INTERACTIONS

Consider a starting dose of 25 mg in patients65 yearspatients with hepatic impairmente.gcirrhosisand patients with severe renal impairmentcreatinine clearance.

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