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Sildenafil is a very effective and safe drug used for the treatment of erectile dysfunction but before you use it you should know more about its adverse effects and contraindications.

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Warnings/Precautions

Issues related to adverse effects:

Hearing loss: some reports of Sudden decrease or loss of hearing. tinnitus and dizziness may be accompanied by hearing changes. No direct relationship between sildenafil and hearing loss has not been determined.

Color discrimination: impairment of color discrimination which is dose-related, Use with caution in case of retinitis pigmentosa.

Decrease in blood pressure (hypotension): those on antihypertensive therapy or fluid depletion may be more sensitive to hypotensive actions. measure blood pressure prior to initiating therapy (start the lowest possible dose). Ethanol may increase the risk of hypotension and orthostasis, avoid or limit ethanol consumption.

Priapism: Painful erection >6 hours has been reported rarely, seek medical assistance for an erection lasting >4 hours.

Vision loss: reports of Sudden loss of vision in one or both eyes, including permanent loss of vision. Other risk factors include smoking, coronary artery disease, diabetes, hyperlipidemia, hypertension, and >50 years of age.  discontinue therapy if you are suffering sudden vision loss and consult a health care provider immediately. No direct relationship between therapy and vision loss has not been determined.

Disease-related issues:

 Use with caution in patients with anatomical deformation of the penis.

Use with caution in case of bleeding disorders; safety has not been established.

Use with caution in case of hypotension (<90/50 mm Hg); uncontrolled hypertension (>170/110 mm Hg); irregular heartbeats,  MI or stroke within the last 6 months; coronary artery disease causing unstable angina or cardiac failure; safety and efficacy have not been studied in these patients. 

Use with caution in case of conditions that may predispose them to priapism (sickle cell anemia, multiple myeloma, leukemia). seek immediate medical attention if the erection persists >4 hours.

Hepatic impairment: use the lowest starting dose (25 mg) of Viagra.

safety has not been established, Use with caution in case of active peptic ulcer disease.

Pulmonary arterial hypertension:  an exacerbation of pulmonary arterial hypertension (PAH) can occur after sudden cessation of sildenafil monotherapy, safety of longer-term use is unclear. 

Renal impairment: dose adjustment may be needed, use the lowest starting dose (25 mg) in severe dysfunction (CrCl <30 mL/minute).

Sickle cell anemia: The effectiveness and safety of sildenafil have not been established in pulmonary hypertension secondary to sickle cell disease. Use with caution

Food Interactions

serum levels/toxicity of orally administered sildenafil can be increased with Grapefruit juice, Monitor for increased effects/toxicity with concomitant oral use.

Contraindications

Concurrent use with certain drugs such as:

Any drug contains organic nitrates in any form (eg, nitroglycerin, isosorbide dinitrate).

Riociguat drug.

protease inhibitors (tipranavir, atazanavir, nelfinavir, indinavir,darunavir, fosamprenavir, lopinavir/ritonavir, ritonavir, saquinavir, )

Pregnancy Considerations

Sildenafil was shown to cross the placenta, due to adverse events in the newborn observed using preliminary data from a study evaluating sildenafil for fetal growth restriction, use of sildenafil in pregnant women outside of a controlled clinical study is not currently recommended. Information related to the use of sildenafil for the treatment of pulmonary arterial hypertension (PAH) in pregnant women is limited. Untreated PAH in pregnancy increases the risk of heart failure, stroke, preterm delivery, and maternal/fetal death. Women with PAH are encouraged to avoid pregnancy. 

Breast-Feeding Considerations

Sildenafil is excreted in breast milk.

The excretion of sildenafil in breast milk was described in a case report following maternal use for the treatment of PAH.