Sildenafil-SZ - Instructions For Use, Reviews, Price, Analogs Of Tablets

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Sildenafil-SZ

Sildenafil-SZ: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Sildenafil-SZ

ATX code: G04BE03

Active ingredient: sildenafil (Sildenafil)

Manufacturer: Severnaya Zvezda, JSC (Russia)

Description and photo updated: 30.11.2018

Prices in pharmacies: from 122 rubles.

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Sildenafil-SZ is a remedy for the symptomatic treatment of erectile dysfunction.

Release form and composition

The drug is produced in the form of film-coated tablets: round, biconvex, blue, at a break - almost white or white (1, 2, 4 or 8 pcs. In cell contour packs, in a cardboard box 1 package; 7 or 10 pcs. In cell contour packs, in a cardboard box 1 or 2 packs; 20 pcs. In polymer cans / bottles, in a cardboard box 1 can / bottle; each pack also contains instructions for the use of Sildenafil-SZ).

Composition of 1 tablet:

• active substance: sildenafil (in the form of citrate) - 25, 50 or 100 mg;
• auxiliary components: povidone (medium molecular weight polyvinylpyrrolidone), lactose monohydrate (milk sugar), microcrystalline cellulose, magnesium stearate, croscarmellose sodium (primellose);
• film casing: Opadray II, including talc, macrogol (polyethylene glycol 3350), partially hydrolyzed polyvinyl alcohol, titanium dioxide (E171), iron oxide (II) black (E172), iron oxide (II) yellow (E172), aluminum lacquer based on brilliant blue.

Pharmacological properties

Pharmacodynamics

The active ingredient of Sildenafil-SZ - sildenafil, is a potent selective inhibitor of cGMP-specific PDE5 (cycloguanosine monophosphate-specific phosphodiesterase type 5).

The physiological mechanism of erection under the action of sildenafil is due to the release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation, which in turn causes an increase in cGMP levels, relaxation of the smooth muscle tissue of the corpus cavernosum and an increase in blood flow.

The drug does not have a direct relaxing effect on the isolated corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting PDE5, which is responsible for the breakdown of cGMP.

The activity of sildenafil in vitro against PDE5 is significantly higher than its activity against other known phosphodiesterase isoenzymes: PDE6 - 10 times, PDE1 - more than 80 times, PDE2, PDE4, PDE7 – PDE11 - more than 700 times, PDE3 - 4000 time. The latter is of particular importance, since PDE3 is one of the key enzymes involved in the regulation of myocardial contractility.

A prerequisite for the development of the effect of sildenafil is sexual stimulation.

Efficiency

There were 21 randomized, double-blind, placebo-controlled studies lasting up to 6 months, in which 3000 patients aged 19 to 87 years with erectile dysfunction of various etiologies (psychogenic, organic and mixed) took part. The effectiveness of the drug was determined by the ability to achieve and maintain an erection sufficient for satisfactory intercourse. The effect of the drug was assessed globally: according to the results of patient surveys, data from erection diaries, using the international index of erectile function (a validated questionnaire on the state of sexual function).

The effectiveness of therapy was recorded in all study groups and confirmed in long-term studies lasting 1 year. Compared with the placebo group (25%), the improvement of erection in patients receiving sildenafil at a dose of 25 mg was 62%, at a dose of 50 mg - 74%, at a dose of 100 mg - 82%.

According to the analysis of the international index of erectile function, in addition to improving erection, patients taking sildenafil noted an increase in the quality of orgasm, pleasure from intercourse and overall satisfaction.

Among the participants who reported an improvement in erectile function with the drug, according to pooled data, there were 83% of patients with spinal cord injuries, 59% of patients with diabetes mellitus and 43% of patients undergoing radical prostatectomy (in the placebo group, these indicators were 12, 16 and fifteen%).

Cardiological examinations

When using sildenafil in doses up to 100 mg, clinically significant changes in the electrocardiogram were not observed in healthy volunteers. After taking the drug, the maximum decrease in systolic pressure in the supine position was 8.3 mm Hg. Art., diastolic pressure - 5.3 mm Hg. Art. A more pronounced but transient decrease in blood pressure (BP) was observed in patients who simultaneously took nitrates.

The hemodynamic effect of the drug when taken in a single dose of 100 mg was evaluated in 14 patients with severe ischemic heart disease (more than 70% of patients had stenosis of at least one coronary artery). In the study, a decrease in blood pressure at rest was noted: systolic - by 7%, diastolic - by 6%. Pulmonary systolic pressure decreased by 9%. There were no changes in cardiac output, blood flow disturbances in the stenotic coronary arteries. There was an increase (by approximately 13%) in adenosine-induced coronary flow in stenotic and intact coronary arteries.

Men (n = 144) who received antianginal drugs (excluding nitrates) with erectile dysfunction and stable angina pectoris, who took part in a double-blind, placebo-controlled study, performed physical exercises until the severity of angina symptoms subsided. In patients taking 100 mg of sildenafil, the duration of the exercise was significantly longer (from 0.9 to 38.9 seconds, on average 19.9 seconds) than in participants receiving placebo.

The effect of varying the dose of sildenafil (up to 100 mg) was studied in a randomized, double-blind, placebo-controlled study in men (n = 568) with erectile dysfunction and hypertension who received more than two antihypertensive drugs. The improvement in erection in the sildenafil group was 71%, in the placebo group - 18%. The incidence of adverse reactions was comparable to that in representatives of other groups and patients taking more than three antihypertensive drugs.

Research on visual impairment

One hour after taking 100 mg of sildenafil, some men using the Farnsworth-Munsell 100 test revealed mild and transient violations of the ability to distinguish shades of color (green / blue), after another 1 hour, visual function was restored. The impairment of color vision is presumably caused by inhibition of PDE6, which is involved in the process of light transmission in the retina.

Sildenafil had no effect on visual acuity, contrast perception, pupil diameter, intraocular pressure, and electroretinogram.

A placebo-controlled crossover study of patients with established early-age macular degeneration (n = 9) who received 100 mg of sildenafil was performed. The drug was well tolerated. Vision was assessed using special visual tests: color perception, visual acuity, modeling of color passage, Amsler grating, photostress, Humphrey perimeter. No clinically significant changes were identified.

Pharmacokinetics

In the recommended dose range, the pharmacokinetics of sildenafil are linear.

The drug is rapidly absorbed after oral administration. The average maximum plasma concentration (C _max) of free sildenafil after a single dose of 100 mg is about 18 ng / ml (38 nM). In the case of taking the tablet on an empty stomach, C _{max is} reached within about 60 minutes (30-180 minutes). When fatty foods are consumed, the absorption rate decreases, as a result of which, on average, C _max decreases by 29%, the time to reach C _max increases by 60 minutes, but the degree of absorption does not change significantly [AUC (area under the concentration-time curve) decreases by 11%].

Absolute bioavailability is 25–63% (average 40%). In vitro, sildenafil at a concentration of ~ 1.7 ng / ml (3.5 nM) inhibits PDE5 activity by 50%.

The volume of distribution of sildenafil at steady state averages 105 liters. Sildenafil and its main circulating N-demethyl metabolite bind to plasma proteins by 96%, this indicator does not depend on the total concentration of the drug. 90 minutes after taking the pill, less than 0.000 2% of the dose received was found in the semen (average 188 ng).

Sildenafil is metabolized mainly in the liver with the participation of cytochrome isoenzymes CYP3A4 (main pathway) and CYP2C9 (minor pathway). N-demethyl metabolite, the main circulating active metabolite, undergoes further biotransformation. Its selectivity for PDE is comparable to that of sildenafil itself, and its in vitro activity for PDE5 is approximately 50% of that of sildenafil.

The plasma concentration of the main metabolite in healthy volunteers was ~ 40% of the sildenafil level. Half-life (T _½) ~ 4 hours.

The total clearance of sildenafil is 41 l / h, the final T _½ is 3-5 hours. The drug is excreted mainly in the form of metabolites: 80% - through the intestines, 13% - by the kidneys.

Pharmacokinetics in special cases:

• advanced age (over 65 years): the clearance of the drug decreases, the concentration of free sildenafil in plasma increases by about 40%. The incidence of side effects does not depend on age;
• renal failure: with mild [creatinine clearance (CC) 50-80 ml / min] and moderate (CC 30-49 ml / min) impairment of renal function, the pharmacokinetic parameters of the drug after taking a dose of 50 mg do not change. In severe renal failure (CC <30 ml / min), the clearance of sildenafil decreases, as a result of which C _max (88%) and AUC (100%) increase by 2 times compared with patients of the same age group with normal renal function;
• cirrhosis of the liver (classes A and B according to the Child-Pugh classification): the clearance of sildenafil decreases, which causes an increase in C _max (47%) and AUC (84%) compared to patients with normal liver function. The pharmacokinetics of the drug in severe liver functional disorders (class C according to the Child - Pugh classification) has not been studied.

Indications for use

Sildenafil-SZ is used for erectile dysfunction characterized by an inability to achieve and / or maintain an erection sufficient for satisfactory intercourse. The drug is effective only for sexual stimulation.

Contraindications

Absolute:

• age up to 18 years;
• female;
• lactase deficiency, lactose intolerance, glucose-galactose malabsorption;
• continuous or intermittent use of nitric oxide donors, organic nitrates or nitrites in any form;
• concomitant use of ritonavir;
• the combined use of other drugs for the treatment of erectile dysfunction;
• hypersensitivity to any component of Sildenafil-SZ.

Relative (Sildenafil-SZ tablets are used with caution, after comparing the benefits and risks):

• anatomical deformity of the penis (Peyronie's disease, cavernous fibrosis, angulation);
• diseases with a risk of developing priapism, such as thrombocythemia, sickle cell anemia, leukemia, or multiple myeloma;
• unstable angina;
• heart failure;
• arterial hypertension (BP> 170/100 mm Hg) or hypotension (BP <90/50 mm Hg);
• severe arrhythmias;
• a stroke or myocardial infarction in the last 6 months;
• a history of anterior non-arteritis ischemic neuropathy of the optic nerve;
• hereditary retinitis pigmentosa;
• peptic ulcer of the stomach and duodenum in the acute phase;
• active bleeding.

Sildenafil-SZ, instructions for use: method and dosage

Sildenafil-SZ tablets should be taken orally, approximately 1 hour before sexual activity.

In most cases, 50 mg is optimal. Depending on the severity of the effect and the tolerability of therapy, the dose can be reduced to 25 mg or increased to 100 mg. The maximum dose is 100 mg, the maximum permissible frequency of use is 1 time per day.

Patients with mild to moderate renal failure (CC 30–80 ml / min) do not need to adjust the dose of the drug. In severe renal insufficiency (CC <30 ml / min), the recommended dose is 25 mg.

Patients with liver cirrhosis can take Sildenafil-SZ 25 mg.

Elderly patients do not need to adjust the dosage regimen.

With the combined use of inhibitors of the isoenzyme of cytochrome CYP3A4 (itraconazole, erythromycin, ketoconazole, saquinavir), the initial dose should be 25 mg.

Simultaneous administration of the drug with ritonavir requires a single dose of sildenafil to be reduced to 25 mg and the interval between doses of Sildenafil-SZ to be increased to 48 hours.

Patients receiving alpha-blockers are allowed to take sildenafil only after hemodynamic stabilization. It is also recommended to reduce the starting dose of Sildenafil-SZ.

Side effects

Side effects registered in clinical and post-marketing studies (according to the frequency of occurrence, they are classified as follows: very often - ≥ 10%, often - from ≥ 1% to <10%, infrequently - from ≥ 0.1% to <1%, rarely - from ≥ 0.01% to <0.1%, very rarely - <0.01%, frequency unknown - based on available data, frequency cannot be determined):

• genitals and mammary gland: infrequently - edema of the genitals, impaired ejaculation, hematospermia, anorgasmia, damage to the tissues of the penis, enlargement of the mammary glands; rarely - bleeding from the penis, prolonged erection, priapism;
• cardiovascular system: often - hot flashes; infrequently - palpitations, increased heart rate, cardiomyopathy, decreased or increased blood pressure, tachycardia, unstable angina pectoris, atrioventricular block, changes in the electrocardiogram, cerebral thrombosis, heart failure, myocardial infarction, cardiac arrest; rarely - atrial fibrillation, ventricular arrhythmia *, sudden cardiac death *;
• immune system: infrequently - allergic reactions, hypersensitivity reactions (including skin rash);
• metabolism and nutrition: infrequently - edema, thirst, peripheral edema, gout, hypernatremia, hypoglycemia, hyperuricemia, uncompensated diabetes mellitus, hyperglycemia;
• respiratory system: often - nasal congestion; infrequently - rhinitis, increased sputum volume, sinusitis, laryngitis, pharyngitis, increased cough, bronchitis, dyspnea, nosebleeds, asthma; rarely - swelling or dryness of the nasal mucosa, a feeling of tightness in the throat;
• nervous system: very often - headache; often - dizziness; infrequently - migraine, drowsiness, insomnia, unusual dreams, vertigo, hypesthesia, paresthesia, ataxia, neuralgia, tremor, hypertonicity, increased reflexes, symptoms of depression, neuropathy; rarely - fainting, transient ischemic attack, cerebrovascular accident, convulsions *, repeated convulsions *;
• urinary system: infrequently - urinary incontinence, nocturia, hematuria, cystitis;
• musculoskeletal system: often - back pain; infrequently - bone / limb pain, synovitis, arthrosis, arthritis, myalgia, tenosynovitis, tendon rupture, myasthenia gravis;
• digestive system: often - dyspeptic disorders, nausea; infrequently - dryness of the oral mucosa, abdominal pain, vomiting, stomatitis, gingivitis, glossitis, gastritis, colitis, gastroenteritis, dysphagia, esophagitis, gastroesophageal reflux disease, rectal bleeding, abnormal liver function tests; rarely - hypesthesia of the oral mucosa;
• hematopoietic system: infrequently - a decrease in the number of leukocytes and hemoglobin concentration;
• organ of hearing: infrequently - pain / noise / ringing in the ears, sudden hearing loss or loss;
• organ of vision: often - cyanopsia, blurred vision, blurred vision; infrequently - eye redness / sclera injections, eye pain, change in the brightness of light perception, disruption of the lacrimal apparatus, photopsia, photophobia, chromatopsia, conjunctivitis, mydriasis, hemorrhage in the eye tissue, cataract; rarely - a feeling of dryness in the eyes, increased eye fatigue, discomfort in the eyes, irritation of the mucous membrane of the eyes, hyperemia of the conjunctiva, edema of the eyelids and adjacent tissues, vision of objects in yellow (xanthopsia) or red (erythropsia) color, the presence of rainbow circles in the field of view around the light source; frequency unknown - decreased acuity or temporary loss of vision, retinal edema, visual field defect, retinal vein occlusion, retinal vascular disease, increased intraocular pressure,non-arteritis anterior ischemic neuropathy of the optic nerve, detachment of the vitreous humor, vitreous traction, diplopia *;
• skin and subcutaneous tissues: infrequently - itchy skin, skin rashes, skin ulceration, exfoliative dermatitis, increased sweating, urticaria, contact dermatitis, herpes simplex; frequency unknown - toxic epidermal necrolysis, Stevens-Johnson syndrome;
• others: infrequently - chills, a feeling of heat, pain in the chest area, accidental falls, accidental injuries, photosensitivity reactions, facial edema, fatigue, asthenia, pain of various localization, shock; rarely - irritability.

* Side effects identified in post-marketing research.

Overdose

It was reported about single doses of Sildenafil-SZ in doses up to 800 mg. Overdose symptoms were comparable to side effects, but developed more frequently.

Treatment is symptomatic. Hemodialysis is ineffective.

special instructions

Before taking Sildenafil-SZ, men are advised to undergo an examination so that the doctor can determine the cause of erectile dysfunction and prescribe adequate treatment.

The simultaneous use of other drugs for the treatment of erectile dysfunction is not recommended, since the efficacy and safety of such combinations has not been studied.

Sildenafil-SZ should not be taken by men for whom sexual activity is undesirable.

Sexual activity poses a certain risk in heart disease, therefore, it is recommended to conduct an examination of the cardiovascular system before taking Sildenafil-SZ.

Sexual activity is undesirable in patients with arterial hypertension, arterial hypotension, unstable angina pectoris, heart failure, life-threatening arrhythmias, as well as with myocardial infarction or stroke in the last 6 months. In clinical studies, there was no significant difference in the incidence of myocardial infarction (1.1 per 100 people per year) and the frequency of mortality from diseases of the cardiovascular system (0.3 per 100 people per year) in people who received placebo and patients taking Sildenafil-SZ.

Arterial hypotension

Sildenafil has a systemic vasodilating effect, which causes a temporary decrease in blood pressure. However, in most cases, it is not clinically significant and does not cause any complications. Nevertheless, in patients with concomitant diseases, it is recommended to carefully assess the risk of possible undesirable manifestations of the vasodilating effect of Sildenafil-SZ, especially during sexual activity.

Patients with obstruction of the left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy) and patients with the rare syndrome of multiple systemic atrophy, which is manifested by severe dysregulation of blood pressure by the autonomic nervous system, are prone to increased susceptibility to vasodilators.

Taking sildenafil during therapy with alpha-blockers in particularly sensitive patients is fraught with the development of symptomatic hypotension. Therefore, special care is required. To avoid the risk of postural hypotension, it is recommended to start taking Sildenafil-SZ only after stabilization of hemodynamic parameters. It is also worth considering reducing the starting dose. The physician should inform patients about the necessary measures in case of signs of developing postural hypotension.

Cardiovascular complications

Post-marketing studies have reported the development of severe cardiovascular complications, including ventricular arrhythmia, unstable angina pectoris, arterial hypertension and hypotension, hemorrhagic stroke, myocardial infarction, sudden cardiac death. These complications were temporarily associated with the use of sildenafil. The majority of patients had associated risk factors.

Many of these disorders were noted soon after sexual activity, some of them after taking the drug without subsequent intercourse.

It is not possible to establish a direct connection between cardiovascular complications and these or other factors.

Bleeding

In in vitro studies, it was found that sildenafil enhances the antiplatelet effect on human platelets of concomitantly used sodium nitroprusside or a nitric oxide donor.

There is no data confirming the safety of using the drug in the presence of conditions accompanied by a risk of bleeding, as well as in exacerbation of gastric ulcer and duodenal ulcer. For this reason, Sildenafil-SZ should be used with extreme caution in this category of patients.

The frequency of nosebleeds in patients with pulmonary hypertension due to diffuse connective tissue diseases is higher (sildenafil group - 12.9%, placebo - 0%) than in patients with primary pulmonary hypertension (sildenafil group - 3%, placebo - 2.4 %). The incidence of nosebleeds is higher with concomitant use of vitamin K antagonists (8.8% versus 1.7% in patients who do not take vitamin K antagonists).

Visual impairment

There are known cases of the development of such a rare disease as non-arteritis anterior ischemic neuropathy of the optic nerve (NPINZN), which causes a decrease and even loss of vision.

Most patients had risk factors: a decrease in the ratio of the diameters of the excavation and the optic nerve head, hyperlipidemia, arterial hypertension, coronary heart disease, diabetes mellitus, smoking, age over 50 years.

The association of acute onset of NPINZN with the use of PDE5 inhibitors was evaluated in an observational study. According to the results obtained, the risk of developing this disease increases by about 2 times after taking a PDE5 inhibitor and lasts up to 5 half-lives of the drug. Some literary publications indicate the following annual incidence of NPINZN: 2.5-11.8 cases per 100,000 men aged 50 years.

In the event of a sudden loss of vision, patients are advised to stop taking the drug and consult a doctor immediately.

Men who already have a history of NPINZN should carefully discuss all possible risks with their doctor before taking Sildenafil-SZ. It is allowed to take the drug only if the expected benefit outweighs the risks.

Hearing impairment

Some clinical and post-marketing studies have reported cases of sudden deterioration and hearing loss after taking PDE5 inhibitors. Most patients have risk factors. At the same time, a direct connection has not been established with taking the drug.

In case of hearing impairment, you should stop taking Sildenafil-SZ and consult a doctor.

Influence on the ability to drive vehicles and complex mechanisms

Sildenafil-SZ does not adversely affect human cognitive, mental and motor functions. However, the drug is capable of lowering blood pressure, causing blurred vision, the development of chromatopsia and other side effects, which should be taken into account by vehicle drivers and persons employed in potentially hazardous industries. The degree of restrictions is determined individually, depending on the tolerance of the drug.

Application during pregnancy and lactation

Sildenafil-SZ according to the registered indication is not intended for use in women.

Pediatric use

Sildenafil-SZ according to the registered indication is not intended for use in children and adolescents under 18 years of age.

With impaired renal function

Patients with mild and moderate renal failure (CC 30–80 ml / min) do not need to adjust the dose of Sildenafil-SZ.

In severe renal insufficiency (CC <30 ml / min), the recommended dose is 25 mg.

For violations of liver function

Patients with cirrhosis of the liver should take Sildenafil-SZ 25 mg.

Use in the elderly

Elderly patients do not need dosage adjustment.

Drug interactions

Effect of sildenafil on other medicinal products

Sildenafil enhances the antihypertensive effect of nitrates, nitric oxide donors, both with prolonged use and when taken for acute indications. The use of these combinations is contraindicated.

Against the background of therapy with the alpha-blocker doxazosin (at a dose of 4 or 8 mg) in patients with benign prostatic hyperplasia with stable hemodynamics, taking sildenafil caused an additional decrease in systolic / diastolic blood pressure in the supine position: when taking a dosage of 25 mg - 7/7 mm rt. Art., dosage 50 mg - 9/5 mm Hg. Art., dosage 100 mg - 8/4 mm Hg. Art.; in the standing position - 6/6, 11/4 and 4/5 mm Hg, respectively. Art. There are rare reports of the development of symptomatic postural hypotension, manifested by dizziness. In some patients, the combination of sildenafil with alpha-blockers can cause the development of symptomatic hypotension.

In patients with arterial hypertension receiving amlodipine, there were no signs of drug interactions. The average additional reduction in systolic / diastolic blood pressure in the supine position is 8/7 mm Hg. Art.

There were no significant drug interactions and changes in pharmacokinetic parameters with the simultaneous use of sildenafil and the following drugs: tolbutamide (250 mg), warfarin (40 mg), HIV protease inhibitors (saquinavir, ritonavir), acetylsalicylic acid (150 mg).

In healthy volunteers, sildenafil (at a dosage of 50 mg) did not enhance the effect of ethanol at its maximum blood concentration of ~ 0.08% (80 mg / dL).

Sildenafil is a weak inhibitor of cytochrome P ₄₅₀ isoenzymes 3A4, 2D6, 2C19, 2E1, 2C9 and 1A2 (50% inhibitory concentration> 150 μmol). When the drug is taken in recommended doses, its maximum concentration is about 1 μmol, therefore, the effect on the clearance of substrates of these isoenzymes is unlikely.

The effect of other drugs on the pharmacokinetics of sildenafil

Sildenafil is metabolized primarily by cytochrome CYP3A4 and CYP2C9, therefore inhibitors of these isoenzymes (ketoconazole, erythromycin, cimetidine) can reduce its clearance, and inducers can increase it.

Saquinavir (an inhibitor of HIV protease and isoenzyme of cytochrome CYP3A4), obtained at 1200 mg / day, when used simultaneously with sildenafil at a dose of 100 mg, increases the C _{max of the} latter by 140%, AUC - by 210%.

Stronger inhibitors of the cytochrome CYP3A4 isoenzyme (ketoconazole, itraconazole) can cause stronger changes in the pharmacokinetics of sildenafil.

Ritonavir (a strong inhibitor of cytochrome P ₄₅₀ and inhibitor of HIV protease), taken 500 mg 2 times / day, when used simultaneously with sildenafil at a dose of 100 mg, causes an increase in C _{max of the} latter by 300%, AUC - by 1000%.

When using sildenafil in recommended doses in patients taking strong inhibitors of the cytochrome CYP3A4 isoenzyme, the C _{max of} sildenafil does not exceed 200 nM, and the drug is well tolerated.

Azithromycin, applied at 500 mg / day for 3 days, has no significant effect on C _max, time to reach C _max, AUC, elimination rate and T _{½ of} both sildenafil and its main metabolite.

A single dose of an antacid (aluminum hydroxide, magnesium hydroxide) does not alter the bioavailability of sildenafil.

The following drugs have no effect on the pharmacokinetics of sildenafil: calcium antagonists, ACE (angiotensin converting enzyme) inhibitors, thiazide and thiazide-like diuretics, cytochrome CYP2D6 inhibitors (tricyclic antidepressants, selective cytochrome CYP9 serum inhibitors) and cytochrome CYP9 reuptake inhibitors.

Analogs

The analogues of Sildenafil-SZ are: Viagra, Viatail, Vizarsin, Vildegra, Vigrande, Vivaira, Dynamo, Zidena, Levitra, Maxigra, Rijamp, Cialis, Silafil, Silden, Taxier, Tedallis, Tornetis, Erexesil and others.

Terms and conditions of storage

Store at a temperature not exceeding 25 ° C out of reach of children, protected from light.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Sildenafil-SZ

Reviews of Sildenafil-SZ are contradictory. Many men note its effectiveness in erectile dysfunction, good tolerance and affordable cost.

However, there are many reviews about the lack of effect when taking Sildenafil-SZ according to the indication, as well as the development of side reactions, including increased blood pressure, a feeling of heat, increased heart rate, dry mouth, heartburn, nasal congestion, headache, dizziness, pain in eyes.

The price of Sildenafil-SZ in pharmacies

The approximate price for Sildenafil-SZ for a package of 4 film-coated tablets is: dosage 25 mg - 85–115 rubles, dosage 50 mg - 166–289 rubles, dosage 100 mg - 267–395 rubles.

Sildenafil-SZ: prices in online pharmacies

Drug name Price Pharmacy

Sildenafil-SZ 25 mg film-coated tablets 4 pcs. 122 RUB Buy

Sildenafil-SZ 50 mg film-coated tablets 4 pcs. 156 r Buy

Sildenafil-SZ 100 mg film-coated tablets 4 pcs. 247 r Buy

Sildenafil-sz grand for oral administration 50mg pack. 0.6g # 4 265 RUB Buy

Sildenafil-sz grand for oral administration 100mg pack. 1.2g # 4 299 r Buy

Sildenafil-SZ 50 mg film-coated tablets 10 pcs. 304 RUB Buy

Sildenafil-SZ 25 mg film-coated tablets 20 pcs. 310 RUB Buy

Sildenafil-SZ tablets p.o. 50mg 14 Pcs. RUB 314 Buy

Sildenafil-SZ 50 mg film-coated tablets 14 pcs. RUB 314 Buy

Sildenafil-SZ 100 mg film-coated tablets 10 pcs. 355 RUB Buy

Sildenafil-SZ tablets p.o. 100mg 14 Pcs. 391 r Buy

Sildenafil-SZ 100 mg film-coated tablets 14 pcs. 391 r Buy

Sildenafil-SZ 50 mg film-coated tablets 20 pcs. RUB 512 Buy

Sildenafil-SZ 100 mg film-coated tablets 20 pcs. 621 RUB Buy

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Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!