Лечение эректильной дисфункции, характеризующейся неспособностью к достижению или сохранению эрекции полового члена, достаточной для удовлетворительного полового акта.
Эффективен только при сексуальной стимуляции.
Противопоказания
гиперчувствительность к силденафилу или любому другому компоненту препарата; одновременный прием донаторов оксида азота или органических нитратов, или нитратов в любых лекарственных формах; одновременный прием ритонавира; пациенты, для которых сексуальная активность нежелательна, в т.ч. с тяжелыми сердечно-сосудистыми заболеваниями, такими как нестабильная ...
Лечение эректильной дисфункции, характеризующейся неспособностью к достижению или сохранению эрекции полового члена, достаточной для удовлетворительного полового акта.
Эффективен только при сексуальной стимуляции.
Противопоказания
гиперчувствительность к силденафилу или любому другому компоненту препарата; одновременный прием донаторов оксида азота или органических нитратов, или нитратов в любых лекарственных формах; одновременный прием ритонавира; пациенты, для которых сексуальная активность нежелательна, в т.ч. с тяжелыми сердечно-сосудистыми заболеваниями, такими как нестабильная стенокардия, тяжелая сердечная недостаточность, угрожающие жизни аритмии, артериальная гипотензия (АД менее 90/50 мм рт. ст.), артериальная гипертензия (АД более 170/100 мм рт. ст.); недавно перенесенные нарушения мозгового кровообращения или инфаркт миокарда; пациенты с потерей зрения на один глаз вследствие передней ишемической оптической нейропатии неартериального генеза (независимо от того, произошло ли это вследствие приема ингибитора ФДЭ5 или нет); наследственные дегенеративные заболевания сетчатки, в т.ч. пигментный ретинит (меньшая часть таких пациентов имеет генетически обусловленное нарушение функций ФДЭ сетчатки); тяжелая печеночная недостаточность; женский пол; возраст до 18 лет.
С осторожностью: синдром множественной системной атрофии; обструкция выходного тракта левого желудочка, в т.ч. аортальный стеноз; гипертрофическая обструктивная кардиомиопатия; анатомическая деформация полового члена; приапизм; множественная миелома; лейкоз; одновременный прием альфа-адреноблокаторов; непереносимость лактозы, дефицит лактазы, глюкозо-галактозная мальабсорбция.
Способ применения и дозы
Внутрь, примерно за 1 ч до планируемой сексуальной активности.; По 50 мг 1 раз в сутки. С учетом эффективности и переносимости доза может быть увеличена до 100 мг или снижена до 25 мг.; Для пациентов с легкой или умеренной почечной недостаточностью (Cl креатинина 30–80 мл/мин) коррекция дозы не требуется.; Для пациентов с тяжелой почечной недостаточностью (Cl креатинина менее 30 мл/мин) первая доза составляет 25 мг. При хорошей переносимости доза может быть увеличена до 50 или 100 мг.; Для пожилых пациентов первая доза составляет 25 мг. При хорошей переносимости доза может быть увеличена до 50 или 100 мг.; Для пациентов с легкой или компенсированной печеночной недостаточностью первая доза составляет 25 мг. При хорошей переносимости доза может быть увеличена до 50 или 100 мг.; Для пациентов, принимающих альфа-адреноблокаторы, первая доза составляет 25 мг. При хорошей переносимости доза может быть увеличена до 50 или 100 мг.
Побочное действие
Ингибиторы изоферментов CYP3A4 и CYP2C9 (кетоконазол, эритромицин, циметидин) снижают метаболизм и увеличивают концентрацию силденафила в крови. В этом случае лечение силденафилом начинают с дозы 25 мг.; При одновременном применении с ритонавиром Сmax силденафила повышается на 300%, AUC на 1000% и сохраняются на высоком уровне даже спустя сутки после приема силденафила.; При одновременном применении с саквинавиром Сmax силденафила повышается на 140%, AUC на 210%.; Фармакокинетика ритонавира и саквинавира не изменяется при применении силденафила.; Силденафил усиливает антиагрегантный эффект натрия нитропруссида.; Никорандил из-за нитратного компонента при взаимодействии с силденафилом может привести к тяжелой артериальной гипотензии.; Одновременный прием силденафила и органических нитратов и других донаторов NO может привести к летальному исходу из-за взаимного усиления эффектов.; Силденафил усиливает гипотензивные эффекты БКК, бета-адреноблокаторов, ингибиторов АПФ.; При одновременном применении повышает эффективность гипогликемических средств.; Азитромицин не оказывает влияние на фармакокинетику силденафила.; При одновременном применении силденафила и альфа-адреноблокаторов, в т.ч. доксазозина, особенно в первые 4 ч после приема силденафила, может наблюдаться выраженное понижение АД и ортостатическая гипотензия.; Грейпфрутовый сок может умеренно повышать концентрацию силденафила в крови.
Передозировка
Частота развития побочных эффектов классифицирована согласно рекомендациям ВОЗ: очень часто — не менее 10%; часто — не менее 1%, но менее 10%; нечасто — не менее 0,1%, но менее 1%; редко — не менее 0,01%, но менее 0,1%; очень редко — менее 0,01%, в т.ч. единичные случаи.; Со стороны нервной системы: очень часто — головная боль; часто — головокружение; нечасто — сонливость, гипестезия; редко — инсульт, обморок; частота неизвестна — транзиторная ишемическая атака, судороги, в т.ч. рецидивирующие.; Со стороны CCC: часто — приливы; нечасто — ощущение сердцебиения, тахикардия; редко — повышение или снижение АД, инфаркт миокарда, фибрилляция предсердий; частота неизвестна — желудочковая аритмия, нестабильная стенокардия, внезапная смерть.; Со стороны органа зрения: часто — нарушение зрения, нарушение цветовосприятия; нечасто — поражение конъюнктивы, нарушение слезотечения, усиленное восприятие света, нарушение четкости зрения, преходящая хроматопсия; редко — покраснение склер, боль в глазных яблоках; частота неизвестна — передняя ишемическая оптическая нейропатия, окклюзия сосудов сетчатки, сужение полей зрения.; Со стороны органа слуха и равновесия: нечасто — вертиго, шум в ушах; редко — глухота.; Со стороны органов дыхания: часто — заложенность носа; редко — носовое кровотечение.; Со стороны ЖКТ: часто — диспепсия; нечасто — рвота, тошнота, сухость слизистой оболочки полости рта.; Аллергические реакции: нечасто — кожная сыпь; частота неизвестна — синдром Стивенса-Джонсона, токсический эпидермальный некролиз (синдром Лайелла).; Со стороны половых органов: частота неизвестна — приапизм, пролонгированная эрекция.; Прочие: редко — боль в груди, усталость.
Особые указания
Симптомы: при однократном приеме препарата в дозе до 800 мг нежелательные реакции (головная боль, приливы, головокружение, диспепсия, заложенность носа, нарушение зрения) были выражены сильнее и встречались чаще, чем при приеме обычных доз; дозы до 200 мг увеличивают частоту, но не выраженность нежелательных реакций.; Лечение: симптоматическая терапия. Гемодиализ неэффективен.
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