Sildenafil Citrate must not be used by men who are taking medicines that contain nitrates of any kind, at any time like nitroglycerin. If Sildenafil Citrate is taken with any drug belonging to the nitrate group, blood pressure could suddenly drop to an unsafe or life threatening level. The concomitant administration of the protease inhibitor ritonavir (a highly potent CYP3A4 inhibitor) substantially increases serum concentrations of sildenafil, therefore co-administration with Sildenafil Citrate is not recommended. It has vasodilator properties, resulting in mild and transient decreases in blood pressure. Prior to prescribing Sildenafil Citrate, physicians should carefully consider whether their patients with certain underlying conditions could adversely be affected by such vasodilatory effects. Caution is advised when a phosphodiesterase type 5 (PDE) inhibitor is co-administered with alpha blocker. PDE inhibitors, including sildenafil and alpha adrenergic blocking agent are both vasodilators with blood pressure lowering effects. When vasodilators are used in combination, an additive effect on blood pressure may be anticipated. It should be used with caution in patients with anatomical deformation of the penis. In humans, sildenafil has no effect on bleeding time when taken alone or with aspirin.
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