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General Information on Sildenafil:

• Active Ingredient: Sildenafil (commonly formulated as sildenafil citrate).
• Class: Phosphodiesterase type 5 (PDE5) inhibitor.
• Indications: Primarily indicated for the treatment of erectile dysfunction (ED) in adult males; lower doses (e.g., 20 mg) are indicated for the treatment of pulmonary arterial hypertension.
• Mechanism of Action: Sildenafil selectively inhibits PDE5, which leads to an increase in cyclic guanosine monophosphate (cGMP) levels. This results in smooth muscle relaxation and enhanced blood flow into the corpus cavernosum, facilitating erection in the presence of sexual stimulation.

Dosage (100 mg):

• The typical initial recommended dose for ED is 50 mg taken approximately 30–60 minutes before sexual activity.
• The dose may be increased to 100 mg if the initial dose is insufficient, with a maximum recommended daily dose of 100 mg.

Safety and Adverse Effects:

• Common Adverse Effects: Headache, flushing, indigestion, nasal congestion, dizziness, and visual disturbances.
• Serious Adverse Events (Rare): Priapism (prolonged erection), sudden severe hypotension, sudden hearing or vision loss.
• Contraindications:
  • Concurrent use with nitrates (e.g., nitroglycerin) or nitric oxide donors due to the risk of severe hypotension.
  • Conditions where sexual activity is not advised (e.g., severe cardiovascular disorders).
  • Known hypersensitivity to sildenafil or its excipients.
• Use with Caution:
  • Patients with cardiovascular disease, hepatic or renal impairment, or retinal disorders.
  • Patients taking alpha-blockers or antihypertensive medications should consult a healthcare provider due to the potential for significant hypotension.

Pharmacokinetics and Interactions:

• Sildenafil is metabolized primarily by hepatic CYP3A4 and to a lesser extent by CYP2C9.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) may increase plasma sildenafil concentration.
• High-fat meals can delay absorption and prolong the time to onset of action.

References and Studies:

1. Viagra (Sildenafil) Prescribing Information (FDA):
   https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020895s031lbl.pdf
2. Clinical Studies:
   • Goldstein I, et al. “Oral sildenafil in the treatment of erectile dysfunction.” N Engl J Med. 1998;338(20):1397–1404. PMID: 9580644
   • Fink HA, et al. “Pharmacologic treatment of erectile dysfunction: a systematic review and meta-analysis.” Ann Intern Med. 2002;136(6):480–492. PMID: 11901489
   • Rendon RA, Nehra A. “Efficacy and safety of sildenafil citrate for the treatment of erectile dysfunction.” Can J Urol. 2000;7(3):1114–1118. PMID: 10968305
3. Meta-analyses and Reviews:
   • Vardi Y, Nini A. “Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus.” Cochrane Database Syst Rev. 2007;(1):CD002187. PMID: 17253479
   • McMahon CG. “Efficacy, safety and patient acceptance of sildenafil citrate in the treatment of erectile dysfunction.” Drug Healthc Patient Saf. 2010;2:99–112. PMID: 21789099

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WHITE COATS FOR BLACK LIVES

On Friday, June 5, 2020, members of Cincinnati Medical Association participated in an observance at University of Cincinnati of George Floyd’s death and demonstrated solidarity in the fight against police brutality.
#blacklivesmatter
#whitecoatsforblacklives

The new officers of the University of Cincinnati Student National Medical association visit the CMA meeting on March 27, 2019!
Medical Students Left to Right: Callyn Samuel (Secretary), Udoka Oji (President), Ronay Thomas (Vice President)