NRA-Sildenafil: Uses, Side Effects and Dosage

ABOUT THIS MEDICATION

What the medication is used for:

NRA-SILDENAFIL* (sildenafil citrate) is a treatment for erectile dysfunction in male adults. This is when a man cannot achieve or maintain a hard, erected penis for satisfactory sexual activity.

It is important to note that NRA-SILDENAFIL works only with sexual stimulation. NRA-SILDENAFIL alone does not increase your sex drive.

What it does:

NRA-SILDENAFIL belongs to a class of medicine called phosphodiesterase type 5 (PDE5) inhibitors. Following sexual stimulation, NRA-SILDENAFIL works by helping to relax the blood vessels in your penis by allowing blood to flow into your penis. This results in improved erectile function.

When it should not be used:

• If you are taking any medicines containing nitrates in any form (oral, sublingual [under the tongue], skin patch, or by inhalation [spray]). Although NRA-SILDENAFIL is used occasionally, nitrates must never be used. Nitrates are found in many prescription medicines that are used in the treatment of angina pectoris (chest pain due to heart disease), such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate. If you do not understand what nitrates are, or are unsure about whether a medication you are taking is a “nitrate”, ask your doctor or pharmacist.

  If you take NRA-SILDENAFIL with nitrate-containing medicines or any other nitrates (e.g., amyl nitrite “poppers”), your blood pressure could suddenly drop to a life-threatening level. You could get dizzy, faint, or even have a heart attack or stroke.

• If you have loss of vision in one or both eyes from an eye

  disease called non-arteritic anterior ischaemic optic

  neuropathy (NAION)

• If you have ever had an allergic reaction to sildenafil citrate or the nonmedicinal ingredients in NRA-SILDENAFIL.

• NRA-SILDENAFIL is not to be used in men for whom sexual activity is inadvisable.

  • Do not take NRA-SILDENAFIL with guanylate cyclase stimulators, such as riociguat.

What the medicinal ingredient is: sildenafil citrate.

What the nonmedicinal ingredients are:

microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and FD & C Blue #2 aluminum lake.

What dosage forms it comes in:

NRA-SILDENAFIL is available as blue, biconvex, diamond-shaped tablets marked ‘SIL on one side, and ‘25, 50, or 100’ on the other. Each tablet contains sildenafil citrate equivalent to either 25mg, 50mg or 100mg sildenafil.

WARNINGS AND PRECAUTIONS

This medicine has been prescribed for you personally and you should not pass it on to others. It may harm them, even if their symptoms are the same as yours.

BEFORE you use NRA-SILDENAFIL talk to your doctor or pharmacist if you:

• have heart problems (irregular heart beats, angina, chest pain, or had a heart attack). If you have heart problems, ask your doctor if your heart is healthy enough to handle the extra strain of having sex. If you have chest pain, dizziness or nausea during sex, stop exerting yourself. You should not use nitrates but you should seek immediate medical assistance.
• are 65 years of age or over
• have had a stroke
• have low blood pressure or uncontrolled high blood pressure
• have liver or kidney problems
• have sickle cell anemia (abnormality of the red blood cells), multiple myeloma (cancer of the bone marrow) or leukaemia (cancer of the white blood cells)
• are allergic to sildenafil or any of the other ingredients of NRA-SILDENAFIL tablets
• have a deformed penis or Peyronie’s disease
• have ever had an erection that lasted more than 4 hours
• have stomach ulcers or other bleeding problems.
• have a rare inherited eye disease called retinitis pigmentosa
• have had temporary, decrease, or permanent loss of vision in one or both eyes, including a condition called Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). The specific type of vision decrease or loss, called non-arteritic anterior ischemic optic neuropathy (NAION), seems to occur rarely when blood flow to the optic nerve is reduced or blocked. Vision decrease or loss may be partial or complete, in one or very occasionally both eyes. While in some cases the condition may improve over time, it can also be irreversible. Rare cases of central serous chorioretinopathy (serous detachment of the macula layers of the retina ) have been reported.
• Rare but serious skin reactions of Stevens-Johnson’s

IMPORTANT: PLEASE READ

• Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) have been reported during the post-marketing period.

NRA-SILDENAFIL is not recommended for use in children under 18 years of age and in women

NRA-SILDENAFIL does not protect against sexually transmitted diseases(STD), including Human Immunodeficiency Virus (HIV).

Alcohol consumption may decrease the ability to get an erection.

Patients should know how to react to the drug before operating a motor vehicle or any machinery.

If you are taking NRA-SILDENAFIL and experience temporary, decrease, or permanent loss of vision, stop taking NRA-SILDENAFIL and call your doctor.

In case of chest pain occurring during or after sexual activity you should not use nitrates but you should seek immediate medical assistance.

Sudden decrease or loss of hearing has been reported in a few number of postmarketing and clinical trial cases with the use of PDE5 inhibitors, including NRA-SILDENAFIL. It has not been established whether these are related directly to the use of these medications or to other factors. If you experience these symptoms, stop taking NRA-SILDENAFIL and call your doctor.

INTERACTIONS WITH THIS MEDICATION

You should tell your doctor or pharmacist about any other medications that you are taking. NRA-SILDENAFIL may interfere with some drugs. Only take NRA-SILDENAFIL with other drugs if recommended by your doctor.

Drugs that may interact with NRA-SILDENAFIL include:

• any drugs that contain nitrates in any form (oral, sublingual [under the tongue], skin patch or by inhalation [spray]). Nitrates are found in many prescriptions that are used to treat angina pectoris (chest pain due to heart disease). You should not take NRA-SILDENAFIL if you are taking these drugs.
• alpha-blockers (drugs used to treat prostate problems or high blood pressure)
• ketoconazole or itraconazole (drugs used to treat fungal infections)
• erythromycin (a drug used to treat bacterial infections)
• ritonavir, saquinavir or other drugs for the treatment of HIV
• cimetidine (a drug generally used to treat duodenal or gastric problems)

• bosentan (a drug used in the treatment of high blood

  pressure in the blood vessels between the heart and the

  lungs)

  • drugs to treat erectile dysfunction. These drugs are Cialis,Levitra, Adcirca and Staxyn.
  • other drugs that contain sildenafil. They can be called

Revatio. They are used in the treatment of high blood

pressure in the blood vessels between the heart and the

lungs.

Grapefruit juice may increase the levels of NRA-SILDENAFIL in your blood.

Usual dose:

Your doctor can determine the dose that works best for you.

Always take NRA-SILDENAFIL as prescribed by your doctor. You should speak with your doctor or pharmacist if you are unsure. A dose above 100 mg per day is not recommended.

Swallow the tablet whole, with some water.

You should not take more than one dose of NRA-SILDENAFIL per day.

If you have serious liver or kidney problems or you are 65 years of age or over, your doctor may start you at the lowest dose (25 mg) of NRA-SILDENAFIL.

How to optimize your use of NRA-SILDENAFIL:

You should take NRA-SILDENAFIL approximately 30 to 60 minutes before sexual activity. You can engage in sexual activity within 30 minutes of taking the tablet and for up to 4 hours. The amount of time it takes to have an effect varies slightly from person to person. Remember, sexual stimulation is required for NRA-SILDENAFIL to work.

You should avoid excessive drinking of alcohol, since alcohol can temporarily impair the ability to get an erection.

NRA-SILDENAFIL can be taken with or without food. However, you may find that it takes longer for NRA-SILDENAFIL to work if you take it with a high-fat meal.

NRA-SILDENAFIL may not work the first time or every time. If NRA-SILDENAFIL did not work for you on one occasion, try again on another day. You will learn how well NRA-SILDENAFIL works for you through your personal experience. The first few times may be charged with emotion or anxiety. If after a few separate attempts, you do not get the results you expect, talk to your doctor.

Overdose:

You should not take more than one dose of NRA-SILDENAFIL per day. If you have taken more NRA-SILDENAFIL than you should, contact your doctor or a poison control centre immediately.

PROPER USE OF THIS MEDICATION

IMPORTANT: PLEASE READ

SIDE EFFECTS AND WHAT TO DO ABOUT THEM

As with most drugs, NRA-SILDENAFIL can cause some side effects. These effects are usually mild to moderate in nature and do not last for a long time.

Side effects may include:

• headache, facial flushing
• nausea, vomiting, indigestion, abdominal pain,
• dizziness
• dry, stuffy, or swollen nose
• throat tightness, dry mouth, decreased sensitivity of

the mouth

• pain in arms and legs, myalgia (muscle pain)
• somnolence
• erection increased

If you notice any side effects not mentioned above, or any of the above- mentioned side effects persist or become bothersome, please contact your doctor or pharmacist

This is not a complete list of side effects. For any unexpected effects while taking NRA-SILDENAFIL, contact your doctor or pharmacist.

HOW TO STORE IT

• Store between 15°C and 30°C, in the original package. Do not freeze.
• Do not take NRA-SILDENAFIL after the expiry date shown on the package.
• Always keep NRA-SILDENAFIL out of reach and sight of children.

REPORTING SUSPECTED SIDE EFFECTS

MORE INFORMATION

This document plus the full product monograph, prepared for health professionals by: Nora Pharma Inc

Date of Revision: June 01, 2018.