Avoid or Use Alternate Drug. Severity: Severe. This helps prevent others, including children and pets, from taking the drug by accident. The effect of severe hepatic impairment (Child Pugh class C) has not been studied. Applies only to oral form of both agents. Minor/Significance Unknown. There also havent been enough studies to know what effects the drug may have on a child who is breastfed. Use Caution/Monitor. Monitor for proper blood pressure when these drugs are used together, Brompheniramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Tucatinib: (Major) Coadministration with tucatinib is not recommended in patients receiving sildenafil for pulmonary arterial hypertension (PAH). In these participants, treatment with sotorasib halts tumour growth for just over six months1. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin. Monitor Closely (2)cimetidine will increase the level or effect of mexiletine by affecting hepatic enzyme CYP1A2 metabolism. Dayvigo is not available in a generic form. Use Caution/Monitor. efavirenz will increase the level or effect of cimetidine by affecting hepatic enzyme CYP2C19 metabolism. cimetidine will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. It can be expected that concomitant administration of CYP3A4 enzyme-inducers, such as rifampin, will decrease plasma levels of sildenafil, however, no interaction studies have been performed. Use Caution/Monitor. Minor (1)cimetidine increases levels of ospemifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use Caution/Monitor. Concomitant use of fenofibric acid with CYP2C9 substrates, such as sildenafil , has not been formally studied. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding, monitor closely. Avoid or Use Alternate Drug.cimetidine will increase the level or effect of nisoldipine by increasing gastric pH. Administration of sildenafil in this population may significantly worsen cardiovascular status. Avoid or Use Alternate Drug. Restasis contains the active drug cyclosporine, which also comes in a pill form thats taken by mouth and used to treat other conditions. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors. Use Caution/Monitor. defibrotide increases effects of apixaban by pharmacodynamic synergism. Tamsulosin: (Moderate) Due to the potential for symptomatic hypotension, patients should be stable on tamsulosin therapy before initiating therapy with the lowest dose of sildenafil. Modify Therapy/Monitor Closely. They can recommend safe and healthy ways to feed your child. Lesinurad: (Moderate) Lesinurad may decrease the systemic exposure and therapeutic efficacy of sildenafil; monitor for potential reduction in efficacy. cimetidine will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. . Use Caution/Monitor. Shake well before each use.Storage: This suspension is stable for 91 days when stored at 4 and 25 degrees C. Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Use Caution/Monitor. Controlled studies in pregnant women show no evidence of fetal risk. Minor/Significance Unknown. For more information and to find out if youre eligible for support, visit the program website. Monitor Closely (1)cimetidine increases levels of epirubicin by decreasing metabolism. cimetidine will decrease the level or effect of iron dextran complex by increasing gastric pH. Its not known if its safe to take Dayvigo while pregnant. Avoid or Use Alternate Drug. PDR.net is to be used only as a reference aid. Use Caution/Monitor. Comment: Concomitant use of H2-receptor antagonists may cause a hyperresponse in gastrin secretion in response to stimulation testing with secretin, falsely suggesting gastrinoma. Interactions with other drugs metabolized by this enzyme and/or inhibiting this enzyme could potentially occur. Use Caution/Monitor. Monitor Closely (1)cimetidine will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown. Adjust finererone dosage as needed. A decreased pressor effect of phenylephrine might occur. Coadministration of other strong CYP3A4 inhibitors increased the sildenafil AUC between 3- and 11-fold. Monitor Closely (1)cimetidine will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)cimetidine will increase the level or effect of sulfamethoxazole by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. cimetidine will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Monitor Closely (1)safinamide will increase the level or effect of cimetidine by Other (see comment). Serious - Use Alternative (1)flurbiprofen and apixaban both decrease anticoagulation. Use Caution/Monitor.Serious - Use Alternative (1)cimetidine will increase the level or effect of alosetron by affecting hepatic enzyme CYP1A2 metabolism. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. The FDA website provides several useful tips on medication disposal. Both drugs have the potential to cause bleeding, monitor closely. Either increases toxicity of the other by pharmacodynamic synergism. Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Minor) Sildenafil is metabolized principally by cytochrome P450 3A4 and 2C9 enzymes. Modify Therapy/Monitor Closely. lasmiditan increases effects of apixaban by P-glycoprotein (MDR1) efflux transporter. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. This action helps to improve your bodys natural ability to make tears, which moistens your eyes and reduces dry eye symptoms. The Food and Drug Administration (FDA) approved Dayvigo in 2019. Use Caution/Monitor. erdafitinib will increase the level or effect of cimetidine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Serious - Use Alternative (1)piroxicam and apixaban both increase anticoagulation. Reduce apixaban dose by 50% when mifepristone used for treatment of Cushing's disease or other hormonal conditions; if patients are already receiving 2.5 mg twice daily, avoid coadministration. Restasis is FDA-approved to treat chronic dry eye. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Major) Coadministration of ritonavir is contraindicated in patients receiving sildenafil for pulmonary arterial hypertension (PAH). Use Caution/Monitor. Apixaban is also substrate of P-gp; if concomitant administration necessary, adjust and hold dose as clinically necessary; may adjust apixaban dosage according to risk, indication and current dose; for treatment of atrial fibrillation with standard apixaban dose (eg, 5 mg twice daily), reduce apixaban to 2.5 mg twice daily; for treatment of atrial fibrillation with low dose apixaban (eg, 2.5 mg twice daily), continue low dose on case-by-case basis. Restasis comes as a liquid emulsion (an oily liquid mixture) thats used as eye drops. Green tea may contain caffeine. cimetidine decreases levels of ponatinib by increasing gastric pH. Discontinue H2-receptor antagonists at least 2 days before administering secretin to aid in the diagnosis of gastrinoma. Monitor Closely (1)cimetidine will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Alpha-blockers: (Moderate) Due to the potential for symptomatic hypotension, patients should be stable on alpha-blocker therapy before initiating therapy with the lowest dose of sildenafil. Avoid this interaction by administering H2 antagonists 10 hr after or 2 hr before nilotinib. There is a degree of cardiac risk associated with sexual activity; therefore, prescribers should evaluate the cardiovascular status of their patients prior to initiating any treatment for erectile dysfunction. With punctal plugs, tiny tubes are placed into your tear ducts. Use Caution/Monitor. Avoid or Use Alternate Drug. Dosage adjustments may be needed based on clinical efficacy. Co-administration of ivacaftor with CYP3A and CYP2C9 substrates, such as sildenafil, can theoretically increase sildenafil exposure leading to increased or prolonged therapeutic effects and adverse events; however, the clinical impact of this has not yet been determined. cimetidine increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use Caution/Monitor. Use Caution/Monitor. cimetidine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. The approximately 4,000-fold selectivity for PDE5 versus PDE3 is important because PDE3 is involved in control of cardiac contractility. Either increases levels of the other by anticoagulation. cimetidine will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Sildenafil and other agents for the treatment of erectile dysfunction should be used with caution in patients with penile structural abnormality (such as angulation, cavernosal fibrosis or Peyronie's disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anemia, leukemia, multiple myeloma, polycythemia, or a history of priapism). Avoid or Use Alternate Drug. Applies only to oral form of both agents. Several combination trials are ongoing, and it is too early to predict which will be successful, says Der. Conversely, patients already receiving an optimized dose of sildenafil should be started on the lowest dose of silodosin; increases in the alpha-blocker dose should be done in a stepwise fashion. Use Caution/Monitor. Now scientists are hoping to save lives with a batch of new compounds that target it. Sildenafil is a sensitive CYP3A4 substrate; cobicistat is a strong CYP3A4 inhibitor. Restasis and Xiidra both contain drugs that are placed into your eye. Monitor Closely (1)lopinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Most Avoid or Use Alternate Drug. Use Caution/Monitor. Applies only to oral form of both agents. Consider alternatives to cimetidine in patients receiving diltiazem. Contraindicated. quinidine will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. No specific dose adjustment recommended when tofacitinib coadministered with potent CYP2C19 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors . Avoid or Use Alternate Drug. Monitor Closely (1)cimetidine will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. cimetidine will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Although clarithromycin is a combined P-gp and strong CYP3A4 inhibitor, the manufacturer has stated that pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration. Use Caution/Monitor. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. Avoid or Use Alternate Drug. Sildenafil is a sensitive CYP3A4 substrate and oral lefamulin is a moderate CYP3A4 inhibitor; an interaction is not expected with intravenous lefamulin. Use Caution/Monitor.Minor (1)cimetidine will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. If you log out, you will be required to enter your username and password the next time you visit. Minor (2)voriconazole will increase the level or effect of cimetidine by affecting hepatic enzyme CYP2C19 metabolism. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. Minor (1)pentobarbital will decrease the level or effect of cimetidine by affecting hepatic enzyme CYP2C19 metabolism. Population pharmacokinetic analysis indicates an approximately 3-fold increase in sildenafil clearance with concomitant use of weak CYP3A4 inducers. Monitor for proper blood pressure when these drugs are used together, Acetaminophen; Dextromethorphan; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors.
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