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Simultaneous administration may lead to symptomatic hypotension. When sildenafil is coadministered with an alpha-blocker, patients should be on stable alpha-blocker therapy prior to initiating treatment; initiate sildenafil at the lowest dose. In patients already taking an optimized dose of sildenafil, initiate viagra imagenes divertidas de buenas therapy at the lowest dose. Coadministration produced an additional mean reduction in BP of 87 mm Hg. Monitor BP and adjust the se dose as needed. BP-lowering effects of antihypertensive agents may be increased. Monitor BP and adjust the dose of the antihypertensive agent as needed.

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Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics of CYP2C9 inhibitors (such as tolbutamide, warfarin), CYP2D6 inhibitors (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and related diuretics, ACE inhibitors, and calcium channel blockers. The AUC of the active metabolite, N-desmethyl sildenafil, was increased 62 by loop and potassium-sparing diuretics and 102 by nonspecific beta-blockers. These effects on the metabolite are not expected to be of clinical consequence. Effects of VIAGRA on Other Drugs.]