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Retrieved 14 November As of , the U. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects.

Retrieved 27 December Journal of Pharmaceutical and Biomedical Analysis. For other uses, see Viagra disambiguation.

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As of , the U. Sildenafil is broken down in the liver by hepatic metabolism using cytochrome p enzymes, mainly CYP 3A4 major route , but also by CYP2C9 minor route hepatic isoenzymes.

Rare but serious side effects include prolonged erections , which can lead to damage to the penis , and sudden-onset hearing loss. Commonly-used classes of drugs". In February , it was announced that Boots , the UK pharmacy chain, would try over-the-counter sales of Viagra in stores in Manchester , England.

Beraprost Epoprostenol Iloprost Selexipag Treprostinil. In clinical trials , the most common adverse effects of sildenafil use included headache , flushing , indigestion , nasal congestion , and impaired vision, including photophobia and blurred vision.