Sildenafil (Intravenous Route)

Also known in the US as Revatio, sildenafil is used to treat signs of pulmonary arterial hypertension in healthy adults.

Overview

The sildenafil injection is prescribed to treat signs of pulmonary arterial hypertension in healthy adults. This kind of high blood pressure takes place in the middle of the lungs and the heart. When the lungs go through hypertension, the heart must increase its workload to pump an adequate amount of blood. This medication is currently manufactured under the US brand name Revatio.

The sildenafil injection can also aid patients who have erectile dysfunction, but patients interested in this must take the oral route of this medication.

This medication aids the ability of adults with high blood pressure to exercise. Children typically are not prescribed sildenafil.

Sildenafil is a phosphodiesterase 5 inhibitor (PDE5), which is a name for several medications that diminish stress on the blood vessels by working on the PDE5 enzyme within the lungs. This means that the sildenafil injection is highly effective for decreasing the total amount of work for the heart.

The sildenafil injection can only be obtained with a prescription from your doctor.

This medication is only available in the solution form to be injected.

Conditions Treated

  • Pulmonary arterial hypertension
  • Erectile dysfunction

Type of Medicine

  • Phosphodiesterase 5 (PDE5) inhibitors

Side Effects

In addition to the desired benefits, medications can occasionally also trigger undesired side effects. While not every side effect may take place, they could warrant medical attention if they do take place.

Consult with your physician or medical care professional right away if any of the subsequent side effects take place:

More Common Side Effects (Medical Care Required):

  • Bloody nose
  • Weight gain or loss (unusual)
  • Hands/feet tingling
  • Chest tightness
  • Breath shortness
  • Breathing difficulty (or labored)
  • Weight gain (sudden)
  • Swelling or bloating of the feet, lower legs, hands, arms, or face
  • Fever

Less Common Side Effects (Medical Care Required):

  • Prickling, crawling, burning, numbness, ‘pins and needles’ sensations, tingling, or itching feelings

Additional Side Effects (Medical Care Required) Occurrence Not Known:

  • Blurred vision
  • Seizures
  • Decreased hearing
  • Vision loss
  • Hearing loss
  • Blindness

Occasionally, side effects may take place that do not typically require medical care. As your body becomes more accustomed to the medication, the side effects may diminish. In addition, your medical care professional can inform you of various ways to reduce or prevent certain side effects. Consult with your physician if any of the subsequent side effects become prolonged or exceedingly bothersome, or if you have questions regarding side effects.

More Common Side Effects (Medical Care Not Required)

  • Belching
  • Skin redness or flushing
  • Moving becomes difficult
  • Sleeping difficulty or inability
  • Joint pain
  • Stomach sour or experiencing feelings of acidity
  • Warm sensations (unusual)
  • Muscle stiffness or unusual pain
  • Indigestion
  • Skin warm to the touch (unusually)
  • Joints swollen
  • Muscle cramping or aching
  • Pain in the legs or arms
  • Nausea
  • Stomach pain, upset, or discomfort
  • Redness of the upper chest, arms, neck, or face
  • Sleep loss
  • Headache
  • Diarrhea

Less Common Side Effects (Medical Care Not Required)

  • Sneezing
  • Cough
  • Stomach or chest feeling burning sensations
  • Tenderness around the cheekbones or eye area
  • Runny nose
  • Nose stuffiness
  • Stomach area feelings of tenderness

Patients may experience additional side effects that are not listed here. Consult with your healthcare professional for questions or concerns, or if you experience additional side effects.

Contact your physician regarding any medical advice you may need regarding side effects. The FDA also accepts side effect reports, and they can be reached at 1-800-FDA-1088.

Dosage

This medication must be administered in a hospital or medical clinic by a trained medical care professional such as a nurse. The sildenafil injection must be given through a needle directly into a vein.

Your physician will likely give you minimal doses of this medication until the condition progresses. Once the condition has improved, your doctor will probably change your medication to an oral prescription that works in a similar manner. For questions regarding this process or switching medications, consult with your physician.

Interactions

Drug Interactions

While some medications should never be used at the same time, other cases may warrant the use of multiple medications being taken simultaneously, even if there is a possibility that an interaction could occur. Under these circumstances, your physician may be inclined to adjust the dose amount, or they may take additional precautions. While having this medication administered, it is imperative that your medical care provider is aware if you are currently taking any of the following medications. The subsequent list of interactions has been compiled according to possible significance of interaction and is not completely all-inclusive.

It is not suggested to take any of the following medications while receiving the sildenafil injection. Your physician may choose not to prescribe the sildenafil injection, or they may adjust the doses for other necessary medications you are also taking.

  • Tipranavir
  • Telaprevir
  • Saquinavir
  • Ritonavir
  • Riociguat
  • Propatyl Nitrate
  • Pentaerythritol Tetranitrate
  • Nitroprusside
  • Nitroglycerin
  • Nelfinavir
  • Molsidomine
  • Lopinavir
  • Isosorbide Mononitrate
  • Isosorbide Dinitrate
  • Indinavir
  • Fosamprenavir
  • Erythrityl Tetranitrate
  • Darunavir
  • Cobicistat
  • Boceprevir
  • Atazanavir
  • Amyl Nitrite
  • Amprenavir

While it is not typically suggested to combine the sildenafil injection with any of the subsequent medications, certain circumstances may require it. In situations where both medications must be prescribed at the same time, your physician may need to adjust the dose or frequency of the medication.

  • Voriconazole
  • Telithromycin
  • Simeprevir
  • Nefazodone
  • Lumacaftor
  • Itraconazole
  • Idelalisib
  • Fluconazole
  • Dihydrocodeine
  • Conivaptan
  • Clarithromycin
  • Ceritinib
  • Cannabis

The following medications, when combined with the sildenafil injection, could trigger an increase of side effects, however, the combination of both medications could prove to be the most optimal form of treatment for your unique situation. If your physician chooses to prescribe both medications, they may adjust the frequency or dose amount of one or both medications.

  • Trimazosin
  • Terazosin
  • Tamsulosin
  • Silodosin
  • Rifapentine
  • Prazosin
  • Nebivolol
  • Moxisylyte
  • Ketoconazole
  • Etravirine
  • Erythromycin
  • Doxazosin
  • Delavirdine
  • Ciprofloxacin
  • Bunazosin
  • Bosentan
  • Alfuzosin

Other Interactions

Some medications should not be given around or near mealtime or when eating specific varieties of food due to the possibility of interactions taking place. The subsequent list of potential interactions has been compiled based on significance and is not typically all-inclusive.

Having the sildenafil injection administered while eating or drinking the following types of food can cause side effects to increase. It may not be avoidable, however. If you must have the following food while on the sildenafil injection, your physician may be inclined to adjust the dose or how frequent the injection is given.

  • Grapefruit juice

Other Medical Issues

Patients who have additional medical complications could experience limitations in the usefulness of sildenafil. Be sure to inform your physician if you currently have additional medical issues, specifically:

  • Penis irregularity (birth defects or curved penis included) patients should take caution as these conditions increase the possibility of issues taking place
  • Chest pain (angina)
  • Heartbeat irregularity (arrhythmia)
  • Heart attack
  • Heart disease
  • High blood pressure (hypertension)
  • Low blood pressure (hypotension)
  • Priapism (history of)
  • Eye disorders (inherited, retinitis pigmentosa)
  • Stroke – patients should take caution as these conditions increase the possibility of issues taking place
  • Diabetes
  • Heart disease
  • Patients who are 50 years old or older
  • Coronary artery disease
  • Eye disorder, little cup to disc proportion within the eye, or crowded disc
  • High levels of fat in the blood (hyperlipidemia)
  • Serious eye conditions (or history of), including non-arteritic anterior ischemic optic neuropathy (NAION)
  • Bleeding illnesses (or history of)
  • Smoking – take caution; can raise the likelihood that severe side effects called NAION could take place in the eye
  • Leukemia (cancer related to blood)
  • Blood disorders, such as sickle-cell anemia; patients should take caution as prolonged erection can take place
  • Stomach ulcer (or history of) likelihood of issues taking place can be increased, unknown whether or not this medication is effective and safe for these individuals
  • Multiple myeloma (cancer related to blood)
  • Lung diseases, including pulmonary veno-occulsive disease (PVOD) can aggravate illness and make it worse

Warnings

It is imperative that your physician carefully monitors the progress of the patient while they are receiving this medication. This gives the doctor a chance to see whether or not the medication is working as it should, and it will allow the patient to decide if they would like to continue the medication.

Patients should never take Viagra®, Cialis® (tadalafil), Levitra® (vardenafil), or similar PDE5 inhibitors while already taking sildenafil. There is already sildenafil in Viagra®. There is a greater possibility that side effects may take place if an excessive amount of sildenafil is taken or if it is combined with these medications.

Patients who are already taking a nitrate medication for angina (chest pain) should not also take sildenafil. Nitrate medications include:

  • Transderm nitro®
  • Nitrostat®
  • Nitrolingual® spray
  • Nitrol® ointment
  • Nitroglycerin
  • Nitro-dur®
  • Nitro-bid®
  • Isosorbide
  • Imdur®

Certain drugs that are illegal do also have nitrates in them, including nitrite, butyl nitrate, or amyl nitrate. Do not also take sildenafil if you are already taking Adempas® (riociguat).

It is highly imperative that the doctor is informed of any heart problems that patients have now or have experienced previously. This medication can trigger severe side effects for patients who have or have had heart issues.

This injection could potentially make blood pressure much lower than it should be. Inform your physician immediately if you have any of the following symptoms: weakness or tiredness (unusual), sweating, confusion, blurred vision, faintness, lightheadedness, or dizziness when suddenly rising from a sitting or lying position.

Consult your physician immediately if there is any loss of vision at all in either or both eyes.

For hearing loss (including abrupt reduction in hearing), be sure to check with your physician immediately. This can be recognized by ringing in the ears or dizziness.

If an erection takes place for longer than four hours, consult your physician or emergency care provider right away, especially if the symptoms are extremely painful. Taking care of these symptoms immediately is required to counteract permanent and severe harm to the penis.

Never take a medication unless your physician has previously approved it. This refers to nonprescription medications that are available over the counter, vitamin or herbal supplements, and other prescription medications.

When contemplating whether or not one should take a medication, they must compare the potential risks that could come about when taking the medication against the benefits it may bring. This choice is one that you should make with your physician. Consider the following aspects of Sildenafil when considering taking this medication.

Allergies

Ensure to let your physician know if you have previously had any allergic reactions that were unusual for you to this medication or additional medications. In addition, please inform your physician if you have additional kinds of allergies, specifically to animals, preservatives, dyes, or foods. Patients must read the ingredients label on any package that is non-prescription, or was obtained over-the-counter.

Specific Demographic Use

Pediatric

Children should never be given the sildenafil injection, particularly for long-lasting conditions.

Geriatric

Current research has not identified any issues that are geriatric-specific that could potentially reduce the effectiveness of the sildenafil injection for elderly patients. Although, geriatric patients will tend to have more heart, kidney, or liver issues that could warrant caution. Elderly patients may need to have their doses adjusted if prescribed the sildenafil injection.

Pregnancy

There has not been any evidence of injury to the fetus in animal studies, but there has not been adequate research in pregnant women; or, animal research has revealed an unfavorable effect, but comparable studies in pregnant women have not revealed any risk to the fetus.

Breastfeeding

There have not yet been any satisfactory studies in regards to understanding the potential risk to the infant when this medication is administered to women who are breastfeeding. Patients must compare the possible benefits against the possible risks prior to having this medication administered while breastfeeding.

Storage

Patients will not need to store this medication, as it will only be stored in a hospital or medical setting. The health care professional administering this medication will ensure they are storing it accurately according to the instructions set out by the manufacturer and the pharmacist.

Summary

The sildenafil injection treats symptoms of pulmonary arterial hypertension, the type of high blood pressure that occurs in the middle of the heart and the lungs. When the lungs undergo hypertension, the heart must, therefore, increase its total expended workload to pump an even greater amount of blood. Sildenafil helps adults with high blood pressure in their ability to exercise, as it takes pressure off of the heart. Exercise is highly important for adults, and those with high blood pressure may benefit from considering sildenafil for this purpose. You should consult with your physician to determine if this drug is the most optimal form of treatment for you.

 

Resources
Last Reviewed:
February 01, 2018
Last Updated:
January 27, 2018