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In a recent case, an infant was to receive a dose of sildenafil oral suspension 2.5 mg (0.25 mL) every 8 hours.
5. Evaluation tests for ODF
The oral suspension comes with a 2 mL oral syringe that only has markings for 5 mg (0.5 mL) and 20 mg (2 mL) (Figure 1). This means that if a 10 mg dose is needed, a volume of 1 mL will be needed to give the correct dose. Since there is not a 1 mL marking on the syringe, the medicine should be drawn up to the 0.5 mL mark twice to give the correct dose. Infants with PAH may need an even smaller dose (less than 0.5 mL) based on their weight. So, parents would not be able to measure the correct dose using the enclosed syringe. When the pharmacy dispensed the medicine, the label included instructions to administer 0.25 mL. However, the pharmacy did not remove the enclosed syringe which could not measure 0.25 mL.
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At home, the parents used the mg dose number (2.5) to measure the medicine. It is possible that the syringe contributed to the confusion since there are no markings for 0.25 mL. The parents probably used the syringe twice to administer 2.5 mL (one 0.5 mL dose plus one 2 mL dose).
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You may be at a higher risk if you have certain health conditions or take blood pressure medicines. If you feel faint or dizzy, lie down. Tell your healthcare provider right away if you have any of the following symptoms of low blood pressure. You may be at higher risk for this if you take a blood thinner medicine. Tell your healthcare provider if you get nosebleeds often while taking sildenafil.
5.3 Epistaxis
If your nosebleed is severe or will not stop after applying pressure, get help right away. People who are allergic to any of the following should not take sildenafil. Any of the ingredients in the specific product dispensed Your pharmacist can tell you all of the ingredients in the specific sildenafil products they stock. Sildenafil should not be taken while you are using certain other medicines. Before taking sildenafil, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
What should I do if I miss a dose of sildenafil?
See the Interactions section for more details. Do not take sildenafil unless it has been prescribed to you by a healthcare provider. Do not share sildenafil with other people, even if they have the same condition as you. Keep sildenafil out of the reach of children. If you keep sildenafil oral liquid in a refrigerator, make sure to keep it away from children who also use the refrigerator. The error was not discovered until the parents requested a refill which was too early based on the volume originally dispensed. Fortunately, the infant did not have any adverse effects from the higher dose of medicine. Here's what you can do: When picking up sildenafil oral suspension from your pharmacy, ask to speak to the pharmacist. Open the package in front of the pharmacist and ask how to measure a dose.
5. Warnings and Precautions
Tell your healthcare provider if you are or plan to become pregnant. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take sildenafil while breastfeeding. If you take sildenafil after you eat a high-fat meal, such as a burger and fries, it may take longer to start working. Your healthcare provider may recommend limiting or avoiding grapefruit while taking sildenafil.
5.4 Visual Loss
Grapefruit or grapefruit juice can raise sildenafil levels in your body, which can increase the risk of side effects. There are no known interactions between sildenafil and alcohol. Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. In particular, make sure that you discuss if you are using any of the following before taking sildenafil. Tell your healthcare provider about all medicines that you take or have recently taken.
Indications and Usage for Sildenafil Oral Suspension
This may not be a complete list of medicines that can interact with sildenafil. If you or someone else has used too much sildenafil, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222. For this use, sildenafil is used only when needed. Take it as your healthcare provider recommends, which is usually between 30 minutes to four pfizer sildenafil 50 hours before planned sexual activity. For this use, take sildenafil as your healthcare provider recommends, which is usually three times a day. If the enclosed syringe does not have markings to measure the dose needed, ask the pharmacist for an appropriate size syringe.
- The solution is usually flavored for better taste.
- Dosing involves measuring with a provided syringe or dropper.
- It offers rapid absorption into the bloodstream.
Then ask the pharmacist to show you how to measure a dose using the syringe.
- Common side effects include headache, flushing, and dizziness.
- Allergic reactions are rare but require immediate medical attention.
- Effects usually last for 4 to 6 hours.
For example, in the case described above, since the dose was less than 1 mL, the pharmacy should have given the parents a 1 mL oral syringe.
Dosages of Sildenafil
If it is almost time for your next dose, skip the missed dose and only take the next dose. Ask your healthcare provider if you are unsure what to do after a missed dose. This survey is being conducted by the WebMD marketing sciences department. Our friendly customer care team is standing by for support. This content is intended for counseling purposes only.
12.2 Pharmacodynamics
This content is informational/educational and is not intended to treat or diagnose any disease or patient. No claims are made as to the safety or efficacy of mentioned preparations. The compounded medications featured in this content have been prescribed and/or administered by prescribers who work with Wedgewood Pharmacy. You are encouraged to speak with your prescriber as to the appropriate use of any medication. Wedgewood Pharmacy's compounded veterinary preparations are not intended for use in food and food-producing animals. The pharmacist should have shown them what marking to use to measure the correct dose (0.25 mL).
- Sildenafil oral solution is prescribed by a healthcare provider.
- It should be taken on an empty stomach for faster effects.
- The liquid form provides flexibility in dosing.
Finally, you should also repeat back, and show the pharmacist how you will measure a dose using the device. Sildenafil citrate 25-mg tabletsa were used to prepare the suspensions. The tablets were ground to fine powder using a mortar and pestle and combined with a 1:1 mixture of methyl-cellulose 1%b (Appendix A) and Simple Syrup, NF,c or a 1:1 mixture of Ora-Plusd and Ora-Sweete (Appendix B).
- The solution is stored at room temperature, away from light.
- Alcohol consumption may increase side effects.
- Do not mix with hot beverages, which can affect stability.
The nominal concentration of sildenafil citrate in each suspension was 2.5 mg/mL.
Why trust our experts?
All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. Sildenafil (Revatio) is a medicine used to treat pulmonary arterial hypertension (PAH), a narrowing of the small blood vessels in the lungs that results in increased pressure. The condition can affect both adults and children. Sildenafil is available as an intravenous infusion, a tablet, and as an oral liquid suspension (10 mg/mL) which is easier to use for children. Approximately 30 mL of each suspension was transferred to 10 2-oz amber plastic prescription bottles.f Five plastic bottles of each suspension were stored at 4 ºC in a refrigerator,g and five were stored at 25 ºC in a temperature-controlled water bath.h The samples were taken after the bottles were shaken on a wrist-action shaker for 10 minutes and then allowed to stand for 2 minutes. The bottles were then gently inverted three times and the caps removed; the samples were withdrawn from the center of the bottles at midlevel of liquid.
| Aspect | Oral Solution | Tablets |
|---|---|---|
| Onset of action | Faster due to quicker absorption | Slightly slower |
| Ease of dose adjustment | Easy to modify dose in small increments | Fixed doses |
| Swallowing difficulties | Easier for children and elderly | Requires swallowing whole |
| Taste masking | Usually palatable with flavors | No taste masking needed |
| Storage and stability | Sensitive to temperature and light | Generally more stable |
Three 500-µL samples were collected from each bottle on days 0, 7, 14, 28, 42, 56, 70, and 91 after preparation and analyzed in duplicate by a high-performance liquid chromatographic (HPLC) method modified and validated in our laboratory. The pH of each solution was measured on each study day. All solutions were observed for any changes in color and turbidity using black and white backgrounds.
Key takeawaysAI
Sexual activity can put extra strain on your heart, which may be unsafe for people with certain health problems, such as a recent heart attack. Talk to your healthcare provider to see if your heart is strong enough for sex. If you feel chest pain, dizziness, or nausea during sex, stop and contact your healthcare provider right away. Sildenafil does not protect against sexually transmitted infections, including HIV. Sildenafil belongs to a group of medicines, known as phosphodiesterase-5 (PDE-5) inhibitors, which are used to treat erectile dysfunction or pulmonary arterial hypertension.
5.1. Bioequivalence and stability testing
You should not take more than one PDE-5 inhibitor medicine. Medicines in this group include avanafil (Stendra), sildenafil (Viagra, Revatio, and others), tadalafil (Cialis and others), and vardenafil (Levitra, Staxyn). Use an accurate measuring device to measure your dose of sildenafil oral liquid. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.
What should I do if I accidentally use too much sildenafil?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if sildenafil is right for you. In particular, make sure that you discuss any of the following. Tell your healthcare provider if you have any of the following. Heart problems, such as heart rhythm problems, chest pain, or heart failure Heart attack, stroke, or heart surgery within the past six months High blood pressure that is still too high despite taking medicines for it Peyronie's disease, or a penis with an abnormal curve or shape An erection lasting longer than four hours A blood disorder, such as sickle cell anemia An inherited eye disease called retinitis pigmentosa Vision loss, or a problem with the nerve between your eyes and brain (optic nerve) Health conditions or factors that raise the risk of optic nerve problems, such as diabetes, high cholesterol, smoking, being older than 50, or having a “crowded disc,” which is something an eye doctor may see in an eye exam Pulmonary veno-occlusive disease, a condition where blood vessels in the lungs are blocked It is not known if or how sildenafil could affect pregnancy or harm an unborn baby.
