From the Research
For patients with end-stage renal disease (ESRD), the recommended starting dose of Viagra (sildenafil) is 25 mg, with a maximum frequency of once every 48 hours, as supported by the study published in 2002 1. This reduced dosing is necessary due to the significantly reduced clearance of sildenafil and its active metabolite in ESRD patients, leading to higher plasma concentrations and increased risk of adverse effects. The study published in 2013 2 also supports the efficacy and safety of sildenafil in patients with ESRD, with 75-85% of patients reporting improved erectile function. However, it is essential to monitor patients for side effects, including headache, flushing, dyspepsia, and hypotension, which may be more pronounced in ESRD patients due to altered drug clearance. Some key points to consider when prescribing sildenafil to ESRD patients include:
- Starting with a low dose of 25 mg and adjusting as needed
- Limiting the frequency of use to once every 48 hours
- Monitoring for adverse effects, particularly hypotension
- Avoiding concomitant use with nitrates due to the risk of severe hypotension
- Advising patients to take the medication approximately 1 hour before sexual activity and understanding that dialysis does not significantly remove the drug from circulation. It is also important to note that many ESRD patients have multiple comorbidities that may affect erectile function, and sildenafil should be used cautiously with other medications. The most recent study published in 2021 3 emphasizes the importance of medical management in ESRD patients, including the treatment of erectile dysfunction, but does not provide specific guidance on sildenafil dosing. Overall, the recommended dosing of sildenafil in ESRD patients is supported by the available evidence, and careful monitoring and caution are necessary to minimize the risk of adverse effects.