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 most recent and highest quality study 1.
Key Considerations
- Sildenafil is primarily eliminated through hepatic metabolism, with approximately 80% of metabolites excreted in feces and 13% in urine, which may lead to decreased clearance in ESRD patients 2.
- ESRD patients may experience higher plasma concentrations and potentially increased side effects due to decreased clearance of sildenafil and its active metabolite 3.
- Patients should be monitored for hypotension, especially if they are taking other medications that may interact with sildenafil, such as nitrates (which are contraindicated) or alpha-blockers (which require careful timing separation) 1.
- Common side effects to watch for include headache, flushing, dyspepsia, and visual disturbances 4.
- If the patient is on dialysis, the timing of sildenafil administration should ideally not coincide with dialysis sessions, as this could affect drug levels unpredictably 3.
Dosing and Administration
- The starting dose of 25 mg can be adjusted based on individual response and tolerability, with a maximum dose of 50 mg per 48 hours 2.
- The sildenafil orodispersible tablet (ODT) formulation may offer a convenient alternative method of administration, with equivalent systemic exposure to the film-coated tablet formulation 4.
Patient Monitoring and Education
- Patients should be educated on the potential risks and benefits of sildenafil treatment, including the importance of monitoring for hypotension and other side effects 1.
- Regular follow-up appointments should be scheduled to assess treatment efficacy and tolerability, and to adjust the dose as needed 5.