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Patients should inform their clinician if they are taking antiretroviral therapy. While reported experience with use of sildenafil in HIV-infected patients receiving antiretroviral therapy is limited, clinically important pharmacokinetic interactions have been demonstrated when the drug was used concomitantly with ritonavir and saquinavir.

Combination antiretroviral therapy usually includes one or more HIV protease inhibitors that are inhibitors of CYP3A4 and/or CYP2C9, and the possibility for an interaction with sildenafil clearance resulting in an increased likelihood of sildenafil-associated adverse effects such as headache, flushing, visual changes, priapism, and possibly hypotension and syncope exists.

Because peak plasma sildenafil concentrations achieved with recommended doses for ED are well below the concentrations necessary for in vitro inhibition of these CYP isoenzymes, the manufacturer states that it flexeril makes me sleepy the next day unlikely that sildenafil will alter the clearance of drugs metabolized by flexeril makes me sleepy the next day isoenzymes.

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The International Index of Erectile Function and a global assessment question "Did the treatment improve your erections? Safety analyses included subjects who received study medication. Men taking nitrate therapy or nitric oxide donors and men with severe cardiac failure, unstable angina, or recent stroke or myocardial infarction were sources. Efficacy analyses included all subjects with baseline and at least one postrandomization evaluation.

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