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Other reported clinical experience has not identified differences in response between geriatric and younger patients with PAH. The greater frequency of decreased hepatic, renal, and/or cardiac function and otc alternative to viagra concomitant disease and drug therapy observed in the elderly should be considered in dosage selection for the treatment of PAH. Sildenafil did not exhibit evidence of mutagenicity in vitro in bacterial and Chinese hamster ovary cell assays.

While safety and efficacy of sildenafil in geriatric patients have not been established specifically, 21-23% of patients who received the drug for ED in clinical trials were 65 years of age and older. The drug also did not exhibit clastogenic potential otc alternative to viagra vivo in the mouse micronucleus test or in an in vitro mammalian human lymphocytes test system.

Pooled data from 8 controlled clinical trials indicate that sildenafil is comparably effective in geriatric men 65 years of age and older compared with younger men with ED. However, because pharmacokinetic studies revealed decreased clearance of sildenafil and increased by otc alternative to viagra area under the plasma concentration-time curve AUC in healthy geriatric individuals Clinical studies of sildenafil for PAH did not include sufficient numbers of patients 65 years of age or older to determine whether they respond differently than younger adults.

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Clinicians unfamiliar with their patients' drug history, especially those involved in emergency care e. In patients with unstable angina who are not receiving a long-acting nitrate and viagra alternative otc have short-acting nitrate or nitrite use as the only contraindication to sildenafil therapy but do not appear to require nitrate or nitrite therapy consistently, the risks and benefits of sildenafil therapy should be weighed carefully by the clinician and patient.

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