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Possible potentiation of systemic vasodilation and symptomatic hypotension 1 Doxazosin: No change or slight increase in plasma doxazosin concentrations depending on sildenafil dose No effect on sildenafil pharmacokinetics 1 No change in efficacy of sildenafil for treatment of ED 1. Consider lower initial sildenafil dose 25 mg for treatment of ED 1 67 Concomitant use not recommended in patients receiving sildenafil for PAH Delavirdine: Reduce initial sildenafil dose for treatment of ED to 25 mg and do not exceed a single mg dose every 48 hours; monitor for adverse effects 29 Etravirine: May administer concomitantly without dosage adjustment, but increase in sildenafil dosage may be needed based on clinical effect Possible decreased clearance of sildenafil Erection plasma sildenafil concentrations; increased plasma bosentan concentrations Clinical importance of pharmacokinetic interaction unclear Consider lower initial sildenafil dose 25 mg for treatment of ED 67 No dosage adjustment necessary when used concomitantly with sildenafil problems with erection PAH AUC and peak plasma concentrations of sildenafil not substantially altered Pharmacokinetics of ethinyl estradiol and levonorgestrel not substantially altered Slight decrease in sildenafil exposure; not considered clinically important Effect on epoprostenol pharmacokinetics not known Possible problems with erection and marked BP reduction; potentially serious or even fatal 26 67 92 Possible beneficial augmented cardiovascular effects in PAH Azithromycin: No pharmacokinetic interaction observed to date Erythromycin: Increased AUC of sildenafil 1 69 Azithromycin: No dosage adjustments necessary Erythromycin: Consider lower initial sildenafil dose 25 mg for treatment of ED; 1 no dosage adjustment necessary when used concomitantly with sildenafil for PAH No substantial effect on INR; 1 67 however, increased bleeding epistaxis observed with concomitant use in patients with PAH Warfarin: No pharmacokinetic interaction observed 1 67 Drug information provided by: IBM Micromedex. Use tadalafil exactly as directed by your doctor.