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The following information outlines crucial safety warnings associated with the use of sildenafil (Revatio). It is essential to understand these risks and take appropriate precautions. Please consult your healthcare provider for any concerns or questions regarding these warnings:

• Risk of Death in Children: High doses of sildenafil (Revatio) have been linked to an increased risk of mortality in children with pulmonary arterial hypertension (PAH) after approximately one year. It is not recommended for long-term use in pediatric patients.

• Low Blood Pressure: Sildenafil (Revatio) can cause blood vessels to relax, potentially leading to a significant drop in blood pressure. If you are on blood pressure medications, monitor your blood pressure closely. Contact your healthcare provider if your blood pressure falls unusually low or if you experience symptoms such as dizziness, lightheadedness, or persistent chest pain. Factors increasing this risk include pre-existing low blood pressure, dehydration, heart conditions, and nerve-related blood pressure issues.

• Serious Lung Disease: Rarely, sildenafil (Revatio) may induce pulmonary veno-occlusive disease, a severe lung condition causing fluid accumulation. Seek immediate medical attention if your PAH symptoms worsen, you have difficulty breathing when lying down, or develop a persistent cough.

• Nosebleeds: The medication may cause nosebleeds, especially if you are also taking blood thinners like warfarin. If a nosebleed persists, seek medical help. Inform your doctor if you have a bleeding disorder or stomach ulcer before starting treatment. Risks are higher for those with PAH due to connective tissue disease or those on blood thinners.

• Vision Loss: Though uncommon, there is a risk of sudden vision changes or permanent eye damage. This could indicate non-arteritic anterior ischemic optic neuropathy (NAION). Seek emergency medical care if you notice any vision changes. Risk factors include a history of eye nerve issues, age over 50, diabetes, high blood pressure, heart disease, high cholesterol, and smoking.

• Hearing Loss: Some individuals have reported permanent hearing loss, tinnitus, or dizziness while taking sildenafil (Revatio). Immediate medical attention is advised if you experience any hearing changes.

• Dangerous Drug Interactions: Avoid using sildenafil (Revatio) with other PDE-5 inhibitors, such as Viagra, tadalafil (Cialis), vardenafil (Levitra), or avanafil (Stendra), as this can lead to dangerous drops in blood pressure and increased side effects.

• Prolonged Erection: Rarely, men may experience prolonged erections lasting more than four hours, which can cause permanent penile damage and impotence if untreated. Seek urgent medical assistance if this occurs. Increased risk is associated with conditions like Peyronie's disease, cavernosal fibrosis, sickle cell anemia, and certain blood cancers.

• Sickle Cell Crisis: Individuals with PAH due to sickle cell disease may experience a sickle cell crisis when taking sildenafil (Revatio). Consult with your healthcare provider before starting the medication if you have this condition.

There are no specific contraindications mentioned for sildenafil (Revatio) use.

When taking this medication, some common side effects may occur, such as dizziness, lightheadedness, headaches, flushing, and stomach upset. Some individuals might also experience nosebleeds, trouble sleeping, muscle pain, redness, or fever. Additionally, vision changes, including increased sensitivity to light, blurred vision, or difficulty distinguishing between blue and green colors, can happen. If these effects are mild, they typically resolve over time, but it's important to consult with a healthcare provider if they persist or worsen.

Other side effects might include a runny nose, stomach irritation, sinus inflammation, and a "pins and needles" sensation. While these are generally not severe, monitoring their progression is advisable.

However, there are rare but serious side effects that require immediate medical attention. These include sudden decreased vision or permanent blindness, known as NAION, sudden hearing loss, or a painful, prolonged erection lasting more than four hours. Additionally, increased shortness of breath, fainting, or symptoms of a severe allergic reaction like rash, severe dizziness, or swelling of the face, tongue, or throat necessitate urgent medical care. If you experience any of these serious side effects, stop using the medication and seek medical help promptly. Always keep open communication with your healthcare provider regarding any side effects you experience.

When taking sildenafil, it is important to be aware of potential interactions with other medications. Avoid using sildenafil with medications like riociguat or vericiguat, as well as nitrates such as nitroglycerin and isosorbide, or recreational drugs known as "poppers" that contain amyl or butyl nitrite. Combining these can lead to a significant drop in blood pressure, resulting in dizziness, fainting, or even more serious consequences like a heart attack or stroke. If you're on alpha blockers for conditions like an enlarged prostate or high blood pressure, such as doxazosin or tamsulosin, be cautious as your blood pressure might become too low, causing dizziness or fainting. Your healthcare provider may adjust your medications to reduce this risk.

Certain drugs can influence how sildenafil is processed in your body, affecting its efficacy. These include azole antifungals like itraconazole and ketoconazole, macrolide antibiotics like clarithromycin, HIV protease inhibitors such as atazanavir and darunavir, and others including rifampin and ritonavir. Additionally, do not use sildenafil in combination with other erectile dysfunction or pulmonary hypertension treatments like tadalafil or vardenafil.

Always inform your doctor and pharmacist about all the medications and supplements you are taking, including over-the-counter drugs, vitamins, and herbal products, to ensure safe and effective use of sildenafil. Your healthcare provider might need to adjust the dosage or frequency of your medications to prevent interactions.