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Revatio 20mg Tablet
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Indications & Clinical Uses
- Revatio 20 mg tablets contain sildenafil (as sildenafil citrate), a phosphodiesterase type 5 (PDE5) inhibitor that relaxes blood vessels in the lungs, and are approved for the treatment of pulmonary arterial hypertension (PAH, WHO Group I) in adults to improve exercise ability and delay clinical worsening; a paediatric dosage form is approved for children aged 1 to 17 years with PAH.
- Revatio is not the same product as Viagra, which is a different sildenafil brand approved only for erectile dysfunction at different doses - the two must never be substituted for one another.
- Revatio is also available as an oral suspension and as an intravenous injection for patients temporarily unable to take tablets; the injection is given in hospital.
- Treatment is started and supervised by a pulmonary hypertension specialist, and the tablets are then taken by the patient at home three times a day.
Side Effects
- The most commonly reported reactions include headache, flushing, indigestion, muscle pain, back pain, pain in the arms or legs and diarrhoea.
- Some patients notice temporary visual disturbances such as blurred vision or blue-tinged sight, or nasal congestion.
- Rare but serious effects include sudden decrease or loss of vision or hearing, a prolonged and painful erection lasting more than 4 hours (priapism), and a significant drop in blood pressure, particularly when Revatio is combined with other blood-pressure-lowering medicines.
- In patients with pulmonary veno-occlusive disease, Revatio can trigger serious fluid build-up in the lungs.
- Seek urgent medical attention for sudden vision or hearing changes, an erection lasting over 4 hours, chest pain, or severe dizziness or fainting.
Precautions & Warnings
- Revatio must never be combined with nitrate medicines in any form (including nitroglycerin and recreational nitrites/'poppers') because the combination can cause a dangerous, sometimes fatal, fall in blood pressure; it is also contraindicated with riociguat.
- It should be used with caution in people with heart disease, low blood pressure, fluid depletion, severe liver or kidney impairment, or a history of stroke or heart attack, and in those with anatomical deformity of the penis or conditions that predispose to priapism such as sickle cell disease.
- Revatio is not approved for pulmonary hypertension caused by veno-occlusive disease unless carefully monitored for pulmonary oedema.
- It is not recommended during pregnancy or breast-feeding.
- Because it can cause dizziness, caution is advised before driving or operating machinery until individual response is known.
Avoid Interactions
- Nitrates in any form must be avoided completely with Revatio because the combination can cause severe, dangerous hypotension; the guanylate cyclase stimulator riociguat is also contraindicated.
- Other PDE5 inhibitors, including sildenafil-containing products such as Viagra, should not be used together with Revatio.
- Strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, ritonavir and other HIV protease inhibitors, substantially increase sildenafil levels and generally require a lower Revatio dose, while strong CYP3A4 inducers such as rifampicin, bosentan and carbamazepine can reduce its effect.
- Alpha-blockers and other antihypertensive medicines can add to blood-pressure-lowering effects.
- Grapefruit juice may modestly raise sildenafil levels and is best avoided.
- Tell your healthcare provider and pharmacist about all prescription, over-the-counter and recreational drugs you use before starting Revatio.
References
Frequently Asked Questions
Revatio (sildenafil) treats pulmonary arterial hypertension, high blood pressure in the lung arteries, in adults and in children aged 1 to 17. It improves exercise ability and slows clinical worsening. Revatio is not the same product as Viagra, which is a different sildenafil brand used only for erectile dysfunction.
Revatio 20 mg tablets are usually taken three times a day, about 4 to 6 hours apart, with or without food. Swallow tablets whole. An oral suspension and a hospital-only intravenous injection are also available for patients who cannot take tablets temporarily.
Common effects include headache, flushing, indigestion, muscle or back pain, and nasal congestion. Get urgent help for sudden vision or hearing loss, an erection lasting more than 4 hours, chest pain, or severe dizziness, as these need immediate medical attention.
Never combine Revatio with nitrate medicines or riociguat - this can cause a dangerous fall in blood pressure. Avoid other sildenafil-containing products like Viagra, and be cautious with strong CYP3A4 inhibitors such as ketoconazole or ritonavir, which raise sildenafil levels and may need a dose change.
Your specialist will regularly check your exercise capacity, blood pressure and symptoms of pulmonary hypertension, and may order blood tests or echocardiograms to track your response. Report any new breathlessness, swelling, fainting, or visual changes promptly between scheduled reviews.
Revatio is not recommended in pregnancy or breast-feeding, as safety data are limited. It is approved for children aged 1 to 17 with pulmonary arterial hypertension using a specific paediatric dosing schedule, prescribed and monitored by a specialist experienced in treating the condition.
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