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There have been postmarketing reports of bleeding events in patients who have taken VIAGRA. A causal relationship between VIAGRA and these events has not been established. In humans, VIAGRA has no effect on bleeding time when taken alone or with aspirin. However, in vitro studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside (a nitric oxide donor). In addition, the combination of heparin and VIAGRA had an additive effect on bleeding time in viagra jokes quotes english anesthetized rabbit, but this interaction has not been studied in humans. The safety of VIAGRA is unknown in patients with bleeding disorders and patients with active peptic ulceration.

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In volunteers with severe renal impairment (Clcr lt; 30 mLmin), sildenafil clearance was reduced, resulting in higher plasma exposure of sildenafil ( 2 fold), approximately doubling of Cmax and AUC. A starting dose of 25 mg should be considered in patients with severe renal impairment [see DOSAGE AND ADMINISTRATION and CLINICAL PHARMACOLOGY ]. Hepatic Impairment. In volunteers with hepatic impairment (Child-Pugh Class A and B), sildenafil clearance was reduced, resulting in higher plasma exposure of sildenafil (47 for C max and 85 for AUC).

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