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Due to age-differences in plasma protein binding, the corresponding increase in the AUC of free (unbound) sildenafil and its active N-desmethyl metabolite were 45 and 57, respectively [see DOSAGE AND ADMINISTRATIONand Use In Specific Populations ] Renal Impairment : In volunteers with mild (CLcr50-80 mLmin) and moderate (CLcr30-49 mLmin) renal impairment, the pharmacokinetics of a single oral dose of VIAGRA (50 mg) were not altered. In volunteers with severe (CLcr lt; 30 mLmin) renal impairment, sildenafil clearance was reduced, resulting in approximately doubling of AUC and Cmax compared to age-matched volunteers with no renal impairment [see DOSAGE AND ADMINISTRATIONand Use In Specific Populations ]. In addition, N-desmethyl metabolite AUC and Cmax values significantly increased by 200 and 79, respectively in subjects with severe renal impairment compared to subjects with normal renal function. Hepatic Impairment : In volunteers with hepatic impairment (Child-Pugh Class A and B), sildenafil clearance was reduced, resulting in increases in AUC (85) and Cmax (47) compared to age-matched volunteers with no hepatic impairment.

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