Idilico (Sildenafil)

Idilico (sildenafil) is a phosphodiesterase type 5 inhibitor that modulates the nitric oxide–cGMP pathway, providing therapeutic benefit in vascular‑related conditions.

• Erectile dysfunction: improves ability to achieve and maintain an erection sufficient for sexual activity.
• Erectile dysfunction related to diabetes: enhances erectile response in men with diabetic vasculopathy.
• Pulmonary arterial hypertension: reduces pulmonary arterial pressure and improves exercise capacity.

• Sildenafil selectively inhibits the enzyme phosphodiesterase type 5 (PDE5) located in smooth‑muscle cells of the corpus cavernosum and pulmonary vasculature. By blocking PDE5, it prevents the breakdown of cyclic guanosine monophosphate (cGMP), allowing cGMP to accumulate. Elevated cGMP causes smooth‑muscle relaxation, vasodilation, and increased blood flow to the penis during sexual stimulation and to the pulmonary arteries, enhancing oxygen delivery.

Sildenafil may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Headache: mild to moderate pain often occurring shortly after dosing.
• Flushing: warmth and redness of the face or upper chest.
• Dyspepsia: indigestion or upset stomach.
• Nasal congestion: stuffy or runny nose.

Serious or Rare Side Effects

• Priapism: prolonged erection lasting more than four hours requiring medical attention.
• Sudden hearing loss: abrupt decrease or loss of hearing without obvious cause.
• Severe hypotension: marked drop in blood pressure that may cause dizziness or fainting.

Before prescribing Idilico, clinicians should evaluate several safety considerations.

• Cardiovascular assessment: ensure the patient can tolerate sexual activity and has no uncontrolled angina.
• Nitrate use: avoid concomitant use with nitrates or nitric‑oxide donors due to risk of severe hypotension.
• Hepatic impairment: use lower doses in patients with moderate to severe liver dysfunction.
• Alcohol consumption: limit excessive alcohol as it may increase hypotensive effects.
• Visual disturbances: monitor for sudden vision loss or changes, especially in patients with retinal disorders.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Sildenafil interacts with several drug classes, requiring dose adjustments or avoidance.

Major Interactions (Avoid)

• Nitrates (e.g., nitroglycerin): combined use can cause life‑threatening hypotension.
• Guanylate cyclase stimulators (e.g., riociguat): additive vasodilatory effect may lead to severe blood‑pressure drops.
• Other PDE5 inhibitors: concurrent use increases risk of adverse events.

Moderate Interactions (Monitor Closely)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may raise sildenafil plasma levels, requiring dose reduction.
• CYP3A4 inducers (e.g., rifampin, carbamazepine): may lower effectiveness by reducing drug concentrations.
• Alpha‑blockers (e.g., doxazosin): may cause additive hypotensive effects, especially with the first dose.