Mensil (Sildenafil)

Sildenafil acts on the nitric oxide–cGMP pathway to treat erectile dysfunction.

• Erectile dysfunction (general): improves the ability to achieve and maintain an erection sufficient for sexual activity.
• Erectile dysfunction associated with diabetes: enhances penile blood flow to counteract diabetes‑related vascular impairment.
• Erectile dysfunction after prostate surgery: aids recovery of erectile function by promoting smooth‑muscle relaxation.

• Sildenafil selectively inhibits phosphodiesterase type 5 enzymes, preventing the breakdown of cyclic guanosine monophosphate (cGMP). Elevated cGMP levels lead to relaxation of smooth muscle in the corpus cavernosum, increased blood inflow, and facilitation of an erection in response to sexual stimulation.

Sildenafil is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Headache: mild to moderate intensity.
• Flushing: warmth and redness of the face or upper body.
• Dyspepsia: indigestion or upset stomach.
• Nasal congestion: stuffy or runny nose.
• Visual disturbances: blurred vision or color tinge.
• Back pain: muscle aches, often mild.

Serious or Rare Side Effects

• Priapism: prolonged erection lasting more than 4 hours.
• Sudden vision loss: non‑arteritic anterior ischemic optic neuropathy.
• Sudden hearing loss: unexplained decrease in hearing acuity.
• Cardiovascular events: chest pain, arrhythmia, or myocardial infarction.
• Severe hypotension: marked drop in blood pressure.
• Allergic reactions: rash, itching, swelling, or anaphylaxis.

Before initiating therapy, consider the following precautions.

• Cardiovascular assessment: evaluate for unstable heart disease or recent myocardial infarction.
• Nitrate use: avoid concurrent use with nitrates due to risk of severe hypotension.
• Alpha‑blocker therapy: use with caution and monitor blood pressure.
• Hepatic/renal function: adjust use in patients with severe impairment.
• Sexual activity timing: advise patients to take the tablet as directed and allow adequate time before intercourse.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Sildenafil may interact with several medicines; monitoring is essential.

Major Interactions (Avoid)

• Nitrates (e.g., nitroglycerin): can cause profound hypotension.
• Guanylate cyclase stimulators (e.g., riociguat): risk of excessive blood pressure lowering.
• Potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): increase sildenafil plasma levels.

Moderate Interactions (Monitor Closely)

• Alpha‑blockers (e.g., tamsulosin): may cause additive blood pressure effects.
• CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce efficacy.
• Other antihypertensives: monitor for additive hypotensive response.