Ultrasound at 12 weeks for nuchal translucency,
How should this medicine be used?
Back to Journals » International Journal of Women's Health » Volume 8 Authors Choudhary R , Desai K, Parekh H, Ganla K Published 9 August 2016 Volume 2016:8 Pages 367—372 Editor who approved publication: Professor Elie Al-Chaer Rana Choudhary,1 Kavita Desai,2 Hetal Parekh,3 Kedar Ganla1 1Department of Reproductive Medicine, Ankoor Fertility Clinic, 2Department of Radiology, Dadar Imaging and Diagnostic Centre, 3IVF Department, Hiranandani Hospital, Mumbai, India Abstract: Fetal growth restriction (FGR) and preeclampsia are the major causes of neonatal morbidity and mortality, which affect up to 8% of all pregnancies. The pathogenesis in FGR is an abnormal trophoblastic invasion leading to compromised uteroplacental circulation. However, in spite of this understanding and identification of high-risk patients, the management options are limited. There are some new studies which have demonstrated the role of sildenafil citrate in improving vasodilatation of small myometrial vessels and therefore improvement in amniotic fluid index, fetal weight, and even uterine and umbilical artery Doppler patterns. We report here the case of a 31-year-old female with infertility and preconceptional thin endometrium responding well to sildenafil citrate, followed by conception.
Missed Dose
However, she presented with an early-onset FGR at 26 weeks of gestation, and again after treatment with sildenafil citrate, showed improvement in amniotic fluid index and fetal weight, finally resulting in delivery of a full-term healthy baby with uneventful neonatal course. Keywords: sildenafil citrate, fetal growth restriction, oligohydramnios, thin endometrium Early-onset fetal growth restriction (FGR) accompanied by severe oligohydramnios is often associated with high perinatal morbidity and mortality.1 Only a proportion of pregnancies with FGR show altered maternal peripheral vascular resistance, while some women may have elevated maternal peripheral vascular resistance in uterine arteries and hence poor perinatal outcome. In such pregnancies, if resistance values are normalized in later trimesters, there may be a significantly better outcome.2 Some recent studies have shown that sildenafil citrate increases uterine blood flow and potentiates estrogen-induced vasodilation.3 In this case of early-onset FGR, sildenafil citrate therapy was successful in managing FGR and accompanied severe oligohydramnios with a favorable neonatal and maternal outcome. A 31-year-old female with a history of secondary infertility of 1 year and 6 months was referred to our clinic. She had two spontaneous miscarriages at tenth week of gestation, the last being 2 years and 6 months back, both followed by dilatation and curettage. nasal bone, and dual marker test were normal.
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Patient was called for
| Condition | Recommendation | Note |
|---|---|---|
| Heart Disease | Consult before use | Risk factors must be evaluated |
| Use of Nitrates | Avoid | Severe hypotension risk |
| Pregnancy | Not recommended | Safety not established |
| Liver Disease | Dose adjustment needed | Metabolism may be affected |
follow-up visits every 3 weeks.
What happens if I miss a dose?
If you become pregnant while taking sildenafil, call your doctor. if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking sildenafil. if you are taking sildenafil to treat erectile dysfunction, tell your doctor if you have ever been advised by a healthcare professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity. Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain, dizziness, or nausea during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise.
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tell all your healthcare providers that you are taking sildenafil. If you ever need emergency medical treatment for a heart problem, the healthcare providers who treat you will need to know when you last took sildenafil. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine. If you are taking sildenafil for erectile dysfunction, you are unlikely to miss a dose since this medication is taken as needed, not on a regular dosing schedule. If you are taking sildenafil for PAH, take the missed dose as soon as you remember it.
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However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. numbness, burning, or tingling in the arms, hands, feet, or legs pain in muscles, back, arms, or legs changes in color vision (seeing a blue tinge on objects or having difficulty telling the difference between blue and green) sudden severe loss of vision (see below for more information) erection that is painful or lasts longer than 4 hours rash; itching; hives; difficulty breathing or swallowing; swelling of the eyes, face, throat, tongue, or lips Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil. The vision loss was permanent in some cases. It is not known if the vision loss was caused by the medication. Ultrasound for congenital malformation at 20
| Side Effect | Frequency | Severity | Notes |
|---|---|---|---|
| Headache | Common | Mild | Usually resolves |
| Flushing | Common | Mild | Reddening of skin |
| Nasal Congestion | Moderate | Mild | Temporary discomfort |
| Dizziness | Less common | Moderate | May impair balance |
weeks did not reveal any abnormality.
MeSH terms
After her last abortion, she did not conceive for 2 years. Multiple cycles of ovulation induction with oral agents as well as injectable gonadotropins were done. All follicular studies showed consistently thin endometrium of 6–8 mm around the time of ovulation. On hysteroscopy done 1 year back, uterine cavity was normal. At our clinic, we started with follicular growth and endometrial thickness monitoring in natural cycle. Fetal weight at that time was 440
- Sildenafil citrate tablets are typically taken 30-60 minutes before intimacy.
- Monitoring by a healthcare professional is recommended for women.
- Use sildenafil cautiously if you have a history of stroke or heart attack.
- Combining sildenafil with other ED medications is dangerous.
- Pregnancy and breastfeeding considerations should be discussed with a doctor.
- Sildenafil does not induce arousal but enhances physiological responses.
- Not suitable for women with or at risk of abnormal heart rhythms.
- Potential for psychological as well as physical benefits exists.
- Ensure trusted pharmacy sources when purchasing sildenafil for women.
- Sildenafil is available in various dosages, such as 25 mg, 50 mg, 100 mg.
- Discontinue use if adverse effects like chest pain occur.
- A comprehensive sexual health evaluation can determine if sildenafil is appropriate.
g, and amniotic fluid index (AFI) was 10.
| Aspect | Details | Notes |
|---|---|---|
| Active Ingredient | Sildenafil Citrate | PDE5 inhibitor |
| Common Use | Female Sexual Arousal | Under Medical Supervision |
| Age Group | Adults (18+) | Not recommended for minors |
| Approval Status | Varies by country | Often off-label use |
Repeat ultrasound at 24 weeks
Detection in biological fluids
If you experience a sudden loss of blue sildenafil vision while you are taking sildenafil, call your doctor immediately. Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor. There have been reports of heart attack, stroke, irregular heartbeat, bleeding in the brain or lungs, high blood pressure, and sudden death in men who took sildenafil for erectile dysfunction. Most, but not all, of these people had heart problems before taking sildenafil. It is not known whether these events were caused by sildenafil, sexual activity, heart disease, or a combination of these and other causes.
Complementary and Alternative Options for Low Libido
Talk to your doctor about the risks of taking sildenafil. Some patients experienced a sudden decrease or loss of hearing after they took sildenafil or other medications that are similar to sildenafil. It is not known if the hearing loss was caused by the medication. If you experience a sudden loss of hearing, sometimes with ringing in the ears or dizziness, while you are taking sildenafil, call your doctor immediately. If you are taking sildenafil (Viagra) for erectile dysfunction, do not take any more doses of sildenafil (Viagra) or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.
Increased genital blood flow
If you are taking sildenafil (Liqrev, Revatio) for PAH, do not stop taking your medication until you talk to your doctor. Call your doctor if you have any unusual problems while you are taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). was suggestive of oligohydramnios (AFI 6)
- Female-specific studies on sildenafil show mixed results.
- Sildenafil is sometimes used off-label for female libido enhancement.
- Always check for allergies before taking sildenafil citrate tablets.
- Sildenafil may cause vision disturbances in some women.
- Proper hydration can reduce side effects when using sildenafil.
- Combining sildenafil with alcohol can increase risks.
- Be aware of potential interactions with hormonal contraceptives.
- Do not share sildenafil tablets to prevent misuse or overdose.
- Women should report any adverse reactions to their healthcare provider.
- Sildenafil may help with certain conditions like Female Sexual Arousal Disorder.
- Cost of sildenafil for women varies, and insurance may not cover it.
- Follow prescribed instructions precisely to avoid overdose.
with a fetal weight of
Side Effects
Store the suspension at room temperature or in a refrigerator, but do not freeze it. Dispose of any unused suspension after 60 days. Keep all medication liquid sildenafil citrate out of sight and reach of children as many containers are not child-resistant. Place the medication in a safe location – one that is up and away and out of their sight and reach. Dispose of unneeded medications in a way so that pets, children, and other people cannot take them.
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Do not flush this medication down the toilet. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website for more information. In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.
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Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies. 490 g (less than fifth percentile).
What should I do if I forget a dose?
Doppler for endometrial blood flow around the time of ovulation was suggestive of absent flow in zones 2, 3, and 4 of endometrium sildenafil 12 5 mg (Applebaum criteria).4,5 An attempt to improve the blood flow was made by starting Aspirin 75 mg, vitamin E, and Pentoxyfylline.6 However, repeat Doppler around the time of implantation did not show any improvement. In the next cycle, successful ovulation induction with gonodatropins was done, and trigger was given when the follicle was 18 mm, followed by intrauterine insemination. Luteal support was given with oral estrogen, progesterone, and vaginal Sildenafil citrate 25 mg (Alivher®; Akumentis Healthcare Ltd., Mumbai, India) twice a day in view of decreased endometrial blood flow in the previous cycle, which may be one of the causes of repeated abortions.7 Doppler for endometrial blood flow around the time of implantation (7–8 days after ovulation) showed good flow in all the zones. Serum β-human chorionic gonadotropin test done 14 days later confirmed the pregnancy. Sildenafil citrate was stopped on confirmation of pregnancy.