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Pharmacokinetics of the drug as determined by peak plasma concentrations or area under the plasma concentration-time sildenafil alternative drugs are dose proportional over the single-dose range of 1. Although single-dose studies indicate that more than 90% of an oral sildenafil dose is absorbed from the GI tract, the drug undergoes extensive metabolism in the GI mucosa during absorption and on first pass through the liver, with only about 40% of a dose reaching systemic circulation unchanged.

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While sildenafil-induced vasodilation generally results in only transient modest reductions in systolic and diastolic blood pressure that usually are clinically unimportant when the drug is taken alone, which rarely may be severe; hypotension, including postural orthostatic hypotension; and syncope have been reported in about 2% or less sildenafil replacement patients receiving the drug for the treatment of ED, with the latter effects occurring at a rate comparable to that reported sildenafil replacement placebo.

in flexible-dose ED studies resulting in discontinuance of the drug. Although the incidence of sildenafil replacement adverse effects with sildenafil reportedly has decreased as the duration of therapy increased, it remains to be established whether tolerance to common adverse vascular effects occurs with continued use.

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