Revatio Adverse Reactions

Summary of the safety profile: In the pivotal placebo-controlled study of Revatio in pulmonary arterial hypertension, a total of 207 patients were randomized to and treated with 20 mg, 40 mg, or 80 mg TID doses of Revatio and 70 patients were randomized to placebo. The duration of treatment was 12 weeks. The overall frequency of discontinuation in sildenafil treated patients at doses of 20 mg, 40 mg and 80 mg TID was 2.9%, 3.0% and 8.5% respectively, compared to 2.9% with placebo. Of the 277 subjects treated in the pivotal study, 259 entered a long-term extension study. Doses up to 80 mg three times a day (4 times the recommended dose of 20 mg three times a day) were administered and after 3 years 87% of 183 patients on study treatment were receiving Revatio 80 mg TID.
In a placebo-controlled study of Revatio as an adjunct to intravenous epoprostenol in pulmonary arterial hypertension, a total of 134 patients were treated with Revatio (in a fixed titration starting from 20 mg, to 40 mg and then 80 mg, three times a day, as tolerated) and epoprostenol, and 131 patients were treated with placebo and epoprostenol. The duration of treatment was 16 weeks. The overall frequency of discontinuations in sildenafil/epoprostenol treated patients due to adverse events was 5.2% compared to 10.7% in the placebo/epoprostenol treated patients. Newly reported adverse reactions, which occurred more frequently in the sildenafil/epoprostenol group, were ocular hyperaemia, vision blurred, nasal congestion, night sweats, back pain and dry mouth. The known adverse reactions headache, flushing, pain in extremity and oedema were noted in a higher frequency in sildenafil/epoprostenol treated patients compared to placebo/epoprostenol treated patients. Of the subjects who completed the initial study, 242 entered a long-term extension study. Doses up to 80 mg TID (4 times the maximum recommended dose of 20 mg three times a day) were administered and after 3 years 68% of 133 patients on study treatment were receiving Revatio 80 mg TID.
In the two placebo-controlled studies adverse events were generally mild to moderate in severity. The most commonly reported adverse reactions that occurred (greater or equal to 10%) on Revatio compared to placebo were headache, flushing, dyspepsia, diarrhoea and pain in extremity.
Tabulated list of adverse reactions: Adverse reactions which occurred in > 1% of Revatio-treated patients and were more frequent (> 1% difference) on Revatio in the pivotal study or in the Revatio combined data set of both the placebo-controlled studies in pulmonary arterial hypertension, at doses of 20, 40 or 80 mg TID are listed in the table as follows by class and frequency grouping (very common (≥ 1/10), common (≥1/100 to < 1/10), uncommon (≥ 1/1000 to < 1/100) and not known (cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Reports from post-marketing experience are included in italics. (See table.)


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In a study to assess the effects of different dose levels of sildenafil on mortality in adults with PAH, the group who received the lower dose 5 mg three times a day (4 times lower than the recommended dose) showed a higher observed number of deaths (all related to underlying disease/disease under study), serious adverse events and severe adverse events than the 20 mg three times a day (recommended dose) and 80 mg three times a day (4 times the maximum recommended dose) groups (see Pharmacology under Actions).
The most commonly reported adverse reactions that occurred (≥ 5%) in the Revatio combined data set were headache and dizziness.