INDICATION
VYBRIQUE™ (sildenafil) oral film is indicated for the treatment of erectile dysfunction (ED).
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
Nitrates: VYBRIQUE is contraindicated in patients using any form of organic nitrates or nitric oxide donors, either regularly and/or intermittently, as it potentiates the hypotensive effects of nitrates. The safe interval for administering nitrates after VYBRIQUE is unknown, even though sildenafil plasma levels are lower at 24 hours after dosing.
Hypersensitivity Reactions: VYBRIQUE is contraindicated in patients with a known hypersensitivity to sildenafil or any component of VYBRIQUE. Hypersensitivity reactions, including rash and urticaria, have been reported.
Concomitant Guanylate Cyclase (GC) Stimulators: Do not use VYBRIQUE in patients using a GC stimulator, such as riociguat; as PDE5 inhibitors, including VYBRIQUE, may potentiate the hypotensive effects of GC stimulators.
WARNINGS AND PRECAUTIONS
Cardiovascular risk: There is a potential for cardiac risk of sexual activity in patients with preexisting cardiovascular disease. VYBRIQUE should not be used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status.
VYBRIQUE was not studied and is not recommended for use in patients with:
- Myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months;
- Resting hypotension (BP <90/50 mmHg) or hypertension (BP >170/110 mmHg);
- Cardiac failure or coronary artery disease causing unstable angina.
Patients with left ventricular outflow obstruction (e.g., aortic stenosis, idiopathic hypertrophic subaortic stenosis) and those with severely impaired autonomic control of blood pressure can be sensitive to the actions of vasodilators, including VYBRIQUE.
Prior to prescribing VYBRIQUE, carefully consider cardiovascular status, especially in combination with sexual activity.
Prolonged erection: Prolonged erection (>4 hours) and priapism (painful erections >6 hours in duration) have been reported infrequently, but can result in permanent penile damage if untreated. Instruct patients to seek immediate medical assistance if an erection persists longer than 4 hours. Use VYBRIQUE with caution in patients with anatomical deformation of the penis (angulation, cavernosal fibrosis, or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (sickle cell anemia, multiple myeloma, or leukemia).
Effects on the eye: Advise patients to stop VYBRIQUE and seek medical care if a sudden loss of vision occurs in one or both eyes, which could be a sign of non-arteritic anterior ischemic optic neuropathy (NAION). Use VYBRIQUE with caution and only when the anticipated benefits outweigh the risks in patients with a history of NAION. Individuals with “crowded” optic disc are also considered at greater risk for NAION.
Patients with known hereditary degenerative retinal disorders, including retinitis pigmentosa, were not included in the sildenafil citrate clinical trials, and use in these patients is not recommended.
Sudden hearing loss: Advise patients to stop taking VYBRIQUE and seek prompt medical attention in the event of sudden decrease or loss of hearing. These events, which may be accompanied by tinnitus and dizziness, have been reported in temporal association to the intake of PDE5 inhibitors, including sildenafil.
Potential drug interactions: VYBRIQUE can potentiate the hypotensive effects of nitrates, GC stimulators, alpha-blockers, and antihypertensives. Initiate VYBRIQUE at 25 mg with concomitant use of alpha-blockers.
CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, itraconazole, erythromycin) increase VYBRIQUE plasma exposure. Decreased blood pressure, syncope, and prolonged erection may occur at higher sildenafil exposures. Do not exceed 25 mg of VYBRIQUE in a 48-hour period with ritonavir. Consider a starting dose of 25 mg of VYBRIQUE with erythromycin or strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, saquinavir).
Sexually transmitted diseases: Use of VYBRIQUE offers no protection against sexually transmitted diseases, including the human immunodeficiency virus (HIV); therefore, counsel patients about protective measures.
Specific Populations: Consider a starting dose of 25 mg of VYBRIQUE for patients ≥65 years, patients with severe renal impairment, or patients with hepatic impairment.
Adverse Reactions: The most common adverse reactions (≥2%) include headache, flushing, dyspepsia, abnormal vision, nasal congestion, back pain, myalgia, nausea, dizziness, and rash.
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