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Important note: The older Ezequel document supplied with this request may contain incomplete or outdated information. The clinical information below has therefore been reviewed and updated against current sildenafil prescribing information, including a SmPC revised in June 2026, while the Egyptian-market information has been checked separately. The current publicly listed Egyptian presentations of Ezequel are Ezequel 50 mg 4 film-coated tablets and Ezequel 100 mg 9 film-coated tablets, with COPAD Pharma identified as the manufacturer. (Egypt Dwa)
Summary
Ezequel is an oral sildenafil product used for the treatment of erectile dysfunction (ED) in adult men. Sildenafil is a potent and selective phosphodiesterase type 5 (PDE5) inhibitor. It enhances the physiological nitric-oxide/cGMP pathway in the corpus cavernosum and thereby facilitates penile erection in the presence of sexual stimulation.
The usual starting dose for ED is 50 mg taken approximately 1 hour before sexual activity, with adjustment to 25 mg or 100 mg according to efficacy and tolerability. The maximum recommended frequency is once daily. (Medicines.org.uk)
The most clinically important safety issue is its potential to cause significant hypotension when combined with nitrates or nitric-oxide donors; concomitant use is contraindicated. Concomitant use with the soluble guanylate-cyclase stimulator riociguat is also contraindicated. (Medicines.org.uk)
Sildenafil is not an aphrodisiac and does not directly cause sexual desire or an erection in the absence of sexual stimulation.
Brand Name
Ezequel
Current Egyptian-market listings identify:
- Ezequel 50 mg 4 f.c. tablets
- Ezequel 100 mg 9 f.c. tablets
Both are listed as containing sildenafil and manufactured by COPAD Pharma. (Egypt Dwa)
Category
Therapeutic category:
PDE5 inhibitor / erectile-dysfunction treatment.
ATC classification:
G04BE03 — Sildenafil, under urological drugs used in erectile dysfunction. (Medicines.org.uk)
The Egyptian commercial classification may describe Ezequel more informally as a “tonic for men,” but pharmacologically it is a PDE5 inhibitor, not a nutritional tonic or testosterone preparation. (Egypt Dwa)
Active Ingredient
Sildenafil, administered as sildenafil citrate.
The active moiety responsible for the pharmacological effect is sildenafil.
Pharmaceutical Form & Strength
Dosage form: Film-coated oral tablet.
Current Ezequel Egyptian presentations identified:
| Product | Strength | Pack |
|---|---|---|
| Ezequel | 50 mg | 4 film-coated tablets |
| Ezequel | 100 mg | 9 film-coated tablets |
The 100-mg strength is the maximum recommended single dose for erectile dysfunction; it is not the recommended starting dose for most patients. (Medicines.org.uk)
Manufacturer & Marketing Authorization Holder
Manufacturer
COPAD Pharma / COPAD Egypt for Trade and Pharmaceutical Industries, Egypt.
COPAD's current official website describes the company as an Egyptian pharmaceutical manufacturer and identifies its manufacturing facility in El Obour City, Egypt. (COPAD Pharma)
Independent Egyptian-market drug listings identify COPAD Pharma as the manufacturer of both current Ezequel presentations. (Egypt Dwa)
Marketing Authorization Holder
A current Ezequel-specific Egyptian MAH record was not publicly retrievable from the sources available for verification, so it would be inappropriate to invent a separate MAH. COPAD should therefore be identified as the manufacturer, while the exact current Egyptian MAH should be confirmed from the Egyptian Drug Authority's official registration record or the current Ezequel package/leaflet.
The Egyptian Drug Authority does publicly distinguish between Applicant and Marketing Authorization Holder (MAH) in its regulatory records, illustrating why these should not automatically be assumed to be identical. (Egyptian Drug Authority)
Mechanism of Action
Penile erection is initiated physiologically by sexual stimulation, which promotes release of nitric oxide (NO) in the corpus cavernosum.
NO activates guanylate cyclase, increasing intracellular cyclic guanosine monophosphate (cGMP).
cGMP promotes relaxation of cavernosal smooth muscle, increasing arterial inflow and facilitating erection.
PDE5 normally degrades cGMP.
Sildenafil selectively inhibits PDE5, thereby reducing cGMP degradation and prolonging/enhancing the NO-mediated erectile response.
Therefore:
Sexual stimulation → NO release → guanylate cyclase activation → ↑ cGMP → cavernosal smooth-muscle relaxation → ↑ penile blood flow → erection
Sildenafil does not independently initiate sexual desire or erection; sexual stimulation is required for its therapeutic effect. (Medicines.org.uk)
Sildenafil is highly selective for PDE5 but is not completely specific. It also inhibits PDE6 at much higher concentrations, which helps explain some transient visual/color-perception effects. Its selectivity for PDE5 over PDE3 is greater than 4,000-fold. (Medicines.org.uk)
Spectrum of Activity
Not applicable.
Ezequel/sildenafil is not an antimicrobial drug, so there is no bacterial, viral, fungal, or parasitic spectrum of activity.
Its relevant pharmacological target is PDE5.
Pharmacokinetics
Absorption
Sildenafil is rapidly absorbed after oral administration.
In the fasted state:
- Tmax: approximately 30–120 minutes, median approximately 60 minutes
- Mean absolute oral bioavailability: approximately 41%
- Exposure increases approximately proportionally across the recommended 25–100 mg dose range. (Medicines.org.uk)
The clinical onset may occur earlier than the median Tmax in some patients, and studies demonstrated erectile responses as early as approximately 25 minutes in some subjects. (Medicines.org.uk)
Effect of food
Food reduces the rate of absorption.
A high-fat/food effect is associated with approximately:
- 60-minute delay in Tmax
- 29% reduction in Cmax
Thus, taking sildenafil after a heavy meal may delay the onset of effect compared with administration in the fasting state. (Medicines.org.uk)
Distribution
The mean volume of distribution is approximately 105 L, indicating substantial tissue distribution.
Sildenafil and its major circulating N-desmethyl metabolite are approximately 96% protein bound.
After a single 100-mg dose, the mean maximum total plasma concentration is approximately 440 ng/mL. (Medicines.org.uk)
Metabolism
Sildenafil is metabolized predominantly in the liver by:
- CYP3A4 — major pathway
- CYP2C9 — minor pathway
Its major circulating metabolite is produced by N-demethylation.
The metabolite retains pharmacological activity, with approximately 50% of the parent drug's in-vitro PDE5 potency. (Medicines.org.uk)
Elimination
The terminal half-life of sildenafil is approximately 3–5 hours.
Approximately:
- 80% of an orally administered dose is eliminated in the feces, mainly as metabolites.
- Approximately 13% is eliminated in the urine, mainly as metabolites. (Medicines.org.uk)
Renal impairment
Mild-to-moderate renal impairment generally does not require an automatic dose reduction.
However, in severe renal impairment (CrCl <30 mL/min), sildenafil clearance is reduced substantially; therefore, 25 mg should be considered as the starting dose, with cautious escalation according to efficacy and tolerability. (Medicines.org.uk)
Hepatic impairment
Sildenafil clearance is reduced in hepatic impairment.
In mild-to-moderate cirrhosis (Child-Pugh A/B), sildenafil exposure is increased; therefore, a 25-mg starting dose should be considered.
Severe hepatic impairment has not been adequately studied and is listed as a contraindication in the referenced SmPC. (Medicines.org.uk)
Indications
Primary indication
Erectile dysfunction in adult men.
Erectile dysfunction is defined as the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.
Sexual stimulation is required for sildenafil to be effective. (Medicines.org.uk)
Important distinction
Sildenafil also has a separate pharmacological indication for pulmonary arterial hypertension (PAH) in appropriately formulated and licensed sildenafil products.
However, Ezequel is presented as an erectile-dysfunction product, and the Ezequel information reviewed here should not be interpreted as authorization of Ezequel for PAH.
Administration
Route: Oral.
Standard adult dose
50 mg approximately 1 hour before anticipated sexual activity, as needed.
Depending on efficacy and tolerability:
- May be reduced to 25 mg
- May be increased to 100 mg
Maximum dose: 100 mg per dose.
Maximum frequency: Once daily. (Medicines.org.uk)
A 100-mg tablet does not mean that 100 mg should routinely be taken as the starting dose.
Practical administration
The tablet should generally be swallowed with water.
A heavy meal, particularly a high-fat meal, can delay absorption and onset. (Medicines.org.uk)
Sildenafil should be taken when sexual activity is anticipated rather than routinely several times per day.
Method of Preparation
No preparation or reconstitution is required.
Ezequel is supplied as a ready-to-use film-coated tablet for oral administration.
The tablet should not be prepared as an injection, infusion, or other dosage form.
Contraindications
1. Hypersensitivity
Contraindicated in patients with known hypersensitivity to sildenafil or any excipient. (Medicines.org.uk)
2. Nitrates and nitric-oxide donors
Concomitant use with:
- Organic nitrates
- Nitric-oxide donors
- Nitrites such as amyl nitrite
is contraindicated because sildenafil can markedly potentiate nitrate-associated hypotension. (Medicines.org.uk)
This is one of the most important contraindications.
3. Riociguat
Concomitant use with riociguat, a soluble guanylate-cyclase stimulator, is contraindicated because of the potential for additive blood-pressure lowering and symptomatic hypotension. (Medicines.org.uk)
4. Patients for whom sexual activity is inadvisable
Sildenafil should not be used in men for whom sexual activity itself is medically inadvisable, including some patients with severe cardiovascular disease such as:
- Unstable angina
- Severe cardiac failure
The key issue is not simply the presence of cardiovascular disease, but whether sexual activity is considered unsafe. (Medicines.org.uk)
5. Previous NAION-related vision loss
Sildenafil is contraindicated in patients who have experienced loss of vision in one eye because of non-arteritic anterior ischemic optic neuropathy (NAION), regardless of whether the event was associated with previous PDE5-inhibitor exposure. (Medicines.org.uk)
6. Other contraindicated groups in the referenced SmPC
The referenced current sildenafil SmPC also lists:
- Severe hepatic impairment
- Hypotension, defined as BP <90/50 mmHg
- Recent history of stroke
- Recent myocardial infarction
- Known hereditary degenerative retinal disorders such as retinitis pigmentosa
as contraindications. (Medicines.org.uk)
Warnings & Precautions
Cardiovascular assessment
Before prescribing sildenafil for ED, the patient's cardiovascular status should be considered because sexual activity itself imposes cardiovascular stress.
Particular caution is warranted in patients who may be unusually susceptible to vasodilation, including those with:
- Left-ventricular outflow obstruction
- Aortic stenosis
- Hypertrophic obstructive cardiomyopathy
- Certain forms of autonomic dysfunction
Sildenafil produces mild, transient reductions in blood pressure in most patients. (Medicines.org.uk)
Alpha-blockers
Patients receiving alpha-blockers may develop symptomatic postural hypotension.
Patients should ideally be hemodynamically stable on alpha-blocker therapy before sildenafil is initiated, and 25 mg should be considered as the starting dose. (Medicines.org.uk)
Priapism
Patients should be warned about prolonged erection.
An erection lasting more than 4 hours requires immediate medical assessment.
Untreated priapism can cause permanent penile tissue damage and permanent erectile dysfunction. (Medicines.org.uk)
Anatomical penile abnormalities
Use caution in patients with:
- Penile angulation
- Cavernosal fibrosis
- Peyronie's disease
and other conditions predisposing to priapism. (Medicines.org.uk)
Visual effects
Transient visual disturbances, including altered color perception, blurred vision and other visual symptoms, may occur.
Sudden visual loss or another sudden visual defect requires immediate discontinuation and medical assessment because NAION and other serious ocular events have been reported. (Medicines.org.uk)
Cardiovascular events
Serious cardiovascular events—including myocardial infarction, unstable angina, ventricular arrhythmia, cerebrovascular events, hypertension and hypotension—have been reported in temporal association with sildenafil use.
Because many affected patients had pre-existing cardiovascular risk factors and many events occurred around sexual activity, causality cannot always be established. (Medicines.org.uk)
Bleeding disorders
Sildenafil has demonstrated an anti-platelet effect in vitro in the presence of sodium nitroprusside. Clinical safety data are limited in patients with bleeding disorders or active peptic ulceration; therefore, careful benefit-risk assessment is appropriate. (Medicines.org.uk)
Other ED treatments
Combining sildenafil with:
- Other PDE5 inhibitors
- Other sildenafil-containing PAH products
- Other pharmacological treatments for erectile dysfunction
is not recommended, because safety and efficacy of such combinations have not been adequately established. (Medicines.org.uk)
Drug Interactions
1. Nitrates — major contraindication
Sildenafil potentiates nitrate-induced hypotension.
Therefore, do not combine sildenafil with nitrates or nitric-oxide donors. (Medicines.org.uk)
Examples include:
- Nitroglycerin
- Isosorbide mononitrate
- Isosorbide dinitrate
- Amyl nitrite
2. Riociguat — contraindicated
Riociguat and sildenafil can produce additive blood-pressure lowering.
Concomitant use is contraindicated. (Medicines.org.uk)
3. Ritonavir — avoid/not advised
Ritonavir is a very potent CYP3A4/P450 inhibitor.
Co-administration can produce approximately:
- 4-fold increase in Cmax
- 11-fold increase in AUC
and markedly prolonged exposure.
The referenced SmPC states that co-administration is not advised and that, if sildenafil is nevertheless used, the dose should not exceed 25 mg within 48 hours. (Medicines.org.uk)
4. Other CYP3A4 inhibitors
Examples include:
- Ketoconazole
- Itraconazole
- Erythromycin
- Cimetidine
- Other clinically significant CYP3A4 inhibitors
These may increase sildenafil concentrations.
When sildenafil is used with CYP3A4 inhibitors, a 25-mg starting dose should be considered. (Medicines.org.uk)
5. Azithromycin
The referenced interaction data found no evidence of a clinically relevant effect of azithromycin 500 mg daily for 3 days on sildenafil AUC, Cmax, Tmax, elimination rate constant, or half-life. (Medicines.org.uk)
This is different from erythromycin, which significantly increases sildenafil exposure.
6. Grapefruit juice
Grapefruit juice is a weak CYP3A4 intestinal inhibitor and may modestly increase sildenafil concentrations. (Medicines.org.uk)
7. Antacids
Single doses of magnesium hydroxide/aluminium hydroxide did not significantly affect sildenafil bioavailability in the referenced study. (Medicines.org.uk)
8. Alpha-blockers
Combination may produce symptomatic hypotension.
Use only after the patient is stable on alpha-blocker therapy, with 25 mg sildenafil considered initially. (Medicines.org.uk)
9. Antihypertensive medications
Sildenafil may cause an additional modest reduction in blood pressure.
Clinical data have not demonstrated a major new adverse-effect pattern when sildenafil is combined with commonly used antihypertensive classes, but individual blood-pressure response should be considered. (Medicines.org.uk)
10. Amlodipine
In a specific interaction study, sildenafil 100 mg added an approximately:
- 8 mmHg reduction in supine systolic BP
- 7 mmHg reduction in supine diastolic BP
to the blood-pressure-lowering effect observed with amlodipine. (Medicines.org.uk)
11. Sacubitril/valsartan
More recent sildenafil labeling notes that adding a single sildenafil dose to steady-state sacubitril/valsartan produced a significantly greater reduction in blood pressure than sacubitril/valsartan alone.
Caution is therefore appropriate when sildenafil is initiated in patients receiving sacubitril/valsartan. (Medicines.org.uk)
12. CYP3A4 inducers
Strong CYP3A4 inducers may reduce sildenafil exposure and efficacy.
For example, bosentan reduced sildenafil exposure substantially in pharmacokinetic studies, while strong inducers such as rifampin are expected to produce even greater reductions. (Medicines.org.uk)
13. Warfarin and aspirin
The referenced studies did not demonstrate clinically important potentiation of:
- Warfarin-related effects
- Aspirin-related bleeding time
with the studied sildenafil doses. (Medicines.org.uk)
This does not mean sildenafil should be considered completely interaction-free in patients receiving anticoagulants or antiplatelet therapy.
Side Effects
The most commonly reported adverse reactions in current sildenafil clinical data include:
- Headache
- Flushing/hot flush
- Dyspepsia
- Nasal congestion
- Dizziness
- Nausea
- Visual disturbances
- Cyanopsia/visual color distortion
- Blurred vision
The current referenced SmPC bases its safety profile on approximately 9,570 patients in 74 double-blind placebo-controlled studies and more than 10 years of post-marketing surveillance. (Medicines.org.uk)
Important adverse reactions
Neurological:
- Headache
- Dizziness
- Somnolence
- Hypoaesthesia
- Rare cerebrovascular events
- Seizures/seizure recurrence
Ophthalmic:
- Visual color distortion
- Visual disturbance
- Blurred vision
- Photophobia
- Photopsia
- Eye pain
- Ocular hyperemia
- Rare NAION
- Retinal vascular occlusion
- Retinal hemorrhage
- Visual-field defects
- Reduced visual acuity
- Diplopia
Cardiovascular:
- Flushing
- Tachycardia
- Palpitations
- Hypotension
- Hypertension
- Rare myocardial infarction
- Ventricular arrhythmia
- Atrial fibrillation
- Unstable angina
- Sudden cardiac death
Gastrointestinal:
- Dyspepsia
- Nausea
- Vomiting
- Upper abdominal pain
- Gastroesophageal reflux
- Dry mouth
Respiratory:
- Nasal congestion
- Epistaxis
- Sinus congestion
Musculoskeletal:
- Myalgia
- Pain in extremity
Genitourinary:
- Haematuria
- Haematospermia
- Penile hemorrhage
- Priapism
- Increased/prolonged erection
Dermatological/severe hypersensitivity reactions:
- Rash
- Rare serious cutaneous reactions including Stevens–Johnson syndrome and toxic epidermal necrolysis
Use in Special Populations
Elderly
No routine dose adjustment is required solely because of age.
However, pharmacokinetic exposure is higher in older adults: sildenafil concentrations may be approximately 90% higher than in younger adults, with approximately a 40% increase in free sildenafil concentration. Clinical judgment should therefore guide dosing. (Medicines.org.uk)
Renal impairment
Mild-to-moderate impairment
Usually no initial adjustment is required.
Severe impairment
For CrCl <30 mL/min, consider 25 mg initially, with cautious escalation if required. (Medicines.org.uk)
Hepatic impairment
Because hepatic clearance is reduced, 25 mg should be considered initially in hepatic impairment.
Severe hepatic impairment is contraindicated in the referenced SmPC. (Medicines.org.uk)
Pregnancy
Ezequel is not indicated for women.
There are no adequate, well-controlled studies establishing an indication for sildenafil in pregnancy in the ED formulation. Animal reproductive studies did not demonstrate relevant adverse effects at studied exposures. (Medicines.org.uk)
Breastfeeding
Ezequel is not indicated for women, and therefore it has no established therapeutic role during breastfeeding.
Children and adolescents
Sildenafil for erectile dysfunction is not indicated below 18 years of age. (Medicines.org.uk)
This should not be confused with other sildenafil formulations used under specialist supervision for pediatric pulmonary arterial hypertension.
Patients with cardiovascular disease
The presence of cardiovascular disease does not automatically mean sildenafil is prohibited.
The critical questions are:
- Is the patient medically stable?
- Is sexual activity itself considered safe?
- Is the patient taking nitrates?
- Is there significant hypotension?
- Is there unstable angina or severe heart failure?
- Are there other major contraindications?
A stable patient with cardiovascular disease may potentially receive sildenafil following appropriate clinical assessment, whereas nitrate use and certain unstable cardiovascular conditions are major contraindications. (Medicines.org.uk)
Patients taking alpha-blockers
Use cautiously and consider starting with 25 mg after the patient is stable on alpha-blocker therapy. (Medicines.org.uk)
Storage Conditions
For sildenafil film-coated tablets, the referenced current SmPC states:
No special storage conditions are required. (Medicines.org.uk)
For the actual Ezequel package, the manufacturer's current package labeling should take precedence, particularly regarding temperature, blister integrity and shelf life.
Keep medicines out of the reach and sight of children.
Additional Sections
Pharmacodynamic clinical observations
Sildenafil produces a generally mild and transient reduction in blood pressure.
After 100 mg in healthy volunteers, the mean maximum reduction in supine:
- Systolic BP: approximately 8.4 mmHg
- Diastolic BP: approximately 5.5 mmHg
In a study involving 14 patients with severe coronary artery disease, sildenafil reduced resting blood pressure but did not impair cardiac output or blood flow through stenosed coronary arteries. However, this does not make sildenafil appropriate for patients with unstable cardiovascular disease or for patients taking nitrates. (Medicines.org.uk)
Visual function and PDE6
Sildenafil has substantially greater selectivity for PDE5 than PDE6, but PDE6 inhibition can occur at higher concentrations.
Transient blue/green color discrimination changes have been observed approximately one hour after a 100-mg dose, with no effect evident after approximately two hours in the cited study.
Importantly, sildenafil had no demonstrated effect on visual acuity or contrast sensitivity in the referenced pharmacodynamic assessment. (Medicines.org.uk)
A small placebo-controlled study involving only nine patients with early age-related macular degeneration found no significant changes in visual tests including visual acuity, Amsler grid, simulated-traffic-light color discrimination, Humphrey perimetry and photostress after a single 100-mg dose. (Medicines.org.uk)
Interpretation: this small study is reassuring regarding acute visual effects in that very small population, but it should not be interpreted as proof that sildenafil cannot cause serious ocular adverse events. Current labeling continues to recognize NAION, retinal vascular occlusion and other visual adverse events. (Medicines.org.uk)
Effect on fertility
A single 100-mg oral dose did not produce an effect on sperm motility or morphology in healthy volunteers. (Medicines.org.uk)
This does not establish that sildenafil treats male infertility; it simply indicates that the studied single dose did not adversely affect those sperm parameters.
Driving and operating machinery
Sildenafil can have a minor influence on the ability to drive or operate machinery.
Dizziness and visual disturbances have been reported. Patients should determine how they personally respond to sildenafil before driving or operating machinery. (Medicines.org.uk)
Overdose
Single doses up to 800 mg have been studied.
Overdose generally produced the same types of adverse reactions seen at therapeutic doses, but with greater frequency and/or severity.
At 200 mg, efficacy did not increase, whereas adverse reactions increased.
Management is primarily supportive and symptomatic.
Hemodialysis is not expected to meaningfully accelerate sildenafil elimination because sildenafil is highly protein-bound and predominantly eliminated as metabolites rather than unchanged drug in the urine. (Medicines.org.uk)
Important clinical point about the 100-mg strength
The availability of Ezequel 100 mg does not mean that 100 mg is the routine starting dose.
For most adult men with ED:
50 mg → assess efficacy/tolerability → 25 mg or 100 mg if appropriate.
The maximum recommended frequency remains once daily. (Medicines.org.uk)
Frequently Asked Questions (FAQ)
1. Is Ezequel the same active drug as Viagra?
Yes. Ezequel contains sildenafil, the same active pharmaceutical ingredient used in Viagra. Different brands may differ in manufacturer, formulation/excipients and packaging, but the active ingredient is sildenafil.
2. Does Ezequel increase sexual desire?
No. Sildenafil facilitates the physiological erectile response after sexual stimulation. It is not a testosterone replacement and is not primarily a libido-enhancing drug.
3. How long before intercourse should Ezequel be taken?
Usually approximately 1 hour before sexual activity. Some men may respond earlier, but onset can be delayed by food, particularly a heavy meal. (Medicines.org.uk)
4. Can 100 mg be taken as the first dose?
It can be used when clinically appropriate, but 50 mg is the usual recommended starting dose. Dose selection should be individualized according to efficacy, tolerability, comorbidities and interacting medicines. (Medicines.org.uk)
5. Can it be taken more than once a day?
The maximum recommended dosing frequency is once daily. (Medicines.org.uk)
6. Can Ezequel be taken with nitrates?
No. This is contraindicated.
This includes nitrate medications such as nitroglycerin and isosorbide preparations and nitric-oxide donors such as amyl nitrite. (Medicines.org.uk)
7. What about a patient taking blood-pressure medication?
Sildenafil can be used in some patients receiving antihypertensive treatment, but it may produce additional blood-pressure lowering. Individual assessment is required, particularly when several vasodilating agents are used. (Medicines.org.uk)
8. What if the patient is taking an alpha-blocker?
Use cautiously. The patient should be stable on alpha-blocker treatment, and 25 mg sildenafil should be considered initially. (Medicines.org.uk)
9. Can sildenafil cause blindness?
Serious ocular events are rare, but NAION and other serious visual events have been reported. Any sudden visual loss or sudden visual defect requires immediate discontinuation and medical assessment. (Medicines.org.uk)
10. What should be done if an erection lasts more than 4 hours?
This is a medical emergency requiring immediate medical attention because prolonged ischemic priapism can permanently damage erectile tissue. (Medicines.org.uk)
11. Can sildenafil be used in renal disease?
Yes in many patients, but severe renal impairment warrants a lower starting dose, generally 25 mg. (Medicines.org.uk)
12. Can sildenafil be used in liver disease?
Exposure increases with hepatic impairment. A 25-mg starting dose should be considered, while severe hepatic impairment is contraindicated in the referenced SmPC. (Medicines.org.uk)
13. Does sildenafil affect sperm?
A single 100-mg dose did not adversely affect sperm motility or morphology in healthy volunteers. (Medicines.org.uk)
14. Does sildenafil work without sexual stimulation?
No. Sexual stimulation is necessary to activate the NO/cGMP pathway on which sildenafil acts. (Medicines.org.uk)
15. Is Ezequel a testosterone or hormonal medication?
No. Sildenafil is a PDE5 inhibitor and has no testosterone-replacement action.
References
- Current Sildenafil 100 mg film-coated tablets SmPC, electronic Medicines Compendium (emc), revised 11 June 2026. This provides current dosing, contraindications, interactions, pharmacokinetics, adverse effects, pharmacodynamics and storage information. (Medicines.org.uk)
- Current Sildenafil 25 mg film-coated tablets SmPC, emc, updated June 2026, supporting current dosing in renal impairment and special populations. (Medicines.org.uk)
- VIAGRA 50 mg SmPC, revised February 2026, supporting current sildenafil ED dosing and special-population information. (Medicines.org.uk)
- Egyptian-market Ezequel listings, documenting the current listed 50-mg/4-tablet and 100-mg/9-tablet presentations and COPAD Pharma as manufacturer. (Egypt Dwa)
- COPAD Pharma official website, confirming COPAD as an Egyptian pharmaceutical manufacturer and its current manufacturing operations. (COPAD Pharma)
- Egyptian Drug Authority — Approved Public Assessment Reports, demonstrating the Authority's distinction between applicant and Marketing Authorization Holder in Egyptian pharmaceutical regulation. (Egyptian Drug Authority)
Final assessment of the older Ezequel information
The older document you supplied remains substantially consistent with the pharmacology of sildenafil, but it should not be reproduced unchanged as a current 2026 drug monograph.
The most important updates/corrections incorporated above are:
- Addition of riociguat as a contraindicated interaction. (Medicines.org.uk)
- Addition of the more recent interaction information concerning bosentan and sacubitril/valsartan. (Medicines.org.uk)
- Updated adverse-event dataset: approximately 9,570 patients/74 placebo-controlled studies and >10 years of post-marketing surveillance in the referenced current SmPC. (Medicines.org.uk)
- Updated adverse-effect terminology and expanded ophthalmic adverse-event information. (Medicines.org.uk)
- Updated pharmacokinetic details, including the 3–5-hour half-life, 41% bioavailability, food effect, renal/hepatic impairment and elderly pharmacokinetics. (Medicines.org.uk)
- Preservation of the n=9 early age-related macular degeneration visual-function study, because it is genuinely part of the sildenafil pharmacodynamic evidence and is scientifically coherent in that location. (Medicines.org.uk)
- Separation of Ezequel-specific Egyptian-market information from general current sildenafil clinical information, avoiding the false impression that every current sildenafil SmPC detail has been independently verified as the exact current Ezequel leaflet.
- Current Egyptian listings identify Ezequel 50 mg ×4 and Ezequel 100 mg ×9, manufactured by COPAD Pharma. (Egypt Dwa)