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Consider a starting dose of 25 mg in patients > 65 years, patients with hepatic impairment (e.g., cirrhosis), and patients with severe renal impairment (creatinine clearance <30 mL/minute) because administration of VIAGRA in these patients resulted in higher plasma levels of sildenafil [see Use in Specific Populations (8.5, 8.6, 8.7) and Clinical Pharmacology (12.3)].

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45. Pomeranz HD, Smith KH, Hart WM Jr, Egan RA "Sildenafil-associated nonarteritic anterior ischemic optic neuropathy." Ophthalmology 109 (2002): 584-7 cialis generic india

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