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Effects of Other Drugs on VIAGRA Sildenafil metabolism is principally mediated by CYP3A4 (big route) and CYP2C9 (slight route). As a result, inhibitors of such isoenzymes may well lower sildenafil clearance and inducers of those isoenzymes might increase sildenafil clearance.This doc does not incorporate all possible Unintended effects and Other in