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Results of Other Medicines on VIAGRA Sildenafil metabolism is principally mediated by CYP3A4 (major route) and CYP2C9 (insignificant route). Consequently, inhibitors of those isoenzymes may possibly cut down sildenafil clearance and inducers of such isoenzymes may possibly raise sildenafil clearance.When sildenafil improves some markers of ailment