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Effects of Other Drugs on VIAGRA Sildenafil metabolism is principally mediated by CYP3A4 (big route) and CYP2C9 (small route). Hence, inhibitors of those isoenzymes may lessen sildenafil clearance and inducers of such isoenzymes could increase sildenafil clearance.The AUC in the active metabolite, N-desmethyl sildenafil, was improved 62% by loop an