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Effects of Other Prescription drugs on VIAGRA Sildenafil metabolism is principally mediated by CYP3A4 (big route) and CYP2C9 (slight route). Consequently, inhibitors of such isoenzymes may lower sildenafil clearance and inducers of those isoenzymes might increase sildenafil clearance.The AUC on the active metabolite, N-desmethyl sildenafil, was inc