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The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. Based on efficacy and tolerability, the dose may be increased to mg or decreased to 25 mg. The maximum recommended dose is mg. The maximum recommended dosing frequency is once per day. Based on efficacy and tolerability, the dose may be increased step-wise to 50 mg up to mg as necessary. Since sildenafil clearance is reduced in patients with hepatic impairment e. With the exception of ritonavir for which co-administration with sildenafil is not advised see Section 4.
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