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Effects of Other Prescription drugs on VIAGRA Sildenafil metabolism is principally mediated by CYP3A4 (big route) and CYP2C9 (minimal route). As a result, inhibitors of those isoenzymes may cut down sildenafil clearance and inducers of those isoenzymes may possibly increase sildenafil clearance.Sildenafil performs by blocking an enzyme in your body