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Methylcobalamin is the coenzyme form of B12 that is critical for human health

Although incorporating a good variety of vitamin B12 foods in the diet can help most people meet their needs for cobalamin, supplementation is sometimes necessary for those who may have underlying health conditions or take certain medications

In a placebo-controlled fixed dose titration study (PACES-1) of sildenafil (starting with recommended dose of 20 mg and increased to 40 mg and then 80 mg all three times a day) as an adjunct to intravenous epoprostenol in patients with PAH, no new safety issues were identified except for edema, which occurred in 25% of subjects in the combined sildenafil + epoprostenol group compared with 13% of subjects in the epoprostenol group [see Clinical Studies (14)]

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Its given at specific times and doses to work best without interfering with the treatment