OBJECTIVES: Maximum sildenafil dose dispensed by the Brazilian public healthcare system for pulmonary arterial hypertension (PAH) treatment is 60 mg daily. According to clinical practice, higher doses have been prescribed by most physicians. This systematic review aims to evaluate sildenafil efficacy and safety in doses above 60mg daily in PAH treatment. METHODS: A systematic review was conducted in May 2011 through Cochrane Collaboration, Medline, EMBASE, and Lilacs databases. Inclusion criteria’s considered were meta-analysis, systematic reviews, randomized clinical trials, and observational studies using sildenafil above 60mg for any etiology PAH on WHO/NYHA functional classes II-IV patients over 12 years old. The exclusion criteria’s were sample size below 10. Only sildenafil as monotherapy was considered. Outcome measures were distance walked in six minutes (6MWD), functional classification, and satisfactory adverse events profile, defined as similar to doses up to 60mg daily. Two independent reviewers selected articles qualitatively rated according to Oxford Center for Evidence-Based Medicine classification. RESULTS: Of 337 titles found, 45 articles evaluated and 16 selected (1 meta-analysis, 5 randomized trials and 10 observational studies). All but one demonstrated the benefit of sildenafil higher doses in 6MWD with satisfactory safety profile . In a 3-year follow up (SUPER 2), 46% of patients increased 6MWD and 60% maintained or improved their functional classification with 240mg daily compared to lower doses baseline. Two studies evaluated optimal sildenafil dose. Chocklingman (2005) found that 100mg daily improved 6MWD (234±44 vs. 377±128 meters, p=0.001) and WHO/NYHA class (3.8±0.4 vs. 2.4±0.5, p=0.002), from baseline.  Garg (2007) tested from 37.5mg to 300mg daily and 6MWD increased from 247.4±74.4 to 366.3±93.8 meters (p=0.0001). Optimal dose appeared to be 150mg daily, with some additional benefit by increasing up to 225mg. CONCLUSIONS: Literature review supports that sildenafil in doses above 60mg daily is safe and may provide additional benefit to patients with PAH functional classes II-IV.