Label: SILDENAFIL CITRATE- sildenafil tablet, film coated

Other risk factors for NAION, such as the presence of "crowded" optic disc, may have contributed to the occurrence of NAION in these studies.

• Using sildenafil with certain medicines can cause serious interactions.
• Blood pressure medications and alpha-blockers are common concerns.
• Always inform your doctor of all medications you're taking.

Neither the rare post-marketing reports, nor the association of PDE5 inhibitor use and NAION in the observational studies, substantiate a causal relationship between PDE5 inhibitor use and NAION [see Adverse Reactions (6.2) ].

In case of emergency/overdose

Prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently since market approval of VIAGRA. VIAGRA should be used with caution in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie's disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anemia, multiple myeloma, or leukemia). However, there are no controlled clinical data on the safety or efficacy of VIAGRA in patients with sickle cell or related anemias. Physicians should advise patients to stop use of all phosphodiesterase type 5 (PDE5) inhibitors, including VIAGRA, and seek medical attention in the event of a sudden loss of vision in one or both eyes. Based on published literature, the annual incidence of NAION is 2.5–11.8 cases per 100,000 in males aged ≥ 50. Therefore, PDE5 inhibitors, including VIAGRA, should be used with caution in these patients and only when the anticipated benefits outweigh the risks.

• Sildenafil is generally safe when used as prescribed.
• Always follow your healthcare provider’s dosage instructions.
• Do not double doses if a dose is missed.

Individuals with "crowded" optic disc are also considered at greater risk for NAION compared to the general population,

• Sildenafil is available both by prescription and some online sources.
• Verify authenticity to avoid fake or substandard drugs.
• Consult a healthcare professional before purchasing.

however, evidence is insufficient to support screening of prospective users of PDE5 inhibitors, including VIAGRA, for this uncommon condition.

Property	Description	Value	Notes
Molecular Formula	C22H30N6O4S
Molecular Weight	474.58 g/mol
Melting Point	189-192°C
Solubility in Water	Slightly soluble		at 25°C
pH Range	3.8 - 4.0		in aqueous solution

There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases); if prescribed, this should be done with caution.

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Viagra Generic	25mg	30 + 4 Pills	47.97€ 45.69€	Buy
Kamagra Polo	100mg	12 Pills	60.21€ 57.34€	Buy
Viagra Generic	25mg	120 + 6 Pills	125.56€ 119.58€	Buy
Kamagra Soft Tabs	100mg	84 + 4 Pills	233.05€ 221.95€	Buy
Viagra Generic	200mg	270 + 10 Pills	379.76€ 361.68€	Buy
Kamagra	100mg	180 + 6 Pills	436.79€ 415.99€	Buy
Viagra Generic	50mg	360 + 10 Pills	225.33€ 214.60€	Buy
Viagra Generic	200mg	120 + 8 Pills	204.80€ 195.05€	Buy
Viagra Generic	200mg	90 + 6 Pills	170.79€ 162.66€	Buy
Viagra Generic	150mg	10 Pills	36.73€ 34.98€	Buy
Viagra Generic	100mg	90 + 6 Pills	129.02€ 122.88€	Buy
Kamagra Oral Jelly	100mg	220 + 18 Sachets	662.24€ 630.70€	Buy
Viagra Generic	25mg	180 + 6 Pills	154.93€ 147.55€	Buy
Viagra Generic	150mg	360 + 10 Pills	423.48€ 403.31€	Buy

Physicians should advise patients to stop taking PDE5 inhibitors, including VIAGRA, and seek prompt medical attention in the event of sudden decrease or loss of hearing.

Indication	Description	Approved Dose	Additional Notes
Erectile Dysfunction (ED)	Improves erectile response in men	50 mg as needed	Taken 30 min to 1 hour before activity
Pulmonary Arterial Hypertension	Vasodilation of pulmonary vasculature	20 mg TID	Used with other PAH therapies
Raynaud's Phenomenon	Relief from vasospasms	Off-label	Experimental use

These events, which may be accompanied by tinnitus and dizziness, have been reported in temporal association to the intake of PDE5 inhibitors, including VIAGRA.

5.2 Worsening Pulmonary Vascular Occlusive Disease

And then on the "appointed day" take 5? Go to the Prostate Cancer Support Group. It seems to be common to do this to try and resolve ED issues. I'm not a medical professional, but here's a document on UCSF that someone on this blog mentioned in another thread. It has a section on Penile Rehabilitation that includes some information related to your question: Best wishes.

Administration Notes

I would think your doctor would’ve checked up before prescribing it for you though, but you never know. You should at least mention to your doctor, the side effects you have felt from taking the drug. See what he has to say about it. Yes, and I have spoken to her. The sildenafil is for "lung blood pressure", whatever that means.

Does Viagra work the first time you use it?

It has not impacted my pulse rate or my BP. I think I'm just sensitive to it. It can cause problems if you normally have low blood pressure. VIAGRA is indicated for the treatment of erectile dysfunction. VIAGRA is a phosphodiesterase-5 (PDE5) inhibitor indicated for the treatment of erectile dysfunction (ED) (1) For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6.1, 6.2) ].

8.7 Patients with Renal Impairment

Hypersensitivity reactions have been reported, including rash and urticaria [see Adverse Reactions (6.1) ]. Do not use VIAGRA in patients who are using a GC stimulator, such as riociguat. PDE5 inhibitors, including VIAGRA, may potentiate the hypotensive effects of GC stimulators. Patients should not use VIAGRA if sexual activity is inadvisable due to cardiovascular status (5.1) Patients should seek emergency treatment if an erection lasts >4 hours. Use VIAGRA with caution in patients predisposed to priapism (5.2) Patients should stop VIAGRA and seek medical care if a sudden loss of vision occurs in one or both eyes, which could be a sign of non arteritic anterior ischemic optic neuropathy (NAION).

Sildenafil Oral Film for ED

VIAGRA should be used with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION. Patients with a "crowded" optic disc may also be at an increased risk of NAION. Patients should stop VIAGRA and seek prompt medical attention in the event of sudden decrease or loss of hearing (5.4) Caution is advised when VIAGRA is co-administered with alpha-blockers or anti-hypertensives. Concomitant sildenafil 50g use may lead to hypotension (5.5) Decreased blood pressure, syncope, and prolonged erection may occur at higher sildenafil exposures. Decrease in VIAGRA dosage is recommended (2.4, 5.6) There is a potential for cardiac risk of sexual activity in patients with preexisting cardiovascular disease.

Storage Requirements

Therefore, treatments for erectile dysfunction, including VIAGRA, should not be generally used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status. VIAGRA has systemic vasodilatory properties that resulted in transient decreases in supine blood pressure in healthy volunteers (mean maximum decrease of 8.4/5.5 mmHg), [see Clinical Pharmacology (12.2) ]. While this normally would be expected to be of little consequence in most patients, prior to prescribing VIAGRA, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects, especially in combination with sexual activity. Use with caution in patients with the following underlying conditions which can be particularly sensitive to the actions of vasodilators including VIAGRA – those with left ventricular outflow obstruction (e.g., aortic stenosis, idiopathic hypertrophic subaortic stenosis) and those with severely impaired autonomic control of blood pressure. There are no controlled clinical data on the safety or efficacy of VIAGRA in the following groups; if prescribed, this should be done with caution. PDE5 inhibitors, including VIAGRA, and alpha-adrenergic blocking agents are both vasodilators with blood pressure lowering effects.

Viagra (Sildenafil) – Proven Support for Erectile Dysfunction

However, VIAGRA may be taken anywhere from 30 minutes to 4 hours before sexual activity (2.1) Based on effectiveness and toleration, may increase to a maximum of 100 mg or decrease to 25 mg (2.1) Maximum recommended dosing frequency is once per day (2.1) For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, VIAGRA may be taken anywhere from 30 minutes to 4 hours before sexual activity. VIAGRA may be taken with or without food. VIAGRA was shown to potentiate the hypotensive effects of nitrates and its administration in patients who use nitric oxide donors such as organic nitrates or organic nitrites in any form is therefore contraindicated [see Contraindications (4.1), Drug Interactions (7.1), and Clinical Pharmacology (12.2) ]. When VIAGRA is co-administered with an alpha-blocker, patients should be stable on alpha-blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at 25 mg [see Warnings and Precautions (5.5), Drug Interactions (7.2), and Clinical Pharmacology (12.2) ].

Drug forms and administration

The recommended dose for ritonavir-treated patients is 25 mg prior to sexual activity and the recommended maximum dose is 25 mg within a 48 hour period because concomitant administration increased the blood levels of sildenafil by 11-fold [see Warnings and Precautions (5.6), Drug Interactions (7.4), and Clinical Pharmacology (12.3) ]. Clinical data have shown that co-administration with saquinavir or erythromycin increased plasma levels of sildenafil by about 3 fold [see Drug Interactions (7.4) and Clinical Pharmacology (12.3) ]. Consider a starting dose of 25 mg in patients > 65 years, patients with hepatic impairment (e.g., cirrhosis), and patients with severe renal impairment (creatinine clearance <30 mL/minute) because administration of VIAGRA in these patients resulted in higher plasma levels of sildenafil [see Use in Specific Populations (8.5, 8.6, 8.7) and Clinical Pharmacology (12.3) ]. VIAGRA is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to 25 mg, 50 mg, or 100 mg of sildenafil. Tablets are sildenafil 20 mg prescription debossed with PFIZER on one side and VGR25, VGR50 or VGR100 on the other to indicate the dosage strengths.

Lactation Precautions

Tablets: 25 mg, 50 mg, 100 mg (3) Administration of VIAGRA to patients using nitric oxide donors, such as organic nitrates or organic nitrites in any form. VIAGRA was shown to potentiate the hypotensive effect of nitrates (4.1, 7.1, 12.2) Known hypersensitivity to sildenafil or any component of tablet (4.2) Administration with guanylate cyclase (GC) stimulators, such as riociguat (4.3) Consistent with its known effects on the nitric oxide/cGMP pathway [see Clinical Pharmacology (12.1, 12.2) ], VIAGRA was shown to potentiate the hypotensive effects of nitrates, and its administration to patients who are using nitric oxide donors such as organic nitrates or organic nitrites in any form either regularly and/or intermittently is therefore contraindicated. After patients have taken VIAGRA, it is unknown when nitrates, if necessary, can be safely administered. Although plasma levels of sildenafil at 24 hours post dose are much lower than at peak concentration, it is unknown whether nitrates can be safely co-administered at this time point [see Dosage and Administration (2.3), Drug Interactions (7.1), and Clinical Pharmacology (12.2) ]. VIAGRA is contraindicated in patients with a known hypersensitivity to sildenafil, as contained in VIAGRA and REVATIO, or any component of the tablet. In some patients, concomitant use of these two drug classes can lower blood pressure significantly [see Drug Interactions (7.2) and Clinical Pharmacology (12.2) ] leading to symptomatic hypotension (e.g., dizziness, lightheadedness, fainting).