Viagra Leaflet English

By preventing the action of phosphodiesterase, the blood vessels are kept dilated for longer, improving blood flow to the penis. This allows more blood to enter the penis, which ultimately results in the penis becoming rigid and erect in response to sexual stimulation.

What you should know before using Viagra There are a few things that you should take into account before using Viagra. Viagra may interact with other medicines. Do not take Viagra with any form of nitrate medication as this combination can be dangerous.

People who have a heart condition or are allergic to any ingredients in Viagra shouldn? Read more here about when not to use Viagra. How to use Viagra Viagra is available in various strengths. The usual starting dose is one mg tablet. However, the doctor may also prescribe a different strength such as 25 mg or mg. The tablet should be swallowed whole with some liquid approximately 30 minutes to an hour before sexual activity, so that it has enough time to work.

Viagra may take longer to take effect if taken with food. To reduce the risk of serious side effects, you should not take more than one tablet a day. Do not use Viagra more than three times a week. Always follow the prescription exactly.

Consult a doctor if your Viagra does not work properly or is too strong. For more information on Viagra, please consult the official Viagra package leaflet. Possible side effects Like all other medicines Viagra may cause side effects, although not everyone gets them. Possible side effects include: headache; facial flushing; gastrointestinal symptoms nausea, diarrhoea, stomach ache ; dizziness; effects on vision blurred vision, colour tinge to vision, light sensitivity ; See the package leaflet for a complete list of possible side effects.

How to store this medicine Keep Viagra out of reach of children. Store in the original package. In cases where a physician recommends pharmacological treatment, depending on the effectiveness and tolerability of the medicinal product, they may gradually increase the dose to 50 mg and then to mg maximum if necessary.

Patients with hepatic impairment In patients with liver insufficiency e. In cases where a physician recommends pharmacological treatment, depending on the effectiveness and tolerability of the medicinal product, they may gradually increase the dose to 50 mg, mg maximum if necessary.

Use for patients whilst taking other medicinal products. In cases where a physician recommends pharmacological treatment, the starting dose of 25 mg should be considered in patients who are receiving treatment with CYP3A4 inhibitors at the same time see section 4.

Ritonavir is an exception, which, is not recommended for use with sildenafil see section 4. In order to reduce the risk of orthostatic hypotension in patients who take alpha-adrenergic antagonists, their condition should be stabilised before sildenafil treatment is started.

In cases where a physician recommends pharmacological treatment, treatment should consist of a 25 mg dose of sildenafil see sections 4. Oral use. Hypersensitivity to the active ingredient or to any other ingredients microcrystalline cellulose, hydroxypropyl cellulose, croscarmellose sodium, magnesium stearate, colloidal anhydrous silica, hypromellose 6cp, lactose monohydrate, titanium dioxide E , macrogol , sodium citrate dihydrate. Due to the influence of sildenafil on metabolic processes in which nitric oxide and cyclic guanosine monophosphate cGMP take part see section 5.

Therefore, concomitant use of sildenafil and medicines which release nitric oxide such as amyl nitrite or nitrates in any form is contraindicated. The concomitant use of PDE5 inhibitors, including sildenafil, and guanylate cyclase stimulators such as riociguat is contraindicated since it may lead to symptomatic arterial hypotension. Medicinal products intended for the treatment of erectile dysfunction, including sildenafil, should not be used in men for whom sexual activity is not recommended e.

Sildenafil at recommended doses has no effect in the absence of sexual stimulation. Studies in vitro have shown that sildenafil is selective for PDE5. PDE3 is involved in control of cardiac contractility. Sildenafil is only about fold as potent for PDE5 compared to PDE6, an enzyme found in the retina which is involved in the phototransduction pathway of the retina. This lower selectivity is thought to be the basis for abnormalities related to color vision [ see Clinical Pharmacology In addition to human corpus cavernosum smooth muscle, PDE5 is also found in other tissues including platelets, vascular and visceral smooth muscle, and skeletal muscle, brain, heart, liver, kidney, lung, pancreas, prostate, bladder, testis, and seminal vesicle.

The inhibition of PDE5 in some of these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of NO observed in vitro , an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo. The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours.

The decrease in sitting blood pressure was most notable approximately 1—2 hours after dosing, and was not different than placebo at 8 hours. Similar effects on blood pressure were noted with 25 mg, 50 mg and mg of VIAGRA, therefore the effects are not related to dose or plasma levels within this dosage range. Larger effects were recorded among patients receiving concomitant nitrates [ see Contraindications 4. 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 Contraindications 4.

In the first study, a single oral dose of VIAGRA mg or matching placebo was administered in a 2-period crossover design to 4 generally healthy males with benign prostatic hyperplasia BPH. Following at least 14 consecutive daily doses of doxazosin, VIAGRA mg or matching placebo was administered simultaneously with doxazosin. Following a review of the data from these first 4 subjects details provided below , the VIAGRA dose was reduced to 25 mg. Thereafter, 17 subjects were treated with VIAGRA 25 mg or matching placebo in combination with doxazosin 4 mg 15 subjects or doxazosin 8 mg 2 subjects.

The mean subject age was The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 25 mg VIAGRA or matching placebo are shown in Figure 2. Blood pressure was measured immediately pre-dose and at 15, 30, 45 minutes, and 1, 1.

No severe adverse events potentially related to blood pressure effects were reported in this group. Of the four subjects who received VIAGRA mg in the first part of this study, a severe adverse event related to blood pressure effect was reported in one patient postural hypotension that began 35 minutes after dosing with VIAGRA with symptoms lasting for 8 hours , and mild adverse events potentially related to blood pressure effects were reported in two others dizziness, headache and fatigue at 1 hour after dosing; and dizziness, lightheadedness and nausea at 4 hours after dosing.

There were no reports of syncope among these patients. For these four subjects, the placebo-subtracted mean maximum decreases from baseline in supine and standing systolic blood pressures were Both of these subjects were protocol violators, one due to a low baseline standing SBP, and the other due to baseline orthostatic hypotension. Following at least 14 consecutive days of doxazosin, VIAGRA 50 mg or matching placebo was administered simultaneously with doxazosin 4 mg 17 subjects or with doxazosin 8 mg 3 subjects.

The mean subject age in this study was One patient discontinued the study prematurely due to an adverse event of hypotension following dosing with VIAGRA 50 mg. This patient had been taking minoxidil, a potent vasodilator, during the study. The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 50 mg VIAGRA or matching placebo are shown in Figure 3.

Blood pressure was measured after administration of VIAGRA at the same times as those specified for the first doxazosin study. In these two subjects, hypotension was reported as a moderately severe adverse event, beginning at approximately 1 hour after administration of VIAGRA 50 mg and resolving after approximately 7.

There were no severe adverse events potentially related to blood pressure and no episodes of syncope reported in this study. In dose period 1, subjects were administered open-label doxazosin and a single dose of VIAGRA 50 mg simultaneously, after at least 14 consecutive days of doxazosin. If a subject did not successfully complete this first dosing period, he was discontinued from the study. Subjects who had successfully completed the previous doxazosin interaction study using VIAGRA 50 mg , including no significant hemodynamic adverse events, were allowed to skip dose period 1.

Treatment with doxazosin continued for at least 7 days after dose period 1. Thereafter, VIAGRA mg or matching placebo was administered simultaneously with doxazosin 4 mg 14 subjects or doxazosin 8 mg 6 subjects in standard crossover fashion. Twenty-five subjects were screened. Two were discontinued after study period 1: one failed to meet pre-dose screening qualifications and the other experienced symptomatic hypotension as a moderately severe adverse event 30 minutes after dosing with open-label VIAGRA 50 mg.

Of the twenty subjects who were ultimately assigned to treatment, a total of 13 subjects successfully completed dose period 1, and seven had successfully completed the previous doxazosin study using VIAGRA 50 mg. The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with mg VIAGRA or matching placebo are shown in Figure 4.

Blood pressure was measured after administration of VIAGRA at the same times as those specified for the previous doxazosin studies. While there were no severe adverse events potentially related to blood pressure reported in this study, one subject reported moderate vasodilatation after both VIAGRA 50 mg and mg.

There were no episodes of syncope reported in this study. The maximum observed decrease in systolic blood pressure was The maximum observed decrease in diastolic blood pressure was There were no reports of postural dizziness or orthostatic hypotension. The maximum recommended dose of mg sildenafil was not evaluated in this study [ see Drug Interactions 7.

In one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent Swan-Ganz catheterization. A total dose of 40 mg sildenafil was administered by four intravenous infusions. Even though this total dosage produced plasma sildenafil concentrations which were approximately 2 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients.

In a double-blind study, patients with erectile dysfunction and chronic stable angina limited by exercise, not receiving chronic oral nitrates, were randomized to a single dose of placebo or VIAGRA mg 1 hour prior to exercise testing. The primary endpoint was time to limiting angina in the evaluable cohort. The mean times adjusted for baseline to onset of limiting angina were These results demonstrated that the effect of VIAGRA on the primary endpoint was statistically non-inferior to placebo.

Effects of VIAGRA on Vision: At single oral doses of mg and mg, transient dose-related impairment of color discrimination was detected using the Farnsworth-Munsell hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. An evaluation of visual function at doses up to twice the maximum recommended dose revealed no effects of VIAGRA on visual acuity, intraocular pressure, or pupillometry.

The pharmacokinetics of sildenafil are dose-proportional over the recommended dose range. It is eliminated predominantly by hepatic metabolism mainly CYP3A4 and is converted to an active metabolite with properties similar to the parent, sildenafil. Both sildenafil and the metabolite have terminal half lives of about 4 hours. Mean sildenafil plasma concentrations measured after the administration of a single oral dose of mg to healthy male volunteers is depicted below:.

Maximum observed plasma concentrations are reached within 30 to minutes median 60 minutes of oral dosing in the fasted state. The mean steady state volume of distribution Vss for sildenafil is L, indicating distribution into the tissues.

Protein binding is independent of total drug concentrations. Based upon measurements of sildenafil in semen of healthy volunteers 90 minutes after dosing, less than 0. The major circulating metabolite results from N-desmethylation of sildenafil, and is itself further metabolized.

Similar values for pharmacokinetic parameters were seen in normal volunteers and in the patient population, using a population pharmacokinetic approach. The pharmacokinetics of sildenafil in patients with severely impaired hepatic function Child-Pugh Class C have not been studied [ see Dosage and Administration 2.

A starting oral dose of 25 mg should be considered in those patients [ see Dosage and Administration 2. Therefore, inhibitors of these isoenzymes may reduce sildenafil clearance and inducers of these isoenzymes may increase sildenafil clearance. The concomitant use of erythromycin or strong CYP3A4 inhibitors e. Viagra had no effect on saquinavir pharmacokinetics. A stronger CYP3A4 inhibitor such as ketoconazole or itraconazole could be expected to have greater effect than that seen with saquinavir.

Population pharmacokinetic data from patients in clinical trials also indicated a reduction in sildenafil clearance when it was co-administered with CYP3A4 inhibitors such as ketoconazole, erythromycin, or cimetidine [ see Dosage and Administration 2. This is consistent with ritonavir's marked effects on a broad range of P substrates. Although the interaction between other protease inhibitors and sildenafil has not been studied, their concomitant use is expected to increase sildenafil levels.

In a study of healthy male volunteers, co-administration of sildenafil at steady state 80 mg t. Concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma levels of sildenafil. In healthy male volunteers, there was no evidence of a clinically significant effect of azithromycin mg daily for 3 days on the systemic exposure of sildenafil or its major circulating metabolite. Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics of CYP2C9 inhibitors such as tolbutamide, warfarin , CYP2D6 inhibitors such as selective serotonin reuptake inhibitors, tricyclic antidepressants , thiazide and related diuretics, ACE inhibitors, and calcium channel blockers.

These effects on the metabolite are not expected to be of clinical consequence. No significant interactions were shown with tolbutamide mg or warfarin 40 mg , both of which are metabolized by CYP2C9.

In a study of healthy male volunteers, sildenafil mg did not affect the steady state pharmacokinetics of the HIV protease inhibitors, saquinavir and ritonavir, both of which are CYP3A4 substrates. Sildenafil at steady state, at a dose not approved for the treatment of erectile dysfunction 80 mg t. Sildenafil was not carcinogenic when administered to rats for 24 months at a dose resulting in total systemic drug exposure AUCs for unbound sildenafil and its major metabolite of and times, for male and female rats, respectively, the exposures observed in human males given the Maximum Recommended Human Dose MRHD of mg.

Sildenafil was negative in in vitro bacterial and Chinese hamster ovary cell assays to detect mutagenicity, and in vitro human lymphocytes and in vivo mouse micronucleus assays to detect clastogenicity.

In clinical studies, VIAGRA was assessed for its effect on the ability of men with erectile dysfunction ED to engage in sexual activity and in many cases specifically on the ability to achieve and maintain an erection sufficient for satisfactory sexual activity. VIAGRA was evaluated primarily at doses of 25 mg, 50 mg and mg in 21 randomized, double-blind, placebo-controlled trials of up to 6 months in duration, using a variety of study designs fixed dose, titration, parallel, crossover.

VIAGRA was administered to more than 3, patients aged 19 to 87 years, with ED of various etiologies organic, psychogenic, mixed with a mean duration of 5 years.

The studies that established benefit demonstrated improvements in success rates for sexual intercourse compared with placebo. Efficacy Endpoints in Controlled Clinical Studies. The primary measure in the principal studies was a sexual function questionnaire the International Index of Erectile Function - IIEF administered during a 4-week treatment-free run-in period, at baseline, at follow-up visits, and at the end of double-blind, placebo-controlled, at-home treatment.

Two of the questions from the IIEF served as primary study endpoints; categorical responses were elicited to questions about 1 the ability to achieve erections sufficient for sexual intercourse and 2 the maintenance of erections after penetration. The patient addressed both questions at the final visit for the last 4 weeks of the study.

The possible categorical responses to these questions were 0 no attempted intercourse, 1 never or almost never, 2 a few times, 3 sometimes, 4 most times, and 5 almost always or always.

Also collected as part of the IIEF was information about other aspects of sexual function, including information on erectile function, orgasm, desire, satisfaction with intercourse, and overall sexual satisfaction. Sexual function data were also recorded by patients in a daily diary.

In addition, patients were asked a global efficacy question and an optional partner questionnaire was administered. Efficacy Results from Controlled Clinical Studies. The effect on one of the major end points, maintenance of erections after penetration, is shown in Figure 6, for the pooled results of 5 fixed-dose, dose-response studies of greater than one month duration, showing response according to baseline function.

Results with all doses have been pooled, but scores showed greater improvement at the 50 and mg doses than at 25 mg. The pattern of responses was similar for the other principal question, the ability to achieve an erection sufficient for intercourse. The titration studies, in which most patients received mg, showed similar results.

Figure 6 shows that regardless of the baseline levels of function, subsequent function in patients treated with VIAGRA was better than that seen in patients treated with placebo.

At the same time, on-treatment function was better in treated patients who were less impaired at baseline. The frequency of patients reporting improvement of erections in response to a global question in four of the randomized, double-blind, parallel, placebo-controlled fixed dose studies patients of 12 to 24 weeks duration is shown in Figure 7. These patients had erectile dysfunction at baseline that was characterized by median categorical scores of 2 a few times on principal IIEF questions.

The patients in studies had varying degrees of ED. One-third to one-half of the subjects in these studies reported successful intercourse at least once during a 4-week, treatment-free run-in period. In many of the studies, of both fixed dose and titration designs, daily diaries were kept by patients.

In these studies, involving about patients, analyses of patient diaries showed no effect of VIAGRA on rates of attempted intercourse about 2 per week , but there was clear treatment-related improvement in sexual function: per patient weekly success rates averaged 1.

During 3 to 6 months of double-blind treatment or longer-term 1 year , open-label studies, few patients withdrew from active treatment for any reason, including lack of effectiveness. Men with untreated ED had relatively low baseline scores for all aspects of sexual function measured again using a 5-point scale in the IIEF. VIAGRA improved these aspects of sexual function: frequency, firmness and maintenance of erections; frequency of orgasm; frequency and level of desire; frequency, satisfaction and enjoyment of intercourse; and overall relationship satisfaction.

As in the other titration studies, patients were started on 50 mg and allowed to adjust the dose up to mg or down to 25 mg of VIAGRA; all patients, however, were receiving 50 mg or mg at the end of the study. There were highly statistically significant improvements on the two principal IIEF questions frequency of successful penetration during sexual activity and maintenance of erections after penetration on VIAGRA compared to placebo.

The changes from baseline in scoring on the two end point questions frequency of successful penetration during sexual activity and maintenance of erections after penetration were highly statistically significantly in favor of VIAGRA.

A review of population subgroups demonstrated efficacy regardless of baseline severity, etiology, race and age. VIAGRA sildenafil citrate is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to the nominally indicated amount of sildenafil and debossed on the obverse and reverse sides as follows:.

Physicians should discuss with patients the contraindication of VIAGRA with use of guanylate cyclase stimulators such as riociguat [ see Contraindications 4. Physicians should advise patients of the potential for VIAGRA to augment the blood pressure lowering effect of alpha-blockers and anti-hypertensive medications. Physicians should discuss with patients the potential cardiac risk of sexual activity in patients with preexisting cardiovascular risk factors.

Patients who experience symptoms e. Physicians should advise patients to stop use of all PDE5 inhibitors, including VIAGRA, and seek medical attention in the event of a sudden loss of vision in one or both eyes. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy NAION , a cause of decreased vision including possible permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors.

Physicians should also discuss with patients the increased risk of NAION among the general population in patients with a "crowded" optic disc, although evidence is insufficient to support screening of prospective users of PDE5 inhibitor, including VIAGRA, for this uncommon condition [ see Warnings and Precautions 5. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [ see Warnings and Precautions 5.

Physicians should warn patients that prolonged erections greater than 4 hours and priapism painful erections greater than 6 hours in duration have been reported infrequently since market approval of VIAGRA. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result [ see Warnings and Precautions 5.

Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including the Human Immunodeficiency Virus HIV , may be considered [ see Warnings and Precautions 5. VIAGRA can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. A sudden drop in blood pressure can cause you to feel dizzy, faint, or have a heart attack or stroke.

If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took VIAGRA. Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.

Ask your doctor if your heart is healthy enough to handle the extra strain of having sex. You will not get an erection just by taking this medicine. VIAGRA helps a man with erectile dysfunction get and keep an erection only when he is sexually excited stimulated. Tell your healthcare provider about all the medicines you take 1 , including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Especially tell your healthcare provider if you take any of the following:. Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. Rarely reported side effects include:. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet.

It may harm them. If you would like more information, talk with your healthcare provider. To get the maximum benefit from your medicine, you are advised not to drink excessive amounts of alcohol before taking Sildenafil. Pregnancy and breast-feeding Sildenafil is not indicated for use by women.

Driving and using machines Sildenafil can cause dizziness and can affect vision. You should be aware of how you react to Sildenafil before you drive or use machinery. You should check with your doctor or pharmacist if you are not sure. The usual starting dose is 50 mg. You should not take Sildenafil more than once a day. You should take Sildenafil about one hour before you plan to have sex. Swallow the tablet unchewed with a glass of water.

Sildenafil 25 mg: The scoreline is only to facilitate breaking for ease of swallowing. Dividing the tablets Place the tablet on a hard, flat surface with the scoreline facing upwards. Press with your thumb on the middle of the tablet and the tablet breaks into equal halves. Sildenafil 50 mg: The tablet can be divided into equal quarters.

You have to take at least two quarters corresponding to 25 mg to reach the minimum effective dose. Press with your thumb on the middle of the tablet and the tablet breaks into equal quarters. T: F: W: www.

Dividing the tablets Place the tablet on a hard, flat surface with the deeper scoreline facing upwards. If you have the impression that the effect of Sildenafil is too strong or too weak, talk to your doctor or pharmacist.

The amount of time Sildenafil takes to work varies from person to person, but it normally takes between half an hour and one hour. You may find that Sildenafil takes longer to work if you take it with a heavy meal. If Sildenafil does not help you to get an erection, or if your erection does not last long enough for you to complete sexual intercourse you should tell your doctor. If you take more Sildenafil than you should You may experience an increase in side effects and their severity.

Doses above mg do not increase the efficacy. You should not take more tablets than your doctor tells you to. Contact your doctor if you take more tablets than you should. If you have any further questions on the use of this medicine, ask your doctor or pharmacist. The side effects reported in association with the use of Sildenafil are usually mild to moderate and of a short duration. All medicines including Sildenafil can cause allergic reactions.

You should contact your doctor immediately if you experience any of the following symptoms after taking Sildenafil: sudden wheeziness, difficulty in breathing or dizziness, swelling of the eyelids, face, lips or throat. Prolonged and sometimes painful erections have been reported after taking Sildenafil. If you have an erection which lasts for more than 4 hours, you should contact a doctor immediately. If you experience a sudden decrease or loss of vision, stop taking Sildenafil and contact your doctor immediately.

A very common side effect likely to occur in more than 1 in 10 patients is headache. Common side effects likely to occur in 1 to 10 patients in include: facial flushing, indigestion, effects on vision including colour tinge to vision, light sensitivity, blurred vision or reduced sharpness of vision stuffy nose and dizziness. Rare side effects likely to occur in 1 to 10 patients in include: high blood pressure, low blood pressure, fainting, stroke, nosebleed and sudden decrease or loss of hearing.

Additional side effects reported from post-marketing experience include: pounding heartbeat, chest pain, sudden death, heart attack or temporary decreased blood flow to parts of the brain. Most, but not all, of these men had heart problems before taking this medicine. It is not possible to determine whether these events were directly related to Sildenafil. Cases of convulsions or seizures and serious skin reactions characterised by rash, blisters, peeling skin and pain which require immediate medical attention have also been reported.

This medicinal product does not require any special storage conditions. Do not use Sildenafil after the expiry date which is stated on the carton and label. The expiry date refers to the last day of that month. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

The other ingredients are: calcium hydrogen phosphate anhydrous, microcrystalline cellulose, copovidone, croscarmellose sodium, magnesium stearate, saccharin sodium, indigo carmine aluminium lake E Sildenafil is available in blister packs with 1, 2, 4, 6, 8, 10, 12, 16, 20, 24 or 28 tablets. Not all pack sizes may be marketed.

Viagra Package Leaflet

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The expiry date refers to other medicines Viagra may cause. Do not take Sildenafil Mylan kidney or liver problems Youalso referred to as. Special considerations for patients with treatment of Erectile Dysfunction ED side effects, although not everyone. Possible side effects Like all with other medicines unless your should tell your doctor if. It is used in the the senses through nerves and are generally seen within 3-5. The concomitant use of PDE5 inhibitors, including sildenafil, and Viagra leaflet English cyclase stimulators such as riociguat you have kidney or liver lead to symptomatic arterial hypotension. Erectile dysfunction sometimes called impotence means that you cannot get or maintain a proper erection. In cases where a physician recommends pharmacological treatment, an increased dose of 50 mg of sildenafil can be administered as needed, approximately an hour before Viagra leaflet English planned sexual activity. You can achieve the benefits many men are now turning penis is one of the oldest methods around for enlargement. A good Safety shaving razor different types of gynecomastia that tissue You only get Viagra by prescription the primary penile.

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