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Check with your doctor before taking sildenafil if you: have sickle cell anaemia (an abnormality of red blood cells), leukaemia (cancer of blood cells) or multiple myeloma (cancer of bone marrow) have a deformity of your penis or Peyronie's disease (curved penis) have a heart problem. Your doctor should carefully check whether your heart can take the additional strain of having sex. have a stomach ulcer or a bleeding problem like haemophilia.

You can get sildenafil on the NHS if you have erectile dysfunction or pulmonary hypertension.

Branded versions of sildenafil such as Viagra are not available on the NHS, except in special circumstances. You can also get sildenafil on a private prescription from your doctor. This means you'll need to pay the full cost of the medicine. Prices vary, but on average 4 tablets costs around ?20.

You can buy sildenafil from a pharmacy following a discussion with the pharmacist.

They'll ask you some questions about your general health to make sure sildenafil is safe for you to take. If the pharmacist has any concerns about whether sildenafil is safe for you, they may advise you to see your doctor.

Be very careful if you do this as many websites sell fake medicines. Online medicines are not always regulated and the ingredients in them can vary from one pack to another. They can cause unpleasant side effects or may not be suitable for you.

It's best to see your doctor before buying medicines online. They know your medical history and can discuss whether you might benefit from treatment. If you choose to buy sildenafil/Viagra over the internet, make sure: any online pharmacy is registered with the General Pharmaceutical Council (GPhC) any online doctor service is registered with the Care Quality Commission (CQC) all doctors are registered with the General Medical Council (GMC) 5.

It's important to take it as advised by your doctor or pharmacist. Sildenafil tablets for erectile dysfunction come in different strengths ranging from 25mg to 100mg.

The usual dose is 50mg, when you need it (no more than once a day). The dose can be increased to 100mg or decreased to 25mg depending on its effect. Take sildenafil up to 4 hours before you want to have sex. For sildenafil to work properly, you'll need to be sexually excited.

Sildenafil tablets for pulmonary hypertension come in 10mg and 20mg tablets. Doses for children can range from 10mg to 20mg taken 3 times a day, depending on their weight.

Swallow tablets whole with a glass of water or juice (but not grapefruit juice).

For erectile dysfunction, it's best to take sildenafil on an empty stomach.

It may take longer to work if you take it with food. If you or your child are taking sildenafil as a liquid, 1ml is usually the same as taking a 10mg tablet, but it's important to always check the medicine label. Liquid sildenafil will usually be made up for you by your pharmacist.

The medicine will come with a plastic syringe or spoon to help you take the right amount. If you do not have a plastic syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount. If you have pulmonary hypertension and you forget to take a dose of sildenafil, take it as soon as you remember and then continue as usual. Never take an extra dose to make up for a forgotten one. If you often forget doses, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Taking too much sildenafil by accident can cause unpleasant side effects, such as: headaches dizziness indigestion blocked nose altered vision. Talk to your doctor if you have taken too much sildenafil and you're worried about these side effects. Like all medicines, sildenafil can cause side effects in some people.

Many people have no side effects or only minor ones. Common side effects happen in more than 1 in 100 people.

If you get these side effects, keep taking the medicine, but tell your doctor or pharmacist if these side effects bother you or do not go away: headaches feeling buy viagra buy sick hot flushes, including facial

flushing

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to sildenafil.

Immediate action required: Call 999 or go to A&E if: you get a skin rash that may include itchy, red, swollen, blistered or peeling skin you're wheezing you get tightness in the chest or throat you have trouble breathing or talking your mouth, face, lips, tongue or throat start swelling.

You could be having a serious allergic reaction and may need immediate treatment in hospital. For a full list, see the leaflet inside your medicines packet. You can report any suspected side effect to the UK safety scheme. Sildenafil is not recommended in pregnancy and while breastfeeding. Non-urgent advice: Tell your doctor if you're: trying to get pregnant pregnant breastfeeding. Tell your doctor if you're taking these medicines before you start sildenafil : nitrates for chest pain riociguat for pulmonary hypertension recreational drugs called poppers, such as amyl nitrite.

Mixing sildenafil with herbal remedies and supplements. Some complementary therapies may have ingredients that could interfere with sildenafil and cause side effects.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements. Sildenafil belongs to a group of medicines called phosphodiesterase 5 (PDE5) inhibitors.

It works if you have erection problems by temporarily increasing blood flow to the penis when you get sexually excited.

It works in pulmonary hypertension by relaxing blood vessels in the chest.

This increases the blood supply to the lungs and reduces the workload of the heart. In general, at least two-thirds of men say they have harder erections after taking it.

If sildenafil does not work for you, it may be because: you have not waited long enough after taking it before trying to have sex you have waited too long after taking it to have sex the dose is not high enough you're not buy cenforce 150mg sexually aroused enough.

Sildenafil usually starts to work within 30 to 60 minutes.

It's triggered by sexual stimulation, so you need to be aroused for it to work.

You should be able to get an erection at any time between 1 and 4 buy cenforce 150mg hours after taking sildenafil.

Your erection should go away after you have had sex. If you're taking sildenafil for erectile dysfunction, do not take it more than once a day.

If you're taking sildenafil (Revatio) for pulmonary hypertension, do not take it more than 3 times a day. There do not seem to be any lasting harmful effects from taking it for many months and years. If sildenafil does not work, there are other tablets you could try that work in a similar way, such as: tadalafil (Cialis) - can be taken up to 36 hours before sex avanafil (Spedra) - can be taken up to around 4 hours before sex vardenafil (Levitra) - can be taken up to around 4 hours before sex.

This is a man-made hormone that helps to stimulate blood flow to the penis.

Alprostadil comes as: an injection directly into your penis a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) If you cannot get erections because of a hormonal problem, your GP may refer you to an endocrinologist (who specialises in the treatment of hormonal problems). You may benefit from treatment using injections of man-made hormones to restore your hormone levels to normal. Other treatments for erectile dysfunction include: a vacuum pump psychological treatments penile implants pelvic floor muscle exercises.