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Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure.

In some patients, the use of VIAGRA with alpha-blockers can lead to a drop in blood pressure or to fainting. medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase) or atazanavir sulfate (Reyataz) some types of oral antifungal medicines, such as ketoconazole (Nizoral), and itraconazole (Sporanox) some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin other medicines that treat high blood pressure other medicines or treatments for ED VIAGRA contains sildenafil, which is the same medicine found in another drug called REVATIO.

REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil]). Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. Take VIAGRA exactly as your healthcare provider tells you to take it. Your healthcare provider will tell you how much VIAGRA to take and when to take it. Your healthcare provider may change your dose if needed. You may take VIAGRA between 30 minutes to 4 hours before sexual activity if needed. If you take VIAGRA after a high fat meal (such as a cheeseburger and french fries), VIAGRA may

take

If you accidentally take too much VIAGRA, call your doctor or go to the nearest hospital emergency room right away. Rarely reported side effects include: an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away.

If it is not treated right away, priapism can permanently damage your penis.

Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION).

It is uncertain whether PDE5 inhibitors directly cause the vision loss. Stop taking VIAGRA and call your healthcare provider right away if you have sudden vision loss in one or both eyes.

Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away. The most common side effects of VIAGRA are: headache flushing upset stomach abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision stuffy or runny nose back pain muscle pain nausea dizziness rash. In addition, heart attack, stroke, irregular heartbeats and death have happened rarely in men taking VIAGRA. Most, but not all, of these men had heart problems before taking VIAGRA. Tell your healthcare provider if you have any side effect that bothers you or does not go away.

These are not all the possible side effects of VIAGRA.

For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects.

You may report side effects to FDA at 1-800-FDA-1088. Store VIAGRA at room temperature between 68°F to 77°F (20°C to 25°C). Keep VIAGRA and all medicines out of the reach of children.

General information about the safe and effective use of VIAGRA.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use VIAGRA for a condition for which it was not prescribed. Do not give VIAGRA to other people, even if they have the same symptoms that you have. This Patient Information leaflet summarizes the most important information about VIAGRA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about VIAGRA that is written for health professionals.

For more information, go to www.viagra.com, or call 1-888-4VIAGRA. Inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and FD & C Blue #2 aluminum lake. This Patient Information has been approved by the U.S. For current full prescribing information, please visit www.pfizer.com .

Viagra (sildenafil citrate), Revatio (sildenafil), Cardura (doxazosin mesylate), and Minipress (prazosin HCl) are registered trademarks of Pfizer Inc.

1 The other brands listed are trademarks of their respective owners and are not trademarks of Pfizer Inc. The makers of these brands are not affiliated with and do not endorse Pfizer Inc or its products. Efficacy and tolerability of sildenafil/ l ?arginine combination relative to sildenafil alone in patients with organic erectile dysfunction.

Faculty of Pharmacy, Ain Shams University, Cairo, Egypt. Faculty of Pharmacy, Ain Shams University, Cairo, Egypt. Department of Urology, Sohag University Hospital, Sohag University, Sohag, Egypt. Department of Urology, Sohag University Hospital, Sohag University, Sohag, Egypt.

Correspondence: Mohammed Saber?Khalaf, Department of Urology, Sohag University Hospitals, Naser city, Sohag, Egypt.

Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.

Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.

Department of Urology, Sohag University Hospital, Sohag University, Sohag, Egypt. Department of Urology, Sohag University Hospital, Sohag University, Sohag, Egypt. Correspondence: Mohammed Saber?Khalaf, Department of Urology, Sohag University Hospitals, Naser city, Sohag, Egypt. Erectile dysfunction is defined as inability to achieve or maintain penile erection sufficient for sexual satisfaction.

The physiology of penile erection depends mainly on nitric oxide release.

Compare the efficacy and safety of oral sildenafil 50 mg alone or in combination with l ?arginine 3 g/day orally on the treatment of erectile dysfunction.

Randomized controlled study with two parallel groups of erectile dysfunction patients; One group received sildenafil 50 mg every other cvs cialis over the counter day, while the other group received a combination of sildenafil (every other day)/ l ?arginine on a daily base. Efficacy was assessed using International Index of Erectile Function?5 score at the baseline and after 8 weeks.

The mean age was 56.3 ± 5 and 56.2 ± 4.4 years in sildenafil and combination groups, respectively. International Index of Erectile Function?5 score was comparable between the two groups at the baseline ( p value 0.44).

International Index of Erectile Function?5 score was improved from 15.3 ± 2.5 at baseline to 19.2 ± 2.3 after treatment, and this was statistically significant with p value.

Adding l ?arginine to sildenafil demonstrated more efficacy than sildenafil alone for treatment of erectile dysfunction patients.

Uses Side Effects Precautions Interactions Overdose Images Uses Side Effects Precautions Interactions Overdose Images.

Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction-ED). In combination with sexual stimulation, sildenafil works by increasing blood flow to the penis to help a man get and keep an erection. This drug does not protect against sexually transmitted diseases (such as HIV, hepatitis B, gonorrhea, syphilis). Consult your doctor or pharmacist for more details.

Read the Patient Information Leaflet provided by your pharmacist before you start taking sildenafil and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

To treat erectile dysfunction-ED, take this drug by mouth as directed by your doctor, usually as needed. Take sildenafil at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour before is the most effective). A high-fat meal may delay how quickly the drug begins to work. The dosage is based on your medical condition, response to treatment, and other medications you may be taking.

Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if your condition does not improve. Dizziness, headache, flushing, or stomach upset may occur.

Vision changes such as increased

sensitivity

If you have heart problems and experience any of these serious side effects while having sex, stop and get medical help right away: severe dizziness, fainting, chest/jaw/left arm pain, nausea. Rarely, sudden decreased vision, including permanent blindness, in one or both eyes (NAION) may occur.

If this serious problem occurs, stop taking sildenafil and get medical help right away.

You have a slightly greater chance of developing NAION if you have heart disease, diabetes, high cholesterol, certain other eye problems ("crowded disk"), high blood pressure, if you are over 50, or if you smoke. Rarely, a sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness, may occur.

Stop taking sildenafil and get medical help right away if these effects occur. In the rare event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and get medical help right away, or permanent problems could occur.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects.

If you notice other effects not listed above, contact your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada - Call your doctor for medical advice about side effects.

You may report side effects to Health Canada at 1-866-234-2345. Before taking sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.

This product may contain inactive ingredients, which can cause allergic reactions or other problems. Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack or life-threatening irregular heartbeat in the past 6 months, chest pain/angina, heart failure), stroke in the past 6 months, kidney disease, liver disease, high or low blood pressure, a severe loss of body water (dehydration), penis

conditions

This drug may make you dizzy or cause vision problems.

Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs overnight delivery cialis

alertness

During pregnancy, sildenafil should be used only when clearly needed.

Since high blood pressure in the lungs is a serious condition that can harm both a pregnant woman and her unborn baby, do not stop this medication unless directed by your doctor.

If you are planning pregnancy, become pregnant, or think you may be pregnant, talk to your doctor about the benefits and risks of using sildenafil. This medication passes into breast milk in small amounts. Drug interactions may change how your medications work or increase your risk for serious side effects.

This document does not contain all possible drug interactions.

Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist.

Do not start, stop, or change the dosage of any medicines without your doctor's approval. A product that may interact with this drug is: riociguat. Sildenafil can cause a serious drop in your blood pressure when used with nitrates.

A serious drop in blood pressure can lead to dizziness, fainting, and rarely heart attack or stroke.

Do not use sildenafil with any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide), recreational drugs called "poppers" containing amyl nitrate, amyl nitrite, or butyl nitrite.

If you are also taking an alpha blocker medication (such as doxazosin, tamsulosin) to treat an enlarged prostate/BPH or high blood pressure, your blood pressure may get too low which can lead to dizziness or fainting.

Your doctor may start treatment with a lower dose of sildenafil to minimize your risk of low blood pressure. Other medications can affect the removal of sildenafil from your body, which may affect how sildenafil works.

Examples include azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin, erythromycin), HIV protease inhibitors (such as ritonavir, saquinavir), hepatitis C virus protease inhibitors (such as boceprevir, telaprevir), mifepristone, rifampin, among others.

Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction-ED or pulmonary hypertension (such as tadalafil, vardenafil).

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control

center

Canada residents can call a provincial poison control center.

Symptoms of overdose may include severe dizziness, fainting, painful/prolonged erection.

Store at room temperature away from light and moisture. In eliciting its mechanism of action, sildenafil ultimately prevents or minimizes the breakdown of cyclic guanosine monophosphate (cGMP) by inhibiting cGMP specific phosphodiesterase type 5 (PDE5) 11,12,13,14,15,16,8,9 .

The result of doing so allows cGMP present in both the penis

and

Interestingly enough, it is precisely via this mechanism why sildenafil was at first researched as a potential treatment for angina - or chest pain associated with inadequate blood flow to the heart - before being serendipitously indicated for treating erectile dysfunction in the late 1980s 7 . Nevertheless, it is because of this mechanism that sildenafil is also indicated for treating pulmonary arterial hypertension but is also additionally notorious for interacting with various anti-anginal or anti-hypertensive agents to develop potentially rapid, excessive, and/or fatal hypotensive crises 4,5,6 . Regardless, sildenafil, among a variety of other similar or related PDE5 inhibitors, has become a common and effective treatment for erectile dysfunction and since its formal approval for medical use in the public in 1998 7 , continues to see millions of prescriptions written for it internationally. Although the medication has historically been most popularly recognized as Pfizer's brand name Viagra, sildenafil is currently available generically and even as a non-prescription over the counter medication in some countries 10 . Type Small Molecule Groups Approved, Investigational Structure. Structure for Sildenafil (DB00203) HIP-0908 HIP0908.

Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor that is predominantly employed for two primary indications: (1) the treatment of erectile dysfunction 5,8,12,13,16 ; and.

(2) treatment of pulmonary hypertension, where: a) the US FDA specifically indicates sildenafil for the treatment of pulmonary arterial hypertension (PAH) (WHO Group I) in adults to improve exercise ability and delay clinical worsening 11 .

The delay in clinical worsening was demonstrated when sildenafil was added to background epoprostenol therapy 11 .

Studies establishing effectiveness were short-term (12 to 16 weeks), and included predominately patients with New York Heart Association (NYHA) Functional Class II-III symptoms and idiopathic etiology (71%) or associated with connective tissue disease (CTD) (25%) 11 ; b) the Canadian product monograph specifically indicates sildenafil for the treatment of primary pulmonary arterial hypertension (PPH) or pulmonary hypertension secondary to connective tissue disease (CTD) in adult patients with WHO functional class II or III who have not responded to conventional therapy 14 .

In addition, improvement in exercise ability and delay in clinical worsening was demonstrated in adult patients who were already stabilized on background epoprostenol therapy 14 ; and.

c) the EMA product information specifically indicates sildenafil for the treatment of adult patients with pulmonary arterial hypertension classified as WHO functional class II and III, to improve exercise capacity 15 .

Efficacy has been shown in primary pulmonary hypertension and

pulmonary

In vitro studies have shown that sildenafil is selective for phosphodiesterase-5 (PDE5) 11,12,13,14,15,16,8,9 .