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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 alertness or clear vision until you can do it safely.

Talk to your doctor if you are using marijuana (cannabis). Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

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 viagra pills usa 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 price of viagra pills 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 right away. US residents can call their local poison control center at 1-800-222-1222. 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.

The combination of nitrates (and drugs such as nicorandil) with sildenafil is contraindicated. This combination must be avoided as it can produce significant hypotension and is potentially fatal. The guidance from the Committee on Safety of Medicines (CSM) regarding nitrates and sildenafil states (1): sildenafil and nitrates - it is stated that these should not be used concurrently. Nitrates are stated as those used for cardiovascular disease, e.g. amyl nitrate sildenafil should not be used in men for whom sexual activity is inadvisable e.g.

patients with severe cardiovascular disorders such as severe heart failure or unstable angina.

The British Heart Foundation have addressed the use of GTN spray and nitrate tablets and phosphodiesterase (PDE5) inhibitors (sildenafil, tadalafil, verdenafil) (2): nitrate therapy is an absolute contraindication to PDE5 inhibitors (1,2,3) combination of nitrates with PDE5 inhibitors can produce unpredictable excess vasodilation, leading to profound hypotension - same risk also applies with nicorandil if hypotension does occur then the patient should be placed in the Trendelenburg position and emergency help sought. Resuscitation with intravenous fluids should be initiated as soon as possible.

GTN spray should not be used within 24 hours of taking sildenafil or vardenafil and within 48 hours of taking tadalafil note though that coital angina is not common and nitrates can often be safely discontinued or substituted in stable patients if a patient has stable angina and erectile dysfunction then a reassessment of the need for nitrates should be undertaken before denying treatment with a PDE5 inhibitor if a patient with CHD (and also taking a PDE5 inhibitor) develops angina during sexual activity, he must discontinue immediately and relax for 5-10 minutes. If he stands up then this will reduce the preload and may relieve symptoms. if the angina pain does not resolve after 20-30 minutes the emergency services should be called informing them of the PDE5 inhibitor use - also sex should not be attempted again before the patient has

undergone

although PDE5Is are safe with most antihypertensive agents, coadministration with nitrates or alpha-blockers poses a risk of severe hypotension (4,5) all alpha-blockers can cause vasodilation and orthostatic hypotension, and coadministration with PDE5Is increases the risk of a clinically significant decrease in BP (5) only after patients are on stable alpha-blocker therapy should PDE5Is be initiated, starting with a low dose (5) Referral to specialist is appropriate if severe CVD which makes sexual activity unsafe or a situation when PDE5 inhibitor use contra- indicated (6) from a therapeutical point of view, intracavernous injections of PGE1 (alprostadil) are efficient and safe second line in the treatment of erectile dysfunction in the cardiac population, whatever the origin.

No drug interactions with the various treatment used in cardiology, notably derived nitrates, has been reported other treatment options include vacuum devices, insertion of transurethral alprostadil (MUSE), intracavernosal alprostadil (Caverjet) nitrates are contraindicated within 24 hours of sildenafil and vardenafil and within 48 hours of tadalafil. Only after patients are on stable alph-blocker therapy should PDE5Is be initiated, starting with a low dose potent cytochrome P450 3A4 inhibitors, including erythromycin, clarithromycin, ketoconazole, itraconazole, and HIV protease inhibitors, increase PDE5I plasma concentrations. PDE5I drug interactions have the potential to cause life-threatening hypotension in patients with coexisting cardiac disease requiring nitrates or alpha blockers (5) "uroselective" alpha-blockers (tamsulosin, alfuzosin) preferentially inhibit alpha 1A and alpha 1D receptors found primarily in the prostate and benefit patients with benign prostatic hypertrophy.

Other alpha-blockers (terazosin) are less selective, and some (doxazosin) are used as third-line agents for hypertension because of their higher affinity for alpha -1B receptors, which are abundant in the peripheral vasculature (5) Viagra. Commonly known as “the little blue pill,” Viagra has raked in billions for pharmaceutical giant Pfizer since its 1998 release.

But the erectile dysfunction drug has been linked to serious side effects, including vision and hearing loss, heart complications and melanoma.

By Kristin Compton Edited By Kevin Connolly Medically Reviewed by Laura Koppen, PharmD, BCPS This page features 20 Cited Research Articles.

Board-certified physicians medically review Drugwatch content to ensure its accuracy and quality.

Drugwatch partners with Physicians’ Review Network Inc. PRN is a nationally recognized leader in providing independent medical reviews.

Reviewer specialties include internal medicine, teva pharmaceuticals generic viagra gastroenterology, oncology, orthopedic surgery and psychiatry.

Food and Drug Administration (FDA) approved Viagra (sildenafil) for prescription use in men with erectile dysfunction (or impotence).

The medication was originally developed and studied as an anti-hypertensive drug to treat high blood pressure as well as a type of cardiovascular (affecting the heart and blood vessels) disease called angina pectoris.

While that effort failed, chemists at pharmaceutical giant Pfizer found that the drug was capable of inducing penile erections within 30 to 60 minutes of use. Pfizer saw an economical advantage with this new discovery and experienced immediate success with Viagra, accumulating about a billion dollars in sales in its first year alone. In 2014, Fox News reported that “over 30 million men suffer from erectile dysfunction,” and it is estimated that approximately 20 million Americans have taken Viagra.

Men’s Health reported around the same time that during the last two or three decades, ED rates have gone up, especially among younger men. The Journal of Sexual Medicine published results from one study that showed that “one out of every four new ED patients is under 40 years old.” In 2016, the FDA approved the first-ever generic version of Viagra to be manufactured and distributed by Teva, a Pennsylvania-based pharmaceutical company. Viagra has always been linked to some serious side effects affecting the eyes, ears, penis, heart and blood vessels. A 2014 study published in JAMA Internal Medicine also points to a possible link between the use of sildenafil (the active ingredient in Viagra) and melanoma, the most dangerous form of skin brand viagra without prescription cancer.