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The co-administration of PDE5 inhibitors, including sildenafil, with guanylate cyclase stimulators, such as riociguat, is contraindicated as it may potentially lead to symptomatic hypotension see section 4. Agents for the treatment of erectile dysfunction, including sildenafil, should not be used in men for whom sexual activity is inadvisable e. VIAGRA is contraindicated in patients who have loss of vision in one eye because of non-arteritic anterior ischaemic optic neuropathy NAION , regardless of whether this episode was in connection or not with previous PDE5 inhibitor exposure see section 4.

The safety of sildenafil has not been studied in the following sub-groups of patients and its use is therefore contraindicated: Cardiovascular risk factors Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity.

Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure see section 5. Prior to prescribing sildenafil, physicians should carefully consider whether their patients with certain underlying conditions could be adversely affected by such vasodilatory effects, especially in combination with sexual activity.

Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction e. Serious cardiovascular events, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of VIAGRA.

Most, but not all, of these patients had pre-existing cardiovascular risk factors. Many events were reported to occur during or shortly after sexual intercourse and a few were reported to occur shortly after the use of VIAGRA without sexual activity.

It is not possible to determine whether these events are related directly to these factors or to other factors. Priapism Agents for the treatment of erectile dysfunction, including sildenafil, 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 anaemia, multiple myeloma or leukaemia.

Prolonged erections and priapism have been reported with sildenafil in post-marketing experience. In the event of an erection that persists for longer than 4 hours, the patient should seek immediate medical assistance.

If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result. Concomitant use with other PDE5 inhibitors or other treatments for erectile dysfunction The safety and efficacy of combinations of sildenafil with other PDE5 inhibitors, or other pulmonary arterial hypertension PAH treatments containing sildenafil REVATIO , or other treatments for erectile dysfunction have not been studied.

In men whose erectile dysfunction is caused by a physical problem, Levitra will not be able to treat its underlying cause. However, from a psychological perspective, it can improve confidence by providing successful erections, and may treat anxiety-induced ED. Please bear in mind, however, that erectile dysfunction can be the first sign of medical problems such as high blood pressure or diabetes.

Treatment of these other conditions is important for your general health, as well as your sexual health. We recommend that all men taking medicine for ED have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances.

Other treatments are available for erectile dysfunction: If your erectile dysfunction is situational, for example, you still have an early morning erection, then psychosexual therapy may be helpful. For further information on treatments for erectile dysfunction, including complementary treatments such as kegel exercises which strengthen the muscles in the pelvic floor and can be helpful for patients with ED please see the NHS website: With Access RX you do not need a previous prescription to get the Viagra.

They do this via telemedicine. You also have the option to do a video consultation with a medical professional. One of their licensed physicians evaluates your information.

If appropriate, they will contact your physician for further information. If everything checks out, the physician writes you a prescription for the Viagra and they ship it out to you. Their prices are competitive with large chain drugstores and you are assured of getting brand-name, American, FDA-Approved Viagra delivered to your door in a couple of days without having to go to a doctor. The icing on the cake is that you save the time and money associated with a visit to a doctor's office.

This is especially fantastic if you do not have medical insurance or if your insurance does not cover Viagra. Interesting Viagra Pharma Factoids: When was Viagra discovered? The drug would not be known as Viagra until the mids. Experimental compound UK, is believed to be useful as a high blood pressure and angina treatment. The scientists hope it may act as a vasodilator and be useful in treating cardiovascular ailments such as hypertension and angina.

Early Phase 1 trials regarding the use of Viagra for angina are unremarkable. Phase 2 clinical study is conducted testing silendafil citrate's usefulness as an angina treatment. Test subjects take it three times a day for a week. The studies had only 28 men involved. Pfizer realizes it has something important; it accelerates the program examining silendafil citrate for erectile dysfunction. FDA agrees to give it a priority review. It was approved with a starting dose of 50 mg with the option to increase the dose to mg or reduce it to 25 mg.

Patent number expires on March 27, Viagra Name The name Viagra is believed to be an amalgam of two words: The "-agra" part of the name Viagra is associated with Niagara Falls , the iconic American waterfall; a metaphor for a massive powerful natural phenomenon. It is believed that one reason Pfizer employs this tablet design is to make it harder to split the tablet with common tablet splitters. The price of Viagra in a 50 mg tablet is approximately the same.

Some people even cut them into quarters, which will save you even more money. Keep away from children and pets. Before taking Viagra, tell your doctor about all other medications you use for erectile dysfunction, or if you are using any of the following medications: Tell your doctor about all the prescriptions and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors.

Do not start using a new medication without telling your doctor. If you have heart problems severe enough to make sexual activity a dangerous, you should avoid using Viagra. Be equally cautious, if you have severe high or low blood pressure, heart failure or unstable angina. In case of cardiac symptoms developing for example, dizziness, nausea, and chest pain during sexual activity, do not continue.

Tell your doctor about the problem as soon as possible. If you have a condition that might result in long-lasting erections, such as sickle cell anemia, multiple myeloma a disease of the bone marrow , or leukemia, use Viagra with caution.

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