USE IN SPECIFIC POPULATIONS

VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works causing side effects.

• Sildenafil citrate was originally developed for hypertension.
• It was later approved for erectile dysfunction treatment.
• Brand names include Viagra and Revatio.

Especially tell your healthcare provider if you take any of the following: medicines called guanylate cyclase stimulators, such as riociguat (Adempas) medicines called alpha blockers

Renal Dose Adjustments

It is not known if VIAGRA is safe and effective in women or children under 18 years of age. take medicines called nitrates (such as nitroglycerin) use street drugs called "poppers" such as amyl nitrate or amyl nitrite, and butyl nitrate take any medicines called guanylate cyclase stimulators such as riociguat (Adempas) are allergic to sildenafil, as contained in VIAGRA and REVATIO, or any of the ingredients in VIAGRA. See the end of this leaflet for a complete list of ingredients in VIAGRA. What should I tell my healthcare sildenafil 60mg provider before taking VIAGRA? Before you take VIAGRA, tell your healthcare provider if you: have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve or heart failure have had heart surgery within the last 6 months have low blood pressure, or high blood pressure that is not controlled have had an erection that lasted for more than 4 hours have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia have retinitis pigmentosa, a rare genetic (runs in families) eye disease have ever had severe vision loss, including an eye problem called non-arteritic anterior ischemic optic neuropathy (NAION) have kidney problems or are having kidney dialysis Tell your healthcare provider about all the medicines you take , including prescription and over-the-counter medicines, vitamins, and herbal supplements. such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress

Product	Dosage	Quantity + Bonus	Price
Kamagra Oral Jelly	100mg	110 + 9 Sachets	334.87€ 318.92€	Buy
Viagra Generic	200mg	60 + 4 Pills	125.19€ 119.23€	Buy
Kamagra	100mg	12 Pills	55.64€ 52.99€	Buy
Viagra Generic	200mg	20 Pills	61.69€ 58.75€	Buy
Viagra Generic	25mg	20 Pills	37.74€ 35.94€	Buy
Viagra Generic	50mg	20 Pills	40.52€ 38.59€	Buy
Viagra Generic	150mg	180 + 10 Pills	236.46€ 225.20€	Buy
Kamagra Soft Tabs	100mg	60 + 4 Pills	180.59€ 171.99€	Buy
Kamagra Soft Tabs	100mg	180 + 8 Pills	425.45€ 405.19€	Buy
Kamagra	100mg	120 + 6 Pills	330.74€ 314.99€	Buy
Kamagra Oral Jelly	100mg	10 Sachets	54.55€ 51.95€	Buy
Kamagra	100mg	32 Pills	121.24€ 115.47€	Buy

(prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin).

2.4 Dosage Adjustments Due to Drug Interactions

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 (5.9) ]. VIAGRA® (vi-AG-rah) (sildenafil citrate) Tablets What is the most important information I should know about VIAGRA? VIAGRA can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. Do not take VIAGRA if you take any other medicines called "nitrates." Do not take VIAGRA if you take medicines called guanylate cyclase stimulators which include: Riociguat (Adempas®) a medicine that treats pulmonary arterial hypertension and chronic-thromboembolic pulmonary hypertension. Tell all your healthcare providers that you take VIAGRA.

Is there a “female Viagra”?

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. VIAGRA does not protect you or your partner from getting sexually transmitted diseases, including HIV—the virus that causes AIDS. VIAGRA is a prescription medicine used to treat erectile dysfunction (ED). VIAGRA helps a man with erectile dysfunction get and keep an erection only when he is sexually excited (stimulated). VIAGRA is not for use in women or children. In some patients, the use of VIAGRA with alpha-blockers can lead to a drop in blood pressure or to fainting.

Parameter	Value	Notes
Absorption Time	30-120 minutes	Peak plasma levels in approx. 1 hour
Bioavailability	About 40%	Due to first-pass metabolism
T1/2 (Half-life)	4-5 hours	Eliminated mainly via hepatic metabolism
Onset of Action	30-60 minutes	Varies with food intake
Duration of Effect	Up to 4-6 hours	Depending on dose and individual

medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase)

• Common side effects include headache and flushing.
• Some may experience nasal congestion or dizziness.
• Serious side effects require immediate medical attention.

or atazanavir sulfate (Reyataz) some types of oral antifungal medicines, such as ketoconazole (Nizoral), and itraconazole (Sporanox)

• Physical activity might improve erectile response when combined with medication.
• Maintain a healthy weight for better sexual function.
• Lifestyle changes can enhance sildenafil efficacy over time.

some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin other medicines that treat

Mechanism of action

The patients in studies had varying degrees of ED. In these studies, involving about 1600 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 1.3 on 50–100 mg of VIAGRA vs 0.4 on placebo; similarly, group mean success rates (total successes divided by total attempts) were about 66% on VIAGRA vs about 20% on placebo. At the end of the long-term study, 88% of patients reported that VIAGRA improved their erections. 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 100 mg or down to 25 mg of VIAGRA; all patients, however, were receiving 50 mg or 100 mg at the end of the study.

How to Take Viagra

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. On a global improvement question, 57% of VIAGRA patients reported improved erections versus 10% on placebo. Diary data indicated that on VIAGRA, 48% of intercourse attempts were successful versus 12% on 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. On a global improvement question, 83% of patients reported improved erections on VIAGRA versus 12% on placebo.

Dosage for erectile dysfunction (ED)

Diary data indicated that on VIAGRA, 59% of attempts at sexual intercourse were successful compared to 13% on placebo. Across all trials, VIAGRA improved the erections of 43% of radical prostatectomy patients compared to 15% on placebo. Subgroup analyses of responses to a global improvement question in patients with psychogenic etiology in two fixed-dose studies (total n=179) and two titration studies (total n=149) showed 84% of VIAGRA patients reported improvement in erections compared with 26% of placebo. Diary data in two of the sildenafil citrate 100 mg studies (n=178) showed rates of successful intercourse per attempt of 70% for VIAGRA and 29% for placebo. VIAGRA was effective in a broad range of ED patients, including those with a history of coronary artery disease, hypertension, other cardiac disease, peripheral vascular disease, diabetes mellitus, depression, coronary artery bypass graft (CABG), radical prostatectomy, transurethral resection of the prostate (TURP) and spinal cord injury, and in patients taking antidepressants/antipsychotics and anti-hypertensives/diuretics. high blood pressure VIAGRA contains sildenafil, which is the same medicine found in another drug called REVATIO.

What is Sildenafil Citrate?

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: Recommended Storage: Store at 25°C (77°F); excursions permitted to 15–30°C (59–86°F) [see USP Controlled Room Temperature]. Advise the patient to read the FDA-approved patient labeling (Patient Information) Physicians should discuss with patients the contraindication of VIAGRA with regular and/or intermittent use of nitric oxide donors, such as organic nitrates or organic nitrites in any form [see Contraindications (4.1) ]. Physicians should discuss with patients the contraindication of VIAGRA with use of guanylate cyclase stimulators such as riociguat [see Contraindications (4.3) ]. Concomitant Use with Drugs Which Lower Blood Pressure Physicians should advise patients of the potential for VIAGRA to augment the blood pressure lowering effect of alpha-blockers and anti-hypertensive medications. Concomitant administration of VIAGRA and an alpha-blocker may lead to symptomatic hypotension in some patients.

Common Adverse Effects

Therefore, when VIAGRA is sildenafil spray co-administered with alpha-blockers, patients should be stable on alpha-blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at the lowest dose [see Warnings and Precautions (5.5) ]. Patients who experience symptoms (e.g., angina pectoris, dizziness, nausea) upon initiation of sexual activity should be advised to refrain from further activity and should discuss the episode with their physician [see Warnings and Precautions (5.1) ]. 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. 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 (5.3) and Adverse Reactions (6.2) ]. 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 (5.4) and Adverse Reactions (6.2) ].

Does Viagra prevent ejaculation?

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 (5.2) ]. Physicians should inform patients not to take VIAGRA with other PDE5 inhibitors including REVATIO or other pulmonary arterial hypertension (PAH) treatments containing sildenafil. Sildenafil is also marketed as REVATIO for the treatment of PAH. The safety and efficacy of VIAGRA with other PDE5 inhibitors, including REVATIO, have not been studied [see Warnings and Precautions (5.7) ]. VIAGRA should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil]).