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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 a little longer to start working. If you accidentally take too much Viagra, call your doctor or go to the nearest buy sildenafil without a prescription hospital emergency room right away. Nitrates: Administration of VIAGRA to patients using nitric oxide donors, such as organic nitrates or organic nitrites in any form either regularly and/or intermittently, is contraindicated.

VIAGRA was shown to potentiate the hypotensive effect of nitrates. Concomitant Guanylate Cyclase (GC) Stimulators: Do not use VIAGRA in patients who are using a GC stimulator, such as riociguat.

PDE5 inhibitors, including VIAGRA, may potentiate the hypotensive effects of GC stimulators.

Hypersensitivity Reactions: VIAGRA is contraindicated in patients with a known hypersensitivity to sildenafil, as contained in VIAGRA and REVATIO, or any component of the tablet. Hypersensitivity reactions have been reported including rash and urticaria.

Cardiovascular: Patients should not use VIAGRA if sexual activity is inadvisable due to cardiovascular status.

Physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by the vasodilatory effects of VIAGRA, especially in combination with sexual activity. There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with the following characteristics: recent serious cardiovascular events, hypotension, or uncontrolled hypertension; if prescribed, this should be done with caution. Prolonged Erection: Prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently. In the event of an erection that persists 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. Use VIAGRA with caution in patients predisposed to priapism.

Effects on the Eye: Patients should stop VIAGRA and seek medical care if a sudden loss of vision occurs in one or both eyes, which could be a sign of non-arteritic anterior ischemic optic neuropathy (NAION). VIAGRA should be used with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION. Patients with a "crowded" optic disc may also be at an increased risk of NAION.

There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with retinitis pigmentosa; if prescribed, this should be done with caution.

Hearing Loss: Sudden decrease or loss of hearing has been reported in temporal association with the intake of PDE5 inhibitors, including VIAGRA.

(It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors.) Physicians should advise patients to stop taking PDE5 inhibitors, including VIAGRA,

and

seek prompt medical attention in the event of sudden decrease or loss of hearing.

Potential Drug Interactions: VIAGRA can potentiate the hypotensive effects of nitrates, alpha-blockers, and antihypertensives. Initiate VIAGRA buy sildenafil 100 mg at 25 mg with concomitant use of alpha-blockers. CYP3A4 inhibitors (eg, ritonavir, ketoconazole, itraconazole, erythromycin) increase VIAGRA plasma exposure. Do not exceed 25 mg of VIAGRA in a 48-hour period with ritonavir.

Consider a starting dose of 25 mg of VIAGRA with erythromycin or strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, saquinavir). Decreased blood pressure, syncope, and prolonged erection may occur at higher sildenafil exposures.

Specific Populations: Consider a starting dose of 25 mg of VIAGRA for patients age >65, patients with hepatic impairment, or severe renal impairment. Sexually Transmitted Diseases: Use of VIAGRA offers no protection against sexually transmitted diseases, including the human immunodeficiency virus (HIV); therefore, physicians should consider counseling their patients about protective measures.

Adverse Reactions: The most common adverse reactions (?2%) with VIAGRA 25 mg, 50 mg, 100 mg vs placebo, respectively, include headache (16%, 21%, 28% vs 7%), flushing (10%, 19%, 18% vs 2%), dyspepsia (3%, 9%, 17% vs 2%), abnormal vision (1%, 2%, 11% vs 1%), nasal congestion (4%, 4%, 9% vs 2%), back pain (3%, 4%, 4% vs 2%), myalgia (2%, 2%, 4% vs 1%), nausea (2%, 3%, 3% vs 1%), dizziness (3%, 4%, 3% vs 2%), and rash (1%, 2%, 3% vs 1%). VIAGRA ® (sildenafil citrate) is indicated for the treatment of erectile dysfunction (ED).

By participating in the VIAGRA Savings Offer Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below: This Savings Offer is not valid for prescriptions that are reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, Veterans Affairs healthcare, or any other federal or state healthcare program (including any state prescription drug assistance program), or the Government Health Insurance Plan available in Puerto Rico (formerly known as "La Reforma de Salud") The value of this Savings Offer is limited to $350 per use or the amount of your co-pay, whichever is less This Savings Offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf This Savings Offer is limited to 50% savings off the amount of your co-pay or your out-of-pocket cost, whichever is less, with a maximum savings of $350 off each prescription for up to 12 prescriptions in a calendar year. Total maximum savings for this Savings Offer are $4,200 You must be 18 years of age or older to redeem this Savings Offer Patients who are enrolled in Medicare, Medicaid, or another state or federal healthcare program may use this Savings Offer if paying for the prescription covered by this Savings Offer outside of their government insurance benefit, and no claim is submitted to Medicare, Medicaid, or any federal or state healthcare program.

Such patients must not apply any out-of-pocket expenses incurred using this Savings Offer toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D true out-of-pocket (TrOOP) costs You are responsible for reporting use of this Savings Offer to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using this Savings Offer, as may be required.

You should not use this Savings Offer if your insurer or health plan prohibits use of manufacturer Savings Offers This Savings Offer is not valid for Massachusetts or California residents whose prescriptions are covered, in whole or in part, by third-party insurance This Savings Offer is not valid where prohibited by law This Savings Offer cannot be combined with any other rebate/offer, free trial, or similar offer for the specified prescription This Savings Offer will be accepted only at participating pharmacies This Savings Offer is not health insurance This Savings Offer is good only in the U.S.

and Puerto Rico This Savings Offer is limited to 1 per person during this offering period and is not transferable No other purchase is necessary This Savings Offer may not be redeemed more than once per 30 days per patient Data related to your redemption of this Savings Offer may be collected, analyzed, and shared with Pfizer for market research and other purposes related to assessing Pfizer's programs.

Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other Savings Offer redemptions and will not identify you Pfizer reserves the right to rescind, revoke, or amend this Savings Offer without notice No membership fees.

The Savings Offer and Program expire on 12/31/2021 For further information, call 1-855-842-4722, visit VIAGRA.com , or write: Pfizer Inc., 235 E 42nd Street, New York, NY 10017.

If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this Savings Offer. Pay for your VIAGRA prescription and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: VIAGRA Savings Offer, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.

Be sure to include a copy of the front of your VIAGRA Savings Card, your name, and mailing address.

Please expect up to 4 to 6 weeks for reimbursement. Long-term safety and effectiveness of sildenafil citrate in men with erectile dysfunction. 1 Medical Affiliated Research Center, Huntsville, AL, USA.

2 Connecticut Clinical Research Center, Waterbury, CT, USA. 3 California Professional Research, Newport Beach, CA, USA.

5 Formerly Pfizer Global Research and Development, Sandwich, UK, currently PPD Inc, Cambridge, UK. 6 Members of the multicenter study group are listed in the appendix.

Because sildenafil citrate is a treatment, not a cure, for erectile dysfunction (ED), many men may choose to use it for an extended period.

Men with ED who had previously completed 1 of 4 double-blind trials with short-term open-label extension (combined duration, 0.9–1.2 years) were eligible for this 4-year, open-label, extension study, which assessed the safety and

effectiveness

of flexible doses (25, 50, and 100 mg sildenafil) used as needed. Adverse events that were serious or led to dosing changes or discontinuation (temporary or permanent) were recorded. Many of the 979 participants (mean age, 58 [range, 27–82] years; mean ED duration, 4.5 years) had concomitant hypertension (28%), diabetes (22%), or hyperlipidemia (14%). Overall, 37 (3.8%) had treatment-related adverse events (none serious) requiring dosage change or discontinuation and 62 (6.3%) discontinued because of

insufficient

response. At each yearly assessment, more than 94% of participants responded affirmatively to the questions: “Are you satisfied with the effect of treatment on your erections?” and “If yes, has treatment improved your ability to engage in sexual activity?” These results argue against the loss of tolerability or the development of tachyphylaxis over a prolonged period of as needed, flexible-dose sildenafil treatment of men with ED. In March 1998, the US Food and Drug Administration (FDA) approved sildenafil citrate (Viagra ® , Pfizer Inc, New York, NY, USA) for the treatment of erectile dysfunction (ED) (FDA 1998).

As of December 2005, more than 27 million men worldwide had received sildenafil for treatment of ED, including an estimated 17 million men in the US (Data on file, Pfizer Inc, New York, NY). Thus, the long-term safety and effectiveness of sildenafil can now buy sildenafil 100 mg be evaluated in men who have been taking the drug for several years. The efficacy, safety, and tolerability of sildenafil in the treatment of men

with

ED have been demonstrated in numerous studies of 1-year duration or less. For example, 1,358 men with ED completed 1 of 4 double-blind trials and continued with open-label sildenafil treatment in extension studies for a total treatment duration of approximately 1 year (Morales et al 1998; Steers et al 2001).

In the current study, 979 of these men subsequently received up to 4 more years of open-label, flexible-dose (25, 50, and 100 mg) sildenafil.

Preliminary (3-year) results were reported previously (Carson et sildenafil 100mg mexico al 2002; Padma-Nathan et al 2002), and we now present the final data. The population included patients with ED of organic and psychogenic etiology and typical concomitant medical conditions for this population (ie, hypertension, diabetes, hyperlipidemia, and a history of ischemic heart disease).

Our objective was to assess the long-term safety and

effectiveness

of sildenafil treatment in men with ED.

This was a 4-year, open-label, flexible-dose (25, 50, and 100 mg) study of sildenafil. Men who previously completed and were compliant with sildenafil or placebo treatment in 1 of 4 double-blind, placebo-controlled trials, and subsequently completed and were compliant with sildenafil treatment in initial open-label extension, were eligible for inclusion in this long-term extension study.

Compliance was assessed by medication diaries and by continued study participation. A total of 1,545 men were originally enrolled in the double-blind trials, with 1,358 of these men continuing in the initial

open-label

extension studies.

The current study includes 979 of the original patients, who agreed to participate in the long-term extension ( Figure 1 ).

The procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional). Number of patients and treatment duration in the original double-blind trials and the initial open-label extensions and disposition throughout 4 years of open-label, flexible-dose (25, 50, and 100 mg) sildenafil long-term extension study.



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