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A borderline low plasma testosterone is rarely significant in otherwise healthy men presenting with erectile difficulty, particularly if the plasma LH is normal.

Patients with hyperprolactinaemia require evaluation for a prolactinoma and their management is dictated by the pituitary tumour. For microprolactinomas, bromocriptine treatment alone can be effective.

The more common macroprolactinomas usually require surgery, sometimes with adjuvant radiotherapy. Intracavernosal therapy Due to the lack of specific treatments for most causes of erectile dysfunction, intracavernosal injections are in wide use.

They represent a major advance in the empirical treatment of erectile dysfunction. The original drug used for intracavernosal therapy was papaverine, a smooth muscle relaxant, often supplemented with phentolamine, an alpha adrenergic blocker. Neither is registered for treatment of erectile dysfunction in any country.

Despite the wide ad hoc usage of these two drugs and their combination, there is little reliable information on their efficacy or safety.

Indeed, there is doubt that these combinations are chemically compatible, stable or sterile under the usual circumstances of use.

The main reason for the preference for prostaglandin E 1 over the papaverine or papaverine/phentolamine combination is that these older drugs are believed to have a

higher

Prostaglandin E 1 Prostaglandin E 1 has the most extensive efficacy and safety record, making it the current drug of choice.

It relaxes the smooth muscle of the corpora cavernosa, resulting in a dose-dependent increase in penile blood inflow and tumescence.

The magnitude of the blood flow and erectile response varies between individuals and according to the

pathology

The usual starting dose of prostaglandin E 1 is 2.5-5 micrograms.

Generally, men with vasculogenic impotence require higher doses than those with neurogenic or psychogenic impotence. The optimal dose for each patient varies considerably and must be individually titrated by progressively increasing the dose (up to a maximum of 30 micrograms) with successive test injections until an adequate response is achieved.

In practical terms, this is defined as an erection firm enough for penetration and lasting from 20-60 minutes.

The first injection (at least) should be given under the direct supervision of a doctor and the patient subsequently taught how to self-inject. It is not sufficient just to send the patient home with a prescription and diagram on how to self-inject any more than it is appropriate to ask a diabetic to start insulin self-injection without careful instruction and supervision. Intracavernosal therapy should generally be supervised by a doctor with appropriate experience.

If an inadequate response is achieved with maximal prostaglandin E 1 dosage, combination therapy with papaverine alone or with phentolamine has been reported to improve the response.

Reliable clinical trials of such add-on therapy are lacking.

The risk of adverse effects (priapism, fibrosis, hepatotoxicity, hypotension) is higher with such multi-drug regimens. In addition, the chemical compatibility, stability and sterility of these ad hoc mixtures is not assured.

The most frequent adverse effect of prostaglandin E 1 intracavernosal therapy is penile or perineal pain.

Some pain occurs after approximately 20% of injections, but is rarely ( Erectile dysfunction treatment. When Roman started, 80% of Viagra sold online was counterfeit.

It became our mission to make it safe and simple for people to get medication they can trust from a licensed pharmacy, prescribed by a real, US-licensed healthcare professional. Erectile dysfunction is the inability to get or maintain an erection adequate for sex.

There are many different causes, but ED ultimately occurs when there is too little blood flow into the penis and too much blood flow out, partially due to an enzyme called PDE5.

Oral ED medications block PDE5 to increase blood flow into the penis and decrease blood flow out. ED medication interferes with the breakdown of chemicals required to obtain and maintain an erection.

This interference keeps more of those chemicals in action longer, improving the ability to get and maintain an erection.

A physician in our network will evaluate whether ED treatment is appropriate for you. If prescribed, we’ll ship it to you in discreet, unmarked packaging. Do not use Viagra/sildenafil if you aren’t healthy enough for sex or if you take nitrates for chest pain. Side effects may include headache, flushing, upset stomach, nasal congestion and abnormal vision.

To avoid injury, seek immediate attention if you have an erection lasting longer than 4 hours.

Stop taking Viagra/sildenafil and seek care if you experience a sudden loss or decrease in vision or hearing. Do not use Viagra if you aren’t healthy enough for sex or if you take nitrates for chest pain.

Side effects may include headache, flushing, upset stomach, nasal congestion and abnormal vision.

To avoid injury, seek immediate attention if you have an erection lasting longer than 4 hours. Stop taking Viagra and seek care if you experience a sudden loss or decrease in vision or hearing.

Do not take Cialis if

you

Stop taking Cialis and seek care if you experience a sudden loss or decrease in vision or hearing or if you experience an allergic reaction like rash, hives, swelling of the lips, tongue or throat, or difficulty breathing or swallowing. To learn more about Cialis, please see the Important Safety Information.

Sildenafil & Viagra manufactured by Pfizer in France.

A physician in our network will evaluate which (if any) ED treatment is appropriate for you. Then

we’ll

Many people get great results the first time they use the medication.

For some, it can take 2-3 uses to see results, and research shows that best results occur after 8 uses . If you still don’t see results, your doctor or nurse practitioner may be able to increase your dose or cialis price no prescription switch you to a different medication. If you experience side effects, message your doctor or nurse practitioner and they’ll help determine if a different medication or dose is better for you.

Sexual health and overall health are inherently related. If erectile dysfunction is interrupting your sex life, your general wellbeing (and that of your partner) is impacted greatly.

Report your symptoms and medical history to a U.S.-licensed physician or nurse practitioner for evaluation.

Your treatment will be sent in discreet packaging, always with free 2-day shipping. Send your doctor or nurse practitioner a message any time to discuss updating your treatment, solving for side effects, or any other questions or concerns. For more information about erectile dysfunction, Roman, Ro and more, visit our FAQ page. To speak to a care representative, give us a call at (888) 798-8686 or email us at [email protected] .

Roman uses telemedicine technology to provide a discreet, convenient, and affordable way for you to receive erectile dysfunction treatment from a U.S.

Complete the dynamic onboarding, submit your photo, ID, and recent blood pressure reading, and our physicians will determine if you’re a candidate for telemedicine. Erectile dysfunction is often a symptom of a more serious underlying condition—like heart disease, diabetes, high blood pressure, or even depression. That’s why we strongly recommend optional laboratory tests. These tests aren’t required to receive treatment on the Roman platform.

But they help identify the underlying cause of your ED.

We want you to get the most comprehensive treatment possible. Just send us your most recent blood test and we’ll add it to your account information to help our physicians give you the most comprehensive care from the convenience of your phone.It might sound funny but regular erections are a great barometer of your overall health.

Learn why paying attention to the strength and frequency of your erection

might

Viagra’s FDA approved prescribing information claims that “82% of patients reported an improvement in their erections.” Other PDE-5 inhibitors (Cialis, Levitra) showed similar results. Oral ED medication is generally considered extremely effective and studies show it works on the majority of men.

It’s important to note that everyone’s reaction to a medication is unique.

Your Roman physician may recommend trying the medication multiple times under different circumstances. They may also increase your dose, depending on your reaction to the medication and any side effects. If you’ve been prescribed ED medication on the Roman platform, please contact a physician on from your account page if you have any questions.

Can a doctor or nurse practitioner diagnose erectile dysfunction remotely? Erectile dysfunction can be diagnosed by a physician based on a patient self-reporting their symptoms and medical history.

Physicians on the Roman platform use telemedicine technologies to diagnose ED in the same way they diagnose patients in-person. Doctors ask you questions to evaluate your symptoms and make sure it’s safe and appropriate to prescribe ED medication. The physicians on the Roman platform use your answers to diagnose your condition and create a treatment plan.

That’s why it’s vital you answer each question to the best of your knowledge and ensure that every communication with your physician is truthful, accurate, and thorough. Why do I need to know my blood pressure to get an ED prescription?

Your blood pressure is an important part of determining

whether

If you’re measuring your blood pressure at home, make sure the device has been “clinically validated.” You can purchase a device online or at your local pharmacy.

We recommend an upper arm cuff over a wrist or finger blood pressure monitor. Before taking your blood pressure, it’s important to avoid the following factors that may cause your blood pressure to temporarily rise: Cold temperatures Exercise Caffeine Stress Smoking Certain medications (check the label on your device) When you’re ready, find a quiet place and sit for 5-10 minutes.

Make sure you’re relaxed and have recently urinated (a full bladder can affect your reading). Apply the cuff on your upper arm and following the directions on the device.Please make sure to take at least two readings.

Enter the higher of the two readings during your online dynamic visit.

Do you offer alternative treatments for erectile dysfunction? Oral ED medications are extremely effective, but they don’t work for everyone. Other treatment options for ED include lifestyle improvements (like exercise, diet, quitting smoking, and limiting alcohol use), surgery, penile vacuum pumps, and other ED medications.

Every treatment comes with risks and benefits that you should fully understand before moving forward with any treatment plan.

Currently, the only erectile dysfunction treatment we offer are oral PDE-5 inhibitors in the form of: If you’d like to pursue alternative ED treatment, we recommend speaking with a physician in-person.

Contact our team at [email protected] and we can recommend a doctor in your area. Orders ship in discreet boxes, with all medication in single use packs. Child proof packaging is available upon request by emailing [email protected] Orders are shipped 2-day air to ensure medication is received as soon as possible.

Postal boxes and mail forwarding addresses will receive standard postal shipping and not 2-day air at this time. Where can I get my blood pressure measured for free?

Enter your location into higi or Pursuant Health to find the nearest location to get a free, clinically verified blood pressure reading. Higi Stations are available free of charge at Rite Aids nationwide, and Pursuant Health stations are available free of charge at Walmarts nationwide. According to the American Urological Association, oral PDE-5 inhibitors should be offered as the “first line of therapy for erectile dysfunction.” So that’s what physicians on the Roman platform use to treat ED.

The most common PDE-5 oral medications they prescribe are: Sildenafil (Viagra) Sildenafil (sildenafil) Tadalafil (Cialis) From treating specific conditions to helping you tackle life-threatening addictions and supporting your body’s natural systems. Starting at $35/Month* Starting at $25/Month* Starting at $15/Month* *Shipped & billed quarterly. Final price depending on prescribed treatment plan.

From receding hairlines, to thinning hair, to breakouts, to fine lines or wrinkles—tell us what’s bothering you so we can help. Starting at $31/Month* Starting at $22/Month* Starting at $29/Month* *Shipped & billed quarterly.

Final price depending on prescribed treatment plan.

Get discreet and genuine prescription medications (if prescribed) or over-the-counter treatment delivered in unmarked packaging. Erectile dysfunction Premature ejaculation Hair loss Cold sores Genital herpes Heart Health Bone Health Stress Relief Prostate Health Testosterone Support Weight management Allergies Nightly Defense skincare Eczema Dandruff Excessive sweating (hyperhidrosis) About Roman. How it works Our story Our medical advisors Our network physicians Transparency Member stories Health Guide Press Careers. Roman-affiliated physician practices are independently owned and operated by licensed physicians who provide services utilizing the Roman telehealth platform. Major League Baseball trademarks and copyrights are used with permission of Major League Baseball.

Erectile dysfunction Premature ejaculation Cold sores Genital herpes. Hair loss treatment Nightly Defense skincare Eczema Dandruff Excessive sweating (hyperhidrosis) Daily health. Allergies Heart health Bone health Stress relief Prostate health Testosterone support.

Sildenafil 20mg (generic revatio) Read this Patient Information before you start taking sildenafil 20 mg (Revatio) and each time you get a refill.

This information does not take the place of talking with your doctor about your medical condition or treatment. If you have any questions about sildenafil, ask your doctor or pharmacist. What is the most important information I should know about sildenafil 20 mg tablets (Revatio)?

Your blood pressure could drop quickly to an unsafe level. Nitrate medicines include: Medicines that treat chest pain (angina) Nitroglycerin in any form including tablets, patches, sprays, and ointments Isosorbide mononitrate or dinitrate Street drugs called “poppers” (amyl nitrate or nitrite) Ask your doctor or pharmacist if you are not sure if you are taking a nitrate medicine. 20 mg sildenafil is a prescription medicine used in adults to treat pulmonary arterial hypertension (PAH).

With PAH, the blood pressure in your lungs is too high.

Your heart has to work hard to pump blood into your lungs.

It improves the ability to exercise and can slow down worsening changes in your physical condition. Sildenafil is not for use in children Adding sildenafil to another medication used to treat PAH, bosentan (Tracleer®), does not result in improvement in your ability to exercise. 20 mg sildenafil tablets contain the same medicine as VIAGRA® (sildenafil), which is used to treat erectile dysfunction (impotence). Do not take 20 mg sildenafil tablets with VIAGRA or other PDE-5 inhibitors.

Who should not take sildenafil 20 mg tablets (Revatio)?

Do not take sildenafil if you: Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension.

Your blood pressure could drop to an unsafe level Are allergic to sildenafil, as contained in VIAGRA ® and REVATIO ® You’ve ever had blockage of veins in your lungs, which is called pulmonary veno-occlusive disease Are a women or a child.

Before you take sildenafil, 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 pulmonary hypertension Have had a stroke Have low blood pressure, or high blood pressure that is not controlled Have a deformed penis shape 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 NAION Have bleeding problems Have or have had stomach or intestinal ulcers Have liver problems Have kidney problems or are having kidney dialysis Have any problem with the shape of your penis or Peyronie’s disease Have any other medical conditions. Tell your healthcare provider about all the medicines you take , including prescription and over-the-counter medicines, vitamins, and herbal supplements.

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

Especially tell your healthcare provider if you take any of the following: Medicines called nitrates Medicines called guanylate cyclase stimulators such as Adempas ® (riociguat) Medicines called alpha-blockers such as Hytrin ® (terazosin HCl), Flomax ® (tamsulosin HCl), Cardura ® (doxazosin mesylate), Minipress ® (prazosin HCl), Uroxatral ® (alfuzosin HCl), Jalyn ® (dutasteride and tamsulosin HCl), or Rapaflo ® (silodosin). 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 ® ) Oral antifungal medicines, such as buy viagra prescription ketoconazole (Nizoral ® ) and itraconazole (Sporanox ® ) Antibiotics, such as clarithromycin (Biaxin ® ), telithromycin (Ketek ® ), or erythromycin Other medicines that treat high blood pressure K antagonists (like coumadin or warfarin) Other

medicines

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]) Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

How should I take sildenafil 20 mg tablets (Revatio)?

Sildenafil may be prescribed to you as tablets or an oral suspension Take sildenafil tablet or oral suspension 3 times a day about 4 to 6 hours apart Take sildenafil tablets or oral suspension at the same times every day.

Sildenafil oral suspension will be mixed for you by your pharmacist.

Do not mix sildenafil oral suspension with other medicine or flavoring. Shake well for at least 10 seconds before each dose.

If you miss a dose, take it as soon as you remember. If it is close to your next dose, skip the missed dose, and take your next dose at the regular time. Do not take more than one dose of sildenafil at a

time

If you take too much sildenafil, call your doctor or go to the nearest hospital emergency room. What are the possible side effects of sildenafil 20 mg tablets (Revatio)? Low blood pressure may cause you to feel faint or dizzy.

Tell your doctor if you get more short of breath after you start REVATIO. More shortness of breath than usual may be due to your underlying medical condition.

decreased eyesight or loss of sight in one or both eyes (NAION).

If you notice a sudden decrease or loss of eyesight, talk to your doctor right away.

If you notice a sudden decrease or loss of hearing, talk to your doctor right away.

It is not possible to determine whether these events are related directly to this class of oral medicines, including REVATIO, or to other diseases or medicines, to other factors, or to a combination of factors.

heart attack, stroke, irregular heartbeats, and death.

Most of these happened in men who already had heart problems. Tell your doctor right away if you have an erection that lasts more than 4 hours.

The most common side effects with sildenafil 20 mg tablets (Revatio) include: Nosebleed Headache upset stomach getting red or hot in the face (flushing) trouble sleeping Fever erection increased respiratory infection Nausea Vomiting Bronchitis Pharyngitis runny nose pneumonia in children. Tell your doctor if you have any side effect that bothers you or doesn’t go away.These are not all the possible side effects of REVATIO. For more information, ask 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.

How should I store sildenafil 20 mg tablets (Revatio)? Store tablets at controlled room temperature, between 20°C -25°C (68°F to 77°F).

Store constituted oral suspension below 30°C (86°F) or in a refrigerator between 2°C to 8°C (36°F to 46°F).

General information about sildenafil 20 mg tablets (Revatio) Medicines are sometimes prescribed for purposes that are not in the patient leaflet.