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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. Do not change your dose or stop taking sildenafil on your own. 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.

Do not use REVATIO for a condition for which it was not prescribed.

Do not give REVATIO to other people, even if they have the same symptoms you have.

This patient leaflet summarizes the most important information about REVATIO. If you would like more information about REVATIO talk with your doctor. You can ask your doctor or pharmacist for information about REVATIO that is written for health professionals.For more information go to www.REVATIO.com or call 1-800-879-3477. What are the ingredients in sildenafil 20 mg tablets (Revatio)? Active ingredients: sildenafil citrate Inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose monohydrate, and triacetin.

Erectile dysfunction (impotence) Erection problems (impotence) are very common, particularly in men over 40. It's usually nothing to worry about, but you should see a GP if it keeps happening.

Most men occasionally fail to get or keep an erection. This is

usually

If it happens more often, it may be caused by physical or emotional problems.

Non-urgent advice: See a GP or go to a sexual health clinic if: erection problems keep happening. It could be a sign of an underlying health condition. How sexual health clinics can help with erection problems. They can provide the same treatment you would get at your GP surgery. Many sexual health clinics offer a walk-in service, where you do not need an appointment. They'll often get test results quicker than GP practices.

The doctor or nurse will ask about your lifestyle and relationships, and any problems you might be having. They'll carry out basic health checks, such as taking your blood pressure. They'll also examine your genitals to rule out any obvious physical cause.

If you have symptoms like needing to pee more often, your doctor may also need to examine your prostate. Treatment for erection problems depends on the cause. Treatments for erectile dysfunction are much better than they used to be, and the problem often goes away.

There are specific treatments for some of the causes of erectile dysfunction. Treatments for some causes of erectile dysfunction Possible cause Treatment Narrowing of penis blood vessels, high blood pressure, high cholesterol Medicine to lower blood pressure, statins to lower cholesterol Hormone problems Hormone replacement (for example, testosterone) Side effects of prescribed medication Change to medicine after discussion with GP. Medicine such as sildenafil (sold as Viagra) is also often used by doctors to treat

erectile

But

have

Nearly all men will experience some erectile dysfunction for the first few months after prostate cancer treatment. However, within one year after treatment, nearly all men with intact nerves will see a substantial improvement.

Within one year, about 40 to 50% of men will have returned to their pre-treatment function. After two years, about 30 to 60% will have returned to pre-treatment function.

These rates vary widely depending on the surgeon and how the extent of “nerve sparing” a surgeon can perform at the time of surgery. About 25 to 50% of men who undergo brachytherapy will experience erectile dysfunction vs. nearly 50% of men who have standard external beam radiation. After two to three years, few men will see much of an improvement and occasionally these numbers worsen over time.

Men who undergo procedures not designed to minimize side effects and/or those whose treatments are administered by physicians who are not proficient in the procedures will fare worse.

Men with other diseases or disorders that impair their ability to maintain an erection (diabetes, vascular problems, etc.) will have a more difficult time returning to pre-treatment function.

Oral medications relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 36 hours. About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they

are

The vacuum constriction device creates an erection mechanically by

forcing

A three-pieced surgically inserted penile implant includes a narrow flexible plastic tube inserted along the length of the penis, a small balloon-like structure filled with fluid attached to the abdominal wall, and a release button inserted into the testicle. The penis remains flaccid until an erection is desired, at which point the release button is pressed and fluid from the balloon rushes into the plastic tube. As the tube straightens from being filled with the fluid, it pulls the penis up with it, creating an erection. Assuming the mechanics are working correctly, it is 100% effective, and about 70% of men remain satisfied with their implants even after 10 years.

Because this procedure is done under general anesthesia, it is not available to men who are not considered good candidates for surgery because of other health reasons.

Erectile Dysfunction Following Radical Prostatectomy. Assuming the management of erectile dysfunction

requires

Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing. Treatment follows diagnosis, and we provide a range of treatment options through the Clinic.

Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis.

Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences. Psychological treatment is an important adjunct to managing erectile dysfunction.

If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic. For instance, there may be relationship problems that negatively affect sexual functioning with your partner.

Referrals can be made to the Johns Hopkins' noted Sexual Behaviors Consultation Unit. Erectile dysfunction following radical prostatectomy for clinically localized prostate cancer is a known potential complication of the surgery.

With the advent of the nerve-sparing radical prostatectomy technique, many men can expect to recover erectile function in the current era.

However, despite expert application of the nerve-sparing prostatectomy technique, early recovery of natural erectile function is not common. Increasing attention has been given to this problem in recent years with the advancement of possible new therapeutic options to enhance erection function recovery following this surgery.

This topic area was handled thoroughly in an article written by Dr.

Burnett, entitled "Erectile Dysfunction Following Radical Prostatectomy," published in the Journal of the American Medical Association, June 1, 2005.

Using a question and answer format, excerpts from this article are provided below. What is the importance of preserved erectile function?

In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function. This matter is frequently important to young men who by age status are more likely to have intact erectile function than older men; however, for all men having normal preoperative erectile function irrespective of age, preservation of this function is understandably important postoperatively.

What are the current expectations with regard to outcomes after radical prostatectomy? Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes.

Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 (PDE5) inhibitors within 2 years. Why is there increasing concern at this time regarding erectile dysfunction issues following radical prostatectomy?

The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas.

Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.

Why does it take so long to recover erections after the very best surgery? A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma.

The most obvious determinant of postoperative erectile dysfunction is preoperative potency status. Some men may experience a decline in erectile function over time, as an age-dependent process.

Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include older age, comorbid disease states (e.g., cardiovascular disease, diabetes mellitus), lifestyle factors (e.g., cigarette smoking, physical inactivity), and the use of medications such as antihypertensive agents that have antierectile effects.

Are there any surgical techniques that have been developed to improve erectile function outcomes?

At this time, there are several different surgical approaches to carry out the surgery, including retropubic (abdominal) or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.

Is another treatment option better for preservation of erectile function? The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate,

precipitous

What current options exist to treat erectile dysfunction after radical prostatectomy? Options include pharmacologic and nonpharmacologic interventions.

Pharmacotherapies include the oral PDE-5 inhibitors (sildenafil [Viagra®], tadalafil [Cialis®], and vardenafil [Levitra®]), intraurethral suppositories (MUSE®), and intracavernous injections (prostaglandin E1and vasoactive drug mixtures). Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants (prostheses).

Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile

prosthesis

A relatively new strategy in clinical management after radical prostatectomy has arisen from the idea that early induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity.

There is an interest in using oral PDE5 inhibitors for this purpose, since this therapy is noninvasive, convenient, and highly tolerable. However, while the early, regular use of PDE5 inhibitors or other currently available, "on-demand" therapies is widely touted after surgery for purposes of erection rehabilitation, such therapy is mainly empiric. Are there new strategies in the near future that may be helpful in improving erection recovery after surgery?

Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy.

The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly

applicable

Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy. Book a free appointment for COVID-19 antibody testing. Speak to a board certified doctor, securely from your phone or computer and get a prescription for Erectile Dysfunction in 15 minutes.

Combined with lifestyle changes ED medication can help you achieve and maintain an erection so you can get your sex life back.

Our doctors also write refills on existing medications.

(The cost of your visit will be the same as your office copay) Get Your Prescription Fast.

Erectile dysfunction can be a frustrating experience

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Online appointments are a discreet and private way to make sure your personal needs are taken care of. PlushCare maintains a 97% patient satisfaction

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You can speak with a top doctor from your phone or computer,

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Which pill works best varies from person to person. That said some of the most commonly used and

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If our online doctors find that you may benefit from Viagra they will electronically send a prescription for it to the pharmacy of your choice. When you run out of medication, they can prescribe a refill.

If the doctor finds that a Cialis prescription may help with your ED they will electronically send a prescription to the pharmacy of your choice.

There are over the counter ED treatments available however, they are proven to be less effective than prescription medications such as Viagra, Cialis and Levitra. It’s important to speak with a doctor to make sure an underlying medical condition, such as heart disease, is not causing your ED. Some common causes of ED are: aging, medical conditions, obesity, medication side effects, psychological conditions, drug or alcohol use, tobacco use, injuries. The average man stays

erect

Studies show ED medication is effective for about 7 out of 10 men.

Visit with a doctor on your smartphone or computer.

We can send prescriptions to any local pharmacy or by mail.

Your doctor will work with you on a treatment plan, which may include lifestyle changes and medication such as: Who Cannot Take ED Medication.

In fact some medical conditions make taking oral ED medication extremely dangerous. ED medication should not be mixed with the following conditions and/or medications: People taking nitrates, including isosorbide dinitrate & isosorbide mononitrate.

People who have had a heart attack or stroke in the past 6 months.

This is not a complete list of conditions and it is extremely important to disclose your entire medical history and prescription history to your doctor before being prescribed ED medication. An FDA investigation showed that medications and supplements bought online without prescriptions aren’t always what they seem.

For example, Viagra samples bought online without a prescription contained only 10% of the advertised strength.