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Thus, the current study demonstrated similar efficacy, although the improvement in the placebo group was larger. It is well documented that in comparison with other disease-specific populations, the efficacy of sildenafil is lower in men with diabetes. (19) reported improved erections in 77–88% of men with broad spectrum ED receiving sildenafil.

Similarly, men with spinal cord injury (20) or depression (21) demonstrated high response rates to sildenafil (78 and 69%, respectively).

The reason for poorer efficacy in the diabetic population is thought to be the multifactorial nature of the disease.

Poor vascular blood supply to the penile arteries as a result of macrovascular disease and atherosclerotic lesions (22), reduced production of nitric oxide and cyclic guanosine monophosphate in the corpus cavernosum as a result of advanced glycosylation product accumulation (23), and impaired neurogenic and endothelium-dependent relaxation of penile arteries (24) all contribute to diabetes-associated ED. Moreover, concomitant medications frequently used in diabetic patients, such as antihypertensive agents (?-blockers, calcium channel antagonists) (25) and lipid-lowering drugs (fibrates, statins) can contribute to a reduced efficacy of sildenafil (26). Patients with type 1 diabetes are often relatively young and may thus benefit from a well-tolerated treatment regimen.

The drop-out rate with sildenafil treatment is low compared with that for other treatments for ED, such as intracavernosal injections, which have a high attrition rate, pain with injection, or nodule formation (27), and penile implants, which may require implant removal because of infection (28).

However, because sildenafil does not resolve ED in all patients with diabetes, each patient should be given information on other treatment options that have shown efficacy for this population.

The efficacy and safety of sildenafil have been assessed from more than 11,000 patient-years of observation in controlled clinical trials, many of which focused on and/or included men with diabetes (29). The safety profile of sildenafil in this study of men with ED and type 1 diabetes is in agreement with previous reports in which the most common adverse events associated with use of sildenafil in flexible-dose studies were headache (20%), flushing (18%), dyspepsia (8%), and visual disturbances (2%), all consistent with the known pharmacological effects of the drug (30). These effects were generally transient and mild to moderate in nature, and the rate of discontinuations because of these events was similar for patients receiving placebo (2.2%) or sildenafil (1.1%). All clinical studies conducted so far have shown that the incidence of adverse events and the rate of discontinuations attributed to them are similar in patients with diabetes compared with patients without diabetes (?2%) (31). Adverse effects on metabolic control are an important consideration when treating patients with diabetes.

There is no indication from clinical trial data that cheap viagra pills for sale sildenafil adversely affects blood glucose levels in patients with diabetes; furthermore, in a previously published study in 21 men with type 1 or 2 diabetes, no clinically significant changes in laboratory test results were observed, suggesting that sildenafil did not impair metabolic control (15). In summary, ED is known to occur with greater frequency in patients with type 1 diabetes than in the general population (32).

It is thus encouraging that treatment with sildenafil was able to improve erections and was well tolerated in men with ED and concomitant diabetes in this study, irrespective of ED severity, level of metabolic control, smoking status, or the presence of cardiovascular complications. Therefore, unless there is a contraindication to the use of sildenafil, it would be reasonable for sildenafil to be considered the initial therapeutic choice for patients with ED and concomitant type 1 diabetes. sildenafil (injection) Pronunciation: sil DEN a fil. What is the most important information I should know about injectable sildenafil?

Some medicines can cause unwanted or dangerous effects when used with sildenafil. Tell your doctor about all your current medicines, especially riociguat (Adempas). Do not use sildenafil if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as "poppers." Using sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure. Do not use sildenafil injection with Viagra similar medications such as avanafil (Stendra), tadalafil (Cialis) or vardenafil (Levitra).

Tell your doctor about all medications you use for erectile dysfunction. Get emergency medical help if you have ringing in your ears, sudden hearing loss, or sudden vision loss.

Sildenafil relaxes muscles of the blood vessels and increases blood flow to particular areas of the body. Sildenafil injection (Revatio) is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women.

Another brand of sildenafil is Viagra , which is used to treat erectile dysfunction (impotence) in men. Revatio is used to treat PAH in both men and women. Do not use sildenafil injection while also taking Viagra or other erectile dysfunction medications, unless your doctor tells you to.

Sildenafil injection may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before using injectable sildenafil?

You should not use sildenafil injection if you are allergic to it, or: if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas).

Do not use sildenafil injection if you are also taking a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate.

Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers").

Using sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure. To make sure this medicine is safe for you, tell your doctor if you have ever had: heart disease or heart rhythm problems, angina (chest pain), coronary artery disease, circulation problems; a condition called pulmonary veno-occlusive disease; a heart attack, stroke, or congestive heart failure; high or low blood pressure; liver or kidney disease; a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia; a bleeding disorder such as hemophilia; a stomach ulcer; retinitis pigmentosa (an inherited condition of

the

Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether sildenafil passes into breast milk or if it could harm a nursing baby.

Do not viagra cost walgreens give this medication to anyone under 18 years old without medical advice.

This medicine is injected into a vein through an IV. Do not self-inject sildenafil if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

Sildenafil injection is usually given three times each day.

Do not use this medicine in larger or smaller amounts or for longer than recommended. Prepare your dose only when you are

ready

Do not use if the medicine has changed colors or has particles in it.

Use a disposable needle only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it).

Keep this container out of the reach of children and pets.

Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated.

These conditions may cause very low blood pressure. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Store at room temperature away from moisture and heat. Skip the missed dose if it is almost time for your next scheduled dose.

Do not use extra medicine to make up the missed dose. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while using injectable sildenafil? Avoid using other medicines to treat impotence without your doctor's advice.

What are the possible side effects of injectable sildenafil? Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using sildenafil and get emergency medical help if you have: heart attack symptoms --chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; vision changes or sudden vision loss; or erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis). Call your doctor at once if you have: ringing in your ears, or sudden hearing loss; irregular heartbeat; swelling in your hands, ankles, or feet; shortness of breath; or a light-headed feeling, like you might pass out. Common side effects may include: nosebleed; headache; upset stomach; viagra cost walgreens flushing (warmth, redness, or tingly feeling); sleep problems (insomnia); or runny or stuffy nose. This is not a complete list of side effects and others may occur.

Call your doctor for medical advice about side effects.

You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect injectable sildenafil?

Do not use Revatio with Viagra or similar medications such as avanafil (Stendra), tadalafil (Cialis) viagra cost walgreens or vardenafil (Levitra).

Tell your doctor about all medications you use for erectile dysfunction.

Tell your doctor about all your current medicines and any you start or stop using, especially: drugs to treat high blood pressure or a prostate disorder; an antibiotic --clarithromycin, erythromycin, or telithromycin; antifungal medicine --ketoconazole or itraconazole; or medicine to treat HIV/AIDS --atazanavir, indinavir, ritonavir, or saquinavir.

Other drugs may interact with sildenafil, including prescription and over-the-counter medicines, vitamins, and herbal products.

Not all possible interactions are listed in this medication guide.

Your pharmacist can provide more information about sildenafil injection.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive.

Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy.

Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z. Sildenafil belongs to a group of medications called phosphodiesterase type 5 inhibitors.

It is used for the treatment of erectile dysfunction (male impotence). It helps to achieve and keep an erection sufficient for sexual activity.

It does this by allowing a greater blood flow into the penis when a man is sexually aroused. It works only with sexual stimulation and does not increase sexual desire. This medication may be available under multiple brand names and/or in several different forms.

Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. Your doctor may have suggested this medication for conditions other than those listed in these drug information articles.

If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do.

It can be harmful for people to take this medication if their doctor has not prescribed it. 25 mg Each blue, diamond-shaped, film-coated tablet engraved with "N" on one side and "25" on the other side, contains sildenafil 25 mg.

Nonmedicinal ingredients : croscarmellose sodium, dibasic calcium phosphate, FD&C Blue No.

2/Indigo Carmine Aluminum Lake, microcrystalline cellulose, magnesium stearate, polyethylene glycol, talc, and titanium dioxide. 50 mg Each blue, diamond-shaped, film-coated tablet engraved with "N" on one side and "50" on the other side, contains sildenafil 50 mg.

Nonmedicinal ingredients : croscarmellose sodium, dibasic calcium phosphate, FD&C Blue No.

2/Indigo Carmine Aluminum Lake, microcrystalline cellulose, magnesium stearate, polyethylene glycol, talc, and titanium dioxide.

100 mg Each blue, diamond-shaped, film-coated tablet engraved with "N" on one side and "100" on the other side, contains sildenafil 100 mg. Nonmedicinal ingredients : croscarmellose sodium, dibasic calcium phosphate, FD&C Blue No.

2/Indigo Carmine Aluminum Lake, microcrystalline cellulose, magnesium stearate, polyethylene glycol, talc, and titanium dioxide.

The usual recommended dose is 50 mg taken as needed, approximately 30 to 60 minutes before sexual activity.

However, the medication may be taken any time from 4 hours to half an hour before sexual activity. Based on the effectiveness and side effects of the medication, the dose may be increased to 100 mg or decreased to 25 mg.

The maximum recommended dose is 100 mg and it is not recommended to take more than one dose per day.

Sildenafil may be taken with or without food, but taking it with a high-fat meal may increase the time before the medication starts working. Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor. It is important to take this medication exactly as prescribed by your doctor. Do not take higher doses of this medication than those prescribed by your doctor. Contact your doctor if you take a greater dose of sildenafil than prescribed.

Store this medication in its original package at room temperature, protect it from moisture, and keep it out of the reach of children. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Do not take sildenafil if you: are allergic to sildenafil or any ingredients of this medication

are

Nitrate medications include nitroglycerin and related medications that are used for the relief of chest pain or angina. They also include amyl nitrite "poppers." Use of these medications with sildenafil could cause a sudden severe drop in blood pressure that could lead to dizziness, fainting, heart attack, or stroke.

are taking the medication riociguat have been advised by your doctor not to engage in sexual activity have a history of vision problems related to nerve damage to the retina caused by decreased blood flow. Nitrates buy viagra online forum are found in medications that are used to treat angina (chest pain). If you are not sure if you are taking nitrates, ask your doctor or pharmacist. Nitrates must NOT be taken by anyone who is using sildenafil because they can cause your blood pressure to drop very low.

This may cause dizziness, fainting, heart attack, or stroke.

What side effects are possible with this medication? A side effect is an unwanted response to a medication when it is taken in normal doses.

Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication.

If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. The following side effects have been reported by at least 1% of people taking this medication.

Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

cough dizziness, particularly when rising from a sitting or lying position dry mouth flushing headache sleepiness stuffy nose. Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of

the

Stop taking the medication and seek immediate medical attention if any of the following occur: chest pains, an irregular heartbeat, or shortness of breath when starting or following sexual activity (if you have a heart condition) prolonged (longer than 4 hours), painful, or inappropriate erection of penis seizures signs of an allergic reaction (e.g., rash, itching, shortness of breath; swollen face, lips, or throat) signs of bleeding from the lungs (e.g., difficulty breathing, bluish colouring of the lips; and skin, cool, clammy skin) signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort signs of stroke (e.g., sudden or severe headache, sudden loss of coordination, vision changes, sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg) Some people may experience side effects other than those listed.

Check with your doctor if you viagra cost walgreens notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors

may

Alcohol: Consumption of alcohol in large amounts may decrease the ability to get an erection and may also temporarily decrease blood pressure, causing dizziness and fainting. Blood pressure: Tell your doctor if you are taking medications to treat high blood pressure.

The combination of these medications and sildenafil may add to the blood pressure-lowering effect of these medications.

You should also let your doctor know if you have or have had low blood pressure. Grapefruit juice: Grapefruit juice can increase the amount of sildenafil in your bloodstream. Do not drink grapefruit juice when taking this medication.

Hearing problems: If you experience a sudden decrease or loss of hearing you should seek medical attention immediately. Heart conditions: If you have or have had heart disease or a heart attack or stroke, you should speak to your doctor before taking any medication for erectile dysfunction.

If chest pains, dizziness, or nausea are experienced during sex, the exertion should be stopped and your doctor informed.