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Sexual activity may be a strain on your heart, especially if you have heart disease.

If you experience chest pain, dizziness, or nausea during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise. tell all your healthcare providers that you are taking sildenafil.

If you ever need emergency medical treatment for a heart problem, the healthcare providers who treat you will need to know when you last took sildenafil. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.

If you are taking sildenafil for erectile dysfunction, you are unlikely to miss a dose since this medication is taken as needed, not on a regular dosing schedule.

If you are taking sildenafil for PAH, take the missed dose as soon as you remember it.

However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn diarrhea flushing (feeling of warmth) nosebleeds difficulty falling asleep or staying asleep numbness, burning, or tingling in the arms, hands, feet, or legs muscle aches changes in color vision (seeing a blue tinge on objects or having difficulty telling the difference between blue and green) sensitivity to light. If you experience any of the following symptoms, call your doctor immediately: sudden severe loss of vision (see below for more information) blurred vision sudden decrease or loss of hearing ringing in ears dizziness or lightheadedness fainting chest pain worsening shortness of breath erection that is painful or lasts longer than 4 hours itching or burning during urination rash.

Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil.

It is not known if the vision loss was caused by the medication. If you experience a sudden loss of vision while you are taking sildenafil, call your doctor immediately. Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.

There have been reports of heart attack, stroke, irregular heartbeat, bleeding in the brain or lungs, high blood pressure, and sudden death in men who took sildenafil for erectile dysfunction.

Most, but not all, of these people had heart problems before taking sildenafil.

It is not known whether these events were caused by sildenafil, sexual activity, heart disease, or a combination of these and other causes.Talk to your doctor about the risks of taking sildenafil.

Some patients experienced a sudden decrease or loss of hearing after they took sildenafil or other medications that are similar to sildenafil. The hearing loss usually involved only one ear and did not always improve when the medication was stopped.

It is not known if the hearing loss was caused by the medication.

If you experience a sudden loss of hearing, sometimes with ringing in the ears or dizziness, while you are taking sildenafil, call your doctor immediately.

If you are taking sildenafil (Viagra) for erectile dysfunction, do not take any more doses of sildenafil (Viagra) or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.

If you are taking sildenafil (Revatio) for PAH, do not stop taking your medication until you talk to your doctor. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and cipla viagra tablets Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not viagra without doctor in the bathroom). Store the suspension at room temperature or in a refrigerator, but do not freeze it. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily.

To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet.

Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. In case of overdose, call the poison control helpline at 1-800-222-1222.

Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital.

It is also important information to carry with you in case of emergencies. Revatio В® Viagra В® AHFS В® Patient Medication Informationв„ў. The American Society of Health-System Pharmacists В® , 4500 East-West Highway, Suite

900

Duplication for commercial use must be authorized by ASHP. Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. ED is defined as trouble getting or keeping an erection that's firm enough for sex. Though it's not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated. Most often when blood flow in the penis is limited or nerves are harmed With stress or emotional reasons As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes.

Finding the cause(s) of your ED will help treat the problem and help with your overall well-being. As a rule, what's good for your heart health is good for your sex health.

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum).

During erection, the spongy tissues relax and trap blood. The blood pressure in the chambers makes the penis firm, causing an erection.

When a man has an orgasm, a second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man's circulation and the erection comes down.

When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold or worry; this is normal and reflects the balance of blood coming into and leaving the penis.

With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex.

When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man's vascular system.

Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs.

ED also causes: Low self-esteem Depression Distress for the man and his partner. If ED is affecting a man's well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man's life.

ED can result from health problems, emotional issues, or from both. Some known risk factors are: Being over age 50 Having high blood sugar (Diabetes) Having high blood pressure Having cardiovascular disease Having high cholesterol Smoking Using drugs or drinking too much alcohol Being obese Lacking exercise. Even though ED becomes more common as men age, growing old is not always going to cause ED.

ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step. ED happens when: There is not enough blood flows into the penis Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.

The penis cannot trap blood during an erection If blood does not stay in the penis, a man cannot keep an erection. Nerve signals from the brain or spinal cord do not reach the penis Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.

Diabetes can cause small vessel disease or nerve damage to the penis Cancer treatments near the pelvis can affect the penis' functionality Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.

Drugs used to treat other health problems can negatively impact erections Patients should talk about drug side effects with their primary care doctors. Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.

Some emotional issues that can cause ED are: Depression Anxiety Relationship conflicts Stress at home or work Stress from social, cultural or religious conflicts Worry about sex performance.

Finding the cause of your ED will help direct your treatment options.

Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem.

Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment. Questions about your health: What prescription drugs, over-the-counter drugs or supplements do you take?

Have you had surgery or radiation therapy in the pelvic area?

Do you have other health problems (treated or untreated)?

Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing.

However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you. Questions about your ED symptoms: How long have you had these symptoms?

Do you wake up in the morning or during the night with an erection? Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation? Do you have problems with ejaculation or orgasm (climax)? How is this problem changing the way you enjoy sex?

Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage. Your health care provider may ask you questions about depression or anxiety.

He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

Are you often under a lot of stress, or has something recently upset you?

Do you have any anxiety, depression or other mental health issues?

Examination focusing on your genitals (penis and testicles) is often done to check for ED.

Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. Most patients do not need a lot of testing before starting treatment.

Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm. For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails. Blood work to check Testosterone and other male hormones Blood work to measure blood sugar (Diabetes) Ultrasonography (penile Doppler) to check blood flow A shot into the penis with a vascular stimulant to cause an erection Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection. The treatment for ED starts with taking care of your heart and vascular health. Your doctor may point out ‘risk factors' that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol. You may be offered alternatives to the drugs you take.

(Never stop or change prescription drugs without first talking to your health care provider.) Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life's stressors, depression or anxiety from past problems with ED (performance anxiety).

The treatments below are available to treat ED directly. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option: Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S.

for ED (Viagra, Cialis, Levitra, Stendra) Testosterone Therapy (when low testosterone is detected in blood testing) Penile Injections (ICI, intracavernosal Alprostadil) Intraurethral medication (IU, Alprostadil) Vacuum Erection Devices Penile Implants Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma.

Penile vascular surgery is not recommended for older men with hardened arteries.

Oral Drugs (PDE5 inhibitors) Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.

Viagra ® (sildenafil citrate) Levitra ® (vardenafil HCl) Cialis ® (tadalafil) Stendra ® (avanafil) For best results, men with ED take these pills about an hour or two before having sex.

The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis.

About 7 out of 10 men do well and have better erections.

Response rates are lower for Diabetics and cancer patients. If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health. Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are: Headache Stuffy nose Facial flushing Muscle aches Indigestion. In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time.

In rare cases, the drug Cialis ® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body.

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors). A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes.

With proper training, 75 out of 100 men can get a working erection using a vacuum erection device. If oral drugs don't work, the drug Alprostadil is approved for use in men with ED.

This drug comes in two forms, based on how it is to be used: intracavernosal injection (called "ICI") or through the urethra (called "IU therapy"). Alprostadil is injected into the side of penis with a very fine needle.

It's of great value to have the first shot in the doctor's office before doing this on your own.

Self-injection lessons should be given in your doctor's office by an experienced professional.

The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment.

Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.

ICI Alprostadil may be used as a mixture with two other drugs to treat ED.

This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED.

Only the Alprostadil ingredient is FDA approved for ED.

The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's

dosage

ICI therapy often produces a reliable erection,

which

Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours.

Failure to undo priapism will lead to permanent penile damage and untreatable ED. For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don't have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage. The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down. The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options. Penile implants are devices that are placed fully inside your body.

They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous.

Semi rigid Implant (Bendable) The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man's penis the firmness needed for sexual penetration.

The implant can be bent downward for peeing or upward for sex. With an inflatable implant , fluid-filled cylinders are placed

lengthwise

Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles).

When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner.

Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate.

There is generally no change to a man's feeling or orgasm. Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing.

The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum. A patient will either go home on the same day or spend one night in the hospital. Recovery Time after Penile Implants: Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs. Discomfort, bruising and swelling after the surgery will last for a few weeks. For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period. Men most often start having sex with their penile implants by eight weeks after surgery.