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Concomitant use may lead to hypotension ( 5.5 ) Decreased blood pressure, syncope, and prolonged erection may occur at higher sildenafil exposures.

It is used to treat different types of bacterial infections, e.g. bladder inflammation.An observational study evaluated whether recent use of PDE5 inhibitors, as a class, was associated with acute onset of NAION.Others were reported to have occurred hours to days after the use of VIAGRA and sexual activity.

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Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state.Based upon measurements of sildenafil in semen of healthy volunteers 90 minutes after dosing, less than 0.001% of the administered dose may appear in the semen of patients.

The titration studies, in which most patients received 100 mg, showed similar results.Hepatic Impairment: In volunteers with hepatic impairment (Child-Pugh Class A and B), sildenafil clearance was reduced, resulting in increases in AUC (85%) and C max (47%) compared to age-matched volunteers with no hepatic impairment.Diary data indicated that on VIAGRA, 48% of intercourse attempts were successful versus 12% on placebo.Although men take Viagra, women experience its effects since it takes two to tango.

It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors.Tell your healthcare provider if you have any side effect that bothers you or does not go away.In addition, the combination of heparin and VIAGRA had an additive effect on bleeding time in the anesthetized rabbit, but this interaction has not been studied in humans.

If you have an erection that lasts more than 4 hours, get medical help right away.The evaluation of erectile dysfunction should include a determination of potential underlying causes and the identification of appropriate treatment following a complete medical assessment.Do not give VIAGRA to other people, even if they have the same symptoms that you have.Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of VIAGRA without sexual activity.Metabolic and Nutritional: thirst, edema, gout, unstable diabetes, hyperglycemia, peripheral edema, hyperuricemia, hypoglycemic reaction, hypernatremia.One-third to one-half of the subjects in these studies reported successful intercourse at least once during a 4-week, treatment-free run-in period.When VIAGRA is taken with a high fat meal, the rate of absorption is reduced, with a mean delay in T max of 60 minutes and a mean reduction in C max of 29%.Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a rare condition and a cause of decreased vision including permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors.

However, in vitro studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside (a nitric oxide donor).This metabolite has a PDE selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50% of the parent drug.The clinical relevance of this finding to men treated with VIAGRA for ED is not known.

Consideration should be given to the following: Patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of PDE5 inhibitors.Information about Viagra including how Viagra works, dosage, how much Viagra costs, and side effects of Viagra.During 3 to 6 months of double-blind treatment or longer-term (1 year), open-label studies, few patients withdrew from active treatment for any reason, including lack of effectiveness.Risk Summary Based on animal data, VIAGRA is not predicted to increase the risk of adverse developmental outcomes in humans.Figure 6 shows that regardless of the baseline levels of function, subsequent function in patients treated with VIAGRA was better than that seen in patients treated with placebo.The patient addressed both questions at the final visit for the last 4 weeks of the study.Some people may also have ringing in their ears (tinnitus) or dizziness.

Take VIAGRA exactly as your healthcare provider tells you to take it.Of the twenty subjects who were ultimately assigned to treatment, a total of 13 subjects successfully completed dose period 1, and seven had successfully completed the previous doxazosin study (using VIAGRA 50 mg).Sildenafil enhances the effect of NO by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum.Sildenafil is approximately 4,000-fold more selective for PDE5 compared to PDE3.Treatment with doxazosin continued for at least 7 days after dose period 1.

Men with untreated ED had relatively low baseline scores for all aspects of sexual function measured (again using a 5-point scale) in the IIEF.Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure.Analysis of the safety database from controlled clinical trials showed no apparent difference in adverse reactions in patients taking VIAGRA with and without anti-hypertensive medication.Following at least 14 consecutive daily doses of doxazosin, VIAGRA 100 mg or matching placebo was administered simultaneously with doxazosin.Thereafter, VIAGRA 100 mg or matching placebo was administered simultaneously with doxazosin 4 mg (14 subjects) or doxazosin 8 mg (6 subjects) in standard crossover fashion.Concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma levels of sildenafil.In placebo-controlled clinical studies, the discontinuation rate due to adverse reactions for VIAGRA (2.5%) was not significantly different from placebo (2.3%). In fixed-dose studies, the incidence of some adverse reactions increased with dose.Figure 3: Mean Standing Systolic Blood Pressure Change from Baseline Blood pressure was measured after administration of VIAGRA at the same times as those specified for the first doxazosin study.

After patients have taken VIAGRA, it is unknown when nitrates, if necessary, can be safely administered.For more information, ask your healthcare provider or pharmacist.Effects of VIAGRA on Vision: At single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels.Figure 2: Mean Standing Systolic Blood Pressure Change from Baseline Blood pressure was measured immediately pre-dose and at 15, 30, 45 minutes, and 1, 1.5, 2, 2.5, 3, 4, 6 and 8 hours after VIAGRA or matching placebo.Mutagenesis Sildenafil was negative in in vitro bacterial and Chinese hamster ovary cell assays to detect mutagenicity, and in vitro human lymphocytes and in vivo mouse micronucleus assays to detect clastogenicity.General information about the safe and effective use of VIAGRA.In a study of healthy male volunteers, sildenafil (100 mg) did not affect the steady state pharmacokinetics of the HIV protease inhibitors, saquinavir and ritonavir, both of which are CYP3A4 substrates.In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance.

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This Patient Information leaflet summarizes the most important information about VIAGRA.Sixty-three percent, 74%, and 82% of the patients on 25 mg, 50 mg and 100 mg of VIAGRA, respectively, reported an improvement in their erections, compared to 24% on placebo.However, VIAGRA may be taken anywhere from 30 minutes to 4 hours before sexual activity.Nervous: ataxia, hypertonia, neuralgia, neuropathy, paresthesia, tremor, vertigo, depression, insomnia, somnolence, abnormal dreams, reflexes decreased, hypesthesia.