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The manufacturers of PDE type 5 inhibitors state that these drugs are contraindicated in any patient receiving organic nitrates or nitrites, either regularly or intermittently and in any form (e. At least 19 deaths have been reported in patients who may have taken sildenafil and who took or were given nitroglycerin or another nitrate/nitrite or who were found with nitroglycerin in their possession. ...

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Other reported clinical experience has not identified differences in response between geriatric and younger patients with PAH. The greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly should be considered in dosage selection for the treatment of PAH. Sildenafil did not exhibit evidence of mutagenicity in vitro in bacterial and Chinese hamster ovary cell assays. Pooled data from 8 controlled clinical trials indicate that sildenafil is comparably effective in geriatric men 65 years of age and older compared with younger men with ED. However, because pharmacokinetic studies revealed decreased clearance of sildenafil and increased (by 40% area under the plasma concentration-time curve (AUC) in healthy geriatric individuals Clinical studies of sildenafil for PAH did not include sufficient numbers of patients 65 years of age or older to determine whether they respond differently than younger adults. ...

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The 10-mg IV dose of sildenafil is predicted to produce pharmacologic effects of sildenafil and its N-desmethyl metabolite equivalent to the 20-mg oral dose. Sildenafil appears to be widely distributed in the body, with a reported volume of distribution at steady state averaging 105 L. It is not known whether sildenafil is distributed into milk. In a study in patients with ED secondary to radical prostatectomy, the estimated duration of vaginal intercourse achieved with a 100-mg sildenafil dose averaged about 7 minutes. ...

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These experts state that combined use of a PDE type 5 inhibitor with a prostanoid or an endothelin-receptor antagonist (added sequentially) may be considered; however, concomitant use of PDE type 5 inhibitors and riociguat is contraindicated because of the risk of hypotension. Combination therapy with drugs that target the different pathophysiologic pathways in PAH may provide additive and/or synergistic benefits. ...

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VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects. If you havethese symptoms, stop taking VIAGRA and contact a doctor right away have or have had heart problems such as a heart attack, rregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure have problems with your blood cells such as sickle cellanemia, multiple myeloma, or leukemia Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, nd herbal supplements. ...

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In these studies, sildenafil improved several aspects of sexual function including frequency, firmness, and maintenance of erection; frequency of orgasm; satisfaction and enjoyment of intercourse; and overall relationship satisfaction. In several randomized, double-blind, placebo-controlled studies in patients receiving sildenafil (flexible doses up to 100 mg or fixed doses ranging from 10-100 mg for 12 weeks) for the treatment of ED attributed to complications of diabetes mellitus, complications of spinal cord injury, or psychogenic causes. r 70% of all attempts at intercourse were successful, respectively, compared with 12, 13, or 29% of all attempts in those receiving placebo. ...

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In another study in such patients, the onset of penile erectile activity was approximately 30-40 minutes after 50-mg dosing, but visual sexual stimulation was not initiated until 30 minutes after dosing in this study. In a study in which sildenafil was combined with visual sexual stimulation in patients with erectile dysfunction (ED) that was not of established organic cause, the median time to onset of penile erectile activity was 19 minutes (range: 12-33 minutes) after oral administration of a single 50-mg dose; visual stimulation was initiated 10 minutes after dosing. ...

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Although no appreciable pharmacokinetic interaction between sildenafil and warfarin was observed in patients with PAH receiving the drugs concomitantly, the incidence of epistaxis was higher (9% than in those receiving sildenafil alone (2% Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics with CYP2D6 inhibitors (such as selective serotonin-reuptake inhibitorsSSRIs, or tricyclic antidepressants) Concomitant administration of sildenafil (80 mg 3 times daily) and epoprostenol resulted in a slight decrease (28% in sildenafil exposure and an approximate 22% decrease in mean steady-state sildenafil concentrations; these reductions are not considered clinically important. tolbutamide, warfarin) or CYP3A4-mediated (e. ritonavir, saquinavir) metabolism by sildenafil in clinical studies. ...

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Amagra-100 is available as packs of four chewable tabs of per pack and in four flavours including banana, pineapple, orange and strawberry. amagra-100 relaxes the blood vessels in the penis increasing blood flow and causing an erection, which is the natural response to sexual stimulation. owever, Kamagra Chewable tabs 100mg will only work if you are sexually aroused. ...

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2017M3A9C. Speakto your doctor about how any drug interactions are being managed or should bemanaged. his research was supported by the Bio Medical Technology Development Program of the National Research Foundation (NRF) and funded by the Korean government (MSIT) (No. ...

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It should be recognized that reduction of blood pressure itself may cause a decrease of perfusion in genital organs. If ED develops after the initiation of antihypertensive drug therapy, the offending agent should be discontinued if possible and an alternative antihypertensive initiated. ...

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Results of the extension study indicate that the effect of sildenafil on exercise capacity is maintained after 1 year of treatment. Following completion of the 12-week study, patients entered into an uncontrolled extension study. ...

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In a separate RigiScan study, sildenafil was still able to produce an erection in response to sexual stimulation 4-5 hours post-dose. Two clinical studies were specifically designed to assess the time window after dosing during which sildenafil could produce an erection in response to sexual stimulation. In a penile plethysmography (RigiScan) study of fasted patients, the median time to onset for those who obtained erections of 60% rigidity (sufficient for sexual intercourse) was 25 minutes (range 12-37 minutes) on sildenafil. ...

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He patient addressed both questions at the final visit for the last 4 weeks of the study. he possible categorical responses to these questions were (0) no attempted intercourse, (1) never or almost never, (2) a few times, (3) sometimes, (4) most times, and (5) almost always or always. wo of the questions from the IIEF served as primary study endpoints; categorical responses were elicited to questions about (1) the ability to achieve erections sufficient for sexual intercourse and (2) the maintenance of erections after penetration. ...

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It has been suggested that blue/green color discrimination impairment could lead to pilot error in detecting taxiway, tower, and runway lights or in detecting color differences in video terminal displays. It has been suggested that at least 6 hours elapse between use of sildenafil in pilots and engagement in flying. In addition, there are theoretical concerns that regular use of sildenafil may be incompatible with safe flight by pilots, air traffic controllers, or others who rely on fluorescent video terminal displays. ...

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In vitro studies indicate that sildenafil is a weak inhibitor of the CYP isoenzymes 1A2, 2C9, 2C19, 2D6, 2E1, and 3A4. Clinically important pharmacokinetic interactions also have been reported with several antiretroviral agents that inhibit CYP3A4 (e. ritonavir, saquinavir) and potentially could result in an increase in sildenafil-associated adverse effects. ...

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Ou may also consider printing out a copy for yourself. efore prescribing, please refer to the patient information. You can view the document and also download it on your computer. ...

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El m dico debe evaluar cuidadosamente la necesidad cl nica de sildenafilo de la madre y cualquier posible efecto adverso en el lactante. En los ensayos cl nicos con sildenafilo se notificaron mareos y trastornos visuales, por lo tanto, los pacientes deben saber c mo les puede afectar antes de conducir veh culos o utilizar maquinas. No se dispone de datos cl nicos sobre los efectos adversos en los lactantes, pero no se espera que las cantidades ingeridas causen efectos adversos. ...

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The effect of severe hepatic impairment on the pharmacokinetics of sildenafil has not been evaluated to date. In addition, AUCs and peak plasma concentrations of the N-demethylated metabolite are 200 and 79% greater, respectively, than those in individuals with normal renal function. In patients with hepatic cirrhosis (Child-Pugh class A or B) sildenafil clearance also is reduced, resulting in increased AUCs (by 85% and peak plasma concentrations (by 47% compared with values observed in age-matched healthy adults. ...

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