12 CLINICAL PHARMACOLOGY

It usually takes 30 to 60 minutes for sildenafil to work for erectile dysfunction.

4. Contraindications

Do not take sildenafil tablets if you take any other medicines called ''nitrates.'' Nitrates are used to treat chest pain (angina). Do not take sildenafil tablets if you take medicines called guanylate cyclase stimulators which include: • Riociguat (Adempas®) a medicine that treats pulmonary arterial hypertension and chronicthromboembolic pulmonary hypertension. Tell all your healthcare providers that you take sildenafil tablets.If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took sildenafil tablets. Sildenafil tablets helps a man with erectile dysfunction get and keep an erection only when he is sexually excited (stimulated). Do not take sildenafil tablets if you: • take medicines called ''nitrates'' (such as nitroglycerin) • use street drugs called ''poppers'' such as amyl nitrate or amyl nitrite, and butyl nitrate • take any medicines called guanylate cyclase stimulators such as riociguat (Adempas) • are allergic to sildenafil, as contained in sildenafil tablets and REVATIO, or any of the ingredients in sildenafil tablets.

Viagra Tablets

See the end of this leaflet for a complete list of ingredients in sildenafil tablets. What should I tell my healthcare provider before taking sildenafil tablets? Before you take sildenafil tablets, tell your healthcare provider if you: • have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve or heart failure • have had heart surgery within the last 6 months • have pulmonary hypertension • have had a stroke • have low blood pressure, or high blood pressure that is not controlled • have a deformed penis shape • have had an erection that lasted for more than 4 hours • have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia • have retinitis pigmentosa, a rare genetic (runs in families) eye disease • have ever had severe vision loss, including an eye problem called non-arteritic anterior ischemic optic neuropathy (NAION) • have bleeding problems • have or have had stomach ulcers • have liver problems • have kidney problems or are having kidney dialysis • have any other medical conditions Tell your healthcare provider about all the medicines you take*,including prescription and over-the-counter medicines, vitamins, and herbal supplements. Sildenafil tablets may affect the way other medicines work, and other medicines may affect the way sildenafil tablet works causing side effects. Especially tell your healthcare provider if you take any of the following: • medicines called nitrates (see 'What is the most important information I should know about sildenafil tablets?') • medicines called guanylate cyclase stimulators, such as riociguat (Adempas) • medicines called alpha blockers such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin). You can take it up to 4 hours before you want to have sex. Taking sildenafil alone will not cause an erection.

• Common adverse reactions (≥2%) include headache, flushing, and dyspepsia.
• Nasal congestion, back pain, and myalgia are also frequently reported.
• Diarrhea, dizziness, and rash occur in a smaller percentage of users.
• Visual disturbances (color tinge, blurred vision) are dose-related.
• These effects are usually mild to moderate and transient in nature.
• Serious cardiovascular events are rare but possible, especially in at-risk patients.
• Priapism is a urological emergency that requires immediate treatment.
• Sudden hearing loss, often accompanied by tinnitus and dizziness, is rare.
• Allergic reactions, including skin rash and itching, can occur.
• There have been reports of seizures and anxiety in post-marketing experience.
• Most side effects diminish with continued use or dose adjustment.

You need to be sexually excited for it to work.

Product	Dosage	Quantity + Bonus	Price
Viagra Generic	25mg	270 + 8 Pills	184.26€ 175.49€	Buy
Kamagra	100mg	360 + 6 Pills	839.95€ 799.95€	Buy
Viagra Generic	50mg	20 Pills	40.52€ 38.59€	Buy
Viagra Generic	25mg	90 + 6 Pills	105.03€ 100.03€	Buy
Viagra Generic	100mg	120 + 6 Pills	149.50€ 142.38€	Buy
Kamagra	100mg	60 + 4 Pills	201.34€ 191.75€	Buy
Kamagra Oral Jelly	100mg	110 + 9 Sachets	334.87€ 318.92€	Buy
Kamagra Polo	100mg	272 + 12 Pills	622.94€ 593.28€	Buy
Viagra Generic	25mg	20 Pills	37.74€ 35.94€	Buy
Viagra Generic	200mg	270 + 10 Pills	379.76€ 361.68€	Buy
Kamagra Soft Tabs	100mg	12 Pills	57.55€ 54.81€	Buy
Kamagra Oral Jelly	100mg	21 Sachets	95.92€ 91.35€	Buy
Kamagra Polo	100mg	60 + 4 Pills	189.39€ 180.37€	Buy
Viagra Generic	150mg	30 + 2 Pills	72.32€ 68.88€	Buy

The most common side effects are headaches, feeling sick, indigestion and dizziness.

Patient Group	Recommended Dose	Frequency of Use	Notes
First-time users	20 mg	Once per day	Take 30-60 min before activity
Experienced users	May increase to 50 mg	As needed	Under medical supervision
Elderly patients	20 mg or lower	As needed	Start with lowest dose
Patients on other medications	Consult doctor	Varies	Adjust dose accordingly

Many people have no side effects or only mild ones.

How to take tablets

What are the possible side effects of sildenafil tablets? Sildenafil tablets can cause serious side effects . Rarely reported side effects include: • an erection that will not go away (priapism). • sudden vision loss in one or both eyes. Stop taking sildenafil tablets and call your healthcare provider right away if you have sudden vision loss in one or both eyes.

Does sildenafil interact with foods or drinks?

If you have these symptoms, stop taking sildenafil tablets and contact a doctor right away. The most common side effects of sildenafil tablets are: • headache • flushing • upset stomach • abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision • stuffy or runny nose • back pain • muscle pain • nausea • dizziness • rash In addition, heart attack, stroke, irregular heartbeats and death have happened rarely in men taking sildenafil tablets. Most, but not all, of these men had heart problems before taking sildenafil tablets. It is not known if sildenafil tablets caused these problems. These are not all the possible side effects of sildenafil tablets. It can be dangerous to take sildenafil if you also take medicines called nitrates (often given for chest pain).

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

All brands listed are the registered trademarks of their respective owners and are not trademarks of Evaric Pharmaceuticals, Inc. Revised: 08/2019 Cialis vs Viagra - What's the difference between them? Sildenafil is a medicine used to treat erection problems (erectile dysfunction). Sildenafil is also sometimes used to treat pulmonary hypertension (high blood pressure in the blood vessels that supply the lungs). If you have erection problems sildenafil works by temporarily increasing blood flow to your penis when you get sexually excited. The combination can cause a dangerous fall in your blood pressure.

What other drugs will affect sildenafil?

• Store sildenafil tablets at room temperature between 20° to 25°C (68° to 77°F). Keep sildenafil tablets and all medicines out of the reach of children. General information about the safe and effective use of sildenafil tablets. Do not use sildenafil tablets for a condition for which it was not prescribed. Do not give sildenafil tablets to other people, even if they have the same symptoms that you have.

Missed Dose

This Patient Information leaflet summarizes the most important information about sildenafil tablets. You can ask your healthcare provider or pharmacist for information about sildenafil tablets that is written for health professionals. What are the ingredients in sildenafil tablets? This Patient Information has been approved by sildenafil citrate tablets 150 mg the U.S. Food and Drug Administration. If you're not sure if you're taking a nitrate, ask your doctor or pharmacist.

• Sildenafil enhances natural erectile response, requiring sexual stimulation.
• It is not effective as a contraceptive or protection against STDs.
• Alcohol consumption can impair its effectiveness and increase side effects.
• Be cautious if you have low blood pressure or heart issues.
• Combining sildenafil with other ED medications can be dangerous.

Do not drink grapefruit juice if you're taking sildenafil (Revatio) for pulmonary hypertension.

Renal Dose Adjustments

It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Warnings and Precautions (5.4)and Adverse Reactions (6.2)]. Priapism Physicians should warn patients that prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently since market approval of sildenafil tablets. Avoid Use with other PDE5 Inhibitors Physicians should inform patients not to take sildenafil tablets with other PDE5 inhibitors including REVATIO or other pulmonary arterial hypertension (PAH) treatments containing sildenafil. The safety and efficacy of sildenafil tablets with other PDE5 inhibitors, including REVATIO, have not been studied [see Warnings and Precautions(5.7)]. Sexually Transmitted Disease The use of sildenafil tablets offers no protection against sexually transmitted diseases.

What are the serious side effects of sildenafil?

Manufactured for: Camber Pharmaceuticals, Inc. Piscataway, NJ 08854. Manufactured by: Evaric Pharmaceuticals Inc. 155 COMMERCE DRIVE, HAUPPAUGE, New York (NY) 11788, United States (USA). Sildenafil Tablets, USP (sil den' a fil) What is the most important information I should know about sildenafil tablets? It affects the way the medicine works.

• Sildenafil helps facilitate natural arousal, not cause an instant erection.
• It is important to hydrate well when taking sildenafil.
• The medication can interact with certain herbal supplements.
• Avoid sharing medication with others due to potential health risks.
• Regular check-ups can help monitor the effects of sildenafil on health.

SILDENAFIL CITRATE- sildenafil citrate tablet, film coated Greenstone LLC What is the most important information I should know about SILDENAFIL CITRATE TABLETS?

What special precautions should I follow?

In pulmonary hypertension it works by relaxing blood vessels in the chest. If you buy sildenafil for erectile dysfunction, it can also be known by the brand names Viagra, Aronix, Liberize and Nipatra. Sildenafil for pulmonary hypertension can also be known by the brand names Revatio and Grandipam. This medicine is available on prescription and you can also buy it from most pharmacies. It comes as standard tablets, chewable tablets, and as a liquid that you swallow. SILDENAFIL CITRATE TABLETS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines.

Condition	Risk Factors	Recommendations
Use with Nitrates	Risk of severe hypotension	Avoid concurrent use
Severe Heart Disease	Increased cardiac stress	Consult cardiologist before use
Severe Liver or Kidney Impairment	Altered drug metabolism	Dose adjustment or avoid use
Hypotension	Blood pressure too low	Use caution, monitor blood pressure
Retinitis Pigmentosa	Risk of vision changes	Consult eye specialist

Do not take SILDENAFIL CITRATE TABLETS if you take any other medicines called "nitrates." Do not take SILDENAFIL CITRATE TABLETS if

INFORMATION ABOUT SILDENAFIL

In some patients, the use of sildenafil tablets with alpha-blockers can lead to a drop in blood pressure or to fainting. • medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase) or atazanavir sulfate (Reyataz) • some types of oral antifungal medicines, such as ketoconazole (Nizoral), and itraconozale (Sporanox) • some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin • other medicines that treat high blood pressure • other medicines or treatments for ED • sildenafil tablets contains sildenafil, which is the same medicine found in another drug called REVATIO. Sildenafil tablets should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil]). • Take sildenafil tablets exactly as your healthcare provider tells you to sildenafil citrate tablets for female take it. • Your healthcare provider will tell you how much sildenafil tablets to take and when to take it.

What Are the Available Sildenafil Dosages?

• Your healthcare provider may change your dose if needed. • Take sildenafil tablets about 1 hour before sexual activity. • Sildenafil tablets can be taken with or without food. If you take sildenafil tablets after a high fat meal (such as a cheeseburger and french fries), sildenafil tablets may take a little longer to start working • Do nottake sildenafil tablets more than 1 time a day. • If you accidentally take too much sildenafil tablets, call your doctor or go to the nearest hospital emergency room right away. you take medicines called guanylate cyclase stimulators which include: Riociguat (Adempas®) a medicine that treats pulmonary arterial hypertension and chronic-thromboembolic pulmonary hypertension.

• Special populations require careful consideration before prescribing.
• In elderly patients (65+), clearance may be reduced; start with a lower dose.
• No dose adjustment is typically needed for patients with mild renal impairment.
• For moderate renal impairment (CrCl 30-80 mL/min), caution is advised.
• In severe renal impairment (CrCl <30 mL/min), a 25mg dose is often recommended.
• For hepatic impairment (Child-Pugh A and B), a 25mg starting dose is advised.
• Sildenafil is not recommended for patients with severe hepatic impairment.
• Safety and efficacy in pediatric patients for ED have not been established.
• Revatio is approved for pediatric PAH patients aged 1 year and older.
• The dose for pediatric PAH is based on body weight and must be carefully calculated.
• Use during pregnancy is only for PAH and requires a careful risk/benefit analysis.