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Use with caution in patients with the following underlying conditions which can be particularly sensitive to the actions of vasodilators including VIAGRA — those with left ventricular outflow obstruction e.
There are no controlled clinical data on the safety or efficacy of VIAGRA in the following groups; if prescribed, this should be done with caution.
In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result. VIAGRA should be used with caution in patients with anatomical deformation of the penis such as angulation, cavernosal fibrosis or Peyronie's disease , or in patients who have conditions which may predispose them to priapism such as sickle cell anemia, multiple myeloma, or leukemia.
However, there are no controlled clinical data on the safety or efficacy of VIAGRA in patients with sickle cell or related anemias. 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.
A similar study reported a consistent result, with a risk estimate of 2. Individuals with "crowded" optic disc are also considered at greater risk for NAION compared to the general population, however, evidence is insufficient to support screening of prospective users of PDE5 inhibitors, including VIAGRA, for this uncommon condition. There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with retinitis pigmentosa a minority of these patients have genetic disorders of retinal phosphodiesterases ; if prescribed, this should be done with caution.
It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions 6. When vasodilators are used in combination, an additive effect on blood pressure may occur. In some patients, concomitant use of these two drug classes can lower blood pressure significantly [see Drug Interactions 7. 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.
Patients should be stable on alpha-blocker therapy prior to initiating a PDE5 inhibitor. In those patients who are stable on alpha-blocker therapy, PDE5 inhibitors should be initiated at the lowest dose [see Dosage and Administration 2. In those patients already taking an optimized dose of a PDE5 inhibitor, alpha-blocker therapy should be initiated at the lowest dose. Stepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a PDE5 inhibitor.
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These messages cause certain chemicals to be released in your penis. One of these chemicals, called cyclic GMP, relaxes and widens certain blood vessels in your penis.
These actions allow blood to flow into the corpus cavernosum, which causes your penis to get hard and become erect. What happens with ED?
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