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It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.
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Life-changing problems or even everyday stress can trigger erectile dysfunction. Talking about these things with a licensed therapist can ease sexual anxiety and help you feel more confident in your relationship.
In healthy male volunteers, there was no evidence of a clinically significant effect of azithromycin (500 mg daily for 3 days) on the systemic exposure of sildenafil or its major circulating metabolite.

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8. When choosing an injection site, avoid any area where a vein is clearly visible. We recommend changing injection sites from left to right as well as up and down the shaft and back again to ensure that you do not develop scar tissue at one specific site.
Mayo Clinic “Acupuncture: Definition,” “Acupuncture: Why it’s done,” “Drugs and Supplements: DHEA,” “Dietary supplements for erectile dysfunction: A natural treatment for ED?”

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If the issue you’re facing is mild or you don’t like the idea of taking medication, you might want to start by trying natural techniques for treating your sexual health.

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Algorithm for evaluating and managing the patient with ED. CV, cardiovascular; CVD, cardiovascular disease; ED, erectile dysfunction.

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    If you are on treatment for a medical or psychiatric problem and you think that this treatment is affecting your sex life tell your doctor. Alternative treatments that may have less likelihood of affecting sexual function are often available.

    GAINSWave™, the latest ED treatment breakthrough, produces healthier, fuller, and more sustained erections for men with and without erectile dysfunction using this proven method.
    In addition, N-desmethyl metabolite AUC and Cmax values significantly increased by 200% and 79%, respectively in subjects with severe renal impairment compared to subjects with normal renal function.

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    You can get sildenafil on the NHS if you have erectile dysfunction or pulmonary hypertension.

    Viagra is an FDA-approved medication considered safe for use; however, it is available by prescription only and patients should talk to their doctor before use.
    Communication is the central pillar of any relationship. There’s nothing like opening up with your partner, and with a professional too perhaps, to help reduce your anxiety.

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    For some men, Viagra just may not be the right medication. Other PDE5 inhibitors may work better for you. In other cases, it could be that another underlying condition may be interfering with how the drug works. For instance, if you have low testosterone, you might also have low sex drive, which can make it difficult to achieve an erection. If this is the case, you may need both testosterone therapy and erectile dysfunction medications. Nerve damage, which is common in those that have diabetes, can also interfere with other necessary interactions in your body needed for an erection. Another common issue is if you have clogged arteries, which can block the increased blood flow from sildenafil. Therefore, there may be many different reasons Viagra might not work for you.

    First line treatment will be medication with a phosphodiesterase inhibitor such as sildenafil (Viagra), tadalafil (Cialis) or avanafil (Spedra). These drugs only work when used together with sexual stimulation and will have no effect on your sex drive. There is no evidence that these drugs are dangerous if you have underlying heart disease. However, they should not be used if you are taking nitrates (e.g. GTN, isosorbide) for angina
    A German study found that 69% of men involved in a sleep apnea study also suffered from ED. Disruptions to breathing during sleep affect oxygen levels in the blood, which can cause problems generating an erection. Lack of sleep also disrupts hormone production.

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    The authors would like to acknowledge the University of Gondar for its support and facilitation of the study. The authors also want to thank all the study participants for their collaboration and participation in the study. 1. Gebreyohannes EA, Bhagavathula AS, Gebresillassie BM, Tefera YG, Belachew SA, Erku DA. Recreational use of phosphodiesterase 5 inhibitors and its associated factors among undergraduate male students in an Ethiopian University: a cross-sectional study. World J Mens Health. (2016) 34:186–93. doi: 10.5534/wjmh.2016.34.3.186 2. Guay AT, Perez JB, Jacobson J, Newton RA. Efficacy and safety of sildenafil citrate for treatment of erectile dysfunction in a population with associated organic risk factors. J Androl. (2001) 22:793–7. Erratum in: J Androl. (2002) 23:113. doi: 10.1002/j.1939-4640.2001.tb02582.x 3. Harte CB, Meston CM. Recreational use of erectile dysfunction medications and its adverse effects on erectile function in young healthy men: the mediating role of confidence in erectile ability. J Sex Med. (2012) 9:1852–9. doi: 10.1111/j.1743-6109.2012.02755.x 4. Zusman RM, Morales A, Glasser DB, Osterloh IH. Overall cardiovascular profile of sildenafil citrate. Am J Cardiol. (1999) 83:35C−44C. doi: 10.1016/S0002-9149(99)00046-6 5. Delate T, Simmons VA, Motheral BR. Patterns of use of sildenafil among commercially insured adults in the United States: 1998-2002. Int J Impot Res. (2004) 16:313–8. doi: 10.1038/sj.ijir.3901191 6. Bechara A, Casabé A, De Bonis W, Helien A, Bertolino MV. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. (2010) 7:3736–42. doi: 10.1111/j.1743-6109.2010.01965.x 7. Makwana S, Solanki M., Raloti S., Dikshit R. Evaluation of recreational use of aphrodisiac drugs and its consequences: an online questionnaire based study. Int J Res Med. (2013) 1:51–9. 8. Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav. (2011) 40:597–606. doi: 10.1007/s10508-010-9619-y 9. Schnetzler G, Banks I, Kirby M, Zou KH, Symonds T. Characteristics, behaviors, and attitudes of men bypassing the healthcare system when obtaining phosphodiesterase type 5 inhibitors. J Sex Med. (2010) 7:1237–46. doi: 10.1111/j.1743-6109.2009.01674.x 10. Gebregeorgise DT, Belay YM, Kälvemark Sporrong S. Sildenafil citrate use in Addis Ababa: characteristics of users and pharmacists' dispensing practices. Int J Clin Pharm. (2018) 40:67–73. doi: 10.1007/s11096-017-0558-8 11. Both R. Sex, tension, and pills: young people's use of contemporary reproductive and sexual health technologies in Addis Ababa, Ethiopia (Doctoral dissertation). Anthropology Department, University of Amsterdam, Amsterdam, Netherland (2017). Available online at: https://pure.uva.nl/ws/files/9794196/Thesis_complete_.pdf 12. Both R. A matter of sexual confidence: young men's non-prescription use of Viagra in Addis Ababa, Ethiopia. Cult Health Sex. (2016) 18:495–508. doi: 10.1080/13691058.2015.1101489 13. Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, et al. Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee. Circulation. (1999) 99:168–77. doi: 10.1161/01.CIR.99.1.168 14. Santtila P, Sandnabba NK, Jern P, Varjonen M, Witting K, von der Pahlen B. Recreational use of erectile dysfunction medication may decrease confidence in ability to gain and hold erections in young males. Int J Impot Res. (2007) 19:591–6. doi: 10.1038/sj.ijir.3901584 15. Schiefer J, Sparing R. Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association? Int J Impot Res. (2005) 17:383–4. doi: 10.1038/sj.ijir.3901301 16. Pomara G, Morelli G, Menchini-Fabris F, Dinelli N, Campo G, LiGuori G, et al. Epistaxis after PDE-5 inhibitors misuse. Int J Impot Res. (2006) 18:213–4. doi: 10.1038/sj.ijir.3901383 17. Tiryakioglu SK, Tiryakioglu O, Turan T, Kumbay E. Aortic dissection due to sildenafil abuse. Interact Cardiovasc Thorac Surg. (2009) 9:141–3. doi: 10.1510/icvts.2009.205849 18. Nachtnebel A, Stöllberger C, Ehrlich M, Finsterer J. Aortic dissection after sildenafil-induced erection. South Med J. (2006) 99:1151–2. doi: 10.1097/01.smj.0000240732.65859.aa 19. Suleman S, Woliyi A, Woldemichael K, Tushune K, Duchateau L, Degroote A, et al. Pharmaceutical regulatory framework in ethiopia: a critical evaluation of its legal basis and implementation. Ethiop J Health Sci. (2016) 26:259–76. doi: 10.4314/ejhs.v26i3.9 20. Gebretekle GB, Serbessa MK. Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals' perspective. Antimicrob Resist Infect Control. (2016) 5:2. doi: 10.1186/s13756-016-0101-z 21. Jackson G, Montorsi P, Cheitlin MD. Cardiovascular safety of sildenafil citrate (Viagra): an updated perspective. Urology. (2006) 68(3 Suppl):47–60. doi: 10.1016/j.urology.2006.05.047 22. Kloner RA, Jackson G, Emmick JT, Mitchell MI, Bedding A, Warner MR, et al. Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men. J Urol. (2004) 172(5 Pt 1):1935–40. doi: 10.1097/01.ju.0000142687.75577.e4 23. Ethiopia CC. Summary and Statistical Report of the 2007 Population and Housing Census. Addis Ababa: Federal Democratic Republic of Ethiopia population Census Commission (2008). 24. Ausó E, Gómez-Vicente V, Esquiva G. Visual side effects linked to sildenafil consumption: an update. Biomedicines. (2021) 9:291. doi: 10.3390/biomedicines9030291 25. Gebreslassie M, Feleke A, Melese T. Psychoactive substances use and associated factors among Axum University students, Axum Town, North Ethiopia. BMC Public Health. (2013) 13:693. doi: 10.1186/1471-2458-13-693 26. Lindsey WT, Stewart D, Childress D. Drug interactions between common illicit drugs and prescription therapies. Am J Drug Alcohol Abuse. (2012) 38:334–43. doi: 10.3109/00952990.2011.643997 27. Murtadha M, Raslan MA, Fahmy SF, Sabri NA. Changes in the pharmacokinetics and pharmacodynamics of sildenafil in cigarette and cannabis smokers. Pharmaceutics. (2021) 13:876. doi: 10.3390/pharmaceutics13060876
    Never increase the dose by more than 0.05 cc or else you run the risk of a painful erection that may not go away. This could require a trip to the emergency room.

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This medication passes into breast milk in small amounts. Consult your doctor before breast-feeding.

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VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects. Especially tell your healthcare provider if you take any of the following:

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Use caution when co-administering alpha-blockers with VIAGRA because of potential additive blood pressure-lowering effects. When VIAGRA is co-administered with an alpha-blocker, patients should be stable on alpha-blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at the lowest dose [see DOSAGE AND ADMINISTRATION, WARNINGS AND PRECAUTIONS, CLINICAL PHARMACOLOGY].

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