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How should this medicine be used?

Doses range from 25 milligrams to 100 milligrams, depending on the drug's effect. The usual dose is 50 milligrams. If you are over 65, have liver or kidney problems, or are taking erythromycin, ketoco nazole, itraconazole, ritonavir, or saquinavir a dose of 25 milligrams may be sufficient. Your doctor will adjust the dosage if the drug is not working properly for you.

Take Viagra only bef ore sexual activity. The manufacturer recommends a maximum of 1 dose per day (1 dose every 2 days for those taking ritonavir).

To avoid low blood pressure, do not take the 50-milligram or 10 0-milligram dose of Viagra within 4 hours of taking an alpha-blocking drug such as Cardura.

Precautions Before Using This Medicine

If you have heart problems severe enough to make sexual activity a danger, you should avoid using Viagra. Use it cautiously--if at all--if you've had a heart attack, stroke, or life-threatening heart irregularities within the past 6 months. Be equally cautious if you have severe high or low blood pressure, heart failure, or unstable angina (crushing heart pain that occurs at any time).

I f you have a condition that might result in long-lasting erections, such as sickle cell anemia, multiple myeloma (a disease of the bone marrow), or leukemia, use Viagra with caution. Also use cautious ly if you have a genital problem or deformity such as Peyronie's disease.

What is this Drug

Viagra (sil-DEN-a-fil) belongs to a group of medicines that delay the enzymes called phosphodiesterases from working too quickly. The penis is one of the areas where these enzymes work. Viagra is used to treat men who have erectile dysfunction (also called sexual impotence).

By controlling the enzyme phosphodiesterase, Viagra helps to maintain an erection that is produced when the penis i s stroked. Without physical action to the penis, such as that occurring during sexual intercourse, Viagra will not work to cause an erection

What special precautions should I follow?

The presence of other medical problems may affect the use of Viagra. Make sure you tell your doctor if you have any other medical problems, especially:
- Arrhythmias (irregular heartbeat) or
- Conditions causing thickened blood or slower blood flow, including leukemia; multiple myeloma (tumors of the bone marrow); or polycythemia, sickle cell disease, and thrombocythemia (blood problems) or
- Priapism (history of)¡XAlthough Viagra does not cause priapism (erection lasting longer than 6 hours), patients with these conditions have an increased risk of priapism and it could occur w ile using Viagra

Drug Interactions

If Viagra is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Viagra with the foll owing:

- Other impotence remedies including Caverject and Muse
- Alpha-blockers such as doxazosin (Cardura)
- Amlodipine (Norvasc)
- Cimetidine (Tagamet)
- Erythromycin ( E-Mycin, Ery-Tab, PCE)
- Itraconazole (Sporanox)
- Ketoconazole (Nizoral)
- Nitrates such as Isordil, Nitro-Bid, and Nitro-Dur
- Rifampin (Rifadin, Rimactane)
- Ritonavir (Nor vir)
- Saquinavir (Fortovase, Invirase)

Precautions while Using this Medicine

Use Viagra exactly as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. If too much is used, the chance of side effects is increased.
-
If you experience a prolonged or painful erection for 4 hours or more, contact your doctor immediately. This condition may require prompt medical treatment to prevent tissue damage of the penis and possi ble permanent impotence.


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