VIAGRA

Using directions

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).

If you take Viagra and develop cardiac symptoms (for example, dizziness, nausea, and chest pain) during sexual activity, do not continue. Alert your doctor to the problem as soon as possible.

If 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 cautiously if you have a genital problem or deformity such as Peyronie''s disease. If an erection lasts more than 4 hours, seek treatment immediately. Permanent damage and impotence could result.

If you have a bleeding disorder, a stomach ulcer, or the inherited eye condition known as retinitis pigmentosa, use this medication with caution. Its safety under these circumstances has not yet been studied.Remember that Viagra offers no protection from transmission of sexually transmitted diseases, such as HIV, the virus that causes AIDS.This drug is not for use by women. Its effects during pregnancy have not been studied.Taking Viagra approximately 1 hour before sexual activity works best for most men. Depending on how and when the drug works for you, an interval of one-half hour to as much as 4 hours may prove ideal.

--If you miss a dose... Viagra is not for regular use. Take it only before sexual activity.

--Storage instructions... Store at room temperature

Cautions

Do not take Viagra if you are taking any nitrate-based drug, including nitroglycerin patches (Nitro-Dur, Transderm-Nitro), nitroglycerin ointment (Nitro-Bid, Nitrol), nitroglycerin pills (Nitro-Bid, Nitrostat), and isosorbide pills (Dilatrate-SR, Isordil, Sorbitrate). Combining Viagra with these drugs can cause a severe drop in blood pressure. If Viagra gives you an allergic reaction, do not use it again.

Possible side effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Viagra.

More common side effects may include:

Abnormal vision (color tinge, blurring, sensitivity to light),acid indigestion, diarrhea, flushing, headache, nasal congestion, urinary tract infection

Less common to rare side effects may include:

Abdominal pain,abnormal dreams, abnormal ejaculation, allergic reactions, anxiety, asthma, bloodshot eyes, bone pain, breast enlargement, cataracts, chest pain, chills,coordination problems, cough,depression, difficulty breathing, difficulty swallowing, dilated pupils, dizziness, drowsiness, dry eyes, dry mouth, emotional or mental disturbances, eye inflammation or pain, other eye disorders, fainting,falling, genital problems, gout, gum inflammation, heart problems, increased night-time urination, increased pressure in the eyes, insomnia, itchy skin, joint disease, light sensitivity, loss of bladder control (urinary incontinence), low blood pressure, migraine headache, muscle ache, numbness, oral inflammation, pain, painful erection, prolonged erection, raised skin patches, rapid or throbbing heartbeat, rectal bleeding, respiratory inflammation, ringing in the ears, seizure, sinus and throat inflammation, skin rash, skin ulcer, slow reflexes, stomach or intestinal inflammation, sweating, swelling, thirst, tremor, vomiting, weakness

Heart attack, stroke, heart irregularities, dangerous surges in blood pressure, and sudden death have all been reported after use of Viagra, usually in men with existing cardiac risk factors, and typically during or shortly after sex.

Possible food and 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 following: Other impotence remedies including Caverject and Muse

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 (Norvir)
Saquinavir (Fortovase, Invirase)

Dosage instructions

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, ketoconazole, 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 before sexual activity. The manufacturer recommends a maximum of 1 dose per day (1 dose every 2 days for those taking ritonavir).

No overdose of Viagra has been reported. However, any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

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