General warnings
Hypotension (low blood pressure levels)
Consumption of this medicine can cause a mild and short-lasting decrease in blood pressure levels. Caution should be exercised if you are taking any medication for lowering high blood pressure levels. It is advised that you report all your current medicines, including any herbs and supplements, to the doctor before beginning treatment with this medicine.
Risk of side effects
The risk of side effects is extremely high in smokers, elderly patients, and patients suffering from conditions including heart diseases, diabetes, high blood pressure levels, high cholesterol levels, etc. Caution should be exercised in such cases and patients should be counseled appropriately. Some side effects like dizziness, numbness, nausea, pain, etc. could occur while having intercourse after taking this medicine. Report any such instances to the doctor immediately. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.
Use in children
This medicine is not recommended for use in patients less than 18 years of age since the safety and efficacy of use are not clinically established.
Other medications
This medicine is not recommended for use in patients who are receiving medicines such as nitroglycerine, riociguat, etc. due to the increased risk of serious adverse effects. This medicine should be used with caution in patients receiving medicines to treat high blood pressure levels, heart diseases, etc. It is advised that you report the use of all your current medicines, including any herbs and supplements, before starting therapy with this medicine.
Deformation of penis
This medicine should be used with caution in patients having a physical deformity of the penis which may be due to angulation, cavernosal fibrosis or Peyronie's disease. The risk of permanent loss of sexual potency is very high if this medicine is used in patients suffering from these conditions. Replacement with a suitable alternative should be considered based on the patient's clinical condition.
Priapism
This medicine may cause Priapism, a painful erection lasting for more than 4 hours. Patients suffering from sickle cell anemia, multiple myeloma, leukemia, physical deformation of the penis, etc. are at higher risk of priapism. Priapism may result in penile tissue damage as well as permanent loss of sexual potency. Hence, this medicine should be used with extreme caution in patients predisposed to priapism. Any incidence of priapism should be reported to the doctor promptly and emergency medical assistance should be taken.
Loss of hearing
This medicine may cause a sudden decrease in hearing capabilities along with a buzzing or a ringing sound in the ears. Stop the use of this medicine and contact your doctor immediately if such symptoms are experienced. Replacement with a suitable alternative may be necessary in some cases based on the clinical condition.
Loss of vision
This medicine may cause a sudden loss of vision in one or both the eyes. It may also cause impairment in color differentiation capacity. Hence, it should be used with extreme caution in patients suffering from a rare genetic disorder of the retina called retinitis pigmentosa since these patients are at a higher risk of vision loss. Stop the use of this medicine and contact your doctor immediately if such symptoms are experienced. Replacement with a suitable alternative may be necessary in some cases based on the clinical condition.
Use in females
This medicine is not recommended for use in females.
Counseling
The underlying cause of erectile dysfunction may be physical, psychological, or both. It is important to determine the underlying cause of erectile dysfunction to devise an appropriate plan of treatment. In cases of psychological causes alone or psychological (including lifestyle) and physical causes, it is important to undergo psychological counseling to achieve the best possible effect.
Lifestyle modification
Chronic lifestyle factors such as obesity, smoking, drinking, etc., could also contribute to ED. Patients with ED are advised to follow major lifestyle modifications like quitting smoking and drinking, weight loss, healthy diet, and exercise along with the standard treatment for better improvement in the condition.
Herpes infection
This medicine is not recommended for use in patients suffering from a herpes infection due to the increased risk of worsening of the patient’s condition. An alternative treatment option should be considered based on the clinical condition of the patient.