Warnings for special population
This medicine is not recommended for use in pregnant women unless absolutely necessary. Your doctor will determine the appropriate course of treatment after evaluating all the risks and benefits associated with the use of this medicine. This medicine may be used in women only to treat pulmonary arterial hypertension.
This medicine is not recommended for use in breastfeeding women unless absolutely necessary. Your doctor will determine the appropriate course of treatment after evaluating all the risks and benefits associated with the use of this medicine. Your doctor may advise you to discontinue the drug or to discontinue breastfeeding based on your clinical condition. This medicine may be used in women only to treat pulmonary arterial hypertension.
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.
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.
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.
This medicine should be used with extreme caution if you have a disease of the heart and blood vessels. It is not recommended for use in patients who have suffered from a heart attack, stroke, or life-threatening arrhythmia within the last 6 months. Use of this medicine is not recommended if your doctor has asked you to not indulge in any sexual activity due to the increased risk of severe adverse effects on the heart.
Report the use of this medicine to your doctor/surgeon before undergoing any surgery including dental procedures.
Risk of side effects
The risk of side effects is extremely high in smokers, elderly patients, and in 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
Use of this medicine is not recommended for patients less than 18 years of age. However, certain studies have been done in children for the treatment of pulmonary arterial hypertension. Your doctor may advise the use of this medicine if other alternatives are not available and only after thoroughly reviewing all the associated risks and benefits.
Use only under medical supervision
This medicine may be available over the counter in certain countries; however, you are strongly recommended to consult a doctor before taking this medicine. It should be taken only under the supervision of a qualified healthcare professional.
Benign Prostatic Hypertrophy (BPH)
Patients suffering from erectile dysfunction are at an increased risk of developing BPH (benign prostatic hypertrophy) and vice versa. Hence, the evaluation of BPH is recommended in patients with erectile dysfunction. Also, this medicine may interact with medicines used for the treatment of BPH and their interaction may cause severe adverse effects. Your doctor will counsel you appropriately based on your clinical condition.
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 case of a psychological cause, you may require counseling along with treatment with this medicine to achieve the best possible effect.