Since this medicine interacts with many other medicines and may cause serious adverse effects, it is advised that you should inform the doctor about all your medicines including herbs and supplements before beginning treatment with this medicine.
Use in healthy men
This medicine should not be used by men who have not been diagnosed clinically with premature ejaculation. Safety and efficacy of this medicine for delaying ejaculation in healthy men is not established and hence self-administration is not recommended.
Use with alcohol and recreational drugs
This medicine should not be used along with alcohol or any other recreational drugs since the risk of serious adverse effects is significantly high.
It is advised to take this medicine only after a proper diagnosis has been made. This medicine should not be used for other forms of sexual dysfunctions.
Use of this medicine may cause a fall in blood pressure, especially while getting up from a sitting or a lying position, leading to lightheadedness, fainting, and falling. An appropriate clinical examination is advised before initiating the uptake of this medicine. It is advised that you get up slowly from a sitting or a lying position to avoid these side effects during treatment with this medicine. Report any such symptoms to the doctor immediately.
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.
This medicine should be used with caution in patients suffering from an active bleeding disorder due to the increased risk of excessive bleeding.
This medicine should be used with caution in patients suffering from a seizure disorder due to the increased risk of worsening of the patient's symptoms. Any seizure episodes should be reported to the doctor on priority. Therapy with the medicine may be discontinued based on the clinical condition of the patient.
This medicine contains lactose and hence it should not be used by patients suffering from a genetic abnormality making them lactose intolerant.
Dizziness and fainiting
Use of this medicine may cause recurring episodes of dizziness and fainting. It is advised that you do not perform any activities that require high mental alertness such as driving a vehicle or operating machinery during treatment with this medicine.
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.
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.
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 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.