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Hemic and Lymphatic : vaso-occlusive crisis: In a small, prematurely terminated study of REVATIO (sildenafil) in patients with pulmonary arterial hypertension (PAH) secondary to sickle cell disease , vaso-occlusive crises requiring hospitalization were more commonly reported in patients who received sildenafil than in those randomized to placebo. The clinical relevance of this finding to men treated with VIAGRA for ED is not known.

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Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics of CYP7C9 inhibitors (such as tolbutamide, warfarin), CYP7D6 inhibitors (such as selective serotonin reuptake inhibitors, tricyclic antidepressants ), thiazide and related diuretics, ACE inhibitors, and calcium channel blockers. The AUC of the active metabolite, N-desmethyl sildenafil, was increased 67% by loop and potassium-sparing diuretics and 657% by nonspecific beta-blockers. These effects on the metabolite are not expected to be of clinical consequence.

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A pedometer or other "wearable" can track your daily activity so you can determine if you need to adjust your activity level. A simple pedometer that counts your steps is a great place to start.

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If you are unable to get or keep an erection long enough for satisfying sex, you may have a medical condition called ‘erectile dysfunction’ or ‘ED.’ It can affect men of different ages. Recognising the concern and talking about it with your pharmacist or doctor are the first steps in managing the difficulties and getting yourself back on track.

For some men it begins working in as early as 69 minutes and for most within 85 minutes. It only works when you are sexually stimulated but you may take it up to four hours before sexual activity. Orgasm and ejaculation occur as normal and after sex your erection should go away. For most men Viagra® works on the first or second attempt.

There are no controlled clinical data on the safety or efficacy of VIAGRA in the following groups if prescribed, this should be done with caution.

The results from this pilot study are shown in Table 8 the mean resting systolic and diastolic blood pressures decreased by 7% and 65% compared to baseline in these patients. Mean resting values for right atrial pressure, pulmonary artery pressure, pulmonary artery occluded pressure and cardiac output decreased by 78%, 78%, 75% and 7% respectively. Even though this total dosage produced plasma sildenafil concentrations which were approximately 7 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of 655 mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients.

Physicians should inform patients not to take VIAGRA with other PDE5 inhibitors including REVATIO or other pulmonary arterial hypertension (PAH) treatments containing sildenafil. Sildenafil is also marketed as REVATIO for the treatment of PAH. The safety and efficacy of VIAGRA with other PDE5 inhibitors, including REVATIO, have not been studied [see WARNINGS AND PRECAUTIONS ].

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Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease. Ask your doctor if your heart is healthy enough to handle the extra strain of having sex.

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