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How should you take this medication?

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, ketoco nazole, 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 bef ore sexual activity. The manufacturer recommends a maximum of 1 dose per day (1 dose every 2 days for those taking ritonavir).

To avoid low blood pressure, do not take the 50-milligram or 10 0-milligram dose of Viagra within 4 hours of taking an alpha-blocking drug such as Cardura.

Before Using This Medicine

Before taking Viagra,

tell your doctor and pharmacist if you are allergic to Viagra or any other drugs.
tell your doctor if you have or have ever had a bleeding disorder; heart, kidney, or liver disease; a heart attack; irregular heartbeats; angina; a stroke; high or low blood pressure; sickle cell anemia; multiple myeloma; leukemia; conditions affecting the shape of the penis (e.g., angulation, cavernosal fibrosa, or Peyronie's disease); or a condition known as retinitis pigmentosa.
if you are having surgery, including dental surgery, tell your doctor or dentist that you ta ke Viagra.
tell your doctor if you use amyl nitrate, amyl nitrite, or butyl nitrate.

What special precautions should I follow?

Use Viagra exactly as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. If too much is used, the chance of side effects is increased.
-
If you experience a prolonged or painful erection for 4 hours or more, contact your doctor immediately. This condition may require prompt medical treatment to prevent tissue damage of the penis and possi ble permanent impotence.

What side effects can this medication cause?

Less common to rare side effects may include:
- insomnia, itchy skin, joint disease, light sensitivity, loss of bladder control (urinary incontinence), low blood pressure, migraine headache, mus cle ache, nosebleeds, 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, vision problems, vomiting, weakness

Before Taking This Medicine

The presence of other medical problems may affect the use of Viagra. Make sure you tell your doctor if you have any other medical problems, especially:
- Heart or blood disease¡XSexual activity i creases the heart rate and blood flow and can increase the chance of problems occurring for some patients who use any type of medicine, including Viagra, that increases sexual ability
- Kidney pr oblems (severe) or
- Liver problems (severe)¡XChance of problems occurring may be increased. Lower starting doses may be used and doses increased as needed and as tolerated

Significant Interactions:

When you are taking Viagra, it is especially important that your health care professional know if you are taking any of the following:

- Cimetidine (e.g., Tagamet)
- Erythromycin (e.g., E.E.S. or Ery-Tab)
- Itraconazole (e.g., Sporanox)
- Ketaconazole (e.g., Nizoral)
- Mibefradil (e.g., Posicor)
- Ritonavir (e.g., Norvir)
- Saquinavir (e.g., Fortovase or Inv irase)¡XThese medicines may increase the unwanted effects of Viagra, unless lower starting doses of Viagra are used
- Nitrates, such as nitroglycerin (e.g., Nitrostat or Transderm-Nitro)¡XViagra creases the lowering of blood pressure by nitrates too much and their use together is not recommended


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