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This safety and warning information is crucial for understanding the potential risks associated with the use of sildenafil (Viagra). Please read carefully and consult your healthcare provider if you have any questions or concerns.

• Heart Conditions: Inform your healthcare provider if you have any heart problems before using sildenafil (Viagra). It is generally not recommended for those with serious heart issues or those who have experienced a heart attack or stroke within the last six months. It is essential to verify with your provider if sildenafil (Viagra) is appropriate for your condition.

• Low Blood Pressure: Combining sildenafil (Viagra) with certain medications, such as alpha blockers, blood pressure medications, or ritonavir (Norvir), can lead to a significant drop in blood pressure. Discuss with your provider if you are on these medications to ensure safe use. Avoid using sildenafil (Viagra) if you are taking any nitrate medication for chest pain, as this can cause a dangerous decrease in blood pressure. Monitor your blood pressure regularly if advised by your healthcare provider.

• Prolonged or Painful Erection (Priapism): In rare cases, sildenafil (Viagra) may cause an erection lasting more than 4 hours, which can lead to permanent damage if untreated. Seek immediate medical attention if this occurs, especially if accompanied by pain. Higher risk exists for individuals with conditions like sickle cell anemia, multiple myeloma, or leukemia.

• Vision Changes: Sudden changes in vision should prompt an immediate visit to the emergency room or a call to your healthcare provider, as sildenafil (Viagra) can rarely result in permanent eye damage. Those with a "crowded" optic disc or blood vessel issues in the eye may be at increased risk.

• Hearing Loss: Some users of sildenafil (Viagra) have reported hearing loss, which may also involve tinnitus or dizziness. Seek emergency medical care if you experience sudden hearing changes.

• Drug Interactions: Sildenafil (Viagra) can interact with various medications. It is vital to inform your healthcare provider of all medications you are taking, especially nitrate medications and blood pressure drugs. Certain antifungals and antivirals, including ritonavir (Norvir), may increase the risk of side effects like headaches or vision changes.

Contraindications:

• Do not use sildenafil (Viagra) if you are taking nitrate medications for chest pain or guanylate cyclase (GC) stimulators such as Adempas (riociguat), as these combinations can pose severe health risks.

Please discuss any concerns with your healthcare provider to ensure the safe use of sildenafil (Viagra).

Common side effects:

• headache
• flushing
• indigestion
• changes in vision or light sensitivity
• stuffy nose

Less common but important to monitor:

• back pain
• dizziness
• muscle ache
• nausea
• rash

Serious side effects:

• erection lasting more than four hours
• sudden vision loss
• dangerously low blood pressure symptoms (severe dizziness, fainting, chest pain, nausea)
• sudden hearing loss
• allergic reaction (rash, severe dizziness, swelling, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Nitrates (such as Nitroglycerin, Isosorbide)
• Poppers (containing amyl or butyl nitrite)
• Riociguat
• Vericiguat
• Sildenafil or other similar medications for erectile dysfunction-ED or pulmonary hypertension (such as Tadalafil, Vardenafil)

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Alpha blockers (such as Doxazosin, Tamsulosin)
• Azole antifungals (such as Itraconazole, Ketoconazole)
• Macrolide antibiotics (such as Clarithromycin, Erythromycin)
• Mifepristone
• Rifampin
• Ritonavir