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For diagnostics of violations of erection, determination of them possible reasons and choice of adequate treatment it is necessary to collect a complete medical history and conduct a thorough physical examination.
Sexual activity represents a certain risk at presence of diseases of the heart, therefore, before any therapy at the violations of erection the physician should refer the patient to the survey of CCC. Sexual activity is undesirable in patients with heart failure, unstable angina, previous 6 months of myocardial infarction or stroke, life-threatening arrhythmias, hypertension (AD >170/100 mm Hg. Art. ) or hypotension (blood PRESSURE <90/50 mm Hg. Art. ) (see section “Contraindications”, subsection “with caution”). Clinical studies have shown no differences in the incidence of myocardial infarction (1. 1 per 100 persons per year) or frequency of mortality from cardiovascular disease (0. 3 per 100 people per year) patients receiving drug Fildena extra power®, compared with patients receiving placebo.
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Drugs intended for the treatment of erection disorders should not be prescribed to men for whom sexual activity is undesirable.
Fildena 100 reviews ® has a systemic vasodilating effect, leading to a transient decrease in blood pressure, which is not clinically significant and does not lead to any consequences in most patients. However, before the appointment of Fildena india®, the doctor should carefully assess the risk of possible adverse events of vasodilating action in patients with relevant diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the output tract of the left ventricle (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as with a rare syndrome of multiple systemic atrophy, manifested by severe violation of the regulation of blood PRESSURE from the autonomic nervous system.
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Rare cases of the development of anterior ischemic optic neuropathy of nonarterial origin as a cause of deterioration or loss of vision were noted against the background of the use of all PDE-5 inhibitors, including sildenafil. Most of these patients had risk factors, such as excavation (deepening) of the optic nerve head, age over 50 years, diabetes, hypertension, coronary artery disease, hyperlipidemia and Smoking. There was no causal relationship between the use of PDE-5 inhibitors and the development of anterior ischemic optic neuropathy of non-arterial origin. The doctor should inform the patient about the increased risk of developing anterior ischemic optic neuropathy of non-arterial origin, if this condition has already been noted. Since the combined use of sildenafil and? -blockers may lead to symptomatic hypotension in individual sensitive patients, Fildena vs viagra ® should be used with caution in patients taking? -blockers (see section “Interaction”). To minimize the risk of developing postural hypotension in patients receiving? -blockers, the drug Fildena extra power® should be started only after achieving stabilization of hemodynamics in these patients. It should also consider reducing the initial dose of Fildena 50 reviews® (see “Method of application and dose”). The doctor should inform the patients about what actions should be taken in case of symptoms of postural hypotension.
A small number of patients with hereditary retinitis pigmentosa have genetically determined disorders of retinal phosphodiesterases. Information about the safety of the drug Fildena sildenafil citrate tablets® in patients with retinitis pigmentosa are not available, so sildenafil should be used with caution (see section “Contraindications”, subsection “with caution”).
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Sildenafil enhances antiaggregatory effect of sodium nitroprusside (donor of nitric oxide) on human platelets in vitro. Information about the safety of the drug Fildena dosage® in patients with internal bleeding or active peptic ulcer of the stomach are not available, so it should be used with caution (see section “Contraindications”, subsection “with caution”).
Treatment of erectile dysfunction should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis, Peyronie’s disease) or in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia) (see section “Contraindications”, subsection “With caution”).
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The safety and efficacy of Fildena XXX® together with other agents for the treatment of erectile dysfunction has not been studied, so the use of such combinations is not recommended (see “Contraindications”).
In some post-marketing and clinical studies with the use of all inhibitors of PDE5, including sildenafil, reported a sudden decrease or loss of hearing patients. However, most of these patients had risk factors for this pathology, and no correlation was found between the use of PDE-5 inhibitors and sudden decrease or loss of hearing. In case of sudden hearing loss or reduction, discontinue sildenafil therapy and consult a physician immediately.
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Influence on the ability to drive or perform work that requires increased speed of physical and mental reactions. Against the background of sildenafil reception of any negative impact on the ability to drive a car or other technical means was not observed. However, since sildenafil may reduce blood PRESSURE, the development of chromatopsia, blurred vision, etc. Side effects, should be carefully treated to the individual action of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.