What is a Cabergoline?

Cabergoline is a dopaminergic medication most often used to treat high levels of the prolactin hormone in the body, a condition known as hyperprolactinemia. It is also sometimes used to treat Parkinson’s disease, prolactinomas, and acromegaly.

Cabergoline is a prescription-only ergot derivative and long-acting dopamine receptor agonist, often sold under the brand name Dostinex. When treating hyperprolactinemia, it works by blocking the release of prolactin from the pituitary gland. It is also used off-label to treat infertility.

How Does Cabergoline Work?

Cabergoline is a dopamine receptor agonist, which has a high specificity and affinity for the dopamine D2 receptor, although it also has an affinity for other receptors. Its mechanism of action involves binding to these receptors in the pituitary gland, which inhibits the release of prolactin. This reduces prolactin levels in the body, which in turn treats symptoms of hyperprolactinemia.

How to Use Cabergoline?

Cabergoline comes as an oral tablet which is usually taken twice a week, with or without food. The dosage depends on the condition being treated and should be followed as directed by a doctor. In the case of hyperprolactinemia, the starting dose is often 0.25mg, increased by 0.25mg every four weeks.

The medication should be stored at room temperature, away from moisture and light, and out of the reach of children.

Remember to speak to a doctor before taking any medication.

What are the Side Effects of Cabergoline?

Cabergoline has many potential side effects, although these are often mild and may go away during treatment. They include:

• Nausea
• Vomiting
• Abdominal pain
• Dizziness
• Tiredness
• Constipation
• Dry mouth
• Diarrhea
• Headache
• Increased libido
• Insomnia
• Hallucinations
• Irregular heartbeat
• Swelling of the face, arms, hands, or feet.
• Weight gain or loss.
• Chest pain or tightness.
• Difficulty breathing when lying down.

More severe side effects require immediate medical attention. These include:

• Allergic reactions, including swelling of the throat or tongue.
• Vision changes.
• Cough that doesn’t go away.
• Sudden changes in mood.
• Uncontrollable urges, including increased sexual urges and gambling.
• Painful periods.
• Breast pain.
• Decreased urination.
• Back or side pain.
• Lumps or pain in the stomach area.
• Difficulty concentrating.

Side effects may be more severe in those with certain health conditions, or when used to treat Parkinson’s disease or restless leg syndrome, as this often requires very high doses. In rare cases, it can cause heart valve problems, organ tissue scarring, and liver function abnormalities.

The medication’s label also warns of the potential for intense or unusual behaviors, including gambling, and for users to be aware of family members exhibiting these symptoms.

How Long For Cabergoline to Work?

Cabergoline’s effect on lowering prolactin levels can be seen in two ways:

Initial Impact: This is quite fast. Studies show a significant decrease in prolactin levels within 3 hours of taking Cabergoline.

Long-Term Effect: The medication has a long-lasting effect due to its slow elimination from the body. This extended action helps maintain lower prolactin levels over time.

However, the degree of prolactin reduction and the time it takes to see its full effects depend on several factors, including:

Dosage: The amount of Cabergoline prescribed will influence how much prolactin levels are lowered.

Individual factors: People metabolize medication differently, so it might take some time to find the optimal dose for you.

Underlying condition: The severity of your prolactin-related condition can affect how long it takes to see full benefits.

Here’s the key takeaway: While Cabergoline has a rapid initial impact, it can take weeks or even months to see its full effect on prolactin levels and experience the complete benefits for your specific condition.

Remember: It’s crucial to discuss your progress with your doctor during regular checkups. They can monitor your prolactin levels and adjust the dosage if needed to achieve the desired outcome.

What are the Possible Uses of the Cabergoline In Pakistan?

Treatment of prolactinomas: These are tumors on the pituitary gland that cause it to produce too much prolactin hormone. Cabergoline helps shrink the tumor and lower prolactin levels.

Lowering prolactin levels for fertility: In women with infertility or menstrual irregularities caused by high prolactin, Cabergoline can help regulate their hormones and improve fertility.

What are the Regulations for Cabergoline Use in Pakistan?

The regulations for Cabergoline use in Pakistan are as followed below.

Cabergoline is a registered pharmaceutical drug in Pakistan that is approved for use. The Drug Regulatory Authority of Pakistan (DRAP) maintains a registry of applications for pharmaceutical drugs.

The recommended therapeutic dose of Cabergoline in Pakistan is 1 mg (two 0.5 mg tablets) as a single dose, typically administered within the first day post-partum for the purpose of lactation inhibition.

Prescribing patterns for Cabergoline in Pakistan show that it is mainly used to inhibit lactation in cases of stillbirth, abortion, and neonatal death. However, it is also sometimes prescribed for mothers with live babies who have other medical conditions.

The regulations require that Cabergoline be prescribed appropriately in terms of timing (within 27 hours of delivery/abortion). Around 74% of prescriptions in Pakistan were found to be within these guidelines.

Cabergoline is not a controlled substance in Pakistan and is not subject to the Controlled Substances Act, unlike in some other countries.

What are the Warning and Precautions of the Cabergoline?

Warnings

Cabergoline has several associated warnings. These include:

It may cause heart valve problems, which can be checked with an echocardiogram. It should not be used by those with heart valve disorders, and symptoms of heart issues such as chest pain and shortness of breath should be reported to a doctor immediately.

It may cause organ tissue scarring, a condition known as fibrosis. Tell your doctor if you have a history of this.

It is not suitable for those who are pregnant, breastfeeding, or under 18 years old.

Avoid if you have uncontrolled high blood pressure, or a history of pregnancy-induced high blood pressure (eclampsia or preeclampsia).

Tell your doctor if you have a mental health problem or a history of psychotic disorders.

Cabergoline may interact with other medications, vitamins, or herbs, including antipsychotic drugs, anti-nausea drugs, and lorcaserin, so make sure your doctor knows all the medicines you take.

It may cause sudden sleep onset, so take extra care when driving or operating machinery.

There have been reports of unusual behavior, including increased sexual urges and gambling. Family members should be made aware of this side effect, so they can contact a doctor if the patient is unable to recognize the problem.

Precautions

Some precautions to take when using cabergoline include:

Getting up slowly from a sitting or lying position, to avoid dizziness.

Regularly attending check-ups with a doctor, who can perform tests to monitor the function of your heart.

Storing the medication carefully, out of reach of children.

Not flushing the medication down the toilet or pouring it down a drain, following disposal guidance instead.

How Does Cabergoline Interact with Other Medicines?

Cabergoline has many potential drug interactions and should not be used with certain medications.

Drugs which should be avoided when taking cabergoline include:

Antipsychotics such as haloperidol, chlorpromazine, and clozapine.

Anti-nausea drugs like metoclopramide and promethazine.

Beta-adrenergic blockers for example, atenolol, propranolol, and sotalol and decongestants such as phenylephrine and pseudoephedrine.

Ergot alkaloids, including ergotamine and dihydroergotamine.

Macrolide antibiotics, such as clarithromycin.

Lorcaserin.

Other medications to be aware of when taking cabergoline include antipsychotic drugs, anti-nausea drugs, and naratriptan—the combination could increase toxicity or cause additive vasospasm. It also has several interactions with blood pressure medications, and may interact with painkillers, including codeine and tramadol.

Cabergoline is also known to interact with grapefruit and St John’s Wort, which may decrease its serum concentration.

Check with a doctor or pharmacist before taking any new medication to ensure it is safe to do so alongside cabergoline.

What happens if I miss a dose of Cabergoline?

If you miss a dose of cabergoline, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, skip the missed dose and continue with your regular schedule, avoiding taking two doses at once.

What happens if I overdose on Cabergoline?

If you overdose on Cabergoline, you may experience symptoms such as stuffy nose, hallucinations, fainting, and other serious effects. An overdose of Cabergoline can lead to severe consequences and requires immediate medical attention. Symptoms of overdose may include stuffy nose, hallucinations, or fainting.

What are the Alternatives of the Cabergoline That are Used in Pakistan?

We understand you might be looking for treatment options for hyperprolactinemia in Pakistan. Cabergoline is one medication used for this condition, but there are other alternatives available.

Bromocriptine: This medication works similarly to Cabergoline and is often the first-line treatment for hyperprolactinemia. It can help normalize prolactin levels and restore fertility.

Quinagolide: Another option is Quinagolide, which works in a similar way to Cabergoline to lower prolactin levels.

Lisuride: This is a less common medication, but it can be an alternative if other options are not well-tolerated or effective for you.

Surgery: In some cases, if medications aren’t successful, surgery may be an option. This surgery removes the pituitary tumor causing the prolactin overproduction.

Other medications: Depending on the underlying cause of your hyperprolactinemia, your doctor might consider other medications such as estrogen-lowering drugs or gonadotropin-releasing hormone agonists.

Wichtig (Important): It’s crucial to consult with a healthcare professional to determine the most suitable treatment for you. They can consider your specific condition and medical history and offer personalized advice on the available alternatives to Cabergoline in Pakistan.

How Successful is Cabergoline Tablet in Pakistan?

The Success of the Cabergoline Tablet in Pakistan based on the some studies.

Studies have shown cabergoline to be more effective than bromocriptine in normalizing prolactin levels in hyperprolactinemic patients in Pakistan. The percentage of success in attaining normal prolactin levels with cabergoline was higher compared to bromocriptine.

 

What is a Tadalafil?

Tadalafil is a prescription drug used to treat male sexual function problems such as impotence or erectile dysfunction. It increases blood flow to the penis, helping men to get and maintain an erection.

How Does Tadalafil Work?

Tadalafil increases blood flow to a specific area of the body. It belongs to a group of medicines called phosphodiesterase 5 (PDE5) inhibitors.
In the case of erectile dysfunction, when a person becomes sexually aroused, tadalafil increases blood flow to the penis. This helps the spongy tissue of the penis to fill with blood, making it become harder.
Tadalafil also relaxes the muscles in the prostate and bladder, which helps to relieve symptoms of an enlarged prostate, such as difficulty urinating.
When treating pulmonary hypertension, tadalafil relaxes the blood vessels in the lungs, allowing blood to flow more easily.

How to Use Tadalafil?

Tadalafil comes as an oral tablet. It’s usually taken once daily at around the same time each day. If you’re using it for erectile dysfunction, you can take it either as needed before sexual activity or daily. If taking it daily, it’s best to take a lower dose of 2.5 or 5mg. If taking it as needed, the dose is typically 10mg, but this can be increased or decreased depending on how well it works for you.
Tablets should be swallowed whole with a drink of water, and can be taken with or without food. If you’re taking the medication daily, make sure you take the expected strength of the tablet as prescribed.
Remember, tadalafil is not a daily medication like a vitamin, and should only be taken once per day.

What are the Uses of the Tadalafil?

Tadalafil is prescribed for the following conditions:
Erectile dysfunction (impotence): It helps men to get and keep an erection.
Symptoms of an enlarged prostate are known as benign prostatic hyperplasia (BPH). It relaxes the muscles in the prostate and bladder to relieve symptoms such as difficulty urinating.
Pulmonary arterial hypertension: It relaxes blood vessels in the lungs to improve exercise ability.

What are the Side Effects of the Tadalafil?

Here are the most commonly reported side effects of tadalafil:

• Headaches
• Muscle aches and pains
• Back pain
• Indigestion or heartburn
• Stomach pain.
• Flushing or redness of the skin
• Nasal congestion
• Dizziness
• Vision changesThese side effects should usually go away within a few days or weeks.
  Less common but more serious side effects include:Painful or prolonged erections last 4 hours or more.
  Sudden decrease or loss of vision or hearing.
  Allergic reaction (swelling of the face, lips, tongue or throat, difficulty breathing)
  Low blood pressure (symptoms include feeling lightheaded or dizzy)
  Get medical help as soon as possible if you experience any of these symptoms.

What are the Warning and Precautions of the Tadalafil?

Tadalafil is not suitable for everyone. Don’t take it if you’re also using nitrate drugs, such as nitroglycerin, for chest pain or heart problems. Combining tadalafil with nitrates can cause a dangerous drop in blood pressure.
Do not take tadalafil if you’re allergic to it, or any of the other ingredients in the tablets. Check with your pharmacist if you’re unsure.
Tell your doctor about any other medications you’re taking, especially alpha blockers, antihypertensives, or potent inhibitors of CYP3A4, such as ketoconazole or ritonavir.
Tadalafil may make you feel dizzy. Don’t drive, use machinery, or do anything that could be dangerous if you’re affected.
Avoid drinking too much alcohol while taking tadalafil, as this can increase the risk of dizziness.
Do not take the medication if you’re pregnant, or breastfeeding. The safety of tadalafil for pregnant or breastfeeding women has not been established.
Store tadalafil safely out of the reach of children.
If you experience sudden loss of vision or hearing, stop taking tadalafil and get medical advice immediately.
In the event of a prolonged erection lasting 4 hours or more, stop taking the medication and seek medical help to avoid permanent damage.

How Does Tadalafil Interact with Other Medicines?

Tadalafil can interact with many other medications, so your healthcare provider should be made aware of all medicines, vitamins and supplements you’re taking.
Here are some of the medications that can react with tadalafil:
Nitrates, such as glyceryl trinitrate, which are used to treat chest pain.
Riociguat is another treatment for pulmonary hypertension.
Alpha blockers, such as doxazosin, are used to treat an enlarged prostate or high blood pressure.
Blood pressure medications, including beta-blockers and angiotensin-converting enzyme (ACE) inhibitors.
Other erectile dysfunction treatments, such as sildenafil or vardenafil.
Protease inhibitors, such as ritonavir, are used to treat HIV.
Antifungal medications, such as ketoconazole and itraconazole.
Certain antibiotics, including erythromycin and rifampin.
Alcohol, because it can increase the risk of dizziness and low blood pressure.
Grapefruit juice, as it can increase the level of tadalafil in your blood and the risk of side effects.
This list is not exhaustive, so make sure you check with a healthcare professional before taking tadalafil with any other medications.

What happens if I miss a dose of Tadalafil?

If you miss a dose of tadalafil, take it as soon as you remember, unless it’s almost time for your next scheduled dose. In which case, skip the missed dose and continue with your regular schedule. Do not take two doses on the same day.
Missed doses are not a problem, but they may reduce the effectiveness of the medication. If you often forget doses, consider setting an alarm or using a medication reminder.

What happens if I overdose on Tadalafil ?

As with any medication, it’s possible to overdose on tadalafil. Taking too much can lead to dangerous side effects, including:

• A sudden drop in blood pressure
• Priapism (a prolonged and painful erection)
• Changes in vision or hearing
• Allergic reaction
• Nausea

Fainting If you think you have overdosed on tadalafil, seek emergency medical help immediately, or contact your local poison control centre.

What is a Lidocaine?

Lidocaine is a local anaesthetic agent, which is commonly used for local and topical anesthesia. It also has antiarrhythmic and analgesic uses and can be administered prior to tracheal intubation. It causes a temporary numbing effect when used topically.

Lidocaine was first discovered between 1943 and 1946 and went on sale in 1948. It is often combined with epinephrine, which acts as a vasopressor and extends lidocaine’s duration of action. Lidocaine is available in many forms, including creams, gels, liquids, sprays, eye drops, patches, and solutions for injection or infusion. The different formulations of lidocaine are used in a wide variety of superficial and invasive procedures. For example, a lidocaine transdermal patch can be applied to the skin to relieve pain caused by post-herpetic neuralgia.

When used correctly and sparingly, topical lidocaine is generally considered safe. However, misuse, overuse, or overdose can lead to serious problems, including methemoglobinemia, a condition where the blood’s ability to carry oxygen to the body’s tissues is impaired. Systemic exposure to excessive quantities of lidocaine can also result in central nervous system and cardiovascular effects, including dizziness, changes in vision, numbness, tingling, vomiting, and even cardiac arrest.

How Does Lidocaine Work?

Lidocaine’s primary mechanism of action is blocking voltage-gated sodium channels, which decreases the rate of contractions of the heart and raises the depolarization threshold. This prevents or reduces the sensation of pain. It also blocks potassium channels and regulates the concentration of ions inside and outside cells. This changes the transmembrane potential and regulates neuronal excitability.

At the cellular level, lidocaine has been shown to reduce the peak currents of sodium channels and accelerate the deactivation process, thereby reducing neuronal excitability. It also inhibits the release of interleukin-1, an inflammatory mediator that acts on polymorphonuclear granulocytes, and activates phagocytosis, respiratory burst, degranulation, and chemotaxis. Lidocaine has also been found to inhibit the release of glutamate, the main excitatory neurotransmitter in the CNS.

When used as an injectable local anaesthetic, lidocaine’s onset of action is rapid, taking less than two minutes on average. The effects of a single dose can last anywhere from half an hour to three hours.

How to Use Lidocaine Topical Cream?

Lidocaine topical cream is available over the counter or on prescription. It comes in various forms and strengths. The appropriate application method may differ depending on the specific product. Always read and follow the instructions provided with the cream or follow the advice of a doctor or pharmacist.

In general, lidocaine cream is applied directly to the skin. The area to be treated should be cleaned and dried beforehand. A thin layer of cream is then applied two or three times daily, or as directed by a healthcare professional. The effects of lidocaine cream can take between 25 to 40 minutes to take effect.

Some products require the application of a waterproof dressing to keep the cream in place. The dressing should be left in place for 30 to 60 minutes, and then removed before the procedure.

Do not apply lidocaine cream to the eyes, ears, nose, mouth, genitals, anus or any open wounds, unless directed by a doctor. Wash your hands immediately after use. Do not use more cream than recommended, as this may cause side effects. Seek medical advice immediately if any side effects occur.

What are the Side Effects of Lidocaine?

When used topically, lidocaine is generally considered safe, and many people experience no side effects at all. Mild side effects may include:

• Itching or tingling at the site of the application
• Redness or mild swelling of the skin
• Paler skin than usual

If any of these mild effects persist or become uncomfortable, stop using the cream and consult a doctor or pharmacist.

In rare cases, more serious allergic reactions can occur. These require immediate medical attention, and signs to look out for include:

• Swelling of the face, lips, throat, or tongue
• Difficulty breathing, a tight throat or feeling like you’re choking.
• Skin, tongue, or lips turning blue, grey, or pale.
• Confusion, drowsiness, or dizziness
• A rash

Other serious side effects may include low blood pressure, and cardiovascular and central nervous system effects, such as changes in vision, irregular heartbeat, shallow breathing, seizures, and loss of consciousness.

Lidocaine should not be used on broken or infected skin, or if you have certain heart conditions, liver disease or a blood disorder called methemoglobinemia. Women who are pregnant or breastfeeding should exercise caution when using lidocaine and consult a doctor first.

What are the Warning and Precautions of the lidocaine?

Here are some important warnings and precautions to be aware of when using lidocaine:

Lidocaine should not be used to relieve teething pain in children. The FDA recommends following the American Academy of Pediatrics’ guidance on treating teething pain, which involves using a teething ring chilled in the fridge or gently rubbing the gums with your finger.

Lidocaine can cause serious side effects, including seizures, loss of consciousness and cardiac arrest, if too much of the medicine is absorbed into the blood. This can happen if large amounts are applied, or if the skin to which it is applied is broken, blistered, or burnt. Do not cover the area to which lidocaine is applied, unless directed to do so by a doctor.

Lidocaine may interact with other medications, including heart rhythm medicines, so check with a doctor or pharmacist if you’re already taking prescribed drugs.

Tell your doctor or pharmacist if you have ever had methemoglobinemia – a blood disorder – or if there is a family history of the condition.

Do not use lidocaine if you are allergic to it, or other amide-type anesthetics.

Contact a poison control centre or seek immediate medical attention in the event of an overdose. Symptoms of overdose may include dizziness, vomiting, irregular heartbeat, and seizures.

Keep lidocaine out of the sight and reach of children and store it away from moisture and heat.

How Does Lidocaine Interact with Other Medicines?

Lidocaine has been reported to interact with many other drugs, increasing the risk of adverse reactions. Some sources refer to at least 297 drugs known to interact with lidocaine. Here are some of the types of drugs that can interact with lidocaine:

• Anti-arrhythmia medications, including amiodarone, propafenone, sotalol, tocainide and mexiletine.
• Other local anaesthetics, such as bupivacaine
• Anesthetics, including propofol.
• Antidepressants, including SSRIs like fluoxetine (Prozac) and clomipramine (Anafranil)
• Antibiotics, including erythromycin, clarithromycin, and ciprofloxacin.
• Anti-hisamines, such as cimetidine
• Beta blockers, including propranolol.
• Calcium channel blockers, such as verapamil and amiodarone
• Cholesterol-lowering drugs, for example, atorvastatin (Lipitor) and simvastatin (Zocar).

Many of these drugs interfere with lidocaine’s metabolism by inhibiting the liver enzyme Cytochrome-P450 3A4 (CYP3A4), which slows the rate at which lidocaine is eliminated from the body. Other drugs may affect the heart rate and rhythm, causing additive side effects.

Some medications should be discontinued one to two weeks before any procedures involving the use of lidocaine, to minimize the risk of drug interactions. These include drugs that are metabolized by the cytochrome P450 system, which could increase the toxicity associated with subcutaneous lidocaine infusion.

You should always consult a healthcare professional before taking any new medication, to ensure it’s suitable in combination with lidocaine.

What happens if I miss a dose of  Lidocaine?

If you miss a dose of lidocaine cream, you should apply it as soon as you remember, unless it’s almost time for your next dose. In this case, you should skip the missed dose and continue with the next one as normal. Do not double the dose to catch up.

If you’re using lidocaine in patch form, remove the protective liner and apply it to the most painful area of the skin, as directed by your doctor. The patch can usually be worn for up to 8 or 12 hours. Follow the instructions carefully, and ensure the area is clean and dry.

Used patches still contain medication, so they should be folded with the sticky sides together and discarded safely, out of the reach of children and pets.

What happens if I overdose on Lidocaine?

Lidocaine is generally considered safe when used correctly and sparingly. However, misuse, overuse, or overdose can lead to serious problems, including death.

The most common ways to overdose on lidocaine are by accidental injection of an excessive dose, topical application over a large area of the body, or ingestion of a topical preparation by children. Systemic toxicity can occur when the body absorbs large amounts of lidocaine very quickly, and symptoms can vary in severity.

The early symptoms of lidocaine overdose are linked to CNS excitation and include circumoral numbness, tongue tingling, dizziness, blurred vision, restlessness, and auditory disturbances. This may lead to muscle twitches, convulsions, and loss of consciousness. In severe cases, there may be respiratory depression, cardiovascular disturbances, and cardiac arrest.

Lidocaine overdose is a medical emergency and requires immediate treatment. The outcomes are often dependent on how quickly treatment is administered. Anyone who thinks they have overdosed on lidocaine should seek medical help immediately or call the relevant poison control centre.

What is a Sildenafil?

Sildenafil is a medication that relaxes the muscles of the blood vessels and increases blood flow to particular areas of the body. It is most well-known under the brand name Viagra, which is used to treat erectile dysfunction in men. It has also been approved to treat pulmonary arterial hypertension and improve exercise capacity in both men and women.

Sildenafil belongs to a class of medications called phosphodiesterase type 5 (PDE5) inhibitors, which work by increasing blood flow to the penis and relaxing the blood vessels in the lungs.

Sildenafil comes in tablet form and is also available as a liquid that can be swallowed. It is available over the counter in some countries, but in the United States, a prescription from a doctor is required.

How Does Sildenafil Work?

In cases of erectile dysfunction, sildenafil increases blood flow to the penis, helping a man to get and keep an erection when sexually aroused. This process occurs via the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway. During sexual stimulation, nitric oxide is released, increasing the level of cGMP in the corpus cavernosum, which in turn relaxes and widens the blood vessels in the penis.

Sildenafil works by blocking the enzyme cGMP-specific phosphodiesterase type 5 (PDE5) which usually breaks down cGMP. By inhibiting PDE5, sildenafil enhances the effect of nitric oxide and cGMP, and therefore increases blood flow to the penis.

How to use Sildenafil Tablet?

Sildenafil tablets are usually taken orally, and the dosage depends on the medical condition for which it is being prescribed.

For erectile dysfunction (ED), the usual dosage is 50mg, taken around 1 hour before sexual activity. The effects can last for up to 4 to 6 hours.
It is recommended that you take the tablet on an empty stomach and avoid consuming large amounts of alcohol before taking the medication. If 50mg is ineffective, your doctor may increase the dosage to 100mg.

For pulmonary arterial hypertension (PAH), sildenafil is typically taken three times a day, every 4 to 6 hours. The dosage is usually 5 or 20mg.

What are the Warnings and Precautions of the Sildenafil?

Here are some important precautions and warnings to be aware of before taking sildenafil:

Sildenafil is contraindicated in patients taking nitrates, such as those who have angina or heart problems. Taking sildenafil with nitrates can cause a dangerous drop in blood pressure.

Do not take sildenafil with guanylate cyclase stimulators, such as riociguat.

Sildenafil may interact with alpha blockers, causing blood pressure to drop too low, and should be used with caution if you are taking these medications.

Avoid alcohol and grapefruit products with sildenafil, as they can worsen side effects.

People with certain eye disorders, including inherited eye conditions, may be at risk of vision changes or loss. Those who have previously experienced eye problems, are over 50, or smoke, are also at greater risk.

Those with a deformed penis shape, such as Peyronie’s disease, have an increased risk of priapism. If an erection lasts longer than 4 hours, seek immediate medical attention as it can cause permanent damage.

Sildenafil is not recommended for children under 18, and in some cases can increase the risk of death.

Women who are pregnant or breastfeeding should consult their doctor before taking the medication.

Elderly patients and those with kidney or liver disease, or a low blood pressure of <90/50mmHg, should exercise caution when taking sildenafil and may require a lower dose.

In the case of an overdose, seek immediate medical attention. Symptoms can include severe dizziness and fainting.

What are the Side Effects of Sildenafil?

The most commonly reported side effects of sildenafil are mild and include:

• Headaches
• Flushing
• Rhinitis
• Dizziness
• Hypotension
• Postural hypotension
• Dyspepsia
• Blue-green colour tinted vision and blurred vision
• Unexplained myalgia
• Nasal congestion
• Heartburn
• Indigestion
• Diarrhoea
• Stomach cramps

There are also some more serious side effects that require immediate medical attention, including:

• Painful or prolonged erection (prolonged erections can cause damage)
• Vision changes or sudden vision loss
• Ringing in the ears or sudden hearing loss
• Irregular heartbeat
• Swelling of the face, hands, feet or lower legs
• Difficulty breathing or concentrating.
• Fainting
• Seizure
• Chest pain or pressure, or pain spreading to the jaw or shoulder.

Sildenafil should not be used by people who are also using a nitrate drug for chest pain or heart problems, as it can cause a serious decrease in blood pressure.

If any of these side effects are experienced, you should speak to your doctor as soon as possible.

How Does Sildenafil Interact with Other Medicines?

Sildenafil should not be taken by anyone who is also using a nitrate drug for chest pain or heart problems, as it can cause a serious drop in blood pressure. This includes nitrates such as nitroglycerin, isosorbide and amyl nitrite.

It also must not be taken with other medications for pulmonary arterial hypertension, such as riociguat, or other erectile dysfunction drugs, including avanafil, tadalafil and vardenafil.

The medication can also interact with alpha blockers, blood pressure drugs, antifungal drugs, HIV protease inhibitors, antibiotics, St John’s Wort, and grapefruit.

As with other medications, sildenafil may also interact with supplements or vitamins, so consult your doctor or pharmacist if in doubt.

What happens if I miss a dose of sildenafil?

If you miss a dose of sildenafil, the course of action depends on whether you are taking the medication for erectile dysfunction (ED) or pulmonary arterial hypertension (PAH).

If you miss a dose of sildenafil and are taking it for ED, take the dose 30 minutes to 4 hours before your next sexual activity, or as soon as you remember. However, if it’s nearly time for your next scheduled dose, just leave out the missed dose and take the next dose at the usual time. Do not take two doses at once.

If you are using sildenafil to treat PAH, take the missed dose as soon as you remember, unless it’s almost time for your next scheduled dose. In this case, skip the missed dose and continue with the next one. Never take two doses at the same time.

What happens if I overdose on Sildenafil?

An overdose of sildenafil can cause dangerous levels of the drug to build up in your body. Symptoms of an overdose can include blurred vision, visual changes, hearing problems, low blood pressure, and a prolonged and painful erection (known as priapism).

Some cases of sildenafil overdose have resulted in death. In at least one case, a 56-year-old man was found dead at home after overdosing on sildenafil, which caused cardiomegaly and diffuse coronary atherosclerosis.

If you think you have overdosed on sildenafil, call your doctor or a poison control center right away, or attend the nearest emergency room.