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Gastro-oesophageal reflux disease, hypoaesthesia oral. Reproductive system and breast disorders. General disorders and administration site braces teeth. Cardiac disorders and vascular disorders.

Serious cardiovascular events, including myocardial infarction, sudden cardiac death, scolymus cynara arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack and hypertension, have been reported postmarketing in temporal association with the use of sildenafil.

Most, but not all, of these patients had pre-existing cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of sildenafil without sexual activity. Others were reported to have occurred hours to days after the use of sildenafil and sexual activity. It is not possible to determine whether these events are related directly to sildenafil, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors.

Tachycardia, hypotension, syncope, and epistaxis have also been reported postmarketing. Rare spontaneous reports have been received of hypotensive events after the use of sildenafil in combination braces teeth alpha-blockers. Other events reported postmarketing braces teeth have been observed in temporal association with sildenafil and not listed in the clinical trials adverse reactions braces teeth include: Nervous system disorders.

Seizure, seizure recurrence and anxiety. Reproductive systems and breast disorders. Priapism and prolonged erection. Nonarteritic anterior ischaemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported rarely postmarketing in temporal association with braces teeth use of phosphodiesterase type 5 (PDE5) inhibitors, including sildenafil.

Most, but not all, of these patients had underlying anatomic or vascular risk factors for developing NAION, including but not necessarily limited to: low cup to disc ratio ("crowded braces teeth, age over 50, diabetes, hypertension, coronary artery disease, hyperlipidaemia and smoking.

An observational study evaluating whether recent use of PDE5 braces teeth, as a class, was associated with acute onset of NAION suggests an increase in braces teeth risk of NAION with PDE5 inhibitor use (see Section 4. Sudden decrease or loss of hearing. Cases of sudden decrease or loss of hearing have been reported postmarketing in temporal association with the use of PDE5 inhibitors, including braces teeth. In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events.

In many cases, medical follow-up information was limited. It is not braces teeth to determine whether these reported events are related directly com brain the use of sildenafil, to the patient's underlying risk factors for hearing loss, a combination of these factors, braces teeth to other factors (see Section 4.

Reporting suspected adverse effects. Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the braces teeth balance of the medicinal product. Sildenafil tablets are intended for oral administration. The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. Based on the efficacy and toleration, the dose may be braces teeth to 100 mg or decreased to 25 mg.

The maximum recommended dose is 100 mg. The maximum recommended dosing frequency is once per day. Since sildenafil clearance is reduced in elderly patients, a first dose of 25 mg should be considered. Based on efficacy and toleration, the dose may be increased to 50 mg and 100 mg. Dosage adjustment in renal impairment. Since sildenafil clearance is reduced in patients with severe renal impairment (Clcr Dosage adjustment in hepatic impairment.

Since sildenafil clearance is reduced in patients with hepatic impairment (e. Use in patients using other medicines. Concomitant use of potent CYP3A4 inhibitors has been associated with increased plasma levels of sildenafil (e.

It can also be expected that more potent CYP3A4 inhibitors such as ketoconazole and itraconazole would result in increased plasma levels of sildenafil.

Since higher plasma levels may increase braces teeth the efficacy and incidence of adverse events, a starting dose of 25 mg should be considered in these patients. Given the extent of the interaction with patients receiving concomitant therapy with ritonavir, it is recommended not to exceed a maximum single dose of 25 mg of sildenafil in a 48 hour period.

In order braces teeth minimise the potential for developing postural braces teeth, patients should be stable on alpha-blocker therapy prior to initiating sildenafil treatment.

In addition, initiation of sildenafil at lower doses should be considered braces teeth Section 4. Sildenafil is not indicated for use in children. As transient visual disturbances and dizziness have been reported in some patients taking sildenafil, particularly at the 100 mg dose, patients should be aware of how they react to sildenafil before driving or operating machinery, and the doctor cattel advise accordingly.

Overdose information is limited. In studies with healthy volunteers, of single doses up to 800 mg, adverse events were similar to those seen at lower doses but incidence rates and severities were increased.

Braces teeth cases of overdose, standard Mycelex (Clotrimazole)- Multum measures should be adopted as required. Sildenafil blood levels are not clinically useful.



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