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The use of casino in combination with antihypertensive drugs does not lead to additional side effects.Special instructions.In order to diagnose erectile dysfunction, determine their possible causes and choose an adequate treatment, a complete medical history must be collected and a thorough physical examination performed. Drugs for the treatment of erectile slot should be used with caution in patients with anatomical deformity of the penis (angulation, cavernous fibrosis, Peyronie's disease), that is, in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia).In the era of post-marketing research, cases of prolonged erection and priapism have been reported.

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If an erection persists for more than 4 hours, the patient should immediately seek medical attention. Unless priapism therapy was carried out immediately, it can lead to damage to the tissues of the penis and irreversible loss of potency.Drugs intended to treat erectile dysfunction should not be determined by men for whom sexual activity is undesirable.

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Sexual activity poses this danger to the presence of heart disease, therefore, on the eve of the beginning of any therapy, in accordance with erectile dysfunction, the doctor should refer the patient to an examination of the state of the cardiovascular system. Sexual activity is undesirable in patients with heart failure, unstable angina pectoris, myocardial infarction or stroke, life-threatening arrhythmias, arterial hypertension (EXTRA> 170/100 mm Hg) in the last 6 months, unless hypotension (TARTAR Cardiovascular complications.

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In the course of the post-marketing use of sildenafil for the treatment of erectile dysfunction, such adverse events were reported, even serious cardiovascular complications (including myocardial infarction, unstable angina pectoris, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, arterial hypertension hypotension) who had a temporary union with sildenafil. Most of these patients, but not all of them, had risk factors for cardiovascular complications. Many of these adverse events occurred shortly after sexual activity, and some of them were noted after taking sildenafil without subsequent sexual activity. It is not possible to establish the presence of a direct connection among the observed undesirable phenomena and the indicated alias other factors.

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slot has a systemic vasodilating effect, leading to a transient decrease in PECLO, which is not clinically significant and does not lead to any consequences in most patients. Nevertheless, before prescribing Viagra, the doctor is forced to carefully assess the danger of possible undesirable manifestations 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 left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as with the sometimes occurring syndrome of multiple system atrophy, manifested by severe dysregulation of PECLO by the autonomic nervous system.

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Since the combined use of sildenafil and alpha-blockers can lead to symptomatic hypotension in some sensitive patients, the Viagra product should be prescribed with caution to patients taking alpha-blockers. In order to minimize the risk of postural hypotension in patients taking alpha-blockers, the dose of Viagra should be taken as then achieving stabilization of hemodynamic parameters in these patients. You should also consider the feasibility of reducing the initial dose of Viagra. It is necessary to inform patients about the book what actions to take if symptoms of postural hypotension appear.