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Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CANNABIDIOL (CBD) are as follows:

Likely effective for.

  • Seizure disorder (epilepsy). A specific prescription product (Epidiolex, GW Pharmaceuticals) is approved by the US FDA to treat seizures caused by Dravet syndrome, Lennox-Gastaut syndrome, or tuberous sclerosis complex. It is unclear if other forms of CBD are helpful for seizure. For now, stick with the prescription product.

Are there safety concerns?

When taken by mouth: CBD is possibly safe to take in appropriate doses. Doses of up to 200 mg daily have been used safely for up to 13 weeks. With the guidance of a healthcare provider, a specific prescription CBD product (Epidiolex) has been used at higher doses and for longer durations.

CBD can cause some side effects, such as dry mouth, low blood pressure, light headedness, and drowsiness. Signs of liver injury have also been reported with high doses of the prescription form of CBD, called Epidiolex.

When applied to the skin: There isn’t enough reliable information to know if CBD is safe or what the side effects might be.

Special precautions & warnings:

Pregnancy and breast-feeding: It may be unsafe to take CBD if you are pregnant or breast feeding. CBD products can be contaminated with other ingredients that may be harmful to the fetus or infant. Stay on the safe side and avoid use.

Children: It is possibly safe for children to take a specific prescription CBD product (Epidiolex) by mouth in doses up to 25 mg/kg daily. This product is approved for use in children with certain conditions who are at least 1 year old. It isn’t clear if other CBD products are safe in children.

Liver disease: People with liver disease may need to use lower doses of CBD.

Parkinson disease: Some early research suggests that taking high doses of CBD might make muscle movement and tremors worse in some people with Parkinson disease.

Are there interactions with medications?

Moderate Be cautious with this combination. Brivaracetam (Briviact) Brivaracetam is changed and broken down by the body. CBD might decrease how quickly the body breaks down brivaracetam. This might increase levels of brivaracetam in the body. Caffeine Caffeine is changed and broken down by the body. CBD might decrease how quickly the body breaks down caffeine. This might increase levels of caffeine in the body. Carbamazepine (Tegretol) Carbamazepine is changed and broken down by the body. CBD might decrease how quickly the body breaks down carbamazepine. This might increase levels of carbamazepine in the body and increase its side effects. Citalopram (Celexa) Citalopram is changed and broken down by the body. CBD might decrease how quickly the body breaks down citalopram. This might increase levels of citalopram in the body and increase its side effects. Clobazam (Onfi) Clobazam is changed and broken down by the liver. CBD might decrease how quickly the liver breaks down clobazam. This might increase the effects and side effects of clobazam. Eslicarbazepine (Aptiom) Eslicarbazepine is changed and broken down by the body. CBD might decrease how quickly the body breaks down eslicarbazepine. This might increase levels of eslicarbazepine in the body by a small amount. Everolimus (Zostress) Everolimus is changed and broken down by the body. CBD might decrease how quickly the body breaks down everolimus. This might increase levels of everolimus in the body. Lithium Taking higher doses of CBD might increase levels of lithium. This can increase the risk of lithium toxicity.

Are there interactions with herbs and supplements?

Herbs and supplements with sedative properties CBD might cause sleepiness and slowed breathing. Taking it along with other supplements with similar effects might cause too much sleepiness and/or slowed breathing in some people. Examples of supplements with this effect include hops, kava, L-tryptophan, melatonin, and valerian.

Are there interactions with foods?

CBD can be taken with food or without food. But taking it with food can cause the body to absorb more CBD than when it is taken without food. This might increase the effects of CBD.

Fatty foods or drinks, such as whole milk, and alcohol can also make the body absorb more CBD.

What dose is used?

CBD has most often been used by adults in doses of 200 mg or less per day. Speak with a healthcare provider to find out what dose might be best for a specific condition.

For information on using prescription CBD, a product called Epidiolex, speak with a healthcare provider.

How to use CBD oil for erectile dysfunction

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

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Erectile dysfunction or ED is a hot topic, and many people are confused about what the issue entails and which remedies—if any—actually work. One popular, albeit controversial, treatment strategy involves using cannabidiol, aka CBD, a molecule found in hemp and marijuana that doesn’t make you feel high but may offer other benefits.

Read on to learn whether CBD oil for erectile dysfunction or sexual performance anxiety works and how to use it.

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How does CBD for erectile dysfunction work?

Unlike THC, CBD doesn’t appear to alter consciousness or cause a person to feel “high.” Currently, it is only FDA-approved to help treat seizure disorders. However, there is ongoing research into the potential benefits of CBD for anxiety, chronic pain, and other health conditions. CBD may also have anti-inflammatory and anti-cancer properties, but these are still being studied (Meissner, 2022).

Scientists don’t fully understand how CBD works, but they suspect it affects certain brain chemicals. Cannabinoids like CBD work by interacting with the body’s endocannabinoid system (ECS). This system involves the whole body and may play a role in pain, memory, movement, appetite, metabolism, and immune system function (Sheikh, 2022).

Here are four ways CBD oil may help with erectile dysfunction:

1. Could lower general anxiety and stress

Some research suggests that CBD may benefit people with anxiety disorders and brain diseases like Alzheimer’s and Parkinson’s (Meissner, 2022). Anxiety can sometimes affect sexual performance and sex drive, so if CBD is beneficial for anxiety disorders, it may help with ED too.

Researchers have found that CBD works on serotonin receptors in the brain. Serotonin can affect a person’s anxiety and fear levels, which is why CBD could lower general stress and anxiety levels (Blessing, 2015).

2. May decrease performance anxiety

Sexual performance anxiety can be caused by relationship problems, a negative body image, fear of disappointing your partner, or pressure to have an orgasm. Since CBD may help lower anxiety levels, it could, in turn, decrease performance anxiety (Blessing, 2015).

According to a variety of studies and preclinical evidence, CBD shows promise to help people with:

If a person’s performance anxiety stems from any of those issues, the studies suggest CBD could help (Blessing, 2015).

What is an erection, and how does it work?

3. Could lower blood pressure

CBD has the potential to lower blood pressure in people with increased heart rates, according to one study from 2017 (Jadoon, 2017).

When blood pressure is lower, it can improve circulation, which may allow more blood to flow to the penis.

4. May improve sleep

Lack of sleep can wreak havoc on the body. If you’re not getting enough rest, it could contribute to erectile dysfunction (Cho, 2018).

Anxiety and stress can often cause sleep disturbances, which is why CBD could help you get a good night’s rest. Some studies suggest that CBD may have therapeutic potential for insomnia (Babson, 2017). In a different study of 72 adults with either anxiety, poor sleep, or both, sleep scores improved with CBD use for 66.7% of the participants (Shannon, 2019).

If a lack of sleep is causing your ED, using CBD for sleep could be helpful.

Can CBD help with ED?

While there’s not a ton of research on the topic of CBD as a treatment for ED, one study found that there are ECS receptors involved in male fertility. And while some studies suggest that cannabis may be indirectly associated with erectile dysfunction and may cause ED in young habitual cannabis users, more research on CBD is needed (du Plessis, 2015).

Some research has shown that CBD may help reduce anxiety for some people (Shannon, 2019). Because anxiety may play a significant role in erectile dysfunction or even cause erectile dysfunction, CBD oil for erectile dysfunction may be a helpful tool. However, more research is needed in this area.

CBD for anxiety: dosage, benefits and side effects

How to use CBD oil for ED

How to use CBD oil will depend on the form you have. You can swallow liquid oils or put them under your tongue and let them absorb that way. You can swallow pills or capsules the same way you would other medications. You may need a special vaporizer or inhaler to use the vaporized forms.

CBD oil comes in many forms, including (Bruni, 2018):

  • Liquid oils
  • Pills or capsules
  • Liquid oils that you swallow or edibles
  • Chewing gum
  • CBD inhaler
  • Creams

You can use CBD for ED by incorporating one or more of these CBD products into your daily routine. Keep in mind that CBD isn’t a magic fix for ED. You’ll want to experiment with different products to see what works best for you. Eating a gummy or taking a CBD capsule may produce quicker results. However, it varies from person to person and depends on the CBD dosage, type, and other factors.

Dosage

The FDA doesn’t approve most CBD products, so accurate dosage guidelines are hard to come by.

The drug, Epidiolex, is a CBD-based treatment used for seizures associated with Lennox-Gastaut syndrome. It’s recommended that people start at a dose of 5 milligrams per kilogram of body weight per day (mg/kg/day). After one week, users can increase their dose to 20 mg/kg/day, depending on their reaction to the drug (DailyMed, 2022).

If you don’t know how much CBD to take, start with a low dose, and work your way up from there over time.

Potential risks or considerations of taking CBD

If you’re considering taking CBD in an attempt to treat erectile dysfunction or any other medical condition or health issue, it’s important to understand the potential risks involved. The US Food and Drug Administration (FDA) has approved one cannabis-derived and three cannabis-related drug products, all of which require a prescription (FDA-a, 2020):

  • Epidiolex for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex (DailyMed, 2022)
  • Syndros and Marinol for the treatment of anorexia associated with weight loss in people with AIDS and nausea/vomiting in people receiving cancer chemotherapy (FDA, 2017; DailyMed-a, 2021)
  • Cesamet for the treatment of nausea/vomiting in people receiving cancer chemotherapy (DailyMed-b, 2021)

Because the FDA doesn’t generally regulate CBD products, it can be difficult to determine the quality of the products you’re getting. It can also be difficult to know what form of CBD (i.e., CBD oil, gummies, CBD capsules, etc.) may work best for you.

Using any drug without this knowledge can cause a host of unwanted side effects that are difficult to predict without guidance or regulation.

Is erectile dysfunction reversible? In most cases, it’s treatable

Potential CBD side effects

CBD side effects may vary from person to person. A few possible side effects include (FDA-b, 2020):

Other benefits of CBD

CBD has plenty of potential benefits, and they’re not all specifically for ED. Some of these benefits include:

  • Pain relief
  • Mental health and wellness assistance
  • Performance anxiety
  • Improved sleep
  • Anti-inflammatory properties
  • Antioxidant properties
  • Anti-nausea

While there are no studies explicitly demonstrating the benefits of CBD on ED, there are studies that indicate CBD may be helpful in the treatment of other conditions. Evidence suggests CBD could be a beneficial treatment for multiple anxiety disorders, but additional research is needed (Shannon, 2019).

Researchers also believe CBD may help slow down messages sent to the brain, change calcium levels in brain cells, and decrease brain inflammation, all of which may help prevent seizures (Maroon, 2018).

Animal studies indicate other potential benefits of CBD, such as its anti-inflammatory potential to treat arthritis pain. But more research is necessary to understand how these benefits could translate to humans (Hammell, 2016).

6 best CBD gummies for anxiety

What causes erectile dysfunction?

Erectile dysfunction can have many causes. Some of these include (NIH, 2017):

Other treatment options for ED

CBD may not be an approved treatment for ED, but there are several other treatment options available.

Medication

After lifestyle modifications, the first line of treatment for ED is usually oral medications taken before sexual intercourse. These drugs are known as PDE-5 inhibitors, and the most common one is sildenafil (brand name Viagra; see Important Safety Information). Other PDE-5 inhibitors include (Krzastek, 2019):

  • Tadalafil (brand name Cialis; see Important Safety Information)
  • Vardenafil (brand name Levitra)
  • Avanafil (brand name Stendra)

Lifestyle changes

Certain lifestyle changes and improvements can also have a positive effect on ED. The following lifestyle habits have all been shown to contribute to ED (NIH, 2017):

  • Lack of physical activity
  • An unhealthy, unbalanced diet
  • Cigarette smoking

Taking actions to modify these behaviors and health conditions may have a major impact.

What is horny goat weed? Does it work?

Managing underlying health conditions

Certain health conditions could cause ED. Some of these include (Krzastek, 2019):

Natural supplements

There are also some natural supplements, herbs, and vitamins that may or may not benefit ED. Some of these include:

  • Horny goat weed: A traditional Chinese medicinal herb often used to treat fatigue and low sex drive. Animal and lab studies have shown that horny goat weed contains a substance called icariin, a mild PDE-5 inhibitor, but it’s unclear if these benefits translate to humans (Anand Ganapathy, 2021).
  • Yohimbine: Some research suggests that Yohimbine, the active ingredient in yohimbe bark, may work better than a placebo to treat ED (NIH, 2020).
  • Vitamin D:Vitamin D deficiency may contribute to problems with erections.
  • Vitamin B3: Some research has shown vitamin B3 supplementation may help increase penile blood flow (Crafa, 2020).
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In general, research on vitamins and natural supplements is limited, so it’s best to work with your healthcare professional to treat ED.

What is CBD?

CBD, or cannabidiol, is a natural substance called a cannabinoid. It comes from the cannabis plant, which is part of the Cannabaceae family. CBD is one of two main cannabinoids; the other one is delta-9-tetrahydrocannabinol (THC).

Cannabis plants with higher levels of THC are classified as marijuana and are controlled substances (FDA-b, 2020). Cannabis plants with very low THC are classified as hemp. CBD can be found in both marijuana and hemp.

Marijuana and depression: does weed make you depressed?

What is erectile dysfunction?

ED is when a person cannot get or sustain an erection long enough to have sex.

Can you naturally cure erectile dysfunction?

There are natural remedies for ED such as CBD, horny goat weed, vitamin D, and vitamin B3. However, there is not enough evidence to say that these natural methods will cure ED.

How do you use CBD for sex?

You can take CBD in a variety of forms, such as tinctures, gummies, and liquids. Taking CBD before sex could help reduce anxiety, which may be causing your ED. CBD could also help increase blood flow to the penis by potentially lowering blood pressure.

Does CBD help with arousal?

CBD could help with arousal by lowering anxiety and stress levels, which can help you relax.

References

  1. Anand Ganapathy, A., Hari Priya, V. M., & Kumaran, A. (2021). Medicinal plants as a potential source of phosphodiesterase-5 inhibitors: a review. Journal of Ethnopharmacology, 267, 113536. doi:10.1016/j.jep.2020.113536. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33137431/
  2. Babson, K. A., Sottile J., & Morabito, D. (2017). Cannabis, cannabinoids, and sleep: a teview of the literature. Current Psychiatry Reports (4), 23. doi:10.1007/s11920-017-0775-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28349316/
  3. Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(14), 825-836. doi: 10.1007/s13311-015-0387-1. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
  4. Bruni, N., Della Pepa, C., Oliaro-Bosso, S., et al. (2018). Cannabinoid delivery systems for pain and inflammation treatment. Molecules(Basel, Switzerland), 23(10), 2478. doi:10.3390/molecules23102478. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30262735/
  5. Cho J. W. & Duffy, J. F. (2018). Sleep, sleep disorders, and sexual dysfunction. World Journal of Men’s Health. 37(3), 261-275. doi:10.5534/wjmh.180045. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30209897/
  6. Crafa, A., Cannarella, R., Condorelli, R. A., et al. (2020). Is there an association between vitamin d deficiency and erectile dysfunction? A systematic review and meta-analysis. Nutrients, 12(5), 1411. doi:10.3390/nu12051411. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32422943/
  7. DailyMed-b. (2021). Cesamet- nabilone capsule. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=83c7ac15-ece9-47de-b83c-d575544fa449
  8. DailyMed. (2022). Epidiolex- cannabidiol solution. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8bf27097-4870-43fb-94f0-f3d0871d1eec
  9. DailyMed-a. (2021). Syndros- dronabinol solution. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a7801c70-995d-46a2-91ee-141ef427c6b5
  10. du Plessis, S. S., Agarwal, A., & Syriac, A. (2015). Marijuana, phytocannabinoids, the endocannabinoid system, and male fertility. Journal of Assisted Reproduction and Genetics, 32(11), 1575–1588. doi:10.1007/s10815-015-0553-8. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26277482/
  11. Hammell, D. C., Zhang, L. P., Ma, F., et al. (2016). Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. European Journal of Pain(London, England), 20(6), 936–948. doi:10.1002/ejp.818. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26517407/
  12. He, C., Wang, Z., & Shi, J. (2020). Pharmacological effects of icariin. Advances in Pharmacology(San Diego, Calif.), 87, 179–203. doi:10.1016/bs.apha.2019.10.004. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32089233/
  13. Jadoon, K. A., Tan, G. D., & O’Sullivan, S. E. (2017). A single dose of cannabidiol reduces blood pressure in healthy volunteers in a randomized crossover study. JCI Insight; 2(12), e93760. doi:0.1172/jci.insight.93760. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470879/
  14. Krzastek, S. C., Bopp, J., Smith, R. P., & Kovac, J. R. (2019). Recent advances in the understanding and management of erectile dysfunction. F1000Research, 8, F1000 Faculty Rev-102. doi:10.12688/f1000research.16576.1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30740217/
  15. Maroon, J. & Bost, J. (2018). Review of the neurological benefits of phytocannabinoids. Surgical Neurology International, 9, 91. doi:10.4103/sni.sni_45_18. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29770251/
  16. Meissner, H. & Cascella, M. (2022). Cannabidiol (CBD). StatPearls. Retrieved on Aug. 12, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK556048/
  17. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (2017). Symptoms & Causes of Erectile Dysfunction. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
  18. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (2020). Yohimbine. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK548703/
  19. Ng, C. F., Lee, C. P., Ho, A. L., & Lee, V. W. (2011). Effect of niacin on erectile function in men suffering erectile dysfunction and dyslipidemia. The Journal of Sexual Medicine, 8(10), 2883–2893. doi:10.1111/j.1743-6109.2011.02414.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21810191/
  20. Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in anxiety and sleep: A large case series. The Permanente Journal, 23, 18–041. doi: 10.7812/TPP/18-041. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30624194/
  21. Sheikh, N. K. & Dua, A. (2022). Cannabinoids. StatPearls. Retrieved on Aug. 12, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK556062/
  22. Sooriyamoorthy, T. & Leslie, S. W. (2021). Erectile dysfunction. StatPearls. Retrieved on Aug. 12, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/
  23. U.S. Food and Drug Administration (FDA-a). (2020). FDA and cannabis: research and drug approval process. Retrieved on Aug 12, 2022 from https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process
  24. U.S. Food and Drug Administration (FDA). (2017). Marinol: highlights of prescribing information. Retrieved on Aug 12, 2022 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018651s029lbl.pdf
  25. U.S. Food and Drug Administration (FDA-b). (2020). What you need to know (and what we’re working to find out) about products containing cannabis or cannabis-derived compounds, Including CBD. Retrieved on Aug 12, 2022 from https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis

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Important Safety Information for Sildenafil (Viagra)

What are the most important things I need to know about VIAGRA® (sildenafil citrate) 25 mg, 50 mg, and 100 mg tablets and generic VIAGRA®?

Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.

  • VIAGRA® and generic VIAGRA® can cause serious side effects. Serious, but rare, side effects include:
    • an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis.
    • sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
    • sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away

    Who should not take VIAGRA® or generic VIAGRA®?

    Do not take VIAGRA® or generic VIAGRA® if you:

    • Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
    • Are allergic to sildenafil, as contained in VIAGRA® and REVATIO®, or any of the ingredients in VIAGRA® or generic VIAGRA® tablets.
    • Are a women or a child

    When should I call my primary provider?

    Call your primary provider right away if you:

    • Have an erection that lasts longer than 4 hours
    • Experience a sudden loss of vision in one or both eyes
    • Experience a sudden decrease in or loss of hearing
    • Experience chest pain, dizziness, or nausea during sex
    • Take too much Viagra or sildenafil citrate

    If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

    What are the most common side effects of VIAGRA® and generic VIAGRA®?

    The most common side effects are:

    • headache
    • flushing
    • upset stomach
    • abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
    • stuffy or runny nose
    • back pain
    • muscle pain
    • nausea
    • dizziness
    • rash

    What should I tell my Roman-affiliated provider before taking VIAGRA® and generic VIAGRA®?

    Before you take VIAGRA® or generic VIAGRA® , tell your healthcare provider if you:

    • Have or have had heart problems such as a heart attack,irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
    • Have had heart surgery within the last 6 months
    • Have pulmonary hypertension
    • Have had a stroke
    • Have low blood pressure, or high blood pressure that is not controlled
    • Have a deformed penis shape
    • Have had an erection that lasted for more than 4 hours
    • Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
    • Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
    • Have ever had severe vision loss, including an eye problem called NAION
    • Have bleeding problems
    • Have or have had stomach or intestinal ulcers
    • Have liver problems
    • Have kidney problems or are having kidney dialysis
    • Have any other medical conditions

    Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

    VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects.

    Especially tell your healthcare provider if you take any of the following:

    • Medicines called nitrates
    • Medicines called guanylate cyclase stimulators such as Adempas® (riociguat)
    • Medicines called alpha-blockers such as Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), Jalyn® (dutasteride and tamsulosin HCl), or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA® with alpha-blockers can lead to a drop in blood pressure or to fainting
    • Medicines called HIV protease inhibitors, such as ritonavir (Norvir®), indinavir sulfate (Crixivan®), saquinavir (Fortovase® or Invirase®), or atazanavir sulfate (Reyataz®)
    • Oral antifungal medicines, such as ketoconazole (Nizoral®) and itraconazole (Sporanox®)
    • Antibiotics, such as clarithromycin (Biaxin®), telithromycin (Ketek®), or erythromycin
    • Other medicines that treat high blood pressure
    • Other medicines or treatments for ED
    • VIAGRA® contains sildenafil, which is the same medicine found in another drug called REVATIO®. REVATIO® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA® should not be used with REVATIO® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])

    Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

    What is the FDA-approved use of VIAGRA® and generic VIAGRA®?

    VIAGRA® (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).

    Roman-affiliated doctors may prescribe VIAGRA® or generic VIAGRA® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment. While this is not an FDA-approved use of the drug, the American Urological Association has included the use of sildenafil citrate in the treatment of PE in its Guideline on the Pharmacologic Management of Premature Ejaculation.

    You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

    Please see the full Prescribing Information for complete safety information.

    Product names referenced herein are trademarks of their respective owners.

    Important Safety Information for Tadalafil (Cialis)

    What Is The Most Important Information I Should Know About CIALIS® (tadalafil) and generic CIALIS®?

    • CIALIS® and generic CIALIS® can cause serious side effects. Serious, but rare, side effects include:
      • An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
      • Changes in vision. Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
      • Sudden decrease or loss of vision. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS® and generic CIALIS®) reported a sudden decrease or loss of vision in one or both eyes. It is uncertain whether PDE5 inhibitors directly cause the vision loss. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS® and generic CIALIS®, and call a healthcare provider right away.
      • Sudden loss or decrease in hearing. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS® and generic CIALIS®. It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors. If you experience these symptoms, stop taking CIALIS® and generic CIALIS® and contact a healthcare provider right away.
      • ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.
      • CIALIS® and generic CIALIS® help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Some form of sexual stimulation is needed for an erection to happen with CIALIS® or generic CIALIS®.
      • CIALIS® and generic CIALIS® do not:
        • Cure ED
        • Increase a man’s sexual desire
        • Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
        • Serve as a male form of birth control
        • Take CIALIS® or generic CIALIS® exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Do not change your dose or the way you take CIALIS® or generic CIALIS® without talking to your healthcare provider.

        Who Should Not Take CIALIS® or generic CIALIS®?

        Do not take CIALIS® or generic CIALIS® if you:

        • Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
        • Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
        • Take any medicines called “nitrates”
        • Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite
        • Take any medicines called guanylate cyclase stimulators, such as riociguat
        • Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients

        When should I call my primary provider?

        Call your primary provider right away if you:

        • Have an erection that lasts longer than 4 hours
        • Experience a sudden loss of vision in one or both of your eyes
        • Experience a sudden decrease or loss hearing
        • Take too much CIALIS® or generic CIALIS®
        • Have an allergic reaction to CIALIS® or generic CIALIS®
        • Symptoms of an allergic reaction may include:
        • Rash
        • Hives
        • Swelling of the lips, tongue, or throat
        • Difficulty breathing or swallowing

        Call your healthcare provider or get help right away if you have any of the symptoms of an allergic reaction listed above.

        If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

        What Should I Tell My Roman-affiliated Provider Before Taking CIALIS® and generic CIALIS®?

        Tell your Roman-affiliated provider about all your medical problems, including if you:

        • Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. You should not take CIALIS® and generic CIALIS® if your healthcare provider has told you not to have sexual activity because of your health problems.
        • Have pulmonary hypertension
        • Have low blood pressure or have high blood pressure that is not controlled
        • Have had a stroke
        • Have liver problems
        • Have kidney problems or require dialysis
        • Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
        • Have ever had severe vision loss, including a condition called NAION
        • Have stomach or intestinal ulcers
        • Have a bleeding problem
        • Have a deformed penis shape or Peyronie’s disease
        • Have had an erection that lasted more than 4 hours
        • Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia

        Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

        Especially tell your healthcare provider if you take any of the following:

        • Medicines called nitrates
        • Medicines called guanylate cyclase stimulators, such as riociguat (Adempas®), used to treat pulmonary hypertension
        • Medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), 4 Jalyn® (dutasteride and tamsulosin HCl) or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS® or generic CIALIS® is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
        • Other medicines to treat high blood pressure (hypertension)
        • Medicines called HIV protease inhibitors, such as ritonavir (Norvir® , Kaletra® )
        • Oral antifungals such as ketoconazole (Nizoral® ), itraconazole (Sporanox® )
        • Antibiotics such as clarithromycin (Biaxin® ), telithromycin (Ketek® ), erythromycin (several brand names exist. Please consult your healthcare provider to determine if you are taking this medicine).
        • Other medicines or treatments for ED.
        • Tadalafil is also marketed as ADCIRCA® for the treatment of pulmonary arterial hypertension. Do not take both CIALIS® or generic CIALIS® and ADCIRCA®. Do not take sildenafil citrate (Revatio®, Viagra®) with CIALIS® or generic CIALIS®.

        Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

        What are the most common side effects of CIALIS® or generic CIALIS®?

        The most common side effects with CIALIS® and generic CIALIS® are:

        • Headache
        • Indigestion
        • Back pain
        • Muscle aches
        • Flushing
        • Stuffy or runny nose

        What is the FDA-approved Use of CIALIS® and generic CIALIS®?

        CIALIS® and generic CIALIS® are prescription medicines used to treat erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both.

        Roman-affiliated doctors may prescribe CIALIS® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.

        You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

        Please see the full Prescribing Information for complete safety information.

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