Leukemia blood related cancer or Multiple myeloma blood related cancer or Sickle-cell anemia blood disorder —Sildenafil should be used with caution in these patients as problems with prolonged erection of the penis may occur. It is in the phosphodiesterase-5 inhibitor PDE5-I class of medications. Stendra avanafil : This is an as-needed medication taken 30 minutes before sex and can last up to six hours. The result of smooth muscle cell target protein phosphorylation is a decrease in intracellular calcium, increased efflux of potassium, and deactivation of myosin light chain kinase, ultimately causing smooth muscle relaxation. Most online providers require a picture of a valid ID, a selfie showing your face, and a recent blood pressure reading taken with a home blood pressure monitor or by a medical provider.Sildenafil is available as oral tablets of 25 mg, 50 mg, and mg strength for erectile dysfunction (ED). Most patients receive a prescription for 50 mg of oral sildenafil, taken as needed approximately 1 hour before sexual activity. The dose can be titrated upward to a maximum of mg or down to 25 mg based on individual . Common Viagra side effects may include: flushing (warmth, redness, or tingly feeling); headache, dizziness; abnormal vision (blurred vision, changes in color vision) runny or stuffy nose, nosebleeds; sleep problems (insomnia); muscle pain, back pain; or. upset stomach. This is not a complete list of side effects and others may occur.  · The effects may be increased because of slower removal of the medicine from the body. Leukemia (blood related cancer) or. Multiple myeloma (blood related cancer) or. Sickle-cell anemia (blood disorder)—Sildenafil should be used with caution in these patients as problems with prolonged erection of the penis may occur.

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