Sildenafil
In the pivotal trial, headache, flushing and dyspepsia were the most common
effects, occurring in 6% to 18% of men.
Visual colour distortion, visual disturbance and blurred vision are all listed
as common. A dedicated study found mild, temporary blue/green
colour-discrimination changes 1 hour after a 100 mg dose, with no effect
remaining 2 hours after the dose.
Sildenafil is contraindicated in men who have already lost vision in one eye
from NAION.
Tadalafil
Frequency rises with higher doses. With once-daily dosing, most headaches occur
in the first 10 to 30 days of treatment.
Tadalafil is contraindicated in men who have lost vision in one eye because of
NAION, whether or not the episode was linked to a PDE5 inhibitor. It is also
contraindicated with nitrate medicines and with guanylate cyclase stimulators,
and after a recent heart attack (within 3 months) or stroke (within 6 months).
Vardenafil
Vardenafil is contraindicated in men who have already lost vision in one eye
from NAION, with nitrate medicines and nitric-oxide donors, and in men with
severe cardiovascular disease.
It can lower blood pressure and has specific precautions for QT prolongation and
rhythm medicines. Film-coated and orodispersible tablets are not interchangeable
dose for dose.
Avanafil
Headache is named as one of the most frequently reported reactions across a
safety database of 2,566 exposed subjects. Back pain sits in the uncommon band
of the adverse-reaction table, although the safety summary names it among the
most frequently reported reactions.
Avanafil is contraindicated with nitrate medicines and nitric-oxide donors, and
in men with serious cardiovascular conditions such as recent heart attack,
stroke or unstable angina.
Dapoxetine
Dapoxetine is a short-acting serotonin reuptake inhibitor used on demand for premature ejaculation.
Figures are from the phase 3 trials.
The EU product information contraindicates dapoxetine in the presence of:
- significant heart disease — heart failure (NYHA II–IV), conduction disorders such as AV block or sick sinus syndrome, ischaemic heart disease or significant valve disease
- any history of fainting
- a history of mania or severe depression
- moderate or severe liver impairment
- treatment with an MAO inhibitor or with thioridazine now or in the last 14 days
- treatment with any other serotonergic medicine — SSRIs, SNRIs, tricyclics, tramadol, triptans, linezolid, lithium, tryptophan or St John’s wort — now or in the last 14 days
- treatment with a strong CYP3A4 inhibitor such as ketoconazole, itraconazole, ritonavir, saquinavir, telithromycin, nefazodone, nelfinavir or atazanavir
- hypersensitivity to dapoxetine or any of the tablet’s ingredients
Dapoxetine is authorised in EU countries including Spain, but Hi-Doctor does not
prescribe it: it needs a doctor who can first check your heart history, your
mood history and your other medicines, because fainting is a recognised risk.
Seek urgent care for
- an erection lasting 4 hours or longer
- sudden loss of vision or hearing
- chest pain, collapse, or a severe allergic reaction
- fainting, severe dizziness, mood changes, or thoughts of self-harm on dapoxetine
And tell your doctor if
- the prescribed dose does not give a satisfactory response after several correctly timed attempts — do not increase the dose yourself
- you have marked dizziness, palpitations, or a headache that is severe or persistent
- any new heart, chest-pain, blood-pressure, rhythm, prostate, antifungal, antibiotic or HIV medicine is started
Start a consultation
Sexual health consultation
Answer the sexual health questionnaire and a registered doctor reviews it.
They decide whether treatment is appropriate, which one, and at what dose —
and declining is a normal outcome. See what it costs
and how the review works.