Kamagra-FX (Sildenafil Oral Jelly) 100mg/5g

Sildenafil is a prescription medicine for erectile dysfunction, and the same molecule is licensed separately at different doses for another condition.

• Erectile dysfunction in adult men: helps achieve and maintain an erection in response to sexual stimulation.
• Erectile dysfunction with an underlying cause: used where the difficulty relates to diabetes, cardiovascular disease, prostate surgery, or spinal injury.
• Patients who struggle with tablets: the oral jelly format offers an alternative for those with swallowing difficulty.
• Requires sexual stimulation to work: sildenafil does not cause an erection on its own and is not an aphrodisiac.
• Not for women or children: it is not approved for use in women, and pulmonary arterial hypertension is treated with a different sildenafil product at different doses.

• During sexual arousal, nerves in the penis release nitric oxide, which raises levels of a messenger called cyclic GMP. Cyclic GMP relaxes the smooth muscle in the blood vessels so more blood flows in and an erection forms. An enzyme called phosphodiesterase type 5 normally breaks cyclic GMP down. Sildenafil blocks that enzyme, so cyclic GMP persists and the response to stimulation is stronger and lasts longer. Without arousal, there is no effect.

Seek emergency care for sudden vision or hearing loss, or an erection lasting more than four hours.

Common Side Effects

• Headache and facial flushing: the most frequently reported effects, caused by widened blood vessels.
• Indigestion and nasal congestion: common and usually mild.
• Dizziness: from the mild fall in blood pressure sildenafil produces.
• Visual changes: a blue tinge to vision, light sensitivity, or blurring, which usually resolves.

Serious or Rare Side Effects

• Severe hypotension with nitrates: the combination can cause a dangerous and potentially fatal fall in blood pressure; nitrates are an absolute contraindication.
• Priapism: an erection lasting more than four hours can permanently damage penile tissue; seek emergency treatment immediately.
• Sudden vision or hearing loss: non-arteritic anterior ischaemic optic neuropathy and sudden hearing loss have been reported; stop the medicine and seek urgent care.

The most important checks are cardiovascular, because both the medicine and sexual activity place demands on the heart.

• Never combine with nitrates: any nitrate medicine or nitrite in any form is an absolute contraindication because of the risk of fatal hypotension.
• Avoid riociguat and other guanylate cyclase stimulators: these also cause dangerous falls in blood pressure.
• Assess cardiovascular fitness first: sexual activity carries cardiac risk, so it is unsuitable where activity is inadvisable on heart grounds.
• Start at a lower dose where indicated: 50mg is the usual starting dose for most patients, with 100mg the maximum, and lower doses used in older patients or organ impairment.
• Take care with alpha-blockers and antihypertensives: these add to the blood pressure lowering effect, so timing and dosing need review.
• Use caution with priapism risk factors: sickle cell disease, multiple myeloma, leukaemia, or penile deformity require careful assessment.

Sildenafil is processed mainly by CYP3A4, and several combinations are dangerous rather than merely inconvenient.

Major Interactions (Avoid)

• Nitrates in any form (glyceryl trinitrate, isosorbide, amyl nitrite): absolutely contraindicated, as the combination can cause a fatal drop in blood pressure.
• Riociguat and other guanylate cyclase stimulators: contraindicated because of severe hypotension, and other PDE5 inhibitors should not be combined either.

Moderate Interactions (Monitor Closely)

• Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin): these raise sildenafil levels sharply, so a reduced dose is required.
• Alpha-blockers (doxazosin, tamsulosin) and antihypertensives: additive blood pressure lowering can cause fainting, so stagger dosing.
• CYP3A4 inducers (rifampicin) and grapefruit juice: these change sildenafil levels and its effect, so review with the prescriber.