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shortness of breathLEVITRA is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.

QT Prolongation [see Warnings and Precautions (5.7)]Do not change your dose of Levitra without talking to your doctor. Your doctor may lower your dose or raise your dose, depending on how your body reacts to Levitra. directions for taking viagra Effects of Tadalafil on Other Medicinal ProductsComuníquese con su médico o busque atención médica de emergencia si su erección es dolorosa o dura más de 4 horas. La erección prolongada (priapismo) puede hacerle da?o al pene. Guest-Maximum dose: 20 mg once a day

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Penile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum. Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in erection. The tissue concentration of cGMP is regulated by both the rates of synthesis and degradation via phosphodiesterases (PDEs). The most abundant PDE in the human corpus cavernosum is the cGMP-specific phosphodiesterase type 5 (PDE5); therefore, the inhibition of PDE5 enhances erectile function by increasing the amount of cGMP. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation. viagra plus Figure 3: Mean Standing Systolic Blood Pressure Change from BaselineSince PDE5 inhibitors such as tadalafil may cause transiently low blood pressure (hypotension), organic nitrates (poppers) should not be taken for at least 48 hours after taking the last dose of tadalafil. Using organic nitrites (such as the sex drug amyl nitrite) within this timeframe may increase the risk of life-threatening hypotension.

Enalapril — A study was conducted to assess the interaction of enalapril (10 to 20 mg daily) and tadalafil 10 mg. Following dosing, the mean reduction in supine systolic/diastolic blood pressure due to tadalafil 10 mg in subjects taking enalapril was 4/1 mm Hg, compared to placebo.