What are the side effects of sildenafil (Kamagra)?

Sildenafil can cause hypotension (abnormally low blood pressure that can lead to fainting and even shock) when given to patients who are taking nitrates. Therefore, patients taking nitrates daily, even patients taking nitrates only once a day, should not take sildenafil. Nitrates are used most commonly to relieve angina (chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate, and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate also are found in some recreational drugs called "poppers".

Sildenafil should be used cautiously in men on alpha blockers such as doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax). There have been occasional reports of low blood pressure in men who have taken the two classes of drugs simultaneously and therefore it is recommended that there be at least a span of 4-6 hours between the ingestion of sildenafil and alpha blockers.

There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil, especially when sildenafil is used in combination with injection of medications into the corpora cavernosa or intraurethral suppositories. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penis and lead to permanent impotence. Therefore, sildenafil should not be used in combination with intraurethral suppositories and corpora cavernosa injections. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be obtained

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