Neogra (sildenafil) relaxes muscles and increases blood flow to particular areas of the body.

Neogra (sildenafil) relaxes muscles and increases blood flow to particular areas of the body.
Neogra is used to treat erectile dysfunction (impotence) in men. Sildenafil is also used to treat pulmonary arterial hypertension and improve exercise capacity in men and women.
Do not take Neogra while also taking sildenafil, unless your doctor tells you to.
Important information
Some medicines can cause unwanted or dangerous effects when used with Neogra. Tell your doctor about all your current medicines, especially riociguat (Adempas).
Do not take Neogra if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as “poppers”. Taking sildenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.
Stop using Neogra and get emergency medical help if you have sudden vision loss.
Before taking this medicine
You should not use Neogra if you are allergic to sildenafil, or:
• if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas).
Do not take Neogra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (“poppers”). Taking Neogra with a nitrate medicine can cause a sudden and serious decrease in blood pressure.
To make sure Neogra is safe for you, tell your doctor about your other medical conditions, especially:
• heart disease or heart rhythm problems, coronary artery disease;
• a recent history (in the past 6 months) of a heart attack, stroke, or congestive heart failure;
• high or low blood pressure;
• liver or kidney disease;
• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
• a bleeding disorder such as hemophilia;
• a stomach ulcer;
• retinitis pigmentosa (an inherited condition of the eye);
• a physical deformity of the penis (such as Peyronie’s disease); or
• if you have been told you should not have sexual intercourse for health reasons.

Neogra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking sildenafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether sildenafil is the actual cause of vision loss.
Neogra is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether sildenafil passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Do not give Neogra to anyone under 18 years old without medical advice.
How should I take Neogra?
Take Neogra exactly as it was prescribed for you. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Neogra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Neogra more than once per day.

Neogra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.
During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Neogra.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Since Neogra is used as needed, you are not likely to miss a dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking Neogra?
Drinking alcohol with this medicine can cause side effects.
Grapefruit and grapefruit juice may interact with sildenafil and lead to unwanted side effects. Avoid the use of grapefruit products while taking Neogra.
Avoid using any other medicines to treat impotence, such as alprostadil or yohimbine, without first talking to your doctor.
Neogra side effects
Get emergency medical help if you have signs of an allergic reaction to Neogra: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop taking Neogra and get emergency medical help if you have:
• heart attack symptoms–chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
• vision changes or sudden vision loss; or
• erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis).
Call your doctor at once if you have:
• ringing in your ears, or sudden hearing loss;
• irregular heartbeat;
• swelling in your hands, ankles, or feet;
• shortness of breath;
• seizure (convulsions); or
• a light-headed feeling, like you might pass out.
Common Neogra side effects may include:
• flushing (warmth, redness, or tingly feeling);
• headache, dizziness;
• abnormal vision (blurred vision, changes in color vision)
• stuffy nose;
• muscle pain, back pain; or
• upset stomach.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.
See also: Side effects (in more detail)
Neogra dosing information
Usual Adult Dose for Erectile Dysfunction:
Initial dose: 50 mg orally once a day, as needed, 1 hour prior to sexual activity
Maintenance: 25 to 100 mg orally once a day, as needed, 1 hour prior to sexual activity

Comments: This drug may be taken anywhere from 30 minutes to 4 hours before sexual activity.

Use: Treatment of erectile dysfunction
Usual Geriatric Dose for Erectile Dysfunction:
Initial dose: 25 mg orally once a day 1 hour prior to sexual activity

Use: Treatment of erectile dysfunction
What other drugs will affect Neogra?
Do not take Neogra with similar medications such as avanafil (Stendra), tadalafil (Cialis) or vardenafil (Levitra). Tell your doctor about all other medications you use for erectile dysfunction.
Tell your doctor about all your current medicines and any you start or stop using, especially:
• an antibiotic such as clarithromycin, erythromycin, or telithromycin;
• antifungal medicine such as ketoconazole or itraconazole;
• medicine to treat HIV/AIDS, such as atazanavir, indinavir, ritonavir, or saquinavir; or
• drugs to treat high blood pressure or a prostate disorder.
This list is not complete. Other drugs may interact with sildenafil, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Part of the physiological process of erection involves the parasympathetic nervous system causing the release of nitric oxide (NO) in the corpus cavernosum of the penis. NO binds to the receptors of the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophos; Neogra super quality worldwidephate (cGMP), leading to smooth muscle relaxation (vasodilation) in the corpus cavernosum, resulting in increased inflow of blood and an erection.
Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum. The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and better erections. Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection. Sildenafil is metabolised by hepatic enzymes and excreted by both the liver and kidneys. If taken with a high-fat meal, there may be a delay in absorption of sildenafil and the peak effect might be reduced slightly as the plasma concentration will be lowered

Contraindications
Use of NEOGRA is contraindicated in patients with a
known hypersensitivity to any component of the tablet.
Consistent with its known effects on the nitric oxide/cGMP
pathway, sildenafil was shown to potentiate the hypotensive
effects of nitrates, and its administration to patients who
are concurrently using organic nitrates in any form is
therefore contraindicated.

Dosage:
For most patients, the recommended dose is 50 mg taken, as needed approximately 1 hour before sexual activity. However, NEOGRA may be taken anywhere from 4 hours to 0.5 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day.

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