It works by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection.

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Condition/Medication	Reason for Contraindication
Heart Disease	Increased risk of adverse cardiovascular events
Liver Impairment	Affects drug metabolism
Concomitant use of Nitrates	Risk of severe hypotension
Allergies	Possible allergic reactions to ingredients

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Psychological Factors and Treatment Outcomes

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Dr. Annie Casta, M.D., FAAP

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Aspect	Details	Notes
Prescription Laws	Usually required in many countries	Varies by jurisdiction
Import Regulations	Some countries restrict import of prescription meds	Check local laws
Online Regulations	Some sites operate illegally, risking safety and legality	Verify legality before purchase
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Government / NIH sources

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