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online viagra without prescription canadian pharmacy viagra Following completion of this phase, the physician should be able to determine the medical status of the patient, to identify and characterize the type of dysfunction, and to determine the need for additional testing such as penile or pelvic blood flow studies, nocturnal penile tumescence testing, or other blood tests. The patient's needs, expectations, and priorities should be discussed in order to decide about further management or referral. Then, the study participants were given 50 milligrams of oral sildenafil; 45 minutes later, resting and post-exercise blood pressure readings were taken again. Common causes of erection problems include: The recommended starting dose of tadalafil for most patients is 10 mg taken orally approximately 1 hour before sexual activity. The dose may be adjusted higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The maximum recommended dosing frequency is once per day, although for many patients tadalafil can be taken less frequently since the improvement in erectile function may last 36 hours. Tadalafil may be taken with or without food. Holverda and his colleagues found that half the patients had PAH. But, both non-PAH and PAH patients experienced significant cardiac blood pressure increases when exercising.