Megalis-D Tablet

• If you are allergic to any active substances or ingredients of the medicine
• If you have not been appropriately diagnosed with premature ejaculation or erectile dysfunction
• If you have low blood pressure (may cause orthostatic hypotension – a drop in blood pressure after suddenly changing positions)
• If you are younger than 18 years of age
• If you have bleeding disorders (this medicine may increase the risk of bleeding)
• If you have a seizure condition
• If you have been diagnosed with mania or bipolar disorder
• If you have been using any recreational drugs
• If you are using any antidepressant medication
• If you have a history of heart conditions, such as heart failure or heart rhythm disorders
• If you have serious kidney or liver disease
• If you are taking a monoamine oxidase inhibitor, thioridazine, an SSRI or SNRI antidepressant, a tricyclic antidepressant, lithium, linezolid, tryptophan or St John's wort, or have taken one recently.
• If you are taking a potent antifungal such as ketoconazole or itraconazole, or certain HIV medicines, which raise the level of this medicine in the body.
• In women, and in anyone under 18 or over 64 years of age.
• If you take a nitrate medicine for chest pain, or any recreational nitrite.
• If you take riociguat, used for high blood pressure in the lungs.

• Dizziness or light-headedness
• Headache
• Nausea
• Diarrhoea
• Difficulty in sleeping or unusual dreams
• Feeling anxious, restless or agitated
• Blocked or runny nose
• Flushing, a sensation of warmth in the face and neck
• Indigestion or an upset stomach
• Muscle pain and back pain

• Fainting, or feeling faint on standing
• A fast or irregular heartbeat
• Sweating, tremor, or ringing in the ears
• Low mood, or a change in mood
• Serious - stop and seek medical help
• Fainting, or losing consciousness
• Thoughts of self-harm, or a marked change in mood or behaviour
• A severe allergic reaction, with swelling of the face, lips, tongue or throat, difficulty breathing, or a widespread rash
• A fit or seizure
• An erection lasting more than four hours, or a painful erection. This is priapism and is an emergency
• Sudden loss or reduction of vision in one or both eyes
• Sudden hearing loss, or ringing in the ears with dizziness
• Chest pain during or after sex. Tell the medical team what you have taken, and do not take a nitrate for it

Other General Warnings

• You have not been diagnosed with erectile dysfunction or premature ejaculation by a doctor. Do not self-medicate.
• You are under 18 years old and not suitable for children.
• You have been diagnosed with hypotension or low blood pressure; this medicine can cause a sudden drop in blood pressure.
• If you are over 65 years old, consult your doctor before taking this medicine.
• If you are using any Ayurvedic, herbal medicines, or supplements for premature ejaculation or erectile dysfunction, notify your doctor to avoid potential side effects.
• You have any deformity or other conditions affecting the penis.
• You have been diagnosed with sickle cell anaemia, blood or bone marrow cancers, or other conditions that increase the risk of prolonged erection; inform your doctor.
• You have severe kidney or liver conditions.
• You experience any vision or hearing loss, immediately notify your doctor.
• You have any heart condition, or have ever fainted.
• You have a history of depression, mania or bipolar disorder, or any psychiatric illness.
• You take an antidepressant, lithium, tramadol, a triptan, linezolid or St John's wort, or have taken one recently.
• You have epilepsy or a history of seizures.
• You have a bleeding or clotting disorder.
• You feel light-headed or faint after taking it. Lie down with your legs raised and tell your doctor before taking it again.
• You notice any change in mood, or thoughts of self-harm.
• You are under 18 or over 64. This medicine is not indicated outside that age range, and not for women.
• You take, or have recently taken, a nitrate medicine for chest pain, or any recreational nitrite.
• You have retinitis pigmentosa, or have had sudden vision loss in one eye.
• You develop chest pain during or after sex. Seek emergency help and tell the team what you have taken.

• Use the Megalis D tablet exactly as your doctor directs.
• Do not exceed the dosage.
• Do not crush, break, or chew the tablet.
• Swallow the medicine whole with a glass of water immediately after opening the bottle.
• You may take this medicine with or without food.
• You must take the tablet few hour before sexual intercourse or as advised by your doctor.
• Take Megalis D exactly as your doctor has prescribed, before planned sexual activity.
• Stay well hydrated, as dehydration may increase the risk of dizziness or fainting.
• Avoid alcohol, as it may increase dizziness, fainting and injury risk.
• Stand up slowly after sitting or lying down. If you feel light-headed, lie down with your legs raised until it passes. Do not stand up until you feel well.
• Do not take it every day.
• If you feel faint at any point, stop and tell your doctor before taking it again.

• Store it in a cool, dry place, protected from direct sunlight, moisture and heat.
• Keep it in the original strip until you take it.
• Keep it out of the sight and reach of children and pets.
• Do not use it after the expiry date printed on the pack.
• Do not share this medicine with anyone else.

• Take the Megalis D tablet exactly as your doctor directs.
• Do not crush, break, or chew the tablet; swallow it whole with a glass of water.
• You can take the medicine with or without food.
• Take the tablet a few hours before sexual intercourse or as your doctor advises.
• Do not exceed the prescribed dose or take more than 1 tablet per day.
• Do not consume alcohol while on this medication, as it can increase side effects.
• Avoid driving or operating heavy machinery if you experience dizziness, faintness, drowsiness or visual disturbances.
• Inform your doctor if you are taking any other medicines, especially nitrates, antifungals, or antidepressants.
• Store the tablets at room temperature in a dry, airtight container, and keep them out of reach of children.
• Drink enough water and avoid alcohol, as dehydration and alcohol may increase the risk of dizziness or fainting.
• Stand up slowly. If you feel light-headed, lie down with your legs raised until it passes.
• Tell your doctor straight away if you faint, or if your mood changes.
• Premature ejaculation often has treatable contributing factors. Ask your doctor about behavioural techniques and about anxiety, which commonly plays a part.
• Do not take it with another medicine for the same problem, and never take an antidepressant alongside it without medical advice.
• It is not for anyone under 18 or over 64, and not for women.
• Get emergency help if an erection lasts more than four hours.
• Erectile dysfunction can be an early sign of heart or blood vessel disease or of undiagnosed diabetes, so get the cause assessed.

Overdose

Missed a Dose

Interactions with other medicines

• Nitrates for chest pain, including glyceryl trinitrate, isosorbide mononitrate and isosorbide dinitrate, and recreational poppers. Together with this medicine, they can cause a sudden, life-threatening fall in blood pressure. Never take them together.
• Riociguat, used for high blood pressure in the lungs, causes the same dangerous drop in blood pressure. Do not take these together.
• Monoamine oxidase inhibitors, thioridazine, SSRI and SNRI antidepressants, tricyclic antidepressants, lithium, linezolid, tryptophan and St John's wort must not be combined with this medicine. A gap is needed when switching from any of them, which your doctor will set.
• Tramadol, triptans for migraine, and other medicines that raise serotonin may increase the risk of serotonin-related adverse effects.
• Potent antifungals such as ketoconazole and itraconazole, some HIV medicines, and certain antibiotics may affect tadalafil levels. Your doctor should check the specific medicine and interaction before use.
• Medicines for blood pressure, alpha blockers for prostate symptoms, and diuretics may increase the risk of low blood pressure or fainting.
• Do not take it with any other medicine for premature ejaculation or erectile dysfunction unless your doctor has specifically prescribed the combination.
• Tell your doctor about every medicine you take, including anything bought without a prescription, online, or as a herbal product.

Interactions with food items