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Indeed, current guidelines do not recommend administration of PDE5i to patients with unstable angina, severe congestive heart failure, or uncontrolled hypertension, patients at high risk for arrhythmias, and patients receiving nitrates [13]

Use during pregnancy and lactation should be limited to cases where the benefits outweigh the risks, as high-dose parenteral administration has not been fully studied in these populations

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Individuals with fish allergies should consult a healthcare professional before use