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This product's label may have been updated. For current full prescribing information, please visit pfizer.Body as a Whole: face edema, photosensitivity reaction, shock, asthenia, pain, chills, accidental fall, abdominal pain, allergic reaction, chest pain, accidental injury.We acknowledge limitations. First, sildenafil use was self-reported in 2000 and not updated during the follow-up. However, the health care–related professional background was reassuring. The misclassification of exposure would tend to affect those unexposed in 2000, leading to a conservative HR estimate. Sildenafil is usually effective within 30 to 120 minutes after administration and may be cleared rapidly, such that the PDE5A inhibition could be transient and reversible.8,12 However, a 2-hour time window is sufficient for some drugs to produce critical transcriptional changes.9 One study in the HPFS has indicated a sharply increased risk of ED with aging.18 With the massive increase in sildenafil use after its introduction, among the recent users in 2000, the expected proportion of users after 2000 could be much higher than that of recent nonusers, which might lead to a chronic downstream effect of PDE5A inhibition. Nevertheless, laboratory studies are warranted to elucidate whether either temporary or long-term use of sildenafil can induce irreversible change in host features and elevated melanoma risk. For example, it remains to be examined whether a single, or repeated, dose of sildenafil can cause sufficient inhibition of PDE5A in melanocytes to promote transcriptional changes of key genes.Prev page:tadalafil buy