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Seek immediate medical help if your erection lasts for more than 4 hours.Duloxetine is a serotonin-norepinephrine reuptake inhibitor. Malegra DXT is a combination of Sildenafil Citrate and Duloxetine. Do not double dose. Do not consume alcohol or fatty meal to avoid interaction with the medicine.Inform your doctor about other disease conditions you are suffering from and the medications taking. It inhibits serotonin reuptake, thereby increasing its amount exponentially in the blood.Patients using Malegra DXT may encounter unwanted side effects such as: flushing, headache, dyspepsia, nasal discharge and stuffiness, vision disturbances (blurred vision, photophobia, blue-tinted vision). Its action at the postsynaptic cleft increases thereby preventing premature ejaculation. The effect may last up to many hours.Take Malegra DXT orally with a light meal at least 60 minutes prior to a sexual activity. An increased level of cGMP relaxes the smooth muscles of the arteries and improves blood flow into the penis and causes an effective erection. Do not take Malegra DXT with medicines containing nitrates.If it is time for your next dose, then skip the missed dose or else take it as soon as you remember. However, consult your doctor for your dose. Its PDE5 inhibiting action releases more of cGMP in the corpus cavernosum of a penis.Consult your doctor right away.The usual recommended dose is one pill a day. Sildenafil is a selective and reversible inhibitor of phosphodiesterase type 5 with specificity to cGMP. New Hampshire, Nashville-Davidson, Florida, Virginia, NY, Oklahoma, Oklahoma, Colorado, Minnesota, Michigan, ID, Virginia, West Virginia, Arkansas, California, CO, MD, Pennsylvania, Rhode Island, Miami, SC, Michigan, San Jose, DE, Florida, Las Vegas, Honolulu, Los Angeles, ND, Idaho, WA, Oakland, Indianapolis, Omaha, NV, Illinois, Ohio, GA, Austin, North Dakota, Maine, OH, Wisconsin, KS, Indiana, Nebraska, New York, Texas, Ohio, NE, WV, TN, Cleveland, Kansas, New Jersey, Jacksonville, Hempstead, NH, North Carolina, IA, District of Columbia, Missouri, Arizona, Boston, Minnesota, District of Columbia, Maryland, Missouri, MS, MT, Maryland, Charlotte, Georgia, San Diego, Kentucky, Detroit, Sacramento, Alaska, VT, Portland, Oklahoma City, Oregon, Iowa, San Francisco, KY, Dallas, Houston, AR, Connecticut, Montana, CT, Columbus, Tucson, CA, Colorado Springs. Arizona, Hawaii, NY, Louisiana, Kansas City, Illinois, Phoenix, Nevada, Fresno, NJ, Milwaukee, Tennessee, MA, New Orleans, Chicago, NC, South Carolina, Mississippi, SD, Minneapolis, FL, Atlanta, Pennsylvania, California, IN, Texas, New Mexico, VA, Virginia Beach, San Antonio, Indiana, Nebraska, Wyoming, TX, Oregon, AL, NM, Washington, Long Beach, MN, Seattle, Utah, Brookhaven, Vermont, WYNew Mexico, DC, OK, Colorado, New York, RI, OR, Albuquerque, South Dakota, Philadelphia, El Paso, Georgia, Wisconsin, MI, PA, WI, Fort Worth, Baltimore, Mesa, AZ, Delaware, Nevada, ME, Alabama, Louisiana, Memphis, North Carolina, AK, Tulsa, Denver, IL, UT, Massachusetts, Washington, LA, MO, Tennessee, Massachusetts, Hawaii, Washington, HI,