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Patients should not advance to higher doses if they are experiencing significant side effects at their current dose level
However, if breakouts persist beyond six weeks, appear in unusual locations, or are accompanied by other symptoms like widespread redness or swelling, you're likely experiencing a true adverse reaction rather than purging
[18] Sildenafil should be used cautiously in patients with gastroesophageal reflux disease (GERD) or hiatal hernia associated with reflux esophagitis
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