The physiological mechanism of penile erection involves the release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood and penile erection.

Sildenafil inhibits phosphodiesterase type 5 (PDE5), which is responsible for the degradation of cGMP in the corpus cavernosum and causes increased levels of cGMP, resulting in penile erection. Sildenafil, at recommended doses, has no effect in the absence of sexual stimulation.

Enigma® is indicated for the treatment of erectile dysfunction.

50 mg as needed, approximately 1 hour before sexual activity. Based on effectiveness and tolerance, the dose may be increased to a maximum of 100 mg or decreased to 25 mg. The maximum recommended dose is once per day.

● Co-administration with nitrates.

● Hypersensitivity to any ingredients.

Headache, flushing, dyspepsia, nasal congestion, urinary tract infection, abnormal vision, diarrhea, dizziness, rash.

Body as a whole: facial edema, photosensitivity reaction, shock, asthenia, pain, chills, abdominal pain, allergic reaction, chest pain.

Cardiovascular: angina pectoris, AV block, migraine, syncope, tachycardia, palpitations, hypotension, postural hypotension, myocardial ischemia, cerebral thrombosis, cardiac arrest, heart failure, abnormal electrocardiogram, cardiomyopathy.

Digestive: vomiting, glossitis, colitis, dysphagia, gastritis, gastroenteritis, esophagitis, stomatitis, dry mouth, abnormal liver function tests, rectal hemorrhage, gingivitis.

Hemic and Lymphatic: anemia and leukopenia.

Metabolic and Nutritional: thirst, edema, gout, unstable diabetes, hyperglycemia, peripheral edema, hyperuricemia, hypoglycemic reaction, hypernatremia.

Musculoskeletal: arthritis, arthrosis, myalgia, tendon rupture, tenosynovitis, bone pain, myasthenia, synovitis.

Nervous: ataxia, hypertonia, neuralgia, neuropathy, paresthesia, tremor, vertigo, depression, insomnia, somnolence, hypesthesia.

Respiratory: asthma, laryngitis, pharyngitis, sinusitis, bronchitis, increased sputum, increased cough.

Skin and Appendages: urticaria, herpes simplex, pruritus, sweating, skin ulcer, contact dermatitis, exfoliative dermatitis.

Special Senses: sudden decrease or loss of hearing, mydriasis, conjunctivitis, photophobia, tinnitus, eye pain, ear pain, eye hemorrhage, cataract, dry eyes.

Urogenital: cystitis, nocturia, breast enlargement, urinary incontinence, abnormal ejaculation, genital edema, and anorgasmia.

Nitrates, alpha-blockers, antihypertensives, CYP3A4 inhibitors (ketoconazole, erythromycin, cimetidine).

Use with caution in patients with cardiovascular disorders, those taking nitrates, alpha-blockers, or antihypertensive drugs, those predisposed to priapism, individuals with hereditary retinal or hearing disorders, and those with renal and hepatic impairment.

Enigma® is not recommended for women and pediatric patients.

Geriatrics: A starting dose of 25 mg is considered.

Hepatic & Renal Impairment: In patients aged >65 years, with hepatic impairment or severe renal impairment, the starting dose is 25 mg.

Store at a temperature not exceeding 30°C in a dry place. Protect from light and moisture.

Medicine: Keep out of reach of children.