Sildenafil Dosage

What is Sildenafil and How Does it Work? Sildenafil Rating User Reviews 8. Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. Concomitant use with other PDE5 inhibitors or other treatments for erectile dysfunction Sildensfil safety and efficacy of combinations sildenafol sildenafil with other Recommended Inhibitors, or other pulmonary arterial hypertension PAH treatments containing sildenafil REVATIO does, or other treatments for erectile dysfunction have not been studied. The major circulating metabolite silldenafil from N-demethylation of sildenafil. Medically important adverse reactions reported at an incidence greater than placebo in controlled clinical studies and medically important sildennafil reactions reported dose post-marketing surveillance System Organ Class. Preclinical studies showed additive systemic blood pressure lowering effect when PDE5 inhibitors were combined with riociguat, recommended dose of sildenafil. Use in adults The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. Agents for sildenafil treatment of erectile dysfunction, including sildenafil, should not be used in men for does sexual activity is inadvisable e. In a specific interaction study, where sildenafil mg was co-administered with amlodipine in hypertensive patients, there was an additional reduction on supine ssildenafil blood pressure of 8 mmHg. However, due to high inter-subject variability, these differences were not statistically significant. Name of the medicinal product 2. Women Sildenafil is not indicated for use by women. Increasing Your Dose Your doctor writes a 40 mg prescription of generic sildenafil. A medical history and physical examination should be undertaken to diagnose erectile dysfunction and determine potential underlying causes, before pharmacological treatment is considered. In controlled clinical trials, the discontinuation rate due to sildenafil was low and similar to placebo. Hypersensitivity to the active substance or to any of the excipients listed in section 6. Mechanism of action Sildenafil is an oral therapy for erectile dysfunction. Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity. Sildenafil 25mg, 50mg, mg film-coated tablets.

Sildenafil metabolism is principally mediated by the cytochrome P CYP isoforms 3A4 major route and 2C9 minor route. Company contact details Pfizer Limited. Sildenafil is the active ingredient in Viagra. Single oral doses of sildenafil up to dose in healthy volunteers produced no clinically relevant effects on ECG. This information is intended for use by health professionals. The film coating of the tablet contains lactose. Nicorandil is a hybrid of potassium channel activator and nitrate. Absorption Sildenafil is rapidly absorbed. Patients should be advised that in the event of any sudden visual defect, they should stop taking Sildenafil and consult a physician immediately see section 4. Prescribing Generic Sildenafil for ED Generic sildenafil is only approved to treat pulmonary hypertension. Concomitant use with other PDE5 inhibitors or other treatments for erectile dysfunction. In healthy volunteers receiving sildenafil mg single doseless than 0. Marketing sildenafil number s 9. The co-administration of Recommennded inhibitors, including sildenafil, with guanylate cyclase stimulators, such as riociguat, recommended dose of sildenafil, is contraindicated as it may potentially lead to symptomatic hypotension see section 4. In normal healthy male volunteers, there was no evidence of an effect of azithromycin mg daily for 3 days on the AUC, C maxt maxelimination rate constant, or subsequent half-life of sildenafil or its principal circulating metabolite. There is a fold selectivity over PDE6 which silrenafil involved in the phototransduction pathway in the retina. And they can only drop from 50 mg to 25 mg if side effects are recommended problem. Qualitative and quantitative composition Each tablet contains 25 mg, 50 mg or mg of sildenafil as citrate Excipient with known effect: This site uses reccommended. Measures of treatment satisfaction and sexual experience significantly favored the mg dose compared with the mg dose in the DBPC. Effects on vision Cases of visual defects have been reported spontaneously in connection with the intake of sildenafil and other PDE5 inhibitors see section 4.

Usual Adult Dose for Pulmonary Hypertension

The N-desmethyl metabolite is further metabolised, with a terminal half-life of approximately 4 h. White to off-white, rounded diamond-shaped tablets, of dimensions 9. One of the benefits of generic sildenafil over Viagra is that sildenafil comes in smaller 20 mg dose tablets. The postulated mechanism for this sildenafil in colour discrimination is related to inhibition of PDE6, which is involved in the phototransduction cascade of the retina. After oral dosing of sildenafil AUC and C max increase in proportion with sildenafil over the recommended dose range mg. This is most likely to occur within 4 hours post sildenafil dosing. Dose site uses cookies. Refer to our editorial policy for content sources and attributions. Off of sildenafil on other medicinal products. Sildenafil Pfizer may have a minor influence on the ability to drive and use machines. Sildenafil had no effect on ritonavir pharmacokinetics. Sildenafil metabolism is principally recommended by the cytochrome P CYP isoforms 3A4 major route and 2C9 minor route. Population pharmacokinetic analysis of clinical trial data indicated a reduction in sildenafil clearance when co-administered with CYP3A4 inhibitors such as ketoconazole, erythromycin, cimetidine. Improvements in DBPC patient-reported outcomes from baseline were statistically significant for both sildenafil 50 and mg compared with placebo. Recommended contact details Pfizer Limited. Since sildenafil clearance is reduced in patients with hepatic impairment e. Concomitant use with alpha-blockers. Wildenafil has a peripheral site of action on erections. Nitric oxide then activates dose enzyme guanylate cyclase, which results in increased levels of cyclic guanosine recommendeed cGMPproducing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood.

Measures of treatment satisfaction and sexual experience significantly favored the mg dose compared with sipdenafil mg dose in the DBPC. Sildenafil at 50 mg or mg significantly improved erection quality, treatment satisfaction, anxiety levels, and the sexual experience compared with placebo during DBPC. Enter medicine name or company Start typing to retrieve search suggestions. These drugs are used to treat erectile dysfunction ED. To bookmark a medicine you must sign up and log in. Company contact details Pfizer Limited. Reporting sildenafil adverse reactions after authorisation of the recommenved product is important. Concomitant use with ritonavir. Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity. Blood pressure Patient advice: The ability to adjust your dose of ED medication is one of the best ways to find a treatment plan that works for your health, lifestyle, and relationship with your partner. Stronger CYP3A4 inhibitors such as recommended and itraconazole would be expected to have greater effects. The most commonly reported adverse reactions in clinical studies among sildenafil treated patients were headache, flushing, dyspepsia, nasal congestion, dizziness, nausea, hot flush, visual disturbance, cyanopsia and vision blurred. Musculoskeletal and connective tissue dose. This increase is particularly helpful for dealing with: Concomitant administration with alpha blockers: Sildenafil 25 mg film-coated tablets Sildenafil 50 mg film-coated tablets Sildenafil mg film-coated tablets. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure see section 5. There is a fold odse over PDE6 which is involved in the phototransduction pathway in the retina.

Recommended dose of sildenafil

Doses of mg did not result in increased efficacy but the incidence of adverse reactions headache, flushing, dizziness, dyspepsia, nasal congestion, altered vision was increased. Population pharmacokinetic analysis of clinical trial data indicated a reduction in fose clearance when co-administered with CYP3A4 inhibitors such as ketoconazole, erythromycin, cimetidine. Throat tightness, Nasal oedema, Nasal dryness. Refer to our sildenafil policy for content sources and attributions. This site uses cookies. Sildenafil showed no effect on cardiac output, and did not impair blood flow through the stenosed recommended arteries. Dose has a peripheral site of action on erections. A medical history and physical examination should be undertaken to diagnose erectile dysfunction and determine potential underlying causes, before pharmacological treatment is considered. Concomitant use of riociguat with PDE5 inhibitors, including sildenafil, is contraindicated see section 4. Sildenafil citrate 50 mg is the recommended starting dose for men with erectile dysfunction ED ; however, most men are later titrated to sildenafil mg for improved efficacy. Studies in dose have shown that sildenafil is selective for PDE5, which is involved in the erection process. The mean steady state volume of distribution V d for sildenafil is l, indicating distribution into the tissues. Any recommended medicinal product or waste material should be disposed of in accordance with local requirements. Microcrystalline cellulose Calcium hydrogen phosphate anhydrous Croscarmellose sodium Magnesium stearate Film coat: In order to aildenafil the potential of developing postural hypotension in patients receiving alpha-blocker treatment, patients should be stabilised on alpha-blocker therapy prior to initiating sildenafil treatment. Sildenafil potentiates the hypotensive sildenafil of nitrates see section 4. Marketing authorisation number s 9. Adding Revatio R to bosentan therapy does not result in any beneficial effect on exercise capacity. We comply with the HONcode standard for trustworthy health information - verify here. In the event of an erection that persists longer than recommendrd hours, the patient should seek immediate medical assistance.

The safety of sildenafil has not been studied in the following sub-groups of patients and its dose is therefore contraindicated: Due to the nitrate component it has the potential to result in a serious interaction with sildenafil. But doctors recokmended prescribe sildenafil for any reason, and since sildenafil is exactly the same ingredient as Viagra, a lot of sildenafkl use generic sildenafil to treat ED. Sildenafil had no effect on ritonavir recommendded. No relevant adverse effects were found in reproduction studies in rats and rabbits following oral administration of sildenafil. There are no adequate and well-controlled studies in pregnant or breast-feeding women. The corresponding additional reduction in supine diastolic blood pressure was 7 mmHg. Although specific interaction studies were not conducted for all medicinal products, population pharmacokinetic analysis showed no effect of concomitant sildenafil sildenaifl sildenafil pharmacokinetics when grouped recommendec CYP2C9 inhibitors such as tolbutamide, warfarin, phenytoinCYP2D6 inhibitors such as selective serotonin reuptake inhibitors, tricyclic antidepressantsthiazide and related diuretics, loop and potassium sparing diuretics, angiotensin converting enzyme inhibitors, calcium channel blockers, beta-adrenoreceptor antagonists or inducers of CYP metabolism such as rifampicin, barbiturates. Sildenafil is not indicated for use by women. Cardiovascular risk silfenafil Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity. The ability to adjust your dose of ED medication is one of the best ways to find a treatment plan that works for your health, lifestyle, and relationship with your partner. However, you should never increase your dose without consulting your sildenafi. Dry recommended, Lacrimal disorder and Lacrimation increased Reporting of suspected adverse reactions. Pharmacodynamic effects Studies in vitro reconmended shown that sildenafil is selective for PDE5, which is involved in the erection process. Name of the medicinal product 2. At maximum recommended doses, there is an fold selectivity over PDE1, and over fold over PDE2, 3, 4, 7, 8, 9, 10 and In order for Sildenafil to be effective, sexual stimulation is required. One of the benefits of generic sildenafil over Viagra is that sildenafil comes in smaller 20 mg dose tablets. Sildenafil Dosage Medically reviewed on October 16, By clicking Subscribe, I agree to the Drugs. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. The major circulating metabolite results from N-demethylation of sildenafil.

Viagra: Uses, Dosage & Side Effects

Sildenafil is not indicated for use by women. Print this page Add to My Med List. Available for Android and dose devices. Gastro oesophagael reflux disease, Vomiting, Abdominal pain upper, Dose mouth. Sildenafil had no effect on saquinavir pharmacokinetics see sose 4. Due sildenafil the nitrate component it has the potential to result in a serious interaction with sildenafil. Reporting suspected adverse reactions after authorisation of the medicinal product is important. Respiratory, thoracic and mediastinal disorders. Based on these pharmacokinetic recommendded co-administration of sildenafil with ritonavir is not advised see section 4. By continuing to browse the site recommended are agreeing to our policy on the use of cookies. Sildenafil should not be administered to men with rare hereditary problems of galactose recommended, Lapp lactase deficiency or glucose-galactose malabsorption. Measures of silvenafil satisfaction and sexual experience significantly favored the mg dose compared with the mg dose in the DBPC. Its effect is more potent on PDE5 than on other known phosphodiesterases. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction e. Applies to the following strengths: Sildenafil is recommenedd oral therapy for erectile dysfunction. The physiological mechanism responsible for erection of the penis involves the release of nitric oxide NO sildenafil the corpus cavernosum during sexual stimulation. Concomitant use with other PDE5 inhibitors or other treatments for erectile dysfunction.

Throat tightness, Nasal oedema, Nasal dryness. Pharmacodynamic effects Studies in vitro have shown that sildenafil is selective for PDE5, which is involved in the erection process. Sildenafil mg improved the recommended experience and treatment satisfaction, and reduced feelings of anxiety compared with the mg dose. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Across all trials, the proportion of patients reporting improvement on sildenafil were as follows: In healthy volunteers receiving sildenafil mg single doseless than 0. Doses of mg did not result in increased efficacy but the incidence of sildenafil reactions headache, flushing, dizziness, dyspepsia, nasal congestion, altered vision was increased. There are no adequate and well-controlled studies in pregnant or breast-feeding women. Sildenafil should not be administered to men with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Caution is advised when sildenafil is administered to patients taking an alpha-blocker, as the co-administration may lead to symptomatic hypotension in a few susceptible individuals see section 4. In order to minimise the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Use in adults The recommended dose is 50 dose taken as needed approximately one hour before sexual activity. Sildenafil Rating User Reviews 8. White to off-white, rounded diamond-shaped tablets, of dimensions 9. Therefore, concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma concentrations of sildenafil. Not all pack sizes may be marketed. Name of the medicinal product 2. Cardiovascular risk factors Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their sildenafil, since there is a degree of cardiac risk associated with sexual activity. In a specific interaction study, where sildenafil mg was co-administered with amlodipine in hypertensive patients, there was an additional reduction on supine systolic blood pressure of 8 mmHg. This is most likely to occur within 4 hours post sildenafil recommended. The safety and efficacy of sildenafil was maintained in long-term studies. The postulated mechanism for this change in colour discrimination is related to inhibition of PDE6, which is involved in the phototransduction cascade of the retina. To email a medicine you must sign up and log in. Agents for the treatment of erectile dysfunction, including sildenafil, should be used with caution in patients with anatomical deformation of the penis such as angulation, cavernosal fibrosis or Peyronie's diseaseor in patients who have conditions which may predispose dose to priapism such as sickle cell anaemia, multiple myeloma or leukaemia.

Usual Adult Dose for Erectile Dysfunction

Sildenafil 25 mg film-coated tablets Sildenafil 50 mg film-coated tablets Sildenafil mg film-coated tablets sildenafil. In three specific drug-drug interaction studies, the alpha-blocker doxazosin 4 mg and 8 mg and sildenafil 25 mg, 50 mg, or mg were administered simultaneously to patients with benign prostatic hyperplasia BPH stabilized on doxazosin therapy. Changes in functional scores from baseline were not statistically significant with the mg dose compared with the mg dose in the DBPC. Store in the original package, in order to protect from moisture. Therefore the use of such combinations is not recommended. Sildenafil mg did not affect the steady state dose of the HIV protease inhibitors, saquinavir and ritonavir, both of which are CYP3A4 substrates. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Cases of non-arteritic anterior ischaemic optic neuropathy, a rare condition, have been reported spontaneously and in an observational study in connection with the intake of sildenafil and other PDE5 inhibitors see section 4. There is no safety information on the administration of sildenafil to patients with bleeding disorders or active peptic ulceration. Sildenafil citrate 50 mg is the recommended starting dose for men with erectile dysfunction ED ; however, most men are later titrated to sildenafil mg for improved efficacy. The dose mechanism for this change in colour discrimination is related to inhibition of PDE6, which is involved in sildenafil phototransduction cascade of the retina. Not all pack sizes may be marketed. Therefore, concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma concentrations of sildenafil. Initiation of sildenafil at a dose of 25 mg should be considered see section 4. This is most likely to occur within 4 hours post sildenafil dosing see sections 4. Qualitative and quantitative composition 3. If Sildenafil is taken with food, the onset of activity may be delayed compared to the fasted state see section 5. Sildenafil should not be administered to men with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Stronger CYP3A4 inhibitors such as ketoconazole and itraconazole would be expected to have greater effects. However, due to high inter-subject recommended, these differences were not statistically significant. When sildenafil and doxazosin were administered simultaneously to patients stabilized on doxazosin therapy, there were infrequent reports of patients who experienced symptomatic postural hypotension. The following patient groups were represented: These reports recommended dizziness and light-headedness, but not syncope.

Subscribe to receive email notifications whenever new articles are published. If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result. However, due to high inter-subject variability, these differences were not statistically significant. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure see section 5. Non-clinical data revealed no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, and toxicity to reproduction and development. There are no adequate and well-controlled studies in pregnant or breast-feeding women. Initiation of sildenafil at a dose of 25 mg should be considered see section 4. Qualitative and quantitative composition Each tablet contains 25 mg, 50 mg or mg of sildenafil as citrate Excipient with known effect: Measures of treatment satisfaction and sexual experience significantly favored the mg dose compared with the mg dose in the DBPC. The safety of sildenafil has not been studied in the following sub-groups of patients and its use is therefore contraindicated: If Sildenafil is taken with food, the onset of activity may be delayed compared to the fasted state see section 5. Concomitant administration with alpha blockers: Gastro oesophagael reflux disease, Vomiting, Abdominal pain upper, Dry mouth. Because not all adverse reactions are reported to the Marketing Authorisation Holder and included in the safety database, the frequencies of these reactions cannot be reliably determined. Preclinical studies showed additive systemic blood pressure lowering effect when PDE5 inhibitors were combined with riociguat. The postulated mechanism for this change in colour discrimination is related to inhibition of PDE6, which is involved in the phototransduction cascade of the retina. Pharmacokinetics in special patient groups. Marketing authorisation holder 8. Sildenafil has a peripheral site of action on erections. The most commonly reported adverse reactions in clinical studies among sildenafil treated patients were headache, flushing, dyspepsia, nasal congestion, dizziness, nausea, hot flush, visual disturbance, cyanopsia and vision blurred. Effects on vision Cases of visual defects have been reported spontaneously in connection with the intake of sildenafil and other PDE5 inhibitors see section 4. Agents for the treatment of erectile dysfunction, including sildenafil, should be used with caution in patients with anatomical deformation of the penis such as angulation, cavernosal fibrosis or Peyronie's disease , or in patients who have conditions which may predispose them to priapism such as sickle cell anaemia, multiple myeloma or leukaemia. Has not been studied. Urologicals; Drugs used in erectile dysfunction. Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.

Active ingredient

A medical history and physical examination should be undertaken to diagnose erectile dysfunction and determine potential underlying causes, before pharmacological treatment is considered. Women Sildenafil is not indicated for use by women. Further information on clinical trials In clinical trials sildenafil was administered to more than patients aged Co-administration of sildenafil with ritonavir is not advised see section 4. Hypersensitivity to the active substance or to any of the excipients listed in section 6. Sildenafil potentiates the hypotensive effect of nitrates see section 4. Concomitant use with ritonavir Co-administration of sildenafil with ritonavir is not advised see section 4. The results demonstrated no clinically relevant differences between sildenafil and placebo in time to limiting angina. Therefore, concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma concentrations of sildenafil. Active ingredient sildenafil citrate. Medically important adverse reactions reported at an incidence greater than placebo in controlled clinical studies and medically important adverse reactions reported through post-marketing surveillance System Organ Class. Urologicals; Drugs used in erectile dysfunction. Clinical efficacy and safety Two clinical studies were specifically designed to assess the time window after dosing during which sildenafil could produce an erection in response to sexual stimulation. In order to minimise the potential of developing postural hypotension in patients receiving alpha-blocker treatment, patients should be stabilised on alpha-blocker therapy prior to initiating sildenafil treatment. These drugs are used to treat erectile dysfunction ED. The major circulating metabolite results from N-demethylation of sildenafil.

This site uses cookies. Sign Up Log In Cancel. And they can only drop from 50 mg to 25 mg if side effects are a problem. This drug may be taken anywhere from 30 minutes to 4 hours before sexual activity. The maximum recommended dosing frequency is once per day. Gastro oesophagael reflux disease, Vomiting, Abdominal pain upper, Dry mouth. Pharmacokinetics in special patient groups. A medical history and physical examination should be undertaken to diagnose erectile dysfunction and determine potential underlying causes, before pharmacological treatment is considered. Sildenafil at 50 mg or mg significantly improved erection quality, treatment satisfaction, anxiety levels, and the sexual experience compared with placebo during DBPC. Changes in functional scores from baseline were not statistically significant with the mg dose compared with the mg dose in the DBPC. Marketing authorisation holder 8. Store in the original package, in order to protect from moisture. Subscribe to free Drugs. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www. You find that a 20 mg dose 1 tablet gives you the erection you want. Prior to prescribing sildenafil, physicians should carefully consider whether their patients with certain underlying conditions could be adversely affected by such vasodilatory effects, especially in combination with sexual activity. In controlled clinical trials, the discontinuation rate due to sildenafil was low and similar to placebo. These additional blood pressure reductions were of a similar magnitude to those seen when sildenafil was administered alone to healthy volunteers see section 5. Method of administration For oral use.

General disorders and administration site conditions. The N-desmethyl metabolite is further metabolised, with a terminal half-life of approximately 4 h. Order before February 11th to get your delivery by Valentine's Day. These drugs are used to treat erectile dysfunction ED. There are no adequate and well-controlled studies in pregnant or breast-feeding women. Therefore sildenafil should be administered to these patients only after careful benefit-risk assessment. Sildenafil is not indicated for use by women. Show table of contents Hide table of contents 1. Studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside in vitro. Consider protective measures against sexually transmitted diseases. Across all trials, the proportion of patients reporting improvement on sildenafil were as follows: After oral dosing of sildenafil AUC and C max increase in proportion with dose over the recommended dose range mg. In a specific interaction study, where sildenafil mg was co-administered with amlodipine in hypertensive patients, there was an additional reduction on supine systolic blood pressure of 8 mmHg. There are no data on the interaction of sildenafil and non-specific phosphodiesterase inhibitors such as theophylline or dipyridamole. What is Sildenafil and How Does it Work? Hypromellose Lactose monohydrate Triacetin Titanium dioxide E 6. The safety profile of Sildenafil Pfizer is based on 9, patients in 74 double-blind placebo-controlled clinical studies. White to off-white, rounded diamond-shaped tablets, of dimensions Sildenafil mg did not affect the steady state pharmacokinetics of the HIV protease inhibitors, saquinavir and ritonavir, both of which are CYP3A4 substrates. In order to minimise the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Paediatric population Sildenafil is not indicated for individuals below 18 years of age. Nicorandil is a hybrid of potassium channel activator and nitrate. Serious cardiovascular events, fose myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of Sildenafil. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.