Disorders like bodily defect of the penis, sickle cell anemia, hypertension, stomach ulcer, numerous myeloma, recent cardiac arrest, a record of a movement or heart attack, chest discomfort, hemophilia, leukemia, liver illness, low blood stress, renal illness, heart tempo issue and cardiovascular disease can make it much less efficient, and you may be started on a higher amount of the medicine to see how your physical body responds.