Extra Super Zhewitra is a medication that combines two active ingredients: vardenafil and dapoxetine. Vardenafil is primarily used for the treatment of erectile dysfunction (ED), while dapoxetine is used for premature ejaculation. There is no established role for Extra Super Zhewitra in the treatment of pulmonary arterial hypertension (PAH), which is a specific type of high blood pressure that affects the arteries in the lungs and the right side of the heart.
Here’s why Extra Super Zhewitra is not used for PAH:

1. Mechanism of Action: Vardenafil, as a phosphodiesterase type 5 (PDE5) inhibitor, primarily works by increasing blood flow to the penis to help achieve and maintain an erection. It does this by relaxing the smooth muscles and widening blood vessels, which is beneficial in treating erectile dysfunction. This mechanism is not directly relevant to the treatment of PAH, which requires medications that specifically target the pulmonary arteries and improve their function.
   
2. Approved Uses: Vardenafil, when used alone or in combination with dapoxetine as in Extra Super Zhewitra, is approved for treating erectile dysfunction and premature ejaculation. It is not approved or indicated for the treatment of pulmonary arterial hypertension.
   
3. Alternative Treatments for PAH: PAH is typically treated with medications such as prostacyclin analogues (e.g., epoprostenol), endothelin receptor antagonists (e.g., bosentan), or phosphodiesterase type 5 inhibitors specifically approved for PAH (e.g., sildenafil, tadalafil). These medications target the underlying mechanisms of PAH, such as vasoconstriction and abnormal cell proliferation in the pulmonary arteries.
   
4. Safety and Efficacy: The safety and efficacy of Extra Super Zhewitra in treating PAH have not been established through clinical trials or regulatory approval. Therefore, it should not be used for this purpose without specific guidance from a healthcare provider.
   

If you have pulmonary arterial hypertension or any other medical condition, it's important to follow your healthcare provider’s recommendations regarding treatment options. They can prescribe medications that are specifically approved and proven effective for managing your condition, ensuring safe and appropriate therapy.