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What is Viagra used for? Viagra is used to treat impotence in men. Viagra increases the body’s ability to achieve and maintain an erection during sexual stimulation. Viagra does not protect you from getting sexually transmitted diseases, including HIV. take Viagra? Men who are currently using medicines that contain nitrates, such as nitroglycerin should not use Viagra because taken together they can lower the blood pressure too much. Viagra should not be used by women or children. You should have a complete medical history and exam to determine the cause of your impotence before taking Viagra. Men who have medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma or who have an abnormally shaped penis may not be able to take Viagra. There are several medications that are known to interact with Viagra, so be sure to tell your doctor about all medications you are taking including those you can get without a prescription. Viagra has not been studied with other treatments for impotence, so use in combination with other treatments is not recommended. How should I take Viagra? Your healthcare provider may prescribe Viagra as one tablet once a day, about 1 hour before sexual activity. However, Viagra may be taken anywhere from 30 minutes to 4 hours before sexual activity. What are some possible side effects of Viagra? a complete list of side effects reported with Viagra. Your healthcare provider can discuss with you a more complete list of side effects. Viagra is generally well tolerated. If any side effects are experienced, they are usually mild and temporary. The following is a listing of the most common side effects: Visual changes such as mild and temporary changes in blue/green colors or increased sensitivity to light. For more detailed information on Viagra, ask your healthcare provider. More Articles... If you have any questions or comments on senior health nutrition, fitness, etc., go to the is for educational / reference use only.generic viagra risks Generic "Viagra" is a substance that is used to treat erectile dysfunction. Generic "Viagra" relaxes the smooth muscle of the penis to allow increased blood flow and erection. It belongs to the family of drugs called phosphodiesterase inhibitors. Generic "Viagra" enables men with ED to respond to sexual stimulation. When a man is sexually excited, the arteries in his penis relax and widen. This allows more blood to flow into the penis. The increased blood flow causes the penis to become hard and erect. The veins that normally carry blood away from the penis then become compressed. This restricts the blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges, resulting in an erection. Sometimes the nerves or blood vessels that are part of this process don't work properly. If this happens, a man may not be able to get or keep an erection. Generic "Viagra" increases blood flow to the penis, so that when a man is sexually excited, he can consistently get and keep an erection. When he is done having sex, the erection goes away. Inactive Ingredients: magnesium stearate, hypromellose, titanium dioxide, lactose, microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, triacetin, and FD & C Blue #2 aluminum lake. What is Generic "Viagra" PRESCRIBED For? Generic "Viagra" is an effective treatment for male erectile dysfunction, or ED. This is also known as impotence. Generic "Viagra" is a little blue pill you take only when you want to have sex. Generic "Viagra" helps men consistently get and keep an erection when they become sexually stimulated. How Should I Take Generic "Viagra"? Take Generic "Viagra" exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Revatio is usually taken three times each day, about 4 to 6 hours apart. Generic "Viagra" is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Generic "Viagra" more than once per day. Generic "Viagra" can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions. If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of Generic "Viagra". Keep out of the reach and sight of children. Do not store above 30°C. Keep tablets in the original package, protected from moisture. Do not use after the expiry date stated on the pack. What are the CONTRAINDICATIONS for taking Generic "Viagra"? Before taking Generic "Viagra", tell your doctor if you have had a heart attack, stroke, or life-threatening irregular heartbeats within the last six months; have a history of heart failure; have coronary artery disease; have angina; have high or low blood pressure; have liver problems; have kidney problems; have ever had blood problems, including sickle cell anemia or leukemia; have a bleeding disorder; have a stomach ulcer; have retinitis pigmentosa (an inherited condition of the eye); have a physical deformity of the penis such as Peyronie's disease; have a condition that could lead to prolonged and painful erections, such as a tumor of the bone marrow, sickle cell anemia, or leukemia; or are taking another medicine to treat impotence. You may not be able to take Generic "Viagra", or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Although Generic "Viagra" is not indicated for use by women, it is in the FDA pregnancy category B. This means that Generic "Viagra" is not expected to be harmful to an unborn baby. Women should not take Generic "Viagra". It is not known whether Generic "Viagra" passes into breast milk. If you are over 65 years of age, you may be more likely to experience side effects from Generic "Viagra". Your doctor may prescribe a lower dose of this medication. What Happens if I MISS A DOSE? Generic "Viagra" is used as need. So, you are not likely to miss a dose. What Happens if I OVERDOSE? Seek emergency medical attention. Symptoms of a Generic "Viagra" overdose are not known, but are likely to include chest pain, dizziness, an irregular heartbeat, and swelling of the ankles or legs. What are the possible SIDE EFFECTS of Generic Viagra"? Like all medicines, Generic "Viagra" can have side effects. These effects are normally mild to moderate in nature. The most common undesirable effects are headache and facial flushing. Less commonly reported undesirable effects are indigestion, dizziness, stuffy nose and effects on vision including colour tinge to vision, increased brightness of light or blurred vision). Muscle aches can occur if Generic "Viagra" is taken more frequently than once a day. Rarely, prolonged and sometimes painful erections have been reported after taking Generic "Viagra". If you have such an erection which lasts continuously for more than 4 hours, you should contact a doctor immediately. Rarely, hypersensitivity reactions (including skin rashes) have been reported. Heart attack, stroke, irregular heart beats, and death have been reported rarely in men taking Generic "Viagra". What other drugs can INTERACT with Generic "Viagra"? Please inform your doctor or pharmacist if you are taking or have taken recently other medicines, even those not prescribed. Generic "Viagra" tablets may interfere with some medicines, especially those used to treat chest pain. In the event of a medical emergency, you should tell anyone treating your condition that you have taken Generic "Viagra". Do not take - Generic "Viagra" with other medicines unless your doctor tells you that you can. Generic "Viagra" may cause a serious increase in the effects of medicines called nitrates, and nitric oxide donors such as amyl nitrite ("poppers"). These are often used for the relief of angina pectoris (or "chest pains"). You should NOT take Generic "Viagra" if you are taking these medicines. If you are taking protease inhibitors, suck as for the treatment of HIV, your doctor may start you on the lowest dose (25 mg) of Generic "Viagra". If you take any medicines that contain nitrates - either regularly or as needed - you should never take Generic "Viagra". If you take Generic "Viagra" with any nitrate medicine or recreational drug containing nitrates, your blood pressure could suddenly drop to an unsafe level. You could get dizzy, faint, or even have a heart attack or stroke. Nitrates are found in many prescription medicines that are used to treat angina. Generic "Viagra" is only for patients with erectile dysfunction. Generic "Viagra" is not for newborns, children, or women. Do not let anyone else take your Generic "Viagra". Generic "Viagra" must be used only under a doctor's supervision. herbal viagra Before proceeding to buy Viagra, we at UK Medix strongly advise that you read through the following information provided specifically on Viagra. We have provided it to answer all your unanswered questions on the medication, however we do understand that some may slip through and remain unanswered, in this case we would recommend that you seek advice from your prescribing physician or if you obtained your Viagra from UK Medix please feel free to contact our medical team for assistance. Please understand that this is not a comprehensive review of Viagra but a guide compiled by us at UK Medix regarding the use and effects. If any aspect of taking Viagra concerns you ensure to consult with your doctor before ordering. Should you take Viagra? Viagra was developed by Pfizer to treat men in their ongoing quest to tackle Erectile Dysfunction (aka impotence). It is a prescription medication that should only be taken if and when you wish to have sex and it is active only on arousal. This arousal may be physical or visual but either way you will need to be sexually aroused for Viagra to work; how aroused you need to be depends entirely on the patient and their individual degree of erectile dysfunction. At UK Medix, we insist that Viagra is not for female patients and thus should only be taken by men who obtain a prescription. It may be dangerous for females as studies have not been carried out and anyway for female impotence, UK Medix have heard of new medications coming out soon, such as a testosterone patch, currently known as Intrinsa. Viagra was originally developed as a compound to be trialed as just another medication for blood pressure and hypertension, not much excitement there really. However, it was in clinical trials that the scientists at Pfizer realized something that would change the course of sexual history worldwide; the side effects of this medication were that impotent men were getting erections. Eureka! (Quote - Archimedes) So, how exactly does Viagra work? Viagra works by causing the smooth muscles in your blood vessels to relax, increasing blood flow around and lowering the blood pressure. The active ingredient in Viagra, sildenafil, is also a PDE5 inhibitor; and it is this in particular that specifies an increase in blood flow to the penis. When a man is sexually stimulated his penile arteries go through a process to relax and enlarge. As they enlarge, the veins that remove blood from the penis are compressed thus restricting blood flow out of the penis, causing an erection. Although erectile dysfunction was originally thought to be purely psychological, the discovery of Viagra refuted this and it is now common fact that the nerves and blood vessels play a key role. If the nerves and blood vessels that facilitate the process of an erection do not work then erectile dysfunction occurs. How Long Does it work for? Viagra is seen to work on about 80% of patients and is active within an hour; it is thought to be one of the quickest medications on the market to work, however it only lasts up to 4 hours. UK Medix has seen this to be a bit of a problem to some patients as an element of planning is required. Other medications now out, such as Cialis, show lasting effects up to 36 hours but again they all have their problems, some patients have siad that , for example, does not start to work as quickly as Viagra. Viagra comes in 3 different dosages; 25mg, 50mg and 100mg. The starting dosage recommended by is 50mg and we here at UK Medix we agree with this; always start at this dosage and adjust accordingly if needs be. However, as with all medications ensure to follow the advice of your prescribing doctor on any of these matters. should be taken as one tablet, with or without meals, up to one hour before sexual activity and it should not then be take again for 24 hours. UK Medix recommend that you read carefully any leaflets that come supplied with your medication.buy viagra cheap What is Viagra used for? Viagra is used to treat impotence in men. Viagra increases the body’s ability to achieve and maintain an erection during sexual stimulation. Viagra does not protect you from getting sexually transmitted diseases, including HIV. take Viagra? Men who are currently using medicines that contain nitrates, such as nitroglycerin should not use Viagra because taken together they can lower the blood pressure too much. Viagra should not be used by women or children. In patients taking Viagra, several heart-related side effects have been reported, including heart attack, sudden death, irregular heart rhythm, stroke, chest pain, and increased blood pressure. It is not possible to determine whether these events are directly related to Viagra, to sexual activity, to the patient’s heart condition, to a combination of these factors, or to other factors. taking certain medications at the same time (e.g., ketoconazole, itraconazole, erythromycin and saquinavir). In these patients, the recommended starting dose of Viagra is 25 mg. Heart attack, stroke, or life-threatening irregular heart rhythm within the last 6 months Because Viagra lowers blood pressure, your doctor will evaluate your overall medical condition to determine if Viagra, in combination with sexual activity, could adversely affect you. Viagra can cause a rare but serious condition of prolonged erection (priapism). It is important to contact your health care provider immediately if your erection lasts longer than 4 hours. Men for whom sexual activity is inadvisable may not be good candidates for Viagra. Tell your doctor if you are taking protease inhibitors for the treatment of HIV. You should have a complete medical history and exam to determine the cause of your impotence before taking Viagra. Men who have medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma or who have an abnormally shaped penis may not be able to take Viagra. There are several medications that are known to interact with Viagra, so be sure to tell your doctor about all medications you are taking including those you can get without a prescription. Viagra has not been studied with other treatments for impotence, so use in combination with other treatments is not recommended. What are some possible side effects of Viagra? a complete list of side effects reported with Viagra. Your health care provider can discuss with you a more complete list of side effects.) ). The following is a listing of the most common side effects Visual changes such as mild and temporary changes in blue/green colors or increased sensitivity to light. For more detailed information about Viagra, ask your health care provider. sildenafil in pulmonary hypertension Why is Viagra prescribed? Viagra is an oral drug for male impotence, also known as erectile dysfunction (ED). It works by dilating blood vessels in the penis, allowing the inflow of blood needed for an erection. Viagra causes erections only during sexual excitement. It does not work in the absence of arousal. How should you take Viagra? Taking Viagra approximately 1 hour before sexual activity works best for most men. Depending on how and when the drug works for you, an interval of one-half hour to as much as 4 hours may prove ideal. --If you miss a dose... for regular use. Take it only before sexual activity. --Storage instructions... Store at room temperature. What side effects may occur? Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Viagra. Abnormal vision (color tinge, blurring, sensitivity to light), acid indigestion, diarrhea, flushing, headache, nasal congestion, urinary tract infection Heart attack, stroke, heart irregularities, dangerous surges in blood pressure, and sudden death have all been reported after use of Viagra, usually in men with existing cardiac risk factors, and typically during or shortly after sex. Why should Viagra not be prescribed? Do not take Viagra if you are taking any nitrate-based drug, including nitroglycerin patches (Nitro-Dur, Transderm-Nitro), nitroglycerin ointment (Nitro-Bid, Nitrol), nitroglycerin pills (Nitro-Bid, Nitrostat), and isosorbide pills (Dilatrate-SR, Isordil, Sorbitrate). Combining Viagra with these drugs can cause a severe drop in blood pressure. If Viagra gives you an allergic reaction, do not use it again. If you have heart problems severe enough to make sexual activity a danger, you should avoid using Viagra. Use it cautiously--if at all--if you've had a heart attack, stroke, or life-threatening heart irregularities within the past 6 months. Be equally cautious if you have severe high or low blood pressure, heart failure, or unstable angina (crushing heart pain that occurs at any time). If you take Viagra and develop cardiac symptoms (for example, dizziness, nausea, and chest pain) during sexual activity, do not continue. Alert your doctor to the problem as soon as possible. If you have a condition that might result in long-lasting erections, such as sickle cell anemia, multiple myeloma (a disease of the bone marrow), or leukemia, use Viagra with caution. Also use cautiously if you have a genital problem or deformity such as Peyronie's disease. If an erection lasts more than 4 hours, seek treatment immediately. Permanent damage and impotence could result. If you have a bleeding disorder, a stomach ulcer, or the inherited eye condition known as retinitis pigmentosa, use Viagra with caution. Its safety under these circumstances has not yet been studied. To avoid low blood pressure, do not take the 50-milligram or 100-milligram dose of Viagra within 4 hours of taking an alpha-blocking drug such as Cardura. Remember that Viagra offers no protection from transmission of sexually transmitted diseases, such as HIV, the virus that causes AIDS. If Viagra is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Viagra with the following: Erythromycin (E-Mycin, Ery-Tab, PCE) Nitrates such as Isordil, Nitro-Bid, and Nitro-Dur Rifampin (Rifadin, Rimactane) Saquinavir (Fortovase, Invirase) Viagra should not be used by women. Its affects during pregnancy and breastfeeding have not been studied. Doses range from 25 milligrams to 100 milligrams, depending on the drug's effect. The usual dose is 50 milligrams. If you are over 65, have liver or kidney problems, or are taking erythromycin, ketoconazole, itraconazole, ritonavir, or saquinavir a dose of 25 milligrams may be sufficient. Your doctor will adjust the dosage if the drug is not working properly for you. Take Viagra only before sexual activity. The manufacturer recommends a maximum of 1 dose per day (1 dose every 2 days for those taking ritonavir). To avoid low blood pressure, do not take the 50-milligram or 100-milligram dose of Viagra within 4 hours of taking an alpha-blocking drug such as Cardura. No overdose of Viagra has been reported. However, any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. generic brands of viagra online Before proceeding to buy Viagra, we at UK Medix strongly advise that you read through the following information provided specifically on Viagra. We have provided it to answer all your unanswered questions on the medication, however we do understand that some may slip through and remain unanswered, in this case we would recommend that you seek advice from your prescribing physician or if you obtained your Viagra from UK Medix please feel free to contact our medical team for assistance. Please understand that this is not a comprehensive review of Viagra but a guide compiled by us at UK Medix regarding the use and effects. If any aspect of taking Viagra concerns you ensure to consult with your doctor before ordering. Should you take Viagra? Viagra was developed by Pfizer to treat men in their ongoing quest to tackle Erectile Dysfunction (aka impotence). It is a prescription medication that should only be taken if and when you wish to have sex and it is active only on arousal. This arousal may be physical or visual but either way you will need to be sexually aroused for Viagra to work; how aroused you need to be depends entirely on the patient and their individual degree of erectile dysfunction. At UK Medix, we insist that Viagra is not for female patients and thus should only be taken by men who obtain a prescription. It may be dangerous for females as studies have not been carried out and anyway for female impotence, UK Medix have heard of new medications coming out soon, such as a testosterone patch, currently known as Intrinsa. Viagra was originally developed as a compound to be trialed as just another medication for blood pressure and hypertension, not much excitement there really. However, it was in clinical trials that the scientists at Pfizer realized something that would change the course of sexual history worldwide; the side effects of this medication were that impotent men were getting erections. Eureka! (Quote - Archimedes) So, how exactly does Viagra work? Viagra works by causing the smooth muscles in your blood vessels to relax, increasing blood flow around and lowering the blood pressure. The active ingredient in Viagra, sildenafil, is also a PDE5 inhibitor; and it is this in particular that specifies an increase in blood flow to the penis. When a man is sexually stimulated his penile arteries go through a process to relax and enlarge. As they enlarge, the veins that remove blood from the penis are compressed thus restricting blood flow out of the penis, causing an erection. Although erectile dysfunction was originally thought to be purely psychological, the discovery of Viagra refuted this and it is now common fact that the nerves and blood vessels play a key role. If the nerves and blood vessels that facilitate the process of an erection do not work then erectile dysfunction occurs. How Long Does it work for? Viagra is seen to work on about 80% of patients and is active within an hour; it is thought to be one of the quickest medications on the market to work, however it only lasts up to 4 hours. UK Medix has seen this to be a bit of a problem to some patients as an element of planning is required. Other medications now out, such as Cialis, show lasting effects up to 36 hours but again they all have their problems, some patients have siad that , for example, does not start to work as quickly as Viagra. Viagra comes in 3 different dosages; 25mg, 50mg and 100mg. The starting dosage recommended by is 50mg and we here at UK Medix we agree with this; always start at this dosage and adjust accordingly if needs be. However, as with all medications ensure to follow the advice of your prescribing doctor on any of these matters. should be taken as one tablet, with or without meals, up to one hour before sexual activity and it should not then be take again for 24 hours. UK Medix recommend that you read carefully any leaflets that come supplied with your medication.
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The most widely used remedy for erectile dysfunction; research has indicated that Viagra has an effect on the condition of the human heart as well as a male's penis. The hormonal stress normally exerted on the human heart has been noted to be decreased in men who take Viagra. When conducted with mice, the testing was more noticeable, Viagra having the tendency to avert harmful and long term effects of chronic hypertension on their heart. The study, lead by the John Hopkins research team, found that there is potential benefits for the treatment of pulmonary hypertension, linked in with how Viagra dilates genital blood vessels. Viagra works by dulling the heart beat, which is increased during stress. It works to decrease the force which is needed to pump blood from the heart to the rest of the body. The research conducted by David Kass, cardiologist and senior researcher of the John Hopkins study noticed Viagra can be effective in blocking short- term consequences of hormonal stresses in the heart. Further evidence on the testing of mice (although further research is needed until this is applicable to humans), indicated that negative effects of heart failure and cardiac hypertrophy on weakened heart muscles can be reversed. Further research is need in this area on humans however. Thirty five men and women were tested and injected with Dobutamine (a synthetic derivative of dopamine that increases heart rate and contractions), which resulted in increased rate of 150%. The men and women were then separated into two groups, one of which were given sildenafil (Viagra) and the other given a placebo (fake) pill. Results showed that the first group's heart rate decreased by 50%, whilst the latter group's further increased. This has led to widespread scientific interest in the effects of sildenafil (Viagra) on the human heart condition. generic viagra online order Male impotence a problem that virtually every man fears, but at sometime or other in life every man has to confront Erectile Dysfunction (ED). A man’s psychology plays a prominent part in his sexual relationship. If he is depressed, stressed or tense, there is bound to be some impact on his sexual relationship. Anxiety about a man’s sexual routine makes him more stressed and causes his ability to perform to decrease. Erectile Dysfunction can be defined as the inability to have or maintain an erection long enough to have satisfactory sexual intercourse. According to research, ED afflicts nearly 30 million men in America alone and is a cause of great tension. The ideal solution to male sexual impotence issues lies in the little blue pill known as Viagra. Viagra has been quite a handy tool to men who have ED or may be suffering from any degree of male sexual dysfunction. Since the advent of Viagra there has been a great deal of confidence in the patients of erectile dysfunction whether suffering because of the physical or psychological issues. Viagra revives the feeling of self-esteem and manliness, which seems to be lost if you are suffering from ED. Viagra works by enhancing the flow of blood in the penile region and causing a firm erection. The sexual lives of many men have improved because they have the option of Viagra. Viagra can proudly claim to be the first anti-impotence oral pill. The basic chemical base in Viagra is sildenafil citrate. This chemical that treats erectile dysfunction by enabling the man to have an erection long enough to satisfactorily complete sexual intercourse. Many people think that Viagra will enhance their libido or improve their sexual prowess, but this is totally baseless. Viagra can surely be termed as a sex pill, but it is not a libido enhancer drug at all. As a matter of fact, Viagra just acts on the chemicals and enzymes present in your body causing an increased flow of blood in the penis to cause an erection. how to buy viagra Viagra turns 10 this month, and didn't time just fly? It seems like only yesterday we started guffawing at the Symbolism for Dummies ads on TV for the little blue pill and its "erectile dysfunction" rivals -- footballs tossed through tires, faucets erupting. The spots ended with a list of potential side effects that sounded like a satire of potential side effects. "More than four hours?" we winced. "Ouch." However discomfiting the commercials, the Food and Drug Administration (FDA) approval of Viagra -- on March 27, 1998 -- is a landmark day in the history of sex. It seemed at the time like a biomedical revolution was upon us all, and about five minutes after word of the magical med went global, the question first was asked: Where is the women's version of Viagra? The short answer: They're still working on it. A bunch of companies have tried and failed to create "pink Viagra," as it's often called. Other companies have drugs in late stages of clinical testing, including a gel that recently began a make-or-break nationwide study with several thousand women. Give us five years, maybe less, say the most optimistic researchers and doctors. Though it's unclear exactly how many women would ask for a prescription, no one doubts that the first company that gets to market a remedy for female sexual dysfunction (FSD), as it's formally known, will earn a fortune. But as this race reaches what could be its final lap, not all of the spectators are cheering. Some, in fact, are booing as loudly as they can. A modest-size but fervent group of psychologists, academics and public health advocates contend that FSD isn't an authentic medical condition, or at least not the sort of problem that should be treated with drugs. These aren't the obtuse male physicians who for decades have been telling women distressed by their lack of libido that "it's all in your head." The anti-FSD crowd is mostly women, many of them self-described feminists. The most prominent is Leonore Tiefer, a psychotherapist and clinical associate professor at New York University, who has long decried what she calls "the medicalization of women's sexuality." "Drug companies want to say to women, 'You don't need to know anything; you can have the satisfying sex life that you seek -- people dancing on TV, the whole bit -- without knowing anything. Just ask your doctor,' " she says. "I resent that, because there are specific harms that come from being ignorant and dependent in the world we live in. There may be lots of people who aren't interested in sex, but is there a medical reason for that, and do we diagnose that?" online viagra prescriptions Should I Confront My Wife About Affair? TEN years ago I fell in love with a girl. She was 22 years younger than me and I was married. But the love I felt for her then - and still do - was overwhelming. So I left my wife for her. It was messy and my two grown-up children made it clear they wanted nothing to do with me after what I had done to their mum. I felt guilty but the dust settled and after the divorce I married my second wife. It was the happiest day of my life. We now have an eight-year-old and I've managed to patch things up with the older ones. My wife is 37 and I'll be 60 this year. The problem is I have been having trouble sustaining an erection. I'm taking Viagra which helps, but I don't have the same energy I used to have. I'm almost certain my wife is having an affair. We had a young guy, in his twenties, help get the garden in our new house into shape and I could see he was attracted to her. She's still an amazing-looking woman and doesn't look a year older than when I first saw her. She's been getting texts which she deletes immediately and I know for a fact when she told me she was round at her mum's that it was a lie. So I'm worried sick. I know I should tackle her about what's going on but I can't. I can't live without her and I don't like the thought of my ex-wife, most of my friends and my relatives pointing out that they all told me the age gap was too big and we wouldn't last. OF course you could carry on as you are with your head buried in the sand. There is the possibility your wife isn't having an affair or even if she is, it isn't serious and will soon blow itself out. Your problem keeping an erection could be affecting self-confidence and putting your imagination into overdrive. In some ways, sitting tight might be the sensible thing to do, especially as you have a young child but no intention of ending the marriage. But I don't think you can live with the uncertainty forever. Maybe you should give yourself a deadline of a few months. If you remain suspicious or get more solid evidence, I don't believe you can go on ignoring the issue. If she wants to save the marriage, counselling through Relate Scotland or Scottish Marriage Care is the next step. But if things can't be fixed, there's no point trying to glue it together just because you don't want those who warned you against marrying a younger woman crowing. If you have a problem, write to: Just Joan, Daily Record, One Central Quay, Glasgow G3 8DA or email j.burnie@dailyrecord.co.uk. I cannot reply personally. generic drug for viagra Is Viagra the Answer for you ? Viagra is not simply a sex pill ...learn its various properties is a pill that not only helps cure erectile dysnfunction but also makes the act of sex more fulfilling. now and know personally how it can help you. Viagra is perhaps one of the most notorious medicines in the market. Considering how integral it is for men's health, psychologically and socially, its funny to note that social and cultural hang-ups still survive in the 21st Century making Viagra, a simple medicine, seem to be a 'drug' that is not mentioned in polite circles. Viagra, is a drug or impotence. Sildenafil is available by prescription only. Viagra can only stimulate if a man is sexually excited. The question is when isn't he sexually excited? Viagra is a medicine, much like Asprin and Panadol that people take to treat their health problems. Erectile Dysfunction is a health problem faced by men. It is prescribed by doctors to help men with erectile problems which can be caused due to age, stress, social pressures or other physiological and psychological reasons. Viagra is not, contrary to popular perception, a sex pill that will help you get bigger erections, act as a love enhancer or protect you against sexually transmitted disease. Viagra is a pill that contains Sildenafil Citrate a chemical that helps treat impotence. Sildenafil Citrate is available under several brand names that vary from Viagra to Revatio and may also be found under its generic name. Commercially speaking Sildenafil citrate's, main competitor is tadalafil [Cialis] and vardenafil [Levitra]. While there maybe many medicines out there that are considered to be alternatives to Viagra, it is that has taken the world by storm and remains the top best seller.

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A consistent inability to sustain an erection sufficient for sexual intercourse. Also commonly known as impotence. Medically, the term erectile dysfunction is used to differentiate impotence from other problems that interfere with sexual intercourse The following drugs and medications are in some way related to, or used in the treatment of Impotence. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. levitra cialis viagra cheaper viagra levitra apcalis The success of any medical treatment of impotence also depends on the kind of relationship a couple has. If both parties have a strong commitment to renew sexual intimacy and are both willing to cooperate with the treatment, then there is greater likelihood of the sexual dysfunction being addressed easily. Good communication skills are vital in identifying and addressing most problems, even sexual problems. Some couples to choose to be silent about the issue and pretend that nothing is wrong. This is damaging because although in some cases impotence does improve over time, in most cases the cause is a physical condition which needs medical treatment. Ignoring or denying the problem may prolong recovery and reduce the chance of an effective treatment.  . Remember that impotence is not just a â€?man's problem'. Although it afflicts only men, it affects both men and women. Admitting to each other that there is a problem and that you are both willing to resolve it is a key to effective sex therapy. It takes a certain amount of preparation, tact, skill and courage to be able to effectively discuss this issue with your partner. Research shows that couples who are in love and share a strong commitment to their relationship are the ones who often seek medical treatment and/or psychological counseling, and are in a better position to benefit from it. Couples who also had an active and fully functioning sex life prior to the onset of impotence have better chances of recapturing the sensuality they once enjoyed.  It is also important that despite the problem of impotence, both partners are still sexually attracted to their mate. Couples who have a sense of humor are also more likely to survive the inconveniences of impotence. While impotence is no laughing matter, the ability of couples to laugh together or share a smile seems to contribute to their ability to rise above life's trials. It is also important that partners enrich themselves with knowledge about sexual functioning, impotence and its possible treatments. Up - to - date information can effectively aid couples in their decisions regarding the treatment of the dysfunction. Restored potency is not a quick - fix for underlying personal and relationship problems. Couples have to understand that it may take medical treatment and/or counseling in order to renew the once loving and warm relationship. Although there is no way of predicting the success of a certain treatment, a more positive response and a greater commitment to renewing intimacy increases the likelihood of an effective treatment. citrate find get sildenafil way Impotence and erectile dysfunction affect many men, and in recent years, have become more widely discussed. Various treatments have been developed to cure such problems, the most popular and widely available being Viagra. There are more and more alternatives to Viagra appearing on the market, some of which are more reliable and trustworthy than others! Read on to discover a legitimate and safe alternatives to Viagra. Firstly, some men experience side effects from using Viagra. Although this isn't widespread amongst users, Viagra alternatives don't involve any risk of side effects. Side effects such as dizziness, loss of vision, headaches, flushing and low blood pressure can occur. In more extreme cases some men have experienced priapism( a painful condition when a man's penis fails to return to its natural flaccid state. The Viagra alternative extracts such side effects as the non- chemical remedies consist of natural herbal ingredients. Such alternatives are widely available and their increased use by male consumers on the rise. Secondly, such herbal alternatives are available over the counter or on the internet (as are Viagra however), without a prescription, and are relatively cheap, ranging from $1- 1.50 a pill. Generic Viagra treatments however are also available without a prescription, and although are slightly more expensive they still appear to be the most popular choice amongst consumers. Thirdly, an alternative Viagra treatment takes 30- 45 minutes to work, however the length of its effect varies widely. Certain herbal ingredients work effectively such as Epicedium (commonly known as the horny goat weed), which is a great sex drive booster. Viagra however, whilst taking about the same time to have an effect on a man's penis normally lasts for around 1-2 hours (sometimes more) from the time of ingestion, and so guarantees a man sexual pleasure. It is important for each individual male to weigh up the pro's and cons to his preferred treatment of erectile dysfunction, taking into account all the available information. buy viagra in the uk FDA has received reports of cases of sudden decreases or loss of hearing following the use of PDE5 inhibitors, Viagra, Levitra, and Cialis for the treatment of erectile dysfunction and Revatio for the treatment of pulmonary arterial hypertension. In some cases, the sudden hearing loss was accompanied by tinnitus and dizziness. Medical follow-up information was often limited for the cases reported postmarketing, which makes it difficult to determine whether these reports are directly related to the use of one of these drugs, an underlying medical condition, or other risk factors for hearing loss, a combination of these factors, or other factors. Sudden hearing loss was also reported in a few patients in clinical trials of these drugs. In response to a request from FDA, the manufacturers of Viagra, Levitra and Cialis have revised the labeling for these products to address the potential risk of sudden hearing loss and to guide patients on what to do if they experience sudden problems with their hearing. FDA is currently working with the sponsor to revise the labeling for Revatio. The approved revised labeling for Viagra, Levitra and Cialis includes a new sections. The revised labeling is available at . This information reflects FDA’s current analysis of data available to FDA concerning this drug. FDA intends to update this sheet when additional information or analyses become available. Includes previous safety information and approval packages.
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Revatio, Viagra What is Viagra? Viagra relaxes muscles and increases blood flow to particular areas of the body. Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. Viagra may also be used for other purposes not listed in this medication guide. Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking Viagra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra. Do not take Viagra more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. Viagra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Viagra, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Viagra is the actual cause of vision loss. Stop using Viagra and get emergency medical help if you have sudden vision loss. Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking Viagra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack. Before taking Viagra, tell your doctor if you are allergic to any drugs, or if you have: a recent history (in the past 6 months) of a heart attack, stroke, or heart rhythm disorder; a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia; if you have been told you should not have sexual intercourse for health reasons. If you have any of these conditions, you may need a dose adjustment or special tests to safely take Viagra. Viagra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Viagra, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Viagra is the actual cause of vision loss. Stop using Viagra and get emergency medical help if you have sudden vision loss. FDA pregnancy category B: This medication is not expected to be harmful to an unborn baby. Do not use Viagra without telling your doctor if you are pregnant or plan to become pregnant during treatment. It is not known if Viagra passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take Viagra? Take Viagra exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label. Revatio is usually taken three times each day, about 4 to 6 hours apart. Viagra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day. Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra. Store this medication at room temperature away from moisture and heat. What happens if I miss a dose? Viagra is used as needed, so you are not likely to be on a dosing schedule. If you miss a dose of Revatio, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting. What should I avoid while taking Viagra? Avoid drinking alcohol, which can increase some of the side effects of Viagra. Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra. ringing in your ears, or sudden hearing loss; chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; swelling in your hands, ankles, or feet; feeling light-headed, fainting; or penis erection that is painful or lasts 4 hours or longer. warmth or redness in your face, neck, or chest; back pain. This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. What other drugs will affect Viagra? Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers"). Before taking Viagra, tell your doctor about all other medications you use for erectile dysfunction, or if you are using any of the following medications: cimetidine (Tagamet, Tagamet HB); an antibiotic such as erythromycin (E-Mycin, Eryc, Ery-Tab) or clarithromycin (Biaxin); doxazosin (Cardura), prazosin (Minipress), Terazosin (Hytrin); HIV medicines such as amprenavir (Agenerase), tipranavir (Aptivus), darunavir (Prezista), efavirenz (Sustiva), nevirapine (Viramune), indinavir (Crixivan), saquinavir (Invirase, Fortovase), lopinavir/ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept); carbamazepine (Tegretol), phenobarbital (Luminal), or phenytoin (Dilantin); or rifampin (Rifadin, Rimactane) or rifabutin (Mycobutin). This list is not complete and there may be other drugs that can interact with Viagra. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Where can I get more information? Your pharmacist can provide more information about Viagra. What does my medication look like? Sildenafil is available with a prescription under the brand names Viagra and Revatio. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. Revatio 20 mg - white, film-coated round tablets Viagra 25 mg - blue, film-coated tablets with a rounded-diamond shape Viagra 50 mg - blue, film-coated tablets with a rounded-diamond shape Viagra 100 mg - blue, film-coated tablets with a rounded-diamond shape Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. viagra find edinburgh search pages sites online A sexual disorder is defined as the inability to enjoy sexual intercourse or having problems in the sex life. A person has difficulty in having or enjoying sex because of these disorders. It does not make any difference in the physical health but it can affect mental state by bringing on panic attacks, anxiety and feelings of depression. Sexual disorders occur in both men and women. It is not easy to diagnose a person with a sexual disorder because not everyone interested in sexual intercourse all the time. Some may not be interested in having sex at all and some have a lower level of desire or sexual need. If there are no symptoms of depression, no relationship problem, but still no interest in sex then, it can be classified as a sexual disorder. Consulting your doctor is the first best step in identifying a sexual disorder. These disorders are quite common and create lot of stress because people feel uncomfortable talking about sexual disorders, even to their doctors. Sexual activity needs comfortable environment, concentration and relaxation. Depending on the cause of sexual disorder, there are various treatments. If it is a physical problem, medication and different therapies can be done. If it is a psychological cause, it is best to consult with sexologists. Sexologists use different therapies to produce interest in sex. Psychotherapies can also be beneficial in this regard. Relationship therapists deal with relationship problems and stress, which may be the cause of the sexual disorder. Vasodilators, Minoxidil, Yohimbine Therapy generic viagra without a prescription In the U.S.— Sildenafil (sil-DEN-a-fil) belongs to a group of medicines that delay the enzymes called phosphodiesterases from working too quickly. The penis is one of the areas where these enzymes work. Sildenafil is used to treat men who have erectile dysfunction (also called sexual impotence). By controlling the enzyme phosphodiesterase, sildenafil helps to maintain an erection that is produced when the penis is stroked. Without physical action to the penis, such as that occurring during sexual intercourse, sildenafil will not work to cause an erection. Sildenafil is also used to treat the symptoms of pulmonary arterial hypertension. This is the high blood pressure that occurs in the main artery that carries blood from the right side of the heart (the ventricle) to the lungs. When the smaller blood vessels in the lungs become more resistant to blood flow, the right ventricle must work harder to pump enough blood through the lungs. Sildenafil helps by increasing the supply of blood to the lungs and reducing the workload of the heart. This medicine is available only with your doctor's prescription, in the following dosage form(s): Tablets (U.S.) In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For sildenafil, the following should be considered: Tell your doctor if you have ever had any unusual or allergic reaction to sildenafil. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Sildenafil is not indicated for use in women. Sildenafil has not been studied in pregnant women. However, sildenafil has not been shown to cause birth defects or other problems in animal studies. It is not known whether sildenafil passes into breast milk. Sildenafil is not indicated for use in women for erectile dysfunction. Mothers who are taking this medicine for pulmonary arterial hypertension and who wish to breast-feed should discuss this with their doctor. Elderly people are especially sensitive to the effects of sildenafil, which may increase their chance of having side effects. Patients 65 years of age and older who are taking this medicine for erectile dysfunction are started on a low dose, 25 mg, of sildenafil. Patients who are taking this medicine for pulmonary arterial hypertension may also need to be started at a lower dose. The dose may be increased by a doctor as needed and tolerated. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking sildenafil, it is especially important that your health care professional know if you are taking any of the following: Alpha-blockers (medicine for high blood pressure—Sildenafil when taken together with an alpha-blocker medicine may cause very low blood pressure. Sildenafil doses above 25 mg should not be taken within 4 hours of taking an alpha-blocker medicine. Bosentan (e.g., Tracleer)—May increase amounts of bosentan in the body Cimetidine (e.g., Tagamet) Erythromycin (e.g., E.E.S. or Ery-Tab) Itraconazole (e.g., Sporanox) Ketaconazole (e.g., Nizoral) Mibefradil (e.g., Posicor) Ritonavir (e.g., Norvir) Saquinavir (e.g., Fortovase or Invirase)—These medicines may increase the unwanted effects of sildenafil, unless lower starting doses of sildenafil are used Erectile dysfunction medicines—These medicines should not be used at the same time as sildenafil because the safety of using these medicines in combination has not been proven. Nitrates, such as nitroglycerin (e.g., Nitrostat or Transderm-Nitro)—Sildenafil increases the lowering of blood pressure by nitrates too much and their use together is not recommended The presence of other medical problems may affect the use of sildenafil. Make sure you tell your doctor if you have any other medical problems, especially: Smoking—These conditions may increase risk for a serious eye problem called NAION. Heart attack, history of (within the last 6 months) or Stroke, history of (within the last 6 months)—Chance of problems occurring may be increased Abnormal penis, including curved penis and birth defects of the penis—Chance of problems occurring may be increased Retinitis pigmentosa—Chance of problems occurring may be increased. It is not known if the medicine is safe for use in these patients Conditions causing thickened blood or slower blood flow, including leukemia; multiple myeloma (tumors of the bone marrow); or polycythemia, sickle cell disease, and thrombocythemia (blood problems) or Priapism (history of)—Although sildenafil does not cause priapism (erection lasting longer than 6 hours), patients with these conditions have an increased risk of priapism and it could occur while using sildenafil Heart or blood disease—Sexual activity increases the heart rate and blood flow and can increase the chance of problems occurring for some patients who use any type of medicine, including sildenafil, that increases sexual ability Liver problems (severe)—Chance of problems occurring may be increased. Lower starting doses may be used and doses increased as needed and as tolerated NAION (serious eye condition) in one or both eyes, previously—May increase your chance of getting NAION again. Special patient directions come with sildenafil. . This medicine usually begins to work within 30 minutes after taking it for erectile dysfunction. It continues to work for up to 4 hours, although its action is usually less after 2 hours. The dose of sildenafil will be different for different patients. . The following information includes only the average doses of sildenafil. If your dose is different, do not change it unless your doctor tells you to do so. Adults up to 65 years of age—50 mg as a single dose no more than once a day, 1 hour before sexual intercourse. Alternatively, the medicine may be taken 30 minutes to 4 hours before sexual intercourse. If needed, your doctor may increase your daily dose to 100 mg or decrease your daily dose to 25 mg. Adults 65 years of age and older—25 mg as a single dose no more than once a day, 1 hour before sexual intercourse. Alternatively, the medicine may be taken 30 minutes to 4 hours before sexual intercourse. If needed, your doctor may increase your daily dose. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend a 25 mg dose and may limit you to a maximum single dose of 25 mg of Viagra in a 48 hour period Adults—20 mg three times per day. Each dose should be taken about 4 to 6 hours apart and can be taken with or without food. Children—Use and dose must be determined by your doctor. Keep out of the reach of children. Store away from heat and direct light. Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down. Keep the medicine from freezing. Do not refrigerate. Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children. Sildenafil has not been studied with other medicines used for treatment of erectile dysfunction. Presently, using them together is not recommended . . If you need emergency medical care for a heart problem, it is important that your healthcare provider knows when you last took sildenafil. . Do not use more of it and do not use it more often than your doctor ordered. If too much is used, the chance of side effects is increased. If you experience a prolonged or painful erection for 4 hours or more, contact your doctor immediately. This condition may require prompt medical treatment to prevent tissue damage of the penis and possible permanent impotence. This medicine does not protect you against sexually transmitted diseases. Use protective measures and ask your doctor if you have any questions about this. It is important to tell your doctor about any heart problems you may have now or may have had in the past. This medicine can cause serious side effects in patients with heart problems. If you experience sudden loss of vision in one or both eyes, stop using sildenafil and contact your doctor immediately. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome: Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products.  uk viagra sales Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking . Abnormal vision (color tinge, blurring, sensitivity to light),acid indigestion, diarrhea, flushing, headache, nasal congestion, urinary tract infection Abdominal pain,abnormal dreams, abnormal ejaculation, allergic reactions, anxiety, asthma, bloodshot eyes, bone pain, breast enlargement, cataracts, chest pain, chills,coordination problems, cough,depression, difficulty breathing, difficulty swallowing, dilated pupils, dizziness, drowsiness, dry eyes, dry mouth, emotional or mental disturbances, eye inflammation or pain, other eye disorders, fainting,falling, genital problems, gout, gum inflammation, heart problems, increased night-time urination, increased pressure in the eyes, insomnia, itchy skin, joint disease, light sensitivity, loss of bladder control (urinary incontinence), low blood pressure, migraine headache, muscle ache, numbness, oral inflammation, pain, painful erection, prolonged erection, raised skin patches, rapid or throbbing heartbeat, rectal bleeding, respiratory inflammation, ringing in the ears, seizure, sinus and throat inflammation, skin rash, skin ulcer, slow reflexes, stomach or intestinal inflammation, sweating, swelling, thirst, tremor, vomiting, weakness Heart attack, stroke, heart irregularities, dangerous surges in blood pressure, and sudden death have all been reported after use of Viagra, usually in men with existing cardiac risk factors, and typically during or shortly after sex.discount viagra online The truth is that these herbal Viagra alternatives work. 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Viagra receives much cynicism about its effects and usefulness, despite the facts that all the evidence suggests otherwise, and there are thousands of satisfied users world wide. Most generally acknowledged as a cure for male erectile dysfunction, it has been documented that Viagra does more than just aid a man's erection. Various reports from numerous areas of health research worldwide point to other possible health benefits of Viagra. For instance, Saarland discovered that Viagra can reduce symptoms of Raynaud's phenomenon, a circulatory disorder. The hormonal stress normally exerted on the human heart has been noted to be decreased in men who take Viagra. When conducted with mice, the testing was more noticeable, Viagra having the tendency to avert harmful and long term effects of chronic hypertension on their heart. The study, lead by the John Hopkins research team, found that there is potential benefits for the treatment of pulmonary hypertension, linked in with how viagra dilates genital blood vessels. After testing on humans, abnormally high heart rates appeared to reduce by 50% after taking sildenafil (Viagra). Current evidence indicates health benefits of Viagra, in addition to the most commonly associated benefit of curing erectile dysfunction.

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Treat Sexual Dysfunctions with Aromatherapy Sexual issues such as impotence, infertility and frigidity are related to a psychological problem that has established itself from stress-related conditions. Generally, the loss of physical sexual function can lead to its own set of emotional feedback and can give rise to stress, depression and anxiety. Libido problems like frigidity (anorgasmia), impotence and retarded ejaculation can arise because of emotional frustration or negative feelings, resulting in a loss in sexual appetite. When the emotional problems have come to an end, the libido and function will return. In cases of frigidity and retarded ejaculation, longer time spent in foreplay and different sexual positions may play a prominent role in solving the problem. In this regard, vaginismus, which is the involuntary spasm of the vaginal muscles is, in theory, attached to overwhelming feelings of fear arising due to trauma or a violent sexual experience. In a few cases vaginismus can be a result of lack of sexual experience, which may lead to fear of sexual intercourse. All sexual issues can result in infertility as conception is less likely to arise if there is an issue with one or both partners’ sexual function. Stress can have a significant bearing on the menstrual cycle, leading to conditions like amenorrhea, dysmenorrhea and menorrhagia affecting a woman’s ability to conceive. In virtually all cases of sexual dysfunction, there is the urgent requirement of a supportive, sympathetic, cooperative partner in the relationship. Establishing intimacy and trust is also essential. Aromatherapy can play a prominent role when used in aromatic baths or massage, which can be termed as intimate routines. In addition, aromatic bathing and massage can assist in keeping you relax and open the method for sexual feedback between two individuals. Massage can turn out to be a sensual experience and a part of foreplay. Another significant factor when dealing with a sexual issue, is the body’s energy system. The chakra attached to sexuality is the sacral chakra, situated between the genitals and the naval. Blockages in this chakra can manifest as psycho-sexual ills. The sacral chakra is orientated to your self gratification, physical comfort, satisfaction and sexuality. With the help of the sacral chakra, you can regulate your feelings as well as emotional expressions. Furthermore, the gonads are situated within the sacral chakra. The sacral chakra can be defined as the sphere of desires, physical pleasures and happiness; it is also the home of the five senses. You are attached to feelings and sense of physical balance with the assistance of this chakra.
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FDA has received reports of cases of sudden decreases or loss of hearing following the use of PDE5 inhibitors, Viagra, Levitra, and Cialis for the treatment of erectile dysfunction and Revatio for the treatment of pulmonary arterial hypertension. In some cases, the sudden hearing loss was accompanied by tinnitus and dizziness. Medical follow-up information was often limited for the cases reported postmarketing, which makes it difficult to determine whether these reports are directly related to the use of one of these drugs, an underlying medical condition, or other risk factors for hearing loss, a combination of these factors, or other factors. Sudden hearing loss was also reported in a few patients in clinical trials of these drugs. In response to a request from FDA, the manufacturers of Viagra, Levitra and Cialis have revised the labeling for these products to address the potential risk of sudden hearing loss and to guide patients on what to do if they experience sudden problems with their hearing. FDA is currently working with the sponsor to revise the labeling for Revatio. The approved revised labeling for Viagra, Levitra and Cialis includes a new sections. The revised labeling is available at . This information reflects FDA’s current analysis of data available to FDA concerning this drug. FDA intends to update this sheet when additional information or analyses become available. Includes previous safety information and approval packages..
If you become dizzy or nauseated, have pain, numbness or tingling in your chest, arms, neck, or jaw during sex, it is of the utmost importance that you stop and call your doctor immediately. you could be having a serious side effect from taking cialis. stop using cialis and get emergency medical assistance from your health provider if you have sudden vision loss. it is also advisable that you get immediate medical assistance if you have any of these signs of an allergic reaction: hives, difficulty breathing, or swelling of your face, lips, tongue, or throat. chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling swelling in your hands, ankles, or feet erection that is painful and lasts for around 4 hours. warmth or redness in your face, neck, or chest headache, upset stomach and back pain tadalafil was administered to over 5,700 men (mean age 59, ranging from 19 - 87 years old) during clinical trials all round the world. in this trial, over 1000 patients were treated for 1 year whereas over 1,300 patients were treated for 6 months or more. in placebo controlled, phase 3 clinical trials, the discontinuation rate because of adverse events in patients treated with tadalafil 10 or 20 mg was 3.1%, which was significantly less than placebo treated patients. in tadalafil clinical pharmacology trials, back pain normally occurred 12 - 24 hours after dosing and often resolved within a mater of two days. across all research with any tadalafil dose, findings of changes in color vision were rare. serious cardiovascular issues, including myocardial infarction and sudden cardiac death have been reported post marketing with the use of tadalafil. many, but not all, of these patients had pre-existing cardiovascular risk issues. most of these events were reported to occur during or shortly after sexual routine, and some were reported to occur shortly after the use of cialis. other adverse events suffer from a lack of clear alternative causation because these reactions were reported voluntarily from a population of uncertain size. this makes it tough to reliably judge their frequency or come up with a causal relationship to drug exposure The most widely used remedy for erectile dysfunction; research has indicated that Viagra has an effect on the condition of the human heart as well as a male's penis. The hormonal stress normally exerted on the human heart has been noted to be decreased in men who take Viagra. When conducted with mice, the testing was more noticeable, Viagra having the tendency to avert harmful and long term effects of chronic hypertension on their heart. The study, lead by the John Hopkins research team, found that there is potential benefits for the treatment of pulmonary hypertension, linked in with how Viagra dilates genital blood vessels. Viagra works by dulling the heart beat, which is increased during stress. It works to decrease the force which is needed to pump blood from the heart to the rest of the body. The research conducted by David Kass, cardiologist and senior researcher of the John Hopkins study noticed Viagra can be effective in blocking short- term consequences of hormonal stresses in the heart. Further evidence on the testing of mice (although further research is needed until this is applicable to humans), indicated that negative effects of heart failure and cardiac hypertrophy on weakened heart muscles can be reversed. Further research is need in this area on humans however. Thirty five men and women were tested and injected with Dobutamine (a synthetic derivative of dopamine that increases heart rate and contractions), which resulted in increased rate of 150%. The men and women were then separated into two groups, one of which were given sildenafil (Viagra) and the other given a placebo (fake) pill. Results showed that the first group's heart rate decreased by 50%, whilst the latter group's further increased. This has led to widespread scientific interest in the effects of sildenafil (Viagra) on the human heart condition.
Generic "Viagra" is a substance that is used to treat erectile dysfunction. Generic "Viagra" relaxes the smooth muscle of the penis to allow increased blood flow and erection. It belongs to the family of drugs called phosphodiesterase inhibitors. Generic "Viagra" enables men with ED to respond to sexual stimulation. When a man is sexually excited, the arteries in his penis relax and widen. This allows more blood to flow into the penis. The increased blood flow causes the penis to become hard and erect. The veins that normally carry blood away from the penis then become compressed. This restricts the blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges, resulting in an erection. Sometimes the nerves or blood vessels that are part of this process don't work properly. If this happens, a man may not be able to get or keep an erection. Generic "Viagra" increases blood flow to the penis, so that when a man is sexually excited, he can consistently get and keep an erection. When he is done having sex, the erection goes away. Inactive Ingredients: magnesium stearate, hypromellose, titanium dioxide, lactose, microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, triacetin, and FD & C Blue #2 aluminum lake. What is Generic "Viagra" PRESCRIBED For? Generic "Viagra" is an effective treatment for male erectile dysfunction, or ED. This is also known as impotence. Generic "Viagra" is a little blue pill you take only when you want to have sex. Generic "Viagra" helps men consistently get and keep an erection when they become sexually stimulated. How Should I Take Generic "Viagra"? Take Generic "Viagra" exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Revatio is usually taken three times each day, about 4 to 6 hours apart. Generic "Viagra" is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Generic "Viagra" more than once per day. Generic "Viagra" can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions. If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of Generic "Viagra". Keep out of the reach and sight of children. Do not store above 30°C. Keep tablets in the original package, protected from moisture. Do not use after the expiry date stated on the pack. What are the CONTRAINDICATIONS for taking Generic "Viagra"? Before taking Generic "Viagra", tell your doctor if you have had a heart attack, stroke, or life-threatening irregular heartbeats within the last six months; have a history of heart failure; have coronary artery disease; have angina; have high or low blood pressure; have liver problems; have kidney problems; have ever had blood problems, including sickle cell anemia or leukemia; have a bleeding disorder; have a stomach ulcer; have retinitis pigmentosa (an inherited condition of the eye); have a physical deformity of the penis such as Peyronie's disease; have a condition that could lead to prolonged and painful erections, such as a tumor of the bone marrow, sickle cell anemia, or leukemia; or are taking another medicine to treat impotence. You may not be able to take Generic "Viagra", or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Although Generic "Viagra" is not indicated for use by women, it is in the FDA pregnancy category B. This means that Generic "Viagra" is not expected to be harmful to an unborn baby. Women should not take Generic "Viagra". It is not known whether Generic "Viagra" passes into breast milk. If you are over 65 years of age, you may be more likely to experience side effects from Generic "Viagra". Your doctor may prescribe a lower dose of this medication. What Happens if I MISS A DOSE? Generic "Viagra" is used as need. So, you are not likely to miss a dose. What Happens if I OVERDOSE? Seek emergency medical attention. Symptoms of a Generic "Viagra" overdose are not known, but are likely to include chest pain, dizziness, an irregular heartbeat, and swelling of the ankles or legs. What are the possible SIDE EFFECTS of Generic Viagra"? Like all medicines, Generic "Viagra" can have side effects. These effects are normally mild to moderate in nature. The most common undesirable effects are headache and facial flushing. Less commonly reported undesirable effects are indigestion, dizziness, stuffy nose and effects on vision including colour tinge to vision, increased brightness of light or blurred vision). Muscle aches can occur if Generic "Viagra" is taken more frequently than once a day. Rarely, prolonged and sometimes painful erections have been reported after taking Generic "Viagra". If you have such an erection which lasts continuously for more than 4 hours, you should contact a doctor immediately. Rarely, hypersensitivity reactions (including skin rashes) have been reported. Heart attack, stroke, irregular heart beats, and death have been reported rarely in men taking Generic "Viagra". What other drugs can INTERACT with Generic "Viagra"? Please inform your doctor or pharmacist if you are taking or have taken recently other medicines, even those not prescribed. Generic "Viagra" tablets may interfere with some medicines, especially those used to treat chest pain. In the event of a medical emergency, you should tell anyone treating your condition that you have taken Generic "Viagra". Do not take - Generic "Viagra" with other medicines unless your doctor tells you that you can. Generic "Viagra" may cause a serious increase in the effects of medicines called nitrates, and nitric oxide donors such as amyl nitrite ("poppers"). These are often used for the relief of angina pectoris (or "chest pains"). You should NOT take Generic "Viagra" if you are taking these medicines. If you are taking protease inhibitors, suck as for the treatment of HIV, your doctor may start you on the lowest dose (25 mg) of Generic "Viagra". If you take any medicines that contain nitrates - either regularly or as needed - you should never take Generic "Viagra". If you take Generic "Viagra" with any nitrate medicine or recreational drug containing nitrates, your blood pressure could suddenly drop to an unsafe level. You could get dizzy, faint, or even have a heart attack or stroke. Nitrates are found in many prescription medicines that are used to treat angina. Generic "Viagra" is only for patients with erectile dysfunction. Generic "Viagra" is not for newborns, children, or women. Do not let anyone else take your Generic "Viagra". Generic "Viagra" must be used only under a doctor's supervision. purchase sildenafil citrate Viagra turns 10 this month, and didn't time just fly? It seems like only yesterday we started guffawing at the Symbolism for Dummies ads on TV for the little blue pill and its "erectile dysfunction" rivals -- footballs tossed through tires, faucets erupting. The spots ended with a list of potential side effects that sounded like a satire of potential side effects. "More than four hours?" we winced. "Ouch." However discomfiting the commercials, the Food and Drug Administration (FDA) approval of Viagra -- on March 27, 1998 -- is a landmark day in the history of sex. It seemed at the time like a biomedical revolution was upon us all, and about five minutes after word of the magical med went global, the question first was asked: Where is the women's version of Viagra? The short answer: They're still working on it. A bunch of companies have tried and failed to create "pink Viagra," as it's often called. Other companies have drugs in late stages of clinical testing, including a gel that recently began a make-or-break nationwide study with several thousand women. Give us five years, maybe less, say the most optimistic researchers and doctors. Though it's unclear exactly how many women would ask for a prescription, no one doubts that the first company that gets to market a remedy for female sexual dysfunction (FSD), as it's formally known, will earn a fortune. But as this race reaches what could be its final lap, not all of the spectators are cheering. Some, in fact, are booing as loudly as they can. A modest-size but fervent group of psychologists, academics and public health advocates contend that FSD isn't an authentic medical condition, or at least not the sort of problem that should be treated with drugs. These aren't the obtuse male physicians who for decades have been telling women distressed by their lack of libido that "it's all in your head." The anti-FSD crowd is mostly women, many of them self-described feminists. The most prominent is Leonore Tiefer, a psychotherapist and clinical associate professor at New York University, who has long decried what she calls "the medicalization of women's sexuality." "Drug companies want to say to women, 'You don't need to know anything; you can have the satisfying sex life that you seek -- people dancing on TV, the whole bit -- without knowing anything. Just ask your doctor,' " she says. "I resent that, because there are specific harms that come from being ignorant and dependent in the world we live in. There may be lots of people who aren't interested in sex, but is there a medical reason for that, and do we diagnose that?" best buy viagra Drugs for treating Erectile Dysfunction (ED) can be taken orally, injected directly into the penis or inserted into the urethra at the tip of the penis. Viagra was the first pill to treat ED when the Food and Drug Administration (FDA) approved it in 1998. Later, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) were given the green light by the FDA to treat ED. Many other oral medicines are being tested for safety and effectiveness. Viagra, Levitra and Cialis belong to a class of drugs known as phosphodiesterase (PDE) inhibitors. The medication is generally taken an hour before any intended sex act, these drugs work by increasing the effects of nitric oxide. Nitric oxide is a chemical whose main function is to relax the smooth muscles in the penis during sexual stimulation and allow increased blood flow. While there is no doubt that oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection (as injections do). The advisable dose for Viagra is about 50 mg, though the physician may adjust this dose to a range of 25 to 100 mg depending on the patient. The advisable dose for Levitra or Cialis is about 10 mg, which can be increased to 20 mg if 10 mg turns out to be insufficient. A decreased dose of 5 mg (or as low as 2.25 mg) is available on the market for patients who take other medicines or have diseases that may decrease in the body's ability to use the drug. No PDE inhibitors should be used more than once a day. It is mandatory that men who take nitrate-based drugs, such as nitro-glycerine for heart issues, should not use either drug because the combination can lead to a sudden decrease in blood pressure. In addition, it is recommended that you tell your doctor if you take any drugs known as alpha-blockers. These are mainly used to treat prostate enlargement or high blood pressure. Often, oral testosterone can minimize ED in men with low levels of natural testosterone, but it is often ineffective and may lead to liver damage. Many patients are of the opinion that other oral drugs (namely yohimbine hydrochloride, dopamine, serotonin agonists, and trazodone) are pretty effective, but the results of scientific research studies have been inconsistent to say the least. Improvements may be instances of the placebo effect, a change that results from the patient's belief that an improvement will take place. sildenafil citrate When Pfizer released Viagra in 1998, they revolutionized oral medical management for erectile dysfunction. Along with its rival medications Cialis and Levitra, Viagra has become a popular drug of choice against impotence. However, anti - impotence drugs are not just used by older men anymore. A growing number of men under the age of 55 are using the â€?blockbuster pill'. A study of more than 5 million insured adults in 1998 to 2002 found that the fastest - growing segments of Viagra users were aged 18 to 55. These finding suggest use of Viagra not only as anti - impotence drug but as enhancement or recreational agent. How does anti - impotence pills like Viagra work? These drugs dilate blood vessels in the genital region leading to an increased blood flow and consequently, erection. However, it does very little to libido, sensation and sensuality. The effects of Viagra are noticed after an hour of taking the pill and the ease of erection lasts up to 12 hours. There may be side effects however such as headaches, flushes, nasal congestion or runny nose, malaise, changes in blood pressure, nausea, irregular heartbeats, and chest pain. Furthermore, anti - impotence drugs such as Viagra and Cialis increases the risk of vision loss in impotent men who have a history of hypertension and heart failure. Results of a study conducted by scientists at the University of Alabama in Birmingham showed that men who suffered heart attack were 10 times more likely to have optic nerve damage if they had been taking anti - impotence pills. Dr. Gerald McGwin, the one who headed the study, observed that there is a strong and statistically significant association between the use of Viagra and/or Cialis and non - anteritic anterior ischaemic optic neuropathy (NAION). NAION is the most common cause of acute optic nerve damage for people over 50 years old. It can cause the loss of vision in one or both eyes. There are also other impotent pills in the market which the Food and Drug Administration (FDA) warns the public about. These products, usually available through the internet, illegally contain the same ingredients as the prescription medicines approved by the FDA. Some of the product names listed by FDA are Zimaxx, Libidus, Neophase, Nasutra, Vigor - 25, Actra - Rx, and 4Everon. Tests showed that these products either contain sildenafil, the active ingredient in Viagra, or valdenafil, the active ingredient in Levitra. Dr. Steven Galson, Director of FDA's Center for Drug and Evaluation and Research, warns that these products threaten the public health because they contain undeclared chemicals similar or identical to the ingredients used in prescription medicines approved by the FDA. Furthermore, because you do not have to consult a doctor to buy this, you may not be aware that these ingredients can have dangerous interactions with drugs prescribed for heart disease, and may dangerously lower your blood pressure.viagra price online The latest alert was prompted by a case report in the Journal of Laryngology & Otology of sudden hearing loss in a man taking Viagra. A search of FDA records found 29 similar reports involving ED drug users and a few people who took the drugs during clinical trials. Although hearing loss is common in men in their 50s -- the age group most likely to take ED drugs -- age-related loss tends to be gradual, unlike the kind tied to the warning. The FDA has also issued a hearing-loss warning on Revatio, a blood pressure drug in the same class. Revatio users who experience hearing problems should stay on the drug until they have checked with their doctor. ED drugs, on the market for more than a decade, generally have an excellent safety record. More-common problems include flushing and muscle soreness. sildenafil citrate generic viagra uprima Viagra has made a significant difference in the quality of life of millions of men and their partners. When the FDA approved the first oral medication for the treatment of erectile dysfunction in 1998, it gave rise to a new world of possibilities that would restore men to healthy sex routine. For plenty of these individuals, the ability to have reliable erections has brought them and their partners’ sexual satisfaction and a tremendous sense of emotional comfort in their lives. Many times, the return to sexual potency greatly enriches overall relationship satisfaction. Thanks to the advantages of Viagra, many men have come to the conclusion that they enjoy sex and had sex more frequently. While Viagra is not an aphrodisiac, men have reported an enhancement in sexual desire and arousal. Some are of the opinion that their orgasms felt more intense and enjoyable. Rather than being directly attached to Viagra, these sorts of opinions are most likely because of an increase in the man's general interest in sex, which is due to their Viagra-assisted reliable erections. Even with the sexual success that having a good erection allows, there are a wide array of psychological and relationship aspects involved in a couple's sexual routine. The continued quality of a couple's sexual routine will still be dependent on past, present and future relationship factors. To illustrate this point, consider The following factors: the sort of changes that occurred in the relationship when, thanks to Viagra, erectile problems were no longer a factor Some couples may enjoy renewed sexual routine, but others might feel that sex will now be required on demand. This can place unnecessary pressure on either partner to perform. If the erectile issues were due to problems between the partners, they need to be addressed. It is not unusual for men to be of the view that everything is in order once modern medicine has restored his erections. This is where work must be done to avoid future problems involving intimacy and communication about sex. Even with the restoration of a man's erections, the same sort of sexual turn-offs and difficulties surrounding sex, (timing, frequency, life-style, routines and methods) can still be crucial issues in judging overall sexual satisfaction.
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If you become dizzy or nauseated, have pain, numbness or tingling in your chest, arms, neck, or jaw during sex, it is of the utmost importance that you stop and call your doctor immediately. You could be having a serious side effect from taking Cialis. Stop using Cialis and get emergency medical assistance from your health provider if you have sudden vision loss. It is also advisable that you get immediate medical assistance if you have any of these signs of an allergic reaction: hives, difficulty breathing, or swelling of your face, lips, tongue, or throat. Chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling Swelling in your hands, ankles, or feet Erection that is painful and lasts for around 4 hours. Warmth or redness in your face, neck, or chest Headache, upset stomach and back pain Tadalafil was administered to over 5,700 men (mean age 59, ranging from 19 - 87 years old) during clinical trials all round the world. In this trial, over 1000 patients were treated for 1 year whereas over 1,300 patients were treated for 6 months or more. In placebo controlled, Phase 3 clinical trials, the discontinuation rate because of adverse events in patients treated with tadalafil 10 or 20 mg was 3.1%, which was significantly less than placebo treated patients. In tadalafil clinical pharmacology trials, back pain normally occurred 12 - 24 hours after dosing and often resolved within a mater of two days. Across all research with any tadalafil dose, findings of changes in color vision were rare. Serious cardiovascular issues, including myocardial infarction and sudden cardiac death have been reported post marketing with the use of tadalafil. Many, but not all, of these patients had pre-existing cardiovascular risk issues. Most of these events were reported to occur during or shortly after sexual routine, and some were reported to occur shortly after the use of Cialis. Other adverse events suffer from a lack of clear alternative causation because these reactions were reported voluntarily from a population of uncertain size. This makes it tough to reliably judge their frequency or come up with a causal relationship to drug exposure.
An oral therapy for erectile dysfunction, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate (cgmp)-specific phosphodiesterase type 5 (pde5). sildenafil citrate is designated chemically as 1 - [[3 - (6,7 - dihydro - 1 - methyl - 7 - oxo - 3 - propyl - 1h - pyrazolo[4,3 - d]pyrimidin - 5 - yl) - 4 - ethoxyphenyl]sulfonyl] - 4 - methylpiperazine citrate and has the following structural formula: sildenafil citrate is a white to off-white crystalline powder with a solubility of 3.5 mg/ml in water and a molecular weight of 666.7. viagra (sildenafil citrate) is formulated as blue, film-coated rounded-diamond-shaped tablets equivalent to 25 mg, 50 mg and 100 mg of sildenafil for oral administration. in addition to the active ingredient, sildenafil citrate, each tablet contains the following inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and fd & c blue #2 aluminum lake. the physiologic mechanism of erection of the penis involves 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. sildenafil has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (no) by inhibiting phosphodiesterase type 5 (pde5), which is responsible for degradation of cgmp in the corpus cavernosum. when sexual stimulation causes local release of no, inhibition of pde5 by sildenafil causes increased levels of cgmp in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. sildenafil at recommended doses has no effect in the absence of sexual stimulation. studies in vitro have shown that sildenafil is selective for pde5. its effect is more potent on pde5 than on other known phosphodiesterases (10-fold for pde6, >80-fold for pde1, >700-fold for pde2, pde3, pde4, pde7, pde8, pde9, pde10, and pde11). the approximately 4,000-fold selectivity for pde5 versus pde3 is important because pde3 is involved in control of cardiac contractility. sildenafil is only about 10-fold as potent for pde5 compared to pde6, an enzyme found in the retina which is involved in the phototransduction pathway of the retina. this lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels (see ). in addition to human corpus cavernosum smooth muscle, pde5 is also found in lower concentrations in other tissues including platelets, vascular and visceral smooth muscle, and skeletal muscle. the inhibition of pde5 in these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed in vitro, an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo. viagra is rapidly absorbed after oral administration, with absolute bioavailability of about 40%. its pharmacokinetics are dose-proportional over the recommended dose range. it is eliminated predominantly by hepatic metabolism (mainly cytochrome p450 3a4) and is converted to an active metabolite with properties similar to the parent, sildenafil. the concomitant use of potent cytochrome p450 3a4 inhibitors (e.g., erythromycin, ketoconazole, itraconazole) as well as the nonspecific cyp inhibitor, cimetidine, is associated with increased plasma levels of sildenafil (see ). both sildenafil and the metabolite have terminal half lives of about 4 hours. in healthy male volunteers. viagra is rapidly absorbed. maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. when viagra is taken with a high fat meal, the rate of absorption is reduced, with a mean delay in t of 29%. the mean steady state volume of distribution (vss) for sildenafil is 105 l, indicating distribution into the tissues. sildenafil and its major circulating n-desmethyl metabolite are both approximately 96% bound to plasma proteins. protein binding is independent of total drug concentrations. based upon measurements of sildenafil in semen of healthy volunteers 90 minutes after dosing, less than 0.001% of the administered dose may appear in the semen of patients. sildenafil is cleared predominantly by the cyp3a4 (major route) and cyp2c9 (minor route) hepatic microsomal isoenzymes. the major circulating metabolite results from n-desmethylation of sildenafil, and is itself further metabolized. this metabolite has a pde selectivity profile similar to sildenafil and an in vitro potency for pde5 approximately 50% of the parent drug. plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil, so that the metabolite accounts for about 20% of sildenafil's pharmacologic effects. after either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the feces (approximately 80% of administered oral dose) and to a lesser extent in the urine (approximately 13% of the administered oral dose). similar values for pharmacokinetic parameters were seen in normal volunteers and in the patient population, using a population pharmacokinetic approach. healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, with free plasma concentrations approximately 40% greater than those seen in healthy younger volunteers (18–45 years). in volunteers with mild (clcr=50–80 ml/min) and moderate (clcr=30–49 ml/min) renal impairment, the pharmacokinetics of a single oral dose of viagra (50 mg) were not altered. in volunteers with severe (clcr=<30 ml/min) renal impairment, sildenafil clearance was reduced, resulting in approximately doubling of auc and c compared to age-matched volunteers with no renal impairment. in volunteers with hepatic cirrhosis (child-pugh a and b), sildenafil clearance was reduced, resulting in increases in auc (84%) and c (47%) compared to age-matched volunteers with no hepatic impairment. therefore, age >65, hepatic impairment and severe renal impairment are associated with increased plasma levels of sildenafil. a starting oral dose of 25 mg should be considered in those patients (see ). in eight double-blind, placebo-controlled crossover studies of patients with either organic or psychogenic erectile dysfunction, sexual stimulation resulted in improved erections, as assessed by an objective measurement of hardness and duration of erections (rigiscan ), after viagra administration compared with placebo. most studies assessed the efficacy of viagra approximately 60 minutes post dose. the erectile response, as assessed by rigiscan , generally increased with increasing sildenafil dose and plasma concentration. the time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours. single oral doses of sildenafil (100 mg) administered to healthy volunteers produced decreases in supine blood pressure (mean maximum decrease in systolic/diastolic blood pressure of 8.4/5.5 mmhg). the decrease in blood pressure was most notable approximately 1–2 hours after dosing, and was not different than placebo at 8 hours. similar effects on blood pressure were noted with 25 mg, 50 mg and 100 mg of viagra, therefore the effects are not related to dose or plasma levels within this dosage range. larger effects were recorded among patients receiving concomitant nitrates (see ). systolic blood pressure, healthy volunteers. single oral doses of sildenafil up to 100 mg produced no clinically relevant changes in the ecgs of normal male volunteers. studies have produced relevant data on the effects of viagra on cardiac output. in one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent swan-ganz catheterization. a total dose of 40 mg sildenafil was administered by four intravenous infusions. the results from this pilot study are shown in table 1; the mean resting systolic and diastolic blood pressures decreased by 7% and 10% compared to baseline in these patients. mean resting values for right atrial pressure, pulmonary artery pressure, pulmonary artery occluded pressure and cardiac output decreased by 28%, 28%, 20% and 7% respectively. even though this total dosage produced plasma sildenafil concentrations which were approximately 2 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of 100 mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients. in a double-blind study, 144 patients with erectile dysfunction and chronic stable angina limited by exercise, not receiving chronic oral nitrates, were randomized to a single dose of placebo or viagra 100 mg 1 hour prior to exercise testing. the primary endpoint was time to limiting angina in the evaluable cohort. the mean times (adjusted for baseline) to onset of limiting angina were 423.6 and 403.7 seconds for sildenafil (n=70) and placebo, respectively. these results demonstrated that the effect of viagra on the primary endpoint was statistically non-inferior to placebo. at single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination (blue/green) was detected using the farnsworth-munsell 100-hue test, with peak effects near the time of peak plasma levels. this finding is consistent with the inhibition of pde6, which is involved in phototransduction in the retina. an evaluation of visual function at doses up to twice the maximum recommended dose revealed no effects of viagra on visual acuity, intraocular pressure, or pupillometry. in clinical studies, viagra was assessed for its effect on the ability of men with erectile dysfunction (ed) to engage in sexual activity and in many cases specifically on the ability to achieve and maintain an erection sufficient for satisfactory sexual activity. viagra was evaluated primarily at doses of 25 mg, 50 mg and 100 mg in 21 randomized, double-blind, placebo-controlled trials of up to 6 months in duration, using a variety of study designs (fixed dose, titration, parallel, crossover). viagra was administered to more than 3,000 patients aged 19 to 87 years, with ed of various etiologies (organic, psychogenic, mixed) with a mean duration of 5 years. viagra demonstrated statistically significant improvement compared to placebo in all 21 studies. the studies that established benefit demonstrated improvements in success rates for sexual intercourse compared with placebo. the effectiveness of viagra was evaluated in most studies using several assessment instruments. the primary measure in the principal studies was a sexual function questionnaire (the international index of erectile function - iief) administered during a 4-week treatment-free run-in period, at baseline, at follow-up visits, and at the end of double-blind, placebo-controlled, at-home treatment. two of the questions from the iief served as primary study endpoints; categorical responses were elicited to questions about (1) the ability to achieve erections sufficient for sexual intercourse and (2) the maintenance of erections after penetration. the patient addressed both questions at the final visit for the last 4 weeks of the study. the possible categorical responses to these questions were (0) no attempted intercourse, (1) never or almost never, (2) a few times, (3) sometimes, (4) most times, and (5) almost always or always. also collected as part of the iief was information about other aspects of sexual function, including information on erectile function, orgasm, desire, satisfaction with intercourse, and overall sexual satisfaction. sexual function data were also recorded by patients in a daily diary. in addition, patients were asked a global efficacy question and an optional partner questionnaire was administered. the effect on one of the major end points, maintenance of erections after penetration, is shown in figure 3, for the pooled results of 5 fixed-dose, dose-response studies of greater than one month duration, showing response according to baseline function. results with all doses have been pooled, but scores showed greater improvement at the 50 and 100 mg doses than at 25 mg. the pattern of responses was similar for the other principal question, the ability to achieve an erection sufficient for intercourse. the titration studies, in which most patients received 100 mg, showed similar results. figure 3 shows that regardless of the baseline levels of function, subsequent function in patients treated with viagra was better than that seen in patients treated with placebo. at the same time, on-treatment function was better in treated patients who were less impaired at baseline. figure 3. effect of viagra and placebo on maintenance of erection by baseline score. the frequency of patients reporting improvement of erections in response to a global question in four of the randomized, double-blind, parallel, placebo-controlled fixed dose studies (1797 patients) of 12 to 24 weeks duration is shown in figure 4. these patients had erectile dysfunction at baseline that was characterized by median categorical scores of 2 (a few times) on principal iief questions. erectile dysfunction was attributed to organic (58%; generally not characterized, but including diabetes and excluding spinal cord injury), psychogenic (17%), or mixed (24%) etiologies. sixty-three percent, 74%, and 82% of the patients on 25 mg, 50 mg and 100 mg of viagra, respectively, reported an improvement in their erections, compared to 24% on placebo. in the titration studies (n=644) (with most patients eventually receiving 100 mg), results were similar. figure 4. percentage of patients reporting an improvement in erections. the patients in studies had varying degrees of ed. one-third to one-half of the subjects in these studies reported successful intercourse at least once during a 4-week, treatment-free run-in period. in many of the studies, of both fixed dose and titration designs, daily diaries were kept by patients. in these studies, involving about 1600 patients, analyses of patient diaries showed no effect of viagra on rates of attempted intercourse (about 2 per week), but there was clear treatment-related improvement in sexual function: per patient weekly success rates averaged 1.3 on 50–100 mg of viagra vs 0.4 on placebo; similarly, group mean success rates (total successes divided by total attempts) were about 66% on viagra vs about 20% on placebo. during 3 to 6 months of double-blind treatment or longer-term (1 year), open-label studies, few patients withdrew from active treatment for any reason, including lack of effectiveness. at the end of the long-term study, 88% of patients reported that viagra improved their erections. men with untreated ed had relatively low baseline scores for all aspects of sexual function measured (again using a 5-point scale) in the iief. viagra improved these aspects of sexual function: frequency, firmness and maintenance of erections; frequency of orgasm; frequency and level of desire; frequency, satisfaction and enjoyment of intercourse; and overall relationship satisfaction. one randomized, double-blind, flexible-dose, placebo-controlled study included only patients with erectile dysfunction attributed to complications of diabetes mellitus (n=268). as in the other titration studies, patients were started on 50 mg and allowed to adjust the dose up to 100 mg or down to 25 mg of viagra; all patients, however, were receiving 50 mg or 100 mg at the end of the study. there were highly statistically significant improvements on the two principal iief questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) on viagra compared to placebo. on a global improvement question, 57% of viagra patients reported improved erections versus 10% on placebo. diary data indicated that on viagra, 48% of intercourse attempts were successful versus 12% on placebo. one randomized, double-blind, placebo-controlled, crossover, flexible-dose (up to 100 mg) study of patients with erectile dysfunction resulting from spinal cord injury (n=178) was conducted. the changes from baseline in scoring on the two end point questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) were highly statistically significantly in favor of viagra. on a global improvement question, 83% of patients reported improved erections on viagra versus 12% on placebo. diary data indicated that on viagra, 59% of attempts at sexual intercourse were successful compared to 13% on placebo. across all trials, viagra improved the erections of 43% of radical prostatectomy patients compared to 15% on placebo. subgroup analyses of responses to a global improvement question in patients with psychogenic etiology in two fixed-dose studies (total n=179) and two titration studies (total n=149) showed 84% of viagra patients reported improvement in erections compared with 26% of placebo. the changes from baseline in scoring on the two end point questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) were highly statistically significantly in favor of viagra. diary data in two of the studies (n=178) showed rates of successful intercourse per attempt of 70% for viagra and 29% for placebo. a review of population subgroups demonstrated efficacy regardless of baseline severity, etiology, race and age. viagra was effective in a broad range of ed patients, including those with a history of coronary artery disease, hypertension, other cardiac disease, peripheral vascular disease, diabetes mellitus, depression, coronary artery bypass graft (cabg), radical prostatectomy, transurethral resection of the prostate (turp) and spinal cord injury, and in patients taking antidepressants/antipsychotics and antihypertensives/diuretics. analysis of the safety database showed no apparent difference in the side effect profile in patients taking viagra with and without antihypertensive medication. this analysis was performed retrospectively, and was not powered to detect any pre-specified difference in adverse reactions. viagra is indicated for the treatment of erectile dysfunction. ), viagra was shown to potentiate the hypotensive effects of nitrates, and its administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is therefore contraindicated. after patients have taken viagra, it is unknown when nitrates, if necessary, can be safely administered. based on the pharmacokinetic profile of a single 100 mg oral dose given to healthy normal volunteers, the plasma levels of sildenafil at 24 hours post dose are approximately 2 ng/ml (compared to peak plasma levels of approximately 440 ng/ml) (see ). in the following patients: age >65, hepatic impairment (e.g., cirrhosis), severe renal impairment (e.g., creatinine clearance <30 ml/min), and concomitant use of potent cytochrome p450 3a4 inhibitors (erythromycin), plasma levels of sildenafil at 24 hours post dose have been found to be 3 to 8 times higher than those seen in healthy volunteers. although plasma levels of sildenafil at 24 hours post dose are much lower than at peak concentration, it is unknown whether nitrates can be safely coadministered at this time point. viagra is contraindicated in patients with a known hypersensitivity to any component of the tablet. there is a potential for cardiac risk of sexual activity in patients with preexisting cardiovascular disease. therefore, treatments for erectile dysfunction, including viagra, should not be generally used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status. viagra has systemic vasodilatory properties that resulted in transient decreases in supine blood pressure in healthy volunteers (mean maximum decrease of 8.4/5.5 mmhg), (see ). while this normally would be expected to be of little consequence in most patients, prior to prescribing viagra, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects, especially in combination with sexual activity. patients with the following underlying conditions can be particularly sensitive to the actions of vasodilators including viagra – those with left ventricular outflow obstruction (e.g. aortic stenosis, idiopathic hypertrophic subaortic stenosis) and those with severely impaired autonomic control of blood pressure. there is no controlled clinical data on the safety or efficacy of viagra in the following groups; if prescribed, this should be done with caution. patients who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months; patients with retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases). prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently since market approval of viagra. in the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. if priapism is not treated immediately, penile tissue damage and permanent loss of potency could result. the concomitant administration of the protease inhibitor ritonavir substantially increases serum concentrations of sildenafil (11-fold increase in auc). if viagra is prescribed to patients taking ritonavir, caution should be used. data from subjects exposed to high systemic levels of sildenafil are limited. visual disturbances occurred more commonly at higher levels of sildenafil exposure. decreased blood pressure, syncope, and prolonged erection were reported in some healthy volunteers exposed to high doses of sildenafil (200–800 mg). to decrease the chance of adverse events in patients taking ritonavir, a decrease in sildenafil dosage is recommended (see , ). the evaluation of erectile dysfunction should include a determination of potential underlying causes and the identification of appropriate treatment following a complete medical assessment. before prescribing viagra, it is important to note the following: caution is advised when phosphodiesterase type 5 (pde5) inhibitors are co-administered with alpha-blockers. pde5 inhibitors, including viagra, and alpha-adrenergic blocking agents are both vasodilators with blood pressure lowering effects. when vasodilators are used in combination, an additive effect on blood pressure may be anticipated. in some patients, concomitant use of these two drug classes can lower blood pressure significantly (see ) leading to symptomatic hypotension (e.g. dizziness, lightheadedness, fainting). patients should be stable on alpha-blocker therapy prior to initiating a pde5 inhibitor. patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of pde5 inhibitors. in those patients who are stable on alpha-blocker therapy, pde5 inhibitors should be initiated at the lowest dose. in those patients already taking an optimized dose of a pde5 inhibitor, alpha-blocker therapy should be initiated at the lowest dose. stepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a pde5 inhibitor. safety of combined use of pde5 inhibitors and alpha-blockers may be affected by other variables, including intravascular volume depletion and other anti-hypertensive drugs. viagra has systemic vasodilatory properties and may augment the blood pressure lowering effect of other anti-hypertensive medications. patients on multiple antihypertensive medications were included in the pivotal clinical trials for viagra. in a separate drug interaction study, when amlodipine, 5 mg or 10 mg, and viagra, 100 mg were orally administered concomitantly to hypertensive patients mean additional blood pressure reduction of 8 mmhg systolic and 7 mmhg diastolic were noted (see ). the safety of viagra is unknown in patients with bleeding disorders and patients with active peptic ulceration. viagra 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 anemia, multiple myeloma, or leukemia). the safety and efficacy of combinations of viagra with other treatments for erectile dysfunction have not been studied. therefore, the use of such combinations is not recom