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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. 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. 5 mg sildenafil citrate However discomfiting the commercials, the -- 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, 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 , 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?" Tiefer's critique centers, in part, on the way that pink Viagra is sure to be marketed -- with ads day and night, suggesting that women who aren't feeling frisky have a medical problem. She and her allies -- organized as the New View Campaign -- are also galled that so much money and media attention are heaped on the lust drug, even before it exists, when for many women the solution to their libido problems isn't that exotic. Maybe they have a partner who hasn't a clue about technique.Maybe they're stressed out. Maybe they can't possibly get in the mood because they're so busy raising children. Therapy, counseling, even free day care, says the New View Campaign, might do more for women's sex lives than any drug company ever could. "People walk out of their doctors' offices with a prescription in hand 85 percent of the time," says Meika Loe, the author of "The Rise of Viagra" and a New View endorser. "But health insurers won't pay if you want to talk to a counselor or if you need advice about how to communicate your sexual desires. We've got a health-care system that is almost entirely focused on medical solutions." On the other side of the FSD divide, allied with the pharmaceutical companies, is a group of physicians who are prescribing off-label treatments for women vexed by their sex lives. (Off-label means the drug hasn't been approved by the FDA for that specific treatment.) The highest-profile of the bunch is Irwin Goldstein, the director of sexual medicine at San Diego's Alvarado Hospital. He and Tiefer have debated the topic of FSD for a decade, but as far as he's concerned, there's really nothing to discuss. He's been using hormones to treat women, and he'll happily put you in touch with patients who will rhapsodize about the results. Women like Virginia, a 60-year-old native of and an artist who, for privacy reasons, asked that her last name be omitted. She'd spent years asking doctors for medical help to boost her sex drive, which had once been voracious. All of them, she says, "rolled their eyes and harrumphed and tried to change the subject." "But when I was younger, a really strong libido was just part of who I was," she goes on. "Losing that was like losing a good friend." Three years ago, she heard Goldstein interviewed on . Within weeks she flew to , the site of his practice at the time, and she soon was taking several hormones. There was tinkering with the combination and the dosage, but a few weeks later she suddenly felt "perky" -- more confident about herself as a sexual being and more attractive. She also started having better sex..
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. Nuts, crocodiles and witch trials may seem to have little to do with Viagra -- but at one time or another, they've all been employed against erectile dysfunction. For centuries, doctors struggled to pinpoint the causes of male impotence, blaming such factors as stress, diet, the wrath of deities and unattractive women. Ancient Greek physician Hippocrates attributed impotence to horseback riding; one of his contemporaries placed the blame on childhood trauma; Egyptians to evil spells. The ancients also left behind an imaginative array of remedies: snacks of almonds, pistachios, dates, currant juice and bird eggs in Persia; a mix of sesame, lentils, rice and sugar cane juice in ancient India -- or goat testicles boiled in milk or butter and boiled alligator testes rubbed on the feet. The Egyptians were more direct, smearing remedies (such as crocodile hearts and wood oil) directly on the penis. In the Islamic empire, impotence was sometimes blamed on an imbalance in the four fluids, or humors, thought to course through the body. Doctors advised men to avoid sex after meals, in the bathroom and with old or unappealing partners. In medieval Europe, impotent men believed they were under spells cast by witches, but also blamed their wives. Impotence was grounds for divorce. In the Victorian era, many thought impotence was due to a depletion of sperm. Doctors cautioned against masturbation (a "waste" of sperm) and prescribed quinine, opium, digitalis and bleeding, to no avail. In the late 1800s, French professor of medicine Charles Edouard Brown-Sequard proposed that injections of animal sperm might restore vitality. He tested the theory by injecting himself with an extract of dog and guinea pig testicles. His colleagues, who agreed the professor looked good for a man of 72, agreed to test the extracts on their patients. Soon the treatment, organotherapy, was all the rage. Starting in the late 1910s, a few doctors went a step further, deciding to transplant whole testicles. In France, Serge Voronoff transplanted monkey testicles into the nether regions of more than 1,000 old men. In Kansas, John Brinkley ran a hospital that specialized in grafting goat testicles onto patients. At a California prison, Leo Stanley gave older inmates testicles of younger, executed prisoners. Although many men claimed to feel rejuvenated by their testicular shots and transplants, few recovered their virility, and researchers continued their search. In the 1930s doctors experimented with surgical adjustment of penile muscles. In the 1940s and 1950s, they tried implants, inspired by the penile bones many animals have. In the 1960s, an effective option finally arrived. A Georgia tire serviceman began work on a vacuum pump to treat his own impotence, which was ultimately approved by the Food and Drug Administration in 1982. The pump appeared just as several researchers began to identify drug treatments for impotence, albeit few with the showmanship exhibited by British doctor Giles Brindley. At a 1983 urology meeting, Brindley injected himself with a drug, phentolamine -- then took the stage, dropped his pants and shared his erection with his colleagues. Brindley injected 33 drugs in his penis before finding one that worked, which may have rendered him slightly envious of the discoverers of Viagra. British researchers Ian Osterloh and Gill Samuels were developing a drug to improve blood flow to the heart when they realized that the drug, sildenafil citrate, was much more effective at improving blood flow to the penis -- and causing erections. In Viagra's first month on the market, doctors wrote well over 500,000 prescriptions. Considering men's history of options -- crocodile hearts, prayer, testicular shots and grafts -- perhaps the blue pill's lasting popularity should come as no surprise.

A Revolution of any sort brings with it a new way a life. Viagra, the little blue bill developed for the treatment of erectile dysfunction (ED) has led to a new sexual revolution. This sexual revolution has brought with it a radical change in terms of sexual morality as well as behaviour all around the globe. This is not just another drug; it is the magic bullet that people have been waiting a long time for. Blame it on their nature, men are whimsical creatures who have big egos more and adjudicate their performance on the basis of their sexual prowess. That is where, when men loose their control over sexual ability, they tend to lose their self control. If a man is suffering from ED he is not going to discuss his sex life with anyone, not even with his health care provider. He may even feel embarrassed to talk about it with his mate. Thanks to Viagra, impotence is no longer a taboo issue. Believe it or not, men are coming up openly to discuss and correct their sexual ailment. The sexual revolution attached with Viagra has changed the whole attitude of men’s towards sexuality. With the assistance of Viagra, men are confident that they can satisfy their partner with ease. All in all, their sexual behavior has become more progressive and adventurous. Viagra can restore virility in about 80% of men who have issues, with only minor side effects such as headaches and indigestion. Older medical treatments can leave men with erections that last for more than four hours if sex does not take place. The best part about Viagra is that it only becomes effective when a man is sexually aroused. The drug start making its presence felt when it blocks the operation of an enzyme that plays a prominent role in breaking down the chemical cyclic GMP which is quite important in maintaining erections. Normally, Viagra assisted erections subside after intercourse, a few men have reported that the drug can remain effective for a day. There is no denying that Viagra is fulfilling the requirements of millions of men all around the globe who are suffering from erectile dysfunction by offering them an opportunity to regain their sex lives and lighten up their low self esteem. It assists in infusing freshness in a stale relationship, is a ray of hope for millions of sexually dissatisfied people and has the ability to redefine the meaning of sex and sexuality in your mind and body. 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. buy online phentermine valium viagra xanax WSJ's Health Blog offers news and analysis on health and the business of health. The lead writer is Jacob Goldstein. He came to The Wall Street Journal from the Miami Herald, where he was a medical writer. Scott Hensley, who covered the drug industry as a reporter for the Journal for seven years, is the editor and also a contributor. The blog also includes contributions from other staffers at the Journal, WSJ.com and Dow Jones Newswires. Write to us at .  lowest price generic viagra Nuts, crocodiles and witch trials may seem to have little to do with Viagra -- but at one time or another, they've all been employed against erectile dysfunction. For centuries, doctors struggled to pinpoint the causes of male impotence, blaming such factors as stress, diet, the wrath of deities and unattractive women. Ancient Greek physician Hippocrates attributed impotence to horseback riding; one of his contemporaries placed the blame on childhood trauma; Egyptians to evil spells. The ancients also left behind an imaginative array of remedies: snacks of almonds, pistachios, dates, currant juice and bird eggs in Persia; a mix of sesame, lentils, rice and sugar cane juice in ancient India -- or goat testicles boiled in milk or butter and boiled alligator testes rubbed on the feet. The Egyptians were more direct, smearing remedies (such as crocodile hearts and wood oil) directly on the penis. In the Islamic empire, impotence was sometimes blamed on an imbalance in the four fluids, or humors, thought to course through the body. Doctors advised men to avoid sex after meals, in the bathroom and with old or unappealing partners. In medieval Europe, impotent men believed they were under spells cast by witches, but also blamed their wives. Impotence was grounds for divorce. In the Victorian era, many thought impotence was due to a depletion of sperm. Doctors cautioned against masturbation (a "waste" of sperm) and prescribed quinine, opium, digitalis and bleeding, to no avail. In the late 1800s, French professor of medicine Charles Edouard Brown-Sequard proposed that injections of animal sperm might restore vitality. He tested the theory by injecting himself with an extract of dog and guinea pig testicles. His colleagues, who agreed the professor looked good for a man of 72, agreed to test the extracts on their patients. Soon the treatment, organotherapy, was all the rage. Starting in the late 1910s, a few doctors went a step further, deciding to transplant whole testicles. In France, Serge Voronoff transplanted monkey testicles into the nether regions of more than 1,000 old men. In Kansas, John Brinkley ran a hospital that specialized in grafting goat testicles onto patients. At a California prison, Leo Stanley gave older inmates testicles of younger, executed prisoners. Although many men claimed to feel rejuvenated by their testicular shots and transplants, few recovered their virility, and researchers continued their search. In the 1930s doctors experimented with surgical adjustment of penile muscles. In the 1940s and 1950s, they tried implants, inspired by the penile bones many animals have. In the 1960s, an effective option finally arrived. A Georgia tire serviceman began work on a vacuum pump to treat his own impotence, which was ultimately approved by the Food and Drug Administration in 1982. The pump appeared just as several researchers began to identify drug treatments for impotence, albeit few with the showmanship exhibited by British doctor Giles Brindley. At a 1983 urology meeting, Brindley injected himself with a drug, phentolamine -- then took the stage, dropped his pants and shared his erection with his colleagues. Brindley injected 33 drugs in his penis before finding one that worked, which may have rendered him slightly envious of the discoverers of Viagra. British researchers Ian Osterloh and Gill Samuels were developing a drug to improve blood flow to the heart when they realized that the drug, sildenafil citrate, was much more effective at improving blood flow to the penis -- and causing erections. In Viagra's first month on the market, doctors wrote well over 500,000 prescriptions. Considering men's history of options -- crocodile hearts, prayer, testicular shots and grafts -- perhaps the blue pill's lasting popularity should come as no surprise. 5 sildenafil citrate soft tab Levitra and Viagra are different drugs used to treat one common issue, Erectile Dysfunction (impotence). There are lots of similarities as well as differences when looking at Levitra vs. Viagra. Advice from your health care provider is the ideal way to conclude which drug is the perfect choice for treating your ED. One should never diagnose and treat ED on their own; it could turn out to be a life threatening move. It is mandatory for men with ED to understand the fact that they are not alone. As a matter of fact, millions of men all over the world suffer from ED each year. Fortunately, advancement in pharmaceutical technology has offered choices for these millions. When comparing Levitra with Viagra, the main point of difference is the main ingredient. While Levitra’s main ingredient consists of vardenfil, a PDE5 inhibitor, the main ingredient in Viagra is sildenafil citrate, which has been used not only to treat ED, but also pulmonary arterial hypertension Side effects arising from the use of vardenfil are: abdominal pain, back pain, photosensitivity, abnormal vision, eye pain, facial edema, hypertension, palpitation, tachycardia, arthralgia, myalgia, rash, itch, priapism, and in a few rare scenarios heart attack. Vardenfil should also not be taken if the patient is using any sort of nitrate medication. This is because it has the tendency to produce very low blood pressure. Health care providers will never prescribe Levitra to a patient at risk of experiencing serious side effects. Viagra was the first pill to be introduced to the market. Side effects of Viagra include: priapism, severe hypotension, myocardial infarction, ventricular arrhythmias, sudden death, stroke and enhanced intraocular pressure. The common side effects consist of sneezing, headache, flushing, dyspepsia, prolonged erections, palpitations, and photophobia. Visual changes including blurring of vision and a curious bluish tinge which have been reported in studies. Levitra and Viagra are nearly identical in that they are to be consumed anywhere from a half an hour to a couple of hours prior to sexual activity. Viagra may have been the starting point in the treatment of ED, but there is no doubt that Levitra has been seen as “new and better”. Levitra’s side effects are far and few versus Viagra, though response of drugs varies from person to person. A detailed analysis of your medical history is required to choose the ideal prescription drug for you. 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. Erectile dysfunction in men is a common problem, even more so in men over the age of 45. different lifestyle traits can contribute to erectile dysfunction, however Viagra is the most commonly used cure for impotence and erectile dysfunction. It is not necessarily the case that men naturally experience a lower sexual drive or erectile dysfunction when they reach a certain age. A man's inability to gain and sustain an erection may be due more to abnormalities in treatable physical conditions. In 1983, Dr Giles Brindley made the discovery and demonstrated that a penis could be made erect by injecting it with the drug Phentolamine. He discovered the penis could be mad erect by relaxing the normally constricted blood vessels. Once the vessels are relaxed, they let increased blood into the penis, which then inflates to form an erection. Two problems however were soon recognised. Phentolamine is not selective enough to target only the penis to inflate and can unpredictably effect other parts of the body. Secondly, the erection is not brought on by sexual stimulation and a man will continue to have an erection until the drug wears off. Viagra combats such drawbacks however. It works by enhancing the natural process that occurs when a man is sexually stimulated. Viagra controls what we might call â€?softeners'- chemicals in the body designed to make the penis soften after an erection has occurred. When a man is sexually stimulated chemicals in the body relax the blood vessels in his penis and increase the blood flow. At the same time the body also produces phosphodiesterase (PDE5), which work to subside the erection afterwards. Erectile dysfunction is an imbalance which results in the inability of a male to sustain an erection. Viagra reduced such â€?softeners', allowing blood flow to the penis to create sustainable erections. Viagra does not take the place of stimulation but increases the effects of stimulation. After the Viagra has worn off (usually 4 or 5 hours later), the normal processes are restored to how they were prior to taking Viagra. Possible side effects can occur, such as flushing and dizziness, and if an individual experiences these, they should consult a doctor. 5generic sildenafil citrate Lifestyle drugs are medicines that treat conditions attached with lifestyle like weight loss tablets, anti-smoking agents, impotence therapies and hair restorers. According to one statistic, companies have invested over $20 billion in research into such drugs since the 1990s and are expected to increase that amount in the coming years. Because impotence is normally termed as an annoyance rather than a real threat to health, the drugs (in this case Viagra) that treat it are frequently called "lifestyle drugs, though potential new applications could give these compounds lifesaving medical roles in near future. Everyone is talking about Viagra these days. TV shows are interviewing ecstatic customers while newspapers and magazines are analyzing its cultural implications. The internet is spreading information on how to get it, bars and cocktail parties are buzzing with jokes about it. Viagra is more than just a blockbuster drug that treats a widespread sexual ailment, it demonstrates a whole new type of drug that will have bearing on the lifestyle of millions. Viagra is a godsend for men with clinically diagnosed impotence. It is similar to weight loss drugs can be a prominent health boon for the seriously obese. The pivotal factor behind the vast appeal of such drugs is their ability to improve the lives of people with less than severe symptoms. Interestingly, many in the Viagra target audience are sexually potent men who are interested in increasing sexual performance. The new lifestyle drugs could turn the pharmaceutical industry into an engine of growth. Global spending on pharmaceuticals is running at about $300 billion annually. At a time when people lay out $25 to $30 a month on cable television, it seems a distinct possibility that they will be willing to pay as much for a lifestyle drug. Such spending could increase the range of the drug industry in new few years, sending ripple effects through the whole economy. Pfizer's competitors are working overtime to improve on Viagra. The drug started its popularity as a potential angina treatment that, but it also suppressed an important enzyme, giving rise to a firm, sustained erection. The main challenge for competitors of Viagra is to develop medicines that do not produce the side effects of Viagra, which include headache and a blue haze in the patient's vision. The speedy entrance of competing drugs highlights the fact that technology is helping the pharmaceutical industry. Not so long ago, making of new drug would take around 15 years but at present one can make a new drug in the matter of few years. Viagra is giving older men a new sex life, but many wives are upset about it. According to a $600,000 study paid for by the Health Research Council of New Zealand, plenty of women are blaming health care providers for giving their husbands Viagra without considering its effects on them. These women believe men's clinics use Viagra as a quick fix for men instead of assisting couples with other issues in their relationship or just accepting that older people do not require sex as often as younger people. The study was conducted on the basis of direct interviews with 27 women with an average age of 53, and 33 men who were interested in being a part of the study. Officially, more than 15 million people around the world have taken Viagra since its inception in 1998. Despite being a costly affair, people are still fond of this drug. Viagra’s price is $100 for a packet of four pills; each pill can have an effect for up to 12 hours. About a quarter of the women came forward for the research because they were interested in discussing about the detrimental effects of Viagra. The other three quarters of the women came into the study because they were not feeling at ease with all the sex they were compelled to perform after their husbands opted for Viagra. Women told the researchers that they feel unnecessary pressure to have sex at night as well as the next morning so the husband could double their pleasure. A few older women experienced pain during sex due to post menopausal vaginal dryness even when they were using lubricants during sex. The irony is that most of the health providers just treat this as a men’s problem rather than a couple’s problem. It is mandatory that how woman feels should be taken into account. Doctors are of the opinion that when male patients asked for prescription of Viagra, they cannot force them to talk to their partners first. According to doctors, interaction between the partners is extremely crucial in this matter but, though they encourage it among male patients, to implement it rests solely in the hands of male patients. Interestingly, those women who are not interested in having sex more frequently risked being labelled dysfunctional themselves causing some pressure on them to have some medical evaluation. herbal viagra online This is a summary of the most important information about Viagra. For details, talk to your healthcare professional. FDA ALERT [7/2005]: A small number of men have lost eyesight in one eye some time after taking Viagra, Cialis, or Levitra. This type of vision loss is called non-arteritic anterior ischemic optic neuropathy (NAION). NAION causes a sudden loss of eyesight because blood flow is blocked to the optic nerve. We do not know at this time if Viagra, Cialis, or Levitra causes NAION. NAION also happens in men who do not take these medicines. People who have a higher chance for NAION include those who: FDA has approved new labels for Viagra, Cialis, and Levitra to include information on possible eyesight loss (NAION). Stop using Viagra, Cialis, or Levitra if you have a loss in your eyesight. Get medical help right away. 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. What is Viagra? Viagra is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. Viagra may help a man with ED get and keep an erection when he is sexually excited. Viagra must be used only under a doctor's care. protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare professional about ways to guard against sexually transmitted diseases. Viagra is only for men with ED. Viagra is not for women or children. Viagra must be used only under a healthcare professional's care. Who Should Not Take Viagra? What are The Risks? The following are the major possible risks and side effects of Viagra therapy. This list is not complete. Viagra can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines such as nitrates and alpha-blockers, and recreational drugs that contain nitrates called "poppers". A sudden drop in your blood pressure could cause you to become dizzy, faint, or have a heart attack or stroke. Tell all your healthcare professionals that you take Viagra. If you need emergency medical care for a heart problem, it will be important for your healthcare professionals to know when you last took Viagra. vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green What Should I Tell My Healthcare Professional? have retinitis pigmentosa, a rare genetic (runs in families) eye disease have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia Can Other Medicines or Food Affect Viagra? Viagra and certain other medicines can interact with each other. Tell your healthcare professional about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them with you to show your healthcare professional. Date created: July 8, 2005, updated October 2, 2007 citrate consult no sildenafil Erectile dysfunction in men is a common problem, even more so in men over the age of 45. different lifestyle traits can contribute to erectile dysfunction, however Viagra is the most commonly used cure for impotence and erectile dysfunction. It is not necessarily the case that men naturally experience a lower sexual drive or erectile dysfunction when they reach a certain age. A man's inability to gain and sustain an erection may be due more to abnormalities in treatable physical conditions. In 1983, Dr Giles Brindley made the discovery and demonstrated that a penis could be made erect by injecting it with the drug Phentolamine. He discovered the penis could be mad erect by relaxing the normally constricted blood vessels. Once the vessels are relaxed, they let increased blood into the penis, which then inflates to form an erection. Two problems however were soon recognised. Phentolamine is not selective enough to target only the penis to inflate and can unpredictably effect other parts of the body. Secondly, the erection is not brought on by sexual stimulation and a man will continue to have an erection until the drug wears off. Viagra combats such drawbacks however. It works by enhancing the natural process that occurs when a man is sexually stimulated. Viagra controls what we might call â€?softeners'- chemicals in the body designed to make the penis soften after an erection has occurred. When a man is sexually stimulated chemicals in the body relax the blood vessels in his penis and increase the blood flow. At the same time the body also produces phosphodiesterase (PDE5), which work to subside the erection afterwards. Erectile dysfunction is an imbalance which results in the inability of a male to sustain an erection. Viagra reduced such â€?softeners', allowing blood flow to the penis to create sustainable erections. Viagra does not take the place of stimulation but increases the effects of stimulation. After the Viagra has worn off (usually 4 or 5 hours later), the normal processes are restored to how they were prior to taking Viagra. Possible side effects can occur, such as flushing and dizziness, and if an individual experiences these, they should consult a doctor. generic viagra pills 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. citrate sildenafil 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. cialis levitra sale viagra You have to be cautious. There are literally thousands of internet operations ready to sell you unregulated versions of Pfizer's Viagra. Often the sites claim to be selling the real thing, and it can be a daunting task to identify a safe resource for genuine, Pfizer Viagra. Ukmedix has had to compete with these fakes (which often are cheaper) and has even had to assist in identifying illegal operations (fakes are a threat to your safety, and ultimately Pfizer). In order to stand out from the crowd and reassure our customers Ukmedix produces useful customer tools e.g. a forum dedicated to viagra and makes sure that with every order sent batch numbers and manufacturer;s hall marks are always maintained. Dispatch pharmacists* are always available on receipt of your order for any further queries of authenticity. This means you can trace the product all the way back to Pfizer's manufacturing facility and even know the date your viagra was produced. *A UK pharmacist will always be able to assist you and any licensed pharmacy should be able to verify the viagra batch number. Apart from being unsafe and more then likely to be completely ineffective, fake viagra (wherever it has been produced) has passed no tests, is unregulated and for all you know may have been produced in a garden shed. In some instances dangerous substances have been found in this copied viagra, which would completely defeat the purpose of your seeking help with impotence in the first place! Ukmedix is obviously a business, but we care about our reputation and we care about our customers. We support Pfizer's Safe Drug Initiative which has been created to specifically find and close any illegal sellers of the unsubstantiated, fake viagra being sold on and offline. To this extent we want to know if you have been sold viagra that you think may be fake or viagra that doesn't look like it should. Contact ukmedix and we will gladly assist you and qualify your findings to Pfizer on your behalf. The fact is that fake viagra could have any substances in it and it is not to be trusted as a suitable replacement for the real thing. Impotence is a health condition that may be complex in its causes. Unnecessary e-mail spam on viagra or ludicrous claims that viagra will fix everything in your life are not what we are about. We never send out unsolicited e-mail and try to encourage you to research as much as you can yourself/ through your doctor and local pharmacists. Viagra has truly revolutionized many millions of lives, but viagra (that is Pfizer's viagra) is not suitable for everybody, and fake viagra is suitable for NO-ONE natural source of sildenafil citrate As effective than the normal, if not better. Non-prescription drug, buy generic viagra over the Internet. Although generic viagra is not an FDA approved drug, it is manufactured by Ajanta Pharma in India a reputable pharmacy company who has being making popular generic drugs since 1990. One thing to do before buying generic viagra over the Internet, is to check phone numbers and contact details on the suppliers website. If something looks fishy, don’t even go there! Click here to on our website today for an excellent experience!.
Life is, of course, all about managing death. or rather, it's all about managing pain and pollution and disease and gravity and germs and bacteria and poison and dick cheney and those little shards of glass in your burrito; it's all about, in short, how you sort through the sundry and ever-increasing laundry list of things in your immediate world that want to torment and toxify and destroy you because oh my god they are legion and they are ready and they are . . did you know? it shouldn't come as much of a surprise, really, given how many millions of drug-blasted americans inhale prescription meds by the fistful and then hit the bathroom and the water flows and the treatment plant churns and pumps it all back into municipal water pipes, still brimming with trace amounts of xanax and zoloft and medrol and norvasc, asthma drugs and cholesterol drugs and birth control pills, cancer drugs and painkillers and diuretics and who the hell knows what else. hell, who needs vitamin water when there's lipitor in your ice cubes? this is the wacky fun reminder: living in the city is deadly and toxic a million ways from sunday. in every breath, electromagnetic waves in every gizmo, plastic off-gassing and high-voc paints and chemicals in the carpet and toxins in your very clothing and every modern home so packed with thriving bacteria and synthetic substances and venomous glade air fresheners it's a wonder we manage to stay upright at all. hell, they just discovered that even our national parks, the fish and trees and lakes and the snow itself, are hugely polluted, . go ahead, hug that tree. but be sure to wear a body condom. this is what we have to accept: you do not avoid poison. you do not escape toxin or chemical or gravity or modern synthetic residue even if you move to the woods and build a humble off-grid shack made only of fresh pine needles and bird dung and make your own jam out of river moss and beetle larvae because, hey look, up there in the sky, it's the very air itself, full of chemicals and pollutants drifting over from china and india and, um, marin county, and you're breathing it in and it's coating the very trees and raining down upon your organic tomatoes right now. sorry. please enjoy your salad. no, you do not escape. you cannot completely block. you merely minimize. you recognize the most dire sources and most abhorrent problems and you choose your battles wisely, as you acknowledge just how complicit you are in all of it, how much you contribute to the problem, and adjust and recalibrate your life accordingly. this is the first, mandatory, all-important step. but more important than that, you learn to shun the paranoia. you gotta mock the relentless direness and shrug off the gods of death, every single day, even as they seem to be multiplying like rabid evangelicals at a colorado megachurch. you gotta keep perspective, recall how man has been under deadly pressure from himself since the dawn of time. otherwise, well, life is merely an army of demons and sins lined up and ready to take a bite out of your sweet, innocent flesh as you stroll by like a virgin at a porn convention. you know? wait, did i mention sin? good thing. because apparently they've . did you hear? indeed, a dour red-robed figure just slithered out of the shadows of the vatican and proclaimed some new additions to the master list of thou shalt nots, adding juicy tidbits like pedophilia and pollution and the taking/dealing of drugs (then you'd best not drink the water, father) and questions of bioethics (stem cell research, cloning, whatnot) to the massive catalog of things that make god scowl and angels whine and for which we are all surely going to hell like, a billion times over. is this not delightful, in a deeply pathetic and insulting sort of way? is it not amusing that, after 2,000 years, they're finally saying, hey gosh, trashing the planet and abusing creation itself is sort of wrong? or that they — the catholic church! — dared to add pedophilia to the list, which is a bit like mcdonald's announcing that beef is bad for you? yo, preacher: heal thyself, ok? as for bioethics, well, of course they worry that we'll try to "play god," which is just sort of cute and ridiculous given how most of us, you know, , every single day, by defying death and tormenting our bodies and launching brutal unwinnable wars (in the name of god, natch), choosing whether or not to eat meat and destroy plants and get pregnant or fall in love or hate gay people or buy an escalade or enjoy adam sandler movies. playing god? who the hell is playing? god, that's where the real action is. and now, the bad news: they didn't remove a single damnable thing. they did not say, ok, we've added some vile and obvious new sins, so just for the sake of balance and just so you don't think we're authoritarian cretins, let's remove a few of the outdated, insulting ones, shall we? condoms? birth control? go for it (they should've said). pre-marital sex? have at it, children. in fact, it's now highly recommended. especially if you do it right. and often. and develop some mad skills so if you ever get married you can keep surprising each other with delightful new ways to enjoy various kitchen tools and yoga straps and viagra chewing gum. praise jesus. better yet, they should take it a step further, and for every new sin they add, they should remove . this way, eventually we'll whittle it down to just one grand sin, one terrifically all-encompassing god-mocking insult. which is, of course, the idea of sin itself. believe in sin? believe that we're all, at our core, corrupt and evil and mortally flawed and that life is basically a grueling slog against disease and pain and pollution and 10,000 household poisons until you eventually whimper and sigh and lay yourself in a chemical-soaked pine box and sink it six feet under? baby, that's the biggest sin of all. and you are hereby absolved. thoughts about this column? . A Revolution of any sort brings with it a new way a life. Viagra, the little blue bill developed for the treatment of erectile dysfunction (ED) has led to a new sexual revolution. This sexual revolution has brought with it a radical change in terms of sexual morality as well as behaviour all around the globe. This is not just another drug; it is the magic bullet that people have been waiting a long time for. Blame it on their nature, men are whimsical creatures who have big egos more and adjudicate their performance on the basis of their sexual prowess. That is where, when men loose their control over sexual ability, they tend to lose their self control. If a man is suffering from ED he is not going to discuss his sex life with anyone, not even with his health care provider. He may even feel embarrassed to talk about it with his mate. Thanks to Viagra, impotence is no longer a taboo issue. Believe it or not, men are coming up openly to discuss and correct their sexual ailment. The sexual revolution attached with Viagra has changed the whole attitude of men’s towards sexuality. With the assistance of Viagra, men are confident that they can satisfy their partner with ease. All in all, their sexual behavior has become more progressive and adventurous. Viagra can restore virility in about 80% of men who have issues, with only minor side effects such as headaches and indigestion. Older medical treatments can leave men with erections that last for more than four hours if sex does not take place. The best part about Viagra is that it only becomes effective when a man is sexually aroused. The drug start making its presence felt when it blocks the operation of an enzyme that plays a prominent role in breaking down the chemical cyclic GMP which is quite important in maintaining erections. Normally, Viagra assisted erections subside after intercourse, a few men have reported that the drug can remain effective for a day. There is no denying that Viagra is fulfilling the requirements of millions of men all around the globe who are suffering from erectile dysfunction by offering them an opportunity to regain their sex lives and lighten up their low self esteem. It assists in infusing freshness in a stale relationship, is a ray of hope for millions of sexually dissatisfied people and has the ability to redefine the meaning of sex and sexuality in your mind and body.

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This is a summary of the most important information about Viagra. For details, talk to your healthcare professional. FDA ALERT [7/2005]: A small number of men have lost eyesight in one eye some time after taking Viagra, Cialis, or Levitra. This type of vision loss is called non-arteritic anterior ischemic optic neuropathy (NAION). NAION causes a sudden loss of eyesight because blood flow is blocked to the optic nerve. We do not know at this time if Viagra, Cialis, or Levitra causes NAION. NAION also happens in men who do not take these medicines. People who have a higher chance for NAION include those who: FDA has approved new labels for Viagra, Cialis, and Levitra to include information on possible eyesight loss (NAION). Stop using Viagra, Cialis, or Levitra if you have a loss in your eyesight. Get medical help right away. 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. What is Viagra? Viagra is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. Viagra may help a man with ED get and keep an erection when he is sexually excited. Viagra must be used only under a doctor's care. protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare professional about ways to guard against sexually transmitted diseases. Viagra is only for men with ED. Viagra is not for women or children. Viagra must be used only under a healthcare professional's care. Who Should Not Take Viagra? What are The Risks? The following are the major possible risks and side effects of Viagra therapy. This list is not complete. Viagra can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines such as nitrates and alpha-blockers, and recreational drugs that contain nitrates called "poppers". A sudden drop in your blood pressure could cause you to become dizzy, faint, or have a heart attack or stroke. Tell all your healthcare professionals that you take Viagra. If you need emergency medical care for a heart problem, it will be important for your healthcare professionals to know when you last took Viagra. vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green What Should I Tell My Healthcare Professional? have retinitis pigmentosa, a rare genetic (runs in families) eye disease have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia Can Other Medicines or Food Affect Viagra? Viagra and certain other medicines can interact with each other. Tell your healthcare professional about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them with you to show your healthcare professional. Date created: July 8, 2005, updated October 2, 2007.
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. 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

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My girlfriend and I are very sexually active. I am very healthy sexually but when we have relations two or three times in a day, I'm a better lover if I take a Viagra. Is this healthy? Every relationship is different in terms of the frequency of intimacy. Some couples have sexual relations every 10 days, and others may crave intimacy daily or even several times a day. The key here is that both individuals need to feel that their lovemaking frequency is just right. The definition of erectile dysfunction is the inability to achieve or maintain a satisfactory erection for sexual relations. While apparently that is not a problem for your first round of lovemaking, it sounds as though you are improving your performance with Viagra when you and your girlfriend enjoy subsequent intimate relations in a short time period. There is nothing wrong with this approach medically. The important point to realize is that intimacy is physical and psychological. Just be certain that while you are fine-tuning your physical sexual abilities, that you and your girlfriend continue to fine-tune the elements that contribute to your emotional and psychological intimacy. Those elements may be as simple as sharing books, discussing lifelong secrets or becoming wine enthusiasts together. online viagra best price This medicine is a phosphodiesterase inhibitor used to treat sexual function problems such as impotence or erectile dysfunction. In combination with sexual stimulation, this medicine works by helping the blood flow into the penis to achieve and maintain an erection. This medicine is not intended for use in women or children. This medicine will not protect against sexually transmitted diseases including HIV infection. Use "safe sex" practices such as latex condoms. Contact your doctor or pharmacist for more details. Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. DO NOT TAKE THIS MEDICINE if you are taking any form of nitroglycerin, (such as tablet, patch, or ointment dose forms) or other nitrates (such as isosorbide), nitroprusside (or any "nitric oxide donor" medicine), or recreational drugs called "poppers" containing amyl or butyl nitrate because very serious interactions may occur. If you are not sure whether a certain medicine is a nitrate, contact your doctor or pharmacist. If you are currently using any of these medicines, tell your doctor or pharmacist before using sildenafil. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking other medicines for impotence, antifungals (such as itraconazole or ketoconazole), cimetidine, delavirdine, erythromycin, mibefradil, or rifampin. If you are taking an HIV protease inhibitor (such as ritonavir or saquinavir), do not take more than a 25 mg dose of sildenafil in a 48-hour period. If you are taking more than a 25 mg dose of sildenafil and are also taking an alpha-blocker medicine (such as doxazosin, prazosin, or terazosin) for various conditions (such as enlarged prostate), separate the time between taking these medicines by more than 4 hours. DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including penis conditions (such as angulation, fibrosis/scarring, or Peyronie's disease), history of painful/prolonged erection (priapism), sickle cell anemia, blood system cancers (such as leukemia or myeloma), vision problems (such as retina diseases like retinitis pigmentosa) or history of vision loss, kidney or liver disease, bleeding disorders, active stomach ulcers, heart problems (such as recent heart attack or irregular heartbeat within past 6 months, heart failure, coronary artery disease with unstable angina, aortic stenosis or idiopathic hypertrophic subaortic stenosis), recent stroke within past 6 months, very high or low blood pressure, or allergies. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine. Follow the directions for using this medicine provided by your doctor. An additional patient information leaflet is available with this medicine. Read it carefully. Ask your doctor, nurse, or pharmacist any questions that you may have about this medicine. TAKE THIS MEDICINE by mouth as needed between four hours and one-half hour before sexual activity (about 1 hour before is most effective); or take as directed by your doctor. DO NOT TAKE THIS MEDICINE more often than once daily as needed. A high fat meal may delay the time of onset of this medicine. Your dosage is based on your medical condition, your response to therapy, and other medicines you are taking. Consult your doctor or pharmacist for more information. STORE THIS MEDICINE at room temperature 77 degrees F (25 degrees C) in a tightly-closed container, away from heat, moisture, and light. Brief storage between 59 and 86 degrees F (15 and 30 degrees C) is permitted. DO NOT TAKE THIS MEDICINE if you have had an allergic reaction to it in the past or to any other ingredient that is found in it. THIS MEDICINE MAY CAUSE VISION CHANGES. DO NOT DRIVE, OPERATE MACHINERY, OR DO ANYTHING ELSE THAT COULD BE DANGEROUS until you know how you react to this medicine. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. TO MINIMIZE DIZZINESS OR LIGHTHEADEDNESS, sit up or stand slowly when rising from a seated or lying position. Your dose is based on your medical condition, response to therapy, and the other medicines you are taking. DO NOT EXCEED THE RECOMMENDED DOSE without checking with your doctor. Rarely, this medicine may change heart rhythm, especially if taken with other medicines that can change the heart rhythm. This change in heart rhythm can result in serious, rarely fatal, irregular heartbeats. Ask your doctor for more information and if you should stop taking any of your other medicines to reduce the risk of this side effect. BEFORE YOU BEGIN TAKING ANY NEW MEDICINE, either prescription or over-the-counter, check with your doctor or pharmacist. CAUTION IS ADVISED WHEN USING THIS MEDICINE IN THE ELDERLY because they may be more sensitive to the side effects of this medicine. THIS MEDICINE SHOULD NOT BE USED IN WOMEN OR CHILDREN. SIDE EFFECTS that may occur while taking this medicine include headache, flushing, stomach upset, heartburn, nasal stuffiness, diarrhea, dizziness, or lightheadedness. Vision changes such as increased sensitivity to light, blurred vision, or impaired blue/green color discrimination may also occur. If these continue or are bothersome, check with your doctor or pharmacist. CONTACT YOUR DOCTOR IMMEDIATELY if you experience vision loss in one or both eyes, hearing loss, ringing in the ears, or severe or persistent dizziness. Sexual activity may put extra strain on your heart, especially if you have heart problems. If you have heart problems and experience any serious side effects while having sex, stop having sex and tell your doctor immediately. These side effects include severe dizziness, fainting, chest pain, or nausea. In the unlikely event that you have a painful or prolonged erection (lasting more than 4 hours), stop using this medicine and seek immediate medical attention or permanent problems could occur. AN ALLERGIC REACTION TO THIS MEDICINE is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, unusual swelling, severe dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include severe dizziness, fainting, or prolonged erection. If your symptoms do not improve or if they become worse, check with your doctor. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed, since they may have a problem that is not effectively treated with this medicine, or they may have a condition that is complicated by this medicine. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS MEDICINE out of the reach of children and pets. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out. Copyright 2008 Wolters Kluwer Health, Inc. - This information is not intended to substitute for professional medical advice. Be sure to contact your physician, pharmacist or other health care provider for more information about this medication. By searching these web site pages, you agree to our

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Viagra is one of the few prescription drugs that require almost no publicity. You can find news stories, detailed description and jokes in print, on television and on the internet. Sexual dysfunction is a very serious issue for those who are suffering as well as for their partners. After years without the ability to enjoy sexual intimacy, it is no surprise that lots of people all over the globe are ready to try Viagra. Though the drug that is capable of restoring penile erectile functions, it has wide array of medical, economic and social problems attached. Older users with severe heart disease may experience side effects which can lead to death and the chemical effects of Viagra are also life threatening. Additionally, adverse social effects of Viagra use have also come into the fray in various media circles. There are newspaper reports that say the lives of older couples are being ruined because of Viagra. Men are leaving longstanding relationships for younger women and there are cases of assault on women because of their lack of response to a partner’s new sexual routine. The normal dose of Viagra is 50 mg taken about an hour prior to the expected sex act, though the medication is effective even if taken four hours prior to sex. It is of paramount importance that the next dose not be used until after a day has passed from the last intake. Most importantly, patients with liver or kidney disease should take lower dosages (25 mg) due to their lower ability to eliminate the drug. The most basic reactions with the use of Viagra are headaches, flushing, indigestion and nasal congestion. These sorts of reactions occur in 4% - 16% of patients taking Viagra. Most of the adverse reactions are mild in nature and quite well handled by healthy individuals. While it cannot be termed as an adverse reaction, the new-found sexual prowess can lead older males with underlying medical issues such as heart disease to exert themselves more than they have in recent years. This can precipitate a heart attack or other acute medical emergency. According to one study, the Food and Drug Administration has reported sixteen deaths that followed the use of Viagra. All of these deaths occurred in individuals sixty years and older suffering from of heart disease, hypertension or diabetes. The use of Viagra may lead to stress and marital discord which can result in divorce and the need for psychological counseling. Apart from that, the enhanced sexual routine may also give rise to sexually transmitted diseases and AIDS in older individuals who would not normally be exposed. generic for viagra 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.

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natural viagra alternative 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. Viagra is giving older men a new sex life, but many wives are upset about it. According to a $600,000 study paid for by the Health Research Council of New Zealand, plenty of women are blaming health care providers for giving their husbands Viagra without considering its effects on them. These women believe men's clinics use Viagra as a quick fix for men instead of assisting couples with other issues in their relationship or just accepting that older people do not require sex as often as younger people. The study was conducted on the basis of direct interviews with 27 women with an average age of 53, and 33 men who were interested in being a part of the study. Officially, more than 15 million people around the world have taken Viagra since its inception in 1998. Despite being a costly affair, people are still fond of this drug. Viagra’s price is $100 for a packet of four pills; each pill can have an effect for up to 12 hours. About a quarter of the women came forward for the research because they were interested in discussing about the detrimental effects of Viagra. The other three quarters of the women came into the study because they were not feeling at ease with all the sex they were compelled to perform after their husbands opted for Viagra. Women told the researchers that they feel unnecessary pressure to have sex at night as well as the next morning so the husband could double their pleasure. A few older women experienced pain during sex due to post menopausal vaginal dryness even when they were using lubricants during sex. The irony is that most of the health providers just treat this as a men’s problem rather than a couple’s problem. It is mandatory that how woman feels should be taken into account. Doctors are of the opinion that when male patients asked for prescription of Viagra, they cannot force them to talk to their partners first. According to doctors, interaction between the partners is extremely crucial in this matter but, though they encourage it among male patients, to implement it rests solely in the hands of male patients. Interestingly, those women who are not interested in having sex more frequently risked being labelled dysfunctional themselves causing some pressure on them to have some medical evaluation. sildenafil citrate tablets Nuts, crocodiles and witch trials may seem to have little to do with Viagra -- but at one time or another, they've all been employed against erectile dysfunction. For centuries, doctors struggled to pinpoint the causes of male impotence, blaming such factors as stress, diet, the wrath of deities and unattractive women. Ancient Greek physician Hippocrates attributed impotence to horseback riding; one of his contemporaries placed the blame on childhood trauma; Egyptians to evil spells. The ancients also left behind an imaginative array of remedies: snacks of almonds, pistachios, dates, currant juice and bird eggs in Persia; a mix of sesame, lentils, rice and sugar cane juice in ancient India -- or goat testicles boiled in milk or butter and boiled alligator testes rubbed on the feet. The Egyptians were more direct, smearing remedies (such as crocodile hearts and wood oil) directly on the penis. In the Islamic empire, impotence was sometimes blamed on an imbalance in the four fluids, or humors, thought to course through the body. Doctors advised men to avoid sex after meals, in the bathroom and with old or unappealing partners. In medieval Europe, impotent men believed they were under spells cast by witches, but also blamed their wives. Impotence was grounds for divorce. In the Victorian era, many thought impotence was due to a depletion of sperm. Doctors cautioned against masturbation (a "waste" of sperm) and prescribed quinine, opium, digitalis and bleeding, to no avail. In the late 1800s, French professor of medicine Charles Edouard Brown-Sequard proposed that injections of animal sperm might restore vitality. He tested the theory by injecting himself with an extract of dog and guinea pig testicles. His colleagues, who agreed the professor looked good for a man of 72, agreed to test the extracts on their patients. Soon the treatment, organotherapy, was all the rage. Starting in the late 1910s, a few doctors went a step further, deciding to transplant whole testicles. In France, Serge Voronoff transplanted monkey testicles into the nether regions of more than 1,000 old men. In Kansas, John Brinkley ran a hospital that specialized in grafting goat testicles onto patients. At a California prison, Leo Stanley gave older inmates testicles of younger, executed prisoners. Although many men claimed to feel rejuvenated by their testicular shots and transplants, few recovered their virility, and researchers continued their search. In the 1930s doctors experimented with surgical adjustment of penile muscles. In the 1940s and 1950s, they tried implants, inspired by the penile bones many animals have. In the 1960s, an effective option finally arrived. A Georgia tire serviceman began work on a vacuum pump to treat his own impotence, which was ultimately approved by the Food and Drug Administration in 1982. The pump appeared just as several researchers began to identify drug treatments for impotence, albeit few with the showmanship exhibited by British doctor Giles Brindley. At a 1983 urology meeting, Brindley injected himself with a drug, phentolamine -- then took the stage, dropped his pants and shared his erection with his colleagues. Brindley injected 33 drugs in his penis before finding one that worked, which may have rendered him slightly envious of the discoverers of Viagra. British researchers Ian Osterloh and Gill Samuels were developing a drug to improve blood flow to the heart when they realized that the drug, sildenafil citrate, was much more effective at improving blood flow to the penis -- and causing erections. In Viagra's first month on the market, doctors wrote well over 500,000 prescriptions. Considering men's history of options -- crocodile hearts, prayer, testicular shots and grafts -- perhaps the blue pill's lasting popularity should come as no surprise.

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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 recommended. In humans, Viagra has no effect on bleeding time when taken alone or with aspirin. In vitro studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside (a nitric oxide donor). The combination of heparin and Viagra had an additive effect on bleeding time in the anesthetized rabbit, but this interaction has not been studied in humans. Physicians should discuss with patients the contraindication of Viagra with regular and/or intermittent use of organic nitrates. Physicians should advise patients of the potential for Viagra to augment the blood pressure