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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
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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.
Sildenafil tablets 25 mg, 50 mg, 100 mg (sil-den-a-fil) treating erectile dysfunction (ed). it may also be used for other conditions as determined by your doctor. viagra is a phosphodiesterase inhibitor. it works by helping to increase blood flow into the penis during sexual stimulation. this helps you to achieve and maintain an erection. you are taking nitrates (eg, isosorbide, nitroglycerin) in any form (eg, tablet, capsule, patch, ointment) or nitroprusside you use certain recreational drugs called "poppers" (eg, amyl nitrate, butyl nitrate) contact your doctor or health care provider right away if any of these apply to you. some medical conditions may interact with viagra . tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have a deformed penis (eg, peyronie disease, cavernosal fibrosis), blood problems (eg, sickle cell anemia, leukemia, multiple myeloma), or any other condition that may increase the risk of a prolonged erection (eg, priapism) if you have a history of certain eye problems (eg, retinitis pigmentosa, sudden vision loss, optic neuropathy, macular degeneration) if you have a history of liver or kidney problems, high or low blood pressure, ulcers, bleeding problems, heart problems (eg, heart failure, irregular heartbeat, aortic stenosis, angina), or blood vessel problems if you have a history of heart attack, stroke, or life-threatening irregular heartbeat, especially within the past 6 months some medicines may interact with viagra . tell your health care provider if you are taking any other medicines, especially any of the following: alpha-blockers (eg, doxazosin), amlodipine, medicines for high blood pressure, nitrates (eg, isosorbide, nitroglycerin), or nitroprusside because severe low blood pressure with dizziness, lightheadedness, and fainting may occur azole antifungals (eg, itraconazole), cimetidine, h2 agonists (eg, famotidine), hiv protease inhibitors (eg, ritonavir), macrolide antibiotics (eg, erythromycin), or telithromycin because they may increase the risk of viagra 's side effects this may not be a complete list of all interactions that may occur. ask your health care provider if viagra may interact with other medicines that you take. check with your health care provider before you start, stop, or change the dose of any medicine. use viagra as directed by your doctor. check the label on the medicine for exact dosing instructions. an extra patient leaflet is available with viagra . talk to your pharmacist if you have questions about this information. take viagra by mouth with or without food. viagra may not work as quickly if you take it with a high-fat meal. viagra is usually taken about 1 hour before sexual activity. however, it may be taken anywhere from 4 hours to ? hour before sexual activity. talk with your doctor about the best way to take viagra . do not take viagra more often than once daily, or as directed by your doctor. if you miss a dose of viagra and you still intend to engage in sexual activity, take it as soon as you remember. continue to take it as directed by your doctor. ask your health care provider any questions you may have about how to use viagra . viagra may cause dizziness, drowsiness, fainting, or blurred vision. these effects may be worse if you take it with alcohol or certain medicines. use viagra with caution. do not drive or perform other possibly unsafe tasks until you know how you react to it. viagra may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. to prevent them, sit up or stand slowly, especially in the morning. sit or lie down at the first sign of any of these effects. patients with heart problems who take viagra may be at increased risk for heart-related side effects, including heart attack or stroke. symptoms of a heart attack may include chest, shoulder, neck, or jaw pain; numbness of an arm or leg; severe dizziness, headache, nausea, stomach pain, or vomiting; fainting; or vision changes. symptoms of a stroke may include confusion, vision or speech changes, one-sided weakness, or fainting. contact your doctor or seek medical attention right away if you experience these symptoms. viagra may rarely cause a prolonged, painful erection. this could happen even when you are not having sex. if this is not treated right away, it could lead to permanent sexual problems such as impotence. contact your doctor right away if this happens. do not use other medicines or treatments for erectile dysfunction while you are taking viagra . viagra does not stop the spread of hiv or other sexually transmitted diseases (stds) to others through sexual contact. use barrier methods of birth control (eg, condoms) if you have hiv infection or an std. viagra will not prevent pregnancy. if your partner may become pregnant and you wish to avoid pregnancy, be sure to use an effective form of birth control. use viagra with caution in the elderly; they may be more sensitive to its effects. viagra is not recommended for use in children; safety and effectiveness in children have not been confirmed. pregnancy and breast-feeding: viagra is not approved for use in women. if you become pregnant, contact your doctor. you will need to discuss the benefits and risks of using viagra while you are pregnant. it is not known if viagra is found in breast milk. if you are or will be breast-feeding while you use viagra , check with your doctor. discuss any possible risks to your baby. all medicines may cause side effects, but many people have no, or minor, side effects. diarrhea; dizziness; flushing; headache; heartburn; mild, temporary vision changes (eg, blurred vision, sensitivity to light, blue/green color tint to vision); stuffy nose; upset stomach. severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; fainting; fast or irregular heartbeat; painful or prolonged erection; ringing in the ears; seizure; severe or persistent dizziness; severe or persistent vision changes; sudden decrease or loss of vision in one or both eyes; sudden hearing loss. this is not a complete list of all side effects that may occur. if you have questions or need medical advice about side effects, contact your doctor or health care provider. you may report side effects to the fda at 1-800-fda-1088 (1-800-332-1088) or at . contact 1-800-222-1222 (the american association of poison control centers), your local poison control center ( ), or emergency room immediately. symptoms may include chest pain; fainting; prolonged erection; severe dizziness. store viagra at 77 degrees f (25 degrees c). brief storage at temperatures between 59 and 86 degrees f (15 and 30 degrees c) is permitted. store away from heat, moisture, and light. do not store in the bathroom. keep viagra out of the reach of children and away from pets. if you have any questions about viagra , please talk with your doctor, pharmacist, or other health care provider. viagra is to be used only by the patient for whom it is prescribed. do not share it with other people. if your symptoms do not improve or if they become worse, check with your doctor. this information is a summary only. it does not contain all information about viagra . if you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider. Why is Viagra prescribed? Viagra is an oral drug for male impotence, also known as erectile dysfunction (ED). It works by dilating blood vessels in the penis, allowing the inflow of blood needed for an erection. Viagra causes erections only during sexual excitement. It does not work in the absence of arousal. How should you take Viagra? Taking Viagra approximately 1 hour before sexual activity works best for most men. Depending on how and when the drug works for you, an interval of one-half hour to as much as 4 hours may prove ideal. --If you miss a dose... for regular use. Take it only before sexual activity. --Storage instructions... Store at room temperature. What side effects may occur? Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Viagra. Abnormal vision (color tinge, blurring, sensitivity to light), acid indigestion, diarrhea, flushing, headache, nasal congestion, urinary tract infection Heart attack, stroke, heart irregularities, dangerous surges in blood pressure, and sudden death have all been reported after use of Viagra, usually in men with existing cardiac risk factors, and typically during or shortly after sex. Why should Viagra not be prescribed? Do not take Viagra if you are taking any nitrate-based drug, including nitroglycerin patches (Nitro-Dur, Transderm-Nitro), nitroglycerin ointment (Nitro-Bid, Nitrol), nitroglycerin pills (Nitro-Bid, Nitrostat), and isosorbide pills (Dilatrate-SR, Isordil, Sorbitrate). Combining Viagra with these drugs can cause a severe drop in blood pressure. If Viagra gives you an allergic reaction, do not use it again. If you have heart problems severe enough to make sexual activity a danger, you should avoid using Viagra. Use it cautiously--if at all--if you've had a heart attack, stroke, or life-threatening heart irregularities within the past 6 months. Be equally cautious if you have severe high or low blood pressure, heart failure, or unstable angina (crushing heart pain that occurs at any time). If you take Viagra and develop cardiac symptoms (for example, dizziness, nausea, and chest pain) during sexual activity, do not continue. Alert your doctor to the problem as soon as possible. If you have a condition that might result in long-lasting erections, such as sickle cell anemia, multiple myeloma (a disease of the bone marrow), or leukemia, use Viagra with caution. Also use cautiously if you have a genital problem or deformity such as Peyronie's disease. If an erection lasts more than 4 hours, seek treatment immediately. Permanent damage and impotence could result. If you have a bleeding disorder, a stomach ulcer, or the inherited eye condition known as retinitis pigmentosa, use Viagra with caution. Its safety under these circumstances has not yet been studied. To avoid low blood pressure, do not take the 50-milligram or 100-milligram dose of Viagra within 4 hours of taking an alpha-blocking drug such as Cardura. Remember that Viagra offers no protection from transmission of sexually transmitted diseases, such as HIV, the virus that causes AIDS. If Viagra is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Viagra with the following: Erythromycin (E-Mycin, Ery-Tab, PCE) Nitrates such as Isordil, Nitro-Bid, and Nitro-Dur Rifampin (Rifadin, Rimactane) Saquinavir (Fortovase, Invirase) Viagra should not be used by women. Its affects during pregnancy and breastfeeding have not been studied. Doses range from 25 milligrams to 100 milligrams, depending on the drug's effect. The usual dose is 50 milligrams. If you are over 65, have liver or kidney problems, or are taking erythromycin, ketoconazole, itraconazole, ritonavir, or saquinavir a dose of 25 milligrams may be sufficient. Your doctor will adjust the dosage if the drug is not working properly for you. Take Viagra only before sexual activity. The manufacturer recommends a maximum of 1 dose per day (1 dose every 2 days for those taking ritonavir). To avoid low blood pressure, do not take the 50-milligram or 100-milligram dose of Viagra within 4 hours of taking an alpha-blocking drug such as Cardura. No overdose of Viagra has been reported. However, any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.
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buy viagra pay with paypal 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..
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. 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.
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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.
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When we speak of sex drive problems, or dysfunction, we automatically think of males and erectile dysfunction, and omit women from the equation. However, many women experience problems with their �libido' or sexual energy, and this phenomena deserves attention too. Viagra is the most common treatment for erectile dysfunction in males, and has traditionally been recommended for men only, women being advised not to use it. So the main reason for this is lack of empirical research stating otherwise, which is due to the absence of definitive studies on women. Viagra however can work for women, as it increases the blood flow to a woman's genitals (much the same way as with a man's), which boosts their libido. There are important considerations however, which shall be listed below. As Viagra is aimed at men's erectile dysfunction, women are unable to obtain a prescription and buy Viagra from a pharmaceutical store. However generic versions are available on the internet, but as so many are on the market, if in doubt contact the supplier as to whether a product is available. When buying from online pharmacies, it is possible to check their pharmacy ID if concerned about legitimacy. It is important for women to take into consideration possible side effects of Viagra, although not widespread there is still a possibility of them occurring. For instance, some Viagra users have reported dizziness, flushing, loss of vision, and so on. Check all possible side effects before commencing use. Furthermore, Viagra should not be taken alongside any nitrate medicines as this can cause abnormally low blood pressure, so always check! Women, who suffer with a low sex drive often, should seek a long term cure other then Viagra in order to increase their libido and have a permanent effect. Long term Viagra use can result in expense, so if the problem continues regularly, even after Viagra use, women should aim to seek other remedial methods.
generic viagra online drugs Male impotence a problem that virtually every man fears, but at sometime or other in life every man has to confront Erectile Dysfunction (ED). A man’s psychology plays a prominent part in his sexual relationship. If he is depressed, stressed or tense, there is bound to be some impact on his sexual relationship. Anxiety about a man’s sexual routine makes him more stressed and causes his ability to perform to decrease. Erectile Dysfunction can be defined as the inability to have or maintain an erection long enough to have satisfactory sexual intercourse. According to research, ED afflicts nearly 30 million men in America alone and is a cause of great tension. The ideal solution to male sexual impotence issues lies in the little blue pill known as Viagra. Viagra has been quite a handy tool to men who have ED or may be suffering from any degree of male sexual dysfunction. Since the advent of Viagra there has been a great deal of confidence in the patients of erectile dysfunction whether suffering because of the physical or psychological issues. Viagra revives the feeling of self-esteem and manliness, which seems to be lost if you are suffering from ED. Viagra works by enhancing the flow of blood in the penile region and causing a firm erection. The sexual lives of many men have improved because they have the option of Viagra. Viagra can proudly claim to be the first anti-impotence oral pill. The basic chemical base in Viagra is sildenafil citrate. This chemical that treats erectile dysfunction by enabling the man to have an erection long enough to satisfactorily complete sexual intercourse. Many people think that Viagra will enhance their libido or improve their sexual prowess, but this is totally baseless. Viagra can surely be termed as a sex pill, but it is not a libido enhancer drug at all. As a matter of fact, Viagra just acts on the chemicals and enzymes present in your body causing an increased flow of blood in the penis to cause an erection.
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Jetlag is defined as a temporary disturbance of the bodily rhythms which is caused by high-speed travel, whether it is on land or on air and across various time zone. This disturbance is usually common in jet aircrafts. People who cross various time zones find it easier to recover from jet lag if the purpose of the travel is for a vacation. This is because when a person travels to a place where he is allowed to relax and recover slowly, it gives him the chance to adjust to the local time of the area. But there are also persons who are not that lucky. People who travel for business purposes usually cross a lot of time zones. When the business traveler reaches his destination he gets busy attending meetings and doing the work that has to be done all based on the local time of that certain place. Thus the business travelers cannot afford the luxury of relaxing and adjusting their bodies to the place's local time. Can Viagra be a relief for jetlag? It is usually not known that there is a certain link between Jetlag and Viagra. A recent study has shown that not only does Viagra treat erectile dysfunction but it can actually also neutralize the effects of jetlag. Viagra has been observed to restore normal bodily clock functions which have been shifted by six hours. Viagra was first developed by Pfizer for aid in treatment of angina and high blood pressure by disturbing the enzyme that causes the reduction of cGMP, a natural compound, cGMP plays a very important in the function of penile erection. In relation to jetlag, cGMP acts in a region of the brain whose role is to regulate the circadian cycle. The circadian cycle is the body's internal clock that determines the waning and the waxing of hormones and also controls the urge to sleep and wake. In a laboratory test, hamsters were injected with Viagra and subjected to bright lights for 6 hours ahead of the regular time. They were observed by a team of researchers from the Universidad Nacional de Quilmes. They found that the injected hamsters have improved in coping with the time difference by 25 to 50 percent as those compared to the hamsters that were not administered with Viagra. The testing gave out a positive result in the light to dark cycle which is the equivalent of traveling from west to east. Further test is needed to really identify the possibility of Viagra as an effective treatment to counter the ill feeling of traveler's jetlag. If this can be validated, then the blue pill can cross the barrier of time and human dysfunction.
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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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HE is only two, but Oliver Sherwood regularly takes Viagra - to keep him alive. The toddler has a rare condition that causes chronic high blood pressure. Something as simple a chest infection could kill him. The pulmonary hypertension, as it is known, can be controlled with four doses of Viagra a day. The drug improves blood flow, which in adults can boost erectile function but in rare cases such as Oliver's can open the veins and capillaries to aid circulation. His mother Sarah, a part-time nurse, said: "We joke when we pick up his drugs that it would be Christmas come early for most people. Obviously the dose isn't high enough to have the effect it would on adults. "Viagra is an expensive drug but it's actually one of the cheapest to treat pulmonary hypertension. "We're just hoping it'll continue to work as he grows a bit older." But Oliver's future could be in doubt because other drugs he could use as he gets older might no longer be funded by the Health Service. Pulmonary hypertension causes the blood pressure in the arteries in the lungs to rise, straining the heart and reducing blood oxygen levels, causing breathlessness and exhaustion. Symptoms include severe coughing and breathing problems as blood fills the lungs, constant nose bleeds, dizziness and chest pains. The condition, which affects 4,000 in Britain, often leads to heart failure. It is so rare that only five children a year are diagnosed with it in the UK. The survival rate is around five years, even with medication such as Oliver, who cannot walk more than a few steps without getting out of breath, takes one tablet of Sildenafil crushed into four 5ml doses a day. Doctors can increase the dose when his condition worsens, but there is no way of telling how much longer the drugs will be effective. As he grows up he will need to switch to more expensive treatments called Epoprostenol and Iloprost to control his condition. But the Government's drug rationing agency, the National Institute for Health and Clinical Excellence, is considering whether to continue prescribing them. Oliver's mother has started a petition calling for the Health Service to keep funding the treatments. Mrs Sherwood, 34, of Hucclecote, Gloucestershire, said: "The only hope we had was that he would be maintained through medication but if anything-happens in the future that hope may be taken away." The Pulmonary Hypertension Association said: "The clinical evidence for this is unfounded and it must be assumed it is based on cost alone." A spokesman for NICE added: "Our review of the evidence suggests that Sildenafil is both clinically effective and cost-effective in treating pulmonary arterial hypertension."
viagra online buy 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.
buy viagra here in the uk Treat Sexual Dysfunctions with Aromatherapy Sexual issues such as impotence, infertility and frigidity are related to a psychological problem that has established itself from stress-related conditions. Generally, the loss of physical sexual function can lead to its own set of emotional feedback and can give rise to stress, depression and anxiety. Libido problems like frigidity (anorgasmia), impotence and retarded ejaculation can arise because of emotional frustration or negative feelings, resulting in a loss in sexual appetite. When the emotional problems have come to an end, the libido and function will return. In cases of frigidity and retarded ejaculation, longer time spent in foreplay and different sexual positions may play a prominent role in solving the problem. In this regard, vaginismus, which is the involuntary spasm of the vaginal muscles is, in theory, attached to overwhelming feelings of fear arising due to trauma or a violent sexual experience. In a few cases vaginismus can be a result of lack of sexual experience, which may lead to fear of sexual intercourse. All sexual issues can result in infertility as conception is less likely to arise if there is an issue with one or both partners’ sexual function. Stress can have a significant bearing on the menstrual cycle, leading to conditions like amenorrhea, dysmenorrhea and menorrhagia affecting a woman’s ability to conceive. In virtually all cases of sexual dysfunction, there is the urgent requirement of a supportive, sympathetic, cooperative partner in the relationship. Establishing intimacy and trust is also essential. Aromatherapy can play a prominent role when used in aromatic baths or massage, which can be termed as intimate routines. In addition, aromatic bathing and massage can assist in keeping you relax and open the method for sexual feedback between two individuals. Massage can turn out to be a sensual experience and a part of foreplay. Another significant factor when dealing with a sexual issue, is the body’s energy system. The chakra attached to sexuality is the sacral chakra, situated between the genitals and the naval. Blockages in this chakra can manifest as psycho-sexual ills. The sacral chakra is orientated to your self gratification, physical comfort, satisfaction and sexuality. With the help of the sacral chakra, you can regulate your feelings as well as emotional expressions. Furthermore, the gonads are situated within the sacral chakra. The sacral chakra can be defined as the sphere of desires, physical pleasures and happiness; it is also the home of the five senses. You are attached to feelings and sense of physical balance with the assistance of this chakra.
buy viagra in jersey 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
