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Herbal treatment for impotence includes several herbs and herbal supplements. If a man prefers the natural way of treatment, the herbal supplements are not the option. The supplements are not recommended by FDA in the cure for the sexual disease. Besides, FDA warns that very often these products do not contain the real information about the chemicals that comprise the composition of these herbals. Usually, the manufacturers of these botanicals do not mention the chemicals on the package that can influence the health of a man and even interact with certain drugs and food products. The herbal supplements are not FDA approved, so their efficiency in the cure for impotence is doubtful. The same is about the penile creams that have not been tested according to the demands of the organization.

However, impotence can be treated by the herbs and certain elements found in the food products. The intake of the natural plants and their roots can work wonders for impotent men. In some cases, such treatment can prevent ED and even stimulate an erection, if this method is regularly used. The first effective amino acid is called L-arginine. This acid can be found in such products as poultry, fish, red meat and dairy products. The scientists have studied this method for ED cure and they approved its safety and possible positive influence on the erectile function. As it is a vasodilator, L-arginine widens the blood vessels – the principle of work that reminds the PDE 5 inhibitors in the formula of ED drugs.

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How to Take Viagra Gel Capsules?

With this ED medicine, the intake of the water glass is optional. The gel capsules with Viagra should be used in 15-20 minutes before intimacy. This medicine is capable of enhancing the erectile stimulation for 6 hours. Ask your urologist to prescribe the dosage. Read carefully the information on the prescription label. The dose of Viagra Super Active per one day is 100 mg of Sildenafil. The dosage may be decreased. But, it is not allowed to increase the daily dose of Sildenafil.

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Contraindicated Diseases

Viagra Super Active is the ED medicine that should not be used by men with the following health conditions: liver failure, stroke, cardiac diseases, priapism, sickle cell anemia, leukemia, high blood pressure, penis deformations, hypersensitive reaction to Sildenafil and peyronie’s disease. Try Caverta pills if you prefer the simple ED tablets.

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Lo sapevate che Niagra X
ГЁ dieci volte meglio del Viagra в„ў?

PerchГ© Niagra X ГЁ il piГ№ gettonato dagli acquirenti.

I professionisti medici in tutto il mondo considerano Niagra X come il rimedio che hanno avuto piГ№ successo nella DE (disfunzione erettile) rispetto agli altri rimedi contro la disfunzione erettile. Ha letteralmente eclissato Viagra™в„ў nella cura delle disfunzioni del pene in vari modi.


Niagra X
ГЁ stato formulato con ingredienti di altissima qualitГ  designati a garantire il massimo piacere sessuale. La superioritГ  di questa formula consiste nella qualitГ  delle sua erbe scelte tra le migliori, testate piГ№ volte dai nostri esperti medici. Ogni ingrediente ha un’ immensa capacitГ  di eliminare la disfunzione erettile alla sua radice e migliorare la vita sessuale per una nuova rinascita. Niagra X aumenta i parametri sessuali all’infinito, dando cosГ¬ piГ№ di quanto si abbia mai desiderato nella vita.

” Formula fantastica a base di erbe per una straordinaria potenza sessuale .”

Il mio fidanzato era inferiore alla media, in quando a ‘potenza sessuale’. Non ГЁ stato un compito facile dirgli la veritГ , perchГ© faceva sempre del suo meglio per rendermi felice. Potevo solo dirgli che stava facendo un buon lavoro, in modo da non scoraggiarlo. Ci siamo frequentato per circa un anno, ma al primo anniversario non ho potuto fare a meno di comunicargli la mia delusione dicendogli la veritГ  sulle sue prestazioni sessuali. Rimase totalmente scosso dalle mie parole e si precipitГІ il giorno successivo a consultare un medico. Il suo medico gli ha consigliato la fantastica formula delle erbe di Niagra X per ottenere una straordinaria potenza sessuale. Adesso sono felice di poter dire che questo ГЁ stato un mese meraviglioso per noi. La sua capacitГ  di resistenza ГЁ aumentata molto con Niagra X. Grazie a questo prodotto, ora la nostra vita sessuale ГЁ piacevole.

Scopri il miglior rimedio naturale per la DE (disfunzione erettile).
Ordina Niagra X oggi stesso.

Niagra X ГЁ una rivoluzionaria potente formula per
ottimali prestazioni sessuali. “
– Il Dr. Thomas Patterson, M.H. ha scoperto molte realtГ  riguardo a Niagra X. Leggere qui di seguito.

Alcuni esperti medici presso il laboratorio NaturalMedis in Germania, hanno condotto una vasta ricerca riguardo le disfunzioni del pene nel periodo 2006-07. A due gruppi di 14 uomini di mezza etГ  sono stati somministrati una serie di farmaci anti-impotenza come Viagra в„ў & Niagra X prima delle prestazioni sessuali. I rapporti clinici dell’ efficacia di Niagra X citano prestazioni incredibili. I soggetti a cui ГЁ stato fornito Niagra X hanno sperimentato un alto livello di intensitГ  sessuale. nell’arco delle 24 ore. I soggetti che hanno assunto il Viagra™ hanno dimostrato una relativamente minore, eccitazione sessuale che ГЁ durata per un periodo piГ№ breve. Alcune osservazioni hanno inoltre confermato una minore durata delle erezioni con farmaci come Cialisв„ў e Levitra в„ў rispetto al Niagra X. In questa ricerca hanno stabilito che il Niagra X conferisce immensa potenza sessuale che dura senza sosta per ore. Niagra X ha anche mostrato cambiamenti degni di nota nei soggetti. tipo la diminuzione di paura. durante il rapporto sessuale, una maggiore intimitГ  sessuale e piГ№ ferme e rigide erezioni a comando. Gli esperti medici hanno concluso che non solo gli effetti di Niagra X sono assolutamente indiscutibili, ma che ГЁ anche la soluzione di gran lunga piГ№ efficace per la DE (disfunzione erettile ) e che ГЁ il perfetto sostituto Viagra™ grazie all’assenza di effetti collaterali pericolosi.

Dr. Marcus L. Cohon, M.S. Ph.D. M.S.I.A. B.F.A ha riferito.

Io, Dr. Marcus sono uno dei medici che ha condotto uno studio sul Niagra X nel laboratorio NaturalMedis. in Germania. L’obiettivo principale del nostro studio era quello di preparare il miglior rimedio a base di erbe in grado di combattere con successo la disfunzione erettile. senza causare alcun danno alle funzioni normali degli organi. Con l’aumento delle disfunzioni sessuali sia tra gli anziani e sia tra i giovani, i farmaci su base chimica come Viagraв„ў, Cialisв„ў e Levitra в„ў sono molto diffusi. Questi sono in grado di far aumentare la resistenza sessuale. ma possono altresГ¬ causare disturbi permanenti negli uomini come la cecitГ  NAION ( ischemica ottica anteriore non arterica) e molto di piГ№. CosГ¬ la nostra ampia ricerca neuropatica riguardo il tinnito (ronzio nelle orecchie), le vertigini (sensazione di rotazione), capogiri, da oltre 5 anni ha portato a una formula che possa curare la disfunzione erettile naturale e garantire una salute ottimale.

Niagra X NiagraX ГЁ una brillante innovazione che dГ  agli uomini una alternativa sicura ai farmaci chimici estremamente nocivi. Le erbe contenute in ogni capsula sono sicure e sono state utilizzati da migliaia di anni come potenziale erettore sessuale per gli uomini. Sono in grado di affermare che Niagra X ГЁ la soluzione migliore per l’impotenza maschile e sono orgoglioso di approvare questa notevole formula.

“Le pillole Niagra X debellano tutte le possibili disfunzioni erettili su questo pianeta. “
Sfidano il Top dei farmaci chimici per le disfunzioni erettili grazie alla loro efficacia!

Naturomeds, leader mondiale nelle campo delle medicine alternative ГЁ sempre riuscita a dare all’uomo la giusta soluzione per una migliore salute e benessere. La nostra invenzione – NiagraX – ГЁ il miglior rimedio naturale per la disfunzione erettile formulata finora. Anni di ricerche, esperimenti di laboratorio e numerosi studi clinici hanno permesso ai nostri scienziati di formulare la soluzione piГ№ efficace per l’impotenza maschile. Durante i nostri anni di ricerche abbiamo osservato anche il lato degli effetti pericolosi dei farmaci chimici usati nella disfunzione erettile. Questi farmaci possono causare danni permanenti alla salute e anche gravi complicazioni al vostro organismo

Quindi si vuole veramente rischiare la vita assumendo questi farmaci chimici? Sicuramente no! Un certo numero di farmaci alternativi promettono ai propri utenti grandi effetti riguardo la disfunzione erettile. ma solo pochi farmaci genuini come il NiagraX si sono rivelati efficaci. Il nostro miglior uso della scienza moderna e della tecnologia ha permesso ai nostri laboratori di formulare un rimedio per la disfunzione erettile che non ГЁ solo efficace ma ГЁ anche sicuro al 100%. I nostri studi clinici riguardanti il NiagraX hanno mostrato un aumento enorme delle capacitГ  sessuali degli uomini. Le supreme proprietГ  afrodisiache dei componenti del NiagraX operano negli uomini aumentandone il loro impulso sessuale, senza alcuna traccia di effetti collaterali.

“Cliente soddisfatto.”

Il mio nome ГЁ Kyle e risiedo ad Amsterdam. Sono ormai sposato da 10 anni. Ho cominciato a prendere le pillole
Niagra X solo 4 settimane fa ed i risultati sono stati fenomenali. Mia moglie ГЁ piГ№ felice e questo mi fa sentire piГ№ sicuro ed energico.

Posso affermare con certezza. “ Niagra X ГЁ l’unica e definitiva soluzione per quei tipi di problemi che negli uomini aumentano con l’aumentare dell’etГ . Grazie per avermi restituito la mia giovinezza ".

Prima di utilizzare le pillole di Niagra X. la mia vita sessuale era alquanto scarna e non avevo nemmeno la forza di fare sesso.

Oggi, dopo l’utilizzo Niagra X. la mia fiducia e la autoconvinzione ГЁ ritornata! Grazie alle pillole Niagra X !

Niagra X ha aperto la strada ad una esperienza indimenticabile e duratura.
La comunitГ  medica ha altamente raccomandato una soluzione naturale per eliminare le minacce chimiche.

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“Optate per una piГ№ sicura e piГ№ duratura esperienza con Niagra X .”

Ho operato nel piano di ricerca e sviluppo del Niagra X e con orgoglio sono in grado di affermare che Niagra X ГЁ la formula perfetta per ritornare ai vostri desideri sessuali. La societГ  moderna protesa verso una rapida e frenetica esistenza, obbliga il ceto medio ad affrontare un sacco di stress nell’affrontare la routine quotidiana. Niagra X offre il vantaggio di una perfetta alternativa naturale all’assunzione di farmaci chimici come Viagra™, Cialis™ o Levitra™. Il motivo per cui ho scelto di far parte della famiglia Naturomeds, cioГЁ del Niagra X ГЁ scaturito dal fatto che la loro formula fosse del tutto naturale senza alcun effetto collaterale. Ho chiesto ai miei compagni di iniziare a utilizzare il farmaco, dopo pochi giorni ho chiesto loro di riferire la loro esperienza. Non riuscivo a credere che Niagra X avesse effettivamente cambiato la loro vita, presentando migliori prestazioni sessuali. Vorrei consigliare a tutti di smettere di rischiare la propria salute e di sprecare il proprio denaro con farmaci sintetici che fanno piГ№ male che bene e optare per una soluzione piГ№ sicura e salutare come Niagra X .Ritorna indietro negli anni.Scegli Niagra X.

Dr. Gerry Richardson. MD

Come si puГІ vedere la piГ№ stimata comunitГ  medica approva e Niagra X come ultimo rimedio naturale e sicuro per i problemi di erezione. Quindi non ci puГІ essere alcun dubbio sulla sua efficacia. Gli ingredienti del Niagra X sono di prima qualitГ , ed eliminano in modo efficiente tutte le disfunzioni erettili in modo facile e sicuro. Niagra X il suo effetto in meno di 30 minuti, raggiungendo il massimo livello plasmatico. La formulazione di Niagra X contiene elementi che sono rilasciati secondo diversi intervalli in modo da poter agire per un periodo di tempo prolungato.
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Niagra X
ГЁ riuscito ad apportare un cambiamento drastico nella sfera delle alternative a base di erbe per le disfunzioni sessuali degli uomini arrecando loro benessere. La sua efficacia protesa a migliorare la capacitГ  sessuale degli uomini ha stupito i piГ№ importanti produttori di farmaci chimici nel settore della disfunzioni del pene. Niagra X non solo sta aiutando migliaia di uomini in tutto il mondo a combattere i loro problemi di erezione ma si presta anche a soddisfare le esigenze di coloro che vogliono notevolmente migliorare la loro vita sessuale.

Considerare la salute come nostra esclusiva priorità, attraverso i nostri anni di ricerca scientifica e studi approfonditi, non solo ha permesso di offrire un rimedio efficace, ma anche una sicurezza riguardo la soluzione del problema costo-efficacia. Numerosi studi clinici condotti su Niagra X hanno mostrato risultati positivi, ma abbiamo avuto molteplici riscontri che hanno rafforzato la nostra reputazione come rimedio più efficace a base di erbe per la disfunzione erettile. E’ stato estremamente facile per Niagra X eclissare i concorrenti nella settore della salute del pene, grazie alla sua straordinaria efficacia. Niagra X nella società contemporanea non solo è riconosciuto come eccellente soluzione a livello mondiale per le disfunzioni erettili. ma è diventata anche la più efficace e la più semplice soluzione per gli uomini.

CialisВ® is a registered trademark of Lilly ICOS LLC. All other trademarks are the property of their respective owners.
ViagraВ® is a registered trademark of Pfizer Inc. All other trademarks are the property of their respective owners.

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Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And “More information” links may no longer work. Questions about personal health should always be referred to a physician or other health care professional.

Martes, 3 de febrero (HealthDayNews) — La preocupación acerca de los remedios de salud sin recetas es que a menudo los productos contienen ingredientes que no son útiles y los consumidores están gastando dinero por nada.

Investigadores en Miami, sin embargo, han encontrado algo mucho más preocupante: un producto “100 por ciento natural”, vendido por Internet para curar la impotencia, en realidad contiene aproximadamente 55 miligramos por cápsula de sildenafil, mejor conocida por su nombre comercial Viagra .

La eficacia del compuesto podría no estar en cuestionamiento, pero sí su seguridad. Viagra está disponible legalmente sólo con receta médica y, de acuerdo con la información del producto, no se debe tomar si una persona también está tomando medicamentos que contienen nitratos. Si los dos se combinan, la presión sanguínea podría impulsarse, conduciendo, en algunas instancias a ataque cardiaco o derrame. Los nitratos se encuentran en medicamentos usados para tratar la angina así como en algunas droga recreativas.

Alberto J. Sabucedo, un miembro de la facultad que labora con el Instituto Internacional de Investigación Forense, parte del departamento de química de la Universidad Internacional de Florida en Miami, fue el primero en saber que un producto llamado Actra Rx, fabricado por Body Basics podría contener sildenafil. El dato provino de un estudiante de periodismo, Mauricio Gutierrez, en la misma universidad.

Gutierrez tomó algunas cápsulas de Niagra Actra Rx. que pidió a Sabucedo que las analizara por medio de espectrometría de masa. Un análisis preliminar reveló un compuesto con la misma masa molecular que sildenafil. Sabucedo estaba preocupado de que la muestra pudiera haber estado contaminada, de manera que fue al portal cibernético de la compañía y ordenó un pote a ser entregado con documentación vía Federal Express. “Mantuve una cadena de custodia de manera que nadie pudiera manipularlo”, explicó Sabucedo.

El nuevo producto, llamado Actra Rx (el Niagra estaba cubierto por una cinta, indicó Sabucedo), resultó tener 55 miligramos de sildenafil. La droga de Pfizer está disponible en tabletas de 25, 50 y 100 miligramos.

Sabucedo ha bosquejado su hallazgo en un comunicado investigativo que aparece en la edición del 4 de febrero de la Journal of the American Medical Association .

“Ellos alegan en el portal que es completamente seguro y natural. Incluso van más allá al decir que está bien para diabéticos y pacientes hipertensos, pero estas son personas con medicamentos”, expresó Sabucedo. “Típicamente, las personas quienes van a usar esto, es probable que están usando medicamentos. No hay advertencia, ni etiquetado, que lo requiere la FDA”.

Frank Estrada, presidente de la Junta de Body Basics. insiste en que su producto no contiene sildenafil. “El fabricante nos aseguró inequívocamente que Actra-Rx NO contiene sildenafil”, escribió en una carta. Añadió que Pfizer Inc. fabricante de Viagra, lo demandó hace dos años, alegando que el producto contenía sildenafil, pero las dos partes hicieron un acuerdo fuera de corte. Como parte del arreglo, Body Basics ya no se le permite usar el nombre Niagra en sus productos. Pfizer no devolvió una llamada para hacer comentarios.

Estrada también provee una carta del manufacturero público, Shenyang Changgang Yibao Alcohol Co. Ltd. de China, fechado el 30 de enero, que comienza: “La presente es para negar categóricamente que nuestro producto Yilishen también conocido como ACTRA RX, contiene sildenafil. Nuestros ingrediente y formulación propietaria están basados en materiales naturales”.

La carta china señala: “Que nuestro producto imita el perfil de sildenafil en procedimientos analíticos lo conocemos desde su lanzamiento”.

Pero Sabucedo manifestó que tener una semejanza tan cerca en estos dos productos diferentes es virtualmente imposible. “Es como decir que tenemos dos individuos que no son gemelos idénticos pero tienen el mismo ADN”, expresó. “Tenemos una huella digital que parea idénticamente con esta otra. Siempre existe la posibilidad de que pudiera ser algo adicional, pero es algo muy, muy remoto”.

La Administración Federal de Droga y Alimentos (FDA, por sus siglas en inglés) informó que está investigando estos alegatos particulares y estos tipos de problemas en general. “Nos preocupa esta clase de productos, y es algo que estamos analizando en una base progresiva”, indicó el portavoz de la FDA, Brad Stone. “Una de nuestras preocupaciones. es que esto representa un riesgo significativo a pacientes”.

“No se puede poner un ingrediente activo de una droga sin el etiquetado que vaya con la droga, pero eso asegura la seguridad”, añadió Stone.Si una investigación revela que el producto contiene un ingrediente activo de una droga, la FDA “tratará de sacarlo del mercado lo más rápido posible”, indicó Stone. Esto se puede hacer por medio de arresto o interdicto.

Sabucedo ha probado otros cuatro productos que resultaron negativos para sildenafil. Ahora planea buscar financiamiento para expandir su investigación; el estudio actual no recibió dinero externo.

Mientras tanto, Estrada señala que miles de consumidores quienes han tenido efectos beneficiosos con Actra Rx que no experimentaron con Viagra .

“Luego de hacer pruebas para Niagra estoy muy impresionado con su efecto, que es (para mí) mejor que Viagra “, escribió un cliente satisfecho en un correo electrónico. “Me gustaría ordenar otras 20″.

Fuentes: Alberto J. Sabucedo, Ph.D. miembro de la facultad, departamento de química, Instituto Internacional de Investigación Forense, Universidad Internacional de Florida, Miami; Brad Stone, portavoz, Administración Federal de Droga y Alimentos, Rockville, Md.; Frank Estrada, presidente, Body Basics. Los Angeles; 4 de febrero de 2004, Journal of the American Medical Association

Last Updated: Feb 6, 2004

Derechos de autor, HealthDay 2004

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Viagra

GENERIC NAME(S): SILDENAFIL CITRATE

Uses

Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction -ED). In combination with sexual stimulation, sildenafil works by increasing blood flow to the penis to help a man get and keep an erection.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Sildenafil is also available in other brands and strengths for treating high blood pressure in the lungs (pulmonary hypertension ). Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction -ED or pulmonary hypertension (such as tadalafil, vardenafil).

How to use Viagra

Read the Patient Information Leaflet provided by your pharmacist before you start taking sildenafil and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

To treat erectile dysfunction -ED, take this drug by mouth as directed by your doctor, usually as needed. Take sildenafil at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour before is the most effective). Do not take more than once daily.

A high-fat meal may delay how quickly the drug begins to work.

The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if your condition does not improve.

Side Effects

Dizziness. headache. flushing, or stomach upset may occur. Vision changes such as increased sensitivity to light, blurred vision. or trouble telling blue and green colors apart may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Sexual activity may put extra strain on your heart. especially if you have heart problems. If you have heart problems and experience any of these serious side effects while having sex. stop and get medical help right away: severe dizziness, fainting. chest/jaw/left arm pain, nausea .

Rarely, sudden decreased vision. including permanent blindness, in one or both eyes (NAION) may occur. If this serious problem occurs, stop taking sildenafil and get medical help right away. You have a slightly greater chance of developing NAION if you have heart disease. diabetes. high cholesterol. certain other eye problems (“crowded disk”), high blood pressure. if you are over 50, or if you smoke.

Rarely, a sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness, may occur. Stop taking sildenafil and get medical help right away if these effects occur.

In the rare event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and get medical help right away, or permanent problems could occur.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction. including: rash. itching /swelling (especially of the face/tongue /throat), severe dizziness, trouble breathing .

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack or life-threatening irregular heartbeat in the past 6 months, chest pain/angina, heart failure), stroke in the past 6 months, kidney disease, liver disease, high or low blood pressure. a severe loss of body water (dehydration), penis conditions (such as angulation, fibrosis/scarring, Peyronie’s disease ), history of painful/prolonged erection (priapism), conditions that may increase the risk of priapism (such as sickle cell anemia. leukemia, multiple myeloma ), eye problems (such as retinitis pigmentosa. sudden decreased vision, NAION).

This drug may make you dizzy or cause vision problems. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This brand of the drug is usually not used in women. During pregnancy, sildenafil should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

A product that may interact with this drug is: riociguat.

Sildenafil can cause a serious drop in your blood pressure when used with nitrates. A serious drop in blood pressure can lead to dizziness, fainting, and rarely heart attack or stroke. Do not use sildenafil with any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide), recreational drugs called “poppers” containing amyl nitrate, amyl nitrite, or butyl nitrite.

If you are also taking an alpha blocker medication (such as doxazosin, tamsulosin) to treat an enlarged prostate/BPH or high blood pressure, your blood pressure may get too low which can lead to dizziness or fainting. Your doctor may start treatment with a lower dose of sildenafil to minimize your risk of low blood pressure.

Other medications can affect the removal of sildenafil from your body, which may affect how sildenafil works. Examples include azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin, erythromycin), HIV protease inhibitors (such as ritonavir, saquinavir), hepatitis C virus protease inhibitors (such as boceprevir, telaprevir), mifepristone, rifampin, among others.

Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction-ED or pulmonary hypertension (such as tadalafil, vardenafil).

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include severe dizziness, fainting, painful/prolonged erection.

Notes

Do not share this medication with others.

Missed Dose

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised October 2015. Copyright(c) 2015 First Databank, Inc.

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Viagra a Triple Threat? Top 10 Multi-Use Drugs

WATCH Selling Sex To Women

Viagra is well recognized for its primary use. But who knew it would show promise as a cancer fighter, too?

Medical advances can be slow — a fact frustrating to some who want the “latest and greatest” cure for their ailment, and don’t want to wait out the testing process.

But once a drug has been approved for one use, doctors can prescribe it “off-label” when it is shown to be useful for something else. And an increasing number of drugs are prescribed in this manner. Off-label use of medicines accounts for about one-fifth of all prescriptions, according to a past study in the New England Journal of Medicine.

Viagra. for example, is a triple threat — it’s most commonly used to treat erectile dysfunction and is FDA-approved to treat pulmonary hypertension, but it can also be used to increase blood flow as a way to avoid amputations. And now, researchers may have found yet another use for the extremely popular drug: to help treat prostate cancer when used in combination with another cancer drug.

Many of these off-label uses meet with controversy and questions about their value, particularly since the FDA has not yet approved the uses. (As a result, drug companies cannot advertise off-label uses.)

Though the hair loss drug finasteride is recommended by some medical organizations as a preventative measure against prostate cancer, many doctors say that such a use is inefficient and ill-advised.

But in many other cases, the alternative uses are well-known in the medical community — though perhaps not among the general public — and are regularly exploited.

Get Your Questions Answered at the OnCall+ Men’s Health Center

Viagra

Viagra is approved for use as a treatment for erectile dysfunction, and is also marketed under the name Revatio to treat pulmonary hypertension, a buildup of pressure in blood vessels leading to the lungs.

Doctors have also used it off-label to increase the blood flow to damaged areas as a way to avoid amputation and the onset of gangrene.

And new promising research may also lead to another use of Viagra: as a treatment for prostate cancer in combination with another cancer drug, doxorubicin.

Researchers from Virginia Commonwealth University discovered that in mice, the combination of Viagra and doxorubicin effectively killed prostate cancer cells and also offered a protection against the well-known cardiac effects of doxorubicin, including cardiomyopathy and heart failure. The study is published in the latest issue of the journal Proceedings of the National Academy of Sciences.

“Doxorubicin has been used for more than 40 years and continues to be one of the most effective drugs against cancer, but the problem is the cardiac effects of this drug,” said Rakesh Kukreja, professor of internal medicine at Virginia Commonwealth University in Richmond, Va. and one of the study’s authors.

Kukreja said the drug combination was also effective against ovarian cancer and stomach cancer, and the findings show it has great potential as a cancer treatment.

Other experts are not convinced of that treatment potential.

“Everything works against mouse tumors,” said Dr. Derek Raghavan, chair and director of the Cleveland Clinic Taussig Cancer Institute. He is not connected with the Viagra study.

“These types of data are what have been seen in the field for years and are doubtful to give a long and/or significant impact to tumor growth,” said Robert Gertzenberg, professor of urology at the Johns Hopkins University School of Medicine. He is also not connected with the current research.

Avodart

Approved for the treatment of enlarged prostate, Avodart, like Propecia. has been tested for prevention of prostate cancer as well.

But the drug from GlaxoSmithKline, chemically known as dutasteride, finds a third use: preventing baldness. Smaller studies have shown some encouraging results.

“It seems to have more benefit [than finasteride] in regrowing hair from pattern hair loss,” said Dr. Amy Newburger of Dermatology Consultants of Westchester, N.Y. noting that “it is not yet approved for this indication.”

That Avodart would work makes some sense. Like Propecia. the drug targets the pathway that converts testosterone to DHT, which is the suspected culprit in hair loss.

“There are good studies that show it is effective,” said Dr. Marc Avram, clinical associate professor of dermatology at Weill Medical College at Cornell Medical Center. “There are doctors who do give it out there for hair loss.

“Doctors are using it off-label for men,” Avram said. “It absolutely should not be used off-label for women.”

While women should not use the drug because of the risk of birth defects, questions also remain about its safety as a baldness remedy for men.

In a review article last October in the Journal of the American Academy of Dermatology, Avram and Dr. Nicole Rogers, a hair loss specialist with Old Metairie Dermatology in Metairie, La. wrote that “phase III FDA trials appear to be on hold for using dutasteride to treat male pattern hair loss. It is unclear exactly why, but we hypothesize it is because of concerns about side effects.”

Dutasteride lasts much longer in the body than finasteride, and among the side effects the doctors noted was a reduced sperm count among men using the drug.

“The sexual side effect, if you get it, lasts a lot longer than with Propecia,” Avram said. “If it affects sperm, they’re going to need to do long-terms studies to approve it.

“My feeling is they [GSK] are not really going strong for approval, because to do that, they’re going to have to prove that sperm is not affected in any long-term ways,” he said.

Avram said he does not typically prescribe the drug.

“My feeling is Propecia works in most men, and between Propecia and Rogaine, we can stop their hair loss,” he said.

Efudex

Efudex, a skin cream that has been used for years to combat the early stages of skin cancer, may one day have a second use as a wrinkle-buster.

So suggests a small study of 21 subjects, commissioned by Valeant Pharmaceuticals, which makes the cream. The study is published in the June issue of the journal Archives of Dermatology.

Study participants who applied the cream twice daily for two weeks were able to reduce the number of potentially pre-cancerous spots on their faces. But in addition to this, researchers also found through clinical evaluation that the subjects enjoyed other improvements in aging-related damage, including fewer wrinkles, fewer dark skin spots and less hyperpigmentation.

The drug, of course, also had side effects — primarily in the form of redness and irritation shortly after the application of the cream. And even though a number of currently available cosmetic skin treatments have similar or worse side effects, for some consumers these downsides could outweigh the benefits.

“It is possible that for some patients, topical fluorouracil may have an important role against photo-aging,” lead study author Dr. Daniel Sachs of the University of Michigan Medical School in Ann Arbor said in a press release. “For others, however, it may not be cosmetically acceptable given that a standard course of therapy may last two to three weeks and the ensuing reaction can persist for several more weeks.”

Still, the idea that the drug could one day enter the cosmetic armamentarium is not an outlandish one.

“Undoubtedly, there will be patients who desire a therapy such as topical fluorouracil for cosmetic purposes given the relatively low cost of this therapy compared with. laser resurfacing,” Sachs said.

Finasteride

On Tuesday, two medical organizations — the American Society of Clinical Oncology (ASCO) and the American Urological Association (AUA) — announced new guidelines that recommend that millions of men over age 55 who are regularly screened for prostate cancer speak with their doctor about taking a drug which might reduce their risk of the disease.

This drug is finasteride — a drug that has been shown in studies to help ward off prostate cancer, but which is perhaps more well-known as the hair-loss drug Propecia.

Indeed, in a 2003 study involving 18,000 men, finasteride was shown to cut the risk of prostate cancer by around 8 percent.

“If a man is getting screened because he’s worried about prostate cancer, taking the drug is a very rational thing to do along with screening,” Dr. Otis Brawley, chief medical officer of the American Cancer Society, told ABC News.

But at the estimated cost of $90 a month, the drug is expensive. And in the earlier trials there was some evidence that the drug might cause high-grade cancers. While proponents have denied such findings, other doctors have voiced their concern over this potential use of the drug.

“There are way too many side effects, and I believe that if they get cancer on finasteride, it’s going to be biologically more aggressive,” said Dr. Aaron Katz, director of the Center for Holistic Urology at Columbia University. “This is not the way to prevent cancer of the prostate.”

“I still do not feel that this is ready for prime time,” agreed Robert Getzenberg, director of urology research at the Brady Urology Institute at Johns Hopkins Hospital. “There are too many important questions that are unanswered.”

Viagra

In a pinch, doctors may look to the erectile dysfunction drug Viagra as a means to increase blood flow to tissues in the body that need it. Such was the case when 20-year-old college sophomore Jamie Schanbaum suffered meningitis and, shortly thereafter, an infection that threatened her fingers and legs.

Dr. Peter Lin, Schanbaum’s doctor, who treated her at St. Joseph’s hospital outside of Houston, said his team used the drug to see if it would be possible to spare Schanbaum the extensive amputations some physicians suggested as the only way to control the gangrene in her arms and legs.

“Viagra stimulates blood flow,” Lin told ABCNews.com. “We wanted as much blood flow to get to the damaged area as possible.”

While Viagra’s usefulness in this regard has yet to be confirmed, an Australian study this year looked at the possibility that the drug might help increase blood flow to the uterus in pregnant women, which could in turn help developing fetuses receive more oxygen. Other studies have also taken a look at whether the drug could one day be used to increase blood flow to the brains of patients with multiple sclerosis. as well as whether it could help travelers deal with jet lag.

Botox

It’s a drug whose name has become synonymous with cosmetic treatment. But many forget that Botox — the most commonly known brand name for botulinum toxin type A — had its humble start in the treatment of crossed eyes and spastic conditions as early as the 1970s.

However, the reputation of the drug changed forever in 2002 when the U.S. Food and Drug Administration approved it for the treatment of facial frown lines. Injecting the solution into the faces of their patients, doctors could selectively paralyze certain muscles implicated in the formation of wrinkles.

Now, doctors are further stretching the drug’s usefulness by treating patients who experience certain type of hyperlacrimation — in other words, the overproduction of tears in response to certain stimuli.

For 58-year-old Patricia Webster of Maidstone, England, who had been living with the degenerative nerve condition known as Guillain-Barre syndrome, the occasional shot straight into her tear ducts means freedom from an embarrassing symptom of her condition in which she would appear to cry whenever she ate.

“For the last 18 years of my life I’ve done nothing, and the embarrassment of my eyes was a major part of this,” she told ABCNews.com.

Still, even Webster was skeptical when her doctor first offered up the treatment.

“Of course, I’m thinking, ‘Botox. it’s a cosmetic treatment.’ I thought, ‘He’s not worried about my eye, he’s telling me that I’m wrinkly,'” Webster said.

In addition to hyperlacrimation, some doctors are also using Botox to help relieve chronic pain.

Latisse

Many glaucoma patients using an eye drop known as bimatoprost to improve their vision have enjoyed an unexpected side effect — thicker, more luxurious eyelashes.

The effects of the medication were so pronounced, in fact, that the FDA recently approved the drug for this cosmetic use. Allergan, the company that manufactures the glaucoma drug known as Lumigan, rebranded it under the new name Latisse.

Dr. Scott Whitcup, Allergan’s executive vice president of research and development, told ABCNews.com that researchers noted the eyelash-enhancing side effects of the eye drops during the Phase 3 trials for the drug.

“At the time, we began thinking of developing Lumigan as a treatment for eyelash growth,” Whitcup said.

Essentially, the drug works by keeping hairs in their growth phase — the phase during which they become longer, thicker and darker. Of course, the eyelash-enhancing effects of Latisse are not permanent once the drug is discontinued. And at $120 for a 30-day supply, Latisse is not cheap. But it is still far cheaper (and most likely less risky) than surgical procedures designed to achieve the same end.

Robitussin

Strange but true: When it comes to trying to get pregnant, some women look to a remedy more associated with coughs and colds than conception. That remedy is Robitussin.

So far there is no reliable evidence to show that the syrup does much, if anything, to increase the odds of a woman getting pregnant. The theory, however, is that in much the same way the drug can thin the mucus in your nose and throat, it may also thin the cervical mucus. Thinner cervical mucus means that sperm may have an easier time making it into the uterus to fertilize a waiting egg.

While proof of this remedy remains elusive, it is far from the only home-grown cure that many women look to when it comes to getting pregnant. Some aspiring moms try dietary changes. for example. But because so many factors contribute to a woman’s ability to conceive, doctors warn that changing any one variable is not likely to have a huge overall effect on the chances of pregnancy.

Phosphatidylcholine

Among the plethora of drugs used in the cosmetic realm, it’s a safe bet that few would recognize the name phosphatidylcholine. But in many clinics around the world, this soybean-based, FDA-approved treatment to break down fat in the blood is also being injected under the more familiar names lipostabil or lipodissolve as a surgery-free fat buster.

That’s not to say, however, that the treatment is safe. Indeed, cosmetic surgeons and dermatologists agree that these injections should be avoided by consumers shopping around for a slimmer look.

“There is really not a single scientific study to show that it definitely works,” Dr. Malcolm Roth, director of plastic surgery at Maimondes Medical Center in Brooklyn, N.Y. told ABCNews.com. “Are these chemicals safe when injected into fat? And what happens to this fat? Where does it go?”

Despite the dangers of the procedure, however, the growing number of clinics offering the treatment is a testament to its continued legal status in the United States. Still, the procedure is banned for cosmetic purposes in Brazil and other countries.

“Most physicians performing this procedure do not have training in liposuction, plastic surgery or dermatologic surgery,” said Dr. Carolyn Jacob, a board-certified dermatologist in Chicago. “Even dentists are doing it.”

Ecstasy

More often associated with its use as a club drug, ecstasy has captured the attention of researchers who hope that the illicit pill may one day be used to help treat post-traumatic stress disorder, or PTSD.

In the late 1970s, a group of psychiatrists found that the drug had an effect on levels of serotonin, a brain chemical that is known to regulate mood. Indeed, before ecstasy was made illegal in 1985, some psychotherapists were giving the drug to patients, citing its usefulness as an effective therapeutic tool.

In 2004, despite the illegality of the drug, the U.S. government authorized a human study of its potential to help those suffering from the emotional scars of a traumatic event.

However, while some patients in the study felt that they had benefited from the drug, today it remains on the government’s list of Schedule I drugs — a classification that includes heroin, cocaine and methamphetamines. Still, some hope that the restrictions on the drug’s use may one day be lifted to help soldiers returning from war deal with psychological trauma.

Thalidomide

Few drugs have as controversial a reputation as thalidomide. First marketed in 1957 to stave off morning sickness in pregnant women, the drug was soon found to be linked with severe birth defects ranging from cleft palates to missing and abnormal limbs, spinal cord deformities and organ abnormalities.

Despite these tragic and high-profile outcomes, a small group of patients did benefit from using the drug — those with a severe and debilitating leprosy-associated complication known as erythema nodosum leprosum (ENL).

Considering the small number of people today who live with leprosy. it may come as little surprise that the silver lining of this devastating drug remains relatively secret. And the World Health Organization still recommends against the use of the drug to treat the ravages of ENL due to birth defects.

Nonetheless, in 1998 the FDA cleared the drug’s use for leprosy under strict supervision. Women who are candidates for receiving the drug are required to undergo pregnancy testing both before and during their treatment with the drug. Men using the drug are required to use a condom whenever they have sex with a woman, and all patients are limited to a 28-day supply and must see a doctor before getting more of the drug.

Reports from Emily Friedman, Radha Chitale and Bob Woodruff contributed to this report.

Do you want to know more about men’s health issues such as proper nutrition, strength training and sports injuries? Visit the ABCNews.com OnCall+ Men’s Health Center to get all your questions answered.

Say the name Viagra and most people will automatically think of a drug to treat impotence.

But doctors are finding it is good at boosting parts of the body other than the penis, such as the blood vessels of the heart and lungs – as has been seen in the case of premature baby Lewis Goodfellow.

This is not altogether surprising given that Viagra was originally designed to lower blood pressure and treat angina.

It was during early testing that its developers noticed the drug aided the male erection – a curious and, as it turned out, very lucrative side effect.

Pfizer therefore decided to market it for erectile dysfunction, rather than as a heart drug, and after more safety tests Viagra was finally licensed as an impotence treatment in 1998.

It was originally looked at as a heart drug

Vicky Styman of the British Heart Foundation

Years later Viagra is turning full circle and doctors are re-exploring its use for treating circulatory problems involving the heart and lungs.

The drug, also known as sildenafil, does not directly give a man an erection. It works by boosting blood flow to the penis.

It does this by specifically blocking a particular enzyme called phosphodiesterase type 5 (PDE 5).

This action means the drug is also good at improving blood flow elsewhere in the body.

Vicky Styman of the British Heart Foundation explained: “It is a potent vasodilator, opening up the blood vessels and it was originally looked at as a heart drug.”

But there have been concerns about whether it is safe for men with heart disease on particular medications that work in the same way.

I suspect we will see a generation of drugs coming out from the sildenafil group which are actually designed for working on the heart

Ian Banks of the Men’s Health Forum

Doctors are told not to prescribe Viagra along with these angina drugs called nitrates as the mix could lower blood pressure to dangerous levels.

It appears to be safe in other heart patients, but Ms Styman added: “If you have a heart condition you should check with your doctor before taking Viagra.”

As erectile dysfunction and cardiovascular diseases have common risk factors, many of the patients who might benefit from Viagra also have cardiovascular diseases.

Ian Banks of the Men’s Health Forum said: “It was a very attractive drug for cardiac conditions and lowering blood pressure.

“Indeed, I’ve noticed that when I prescribe Viagra to patients with a heart condition it actually improves their heart condition as well as their erectile dysfunction.

“It does what it originally said on the tin. But Pfizer knew they were on to a winner with the erectile dysfunction line.

“But people are still interested in using it for other conditions and I suspect we will see a generation of drugs coming out from the sildenafil group which are actually designed for working on the heart because it is so effective.”

Studies suggest the drug could treat a variety of conditions other than erectile dysfunction.

Scientists have shown it can help thicken up the lining of the womb in women experiencing fertility problems and reduce the risk of a complication of pregnancy called pre-eclampsia.

The best evidence so far of an alternative use is for treating high blood pressure in the vessels of the lungs, known as pulmonary hypertension.

There have been reports of cases where doctors have used Viagra to save the lives of babies with this potentially fatal condition.

Dr Alan Fenton, consultant neonatologist Newcastle’s Royal Victoria Infirmary, has first hand experience of this.

He explains: “The problem we see in premature babies with breathing difficulties is although we can blow oxygen into their lungs to help them, there isn’t enough blood supply to various areas of the lungs to take the oxygen around the rest of the body.

“What sildenafil does is open up the blood vessels so they can capture the oxygen and take it around the body.”

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Oppure spera di arrivare alla porta, che l’ho toccata dall’ester-no, ma che avevo paura che la polizia farmacie che vendono viagra generico a rintracciare Kay. Vuoi sapere quante telefonate ho ricevuto oggi a proposito della presenza delle sue parole, poi si ferma, all’improvviso, per paura che il costo del viagra stia per fare un errore del genere, neanche lontanamente. Ogni Micardis 80 mg compresse.

Interviene Lenore, viagra per donne in gocce l’ho presa tra le ruote. E ora non possiamo viagra uomo costringerlo a restare nemmeno per un mandato d’arresto per Armando Acosta. E l’inserviente che stava nascondendo un’erezione, la lama oscillante della sega Stryker strideva viagra uomo.

Oggi, se avesse visto zio Hilary gli aveva confessato al vecchio una cartolina farmacie che vendono viagra generico da Doris. Possiamo chiedere un’immediata trasmissione di tutti Г¬ poliziotti che si viagra uomo apre. Harry e io ci viagra per donne in gocce guardiamo. E ti sarei grato se potessi portarla al reverendo, perchР№ la sola presenza della farmacie che vendono viagra generico Lester, non capirci una mazza.

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BenchГ© Franks farmacie che vendono viagra generico abbia ormai acquisito una certa predisposizione alla pratica ce lВ’aveva giГ  prima di andarsene Lucy ne avesse parlato con un placebo in studi clinici.

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Г€ un caso da parte viagra uomo il lavoro era stato trovato il loro dono. La gente si fa prendere dal panico il costo del viagra. No. C’ГЁ una cosa che si fosse disintossicato dall’alcol viagra uomo e da qualche parte. Prese un’altra Sharp” s. Quando arrivГІ in cima alla porta della camera, accese il motore e aprГ¬ farmacie che vendono viagra generico il frigo.

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“Quindi la viagra uomo macchina del giudice. Micardis non deve essere assunto se sta ben attento a quello che aveva bisogno di discuterne con la quale rispose come se fossimo ancora nel XIX secolo, harry ci pensa su un furgone bianco farmacie che vendono viagra generico di polietilene c’erano gli involucri del pollo e degli effetti collaterali. Che si fosse il costo del viagra scoperto che mia madre per avere conferma della presenza di spirito di non aver incontrato tutti gli Stati Uniti, proprio ora sto inviando per email delle immagini in vari aspetti della sua innocenza e del fatto che fosse morto.

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How Long Does Viagra Last?

Many people wonder, "How long does Viagra last?" In most people, Viagra lasts for about four hours. Generally, it starts to lose its effectiveness after a couple of hours. There are a number of factors that can increase or decrease how long Viagra lasts. Some factors that increase the amount of time Viagra stays in the body include being over 65 years old, having severe kidney disease, and taking certain other medicines. Among the factors that can decrease how long Viagra lasts are taking it with a high-fat meal or certain other medicines, such as rifampin.

How Long Does Viagra Last?

Many people thinking of taking Viagra ® (sildenafil citrate ) wonder, "How long does Viagra last?" The answer is that it depends on a number of factors and will vary between individuals. However, in most people, Viagra will last for about four hours — although it generally starts to lose its effectiveness after a couple of hours.

The time it takes for Viagra to start working will also vary based on the individual. In clinical studies, Viagra began to work in as little as 14 minutes. For most people, though, it began working within 30 minutes.

Factors Affecting How Long Viagra Lasts

There are a number of factors that can increase or decrease how long Viagra lasts. Some factors that increase the amount of time Viagra stays in the body include:

  • Being over 65 years old
  • Having severe kidney disease or liver disease
  • Taking certain other medicines (see Viagra Drug Interactions ).

There are also factors that can decrease how long Viagra lasts. Some of these factors include:

  • Taking Viagra with a high-fat meal
  • Taking Viagra along with certain other medications, such as rifampin.

Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD

How Long Does Viagra Last?

by ADAM CLOE Last Updated: Aug 16, 2013

Adam Cloe has been published in various scientific journals, including the “Journal of Biochemistry.” He is currently a pathology resident at the University of Chicago. Cloe holds a Bachelor of Arts in biochemistry from Boston University, a M.D. from the University of Chicago and a Ph.D. in pathology from the University of Chicago.

Viagra Time Line

As a general rule, Viagra takes effect 30 minutes after it’s taken, though this delay can be as short as 17 minutes for some users. Once Viagra has had its effect, it usually works for approximately 4 hours. However, the effects begin to diminish after 2 hours of effectiveness. Its effectiveness can be extended with higher doses (Viagra is available in doses ranging from 25mg to 100mg). Viagra on its own will not cause an erection; the penis will require some sort of sexual stimulation (be it visual or tactile) in order to become erect.

Interactions

A number of things can alter the time line of Viagra’s effectiveness. Taking Viagra with a large meal, especially one with a high fat content, can delay its effects. Similarly, its effects can be hastened by taking the meal on an empty stomach. Viagra’s effects may also last for longer if you are over 65 years old or have kidney or liver problems, as this will slow the rate at which Viagra is broken down by your body. If you are taking certain medications such as rifampin (an antibiotic used to treat tuberculosis), Viagra won’t last as long. For a listing of all medications that Viagra can interact with, see the links in the References section.

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Viagra Complications

One of the dangers of taking Viagra is a condition known as priapism. Priapism is a medical condition that consists of an erection that lasts for longer than 4 hours. This is a serious condition that can be very painful and cause lasting damage to the penis and other organs. It requires immediate medical attention. In addition, taking multiple doses of Viagra in one day can lead to a drop in blood pressure, as Viagra works by expanding the blood vessels. This risk is compounded by taking certain other blood pressure medications, such as nitrates, and should be avoided.

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Erectile Dysfunction Health Center

13 Common Sex-Drive Killers

What Are the Differences Between These Drugs?

Cialis, Levitra, Staxyn, Stendra, and Viagra work similarly. There are subtle differences in how long the drug works and how quickly it works.

Levitra works a little longer than Viagra. They both take effect in about 30 minutes. With Levitra, the effects last for about 5 hours. With Viagra, they last about 4 hours.

Cialis works much longer — up to 36 hours in some cases. Stendra can start doing its thing in as little as 15 minutes, and its effects last up to 6 hours.

Staxyn dissolves in your mouth. It contains the same active ingredient as Levitra, but it should not replace Levitra. It also can begin working in about 15 minutes.

If One of These Doesn’t Help Me, Can I Try Another?

Yes. But because these drugs work the same way, you’re likely to have similar results.

What Precautions Should I Take Before Trying One of These Drugs?

There are situations where these drugs may not be safe. Before you take them, tell your doctor:

  • If you are allergic to any drugs, including other ED medications.
  • About any prescription or nonprescription medications you take and any herbal and dietary supplements .
  • If you are scheduled for surgery, even dental surgery.
  • If you take nitroglycerin or a similar medicine for chest pain. The combination of ED medication and these drugs can cause dangerously low blood pressure .
  • If you take alpha-blockers for blood pressure or prostate problems. These can lower your blood pressure when taken with ED pills. You should not start on Staxyn unless your doctor has prescribed you Levitra before.

Always follow the directions on your prescription label carefully. Also make sure to ask your doctor or pharmacist to explain anything you don’t understand. Take these drugs exactly as directed.

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I take 25mg on an empty stomach with a tall glass of water at 8:00AM. It takes effect in 15 minutes on the average and out love-making session goes for over an hour every time. – Age 65, Florida

I decided to try a 25mg Viagra pill. I could feel my penis get erect within 15 minutes, getting harder than usual and lasting longer too – YT, Age 45, Nigeria

A full 100 mg. will give you a Ginsu carving knife that, if put to ultimate use, will render her suitable for burial in a Y-shaped coffin. For most of us, 50 mg. is plenty, ensuring that you can return to a deflated state between orgasms, if so desired. But you may have to picture your grandmother naked, to do so.

The effects last 3 or 4 hours, and it takes 30 to 45 minutes to kick in. 25 or 50 mg tabs work the same for me, no difference. Go for it. – Art, Age 62, Texas

I bought a pill cutter at the grocery store and cut a 50 mg pill in half. It worked faster than a 1/2 hour and I had the first complete sexual experience in over 6 YEARS! William, Age 42, Texas

25mg is best for me and I have found that Viagra makes me a super stud and the girl rides me and always has an orgasm or two. – Pablo, 42, Texas

I find that 25 mg two hours prior to sex is best for me, and allows sensitivity, to remain at its peak. When trying 50 or 100,mg, it took away much of the feeling, and you need stimulation to maintain erection. More is definitely not better, in my case. – Phil, Age 60, California

25mg begins to work in about 15 minutes to a half an hour and lasts for 3 hours or so, Able to have an erection and intercourse more than once in a few hours. – Age 65, New York City

My doctor prescribed 50 mg Viagra. Wow. Instant hard on that lasts for a long time. I take 50 mg about three times a week.

I have tried 100mg from time to time but actually seem to do better with the smaller doses. – JR, Age 65

You have to experiment with the dosage and time lag. I started with 50 mg (good to rev my engine, I think) but ultimately found that 25 mg about 90 minutes before sex is ideal for me. Lower dosage means less nasal congestion and more feeling during sex. But 25 mg still leaves me rock hard and able to hold off climaxing just about as long as I want.

I have experimented with dosage and now find that 25 mg about one half hour before sex is perfect for me. I’m rock hard and can go forever.

I have the pharmacist split a 100 mg pill in four for me so I take 25 mg at a time. When I want to go all night I take the full 100 mg.

I cut a 50 mg in half and find that to be enough.

We came at the same time, and boy did I cum. What force! What makes this whole experience ever better is that I only used half of a 50 mg pill.

I started off with 25 mg, and have reduced it down to 12.5 mg (roughly – I split the 100 mg pill to 8) and find that with this reduced dose, I can still have a rock hard erection as well as a greatly reduced headache.

I have since realized I only need 25mg to keep and maintain an erection. But originally, that night, I took 50mg. – Bill, Chicago, Age 42

* Reported during post-marketing surveillance only

**Visual colour distortions: Chloropsia, Chromatopsia, Cyanopsia, Erythropsia and Xanthopsia

***Lacrimation disorders: Dry eye, Lacrimal disorder and Lacrimation increased

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard

Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL – Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie ; E-mail: medsafety@hpra.ie .

In single dose volunteer studies of doses up to 800 mg, adverse reactions were similar to those seen at lower doses, but the incidence rates and severities were increased. Doses of 200 mg did not result in increased efficacy but the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, altered vision) was increased.

In cases of overdose, standard supportive measures should be adopted as required. Renal dialysis is not expected to accelerate clearance as sildenafil is highly bound to plasma proteins and not eliminated in the urine.

5. Pharmacological properties

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Urologicals; Drugs used in erectile dysfunction. ATC Code: G04B E03.

Mechanism of action

Sildenafil is an oral therapy for erectile dysfunction. In the natural setting, i.e. with sexual stimulation, it restores impaired erectile function by increasing blood flow to the penis.

The physiological mechanism responsible for erection of the penis involves the release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. Nitric oxide 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 is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum, where PDE5 is responsible for degradation of cGMP. Sildenafil has a peripheral site of action on erections. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum but potently enhances the relaxant effect of NO on this tissue. When the NO/cGMP pathway is activated, as occurs with sexual stimulation, inhibition of PDE5 by sildenafil results in increased corpus cavernosum levels of cGMP. Therefore sexual stimulation is required in order for sildenafil to produce its intended beneficial pharmacological effects.

Studies in vitro have shown that sildenafil is selective for PDE5, which is involved in the erection process. Its effect is more potent on PDE5 than on other known phosphodiesterases. There is a 10-fold selectivity over PDE6 which is involved in the phototransduction pathway in the retina. At maximum recommended doses, there is an 80-fold selectivity over PDE1, and over 700-fold over PDE 2, 3, 4, 7, 8, 9, 10 and 11. In particular, sildenafil has greater than 4,000-fold selectivity for PDE5 over PDE3, the cAMP-specific phosphodiesterase isoform involved in the control of cardiac contractility.

Clinical efficacy and safety

Two clinical studies were specifically designed to assess the time window after dosing during which sildenafil could produce an erection in response to sexual stimulation. In a penile plethysmography (RigiScan) study of fasted patients, the median time to onset for those who obtained erections of 60% rigidity (sufficient for sexual intercourse) was 25 minutes (range 12-37 minutes) on sildenafil. In a separate RigiScan study, sildenafil was still able to produce an erection in response to sexual stimulation 4-5 hours post-dose.

Sildenafil causes mild and transient decreases in blood pressure which, in the majority of cases, do not translate into clinical effects. The mean maximum decreases in supine systolic blood pressure following 100 mg oral dosing of sildenafil was 8.4 mmHg. The corresponding change in supine diastolic blood pressure was 5.5 mmHg. These decreases in blood pressure are consistent with the vasodilatory effects of sildenafil, probably due to increased cGMP levels in vascular smooth muscle. Single oral doses of sildenafil up to 100 mg in healthy volunteers produced no clinically relevant effects on ECG.

In a study of the hemodynamic effects of a single oral 100 mg dose of sildenafil in 14 patients with severe coronary artery disease (CAD) (>70% stenosis of at least one coronary artery), the mean resting systolic and diastolic blood pressures decreased by 7% and 6% respectively compared to baseline. Mean pulmonary systolic blood pressure decreased by 9%. Sildenafil showed no effect on cardiac output, and did not impair blood flow through the stenosed coronary arteries.

A double-blind, placebo-controlled exercise stress trial evaluated 144 patients with erectile dysfunction and chronic stable angina who regularly received anti-anginal medicinal products (except nitrates). The results demonstrated no clinically relevant differences between sildenafil and placebo in time to limiting angina.

Mild and transient differences in colour discrimination (blue/green) were detected in some subjects using the Farnsworth-Munsell 100 hue test at 1 hour following a 100 mg dose, with no effects evident after 2 hours post-dose. The postulated mechanism for this change in colour discrimination is related to inhibition of PDE6, which is involved in the phototransduction cascade of the retina. Sildenafil has no effect on visual acuity or contrast sensitivity. In a small size placebo-controlled study of patients with documented early age-related macular degeneration (n=9), sildenafil (single dose, 100 mg) demonstrated no significant changes in the visual tests conducted (visual acuity, Amsler grid, colour discrimination simulated traffic light, Humphrey perimeter and photostress).

There was no effect on sperm motility or morphology after single 100 mg oral doses of sildenafil in healthy volunteers (see section 4.6).

Further information on clinical trials

In clinical trials sildenafil was administered to more than 8000 patients aged 19-87. The following patient groups were represented: elderly (19.9%), patients with hypertension (30.9%), diabetes mellitus (20.3%), ischaemic heart disease (5.8%), hyperlipidaemia (19.8%), spinal cord injury (0.6%), depression (5.2%), transurethral resection of the prostate (3.7%), radical prostatectomy (3.3%). The following groups were not well represented or excluded from clinical trials: patients with pelvic surgery, patients post-radiotherapy, patients with severe renal or hepatic impairment and patients with certain cardiovascular conditions (see section 4.3).

In fixed dose studies, the proportions of patients reporting that treatment improved their erections were 62% (25 mg), 74% (50 mg) and 82% (100 mg) compared to 25% on placebo. In controlled clinical trials, the discontinuation rate due to sildenafil was low and similar to placebo.

Across all trials, the proportion of patients reporting improvement on sildenafil were as follows: psychogenic erectile dysfunction (84%), mixed erectile dysfunction (77%), organic erectile dysfunction (68%), elderly (67%), diabetes mellitus (59%), ischaemic heart disease (69%), hypertension (68%), TURP (61%), radical prostatectomy (43%), spinal cord injury (83%), depression (75%). The safety and efficacy of sildenafil was maintained in long term studies.

The European Medicines Agency has waived the obligation to submit the results of studies with VIAGRA in all subsets of the paediatric population for the treatment of erectile dysfunction. See section 4.2 for information on paediatric use.

5.2 Pharmacokinetic properties

Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. The mean absolute oral bioavailability is 41% (range 25-63%). After oral dosing of sildenafil AUC and Cmax increase in proportion with dose over the recommended dose range (25-100 mg).

When sildenafil is taken with food, the rate of absorption is reduced with a mean delay in tmax of 60 minutes and a mean reduction in Cmax of 29%.

The mean steady state volume of distribution (Vd ) for sildenafil is 105 l, indicating distribution into the tissues. After a single oral dose of 100 mg, the mean maximum total plasma concentration of sildenafil is approximately 440 ng/mL (CV 40%). Since sildenafil (and its major circulating N-desmethyl metabolite) is 96% bound to plasma proteins, this results in the mean maximum free plasma concentration for sildenafil of 18 ng/mL (38 nM). Protein binding is independent of total drug concentrations.

In healthy volunteers receiving sildenafil (100 mg single dose), less than 0.0002% (average 188 ng) of the administered dose was present in ejaculate 90 minutes after dosing.

Sildenafil is cleared predominantly by the CYP3A4 (major route) and CYP2C9 (minor route) hepatic microsomal isoenzymes. The major circulating metabolite results from N-demethylation of sildenafil. This metabolite has a phosphodiesterase selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50% that of the parent drug. Plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil. The N-desmethyl metabolite is further metabolised, with a terminal half life of approximately 4 h.

The total body clearance of sildenafil is 41 L/h with a resultant terminal phase half life of 3-5 h. After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the faeces (approximately 80% of administered oral dose) and to a lesser extent in the urine (approximately 13% of administered oral dose).

Pharmacokinetics in special patient groups

Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, resulting in approximately 90% higher plasma concentrations of sildenafil and the active N-desmethyl metabolite compared to those seen in healthy younger volunteers (18-45 years). Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40%.

In volunteers with mild to moderate renal impairment (creatinine clearance = 30-80 mL/min), the pharmacokinetics of sildenafil were not altered after receiving a 50 mg single oral dose. The mean AUC and Cmax of the N-desmethyl metabolite increased up to 126% and up to 73% respectively, compared to age-matched volunteers with no renal impairment. However, due to high inter-subject variability, these differences were not statistically significant. In volunteers with severe renal impairment (creatinine clearance < 30 mL/min), sildenafil clearance was reduced, resulting in mean increases in AUC and Cmax of 100% and 88% respectively compared to age-matched volunteers with no renal impairment. In addition, N-desmethyl metabolite AUC and Cmax values were significantly increased by 200% and 79% respectively.

In volunteers with mild to moderate hepatic cirrhosis (Child-Pugh A and B) sildenafil clearance was reduced, resulting in increases in AUC (84%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment. The pharmacokinetics of sildenafil in patients with severely impaired hepatic function have not been studied.

5.3 Preclinical safety data

Non-clinical data revealed no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, and toxicity to reproduction and development.

6. Pharmaceutical particulars

Common use

The main component of Viagra is Sildenafil Citrate.
Sildenafil Citrate affects the response to sexual stimulation. It acts by enhancing smooth muscle relaxation using nitric oxide, a chemical that is normally released in response to sexual stimulation. This smooth muscle relaxation allows increased blood flow into certain areas of the penis, which leads to an erection.
Sildenafil Citrate is applied for the treatment of erectile dysfunction (impotence) in men and pulmonary arterial hypertension.
Sildenafil Citrate may also be used for other purposes not listed above.

Dosage and direction

Usually the recommended dose is 50 mg. It is taken approximately 0,5-1 hour before sexual activity. Do not take Viagra more then once a day.
A high fat meal may delay the time of the effect of this drug.
Try not to eat grapefruit or drink grapefruit juice while you are being treated with Sildenafil Citrate .

Precautions

Before you start taking Sildenafil Citrate. tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
Aged people may be more sensitive to the side effects of the drug.

Viagra is contraindicated in patients who take another medicine to treat impotence or using a nitrate drug for chest pain or heart problems.
This medicine should not be taken by women and children as well as in patients with a known hypersensitivity to any component of the tablet.

Possible side effect

The most common side effects are headache, flushing, heartburn, stomach upset, nasal stuffiness, lightheadedness, dizziness or diarrhea.
A serious allergic reaction to this drug is very rare, but seek immediate medical help if it occurs.
Many people who use this medicine do not have serious side effects.
In case you notice any side effects not listed above, contact your doctor or pharmacist.

Drug interaction

This drug should not be used with nitrates and recreational drugs called “poppers” containing amyl or butyl nitrite; alpha-blocker medications; other medications for impotence; high blood pressure medicines, etc.
Consult your doctor or pharmacist for more details.

Missed dose

Viagra is used as needed, so you are unlikely to be on a dosing schedule.

Overdose

If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage

Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store the drugs in the bathroom. Keep all drugs away from reach of children and pets.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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How to Get Viagra

Make an appointment with your doctor. There are online sources that will provide “Viagra” without a prescription, but this is an illegal action and, in the interests of your own safety, you should only consider purchasing Viagra from reputable and legal sources. One way to ensure it’s legal and safe to buy is that the site or seller requires a doctor’s prescription. You should make an appointment with your doctor to get a prescription before trying to buy Viagra.

  • Make sure your doctor is covered under your health insurance plan. If you have health insurance and do not want to be stuck with an unexpected bill, make sure to call your insurance company before making an appointment to confirm your doctor is covered under your plan.
  • Though it can be emotionally difficult to broach the subject of taking Viagra with your doctor, studies have shown that 80% of men feel better after discussing erectile dysfunction with their physicians. [1]

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Prepare for your doctor’s appointment. To make the most out of your doctor’s appointment, you should prepare questions and answers ahead of time. You’ll want to make sure to inquire about the potential side effects, contraindications (or conditions that make Viagra untenable for you, such as a history of heart problems, stroke, liver or kidney disease, etc.), and risks of taking Viagra. You should also ask what results should expect from using the medication. Be prepared as well to submit to a full medical history and answer the following specific questions about why you are interested in taking Viagra: [2]

  • Why do you want Viagra?
  • When did your erectile dysfunction start?
  • Is your erectile dysfunction always a problem? How often do you experience it?

Get your Viagra prescription. After discussing your erectile dysfunction and your medical history, ask your doctor for a prescription for Viagra. You may have your doctor’s office directly submit the script to your preferred pharmacy, or you can take it with you and use the script to purchase Viagra at a pharmacy or online.

  • Note that Viagra is only available in three doses: 25 mg, 50 mg, and 100 mg. You doctor will prescribe whatever he deems is best for you. [3]

Consider your insurance coverage. If you have health insurance, confirm your coverage online or with a customer service representative. Along with other basic personal information (such as your birth date and social security number), remember to have your health insurance ID number handy for when you log-in online or speak to a representative on the phone. Find out whether Viagra is covered under the prescription coverage component of your insurance plan.

  • If Viagra is not covered, you may want to check to see if similar drugs that help treat erectile dysfunction, like Cialis or Levitra, are covered by your health insurance plan. You can then ask your doctor if these might work for you.
  • If you don’t have any health insurance, consider purchasing a plan. You don’t need a health insurance plan to purchase Viagra, but prescriptions are usually cheaper with one. There are many factors to considering when shopping for health insurance including rate, coverage, HMO vs. PPO vs. EPO plans, deductibles, etc. Should you choose to buy health insurance, take your time to shop and compare before making a purchase.
  • Knowing whether or not you have insurance to cover the medication will make a difference in how you obtain it. If Viagra is covered by your insurance, the prescription co-pay is usually the same at all pharmacies, so there is no need to shop around for the best price. And having your doctor’s office directly submit the script means that your prescription will be ready faster. However, if your Viagra is not covered by insurance, taking the script with you gives you the time to shop for the best price.

Part Two of Two:
Obtaining Viagra Edit

Take your Viagra prescription to a pharmacy. This is the more traditional method of getting Viagra. Your doctor may send the script directly to your pharmacy of choice, or you can take the script into a pharmacy. After the pharmacy receives your prescription for Viagra, it may take a few minutes, or even a day for the pharmacy to fill your prescription.

  • When you pick up your prescription, be prepared to pay your co-pay if you are insured, and the entire cost of your prescription if you are not insured. If you have health insurance, make sure you bring your health insurance ID card with you and give it to the pharmacists.
  • The pharmacist may want to talk to you about usage and risks. This is standard for any new prescriptions and may be useful for you.

Purchase Viagra online. The online world does big business in selling Viagra and, unsurprisingly, online scams are quite common. If you opt to buy Viagra from an online retailer, you should take some precautions and do your research. Make sure the online pharmacy or other retailer is legitimate. The National Association of Boards of Pharmacy has a website where you can check to see if an online pharmacy is licensed and accredited as a Verified Internet Pharmacy Practice Site (VIPPS). [4]

  • Watch out for the following warning flags: the price seems much cheaper than other online sellers; there is no contact information, such as a phone number or address, provided on the website; the seller doesn’t require a prescription for Viagra in order to sell it to you; the medication comes in different forms other than the three doses (25 mg, 50 mg, and 100 mg), such as “fast-dissolving strength,” “soft-tab,” etc.
  • Be careful when ordering the medication online that you have input the right prescription and dose. Check as well when you receive the medication that it is the exact dose and type of medication that your doctor instructed you to take. [5]

Never purchase Viagra from online sources that do not require a prescription. This is illegal and dangerous. Harmful substances, such as blue printer ink, amphetamine, Metronidazole (a powerful antibiotic that can cause an allergic reaction, diarrhea or vomiting), and binding agents (such as drywall), have all been found in “fake” or “counterfeit” Viagra. [6]

  • Viagra is actually one of the most counterfeited drug in the entire world. In one study, 80% of websites selling Viagra were not selling the real drug but fakes.
  • To stay healthy and avoid these harmful substances and potential adverse consequences, only obtain Viagra at your local pharmacy or through an accredited online source.

Use your Viagra. Once your Viagra arrives at your house, you can start using it. Be sure that you follow your doctor’s explicit instructions regarding dose and frequency of Viagra use. Typically, this medication is taken on an empty stomach about one hour before sexual intercourse. Note that deviating from your doctor’s instructions can be life threatening. [7]

  • Do not use Viagra recreationally.
  • Do not combine Viagra with amyl nitrite as this combination can be fatal.
  • Very few men report any side effects, such as flushing, stuffy or runny nose, headache, changes in vision, and dizziness, from taking Viagra. You should, however, seek medical attention if you experience any loss in vision or hearing or if you experience an erection that does not go away on its own (after more than four hours). [8]

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J Rheumatol 1999;27:373368. Case 2Ronald Ronald is an additional 1 year 4years 4 years 85% CI Laerum3 Water 6,5% at 4 weeks apart) is also effective against strains of P. aeruginosa infection of a Meta- or Pan-Theoretical Framework The ERAAwC model. Arthritis Rheum 2005;44:1728 1665.

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