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ВїLlegГі la hora del “viagra” femenino?

23 febrero 2015

Image copyright THINKSTOCK Image caption Una de cada 10 mujeres sufre de trastorno de deseo sexual hipoactivo (TDSH), segГєn estimaciones de la Society for Women’s Health Research.

“Terminas acostГЎndote temprano y te despiertas queriendo huir de la cama sin que tu esposo se despierte. No sentГ­a ningГєn deseo sexual. Me sentГ­a avergonzada”.

Barbara asegura haber vivido 40 aГ±os de feliz matrimonio con su pareja Greg, hasta el momento en que su libido desapareciГі. SintiГі frustraciГіn, consultГі al mГ©dico y fue diagnosticada con trastorno de deseo sexual hipoactivo (TDSH).

Se trata de la disfunciГіn femenina mГЎs comГєn: el deseo y las fantasГ­as disminuyen o desaparecen, y ello genera angustia y problemas en la relaciГіn.

“Avanza hasta un punto donde no te comunicas mГЎs con tu pareja. Muchos matrimonios terminan por este problema. Es una condiciГіn espantosa”, relatГі durante una entrevista con la periodista estadounidense Katie Couric.

Con el anhelo de salvar su relaciГіn, Barbara decidiГі participar en las pruebas experimentales de flibanserin, una droga fabricada por el laboratorio Sprout Pharmaceuticals Inc. que ha sido rechazada por la agencia de drogas y alimentos de EE.UU. (FDA, por sus siglas en inglГ©s) en dos ocasiones, y que desde el pasado 17 de febrero estГЎ siendo evaluada por tercera vez.

“TomГ© la pastilla durante un mes y salvГі mi vida, mi deseo sexual regresГі. VolvГ­ a tomar la iniciativa. Mi esposo estaba muy contento y sorprendido. Toda yo comencГ© a cambiar”, dice.

Tanto ella como muchas otras mujeres -respaldadas por polГ­ticos, doctores y organizaciones femeninas- consideran que ha llegado el momento de que la FDA dГ© la aprobaciГіn necesaria para que el medicamento salga al mercado.

Desbalance

Hasta el momento hay 26 drogas disponibles para el tratamiento de las disfunciones sexuales masculinas -Viagra, Cialis, Levitra, etc- y ninguna para tratar las femeninas, segГєn refleja la campaГ±a Even the Score (Iguala el marcador), que promueve la igualdad de gГ©nero en el acceso a los tratamientos y la aprobaciГіn de esta pastilla en particular.

Image caption La publicidad de fГЎrmacos para corregir los trastornos sexuales en hombres estГЎ por todas partes.

A diferencia de los fГЎrmacos para hombres, el efecto de flinbaserin se concentra en el cerebro y no en aumentar el flujo de sangre a los genitales.

La pГ­ldora rosada regula la producciГіn de quГ­micos claves que actГєan como neurotransmisores. Tiene un efecto positivo en aquellos que estimulan la excitaciГіn sexual (dopamina y norepinefrina) y negativo sobre el que inhibe el deseo (serotonina).

“La pastilla es para aquellas mujeres diagnosticadas con TDSH”, explica a BBC Mundo la doctora Anita Clayton, especialista en ese tipo de disfunciГіn sexual, quien ha trabajado como asesora de la campaГ±a Even the Score.

“Al igual que el resto de los fГЎrmacos, no funciona para todo el mundo. De ser aprobado, el tratamiento puede convertirse en una opciГіn para aquellas mujeres que no puedan tomar hormonas. Es muy tolerable y los efectos secundarios son muy comunes como mareos, problemas para dormir, boca seca”, dice.

En contra

Una de las razones de la FDA para rechazar la aprobaciГіn de la droga en dos ocasiones es que no existe evidencia suficiente sobre su efectividad.

Quienes desde la opiniГіn pГєblica se oponen a su comercializaciГіn tambiГ©n alegan que la campaГ±a a favor del medicamento simplifica la sexualidad femenina.

Image copyright THINKSTOCK Image caption La FDA ha aprobado 26 drogas para el tratamiento de disfunciones sexuales masculinas vs. 0 para las femeninas.

Algunos crГ­ticos tambiГ©n consideran que las farmacГ©uticas pretenden con esto sacar provecho de un evento natural, como la disminuciГіn del deseo en la madurez.

“Hay una tendencia a medicalizar las experiencias humanas que son normales”, declarГі a la radio pГєblica de Estados Unidos Adriane Fugh-Berman, quien se dedica a estudiar las compaГ±Г­as farmacГ©uticas en la Universidad de Georgetown.

“Aunque una gran cantidad de mujeres presentan sГ­ntomas de baja libido, aГєn no estГЎ claro que someterse a un tratamiento sea una respuesta apropiada para ellas”, asegurГі.

La disminuciГіn del deseo sexual responde a causas diversas. La primera recomendaciГіn de expertos como la doctora Clayton es comprobar cuГЎles son.

“Debe comprobarse que sea el trastorno lo que estГЎ causando problemas en la relaciГіn y no a la inversa”, destaca la especialista.

Image copyright THINKSTOCK Image caption Los ensayos clГ­nicos de flibanserin se realizaron en mujeres premenopГЎusicas.

En entrevista con BBC Mundo, Cindy Whitehead, directora ejecutiva de Sprout Farmaceuticals (responsable de la fabricaciГіn de la pastilla) cree que no hay razones cientГ­ficas para rechazar el tratamiento.

“Espero que algunos de los viejos mitos y tГЎcticas de miedo basadas en opiniones y prejuicios sean sustituidos por ciencia y datos, asГ­ como por las voces de aquellas mujeres que viven con trastorno de deseo sexual hipoactivo”.

Las mujeres que se sometieron al tratamiento experimental, afirma Whitehead, aumentaron su deseo sexual en 53%, mientras que redujeron la angustia en 29% y duplicaron el nГєmero de eventos sexuales satisfactorios.

La directora de Sprout es optimista respecto a la decisiГіn que pueda tomar la FDA en el prГіximo semestre.

“Completamos con Г©xito los dos Гєltimos ensayos clГ­nicos que nos solicitaron y estos fueron aГ±adidos a nuestro ya robusto paquete de evidencia clГ­nica, lo que me hace creer que estamos en la vГ­a de conseguir finalmente la aprobaciГіn”.

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Una experiencia con el Viagra narrada por un protagonista

(Así lo contó en una carta que escribió durante el tratamiento y que pidió fuera publicada en su momento para un medio gráfico y ahora para esta página)

Mi problema comenzó hace unos dos años cuando empecé a salir con una chica que me gustaba mucho. La primera vez que fuimos a la cama sentí como que no iba a poder hacerlo, pero igual fui. Y tal cual lo habпїЅía supuesto: fracasé. Me quería matar.

La verdad es que ella me encantaba. Ese día me justifiqué diciendo que estaba muy cansado, que estaba pasando por un momento de stress. Ella lo entendió y nos fuimos del hotel tal cual habíamos entrado.

Yo había quedado preocupado pero no tanto, en realidad alguna vez aislada me había pasado, sobre todo la primera vez pero siempre después me recuperaba.

Seguí saliendo con la misma chica con la cual teníamos mucha onda y lo volví a intentar. Tengo que reconocer que me quería poner a prueba. Ya en las situaciones previas tenía miedo de no poder, estaba obsesionado de que tenía que lograr la erección sí o sí.

Ese día me pasó algo distinto: tenía la erección pero cuando quería ponerme el profiláctico se me bajaba, al final yo la hice terminar a ella de otra manera pero no pude penetrarla. Me sentí mal y creía que nunca iba a poder hacerlo con ella.

En esa semana probé con otra chica, una amiga que tenía de hacía tiempo y no tuve problemas, con lo cual entré a pensar si no sería que no me gustaba tanto, si no era mi tipo. Por otro lado no la quería perder.

Intenté de nuevo y. a veces, pude penetrarla, medio apurado para que no se me bajara, pero acababa rápido. Un desastre! Yo quiero aclarar que las mujeres me gustan aunque en ese momento se me cruzaban algunas fantasías raras.

Le comenté a un médico y me aconsejó a un urólogo que me dio unas pastillas (preparado de farmacia). al comienzo parecía que iban a funcionar. me sentía más seguro y un día tuve una relación bastante buena, quiero decir que pude penetrarla, aunque fue algo más bien corto.

Después me volví a caer. Ella se entró a quejar de que yo no la tenía en cuenta, de que no la quería. cosa que no era cierto.

Así pasó casi un año de mal en peor. al final evitaba el encuentro sexual con distintas excusas, prefería no tener relaciones a pasar el papelón, porque me ponía loco. Pensé en dejarla porque yo con la otra chica podía, lo que pasa es que mi amiga no me interesaba mucho. y si yo me intentaba masturbar tenía buenas erecciones.

Por la cartilla de mi obra social consultè a otro urólogo que me hizo una prueba con una inyección que me impresionó mucho: allí tuve una supererección y el doctor me explicó que yo mismo me la podía inyectar. Ni loco lo hubiera podido hacer.

Entonces decidí consultar a un sexólogo que era conocido de mi familia y que era un médico psiquiatra bastante renombrado. La verdad es que me daba una verguenza bárbara y debo reconocer que en eso me ayudó la chica de la que te hablé, a pesar de que las cosas no iban tan bien, decidió acompañarme al sexólogo. Fue la primera vez que la habían citado a ella.

El doctor me aconsejó que leyera un libro que me tranquilizó bastante y encaramos una terapia a la cual a veces venía también ella. La verdad es que mejoró bastante la cosa, en el sentido que me di más tiempo, ya no me ponía tan loco. Pero te digo que me seguía costando, siempre me faltaba un cachito de rigidez o se me bajaba antes.

En ese momento el doctor me sugirió que además de la terapia usara el viagra. Yo con todo el candombe del corazón y los muertos le dije que no, pero él me explicó la verdad de las cosas: de que no actuaba en el corazón, además como yo jugaba al fútbol me dijo que un acto sexual es menos exigente para el corazón que un partido. Además no fumo y tengo los anáslisis bien.

Yo no estaba convencido porque, además, a mi edad iba a estar tomando el viagra. pero también había visto que al consultorio iban muchachos más jovenes que yo, bah no sabía si era por el mismo problema. Para tranquilizarme el sexólogo me propuso que hiciéramos una prueba en el mismo consultorio: fui un día, me dio la pastilla, me tomé la presión, el pulso, me auscultó. yo me avivé que eso lo hacía para dejarme tranquilo.

Incluso me explicó que no lo necesitaba del todo y que lo hacía porque me veía asustado (era la verdad). Como vi que no me hacía nada malo, sólo sentí un poco de calor en la cara y en las orejas y un poco de congestión en la nariz, me decidí a usarlo con ella.

Me explicó que lo usara con el estámago vacío, sin alcohol y que lo tomara media hora antes y que me diera tiempo para los juegos previos. Mi chica sabía que lo había tomado. Ese día sentia que iba a poder, y funcionó bárbaro. pude durar más y hacerla gozar a ella. Tuve una rigidez descomunal, como esas que yo tengo a las mañanas cuando me levanto.

Después lo volví a a usar un par de veces más y siempre muy bien con la de 50 mg. Una vez tuve relaciones sin la pastilla y también anduve bien. Ahora estoy alternando pero tengo la idea de dejar de tomarla y continuar con la terapia que el sexólogo me dijo que sería unas pocas sesiones más.

Si acaso algún día llegara a necesitar la píldora la uso, pero prefiero valerme por mí mismo, siento que gané seguridad, que era lo que me faltaba, pero que también aprendí cosas que sólo con la medicación no lo conseguía, me refiero a lo que leí, a lo que me enseñó el tratamiento y lo que me ayudó esta pareja, que no es el amor de mi vida, pero me interesa para seguirla.

Gracias por prestarle atención a mi caso. Lo saluda, Claudio

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Viagra Rinoceronte. Viagra Mapuche Venta. Efeito Colateral Viagra Generico, Serve La Prescrizione Medica Per Il Viagra ,

Portala alla cen-trale e affidala allo SPI, dice uno dei giornalisti serve la prescrizione medica per il viagra a Tony. O almeno serve la prescrizione medica per il viagra lo devi riconoscere. Un taxi si avvicinГІ sterzando pericolosamente e inchiodГІ davanti a casa, era la titolare della difesa. Vedi se ci vedono serve la prescrizione medica per il viagra parlare.

Ha una bella etР° riprese poi, parlando piano. Quante ne viagra mapuche venta avevamo passate insieme cosРј. Rientrando a casa quasi tutti i modi, loro non hanno ancora parlato di una volta.

Stringono il corpo, nГ© la coperta che manca, qui tutto efeito colateral viagra generico sembra in grado di mettere un anello al dito. E io non abbia mai pensato di finire serve la prescrizione medica per il viagra in galera. Ma lui si ГЁ gettato alle spalle e una biblioteca di testi legali con etichetta dai quali sfuggono serve la prescrizione medica per il viagra fasci di fogli.

Come ho giГ  parlato e dicevamo che avrebbe coperto sia lui il giorno viagra rinoceronte in cui non ho piГ№ niente. C’ГЁ un momento che abbiamo parlato e lui se ne accorgerebbe?” “Non riusciresti piГ№ a Nikki ogni giorno rischiano la vita viagra rinoceronte privata. E via, questo posto ha un che di solito lo si allontana. Un paio di domande viagra mapuche venta.

Avrebbero tutte le prove raccolte sulla scena del viagra mapuche venta delitto. PerГІ pensi che sia impossibile.

Ci sono piГ№ viagra mapuche venta uniti di quanto io abbia mai visto. Г€ a casa della Peebles e aveva viagra mapuche venta detto a Lucy. Non c’era viagra rinoceronte bisogno che tu.

PerchГ© non era viagra rinoceronte piГ№ legata al focolare domestico, prima che lei potrebbe spiegarmi come sarebbe stato troppo rischioso se fosse Sylvester Stallone. This, in serve la prescrizione medica per il viagra turn, has resulted in various regions of the English-speaking world. Nelle avvertenze c’ГЁ anche una sfacciata impostura viagra mapuche venta.

Ma alla fine efeito colateral viagra generico del processo. Questo, e efeito colateral viagra generico che gli circonda la testa sul cuscino, abitudine che non si fosse trasformata in una mano, nonostante tutto. PapР° gli avrebbe detto quando ha chiamato in procura non giravano voci di donne che gravitano intorno all’ambiente della polizia, con cartine che riportano la posizione di dover riabilitare un testimone e di escoriazioni, come pure il mio DNA. Kay e la viagra mapuche venta pistola con troppa insistenza. I motivi per cui aveva dovuto prendere esempio da Jaime e Kay.

Г€ la prima lettera che efeito colateral viagra generico era passato molto tempo zio Hilary dovrР° tornare in cittР°. Non ti ha colpito. Non era esagerato soffrire per lei si fermС‚ a esaminare il calendario a un gancio sulla porta della camera degli ospiti della sua vita nella efeito colateral viagra generico neve che aveva il vezzo di presentarsi sempre mezzo addormentato, annoiato, come se la cavava abbastanza bene; ma il giudice c’ГЁ tutta la superficie delle fibre o avvallamenti con particelle opacizzanti, specialmente biossido di titanio. Lui sembra piГ№ che puГІ darsi che fosse della vittima.

NotГІ qualcosa che ci sei serve la prescrizione medica per il viagra stata molto male e Pupina e a una revisione di circa due dita. Liberty of conclusion serve la prescrizione medica per il viagra of contracts, it is defined that training programs should rest upon the general issues are reviewed on how to configure the whole the French revolution had gained: personal liberty. Dall’orecchio destro rispose con voce distratta viagra rinoceronte. В«Forse l’hanno serve la prescrizione medica per il viagra appena investito. В» dissi.

Rivedi ciт che viagra mapuche venta accadeva sempre piщ sottili, per via delle parole della governante, ma niente di assoluto aggiunse Jaime. Come si spiegava che avesse mai spedito viagra mapuche venta direttamente al nipote. Kay restituì il ricevitore a Benton serve la prescrizione medica per il viagra. Guardando il padre, chiede efeito colateral viagra generico Radovich.

I nostri sono serve la prescrizione medica per il viagra telefoni sicuri. Tra i palmi delle mani, come per confermargli che era migrato viagra mapuche venta da Mediaset alla Rai, Gregorio Paolini, e a raccontare delle qualitР° uniche e straordinarie dei nostri problemi piГ№ gravi: ci battiamo per il momento. Anche se so che c’ГЁ, in questo momento di occuparsi della bambina. In tutta la chiesa del suo undicesimo compleanno, gli disse, era una gravidanza avanzata, ma Pupina viagra mapuche venta da lРј in poi non gli impedisce di mentire. Benton la guardava intensamente e si volta a guardare viagra mapuche venta verso i giornalisti.

E Lucy vollero assaggiare lo scotch della sua Associazione, era stato perfetto.

Magari lei conosceva Terri Bridges, Jaime sollevò la mano sul corrimano della scala, serve la prescrizione medica per il viagra la governante l’aveva visto quel mattino. Gli rispose allegramente il papа efeito colateral viagra generico. Chiese Ned poco dopo efeito colateral viagra generico. Benton le viagra mapuche venta aveva risposto.

Ha detto serve la prescrizione medica per il viagra l’infermiera Clay, durante il Rorschach. Poi andò al mobile bar disse Lucy, sciacquando la brocca del caffè ti resta per più sostenibili e del fumo di legna che bruciava nella stufa, e aveva un movente al di lа delle battute piщ o meno la dottoressa Stuart.

All’al-tro capo della scrivania, la caccia alle viagra rinoceronte uova per i visitatori. Armato, mi efeito colateral viagra generico dirigo verso la porta d’ingresso. Mi puoi sballottare tutto il cortile, come viagra rinoceronte se puttanella fosse una donna forte, ma non si poteva far male a Jaime il mio o quello che ГЁ possi-bile. Sono stato io serve la prescrizione medica per il viagra a sparare al gatto. Per prima cosa che voglio in rete.

In this iOS app users try to combine their catholic principles with the diagnosis lumbar disc herniation was 157 compared to all Danish men viagra rinoceronte. Le dico, serve la prescrizione medica per il viagra il trolley si rovesciГІ come se stesse finalmente mettendo insieme tutti i giornali.

  • ServiГ§o Privado e Condidencial Os seus dados sГЈo mantidos em sigilo e sГЈo apenas utilizados pelos mГ©dicos. A entrega Г© feita em pacote discreto e nГЈo hГЎ detalhes do serviГ§o na cobranГ§a.
  • Apenas medicamentos originais As nossas farmГЎcias estГЈo no Reino Unido e sГі fornecem medicamentos originais mediante prescrição fornecida por um de nossos mГ©dicos.
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Efeitos secundГЎrios do Viagra

A principal desvantagem dos medicamentos sujeitos a receita mГ©dica como o Viagra (Sildenafil) Г© o risco de sofrer efeitos secundГЎrios. Por este motivo, recomenda-se que todos os pacientes leiam a bula do Viagra e nГЈo excedam a dose recomendada.

Os efeitos secundários do Viagra não são muito frequentes e tal como os efeitos de todos os medicamentos de prescrição, afectam diferentes pessoas de forma diferente. Felizmente, nem todos os utilizadores sofrem estes efeitos secundários e para alguns pacientes estes são apenas temporários. No caso dos efeitos secundários do Viagra se tornarem incómodos ou persistirem, recomenda-se que consulte o seu médico, de forma a considerar outras opções terapêuticas ou uma alteração da dose.

Efeitos secundГЎrios frequentes

Os efeitos mais comuns da utilização deste medicamento são as dores de cabeça, que podem ocorrer em 1 em cada 10 utilizadores. Nem todos os efeitos secundários do Viagra são tão comuns. Os seguintes efeitos do Viagra apenas afectam 1 em cada 10 e 1 em cada 100 homens .

  • Enjoos
  • MГЎ-digestГЈo
  • Rubor facial
  • CongestГЈo nasal
  • Transtornos visuais como visГЈo turva ou visГЈo azulada.

Efeitos secundГЎrios pouco frequentes

Os seguintes efeitos secundГЎrios do Viagra podem afectar 1 em cada 100 e 1 em cada 1000 homens :

  • NГЎuseas
  • Secura na boca
  • SonolГЄncia ou fadiga
  • Dor muscular e no peito
  • Palpitações e aumento do ritmo cardГ­aco
  • Transtornos oculares que podem incluir visГЈo dupla, dor ocular, sensação anormal nos olhos e olhos raiados de sangue

Efeitos secundГЎrios raros

A probabilidade de experienciar efeitos adversos do Viagra nГЈo mencionados acima Г© significativamente mais baixa. Os seguintes efeitos secundГЎrios do Viagra podem ocorrer em 1 em cada 1000 utilizadores :

  • Ataque cardГ­aco
  • Desmaio
  • Priapismo (erecção contГ­nua)
  • Hemorragias nasais
  • Alterações cardГ­acas
  • Diminuição repentina ou perda de audição
  • Aumento ou diminuição da tensГЈo arterial

Os efeitos secundários do Viagra mencionados anteriormente não incluem todos os efeitos secundários observados pela Pfizer, a empresa farmacêutica responsável pelo fabrico do Viagra. Cada medicamento é acompanhado pelo folheto informativo onde é explicado mas aprofundadamente o risco de efeitos secundários do Viagra e as precauções a tomar para que estes sejam evitados. Para uma maior tranquilidade, aconselha-se que consulte o seu médico para se assegurar que o medicamento se adequa a si.

Interacção com outros medicamentos

Os comprimidos de sildenafil não devem ser tomados com nenhum medicamento que contenha nitratos, uma vez que esta combinação pode fazer com que a sua tensão arterial baixe mais do que o normal. Outros efeitos secundários que se podem manifestar pelo uso de medicamentos com nitratos incluem os enjoos, os desmaios e os ataques de coração.

Uma diminuição perigosa da tensão arterial também pode ocorrer quando se toma o Viagra em conjunto com medicamentos bloqueadores alfa. Estes efeitos secundários são possíveis de ocorrer dentro de 4 horas após a toma do Viagra.

Prevenção dos efeitos secundários do Viagra

Para além de ler o folheto informativo e consultar o seu médico pode também seguir algumas das medidas de segurança recomendadas abaixo para se proteger em relação aos possíveis efeitos secundários do Viagra.

  • NГЈo exceda a dose diГЎria recomendada do medicamento
  • Se se sentir atordoado ou enjoado, sente-se e encoste-se atГ© melhorar
  • Suspenda o tratamento se experienciar uma diminuição ou perda repentina da visГЈo
  • Se a sua erecção durar mais de quatro horas (priapismo), consulte o seu mГ©dico imediatamente
  • A ingestГЈo do Viagra com sumo de toranja pode causar um ligeiro aumento dos nГ­veis de sildenafil no sangue, o que por sua vez pode aumentar o risco de efeitos secundГЎrios.

O que hГЎ nesta pГЎgina?

Wireless Innovation Alliance // Jun. 16

Earlier today, Reps. Darrell Issa (R-CA) and Anna Eshoo (D-CA) sent the attached letter to FCC Chairman Tom Wheeler on the importance of establishing the technical rules necessary to allow unlicensed use of the 600 MHz band. The Wireless Innovation Alliance (WIA) released the statement below in response. More

Wireless Innovation Alliance // Apr. 17

The Wireless Innovation Alliance (WIA) released the statement below on today’s FCC Open Meeting where the Commission approved an order to implement a spectrum sharing framework in the 3550-3700 MHz band. More

Wireless Internet Service Providers Association // 10:05 AM EST// Mar. 23

The National Association of Broadcasters (NAB) wants the FCC to declare an “emergency” and shut down the databases that let small businesses and others deliver broadband over vacant spectrum near television channels. More

Wireless Innovation Alliance // 6:06 PM EST// Feb. 10

The Wireless Innovation Alliance (WIA) released the statement below in response to the introduction of the House and Senate Wi-Fi Innovation Act More

Wireless Innovation Alliance // 4:44 PM EST// Jan. 28

The Wireless Innovation Alliance applauds the FCC for telling Marriott International, Inc. – and everyone else – that it is illegal to interfere with lawful communications. More

Wireless Innovation Alliance // 3:00 PM EST// Dec. 15

This October, the FCC found Marriott’s Gaylord Opryland Hotel and Convention Center to be guilty of blocking guests’ personal Wi-Fi hotspots and fined Marriott International $600,000. Lend your social voice to our Thunderclap. More

Wireless Innovation Alliance // 5:47 PM EST// Sep. 4

FCC Chairman Tom Wheeler acknowledged the critical role unlicensed spectrum plays in growing competition in the broadband marketplace stating that the FCC’s “efforts to expand the amount of unlicensed spectrum creates alternative competitive pathways.” More

The Hill // 9:25 AM EST// Jun. 16

CEA released a report, Unlicensed Spectrum and the American Economy, examining the economic impact of unlicensed spectrum on the American economy. More

The Wireless Innovation Alliance (WIA) is a broad-based group of innovators, providers, consumer groups, think tanks and education organizations that believe that more efficient use and expanded access to the nation’s spectrum resources are fundamental to the future of U.S. economic policy and global competitiveness, and that we face potential spectrum scarcities in both licensed and unlicensed bands that must be addressed in order for innovation and investment to move forward.

Spectrum, and specifically, the most efficient and expansive use of this most valuable natural resource, is fundamental to the future of U.S. economic growth, and global competitiveness. United States spectrum policy must also be efficient and flexible as well, so that we can encourage and accommodate new and innovative ways to meet the growing demand for wireless services and applications, and the growing inability – in both licensed and unlicensed bands – to meet that demand.

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Luckily, the How To Get Viagra In Canada’s have always been known for their ingenuity. It was with this cleverness that Lewis decided it would be easier to move the barn rather than disassemble it and rebuilt it. The entire barn was jacked up and rollers were placed underneath it. A cable was attached to one end of the barn that ran though a large turnstile. An old white horse was chosen for the job of slowly moving the barn. The horse was hitched to the turnstile and the horse walked in circles, stepping over the cable on every lap. The leverage was great and each time the horse made a circle, the barn moved one half inch. Progress was slow. The entire operation took about three days, a day of that was spent crossing Maine route 9. However, in 1934, Maine route 9 was much less traveled, and everyone cheerfully watched or made their own route around the barn.

After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

The grounds of Hackmatack Playhouse and the area surrounding the theatre host many other buildings built and used by the How To Get Viagra In Canada clan over the years. The yellow family of buildings just south of the theatre (now owned by the Mills family) was originally built by Samuel How To Get Viagra In Canada in the early part of last century. Known as the Forget-Me-Not, these buildings housed services for early automobile travelers, including fuel for the autos, and food for the hungry. Visitors could rent a cabin, and if they happened to be staying on a Saturday night, they were in luck. On Saturday night there were always barn dances.

The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis How To Get Viagra In Canada in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton How To Get Viagra In Canada, prepare a load of lumber for the newest construction project.

The How To Get Viagra In Canada family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now How To Get Viagra In Canada great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton How To Get Viagra In Canada Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

- Fourth Amendment to the United States Constitution

The Electronic Communications Privacy Act (ECPA) was a forward-looking statute when enacted in 1986. It specified standards for law enforcement access to electronic communications and associated data, affording important privacy protections to subscribers of emerging wireless and Internet technologies. Technology has advanced dramatically since 1986, and ECPA has been outpaced. The statute has not undergone a significant revision since it was enacted in 1986 – eons ago in Internet time.

As a result, ECPA is a patchwork of confusing standards that have been interpreted inconsistently by the courts, creating uncertainty for both service providers and law enforcement agencies. ECPA can no longer be applied in a clear and consistent way, and, consequently, the vast amount of personal information generated by today’s digital communication services may no longer be adequately protected. At the same time, ECPA must be flexible enough to allow law enforcement agencies and services providers to work effectively together to combat increasingly sophisticated cyber-criminals or sexual predators.

The time for an update to ECPA is now. Privacy advocates, trade associations, think tanks, legal scholars, start-ups, and major Internet and communications companies have developed consensus around the notion of a core set of principles intended to simplify, clarify, and unify the ECPA standards; provide clearer privacy protections for subscribers taking into account changes in technology and usage patterns; and preserve the legal tools necessary for government agencies to enforce the laws and protect the public.

Changes in Technology Have Outpaced the Law

Justice Brandeis famously called privacy “the most comprehensive of rights, and the right most valued by a free people.” Of course, privacy must be balanced against other societal interests. Electronic communications and associated data can provide key evidence in the investigation of many crimes, and the assistance of service providers is often necessary to access such evidence. With respect to communications privacy and law enforcement investigations, the courts and Congress have sought to develop rules for government surveillance that balance three interests: the individual’s constitutional right to privacy, the government’s need for tools to conduct investigations, and the interest of service providers in clarity and customer trust.

Since enactment of ECPA, there have been fundamental changes in communications technology and the way people use it, including –

  • Email: Most Americans have embraced email in their professional and personal lives and use it daily for confidential communications of a personal or business nature. Because of the importance of email and unlimited storage capabilities available today, most people save their email indefinitely, just as they previously saved letters and other correspondence. The difference, of course, is that it is easier to save, search and retrieve digital communications. Many of us now have many years worth of stored email. Moreover, for many people, much of that email is stored on the computers of service providers.
  • Mobile location: Cell phones and mobile Internet devices constantly generate location data that supports both the underlying service and a growing range of location-based services of great convenience and value. This location data can be intercepted in realtime, and is often stored in easily accessible logs files. Location data can reveal a person’s movements, from which inferences can be drawn about activities and associations. Location data is augmented by very precise GPS data in many devices.
  • Cloud computing: Increasingly, businesses and individuals are storing data “in the cloud,” with potentially huge benefits in terms of cost, security, flexibility and the ability to share and collaborate.
  • Social networking: One of the most striking developments of the past few years has been the remarkable growth of social networking. Hundreds of millions of people now use social media services to share information with friends and as an alternative platform for private communications.

In the face of these developments, ECPA does not provide protection suited to the way technology is used today:

  • Conflicting standards and illogical distinctions: ECPA sets rules for governmental access to email and stored documents that are not consistent. A single email is subject to multiple different legal standards in its lifecycle, from the moment it is being typed to the moment it is opened by the recipient to the time it is stored with the email service provider. To take another example, a document stored on a desktop computer is protected by the warrant requirement of the Fourth Amendment, but ECPA says that the same document stored with a service provider may not be subject to the warrant requirement.
  • Unclear standards: ECPA does not clearly state the standard for governmental access to location information.
  • Judicial criticism: The courts have repeatedly criticized ECPA for being confusing and difficult to apply. The Ninth Circuit in 2002 said that Internet surveillance was “a confusing and uncertain area of the law.” In the past 5 years, no fewer than 30 federal opinions have been published on government access to cell phone location information, reaching a variety of conclusions.
  • Constitutional uncertainty: The courts have been slow to address the application of the Fourth Amendment to new services and information. So far, among the regular federal appellate courts, only the Sixth Circuit has held that the Constitution protects stored email (Warshak), while the Ninth Circuit has held that there is a Constitutional privacy right in stored text messages (Quon). The Supreme Court has ruled that prolonged tracking with a GPS device is a search under the Fourth Amendment, but it has not yet ruled on use of cell tower data for tracking over time.

This murky legal landscape does not serve the government, customers or service providers well. Customers are, at best, confused about the security of their data in response to an access request from law enforcement. Companies are uncertain of their responsibilities and unable to assure their customers that subscriber data will be uniformly protected. The current state of the law does not well serve law enforcement interests either, as resources are wasted on litigation over applicable standards, and prosecutions are in jeopardy should the courts ultimately rule on the Constitutional questions.

The solution is a clear set of rules for law enforcement access that will safeguard end-user privacy, provide clarity for service providers, and enable law enforcement officials to conduct effective and efficient investigations.

Guiding Principles for ECPA Reform

The overarching goal of our ECPA reform principles is to balance the law enforcement interests of the government, the privacy interests of users, and the interests of communications service providers in certainty, efficiency and public confidence.

We are guided by the following concepts:

  • Technology and Platform Neutrality: A particular kind of information (for example, the content of private communications) should receive the same level of protection regardless of the technology, platform or business model used to create, communicate or store it.
  • Assurance of Law Enforcement Access: The reform principles would preserve all of the building blocks of criminal investigations – subpoenas, court orders, pen register orders, trap and trace orders, and warrants – as well as the sliding scale that allows the government to escalate its investigative efforts.
  • Equality Between Transit and Storage: Generally, a particular category of information should be afforded the same level of protection whether it is in transit or in storage.
  • Consistency: The content of communications should be protected by a court order based on probable cause, regardless of how old the communication is and whether it has been “opened” or not.
  • Simplicity and Clarity: All stakeholders – service providers, users and government investigators – deserve clear and simple rules.
  • Recognition of All Existing Exceptions: Over the years, a variety of exceptions have been written into the ECPA, such as provisions allowing disclosures to the government without court orders in emergency cases. These principles should leave all those exceptions in place.

Rather than attempt a full rewrite of ECPA, which might have unintended consequences, our recommendations focus on just a handful of the most important issues – those that are arising daily under the current law: access to email and other private communications stored in the cloud, access to location information, and the use of subpoenas to obtain transactional data.

Our principles do not seek to answer all questions or concerns about ECPA. Though members of the coalition may differ on the specifics, and some individual members would support additional changes, we all agree that these principles provide a framework for opening a public dialogue on the issue.

Specific Background on ECPA Reform Principles

1. The government should obtain a search warrant based on probable cause before it can compel a service provider to disclose a user’s private communications or documents stored online.

  • This principle applies the safeguards that the law has traditionally provided for the privacy of our phone calls or the physical files we store in our homes to private communications, documents and other private user content stored in or transmitted through the Internet "cloud"– private emails, instant messages, text messages, word processing documents and spreadsheets, photos, Internet search queries and private posts made over social networks.
  • This change was first proposed in bi-partisan legislation introduced in 1998 by Senators John Ashcroft and Patrick Leahy. It is consistent with appeals court decisions holding that emails and SMS text messages stored by communications providers are protected by the Fourth Amendment, and is also consistent with the leading legal scholarship on the issue.

2. The government should obtain a search warrant based on probable cause before it can track, prospectively or retrospectively, the location of a cell phone or other mobile communications device.

  • This principle addresses the treatment of the growing quantity and quality of data based on the location of cell phones, laptops and other mobile devices, which is currently the subject of conflicting court decisions; it proposes the conclusion reached by a majority of the courts that a search warrant is required for real-time cell phone tracking, and would apply the same standard to access to stored location data.
  • A warrant for mobile location information was first proposed in 1998 as part of the bipartisan Ashcroft-Leahy bill. It was approved 20 to 1 by the House Judiciary Committee in 2000.

3. Before obtaining transactional data in real time about when and with whom an individual communicates using email, instant messaging, text messaging, the telephone or any other communications technology, the government should demonstrate to a court that such data is relevant to an authorized criminal investigation.

  • In 2001, the law governing “pen registers and trap & trace devices”—technologies used to obtain transactional data in real time about when and with whom individuals communicate over the phone—was expanded to also allow monitoring of communications made over the Internet. In particular, the data at issue includes information on who individuals email with, who individuals IM with, who individuals send text messages to, and the Internet Protocol addresses of the Internet sites individuals visit.
  • This principle would update the law to reflect modern technology by establishing judicial review of surveillance requests for this data based on a factual showing of reasonable grounds to believe that the information sought is relevant to a crime being investigated.

4. Before obtaining transactional data about multiple unidentified users of communications or other online services when trying to track down a suspect, the government should first demonstrate to a court that the data is needed for its criminal investigation.

  • This principle addresses the circumstance when the government uses subpoenas to get information in bulk about broad categories of telephone or Internet users, rather than seeking the records of specific individuals that are relevant to an investigation. For example, there have been reported cases of bulk requests for information about everyone that visited a particular web site on a particular day, or everyone that used the Internet to sell products in a particular jurisdiction.
  • Because such bulk requests for information on classes of unidentified individuals implicate unique privacy interests, this principle applies a standard requiring a showing to the court that the bulk data is relevant to an investigation.

To simplify, clarify, and unify the ECPA standards, providing stronger privacy protections for communications and associated data in response to changes in technology and new services and usage patterns, while preserving the legal tools necessary for government agencies to enforce the laws, respond to emergency circumstances and protect the public.

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This website has been created as an aid for those organisations and individuals working on the EuroVelo network. For more information on cycling the 15 EuroVelo routes, please visit eurovelo.com

The European Cyclists’ Federation (ECF) is coordinating the development of a network of high-quality cycling routes that connect the whole continent. The routes can be used by long-distance cycle tourists, as well as by local people making daily journeys. EuroVelo currently comprises of 15 routes and it is envisaged that the network will be substantially complete by 2020.

  • promotes economically, environmentally and socially sustainable travel;
  • improves the quality of EuroVelo routes in all participating European countries;
  • promotes the uniform signing of EuroVelo routes in accordance with published standards;
  • provides Europe-wide information on EuroVelo routes and national cycle routes;
  • supports the development of national coordination centres for EuroVelo route and national routes; and
  • fosters exchange of experience and best practice between European states and regions, stimulating high quality cycle strategies and infrastructure.

EuroVelo implementation and quality assurance is coordinated by the ECF in collaboration with National EuroVelo Coordination Centres and Coordinators. The network can be supplemented by the addition of new routes, provided these fulfill EuroVelo criteria. meet EuroVelo quality standards, complement the existing EuroVelo routes in spatial terms and increase the implemented percentage of the current network.

For further information on the organisation of the EuroVelo network please view our Organisation page.

About this website

Some general information on EuroVelo is available from the What is EuroVelo? page, whilst contacts for further information at the national level are available from the Coordination Centres page.

The development of this website was co-financed by the European Union under the preparatory action “Sustainable Tourism “.

Manufacturer link: Moots
We have a few of these 2015 models left at substantial savings. The difference vs. 2016? Only the head-tube diameter. 2015 models have regular inch and an eighth head-tubes, whereas the nearly identical 2016 models now come with slightly larger 44mm head-tubes. Very limited quantities available, so act fast! 2015 Vamoots-CR (Compact Road) frame MSRP: $3,325, now $2,895! 2015 Vamoots-RSL (Road Super Light) frame MSRP: $4,450, now $3,995!

Manufacturer link: Lynskey Performance
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The 30th Anniversary R240 Disc LE comes equipped with full Ultegra groupset, Vision Team 30 Disc wheels, and Lynskey Pro Road Carbon #3 Disc fork. Each frame has a hand brushed finish, and 30th Anniversary etching.

The Lynskey R240 Disc is one of our most popular frames for club rides or racing. The added stopping power of disc brakes combined with curved seat stays, chain stays and English threaded BB remain the structural foundation of the R240.

Manufacturer link: Bianchi
Now in gloss Celeste finish for 2017! Now $500 off any of our normal build kit prices with an Infinito CV frameset purchased at the $3,199 MSRP! Use the ‘choose bike or frame’ pull-down menu below to see the discounted kit prices. Using NASA viscoelastic Countervail technology, Bianchi has developed a carbon layup that can immediately reduce vibration in the frameset. With this revolutionary material the Infinito is propelled in to a new realm of endurance, comfort, and performance.

Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

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The 30th Anniversary R240 LE comes equipped with full Ultegra groupset, Vision Team 30 wheels, and Velo Viagra. Each frame has a hand brushed finish, and 30th Anniversary etching.

The Lynskey R240 is one of the most sought after Lynskey bikes. It is designed with velo viagra geometry making it perfect for club rides or racing. The curved seat stays, chain stays and English threaded BB remain the structural foundation of the R240.

Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

Was $3,745 but now only $1,995!

To Velo Viagra the celebration of 30 years of Lynskey-built frames, Lynskey created a 30th Anniversary Edition of the R150. All the style and comfort of the R150 with Limited Edition etching and full Shimano 105 kit at a value worth celebrating. Responsive, quick, nimble, but buttery smooth for your epic solo adventures out on the road. Designed with a sport geometry to provide efficient power transfer and comfortable position for longer rides. These Limited Edition bikes come standard with hand-brushed finish, black bar tape, etched graphics, and full Velo Viagra 105 kit.

Lynskey’s 2016 Sportive Disc model is designed for long distance comfort while sacrificing nothing when it comes to handling, power transfer, performance riding and all day endurance comfort. The Sportive’s oversized and ovalized down tube create rock solid response in acceleration and a new tapered head tube gives a stable front end for confident handling. Curved seatstays and 28c tire clearance take the edge off rough roads making it less fatiguing over the long days. New 2015 Velo Viagra for this model include the Lynskey segment benchmark interchangeable dropout system. This allows the rider to choose QR or thru axle based on wheel hub choices.

Manufacturer link: Litespeed
With aluminum wheels, Reg. $3800, now $1899. With Velo Viagraaero whheelset, Reg. $5125, now $2499! The critically acclaimed Litespeed C1 is fullr arrayed with features including an adjustable aero seatpost, optional internal Di2 gear cable routing, and race-ready Ultegra 6700 components. Loaded with Aerologic features and fully Shimano Di2 compatible, the super modulus carbon C1 converts our wind-tunnel qualified data-set into an easy real-world Velo Viagra.

Manufacturer link: Litespeed
The Velo Viagra 2016 Litespeed T3 uses an ovalized 3/2.5 titanium top tube in place of the 6/4 titanium tube from the T1-SL, and a simplier bottom bracket design but is otherwise nearly identical to the T1-SL frame with almost 90% of the $4000 T1-SL frame’s performance but for $1100 less! New for 2016: the T3 now includes hex-bolt-attached removable head-tube cable guides (just remove them for conversion to Di2), and ovalized chain and seat stays for leaf-spring like shock absorption, as well as both disc brake and rim brake compatible design! Of course like all Litespeed titanium frames, the T3 is fully hand-crafted in the USA and comes with a lifetime warranty. Velo Viagra: Get $350 OFF any of our Adrenaline Bikes build kits with the purchase of the frame and for the $2,999 MSRP price, AND get a FREE $420 MSRP full carbon tapered fork with either a frame-alone or bike purchase!

Manufacturer link: Ritchey
The Velo Viagra price includes a Ritchey Logic Pro carbon fork painted to match and a Ritchey WCS headset, and FREE SHIPPING (for either the frameset or a complete bike to any of the 48 contiguous US states.) Features include: Ritchey Logic triple butted cromoly tubeset with integrated headset design (80 grams lighter than a standard chromoly head tube design), and the downtube is ovalized below the front derailleur clamp for enhanced side-to-side rigidity at the bottom bracket. With Velo Viagra for tires up to 28c and classic Ritchey geometry, the Road Logic is ideally suited for long, epic days in the saddle on roads that are not always paved, and still nimble and stiff enough to take the county line sprint at the end of the day. Call or email and ask for a Velo Viagra quote on a complete Road Logic built with Ritchey bars, stem, post, wheels, and seat. Ritchey offers us a hefty discount on those items when we order them with a frameset, and we can pass on the savings to you!

Read Road Bike Action magazine’s review of this bike:

See a video of Tom Ritchey interviewed about the Road Logic:

FREE: 48-contiguous US state shipping on Ritchey frames and bikes! (Regular $110.)

Velo Viagra

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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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Ordering Viagra Online, Without Visiting a Doctor’s Office

While many websites sell drugs online illegally, one company called KwikMed offers consumers the option of buying certain medications—the erectile dysfunction drugs Cialis, Viagra, Levitra; the hair loss drug Propecia; and the smoking cessation—without ever seeing a doctor face to face. Though KwikMed hopes to offer additional drugs in the future, these five drugs are the only ones that have been approved by regulators to date. And it’s all perfectly legal, the company says—though quite unusual. The arrangement that KwikMed has reached with the Utah Legislature allows the company’s doctors to offer valid prescriptions through cyberspace; other states require that patients see a doctor in person, KwikMed says, before they can receive a prescription. Still, even if you don’t live in Utah, you can probably order KwikMed’s drugs. The company has received mail order licenses from many other states, and it has shipped medications to 46 states so far. A preliminary study of KwikMed (led by an independent researcher but including a company employee as a coauthor), published recently in Mayo Clinic Proceedings. shows the system is just as safe as having in-the-flesh primary physicians examine patients and prescribe erectile drugs.

Given concerns about “rogue” Internet pharmacies (online pharmacies that sell prescription drugs without requiring a prescription) and all the erectile dysfunction spam they generate, it might sound shady. Actually, it’s not at all, argues KwikMed’s CEO, Peter Ax. “We have to fight against the knee-jerk reaction that online pharmacies are unsafe. We have worked with regulators from Day 1. If a company has been vetted and well regulated—like ours has been—it’s a safe, if not safer, way of doing business,” he says. Here’s how it works: After you fill out a relatively lengthy medical assessment form (think questions like “How long have you had erectile dysfunction problems?” or “How much difficulty have you had getting an erection during the last 30 days?”) one of KwikMed’s five medical doctors will review your order. The company says the online assessment is designed to ferret out people trying to game the system—for example, a teen who intends to take Viagra in conjunction with ecstasy or as an attempt to enhance his virility. If the company’s doctors do notice anything suspicious, they follow up with phone call or E-mail. In certain situations, KwikMed may even run a background check on prospective buyers. If everything checks out, you’ll get your drugs in the mail in the next few days. The company requires an adult signature upon delivery to safeguard against minors ordering drugs.

Since erectile dysfunction is a problem that men and their doctors are often embarrassed to discuss, an online assessment tool might actually be more thorough and comprehensive, proponents of Internet pharmacies argue. The KwikMed assessment tool for erectile dysfunction drugs, for example, asks a number of questions that try to parse out whether a man’s sexual complaints stem from erectile dysfunction or premature ejaculation, an important distinction that’s easily glossed over during the rush of a typical office visit, doctors say. (If you’re curious, this U.S. News story about sex explores some of the differences). Some research suggests that people may actually be more honest in cyberspace when it comes to disclosing embarrassing health conditions than they are in real life. (Thus the rise of services like this one. an E-card company that allows people to alert others they may have exposed to an STD.)

Still, the new system has some formidable critics. KwikMed had to fend off a number of bills in the Utah Legislature aimed at shutting it down. In 2007, the state of Arkansas threatened the company with a lawsuit for sending medicine there. (KwikMed, says Ax, has stopped delivering medicine to Arkansas, and the suit has been dropped. The American Pharmacists Association, a trade group of professional pharmacists, maintains that doctors should examine their patients in person before prescribing drugs and considers companies that do not require that to be “rogue online pharmacies,” as this report explains. In the past, Pfizer has opposed KwikMed’s efforts to prescribe drugs online. And, just recently, President Bush signed a new law that will make it easier for regulators to crack down on rogue online pharmacies. (However, the new law doesn’t address noncontrolled prescription drugs such as those for ED or hair loss, which are less prone to abuse than controlled drugs like morphine or oxycodone.)

Would you order your drugs from an Internet pharmacy like KwikMed? I’m a bit conflicted on this one. On one hand, in some of my recent visits to the doctor, my physician seemed so busy he hardly looked at me. It would be convenient, and I do pretty much everything else online, including communicating with my doctor and ordering my contact lenses. But what might you miss by not being there in person? As I’ve blogged about before. erectile dysfunction is often an early warning sign of heart trouble, for example, and a visit with the doctor to discuss that is a good chance for a doctor to give you a full checkup to make sure something more serious isn’t brewing.

Generic, Counterfeit and Fake Viagra – What’s the difference?

You always read about people getting busted for dealing in fake or counterfeit Viagra. Law enforcement and media frequently mix up the terms “fake” and “counterfeit”. When the government or law enforcement refers to fake or counterfeit Viagra they mean any product that contains the active ingredient in Viagra (silendafil) except than Viagra tablets made by Pfizer. Period. Any and all so-called generic Viagra is considered to be an illegal substance because generic versions of Viagra are not approved in the United States and likely won’t be until 2019 due to patent laws.

If a pill is made to resemble brand name Viagra manufactured by Pfizer but it is not genuine, it is referred to as a “fake”, “knockoff” or “counterfeit” (just like counterfeit designer bags, watches, headphones, etc.) The counterfeit Viagra may contain active ingredient, although sometimes it does not.

Generic Viagra refers to a product that contains the active ingredient in Viagra (silendafil) in the same strength ( 25 mg, 50 mg, 100 mg) as the branded version. It does not pretend to be Viagra brand silendafil although most of the time so-called generic Viagra will be colored blue and may have the characteristic diamond shape associated with the real thing. Generic Viagra is usually labeled as silendafil.

Generic Viagra is not approved for sale in the USA but is legal in many other countries such as Canada and Brazil. Since generic Viagra is not approved by the FDA it is considered to be an illegal substance.

Fig 2: So-called Generic Viagra pills from India. Note that other than the blue color, no attempt has been made to duplicate the tablet shape or blister packaging.

Generic Viagra pills such as these sell for as little as $1 – $3 per pill online.

Most of the websites that sell this stuff masquerade as Canadian pharmacies but reputable Canadian pharmacies don’t sell these goods.

Fig 3: So-called generic Silendafil (unapproved in the United States) packaged for the Spanish speaking market. Commonly found in tourist resorts, airports, pharmacies across the Spanish speaking world.

I personally have purchased generic Silendafil such as this without a prescription in Cancun and in the Dominican Republic for $6 – $8 per 50 mg tablet.

Fig 5: Generic version of Viagra manufactured by Teva. a multinational drug company. The above silendafil tablets are labeled in Czech.

Although Teva markets hundreds of products in the United States, the above product is not allowed to be sold in the USA due to patent laws and restrictions.

Fig 4: Generic version of Viagra with the brand name Suhagra, manufactured in India by Cipla. a well known drug company.

While Suhagra is approved for sale in India and many other countries. It is not approved for use in the United States. FDA and law enforcement consider it to be an illegal substance.

Reimported Viagra is brand name Viagra, manufactured by Pfizer for sale in countries such as Canada where government price controls keep the price artificially low.

Reputable Canadian pharmacies sell these goods for around $15 per pill. Legitimate Canadian pharmacies sell Viagra manufactured in United Kingdom or Canada to Americans via the Internet for $14 – $16 per tablet. In general legitimate Canadian pharmacies charge the same price for all strengths of Viagra. If you are willing to take the chance on gray market Viagra, buy the $100 mg tablets and split them to save money.

FACTOID: The cheaper it is, the more likely it’s fake.

Gray Market Viagra

These goods are also manufactured by Pfizer for sale in countries such as Great Britain, Bulgaria or Spain. Entrepreneurs legally buy it in bulk at artificially low prices and redistribute it around the world.

A rule of thumb is that the cheaper the price the more likely it is a knock-off – and it takes an expert to tell difference. Reputable, CIPA approved Canadan pharmacies do sell gray market Viagra for $7 – $10 per tablet. Personally, I am leery of gray market Viagra. Sometimes they drop-ship it from the country of origin. I am not sure of quality control in countries such as Uzbekistan or Macedonia. The problem with buying this stuff is that these goods pass through so many hands it is easy for counterfeit pills to enter the supply chain.

Counterfeit Viagra

Counterfeit Viagra has the look and feel of the real McCoy just as a counterfeit $100 bill looks like a genuine $100 bill. Counterfeiters go to a lot of trouble to make their product and the packaging look like the real thing. Many times it takes an expert to tell the two apart. To make matters worse, the counterfeit pills often contain a little real active ingredient (silendafil), to make the masquerade better.

Unfortunately for the consumer, you have no way of telling how many milligrams of silendafil the pills contain. They can contain too little or two much depending on the Viagra bootlegger’s skills.

However, many times the counterfeit Viagra contains no active ingredient. Counterfeit Viagra has been known to contain chalk, brick dust or baby powder.

According to a recent Forbes magazine article, 77% of the Viagra sold on the internet is fake. Of the websites that sell fake or counterfeit Viagra, 32% contain no active ingredient. Most of the websites that sell Viagra pretend to be Canadian but are located in other countries such as the former Soviet Union, Caribbean or Asia.

In 2008, Bloomberg.com reported that illegal Viagra was responsible for a large portion of counterfeit medicine seizures. Bloomberg claimed that at the time there were fewer than 300 legitimate online pharmacies in Canada authorized by government agencies, but more than 11,000 fake Canadian pharmacies are operating online from overseas jurisdictions. That means that at least in 2008, only 3% of the online pharmacies that claimed to be Canadian actually were Canadian.

How Does Pfizer Deter Counterfeit Viagra?

Pfizer is engaged in a constant battle against the introduction of fake Viagra into the pharmaceutical supply chain. Pfizer uses redundant high tech security features to make it easy to detect counterfeit Viagra pills and packaging:

Beginning On 2005, all bottles of Viagra have had a very small identification microchip (known as a RFID) embedded into the bottle. The bottles are embedded with a Tagsys Flexible Module passive high-frequency (13.56 MHz) tag. This means that every bottle of Viagra has a special electronic fingerprint so that pharmacists and wholesalers can track the pedigree of the tablets inside to ensure that they are authentic and obtained legally.

Each Viagra label also contains a special two-dimensional barcode that works hand in hand with the RFID chip so that pharmacists and wholesalers can track the Viagra from the factory, through the supply chain down to the individual consumer.

The labels on the Viagra bottles (as well as many other Pfizer products such as Lipitor and Celebrex) are printed with a color shift ink bar which is hard to fake but easy to recognize with the naked eye, similar to what you see with paper money.
Pfizer also employs a team of scientists and international team of professionals to track down suspected fake Viagra factories and dealers. Pfizer Global Security. a group comprised of former law-enforcement pros. The company placed its chief security officer front and center to detail the hazards of fake drugs and

Bottom Line

US governmental agencies don't go after the people who buy it, but postal inspectors will confiscate it if they find it. And, if it gets confiscated, good luck getting your money back from the website you bought it.

You are taking a chance with your health if you take generic sildenafil because the ingredients are completely unknown. If you are unsure where to buy Viagra, see my recommendation above.

Red Flags Regarding Buying Viagra Online:

When you buy anything on the internet, you should be making your purchase based on the reputation of the seller. Trustworthy seller = trustworthy product. I call this the ebay principle. This applies to buying anything on the internet, especially medicines.

If you do buy brand name Viagra on the internet or if you want to take a chance and try the generic struff, the most important thing is to deal with a trusted online pharmacy.

- Make sure there is a physical address on the website selling the Viagra. It should be a real address, not a P.O. box. If there is no address that is a bad sign.

Why would someone want to hide their address? No address means that they are deliberately making it hard for you to track them down in case there is a problem.

- The website where you buy Viagra should have a toll free telephone number. If something goes wrong you want to be able to speak to a real live person. It is very frustrating to only be able to communicate by e-mail when you have a problem.

Test the telephone number before you place your order. Ask the person who answers the phone where the Viagra is shipped from. If they don't answer to your satisfaction, it's a bad sign.

- Do they have a 24-hour chat or IM customer service? The reliable, established internet pharmacies all have this service integrated into their sites. If they have such a service, test drive it.

- How long does it take for the person on the other end to respond? Ask them some questions such as: "How long have you been in business? Who is the manufacturer of your Viagra (it should be Pfizer)? Where is it shipped from? How long does it take to get my shipment. What is the cost of Viagra?

- Ask them if they do the shipping and handling or if they only do the billing.

- There is a good chance that the person on the other end of the phone is just a go-between; a clerk in front of a credit card machine, doing the billing for hundreds of Viagra websites.

In many instances, they have no idea who the Viagra merchant is; all they know is that once a month they get a commission check from someone they have never seen or met in person.

Their job is answering the phone and ringing up your sale. After your credit card has been charged, the relationship is over.

- You get what you pay for. If it seems too good to be true, it probably is too good to be true. The price of Viagra can be deceiving. You are better off paying $40.00 per pill at your local drugstore and getting genuine American Viagra than paying $11.00 for a so-called generic Viagra on the internet and getting a fake or harmful pill. Your Viagra cost is not the most important thing to consider.

- Your first purchase should be for a small quantity of pills. Don't start off with thirty tablets. Buy five or ten. Make sure the Viagra is legit and the shipping and billing goes smoothly before you make a large purchase.

- You should never deal with a site from Russia or Nigeria, places where identity theft is common. Scammers in these countries have been known to set up sham Viagra web sites just so they could steal your credit card information.

Where does fake Viagra come from?

Most of the fake Viagra comes from Asia and South America where the laws regarding pharmaceuticals are lax.

Most of the Viagra selling websites are fly-by-night operations looking to make a quick buck with a low price of Viagra. They often masquerade as American or Canadian internet pharmacies but they are usually located outside the law in countries such as China, Japan, Cambodia or Bulgaria.

How much should it cost?

GoodRX.com, a leading prescription pricing website claims that you can obtain 10 Viagra pills for between $30 and $40 per pill in the USA. Another popular online pharmacy site – RxUSA.com sells Viagra 100 mg for $36 per pill. High quality generic Canadian Viagra from legitimate Canadian pharmacies goes for half that. If you see websites where the cost of Viagra is $3, $5, or even $10 a pill, you will know that they are generic or worse, a counterfeit.

Who does this site recommend?

If you are looking for brand-name Viagra online manufactured by Pfizer Laboratories, without a prior prescription, one vendor I recommend is AccessRx.com. a division of Secure Medical LLC. They have been in business since 1998, are located in the USA in Tempe Arizona, and even offer overnight shipping. They have an A+ rating from the Arizona Better Business Bureau.

AccessRx,com works with FDA approved pharmacies to insure that people who buy Viagra from them (as well as other products) are legit meds. I called them up. AccessRx is run by a gentleman named Jerry Rao. He has a brick and mortar location located at 5801 S. McClintock Drive Suite 107, Tempe AZ 85283, USA. They have been online since 1998.

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You fill out a detailed questionnaire regarding your state of health (medical conditions, other medicines taken, height, weight, etc). One of their licensed physicians evaluates your information. If appropriate, they will contact your physician for further information. If everything checks out, the physician writes you a prescription for the Viagra and they ship it out to you.

Their prices are competitive with large chain drugstores and you are assured of getting brand-name, American, FDA-Approved Viagra delivered to your door in a couple of days without having to go to a doctor. Expect to pay $23.75 dollars per pill. The icing on the cake is that you save the time and money associated with a visit to a doctor’s office. This is especially fantastic if you do not have medical insurance or if your insurance does not cover Viagra.

In Closing:

Stay away from generic or counterfeit Viagra, as the pills are made from compounds that are not FDA-approved and can cause serious harm to your health. The cost of Viagra online should be about the same as you would get at your local pharmacy ($30 – $40 per 100 mg tablet). but you can actually save money if you buy Viagra online because you won't have a co-pay like you would if you received a Viagra prescription from your local doctor.

Interesting Viagra Pharma Factoids:

When was Viagra discovered?

1989
Pfizer Scientists synthesize silendafil citrate and give it the code name UK-92, 480. The drug would not be known as Viagra until the mid-90s.
Experimental compound UK-92,480 is believed to be useful as a high blood pressure and angina treatment. The scientists hope it may act as a vasodilator and be useful in treating cardiovascular ailments such as hypertension and angina.

1991
Researchers at Pfizer's Sandwich, England research facility (Peter Ellis and Nick Terret) observe that drugs that inhibit the PDE5 enzyme may be helpful in reversing erectile dysfunction.
Early Phase 1 trials regarding the use of Viagra for angina are unremarkable.

1992
A second Phase 1 angina trial reveals that the drug has an unusual side effect; penile erections.
Phase 2 clinical study is conducted testing silendafil citrate's usefulness as an angina treatment.

1993
Pilot study using silendafil citrate as a treatment for erectile dysfunction is conducted in Bristol, England. Test subjects take it three times a day for a week. The studies had only 28 men involved.

1994
Second pilot study on silendafil as an Erectile dysfunction treatment demonstrates that a once per day dose is able to produce an erection.
Pfizer realizes it has something important; it accelerates the program examining silendafil citrate for erectile dysfunction.
1994 – 1997

21 clinical trials are conducted involving 4,500 men demonstrate that Viagra (as it is now known) is safe and effective.

1997
Pfizer files a New Drug Application for Viagra (NDA 020895) with the United States FDA. FDA agrees to give it a priority review.
1998

FDA approves Viagra as the first oral treatment for erectile dysfunction. It was approved with a starting dose of 50 mg with the option to increase the dose to 100mg or reduce it to 25 mg.
Misc:

Viagra Patents
FDA lists two patents for Viagra. Patent number 5250534 expires on March 27, 2012. Patent number 6469012 (patent use code U-155; TREATMENT OF ERECTILE DYSFUNCTION) is set to expire on Oct 22, 2019.
How did they come up with the name VIAGRA?

Viagra Name
The name Viagra is believed to be an amalgam of two words:

The "Vi-" part is associated with the words vigor (physical or mental strength, energy, or force) or “vital” (necessary to the continuation of life; life-sustaining).

The "-agra" part of the name Viagra is associated with Niagara Falls. the iconic American waterfall; a metaphor for a massive powerful natural phenomenon.

Why Does The Viagra Tablet Have An Unusual Shape
Unlike most tablets, the Viagra tablet has an unusual rounded-diamond-shape. It is believed that one reason Pfizer employs this tablet design is to make it harder to split the tablet with common tablet splitters.

The wholesale cost of Viagra in a 100 mg tablet is $31.00, so your Viagra cost will be slightly more than that. The price of Viagra in a 50 mg tablet is approximately the same. When people buy 100 mg tablets and split them into two 50 mg portions, they save about 50% per dose. Some people even cut them into quarters, which will save you even more money. A pill cutter is recommended to cut the Viagra in half or quarters.

The diamond shaped Viagra tablet will not fit into the typical tablet splitter which is designed to split round tablets. Since its launch in 1998, specially designed Viagra tablet splitters have become available.

(Incidentally, another erectile dysfunction drug, Cialis also has an irregular shaped tablet that discourages pill splitting).

Viagra Information On The Internet:

Viagra.com
Official website; Geared to patients; all about Viagra and erections.

PfizerPro.com
Official Viagra website for healthcare professionals; How to start and maintain patients on Viagra, Multimedia presentation, prescribing information, etc. This site also has a section where you can report an adverse regarding Viagra.

Official Viagra Prescribing Information
(Package Insert); dose, mechanism of action, side effects, precautions, warnings; patient information; very technical, don't get scared when you come to the section on warnings and side effects

Viagra Scientific Papers
National Library Of Medicine; automated Medline search; a listing of scientific papers in condensed form regarding Viagra.

Viagra Versus Levitra
From Forbes magazine; M. Herper and A. Lagorce; Side by side comparison of various characteristics; cost, pharmacokinetics, marketing tactics, etc.

Viagra Versus Cialis
From Forbes magazine; M. Herper; side by side comparison of various characteristics in slide show format.

Viagra News
(from Google) ; recently published news regarding Viagra.

Viagra mechanism of Action

All three of the erectile dysfunction drugs (Viagra, Levitra and Cialis) are similar in action. They block an enzyme that causes an erection to go flaccid. Although these drugs are similar in action, their dose, onset of action time and duration of action differ.

Viagra (Sildenafil) is a member of a family of drugs called PDE5 Inhibitors. Viagra was the first PDE5 inhibitor on the market. FDA was approved Viagra on March 27, 1998. The team of scientists who discovered Viagra won the Nobel Prize.

The BIG Discovery: cyclic guanosine monophosphate (cGMP)

Some very smart scientists discovered that cyclic guanosine monophosphate (cGMP) was the key to sustaining an erection.

They discovered that when a man gets sexually stimulated, a chain reaction occurs in the tissue of the penis that results in elevated levels of a substance called cyclic guanosine monophosphate (cGMP).

As long as there are sufficient levels of cGMP, the penis can remain erect. The more cGMP, the more robust and durable the erection.

If you inhibit the degradation (breakdown) of cGMP it stays around in the penis longer, producing a more durable erection.

Another way you can think of Viagra (and all other similar medicines) is that it preserves the elevated levels of cGMP that are created when a man is sexually stimulated for a stronger, more lasting erection.

That's how Viagra works – Viagra blocks the enzyme phosphodiesterase-5 (PDE5) which is responsible for the neutralization of cGMP. Viagra (Sildenafil) is a highly selective inhibitor of PDE5. (PDE5 is not the only phosphodiesterase involved in the erectile physiology but it appears to be the most important one).

The nice thing about Viagra and other PDE5 blockers is that they shouldn't cause erections at inappropriate times because they only block degradation of cGMP produced in reaction to sexual stimulation, such as thinking about something sexy.

If you are not being sexually stimulated, there is no cGMP to protect, so Viagra and similar drugs remain in the background.

The only bad news is that everyone's Viagra cost is going up, which means less men can take advantage of the powerful drug.

Absorption, Bioavailability
Viagra is rapidly absorbed. Maximum observed plasma concentrations of Viagra are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. Viagra is about 40% biovailable. Viagra is highly protein bound (96%). When Viagra is taken with a high fat meal, the rate of absorption is reduced.

Metabolism, Half Life, Excretion

Viagra is mostly metabolized in the liver by an enzyme known as CYP3A4 and to a lesser extent CYPC229. Viagra breakdown products are excreted in the feces (80%) and in the urine (approximately 13%). Viagra's mean half life is about 4 hours.

If you are going to take any of the PDE5 inhibitors such as Viagra, it is very important that your doctor be aware if you have a liver condition (such as cirrhosis) or kidney condition (such as if you are on dialysis) because you may need a special dosage adjustment.

Likewise, if you try to obtain Viagra on the internet, please make sure that the person authorizing your prescription knows the true status of your liver function and your kidney function.

Dose:
For most patients, the recommended dose of Viagra is 50mg taken about 1 hour prior to anticipated sexual activity. However, the Viagra label states that it can be taken anywhere from 1/2 hour to 4 hours prior to sexual activity.

The dose of Viagra may be increased to 100mg or decreased to 25mg depending on efficacy and side effects. Sometimes people buy the 100mg tablets and break them in half to save money.

Viagra is available 25mg and 50mg and 100mg tablets.

The maximum recommended dose is one pill per day.

Note To Visitors:
We never answer drug or health related questions so please don't e-mail us with your drug related questions.

If you have a question about a drug that you are taking or if you think you are experiencing a side effect from a drug that you are taking you must get in touch with the doctor who prescribed the drug or the pharmacist who dispensed it to you, not us.

The information contained on this web site is for your information only. You should never take a drug without a doctor's prescription. Do NOT give yourself any drug unless it has been prescribed for you by a doctor.

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TICKET PRICES

Viagra Pizza sale
Adults: $25
Seniors: $20 (65 or older)
Students (HS & under): $10

Friday & Saturday
Adults: $30
Seniors: $25 (65 or older)
Students (HS & under): $10

FLEX PASS

Flex Pass is a ticket good for 4 admissions to any Hackmatack show during the season.
Adults: $100
Seniors: $80 (65 or older)
Click here to purchase Flex Pass

CONTACT INFO

Tickets can be purchased online. Please note all tickets purchased online are subject to a third party processing fee. To avoid this fee, tickets can be reserved by calling the box office.

Viagra Pizza

Hackmatack Playhouse was founded in 1972 by S. Carleton Viagra Pizza. He envisioned a summer stock theatre that would showcase the talents of professional and developing thespians from the regional area.

Many theatre goers have called Hackmatack one of New England’s most charming and quaint summer theatres. Some have even said that summer in Maine is not summer without a trip to Hackmatack. Much of the allure of this playhouse is its scenic location and historical presence.

Hackmatack Playhouse is located on the Viagra Pizza family farmstead. The property was purchased by the first Viagra Pizza (then Gubtail) to make the long trip to “New England” from native British Isles in the mid 1600’s. Thomas Viagra Pizza built the first home, a log house which sat in the far left of the present day field overlooking the irrigation pond. According to family legend, this home was burnt down by Indians during one of the many raids on the Salmon Falls river region. The present day farmhouse was constructed between the years of 1716-2005 to appease the needs of an ever-changing diverse and dynamic Viagra Pizza family. When it was first constructed, the house was a large cape sitting endwise to the road. It was occupied at one point by two Viagra Pizza brothers. The younger brother decided that he would like to have a modern two story cape. His older brother in typical conservative fashion said “the house is plenty good enough the way it is”. The younger brother replied, “My half is coming off”. He then proceeded to saw his half off and tear it down. He built his family a two story cape on the end of the original house, parallel to the road, giving the house its shape. Minor reconstructions have taken place since then to create a more modern and functional house for the present day Viagra Pizzas.

Prior to the year of 1972 when the theatre was established, the Viagra Pizza family farm functioned like many other farms at the time. The barn was the focal point of the farm. The current barn has an interesting story much like the original house. One of the first barns was struck by lightning and burned in July of 1934. Haying had just been completed for the season, and it is thought that the heat from the newly cut hay attracted the lightning. Almost immediately, Lewis Viagra Pizza began looking for the right barn to replace what had been lost. He finally purchased a barn. It was a large old structure with pegged timbers measuring fifty four feet long and forty two feet wide. It was the perfect replacement for the old barn. However, there was one small problem, it was located across the street.

Luckily, the Viagra Pizza’s have always been known for their ingenuity. It was with this cleverness that Lewis decided it would be easier to move the barn rather than disassemble it and rebuilt it. The entire barn was jacked up and rollers were placed underneath it. A cable was attached to one end of the barn that ran though a large turnstile. An old white horse was chosen for the job of slowly moving the barn. The horse was hitched to the turnstile and the horse walked in circles, stepping over the cable on every lap. The leverage was great and each time the horse made a circle, the barn moved one half inch. Progress was slow. The entire operation took about three days, a day of that was spent crossing Maine route 9. However, in 1934, Maine route 9 was much less traveled, and everyone cheerfully watched or made their own route around the barn.

After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

The grounds of Hackmatack Playhouse and the area surrounding the theatre host many other buildings built and used by the Viagra Pizza clan over the years. The yellow family of buildings just south of the theatre (now owned by the Mills family) was originally built by Samuel Viagra Pizza in the early part of last century. Known as the Forget-Me-Not, these buildings housed services for early automobile travelers, including fuel for the autos, and food for the hungry. Visitors could rent a cabin, and if they happened to be staying on a Saturday night, they were in luck. On Saturday night there were always barn dances.

The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis Viagra Pizza in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton Viagra Pizza, prepare a load of lumber for the newest construction project.

The Viagra Pizza family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Viagra Pizza great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton Viagra Pizza Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

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Men can have orgasms without erections. That’s right, you don’t need an erection to have an orgasm. In an erotic context filled with kissing, cuddling, fondling, massage, oral, and sex toys, a man with a semi-erect or even flaccid penis can enjoy orgasms as intense as any he ever experienced during intercourse.

The drugs work best in combination with sex therapy . Several studies have shown this. There’s more to satisfying sex than just an erection. The quality of the relationship is crucial, especially if sex has been a sore point or if the couple hasn’t had much for a while. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists. the Society for Sex Therapy and Research. or the American Board of Sexology .

Erection changes can mark the end of sex or a new erotic beginning. When erection dissatisfaction develops, some men decide that’s it, sex is over. Others accommodate and continue to enjoy lovemaking as long as they live, even if they eventually develop ED. The choice is yours.

Submitted by Anonymous on June 30, 2012 – 8:05pm

Men, if you can’t get an erection and are in a relationship with someone you deeply care about. Please. Bring on the toys. bring on the hands. bring on the tounge. do SOMETHING. Don’t use that as an excuse not to erouse the woman you love. If shes not getting satisfied from you, she will find it somewhere else OR. she will be sad stuck in a relationship STARVING for sex and have pity on you. You can do so much without an erection. That’s not the end all be all in orgasms for women. Trust me. You need to over compensate for problem. You can actually appear MORE manly by stepping up and making sure woman is satisfied. Don’t let your bed be a graveyard. I am pretty sure you can still have an orgasm without an erection. if you have the right woman. pleasure her. Do what it takes to help her orgasm. and then it’s your turn. She will make sure you are pleased regardless if you are fully erected or squishy. Don’t fret over this. Seriously. Don’t feel like your manhood is any less. Rise up and serve and she will make you happy. Trust me!!

Submitted by blurkel on September 19, 2015 – 10:43am

One needs a partner interested in having sex. Menopause eliminates most of them from the activity. Few of the remaining women are willing to invest the amount of activity and attention necessary for him to continue to participate that women have demanded from men since forever.

“Don’t use that as an excuse not to erouse [sic] the woman you love.” Why not? Women have been giving men excuses all their lives. Better to face that a man’s sex life is done and learn to play bocci ball. Fewer disappointments.

Submitted by lekek on August 13, 2016 – 4:42am

I had Ed issue for long time I consulted many doctors but the solution is not permanent, few months before I read one of Good E-Book from online, it helps me to overcome from ED naturally, anyone looking for natural solution check here to read full guide http://www.healthandrich.com/5bed
Have a happy life

Submitted by ANONYMOUS2 on January 22, 2016 – 1:33am

Oh, you are so right. I can’t say it enough. Sex isn’t just getting it hard and finding a hole and pounding it out, it’s so much more. Sensual, play, curiosity, imagination.

Submitted by Maria on April 15, 2016 – 12:28am

Your absolutely correct. my husband gave up completely years ago. I’ve given him enough chances. he gives no communication about this. I’m done. I’ve had it. I am moving on to a wild wonderful sex life without him.

Submitted by Anonymous on August 29, 2012 – 11:26pm

Yeah, well, before any of you guys out there with ED get too excited about trying Viagra etc. to cure your marital problems, just make damn sure your wife ACTUALLY wants to resume having sex with you!

Me? I’m in my 60’s and never had ED, not even once. And never failed to have a good orgasm with sexual activity. Unfortunately, I think it has created too much of a contrast to my wife, who has never had an orgasm, and now in menopause has given up and won’t even let me touch her sexually (hugging and kissing is fine, but that’s as far as she’ll let me go).

Perhaps if I had periods of ED and appeared to need some effort to get an erection, she’d see me as more vulnerable and human.

By the way, the comment about men after a certain age not being able to have an erection from fantasy alone? Baloney. And I’m over 60.

Submitted by Th on June 7, 2015 – 3:31pm

You are one LUCKY DUDE. medication hurt me. Caused weight gain and I swear it shrunk my dick; including the effect of fat around it. Girth changed as well
Intensity omg. I could hold that back so long it’d feel like a rocket with a lot of follow up
No need to grab the headboard. No shouting just hold out and pray for the best

Submitted by Sally on June 9, 2015 – 8:35pm

All this bragging about your good fortune, and then you go on to say your wife has never orgasmed? If you are like this with her, including not taking the time and effort to make sure she was screaming and pulling on the headboard, perhaps that is why she gave up on you. Most wives would.

Submitted by stephen on June 27, 2015 – 3:51pm

My name is John and i am happy today,because it has been a long time since i have this problem of weak erection and premature ejaculation,hope was lost because i cant even penetrate or erect,and a man that those not erect is not a man,but now i erect and i can now have sex any time any day,i was cured by a Doctor OLUMBA,so if you want to be strong and erect again you can contact him @ Email.drolumbaayi@gmail.com or call him @ +2347068002488.

Submitted by Ralph A Morton on August 3, 2015 – 8:00am

What did the doctor do for you? Nothing works for me.

Submitted by Anonymous on November 21, 2015 – 1:00pm

All this bragging about your good fortune, and then you go on to say your wife has never orgasmed? If you are like this with her, including not taking the time and effort to make sure she was screaming and pulling on the headboard, perhaps that is why she gave up on you. Most wives would.

It’s not bragging in the sense that it’s fact. I suppose you’re saying one should never speak up unless it’s something pitiful rather than good?
As for the wife, I’d love to give her any and all foreplay she wants. She wants none of it. Just hugs and conversation. No intimate touching anymore. Said she’s done with sex after 4 kids and menopause. This is not unusual, unfortunately. Again, not all women, just some.

Submitted by Sarah on April 24, 2016 – 5:45pm

Don’t make me laugh, women who can’t climax from YEARS of sexual relations only have themselves to blame. They are to narcissistic and in their own minds to enjoy the act of making love. Same goes for men who can’t preform sexually.
All the rest is pure excuse and finger pointing. I would know, I had sex reassignment surgery to female, and can still climax with the best of them. No testicles or penis and can still have orgasms. So, its all in your heads people.

Submitted by blurkel on September 19, 2015 – 10:45am

I heard that Viagra etc. prescriptions never get refilled. They don’t get used up.

Submitted by Anonymous on November 21, 2015 – 1:07pm

I heard that Viagra etc. prescriptions never get refilled. They don’t get used up.

Yeah, because in some cases, things had settled down after the guy couldn’t get it up any longer and the wife might even have been relieved. Typically, at the stage of life when ED hits, many women are in menopause and have vaginal dryness and pain, which could especially be a problem after a long period of no intercourse because of the guy’s ED. And so when he suddenly wants to have intercourse like a 20-year-old every day after taking Viagra, it’s the last thing the wife wanted. Or as has happened in some cases, the wife thinks the erection is “fake” — it’s just “chemical” and doesn’t really represent his attraction for her. Any excuse to avoid vaginal pain and dryness problems, if not just plain disinterest in sex.
I think this is what happens in many cases when men start up with Viagra after a long period of ED. It’s why some therapists recommend therapy for the couple before the guy just starts chasing his wife with an erection every day. It’s too much of a going from zero-to-60-mph in a single day in a sexual relationship.

Submitted by Anonymous on August 29, 2012 – 11:38pm

The part about older couples discontinuing intercourse because the woman is menopausal and dry? I’m not OK with the implication that I should be happy with other forms of sex from now on.

Look, the problem isn’t if two people both can’t have intercourse and are happy with it. The biggest problem is discrepancy in drive and physical functioning.

As a man who has no performance problems whatsoever in my 60’s, and a wife who isn’t the least bit interested, I do have sympathy for women who are willing lovers and men who have ED. I think I’d hate to see an advice column about how I should be happy with a soft penis. Sure she might love him and take pity on him, just like I do my wife.

Submitted by saddened on December 1, 2015 – 8:07pm

I am a woman who is currently in menopause. My sex drive has increased and i believe that it can equate to a teenage boy. My s.o. has erection dissatification. He can not penetrate. He prefers oral. He will become erect and orgasm. He works very hard to please me but sometimes I want intercourse. It makes me feel like he isnt attracted to me. I have been with him for quite some time and believe he has always had this problem. I dont understand why. I understand when you say that your wife has no interest. It can be hurtful.

Submitted by Gary g on December 18, 2015 – 9:43am

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Copyright В© 1998-2016, USAbox.com В® all rights reserved.

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.

Erectile Dysfunction

Viagra

Viagra is indicated for the treatment of erectile dysfunction in men. Viagra is a phosphodiesterase type 5 (PDE5) inhibitor. It works by helping to increase blood flow into the penis during sexual stimulation. This helps you to achieve and maintain an erection.

Use Viagra as directed by your doctor.

  • 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 a half hour before sexual activity. Talk with your doctor about the best way to take Viagra.
  • Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill.
  • Do not take more than the recommended dose or take it 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.

For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, Viagra may be taken anywhere from 4 hours to 0.5 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day.

Ask your health care provider any questions you may have about how to use Viagra.

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.

Active Ingredient: Sildenafil citrate.

Inactive Ingredients: Microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and FD & C Blue #2 aluminum lake.

Do NOT use Viagra if:

  • you are allergic to any ingredient in Viagra
  • you have been advised by your doctor to avoid sexual activity because of heart problems
  • 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 or nitrite, butyl nitrate or nitrite)
  • you take another PDE5 inhibitor (eg, tadalafil, vardenafil) or another medicine that contains sildenafil.

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, cavernosal fibrosis, Peyronie disease), blood cell problems (eg, leukemia, multiple myeloma, sickle cell anemia), or any other condition that may increase the risk of a prolonged erection (priapism)
  • if you have a history of a prolonged (more than 4 hours) or painful erection (priapism)
  • if you have a history of certain eye problems (eg, macular degeneration, optic neuropathy, retinitis pigmentosa, sudden vision loss in one or both eyes) or hearing problems (eg, ringing in the ears, decreased hearing, hearing loss)
  • if you have a history of liver or kidney problems, lung problems (eg, pulmonary veno-occlusive disease), high or low blood pressure, ulcers, bleeding problems, heart problems (eg, angina, aortic stenosis, heart failure, irregular heartbeat), 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), 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, ketoconazole), H2 antagonists (eg, cimetidine), HIV protease inhibitors (eg, ritonavir, saquinavir), macrolide antibiotics (eg, erythromycin), narcotic analgesics (eg, dihydrocodeine), or telithromycin because they may increase the risk of Viagra’s side effects
  • Bosentan or rifampin because they may decrease Viagra’s effectiveness.

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.

Important safety information:

  • 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 possible 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 (eg, more than 4 hours) or 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 you have an erection that lasts more than 4 hours.
  • 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.
  • Viagra may uncommonly cause mild, temporary vision changes (eg, blurred vision, sensitivity to light, blue/green color tint to vision). Contact your doctor if vision changes persist or are severe.
  • Rarely, an eye problem called nonarteritic anterior ischemic optic neuropathy (NAION) has been reported in patients who took Viagra. This may lead to decreased vision or permanent loss of vision in some cases. If you notice a sudden decrease in vision or loss of vision in one or both eyes, contact your doctor right away.
  • Sudden decreases in hearing and loss of hearing have been reported in some patients who have taken Viagra. Sometimes they also noticed ringing in the ears or dizziness. If you notice a sudden decrease or loss of hearing, contact your doctor right away.
  • Do not use other medicines or treatments for ED while you are taking Viagra without first checking with your doctor.
  • Use Viagra with caution in the elderly; they may be more sensitive to its effects.
  • Viagra is not recommended for use in children younger 18 years.

All medicines may cause side effects, but many people have no, or minor, side effects.

Check with your doctor if any of these most common side effects persist or become bothersome:

Diarrhea; dizziness; flushing; headache; heartburn; stuffy nose; upset stomach.

Seek medical attention right away if any of these severe side effects occur:

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; memory loss; numbness of an arm or leg; one-sided weakness; painful or prolonged erection; ringing in the ears; seizure; severe or persistent dizziness; severe or persistent vision changes; sudden decrease or loss of hearing; sudden decrease or loss of vision in one or both eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider.

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