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Me desesperГ© y arranquГ© la ropa, y me abofeteГі. Entonces salГ­ de la casa, buscando el desierto, y me fui sin saber a dГіnde Y, dos serpientes se acercГі a uno tawnycoloured, y el otro blanco y luchaban juntos.

RecogГ­ una piedra y golpeГі la tawnycoloured uno a matar por fue la superaciГіn de la blanca.

Entonces la serpiente blanca partiГі, y por un tiempo regresГі acompaГ±ado de otros diez serpientes blancas, y vinieron a la serpiente muerta y lo rompiГі en pedazos, que de haber hecho lo fueron. Tarde habiendo llegado yo pongo levitra despues de comer el desierto a dormir, cuando de repente oГ­ una voz recitando estos musulmana O cuya guiar el CorГЎn, AsГ­ que me dijo la voz, cuya forma no vi A tu objeto de adoraciГіn, informar quiГ©n eres! Con lo cual la voz adoptado la forma de un hombre, y respondiГі: No temas, tu conducta tipo conocido Si luego tienes cualquier que desee familiarizarse con los que puede tener el placer de realizar Para saber, oh Abou Mahomed, que yo, el hermano de la serpiente blanca, cuyo enemigo tГє mataste. Somos cuatro hermanos, y estamos agradecidos por tu amabilidad. Y saber tambiГ©n que quien estaba en la forma de un mono, y quiГ©n te, uno el mal Genios engaГ±ado. Durante mucho tiempo hath sido deseosos robar la joven, pero no podГ­a porque el talismГЎn. Pero no temas, ni la desesperaciГіn.

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Para ti serГЎ transmitir tu novia, y luego el hombre lanzГі un fuerte grito con una voz terrible, y, una tropa personas se acercaron y les preguntaron el viagra pone los ojos rojos dГіnde la morada Marid. Y ellos respondieron: En la Ciudad de latГіn, sobre la que no vuelve a levantarse el sol. Y el hombre dijo: O Abou Mahomed, el montaje de una vuelta esta tropa, para que es cialis 20 mg y te llevarГЎ a la doncella.

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Sabemos que un Marid el bien genios, pero mientras tГє estГЎs de espaldas mencionar no el nombre de AlГЎ, porque si tГє mencionan te dejarГ© caer, y tГє humillado perecen miserablemente. Yo le respondГ­ que oigo Uno la tropa se acercГі y se inclinГі, y le dije Monte.

Y yo montГ©. A continuaciГіn, se elevГі conmigo viagra valladolid en el cielo, hasta cuanto dura la levitra que habГ­a ascendido a cabo la vista del mundo, y vi las estrellas parecidas a las montaГ±as, y escuchГі a los ГЎngeles alabando la perfecciГіn Allah en el Cielo.

Y todo el tiempo el Marid fue divertido y el desvГ­o de mencionar el nombre de Allah. Cuando, un estar ahГ­ vestidos con prendas verdes, y tener cerraduras pelo largo y un rostro resplandeciente, y llevando en la mano una lanza desde la que saltaron chispas, se acercГі y dijo O Abou Mahomed, dicen que no Deidad sino AlГЎ, o me herirГЎ ti con esta lanza. Y el corazГіn era estallido lista porque no mencionar el nombre de Allah, cuyo nombre exaltado! y me dijo que no hay mГЎs dios que AlГЎ! e inmediatamente el Ser hiriГі al Marid con su lanza, con lo cual se disolviГі y se convirtiГі en cenizas.

Y me caГ­ de espaldas, y continuГі cayendo hasta se me cayГі en el mar rugiente. Y, no estaba cerca, un barco que contiene levitra generico en farmacias cinco marineros, y cuando vieron que tuvo en el recipiente, y comenzГі hablar en un idioma que yo no conocГ­a. Procedieron su viaje hasta que llegaron a su propia tierra. Luego la llevaron en su Rey, que estaba familiarizado con el idioma ГЎrabe, y besaron el suelo delante de Г©l. Г‰l trata con honor, y otorgado a un vestido hermoso, y nombrГі a uno de sus guardias. Y yo residГ­ allГ­ por espacio de un mes, despuГ©s de que me fui un rГ­o, y me sentГ© a su banco.

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La sierra celebrado con su punto se volviГі hacia el cuello y el mango hacia el cartГ­lago ensiforme. Se debe cortar mГЎs profundamente anteriormente, y enteramente dividir el manubrio en su borde superior, siendo el corte mГЎs superficial a continuaciГіn, y sГіlo ranurado el hueso en su extremo inferior.

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Esta oblicuidad el corte requiere la incisiГіn de piel de larga Un cincel stout luego se aplica en la sierra de corte en el borde superior del manubrio, y el hueso tomar viagra engorda indivisa fina capa de la superficie hecha posterior dan paso como la acciГіn de cuГ±a del cincel obliga a los dos La piel siendo bien retraГ­da, una incisiГіn transversal realizado en el periostio travГ©s de la cara del hueso en el nivel de la primera las farmacias similares venden viagra o segunda espacio intercostal, y el cincel aplicado en esta lГ­nea directamente de forma donde comprar viagra spray oblicua hacia el exterior desde la lГ­nea media a cada lado como dividir cada media del hueso de la cuerpo del esternГіn.

El equipo no permitido cortar por completo a travГ©s del hueso en la frontera exterior de la lesiГіn miedo la pleura o arteria mamaria interna.

Ambos se encuentran a poca distancia de los huesos, que el peligro hiriendo a ellos no genial. Retractores fuertes se insertan entonces en la mediana de sierra de corte, y con un poco de fuerza de las dos mitades pueden suficientemente separados permitir el acceso del periostio, que cuidadosamente debe incisa o rayado a travГ©s con el punto de la cuchilla, comenzando por encima de donde el peligro daГ±ar el sub yacente partes menos. como se usa la kamagra Como divide el periostio, las mitades del hueso una mentira mГЎs ampliamente separados, y este intervalo se extiende gradualmente Prom pulgada casi el doble de esa distancia como el Fuerte de tracciГіn constante mantenida durante la operaciГіn subsiguiente.

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Una separaciГіn de tres viagra pierde efecto con el tiempo centГ­metros pueden obtenerse en cualquier caso, y esto abundante, Las pequeГ±as ramas intercostales la arteria mamaria interna son algo tortuoso y suficientemente largo permitir el movimiento libre del hueso sin recibir daГ±o. Los mГєsculos y la fascia se dividen disecciГіn roma, o con unas pinzas y tijeras, en la lГ­nea media, comenzando arriba, dobles ligaduras estГЎn aplicando las venas que cruzan la lГ­nea de incisiГіn.

En el caso informaron que los nervios no fueron vistos en absoluto e incluso en una ligadura de la primera parte de la subclavia este mГ©todo, el autor no cree que haya woidd.

ningГєn peligro el nervio larГ­ngeo recurrente, porque la vaina del buque harГ­a abierto lo antes expuesto, y las manipulaciones posteriores tendrГ­a lugar dentro de la vaina completamente separado del nervio.

Que se anule DiagnГіstico Precoz y Tratamiento Operativo difusa, purulenta peritonitis Afpendical Origen. Dr. Bauer, Malmoe, Dinamarca, en la quinta reuniГіn de los cirujanos escandinavos, leyeron un documento al respecto. Г‰l primero discutiГі irritaciГіn peritoneal, que tiene diferentes escritores han descrito de diversas maneras.

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Algunos asumen una infecciГіn del peritoneo debido influencias nerviosas, pero donde la inflamaciГіn juega un papel subordinado.

Otros, como Tietze y Lennander, piensan que una inflamaciГіn benigna, serosa o sero-fibrinoso el peritoneo. El escritor afirma que significa mГЎs pueden significar un ligero afecto el peritoneo o mayo el inicio de una peritonitis muy grave para reunido con en todas sus formas. Lennander aconseja no operar en tales casos, sin embargo Bauer ha hecho en tales casos y se encontrГі una peritonitis difusa comenzando. El cuadro clГ­nico diferente segГєn su etapa. Diagnosticada fГЎcilmente mГЎs tarde, en un primer momento su reconocimiento difГ­cil, pero muy necesario. El paciente se apoderГі de un dolor muy violento, que puede grande que puede colapsar o caer a la vez. Dolores cГіlicos pueden preceden, aunque a menudo no hay prГіdromos. El dolor puede, en el epigastrio o alrededor del ombligo, y rara vez cerca del ciego. Puede vГіmitos, heces, no rara vez sueltos.

Diario

El viagra (sildenafil), sus orГ­genes y los efectos colaterales

Actualmente cada vez es mГЎs comГєn que un hombre utilice una pequeГ±a y mГЎgica pastilla azul para mantener relaciones sexuales: El Viagra (citrato de sildenafil). Desde 1998 la utilizaciГіn de esta pГ­ldora es la moneda corriente para luchar en contra de los problemas de erecciГіn e impotencia masculina. Sin embargo, los hombres tambiГ©n emplean el Viagra como un estandarte de conquista.

Pese a que mГЎs de 600.000 mГ©dicos a nivel mundial hayan elegido el Viagra para ayudar a mГЎs 20 millones de pacientes con problemas de erecciГіn, poco sabe el comГєn denominador de la poblaciГіn acerca de los efectos y problemas que puede llegar a causar tomar Viagra.

ВїPor quГ© se produce la disfunciГіn erГ©ctil?

Existen diversas causas que se pueden asociar con los problemas de un hombre a la hora de lograr la erecciГіn. Dentro de las mГЎs comunes estГЎ la diabetes como una de las razones mГ©dicas mГЎs frecuentes; en especial en hombres de mayores de sesenta y cinco aГ±os. AdemГЎs, las cardiopatГ­as (o problemas relacionados con el corazГіn) tambiГ©n originan problemas erГ©ctiles. del mismo modo que la presiГіn sanguГ­nea alta.

ВїDe dГіnde viene el Viagra?

La utilizaciГіn de esta pastilla cimentГі la primera modalidad de tratamiento no quirГєrgico para enfrentar la impotencia masculina que no debe ser administrada ni por vГ­a intravenosa, ni directamente en el pene. En un principio, el Sildenafil. o Citrato de Sildenafil, fue concebido para tratar a las anginas de pecho, aunque con escaso resultado. No obstante, indujo un gran nГєmero de erecciones masculinas y los laboratorios Pfizer decidieron entonces comercializarla para tratar la impotencia masculina .

Luego de que fuera patentada en 1996 y finalmente, en 1998, aprobada en los Estados Unidos por la FDA (Food and Drug Administration), el Viagra se convirtiГі en un Best Seller: Desde 1999 su venta excede el billГіn de dГіlares anual.

Su nombre puede estar inspirado en la palabra sГЎnscrita vyaghra en sГЎnscrito, cuyo significado es Tigre

Recaudos que se deben tomar antes consumir Viagra

Es importante que las personas sean precavidas frente a la decisiГіn de tomar Viagra. De este modo, es conveniente que previo al inicio del consumo de esta medicaciГіn, sus usuarios se realicen chequeos mГ©dicos y un examen fГ­sico para poder distinguir si no existen riesgos. Del mismo modo, el paciente estГЎ obligado a informarle a su mГ©dico cuГЎles son los medicamentos que habitualmente ingiere, ya que algunos pueden tener una interacciГіn negativa con los componentes del Viagra.

Los efectos secundarios

Tomar viagra puede causar algunos efectos secundarios tales como: Dolor de cabeza, enrojecimiento del rostro, nauseas y congestiГіn nasal.

Si bien Г©stos son los mГЎs frecuentes, tambiГ©n existen otros que no se presentan tan a menudo, aunque su apariciГіn es posible: Mareos, visiГіn anormal, visiГіn borrosa, sensibilidad a la luz, dolor en la vejiga, orina oscura o con restos de sangre y dolor al orinar. Finalmente, y quizГЎs la consecuencia mГЎs preocupante, es el dolor de tГіrax que precisa de asesoramiento mГ©dico inmediato.

ВїCГіmo actГєa el Viagra en el cuerpo?

Esta medicaciГіn produce una relajaciГіn en los mГєsculos lisos del pene, de modo que el miembro tiene un mayor flujo sanguГ­neo, que posibilita una erecciГіn duradera y firme.

Usualmente, tomar viagra es un tratamiento eficaz para quienes sufren de impotencia masculina. No obstante, existen casos que no se pueden resolver porque la raГ­z de los problemas de erecciГіn es otra mГЎs profunda.

MГ©todo de empleo

El Viagra se debe consumir una hora o una hora media previo a mantener relaciones sexuales; la duraciГіn de su efecto puede ser de hasta cuatro horas. Esta pastilla debe emplearse sГіlo una vez al dГ­a, y sГіlo en el caso de ser necesaria.

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Cuanto cuesta el viagra en la paz bolivia

Se emitiГі una orden de hace una semana, que le obligaba a buscar ante un juez magistrado en 6 cargos de delitos graves. AsГ­ que comprar sin receta Viagra sin temor en lГ­nea y encontrar en el correo rГЎpido tambiГ©n. La situaciГіn se vuelve impotente simplemente con ciertos socios tal vez en ciertas circunstancias (medio ambiente). Aunque en realidad deberГ­a haber ninguna vergГјenza en tener Г©xito como responsable acerca de las pruebas de ETS regular, podrГ­a todavГ­a ser mucho mГЎs cГіmodo para reservar y pagar en el Internet y recibir sus pruebas desde el correo. Usted puede ordenar en lГ­nea que le permiten obtener ofertas decentes de productos de belleza surtidos. Por lo tanto, podrГ­a ser altamente mejor para apagar durante el uso de la ingesta de fГЎrmaco que tiene nitratos en ellos. Mares seГ±alaron que espera que la suspensiГіn servirГЎ como ejemplo para evitar futuros corredores de caballos del engaГ±o y la bГєsqueda para inyectar caballos con sustancias dopantes ilГ­citos como Viagra. Tenga en cuenta que Sildenafil califica por la FDA simplemente para tratar su impotencia y se simplemente no aprobado para el tratamiento del mal de altura. Mientras que muchos hombres toman Viagra para aumentar su vida sexual, para los perros como duquesa que realmente es, simplemente, una droga que les mantiene vivos. El Viagra prepara plantas de maduraciГіn justo sobre todo desde que trabaja en los penes de los hombres. Una lista completa de los productos retirados del mercado de operaciones del Atlas se pudo encontrar en este sitio web de la FDA. Independientemente de dГіnde lo hacen, van a encontrar un enfoque para orientar sus sentimientos que funcione. Estos tumores tienen un mayor ritmo de repeticiГіn locales y metГЎstasis a causa de sus cualidades biolГіgicas inherentes, y tambiГ©n, ya que normalmente tienden ser mal diagnosticados, lo que lleva a un pronГіstico pobre, ademГЎs de una tasa de mortalidad mГЎs alta. Sin embargo, algunos salones profesionales expertos tambiГ©n estarГЎn proporcionando luz lГЎser suaves calmantes mГ©todos de tratamiento alternativas, mГ©todos de cirugГ­a de ojos suaves de luz lГЎser, la epidermis tratamientos grГЎficos y otros tipos de tratamientos de medicaciГіn alternativas como baГ±era de lodo y baГ±era de aire de calma. Alrededor del 70 por ciento que se enfrentan los hombres despliegan reportГі una cierta mejora en el logro de una erecciГіn mГЎs dura y mГЎs grandes. No sГіlo hizo que sucediera drГЎsticamente a aliviar mis sГ­ntomas, parecГ­a aumentar mi energГ­a y la libido (aunque no estoy seguro de los detalles fue porque dentro de los ingredientes o tratamientos para mi condiciГіn. Cuando todos de repente mi corazГіn comenzГі libras, no puedo respirar, no habrГЎ una opresiГіn en mi pecho haciendo. El Cialis ayuda al relajar los mГєsculos y aumentar la circulaciГіn de la sangre a determinadas zonas dentro del cuerpo. En esta investigaciГіn, 132 personas que sufren junto con el mal de altura obtuvieron la dosis de sildenafil en la baja concentraciГіn (15 mg) por alrededor de cada semana. La fabricaciГіn de Viagra genГ©rico es perfectamente legal en muchos otros paГ­ses, incluyendo a las personas que han bien desarrollados, las normas modernas de seguridad y regulaciГіn, como Reino Unido. TambiГ©n es importante con el hombre a respirar profundamente para ayudarle a relajarse. En resumen, lo mejor es emplear una dosis normal de cautela de los consumidores al comprar Viagra en lГ­nea en la farmacia que nunca only’ve usado antes. ВїSe puede utilizar una larga barba pie que simplemente no ha recortado en ocho meses o va a mantener la barba recortada para su longitud asociada con un par de dГ­as de crecimiento. Si nos quedamos usando las fotos de Playboy y The Devil Wears Nada episodio, entonces esta respuesta no es un.

cuanto cuesta el viagra en la paz bolivia
Los investigadores ya probaron la pequeГ±a pГ­ldora azul que se utiliza para tratar la impotencia masculina en las fresas, los claveles, las legumbres, las rosas y mГЎs. Por supuesto, con el Г©xito del Viagra, es simplemente una cuestiГіn de tiempo antes de que se enfrenta a una competencia. A medida que las cosas se les llama sugieren que puede haber sin duda un gran potencial dentro de este medicamento en particular en la lucha contra la disfunciГіn erГ©ctil. Primobolan tiene propiedades estrogГ©nicas incluso mГЎs bajos que la nandrolona. Para ser conscientes de ello, primero debe saber un poco acerca de sГ­ mismos erecciones – despuГ©s de lo cual vamos a conseguir para su informaciГіn nitty arenoso Viagra. Efectos secundarios Las medidas dentro de un contexto en el ser peores en lugar de la enfermedad, es bueno para conseguir barato Kamagra es como una droga. Esas famosas “pastillitas azules” que fueron comercializados inicialmente a los hombres en realidad podrГ­a ayudar a salvar la vida de su perro. Por una parte, la bГєsqueda de un tono mГЎs claro en sus cerraduras si la piel es de tono mГЎs oscuro le permite tener mГЎs chispa y el brillo. Durante siglos, el salitre continГєa llegando a ser aГ±adido a los alimentos de la manera que. A travГ©s de la auto-educaciГіn de nosotros mismos, el conocimiento y el conocimiento a travГ©s vienen una transformaciГіn en nuestra manera de pensar, de actuar y de sentir. Mientras aplica el mehndi, hacer uso de un magnГ­fico dispensador ya que garantiza la facilidad y perfecciГіn dentro del arte. Sin embargo, la impotencia masculina puede ser tambiГ©n una reacciГіn a otros trastornos que realmente deberГ­a ser administrado primero en un intento de mejorar la probabilidad mayor con el tratamiento exitoso. PrГіxima mente el deseo sexual masculino que se llama libido se promueve lleva los impulsos sobre las vГ­as nerviosas para el pene. En junio de 2009, que muestra llegГі a la direcciГіn de encubierto Houston, en esta ocasiГіn el papeleo del envГ­o que se examinГі por la Aduana y funcionarios de correos, dijo que los envГ­os contenГ­an una “Muestra de Juguetes. Viagra ofrece un fondo excelente, ya que realmente es utilizado por 20 millones de hombres en todo el mundo. La droga se cuelga sobre torrente sanguГ­neo dentro de aproximadamente cuatro horas, y despuГ©s de que se lava fuera de la sangre porque desde el hГ­gado y los riГ±ones. Por otra parte, varios tintes de cabello pueden causar alergias a ellos, a fin de comprobar las marcas de productos para el cabello que puedan estar utilizando; usted puede tener en tintes para el cabello seguras consideraciГіn, que contienen ingredientes naturales. Esto facilita la presiГіn dentro de las arterias y durante la estimulaciГіn sexual; Se inundan el desarrollo de un torrente de sangre que induce el pene para conseguir erigir. Por lo general es el resultado de las enfermedades varГіn tenГ­a en el pasado, el estrГ©s y la ansiedad terrible y enfermedades mentales tan distintos. Rumor serГЎ que estГЎn inhalando la nuez moscada, la sal. Hombres, esto puede ser un momento despuГ©s de descubrir cГіmo apenas recibir y echar un vistazo a la relajaciГіn progresiva para todo el perineo y el ГЎrea anal que comienza a la salida y el pulso como si eso le respirando a travГ©s de Г©l. La impotencia tambiГ©n podrГ­a afectar a las mujeres, a pesar de que los sпїЅ
omas son muy diferentes. In humans, aging could be the multidimensional method that marks the physical, psychological, and social change inside the life. Efectos negativos mГЎs comunes son dolor de cabeza, indigestiГіn, dolor de hombros, dolores musculares, enrojecimiento, congestiГіn o secreciГіn nasal o tinte azul temporario en la visiГіn o dificultad para distinguir la diferencia.

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Viagra (sildenafil) facts

What is Viagra?

Viagra is the trade name for a drug called Sildenafil. Viagra is one of a class of drugs known as PDE-5 (Phosphodiesterase type 5) inhibitors.

Viagra and the other PDE-5 inhibitors can help men with erectile dysfunction (male impotence) by enhancing the erectile response when a man is sexually stimulated. Aside from Viagra, the other drugs in this class are Cialis (Tadalafil) and Levitra (Vardenafil).

How does Viagra work?

Viagra does not cause a man to be sexually aroused. Viagra is only effective if you are sexually aroused. To understand how it works you need to understand the mechanics of how a man gets an erection. When you get sexually stimulated, the nervous system in the erectile tissue of your penis releases nitric oxide (NO).

The nitric oxide stimulates an enzyme that produces something called a messenger cyclic guanosine monophosphate (cGMP). The cGMP relaxes the smooth muscle cells. One result of this is that the arteries in your penis dilate and the blood can flow into your penis more easily. Another result is that the erectile tissue itself fills with blood. Both of these process result in an erection. Viagra works by maintaining the level of cGMP in the smooth muscle cells.

If you are not turned on, your brain will not stimulate the release of any nitric oxide and you will not produce any cGMP.

Is Viagra effective?

Clinical studies have shown that when compared to placebo, Viagra and the other drugs in the same class, result in significant improvement in erectile function. Although established to be a safe and effective drug, Viagra isn’t appropriate for everyone and may not work in all cases.

How does it affect blood pressure?

Viagra can slightly lower blood pressure. This is not a problem for most men. But Viagra’s effect on blood pressure is exaggerated if the Viagra is taken with a nitrate drug.

Nitrates are one of the treatments doctors prescribe for angina. If you take Viagra when you are also taking nitrates, the combined effect of the Viagra and the nitrates can lower your blood pressure to such an extent that it could prove fatal. Never take Viagra at the same time as taking nitrates.

If I have a heart condition can I take it?

If you have a heart condition it is important that you discuss this with the doctor before taking Viagra. Viagra may not be appropriate because of the danger of interacting with the nitrates.

Can women take it?

Viagra is not currently licensed for use by women.

How quickly does it work?

On average, Viagra becomes effective in just under an hour when you take a tablet on an empty stomach. Viagra can remain effective for between four and six hours. If you take it after a meal that has a high fat content, it may take longer than an hour to become effective.

Why are there different doses?

Viagra is available in three dosages: 25mg, 50mg and 100mg. Some men may respond to a lower dose of Viagra. Some men may already be taking medicines that interact with Viagra and thus need to adjust the Viagra dosage they are taking.

What dose is right for me?

The doctor needs to decide which dosage of Viagra is most appropriate. The doctor will take into account potential drug interactions, your age, the severity of your erectile dysfunction and any previous experience you have had with Viagra.

What if it does not work the first time I use it?

Viagra might not work the first time you take it. Most doctors advise taking Viagra at least eight times before trying a different medicine.

What are the side-effects?

Viagra’s Side effects are generally mild and brief. Viagra’s most common side-effects are headache and facial flushing. Less frequently, men taking Viagra have reported indigestion, a stuffy nose and a blue tint to the vision.

Does it interact with other medicines?

Viagra interacts with many drugs. The following list is not complete but it is important to inform the doctor of all prescription and non-prescription medication taken, especially:

  • nitrate medications (e.g. glyceryl trinitrate (GTN), nitroglycerin, isosorbide mononitrate or dinitrate)
  • nitroprusside
  • cimetidine
  • erythromycin
  • azole antifungals (e.g. itraconazole, ketoconazole)
  • mibefradil
  • rifamycins (e.g. rifampicin)
  • Alpha blockers, prescribed for prostate disease or high blood pressure
  • Ritonavir, Amyl, Butyl or Isopropyl nitrates (‘Poppers’)

Who shouldn’t use it?

Men who have any of the following conditions should also avoid taking it:

  • severe heart or liver problems
  • recent stroke or heart attack
  • low blood pressure
  • certain rare inherited eye diseases

Does it treat the underlying causes of impotence?

Viagra will resolve the underlying cause of erectile dysfunction although if the cause is primarily psychological, it may help to break the cycle of anxiety and failure associated with being unable to achieve a satisfactory erection.

What kind of tests might highlight the underlying causes of male impotence?

A blood test for diabetes should be performed along with cholesterol and triglyceride blood tests. It is becoming increasingly accepted among doctors that sex hormone levels (Testosterone) should also be checked by way of a blood test.

What other impotence treatments are available?

The other drugs, Levitra and Cialis work in similar ways. Viagra is generally prescribed as the first line treatment. Cialis has a much longer half-life than Viagra and Levitra and therefore its effect lasts much longer.

This does not mean one has prolonged erections but the length of time available for further erections is increased without the need to take further doses. It also means however that the side effects if present will last longer. Levitra, like Cialis, can be taken with food whereas Viagra should be taken on an empty stomach.

Some studies have shown Levitra to be more suitable for men suffering from diabetes. Other treatments include Caverject (‘Alprostadil’), which is a medication injected directly into the penis and MUSE (another form of ‘Alprostadil’), which is a pellet inserted into the urethra. These may be of use for men who have to take Nitrates and are therefore unable to take the PDE5 inhibitors.

The use of vacuum pumps and other mechanical devices for producing and maintaining erections are alternatives to taking medication.

Viagra and performance anxiety

-)

Hello Doctor. My doctor prescribed me viagra for performance anxiety. I suffer from anxiety disorder. It worked great and sometimes didnt even need it. Ive been taking it usually a couple times a week. Last couple times I took it it dindnt work very well. Is there a tolerance build up to viagra? For a man like me who didnt physicaly need it, could it damage my penis and make me impotent? Been taking it for 4 months 2 to 3 times a week.

I’m in the same boat, 24 years old and performance anxiety for 6 years. The last 2 years I was in a relationship and for the first time I didn’t have any issues whatsoever. The 4 years before that it was bad enough I was taking viagra just to hook up for one night stands. I was also in a 3 year relationship that I needed to rely on viagra for.

I am 18 and suffer from performance anxiety. i cant maintain an erection when im with my girlfriend. We’ve tried many times it just doesnt work cause im nervious. is there any cure or way to maintain an erection for sure? would a penile pump work?

But in other times they just don’t have any effect. I have been told that as long as I have performance anxiety. all the viagra in the world will not help. To over come the problem, my doctor prescribed me Trazodone Hydrochloride 100mg every night. I have to say that after taking Trazodone for a couple of weeks I could have healthy sex with or without viagra. I took Trazodone for a bit more than 3 months and then gradually stopped.

I am prone to occasional bouts of sexual performance anxiety. Usually, it occurs when I’m with someone I really care about for the first time. My mind gets pre-occupied with wanting to be good for her and to give her total satisfaction. Of course, these thoughts start to weigh heavily, and it affects my ability to get an erection. Usually though, after a few times with that person, I settle down and relax into the great lover I am. I’m not jesting with that comment.

Secondly, I suggest you do some research on the subject of ED and sexual performance anxiety. Read books (I recommend ‘Erectile Dysfunction: Current Investigation and Management’ by Ian Eardley and Krishna Sethia, you can order it at bn.com), talk to experts, search the Internet. The more you know about these problems, the less stressful they will be. I’ve already mentioned the ‘fight or flight response’ here.

Well, I stop masturbating a couple months ago and I definitely feel increased sensitivity in penis head when a woman touches me PLUS I now enjoy sex more thru condom. However, my anxiety keeps coming, always thinking about my past and thinking I will not get full erection. PLUS I always have a conscious with my penis when it’s erect (never in an upright position). So if a woman is too rough, pushing it down, applying pressure, etc. that may make me lose my erection.

Hi! If you were my patient, I would advise you that "performance anxiety" is fairly common. There is no harm in taking Viagra–it will not damage the sperm or increase the risk of any type of birth defect over baseline. A urologist is the type of doctor that would most likely be able to help you if your general doctor is uncomfortable prescribing it. Good luck!

The problem is that in my head I want sex all the time, but when it comes to the act, I have no faith in the ability to maintain my erection hard enough for penetration. I’m in the performance anxiety cycle I believe. I’m desperate, I want sex all the time and feel I am missing out on a vital part of life, but every time I am in a sexual situation I worry that I won’t be able to perform.

This can be done usually, though not always, without medication. The commonest cause of erectile dysfunction in young men is performance anxiety and the commonest cause of this is watching yourself trying to get or maintain an erection. Once a man is up in the audience looking at himself he is doomed to failure. Here is what is happening: Your subconscious brain is trying to get a message through to your penis to get ready for action and get erect or to stay erect.

Its best if you can keep away from drugs, get to relax and stop trying, its all in his head, he can see what he wants to happen before it happens, get him in a hot bath with you, its relaxing and your both naked, and this way he can see all of you and work from there, and yes dont forget some candles and some wine.

It can become a self-fulfilling prophesy when your worry and anxiety inhibits your erections. If you convince yourself you can’t have sex without a drug, you’re at a terrible disadvantage. So let’s talk about your options. First of all, why do you feel you need Viagra? Are you uninterested in sex? Viagra doesn’t create sexual interest, although many hope that it will. Realize that men can have a multitude of sexual concerns with many possible causes.

If you are young — under the age of 30 your erectile dysfunction is probably due to performance anxiety and you don’t need Viagra. If you are older then get proper Viagra made by Wyett.

I am 55 years old. No medical issues, I took viagra in 2004 and it worked fine for about 2 years. However it stopped working, my erections are not hard enough for penetration however I can only have an orgasm through masturbation. A ring seems to help but I loose my erection just before penetration. I went to Boston Medical group for injections, they get me hard but my erection lasts only 15 minutes and is floppy. My testosterone went from 234 to 263 after 3 months on Androgel.

I have battled erection difficulty and performance anxiety my entire life. I have been prescribed Viagra twice, but never taken it due to being scared. I also take Adderall for ADHD. Last night I decided to try it with my girlfriend. I did not take my Adderall that day. That evening, I took 50 mg of Viagra. The pills were a little more than one month expired, but my doctor said they should still be fine. I’m sad to say they had almost no effect.

I just recently began a new relationship and used this about 4 times and stopped using Viagra last week. I have since then been able to proceed with non-drug induced intercourse and have not seen any problems however, my penis does seem to be a little bigger when flaccid. I’ve heard of people causing permanent impotence in themselves when abusing this drug.

In the past, I had been prescribed Viagra as I was having more or less of a performance anxiety issue with this one girl that I was with and used this only a few times to just get over this mental hump and then was ok afterwards having sex without the use of pills.

I feel that at 27 you are too young to have to use Viagra. If you have performance anxiety ED, then you should work on that other ways and not jump to a pill as a quick solution for your long-term health.

So Im going to find a way to get viagra for my performance anxiety. Im a young guy, so i dont want a 4 hr erection, just a raging strong enough one to get over my nervous, etc. how many mgs would you reccomend to get what I desire without an embarrasing trip to the ER?

Here I go again as a contrarian. I have HCV. I don’t know how long I have had it; could be since the mid 70’s. My latest suspicions are that since my LFT’s were perfect in 1990 (w/ moderate drinking) and out of range in 2002 (while not drinking) that I could have possibly been infected more recently. I’m rather normal or better than normal physically and I would say that I seem somewhat unaffected by HCV and the thread topic, although I am within spitting distance of 60 years old.

with a new woman you have performance anxiety and you are over excited. If you keep yourself in control, you may be able to do it. For keeping control. learn abdominal breathing from Google, practice for 10 minutes twice a day. So when you are with her do deep, slow and even breathing. I hope you will be able to do it. Another method is masturbate half an hour before. After hale an hour, you will be aroused, and then do it. You will be successful.

Took Viagra no problem went back on klonopin and luvox and didnt need viagra. Had another case of performance anxiety two years later and my obsessions started again. Used Viagra and then no problem.Met my wife 6 months ago again performance anxiety, took cialis and it worked until I made a decision to try celexa for two weeks and I dont know if it was my anxiety or fear or did it really kill my sex drive. Viagra or Cialis didnt work. Went back on Luvox up to 150mg and Neurontin 300mg 2x a day.

Took Viagra no problem went back on klonopin and luvox and didnt need viagra. Had another case of performance anxiety two years later and my obsessions started again. Used Viagra and then no problem.Met my wife 6 months ago again performance anxiety, took cialis and it worked until I made a decision to try celexa for two weeks and I dont know if it was my anxiety or fear or did it really kill my sex drive. Viagra or Cialis didnt work. Went back on Luvox up to 150mg and Neurontin 300mg 2x a day.

Lloyd’s will always sell you drugs, that’s what they do. 95% of erectile dysfunction in a man of your age is caused by Performance Anxiety. The remaining 5% — diabetes, venous leak and so on are very rare. What you have is easy to fix. Just take intercourse off the menu for a while. No performance no anxiety. Good luck. Hope this helps.

My first thought is that you are much too young to need Viagra and quite possibly it’s the Viagra that is getting in the way. Since your organs are working properly during masturbation, a kind of performance anxiety may be overtaking the situation during intercourse. Cut out the use of Viagra, involve plenty of foreplay, and let your body react in a natural way.

Relax, enjoy your own unique sexuality and stop judging yourself. And. no, drugs won’t help you if your problem is caused by anxiety and worry. Viagra doesn’t alleviate anxiety, etc. All it does is open up blood flow to the penis. It’s for men who have a medical condition such as diabetes, which prevents blood flow. Don’t forget: YOU ARE IN CHARGE of your sexuality. Take a deep breath and look at the above issues to see if any relate to you.

I believe that in cases of sexual performance anxiety. VIGAMED (oral phentolamine) may be better than Viagra. What happens when you get too anxious (fight or flight response)? Basically, the rush of adrenaline blocks peripheral blood circulation and inhibitis penile erections. This is where VIGAMED comes in. VIGAMED is not a PDE-5 inhibitor, it is an alpha blocker, it blocks alpha receptors in the penis and inhibits the effects of stress hormones.

I’m still using it for this one girl I’m seeing and have actually begun taking ginko bilboa and horny goat weed to try and increase my libido a bit. Just wondering if it’s safe to use Viagra once in a while when needed or if it can lead to permananent damage or dependancy. Thanks in advance.

Erectile Dysfunction Health Center

WebMD archives content after 2 years to ensure our readers can easily find the most timely content.

To find the most current information, please enter your topic of interest into our search box.

“>WebMD Feature Archive

April 10, 2000 (Mill Valley, Calif.) — In his early 40s, Ron Hanson was too young to be having trouble getting and sustaining erections. But like many men, he was too embarrassed at first to talk about the problem. Hanson (not his real name) waited seven years to see a urologist. By the time he spoke up, erectile dysfunction had become a household word, thanks to the popularity of the drug Viagra. But the widely touted drug, Hanson soon learned, doesn’t work for everyone.

When Viagra (sildenafil) hit the market in 1998, some men thought it was the long-awaited answer to their problems. Many rushed to doctor’s offices to give it a try. According to the Grey Clinic in Indianapolis, which specializes in erectile dysfunction. 17% of men between 18 and 55 experience occasional impotence, while 6% have regular erectile difficulties. For men over 55, that number jumps to about one in three. Some common causes of impotence are diabetes. heart disease. and psychological problems. It also frequently occurs after prostate cancer surgery.

Because Viagra works in a way that’s similar to drugs that contain nitrates, however, it isn’t recommended for men who take nitrates for heart disease or those with certain other heart conditions. In some men, it causes bad headaches. In others, it just plain doesn’t work. In some instances, men may notice they have trouble telling blue and green colors apart when they start taking the drug.

During an erection, blood flows quickly into the penis. which increases its length, width, and firmness. If the “in” vessels (arteries ) are too narrow or if blood drains too quickly through the “out” vessels (veins), men may have trouble achieving or maintaining an erection, says Arnold Aigen, MD, a urologist with Camino Medical Group in Sunnyvale, Calif. Viagra, which increases inflow, may not be strong enough to work its magic if the arteries are too narrow.

Hanson tried Viagra, but he couldn’t tolerate the headaches it caused. Luckily, when Viagra fails, he discovered, there are several alternatives.

Alprostadil to the Rescue

A drug called Alprostadil. either alone or sometimes in conjunction with others such as papaverine and/or phentolamine, can be injected directly into the penis to dilate the arteries, experts say. The drug produces an erection in about 10 minutes that can last up to an hour. But there are several disadvantages, says Teresa Beam, MD, a urologist with the Grey Clinic. Some patients are averse to using a needle, which is why many men abandon the therapy. Those who give it a try may experience pain at the injection site or priapism (a painful erection lasting too long).

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Viagra For Life in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Viagra For Life is the perfect place to spend a relaxing weekend or a lifetime.

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Manufacturer link: Moots
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Manufacturer link: Bianchi
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Wednesday through Saturday evenings at 8:00 pm with a Thursday matinee at 2:00 pm.

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Adults: $100
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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.

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

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Prior to the year of 1972 when the theatre was established, the Meilleur Viagra Generique 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 Meilleur Viagra Generique 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 Meilleur Viagra Generique’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 Meilleur Viagra Generique 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 Meilleur Viagra Generique 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 Meilleur Viagra Generique 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 Meilleur Viagra Generique, prepare a load of lumber for the newest construction project.

The Meilleur Viagra Generique 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 Meilleur Viagra Generique 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 Meilleur Viagra Generique 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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Me tomo 25 mg en ayunas con un vaso grande de agua a las 08:00 hrs. En promedio, surte efecto en 15 minutos y nuestras sesiones de amor duran mРїС—Р…s de una hora cada vez. -65 aРїС—Р…os, Florida.

DecidРїС—Р… probar una pРїС—Р…ldora de Viagra de 25 mg. SentРїС—Р… que el pene se me ponРїС—Р…a duro al cabo de 15 minutos. Se vuelve mРїС—Р…s duro que de costumbre y tambiРїС—Р…n dura mРїС—Р…s. РїС—Р…YT, 45 aРїС—Р…os, Nigeria.

Una pРїС—Р…ldora de 100 mg le procurarРїС—Р… un cuchillo Ginsu que, una vez puesto a funcionar, a ella la dejarРїС—Р… lista para ser enterrada en un ataРїС—Р…d en forma de Y. Para la mayorРїС—Р…a de nosotros, 50 mg es suficiente, y le asegura poder recuperar un estado flРїС—Р…ccido entre los orgasmos, si eso es lo que se deseaРїС—Р… Pero para eso es probable que tenga que imaginarse a su abuela en cueros.

Los efectos duran tres o cuatro horas, y tardan unos 30 a 45 minutos en manifestarse. Las pРїС—Р…ldoras de 25 mg o 50 mg funcionan indistintamente para mРїС—Р…. AtrРїС—Р…vase a probarlo. РїС—Р…Art, 62 aРїС—Р…os, Texas.

ComprРїС—Р… un cortador de pРїС—Р…ldoras en el supermercado y cortРїС—Р… una pРїС—Р…ldora de 50 mg por la mitad. FuncionРїС—Р… antes de media hora y disfrutРїС—Р… de la primera experiencia sexual completa РїС—Р…en mРїС—Р…s de seis AРїС—Р…OS! -William, 42 aРїС—Р…os, Texas.

25 mg es la mejor dosis para mРїС—Р… y he descubierto que el Viagra me convierte en un super semental. Mi chica se monta encima y siempre tiene uno o dos orgasmos. РїС—Р…Pablo, 42 aРїС—Р…os, Texas.

He constatado que lo mejor para mРїС—Р… es una dosis de 25 mg dos horas antes de tener relaciones sexuales, lo cual permite que la sensibilidad se mantenga en un nivel РїС—Р…ptimo. Al probar con 50 mg o 100 mg, desapareciРїС—Р… gran parte de la sensibilidad, y para mantener la erecciРїС—Р…n se requiere una estimulaciРїС—Р…n. Desde luego, en mi caso mРїС—Р…s no es sinРїС—Р…nimo de mejor. РїС—Р…Phil, 60 aРїС—Р…os, California.

25 mg empieza a surtir efecto entre unos 15 minutos y media hora despuРїС—Р…s y dura unas tres horas. Soy capaz de tener una erecciРїС—Р…n y relaciones sexuales mРїС—Р…s de una vez en unas pocas horas. -65 aРїС—Р…os, Nueva York.

Mi mРїС—Р…dico me prescribiРїС—Р… Viagra de 50 mg. РїС—Р…Vaya! Una erecciРїС—Р…n inmediata que dura un buen rato. Tomo 50 mg unas tres veces a la semana.

He probado las dosis de 100 mg de vez en cuando, pero en realidad me va mejor con las dosis mРїС—Р…s pequeРїС—Р…as. РїС—Р…JR, 65 aРїС—Р…os.

Hay que experimentar con diferentes dosis e intervalos de tiempo. Yo empecРїС—Р… con 50 mg (adecuado para estimular mi organismo, creo) pero con el tiempo he descubierto que lo ideal para mРїС—Р… es una dosis de 25 mg unos 90 minutos antes de tener relaciones sexuales. Las dosis mРїС—Р…s pequeРїС—Р…as significan menos congestiРїС—Р…n nasal y mРїС—Р…s sensibilidad durante el coito. Pero la dosis de 25 mg todavРїС—Р…a me mantiene duro como una piedra y capaz de contener el orgasmo prРїС—Р…cticamente hasta cuando quiero.

He experimentado con diferentes dosis y he descubierto que 25 mg una media hora antes de tener relaciones sexuales es perfecto para mРїС—Р…. Se me pone dura como una piedra y puedo durar una eternidad.

Le pido al farmacРїС—Р…utico que me parta una dosis de 100 mg en cuatro dosis de 25, que es lo que tomo cada vez. Cuando quiero que dure toda la noche, me tomo los 100 mg.

Yo parto las pРїС—Р…ldoras de 50 mg por la mitad y con eso me basta.

Nos corrimos juntos, y РїС—Р…madre mРїС—Р…a. quРїС—Р… manera de correrse. РїС—Р…QuРїС—Р… potencia! Lo que hace de esta experiencia algo cada vez mejor es que sРїС—Р…lo utilizo la mitad de una dosis de 50 mg.

Yo comencРїС—Р… con una dosis de 25 mg. Y la he reducido a 12,5 mg (parto la pРїС—Р…ldora de 100 mg en 8 trozos) y he descubierto que con esta dosis reducida, puedo seguir teniendo una erecciРїС—Р…n durРїС—Р…sima asРїС—Р… como un dolor de cabeza muy ligero.

He llegado a descubrir que sРїС—Р…lo necesito 25 mg para tener y conservar una erecciРїС—Р…n. Pero, la primera noche tomРїС—Р… 50 mg. РїС—Р…Bill, Chicago, 42 aРїС—Р…os.

CРїС—Р…mo tomar Viagra

Contrario del viagra

Antitoxina como un profilГЎctico.

Cowperthwaite, en su difunto Medicina PrГЎctica, dice que convencidos experiencias de tomar viagra de la gran antitoxina nocividad, cuando se utiliza en general y de manera indiscriminada como profilГЎctico.

No quiso usar como profilГЎctico en un amigdalar difteria epidemia, pero utilizarГ­a puedo tomar cialis diario sГіlo en presencia de un caso de clase muy malignos.

Recomienda unidades, segГєn tadalafil cialis la edad, con viagra conseguir fines de inmunizaciГіn.

Esto porque duele la cabeza cuando tomas viagra considerado como una dosis bastante pequeГ±o. El autor piensa que la idea de que la antitoxina no hay servicio cuando se usa al final de la enfermedad incorrecta.

Puedo tomar la mitad de un viagra

Fue la observaciГіn de estos casos de clase, donde la antitoxina, en el Гєltimo momento, demostrГі un verdadero salvador, que le obligГі admitir la eficacia del tratamiento, a pesar de fuertes convicciones previas al contrario.

Viagra efectos secundarios graves

Creemos que las recuperaciones de antitoxina administrados tarde en el curso de la enfermedad son excepcionales. Si se utiliza en un caso, el mГ©dico no puede comenzar antes de tiempo.

Se ha dicho que en ningГєn caso no falle cuando se administra dentro de las primeras veinticuatro horas.

Esto no es cierto. Antitoxina no significa un remedio especГ­fico, y creen que llegarГЎ el momento en que viagra entra por la seguridad social definitivamente se conoce que los casos de difteria amables antitoxina tal vez curada, y quГ© tipos no son susceptibles a sus efectos curativos. Ciertamente no Vaccinium como un agente inmunizante.

Empleamos una atenciГіn enfermera graduada para uno de nuestros casos. Ella habГ­a estado tomando polvos Vaccinium. Ella vino y querГ­a casos de viruela. En unas dos semanas la enfermedad desarrollada, a pesar de que habГ­a llevado a los polvos fielmente. lo mas parecido al viagra Estuvo a punto de morir. Los polvos hicieron absolutamente nada bueno. Dr. Mann, viagra venta libre en farmacias en Nueva Inglaterra Gaceta. Polvos cuanto dura el viagra para hacer efecto Vaccinium o pГ­ldoras no son tan buenos como la vacunaciГіn! cialis forma de tomar La homeopatГ­a no avanzado tal sustituciГіn mГ©todos. Experiencias clГ­nicas con Echinacea. Dr.

Diario

Ahora se puede picar la Viagra por la mitad

Hombre inventa artefacto para cortar la píldora eréctil

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

Por Amanda Gardner
Reportera de HealthDay

Jueves, 5 de diciembre (HealthDayNews) — Cuando se trata de Viagra. la economía es la madre de la inventiva.

La píldora eréctil en forma de diamante cuesta lo mismo (casi $10 cada una) si se recibe la versión de 25, 50 ó 100 miligramos. Esta estrategia de precio fijo ha llevado a muchas personas mayores de 50 a comprar píldoras de dosis mayores y tratar de picarlas en pedazos más pequeños.

“El paciente debe tomar la droga a base de la dosis recomendada por el médico”, dijo el doctor Ira Sharlip, presidente de la Sociedad de Medicina Sexual de Norte América. “Pero puedo afirmar que es una práctica común para los doctores recomendar una dosis de 50 miligramos y escribir una receta para una tableta de 100 miligramos”.

La táctica podría duplicar la diversión, pero otra cosa es lograr que sea funcional.Carmen Reitano, 71 años, inventor y usuario de Viagra. estaba cambiándose en los vestidores no hace mucho cuando surgió la conversación de los peligros y las dificultades de picar las pastillas.

“Se deshace”, se quejó un hombre.

“No la puedes picar”, dijo otro.

“La cortas con un cuchillo y se parte con tanta fuerza que rebota en la pared, entonces tienes que estar buscando las piezas”, dijo un tercero.

Reitano nunca había tratado de picar sus píldoras de Viagra aunque su compañía de seguros sólo recetaba cuatro al mes. No obstante, luego de escuchar la varonil conversación, decidió darle pensamiento. Fue a su casa, tomó el cuchillo de cocina e intentó cortar una de sus píldoras de Viagra. Nada pasó. Lo intentó con un cuchillo X-acto. Nada. Un martillo. El resultado fue el mismo: Nada.

Sharlip dijo que sus pacientes han podido cortar la Viagra con picadores de pastillas, “y lo han logrado. Sin embargo, muchos otros insisten en que la forma de la pastilla no ayuda a que parta con facilidad”.

“La conclusión a la que se llega es que fue diseñada a propósito para resistir a que la picaran”. Opinó Reitano. “No es plana. Es difícil de sostener. No hay líneas punteadas en la cobertura”. También descubrió que la medicación interna no siempre tiene una consistencia sólida, lo que explica la razón por la cual hay informes de que al picarla vuela en pedazos o se deshace.

Reitano, quien retiene varios patentes, no fue disuadido. “Se me ocurrió de repente que esta píldora estaba fabricada como un tablero, indicó. Era yeso encapsulado en papel de construcción. Y la forma de romperla es marcarla en un lado y golpearla en el otro, y se rompe por la línea débil”.

Con este principio en mente, Reitano utilizó instalaciones de ajuste de tubos de PVC para ensamblar un prototipo y lo llevó a la firma que había manufacturado uno de sus otros productos, un protector de antena para el teléfono celular Motorola StarTAC. La compañía construyó un prototipo, lo probó, y quién los diría. funcionó.

El 5 de noviembre, se concedió a Reitano la patente No. 6,474,525 de la Oficina de Comercio y Patente de EE.UU. para su “picador de píldoras para píldoras de formas complejas”. El producto actual, el V2 Pill Splitter. está disponible en dos tamaños: para las píldoras de 50 miligramos y para las de 100 miligramos.

Ahora Reitano, que lleva casado con su esposa por 47 años, es un picador de pastillas. Y los ingresos están creciendo a medida que hombres de todas partes del mundo compran el artículo (por $24.95) directamente a la página en el Internet de Reitano, www.v2pillspliter.com. Pfizer, que manufactura Viagra. no emitió comentarios. Sin embargo, la compañía por medio de su página cibernética no recomienda partir las píldoras.

Un urólogo de Boston dijo a Reitano que más de la mitad de los pacientes ahora está picando las píldoras (claro está, luego de pedir permiso al doctor) y un hombre de la ciudad de Nueva York llamó a Reitano para decir que estaba ahorrando $1,000 al año. “Dios te bendiga”, respondió Reitano.

Puedes obtener un documento de disfunción eréctil de los Institutos Nacionales de la Salud. Y la Administración de Drogas y Alimentos de EE.UU. tiene más información sobre Viagra .

Fuentes: Carmen Reitano, fundador y presidente, Three Chestnuts Technologies Inc., Newburyport, Mass.; Ira Sharlip, M.D. presidente, Sociedad de Medicina Sexual de Norte América, y urólogo, San Francisco; Oficina de Comercio y Patente de EE.UU.

Last Updated: Dec 10, 2002

Copyright © 2002 ScoutNews, LLC. All rights reserved.

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Nitric Oxide and Viagra

The structure of Viagra
Use your mouse to manipulate
the molecule

Viagra

In a random survey of males aged 40-70, more than 50 percent indicated that they had some form of erectile dysfunction (ED), i.e. the inability to achieve an erection. The development of the drug Viagra, an inhibitor of cyclic GMP-specific phosphodiesterase, has been of great importance to many males suffering from ED.

Achievement of a penile erection in males is largely an application of basic principles of hydraulics. Stimulation of the nerves innervating the penis causes the dilation of the deep arteries supplying blood to the penis. The large amount of blood entering the penis engorges the cavernous blood sinuses comprising much of the penis volume. This engorgement in turn acts to compress the veins draining blood from the penis. The increased inflow and decreased outflow of blood causes an erection. Cessation of nervous impulses to the penis acts to abolish the erection.

Nitric Oxide

Nitric oxide (NO) is of major importance in the signaling pathways leading to penile erections. NO is very unique for a biochemical signalling molecule because it is a gas. NO displays free radical behavior, and is formed from arginine by the enzyme nitric oxide synthase (NOS):

arginine + O2 citrulline + NO

As a gas, NO is able to pass through cell membranes without the aid of dedicated transporters and its free radical character makes it particularly reactive with iron-containing proteins.

Originally called UK-92,480, Viagra was initially developed for treatment of hypertension. In a subsequent human toleration study as a possible drug for angina, some very strange side-effects were noted.

NO acts as a vasodilator in the process of penile erection. NO is supplied from two sources. The first is as a neurotransmitter liberated by the cavernous nerve which innervates smooth muscle surrounding penile arteries. The second source is the endothelial cells lining the deep arteries of the penis. Endothelium-derived NO is formed in response to stimulation of the endothelial cells by cholinergic nerves. Acetylcholine causes the production of inositol triphosphate (IP3), an important second messenger in many hormone signal transduction pathways. IP3 opens calcium channels in the endoplasmic membrane of the endothelial cells; the liberated calcium then activates NO synthase and causes the production of NO.

Whatever the source, endothelial cells or cavernous nerve, NO diffuses across the muscle cell membrane and binds to guanylyl cyclase. Guanylyl cyclase catalyzes the synthesis of cyclic GMP from GTP. cGMP then activates a cGMP dependent protein kinase which in turn stimulates the uptake of calcium by the endoplasmic reticulum of the muscle cell. The reduced levels of cytoplasmic calcium cause the muscle cell to relax. As a consequence of muscle cell relaxation, vasodilation occurs.

Stimulation and inhibition of muscles by NO

As is true of any signaling pathway, there must be a way to terminate the action of the signal. cGMP is converted into GMP by a specific phosphodiesterase (PDE.) There are 10 families of PDEs: PDE1-10. The major PDE found in vascular smooth muscle is PDE5. Viagra (sildenafil) is a specific inhibitor of PDE5. By blocking the breakdown of cGMP, Viagra acts to prolong the effects of cGMP and, hence, the erection. The side effects of Viagra are relatively minor. Some minor vision problems have been reported; these are due to inhibition of PDE6, the phosphodiesterase used in signal transduction of light signals in the retina.

Other Biochemical Uses of NO

In addition to its role as a vasodilator and neurotransmitter, NO is produced by macrophages. These phagocytic cells of the immune system use NO to impair DNA synthesis and metabolism in microorganisms. NO can also react with other free radicals, in particular the superoxide radical, to form peroxynitrites that are effective against bacteria, fungi and other pathogens. Nitrites have been added as preservatives to meat for years; part of the effectiveness of added nitrites may be due to the antimicrobial action of generated NO.

Massive bacterial infections are known to cause septic shock, the hallmark characteristic of which is a dramatic lowering of blood pressure. This is due to the release of massive amounts of NO directed against the bacteria; the unfortunate side effect is the extreme vasodilation that occurs in response to NO.

Neurotransmitter, natural supplements, herbs, vitamins that increase levels
Feb 13 2016 by Ray Sahelian, M.D.

Definition
A neurotransmitter is defined as a chemical messenger which is released from the synaptic terminal of a neuron at a chemical synapse that diffuses across the synaptic cleft and binds to and stimulates the post-synaptic membrane. In simple words it is a chemical messenger released from one nerve cell which makes its way to another nerve cell where it influences a particular chemical reaction to occur. Neurotransmitters control major body functions including movement, emotional response, and the physical ability to experience pleasure and pain.

The ones that are most familiar to the public are serotonin (which is influenced by taking an over the counter supplement called 5-HTP), norepinephrine, dopamine. acetylcholine (which can be influenced by taking choline), and GABA. Click on each link to find out how you can increase specific neurotransmitter levels through the use of natural supplements. If you would like to purchase some supplements, consider Hydroxytryptophan supplement to increase serotonin levels, and mucuna pruriens herb to increase dopamine levels. I have not found GABA supplements to be very effective in reducing anxiety although some people reports it helps them.

Types of these chemicals present in the body
Neurotransmitters can be broadly classified into several categories:
Small molecule transmitters and neuroactive peptides. Around 10 small-molecule neurotransmitters are generally recognized: acetylcholine, 5 amines, and 3 or 4 amino acids.
Purines, (Adenosine, ATP, GTP and their derivatives).
Fatty acids
Neuroactive peptides have been found, among them neuropeptide Y and hormones such as leutenizing hormone.
Single ions, such as the mineral zinc are considered neurotransmitters by some.
Gases such as nitric oxide

Serotonin has many important influences
Serotonin happens to be the most widely studied neurotransmitter since it helps regulate a vast range of psychological and biological functions. Serotonin (5-hydroxytryptamine or 5-HT) was first identified in 1948. The wide array extent of psychological functions regulated by serotonin involves mood, anxiety, libido, aggression, and thinking abilities. Other brain neurotransmitters, such as dopamine and norepinephrine. also influence mood and arousal. However, serotonin generally has different effects. For instance, excess amounts of serotonin cause relaxation, sedation, and a decrease in sexual drive. Prozac, a common antidepressant of the SSRI type, elevates serotonin levels in the brain. One of the common side effects of SSRIs is diminished sexual urge and sensation. There is a nutrient called 5-hydroxytryptophan 5-HTP that is the immediate precursor to serotonin. When ingested as a supplement, 5-HTP converts in the brain into serotonin. The substance 5-HTP is often used to treat depression and anxiety. Many people report that 5-HTP supplements decrease sex drive and interest.

Dopamine benefit and physiological effects
Dopamine is one of the most important neurotransmitters involved in the human sexual response. Dopamine has a significant effect on sexual desire. Plus, elevation of dopamine levels often leads to an improvement in mood and alertness. A number of psychiatric disorders, particularly Parkinson’s disease and mood disorders, are attributed to imbalances in dopamine levels. Dopamine is made from the amino acid tyrosine. Once produced, dopamine can, in turn, convert into the brain chemicals norepinephrine and epinephrine. Some of the natural supplements that increase dopamine levels include NADH and CDP-choline.

Acetylcholine neurotransmitter
Acetylcholine was the very first neurotransmitter to be identified back in the early 1900s. It is made simply from choline, a natural substance found in lecithin, and a two-carbon molecule called acetyl. Acetylcholine plays numerous roles in the nervous system. In the brain, acetylcholine is involved in learning and memory whereas in the genital organs, acetylcholine is released by the parasympathetic nerves. Acetylcholine helps in the release of nitric oxide, which leads to the relaxation of smooth muscles and engorgement of the genital organs. Nutrients that elevate levels of acetylcholine include choline and CDP-choline.

Norepinephrine and Epinephrine
In the flaccid state of the penis, frequent release of norepinephrine from sympathetic nerves contracts the arteries in the penis and also contracts the smooth muscles of the corpora cavernosum. Therefore, in the normal state, norepinephrine keeps the penis soft. A relative predominance of norepinephrine-induced contraction over nitric oxide-mediated relaxation may contribute to erectile dysfunction. Two amino acids phenylalanine and tyrosine, sold as supplements, are converted into dopamine. Dopamine, in turn, is converted into norepinephrine, and then epinephrine. The ingestion of these amino acids elevates dopamine and norepinephrine levels, and hence will lead to alertness and mood elevation and increased sexual interest. However, excess amounts of norepinephrine and epinephrine may make it difficult to have erections. In addition, high amounts raise blood pressure, increase heart rate, and cause anxiety, irritability, and insomnia. Yohimbe, the natural sex booster from Africa, facilitates erections by blocking the inhibitory action of norepinephrine on the penis.

Nitric Oxide: Say Yes to NO
Nitric oxide (NO) is the most important neurotransmitter involved in the engorgement of genital organs leading to erections. I will mention NO several times Throughout this book, since some you will find herbs and nutrients that help in the formation of this chemical. For instance, the amino acid arginine can be metabolized into NO by an enzyme known as nitric oxide synthase. This conversion is done in endothelial cells, which are cells that line the inside of blood vessels. Ginseng, the popular herbal aphrodisiac, is also thought to increase NO levels. NO functions by activating an enzyme called guanylate cyclase. Guanylate cyclase, in turn, helps form cyclic guanosine monophosphate (cGMP). cGMP becomes the secondary messenger that causes smooth muscle relaxation, resulting in venous engorgement and erections. Under normal conditions, cGMP helps the smooth muscles surrounding the arteries of the penis and the smooth muscles of the corpus cavernosum to relax. This allows blood to easily flow into the penis. Any condition that interferes with the signaling of these messenger enzymes can quickly lead to the breakdown of the entire process and cause erectile dysfunction. Viagra works by blocking an enzyme that breaks down cGMP, hence more of this chemical is left to help dilate the genital arteries. Interestingly, having adequate levels of androgen hormones in the body makes it easier for the genital organs to respond to nitric oxide.
NO is a biological messenger molecule produced by one of the essential amino acids L-arginine by the catalytic action of the enzyme NO synthase (NOS). The dual role of nitric oxide as a protective or toxic molecule is due to several factors, such as; the isoform of NOS involved, concentration of NO and the type of cells in which it is synthesised, the availability of the substrate L-arginine, generation of guanosine 3,5′-cyclic monophosphate (cGMP) from soluble guanylate cyclase and the overall extra and intracellular environment in which nitric oxide is produced.

GABA
In the adult central nervous system (CNS), gamma-amino butyric acid (GABA) is a predominant inhibitory neurotransmitter, and is involved in relaxation. Thus, dysfunction of the GABA system is implicated in the pathophysiology of several neuropsychiatric disorders, including anxiety and depression.
In mammals, 16 different polypeptides (alpha1-alpha6, beta1-beta3, gamma1-gamma3, delta, epsilon, pi, and theta) have been identified, using recombinant DNA techniques, each of which is encoded by a distinct gene. The products of these genes assemble in diverse combinations to form a variety of receptor subtypes that have different sensitivities to a number of clinically relevant compounds, such as the benzodiazepines (BZs). 2. Based on a number of chromosomal mapping techniques, the majority of the GABA(A) receptor genes have been localized, in man, in four clusters on chromosomes 4, 5, 15, and the X. Furthermore, the genes that are present within these clusters have a conserved transcriptional orientation. It has, therefore, been proposed that the clusters arose largely as a consequence of two whole-genome doublings that occurred during chordate evolution, and that the ancestral cluster contained an "alpha-like," a "beta-like," and a "gamma-like" subunit gene.
Piracetam is a derivative of GABA. Supplements of GABA are also available, however it is unclear how effectively they can cross the blood brain barrier.

Glutamate neurotransmitter
The role of glutamate receptors in synaptic transmission and excitotoxicity in the nervous system is well established. Recent evidence has emerged that glutamatergic mechanisms also exist in a wide variety of non-neuronal cells. In the case of thymocytes and lymphocytes, several types of glutamate receptor are expressed which can induce functional changes. Glutamate may serve as a signaling agent between the immune and nervous systems.

Histamine neurotransmitter
Histamine has many actions in both the periphery and in the central nervous system. In the lungs, histamine acts the smooth muscle of the smaller bronchioles to cause constriction, and reduced air flow. In the stomach, histamine is involved in acid secretion.

Neurotransmitter testing
Many types of neurotransmitter tests are available to measure the levels of major neurotransmitters including serotonin, norepinephrine, epinephrine, GABA and dopamine. This testing can be done by urine, blood, or a spinal tap to measure levels in the spinal fluid. However, only in rare cases is it necessary to do such testing. Even if we know the blood level of these neurotransmitters, and we find a deficiency, it offers little help in guiding therapy since levels and production fluctuate easily from day to day and hour to hour. Neurotransmitter testing is not a reliable way to determine how a person will respond to a particular medicines or supplement for conditions such as depressions, anxiety, ADHD, etc. Neurotransmitter testing could reveal an imbalance that would be accurate for that particular time period only but testing days, weeks or months later could reveal completely different results. Testing is appropriate in cases of imbalance or excess in extreme conditions such as pheochrmocytoma and other clear cut medical conditions but not for the average person who does not have a very serious condition.

Q. I respect your opinion and advice but I saw this quote "I am not convinced that testing for neurotransmitter levels adds to the clinical treatment of a patient’. and would like to share my experience. My daughter was unable to focus on her studies and suffered extreme fatigue. We had her tested for several things and nothing seemed to help. I found information that suggested her neurotransmitters may have been contributing to her condition. Several doctors refused to submit her to a urine and/or saliva test and finally we found a naturopath willing to submit the test and treat her depending on the results. She was severely unbalanced and a regimen was developed using vitamins and supplements to address the issue. In three months we noticed several changes for the better in her. She lost weight, had a better self-image, but most of all her ability to concentrate on any matter was improved. She has subsequently gone back to school and her grades have improved. We have high hopes that she will be able to complete her university education. BTW she is majoring in neuroscience. Hopefully someday there will be enough scientific evidence to encourage you to change your opinion. Thank you and keep up the good work.
A. Many doctors, naturopaths and Oriental medicine doctors prescribe vitamins and supplements to their patients who end up improving. In almost all cases these improvements are done without neurotransmitter level testing. Neurotransmitter testing just adds to the cost of medical care, which most people in these tough economic times cannot afford. There may be cases where such testing is appropriate and helpful and we are glad your daughter was helped and we wish you and her well.

Interpreting urine neurotransmitter levels is complicated
Both stimulatory and inhibitory effects of dietary 5-hydroxytryptophan and tyrosine are found on urinary excretion of serotonin and dopamine in a large human population.
Neuropsychiatr Dis Treatment. 2009; Trachte GJ, Uncini T, Hinz M. Department of Physiology and Pharmacology, University of MN Medical School Duluth, Duluth, MN, USA;
Amino acid precursors of dopamine and serotonin have been administered for decades to treat a variety of clinical conditions including depression, anxiety, insomnia, obesity. Dietary administration of these amino acids is designed to increase dopamine and serotonin levels within the body, particularly the brain. Convincing evidence exists that these precursors normally elevate dopamine and serotonin levels within critical brain tissues and other organs. However, their effects on urinary excretion of neurotransmitters are described in few studies and the results appear equivocal. The purpose of this study was to define, as precisely as possible, the influence of both 5-hydroxytryptophan (5-HTP) and tyrosine on urinary excretion of serotonin and dopamine in a large human population consuming both 5-HTP and tyrosine. Curiously, only 5-HTP exhibited a marginal stimulatory influence on urinary serotonin excretion when 5-HTP doses were compared to urinary serotonin excretion; however, a robust relationship was observed when alterations in 5-HTP dose were compared to alterations in urinary serotonin excretion in individual patients. The data indicate three statistically discernible components to 5-HTP responses, including inverse, direct, and no relationships between urinary serotonin excretion and 5-HTP doses. The response to tyrosine was more consistent but primarily yielded an unexpected reduction in urinary dopamine excretion. These data indicate that the urinary excretion pattern of neurotransmitters after consumption of their precursors is far more complex than previously appreciated. These data on urinary neurotransmitter excretion might be relevant to understanding the effects of the precursors in other organs.

Monoamine neurotransmitter
These include serotonin, norepinephrine, GABA, glutamate, and dopamine. The monoamine hypothesis holds that mood disorders are caused by a depletion in one or more of these neurotransmitters.

Neurotransmitter metabolism
The process by which our bodies make, use, and break down neurotransmitters is extremely complicated. When there is a disruption within this process, abnormalities can occur in any of their essential functions.

Acetylcholine is derived from Choline
Serotonin [5-Hydroxytryptamine (5-HT)] is derived from tryptophan amino acid
GABA is derived from Glutamate
Histamine is derived from Histidine
Epinephrine, norepinephrine and dopamine are derived from tyrosine amino acid
Adenosine is derived from ATP
Nitric oxide is derived from Arginine

Neurotransmitters are responsible for transmitting information across the synaptic gap between neurons. Neurotransmitters are stored in synaptic vesicles. When action potentials are conducted down an axon, synaptic vesicles attach themselves to the presynaptic membrane, then break open and spill neurotransmitter into the synaptic cleft. Neurotransmitters in the synaptic cleft attach to postsynaptic receptor sites and trigger an action potential in the postsynaptic membrane. Some neurotransmitters attach to presynaptic neurotransmitter receptors (autoreceptors) located on the membrane (pre-synaptic membrane) of the cell that originally released them.

Depression
Rev Neurosci. 2015. Plant-derived natural medicines for the management of depression: an overview of mechanisms of action. Hypericum species could normalize brain serotonin level. Liquiritin and isoliquiritin from Glycyrrhiza uralensis rhizome act via the noradrenergic system. Rosmarinus officinalis and curcumin from Curcuma longa interact with D1 and D2 receptors as well as elevate the brain dopamine level. Sida tiagii and Aloysia gratissima involve γ-aminobutyric acid and N-methyl-D-aspartate receptors, respectively. Fuzi polysaccharide-1 from Aconitum carmichaeli could affect brain-derived neurotrophic factor signaling pathways. Psoralidin from Psoralea corylifolia seed modulate the hypothalamic-pituitary-adrenal axis. The total glycosides of Paeonia lactiflora demonstrate an inhibitory effect on both subtypes of monoamine oxidase. 3,6′-Di-o-sinapoyl-sucrose and tenuifoliside A from Polygala tenuifolia exhibit cytoprotective effects on neuronal cells.

Questions about natural supplements and how they influence neurotransmitter levels
Q. I have been using Dr. Sahelian’s formulated 5htp for some time now and it’s been very good. My neurotransmitters became unbalanced just about when my hormones did. A nightmare. That’s when I changed over to a naturopath (a woman, too) and she has enlightened my to things I’d never known. Now things have so improved. I am very happy to know him (through his books). He is a very learned man.

Q. I currently go to a MD. He says there are no tests to measure neurotransmitters, so when he prescribes me anti-depressants it’s a hit and miss basis. Effexor didn’t work. I currently am trying Wellbutrin. Do you know of any tests to see which neurotransmitter is off and causing the depression I have?
A. There are no routine blood tests to check neurotransmitter levels in the blood. There are advanced labs that can do this but there is no guarantee that blood levels reflect the levels in the central nervous system or would be useful in a practical manner in guiding the choice of an antidepressant. It may take trail and error to find the ideal way to treat depression with natural methods or antidepressant drugs.

Q. IпїЅd appreciate a list of herbs that modulate or reduce catecholamine neurotransmitters (both epinephrine and norepinephrine) as well as any known to support PNS activity.
A. See the links for dopamine at the top of the page.

Q. My 32 y.o. daughter has been on Abilify for several years and wants to get off as she is concerned about side effects. She had neurotransmitter tests which showed she was low in dopamine and serotonin. Do you have supplements for this?
A. There are countless hormones, substances and chemicals in the body that have an influence on mood, behavior, and cognitive abilities. Sometimes focusing on one or two oversimplifies the complexity of all the physiological functions of the body. Nevertheless, you will find links to the respective neurotransmitters.

Q. I have had testing done by a company (I won’t mention the name) for neurotransmitter levels. They point out that the neurotransmitters undergo a daily variation and are greatly influenced by uncontrolled daily stressors. They have people test a certain time after waking but before going to work, etc. They have done something like half million reference tests on healthy individuals to get their optimal ranges. Since they started with around 300 tests, those optimal ranges have changed very little, so they have stood the test of time. They also make it very clear that neurotransmitters are present in the central and peripheral nervous system, so the tests are not diagnostic, but are biomarkers. There are trends that show up consistently relating to certain symptoms or conditions. I think in general maybe you can’t measure neurotransmitter levels, but there are many research papers that say otherwise. I think it’s all about how you do it, as in the above mentioned testing. One article I will reference was recently in the Townsend Letter: "Urinary Neurotransmitter Analysis as a Biomarker for Psychiatric Disorders" by Amnon Kahane, MD.
A. There is still a wide gap between testing for neurotransmitter levels and determining which form of therapy and in what dosage would work best. Neurotransmitter levels can be influenced on a daily basis by diet, activity level, sleep patterns, stress, and a number of factors. As of January 2014, I am not convinced that testing for neurotransmitter levels adds to the clinical treatment of a patient.

Q. My name is Marty L. Hinz, MD, President Clinical Research, NeuroResearch Clinics, Inc. Cape Coral, Florida USA. There is a recently published peer reviewed literature relating to neurotransmitters and neurotransmitter testing. I attached a chapter from a new medical text book edited by Ingrid Kohlstadt, MD of Johns Hopkins Medical School and a writing by the University of Minnesota Medical School that is in the May 2009 Journal of NeuroPsychiatry. Of concern is laboratory companies out there that are promoting neurotransmitter testing trying to test basic neurotransmitter science that is not supported by the literature and these peer reviewed articles.
A. A review of the chapter written by D. Marty L. Hinz, M.D. that was attached in the email leads to a section that says,

TABLE 29.1
The пїЅGeneric Amino Acid Dosing ProtocolпїЅ (milligrams of 5-HTP / milligrams tyrosine) If relief of symptoms is not obtained with level 3 dosing, obtain urinary neurotransmitter testing. Use of proper levels of cofactors and sulfur amino acids is required for optimal results
LEVEL AM NOON 4 PM 7 PM
1 150/1500 150/1500
2 150/1500 150/1500 300/1500
3 150/1500 150/1500 300/1500 300/1500

The generic protocol developed for treatment of neurotransmitter dysfunction disease relating to the catecholamine system and/or serotonin system involves the use of tyrosine, 5-HTP, and cofactors. Results do not appear to be dependent on taking the amino acids with or without food. The following cofactors need to be used along with the amino acid precursors:
пїЅ Vitamin C 1000 mg/day
пїЅ Vitamin B6 75 mg/day
пїЅ Calcium 500 mg 500 mg/day

In addition
пїЅ Cysteine 4500 mg/day in equally divided doses
пїЅ Selenium 400 mcg/day
пїЅ Folic acid 2000 to 3000 mcg/day

Dr. Sahelian comments: I am concerned that many people on this protocol will have heart rhythm disturbances and insomnia. Tyrosine can cause heart rhythm problems in as a low a dosage as 250 mg. I also do not believe that urinary neurotransmitter testing is necessary, it is just an additional expense. I have not seen any peer reviewed published research that demonstrates that repeatedly testing urinary neurotransmitter levels leads to a better outcome for patients who are depressed.
Many people with mild to moderate depression may find mood elevation with using 50 to 100 mg of 5-HTP supplements bought online or in a health food store without incurring the expense of doctor visits and neurotransmitter testing. Others benefit from SAM-e and St. John’s wort. Some people who promote these kinds of tests are likely to monetarily profit from the testing. There have been countless people who have recovered from their depression without incurring the costs of such urinary neurotransmitter testing.
I am also concerned about the high dosages of selenium. Studies have shown that high amounts, usually over 100 mcg a day, can reduce longevity.

I am a 37 year old female who has been battling severe brain fog, fatigue and fibromyalgia for over 4 years now. Time and time again, your website has provided much necessary information that has helped me on my road to recovery and I thank you for the value you have given! I am also writing in hopes that you’ll share a bit more of your wisdom with me, as I have hit a mental roadblock. (literally and figuratively). My neurotransmitter test results are showing extremely high levels of Glycine, Epinephrine, GABA, PEA, Histamine and elevated levels of Dopamine, Serotonin and Glutamate. Also, I have extremely low Taurine and low Norepinephrine, (also low DHEA, Testosterone and high Pregnenolone). My present doctor does not know how to treat these imbalances and I have no idea where else to turn for help. Do you know any doctors experienced with neurotransmitters who treat patients using natural means that you can suggest? Do you know where a layman such as myself can gather information that will enable me to construct a course of action? Any light you can shed on neurotransmitters would be beneficial and greatly appreciated.
I do not find neurotransmitter testing to be a useful or cost effective way to determine a diagnosis or form a good treatment. The most important issues that have to be addressed is to make sure there are no obvious medical reasons for the fatigue. Next, one has to make improvements in exercise habits, proper diet, and obtain a good sleep each night. Yoga is very helpful in improving all the symptoms you mention. You can begin with relaxation yoga classes. After all these basic lifestyles improvements have been made, then one can try different natural supplements to see if there are any additional benefits.

I would like to enquire if it is safe to take Adrenal Stress End with a brain boosting formula. I have had a urine neuro transmitter which is showing low seratonin, gaba and dopamine and high noadrenaline and adrenalinemain symptom is burning / cold / buzzing sensation throughout the body like numbness and pins & needles.
It is best to take the Adrenal Stress End on a different day.

Manufacturers of “female Viagra” flibanserin appeal FDA denial

The manufacturer of a potential “female Viagra” is appealing the Food and Drug Administration’s letter denying the drug’s approval, saying the company has gone above and beyond what is necessary to prove its treatment works and is necessary for many women.

Sprout Pharmaceuticals received a Complete Response Letter (CRL) from the FDA regarding its new drug application (NDA) for flibanserin in October. At that time, the company said FDA asked for more information before the agency approved the drug for the U.S. market.

But, Sprout believes that it has provided enough research on flibanserin, which the manufacturer lauds as a non-hormonal treatment for dwindling female libido.

Since the drug was first denied in June 2010 by an FDA advisory panel. the company added 14 new clinical studies with data on more than 3,000 new patients to its re-submitted application. In total, more than 11,000 women have tried out the drug. More than 5,000 subjects were enrolled in phase III trials, which marks the final stage of efficacy and safety testing.

“Sprout strongly believes that it has satisfied the statutory requirements for approval of flibanserin,” Cindy Whitehead, president and chief operating officer of Sprout Pharmaceuticals, said in a press release.

The need for a drug to help sexual dysfunction in women is high. WebMD reports that 43 percent of women experience some form of a sexual problem, including low sex drive or what is known as hypoactive sexual desire disorder (HSDD). HSDD is the most commonly reported form of sexual problems in women, affecting up to one-third of adult women. Women who experience the sexual problem have little or no sexual fantasies or desires, leading to interpersonal problems or added stress.

While there are several treatments for male sexual dysfunction, not much medication exists for women. Pfizer, which manufactures Viagra, stopped working on a female version of the treatment in 2004, and BioSante Pharmaceuticals Inc.’s testosterone gel for women failed two large studies in 2011, Bloomberg reported. Procter and Gamble also submitted a testosterone patch for women called Intrinsa in 2004, but it was denied by the FDA because of concerns of long-term safety. The drug was available on the European market until May 2012, when the European Medicines Agency withdrew marketing authorization for the treatment upon the manufacturing company’s request.

“Women’s sexual health has been really underground,” Sheryl Kingsberg, chief of the division of behavioral medicine at Case Medical Center in Cleveland, said to Bloomberg. “One reason that women’s sexual desire has lagged is desire is in the brain.”

Sprout Pharmaceuticals believes that flibanserin could be an answer. The drug works by increasing levels of neurotransmitters dopamine and norepinephrine in the brain, which have been linked to sexual drive. The drug also reduces serotonin, a neurotransmitter that has been associated with lowering sexual desire. The compound was first developed by German company Boehringer Ingelheim, but Sprout Pharmaceuticals bought the drug in 2011.

Clinical trials have looked at both premenopausal and postmenopausal women, but Sprout is only seeking approval for the premenopausal market at this time.

Whitehead said that the company’s research has shown that not only did women see more benefit from flibanserin than taking a placebo, they reported that there was significant improvements to their sex lives. The medication is said to increase satisfying sexual events, increase sexual desire and decrease any associated stress from lack of sexual activity.

Research that supports the company’s claims include a study published in May 2010 from the American College of Obstetricians and Gynecologists that showed that after a 24-week treatment of flibanserin, women improved their sexual desire by 18 percent .

A Dec. 2013 study in Menopause showed that 38 percent of test subjects given flibanserin had improvements in their sex lives. While 30 percent experienced side effects like headaches, nausea, dizziness and sleepiness, only 8 percent found them so bad that they wanted to stop treatment. Research published in May in the Journal of Sexual Medicine said that satisfying sexual events went up 2.5 times for women who took the drug.

“What the Division (FDA) characterizes as a modest effect in their risk/benefit evaluation, we see as meaningful effect on the hallmark characteristics of the condition,” Whitehead continued. “It is the basis of our dispute.”

The FDA told CBS News that it can only provide information on approved drug product applications, and any information on treatments currently going through the approval process or treatments that have been denied belongs to the manufacturer or sponsor of the medication.

The FDA accepted Sprout Pharmaceuticals appeal on Dec. 3, and is expected to rule in the first quarter of 2014.

The appeals process isn’t guaranteed. Out of 17 appeals the FDA considered in 2012, 14 were denied, according to agency statistics .

© 2013 CBS Interactive Inc. All Rights Reserved.

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Happy 10th Anniversary. VIAGRA.

Ten years ago this month the lives of millions of men and women were changed almost overnight by the advent of a little blue pill — the first oral treatment for impotence.

Viagra, developed by accident by scientists at Pfizer Laboratories, was first approved for use by the US Food and Drug Administration on March 27, 1998.

`Originally, we were testing sildenafil, the active drug in Viagra, as a cardiovascular drug and for its ability to lower blood pressure,` said Dr Brian Klee, senior medical director at Pfizer.

`But one thing that was found during those trials is that people didn`t want to give the medication back because of the side effect of having erections that were harder, firmer and lasted longer.`

Since Viagra went on the market it has been used by 35 million men around the globe, and it took impotence off the taboo list, making it infinitely easier to treat.

Urologists` waiting rooms became busier as news got round that the condition, which was rechristened with a new, scientific name — erectile dysfunction, or ED — could be treated with a triangular blue pill.

Previous treatments had involved surgically inserting a prosthesis into the penis, injecting a substance into the male sex organ or using urethral suppositories.

`Viagra brought a lot more people into the office because of the ease of treatment,` Dr Irwin Shuman, a urologist of 40 years` experience in Washington, told AFP.

`In the old days, when we didn`t have much in the way of treatment, we would do a lot more evaluation, looking for answers as to why somebody had the problem,` he said.

In one test, men would be observed while sleeping to see if erections occurred.

Men who failed to get the usual five to six erections per night were deemed to have a physical problem, and those who did get nocturnal erections were said to have a psychological problem and were sent to see a sex counsellor.

So Viagra helped move impotence out of the psychological realm and into the world of physical illnesses. `What we have come to understand in the past 10 years is that ED is a vascular disease,` said Klee.

`What happens is veins and arteries that deliver and remove blood from the penis are not working the way they should, and Viagra allows those vessels to dilate and increase blood flow to the penis,` he said.

Dr Abraham Morgentaler, director of Men`s Health Boston, and associate clinical professor of urology at Harvard Medical School, hailed Viagra as a `benefit to medicine.`

But, he added, the drug has not delighted all those who took it.

`There are two truths to Viagra: for those who refill (get a new prescription), it`s wonderful and they`re happy,` Morgentaler told AFP.

`But a lot of people look to Viagra for personal happiness, thinking a hard penis can resolve relationship issues,` and they end up disappointed, added the doctor and author of the book `The Viagra Myth.`

Some patients say taking Viagra `does not correspond to the way they want to have sex,` Morgentaler said.

Viagra works best on an empty stomach or after eating a low-fat meal, the medication`s official website says. It kicks in about 30 minutes after being taken, works for four hours, and only with sexual arousal, the website says.

But it`s not the answer for everyone. Morgentaler said he had a 78-year-old patient in his office who `didn`t like the idea of programming sex. Guys, and often women, too, don`t necessarily want to compromise the ideal of sex as something magical, spontaneous, romantic.`

Morgentaler also spoke of the darker side of Viagra, which has evolved since it and two other ED treatments became easily available over the Internet.

`It`s the use of Viagra by healthy young men who don`t need it,` he said.

`These young men take a pill whenever they go out. Maybe because they are inexperienced or shy and Viagra makes them more confident, or maybe because they have inflated ideas about what sex is supposed to be like from seeing Internet porn, which they also have easy access to, and they want to heighten their feelings of masculinity,` he said.

`I am concerned — not that these young men will get addicted physically, but that they will become psychologically dependent on Viagra,` said Morgentaler.

`Sex is an entree into a relationship, and most often what we want from a relationship is to be loved for what we are.

`But some of these young men feel they have to take a pill to be acceptable, and I fear they are potentially missing the opportunity to have true emotional connections with a partner, based on reality, not mythology.`

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To Get Viagra In Dublin

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Common use

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

Dosage and direction

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

Precautions

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

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

Possible side effect

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

Drug interaction

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

Missed dose

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

Overdose

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

Storage

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

Disclaimer

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

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