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Viagra

GENERIC NAME(S): SILDENAFIL CITRATE

Uses

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

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

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

How to use Viagra

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

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

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

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

Tell your doctor if your condition does not improve.

Side Effects

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

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

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

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

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

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

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

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

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

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

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

Precautions

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

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

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

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

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

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

Interactions

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

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

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

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

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

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

Overdose

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

Notes

Do not share this medication with others.

Missed Dose

Storage

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

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

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

Images

PATIENT INFORMATION

VIAGRA®
(vi-AG-rah)
(sildenafil citrate) Tablets

What is the most important information I should know about VIAGRA?

VIAGRA can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. Do not take VIAGRA if you take any other medicines called “nitrates.” Nitrates are used to treat chest pain (angina ). A sudden drop in blood pressure can cause you to feel dizzy, faint, or have a heart attack or stroke .

Do not take VIAGRA if you take medicines called guanylate cyclase stimulators which include:

  • Riociguat (Adempas®) a medicine that treats pulmonary arterial hypertension and chronicthromboembolic pulmonary hypertension.

Tell all your healthcare providers that you take VIAGRA. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took VIAGRA.

Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex.

Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease. Ask your doctor if your heart is healthy enough to handle the extra strain of having sex.

VIAGRA does not protect you or your partner from getting sexually transmitted diseases, including HIV —the virus that causes AIDS .

VIAGRA is a prescription medicine used to treat erectile dysfunction (ED). You will not get an erection just by taking this medicine. VIAGRA helps a man with erectile dysfunction get and keep an erection only when he is sexually excited (stimulated).

VIAGRA is not for use in women or children.

It is not known if VIAGRA is safe and effective in women or children under 18 years of age.

Who should not take VIAGRA?

Do not take VIAGRA if you:

  • take medicines called nitrates (such as nitroglycerin)
  • use street drugs called “poppers” such as amyl nitrate or amyl nitrite, and butyl nitrate
  • take any medicines called guanylate cyclase stimulators such as riociguat (Adempas)
  • are allergic to sildenafil, as contained in VIAGRA and REVATIO, or any of the ingredients in VIAGRA. See the end of this leaflet for a complete list of ingredients in VIAGRA.

What should I tell my healthcare provider before taking VIAGRA?

Before you take VIAGRA, tell your healthcare provider if you:

  • have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve or heart failure
  • have had heart surgery within the last 6 months
  • have pulmonary hypertension
  • have had a stroke
  • have low blood pressure. or high blood pressure that is not controlled
  • have a deformed penis shape
  • have had an erection that lasted for more than 4 hours
  • have problems with your blood cells such as sickle cell anemia. multiple myeloma. or leukemia
  • have retinitis pigmentosa. a rare genetic (runs in families) eye disease
  • have ever had severe vision loss, including an eye problem called non-arteritic anterior ischemic optic neuropathy (NAION)
  • have bleeding problems
  • have or have had stomach ulcers
  • have liver problems
  • have kidney problems or are having kidney dialysis
  • have any other medical conditions

Tell your healthcare provider about all the medicines you take*, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works causing side effects. Especially tell your healthcare provider if you take any of the following:

  • medicines called nitrates (see “What is the most important information I should know about VIAGRA?” )
  • medicines called guanylate cyclase stimulators, such as riociguat (Adempas)
  • medicines called alpha blockers such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA with alpha-blockers can lead to a drop in blood pressure or to fainting .
  • medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase) or atazanavir sulfate (Reyataz)
  • some types of oral antifungal medicines, such as ketoconazole (Nizoral), and itraconazole (Sporanox)
  • some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin
  • other medicines that treat high blood pressure
  • other medicines or treatments for ED
  • VIAGRA contains sildenafil, which is the same medicine found in another drug called REVATIO. REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH ). VIAGRA should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil]).

Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure.

Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.

How should I take VIAGRA?

  • Take VIAGRA exactly as your healthcare provider tells you to take it.
  • Your healthcare provider will tell you how much VIAGRA to take and when to take it.
  • Your healthcare provider may change your dose if needed.
  • Take VIAGRA about 1 hour before sexual activity. You may take VIAGRA between 30 minutes to 4 hours before sexual activity if needed.
  • VIAGRA can be taken with or without food. If you take VIAGRA after a high fat meal (such as a cheeseburger and french fries), VIAGRA may take a little longer to start working
  • Do not take VIAGRA more than 1 time a day.
  • If you accidentally take too much VIAGRA, call your doctor or go to the nearest hospital emergency room right away.

What are the possible side effects of VIAGRA?

VIAGRA can cause serious side effects. Rarely reported side effects include:

  • an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, priapism can permanently damage your penis.
  • sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have sudden vision loss in one or both eyes.
  • sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus ) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away.

The most common side effects of VIAGRA are:

  • headache
  • flushing
  • upset stomach
  • abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
  • stuffy or runny nose
  • back pain
  • muscle pain
  • nausea
  • dizziness
  • rash

In addition, heart attack, stroke, irregular heartbeats and death have happened rarely in men taking VIAGRA. Most, but not all, of these men had heart problems before taking VIAGRA. It is not known if VIAGRA caused these problems.

Tell your healthcare provider if you have any side effect that bothers you or does not go away.

These are not all the possible side effects of VIAGRA. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1800-FDA-1088.

How should I store VIAGRA?

  • Store VIAGRA at room temperature between 68°F to 77°F (20°C to 25°C).

Keep VIAGRA and all medicines out of the reach of children.

General information about the safe and effective use of VIAGRA.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use VIAGRA for a condition for which it was not prescribed. Do not give VIAGRA to other people, even if they have the same symptoms that you have. It may harm them.

This Patient Information leaflet summarizes the most important information about VIAGRA. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about VIAGRA that is written for health professionals.

For more information, go to www.viagra.com, or call 1-888-4VIAGRA

What are the ingredients in VIAGRA?

Active ingredient: sildenafil citrate

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

This Patient Information has been approved by the U.S. Food and Drug Administration.

Last reviewed on RxList: 10/3/2015
This monograph has been modified to include the generic and brand name in many instances.

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Viagra er et af de bedst kendte lægemidler i verden. Næsten alle voksne har hørt om det, og kan fortælle dig, hvad den gør. Faktisk er det så populært, at mænd, der bruger denne medicin kalder det et vidundermiddel eller bare den lille blå pille. Og intet andet vidnesbyrd kunne give bedre og mere pålidelige oplysninger end de personer, der faktisk bruger produktet.

SГҐ hvad er det gode ved “den blГҐ pille”? Det er simpelt: nГҐr det virker efter hensigten, forГҐrsager det en mand, der er seksuelt stimuleret til at fГҐ en god og langvarig erektion. Klik her for at kГёbe nu

Hvis du ønsker at vide præcis, hvordan det virker, vil du uvægerligt komme på tværs af flere vilkår, men det er nødvendigt at forstå det hele. Det aktive stof i Viagra er Sildenafil citrat. Dets virkningsmekanisme er ganske kompliceret, og det involverer avanceret teknologi:

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Den hastighed, hvormed stoffet virker er ikke det samme med enhver mand. Nogle kan være i stand til at opnå en hurtig erektion, som naturligvis skal stimuleres først. Mens nogle kan have til at vente et stykke tid. Imidlertid vil lægemidlet, som det er blevet undersøgt under kliniske forsøg, begynde at vise dets effektivitet på cirka 15 minutter. Nogle har også først opnået erektion efter så lang tid som 30 minutter på medicinen.

Hvor lang tid tager det Sidste?

I gennemsnit forbliver virkningen af lægemidlet i omkring et par timer. Efter fire timer burde lægemidlet være udrenset. Hvis du har en langvarig erektion som varer 4 eller flere timer, stop med at bruge dette stof og tale med din læge.

Dette produkt kan forårsage nogle allergiske reaktioner. Så før du tager Sildenafil, fortæl lægen eller apoteket, hvis du er allergisk over for det, eller hvis du har andre allergier. Du skal også være forsigtig, hvis du har følgende sygdomme og tilstande i din sygehistorie: højt eller lavt blodtryk, seglcelleanæmi, smertefuld eller langvarig erektion, alvorligt tab af vand i kroppen (dehydrering), øjenproblemer, hjerteproblemer (hjerteanfald, uregelmæssig hjerteslag, hjerteinsufficiens), nyre og leversygdom. Du må ikke køre bil, betjene maskiner eller udføre aktiviteter, der kræver årvågenhed eller klar vision, indtil du er sikker på at du kan udføre sådanne aktiviteter sikkert, da dette stof kan gøre dig svimmel eller forårsage problemer med synet.

Blandt de mulige bivirkning er: hovedpine, svimmelhed, uklarhed, rødmen, halsbrand, næseblod, søvnløshed og urolig søvn, ødem (hævede hænder, ankler og fødder). Syn ændringer såsom øget lysfølsomhed, sløret syn, eller problemer med at se forskel på blå og grønne farver, kan også forekomme. I sjældne tilfælde kan Viagra forårsage pludselige høreproblemer (såsom fald / tab af hørelsen på det ene eller begge ører, ringen for ørerne).

Der er en masse succeshistorier omkring brug Viagra over internettet. Her er en af dem:

”Jeg havde aldrig forestillet mig i mit liv, at jeg kunne blive befriet fra dette problem, som jeg har haft, men nu er jeg en glad mand igen. Mit problem startede, da jeg var i slutningen af tredverne. Jeg boede hos min kæreste gennem mange år i vores lejlighed, og livet var meget godt. Vi elskede hinanden meget og havde et godt sexliv. Jeg ejede min egen restaurant, og det var en succes, men mit job var også meget stressende og gav mig tit hovedpine. Jeg tror, det kan have været, hvad der forårsagede mit problem med min erektion. Min kæreste bemærkede det, og hun var ked af det, men jeg ønskede ikke at tro på det. DA det blev helt slemt, kunne jeg ikke udføre noget mere. Før jeg vidste af det, var det forbi, og hun forlod mig. Jeg blev ruineret, jeg følte jeg havde mistet alt, hvad jeg havde. Min gode ven rådede mig til at prøve Viagra. I første omgang lød vanvittigt for mig, at der kunne være en pille, der kunne hjælpe mig med mine erektioner. Problemet var, at jeg var nødt til at gå til en læge først, og forklare præcist, hvad der skete. Jeg fik lært fra en ung alder, at jeg ikke skal tale om den slags ting, og jeg ønskede ikke at nogen skulle se min svaghed. Men den virkelige svaghed var at jeg boede i elendighed, og ikke gjorde noget ved det. Men min ven fortalte mig, at jeg kunne undgå alt dette ved blot at bestille det online. Og det gjorde jeg tilsidst. Og så havde jeg pillerne, men jeg vidste ikke, hvad jeg skulle gøre med dem, fordi min kæreste længe havde forladt mig. Jeg fik et job i en anden restaurant som kok, og tingene begyndte at gå godt for mig igen. Jeg mødte en vidunderlig kvinde på arbejdet, og vi begyndte at se hinanden. Første gang vi elskede, det var helt fantastisk. Jeg tog pillen omkring 45 minutter i forvejen. Wow, jeg var meget overrasket over resultaterne, og min nye kæreste var meget imponeret. Jeg sagde ikke noget til hende om de piller jeg tog, men hun har helt sikkert bemærket min energi.”

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Viagra er nok den mest berømte receptpligtig medicin til behandling af erektil dysfunktion. Siden 1998 kan du købe Viagra, og det er siden blevet brugt af mænd i alle aldre. Det er produceret af den farmaceutiske selskab Pfizer i Usa.

Virkning

Viagra blev opdaget ved et uheld. Faktisk, det blev udviklet, med henblik på at behandle patienter, der lider af en svaghed i hjertemusklen. Som enhver anden medicin, der skal godkendes, også var nødt til at gå gennem dette, at en række undersøgelser med forsøgspersoner for at undersøge effekt og bivirkninger. Utroligt, at mange af disse test personer bemærket i sagen om den påståede behandling af din hjertesygdom, forekomsten af stærke erektioner – fødslen af Viagra.

Effekten af Styrken er gennem stoffet Sildenafil. Hos mænd med erektil dysfunktion, det kommer til distribution af et enzym, der forårsager tidlig sagging af Penis. Den tætsiddende vener, hvilket resulterede i en ophobning af blod og dermed excitation, at udvide. Blodet strømmer tilbage, erektion. Sildenafil er taget, og det er på dette punkt, og forhindrer, at udskillelsen af et enzym, der forårsager afslapning af Penis efter en orgasme.

Der er nogle lægemidler, som, når de kombineres tage med Viagra til en langsommere fjernelse; effekten er ofte stærkere og længere. Da udveksling virkning, men også komplikationer kan forekomme, at dette bør undgås. Blandt de lægemidler, for eksempel, forskellige antibiotika, lægemidler til behandling af HIV-infektion, depression, eller øget produktion af mavesyre. Også sammen med Anti-svampe agenter, eller antihypertensiv agenter, bør det ikke anvendes sammen. Der er også naturlige stoffer såsom perikon kan indvirke på effekten af Viagra skal Berøres, før du tager Spørg din læge til at holde, hvis for mere medicin for at være taget .

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Selv om Viagra er en meget overbevisende effekt som en seksuel forstærker, men vi må ikke glemme, at det er et stof, bivirkninger kan forekomme. I nogle tilfælde, for eksempel, hovedpine eller fordøjelsesproblemer. Det er muligt sløret syn, influenza-lignende symptomer, også maven slimhinde betændelse i huden, halsbrand, feber, haemorrhoids eller andre lidelser. Disse er dog sjældent forekommende bivirkninger. I ekstreme tilfælde, og i tilfælde af fysisk disponerede personer, kan det i ekstraordinære tilfælde, for at komme til problemer med hjertet eller besvimelse efter at have taget. Er der andre bivirkninger, der kan opstå, bør brugere, før du tager læs omhyggeligt indlægssedlen .
Da blodtrykket sænkes, og reaktionen forsvinder, det er ikke tilrådeligt, hvis brugerne bruger under time-frame, betjene maskiner eller deltage aktivt i trafikken. Den forstyrrende effekt kan blive forstærket, når alkohol bliver indtaget.

Anvendelse

Da Viagra fås i doser på 25, 50 og 100 mg er til rådighed, vil lægen anbefale en dosis for at opnå den ønskede erektion. Generelt, 50 mg til at øge styrken. 100mg tabletter kan nemt opdeles, så en langt bedre pris-ydelses-forhold der er opnået end 50 mg tabletter.

Dermed effekten opstГҐr pГҐ det Гёnskede tidspunkt, skal jeg tage det en time fГёr. Effekten vil sГҐ vare i op til fem timer. En erektion opstГҐr, men kun hvis manden er seksuelt ophidset.

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Inden længe vil kvinder i USA kunne booste deres sexlyst med en pille.

De amerikanske sundhedsmyndigheder har nemlig givet grГёnt lys for en pille, der kan Гёge kvinders lyst til sex, skriver CBS.

Lægemidlet Flibanserin bliver ofte omtalt som »Viagra for kvinder« og er to gange tidligere blevet afvist af den amerikanske lægemiddelsstyrelse, FDA. Men nu vil midlet altså inden længe være tilgængeligt med en recept fra lægen.

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Erectile Dysfunction Health Center

13 Common Sex-Drive Killers

What Are the Differences Between These Drugs?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gray Market Viagra

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

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

Counterfeit Viagra

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

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

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

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

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

How Does Pfizer Deter Counterfeit Viagra?

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

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

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

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

Bottom Line

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

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

Red Flags Regarding Buying Viagra Online:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where does fake Viagra come from?

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

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

How much should it cost?

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

Who does this site recommend?

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

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

No Prescription needed? Welcome To Internet Enabled Telemedicine:

With Access RX you do not need a previous prescription to get the Viagra. They do this via telemedicine. (You also have the option to do a video consultation with a medical professional).

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

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

In Closing:

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

Interesting Viagra Pharma Factoids:

When was Viagra discovered?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Viagra Information On The Internet:

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

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

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

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

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

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

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

Viagra mechanism of Action

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

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

The BIG Discovery: cyclic guanosine monophosphate (cGMP)

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

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

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

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

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

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

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

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

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

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

Metabolism, Half Life, Excretion

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

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

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

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

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

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

The maximum recommended dose is one pill per day.

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

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

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

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РїС—Р…hay algo que pueda considerarse el Viagra femenino?

Antes que nada, para eliminar un equРїС—Р…voco, tengo que decir que NO hay un Viagra "femenino" como si hubiera una formulaciРїС—Р…n o una presentaciРїС—Р…n diferente: estamos hablando del mismo fРїС—Р…rmaco (citrato de sildenafil ) que en los varones resulta sumamente eficaz en los tratamientos para la impotencia .

Se realizaron distintos estudios (y hay otros en desarrollo) sobre su efecto en mujeres, habida cuenta de las similitudes en cuanto a estructura y bioquРїС—Р…mica de los tejidos del pene y el clРїС—Р…toris (que no es sРїС—Р…lo lo que se visualiza sino que tiene un cuerpo y dos "brazos" laterales que se ingurgitan con sangre durante la etapa de excitaciРїС—Р…n), o sea que el mecanismo de acciРїС—Р…n del sildenafil serРїС—Р…a similar en el interior del pene como del clРїС—Р…toris.

РїС—Р…el Viagra tiene sustancias que aumentan la libido de las mujeres?

El Viagra no es una sustancia que aumente la libido ya que actРїС—Р…a en la fase de erecciРїС—Р…n de la respuesta sexual (sabemos tambiРїС—Р…n que el clРїС—Р…toris tiene capacidad erРїС—Р…ctil) y necesita de la presencia del deseo, del juego amoroso y del estРїС—Р…mulo sexual para que actРїС—Р…e. Ahora bien, cuando un varРїС—Р…n disfuncional, que viene padeciendo por aРїС—Р…os y evitando los encuentros para no fracasar, ve que puede darse y darle satisfacciРїС—Р…n a su pareja, obviamente que aumenta su autoestima y su deseo sexual por vРїС—Р…a indirecta, no fue el medicamento que produjo ese resultado sino lo que logrРїС—Р…: la recuperaciРїС—Р…n de la respuesta erectiva y una mejor calidad de vida.

En las mujeres no actРїС—Р…a aumentando la fase del deseo sino la turgencia y sensibilidad clitoridiana.

РїС—Р…en quРїС—Р… casos se podrРїС—Р…a usar?

PodrРїС—Р…amos pensar que, el sildenafil, al aumentar la congestiРїС—Р…n vascular y, quizРїС—Р…s, la lubricaciРїС—Р…n en mujeres pre y post menopРїС—Р…usicas con este tipo de problemas, podrРїС—Р…a mejorar la lubricaciРїС—Р…n y dilataciРїС—Р…n vaginal, evitando el dolor en la penetraciРїС—Р…n con el menor placer que esta dificultad le traРїС—Р…a a esa mujer. TambiРїС—Р…n en estos casos suelo indicar geles РїС—Р…ntimos lubricantes (como el KEMIAL ), que no modifiquen el medio vaginal ni abran los poros del profilРїС—Р…ctico y por supuesto, en los casos indicados, la terapia hormonal de reemplazo (THR).

Al aumentar la turgencia clitoridiana el Viagra podrРїС—Р…a mejorar tal vez la respuesta orgРїС—Р…smica, con lo cual serРїС—Р…a un complemento en los tratamientos sexolРїС—Р…gicos en mujeres con anorgasmias . En el Congreso de psiquiatrРїС—Р…a norteamericano de Chicago 2000 donde presentamos un trabajo sobre "Efectos del Viagra en varones con y sin factores de riesgo", hubo otro trabajo que hablaba de su uso (con buena respuesta) en mujeres con problemas sexuales por los efectos secundarios de los antidepresivos.

Otros trabajos detectan mejoras en la lubricaciРїС—Р…n a un 63% de las mujeres vs el 0% del placebo y que la respuesta orgРїС—Р…smica mejorРїС—Р… en un 56% frente al 6% del placebo. Un estudio hecho con 22 mujeres con histerectomРїС—Р…a (extirpaciРїС—Р…n del РїС—Р…tero) y disfunciones sexuales mostraba que el sildenafil podrРїС—Р…a mejorar la sensibilidad, la capacidad orgРїС—Р…smica y la disminuciРїС—Р…n del dolor en el coito. Pero nunca, ni tampoco en el varРїС—Р…n, podemos centrar todo el tratamiento en un sРїС—Р…lo recurso: pensemos que en un encuentro sexual se ponen en juego mРїС—Р…ltiples coordenadas (socio-culturales, ideolРїС—Р…gicas, situacionales, enfermedades, estrРїС—Р…s . conflictos psicolРїС—Р…gicos y vinculares, efectos medicamentosos negativos sobre la funciРїС—Р…n sexual, etc.) de tal manera que un РїС—Р…nico abordaje no podrРїС—Р… dar cuenta de todas las variables.

РїС—Р…quРїС—Р… porcentaje de las consultas son hechas por mujeres?

En nuestro Centro de SexologРїС—Р…a y PsiquiatrРїС—Р…a aproximadamente un 40% son mujeres con edades que van desde los 18 a los 70 aРїС—Р…os. Los motivos de consulta suelen ser variados:

Trastornos obsesivos . fobias (agorafobia, claustrofobia, fobias sociales), ataques de pРїС—Р…nico . fobias sexuales (fobia al contacto, a la penetraciРїС—Р…n, a ver los genitales), psicosis (esquizofrenias . bipolares . neurosis, depresiones (en estos casos en mayor proporciРїС—Р…n que los varones).

Anorgasmias parciales en coito (no lo logran por penetraciРїС—Р…n pero sРїС—Р… de otras maneras)

Deseo sexual inhibido ("falta de ganas")

Dispareunias (dolor en coito y problemas en la lubricaciРїС—Р…n )

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La principal ventaja de Cialis respecto de la Viagra es la duraciГіn. La Viagra funciona durante 4 horas, y por lo tanto siempre debe ser tomada antes del sexo. Cialis estГЎ activo durante 36 horas. La nueva versiГіn de Cialis, Cialis Once a Day. se toma diariamente. Esto permite que el usuario tenga una experiencia sexual espontГЎnea en cualquier momento.

Cialis funciona mГЎs rГЎpido que la Viagra

Cialis trabaja mГЎs rГЎpido que la Viagra. Un cuarto de hora despuГ©s de tomar la pГ­ldora, una persona con problemas de erecciГіn puede estar sexualmente activa. El efecto de Cialis dura mГЎs tiempo que la Viagra. Una persona con disfunciГіn erГ©ctil podrГ­a tener una vida sexual activa de un dГ­a, un promedio de 36 horas despuГ©s de la ingestiГіn. Se le da al paciente una ventaja Гєnica sobre la Viagra. PodrГЎ disfrutar de una renovada y mejorada vida sexual en un perГ­odo de tiempo mГЎs corto.

Funcionamiento de la Viagra y de Cialis

Cuando un hombre es sexualmente excitado, ciertos tejidos en el pene se relajan. Esto provoca una corriente natural de sangre hacia el pene y la erecciГіn se produce. La Viagra ayuda al paciente con la disfunciГіn erГ©ctil al incrementar la liberaciГіn de quГ­micos que causan la relajaciГіn de los tejidos del pene y sus alrededores.

Cialis funciona quГ­micamente casi de la misma manera, pero el paciente usa una dosis menor y obtiene una erecciГіn mГЎs rГЎpida. La duraciГіn del efecto de Cialis es aproximadamente diez veces mГЎs que el de la Viagra. La espontaneidad de la experiencia sexual es mayor. Esto es tan importante para el hombre como para la mujer.

Peligros de Viagra y Cialis

Tanto la Viagra como Cialis tienen un peligroso efecto cuando son tomadas por personas que tienen un tratamiento con una medicaciГіn a base de nitratos. Entre estos medicamentos se incluyen las pastillas del corazГіn que son suministradas como un tratamiento para el dolor torГЎcico. TambiГ©n ciertos medicamentos que aumentan la libido incluyen la misma soluciГіn de nitratos. La Viagra no debe ser nunca tomada por pacientes que usen nitratos. Cialis tiene un efecto potenciador similar en estos medicamentos y no es apropiado para estos pacientes.

A pesar de que Cialis. Levitra y Viagra tienen otros ingredientes, estos activos, inhibidores del PDE-5, no son todavГ­a apropiados para pacientes que busquen un tratamiento para sus corazones, hГ­gado o riГ±ones. Aunque no ha sido estudiado, hay razones teГіricas que hacen esperar la interacciГіn con los inhibidores de la proteasa. Los inhibidores de la proteasa se espera que incrementen el nivel de sangre de Cialis. El resultado puede causar mГЎs efectos secundarios de Cialis, ademГЎs de una mayor actividad. La dosis debe ser adaptada adecuadamente. Esto es tambiГ©n aplicable para la Viagra.

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Viagra, Cialis o Levitra ВїcuГЎl es mejor?

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Ante la variedad de productos para la disfunciГіn erГ©ctil en el hombre, muchos se preguntan quГ© marca es mejor. Lo cierto es que no hay ninguna mejor, sino que para cada hombre una se adapta mejor. Viagra es el medicamento para la impotencia mejor conocido de los tres, por haberse vendido desde hace ya casi quince aГ±os, conociГ©ndose muy bien sus efectos y posibles efectos secundarios.

Viagra surte sus efectos tras unos cuarenta minutos despuГ©s de tomarla siendo mejor ingerirla con el estГіmago vacГ­a. Los efectos de la Viagra tienen una duraciГіn de entre cuatro y seis horas. Levitra, por su parte, tiene una duraciГіn de tiempo similar y tiende a verse menos afectada por la comida o el alcohol, pudiГ©ndose tomar con las comidas. Existen algunas evidencias de que Levitra es mГЎs eficaz en los hombres diabГ©ticos. Los efectos del Cialis duran hasta 36 horas por lo que muchos hombres lo prefieren implicando una menor planificaciГіn que Viagra o Levitra. La desventaja es que si usted experimenta sus efectos secundarios, Г©stos pueden durar mГЎs tiempo.

Los tres medicamentos para la disfunciГіn erГ©ctil tienen similares efectos secundarios: dolor de cabeza, congestiГіn nasal, enrojecimiento facial, dolor de estГіmago o dolor de espalda es la mГЎs comГєn. Viagra, Cialis y Levitra no deben tomarse en caso de tomar medicamentos o sustancias estupefacientes que contengan nitratos. Cialis no debe ser tomado por los hombres que estГ©n tomando medicamentos llamados bloqueadores alfa, que se utilizan a veces para tratar problemas de prГіstata o presiГіn arterial alta. Los hombres que toman bloqueadores alfa puede usar Viagra o Levitra, pero permitiendo al menos seis horas de diferencia entre la toma del bloqueador alfa y la toma de Viagra o Levitra.

A menudo se recomienda que los hombres prueben los tres medicamentos y poder comprobar asГ­ si Viagra, Levitra o Cialis surten mejores efectos y se adaptan mejor al estilo de vida. De esa manera usted puede probar los efectos de cada uno y elegir el mГЎs adecuado. Es importante saber dГіnde comprar Cialis, Viagra o Levitra online para asegurar un servicio fiable. Hay numerosos sitios web que ofrecen medicamentos para la impotencia, pero muchos medicamentos son falsos o se venden sin receta mГ©dica. Aparte del hecho de que estos medicamentos falsificados pueden no funcionar, tambiГ©n existe el riesgo de sufrir efectos adversos potencialmente graves en comparaciГіn con la toma de un medicamento original.

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COMPRAR CIALIS BARATO 09/16/2016 22:29

SГіlo en esta web confГ­o http://europepharm.net
mi confianza se debe a que su pГЎgina de facturaciГіn tiene el protocolo https en el navegador, con ello puedo pagar con mi tarjeta de crГ©dito sin problemas, ya he comprado en 4 ocasiones y todo muy discreto, la recomiendo.

figaro333 03/12/2015 23:28

Mejore mi vida sexual usando viagra, esta medicina me permitio aumentar mi potencia sexual y llegar a satisfacer a mi pareja sin problemas, me siento muy satisfecho con los resultados obtenidos con esta medicina. Les comparto la farmacia en linea donde estoy pidiendo l
as pastillas con total seguridad, ademas son muy economicas. http://e-wartrolreviews.com/pills por eso la recomiendo.

figaro333 03/12/2015 23:27

Mejore mi vida sexual usando viagra, esta medicina me permitio aumentar mi potencia sexual y llegar a satisfacer a mi pareja sin problemas, me siento muy satisfecho con los resultados obtenidos con esta medicina. Les comparto la farmacia en linea donde estoy pidiendo l
as pastillas con total seguridad, ademas son muy economicas. por eso la recomiendo.
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francisco 03/07/2015 13:11

Yo he tomado levitra me gustarГ­a .tomar cialis para mГЎs ereccion no creo que pase nada por probar hay que tener miedo al tomarlas quiero probarlas digame

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Welcome to AthletesPharmacy Anabolic Steroids Store

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Anabolic steroids are artificial/synthetic substances that have the same compound as testosterone – male sex hormone. These synthetic hormones stimulate skeletal and muscle growth, increase appetite and muscle strength – known as AAS anabolic effect .Women should be cautious when taking these drugs because they progress male sexual characteristics, such as facial hair growth and deepening in the voice – phenomenon known as androgenic effect. these effects are permanent.

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

- Fourth Amendment to the United States Constitution

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

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Changes in Technology Have Outpaced the Law

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

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

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

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

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

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

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

Guiding Principles for ECPA Reform

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

We are guided by the following concepts:

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

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

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

Specific Background on ECPA Reform Principles

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

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

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

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

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

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

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

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

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

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