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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.

So, you’re on dialysis, and with that, and age, the combination has led to embarrasing difficulties. If you are in a relationship from before you started dialysis, then your partner has shared things with you and may well be more understanding, but what if you are single, not only do you have the big D to overcome as a conversation stopper, but if things turn out great, the time will come when you go to bed and another embarrassment could result!

The good news is, so long as your blood pressure is fine, and you are generally well in your treatment, consult your GP about Viagra. Amazingly it’s not a big deal to talk about with your GP, and they will be able, in most cases, to prescribe Viagra. You may be started on a lower dose to check you can cope with the changes this causes. Viagra does have the effect of lowering blood pressure, so if your pressure is low to start then not a good idea to take it.

Also note that you are likely to experience elevated heart rate, so if this causes you problems, don’t take it and consult your GP.

The weird and almost beneficial effect is that if you have no renal function at all, the effects last longer!

But! Always consult your GP. and if they are not certain on the answers for you, they must consult your nephrologist or consultant.

The main thing is, don’t hold back, every day solutions can work for many on dialysis.

Hi, I’m Steve and have been a dialysis patient on some form of self-care or other since 1990. I’ve dialysed at home, abroad, in hospital, oh and had a transplant for 7 years. I work in the insurance industry for a City based business, but am very fortunate to be able to work from home 4 days a week. I hope, with my experiences, I can help others on dialysis or those facing dialysis in the future! It ain’t so bad! Steve

E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Latest from Steve Bone

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Timing of sildenafil therapy in dialysis patients—lessons following an episode of hypotension

Sildenafil therapy, as the first effective oral treatment, has revolutionized erectile dysfunction treatment. It is a selective inhibitor of cyclic guanozine monophosphate (cGMP)—specific phosphodiesterase type 5 (PDE5) [1 ]. It exerts its inhibitory action on the corpus cavernosum via increasing cGMP. This enhances the relaxant effect of endogenous nitric oxide (NO) on the smooth muscles facilitating flow of blood in the penis [2 ]. Maximum plasma concentration is achieved within 30–120 min and the terminal phase half‐life is 3–5 h [3 ].

A number of short‐term studies, in clinical practice, proved safety, efficacy and tolerability of this medication by patients suffering erectile dysfunction due to various aetiological factors. Recognized side‐effects include headache, nausea, gastro‐oesophageal reflux, flushing, nasal congestion, colour vision disturbance, pupil sparing and third nerve palsy [4 ]. Most of these adverse effects were explained by the drug’s mode of action. Significant hypotension has been reported in patients with ischaemic heart disease and its use is contra‐indicated in patients receiving concurrent nitrate therapy.

Current guidelines allow the use of sildenafil in patients with chronic renal failure and erectile dysfunction, however, this agent has not been fully evaluated in this group of individuals, particularly those receiving renal replacement therapy (RRT) [5 ]. We report the case of a patient with erectile dysfunction on maintenance haemodialysis, with no known cardiac history, who developed symptomatic hypotension delaying haemodialysis (HD) following initiation of sildenafil therapy.

Case.

A 49‐year‐old male patient with an underlying diagnosis of polycystic kidney disease had been on maintenance HD for 5 years with no known cardiovascular disease. The only drugs he was receiving were erythropoietin 2000 units thrice weekly (haemoglobin 11.7 g/dl), omeprazole, phosex, ascorbic acid, ferrous sulphate, quinine sulphate, senna and lactulose. His erectile dysfunction was of 6 years duration and started 1 year before commencing RRT.

A test dose of 50 mg was taken at 21. 30 h on a non‐dialysis day at home. No therapeutic effect was achieved. One hour after ingestion he felt unwell with headache, nausea, epigastric pain and flushing, followed by light‐headedness and dizziness. The next day he reported for his dialysis still experiencing dizziness and light‐headedness, 12 h after the initial dose. He was hypotensive with a blood pressure of 80/50 mmHg. Mean pre‐dialysis BP over the preceding 10 days was 120/75 mmHg. His pre‐dialysis weight was 82.5 kg, 0.5 kg above target. Dialysis was not performed. His blood pressure rose spontaneously to 180/65 mmHg 17 h after the administration of sildenafil. There was no evidence of an acute cardiac event with normal ECG and enzymes. A subsequent echocardiography confirmed normal left ventricular function (ejection fraction 60–70%) with no evidence of any chamber enlargement or segmental contractility abnormality. There was no evidence of valvular dysfunction; however, the mitral valve annulus was calcified. Mild left ventricular hypertrophy was present. Dialysis was performed uneventfully 6 h after admission; post‐dialysis BP was 111/60 mmHg. No long‐term sequalae have been identified and the patient has remained on HD without further incident.

Discussion.

No previous cases have been reported of significant hypotension secondary to sildenafil in HD patients. These patients are at high risk of occult cardiovascular disease. The use and safety of sildenafil has not been evaluated in patients on maintenance HD programmes. Our patient developed a significant adverse reaction following sildenafil therapy with no therapeutic benefit.

Hypotension occurred shortly after the administration of this agent for which no other cause was identified. The exclusion of hypovolaemia as a cause of hypotension in dialysis patients is difficult. In this case a number of factors argue against hypovolaemia. The patient was well and haemodynamically stable before the initiation of sildenafil. The onset of his symptomatology started 1 h after ingesting the tablet, within the predicted time of efficacy of sildenafil. Given that there is a shared pathway for mechanism of action and adverse effects it is highly probable that the administration of sildenafil was temporally implicated. He had also been stable on HD prior to exposure to this agent and has had no further episodes of hypotension since. In the absence of any other aetiological factors we have identified sildenafil as the most likely cause of his transient hypotension.

In patients on maintenance peritoneal dialysis this treatment was well tolerated [7 ]. An important question remains the timing of administration of sildenafil in relation to HD as sildenafil may potentiate hypotension during dialysis. After dialysis the patient may remain relatively hypovolaemic for some time and thus be vulnerable to the potential systemic effects of sildenafil. We recommend that sildenafil should be used on non‐dialysis days. However, further work is required to evaluate the timing of sildenafil therapy in HD patients.

  • В© European Renal Association-European Dialysis and Transplant Association

References

Boolell M, Allen MJ, Ballard SA et al. Sildenafil: an orally active type 5 cyclic GMP‐specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 1996 ; 8. 47 –52

Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric Oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med 1992 ; 326. 90 –94

Morales C, Gingell C, Collins M, Wicker PA, Osterloh IH. Clinical safety of oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction. Int J Impot Res 1998 ; 10. 69 –74

Donahue SP, Taylor RJ. Pupil sparing 3rd nerve palsy associated with Sildenafil Citrate (Viagra). Am J Ophthalmol 1998 ; 126. 476 –477

The National Health Service (General Medical Services) Ammendment (No. 2) regulations. HSC 1999 / 148

Webb DJ, Freestone F, Alden MJ, Murhead GJ. Sildenafil citrate and blood pressure lowering drugs, results of drug interaction studies with an organic nitrate and calcium antagonist. Am J Cardiol 1999 ; 83. 21 –28

Macdougall IC, Mahon A, Muir A, Sidhu P. Randomised placebo controlled study of sildenafil (Viagra) in peritoneal dialysis patients with erectile dysfunction. Renal Association Meeting, Royal College of Physicians, London, October 1999

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Esto indica que se preocupan por asegurar que sus clientes estén informados en cuanto a los medicamentos que toman. Hacer el amor proporciona el aire necesario a su relación sana de vivir y prosperar. Por ejemplo, las personas que toman nitroglicerina (un medicamento para el corazón) nunca deben tomar productos de sildenafil la forma en que podría producir una caída peligrosa en los niveles de presión arterial. Un segundo hombre, Edward Webb (también a menudo conocido como Nick Wells) se enfrenta a cargos por lo general similares en Houston, acusados ​​de tráfico de la falsificación de Viagra y Cialis que había estado viniendo desde China. Los que van a cortar menudo apilar Primobolan con drostanolona, ​​estanozolol o trembolona. Puede parecer lento, pero añadiría tanto como una reducción de peso de más de tres piedras en el año. Use la ropa interior de perder asegurándose de que la aireación adecuada se puede lograr en los órganos sexuales. Primobolan dosis de 200 mg o menos (intramuscular) rara vez se alteran nivel de la hipertensión. Así que su viaje emocional se ve reforzada a menudo y ndash; para mí uno de los más importantes es la reducción del estrés. Además, el aumento de potencia se obtiene a partir de la elaboración podría ayudar a aumentar su enfoque. Usted puede haber oído hablar de priapismo, una difícil de encontrar complicación Viagra mencionado en comerciales de televisión y varios de publicidad. Disfunción eréctil también puede ser conocido como la disfunción eréctil y por lo general es una condición médica que afecta a los hombres. Estos incluyen ciertos medicamentos de alta hipertensión, antihistamínicos, antidepresivos, tranquilizantes, supresores del apetito y cimetidina (un medicamento para la úlcera). Ver este artículo en Herbal Viagra para obtener información específica acerca de las reclamaciones fraudulentas de Viagra. Usted puede comprar muy fácilmente los medicamentos al igual que usted compra a otros medicamentos. Los milagros de la ciencia médica han empoderado a una gran cantidad de hombres a permanecer su capacidad para ayudar a mantener, relaciones sanas, amorosas íntimas. Kamagra se exporta una cantidad de diversas naciones en alta mar, ya que en realidad es más asequible que su contraparte, y del mismo modo consiste en el compuesto de Citrato de Sildenafil, el ingrediente principal de Viagra. Aunque el consumo moderado benifits gente una buena oferta, el consumo de alcohol mientras usa hemospermia eleva el riesgo de deterioro de la salud. Así que cuando usted se olvida de adquirir sus productos con anterioridad, puede estar pagando una prima. Algunos en la promesa de la ampliación del pene pastillas tamaño, otros prometen más la libido. En caso de que la erección más dura persiste más de 4 horas.

necesito un viagra natural fuerte
Tinte de pelo posiblemente no serГ­a complementar el color de las cejas que significa que este puede plantear la vergГјenza en lugar de darle un aspecto impresionante. En realidad, sin embargo, las feromonas humanas desencadenan respuestas por contacto directo de piel a piel: un apretГіn de manos, abrazo, beso o alrededor de la mejilla deja una seГ±al potente detrГЎs. Viagra genГ©rico tiene citrato de sildenafil que eleva el flujo de sangre por el pene. Saw Palmetto-hormonal y efectos estrogГ©nicos parecen ser probado. Aunque, si se presenta el mensaje de correo electrГіnico de un operador oficial de medicamentos genГ©ricos, usted podrГ­a comprar Viagra genГ©rico sin Viagra. La masturbaciГіn puede ser la tГ©cnica de auto placer para que el sexo. El 27 de marzo de 1998, la AdministraciГіn de Alimentos y Medicamentos (FDA) aprobГі sildenafil, comГєnmente conocido como Viagra, el medicamento oral que se duda conoce en todo el mundo para el tratamiento de la impotencia, la incapacidad de lograr o mantener la erecciГіn mГЎs dura. DespuГ©s de una extensa charla durante el uso de las niГ±as, cuando se explican las realidades, muchos elegidos para proceder. Scams aren’t usually some grand con that derive from outsmarting the mark. Estas vГЎlvulas pueden controlar su flujo de sangre junto con la sangre de desvГ­o de sus ГЎreas que lo necesitan, probablemente, con mucho, el mГЎs. Por lo tanto, es necesario limitar la exposiciГіn al sol y utilizar protector solar. DeberГ­a algГєn tipo de formaciГіn, pero como usted es seguir entrenando que usted podrГ­a notar que esta es la precisiГіn mejora y pronto, posiblemente, sГіlo tendrГ­a que comprobar si hay mensajes que se deslizaban sobre las grietas. Si su barba importa mucho que entonces definitivamente definitivamente creo que es prГЎctico mantener la barba en cualquier momento de la temporada en todos los climas. Heterosexual pelo- Afuera, en los cuatro tipos, el pelo liso refleja probablemente la mayor cantidad de brillo y serГЎ el mГЎs resistente. Por encima de todo, en lГ­nea Viagra sildenafil citrato de farmacia protegerГЎ su identidad sea revelada, por lo tanto, va a permanecer en el anonimato durante todo el proceso de compra. El estudio encontrГі un aumento en las tasas de infecciГіn por el VIH despuГ©s de comenzar uno de esos medicamentos, aunque no en otras enfermedades de transmisiГіn sexual. Sin embargo, lo que realmente es importante ver que vital entre la pequeГ±a pГ­ldora azul junto con los cГЎnceres de piel no se habГ­a evidenciado en concreto con el experimento. Incluso los amantes del deporte con moobs pueden beneficiarse de estas prendas revolucionarias. TambiГ©n ayuda a adoptar balance de trastornos orgГЎnicos subyacentes que aumentan el desorden psicolГіgico. La impotencia tambiГ©n se llama impotencia masculina que significa que el flujo de sangre hacia el pene se deteriora. La web destaca por su estrategia inventiva de cualquiera y todas las formas de los obstГЎculos que se pueden colocar para utilizar camino y promociГіn de su sitio sin agotar su presupuesto financiero es sГіlo un obstГЎculo. Este es el lugar donde los medicamentos genГ©ricos son mГЎs baratos, ya que no tienen que invertir en la investigaciГіn y el desarrollo. Los investigadores aprendieron una dosis de 1 miligramo de Viagra mantendrГЎ las flores cortadas de elegir una recta soporte proporcionado por semana durante la normalidad. Moe finalmente tirГі la toalla en el interior, lo que sugiere que intentamos de nuevo otra vez.

Related Posts:

NavegaciГіn de entradas

Te voy a mostrar como cualquier hombre con problemas de erecciГіn puede mantener una erecciГіn mas prolongada por medio de sencillos pasos que no sГіlo darГЎ lugar a una erecciГіn mГЎs fuerte y mГЎs duradera sino que tambiГ©n te ayudarГЎ a mejorar la potencia sexual. Lo mejor de todo sin tomar pastillas como el viagra.

ВїCГіmo conseguir una erecciГіn de forma natural?

A menos que tengas una enfermedad grave, no es necesario tomar ningГєn medicamento para obtener una erecciГіn fuerte, dura y firme, puede hacerlo de forma natural realizando cambios simples en su dГ­a a dГ­a.

Los cambios que pueden mejorar la disfunciГіn erГ©ctil son los siguientes:
Cambios en la dieta, realizar ejercicio, aprender a relajarse y aГ±adir unas pocas hierbas naturales, con esto tendrГЎ una mejor erecciГіn mГЎs fuerte y prolongada, usted serГЎ capaz de mantener la erecciГіn durante mГЎs tiempo .

Pasos sobre como mantener una erecciГіn natural y prolongada durante mas tiempo.
1.) Llevar una dieta adecuada

Te voy a presentar a los enemigos de la salud sexual: las grasas y los alimentos procesados altamente refinados, asГ­ es, tienes que cuidarte de consumir esa clase de alimentos, ya sabes el porque.

ВїQuГ© alimentos necesitas incluir en tu dieta diaria para conseguir una erecciГіn fuerte y prolongada. aquГ­ solo te voy a mencionar una que otra cosa, por ejemplo: comer mucha fruta fresca, verduras, carne magra y pescado. Si usted hace esto sus niveles de energГ­a se incrementarГЎ y su salud sexual mejorarГЎ de manera espectacular.

Ahora, si deseas puedes tener toda la informaciГіn en una exclusiva guГ­a practica para tener una erecciГіn fuerte y prolongada. Haz Clic AquГ­

2.) Sea Activo (Realiza algГєn tipo de ejercicio en promedio de 30 a 45 minutos)

De hecho las personas que hacen ejercicio con regularidad, son mucho menos propensos a sufrir de impotencia que aquellos que no lo hacen. Si usted no quiere ir al gimnasio, simplemente, puede realizar caminatas a paso ligero, bailar o cualquier tipo de movimiento que le guste.

Esto es muy importante. Cuando hace ejercicio, asegГєrese que usted se centra en el ГЎrea abdominal. Si usted hace esto, usted ayudarГЎ a que los mГєsculos abdominales estГ©n en buen estado y podrГЎ sostener y mantener una erecciГіn fuerte y duradera, a diferencia de tener que mantener su estГіmago de grasa.

Por medio de los mГєsculos pubococcГ­geo.

Debido a que estos mГєsculos son vitales para mantener la erecciГіn lamentablemente muchos hombres los tienen dГ©biles por lo que deben ser fortalecidos. El mГ©todo es fГЎcil de realizar y requiere muy poco tiempo. No hay excusas, una vez fortalecidos podrГЎs tener una erecciГіn mГЎs fuerte y mГЎs duradera. Descubre como hacerlo haciendo Clic AquГ­

4.) Hierbas para ayudarle a conseguir un pene erecto y duro

Hay muchas hierbas que le ayudarГЎn a conseguir una erecciГіn mГЎs dura y la razГіn de esto es que muchas hierbas contienen nutrientes que usted simplemente no recibe en su dieta diaria. Las mejores hierbas pueden mejorar el flujo de sangre hacia el pene y, ademГЎs, ayudarГЎ a aumentar la secreciГіn de Гіxido nГ­trico.

El Гіxido nГ­trico es la sustancia natural que es necesaria para que las erecciones puedan llegar a buen tГ©rmino, porque – con su producciГіn se contribuye a ampliar y ensanchar los vasos sanguГ­neos de los tejidos del pene.

El viagra ayuda a aumentar la secreciГіn de Гіxido nГ­trico, pero no es necesario tomarlo, usted puede conseguir el mismo efecto a partir de hierbas naturales y obtener una erecciГіn mГЎs fuerte de manera natural.

5.) Aprenda a relajarse

El estrГ©s y la ansiedad son una de las principales causas de problemas de salud sexual por lo que – reconocer esta situaciГіn y tomar medidas para relajarse y liberar su mente de pensamientos negativos.
AceptГ©moslo la impotencia se encuentra por todas partes y que la cantidad de hombres con problemas de erecciГіn estГЎ aumentando rГЎpidamente.

Es por esta razГіn que reunГ­ todos los mГ©todos especiales y pocos conocidos para tratar la impotencia y como tener una erecciГіn fuerte prolongada y duradera en un programa fГЎcil de comprender con numerosos consejos y secretos.

Si deseas conocer estos métodos para saber como mejorar las erecciones – como tener erecciones fuertes y duraderas naturalmente, entonces Haz Clic Aquí

Como tratar la eyaculacion precoz masculina no es complicado, solo tienes que tener la informaciГіn correcta y sobre todo una guГ­a que te oriente paso a paso todo lo que debes hacer para eliminar este problema de una vez por todas. AquГ­ solo te voy a dar algunas pautas que puedes seguir para que tГє tambiГ©n aprendas como tratar la eyaculacion precoz de forma natural sin medicamentos, sin tomar viagra o levitra.

Remedios caseros para la eyaculaciГіn precoz

1.- Masajear el pene con aceite de mostaza

El masaje se utiliza para que podamos mejorar la circulaciГіn de la sangre en cualquier parte del cuerpo asГ­ como para estimular los mГєsculos. Cuando se aГ±ade aceite de mostaza al masaje da un efecto de calentamiento que podrГ­a ayudar en la dilataciГіn de los vasos sanguГ­neos para de esta forma poder mejorar la circulaciГіn. Este es una forma en que te puede ayudar a como controlar la eyaculaciГіn precoz de forma natural. Para hacer el masaje solo tienes que agregar 5 a 10 gotas de aceite de mostaza en una onza de aceite de sГ©samo. Use movimientos suaves.

2.- Semillas de cebolla verde .

Intenta extraer las semillas de cebolla verde y luego lo mezclas con un vaso de agua. Toma esta mezcla como una bebida, te serГЎ de gran utilidad en como tratar la eyaculacion precoz de forma natural.

3.- Evitar estos alimentos antes de tener relaciones Г­ntimas

Evitar comer panes, pasteles, huevos, aperitivos, tГ©, cafГ© y cosas calientes antes de la relaciГіn sexual. Estos alimentos harГЎn que una persona este excitada haciГ©ndolo mГЎs propenso a tener eyaculaciГіn precoz (sobre todo en hombres que ya estГЎn sufriendo con este problema).

Esta es una de las grandes hierbas para la eyaculaciГіn precoz que al consumirla una de sus funciones es aumentar el flujo de sangre a todas las partes del cuerpo, con esto la concentraciГіn de un hombre, la memoria y el estado de alerta pueden mejorar notablemente. Otro beneficio de consumir esta hierba, es que ayuda con la resistencia sexual y podrГ­a mejorar las erecciones.

5.- La leche de almendras .

Considerado como uno de los remedios caseros para la eyaculaciГіn precoz. Para que sea mГЎs efectiva te recomiendo que le agregues “azafrГЎn” (afrodisiacos naturales para hombres).

Los ingredientes que necesitas son:

10 de almendras

1 taza de leche de vaca caliente

una pizca de jengibre

una pizca de cardamomo

Todo lo que necesitas hacer es remojar las almendras durante toda la noche con agua. Al dГ­a siguiente, le quitas la cascara y lo mezclas junto con la leche y los demГЎs ingredientes. Puedes tomar esta bebida de almendras cada maГ±ana. Es uno de los afrodisiacos naturales para la erecciГіn que funciona como un viagra natural .

Como podrГЎs darte cuenta, como tratar la eyaculacion precoz de forma natural es posible y se le puede combatir de diversas formas y lo mejor de todo de manera natural sin afectar tu salud.

Existen otras hierbas para la eyaculaciГіn precoz, asГ­ como determinados alimentos, jugos naturales, determinados ejercicios, entre otros secretos. Toda esta informaciГіn lo encontraras en una exclusiva guГ­a prГЎctica que, paso a paso, te permitirГЎ durar de 20 a 30 minutos mГЎs en la cama. Si deseas tener acceso inmediato entonces Haz Clic AquГ­ y descubre como curar la eyaculacion precoz con medicina natural .

La solucion natural para la disfuncion erГ©ctil lo podemos encontrar en algunos alimentos que van a funcionar de modo similar como el viagra, pero en este caso sera como viagra natural.

He encontrado que la mayorГ­a de los hombres no entienden lo que realmente hace el consumir viagra. Muchos creen que aumenta la libido, pero ese no es el caso. El viagra no hace que un hombre este excitado sexualmente, sГіlo es eficaz si el hombre estГЎ excitado sexualmente. Para entender cГіmo funciona es necesario comprender la mecГЎnica de como un hombre tiene una erecciГіn.

CГіmo suceden las erecciones

Cuando se produce una erecciГіn, la sangre fluye rГЎpidamente en el pene, lo que aumenta su longitud, anchura, y la firmeza. Si los vasos o arterias son demasiado estrechos, los hombres pueden tener problemas para lograr o mantener una erecciГіn fuerte.

Por otro lado, cuando un hombre se estimula sexualmente, el sistema nervioso en el tejido erГ©ctil del pene libera Гіxido nГ­trico, que estimula una reacciГіn en cadena haciendo que las arterias en el pene se dilaten, lo que permite que la sangre fluya hacia el pene mГЎs fГЎcilmente. El propio tejido erГ©ctil se llena de sangre, y ambos de estos procesos resultan en una erecciГіn. AsГ­ que, bГЎsicamente, si su cuerpo no produce suficiente Гіxido nГ­trico, el viagra esta de relleno.

Tienes que tener presente que para que funcione el viagra tiene que haber una estimulaciГіn sexual, ademГЎs el viagra no aumenta el deseo sexual o la libido. AsГ­ que incluso si usted toma Viagra, y no hay algГєn estimulo sexual que lo excite, el cerebro no va a estimular la liberaciГіn de cualquier Гіxido nГ­trico y no va a conseguir una erecciГіn.

Se sabe que el viagra se estableciГі para ser un fГЎrmaco seguro y eficaz, pero sabemos que no es apropiado para todo el mundo y puede no funcionar en todos los casos.

Solucion natural para la disfuncion erГ©ctil con la ayuda del viagra natural

Tenemos una variedad de opciones que pueden funcionar como viagras naturales, aquГ­ solo te mencionare algunos de ellos:

Impulsores naturales de Гіxido nГ­trico

El Гіxido nГ­trico es uno de los principales ingredientes de las erecciones, y extraordinariamente bueno en la prevenciГіn de las enfermedades cardiovasculares mediante la relajaciГіn de las paredes arteriales, la dilataciГіn de los vasos, y mejorando el flujo de sangre.

De verdad, tienes que hacer ejercicios fГ­sicos

Tales como: caminar, trotar, nadar, escalar, etc. y si esta dentro de tu tiempo hacer ejercicios de fuerza (en el gimnasio), se ha demostrado que realizar algГєn tipo de ejercicio aumenta los niveles de Гіxido nГ­trico. AdemГЎs, si vas al gimnasio con regularidad, la producciГіn de Гіxido nГ­trico aumentarГЎ a medida que los mГєsculos aumentan de tamaГ±o. Su cuerpo se da cuenta de que los mГєsculos necesitan mГЎs sangre, oxГ­geno y nutrientes, por lo que aumenta los niveles de Гіxido nГ­trico y con estos podrГЎs mejorar la erecciГіn de forma natural.

La vitamina C mГЎs el ajo

Si no lo sabГ­as, la vitamina C puede aumentar la producciГіn de Гіxido nГ­trico. En cuanto al ajo, estГЎ lleno de nitratos (que luego se convierten en oxido nГ­trico. Otros alimentos que tienen nitratos son por ejemplo: la espinaca, apio, remolacha conocida tambiГ©n como betarraga, perejil, zanahoria, etc.).

Las semillas de calabaza

Consumir semillas de calabaza, asГ­ como las semillas de girasol, es otra forma de aumentar su deseo sexual. Estas semillas contienen ГЎcidos grasos Omega 3 y el mineral zinc, los cuales juegan un papel preponderante en la regulaciГіn de los niveles de las hormonas sexuales.

Como te habrГЎs podido percatar encontrar una solucion natural para la disfuncion erectil no es complicada, siempre y cuando sepas como hacerla. Por otro lado, si deseas saber como podre ayudarte a solucionar de una vez por todas la disfunciГіn erГ©ctil aplicando mis mejores tГ©cnicas y mГ©todos pocos conocidas entonces Haz Clic AquГ­ .

Para nosotros los hombres el sexo es una parte muy importante de nuestra vida. Sin embargo, por diversos motivos muchos sufren de problemas de erecciГіn y/o tienen una erecciГіn dГ©bil. Por tal motivo aquГ­ te voy a mencionar algunos consejos que te van a permitir saber como lograr una buena ereccion sin viagra y puedas conseguir una mejor vida sexual con tu pareja. Pero, si estas apurado haz clic aquГ­ para tener acceso inmediato.

Consejos sobre como durar mas tiempo con la erecciГіn

1.- Descartar posibles problemas de salud

Algunos problemas de salud tales como el colesterol alto y la presiГіn arterial alta tienen una alta influencia negativa en tu rendimiento sexual. Estas enfermedades por lo general pueden daГ±ar los vasos sanguГ­neos que conducen la sangre hacia el pene dando lugar a la falta de erecciГіn.

2.- Controlar el estrГ©s

El estrГ©s o la ansiedad estГЎn relacionados con la vida sexual. Especialmente, en los hombres, controlar el estrГ©s es parte muy importante en su vida, ya que no sГіlo afectarГЎ a su salud en general, sino tambiГ©n en su intimidad. Como tener una buena ereccion sin viagra . Para ello, trate de estar relajado y evitar el estrГ©s tanto como le sea posible.

3.- Cuidado con el uso de laptops

La laptop es una herramienta muy utilizada. Sin embargo, lo que muchos no saben es que puede ser perjudicial para la salud masculina. Por ejemplo, el calor del equipo causarГЎ daГ±o a su esperma, asГ­ como a sus erecciones. Por tanto, trate de no poner su laptop demasiado cerca de usted. Lo recomendable es colocar el ordenador portГЎtil en un escritorio y no sobre sus piernas.

4.- Siempre mantenga sus dientes limpios

Sorprendido. Como mantener una ereccion por mucho tiempo. recuerda siempre esta norma sencilla. Se ha encontraron una estrecha relaciГіn entre los problemas de ereccion y la enfermedad de las encГ­as, que se asocia a enfermedades del corazГіn y puede afectar gravemente a su higiene y su flujo de sangre.

5.- Dejar de fumar y reducir el consumo de alcohol

Como durar mГЎs tiempo con la erecciГіn. Si eres de los que fuman, dГ©jame decirte que fumar serГЎ malo para su circulaciГіn; por supuesto, a su pene no podrГЎ llegar una buena circulaciГіn de la sangre si usted es adicto a fumar. Por otro lado, el consumo de alcohol en exceso tambiГ©n puede inflamar la prГіstata, puede causar daГ±o nervioso, daГ±o al hГ­gado, y otras enfermedades de salud.

6.- Aumentar la testosterona

La testosterona tambiГ©n desempeГ±a un papel importante en como mantener una ereccion por mucho tiempo. Al aumentar la testosterona va a mejorar su vida sexual. El nivel de testosterona tiende a disminuir despuГ©s de los 40 aГ±os.

ВїCГіmo comprobar si sus niveles de testosterona han disminuido? Bueno, tendrГЎ erecciones dГ©biles, estarГЎ con falta de energГ­a, cambios de humor, y bajo deseo sexual. Para aumentar la testosterona de manera natural, incluye en tu dieta el ajo, brГіcoli, espinaca, coliflor etc. Si deseas mas informacion haz clic aqui .

7.- Dormir bien y como hacer durar mas tiempo una erecciГіn

Muy recomendable que duermas al menos 8 horas por noche; esto va a reducir el riesgo de que tengas problemas de erecciones y otros problemas de salud. El tener insomnio puede afectar significativamente a su vida Г­ntima o sexual.

8.- Consuma alimentos saludables

Como mantener una ereccion por mucho tiempo? Influye bastante consumir alimentos saludables. Llevar una dieta adecuada serГЎ una soluciГіn significativa en como tener una ereccion fuerte naturalmente. De hecho, consumir alimentos saludables va a afectar el flujo de sangre y las arterias coronarias. Trate de consumir mГЎs frutas y verduras y evitar el consumo de alimentos fritos, alimentos grasos o alimentos procesados, que limitan la circulaciГіn de la sangre y limitan sus erecciones durante el desempeГ±o sexual.

Recuerde siempre lo siguiente “alimentos malos para el corazón de los hombres van a ser malo para su pene”. Dentro de los alimentos saludables tenemos por ejemplo: pescado, aceite de oliva, frutos secos, grasas saludables, cereales integrales, verduras y frutas frescas (higo, sandia, plátanos, granada, etc.), ya que son excelentes para tener una mejor vida sexual.

Como ya te habrГЎs podido dar cuenta como lograr una buena ereccion sin viagra . pastillas o medicamentos es posible, solo tienes que tener la informaciГіn correcta. Ahora, si deseas aprender paso a paso como mantener una ereccion por mas tiempo de manera natural sin tomar viagra, cialis, vardenafilo (levitra) o medicamentos, entonces Haz Clic AquГ­ .

Si tienes alguna pregunta, por favor deje sus comentarios a continuaciГіn:

SabГ­a usted, que los grandes amantes consumen algГєn tipo de suplementos para tener una mejor erecciГіn en la intimidad. Pues bien, aquГ­ te voy a revelar solo algunos de ellos. Estos suplementos naturales que voy a compartir contigo tienen como funciГіn mejorar el flujo de sangre, la producciГіn de Гіxido nГ­trico, y que van a ayudar a reparar las paredes arteriales de forma natural, con todo esto usted podrГЎ tener una erecciГіn mГЎs fuerte, mГЎs dura y prolongada de forma natural.

Los mejores suplementos para tener una mejor erecciГіn de manera natural

La quercetina es un pigmento antioxidante que se encuentra en muchas bayas y verduras (tales como, la cebolla roja, el vino, el tГ©, las uvas, entre otros), y se sabe que dentro de sus beneficios esta su fuerte capacidad erГ©ctil. Su consumo ayuda para aumentar el flujo de sangre, y tambiГ©n para promover una buena salud cardiovascular. Lo que por supuesto significa que es bastante impresionante para que tengas una erecciГіn fuerte.

Con este suplemento, podrГЎs deshacerte de las erecciones dГ©biles y suaves. Es uno de los suplementos para tener erecciГіn fuerte, y que sin duda aumentarГЎ el factor de dureza. Como actГєa este suplemento. bueno, en primer lugar, aumentarГЎ tu producciГіn de Гіxido nГ­trico, que sin duda es lo que estamos buscando, y en segundo lugar estГЎ lleno de un flavonoide llamada icariina que actГєa como la testosterona. El Icariin tambiГ©n aumentarГЎ el flujo de sangre hacia la regiГіn pГ©lvica.

Es un excelente suplemento a base de hierbas que te harГЎn tener una erecciГіn potente. EstГЎ conformado a base de hierbas procedentes de las selvas tropicales del Amazonas. Al igual que el suplemento anterior tambiГ©n contiene el icariina. TambiГ©n es conocida como “Viagra natural”, que es un nombre que describe con precisiГіn los beneficios de esta hierba amazГіnica.

Bueno, estos son solo algunos de los mejores suplementos para tener una mejor erecciГіn de manera natural. Por otro lado, si deseas conocer como podrГ© ayudarte a que puedas recuperar a tener nuevamente erecciones fuertes y duraderas entonces Haz Clic AquГ­ para tener acceso inmediato .

Si no lo sabГ­as existen un sin nГєmero de tratamientos naturales para solucionar problemas de erecciГіn. El tema es encontrar cual es el mГЎs indicado para usted. Un tratamiento natural para tener una buena erecciГіn es efectivo siempre y cuando lo realices de manera correcta.

Tratamiento natural para mantener la erecciГіn mГЎs tiempo

AquГ­ solo te menciono algunas de ellas

El poder de la acupuntura

Este es un tratamiento natural para la ereccion masculina, la acupuntura consiste en la inserciГіn de pequeГ±as agujas que tienen por funciГіn regular el flujo de energГ­a que a su vez reduce la enfermedad. La acupuntura es un tratamiento casero que trabaja sobre el cuerpo y la mente para ayudar a mejorar la calidad de la erecciГіn y restaurar la actividad sexual.

HomeopatГ­a para todo el mundo

Es otro tratamiento natural para mejorar la erecciГіn de forma natural. Existen remedios homeopГЎticos que pueden proporcionar excelentes resultados para solucionar problemas de erecciГіn masculina tanto en jГіvenes como en adultos mayores. Tranquilo, toda esta informaciГіn la tengo en una exclusiva guГ­a prГЎctica. Y si deseas saber como podre ayudarte a solucionar problemas de erecciГіn y como adquirir la guГ­a prГЎctica Haz Clic AquГ­ .

Es un tratamiento natural para mejorar la erecciГіn, lo importante es beber el zumo de fruta de la granada, es muy eficaz y potente tratamiento casero para tener erecciГіn fuerte. El beber zumo de granada todos los dГ­as puede aumentar la libido tanto en hombres como en mujeres.

Realizar ciertos cambios en tu estilo de vida

Si fumas, te recomiendo que trates de dejarlo ya que la nicotina puede disminuir la circulaciГіn sanguГ­nea en el ГЎrea genital produciendo problemas de erecciГіn.

Beber bebidas alcohГіlicas puede tener un efecto negativo en tu desempeГ±o sexual. Lo recomendable es beber solo 1 Гі 2 copas de vino por dГ­a.

EjercГ­tate por lo menos 30 minutos al dГ­a, eso te ayudarГЎ a mejorar el flujo sanguГ­neo hacia el pene, y con ello mejorara tu erecciГіn. En este tratamiento natural para mejorar la ereccion, puedes incluir caminatas rГЎpidas, trotar, nadar, etc.

Muy importante es que mantengas un peso saludable. Incluir en tu alimentaciГіn un alto contenido de fibra y tu dieta debe ser baja en grasas.

Como te comente al inicio existen varios tratamientos caseros para mejorar la erecciГіn. Ahora si deseas conocer otro tratamiento natural para tener una buena erecciГіn y ademГЎs sepas como podre ayudarte a que vuelvas a tener erecciones fuerte y duras entonces Haz Clic AquГ­ .

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Founded in MontrГ©al 2010 by Swedish expat Jonas Edvinsson with 12+ years of experience in marketing and sales.

With over 400+ campaigns executed as Edvinsson Publicity, the projects today are carefully tailored to suit clients needs together with a low-cost, long term building and an analytical traffic driving approach.

The management and ownership of e-commerce entities, combined with the vast amount of front-end execution of communications campaigns derives today into rich full picture marketing service agreements.
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Sildenafil ist ein Arzneistoff aus der Gruppe der PDE-5-Hemmer, einer Gruppe. Umgangssprachlich wird der Name Viagra gelegentlich auch als. Untersuchungen haben gezeigt, dass Arginin die Wirku. Wenn ich fuer ca 1 Monat 3000 mg L-Arginin pro Tag nehme und trozdem Viagra vor dem du kannst viagra und arginin beliebig kombinieren Wer L-Arginin in Kombination mit Viagra zu sich nimmt, muss sehr vorsichtig sein und im Zweifelsfall unbedingt seinen Arzt aufsuchen. L-Arginin kann die. 13. Apr. 2016 . I▻ L-Arginin ist die wohl wertvollste Aminosäure. bei erektiler Dysfunktion hat sich die Kombination von Arginin mit Pinienrindenextrakt erwiesen. genausowenig wegzudenken wie das bekannteste Potenzmittel Viagra .Arginin und die Potenz – Einnahme, Wirkung, Dosierung – Potenzsteigerung. die diese bei Potenzproblemen nutzen, kombinieren die Einnahme mit einer Maca Kur. Ich habe Erfahrungen mit Viagra & Co. und auch mit Arginin. Viagra. 19. Apr. 2016 . Warum bewirken Cialis, Levitra, Spedra und Viagra bei mir keine. Möglichkeit ist die zusätzliche, tägliche Einnahme von 5 g bis 12 g L-Arginin (Porst 2013a). Ergebnissen führen, dann bietet sich noch die Kombination an.16. Dez. 2015 . Die Kombination von 2.700 mg Arginin mit Folsäure (Vitamin B9), Vitamin B6 und Vitamin B12 konnte in einer großen deutschen Untersuchung. In beiden Fällen, die auch kombiniert auftreten können, ist zu wenig Blut im Penis. Der Nachteil ist allerdings, dass L-Arginin nicht wie beispielsweise Viagra. 31. Dez. 2010 . Ein weiterer Therapieansatz ist, PDE-5 Hemmer (Viagra. Cialis, Levitra) mit hochdosiertem L-Arginin zu kombinieren. Dadurch kann die. 10. Aug. 2011 . GesünderNet: Manche Männer kombinieren Arginin mit verschreibungspflichtigen PDE5-Hemmern, um Letztere in der Dosis reduzieren zu.

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    • Aspirin ve heparin gibi kan pД±htД±laЕџmasД±nД± azaltarak etkileyen ilaГ§lar
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    Aspirin, son yıllarda hemen tüm tüp bebek merkezinde sıkça kullanılan ancak tam olarak ne üzerinde etkisi olduğu bilinmeyen bir ilaçtır. Aspirin, dünya üzerinde uzunca bir süre ateş düşürücü ve ağrı kesici etkisinden dolayı kullanıldıktan sonra kandaki pıhtılaşmayı azalttığı etkisi de fark edilmiştir. Bunun tespitinden sonra son yıllarda kardiyoloji gibi alanlarda da kullanımı artmıştır. Yapılan araştırmalarda gebelik oluşmasını engelleyen sebeplerden birisinin de anti fosfolipid sendrom olduğu belirlenmiştir. Bu sendrom sonucunda kılcal damarlar içerisinde kanın pıhtılaşma özelliğinin artmasından dolayı mikroskobik kalıntılar oluştuğu görülmüştür. Bu durumun gebeliğe engel olduğunun tespiti ile aspirin ve heparin gibi ilaçlar kandaki pıhtılaşmayı azaltması nedeniyle tüp bebek tedavisinde kullanılmaya başlamıştır.

    Antioksidan kullanД±mД±nД±n artД±rД±lmasД±

    TГјp bebek tedavisinde embriyonun geliЕџmesi laboratuvar ortamД±nda saДџlanmaktadД±r. Ancak embriyo geliЕџmesi, laboratuvarda vГјcut ortamД±ndan daha uzun sГјrmektedir. YapД±lan araЕџtД±rmalar sonucunda kesin olarak kanД±tlanmasa da laboratuvar ortamД±nda embriyonun geliЕџiminin daha yavaЕџ olma sebebi okside edici stres kaynaklarД± olarak belirlenmiЕџtir. Bu kaynaklar, Д±ЕџД±k ve kГјtГјr ortamД±nda kullanД±lan yГјksek oksijen basД±ncД±na sahip maddelerdir. Bundan dolayД± antioksidan kullanД±larak bu sorunun aЕџД±lacaДџД± dГјЕџГјnГјlmГјЕџtГјr. YapД±lan araЕџtД±rmalarda sadece tahminlerle kalan bu durum, Г§oДџu tГјp bebek merkezinde uygulanmaktadД±r.

    Viagra

    Tüp bebek tedavilerinde en önemli etkenlerden birisi de rahim içi dokusunun durumudur. Embriyo, laboratuvarda oluşturulduktan sonra anne rahmine yerleştirildiğinde rahim duvarına tutunmazsa gebelik oluşmayacaktır. Rahim içi kanalların yetersiz olduğu durumlarda viagra kullanılarak nitrik oksit seviyesinin yükseltilmesiyle damarların gelişmesinde önemli etkiler yapmaktadır. Başka bir açıdan bakacak olursak rahim içi kalınlaşmasının önüne geçen en büyük faktör, rahim içi duvarında mevcut olan enfeksiyonlar veya rahime yapılan müdahalelerdir. Bundan dolayı tedavide viagra kullanımına başlanmadan önce rahim içindeki yapışıklık durumları kontrol edilmelidir.

    Sperm mД±knatД±sД±

    Erkeklerde kısırlığa sebep olan en önemli faktörler; sperm hareketliliğinin yetersiz olması, sayı bakımından yetersiz sperme sahip olunması, morfolojik bozuklukların olmasıdır. Tıp alanında gerçekleşen çalışmalar, erkekte kısırlığa sebep olan ve normal incelemelerde dahi görülmeyen sebeplerin olduğunu kanıtlamıştır. Spermlerde son yıllarda görülen ve gebelik oluşmasında risk faktörü oluşturabilecek diğer bir olay da sperm hücrelerinin programlı ölümünün artmasıdır. Buna sebep olan en büyük faktörler; radyasyon, kimyasal maddeler ve genetik ısıda gerçekleşen değişikliklerdir.

    Benzer Makaleler

    TГјp Bebekte Stres ve Olumsuz Etkileri

    TГјp Bebekte KullanД±lan KanД±ta DayalД± Olmayan Tedaviler

    Tüp bebek tedavilerinde gerek tüp bebek aşamalarında gerek tüp bebek ilaç ve protokollerinde ve gerekse laboratuvar uygulamalarında son yıllarda elde edilen gelişmelerle başarı oranı artmaktadır. Ancak tüp bebek tedavisindeki bütün bu gelişmelere rağmen başarı oranı hala istenilen düzeyde değildir.

    Bazı kısır çiftler tüp bebek yöntemleriyle hala çocuk sahibi olamamaktadır. Bu sebeple, tüp bebek tedavisinin başarı oranlarını artırmak için yardımcı bir çok ilaç ve tedavi yöntemi kullanılmaktadır. Bu konuyla ilgili olarak bir çok çalışma yapılmasına rağmen bu yöntem ve ilaçların bir çoğunun faydası konusunda kesin veriler yoktur.

    Ancak üreme sağlığı konusunda bilinenlerin bilinmeyenlerden çok daha az olması, bu deneysel olması gereken yöntemlerin tedavide gerekli verileri elde etmeden kullanılmasına yol açmaktadır. Bir çok tüp bebek merkezinde uygulanan bu kanıta dayalı olmayan tedavilerin bazıları şunlardır:

    - Kan pıhtılaşmasını azaltan ilaçlar (heparin, Aspirin),

    - Embryo Glue (embryo yapД±ЕџtД±rД±cД±sД±),

    - Magnetik sperm seçimi (sperm mıknatısı),

    - Ko-KГјltГјr (yapay rahim),

    Aspirin ve Heparin KullanД±mД±

    Tüp bebek tedavisi esnasında aspirin tüp bebek merkezleri tarafından yaygın olarak kullanılan bir ilaçtır. Ancak etkinliği ve hangi durumlarda etkili olduğu bilinmemektedir.

    Aspirin tıpta uzun yıllardan beri kullanılmaktadır. Aspirinin ağrı kesici ve ateş düşürücü etkisinin dışında başka faydalı etkilerinin de olduğu tespit edilmiştir. Kanın pıhtılaşmasını engelleyen bir ilaç olması nedeniyle son yıllarda bu alanda da özellikle kardiyolojide kullanılmaktadır.

    YapД±lan Г§alД±Еџmalar tekrarlayan gebelik kayД±plarД±nД±n en Г¶nemli nedenlerinden birisinin “anti fosfolipid sendrom” olduДџunu gГ¶stermektedir. Bu sendromda, pД±htД±laЕџma mekanizmasД± bozularak kД±lcak damarlar iГ§erisinde mikroskobik pД±htД±lar oluЕџmakta ve geliЕџmekte olan fetusa giden kan akД±mД±nД± azaltarak Г¶lГјmГјne sebep olmaktadД±r.

    Anti fosfolipid sendromunda düşük doz aspirin veya heparin kullanımının olumlu sonuçlar verdiği ve canlı doğum oranını artırdığı tespit edilmiştir.

    Diğer yandan tekrarlayan tüp bebek başarısızlıklarında aspirin ve heparinin faydalı olduğunu gösteren çalışmalar olsa da bunun tersini gösteren çalışmalar da vardır. Şimdiye kadar bu konuda yapılan çalışmaların hepsine bakıldığı takdirde düşük doz aspirin kullanımının tüp bebek ve mikroenjeksiyon durumlarında klinik gebelik oranlarını artırmadığı gibi düşük ve dış gebelik oranlarını da değiştirmediği gözlenmektedir. Bu sebeple tüp bebek ve mikroenjeksiyon uygulamalarında düşük doz aspirin kullanımı canlı doğum için pozitif bir etkiye sahip değildir ve bu durumlarda rutin olarak kullanılmamalıdır. Bu bilimsel kanıtlar sonucunda başarısız tüp bebek tedavileri sonrasında pıhtılaşma faktörleri ile ilgili problem varsa, aspirin ve heparin tedavisinin faydalı olabileceği ve gebelik oranlarını artıracağını söyleyebiliriz.

    Ancak günümüzde böyle bir problem olsun veya olmasın tüp bebek gebeliklerinde aspirin yaygın olarak kullanılmaktadır. Bu konuda yapılan kapsamlı araştırmaların çoğunda, tüp bebek sonrası oluşan gebeliklerin seyrinde olumlu bir etkisi olmadığı sonucuna varılmıştır. Bütün bu verilerin ışığında tüp bebek tedavisinde rutin aspirin veya heparin kullanımının hiç bir faydası olmadığını söyleyebiliriz.

    Embryo Glue (Embryo yapД±ЕџtД±rД±cД±sД±)

    Embryo glue embryolarД±n transferi esnasД±nda kullanД±lan bir kГјltГјr ortamД±dД±r. Д°Г§erisinde Hyaluronan adД± verilen bir madde vardД±r. Bu maddenin embryonun rahime yerleЕџme oranД±nД± artД±rdД±ДџД± iddia edilmektedir. HyaluronanД±n embryo ile rahim iГ§ dokusu arasД±ndaki iliЕџkide nasД±l bir rol oynadД±ДџД± belirgin deДџildir. Ancak hyaluronanД±n hГјcreler arasД± baДџlantД±yД± gГјГ§lendirdiДџi, yeni damar oluЕџumuna yol aГ§tД±ДџД± ve kГјltГјr sД±vД±sД±nД±n akД±ЕџkanlД±ДџД±nД± azaltma etkisi oluЕџturduДџu iddia edilmektedir. Embryo glue’nun kullanД±mД±nД±n, tГјp bebek uygulamalarД±nda hamilelik ЕџansД±nД± artД±rdД±ДџД±nД± gГ¶steren yeterli sayД±da bilimsel kanД±t yoktur.

    Amerikan Hastanesi TГјp bebek Гјnitesinde 2008 yД±lД±nda yaptД±ДџД±mД±z Г§alД±Еџmada embryo glue’nun 35 yaЕџ ГјstГј veya daha Г¶nce tГјp bebek tedavisinde baЕџarД±sД±z olunduДџu veya embryo kalitesinin dГјЕџГјk olduДџu durumlarda hamilelik oranlarД±nД± artД±rdД±ДџД±nД± gГ¶sterdik. Ancak bu alt gruplarda gebelik oranlarД±ndaki artД±ЕџД± gГ¶steren yayД±n sayД±sД± henГјz yetersizdir.

    Tüp bebek ile ilgilenen bütün bilim adamlarının görüşü, embryonun yerleşme oranını artırmanın en önemli şartı kaliteli embryo elde etmektir. Yerleşme potansiyeli olmayan bir embryonun herhangi bir madde ile rahim içine yerleşmesini sağlamak mümkün değildir.

    GГјnГјmГјzde Amerikan Hastanesi TГјp bebek Гјnitesinde embryo glue 35 yaЕџ ГјstГј, embryo kalitesi dГјЕџГјk ve daha Г¶nceden tГјp bebek denemesinde baЕџarД±sД±z olmuЕџ kadД±nlarda kullanД±lmaktadД±r.

    Embryo gelişimi laboratuvar ortamında, vücut içi gelişime göre daha yavaş olmaktadır. Bunun sebebinin okside edici stress kaynaklarının olduğu düşünülmektedir. Bu okside edici stress kaynakları yüksek oksijen basıncı, ışık ve kültür ortamında kullanılan maddelerdir. Bu nedenle bilinen antioksidan maddelerin embryoların laboratuvar ortamında gelişimine etkisi konusunda bir çok çalışma yapılmıştır. Ancak bu konularda bir fikir birliği oluşmamıştır. Antioksidan tedavisinin erkek kısırlığında etkili olabileceğini bildiren yayınlar mevcuttur. Özellikle sigara kullanan erkeklerde C vitamiminin kullanımının sperm kalitesini artırdığı gösterilmiştir.

    Aynı şekilde A ve E vitaminleri üzerinde de bir çok çalışma vardır. Ancak antioksidan tedavisi güvenli dozların aşılması durumunda aksine zararlı olmaktadır. A vitamininin yüksek dozda alınması bebekte ürogenital ve kas sistemini ilgilendiren sakatlıklara yol açabilir. Aynı şekilde yüksek doz C vitamini kadında yumurtlamayı bloke edebilmektedir.

    Antioksidanların kullanımının gebelik sonuçları ve infertilite üzerindeki etkileri günümüzde henüz net olarak ortaya konulamamıştır.

    Embryo transferi sonrasД±nda destekleyici tedavi zamanlamasД±

    Tüp bebek tedavilerinde yumurtaların vücut dışına alınma işleminin yumurtalıklarda yarattığı hasar ve kullanılan ilaçların beyin-yumurtalık arasındaki ilişkiyi bozması nedeniyle hamilelik için gerekli olan progesteron hormonu yeterince salgılanamaz. Bu nedenle bu hormon enjeksiyon, vajinal veya ağız yoluyla verilir. Tedaviye başlama ve bitirme zamanı, tedavinin veriliş yolu ve dozu konusunda bir görüş birliği yoktur. Görüş birliği olmayan bir diğer konuda hamilelik oluşması durumunda tedavinin ne kadar süreyle devam edeceği konusundadır. Bu tedavinin hamilelik tespit edildikten sonra devam edilmesinin düşük oranlarını azalttığına dair herhangi bir kanıt yoktur. Ancak günümüzde bir çok tüp bebek merkezi bu tedaviyi plasentanın oluşumuna kadar, yani 12. Haftaya kadar sürdürmektedir.

    Tedavinin kullanım şekli üzerinde yapılan çalışmalar en etkili yöntemin enjeksiyon yoluyla (progesteron ampul) yapılan tedaviler olduğunu gösterse de bu tedavi şeklinin kullanımındaki zorluklar nedeniyle bir çok tüp bebek merkezi vajinal uygulamaları (Crinon jel, progestan tablet) tercih etmektedir. Son zamanlarda yapılan bir çok çalışmada ilacın vajinal yoldan verilmesinin enjeksiyonla verilmesi kadar etkili olduğunu da göstermektedir.

    Rahim iГ§i dokusunun (endometrium) kalД±nlaЕџmasД±nД±n rahime gelen kan akД±mД±na baДџlД± olduДџu ve bunun tГјp bebek tedavisi baЕџarД±sД± Гјzerindeki etkisi net olarak bilinmektedir. Viagra vГјcutta bulunan ve damarlarД±n geniЕџlemesini saДџlayan nitrik oksitin etki sГјresini uzatД±r.Bundan dolayД± Viagra’nД±n rahim iГ§i kalД±nlaЕџmasД±nД±n yetersiz olduДџu durumlarda kullanД±mД±nД±n baЕџarД± oranД±nД± artД±rabileceДџi bildirilmektedir.

    Diğer yandan rahim içi kalınlaşmasını engelleyen en önemli faktörün rahim içindeki geçirilmiş müdahale veya enfeksiyonlara bağlı olarak ortaya çıkan rahim içi yapışıklıkları olduğunu da unutmamak gerekir. O nedenle Viagra kullanımı öncesi rahim içinde yapışıklık olmadığı histeroskopi ile gösterilmelidir. Bu konuda yapılan çalışmalar henüz yeterli olmasa da rahim içi dokunun kalınlaşmadığı durumlarda Viagra kullanımının faydalı olduğunu söyleyebiliriz.

    Magnetik sperm seçimi (sperm mıknatısı)

    Sperm sayısının az olması (oligospermi), hareket kapasitelerinin düşük olması (astenospermi) ve morfolojik bozukluklar (teratospermi) erkek kısırlığında rol oynayan önemli parametrelerdir. Son yıllarda yapılan çalışmalar bu spermlerde normal mikroskoplarla tespit edilemeyen başka bozuklukların da olduğunu göstermiştir.

    Sperm faktörü olan durumlarda bu nedenlerle hamilelik oranlarının azaldığı öne sürülmektedir. Bu spermlerde apoptozis (hücrenin programlı ölümü) oranlarının arttığı bildirilmiştir. Sperm parametrelerini bozan genetik, ısı, kimyasal maddeler gibi etkenler aynı zamanda apoptozis oranını da artırmaktadır.

    Apoptotik sperm hücrelerini mikroenjeksiyonda kullanmamak için Magnetic Activated Cell Sorter (MACS) denen bir teknoloji kullanılmaktadır. Bu teknik mikroenjeksiyon uygulanacak erkek kısırlığı durumlarında ümit verici olsa da bu konuda kesin görüş bildirmemizi sağlayacak yeterli çalışma yoktur.

    TГјp bebek tedavisinde kullanД±lan tartД±ЕџmalД± tekniklerden birisi de kГјltГјr ortamД±nda insan embriyolarД±nД±n geliЕџimini desteklemek Гјzere “besleyici hГјcreler”in (farklД± tГјrdeki hayvanlardan farklД± hГјcre tipleri) kullanД±mД±dД±r. Teoride, bu ko-kГјltГјrler (besleyici katmanlar), kГјltГјr ortamД±nД± farklД± bileЕџenler ekleyerek veya iГ§erisinden alarak desteklemektedirler. Bu bileЕџenler tam olarak tanД±mlanmamД±Еџ olup, embriyo geliЕџimi iГ§in Г¶nemli olan artД±klar veya besinler iГ§erebilir.

    KullanД±lan “besleyici hГјcrelerin” normal hД±zda sayД±ca artmasД±na (kendi sayД±larД±nД± artД±rmak Гјzere Гјremelerine) izin verilmez, çünkГј bu durumda iГ§inde bulunduklarД± ortamД±n besinini tГјketmeleri veya ortamД± asitleЕџtirmeleri sГ¶z konusu olabilir. Bu nedenle, uygun hГјcre sayД±sД±na ulaЕџtД±klarД±nda radyasyon veya benzeri tekniklerle Гјremeleri engellenir.

    Kullanılan hücrelerin türleri laboratuvardan laboratuvara değişmektedir. Ko-kültür literatüründe çok farklı tipte havyan ve doku türleri gözle görülür bir başarıyla kullanılmıştır. Farklı türlerden hücreler kullanılmış olmakla beraber, bazı tüp bebek merkezleri, farklı hücrelerin ortama zararlı virüsler veya zehirler bulaştırabileceği görüşü ile yalnızca embriyonun biyolojik ebeveynlerinden birisine ait hücreleri kullanmaktadırlar. Belirlenen taze insan hücrelerinin kullanılabilmesi için tüp bebek merkezinde hücre kültürü konusunda uzmanlığa sahip bir biyoloğun bulunması şarttır.

    Ko-kültürlerin (besleyici hücrelerin) kullanımı ile embriyo kalitesinin arttırıldığı bazı yayınlarda raporlanmıştır. Literatürde bununla çelişen bilgiler ise embriyo kalitesinde veya hamilelik oranlarında herhangi bir artış olmadığını göstermektedir. Genel olarak Ko-kültür kullanımının IVF başarı oranlarını yükselttiği yolunda bir ifade şu an için ispatlanmış değildir. (2002). Bu nedenle bu teknik uzun yıllardır bilinmesine rağmen dünya üzerinde çok az klinik tarafından kullanılmaktadır.

    Гњlkemizde ise ko-kГјltГјr tekniДџi “yapay rahim” gibi aldatД±cД± bir isimle daha Г§ok ticari amaГ§la kullanД±lmaktadД±r. Bilimsel olarak faydasД± ispatlanmamД±Еџ bu teknik daha Г¶nce baЕџarД±sД±z denemeleri olan Г§iftlere mucize ve Г§ok ileri bir teknik olarak sunulmaktadД±r. Pek Г§ok Г¶nemli tГјpbebek merkezi bu tekniДџi kullanmamalarД±na karЕџД±n yГјksek baЕџarД± oranlarД±na sahiptirler. Bu nedenle genel olarak; zaten Г§ok baЕџarД±lД± olan tГјpbebek laboratuvarlarД±nД±n baЕџarД±sД±nД±n bu uygulamadan etkilenmediДџi ama koЕџullarД± yeterli olmayan laboratuvarlar iГ§in bu uygulamanД±n kГјltГјr ЕџartlarД±nД± geliЕџtirebileceДџi dГјЕџГјnГјlmektedir.

    Lenfosit aЕџД±sД± yapД±lmasД±

    Bu yöntemde babadan alınan kan içinden ayrılan lenfosit hücreleri annede cilt altına verilerek bağışıklık sistemi değiştirilmeye çalışılmaktadır. Tekrarlayan gebelik kayıpları olan çiftlerde önerilmiş ancak bu grupta dahi etkinliği kanıtlanmamış bir tedavi yöntemidir (Ober 1999).

    Tüp bebek başarısızlıkları olan çiftlerle ilgili tek bir çalışma yayınlanmış ve bu çalışmada sonuçların aşılamayı takip eden ilk 6 ay içinde tüp bebek yaptıran olgularda yükseldiği gösterilmiştir (Kling 2002). Ancak bu tedavinin de diğerleri gibi etkinliği iyi planlanmış çalışmalarda gösterilememiştir.

    Biz lenfosit aşısını hastaya maddi külfet getirmesinin yanı sıra hiçbir faydası olmadığından önermiyoruz.

    DHEA bГ¶brek ГјstГј bezinden salgД±lanan bir hormondur. Bu horman vГјcutta testosteron ve Г¶strojene dГ¶nГјЕџГјr. YumurtalД±klar Гјzerindeki etkisi tam olarak bilinmemektedir. DHEA’nД±n yumurtalД±k cevabД± zayД±f kadД±nlarda kullanД±lmasД±nД±n bu kadД±nlarda tГјp bebek tedavisi baЕџarД±sД±nД± artД±rdД±ДџД±nД± gГ¶steren bazД± Г§alД±Еџmalar vardД±r. Ancak bu iyimser sonuГ§lar sadece 3 bilim adamД±ndan ve iyi yapД±lmamД±Еџ klinik Г§alД±Еџmalardan gelmektedir. DolayД±sД±yla bu konuda gГ¶rГјЕџ bildirmek iГ§in daha fazla Г§alД±Еџmaya ihtiyaГ§ vardД±r.

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    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.

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    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).

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler’s educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

    For centuries, men have tried all sorts of natural remedies for erectile dysfunction (ED ) — the repeated inability to get or maintain an erection firm enough for sexual intercourse. But do they really work? It is simply not scientifically known at this point. Furthermore, you take these remedies at your own risk, because their safety profiles have not been established. What follows are commentaries by experts and reviews in the field of alternative treatments that are available over the counter for erectile dysfunction and impotence .

    Causes of erectile dysfunction (impotence)

    “Just because there is evidence doesn’t mean it’s good evidence,” says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil ). “And before men with ED start down the naturopathic route, it’s smart to make sure that there isn’t some underlying medical condition that needs to be corrected.” Moreover, it is estimated that 30 million American men have erectile dysfunction. and 70% of cases are a result of a potentially deadly condition like atherosclerosis. kidney disease. vascular disease. neurological disease, or diabetes. Additionally, ED can also be caused by certain medications, surgical injury, and psychological problems.

    Medically Reviewed by a Doctor on 6/29/2016

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    By Daily Mail Reporter 14:48 GMT 07 Apr 2009, updated 17:57 GMT 07 Apr 2009

    A Chinese ‘herbal Viagra’ sold throughout the UK contains dangerous levels of hidden pharmaceutical drugs, medicine chiefs warned today.

    Tests on the product, Jia Yi Jian, revealed huge doses of two drugs prescribed on the NHS for obesity and impotence.

    Sibutramine, marketed as Reductil, is an appetite suppressant while tadalafil, commonly known as Cialis, treats erectile dysfunction in a similar way to Viagra.

    The maximum dosages per tablet normally allowed for sibutramine is 15 milligrams and for tadalafil 20 milligrams.

    But the red and black capsules of Jia Yi Jian seized by the Medicines and Healthcare Regulatory Agency (MHRA) each contained 68.1 milligrams of sibutramine and 50.06 milligrams of tadalafil.

    The undeclared ingredients were deliberately put in the Chinese herbal medicine to con the public, says the MHRA.

    Related Articles

    The levels are said to be high enough to cause serious side effects, including heart and blood pressure problems. Adverse reactions could also occur with other prescription drugs, such as those used to treat blood pressure and heart disease, and some antidepressants.

    An MHRA spokeswoman said an investigation was on-going and could not give details about how and where the product was seized.

    She said Jia Yi Jian was sold both for weight loss and erectile dysfunction and widely available at stores selling traditional Chinese medicines.

    The product, manufactured by Hunan Aimin Pharmaceutical Ltd, based in Hengyang, Hunan Province, China, is advertised as 100 per cent herbal.

    ‘The pharmaceuticals are deliberately included to make it work,’ said the spokeswoman. ‘People think they are getting something completely herbal but it contains up to four times the dose of pharmaceuticals found in legally prescribed medicinal products.’

    The MHRA has its own intelligence and enforcement officers and the power to raid premises and seize products.

    Selling a herbal product containing unlicensed pharmaceutical medicines could result in a criminal prosecution.

    Richard Woodfield, MHRA Group Manager for Herbal Medicines, said people should consult their GP before taking any herbal medication, particularly for serious conditions.

    Anyone taking Jia Yi Jian was advised to stop immediately and seek health advice.

    ‘This product, adulterated with large and uncontrolled amounts of pharmaceutical substances, presents a clear risk to consumers,’ said Mr Woodfield.

    ‘There is continuing evidence that some so-called ‘herbal’ products on the UK and international markets are nothing of the kind.

    ‘Often, such marketing claims about the supposed natural ingredients in these unlicensed products are simply an attempt to divert the consumer’s attention away from very low manufacturing and ethical standards.

    ‘The MHRA has issued warnings previously about adulterated products supplied by some TCM (traditional Chinese medicine) outlets, but the problem is by no means limited to that sector.

    ‘The safest method to obtain medication is to see a health care professional and have a proper diagnosis, especially as sometimes conditions such as erectile dysfunction can be the symptom of something more serious.’

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    Viagra ‘added to Chinese alcohol’

    Image copyright AFP/Getty Images Image caption The powdered Viagra was added to a popular spirit, investigators say

    Distillers in China added Viagra to thousands of bottles of spirits and told customers it had “health-preserving qualities”, food safety officials say.

    More than 5,300 bottles of alcohol were seized by the investigators in the southern city of Liuzhou.

    They also found packets of a white powder called Sildenafil, better known as the anti-impotence drug Viagra.

    Police in the Guangxi region are now investigating the two distillers.

    The Liuzhou Food and Drug Administration said (in Chinese) that the powder was added to three different types of ‘baijiu’ – a strong, clear spirit that is the most popular drink in China.

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    Viagra Patent Expiration Date Extended to 2020

    Viagra Patent expiration no longer an issue for “the little blue pill”
    NO legal “generic Viagra” in U.S. for several more years

    U.S. men seeking a generic version of Viagra (sildenafil citrate) – the first and the most popular prescription drug for Erectile Dysfunction (ED) – are going to have to wait for a few more years. Viagra’s patent, originally scheduled to expire in late March of 2012, has been extended to April of 2020. That’s good news for the manufacturer, Pfizer, Inc. of course, but it’s also good news for patients suffering from Erectile Dysfunction.

    There has been a lot of informed speculation in recent years about what would happen when Viagra finally did become available in generic form. Acclaimed pharmaceutical industry observer and reporter Jim Edwards has written about that issue for this site (links are below). Several drug companies were poised to leap on the opportunities presented by the expired patent – most notably, Teva Pharmaceuticals, which gained tentative approval from the Food and Drug Administration (FDA) to market a generic version of Viagra.

    In March of 2010, however, Pfizer sued Teva for patent infringement, based on a second Pfizer patent which runs until 2019. This second patent is sometimes referred to as a “method-of-treatment patent.” Pfizer argued that even though sildenafil was to come up for grabs in 2012, Pfizer should retain exclusive rights to market it as an ED treatment until 2019. Pfizer ultimately prevailed against Teva in a 12-day bench trial held in the summer of 2011, and it was declared that the company’s Viagra patent would stand solid through 2019.

    Early in 2012, Pfizer was granted an additional six months of U.S. patent protection for Viagra, because the company is studying the effect of another one of its products containing Viagra’s active ingredient, sildenafil, in children with pulmonary hypertension. With this latest development, Pfizer’s patent for Viagra stands through April of 2020.

    Consequently, there is still no legal “generic Viagra” available in the United States – despite what some online advertisers claim – nor is there an over-the-counter (OTC) version of this drug yet. Prescription Viagra, the “little blue pill,” remains the only legal option for U.S. shoppers seeking the proven ingredient sildenafil as a treatment for Erectile Dysfunction. To purchase Viagra online from a safe online facilitator, click here.

    ED drugs: the state of the market today

    Had Viagra’s patent expired, the market would probably have been flooded with generic substitutes from numerous other manufacturers besides Teva, and prices most likely would have plummeted across the board, Edwards noted. Not only would there have been a price reduction on brand-name Viagra, but the prices of Viagra’s main competitors in the U.S. market – Bayer’s Levitra (vardenafil HCl) and LillyICOS’s Cialis (tadalafil) – would probably have dropped as well to remain competitive.

    Viagra, Cialis, Levitra, and Staxyn (another Bayer product similar to Levitra) are the only prescription ED drugs presently allowed in the U.S. by the FDA. All of these medications – Viagra, Cialis, and Levitra/Staxyn – work similarly by helping to increase blood flow to the penis. They are in a class of drugs known as PDE5 inhibitors. Currently Levitra’s patent is set to expire in 2018, and Cialis’ patents expire between 2017 and 2020.

    Since Viagra’s patent expiration is no longer an issue, the big question is how the patent extension will affect the marketplace. As indicated above, Pfizer doesn’t have a monopoly on prescription ED treatments in the U.S. and sales of Cialis, Cialis for Daily Use, Levitra, and Staxyn will continue to cut into Pfizer’s profits. However, as long as no generic equivalents of these PDE5 inhibitors are available, the pharmaceutical companies holding the patents will continue to dominate the market in the United States. This won’t keep competitors from continuing in their efforts to develop similar, though not identical, ED drugs.

    Be informed about Erectile Dysfunction (ED)

    Safety first: Patients benefit from Viagra patent extension

    It’s hardly surprising that Pfizer and other manufacturers of prescription ED medications are pleased about the extension of Pfizer’s patent for Viagra, as are some distributors and retailers. But where does this action leave patients? Prescription drugs can be expensive, and most people know that the lack of generic alternatives generally means patients must pay higher prices for their medications. Moreover, Pfizer has been raising its prices for Viagra steadily since the drug was first approved in 1998. Even so, there are several clear advantages for patients who choose brand-name medications.

    Generic drugs: a cautionary note

    Quality control is certainly an issue. With a brand-name drug such as Viagra from an established and strictly regulated manufacturer such as Pfizer, the quality is consistent from batch to batch, and the patient always knows exactly what he is getting.

    This is certainly not to imply that legal, reputable manufacturers of generic drugs don’t exercise quality control as well. They do. All prescription drug manufacturers must comply with FDA requirements in order to legally sell their products in the United States. They must demonstrate that their drugs are bioequivalent to the brand-name medication. However, bioequivalent does not mean completely identical. With generics, there may be variations from one manufacturer to another, and sometimes even from one batch of a given manufacturer’s generic product to another. Some makers of generics may use different manufacturing processes than the manufacturer of the brand name drug, or they may include additives that alter the effectiveness of the drug for some patients. It’s all perfectly legal, but with some drugs and some patients, even a small difference between a generic and a brand name can be pretty significant.

    Whether any of this will be a problem when and if Viagra becomes available as a generic in the U.S. remains to be seen, but it is a point worth considering. In any case, a patient who is taking a brand-name prescription medication should always consult with a doctor and/or reputable pharmacist before switching to a generic.

    Counterfeit drugs are even worse

    Legally manufactured and distributed generic drugs can be problematic for some patients, but a far worse problem is that of counterfeit drugs being churned out by illegal manufacturers and distributors whose shoddy products have depleted the pocketbooks, and compromised the health, of countless patients. Counterfeiting is a serious problem, but legal pharmaceutical manufacturers such as Pfizer have high-tech ways to address this issue. For example, Viagra as supplied by Pfizer comes packaged with an RFID chip, a high-frequency electronic “fingerprint” tag, a barcode, and labels printed in color-shift ink. Every bottle sold can be tracked.

    As for the pills themselves, cleverly counterfeited drugs may look like “the real thing,” but in many cases they may be deficient or completely lacking in the active ingredient of the brand-name drug. Many are manufactured in developing countries in unregulated factories, and may contain untested ingredients or toxins. Moreover – and this cannot be stressed enough – they are illegal. and even if they don’t pose health threats they are subject to seizure, and the purchasers may be subject to serious legal action as well. It’s really not worth the risk.

    Apropos of the latter point, some particularly devious drug counterfeiters have found creative new ways to compound their harm to consumers. As reported in April 2012 by ABC-News’ Nightline. some patients purchasing medications from questionable online sources have subsequently been contacted by individuals impersonating Drug Enforcement Agency (DEA) officers. Typically, the phony DEA agent will threaten to arrest the hapless consumer for buying illegal drugs unless the victim pays thousands of dollars to make the problem go away. Some people have wiped out their bank accounts in a desperate attempt to stay out of trouble, and at least one woman was so distressed that she committed suicide, according to the Nightline story.

    In short, there are a lot of very bad players out there, and they will continue to come up with new ways to part consumers from their money.

    Weighing the true cost

    There’s no denying that brand-name products are generally more expensive than generics or store brands. This is true not only of prescription medications but also of over-the-counter drugs, personal care products, food products, and many other consumer goods. Sometimes, of course, generic substitutes are perfectly acceptable. For instance, there may be little difference between a store-brand body lotion and a brand-name equivalent, and even if there is a difference in fragrance or texture, it’s usually not a health-critical issue. However, when a patient’s health is on the line, as it is with prescription drugs, it may be wise to remember the saying, “You get what you pay for.”

    Again, this doesn’t mean that all generics are “bad,” and many insurance or managed-care plans require that a generic substitute be used when available, in order to keep costs down. Sometimes, however, keeping costs down is not necessarily to the benefit of the patient.

    For those who wonder why prescription drugs are so expensive, it’s not solely because of marketing costs, as some critics claim. An enormous amount of expensive and time-consuming research goes into developing a drug and getting it to market. Much of this expenditure is for the protection of the consumer.

    The long and winding road to the marketplace

    For a drug – or a medical device or instrument, for that matter – to be legally sold and used in the U.S. it must undergo a rigorous testing and approval process. Research and clinical trials are conducted all over the world, and other countries have their own approval processes, as well as government agencies that are roughly equivalent to the FDA. But our focus here is on the United States.

    At any given time, hundreds of drugs are being researched and tested, but most never make it past the preliminary research stages. Research is a very involved, step-by-step undertaking designed to ensure maximum safety and accurate results. It begins with pre-clinical trials, which often involve animal testing for toxicity and other basic issues. Researchers must do everything possible to ensure that the drug they are exploring is reasonably safe to begin testing on humans. It is only after basic safety issues are satisfied that clinical trials can proceed.

    Clinical trials are those involving human volunteers, and they are generally performed in several phases. Phase 0 trials are used to provide early assessment about whether a certain type of drug or treatment is safe and beneficial to human participants. Phases I through III generally involve a progressively increasing number of study subjects, with a progressively more detailed exploration of the drug’s effectiveness (and possible side effects), compared to a placebo. If a product successfully passes through Phase III it will usually be approved by the FDA. But manufacturers are ever vigilant and continue to monitor their products even after approval. That’s where Phase IV trials come in; they involve long-term surveillance of a drug even after it has been approved and is in general use.

    Sometimes clinical trials can last for many years, and sometimes drugs are put on a “fast track” to approval. Either way, study results must be meticulously documented, and the data must be submitted to the FDA as part of the long and involved approval process. The FDA’s own site has an article about that if you are interested

    The system is not perfect. Sometimes researchers, being human, make mistakes or don’t accurately report test results. Sometimes a drug that passes all of the earlier clinical trials is approved for the market, and later turns out to have unwanted long-term effects. But the important point is that there is a system, one with very well established protocols and regulations, so if a researcher or drug company messes up somewhere along the way, either intentionally or unintentionally, there is accountability. The same simply cannot be said of the illegal imports discussed above. Nor can it even be said about most of the legal but unregulated remedies and supplements and treatments on the market, many of which are ineffective at best, harmful at worst, and sometimes as pricey as some prescription drugs.

    This doesn’t mean that all non-prescription or “natural” treatments for Erectile Dysfunction are harmful or completely ineffective; there are a few that have shown promise in some studies (see sidebar). However, to avoid unwanted side effects or interactions, patients should still inform their health care practitioners of everything they are taking.

    Sticking with “the real deal”

    Even the most informed speculation is just that: speculation. No doubt much will happen between now and 2020 when the Viagra patent finally expires. Researchers are currently working to find safer, more effective alternatives for treatment of ED; drugs with different modes of action than the popular PDE5 inhibitors are in various stages of research and development. And in keeping with a growing trend in medical R&D, future ED treatments may be more individualized than the current one-size-fits-most therapies.

    There is also the possibility that eventually one or more of the manufacturers of existing ED medications may apply for over-the-counter status for these drugs. At one point during the speculation over the patent-expiration issue, Pfizer had declared that because of considerations about potential side effects, the company would not be applying for OTC status for Viagra. But that could change in the future.

    Meanwhile, many people will continue to seek cheaper or more “natural” substitutes that are easily available to anyone who has a valid credit card, but – and it can’t be repeated often enough – caveat emptor .

    While the world waits for the next generation of ED drugs, men whose doctors have determined that sildenafil citrate is the best option to treat their ED can continue to rely on the famous little blue pill, Viagra. Sticking with the original prescription ED medication has turned out to be a good choice for millions of men with Erectile Dysfunction. Of course it is also important to obtain medications through a reliable source – either a reputable brick-and-mortar pharmacy or a trustworthy online supplier, such as AccessRX.com .

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