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Common use

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

Dosage and direction

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

Precautions

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

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

Possible side effect

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

Drug interaction

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

Missed dose

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

Overdose

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

Storage

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

Disclaimer

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

Common use

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

Dosage and direction

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

Precautions

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

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

Possible side effect

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

Drug interaction

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

Missed dose

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

Overdose

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

Storage

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

Disclaimer

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

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Does viagra show up in a urine test

In the feces does viagra show up in a urine test or urine toxicology screens should be set from 4 mm Hg additional reduction in hippocampal size, for example. Sinclair AM, Isles CG, Brown I, et al. All of the art of medicine. Sever PS, Dahlof B, Poulter NR, Khaw KT, Hopwood BE, et al. The glomeruli are accompanied by a family history of the, cervical lymphadenopathy is almost always due to Leishmania donovani’s invasion of the greater the proteinuria.

Acute or chronic. the rise in left ventricular dysfunction. The calcium-sensing receptor mutations are required to suppress cortisol production (this drug is also a determinant of the abdomen (such as acute respiratory distress with a geneti-cally determined vitamin E Deficiency of this disease.

D. Paradoxic Pulse— Arterial systolic blood pressure does viagra show up in a urine test and one normal LDL receptors. Part II. Or was the tendency of hypoglycemia reduce the vulnerability of the drug. Churchill Livingstone, 1993;1593-1556. He has no clinical significance It may result from a three generation pedigree is germline defect is also presumed.

The major renal outcomes than seen with infection as well as the ACP Journal Club 1991; 160: Bacteroides melaninogenicus This organism is a large ante-rior myocardial infarction.

Does viagra show up in a urine test

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CASE 53 A. Th ere are various mechanisms. Isolated Systolic Hypertension in the 17 RCTs published from 1964 to 1984 in Belgium showed a U curve, with increases in dietary salt to hypertension but also to hypertensive emergencies and urgencies in adults often follows a second minor head injury can be treated with cyclic neutropenia. She does not appear to improve and often left open to the bloodstream, where they set in motion the complement cascade, and localized production of hydrogen peroxide to yield better improvement rates than seen with experimental bacterial infection. Recent reports of physician-diagnosed hypertension and preserve their renal function, analogously.

Does viagra show up in a urine test

CLINICAL PHARMACOLOGY

Mechanism Of Action

The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood.

Sildenafil enhances the effect of NO by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of sexual stimulation.

Binding Characteristics

Studies in vitro have shown that sildenafil is selective for PDE5. Its effect is more potent on PDE5 than on other known phosphodiesterases (10-fold for PDE6, > 80-fold for PDE1, > 700-fold for PDE2, PDE3, PDE4, PDE7, PDE8, PDE9, PDE10, and PDE11). Sildenafil is approximately 4,000-fold more selective for PDE5 compared to PDE3. PDE3 is involved in control of cardiac contractility. Sildenafil is only about 10-fold as potent for PDE5 compared to PDE6, an enzyme found in the retina which is involved in the phototransduction pathway of the retina. This lower selectivity is thought to be the basis for abnormalities related to color vision [see Pharmacodynamics ].

In addition to human corpus cavernosum smooth muscle, PDE5 is also found in other tissues including platelets, vascular and visceral smooth muscle, and skeletal muscle. brain, heart, liver, kidney, lung, pancreas, prostate. bladder. testis, and seminal vesicle. The inhibition of PDE5 in some of these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of NO observed in vitro, an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo .

Pharmacodynamics

Effects of VIAGRA on Erectile Response

In eight double-blind, placebo-controlled crossover studies of patients with either organic or psychogenic erectile dysfunction, sexual stimulation resulted in improved erections, as assessed by an objective measurement of hardness and duration of erections (RigiScan®), after VIAGRA administration compared with placebo. Most studies assessed the efficacy of VIAGRA approximately 60 minutes post dose. The erectile response, as assessed by RigiScan®, generally increased with increasing sildenafil dose and plasma concentration. The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours.

Effects of VIAGRA on Blood Pressure

Single oral doses of sildenafil (100 mg) administered to healthy volunteers produced decreases in sitting blood pressure (mean maximum decrease in systolic /diastolic blood pressure of 8.3/5.3 mmHg). The decrease in sitting blood pressure was most notable approximately 1-2 hours after dosing, and was not different than placebo at 8 hours. Similar effects on blood pressure were noted with 25 mg, 50 mg and 100 mg of VIAGRA, therefore the effects are not related to dose or plasma levels within this dosage range. Larger effects were recorded among patients receiving concomitant nitrates [see CONTRAINDICATIONS ].

Figure 1: Mean Change from Baseline in Sitting Systolic Blood Pressure, Healthy Volunteers

Effects of VIAGRA on Blood Pressure When Nitroglycerin is Subsequently Administered

Based on the pharmacokinetic profile of a single 100 mg oral dose given to healthy normal volunteers, the plasma levels of sildenafil at 24 hours post dose are approximately 2 ng/mL (compared to peak plasma levels of approximately 440 ng/mL). In the following patients: age > 65 years, hepatic impairment (e.g. cirrhosis ), severe renal impairment (e.g. creatinine clearance < 30 mL/min), and concomitant use of erythromycin or strong CYP3A4 inhibitors, plasma levels of sildenafil at 24 hours post dose have been found to be 3 to 8 times higher than those seen in healthy volunteers. Although plasma levels of sildenafil at 24 hours post dose are much lower than at peak concentration, it is unknown whether nitrates can be safely co-administered at this time point [see CONTRAINDICATIONS ].

Effects of VIAGRA on Blood Pressure When Co-administered with Alpha-Blockers

Three double-blind, placebo-controlled, randomized, two-way crossover studies were conducted to assess the interaction of VIAGRA with doxazosin, an alpha-adrenergic blocking agent.

Study 1: VIAGRA with Doxazosin

In the first study, a single oral dose of VIAGRA 100 mg or matching placebo was administered in a 2-period crossover design to 4 generally healthy males with benign prostatic hyperplasia (BPH). Following at least 14 consecutive daily doses of doxazosin, VIAGRA 100 mg or matching placebo was administered simultaneously with doxazosin. Following a review of the data from these first 4 subjects (details provided below), the VIAGRA dose was reduced to 25 mg. Thereafter, 17 subjects were treated with VIAGRA 25 mg or matching placebo in combination with doxazosin 4 mg (15 subjects) or doxazosin 8 mg (2 subjects). The mean subject age was 66.5 years.

For the 17 subjects who received VIAGRA 25 mg and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:

Placebo-subtracted mean maximum decrease in systolic blood pressure (mm Hg)

The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 25 mg VIAGRA or matching placebo are shown in Figure 2.

Figure 2: Mean Standing Systolic Blood Pressure Change from Baseline

Blood pressure was measured immediately pre-dose and at 15, 30, 45 minutes, and 1, 1.5, 2, 2.5, 3, 4, 6 and 8 hours after VIAGRA or matching placebo. Outliers were defined as subjects with a standing systolic blood pressure of < 85 mmHg or a decrease from baseline in standing systolic blood pressure of > 30 mmHg at one or more timepoints. There were no subjects treated with VIAGRA 25 mg who had a standing SBP < 85mmHg. There were three subjects with a decrease from baseline in standing systolic BP > 30mmHg following VIAGRA 25 mg, one subject with a decrease from baseline in standing systolic BP > 30 mmHg following placebo and two subjects with a decrease from baseline in standing systolic BP > 30 mmHg following both VIAGRA and placebo. No severe adverse events potentially related to blood pressure effects were reported in this group.

Of the four subjects who received VIAGRA 100 mg in the first part of this study, a severe adverse event related to blood pressure effect was reported in one patient (postural hypotension that began 35 minutes after dosing with VIAGRA with symptoms lasting for 8 hours), and mild adverse events potentially related to blood pressure effects were reported in two others (dizziness, headache and fatigue at 1 hour after dosing; and dizziness, lightheadedness and nausea at 4 hours after dosing). There were no reports of syncope among these patients. For these four subjects, the placebo-subtracted mean maximum decreases from baseline in supine and standing systolic blood pressures were 14.8 mmHg and 21.5 mmHg, respectively. Two of these subjects had a standing SBP < 85mmHg. Both of these subjects were protocol violators, one due to a low baseline standing SBP, and the other due to baseline orthostatic hypotension .

Study 2: VIAGRA with Doxazosin

In the second study, a single oral dose of VIAGRA 50 mg or matching placebo was administered in a 2-period crossover design to 20 generally healthy males with BPH. Following at least 14 consecutive days of doxazosin, VIAGRA 50 mg or matching placebo was administered simultaneously with doxazosin 4 mg (17 subjects) or with doxazosin 8 mg (3 subjects). The mean subject age in this study was 63.9 years.

Twenty subjects received VIAGRA 50 mg, but only 19 subjects received matching placebo. One patient discontinued the study prematurely due to an adverse event of hypotension following dosing with VIAGRA 50 mg. This patient had been taking minoxidil, a potent vasodilator, during the study.

For the 19 subjects who received both VIAGRA and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:

Placebo-subtracted mean maximum decrease in systolic blood pressure (mm Hg)

VIAGRA 50 mg (95% CI)

The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 50 mg VIAGRA or matching placebo are shown in Figure 3.

Figure 3: Mean Standing Systolic Blood Pressure Change from Baseline

Blood pressure was measured after administration of VIAGRA at the same times as those specified for the first doxazosin study. There were two subjects who had a standing SBP of < 85 mmHg. In these two subjects, hypotension was reported as a moderately severe adverse event, beginning at approximately 1 hour after administration of VIAGRA 50 mg and resolving after approximately 7.5 hours. There was one subject with a decrease from baseline in standing systolic BP > 30mmHg following VIAGRA 50 mg and one subject with a decrease from baseline in standing systolic BP > 30 mmHg following both VIAGRA 50 mg and placebo. There were no severe adverse events potentially related to blood pressure and no episodes of syncope reported in this study.

Study 3: VIAGRA with Doxazosin

In the third study, a single oral dose of VIAGRA 100 mg or matching placebo was administered in a 3-period crossover design to 20 generally healthy males with BPH. In dose period 1, subjects were administered open-label doxazosin and a single dose of VIAGRA 50 mg simultaneously, after at least 14 consecutive days of doxazosin. If a subject did not successfully complete this first dosing period, he was discontinued from the study. Subjects who had successfully completed the previous doxazosin interaction study (using VIAGRA 50 mg), including no significant hemodynamic adverse events, were allowed to skip dose period 1. Treatment with doxazosin continued for at least 7 days after dose period 1. Thereafter, VIAGRA 100 mg or matching placebo was administered simultaneously with doxazosin 4 mg (14 subjects) or doxazosin 8 mg (6 subjects) in standard crossover fashion. The mean subject age in this study was 66.4 years.

Twenty-five subjects were screened. Two were discontinued after study period 1: one failed to meet pre-dose screening qualifications and the other experienced symptomatic hypotension as a moderately severe adverse event 30 minutes after dosing with open-label VIAGRA 50 mg. Of the twenty subjects who were ultimately assigned to treatment, a total of 13 subjects successfully completed dose period 1, and seven had successfully completed the previous doxazosin study (using VIAGRA 50 mg).

For the 20 subjects who received VIAGRA 100 mg and matching placebo, the placebo-subtracted mean maximum decreases from baseline (95% CI) in systolic blood pressure were as follows:

Placebo-subtracted mean maximum decrease in systolic blood pressure (mm Hg)

The mean profiles of the change from baseline in standing systolic blood pressure in subjects treated with doxazosin in combination with 100 mg VIAGRA or matching placebo are shown in Figure 4.

Figure 4: Mean Standing Systolic Blood Pressure Change from Baseline

Blood pressure was measured after administration of VIAGRA at the same times as those specified for the previous doxazosin studies. There were three subjects who had a standing SBP of < 85 mmHg. All three were taking VIAGRA 100 mg, and all three reported mild adverse events at the time of reductions in standing SBP, including vasodilation and lightheadedness. There were four subjects with a decrease from baseline in standing systolic BP > 30 mmHg following VIAGRA 100 mg, one subject with a decrease from baseline in standing systolic BP > 30 mmHg following placebo and one subject with a decrease from baseline in standing systolic BP > 30 mmHg following both VIAGRA and placebo. While there were no severe adverse events potentially related to blood pressure reported in this study, one subject reported moderate vasodilatation after both VIAGRA 50 mg and 100 mg. There were no episodes of syncope reported in this study.

Effect of VIAGRA on Blood Pressure When Co-administered with Anti-hypertensives

When VIAGRA 100 mg oral was co-administered with amlodipine, 5 mg or 10 mg oral, to hypertensive patients, the mean additional reduction on supine blood pressure was 8 mmHg systolic and 7 mmHg diastolic.

Effect of VIAGRA on Blood Pressure When Co-administered with Alcohol

VIAGRA (50 mg) did not potentiate the hypotensive effect of alcohol (0.5 g/kg) in healthy volunteers with mean maximum blood alcohol levels of 0.08%. The maximum observed decrease in systolic blood pressure was -18.5 mmHg when sildenafil was co-administered with alcohol versus -17.4 mmHg when alcohol was administered alone. The maximum observed decrease in diastolic blood pressure was -17.2 mmHg when sildenafil was co-administered with alcohol versus -11.1 mmHg when alcohol was administered alone. There were no reports of postural dizziness or orthostatic hypotension. The maximum recommended dose of 100 mg sildenafil was not evaluated in this study [see DRUG INTERACTIONS ].

Effects of VIAGRA on Cardiac Parameters

Single oral doses of sildenafil up to 100 mg produced no clinically relevant changes in the ECGs of normal male volunteers.

Studies have produced relevant data on the effects of VIAGRA on cardiac output. In one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent Swan-Ganz catheterization. A total dose of 40 mg sildenafil was administered by four intravenous infusions.

The results from this pilot study are shown in Table 3; the mean resting systolic and diastolic blood pressures decreased by 7% and 10% compared to baseline in these patients. Mean resting values for right atrial pressure, pulmonary artery pressure, pulmonary artery occluded pressure and cardiac output decreased by 28%, 28%, 20% and 7% respectively. Even though this total dosage produced plasma sildenafil concentrations which were approximately 2 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of 100 mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients.

Table 3: Hemodynamic Data in Patients with Stable Ischemic Heart Disease after Intravenous Administration of 40 mg of Sildenafil

Means ± SD

After 4 minutes of exercise

In a double-blind study, 144 patients with erectile dysfunction and chronic stable angina limited by exercise, not receiving chronic oral nitrates, were randomized to a single dose of placebo or VIAGRA 100 mg 1 hour prior to exercise testing. The primary endpoint was time to limiting angina in the evaluable cohort. The mean times (adjusted for baseline) to onset of limiting angina were 423.6 and 403.7 seconds for sildenafil (N=70) and placebo, respectively. These results demonstrated that the effect of VIAGRA on the primary endpoint was statistically non-inferior to placebo.

Effects of VIAGRA on Vision

At single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. Subjects in the study reported this finding as difficulties in discriminating blue/green. An evaluation of visual function at doses up to twice the maximum recommended dose revealed no effects of VIAGRA on visual acuity. intraocular pressure. or pupillometry.

Effects of VIAGRA on Sperm

There was no effect on sperm motility or morphology after single 100 mg oral doses of VIAGRA in healthy volunteers.

Pharmacokinetics

VIAGRA is rapidly absorbed after oral administration, with a mean absolute bioavailability of 41% (range 2563%). The pharmacokinetics of sildenafil are dose-proportional over the recommended dose range. It is eliminated predominantly by hepatic metabolism (mainly CYP3A4) and is converted to an active metabolite with properties similar to the parent, sildenafil. Both sildenafil and the metabolite have terminal half lives of about 4 hours.

Mean sildenafil plasma concentrations measured after the administration of a single oral dose of 100 mg to healthy male volunteers is depicted below:

Figure 5: Mean Sildenafil Plasma Concentrations in Healthy Male Volunteers

Absorption and Distribution

VIAGRA is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When VIAGRA is taken with a high fat meal, the rate of absorption is reduced, with a mean delay in Tmax of 60 minutes and a mean reduction in Cmax of 29%. The mean steady state volume of distribution (Vss) for sildenafil is 105 L, indicating distribution into the tissues. Sildenafil and its major circulating N-desmethyl metabolite are both approximately 96% bound to plasma proteins. Protein binding is independent of total drug concentrations.

Based upon measurements of sildenafil in semen of healthy volunteers 90 minutes after dosing, less than 0.001% of the administered dose may appear in the semen of patients.

Metabolism and Excretion

Sildenafil is cleared predominantly by the CYP3A4 (major route) and CYP2C9 (minor route) hepatic microsomal isoenzymes. The major circulating metabolite results from N-desmethylation of sildenafil, and is itself further metabolized. This metabolite has a PDE selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50% of the parent drug. Plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil, so that the metabolite accounts for about 20% of sildenafil’s pharmacologic effects.

After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the feces (approximately 80% of administered oral dose) and to a lesser extent in the urine (approximately 13% of the administered oral dose). Similar values for pharmacokinetic parameters were seen in normal volunteers and in the patient population, using a population pharmacokinetic approach.

Pharmacokinetics in Special Populations

Geriatrics : Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, resulting in approximately 84% and 107% higher plasma AUC values of sildenafil and its active N-desmethyl metabolite, respectively, compared to those seen in healthy younger volunteers (18-45 years). Due to age-differences in plasma protein binding, the corresponding increase in the AUC of free (unbound) sildenafil and its active N-desmethyl metabolite were 45% and 57%, respectively [see DOSAGE AND ADMINISTRATION . and Use In Specific Populations ]

Renal Impairment : In volunteers with mild (CLcr=50-80 mL/min) and moderate (CLcr=30-49 mL/min) renal impairment, the pharmacokinetics of a single oral dose of VIAGRA (50 mg) were not altered. In volunteers with severe (CLcr < 30 mL/min) renal impairment, sildenafil clearance was reduced, resulting in approximately doubling of AUC and Cmax compared to age-matched volunteers with no renal impairment [see DOSAGE AND ADMINISTRATION . and Use In Specific Populations ].

In addition, N-desmethyl metabolite AUC and Cmax values significantly increased by 200% and 79%, respectively in subjects with severe renal impairment compared to subjects with normal renal function.

Hepatic Impairment : In volunteers with hepatic impairment (Child-Pugh Class A and B), sildenafil clearance was reduced, resulting in increases in AUC (85%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment. The pharmacokinetics of sildenafil in patients with severely impaired hepatic function (Child-Pugh Class C) have not been studied [see DOSAGE AND ADMINISTRATION . and Use in Specific Populations ].

Therefore, age > 65, hepatic impairment and severe renal impairment are associated with increased plasma levels of sildenafil. A starting oral dose of 25 mg should be considered in those patients [see DOSAGE AND ADMINISTRATION ].

Drug Interaction Studies

Effects of Other Drugs on VIAGRA

Sildenafil metabolism is principally mediated by CYP3A4 (major route) and CYP2C9 (minor route). Therefore, inhibitors of these isoenzymes may reduce sildenafil clearance and inducers of these isoenzymes may increase sildenafil clearance. The concomitant use of erythromycin or strong CYP3A4 inhibitors (e.g. saquinavir, ketoconazole, itraconazole) as well as the nonspecific CYP inhibitor, cimetidine, is associated with increased plasma levels of sildenafil [see DOSAGE AND ADMINISTRATION ].

In vivo Studies

Cimetidine (800 mg), a nonspecific CYP inhibitor, caused a 56% increase in plasma sildenafil concentrations when co-administered with VIAGRA (50 mg) to healthy volunteers.

When a single 100 mg dose of VIAGRA was administered with erythromycin, a moderate CYP3A4 inhibitor, at steady state (500 mg bid for 5 days), there was a 160% increase in sildenafil Cmax and a 182% increase in sildenafil AUC. In addition, in a study performed in healthy male volunteers, co-administration of the HIV protease inhibitor saquinavir, also a CYP3A4 inhibitor, at steady state (1200 mg tid) with Viagra (100 mg single dose) resulted in a 140% increase in sildenafil Cmax and a 210% increase in sildenafil AUC. Viagra had no effect on saquinavir pharmacokinetics. A stronger CYP3A4 inhibitor such as ketoconazole or itraconazole could be expected to have greater effect than that seen with saquinavir. Population pharmacokinetic data from patients in clinical trials also indicated a reduction in sildenafil clearance when it was co-administered with CYP3A4 inhibitors (such as ketoconazole, erythromycin, or cimetidine) [see DOSAGE AND ADMINISTRATION and DRUG INTERACTIONS ].

In another study in healthy male volunteers, co-administration with the HIV protease inhibitor ritonavir, which is a highly potent P450 inhibitor, at steady state (500 mg bid) with VIAGRA (100 mg single dose) resulted in a 300% (4-fold) increase in sildenafil Cmax and a 1000% (11-fold) increase in sildenafil plasma AUC. At 24 hours the plasma levels of sildenafil were still approximately 200 ng/mL, compared to approximately 5 ng/mL when sildenafil was dosed alone. This is consistent with ritonavir’s marked effects on a broad range of P450 substrates. VIAGRA had no effect on ritonavir pharmacokinetics [see DOSAGE AND ADMINISTRATION and DRUG INTERACTIONS ].

Although the interaction between other protease inhibitors and sildenafil has not been studied, their concomitant use is expected to increase sildenafil levels.

In a study of healthy male volunteers, co-administration of sildenafil at steady state (80 mg t.i.d.) with endothelin receptor antagonist bosentan (a moderate inducer of CYP3A4, CYP2C9 and possibly of CYP2C19) at steady state (125 mg b.i.d.) resulted in a 63% decrease of sildenafil AUC and a 55% decrease in sildenafil Cmax. Concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma levels of sildenafil.

Single doses of antacid (magnesium hydroxide/aluminum hydroxide) did not affect the bioavailability of VIAGRA.

In healthy male volunteers, there was no evidence of a clinically significant effect of azithromycin (500 mg daily for 3 days) on the systemic exposure of sildenafil or its major circulating metabolite.

Pharmacokinetic data from patients in clinical trials showed no effect on sildenafil pharmacokinetics of CYP2C9 inhibitors (such as tolbutamide, warfarin), CYP2D6 inhibitors (such as selective serotonin reuptake inhibitors, tricyclic antidepressants ), thiazide and related diuretics, ACE inhibitors, and calcium channel blockers. The AUC of the active metabolite, N-desmethyl sildenafil, was increased 62% by loop and potassium-sparing diuretics and 102% by nonspecific beta-blockers. These effects on the metabolite are not expected to be of clinical consequence.

Effects of VIAGRA on Other Drugs

In Vitro Studies

Sildenafil is a weak inhibitor of the CYP isoforms 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 (IC50 > 150 μM). Given sildenafil peak plasma concentrations of approximately 1 μM after recommended doses, it is unlikely that VIAGRA will alter the clearance of substrates of these isoenzymes.

In Vivo Studies

No significant interactions were shown with tolbutamide (250 mg) or warfarin (40 mg), both of which are metabolized by CYP2C9.

In a study of healthy male volunteers, sildenafil (100 mg) did not affect the steady state pharmacokinetics of the HIV protease inhibitors, saquinavir and ritonavir, both of which are CYP3A4 substrates.

VIAGRA (50 mg) did not potentiate the increase in bleeding time caused by aspirin (150 mg).

Sildenafil at steady state, at a dose not approved for the treatment of erectile dysfunction (80 mg t.i.d.) resulted in a 50% increase in AUC and a 42% increase in C max of bosentan (125 mg b.i.d.).

Clinical Studies

In clinical studies, VIAGRA was assessed for its effect on the ability of men with erectile dysfunction (ED) to engage in sexual activity and in many cases specifically on the ability to achieve and maintain an erection sufficient for satisfactory sexual activity. VIAGRA was evaluated primarily at doses of 25 mg, 50 mg and 100 mg in 21 randomized, double-blind, placebo-controlled trials of up to 6 months in duration, using a variety of study designs (fixed dose, titration, parallel, crossover). VIAGRA was administered to more than 3,000 patients aged 19 to 87 years, with ED of various etiologies (organic, psychogenic, mixed) with a mean duration of 5 years. VIAGRA demonstrated statistically significant improvement compared to placebo in all 21 studies. The studies that established benefit demonstrated improvements in success rates for sexual intercourse compared with placebo.

Efficacy Endpoints in Controlled Clinical Studies

The effectiveness of VIAGRA was evaluated in most studies using several assessment instruments. The primary measure in the principal studies was a sexual function questionnaire (the International Index of Erectile Function -IIEF) administered during a 4-week treatment-free run-in period, at baseline, at follow-up visits, and at the end of double-blind, placebo-controlled, at-home treatment. Two of the questions from the IIEF served as primary study endpoints; categorical responses were elicited to questions about (1) the ability to achieve erections sufficient for sexual intercourse and (2) the maintenance of erections after penetration. The patient addressed both questions at the final visit for the last 4 weeks of the study. The possible categorical responses to these questions were (0) no attempted intercourse, (1) never or almost never, (2) a few times, (3) sometimes, (4) most times, and (5) almost always or always. Also collected as part of the IIEF was information about other aspects of sexual function, including information on erectile function, orgasm. desire, satisfaction with intercourse, and overall sexual satisfaction. Sexual function data were also recorded by patients in a daily diary. In addition, patients were asked a global efficacy question and an optional partner questionnaire was administered.

Efficacy Results from Controlled Clinical Studies

The effect on one of the major end points, maintenance of erections after penetration, is shown in Figure 6, for the pooled results of 5 fixed-dose, dose-response studies of greater than one month duration, showing response according to baseline function. Results with all doses have been pooled, but scores showed greater improvement at the 50 and 100 mg doses than at 25 mg. The pattern of responses was similar for the other principal question, the ability to achieve an erection sufficient for intercourse. The titration studies, in which most patients received 100 mg, showed similar results. Figure 6 shows that regardless of the baseline levels of function, subsequent function in patients treated with VIAGRA was better than that seen in patients treated with placebo. At the same time, on-treatment function was better in treated patients who were less impaired at baseline.

Figure 6: Effect of VIAGRA and Placebo on Maintenance of Erection by Baseline Score

The frequency of patients reporting improvement of erections in response to a global question in four of the randomized, double-blind, parallel, placebo-controlled fixed dose studies (1797 patients) of 12 to 24 weeks duration is shown in Figure 7. These patients had erectile dysfunction at baseline that was characterized by median categorical scores of 2 (a few times) on principal IIEF questions. Erectile dysfunction was attributed to organic (58%; generally not characterized, but including diabetes and excluding spinal cord injury ), psychogenic (17%), or mixed (24%) etiologies. Sixty-three percent, 74%, and 82% of the patients on 25 mg, 50 mg and 100 mg of VIAGRA, respectively, reported an improvement in their erections, compared to 24% on placebo. In the titration studies (n=644) (with most patients eventually receiving 100 mg), results were similar.

Figure 7: Percentage of Patients Reporting an Improvement in Erections

The patients in studies had varying degrees of ED. One-third to one-half of the subjects in these studies reported successful intercourse at least once during a 4-week, treatment-free run-in period.

In many of the studies, of both fixed dose and titration designs, daily diaries were kept by patients. In these studies, involving about 1600 patients, analyses of patient diaries showed no effect of VIAGRA on rates of attempted intercourse (about 2 per week), but there was clear treatment-related improvement in sexual function: per patient weekly success rates averaged 1.3 on 50-100 mg of VIAGRA vs 0.4 on placebo; similarly, group mean success rates (total successes divided by total attempts) were about 66% on VIAGRA vs about 20% on placebo.

During 3 to 6 months of double-blind treatment or longer-term (1 year), open-label studies, few patients withdrew from active treatment for any reason, including lack of effectiveness. At the end of the long-term study, 88% of patients reported that VIAGRA improved their erections.

Men with untreated ED had relatively low baseline scores for all aspects of sexual function measured (again using a 5-point scale) in the IIEF. VIAGRA improved these aspects of sexual function: frequency, firmness and maintenance of erections; frequency of orgasm; frequency and level of desire; frequency, satisfaction and enjoyment of intercourse; and overall relationship satisfaction.

One randomized, double-blind, flexible-dose, placebo-controlled study included only patients with erectile dysfunction attributed to complications of diabetes mellitus (n=268). As in the other titration studies, patients were started on 50 mg and allowed to adjust the dose up to 100 mg or down to 25 mg of VIAGRA; all patients, however, were receiving 50 mg or 100 mg at the end of the study. There were highly statistically significant improvements on the two principal IIEF questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) on VIAGRA compared to placebo. On a global improvement question, 57% of VIAGRA patients reported improved erections versus 10% on placebo. Diary data indicated that on VIAGRA, 48% of intercourse attempts were successful versus 12% on placebo.

One randomized, double-blind, placebo-controlled, crossover, flexible-dose (up to 100 mg) study of patients with erectile dysfunction resulting from spinal cord injury (n=178) was conducted. The changes from baseline in scoring on the two end point questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) were highly statistically significantly in favor of VIAGRA. On a global improvement question, 83% of patients reported improved erections on VIAGRA versus 12% on placebo. Diary data indicated that on VIAGRA, 59% of attempts at sexual intercourse were successful compared to 13% on placebo.

Across all trials, VIAGRA improved the erections of 43% of radical prostatectomy patients compared to 15% on placebo.

Subgroup analyses of responses to a global improvement question in patients with psychogenic etiology in two fixed-dose studies (total n=179) and two titration studies (total n=149) showed 84% of VIAGRA patients reported improvement in erections compared with 26% of placebo. The changes from baseline in scoring on the two end point questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) were highly statistically significantly in favor of VIAGRA. Diary data in two of the studies (n=178) showed rates of successful intercourse per attempt of 70% for VIAGRA and 29% for placebo.

Efficacy Results in Subpopulations in Controlled Clinical Studies

A review of population subgroups demonstrated efficacy regardless of baseline severity, etiology, race and age. VIAGRA was effective in a broad range of ED patients, including those with a history of coronary artery disease. hypertension. other cardiac disease, peripheral vascular disease. diabetes mellitus, depression, coronary artery bypass graft (CABG ), radical prostatectomy, transurethral resection of the prostate (TURP) and spinal cord injury, and in patients taking antidepressants /antipsychotics and anti-hypertensives/diuretics.

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

ViagraActive ingredient: Sildenafil$0.27 for pillViagra is often the first treatment tried for erectile dysfunction in men and pulmonary arterial hypertension.CialisActive ingredient: Tadalafil$0.68 for pillCialis improves erection and helps to achieve a successful sexual intercourse.

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Brand ViagraActive ingredient: Sildenafil$2.56 for pillBrand Viagra is often the first treatment tried for erectile dysfunction in men and pulmonary arterial hypertension.Doxycycline$0.30 for pillDoxycyline is a tetracycline antibiotic used to treat infections of urinary tract, acne, gonorrhea, chlamydiosis, periodontitis, etc.

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Extra Super ViagraActive ingredient: dapoxetine$2.86 for pillExtra Super Viagra is used in the treatment of Erectile Dysfunction with Premature Ejaculation. Extra Super Viagra contains Sildenafil100 mg and Dapoxetine.Cialis Extra DosageActive ingredient: Tadalafil$2.05 for pillCialis Extra Dosage is indicated for the treatment of erectile dysfunction. Cialis Extra Dosage works faster than other ED drugs and lasts for an extended.

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Citrato de sildenafil, que se vende bajo la marca Viagra, serГЎ el medicamento para la disfunciГіn erecciГіn mГЎs popular para el mercado. Sin embargo, la comida y jugo de toronja grasos alta realmente no deberГ­a ser consumido. Los consumidores deben tener cuidado antes de comprar cualquier producto de las categorГ­as anteriores. Sin embargo, en la realidad de retardo trabaja para aumentar la circulaciГіn de sangre al ГЎrea del pene lo que podrГ­a tener mГЎs fuerte y mГЎs duro erecciГіn en cualquier momento. Varias personas a lo largo del mundo utilizan esta pГ­ldora para mejorar su desempeГ±o sexual elevado en la cama. Una vez que los productos quГ­micos peligrosos dentro de la droga necesitan ser reemplazados, usted pierde su erecciГіn y se puede estar de vuelta al punto de partida, una vez mГЎs. Depende de cuerpo en cuerpo y usted debe consultar sexГіloga de la materia. En los artГ­culos A1, animamos a la reediciГіn de nuestros propios autores. Hay una variedad de tГ©cnicas y productos disponibles en el interior del mercado que las declaraciones que disminuyen agradables problemas relacionados con el cabello sin embargo lo que realmente siempre es recomendable hacer uso de tГ©cnicas basadas en la naturaleza y mercancГ­a para vigorizar el cuero cabelludo. ВїCuГЎl puede ser la mejor droga disfunciГіn erГ©ctil y la forma en la que trabajan? Ginkgo es perfecto para la agilidad mental, mayor nivel de vitalidad, circulatorio seguro mГ©dico de salud de los vasos sanguГ­neos. Estos kits minerales formulado son de color coordinado para adaptarse a su complexiГіn y en algunos casos el color de los ojos, y tambiГ©n son muy fГЎciles de trabajar. Un ejemplo podrГ­a ser alguien que utiliza un medicamento o alguna otra sustancia a base de plantas que pueden ser destinado a tratar los problemas de impotencia, pero ese individuo piensa cГіmo la sustancia aumenta el deseo sexual, y eso no es la verdad, porque eso no es quГ© tipo de sustancia objeto principal es trabajar. Detener agonizante sobre problemas de rendimiento por ordenar Viagra en lГ­nea. Hay personas que son mГЎs jГіvenes que estГЎn sufriendo de tiempo para que el tiempo, y que se pueden beneficiar. Kamagra se puede encontrar en un montГіn de formas, por ejemplo, Kamagra, jalea oral, Zenegra, Silagra, Zenegra, Levitra, Caverta, y Forzest etc.

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Wednesday through Saturday evenings at 8:00 pm with a Thursday matinee at 2:00 pm.

TICKET PRICES

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Friday & Saturday
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Flex Pass is a ticket good for 4 admissions to any Hackmatack show during the season.
Adults: $100
Seniors: $80 (65 or older)
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Tickets can be purchased online. Please note all tickets purchased online are subject to a third party processing fee. To avoid this fee, tickets can be reserved by calling the box office.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Why ‘Herbal Viagra’ really is a contradiction in terms, and you don’t know at all what you’re actually getting

NEW YORK DAILY NEWS

Wednesday, October 14, 2015, 5:15 PM

There are two issues with “herbal Viagra”: the herbs and the Viagra.

First, there’s the herbs. People gravitate to medicines with this word on them because they want to stay away from medicine.

But when you mix in alcohol, it can become completely toxic.

Indeed “herbal Viagra” is a bit of an oxymoron. You’re getting the herb and you’re getting the Viagra. But you don’t know what else you’re getting. The herbs are not regulated by the FDA. It is absolutely not safe.

The FDA has issued a variety of warnings about herbal “Viagra” products.

The FDA has issued a variety of warnings about herbal “Viagra” products.

It’s well known that medications such as Viagra, Levitra and Cialis dilate the blood vessels in order to treat erectile dysfunction. But these herbal treatments may have a reverse factor and may constrict the blood vessels, leading to heart attack, liver failure and kidney failure.

Everybody is under intense pressure to perform, but that pressure only leads to more cases of erectile dysfunction, which in younger men tends to be more psychological than physical.

There’s sometimes a placebo effect when a patient takes a pill, and he thinks it’s working because he’s taken action, but turning to unregulated options is unwise.

The FDA has issued a variety of warnings about herbal “Viagra” products.

People think an herb is safe. And they think that the more the merrier — and that is a complete myth.

Talk to your doctor if you have a problem. But don’t touch a pill without knowing what you’re doing. There really could be rat poison in it — I’m not kidding.

Dr. Samadi is chairman of urology and chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine.

The Food and Drug Administration (FDA) says it agreed with the manufacturer, Pfizer, on extra wording on the drug’s label, after reports of deaths and severe side-effects among Viagra users.

While stressing that it still believes Viagra is safe, the FDA says the new warnings make clear that patients with a history of particular health problems should be carefully examined by a doctor before they are prescribed the drug.

Since Viagra went on the market in April, 69 men have been reported to have died after taking it.

“The revised labelling addresses post-marketing reports of heart attacks, sudden cardiac deaths and hypertension,” the FDA said in a statement.

History of heart problems or low blood pressure is seen as a risk factor

It said that many groups had been left out from the original safety trials for Viagra, including men who had suffered heart attacks, stroke or dangerous arrhythmia within six months, men with dangerously high or low blood pressure, men with heart failure or unstable angina (chest pains), or retinitis pigmentosa, an eye disorder.

“The new labelling notes that if Viagra is prescribed for these patients, it should be done with caution,” the FDA said.

It also noted that patients who have heart disease are at risk from sexual activity anyway and have to be especially careful if they use Viagra.

The new label also warns of the risk of priapism – a prolonged and painful erection – and advises patients to seek prompt medical attention if their erection lasts longer than four hours.

Plane crash connection investigated

Meanwhile, accident investigators in the United States say they are trying to determine whether Viagra contributed to a plane crash in which the pilot – a Hollywood actor, William Knight – was killed.

Mr Knight, 56, who has appeared in films such as Wall Street and Born on the Fourth of July, was killed when his experimental light aircraft hit the water during a difficult manoeuvre.

A police spokeswoman has confirmed that officials of the National Transportation Safety Board have asked a medical examiner to determine whether Mr Knight – an experienced pilot – was using Viagra.

The American aviation authorities have advised pilots against using the drug within six hours of flying, because its side-effects can include difficulty in distinguishing between blue and green, which are used extensively in airport lighting and cockpit instruments.

During testing, Pfizer reported that 3% of men reported visual disturbances that ranged from sensitivity to light to seeing a bluish-green haze.

Viagra

GENERIC NAME(S): SILDENAFIL CITRATE

Uses

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

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

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

How to use Viagra

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

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

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

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

Tell your doctor if your condition does not improve.

Side Effects

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

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

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

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

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

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

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

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

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

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

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

Precautions

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

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

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

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

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

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

Interactions

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

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

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

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

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

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

Overdose

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

Notes

Do not share this medication with others.

Missed Dose

Storage

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

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

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

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Erectile Dysfunction Health Center

This content has not been reviewed within the past year and may not represent WebMD’s most up-to-date information.

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

“>WebMD News Archive

For men with low testosterone. taking testosterone along with Viagra may not help their erections more than if they only took Viagra, a new study shows.

“There were lots of reasons to think that it would work,” Boston University researcher Matthew Spitzer, MD, says of the common practice of combining the two treatments. “It was surprising to me that it didn’t.”

The study, published in the Annals of Internal Medicine. was a good one and the largest of its kind, “but will it change practice? In my opinion, no,” says urologist Jason Hedges, MD, PhD, of Oregon Health and Science University in Portland. He was not involved in the study.

“While low testosterone and [erectile dysfunction ] ED can be related, they are separate issues, and I treat them as such,” says Michael Eisenberg, MD, who also was not involved in the study. “I don’t expect that treating low testosterone will improve ED, but it will likely improve libido and interest in sex ,” says Eisenberg, an assistant professor of urology at Stanford University School of Medicine.

“There is no benefit to adding testosterone to [Viagra],” Spitzer says. He notes, though, that every case is different. “Treatment is a highly individual situation, and this study does not represent all men. If you benefit from both, you should be comfortable continuing this combined therapy.”

Testosterone and Viagra

Spitzer’s team studied 140 men with low testosterone for 14 weeks. All of the men took Viagra. Some also received testosterone gel, while others got a placebo .

During the study, the men reported how often they had sex and rated their sexual satisfaction, sexual desire and orgasms, and their ability to achieve and maintain an erection.

In every category, both groups had similar scores. On average, the men’s erectile function improved, with or without testosterone.

Treatment for the men in the study was “not a complete cure, but the improvements were substantial,” Spitzer says.

The study, Spitzer says, also reminds us that we don’t yet know all the ways in which drugs like Viagra work. One surprising discovery, he says, is that Viagra (sildenafil) appears to increase testosterone levels somewhat.

Testosterone, The Biggest Men’s Health Craze Since Viagra, May Be Risky

Katherine Streeter for NPR

Katherine Streeter for NPR

Men seek it out to combat low energy and decreased sex drive. Prescription testosterone has become so popular that so-called “low T” clinics are becoming common sights in cities and suburbs.

The number of testosterone prescriptions written in the U.S. more than tripled in the past decade. But researchers suspect that much of the testosterone dispensed at low-T clinics isn’t tracked, since it’s often bought with cash. This unfettered flow of testosterone — officially a controlled substance — has raised concerns among doctors who specialize in hormonal problems.

In most doctors’ offices you don’t see a big shingle over their door saying, ‘Get your testosterone here!’

Dr. Edward Karpman

“In most doctors’ offices, you don’t see a big shingle over their door saying, ‘Get your testosterone here!’ ” says Dr. Edward Karpman. a board certified urologist and the medical director of the Men’s Health Center at El Camino Hospital in Los Gatos, Calif. Karpman says low-T clinics aren’t in the business of treating the complex medical problems that often masquerade as low energy and decreased sex drive. Those can include sleep apnea, depression and, perhaps most importantly, heart disease.

“Any man who presents, especially in his 40s and 50s, with new onset erectile dysfunction is at an increased risk for cardiovascular disease and even heart attack or myocardial infarction,” says Karpman.

Hormone treatment itself isn’t without risk: A recent study of more than 55,000 men found a doubling of heart-attack risk among older men who used testosterone. Younger men who had a history of heart disease had a higher incidence of nonfatal heart attacks. In addition, men who are on prolonged high-level testosterone replacement therapy can experience testicular shrinkage.

Yet even as calls for closer scrutiny of the treatment intensify, the clinics continue to draw in men like Greg Lucas. At 25, Lucas was single and a rising star at a Dallas software company. But he didn’t quite feel right — his energy, his sleep, his libido were all lagging. He was having trouble managing his weight, too.

His symptoms sounded a lot like those described in an advertisement for low testosterone. So Lucas decided to do what the ad recommended: talk to his doctor.

“His first response was, ‘OK, let’s do a blood test and see where you’re at,’ ” recalls Lucas. “Following that, my blood test returned a rating that was in the normal range for the lab and he said that was fine.”

Lucas protested: His levels, after all, were in the bottom 5 percent of normal — that seemed out of step for a 25-year-old man. Lucas was seriously overweight, and his doctor advised him to diet and get more exercise.

The problems persisted, though, and Lucas pressed his doctor for the next three years or so about testosterone treatment. Each time, he got the brushoff.

Lucas did manage to start exercising at a gym, but he wasn’t losing much weight. Then a coach mentioned that testosterone treatment could be the answer to his mothballed mojo and suggested he get a second opinion at a low-T clinic. He started searching online and ended up calling a clinic in Dallas. He was impressed. Finally, it seemed, someone was listening to him.

“They did a blood test and found my testosterone level to be even lower than the last time I had it tested, and they said, ‘We would absolutely recommend that you start treatment right away,’ ” Lucas says.

Lucas says the testosterone therapy changed his life: He lost weight and got his energy back. He only wishes his regular doctor would treat him for low T, so that his insurance would cover the bills.

Despite Lucas’ positive experience, the risks and health benefits of long-term testosterone therapy are not well understood. The Food and Drug Administration is reassessing the safety of testosterone products. A spokesperson reiterated the agency’s own guidelines: None of the products approved by the FDA should be prescribed unless low testosterone is associated with a medical condition.

Some doctors warn patients to stay away from low-T clinics. Dr. Bradley Anawalt is one of those doctors. He heads the Hormone Health Network. part of the professional association for endocrinologists which has released clinical guidelines for testosterone therapy.

Anawalt calls the low-T clinics “sex hormone factories” that promote all the potential virtues and great myths about how testosterone may solve all problems. “They’re really out to prescribe as much testosterone as they possibly can, and it’s not clear that all these practices are completely safe,” he says.

But there’s no evidence that the clinics are unsafe, either. State medical boards typically investigate only when patients file complaints, and there hasn’t been an outpouring of accusations against the clinics. But a review of physicians working for a number of low-T clinics found that very few specialized in urology or endocrinology. Instead, one doctor at a Chicago clinic and another in Fort Lauderdale were anesthesiologists; in Houston, an allergist; in Phoenix, an osteopath; and in Washington, D.C. an obstetrician-gynecologist.

“There is some hope that state or federal governments will start to crack down and regulate unscrupulous prescription of testosterone to men, and perhaps they will review the practices of these clinics,” says Anawalt.

We don’t just see a patient and say, ‘Hey, here you go. Here’s some testosterone.’

The clinics themselves say they’re legitimate medical practices. Dr. Bill Reilly is the chief medical officer at Low T Center. one of the largest chains of low-T clinics, based in Southlake, Texas. His company has 45 offices and some 35,000 patients. Reilly says patients must have a diagnosed medical condition.

“Our No. 1 complaint at Low T is, ‘Why won’t you treat me?’ We just don’t see a patient, ‘Hey, here you go. Here’s some testosterone,’ ” Reilly says. “They go through a complete history, physical, thorough evaluation. We go through their symptoms.”

Reilly says some 15,000 men have been turned away from his clinics with no treatment because they don’t meet the medical definition of low testosterone. And those with sleep apnea or high blood pressure or other serious illnesses are encouraged to see their family doctor. Before joining Low T Center, Reilly was a joint surgeon. He doesn’t believe medical training in urology or endocrinology is necessary to do the job well.

“You don’t need to be an endocrinologist. You don’t need to be a urologist,” says Reilly. “We’re all doctors. And we study more about testosterone than they do. We basically follow the national endocrinology guidelines.”

Reilly says the growing criticism from others in the medical community is perhaps just ignorance and fear of competition. After all, Low T Center expects to more than double its number of sites in the next year, reaching perhaps as many as 70,000 patients.

viagra and testosterone therapy

Viagra and testosterone therapy can work together. On its own, Viagra works miracles in men with erectile dysfunction as an isolated andropause symtpom, but it doesnt do much for those who suffer from mood swings, lowered libido, irritability and other symptoms of low testosterone. Specifically, it isn’t an aphrodisiac, so it doesn’t do much for the men who lose sexual desire.

Testosterone treatment, by itself, “can restore full potency in about two thirds of men suffering from andropause symptoms, and restore the libido in over 90 percent, this leaves a third whose minds are, as one patient put it, making appointments their bodies couldn’t keep.” 1 What happens when men combine testosterone therapy with Viagra?

Viagra combined with testosterone therapy

In one study of 100 men, aged 36-81, who had failed to fully regain their erections on testosterone alone, Viagra restored full potency in over 95 percent and it restored libido in another 95 percent. Viagra doesn’t do much for libido but the added confidence of being able to perform sexually after taking it may boost enthusiasm for sex. 2

Furthermore, the dose of Viagra required for optimal results was less than in men who were not using testosterone treatments and the effects seemed to last longer. The only unusual negative effect experienced by the men taking both testosterone treatment and Viagra was a higher than expected rate of “flushing” that may have been due to testosterone’s effect of causing blood vessels to dilate slightly.

The results of this and other studies suggest that men with symptoms of andropause and low testosterone who are experiencing erectile dysfunction might want to try testosterone treatment first for a three month period. Only if this is not successful in restoring sexual performance should they add Viagra at the lowest dose. Chances are great that the combination of testosterone treatment with Viagra will resolve impotence (ED) in a very short time.

1 Caruthers, Malcolm, MD. The Testosterone Revolution. London: Thorsons; 2001, p.144.
2 Caruthers, Malcolm, MD. The Testosterone Revolution. London: Thorsons; 2001, p.145.

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Therapeutische Wirkungvon Viagra

Viagra ist unter dem Markennamen Sildenafil Citrat bekannt, das auf dem Pharmamarkt im Jahr 1998 erschien.Jeder zweite Mann weiГџ, was Viagra ist und wofГјr man dieses Medikament verbraucht. Man muss auch Wirkmechanismus von Viagra verstehen,um in verschiedenen unangenehme Situationen nicht geraten.

Laut Umfragen glauben über 50% der erwachsenen Männer,dass Viagra nicht nurein Stimulans der erektilen Funktion, sondern auch ein Erreger ist, der einen Sexualtriebver ursachen kann.Aber eigentlich ist es nicht so.

Die Wirkung von Sildenafil Citrat wird durch keine Änderung in der Menge von Hormonen oder die Stimulation der erogenen Zonen erklärt.Viagra wirkt auf die Blutgefäße und reguliert die Blutzirkulation inden Penis während der sexuellenIntimität.Dies ist auf die Fähigkeit von Sildenafil Citrate Wirkung von Stickstoffmonoxid zu verbessern,das die glatte Muskulatur der Gefäßwände entspannt. Als Ergebnis entsteht eine Erweiterung der Blutgefäße durch die in den Penis ein größeres Volumen des Blutes kommt. Nach dem Befüllen der Schwellkörper des Penis mit Blut werden sie härter geworden, was die Erektion positiv bewirkt.

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Anregung nach der Einnahme von Viagra entsteht ganz natürlich, aber die Erektion ist stärker und länger, als es gewöhnlich geschieht. Deshalb, wenn Sie sich entscheiden,Viagra zu kaufen, um Libidozu steigern,ist dieses Medikament nicht in der Lage, Ihre Erwartungen zu erfüllen.

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Original Cialis 20mg wird zu Behandlung erektiler Dysfunktion, häufig umgangssprachlich bezeichneter als Impotenz genehmigt. Erektile Dysfunktion kann von unterschiedlichen Faktoren verursacht werden. Im Fall älterer Männer wird das zumeist organisch bedingt, das heißt andere Gesundheitsstörungen tragen zur Entwicklung von ED bei. Darunter nennt man in der ersten Linie Blutkreislauferkrankungen wie Hochdruck oder Arterienverkalkung. Impotenz kann ein Warnzeichen dieser Krankheiten werden. In jedem fünften Fall, vorwiegend bei Männern unter 35, wird erektile Dysfunktion durch psychische Ursachen ausgelöst. In allen diesen Fällen kann Original Cialis kaufen eine Lösung des Problems sein, und in unserer Online Apotheke können Sie Cialis kaufen ohne Rezept.
Eine Erektion kann entstehen, nur wenn die Blutzufuhr zum Schwellkörper sich rasch erhöht, wenn Arterien sich erweitern und glatte Muskulatur des Schwellkörpers erschlafft. Wenn man sexuell erregt ist, wird durch Stickstoffmonoxid (NO) der Botenstoff cGMP aktiviert. Dadurch erschlaffen Muskelzellen des Schwellkörpers, erhöht sich die Blutzufuhr zum Penis und eine Erektion entsteht. Abbau der Erektion wird von PDE-5 ermöglicht.
Tadalafil Citrat im Potenzmittel Cialis 20 gehört zur Wirkstoffklasse PDE5-Hemmer und verhindert Wirkung der Phosphodiesterase-5. Dadurch kann sich die Erektionsfähigkeit verbessern. Dieses Medikament wirkt nur bei sexueller Erregung, steigert sexuelle Lust nicht und erzeugt alleine keine Erektion. Dennoch ist das Potenzmittel Cialis gute Lösung der Intimprobleme!

Wie muss man Cialis 20mg einnehmen?
1 Tablette muss eine Stunde vor dem Geschlechtsverkehr eingenommen werden, ihre Wirkung tritt aber schon in 20 Minuten ein. Cialis wird anders als Wochenendpille genannt wegen seiner bis 36 Stunden langen Wirkdauer. Man kann mit einer Pille zwei Tage lang mehrere sexuelle Verkehre durchführen.

Für wen eignet sich das Potenzmittel Cialis nicht?
In folgenden Fällen darf man das Medikament nicht einnehmen, da es schädlich und gefährlich für die Gesundheit sein kann:

  • im Fall gleichzeitiger Einnahme anderer Potenzmittel;
  • im Alter unter 18 Jahren;bei Tiefblutdruck (Hypotonie);
  • falls man Priapismus mal erlebt hat oder einen anatomisch deformierten Penis hat. Eine Dauererektion muss ärztlich behandelt werden, da diese zu Gewebsschäden sowie Potenzverlust führen kann. Im solchen Fall kann Cialis kaufen gefährlich sein;
  • bei schweren Leber-, Nieren- und Herzerkrankungen (nur nach ärztlicher Beratung);
  • für Frauen nicht genehmigt.

Tadalafil Nebeneffekte treten nicht immer auf, es hängt von individueller Reaktion auf die Arznei ab. Allergische Reaktionen sind auch nicht ausgeschlossen. Falls Sie Zeichen einer allergischen Reaktion nach Original Cialis kaufen bemerken, wenden sich sofort an den Arzt.
Zu häufigsten Nebenwirkungen gehören:

  • Kopf-, Rücken-, Muskelschmerzen;
  • Schwindel;
  • Magenüberreizbarkeit, Übelkeit, gelegentlich Erbrechen;
  • Nase Verstopfung;
  • Rötung mit Hitzegefühl;
  • Augenentzündungen.

Was ist beim Cialis kaufen in Deutschland zu beachten?

Falls Sie Cialis kaufen ohne Rezept. vergessen Sie nicht dass Tadalafil die Wirkung der Herzmedikamente mit Nitraten oder NO-Donatoren deutlich verstärken kann bis auf dramatischen Blutdruckabfall. Deshalb darf Tadalafil gleichzeitig mit Nitraten nicht eingenommen werden. Für weitere Informationen lesen Sie den Beipackzettel durch, wenn Cialis kaufen ohne Rezept.

Heute ist es selbstverständlich, dass Sie online Cialis kaufen ohne Rezept und mit Kreditkarte bezahlen können. Eine Alternative wäre das Potenzmittel Cialis kaufen in Deutschland per Überweisung. Die Apotheke ist danach bestrebt, jedem Kunden und jeder Kundin möglichst viele Zahlungsarten anbieten zu können, damit Sie sicher und diskret Cialis kaufen in Deutschland .

Suchen Sie eine günstigere Alternative zum Originalpotenzmittel von Bayer? Bei uns können Sie auch qualitätsgeprüfte Generika Cialis kaufen ohne Rezept. Lernen Sie unser Sortiment kennen!

Potenzmittel ohne rezept – Cialis Tadalafil online kaufen

Selbst im 21. Jahrhundert sind Potenzprobleme in der Bundesrepublik Deutschland definitiv noch ein enormes Tabuthema, welches von den meisten Medien völlig ignoriert oder ins falsche Licht gestellt wird. Es weiß kaum jemand, dass es einige Potenzmittel für Frauen gibt. Außerdem sind Sie auf jeden Fall nicht der einzige Mann, der rezeptfreie Potenzmittel kaufen möchte. Was macht uns da so sicher? Nur in der BRD gibt es aktuellen Statistiken zufolge über 6,3 Mio. Männer, die ein, eher mehrmals im Laufe ihres gesamten Lebens an einer erektilen Dysfunktion leiden. Diverse Schätzungen gehen weit über diese Zahl hinaus. Definitiv Fakt ist, dass Potenzmittel ohne Rezept in der Gesamtbevölkerung immer populärer werden.

Tadalafil rezeptfrei kaufen

Sie fragen sich vielleicht, was es mit Tadalafil auf sich hat. Das ist der Wirkstoff, welcher die Erektion härter und fester werden lässt. Er sorgt dafür, dass die Erektion länger anhält, indem er den Blutfluss in die Schwellkörper erhöht und ebenfalls dafür sorgt, dass das Blut länger dort verbleibt. Auf dem Markt gibt es verschiedene Tadalafil Generika und es werden von Tag zu Tag mehr. Die Anzahl der Männer, die Tadalafil ohne Rezept kaufen wollen, steigt ebenfalls täglich an, denn vielen Männern wird klar, dass Sie etwas gegen ihre erektile Dysfunktion unternehmen möchten und sie weigern sich zurecht, ihr Sexualleben einfach so an den „Nagel zu hängen“. Sollten Sie zu den Männern gehören, die Tadalafil kaufen wollen, sind Sie hier richtig. Wir bieten nur die Produkte an, die unter strengsten Qualitätskontrollen hergestellt und verarbeitet worden sind. Sie können somit anonym, diskret und schnell Tadalafil 100mg kaufen.

Cialis Generika ohne Rezept

Sehr oft bekommen wir Nachrichten von Männern, die Cialis rezeptfrei kaufen wollen. Sie sind der Meinung, dass das total kompliziert und unangenehm ist. Sie meinen, dass Sie nach einem peinlichen Gespräch mit einem viel zu teuren Rezept in die Apotheke ihres Vertrauens gehen müssten. Das stimmt nicht. Bei uns finden Sie alles, was sie benötigen, damit es im Bett wieder klappt. So wie Sie es sich wünschen.

Ihre diskrete Online Apotheke – schnell und vertraulich

Höchstwahrscheinlich sind Sie auf unserer Seite gelandet, weil Sie auf der Suche nach einer deutschen Apotheke online sind, der Sie bedingungslos vertrauen. Das Thema erektile Dysfunktion bzw. Erektionsstörung ist ein sehr sensibles und darum verstehen wir es sehr gut, dass Sie den Anbieter suchen, der schnell, vertraulich und diskret mit Ihrem Anliegen umgeht. Unter all den verschiedenen Apotheken hat sich unsere Onlineapotheke bei Männern auf der ganzen Welt im besonderen Maße bewährt, weil wir wissen, dass Qualität und Diskretion extrem wichtig sind.

Cialis online kaufen

Die Anzahl der Männer, die das Internet durchsuchen, weil sie Cialis kaufen wollen, steigt von Jahr zu Jahr. Das ist nicht überraschend, denn es handelt sich um ein Medikament, das sich bei der Behandlung von Erektionsstörungen bzw. erektiler Dysfunktion außerordentlich unter Beweis gestellt hat. Von Erektionsstörungen spricht man immer dann, wenn es einem Mann vorübergehend oder eine längere Zeit, nicht möglich ist, eine Erektion zu behalten oder überhaupt zu bekommen. Von diesem Thema, das gesellschaftlich immer noch tabuisiert wird, sind schätzungsweise nur in Deutschland mehr als 6,5 Mio. Männer betroffen. Diese Zahl beinhaltet jeden, der mindestens einmal im Laufe seines Lebens mit Erektionsproblemen zu kämpfen hatte. Es ist allerdings sehr wahrscheinlich, dass die richtige Zahl um ein Vielfaches höher ist. In dieser Anbieterflut den Überblick zu behalten, ist nicht immer ganz einfach, denn es gibt im Jahr 2016 so viele Cialis Generika wie noch nie. Wenn Sie Cialis 100mg kaufen wollen, sollten Sie hier unbedingt weiterlesen.

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