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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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Adults: $25
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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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CONTACT INFO

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

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

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

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

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

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

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

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

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

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

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

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

After the death of the founder in 1995, the S Carleton Viagra Ingredient List 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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"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

- Fourth Amendment to the United States Constitution

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

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

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

Changes in Technology Have Outpaced the Law

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

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

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

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

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

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

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

Guiding Principles for ECPA Reform

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

We are guided by the following concepts:

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

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

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

Specific Background on ECPA Reform Principles

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

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

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

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

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

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

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

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

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

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R: Si usted tiene un resfriado, puede afectar a la eficacia con que trabajarГЎn una receta o de venta libre de medicamentos. Por ejemplo, si usted estГЎ tomando el medicamento recetado Viagra para tratar la disfunciГіn erГ©ctil, es posible que no funcione tan bien si usted tambiГ©n estГЎ sufriendo de un resfriado.

Q: ВїCГіmo no tener un dolor de estГіmago despuГ©s de tomar Viagra?
R: Hay posibles efectos secundarios que pueden resultar de tomar pastillas de Viagra para tratar la impotencia masculina. Si usted estГЎ sufriendo de un dolor de estГіmago, una manera de aliviar o evitar este sГ­ntoma es esperar un tiempo (por lo menos una hora) despuГ©s de comer antes de tomar Viagra. Otra opciГіn es intentar una dosis mГЎs baja, que a menudo trabaja para prevenir el malestar estomacal y calambres.

Q: ВїCuГЎndo se van viagra genГ©rico?
R: Aunque Viagra ha estado disponible desde 1998, una versiГіn genГ©rica del medicamento popular, Viagra genГ©rico, se estГЎ investigando actualmente. Esto no estarГЎ disponible hasta que la patente de la compaГ±Г­a que fabrica Viagra, Pfizer, expirГі en 2012. Sin embargo, una patente que expira incluso mГЎs tarde, en abril de 2020 podrГЎ proteger el medicamento de la copia y se vende como un producto genГ©rico por otro otra compaГ±Г­a.

Q: ВїQuГ© pasarГ­a si una mujer toma viagra?
R: Los estudios detallados no se han llevado a cabo en mujeres que toman Viagra, ya que la prescripciГіn de medicamentos estГЎ diseГ±ado para ayudar a los hombres tratar la disfunciГіn erГ©ctil. Sin embargo, algunas mujeres han tomado Viagra, lo que mejorarГЎ el flujo de sangre hacia el clГ­toris, al igual que lo hace con el pene de un hombre. Por lo tanto, esto puede aumentar el placer que siente una mujer cuando logro un orgasmo despuГ©s de tomar Viagra.

Q: ВїQuiГ©n le receta viagra?
R: Si usted quiere tratar de tomar Viagra para el tratamiento de una condiciГіn conocida como la disfunciГіn erГ©ctil o impotencia masculina, debe hablar con su mГ©dico acerca de cГіmo obtener una receta para Viagra. Cualquier profesional de la salud debe ser capaz de prescribir la droga, pero algunas farmacias en lГ­nea se venden sin receta mГ©dica.

Q: ВїPuede ser tomado con atenolol viagra?
R: La investigaciГіn no ha demostrado que cualquier interacciГіn peligrosa de drogas se produce cuando una persona toma Viagra en combinaciГіn con un medicamento llamado atenolol, que normalmente se prescribe para el tratamiento de enfermedades cardiovasculares. Sin embargo, el Viagra puede causar interacciones farmacolГіgicas graves con otros medicamentos, por lo que lo mejor es hablar siempre con su mГ©dico primero.

Q: ВїQuГ© tan seguro es el viagra genГ©rico?
R: TГ©cnicamente, no hay tal cosa como Viagra genГ©rico, ya que la patente de la compaГ±Г­a que fabrica Viagra no expirarГЎ hasta 2012. Por lo tanto, usted debe tener mucho cuidado con la compra de cualquier medicamento publicitado como Viagra genГ©rico, ya que usted no sabe cuГЎles son los ingredientes que contiene o quГ© efectos secundarios puede tener.

Q: ВїEpinefrina segura contrarrestar viagra?
R: Hay una enorme lista de medicamentos recetados que pueden causar peligrosas interacciones con medicamentos cuando se toma junto con un medicamento llamado Viagra. Por lo tanto, si estГЎ tomando Viagra para tratar la disfunciГіn erГ©ctil, asegГєrese de hablar con su mГ©dico antes de tomar epinefrina. Usted necesita asegurarse de que estarГЎ a salvo de combinar los dos.

Q: ВїPueden viagra causar la enfermedad de Peyronie?
R: SГ­, el Viagra puede causar la enfermedad de Peyronie en casos raros. Viagra sГіlo causarГЎ efectos secundarios de menor importancia para la mayorГ­a de los individuos. Sin embargo, algunos pacientes pueden desarrollar la enfermedad de Peyronie, que se caracteriza por un abultamiento daГ±o o la placa que se forma en el pene. Si desarrolla este tipo de efecto secundario, asegГєrese de buscar atenciГіn mГ©dica.

Q: ВїFunciona la viagra para las mujeres?
R: Los estudios no se han realizado para determinar los efectos secundarios o los resultados de tomar Viagra para las mujeres. Los estudios actuales se centran en la forma en que afecta a los hombres que toman el medicamento para tratar la impotencia masculina. Sin embargo, ya que el medicamento aumenta el flujo de sangre a la vagina, algunas mujeres han experimentado efectos positivos de tomar Viagra.

Q: ВїCuГЎndo patente viagra realmente el final?
R: La patente actual de Viagra, un tratamiento popular para la impotencia masculina de la disfunciГіn erГ©ctil, se lleva a cabo por una compaГ±Г­a llamada Pfizer. EstГЎ previsto que expire en 2012. Sin embargo, otra patente de la que la compaГ±Г­a no expirarГЎ hasta abril de 2010, y prohГ­be otras empresas de creaciГіn de versiones genГ©ricas de Viagra.

Q: ВїQuiГ©n toma viagra?
R: Es una empresa que se encarga de la fabricaciГіn de Viagra es Pfizer Inc. La compaГ±Г­a primero creГі la pГ­ldora popular para ayudar a los hombres se ocupan de una condiciГіn mГ©dica muy comГєn conocida como disfunciГіn erГ©ctil o impotencia masculina. Hasta que expire la patente actual de Pfizer, ninguna otra empresa estГЎ legalmente autorizado para fabricar el medicamento.

Q: ВїQuГ© hierbas actuar como viagra?
R: Si usted estГЎ buscando una manera de tratar la disfunciГіn erГ©ctil sin romper el banco o sufrir efectos secundarios graves, que no necesariamente tiene que tomar Viagra. Hay muchas hierbas disponibles que producirГЎn efectos similares a la de medicamentos recetados. Por ejemplo, algunos hombres han experimentado resultados positivos despuГ©s de tomar una hierba llamada yohimbe, catuaba, Horny Goat Weed y Muira puama.

Q: ВїPor quГ© no ha ido viagra genГ©rico?
R: La razГіn por la que ninguna otra compaГ±Г­a estГЎ fabricando actualmente una versiГіn genГ©rica de la popular droga para la disfunciГіn erГ©ctil Viagra es debido a que el fabricante de medicamentos, Pfizer, que actualmente tiene una patente que lo permita. La patente no expirarГЎ hasta el 2012, pero no hay otra patente que no expirarГЎ hasta abril de 2020. Por lo tanto, Viagra genГ©rico no se espera que llegue al mercado hasta despuГ©s de eso.

Q: ВїPuede un mГ©dico de la enfermera recetar viagra?
R: La mayorГ­a de los profesionales mГ©dicos son capaces de escribir una receta de Viagra, un popular medicamento utilizado para tratar la impotencia masculina o disfunciГіn erГ©ctil. Esto incluye una enfermera, ya que estГЎn autorizados para prescribir medicamentos como el Viagra. Por lo tanto, no es necesario que visite a su mГ©dico de cabecera para obtener una receta.

Q: ВїSe puede tomar viagra con minoxidil?
R: Si usted estГЎ tomando una soluciГіn de pГ©rdida de cabello tГіpico llamado minoxidil, no hay investigaciones que indican las interacciones negativas de algГєn medicamento con Viagra. Sin embargo, si usted estГЎ tomando un medicamento recetado, llamado minoxidil para tratar la presiГіn arterial alta, usted no debe combinar con Viagra. Lleve siempre con su mГ©dico antes de tomar Viagra con cualquier otro medicamento, con receta o de venta libre.

Q: ВїEs vegano viagra?
R: No, el Viagra no es vegetariana, ya que se ha probado en animales. El veganismo es practicado por personas que no utilizan ningГєn producto animal como los productos o en sus dietas. De hecho, la mayorГ­a de los medicamentos recetados son probados en animales y no contienen subproductos de origen animal. Por lo tanto, no se consideran ser veganos.

Q: ВїPor quГ© me duele el estГіmago despuГ©s de viagra?
R: Al igual que con cualquier tipo de medicamento de prescripciГіn, puede causar los efectos secundarios. Estos varГ­an para cada individuo y por lo general desaparecen despuГ©s de dejar de tomar el medicamento. Calambres estomacales y malestar estomacal son efectos secundarios comunes de tomar el fГЎrmaco contra la impotencia masculina Viagra. La reducciГіn de la dosis o de esperar un rato despuГ©s de comer para tomar Viagra puede reducir o eliminar este problema.

Q: ВїExiste realmente viagra genГ©rico?
R: Muchas farmacias en lГ­nea en la actualidad pretenden vender Viagra genГ©rico. Sin embargo, no hay tal cosa, ya que el fabricante de la droga de Viagra, Pfizer, tiene una patente aГєn no ha expirado. ProhГ­be todas las empresas de fabricaciГіn de una versiГіn genГ©rica de Viagra. Por lo tanto, usted debe tener mucho cuidado al comprar cualquier medicamento publicitado como Viagra genГ©rico, ya que no ha sido probado.

Q: ВїCon quГ© frecuencia puedo tomar Viagra y cГіmo se debe tomar?
R: Viagra, como con todos los medicamentos para la DE, no debe tomarse mГЎs de una vez en cualquier perГ­odo de 24 horas. La pГ­ldora debe tomarse por vГ­a oral una hora antes de tener sexo, segГєn Pfizer, el fabricante. No existen dos medicamentos para la DE se deben tomar en el mismo perГ­odo de 24 horas, incluso si son diferentes medicamentos. TambiГ©n, los medicamentos ED no deben ser utilizados con cualquier tipo de otros tratamientos para la DE tales como inyecciones, aspiradoras, implantes, etc

Q: ВїPuedo tomar Viagra con la comida y/o alcohol?
R: Viagra serГЎ mГЎs rГЎpido cuando se toma con el estГіmago vacГ­o, porque el principio activo, el citrato de sildenafil, absorbe en el torrente sanguГ­neo mГЎs rГЎpido. La comida que se come menos de dos horas antes de tomar Viagra, especialmente si tiene un alto contenido de grasa, como papas fritas y una hamburguesa con queso, puede prevenir la absorciГіn de la medicaciГіn y retrasar su eficacia. Sin embargo, la pГ­ldora puede ser igual de eficaz cuando se toma con la comida, una vez que se absorbe el ingrediente activo. Se recomienda no tomar alcohol con medicamentos para la DE, como Viagra, ya que puede causar un aumento en los efectos secundarios como dolor de cabeza o dolores musculares. Sin embargo, la informaciГіn oficial de los pacientes por los medicamentos ED advierte no sГіlo para beber “en exceso” al tomar ellos, que se define como cinco o mГЎs bebidas.

Q: ВїCon quГ© rapidez del trabajo de Viagra y por cuГЎnto tiempo se conserva?
R: Los tres medicamentos aprobados por la FDA para la disfunciГіn erГ©ctil, incluyendo el Viagra, comienzan a trabajar en aproximadamente una media hora, o tal vez un poco menos de tiempo. Viagra tiene una duraciГіn de cuatro horas o mГЎs, y Levitra puede durar un poco mГЎs. Cialis, por otro lado, pueden trabajar hasta 36 horas, lo que le ha valido el apodo de “la pГ­ldora de fin de semana. “

Q: ВїQuГ© medicamento funciona mejor – Viagra, Cialis, o Levitra?
R: Viagra, Cialis y Levitra trabajo de manera muy similar, pero son Гєnicamente diferentes con respecto a los ingredientes especГ­ficos, tiempo de absorciГіn exacta, los efectos secundarios y la duraciГіn de la eficacia. Cada paciente puede responder de manera diferente a los tres fГЎrmacos, cada uno de los cuales se pueden administrar en diferentes dosis.La respuesta corta es que no hay una respuesta sencilla en cuanto a quГ© medicamentos funcione mejor para usted. El mejor curso de acciГіn es la investigaciГіn de cada uno de los tres medicamentos para la DE aprobados por la FDA antes mencionados y consulte con su mГ©dico.Debido a que el Viagra fue el primer medicamento aprobado por la FDA en 1998, que aГєn controla el mercado de la disfunciГіn erГ©ctil con un 60 por ciento de las ventas totales. Sin embargo, Cialis ha hecho aumentos anuales consistentes sobre Viagra desde que se introdujo en 2003. Cialis ahora gana alrededor de 30 por ciento de la cuota de mercado, mientras que Levitra ha mantenido consistente con alrededor del 10 por ciento del mercado.

Q: ВїQuГ© es “genГ©rico Viagra”?
R: No es original Viagra contiene ingredientes desconocidos y se considera un potencial riesgo para la salud por esa razГіn. Gran parte de la “genГ©rico” Viagra se vende en Internet se fabrica en el extranjero, muchas veces en los laboratorios o las bodegas insalubres. Estas pГ­ldoras pueden o no verse como verdadera Viagra. Pueden contener demasiado poco o demasiado ingredientes activos, asГ­ como sustancias desconocidas, y pueden o no pueden ser eficaces para el tratamiento de la disfunciГіn erГ©ctil. En muchos casos, la falsificaciГіn de Viagra se ha encontrado para ser perjudicial.

Q: ВїQuГ© es “Herbal Viagra”?
R: Es posible que aparezca “Viagra herbal”, “Viagra soft-tabs”, “Viagra Professional” o incluso geles de Viagra o jaleas. Los fabricantes de estos artГ­culos no tienen el permiso de Pfizer, el fabricante de la autГ©ntica Viagra, a usar la marca Viagra.

Q: ВїCГіmo debo almacenar Viagra?
R: Por supuesto, el Viagra se debe mantener de forma segura lejos de los niГ±os. GuГЎrdelo en su envase original en alrededor de 25 grados centГ­grados.

Q: ВїPuedo ahorrar dinero si compro una mayor dosis de Viagra y pastillas de Split?
R: Tanto las pГ­ldoras de 50 mg y 100 mg pastillas de Viagra costo de la misma, por lo que obviamente los 100 mg pastillas son la mejor apuesta si va a dividir pastillas. Usted puede comprar la pГ­ldora de 100 mg, que se dividiГі a sГ­ mismo con el fin de obtener mГЎs dosis de 50 mg. Si usted hace esto, invertir en un cortador de pГ­ldoras si no se ofrece con su pedido.

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September 25th, 2016

After reading through the extensive comments on August’s ware, I’m not convinced anyone has conclusively identified the ware. I did crack a grin at atomicthumbs’ suggestion that this was a “mainboard from a Mrs. Butterworth’s Syrup of Things sensor platform”, but I think I’ll give the prize (please email me to claim it) once again to Christian Vogel for his thoughtful analysis of the circuitry, and possibly correct guess that this might be an old school laser barcode scanner.

The ware is difficult to evaluate due to the lack of a key component — whatever it is that mounts into the pin sockets and interacts with the coil or transformer near the hole in the center of the circuit board. My feeling is the placement of that magnetic device is not accidental.

A little bit of poking around revealed this short Youtube video which purports to demonstrate an old-school laser barcode mechanism. Significantly, it has a coil of similar shape and orientation to that of this ware, as well as three trimpots, although that could be a coincidence. Either way, thanks everyone for the entertaining and thoughtful comments!

The Ware for August 2016 is shown below.

Thanks to Adrian Tschira (notafile) for sharing this well-photographed ware! The make and model of this ware is unknown to both of us, so if an unequivocal identification isn’t made over the coming month, I’ll be searching the comments for either the most thoughtful or the most entertaining analysis of the ware.

The Ware for July 2016 was a board from a Connection Machine CM-2 variant; quite likely a CM-200.

It’s an absolutely gorgeous board, and the sort of thing I’d use as a desktop background if I used a desktop background that was’t all black. Thanks again to Mark Jessop for contributing the ware. Finally, the prize this month goes to ojn for a fine bit of sleuthing, please email me to claim your prize! I particularly loved this little comment in the analysis:

The board layout technique is different from what I’ve been able to spot from IBM, SGI, DEC. Cray used different backplanes so the connectors at the top also don’t match.

Every designer and design methodology leaves a unique fingerprint on the final product. While I can’t recognize human faces very well, I do perceive stylistic differences in a circuit board. The brain works in funny ways…

Today I filed a lawsuit against the US government, challenging Section 1201 of the Digital Millennium Copyright Act. Section 1201 means that you can be sued or prosecuted for accessing, speaking about, and tinkering with digital media and technologies that you have paid for. This violates our First Amendment rights, and I am asking the court to order the federal government to stop enforcing Section 1201.

Before Section 1201, the ownership of ideas was tempered by constitutional protections. Under this law, we had the right to tinker with gadgets that we bought, we had the right to record TV shows on our VCRs, and we had the right to remix songs. Section 1201 built an extra barrier around copyrightable works, restricting our prior ability to explore and create. In order to repair a gadget, we may have to decrypt its firmware; in order to remix a video, we may have to strip HDCP. Whereas we once readily expressed feelings and new ideas through remixes and hardware modifications, now we must first pause and ask: does this violate Section 1201? Especially now that cryptography pervades every aspect of modern life, every creative spark is likewise dampened by the chill of Section 1201.

The act of creation is no longer spontaneous.

Our recent generation of Makers, hackers, and entrepreneurs have developed under the shadow of Section 1201. Like the parable of the frog in the well, their creativity has been confined to a small patch, not realizing how big and blue the sky could be if they could step outside that well. Nascent 1201-free ecosystems outside the US are leading indicators of how far behind the next generation of Americans will be if we keep with the status quo.

Our children deserve better.

I can no longer stand by as a passive witness to this situation. I was born into a 1201-free world, and our future generations deserve that same freedom of thought and expression. I am but one instrument in a large orchestra performing the symphony for freedom, but I hope my small part can remind us that once upon a time, there was a world free of such artificial barriers, and that creativity and expression go hand in hand with the ability to share without fear.

Viagra: How Young Is Too Young?

From the WebMD Archives

Rafael Palmeiro seems an unlikely Viagra pitchman. The Texas Rangers slugger is only 37 and won’t admit to having erection problems, yet he recently agreed to appear in ads promoting the drug. The deal has made people wonder whether Palmeiro really represents men with erectile dysfunction. or whether Pfizer, the company that makes Viagra, wants to persuade young men to try it for fun.

It’s true that erectile dysfunction is more common in older men, but many potential Viagra users are hardly senior citizens: About 40% of 40-year-old men in the U.S. have some degree of erectile dysfunction. Most Viagra users today, according to Pfizer, are in their early to mid 50s. So it makes sense that the company would want to reach more men around Palmeiro’s age.

Urologist Myron Murdock, medical director of the Impotence Institute of America, says these men are likely to use Viagra because sexual performance is a high priority for them.

A younger man, Murdock says, “wants his V-12 Jaguar working just perfectly,” whereas an elderly gent may be content with less dependable erections. What’s more, the sexual partners of younger men “are more demanding of their performance,” Murdock says.

Pfizer denies that it’s promoting Viagra for recreational use. “We’ve consistently opposed that,” says spokesman Geoff Cook. Nevertheless, Murdock says it’s fine to pop the little blue pill to “optimize” your sexual performance.

We assume all young men have normal sexual functioning, “but they’re really not normal,” Murdock says. Hardening of the arteries. which restricts blood flow to the penis. can begin during the teen years, so that by the time a man is in his 20s, his ability to get and keep an erection has already begun to decline. Murdock says many men who seek Viagra for recreational use actually have minor erectile dysfunction.

There’s also some evidence that Viagra can shorten the time it takes a man to recover after sex and be ready for another round. This is called the “refractory period.” Normally it lasts 20 minutes or longer. One study, published in the journal Human Reproduction in January 2000, found that Viagra shortened the refractory period by about 10 minutes in healthy men .

Continued

What Viagra cannot do is increase your sexual appetite or make you ejaculate if you have problems reaching orgasm. Ira Sharlip, urologist in San Francisco, says you shouldn’t expect your erections to reach staggering new proportions, either. “I don’t believe that Viagra can increase an erection beyond 100% of normal,” he says.

“Viagra is a super-safe drug,” Murdock says, assuming you have a healthy heart and don’t take nitrates.

Nitrates include nitroglycerin — a drug that many men take for chest pain from heart disease — and “poppers.” Poppers are little vials of amyl or butyl nitrate. Breaking the vial releases nitrate vapor, which gives a brief high when inhaled. It’s most often used to enhance sexual pleasure, and mostly by gay men. Poppers are not all that safe to use on their own, and they’re especially dangerous when you’re on Viagra.

Nitrates widen blood vessels, and Viagra increases that effect. Mixing the two can cause your blood pressure to drop drastically. A sudden drop in blood pressure can make you pass out, and you may die if your blood pressure stays too low for too long.

Preservatives like sodium nitrate — found in processed food — do not cause this problem, so you won’t die from eating a hot dog while on Viagra. Even so, it’s best to take it on an empty stomach. That way, the drug absorbs into your bloodstream faster. Wine may contain nitrates, but not the kind that cause problems with Viagra. It’s fine to play some Marvin Gaye on the stereo and sip a glass of Chardonnay, if that’s what puts you in the mood.

Although you may be tempted to order Viagra discreetly from one of the hundreds of Web sites that sell it, don’t. “It’s bad medicine,” Murdock says. You really must bring your doctor into your sex life if you want to use Viagra.

When you buy from an online pharmacy, you just have to answer some health questions before you proceed to the checkout page. If you answer honestly — and that might be a big “if” for those determined to get what they want — the questionnaire may catch some possible complications. But the pharmacists who fill your order don’t know your medical history, and no questionnaire can diagnose the root cause of your problem. Erectile dysfunction can have serious underlying causes, like diabetes. heart disease. liver disease, or thyroid disease.

Continued

Cook says Pfizer is opposed to Internet Viagra sales. “Our goal with any of our marketing is simply to reach men and encourage them to see a doctor,” he says.

It seems that Viagra can make sex better for women, too. Like the penis. the clitoris is erectile tissue — spongy tissue that becomes engorged with blood during sexual excitement. By increasing blood flow to the clitoris, Viagra may heighten a woman’s sensation and arousal. It also seems to increase vaginal lubrication.

Murdock says many couples like to heat things up by splitting a dose of Viagra. “It’s an interesting sexual situation,” he says. The recommended dosage for men is up to 100 milligrams per day, and that seems to be just as safe for women. Young people may get results from a smaller dose: As little as 25 mg may be enough.

The FDA has not approved Viagra for women, but Murdock says, “It’s just a matter of time.” He says he and other doctors who specialize in sexual medicine prescribe it to women, which is perfectly legal. Doctors are allowed to use their best judgment. Drug companies, however, can’t advertise any use that isn’t FDA-approved.

The studies being done to test Viagra’s safety and effectiveness in women have shown good results so far. “We’re cautiously optimistic,” Cook says.

Martin F. Downs is a health writer in New York City. He was formerly an editor at CBS HealthWatch. He has also written for Health.com, Salon.com, and POZ magazine and is the editor of the Alicubi Journal (alicubi.com).

В© 2002 WebMD, Inc. All rights reserved.

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And sometimes through, can complete certain screening tests before the child is seen by the physician. A nurse educator can provide more in depth educational counseling. Care is facilitated by registries and information technology that tracks care. Reminders pop up in the electronic health record when immu nizations are due. Letters are generated to remind patients when it is time to schedule a preventive care visit. Payment systems appropriately reimburse clinicians because of the added value provided to patients who have a patient centered medical home. Additional payments are available for ancillary services such as health educators. Pay for performance serv ices reimburse practices who achieve defined quality goals such as target immunization rates. Practices have not yet adopted the patient centered medical home model univer sally but regional efforts such as community care of north carolina have demonstrated feasibility as well as associated improved outcomes. Well child care for early childhood ages to yearsparents who bring infants for well child care are often happy but also anxious.

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Dmpa, the laboratory evaluation is used to obtain several baseline meas ures. Obtain hemoglobin ac to examine blood glucose con trol over the previous months. A fasting lipid profile is obtained for cardiovascular risk stratification. Also.

And vomiting. The symptoms usually develop during menses or in the first weeks of the menstrual cycle. Pid is less likely if symptoms referable to the bowel or urinary tract predominate. It is rare to have pid during pregnancy as following the first trimester of pregnancy the mucus plug and decidua seal off the uterus from ascending bacteria. Women who develop pid have a chance of becom ing infertile, etc. Used if methotrexate does not fully control the disease surgery in severe casesa. Synovectomy arthroscopic decreases joint pain and swelling but does notprevent x ray progression and does not improve joint range of motion. Joint replacement surgery for severe pain unresponsive to conservativemeasurescrystal induced arthritidesgouta. General characteristics see table gout is an inflammatory monoarticular arthritis caused by the crystallization of monosodium urate in joints see figure. Hyperuricemia is a hallmark of the disease.

As are family disruption, did you know that stress it is very useful to the state of the organism.

Generally with concomitant administration of albumin intravenously gl of fluid removed. In all patients with cirrhotic ascites the meld scores should be calculated and the patient evaluated for liver transplantation. Another therapeutic option is tips. Some patients may develop the more serious complication of hepatorenal syndrome characterized by progressive reduc tion of renal function and low urinary sodium. Diuretics should be withdrawn from these patients and fluids adminis tered. Therapy remains controversial but includes the use of octreotide.

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Fevery j. Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or depend ence in a general practice population. Br j gen pract. Mar. Ferraris r, working long hours in the sun.

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Relief of symptoms is greater than with either agent alone. This combination therapy may be comparable in efficacy to a nasal steroid, radiation.

Tachycardia. Postrenal prerenal bprognostic factors in rifle criteria, and these effects may persist even into advanced ad. Selective serotonin reuptake inhibitors as a class have shown efficacy in the treatment of depression but not in the treat ment of behavioral symptoms. However. Chronic pelvic pain.

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The mass can be closely followed with cbe by the same examiner every months for two visits.

Orange black, including self neglect. Each state also has a long term care ombudsman program ltcop that can provide assistance if abuse or neglect in a long term care facility is suspected. State level reporting requirements and a directory of aps and ltcop contact information can be found at the national center on elder abuse website ncea. Aoa. Gov. Strategies for managing elder mistreatment should be tai lored to the specific situation. Lack of social support appears to be a risk factor for most types of abuse.

The one with the fewest potential drug interactions is optimal. Affordability is another important consideration for many patients. Uninsured or underinsured patients may not take their medication regularly if they cannot afford it. Some insured patients will not be able to afford the copays on multi ple medications. Fortunately.

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Approach the parent as a partner. Recognize that many parents present with an agenda or opinion often well informed par ticularly with regard to medication. Describe the course.

And a noncontrast computerized tomography scan or magnetic resonance imaging scan of the brain. Recommended diagnostic strategyfigure. Outlines a general diagnostic strategy for addressing cognitive impairment in primary care. Suspicion is initially raised when the patient appears to not remember well or to be confused during a routine office visit.

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But can complement upper endoscopybiopsy findings. Abdominal ct scan for staging and to detect presence of metastases. Fobte. Treatment surgical resection with wide cm margins total or subtotal gastrectomy withextended lymph node dissection. Chemotherapy may be appropriate in some cases. Figure a an ap supine film of small bowel obstruction shows prominent valvulae conniventes. Air is confined to the small bowel, and heart disease is actually one of the less common causes of chest pain in the primary care setting. The general approach to the patient with chest pain is rapid assessment and treatment of possible life threatening conditions if present.

Only will report com plete resolution of their fatigue. Patients who experience intensification of their symptoms lasting more than hours after physical exertion have the worst prognosis. Although physicians often dispense medication or recommend tests.

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Supplemented by care models for frail older adultsstrength ofmodel name description features outcomes recommendationprogram of all inclusive care for the elderly pace combines fundingfrom acute and long term insur ance sourcesmedicare and medicaid for nursing homeeligible patientsextensive use of adult day care, the woman should be referred to a sur geon rather than told to return for reexamination. Laboratory teststhe first step in evaluating a breast mass.

Which consists of oral rifampin for days. The meningococcal vaccine is effective against serotypesanswerspage answers l a and c.

She was under increased stress dealing with the loss of her mother to a heart attack. During the funeral she complained of severe back pain.

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Cbc. E. Treatment nonpharmacologic therapya. Diet adequate calorie intake, neulasta. See peg lgrastim neupogen. See filgrastim neural.

Above the biologic laws that govern the animal kingdom. I have already acknowledged that we do not fully understand the cognitive or upper brain. It is perfectly true that a deep psychologic trauma such as child abuse will remain in memory in perpetuum. This memory becomes an internal stress factor which is a trigger to abnormal retaliatory behavior. But in my view.

With to of women experiencing good relief. The weight of evidence regarding phytoestrogens is that they are not effective therapy. Alternatives to estro gen for treatment of hot flashes include gabapentin, or magnetic resonance imaging is used to evaluate pid in women who have an adnexal mass on palpa tion.

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Response to treatment, with ongoing monitoring and support over time. Key points one third of patients presenting to a family physiciansoffice complain of fatigue. There are four general categories of fatigue physiologic tiredness relieved by rest secondary fatigue associated with illness chronic fatigue unrelated to illness and lasting more than months and fatigue in the elderly. Patients suffering fatigue commonly present with somatic complaints because physicians express greater comfort treating physical symptoms. All patients complaining of fatigue should be screened fordepression. Physical fitness.

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Viagra protects the heart: back to the future for the love pills

New researchpublished today in BMC Medicineshows that Viagra could be used as a safe treatment for heart disease. In this guest post, lead author on the paper, Andrea M. Isidori of Department of Experimental Medicine at Sapienza University of Rome, tells us more about the background to this research and what they found out.

Everybody’s heard of Viagra (sildenafil). It was the first phosphodiesterase type 5 inhibitor (PDE5i) marketed for the treatment of erectile dysfunction. But few people are aware of the other beneficial effects and potential new uses for this class of drugs.

Viagra was originally tested for heart problems – angina pectoris, a chest pain associated with coronary heart disease – on the basis of its vasodilatory effects (in other words it widens the blood vessels). Its results as an anti-angina drug were only modest, but patients reported the unexpected “side effect” of improved erections. The focus of interest in this drug shifted rapidly from the heart to the bedroom.

In the first decade (1998-2008) after its approval, Viagra revolutionized the sex lives of millions and became one of the most commercially successful drugs in the world, with over 1.8 billion pills used by about 35 million people. The number is still growing.

However, the success of the blue pill was accompanied by isolated early reports of cardiovascular events and sudden deaths. Nonetheless, subsequent large surveillance studies merging data from placebo-controlled clinical trials, the prospective observational cohort study and the International Men’s Health Study (IMHS) demonstrated that myocardial infarction and all-cause mortality rates for Viagra were similar to placebo, suggesting that its use was not associated with any greater risk.

So how can we explain the early reports of cardiovascular side effects?

Mainly through its incorrect use alongside nitro compounds (NO-donors). This can produce an acute drop in blood pressure that, combined with the increased oxygen required during sex, can be detrimental in men with heart disease.

Clearly, this is the result of a series of conditions occurring simultaneously. When Viagra is taken correctly, it is no longer a concern. Nevertheless, in the mind of the public, use of the “love pill” was at this time invariably considered dangerous for patients with heart disease.

Now is the time to change public opinion on this type of drug

Today, these drugs can be taken daily to treat other conditions: pulmonary arterial hypertension and lower urinary tract symptoms, for example.

Interest in continuously administered PDE5is is growing in several areas, such as andrology and urology, for rehabilitation of erectile function, relief of the symptoms of benign prostatic hyperplasia and treatment of some bladder disorders; respiratory medicine, for its effects on pulmonary hemodynamics; neurology, to protect the brain against ischemic injury; and rheumatology, for the treatment of Raynaud’s phenomenon .

What about cardiology?

Several animal studies have shown that Viagra attenuates cardiac remodeling, with an anti-hypertrophic and anti-fibrotic effect, and protects the heart against different types of injury.

Some small clinical trials have demonstrated that chronic PDE5 inhibition improves cardiac performance and geometry in various clinical conditions, including heart failure, myocardial infarction and diabetic cardiomyopathy.

In the last sixteen years pre-clinical and clinical research into the extra-urological effects of PDE5i has expanded dramatically, revealing previously unsuspected indications for these drugs. Once more, the blue pill could change the quality of life of millions of people.

Andrea M. Isidori

Our meta-analytic research just published in BMC Medicine originated to clarify some controversies emerging from the available human studies. We wanted to analyze if chronic PDE5i administration was cardioprotective and safe, and, if so, where the benefits were mainly seen: cardiac muscle, peripheral vessels, or both.

We showed that continuous administration of Viagra improves cardiac performance and has an anti-remodeling effect without a major impact on vascular parameters, suggesting that it does indeed have a direct effect on the heart.

The novelty of this meta-analysis is the identification of subgroups of patients that may benefit more from PDE5i: patients with cardiac hypertrophy and heart failure, and patients developing a maladaptive remodeling to different injuries, in which the cardiac pump no longer works well.

Our study is the first to show in a large patient cohort that chronic PDE5i administration improves cardiac output and decreases heart rate.This could result in longer survival, increased exercise tolerance and a better quality of life. Surprisingly, the magnitude of effects was similar to that seen with the drugs currently used to treat these clinical conditions, and was obtained in a relatively brief period (3 to 12 months).

Most strikingly, we found that PDE5is are among the very few drugs that are able to improve diastolic relaxation, thus helping the correct refilling of the ventricle after each contraction, a nearly unique feature in drugs used in cardiology, and with incredible potential for future development in the prevention of heart failure.

We also demonstrated their high tolerability and safety in a population that included elderly patients with various stages of cardiac disease and numerous comorbidities who were taking multiple pharmacological treatments. This setting resembles what we normally see in real life, supporting that daily administration is safe and involves no increase in the risk of adverse events compared to on-demand use.

It is now time for a large multicenter study of the effects of PDE5is on cardiac architecture, taking into account the evidence emerging from this meta-analysis. This publication sets the scene for a change in general opinion on PDE5is.

Love pills go back to the future: sex goes back to the heart.

Topics:

Viagra May Treat Other Ailments

From the WebMD Archives

Nov. 7, 2005 – The drug made famous for its treatment of erectile dysfunction appears to have another therapeutic use.

A study in the journal Circulation suggests Viagra could help treat a circulatory disorder called Raynaud’s phenomenon. which affects about 5% of the population. Raynaud’s phenomenon can be associated with other diseases such as lupus .

Raynaud’s phenomenon causes episodes of numbness, tingling, and pain in the fingers and toes, as well as skin sores or gangrene in severe cases. The attacks are spawned by spasms in small blood vessels in response to cold temperatures or emotional stress.

These spasms cause blood vessels to constrict and compromise blood flow to distal areas such as toes and fingers. The disorder is sometimes treated with medications to relax the blood vessels, but this is not always successful.

The Viagra study involved 18 patients (mostly women) whose Raynaud’s symptoms were not responsive to conventional therapies. While taking Viagra twice a day for four weeks, the patients experienced improved blood flow in the capillaries and fewer Raynaud’s attacks. Symptoms improved and the duration of attacks was also shorter. In those who had skin sores, the ulcers began to heal visibly.

These effects did not occur while patients were taking a placebo. At the end of the study, 16 of the participants asked to continue taking Viagra off-label (that is, for a purpose other than its FDA-approved use).

Viagra causes blood vessels to dilate in a different way from other vasodilating drugs, which may explain why it helped Raynaud’s patients who didn’t respond to standard treatments. The researchers conclude that drugs like Viagra could offer “a promising new approach in patients with microcirculatory disorders.”

Although Viagra has risk for serious side effects such as heart attack. stroke. and vision loss. none of the study participants reported any such adverse effect. The side effects reported by study participants included headache. muscle pain. flushing, mild nausea. dizziness. and nasal congestion.

One of the researchers has served as a consultant and speaker for Viagra’s manufacturer, Pfizer. Pfizer is a WebMD sponsor.

WebMD Health News Reviewed by Louise Chang, MD on November 07, 2005

Sources

SOURCES: Fries, Roland. Circulation. 2005; vol. 112. News release, American Heart Association. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

В© 2005 WebMD, Inc. All rights reserved.

Viagra Safe for Some Men With Heart Failure

From the WebMD Archives

March 9, 2004 — Men with mild to moderate forms of heart failure may be able to safely use the drug Viagra to treat erectile dysfunction. a new study shows.

Researchers found selected men with heart failure were able to use the drug without dangerous side effects if they were not taking nitrates (drugs commonly used to treat heart failure) and had no evidence of a lack of blood flow and oxygen to the heart muscle — commonly caused by narrowed heart arteries .

Previous reports have shown that Viagra could trigger potentially dangerous drops in blood pressure in these men. But this study showed that although the drug caused a slight reduction in blood pressure in this group of 35 men, no one experienced a dangerous drop in blood pressure or other significant side effects while taking Viagra.

However, Viagra can cause significant decreases in blood pressure in people taking nitrates and should not be taken by this group.

According to researchers, erectile dysfunction affects more than half of all men aged 40 to 70 and is common among men with heart failure, both are conditions that are linked to vascular problems. Heart failure is a condition in which the heart is unable to pump enough blood to meet the body’s needs.

Despite the fact that ED is common among men with heart failure, researchers say the effectiveness and safety of treatment of erectile dysfunction has not been thoroughly studied.

Study Clears Some Viagra Fears

Researchers say initial reports of deaths associated with Viagra use soon after the drug was released have caused physicians to hesitate before prescribing the drug to patients with significant heart disease .

However, it is now known that the drug does not increase heart-related deaths, say researcher Linda J. Webster, MScN, of the University of Alberta, and colleagues.

In this study, researchers looked at the effects of treating ED with Viagra in a carefully selected group of 35 men with mild to moderate heart failure who did not use nitates. The men were randomly divided into two groups: one took Viagra for six weeks and then switched to a placebo for six weeks, and the other took a placebo for six weeks and then took Viagra for another six weeks.

Continued

The results appear in the March 8 issue of the Archives of Internal Medicine .

The study showed that Viagra caused an average drop in blood pressure of about 6 mm Hg — an insignificant drop that did not lead to symptoms.

Researchers found Viagra improved ED and quality of life among this group, and also appeared to reduce symptoms of depression .

“This study provides new evidence that it is safe and effective to treat men with ED and moderate heart failure with sildenafil,” they write.

WebMD Health News Reviewed by Brunilda Nazario, MD on March 09, 2004

Sources

SOURCE: Webster, L. Archives of Internal Medicine, March 8, 2004; vol 164: pp 524-520.

В© 2004 WebMD, Inc. All rights Reserved.

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