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Comparison of Viagra, Levitra and Cialis

Male sexual dysfunction is one of the most common health problems affecting men and is more common with increasing age. Chronic ED affects about 5% of men in their 40s and 15пїЅ25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.

In around 95% of the cases, a satisfactory treatment can be found. Erectile dysfunction is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for erectile dysfunction.

Three PDE-5 inhibitors

Currently, there are three oral medications approved by the FDA for the treatment of erectile dysfunction: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). They block the enzyme phosphodiesterase type 5 (PDE-5) and belong to a class called phosphodiesterase (PDE) inhibitors.

Since introduction of the first PDE-5 inhibitor Viagra, there has been a fundamental change in the treatment of erectile dysfunction. Although there are a number of options available for non-surgical treatment, it is clear that oral therapy has revolutionized the treatment approach to patients with erectile dysfunction. The development of the PDE-5 inhibitors Levitra and Cialis prompts the question of whether and how these sexual medications differ in terms of their efficacy and adverse effects.

Viagra was the first and is probably the most famous of the three PDE-5 inhibitors used to treat erectile dysfunction. Viagra was approved for erectile dysfunction in March 27, 1998. Viagra is manufactured by Pfizer, Inc.

Levitra was the second PDE-5 inhibitor to come to market in the United States, and it was approved by the FDA in August 19, 2003. Levitra is manufactured by Bayer Pharmaceuticals Corporation.

Cialis was the third PDE-5 inhibitor to come to market in the United States and was approved by the FDA at the end of November 21, 2003. Cialis is manufactured by Lilly ICOS LLC.

The major advantage of these medications for sexual enhancement is that they do not cause an erection at inappropriate times, because they act only in response to sexual stimulation. If there is no sexual stimulation drug remains in the background. All three are taken orally prior to planned sexual activity, acting to increase blood flow in the penis in response to sexual stimulation. However, there are important differences between the three, differences that could influence safety, specificity, duration of action, adverse effects, and ultimately, public acceptance within this class.

back pain, muscle aches, nasal congestion, facial flushing, dizziness

Mechanism of action

Sildenafil, vardenafil, and tadalafil do not directly cause an erection of the penis, but they alter the body’s response to sexual stimulation by enhancing the effect of the nitric oxide, a chemical that is normally released during stimulation. Nitric oxide causes relaxation of the muscles in the penis, which allows for better blood flow to the penile area.

All PDE-5 inhibitors have demonstrated excellent efficacy in general and in specific populations (eg, men with diabetes mellitus or those who have undergone radical prostatectomy). Viagra, at 84%, is slightly more effective than Levitra at 80% and Cialis at 81%.

Viagra and Levitra differ only minimally in terms of their structure, while Cialis differs markedly from Viagra and Levitra in terms of its molecular structure, which is also reflected in pharmacokinetic differences.

  • Viagra. 25 mg, 50 mg 100 mg tablets
    • Onset of action. 30 minutes (effect delayed if taken with food)
    • Duration of action. 4 to 5 hours
  • Levitra. 2.5 mg, 5 mg, 10 mg, 20 mg tablets
    • Onset of action. 25 minutes (effect delayed by fatty meal)
    • Duration of action. 4 to 5 hours
  • Cialis. 5 mg, 10 mg, 20 mg tablets
    • Onset of action. 16-45 minutes (effect NOT delayed by food)
    • Duration of action. 36 hours

Viagra does not work as well as it would otherwise if you eat a high-fat meal around the time you take it. Viagra should be taken on an empty stomach. Levitra may be slightly less effective if you eat a high-fat meal, but a moderate-fat meal does not reduce its effectiveness. Cialis works without regard to what you eat.

Viagra and Levitra have similar half-lives, and onset and duration of action. Cialis has a slower onset of action and longer duration of action, which is attributed to its longer half-life.

Men who wish for spontaneity may opt for Cialis, which may allow for successful intercourse up to 36 hours postdose, even though it takes longer to reach peak effect. The considerably longer duration of effect for Cialis will likely allow less frequent dosing and greater impulsiveness between partners, but also could potentially prolong adverse effects.

PDE-5 inhibitors are primarily excreted via the fecal route with varying percentages eliminated renally.

The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient.

The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for men who take other medicines or have conditions that may decrease the body’s ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE-5 inhibitors should be used more than once a day.

Most common side effects:

  • Viagra. headache, epistaxis, flushing, indigestion, dizziness, nasal congestion, abnormal vision
  • Levitra. headache, flushing, indigestion, nausea, dizziness, nasal congestion
  • Cialis. headache, indigestion, back pain

PDE-5 inhibitors are generally well tolerated. Side effects include headache, flushing, dyspepsia, and nasal congestion.

Visual abnormalities are encountered with Viagra, but are less likely with Levitra and unlikely with Cialis. Flushing and dyspepsia that are associated with Viagra and Levitra are less common with Cialis. Back pain and muscle aches (myalgia) may occur with Cialis, but are unusual with either Viagra or Levitra. Side effects of Cialis tend to last longer, but are less marked than with the other drugs.

Precautions and contraindications

All PDE-5 inhibitors are absolutely contraindicated in persons who take organic nitrates, because they induce vasodilation.

The FDA no longer considers concomitant use of alpha-blockers a contraindication to use of PDE-5 inhibitors. However, persons on alpha-blockers must be on a stable dose of alpha-blocker prior to using a PDE-5 inhibitor.

Since both Viagra and Levitra have moderate vasodilatory and hypotensive effects, they should not be given in the presence of marked arterial or orthostatic hypotension, and should only be administered with caution in aortic stenosis or hypertrophic obstructive cardiomyopathy.

Men who have had a heart attack or stroke within the past 6 months and those with certain medical conditions (e.g. uncontrolled high blood pressure, severe low blood pressure or liver disease, unstable angina) that make sexual activity inadvisable should not take Cialis. Dosages of the drug should be limited in patients with kidney or liver disorders.

The differences between the 3 drugs are not great. All appear to be effective and safe. Levitra has less side effects compared to Viagra and lasts about the same time as Viagra in the body. Cialis has few side effects and lasts longer in the body to increase spontaneity than either Levitra or Viagra and there is no reduction in absorption when Cialis is taken with food. However, the longer half-life imposes increased risk for drug interactions.

  • 1. The Merck Manual of Medical Information. Mark H. Beers et al. eds. 2nd Home Edition. Whitehouse Station, NJ: Merck; 2003.
  • 2. Doggrell SA. Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction. Expert Opin Pharmacother. 2005 Jan;6(1):75-84.
  • 3. Viagra Prescribing Information PDF
  • 4. Levitra Prescribing Information PDF
  • 5. Cialis Prescribing Information PDF

Published: May 05, 2007
Last updated: March 24, 2016

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Viagra is one of the best-known drugs of all time. Nearly every adult in America has heard of the drug and can tell you what it does.

In the years since it was introduced in 1998, former Republican presidential nominee Bob Dole has served as a spokesman for the drug, manufacture of counterfeit pills has gone through the roof, and Viagra jokes are now a permanent feature of the pop culture landscape.

Related Articles

What’s the big deal about "the little blue pill"?

It’s simple: When it works as intended, Viagra causes a man who is sexually stimulated to get an erection.

How does Viagra do that? And why does Viagra work only if the man is sexually stimulated? For that matter, what causes an erection in the first place? In this article, we’ll answer all of those questions and more.

This is a fascinating story — it involves the technology of the human body and the techniques that scientists use to control its different parts with drugs. And in the case of Viagra, the story starts with the penis.

Print |
<a data-track-gtm="Byline" href="about-author.htm#brain"> Marshall Brain </a> &amp; <a data-track-gtm="Byline" href="about-author.htm#lambert"> Katie Lambert </a> "How Viagra Works" 8 November 2004.<br />HowStuffWorks.com. &lt;http://science.howstuffworks.com/viagra.htm&gt; 26 September 2016″ href=”#”>Citation & Date

I take 50mg 15 minutes before love making, and now I can spend hours with foreplay and not worry if I’m gonna go soft or lose interest.

It takes effect in 15 minutes on the average and out love-making session goes for over an hour every time. – Age 65, Florida

I could feel my penis get erect within 15 minutes, getting harder than usual and lasting longer too – YT, Age 45, Nigeria

The effects last 3 or 4 hours, and it takes 30 to 45 minutes to kick in. – Art, Age 62, Texas

It worked faster than a 1/2 hour and I had the first complete sexual experience in over 6 YEARS! William, Age 42, Texas

It begins to work in about 15 minutes to a half an hour and lasts for 3 hours or so

I find that 25 mg two hours prior to sex is best for me, and allows sensitivity, to remain at its peak. – Phil, Age 60, California

The first time I took it, my wife and I had already made love that afternoon. Viagra worked well in producing another HARD erection for us that night. The next time I tried it was an hour before bedtime. This produced even greater results. – JimmyB, Age 45

I’ve found I need to take it at least 30 minutes before sex. Not only is my erection harder, but the quantity of my orgasm and the force of it is greatly increased by Viagra

I take it about an hour before making love (which for us is usually mid afternoon.)

The doctor told me when he prescribed it that the first time I tried some it would take a little while to work, like almost an hour, and to be patient. So I took it, and set back to wait. I was surprised to find out that I didn’t have to wait near that long. I was ready to go in fifteen minutes, and went a little longer than she wanted me to go.

But 30 mins after taking a 50mg dose of Viagra (with no side effects other than a very mild headache), then – boing. – my penis is as stiff as it used to be when I was 15! – Richard, Age 53, UK

I started with 50 mg (good to rev my engine, I think) but ultimately found that 25 mg about 90 minutes before sex is ideal for me.

I had a rock hard erection about a half hour after taking the pill. – Age 37. Utah

Viagra (sildenafil) facts

What is Viagra?

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

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

How does Viagra work?

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

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

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

Is Viagra effective?

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

How does it affect blood pressure?

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

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

If I have a heart condition can I take it?

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

Can women take it?

Viagra is not currently licensed for use by women.

How quickly does it work?

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

Why are there different doses?

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

What dose is right for me?

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

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

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

What are the side-effects?

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

Does it interact with other medicines?

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

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

Who shouldn’t use it?

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

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

Does it treat the underlying causes of impotence?

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

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

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

What other impotence treatments are available?

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

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

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

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

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Interactions

CGMP Specific PDE Type-5 Inhibitors/Nitrates

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Severe. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, the effects of your nitrate medicine may increase.

What might happen:

Your blood pressure may decrease and cause weakness, fatigue, dizziness, loss of consciousness. You may also experience a heart attack or stroke.

What you should do about this interaction:

Contact your healthcare professionals (e.g. doctor or pharmacist) right away about taking these two medicines together. They may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

References:

1.Stendra (avanafil) US prescribing information. Vivus, Inc. September, 2015.

2.Viagra (sildenafil) US prescribing information. Pfizer Inc. September, 2015.

3.Cialis (tadalafil) UK summary of product characteristics. Eli Lilly and Company Limited September 16, 2008.

4.Cialis (tadalafil) US prescribing information. Eli Lilly and Company April, 2016.

5.Levitra (vardenafil hydrochloride trihydrate) UK summary of product characteristics. Bayer plc December 20, 2006.

6.Levitra (vardenafil hydrochloride) US prescribing information. Bayer Pharmaceuticals Corporation September, 2015.

7.Levitra (vardenafil hydrochloride) Canadian prescribing information. Bayer, Inc. October 24, 2006.

8.Ikorel (nicorandil) Australian prescribing information. Aventis Pharma August 13, 2003.

9.Imdur (isosorbide mononitrate) US prescribing information. Key Pharmaceuticals, Inc. July, 2002.

10.Nitrostat (nitroglycerin) US prescribing information. Pfizer March, 2014.

Viagra is a vasodilator. as the smooth muscle relaxes and the blood vessel dilates, this promotes influx of blood flow to the penis causing an erection. Since it is a vasodilator it can cause hypotension or low blood pressure. For those who have heart problem and is taking nitrates for anginal pain, nitrates is a vasodilator itself. It relaxes the smooth muscle of the arteries causing good blood flow to the heart. An adequate blood flow to the heart will relieve the anginal or ischemic pain. For this reason taking 2 vasodilators together can cause severe hypotension, this may lead to shock and eventually death if not treated immediately.

Individuals who have angina are usually advised to take their nitrates prior to a vigorous activity or any activity that may cause angina pain. This could be the reason why most males take nitrates prior to sex but at the same time take viagra as well, not knowing the synergistic effect of both. Recently I saw an advertisement about pros-T-vac. It is a gadget used to enhance erection. This can be a promising alternative for men with heart problem.

Viagra is not only used for erectile dysfunction but it is now being prescribed for pulmonary hypertension. For this reason female population are not excluded. It is therefore important during an emergency to let the doctor knew that you are taking prescription viagra especially if you are having chestpain.

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The information in this Medicines for Cardiovascular Disease section has been taken from a number of sources. It is meant to give you information about certain medicines, but it does not cover all of the possible uses, warnings, side effects, or interactions with other medicines and vitamin or herbal supplements. This information should not be used as medical advice for individual problems. Please talk to your doctor and/or your pharmacist for prescription instructions.

Why do I need to take nitrates?

Nitrates are used to treat the chest pain associated with angina and to ease the symptoms of congestive heart failure (CHF) .

How do nitrates work?

Nitrates are a vasodilator . Vasodilators widen (dilate) the blood vessels, improving blood flow and allowing more oxygen-rich blood to reach the heart muscle. Nitrates also relax the veins to ease the workload on the heart when blood is returning to the heart from the arms and legs.

How much do I take?

Nitrates come in different forms. Depending on the form you are taking, nitrates can be used to prevent an angina attack, limit the number of attacks that you have, or relieve the pain of a current attack.

  • Pill forms include oral (swallowed with liquid), chewable (chewed and held in the mouth before swallowing), sublingual (dissolved under the tongue), or buccal (held under the lip or in the cheek until they dissolve).
  • The topical (ointment) or transdermal (stick-on patch) forms send nitrates through the skin.
  • The translingual (spray) form is sprayed on or under the tongue.

The amount of medicine that you need to take may vary. Talk to your doctor or pharmacist for more information about how and when to take this medicine.

What if I am taking other medicines?

Other medicines that you may be taking can increase or decrease the effect of nitrates. These effects are called an interaction . Be sure to tell your doctor about every medicine and vitamin or herbal supplement that you are taking, so he or she can make you aware of any interactions.

The following are categories of medicines that can increase or decrease the effects of nitrates. Because there are so many kinds of medicines within each category, not every type of medicine is listed by name. Tell your doctor about every medicine that you are taking, even if it is not listed below.

  • Viagra (sildenafil), Levitra (vardenafil), or Cialis (tadalafil). Do not take Viagra, Levitra, or Cialis within 24 hours of taking nitrates . When these erectile dysfunction medicines are mixed with nitrates, the combination can lower your blood pressure and make you dizzy, lightheaded, or faint. In some cases, patients have died after mixing erectile dysfunction medicines with nitrates.
  • Medicines to treat high blood pressure
  • Certain heart medicines
  • Over-the-counter cough, cold, and flu medicines
  • Over-the-counter herbal supplements for treating cough, cold, and flu

While taking nitrates, you should avoid smoking. Smoking can decrease the effect of the medicine. You should also avoid alcohol, because it can increase the effect of the medicine.

What else should I tell my doctor?

Talk to your doctor about your medical history before you start taking nitrates. The risks of taking the medicine need to be weighed against the good it will do. Here are some things to consider if you and your doctor are deciding whether you should take a nitrate.

  • You are thinking of becoming pregnant, you are pregnant, or you are breast-feeding your baby.
  • You are over 60. Dizziness is more common in older patients.
  • You have recently had a stroke.
  • You have recently had a heart attack.
  • You have kidney or liver disease.
  • You have an overactive thyroid.
  • You often have severe headaches.
  • You have anemia.
  • You have glaucoma.

What are the side effects?

Sometimes a medicine causes unwanted effects. These are called side effects . Not all of the side effects for nitrates are listed here. If you feel these or any other effects, you should check with your doctor.

Common side effects:

  • Dizziness
  • Headaches
  • Flushing of your face and neck
  • Upset stomach or throwing up
  • Low blood pressure (hypotension)
  • Irregular heart rhythms (arrhythmia)

Less common side effects:

Rare side effects:

  • Dry mouth
  • Skin rash and peeling
  • Blurry vision

Again, tell your doctor right away if you have any of these side effects. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine without checking with your doctor, it can make your condition worse.

See on other sites:

Safemedication.com
A consumer-based site by the American Society of Health-System Pharmacists that provides information about all types of medicines as well as safety tips for their proper use. The site’s search feature lets users search medicines by the brand or generic name.

Updated July 2015

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New Viagra: Can Cholesterol-Lowering Statins Beat Erectile Dysfunction?

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Research has showed statins may increase erectile function by half as much as Viagra

Statins, the popular cholesterol-lowing drugs, may help men with erectile dysfunction.

Scientists at the Rutgers Robert Wood Johnson Medical School have led the first meta-analysis of previous studies on the link between erectile dysfunction and the drugs.

Led by Dr John Kostis, the team analysed 11 trials to find a significant effect of statins on erectile function in men who had both high cholesterol and erectile dysfunction. The results showed their erectile function scores increased.

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Kostis said: “The increase in erectile function scores with statins was approximately one-third to one-half of what has been reported with drugs like Viagra, Cialis or Levitra.”

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The University of Adelaide has also carried out a study on erectile dysfunction. Its results showed that the effects could be reversed through lifestyle changes.

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Why should Viagra concern women? When women go through menopause, the hormonal changes they experience often lead to a drop in libido and less interest in sex. It's nature taking its course – just another phase in the female life cycle. It's the way we're built and programmed, biologically speaking.

So what do we do about Viagra and the other ED (erectile dysfunction) drugs that are now commonplace and marketed directly to men in TV commercials and magazine ads?

Continue Reading Below

It's an important question to ponder, because as every woman knows, it takes two to tango. Viagra's impact on men's sex lives also impacts women's sex lives.

Meika Loe has pondered this very question in her book, The Rise of Viagra: How the Little Blue Pill Changed Sex in America. And the answers she's uncovered are disturbing. Loe, who is Assistant Professor of Sociology & Anthropology and Women's Studies at Colgate University, has also written extensively about sex and senior women.

Loe spoke to About.com about Viagra (marketed by Pfizer) and how women's sexuality has been affected by the introduction of these ED drugs.

Viagra is marketed to aging men whose female counterparts are going through their own sexual crisis – menopause. These women want less sex but their partners now want more.

Isn't this counter-intuitive? Doesn't this turn the bedroom into a battlefield at a time when women are already vulnerable (e.g. empty nest syndrome. feeling less attractive as we age, physical changes due to menopause including hair loss and weight gain, etc.)

I recently visited my ob/gyn, and upon hearing about my research, she volunteered that many of her women patients have complained that Viagra has not helped their sex lives .

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The introduction of the pill has made sexuality, among other things, intercourse-focused and thus less satisfying.

I hear this kind of thing over and over. My analysis of syndicated advice columns after Viagra's debut in 1998 revealed many negative responses among women. Women writing to Dear Abby. for example, were either no longer interested in sex (and thus Viagra created new unwelcome pressure to be sexually active again), or fearing their husbands were having affairs in the context of their newfound sexual potency, and/or experiencing sometimes painful physiological effects of reigniting their sex lives later in life.

It seems that Viagra raised quite a few questions for married women about marital obligation, for example. Then again, there were other letters that reflected excitement about husbands feeling healthy and confident after a period of impotence, so the response to Viagra in the population is quite complex.

I would have liked to see an explosion of people communicating about sexuality after Viagra's release, but in our pill-for-everything culture, we tend to let the pill do the work and forget that it may not be an end-all be-all. Viagra tended to just exacerbate or throw light on already existing problems in relationships.

It should be telling that at this point, almost 10 years after Viagra's debut, only 50% of men who received prescriptions for Viagra end up refilling their prescriptions.

It's not simply about a man being able to have pleasurable sex. It's also about power and dominance, virility despite aging. It's a way for men to deny that they are past their sexual peak. What are the long-term implications for a society that has Viagra in its drug arsenal?

Viagra was the harbinger of things to come in the form of the pharmacology of aging and sexuality (sexual medicine is in expansion mode post-Viagra).

All of this is due to a combination of, among other things, changing demographics (e.g. aging population), direct to consumer advertising/ consumer-based medicine (Viagra being one of the first drugs to be advertised directly to the consumer) and pharmaceutical expansion.

It is important to see that Viagra's popularity fits in a particular cultural moment in our history, and there will be/have been plenty of other products to follow (including medications ) that emphasize the holy triumvirate: youth, vitality, and performance.

In short, as a sociologist I see Viagra as a cultural product and thus a window onto our culture. It helps us see where we are when it comes to sexuality (and our ambivalence), gender (masculinity and sexual performance packaged together), medicine (quick-fix and lifestyle enhancement emphasis more than ever), and aging (we’re uncomfortable with it but do we all want to be 18 again?).

Pfizer has helped to reinforce these traditional and not-so-traditional ideals with Viagra and it has been fascinating to see how successful they have been here and around the world with this youth, vitality, and performance-based message.

Again, now that the initial curiosity factor has disappeared, it is unclear how successful sexual dysfunction medication really is. Viagra has spurred several like products – Cialis and Levitra. But the refill rate on all three is low.

Viagra is certainly sociologically significant as it has highlighted many social problems in the way we do health and gender and sexuality in our society.

Is Viagra use common within the general population – men of all ages? How does this affect behavior or alter men and women's sexual intimacy?

It is difficult to find demographic information about who uses Viagra, but in Internet chatrooms, doctors' offices, pharmacies, etc. you find men of all ages interested in discussing the drug.

I spoke with young men who had purchased Viagra out of insecurity – a 'just in case' situation where they felt they had to live up to some social standard their first time and had purchased the pills (or borrowed them) to have some assurance of adequate performance.

I also spoke with men in their 80s who felt like it gave them 'life' again.

Viagra for Her

From the WebMD Archives

July 22, 2008 — Viagra, often prescribed to help men’s erectile dysfunction. also helps women who experience sexual problems from antidepressant use, according to a new study.

Sexual dysfunction is a well-known side effect of some antidepressants. with up to 70% of men and women on antidepressants reporting sexual problems. It’s a major reason depressed patients stop taking their medication. according to H. George Nurnberg, MD, the study’s lead author and a professor at the University of New Mexico School of Medicine in Albuquerque. The study is published in TheJournal of the American Medical Association.

In the study, Nurnberg and his colleagues found that when women being treated with an antidepressant were given Viagra, they were more likely to have orgasms than those on the placebo .

”Seventy-two percent of the women on Viagra vs. 27% of the women on placebo got to ‘much improved’ or ‘very much improved’ on a scale [of sexual functioning],” says Harry A. Croft, MD, medical director of the San Antonio Psychiatric Research Center in Texas and a co-author on the study.

”What Viagra did was increase the orgasm and the time to orgasm,” says Croft, noting that orgasm difficulties are common in women on antidepressants. The Viagra also improved the satisfaction of the partner, he says. But ”it didn’t increase drive and desire.”

The findings are no surprise to Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego and editor-in-chief of The Journal of Sexual Medicine. “I actually prescribe a lot of Viagra for women,” says Goldstein, who reviewed the study for WebMD.

Viagra for Her: Study Details

The researchers evaluated 98 women on antidepressants, average age 37 and all premenopausal, assigning half to the Viagra group and half to the placebo group for the eight-week study. Viagra doses started at 50 milligrams a day, taken one or two hours before expected sexual activity, and could be increased to 100 milligrams. No one knew which pill they were taking.

On average, the women had been taking antidepressants for two years and had suffered sexual problems for at least four weeks.

Continued

The study was conducted at seven U.S. research centers between September 2003 and January 2007.

Because sexual problems are a prime reason patients give for stopping the antidepressants, experts think it is important to find a way to relieve the sexual problems.

Before starting the study, the women reported a variety of sexual problems, including lack of libido. difficulty becoming aroused or becoming lubricated, lack of orgasm, or delay in achieving orgasm.

Viagra for Her: Study Results

Researchers used standard measures to evaluate sexual functioning and had the women keep a sexual activity log. They also assessed hormone levels.

When Nurnberg’s team looked at overall sexual functioning, they found that 73% of the women on placebo had no improvement in sexual functioning but only 28% of the women taking Viagra reported no improvement.

When they looked at the individual measures, they found women treated with Viagra were significantly more likely to reach orgasm than those in the placebo group. When they looked at the individual measures, such as desire or lubrication, they did not find significant differences.

There was a significant difference, Croft says, in the partner’s satisfaction.

The higher a woman’s testosterone levels, the researchers also found, the more likely a positive treatment response occurred, regardless of group assignment.

The women reported some side effects, with the most common being headache. reported by 43% of the women on Viagra and 27% of those on placebo. Transient vision disturbances were reported by 14% of those on Viagra and 2% of those on placebo. No one dropped out of the study because of their side effects. In those women who continued their dose of antidepressants, their depression didn’t worsen during the study, regardless of their group assignment.

The study was supported by an independent grant from Pfizer, which makes Viagra. The grant was initiated by the researchers and the pharmaceutical company had no other role in the study, the researchers say.

The study, Croft says, ”is the first and only double-blind, randomized trial that shows it works for this.” Viagra, he notes, is not approved by the FDA for use in women, so the use is ”off-label” and not typically covered by insurance .

Continued

Viagra for Her: Second Opinion

Evaluating a woman’s hormone levels before prescribing Viagra for sexual problems is important, says Goldstein, who is also a clinical professor of surgery at the University of California, San Diego. Normal testosterone levels, he says, are crucial for the successful effect of the drug.

“What Viagra does in women with normal testosterone [levels] is engorge their clitoris [with blood ], which allows them to have orgasm,” he tells WebMD. “Viagra acts on a man’s penis and a woman’s clitoris.”

The finding that the drug did not affect desire or arousal comes as no surprise, either, he says. “Viagra has never been shown to increase desire in men or in women.”

WebMD Health News Reviewed by Brunilda Nazario, MD on July 22, 2008

Sources

News release, The Journal of the American Medical Association.

Irwin Goldstein, MD, director, sexual medicine, Alvarado Hospital, San Diego; clinical professor of surgery, University of California, San Diego; editor-in-chief, The Journal of Sexual Medicine; director, San Diego Sexual Medicine.

Harry A. Croft, MD, medical director, San Antonio Psychiatric Research Center.

Nurnberg, H. The Journal of the American Medical Association; July 23, 2008; vol 300: pp 395-404.

В© 2008 WebMD, LLC. All rights reserved.

Viagra Improves Sex for Some Women

From the WebMD Archives

Jan. 7, 2004 — Viagra can do wonders for men. But a new study shows it also improves sex for some postmenopausal women.

The findings come from a research team led by sexual-function gurus Jennifer R. Berman, MD, and Laura A. Berman, PhD. The placebo -controlled study, funded by Viagra maker Pfizer Inc. evaluated 202 postmenopausal women diagnosed with female sexual arousal disorder (FSAD). This disorder is defined as distress from an inability to attain or maintain sexual excitement.

Half the women were treated with Viagra; the other half got inactive placebo pills. Many of the women who got the placebo reported improved genital sensation. Some even reported more sexual satisfaction. But both of these improvements were much more common among women who took Viagra.

The little blue pill didn’t work for women who, in addition to FSAD, also had something called hypoactive sexual desire disorder or HSDD. While many women with FSAD have difficulties with genital blood flow — suggesting a physical problem that Viagra can help — women with HSDD may be more likely to have an underlying emotional or relationship problem leading to lack of sexual desire.

“Unresolved emotional or relational issues should be addressed before beginning medical therapies,” Berman and colleagues stress. Their report appears in the December 2003 issue of The Journal of Urology.

Viagra, Genital Sensation, and Sexual Satisfaction

Women were included in the study if they were postmenopausal or if they had a hysterectomy. Their ages ranged from 30 to 71 with an average age of about 51.

The Berman team focused on the women’s answers to two questions after taking Viagra or placebo:

  • After taking the study medication. the sensation/feeling in my genital (vagina. labia, clitoris) area during intercourse or stimulation seemed to be: (a) more than before, (b) less than before, or (c) unchanged.
  • After taking the study medication, intercourse and/or foreplay was (a) pleasant and satisfying; better than before taking the study medication; (b) unpleasant; worse than before the study medication; (c) unchanged; no difference; or (d) pleasant but still not like it used to be or I would like it to be.

Continued

Among placebo recipients, 44% reported improvement in the first question and 28% reported improvement in the second question.

Among all Viagra recipients, 57% reported improvement in the first question and 42% reported improvement in the second question.

But among Viagra recipients with sexual arousal disorder who did not have HSDD, the results were more striking: 69% reported improvement in the first question. This group was eight times more likely to report improvement than women without HSDD who got placebo.

Similarly, among Viagra recipients with sexual arousal disorder who did not have HSDD 50% reported improvement in the second question. This group was 11 times more likely to report improvement than non-HSDD women who got placebo.

The authors note that women who respond to Viagra may need to have normal levels of estrogen and testosterone. For many postmenopausal women, that may mean menopausal replacement therapy. In the present study, the women had normal hormone levels or were receiving menopausal replacement therapy.

SOURCE: Berman, J.R. The Journal of Urology. December 2003; vol 170: pp 2333-2338.

WebMD Health News

В© 2004 WebMD, Inc. All rights Reserved.

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Viagra and/or Equivalents

Viagra (sildenafil)

Viagra Description

The drug Sildenafil citrate is sold under the brand name Viagra by the pharmaceutical company Pfizer. Other brand names for the drug are Revatio and both serve the same function. The drug is prescribed in cases of erectile dysfunction and pulmonary arterial hypertension. It is known to be effective in increasing exercise related stamina in both men and women. It has been available in the markets since then. In a clinical trial on 3000 patients, Viagra was found effective for sustaining erection in 60 to 80% of the patients. Viagra has received approval from the Food and Drug Administration of USA in March 1998.

Conditions Treated by Viagra

Viagra is mainly used to treat erectile dysfunction. It is a drug that is administered orally. The pill is a small one and can be easily taken. It needs to be between one and half to four hours before sexual intercourse. Taking the pill one hour before is the ideal time. Viagra is also effective in keeping high blood pressure under control. The drug is effective in both cases because of the mechanism of action. Sildenfil citrate helps to relax muscles and increases blood supply to certain organ. This is why the drug is effective for the above mentioned problems and has also been used by sportsmen for enhancing their performance.

Viagra Dosage Information

a.) Typical Dosage Recommendations

Viagra is available in the form of an oral pill. This tiny, blue pill comes in a diamond shape usually in a packet of four. There are a range of doses available from 25mg to 100mg. In case of erectile dysfunction Viagra needs to be taken a minimum of half an hour to four hours before sexual intercourse. The dose of Viagra for erectile dysfunction is usually 25 mg to 100 mg taken not more than once per day between 30 minutes and 4 hours prior to sexual intercourse.

b.) Missing A Dose

Viagra is not a medicine that is prescribed in a fixed dose format. Since it is linked to sexual performance it needs to be taken only before intercourse. So there are health problems in case of missing a dose.

c.) Overdosing

Excessive consumption of Viagra can pose health problems. If there is overdose, it is important to seek medical help immediately. Usually in such cases the individual will experience dizziness, pain in the chest and uneasiness. There could be nausea and some irregularities in heartbeats.

Viagra Warnings

Viagra can sometimes cause vision related problems. Therefore people who have a history of eye-related problems must exercise caution while taking the drug. Usually patients above 50 years of age are required to take a detailed medical examination before the doctor can prescribe the drug. As is always prescribed, patients must provide their compete medical history before the doctors prescribes the drug. Any pre-existing complications with erection should be reported. Also since Viagra can result in irregular heartbeats, patient need to inform the doctor if they have any history of hart related problems, or problems associated with the kidney or liver.

Viagra Side Effects

Remember that there are some precautions that the patient who takes Viagra must follow. For instance alcohol should not be taken with the drug, as it is more likely to have side effects. Usually Viagra can cause some amount of dizziness. There can also be some problems with urination. In a small minority, there have been vision related problems or even rashes on the skin. It is particularly important that these three problems should be reported as an emergency. There could be other side effects also such as swollen feet, especially around the ankles. At times there could be a change in the sense of hearing or even loss of hearing. These are uncommon though, and if observed, they should be reported soon. Some patients also experience a kind of pain or uneasiness in the chest. Often this pain could extend as far as the arm or one side of the body also. It could often begin as a slight tingling in the chest region, at the time of sexual intercourse. Although it might seem too minor, a doctor must be consulted immediately. Painful erection or one that lasts for too long is also something that needs to be reported to the doctor. Apart from these side effects there are also minor ones. There could be a headache or pain in the back and lumbar region. Some people might also experience a blocked nose or some kind of redness on their face. This could be accompanied by a warm sensation on the neck, chest or face. Some people also face problems related to their memory. None of these side effects should ever be overlooked. It is best to consult a doctor at the right time rather than attempting self-medication or any home remedies. If the patient experiences any of the above suddenly such as losing vision during sexual intercourse of feeling giddy then it must be treated as an emergency.

Drug Interactions With Viagra

Viagra works not only in erectile dysfunction cases but also those, which are related to blood pressure or hypertension. Therefore the drug interactions are likely to be several. It is necessary for patients to inform the doctor about all other medications that they might be taking. This is in order to avoid any interactions between two drugs and the ensuing complications.

Patients who are already taking some nitrate medicines are especially told to avoid taking Viagra. Many of the drugs used for the treatment of tuberculosis such as:

Similarly some drugs prescribed to people with HIV/AIDS can also cause complications. Most of the drugs used for heart disease and blood pressure such as:

This is also why patients with existing hypertension are not prescribed Viagra. Some drugs used in psychiatric conditions such as depression can also interact with Viagra. This includes the drug Nefazodone. Some kinds of antibiotic drugs or drugs used in fungal infections are also known to interact adversely with Viagra.

If you have any questions about buying discount Viagra online or any other prescription products you can contact our team of professional Patient Service Representatives or one of our pharmacists 24-7 by calling 1-800-226-3784.

Notice: The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gray Market Viagra

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

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

Counterfeit Viagra

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

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

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

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

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

How Does Pfizer Deter Counterfeit Viagra?

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

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

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

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

Bottom Line

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

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

Red Flags Regarding Buying Viagra Online:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where does fake Viagra come from?

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

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

How much should it cost?

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

Who does this site recommend?

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

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

No Prescription needed? Welcome To Internet Enabled Telemedicine:

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

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

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

In Closing:

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

Interesting Viagra Pharma Factoids:

When was Viagra discovered?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Viagra Information On The Internet:

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

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

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

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

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

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

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

Viagra mechanism of Action

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

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

The BIG Discovery: cyclic guanosine monophosphate (cGMP)

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

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

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

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

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

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

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

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

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

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

Metabolism, Half Life, Excretion

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

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

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

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

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

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

The maximum recommended dose is one pill per day.

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Welcome

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Que alguien se alegra de los organizadores de la feria, cuando no cumple stomatpoliklinike un mГ©dico y un fontanero en una bata blanca! O perigos de sildenafil cuando se sube a un aviГіn cuyo piloto de repente se vuelve costurera motoristka De alguna manera, incluso crema elecciГіn banal, buscamos que ha sido probado por dermatГіlogos y alergia: miedo de lastimarse a sГ­ mismo. Un pueblo sin una pizca de medobrazovanie, presentes en todo el paГ­s como perigos de sildenafil sanadores. Mientras tanto, algunos de perigos de sildenafil citrate los mГ©todos de los psГ­quicos como una explicaciГіn de por quГ© estos mГ©todos fallan, causando confusiГіn y la risa. no todos viagra perigos de “arena saligenina AsГ­ como una broma: “. Bruja hereditaria Eliminar daГ±os: disparar primero y luego daГ±o” citrato de sildenafil comentГЎrios “El hombre mago creГі su fantasma para confundir a todos los que nos sentimos masculina energГ­a, no femenino” – convenciГі a 29 perigos de sildenafil citrate aГ±os de edad, Sergei Jarkov Kolsnichenko cuando casi nadie uno fue capaz de determinar que se sienta detrГЎs de la pantalla Hope Babkin.

Viagra perigos de ayudaВїquiГ©n

Singer no sГіlo aprende, sino incluso mezclada con Sviatoslav Vakarchuk perigos de viagra! Bielorrusa Inna Galinova tratГі de encontrar los restos del naufragio, estrellГЎndose en el recipiente con agua, los huevos de gallina. CГіmo pollo – ni siquiera aves acuГЎticas! – Pieza de varias toneladas de hierro se asocia con quien habГ­a permanecido en el fondo del Mar Negro durante casi 50 aГ±os, explicar lo psГ­quico, por desgracia, no podГ­a. Y Nina perigos de viagra Shevlyagina Yenakievo ponchГі aГєn mГЎs: un dГ­a dijo que se puso un hechizo!

Jugar enana perigos viagra de paseo v pensaba

El tratamiento de la impotencia, la infertilidad, la hepatitis.

Con una low cost viagra sonrisa (y que era muy divertido) sacГі de su bolsa un hueso de pollo, cuidadosamente embalado en una bolsa de plГЎstico. de perigos viagra Al parecer, alguien que “induce” preocupado, perigos de sildenafil citrate como si la bolsa de Nina no manchar el final del proyecto por la batuta milagros interceptado Kolesnichenko. Г‰l no sГіlo encontrГі un barco en alta mar, pero tambiГ©n quiso descender a una profundidad de 10,4 metros hasta el mismo aspecto. A pesar de que hasta este psГ­quica nunca se zambullГі y una tormenta en cuatro puntos, se le perigos de viagra permitiГі. En la mano pasa a ser puramente un traje de buceo, un hombre alto que se acercГі a cuerpo atlГ©tico.

FГ­sica quГ­mica erwin contactos; de perigos viagra arreglan

Г‰stos perigos de sildenafil son sГіlo nadГі pantalones Sergei, y surgiГі en pantalones cortos. Swam sobre el arrecife y bajo el agua cambiГі rГЎpidamente? En un concurso donde los participantes llevaron por un camino lleno de perigos de viagra baches a ciegas, el conductor parece haber sido un psГ­quico tambiГ©n – leer los pensamientos. “Hay sildenafiili lääkkeet un giro a la derecha? ” – Y entonces le pide que repita su Sergey.

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“AquГ­ estГЎ, girar a la derecha viagra hinnoittelu – y terminar” – Encantado de que el conductor con confianza girando a la izquierda. Bueno, cuando era necesario para determinar que estaba ante el espejo (era una bailarina de Vlad Yama) Kolesnichenko superГі a sГ­ mismo. Esta vez no hubo magos malignos y fantasmas. viagra perigos de “Esta persona tiene una niГ±a con un nombre como flor Sabemos solamente un tal nombre -. Lily” – dijo perigos de viagra Sergey.

Perigos viagra

Provisões perigos viagra insolação as

MantГЄ-lo na geladeira.

Ferva em banho-maria por 10 minutos, legal, tensГЈo. Tome 1 colher de sopa 3 vezes ao dia. Prepare os ingredientes nas seguintes proporções: CГЎlamo rizoma – a metade da grama Boudreau hederacea – praghas walmart viagra 2 partes de erva Verbena officinalis – 1 parte de grama planta de flores amarelas – 1 parte de erva manjerona – 2 partes de erva Erva perigos viagra de SГЈo JoГЈo – 7 peГ§as bagas de zimbro comuns – 1 / 2 partes de erva fireweed angustifolia – perigos sildenafil citrate 2 partes peppermint folhas – 1 parte de folha de bananeira – 2 partes grama knotweed – Parte 1, quadris canela – 3 partes. Todas as noites, perigos viagra 2-3 colheres de viagra perigos sopa de coleta (dependendo do peso consciГЄncia: viagra priporat perigos do paciente) para preencher uma garrafa tГ©rmica (0,5 litros) e despeje ГЎgua fervente. No dia seguinte, beber toda a infusГЈo de 3 recepção calorosa por 20-30 minutos antes das refeições com distonia neuro do tipo hipertensiva.

Futuro osmotrelieto max viagra perigos ac:

Prepare os ingredientes nas seguintes proporções: sup (raiz) – 1 parte de limГЈo verbena (folhas) – 2 partes de planta de flores amarelas (erva) – 2 partes de orГ©gano (erva) – 4 peГ§as, erva de SГЈo JoГЈo (erva) – 14 peГ§as, Chipre (folhas) – 4 PeГ§as, hortelГЈ (folhas) – 2 peГ§as de tanchagem (folhas) – 4 PeГ§as, nГі-grama (relva) – 2 peГ§as, quadris (fruta) – 6 peГ§as.

A fruta esmagada de magnГіlia chinГЄs derramar ГЎlcool de 40 graus em uma proporção de 1:10, insistem 2 semanas. Tome 25-40 gotas (dependendo perigos sildenafil da idade e do peso corporal) 1 colher de sopa de ГЎgua fria fervida duas vezes por dia, antes do pequeno almoГ§o e jantar, a 30 minutos antes das refeições. Prepare os ingredientes perigos sildenafil nas seguintes proporções: cardo espinhoso (grama) – perigos sildenafil citrate 10 peГ§as; Briar canela (fruta) – 6 peГ§as; vidoeiro branco (folhas), Veronica officinalis (erva), dente de leГЈo (raiz) – 4 partes; madeira morango (folhas), hissopo officinalis (erva), urtiga (grama), groselha preta (grama), cavalinha (erva) – 2 partes; Elecampane (root), hortelГЈ-pimenta (folha) – perigos sildenafil 1 parte. 2-3 colheres de sopa da mistura (dependendo do peso corporal do paciente) noite despeje em uma garrafa tГ©rmica e despeje 0,5 litros perigos viagra de ГЎgua fervente. No dia seguinte, toda a bebida de infusГЈo 3 admissГЈo quente por 20-40 minutos antes de comer. Aralia raГ­zes trituradas derramar 70% de ГЎlcool na proporção de 1:5, a insistir em 10 dias.

2-3 colheres de sopa da mistura Г© colocada noite em uma garrafa tГ©rmica, despeje 0,5 litros de ГЎgua fervente.

Tome 2-3 vezes ao dia 30-40 gotas em uma colher de sopa de água fria fervida por viagra efetivos soplyak.Voobshe perigos 1-1,5 meses. Tintura em um lugar fresco. Cozinhe álcoolato levzei carthamoides (raiz maral). Tome 20-30 gotas em uma colher de sopa de água fria fervida duas vezes por dia, antes do pequeno almoço e jantar, a 30 minutos antes das refeições. dissolvido em um trava-língua, psihoreanimatologiya viagra perigos copo de chá forte doce. Beber 3 vezes ao dia durante uma semana.

Transparentes srelnego viagra perigos falciforme

O prГіximo dia de tensГЈo.

Para nГЈo aumentar perigos viagra a dose, pois pode tornar-se palpitações mais freqГјentes. Sob pressГЈo reduzida, tonturas e depressГЈo levar a geleia real, sob a forma de comprimidos de 2 g laminação. responsГЎvel perigos viagra de mel 3-4 vezes por dia antes das refeições Lyudmila, amamentação viagra perigos. No entanto, Г© contra-indicado em doenГ§a de Addison, doenГ§as infecciosas agudas das glГўndulas supra-renais. Prepare os ingredientes nas seguintes proporções: Rhodiola rosea (raiz), alto (root) do diabo, quadris (frutas) – 4 peГ§as; urtiga (folhas), espinheiro (fruta) – 3 partes; Erva de SГЈo JoГЈo (erva) – 2 partes. Duas colheres de sopa da mistura perigos sildenafil de despejar 0,5 litros de ГЎgua fervente, deixe por 10 horas, deixe ferver por 1 minuto, escorra, legal. Beber 100 ml do caldo, 3 vezes ao dia.

Formação pesquisa programa viagra perigos desenvolvidos o comoas

3 doses beber recepção morna por 20-40 minutos antes de comer.

Preparações de ginseng tem viagra perigos tratá-lo Bateson um efeito tônico em hipotensão arterial. Prepare uma tintura com vodka com base de 1:5. Tome 25 gotas 3 vezes ao dia. Preparativos diabo alto na ação türkei viagra apotheke kosten como ginseng. Tome 30-40 gotas duas vezes ao dia. Tratamento de hipotensão dieta é destinado a restabelecer a perigos sildenafil citrate todo o corpo.

Prórússia perigos viagra ëüíîñòü ïîñëå rivais

20 g de erva seca em pГі sedum despeje 1 xГ­cara de ГЎgua fervente.

A proteína, a vitamina C e as vitaminas B verificou-se ser úteis no tratamento e prevenção da hipotensão. Entre eles, especial ênfase perigos viagra na vitamina B3 (levedura, fígado, gema de ovo, partes verdes das plantas, leite, cenouras, etc Um dos remédios eficazes casa -. viagra warnschild Suco beterraba crua paciente deve beber pelo menos 100 ml de sumo duas vezes por dia. Melhoria significativa ocorre dentro de uma semana recomendado para comer alimentos salgados e bebida taça diária de água com meia colher de chá de sal preto ou verde chá acabado de fazer, que contém substâncias tônico natural paserovanny. ikshoz perigos viagra -. uma bebida perfeita perigos sildenafil citrate para pessoas predispostas a reações hipotensores Tratar hipotensão -.

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nenhuma tarefa fГЎcil paciente deve respeitar o dia (noite de sono pelo menos 8 horas por dia), para o exercГ­cio de ginГЎstica, perigos sildenafil citrate natação, andar de medicamentos utilizados principalmente medicamentos com efeito sedativo, como os pacientes se lamentar muitas vezes irritado, sofrendo de ansiedade, medo. AlГ©m disso, tГґnicos usados ​​(Rhodiola endГіcrino funções vindouras perigos viagra rosea, echinacea, Leuzea, Pantocrinum ginseng, Aralia na forma de tinturas e extratos). Um resultado perigos sildenafil citrate positivo dГЎ uma combinação de tonificação e substГўncias calmantes tГ©cnicas de fisioterapia. tambГ©m sГЈo amplamente utilizados no tratamento da hipotensГЈo. Isto Г© principalmente diferentes tipos de ГЎgua – de massagem subaquГЎtica, vГЎrios tipos de chuveiro terapГЄutico (harpa, chuva, circular, contraste) e banheiros (cloreto de sГіdio, radГґnio, nitrogГЄnio, bromo).

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