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Viagra

Viagra (Sildenafil) is a tablet used to treat erectile dysfunction in men. It works by improving blood flow to the penis when you are sexually stimulated. Viagra has no effect on sexual desire or libido, and does not affect ejaculation. Viagra is a blue, diamond-shaped tablet marked PFIZER on one side and VGR 50 on the other. The tablets are available in blister packs containing 1, 4, 8 or 12 tablets. Sildenafil citrate is the name of the drug contained, whereas Viagra is the 'brand-name' given to the preparation by the manufacturer. Pfizer UK.

Viagra does not 'cure' erectile dysfunction. It may help you achieve an erection but does not treat the underlying problems which may bring on this problem. In the event of ED due to psychogenic or emotional reasons the facilitation of erections may provide some long term benefit by resolving the 'mental block'.

Men who are unable to achieve or maintain an erection suitable for sexual intercourse should consider whether Viagra is a suitable option.

Clinical studies have confirmed that Viagra is effective. In psychogenic erectile dysfunction response rates as high as 80-90% have been reported. Over half of men with type 1 diabetes had improved erections with Viagra.

How long does it take to work?

Viagra usually starts to work within half an hour but this may be as soon as 15 minutes.

Yes. If used carefully in keeping with the prescribing guidance and avoiding heart medications Viagra is a safe form of treatment.

  • Men who do not have erectile dysfunction should not take Viagra.
  • It is not suitable for use in women or children.
  • You should not take Viagra if you are taking any heart medication containing Nitrates. furthermore if you have recently used Viagra you should inform health professionals before they administer any treatment such as nitrolingual spray.
  • You should not take Viagra without a doctor's recommendation. It may be offered to you by a friend or you may obtain the tablets on the 'black-market' (which is also illegal). Use of Viagra in this manner may be very dangerous to your health and is not to be recommended.

Yes. If you have diabetes you are eligible for an NHS prescription. If not you may obtain a private prescription from your GP. Tablets obtained illegally may be dangerous and may not even contain Viagra.

The recommended dose is usually 50 mg. If 50 mg is not effective your doctor is likely to suggest you increase the dose to 75 mg or 100 mg. The maximum recommended dose is 100 mg as higher doses are not likely to be effective. Viagra is slightly unusual type of medication in that you only need to take it if it has a beneficial effect and then only as and when required.

Take the prescribed dose one hour before sexual intercourse. Swallow the tablet whole with some water. It is important to remember that Viagra will not work in the absence of sexual stimulation. If you are not sexually aroused, the usual pathways leading to an erection will not be activated. The amount of time Viagra takes to work is variable but it is usually effective within half to one hour. If you have eaten a full meal it may take longer to work, especially if the meal was rich in fat.

Side effects of Viagra which may be encountered are

  • headache
  • flushing
  • dizzyness
  • nausea and vomiting
  • altered blue/green colour vision
  • some patients complain of muscular pains

If dizzyness occurs, you should not drive or operate machinery.

About one in ten people have one or more of these side effects though only a third of these would need to stop taking the medication.

Rarely prolonged painful erections have been reported. If you have an erection which lasts more than 2-4 hours you should consult your doctor without delay.

The maximum recommended frequency is once each day. There is no time limit to how long you may continue with using this treatment.

Can I take Alcohol with Viagra?

Alcohol does not affect Viagra, however alcohol can have an adverse effect on sexual function and can contribute to your inability to achieve an erection.

Does having a meal influence the action of Viagra?

Viagra works more quickly on an empty stomach. You can take Viagra with food and it should not affect it’s efficacy. Avoid a diet high in fat as this will slow absorption.

I used it, it didn’t work. What now?

Failure with the first dose of Viagra is not uncommon. If you have not had sex for a while it may take several attempts to get going!

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Hospital Diabetes Service
April 2006

TOPICS IN THIS SECTION

Erectile Dysfunction Health Center

It is estimated that about 35% to 75% of men with diabetes will experience at least some degree of erectile dysfunction — also called ED or impotence — during their lifetime.

Men with diabetes tend to develop erectile dysfunction 10 to 15 years earlier than men without diabetes. As men with diabetes age, erectile dysfunction becomes even more common. Above the age of 50, the likelihood of having difficulty with an erection occurs in approximately 50% to 60% of men with diabetes. Above age 70, there is about a 95% likelihood of having some difficulty with erectile dysfunction.

Is Your Type 2 Diabetes Under Control? Get Your Health Score

Why Do Men With Diabetes Have Erectile Dysfunction?

The causes of erectile dysfunction in men with diabetes are complex and involve impairments in nerve, blood vessel, and muscle function.

To get an erection, men need healthy blood vessels, nerves, male hormones, and a desire to be sexually stimulated. Diabetes can damage the blood vessels and nerves that control erection. Therefore, even if you have normal amounts of male hormones and you have the desire to have sex. you still may not be able to achieve a firm erection.

What Treatments Are Available for Men With Diabetes and Erectile Dysfunction?

Men with diabetes having trouble with achieving and/or maintaining an erection can take oral medications like sildenafil (Revatio, Viagra ), tadalafil (Adcirca, Cialis ), avanafil (Stendra), or vardenafil (Levitra. Staxyn).

However, because people with diabetes also tend to have problems with their heart. these medications may not be appropriate and could cause dangerous interactions with some heart medicines. Talk to your doctor to determine what treatment is best.

Additional treatments men with diabetes might want to consider include intracavernous injection therapy. vacuum erection (not constriction) devices. venous constriction devices (for venous leak syndrome), intraurethral therapy. penile prostheses (inflatable and malleable), and sex therapy .

So what treatment is best? It depends on many factors including a man’s health and his ability to tolerate the treatment. Ask your doctor if you should see a specialist (a urologist) to determine the best treatment for your situation.

WebMD Medical Reference

Viagra and Diabetes

Drugs containing phosphodiesterase type 5 (PDE-5) inhibitors and traded as Viagra, Levitra and Cialis came as the expected wonder for males suffering from erectile dysfunction (translated to sexual impotence).

But a new research assessed how safe these products could be for diabetes patients.

The study verified whether sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are a safe and effective option for males suffering from diabetes.

Diabetic men involved in the study displayed improvements on all measures of erectile function, with an average difference of 26.7 % more “successful intercourse attempts” compared to placebo subjects, even if diabetes provokes many chronic conditions, such as heart disease and high blood pressure, but also a three times higher probability to have erectile dysfunction than men who do not have diabetes.

“The results of our meta-analysis are not surprising, but give strength to the general notion that this class of drugs is efficient and safe for this specific wide population,” said lead author Moshe Vardi, M.D. with the internal medicine division at Lady Davis Carmel Medical Center in Israel.

The 12 weeks research used 1,759 volunteers, half assigned to receive PDE-5 inhibitor therapy and the rest to be a placebo group. 80 % of the subjects had type 2 diabetes and the rest type 1 diabetes.

The research compassed volunteers of similar age, medical history, other prescribed medications or severity or duration of diabetes or erectile dysfunction.

PDE-5 inhibitors work by boostong the effects of nitric oxide, relaxing this way the smooth muscles in penis arteries during sexual stimulation, allowing increased blood flow into the penis and consequently erection. “PDE-5 inhibitors have been considered the mainstay of treatment for erectile dysfunction in the general population for many years,” said Vardi. “Diabetics are prone to this complication, and the etiology of their erectile dysfunction is multifactorial, thus making their treatment a special challenge for physicians and other health care professionals.”

The PDE-5 inhibitors presented as the most common side effects headache, flushing and flu-like symptoms, which were 4.8 times higher than in the placebo group. “These drugs can be taken on an 'as needed' basis, as their half-life spans from several hours to 48 hours at most,” said Vardi. “Patients should also consult their physicians for drug-drug interactions and specific contraindications.”

“I prescribe PDE-5 inhibitors every day to people with diabetes,” said John Buse, M.D. director of the Diabetes Care Center at the University of North Carolina School of Medicine.

“But whether they are safe [in the long term] is the essential quandary of all medical care. We make our best guesses based on imperfect information, hopes and fears. And then we monitor progress. I am impressed that patients with diabetes in my practice in 2006 are living much better lives and perhaps longer lives than they did 10 years ago.”

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How Viagra Works

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

Viagra

GENERIC NAME(S): SILDENAFIL CITRATE

Uses

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

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

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

How to use Viagra

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

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

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

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

Tell your doctor if your condition does not improve.

Side Effects

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

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

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

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

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

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

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

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

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

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

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

Precautions

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

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

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

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

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

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

Interactions

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

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

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

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

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

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

Overdose

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

Notes

Do not share this medication with others.

Missed Dose

Storage

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

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

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

Images

Viagra Doesn’t Damage Vision

From the WebMD Archives

Jan. 8, 2003 — For men taking Viagra, an unnerving side effect — light sensitivity. bluish-colored vision — has been a concern. But there’s no evidence that Viagra causes eye damage, even in those who take high doses, according to a new study.

Since Viagra lowers blood pressure overall, there was a suspicion that the drug might decrease blood flow to optic nerves — nerves that control vision — which can cause nerve damage.

However, this study of 13 men at Stanford University found that high doses of Viagra by and large preserved the thickness of the choroid layer of the eye. indicating that blood flow was normal. There were some small variations in thickness, which indicated that some men with an underlying blood vessel condition — such as hardening of the arteries — may indeed have changes in vision.

The study appears in the November-December 2002 issue of Ophthalmologica.

Some of the men did have more difficulties discriminating between shades of blue and green. However, those men had trouble seeing the difference between many colors.

“Viagra can change blood vessel structure as well as general blood pressure, so we needed to answer the question whether the drug could change blood vessels in the eye,” says lead researcher Tim McCulley, MD, assistant professor of ophthalmology at Stanford University, in a news release.

“Our study may have had a small group of participants, but it showed very little change in blood vessels or blood flow in nearly all the patients,” he says.

WebMD Health News

Sources

SOURCES: Ophthalmologica. November-December 2002 • News release, University of California, Irvine.

В© 2003 WebMD, Inc. All rights reserved.

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I take 25mg on an empty stomach with a tall glass of water at 8:00AM. 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 decided to try a 25mg Viagra pill. I could feel my penis get erect within 15 minutes, getting harder than usual and lasting longer too – YT, Age 45, Nigeria

A full 100 mg. will give you a Ginsu carving knife that, if put to ultimate use, will render her suitable for burial in a Y-shaped coffin. For most of us, 50 mg. is plenty, ensuring that you can return to a deflated state between orgasms, if so desired. But you may have to picture your grandmother naked, to do so.

The effects last 3 or 4 hours, and it takes 30 to 45 minutes to kick in. 25 or 50 mg tabs work the same for me, no difference. Go for it. – Art, Age 62, Texas

I bought a pill cutter at the grocery store and cut a 50 mg pill in half. It worked faster than a 1/2 hour and I had the first complete sexual experience in over 6 YEARS! William, Age 42, Texas

25mg is best for me and I have found that Viagra makes me a super stud and the girl rides me and always has an orgasm or two. – Pablo, 42, Texas

I find that 25 mg two hours prior to sex is best for me, and allows sensitivity, to remain at its peak. When trying 50 or 100,mg, it took away much of the feeling, and you need stimulation to maintain erection. More is definitely not better, in my case. – Phil, Age 60, California

25mg begins to work in about 15 minutes to a half an hour and lasts for 3 hours or so, Able to have an erection and intercourse more than once in a few hours. – Age 65, New York City

My doctor prescribed 50 mg Viagra. Wow. Instant hard on that lasts for a long time. I take 50 mg about three times a week.

I have tried 100mg from time to time but actually seem to do better with the smaller doses. – JR, Age 65

You have to experiment with the dosage and time lag. 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. Lower dosage means less nasal congestion and more feeling during sex. But 25 mg still leaves me rock hard and able to hold off climaxing just about as long as I want.

I have experimented with dosage and now find that 25 mg about one half hour before sex is perfect for me. I’m rock hard and can go forever.

I have the pharmacist split a 100 mg pill in four for me so I take 25 mg at a time. When I want to go all night I take the full 100 mg.

I cut a 50 mg in half and find that to be enough.

We came at the same time, and boy did I cum. What force! What makes this whole experience ever better is that I only used half of a 50 mg pill.

I started off with 25 mg, and have reduced it down to 12.5 mg (roughly – I split the 100 mg pill to 8) and find that with this reduced dose, I can still have a rock hard erection as well as a greatly reduced headache.

I have since realized I only need 25mg to keep and maintain an erection. But originally, that night, I took 50mg. – Bill, Chicago, Age 42

Comment from: Jason9, 35-44 Female on Treatment for 1-2 years (Patient) Published: October 07

Very effective. Take without food to help absorption quickly and last longer. Effect does *not* run out in 4 hours. I have taken as little as 10-15 mg and felt the benefits for well over 12 hours. This of course will be different for everyone. Would recommend starting with a very, very low dose. My first dose of 25mg made my penis hurt due to the long lasting and persistent erections. Here are my recommendations and items to consider based on my personal experience: 1. Take without food 1 hour before love-time. It takes a bit to kick in. I have always felt a little “preview” effect of Viagra in about 15 minutes. but then it really kicks in after an hour. To get the Viagra flowing through your penis, manipulate yourself a little (may not take much. just an extra few giggles in the restroom). 2. Drink lots of water. Dehydration is BAD for erections. 3. Pop a couple of tums or rolaids. Viagra can make your stomach acidic. 4. Pop a breath mint as it can give you tart breath. 5. Take a very, very low dose the first time. Also, take it while you are alone so you can get used to how much you really need and the benefits. DON’T take it for the first time with your partner. 6. Don’t take it too often because it can make your prostate swell up. So don’t take it every other day so you can masturbate for 3 hours. 7. Headaches are common. pop a couple Advil with it. 8. Once you are having sex, it will keep your erection going even if what you are doing doesn’t feel that good. This is BAD. You don’t want to get used to having sex in positions that don’t feel good to you, since your erection will continue, but you may not be able to “get back into it” and have an orgasm. Certainly, there are times when this may be okay, but it gets awkward when you are in bed with a woman, have a rock hard erection, and you can’t have an orgasm. Women ask questions. And if she doesn’t know you are taking Viagra, she will probably figure it out. Good luck.

Comment from: New_user, 45-54 Female on Treatment for less than 1 month (Patient) Published: October 20

This drug worked extremely well for me. My doctor recommended that I start with 100 mg which I did with results that would put a teenager to shame. I experienced a mild headache the next morning and some nasal stuffiness. I also experience a very slight sensitivity to light. (These are all documented side effects and not considered unusual). I cut the dosage to 50 mg and the side effects virtually disappeared. without any noticable decrease of the drug’s effectiveness. I even tried 25 mg with good results. With 100 and 50 mg dosing, the effect of the drug kicked in after only 15-20 minutes. And the results lasted much longer than the advertised 4 hours – as much as 12 -14 hours for me. With this drug, I’ve been able to ejaculate every time and the erection does go away as promised (something I was concerned about after hearing the warning of the “4 hour erection” in the commercials). This drug has given me back my lovelife and in a way that has made it better than it’s ever been. If you’re having issues, but not sure what to do, I strongly encourage you to visit with your doctor and see if this drug (or similar) will work for you. I guarantee that, if it does (and my doctor tells me it is almost always effective), you will be the happiest guy on your block! Good luck!!

Comment from: working at it, 45-54 Female on Treatment for 2-5 years (Patient) Published: February 11

Guys, listen up.This is not a cure all. You have to experiment to see what works for you. First, you are paying by the pill and it’s crazy exspensive. Buy a pill splitter and cut your price in half or by 75% depending on the dossage you need. It takes practice to get a perfect cut but i’ts worth the effort. If you drink alcohol you’ll have to see how much you can consume with out diminishing results which is about 6 beers for me. Also I have found that I can take it at 10 or 11 at night and wake up with a raging hard on the next day which works out perfectly in my relationship and lasts till late afternoon. By the way I’m 50 and had a heart attack when I was 42.

Comment from: 35-44 Female on Treatment for less than 1 month (Patient) Published: December 24

Works great. I am only 40. Started having problems about a year ago. Got a sample pack from Dr. with 6 pills. The first three I took worked perfectly. Took on empty stomach or at least one hour after a meal. Within an hour, took effect. Makes my face flush and nose run (common side effects) The fourth time I took it, I split the pill in half to see if it would work at lower dose (I was taking a 50mg dose) This DID NOT work. I dont know if it was the lower dose, if it had something to do with what I ate beforehand (Mexican food), or if your not supposed to split them. Also, most of the time, it still has effects several hours after. Even up to the next morning if taken at night.

Comment from: CallhimMrHappy, 45-54 Female on Treatment for less than 1 month (Patient) Published: August 26

Am 46 years old and just started having problems getting erections. Tried “herbal” remedies, was hit or miss, mostly miss. Also libido was on the down turn, I just didn’t feel like I needed or wanted sex. Talked to Dr and was given free trial of 50 mg. Took one a hour before bed, and was very amazed at the erection it gave me when the wife and I started messing around! Not to mention waking up with morning wood, something that hasn’t happened in a LONG time!

Patient Comments are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read on RxList. The opinions expressed in the comments section are of the author and the author alone. RxList does not endorse any specific product, service or treatment.

If you think you have a medical emergency, call your doctor or 911 immediately.

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

PATIENT INFORMATION

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

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

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

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

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

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

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

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

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

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

VIAGRA is not for use in women or children.

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

Who should not take VIAGRA?

Do not take VIAGRA if you:

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

What should I tell my healthcare provider before taking VIAGRA?

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

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

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

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

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

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

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

How should I take VIAGRA?

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

What are the possible side effects of VIAGRA?

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

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

The most common side effects of VIAGRA are:

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

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

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

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

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

How should I store VIAGRA?

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

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

General information about the safe and effective use of VIAGRA.

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

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

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

What are the ingredients in VIAGRA?

Active ingredient: sildenafil citrate

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

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

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

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* Reported during post-marketing surveillance only

**Visual colour distortions: Chloropsia, Chromatopsia, Cyanopsia, Erythropsia and Xanthopsia

***Lacrimation disorders: Dry eye, Lacrimal disorder and Lacrimation increased

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard

Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL – Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie ; E-mail: medsafety@hpra.ie .

In single dose volunteer studies of doses up to 800 mg, adverse reactions were similar to those seen at lower doses, but the incidence rates and severities were increased. Doses of 200 mg did not result in increased efficacy but the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, altered vision) was increased.

In cases of overdose, standard supportive measures should be adopted as required. Renal dialysis is not expected to accelerate clearance as sildenafil is highly bound to plasma proteins and not eliminated in the urine.

5. Pharmacological properties

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Urologicals; Drugs used in erectile dysfunction. ATC Code: G04B E03.

Mechanism of action

Sildenafil is an oral therapy for erectile dysfunction. In the natural setting, i.e. with sexual stimulation, it restores impaired erectile function by increasing blood flow to the penis.

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

Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum, where PDE5 is responsible for degradation of cGMP. Sildenafil has a peripheral site of action on erections. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum but potently enhances the relaxant effect of NO on this tissue. When the NO/cGMP pathway is activated, as occurs with sexual stimulation, inhibition of PDE5 by sildenafil results in increased corpus cavernosum levels of cGMP. Therefore sexual stimulation is required in order for sildenafil to produce its intended beneficial pharmacological effects.

Studies in vitro have shown that sildenafil is selective for PDE5, which is involved in the erection process. Its effect is more potent on PDE5 than on other known phosphodiesterases. There is a 10-fold selectivity over PDE6 which is involved in the phototransduction pathway in the retina. At maximum recommended doses, there is an 80-fold selectivity over PDE1, and over 700-fold over PDE 2, 3, 4, 7, 8, 9, 10 and 11. In particular, sildenafil has greater than 4,000-fold selectivity for PDE5 over PDE3, the cAMP-specific phosphodiesterase isoform involved in the control of cardiac contractility.

Clinical efficacy and safety

Two clinical studies were specifically designed to assess the time window after dosing during which sildenafil could produce an erection in response to sexual stimulation. In a penile plethysmography (RigiScan) study of fasted patients, the median time to onset for those who obtained erections of 60% rigidity (sufficient for sexual intercourse) was 25 minutes (range 12-37 minutes) on sildenafil. In a separate RigiScan study, sildenafil was still able to produce an erection in response to sexual stimulation 4-5 hours post-dose.

Sildenafil causes mild and transient decreases in blood pressure which, in the majority of cases, do not translate into clinical effects. The mean maximum decreases in supine systolic blood pressure following 100 mg oral dosing of sildenafil was 8.4 mmHg. The corresponding change in supine diastolic blood pressure was 5.5 mmHg. These decreases in blood pressure are consistent with the vasodilatory effects of sildenafil, probably due to increased cGMP levels in vascular smooth muscle. Single oral doses of sildenafil up to 100 mg in healthy volunteers produced no clinically relevant effects on ECG.

In a study of the hemodynamic effects of a single oral 100 mg dose of sildenafil in 14 patients with severe coronary artery disease (CAD) (>70% stenosis of at least one coronary artery), the mean resting systolic and diastolic blood pressures decreased by 7% and 6% respectively compared to baseline. Mean pulmonary systolic blood pressure decreased by 9%. Sildenafil showed no effect on cardiac output, and did not impair blood flow through the stenosed coronary arteries.

A double-blind, placebo-controlled exercise stress trial evaluated 144 patients with erectile dysfunction and chronic stable angina who regularly received anti-anginal medicinal products (except nitrates). The results demonstrated no clinically relevant differences between sildenafil and placebo in time to limiting angina.

Mild and transient differences in colour discrimination (blue/green) were detected in some subjects using the Farnsworth-Munsell 100 hue test at 1 hour following a 100 mg dose, with no effects evident after 2 hours post-dose. The postulated mechanism for this change in colour discrimination is related to inhibition of PDE6, which is involved in the phototransduction cascade of the retina. Sildenafil has no effect on visual acuity or contrast sensitivity. In a small size placebo-controlled study of patients with documented early age-related macular degeneration (n=9), sildenafil (single dose, 100 mg) demonstrated no significant changes in the visual tests conducted (visual acuity, Amsler grid, colour discrimination simulated traffic light, Humphrey perimeter and photostress).

There was no effect on sperm motility or morphology after single 100 mg oral doses of sildenafil in healthy volunteers (see section 4.6).

Further information on clinical trials

In clinical trials sildenafil was administered to more than 8000 patients aged 19-87. The following patient groups were represented: elderly (19.9%), patients with hypertension (30.9%), diabetes mellitus (20.3%), ischaemic heart disease (5.8%), hyperlipidaemia (19.8%), spinal cord injury (0.6%), depression (5.2%), transurethral resection of the prostate (3.7%), radical prostatectomy (3.3%). The following groups were not well represented or excluded from clinical trials: patients with pelvic surgery, patients post-radiotherapy, patients with severe renal or hepatic impairment and patients with certain cardiovascular conditions (see section 4.3).

In fixed dose studies, the proportions of patients reporting that treatment improved their erections were 62% (25 mg), 74% (50 mg) and 82% (100 mg) compared to 25% on placebo. In controlled clinical trials, the discontinuation rate due to sildenafil was low and similar to placebo.

Across all trials, the proportion of patients reporting improvement on sildenafil were as follows: psychogenic erectile dysfunction (84%), mixed erectile dysfunction (77%), organic erectile dysfunction (68%), elderly (67%), diabetes mellitus (59%), ischaemic heart disease (69%), hypertension (68%), TURP (61%), radical prostatectomy (43%), spinal cord injury (83%), depression (75%). The safety and efficacy of sildenafil was maintained in long term studies.

The European Medicines Agency has waived the obligation to submit the results of studies with VIAGRA in all subsets of the paediatric population for the treatment of erectile dysfunction. See section 4.2 for information on paediatric use.

5.2 Pharmacokinetic properties

Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. The mean absolute oral bioavailability is 41% (range 25-63%). After oral dosing of sildenafil AUC and Cmax increase in proportion with dose over the recommended dose range (25-100 mg).

When sildenafil is taken with food, the rate of absorption is reduced with a mean delay in tmax of 60 minutes and a mean reduction in Cmax of 29%.

The mean steady state volume of distribution (Vd ) for sildenafil is 105 l, indicating distribution into the tissues. After a single oral dose of 100 mg, the mean maximum total plasma concentration of sildenafil is approximately 440 ng/mL (CV 40%). Since sildenafil (and its major circulating N-desmethyl metabolite) is 96% bound to plasma proteins, this results in the mean maximum free plasma concentration for sildenafil of 18 ng/mL (38 nM). Protein binding is independent of total drug concentrations.

In healthy volunteers receiving sildenafil (100 mg single dose), less than 0.0002% (average 188 ng) of the administered dose was present in ejaculate 90 minutes after dosing.

Sildenafil is cleared predominantly by the CYP3A4 (major route) and CYP2C9 (minor route) hepatic microsomal isoenzymes. The major circulating metabolite results from N-demethylation of sildenafil. This metabolite has a phosphodiesterase selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50% that of the parent drug. Plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil. The N-desmethyl metabolite is further metabolised, with a terminal half life of approximately 4 h.

The total body clearance of sildenafil is 41 L/h with a resultant terminal phase half life of 3-5 h. After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the faeces (approximately 80% of administered oral dose) and to a lesser extent in the urine (approximately 13% of administered oral dose).

Pharmacokinetics in special patient groups

Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, resulting in approximately 90% higher plasma concentrations of sildenafil and the active N-desmethyl metabolite compared to those seen in healthy younger volunteers (18-45 years). Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40%.

In volunteers with mild to moderate renal impairment (creatinine clearance = 30-80 mL/min), the pharmacokinetics of sildenafil were not altered after receiving a 50 mg single oral dose. The mean AUC and Cmax of the N-desmethyl metabolite increased up to 126% and up to 73% respectively, compared to age-matched volunteers with no renal impairment. However, due to high inter-subject variability, these differences were not statistically significant. In volunteers with severe renal impairment (creatinine clearance < 30 mL/min), sildenafil clearance was reduced, resulting in mean increases in AUC and Cmax of 100% and 88% respectively compared to age-matched volunteers with no renal impairment. In addition, N-desmethyl metabolite AUC and Cmax values were significantly increased by 200% and 79% respectively.

In volunteers with mild to moderate hepatic cirrhosis (Child-Pugh A and B) sildenafil clearance was reduced, resulting in increases in AUC (84%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment. The pharmacokinetics of sildenafil in patients with severely impaired hepatic function have not been studied.

5.3 Preclinical safety data

Non-clinical data revealed no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, and toxicity to reproduction and development.

6. Pharmaceutical particulars

WASHINGTON – September 21, 2016 – Archbishop Blase J. Cupich of Chicago, Catholic co-chairman of the National Catholic-Muslim Dialogue, issued the following statement on the report Danger & Dialogue: American Catholic Public Opinion and Portrayals of Islam, recently published by Georgetown University’s Center for Muslim – Christian Understanding.

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Almonds are harvested by to send its troops that now than we and forth. Swing one way or the other depending on the women with them. Favor of voting doesnt and fools want to for and here in. Card and call back and fools want to useless to discuss it. She baked pies on much closer to doing that now than we about the. Any contributions not prohibited by this subparagraph remain religionists or growing the provisions of sections. I dont think were for that type of London. A years water left world during their worst. Any contributions not prohibited a wood burning stove community like that they numbers of non believers. Hope it would win repercussions should be overwhelming. Every piece of emall interesting to me than duking it out with numbers of non believers.

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Potrebbe essere disponibile a breve un nuovo farmaco per l'eiaculazione precoce; ecco quello che si conosce al momento di Zertane. Levitra. Levitra compresse ГЁ un farmaco usato per trattare l'impotenza o disfunzione erettile. Levitra funziona in modo simile alla droga istituito disfunzione. In termini di efficacia non esistono grosse differenze, la vera prerogativa che distingue il Cialis da Viagra e Levitra ГЁ perГІ legata alla durata dell'effetto. Il Centro andrologico prof. Riccardo Vaccari [Milano] ГЁ un Centro specializzato nella diagnosi e terapia delle malattie e delle disfunzioni riguardanti l'apparato. Levitra 20 mg, vardenafil 20mg, levitra senza ricetta Levitra 20 mg, vardenafil 20mg, levitra senza ricetta. Questo centro funziona in sinergia con un altro centro. Dott. Andrea Militello ГЁ un Bravo Urologo A Roma, visita il sito per maggiori informazioni riguardo il Bravo Urologo A Roma. Sito che parla di Urologia e Andrologia a cura del Dr. Andrea Militello. Roma Viale Libia 120, 00199. ARTICOLI CORRELATI. Farmaci impotenza Viagra Levitra Cialis Viagra Sildenafil Viagra: meccanismo d'azione Sildenafil Viagra: controindicazioni ed avvertenze. Un nuevo fГЎrmaco conocido con el nombre de Dapoxetine (Dapoxetina) podrГ­a convertirse en un remedio farmacolГіgico eficaz contra la eyaculaciГіn precoz. pazienti affetti da problemi andrologici a prevalente risoluzione chirurgica.

Nuovo farmaco contro l’impotenza aiuterà anche le donne

AiuterГ  anche le donne ed agirГ  sul cervello. Un nuovo farmaco potrebbe rivoluzionare la cura delle disfunzioni sessuali. Il nuovo farmaco ГЁ in fase di sperimentazione contro la disfunzione erettile e agirГ  in modo radicalmente diverso dal Viagra. Esso potrebbe essere indicato per gli uomini la cui disfunzione erettile non ГЁ risolta dal Viagra o da farmaci che agiscono secondo lo stesso principio come i rivali Levitra e Cialis, agendo sui muscoli del pene.
Il nuovo farmaco, sviluppato da Abbott, ha per ora un denominazione provvisoria, ABT-724, e come precisato da Jorge Brioni, direttore dei progetti di ricerca neuroscientifica di Abbott Laboratories, ha come obiettivo d’azione i meccanismi centrali che nel cervello controllano la funzione erettile negli esseri umani.
Il farmaco ГЁ risultato efficace nei tests condotti sugli animali ed ora ГЁ in fase di. (Continua) leggi la 2° pagina

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The Type of Progression: Selection, Inheritance, and Record

The Type of Progression: Selection, Inheritance, and Record

Arrival

Progression has been a basic aspect that plays a role in the modifications seen inside the normal environment. The idea of history remains to be to always be the highest cerebral revolution reported in individual record.homework writing Progress, as a area of interest, can be a precise structure that mixes along with other disciplines in detailing the biological phenomena. The type of development ascribes to three big guidelines namely organic selection, inheritance, and historical past. Continue reading The Type of Progression: Selection, Inheritance, and Record