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Sangrado nasal (epistaxis)

ВїDe dГіnde procede la sangre en una hemorragia nasal?

En la hemorragia nasal, tambiГ©n llamada epistaxis, la sangre procede normalmente de un vaso sanguГ­neo localizado en la parte anterior del tabique nasal, aunque puede proceder tambiГ©n de niveles mГЎs posteriores de la fosa nasal.

ВїPor quГ© se produce un sangrado nasal?

Sin embargo, la mayorГ­a de los sangrados nasales que no son por un traumatismo se produce sin una razГіn desencadenante concreta.

  • Por traumatismo nasal. Esta es la causa mГЎs frecuente
  • Por hurgarse con excesiva fuerza o mucha veces en la nariz
  • Por un catarro nasal, llamado tambiГ©n rinitis. Las principales causas son la infecciГіn nasal por un virus o la alergia
  • Por sequedad de la mucosa nasal debido a permanecer en un ambiente mal ventilado
  • Por hipertensiГіn grave (enfermedad en la que aumenta la tensiГіn arterial mГЎs de lo debido)
  • Por el tratamiento con ciertas clases de medicamentos; como por ejemplo los anticoagulantes o los antiagregantes, que son fГЎrmacos que disminuyen la capacidad de la sangre para formar coГЎgulos que detengan las hemorragias. Los anticoagulantes son necesarios para disminuir el mayor riesgo de trombosis que tienen algunos enfermos con arritmias cardiacas u otros problemas del corazГіn o de los vasos sanguГ­neos. Con respecto a los antiagregantes, el principal de todos y tambiГ©n el mГЎs conocido es la aspirina -ГЎcido acetilsalicГ­lico- pero existen muchos otros. Se usan fundamentalmente para el tratamiento de la inflamaciГіn y las enfermedades reumГЎticas.
  • Por exposiciГіn a sustancias quГ­micas irritantes de las mucosas
  • Por desviaciГіn del tabique nasal

Vea nuestra secciГіn ‘OtorrinolaringologГ­a ‘. Le sugerimos:

ВїSabe distinguir entre un simple catarro y una gripe? Haga nuestro test y obtenga algunas respuestas.

Otras causas menos frecuentes de sangrado nasal

  • Por enfermedades de la sangre como la leucemia aguda o enfermedades de la coagulaciГіn como la hemofilia
  • Por tumores en la cavidad nasal
  • Por enfermedades de los vasos sanguГ­neos como la enfermedad de Rendu-Osler

Signos de alarma en un sangrado nasal grave

  • Sangrado muy abundante
  • Palpitaciones, respiraciones breves y palidez de la piel
  • Tragar grandes cantidades de sangre, lo que puede provocar vГіmitos .

ВїCГіmo evitar los sangrados nasales?

  • Evitar golpearse la nariz y hurgarse excesivamente.
  • Tratar la causa de las enfermedades que provocan el sangrado nasal.
  • Conseguir un humidificador para los ambientes cerrados si vive en un clima seco o a gran altitud.

ВїCuГЎl es la conducta mГЎs recomendable ante un sangrado nasal?

  • SiГ©ntese derecho con su cabeza ligeramente inclinada hacia delante.
  • Comprima la punta de su nariz durante 5 minutos mientras respira por la boca.
  • Si el sangrado remite, entonces vuelva a comprimir su nariz durante 8-10 minutos. Esto permitirГЎ el cese definitivo de la hemorragia.
  • Aplicar un cubito de hielo sobre la nariz favorece que fluya menos sangre por la zona y por tanto puede ayudar tambiГ©n a un control mГЎs eficaz del sangrado.

Consejos importantes

  • No se suene la nariz durante las 12 horas siguientes de haber cedido el sangrado. Esto ayudarГЎ a que la sangre seca mantenga taponado el punto de sangrado.
  • No se trague la sangre. Puede provocarle nauseas o vГіmitos, o podrГ­a enmascarar una pГ©rdida de sangre mayor.
  • Si sufre hemorragias nasales frecuentes es obligado consultar a su mГ©dico.

La evoluciГіn mГЎs frecuente del sangrado nasal

  • El sangrado generalmente cede si sigue las instrucciones anteriormente mencionadas.
  • Un sangrado importante puede requerir un tratamiento hospitalario. En casos muy infrecuentes, en los que se haya perdido mucha sangre, una transfusiГіn sanguГ­nea.

ВїCГіmo se trata un sangrado abundante y quГ© clase de medicaciГіn puede ser necesario administrar?

  • Contacte con su mГ©dico o acuda a un servicio de urgencias si los consejos antes descritos no ayudan a contener la hemorragia. Inicialmente, el doctor tratarГЎ de detener el sangrado utilizando sustancias que tienen como efecto el cierre de los vasos sanguГ­neos afectados.
  • Cuando el sangrado por fin ceda, el mГ©dico puede que estime conveniente sellar la fuente de sangrado con una sustancia quГ­mica para prevenir que sangre de nuevo.
  • Si el sangrado no cede puede ser necesario introducir una gasa permanente en la nariz.
  • En casos raros, puede ser necesaria una operaciГіn para ligar el vaso sanguГ­neo que aporta sangre a la zona hemorrГЎgica.
  • Si el sangrado es causado por otra enfermedad, como pueda ser una subida grave de tensiГіn, es muy importante elegir el tratamiento adecuado de esa enfermedad para evitar la repeticiГіn de nuevos episodios de sangrado nasal y prevenir el resto de consecuencias asociadas a tal enfermedad.

Dr. Lars Trier Hansen. especialista en OtorrinolaringologГ­a; Dr. Robert Mills. especialista en OtorrinolaringologГ­a

MГЎs sobre:

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Nada de ‘selfies’, nada de ‘Kate’ y nada de sombreros despuГ©s de las seis: las reglas de oro para dar la mejor de las bienvenidas a los Duques de Cambridge a CanadГЎ

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    Noticias relacionadas

    ¿La Viagra causa sangrado nasal?

    Probablemente sea una coincidencia, dicen expertos en reportaje británico

    Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And “More information” links may no longer work. Questions about personal health should always be referred to a physician or other health care professional.

    Por Serena Gordon
    Reportera de HealthDay

    Jueves, primero de agosto (HealthDayNews) — Luego de tratar dos pacientes que confrontaron problemas severos de sangrado por la nariz luego de utilizar Viagra, doctores en Gran Bretaña se preguntan si la droga contra la impotencia es en cierto modo culpable.

    En la edición más reciente de “Journal of the Royal Society of Medicine”, cirujanos del Hospital San Jorge en Londres describieron dos casos en los que hombres fueron admitidos al hospital con sangrado nasal severo luego de utilizar Viagra.

    Ellos sospecharon que la droga puede inundar las venas de la nariz, al igual que ocurre con las venas del pene, haciendo más propenso el sangrado en personas que ya padecen de vasos sanguíneos débiles.

    Pero, [los doctores] admitieron que solo se trata de una teoría.

    “Esto es sólo una teoría basada en dos casos reportados, y hasta ahora no existe evidencia científica que pruebe la relación”, dijo uno de los autores del artículo, doctora Lucy Hicklin, cirujana de oído, nariz y garganta en el Hospital San Jorge.

    Pero, los doctores dicen que si el sangrado nasal está relacionado con el uso de Viagra, puede que el problema no se haya reportado debido a que los pacientes con frecuencia sienten vergüenza al revelar problemas relacionados con el sexo.

    En el primer caso, un hombre en sus 50 años acudió a la sala de urgencias debido a que su nariz había sangrado por seis horas. Tenía un historial de hipertensión, y tomaba medicamentos para tratarla. Dijo a los doctores que había tomado Viagra y se involucró en una actividad sexual “energética” varios días antes. Su nariz había sangrado en varias ocasiones desde que tomó Viagra pero el sangrado se detuvo solo. Fue admitido al hospital y fue dado de alta seis días después.

    El segundo hombre tenía más de 70 años y también fue tratado por hipertensión. Llegó a la sala de urgencias debido a que su nariz había sangrado por cinco horas. Él dijo a los doctores que había tomado Viagra en la mañana para mejorar su desempeño sexual. Los doctores lo admitieron en el hospital y fue dado de alta dos días después.

    Ninguno de los hombres tomó dosis no recomendadas de la droga; ambos tomaron la dosis recomendada de 50 miligramos.

    Los autores sugieren que los pacientes que han tenido sangrado nasal en el pasado deben discutirlo con su doctor antes de tomar Viagra.

    El doctor Nachum Katlowitz, director de disfunción sexual masculina en Maimonides Medical Center en Brooklyn, N.Y. dice que estos casos no le conciernen.

    “Nunca he tenido un paciente con ese problema”, dijo.

    Katlowitz dice que generalmente está bien para las personas con alta presión tomar Viagra. Pero, señala que quienes tienen alta presión son más propensos a tener sangrado nasal.

    Un efecto secundario conocido del uso de Viagra es la congestión nasal, dijo Katlowitz. Aun es extremadamente raro que la droga cause este tipo de sangrado.

    “Hay siete millones de recetas de Viagra afuera, y estos son solo dos casos de sangrado”, añadió.

    Fuente: Lucy Hicklin, M.D. consultora y cirujana de oído, nariz y garganta, Hospital San Jorge en Londres, R.U.; Nachum Katlowitz, M.D. director de disfunción sexual masculina, Maimonides Medical Center. Brooklyn, N.Y. y director de fertilidad masculina, Hospital Universitario de Staten Island, Staten Island, N.Y.; agosto de 2002, “Journal of the Royal Society of Medicine”

    Last Updated: Aug 6, 2002

    Copyright © 2002 ScoutNews, LLC. All rights reserved.

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

    TICKET PRICES

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    Adults: $25
    Seniors: $20 (65 or older)
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    Friday & Saturday
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    Many theatre goers have called Hackmatack one of New England’s most charming and quaint summer theatres. Some have even said that summer in Maine is not summer without a trip to Hackmatack. Much of the allure of this playhouse is its scenic location and historical presence.

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

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

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

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

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

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

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

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

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

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

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

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    Why Viagra and grapefruit juice don’t mix

    It's been called the most popular drug in the world– the little blue pill, Viagra. And while most men know they should not take Viagra if they are also using a nitrate drug for chest pain or heart problems, many may not know about this.

    “Viagra, which is used for treating erectile dysfunction, when combined with grapefruit juice can reach toxic levels that result in men having hot flushes. It can also significantly lower their blood pressure and it can produce unwanted side effects,” said Dr. Neil Baum, a urologist.

    Baum says as little as one grapefruit or an 8 oz. glass of juice can cause a change in absorption for 24 hours.

    “The grapefruit juice in the small intestine where pills are absorbed prevents the breakdown of the medication, so when it's absorbed, it's absorbed in larger quantities and can reach toxic levels,” Baum said.

    The reason Viagra should not be taken with a nitrate medicine is because it can cause a serious drop in blood pressure. For that reason doctors say men who become dizzy, nauseated or have pain, numbness or tingling in the chest, arm, neck or jaw should get medical attention right away. And taking Viagra in the same day as grapefruit can have a similar effect.

    “It can drop a man's blood pressure, it can cause a man to feel hot and warmed and flushed, and so taking away the enjoyment that sexual intimacy is supposed to create it can subtract from that and can make the man quite uncomfortable,” Baum said.

    Some other fruits can also have the same effect, like Seville oranges, limes and pomelos. But sweet oranges do not cause this interaction.

    © Copyright 2000 – 2016 WorldNow and WCAX

    Viagra and Grapefruit Juice — Not a Good Mix

    A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

    The original formulation of the protease inhibitor saquinavir — Invirase — became available in North America around the mid-1990s. However, Invirase was poorly absorbed. The manufacturer suggested that taking Invirase with concentrated grapefruit juice would enhance the absorption of this drug. This effect occurs because grapefruit juice contains compounds that impair the activity of certain enzymes in the intestine — enzymes that help break down Invirase.

    A few years later, doctors began to use another protease inhibitor. ritonavir (Norvir), in combination with Invirase. Ritonavir is much more effective than grapefruit juice at inhibiting enzymes in the intestine and liver. Examples of other drugs affected by grapefruit juice include the following:

    • beta blockers — Cardizem (diltiazem)
    • sedatives/sleeping pills — Halcion (triazolam), Versed (midazolam)
    • transplant drug — cyclosporine (Neoral, Sandimune)

    Now it appears that grapefruit juice can also affect the absorption of the popular erectile dysfunction drug Viagra (Sildenafil). Because erectile dysfunction is common in some males with HIV/AIDS, we report on the interaction between grapefruit juice and Viagra.

    Study Details

    Researchers in Köln, Germany, conducted a study using 24 healthy, HIV negative male subjects whose average age was 29 years. The men received a glass of grapefruit juice on an empty stomach and then one hour later another glass of grapefruit juice with Viagra 50 mg. Blood samples were collected over the next 24 hours. A week later the experiment was repeated with water being substituted for grapefruit juice.

    Results

    Researchers found that the absorption of Viagra increased by 23% when taken with grapefruit juice instead of water. Grapefruit juice also delayed the absorption of Viagra. This latter point is important because Viagra is supposed to be taken one hour before sex, and taking the drug with grapefruit juice may result in disappointment for some users of Viagra.

    The grapefruit juice used in this study was white juice and supplied by Döhler-Euro Citrus NBI, GmbH. Other brands, types and doses of grapefruit juice may have different effects. The researchers suggest that the combination of Viagra and grapefruit juice be “avoided.”

    Men who use protease inhibitors are usually prescribed less-than-normal doses of Viagra because protease inhibitors can raise levels of Viagra several times greater than normal, which can cause dangerous side effects. Therefore, men who use protease inhibitors and Viagra may wish to also avoid taking Viagra with grapefruit juice.

    References

    1. Jetter A. Kinzig-Schippers M. Walchner-Bonjean M. et al. Effects of grapefruit juice on the pharmacokinetics of sildenafil. Clinical Pharmacology and Therapeutics 2002; 71:21-29.
    2. Hyland R. Roe E. G. Jones B. C. and Smith D. A. Identification of the cytochrome P450 enzymes involved in the N-demethylation of sildenafil. British Journal of Clinical Pharmacology 2001; 51(3):239-248.
    3. Muirhead G. J. Wulff M. B. Fielding A. et al. Pharmacokinetic interactions between sildenafil and saquinavir/ritonavir. British Journal of Clinical Pharmacology 2000; 50(2):99-107.

    A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

    Grapefruit & Cialis

    by RACHEL NALL Last Updated: Jul 09, 2011

    Rachel Nall began writing in 2003. She is a former managing editor for custom health publications, including physician journals. She has written for The Associated Press and “Jezebel,” “Charleston,” “Chatter” and “Reach” magazines. Nall is currently pursuing her Bachelor of Science in Nursing at the University of Tennessee.

    While you may enjoy the vitamin C-packed nutrients found in grapefruits, eating grapefruit with certain medications can negatively impact your health. One example is the medication Cialis, generic name tadalafil, which is prescribed to treat erectile dysfunction. If you are currently taking this medication and wish to consume grapefruits or grapefruit juice, talk to your physician first.

    Enzyme Concentration

    Grapefruit contains certain enzymes that interact with an enzyme in your intestine and liver known as CYP 3A4. This enzyme is responsible for breaking down certain medications, like Cialis, in your body. When you eat a grapefruit, the grapefruit can reduce the amount of CYP 3A4 in your intestines by as much as 47 percent.

    How Cialis Is Affected

    When you typically take Cialis, the CYP 3A4 in your body starts to break down the medication, releasing it at an expected rate and helping it to work on your body’s systems. However, if you have eaten grapefruits, you have less of this enzyme in your body, which means Cialis stays in your body longer. Some people tend to have more CYP 3A4 in their bodies than others, which means grapefruit’s effects on Cialis can vary.

    You Might Also Like

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    Medications to Avoid When Eating Grapefruit

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    Alternatives to Cialis

    Lisinopril Side Effects With Grapefruit

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    Benefits of Eating Grapefruit

    Can You Eat Grapefruit With Norvasc?

    Can I Eat Grapefruit While Taking Cymbalta?

    Can Grapefruit Juice Be Drunk if You Are Taking Thyroid Medicine?

    Grapefruit & Coumadin

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    Does Grapefruit Juice Enhance Tramadol?

    Bioavailability

    Cialis is a medication that tends to rank low in terms of bioavailability. Bioavailability is a term that refers to how much medication the body absorbs. For example, if you take a vitamin that has 100 g of calcium, you’re your body may absorb only half this amount. Because Cialis is not absorbed as much as other medications, the medication may be administered at a higher dose. This is problematic when you eat a grapefruit because Cialis’ bioavailability increases, meaning more circulates in your bloodstream.

    Time Frame

    Even if you do not take Cialis regularly, grapefruit can have harmful effects. This is because even 8 oz. of grapefruit juice can stay in your digestive system for 72 hours. If you drank a glass of grapefruit juice three days before and take Cialis, it is possible you could experience side effects related to grapefruit consumption. Therefore, if you know you may be taking the medication in the near future, it’s best to avoid grapefruit products entirely.

    Side Effects

    Common side effects associated with Cialis include redness, cold-like symptoms, headaches, memory problems or muscle pain. Eating grapefruit while taking Cialis can heighten these effects. In some instances, you can experience more serious side effects like changes in vision, irregular heartbeat, shortness of breath or fainting. If you have these symptoms, seek immediate medical attention and inform your physician if you have recently consumed grapefruit.

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    Dangers of 'herbal Viagra': What every man should know

    In this 2012 file photo, Los Angeles Clippers’ player Lamar Odom brings the ball up in an NBA basketball game against the Phoenix Suns in Los Angeles. Odom, the former NBA star and reality TV personality embraced by teammates and fans alike for his humble approach to fame, was hospitalized and his estranged wife Khloe Kardashian is by his side, after being found unresponsive in a Nevada brothel where he had been staying for days. (Photo: Jae C. Hong, AP)

    Basketball player Lamar Odom’s collapse this week – after allegedly using cocaine and sexual supplements – has raised questions about the supplements and their safety and whether they could increase the dangers posed by illegal drugs. Odom is now on life support at a Nevada hospital.

    USA TODAY’s Liz Szabo talked to medical experts about these products.

    Q. What is in a sexual performance supplement?

    A. Although these supplements are often called “herbal Viagra” – suggesting that they contain a safer or more natural form of the little blue pill – many contain the active ingredient in real Viagra, according to the Food and Drug Administration.

    Odom apparently took supplements called Reload 72-hour Strong and Libimax, according a spokesman for the legal Nevada brothel where he collapsed, who spoke to the Associated Press.

    Lamar Odom's sex enhancement supplements may have been spiked

    Tests by the FDA in 2013 found sildenafil, Viagra’s active ingredient, in Reload. In 2009, the manufacturer of LibiMax recalled the product after tests found that it contained tadalafil, another drug for erectile dysfunction.

    Problems aren’t limited to LibiMax and Reload. The FDA has found that 300 sexual supplements contain unidentified ingredients.

    “Not only do these products contain undisclosed drug ingredients,” the FDA says on its website, “but they also sometimes may include combinations of undisclosed ingredients or excessively high doses, both potentially dangerous situations.”

    Some herbal sexual supplements also contain saw palmetto, ginseng and horny goat weed, used for centuries in China to treat low libido and erectile dysfunction. Others contain yohimbine,made from the bark of a type of evergreen tree, said Pieter Cohen, an assistant professor at Harvard Medical School.

    Taking a sexual supplement “is like playing Russian roulette,” said Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. “You don’t know what you’re getting any time you open a bottle of ‘herbal Viagra.'”

    Q. Why would supplement makers put an expensive drug like Viagra, which can sell for $5 to $10 a pill, into an herbal supplement?

    A. Although Viagra is expensive in the USA, it’s dirt cheap in China, which makes many of these supplements, Cohen said. Chinese companies sell sexual supplements for a fraction of the cost of Viagra, but can still make a profit. Unlike Viagra, however, which comes in a standard dose, supplements may not have a standard dose of medication. So men could get much less of the active ingredient they’re looking for — or much more.

    Q. How risky are these supplements?

    A. According to the FDA, the hidden ingredients in these supplements can pose life-threatening risks.

    That’s because the active ingredients in erectile dysfunction drugs can interact with prescription drugs such as nitroglycerin, used to treat chest pain and other heart problems, according to the FDA. That’s a big risk, given that the older men who seek out erectile dysfunction drugs are often the same ones who take nitroglycerin, including men with diabetes, high blood pressure, high cholesterol or heart disease.

    Both Viagra-like drugs and nitroglycerin lower blood pressure, Glatter said. Taken together, the combination can cause heart rhythm problems, heart attacks and strokes.

    In its 2013 warning about Reload, the FDA said: “Consumers should stop using this product immediately and throw it away. Consumers who have experienced any negative side effects should consult a health care professional as soon as possible.”

    Even prescription erectile dysfunction drugs such as Viagra, which are regulated much more tightly than herbal supplements, can cause heart attacks, Glatter said.

    Sexual supplements that contain Viagra-like drugs are especially risky if men take large doses, Glatter said. Odom reportedly took 10 of the pills.

    Consumers should be skeptical about claims that appear too good to be true, said Craig Hopp, program director of extramural research the National Center for Complementary and Integrative Health, part of the National Institutes of Health. Some herbal sexual supplements promise results in 30 minutes, for example. While pharmaceuticals can work that quickly, Hopp said that plants don’t. Supplements that claim to work as quickly as drugs are probably laced with drugs.

    Q. Do sexual supplements work?

    A. No supplements have ever been shown to be effective for erectile dysfunction, according to the National Center for Complementary and Integrative Health .

    Unlike prescription drugs, which must prove they’re safe and effective before being approved by the FDA, supplement makers don’t have to prove that their products work before selling them, said Charles Bell, programs director for Consumers Union, the advocacy arm of Consumer Reports magazine. Because supplements aren’t tested through a rigorous scientific process, consumers have no way to know if they really work.

    Q. Are supplements riskier than prescription or over-the-counter erectile dysfunction drugs?

    A. Unlike prescription and over-the-counter drugs, supplement makers aren’t required to post warnings about such side effects or drug interactions on their product labels, Bell said. Many men may not realize the risks.

    Sexual supplements can sometimes be much stronger than regular Viagra, Glatter said. “You take more and more pills thinking it’s safe,” Glatter said. “People think, ‘It’s natural, so it must be safe.'”

    A study in The New England Journal of Medicine this week found that at least 23,000 Americans go to the emergency room – including 2,000 who are hospitalized – after taking dietary supplements. Many of the most common symptoms are heart palpitations.

    Viagra

    GENERIC NAME(S): SILDENAFIL CITRATE

    Uses

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

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

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

    How to use Viagra

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

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

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

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

    Tell your doctor if your condition does not improve.

    Side Effects

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

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

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

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

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

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

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

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

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

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

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

    Precautions

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

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

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

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

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

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

    Interactions

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

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

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

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

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

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

    Overdose

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

    Notes

    Do not share this medication with others.

    Missed Dose

    Storage

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

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

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

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    Travel and Supply

    Tourism Deliver

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