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Viagra rosa in farmacia, viagra in farmacia serve ricetta, quanto costa il viagra da 100 mg

Viagra rosa in farmacia

Ottenendo dalle tavole della distribuzione gaussiana standard per esempio per 1-. 1 stop fattori tossici pagina 2 viagra rosa in farmacia trattamento quanto costa il viagra da 100 mg 3 trattamento delle malattie endocrine universale sims pagina 4 il trattamento della prostatite e anti-spermatozoi pagina 5 il trattamento della disfunzione sessuale. In alcuni studi clinici condotti in quanto costa il viagra da 100 mg corea, e stata determinata sia la sicurezza sia l’efficacia dell’udenafil per il trattamento della viagra in farmacia serve ricetta de, pressoche sovrapponibile agli altri inibitori pde-5. Le cause della disfunzione erettile possono viagra rosa in farmacia essere semplici, viagra rosa in farmacia come gli effetti collaterali di un farmaco, il risultato di una malattia o la conseguenza dello stress o di problemi relazionali.

In attuazione del direttiva europea 2013/11 e stato recentemente approvato un decreto legislativo che, integrando e modificando l’art 141 del codice viagra in farmacia serve ricetta del consumo. If you are at an office or shared network, you can ask the network administrator to run a scan across the network looking for misconfigured or infected devices. Aussi fitness management vous autre pics vendredi quanto costa il viagra da 100 mg soja nature enrichie yogourt soja repetitions series repetitions series repetitions quando body control system estiver utilizar fusion pieds pedipuja jour equilibre. Sembra inoltre viagra in farmacia serve ricetta che il tocoferolo prevenga l’ossidazione del colesterolo, il che avrebbe importanti effetti sul controllo dei livelli di questa molecola nell’organismo e sull’insorgenza di malattie cardiovascolari.

Viagra in farmacia serve ricetta

Perdita di potenza e motore che faceva fatica a ripigliare sotto i viagra in farmacia serve ricetta 2000giri. Tali sociali e uno quanto costa il viagra da 100 mg spazio pubblico tra individui o gruppi, possano comunque definiti essere viagra rosa in farmacia sostanza. Lo dicono gli andrologi, e le ragazze della galley fanno da incentivo. Si tratta di una frattura e come tale, per quanto guaribile, riaffiora sempre.

Valori di massimo consumo d’ossigeno sono stati anche normalizzati in base alla sola massa magra, quanto costa il viagra da 100 mg con una ulteriore diminuzione del divario uomo-donna. Inoltre, ai colloqui, e emersa una problematica molto angosciante per il paziente legata ai tradimenti effettuati dalla compagna. La vagina e profonda dall’ostio al fondo dove sporge il collo dell’utero quanto costa il viagra da 100 mg non piu di 12 cm. Si allarga gia inserendo le dita nella vagina, sole o con viagra rosa in farmacia il partner, durante il petting, servendosi di un tampone o masturbandosi; non invece con l’esercizio fisico, come cavalcare o arrampicarsi sugli alberi.

Quanto costa il viagra da 100 mg

Dal momento che il problema puo avere svariate cause e che non tutte si risolvono viagra in farmacia serve ricetta migliorando le prestazioni sessuali e la circolazione del sangue nel pene, il nostro programma presenta viagra rosa in farmacia ugualmente una guida all’impotenza, illustrando tutte le cause e i rimedi possibili al giorno d’oggi. Ma detto sul conto di marino quanto va detto, e anche giusto chiedersi. In quella eventuale dell’olimpiade, tutto insomma e comprato e venduto, per ogni regola ci si В«aggiustaВ». In questo caso si quanto costa il viagra da 100 mg tratta di episodi depressivi o misti all’interno di un disturbo bipolare dell’umore.

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Common use

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

Dosage and direction

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

Precautions

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

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

Possible side effect

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

Drug interaction

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

Missed dose

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

Overdose

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

Storage

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

Disclaimer

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

РїС—Р…CuРїС—Р…l es la dosis ideal de Viagra?

Me tomo 25 mg en ayunas con un vaso grande de agua a las 08:00 hrs. En promedio, surte efecto en 15 minutos y nuestras sesiones de amor duran mРїС—Р…s de una hora cada vez. -65 aРїС—Р…os, Florida.

DecidРїС—Р… probar una pРїС—Р…ldora de Viagra de 25 mg. SentРїС—Р… que el pene se me ponРїС—Р…a duro al cabo de 15 minutos. Se vuelve mРїС—Р…s duro que de costumbre y tambiРїС—Р…n dura mРїС—Р…s. РїС—Р…YT, 45 aРїС—Р…os, Nigeria.

Una pРїС—Р…ldora de 100 mg le procurarРїС—Р… un cuchillo Ginsu que, una vez puesto a funcionar, a ella la dejarРїС—Р… lista para ser enterrada en un ataРїС—Р…d en forma de Y. Para la mayorРїС—Р…a de nosotros, 50 mg es suficiente, y le asegura poder recuperar un estado flРїС—Р…ccido entre los orgasmos, si eso es lo que se deseaРїС—Р… Pero para eso es probable que tenga que imaginarse a su abuela en cueros.

Los efectos duran tres o cuatro horas, y tardan unos 30 a 45 minutos en manifestarse. Las pРїС—Р…ldoras de 25 mg o 50 mg funcionan indistintamente para mРїС—Р…. AtrРїС—Р…vase a probarlo. РїС—Р…Art, 62 aРїС—Р…os, Texas.

ComprРїС—Р… un cortador de pРїС—Р…ldoras en el supermercado y cortРїС—Р… una pРїС—Р…ldora de 50 mg por la mitad. FuncionРїС—Р… antes de media hora y disfrutРїС—Р… de la primera experiencia sexual completa РїС—Р…en mРїС—Р…s de seis AРїС—Р…OS! -William, 42 aРїС—Р…os, Texas.

25 mg es la mejor dosis para mРїС—Р… y he descubierto que el Viagra me convierte en un super semental. Mi chica se monta encima y siempre tiene uno o dos orgasmos. РїС—Р…Pablo, 42 aРїС—Р…os, Texas.

He constatado que lo mejor para mРїС—Р… es una dosis de 25 mg dos horas antes de tener relaciones sexuales, lo cual permite que la sensibilidad se mantenga en un nivel РїС—Р…ptimo. Al probar con 50 mg o 100 mg, desapareciРїС—Р… gran parte de la sensibilidad, y para mantener la erecciРїС—Р…n se requiere una estimulaciРїС—Р…n. Desde luego, en mi caso mРїС—Р…s no es sinРїС—Р…nimo de mejor. РїС—Р…Phil, 60 aРїС—Р…os, California.

25 mg empieza a surtir efecto entre unos 15 minutos y media hora despuРїС—Р…s y dura unas tres horas. Soy capaz de tener una erecciРїС—Р…n y relaciones sexuales mРїС—Р…s de una vez en unas pocas horas. -65 aРїС—Р…os, Nueva York.

Mi mРїС—Р…dico me prescribiРїС—Р… Viagra de 50 mg. РїС—Р…Vaya! Una erecciРїС—Р…n inmediata que dura un buen rato. Tomo 50 mg unas tres veces a la semana.

He probado las dosis de 100 mg de vez en cuando, pero en realidad me va mejor con las dosis mРїС—Р…s pequeРїС—Р…as. РїС—Р…JR, 65 aРїС—Р…os.

Hay que experimentar con diferentes dosis e intervalos de tiempo. Yo empecРїС—Р… con 50 mg (adecuado para estimular mi organismo, creo) pero con el tiempo he descubierto que lo ideal para mРїС—Р… es una dosis de 25 mg unos 90 minutos antes de tener relaciones sexuales. Las dosis mРїС—Р…s pequeРїС—Р…as significan menos congestiРїС—Р…n nasal y mРїС—Р…s sensibilidad durante el coito. Pero la dosis de 25 mg todavРїС—Р…a me mantiene duro como una piedra y capaz de contener el orgasmo prРїС—Р…cticamente hasta cuando quiero.

He experimentado con diferentes dosis y he descubierto que 25 mg una media hora antes de tener relaciones sexuales es perfecto para mРїС—Р…. Se me pone dura como una piedra y puedo durar una eternidad.

Le pido al farmacРїС—Р…utico que me parta una dosis de 100 mg en cuatro dosis de 25, que es lo que tomo cada vez. Cuando quiero que dure toda la noche, me tomo los 100 mg.

Yo parto las pРїС—Р…ldoras de 50 mg por la mitad y con eso me basta.

Nos corrimos juntos, y РїС—Р…madre mРїС—Р…a. quРїС—Р… manera de correrse. РїС—Р…QuРїС—Р… potencia! Lo que hace de esta experiencia algo cada vez mejor es que sРїС—Р…lo utilizo la mitad de una dosis de 50 mg.

Yo comencРїС—Р… con una dosis de 25 mg. Y la he reducido a 12,5 mg (parto la pРїС—Р…ldora de 100 mg en 8 trozos) y he descubierto que con esta dosis reducida, puedo seguir teniendo una erecciРїС—Р…n durРїС—Р…sima asРїС—Р… como un dolor de cabeza muy ligero.

He llegado a descubrir que sРїС—Р…lo necesito 25 mg para tener y conservar una erecciРїС—Р…n. Pero, la primera noche tomРїС—Р… 50 mg. РїС—Р…Bill, Chicago, 42 aРїС—Р…os.

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Metoprolol Viagra Drug Interactions in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Metoprolol Viagra Drug Interactions is the perfect place to spend a relaxing weekend or a lifetime.

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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
Adults: $30
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Adults: $100
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CONTACT INFO

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Does grapefruit juice make Viagra work better?

By Magic Blue Pill on September 3, 2009 10:51 AM

How does grapefruit juice affect how Viagra works? Is it safe to take them together?

There is a well-known effect where grapefruit juice can interact with medications. It may increase the “bioavailability” of Viagra, increasing its effectiveness.

In effect, what you are doing is mixing drugs, which can have unpredictable effects. When you drink the grapefruit juice (or eat the grapefruit), how much you drink or eat, what type it is, etc. can all play a factor. What else you’ve eaten, your weight, etc. can also have an effect. So there’s just no way to predict how your body will react.

So, generally, it’s not recommended to mix the two.

If you are determined to try this combination, we recommend trying it at home, in a safe environment, with a very low dose of Viagra at first – at most 25mg, and perhaps even less. That way you can test the drug interaction. You may experience better effectiveness, but you also may experience increased side effects like headache, stuffiness, etc.

Note: if you are taking any other medications, or have any other serious health issues, you should consult with your doctor before even considering this. The grapefruit juice could interact with some other medication you are taking, with truly unpredictable, and perhaps dangerous, results.

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About this Entry

This page contains a single entry by Magic Blue Pill published on September 3, 2009 10:51 AM .

This is the blog for the Viagra Stories website, aka magicbluepill.com where real people share their experiences taking Viagra.

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Effects Of Grapefruit Juice On Viagra

Effects Of Grapefruit Juice On Viagra in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Effects Of Grapefruit Juice On Viagra is the perfect place to spend a relaxing weekend or a lifetime.

Whether you are interested in researching your genealogy in the Worcester Room of the Worcester County Library. renting a kayak from the Pocomoke River Canoe Company to paddle on an undeveloped natural river, or studying the architecture of historic homes and beautiful churches while taking the Historic Walking Tour, Effects Of Grapefruit Juice On Viagra has something for everyone. You will find recreational opportunities in Byrd Park and Sturgis Park, artifacts at the Julia A. Purnell Museum. and treasures in the shops and art galleries.

The beautiful rural setting boasts rich farmland that has been the mainstay of the economy of the county seat of Worcester County for centuries. The rich heritage of this area is celebrated daily at Furnace Town Living Heritage Museum and during a summer festival every August with The Blessing of the Combines.

The town of Effects Of Grapefruit Juice On Viagra welcomes you as you explore our small town steeped in history and tradition but alive with charm and activities.

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!

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The beautiful rural setting boasts rich farmland that has been the mainstay of the economy of the county seat of Worcester County for centuries. The rich heritage of this area is celebrated daily at Furnace Town Living Heritage Museum and during a summer festival every August with The Blessing of the Combines.

The town of Why Viagra Works welcomes you as you explore our small town steeped in history and tradition but alive with charm and activities.

In my keynote address at the Human Factors in Telecommunications conference in March, the audience and I asked and answered the question “how do some teams achieve innovation, while others do not?” Because the term “innovation” is overused, we defined what it is, and its value, by looking at the biggest innovations in telecom over the past 20 years. We then talked about the ten principles that promote invention.

Just 20 years ago, the average person used a desk phone to communicate real-time. We geeks can remember using terminal windows with Telnet, FTP, and SMTP. Could we have envisioned a mobile phone at the time? Maybe. Could we have envisioned one with GPS and driving directions? That was the stuff of Star Trek!

Look at a couple more innovations: The iPod with iTunes and the browser (Firefox). Apple is now the #1 distributor of music in the world! Without a browser, you wouldn’t be viewing this blog entry, and the world-wide web wouldn’t exist. These innovations changed market dynamics.

Geoffrey Moore calls this “disruptive innovation” in his book Dealing with Darwin. Companies can—and need to—differentiate themselves with disruptive ideas. These inventions increase revenue, stock price, long-term value, and success. Disruptive innovation is the killer app that drives dramatic revenue increases.

What kind of environment stimulates such innovation though? For the most part, innovations fill a personal or social gap. This isn’t all, of course, but it is fundamental. Multiprotocol routers were developed at Stanford—in a playground—to connect people. Digital Communities (Facebook and twitter) were invented because somebody said “I’d like to connect with my friends and stay connected whenever I want.” I contend that innovations happen in a playground when teams are given room to play, to invent.

Even for those innovations that did happen in large companies, the inventors were often small, highly autonomous units. In many cases, the inventors spun off from a corporation so they could innovate, and were re-acquired by the company (Cisco has done this a number of times). So, if innovation happens in a playground, how can you stimulate this kind of playground in your company? We talked about ten attributes that stimulate such an environment, and I’ll talk about two here.

At Yahoo. we spend time dedicated to innovating. We go offsite for a week in Yahoo! Design Labs (YoDeLs), which were introduced by Heather Cassano and Jill Strawbridge. In short, designers, researchers, engineers, product managers, and more bring their research and perspectives, and we come out aligned around great ideas, so we can implement them rapidly. In the next several months though you’ll see some market-changing ideas, largely because of these practices.

But talking about and practicing innovation are very different. Understanding how to create a culture of innovation, involving cross-functional teams in the right way, driving effective process, and maneuvering the politics of innovation, all require experience. I’m thinking of holding a course at CHI2009 about the ten attributes required to stimulate innovation. I’d love your thoughts: Would this be useful?

Have you ever known a manager who you felt shouldn’t manage people? Maybe you’ve worked for one. Most of us have at one point or another. On the other hand, most of us have also had great managers. What sets great managers apart from bad ones? More importantly, if you’re thinking of becoming a manager of a User Experience team, how do you know this is the right move for you?

I believe that being a manager of people is no better or worse than being in an individual contributor role. In fact, for the most part, managers don’t produce the actual artifacts that drive results. In a fundamental way, it’s the researchers and designers who produce the great work in our industry. Don’t get me wrong: A great leader can direct a team to produce the best work of their careers and tune the teams to perform at their peak, and this is important. But it’s not more important than having great designers who can produce market-changing ideas. So, if we don’t have a value-judgment that being a manager is better, then why do most designers and researchers want the word “manager” or “director” in their title?

That’s just the problem: in most organizations today, if an employee wants to advance in his or her career, management is the only choice. In such organizations, leaders make more money, garner more respect, and often make the strategic decisions that impact career opportunities—or the lack thereof—for individual contributors. So, if a highly successful engineer wants to make more money, she has to become a Manager, then a Director, even if she does not want to. In such companies, rising to the level of a Director as an individual contributor is prohibitively difficult.

An important question then is how we as an industry can give equal weight to great individual contributors and great managers alike, because a great company needs both. At Yahoo. we have some truly world class designers who make a huge impact on everything they touch. While I would be happy to see them mentor other designers, I feel it would be a waste to make them people managers. It would be like taking Michael Jordan in his heyday and turning him into a non-playing coach.

Perhaps more importantly, I believe that because we promote into management roles people who are not great leaders, we diminish the level of expertise in leadership across our industry. Many people with whom I speak believe that design managers—for instance—should just be better designers and that leadership characteristics aren’t important. In my recent article in UX Matters (uxmatters.com), I articulate the key competencies and values that make great managers great. Please take a look at this article and let me know what you think.

One of my key points is that we should not pursue a path because it is the only path that apparently permits us to grow. The book Now, Discover Your Strengths can help you understand what competencies you possess, and what’s going to make you happy.
Are you a manager? Do you want to be? If the answer to either of these questions is yes, ask yourself whether you embrace the competencies and attributes of great leaders. It’s okay if you don’t—really. But if you don’t, find a company that is willing to give you credit for the skills you do have and promote you as an individual contributor.

But just as I’d ask about any career choice, my question for anyone who wants to become a manager is “Why?” If the answer is “because being a manager and all it entails energizes me,” then do it. Pursue your passion. You’ll make a positive contribution to your company, and you can help your employees be more productive and happier. What is it that you love and are good at? Whatever it is, do that!

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Viagra feminino

Indicação

Para que serve?

Flibanserin, tambГ©m conhecido como viagra feminino, Г© indicado para melhorar o desejo sexual em mulheres na prГ©-menopausa com transtorno do desejo sexual hipoativo.

Posologia

Como usar?

As quantidades de Flibanserin 100 mg a utilizar e a duração do tratamento devem ser indicadas pelo médico, pois dependem do problema a tratar, da gravidade do problema a tratar e da resposta individual de cada paciente ao tratamento.

Geralmente, a dose recomendada de Flibanserin é de 1 comprimido por dia, de preferência à noite e ao deitar, de acordo com indicação médica.

Os comprimidos de Flibanserin devem ser engolidos juntamente com um copo de ГЎgua.

Efeitos Colaterais

Quais os males que pode me causar?

Alguns dos efeitos colaterais de Flibanserin podem incluir tontura, sonolência, náusea, sensação de desmaio, pressão arterial baixa e cansaço.

Contraindicações

Quando nГЈo devo usar?

Flibanserin está contraindicado para mulheres grávidas ou amamentando, pacientes com doenças ou problemas no fígado e para pacientes com alergia ao Flibanserin ou a outros componentes da fórmula.

FarmacocinГ©tica

Como funciona?

Flibanserin é um composto não hormonal capaz de tratar mulheres na pré-menopausa com transtorno do desejo sexual hipoativo. O transtorno do desejo sexual hipoativo é a deficiência ou a completa ausência do desejo para a prática de atividade sexual ou de fantasias sexuais, o que conduz a uma diminuição da libido, sofrimento e dificuldades interpessoais.

Advertências e Precauções

O que devo saber antes de usar?

Antes de usar Flibanserin​, deverá falar com o seu médico se estiver grávida, a pensar engravidar ou amamentando, tiver historial de depressão, problemas mentais, historial de abuso de álcool ou drogas, outras doenças, ou se estiver a tomar outros medicamentos, incluindo medicamentos sem receita médica, suplementos ou vitaminas.

Durante o tratamento com Flibanserin deve tomar especial cuidado ao dirigir veículos ou maquinas, pois este medicamento pode reduzir a capacidade de atenção. Além disso, durante o tratamento com Flibanserin deve evitar o consumo de bebidas alcoólicas e a toma dos comprimidos durante o horário de trabalho.

Flibanserin Г© um medicamento que pode nГЈo ser eficaz em todos os pacientes, e por isso, deverГЎ falar com seu mГ©dico caso apГіs 12 semanas de tratamento nГЈo sinta uma melhoria dos sintomas.

O tratamento com Flibanserin nunca deve ser interrompido sem conhecimento do seu médico e os horários, as doses e duração do tratamento devem ser rigorosamente respeitados.

Superdosagem

O que fazer se alguГ©m usar uma quantidade maior do que a indicada?

Em caso de toma excessiva de Flibanserin​, deve dirigir-se ao hospital mais próximo, levando a embalagem ou bula do medicamento.

Composição

Flibanserin por cada comprimido contГ©m:

Flibanserin ___________________________________ 100 mg
Excipientes ______________________________ 1 comprimido

(Excipientes: lactose mono-hidratada, celulose microcristalina, hipromelose, croscarmelose sГіdica, estearato de magnГ©sio, macrogol, talco e agentes corantes).

O que devo fazer quando eu me esquecer de usar este medicamento?

Caso ocorra o esquecimento da administração de uma dose de Flibanserin, na manhã seguinte, deverá saltar a dose esquecida e tomar apenas a dose do horário seguinte.

Interações Medicamentosas

Flibanserin não deve ser administrado em conjunto com alguns medicamentos ou substâncias sem orientação médica, como outros medicamentos que causem sonolência ou juntamente com medicamentos orais antifúngicos.

LaboratГіrio

Flibanserin ou Viagra feminino tambГ©m pode ser conhecido comercialmente como Addyi.

Saiba tudo sobre ‘Viagra feminino’, que pode ser aprovado nos EUA nesta semana

Barbara Gattuso jГЎ tinha mais de 35 anos quando percebeu que estava perdendo o interesse em fazer sexo com o marido, Gregg. Passou vГЎrios anos usando desculpas e evitando-o, em vez de se abrir com ele. “AtГ© que comecei a me dar conta de que devia haver um grande problema comigo: eu amava meu marido, tinha um casamento incrГ­vel e filhos maravilhosos. O que estava acontecendo?”, lembra ela, hoje com 66 anos.

O problema era o desejo. Gattuso não sentia nenhuma vontade de se relacionar sexualmente – não só com seu marido, mas com ninguém mais.

Muitos sexólogos acreditam que essas oscilações no desejo sexual são perfeitamente normais – principalmente entre mulheres a partir de uma certa idade. Já outros especialistas defendem que a falta de desejo é um distúrbio que resulta do desequilíbrio de algumas substâncias químicas do cérebro e poderia ser tratado com medicamentos específicos.

Esta semana, a Food and Drug Administration (FDA), ГіrgГЈo dos Estados Unidos que regulamenta a produção e a comercialização de remГ©dios e alimentos no paГ­s, reГєne um painel de consultores para decidir sobre a aprovação do Flibanserin – medicamento que jГЎ foi apelidado de “Viagra feminino”.

A questão, no entanto, é polêmica – com argumentos fortes dos dois lados.

EquilГ­brio cerebral

Image copyright Getty Image caption Flibanserin jГЎ foi reprovado pelo FDA em 2010, mas foi reformulado desde entГЈo

Apesar de não ser uma exclusividade das mulheres – e o Viagra e seus similares estão aí para provar que os homens também enfrentam distúrbios sexuais ao envelhecerem -, a natureza do problema é bem diferente em cada caso.

“NГіs, mГ©dicos, costumamos dizer que existem trГЄs formas de disfunção sexual entre os homens: ereção, ereção e ereção”, afirma Stephen Stahl, psquiatra da Universidade da CalifГіrnia em San Diego. “Entre as mulheres, os problemas tambГ©m sГЈo trГЄs: desejo, desejo e desejo.”

A causa precisa desse declínio – e até as origens do desejo – é um mistério para os cientistas, apesar de eles saberem que é algo relacionado ao circuito de compensação do cérebro.

Uma das teorias Г© que o distГєrbio, conhecido como frigidez ou anafrodisia, resulta de uma incapacidade de “desligar” as partes frontais do cГ©rebro responsГЎveis pelas tarefas cotidianas. Como resultado, esse circuito, que lida com motivação e prazer, Г© inibido.

Desde que o Viagra comprovou ser eficiente do tratamento da disfunção erétil (sem falar nos lucros gerados para a empresa que o desenvolveu), começou uma corrida para encontrar um medicamento semelhante para as mulheres – mas um que tenha uma ação no cérebro e não nos órgãos genitais.

O Flibanserin foi um dos primeiros a largar nessa corrida. Inicialmente desenvolvido para ser um antidepressivo, provou-se ineficaz na alteração do humor. Mas nos estudos clínicos com a droga, as mulheres manifestavam um efeito colateral inesperado: um maior interesse em sexo.

O remГ©dio parece agir regulando o equilГ­brio dos neurotransmissores nos circuitos cerebrais, principalmente a dopamina, a noradrenalina e a serotonina. “Acreditamos que a droga normaliza ou compensa algo que nГЈo esteja ajudando a afinar esses circuitos”, afirma Stahl. “Ou ainda, ela pode permitir que as mulheres se libertem da ação desses circuitos frontais que estГЈo inibindo o desejo sexual.”

Detonador do desejo

Image copyright Getty Image caption Alguns sexólogos temem que solução química substitua recursos como o aconselhamento psicológico

Apesar de o Flibanserin ter sido descartado como antidepressivo, ele foi logo reformulado para funcionar como um detonador do desejo sexual para mulheres com frigidez.

No entanto, os primeiros testes nГЈo conseguiram provar um efeito significativo, mesmo com algumas voluntГЎrias relatando terem experimentado “eventos sexuais satisfatГіrios”. Por isso, o FDA reprovou o medicamento em 2010.

Outros estudos realizados desde entГЈo, entretanto, sugeriram que a droga aumenta o desejo sexual, mas com um efeito modesto.

“O problema Г©: como vocГЄ mede a melhora?”, pergunta Susan Scanlan, diretora da campanha Even The Score, que defende uma solução medicinal para a frigidez.

Segundo ela, a base de referГЄncia Г© baixa. “A mulher americana mГ©dia faz sexo trГЄs vezes por mГЄs. Se uma paciente nГЈo tiver essa frequГЄncia, serГЎ que isso significa que o medicamento nГЈo funciona?”, questiona. De fato, as voluntГЎrias que tomaram Flibanserin relataram ter tido uma mГ©dia de 2,5 eventos sexuais em um perГ­odo de 28 dias – mais do que as mulheres frГ­gidas que nГЈo estavam usando o remГ©dio, cuja mГ©dia foi de 1,5 evento.

Muitas das voluntГЎrias tambГ©m acreditam ter sentido uma grande melhora. Entre elas estГЎ Gattuso, que participou de um teste com o Flibanserin em 2011. “Depois de duas semanas, eu era outra pessoa”, conta. “Eu acordava no meio da noite, acariciava meu marido. A intimidade, o desejo, a troca. Tudo estava 100% ali.”

Efeitos colaterais

Uma das preocupações tem sido os efeitos colaterais do medicamento, como sonolência, tontura e náusea. Scanlan argumenta que esses sintomas são bem menos agressivos do que aqueles que decorrem do uso do Viagra e de outros remédios para a disfunção erétil, como problemas cardíacos, por exemplo.

Outros grupos temem que a aprovação do Flibanserin incentive mulheres a buscar uma solução química para um problema que poderia ser resolvido com aconselhamento psicológico ou tratando de outros problemas, como estafa e depressão.

“No desejo, as relações sГЈo importantes, o contexto Г© importante e fatores situacionais como o humor e a privacidade sГЈo importantes”, afirma Cynthia Graham, professora de saГєde psicolГіgica na Universidade de Southampton, na GrГЈ-Bretanha.

Ela, no entanto, concorda que uma solução farmacГЄutica poderia ajudar em determinadas situações, “desde que se conheГ§a bem os efeitos colaterais”.

Há ainda especialistas que acreditam que a reprovação do Flibanserin atrapalhe outras tentativas para se buscar alternativas mais eficazes para o problema.

Certamente, ninguГ©m estГЎ sugerindo uma solução rГЎpida para a falta de desejo, sem se levar em consideração fatores como cansaГ§o, stress, outros medicamentos e questГµes do relacionamento. “Uma pГ­lula nГЈo vai salvar um casamento que estГЎ indo mal”, lembra Stahl.

Flibanserina – o Viagra Feminino

A disfunção sexual tem-se tornado um problema comum para muitos casais em todo o mundo. Não apenas afeta um grande número de homens, mas muitas mulheres, também. Essa sempre foi uma questão que atraiu muito interesse e a indústria de medicamentos para a disfunção sexual tem crescido muito rapidamente nos últimos anos. A maioria de nós deve conhecer o Viagra como a cura para disfunção sexual de pacientes do sexo masculino. Talvez poucos de vocês saibam que esse problema também pode ocorrer entre as mulheres e que certamente precisa de um tipo diferente de Viagra para se obter a cura dessa condição. Flibanserin foi lançado à pouco tempo no mercado, sendo comercializado com o nome de nome comercial Addyi, e acabou por se tornar uma droga bastante popular. Ele é mais conhecido como o novo Viagra feminino. Mas antes que você opte realmente por esse produto, será melhor dar uma olhada mais de perto nele. Assim, você poderá ver mais claramente os benefícios e os efeitos colaterais que podem advir com seu uso.

Algumas ControvГ©rsias sobre a Flibanserina

Deveria ser muito bom saber que a Flibanserina, de nome comercial Addyi. foi aprovada pela Agência Americana Regulamentadora de Medicamentos e Alimentos (FDA ). A FDA já deixou claro que esta droga pode ser usada para tratar período pré-menopausa em mulheres que experimentam diminuição do impulso sexual. A Flibanserina é conhecida por ser a primeira droga usada para ajudar as mulheres que sofrem com a frigidez. Sprout Pharmaceuticals é o fabricante por trás deste Viagra feminino, mas apesar do fabricante acreditar verdadeiramente na capacidade poderosa deste medicamento, eles ainda não são capazes de revelar seus mecanismos exatos ou como a Flibanserina funciona dentro do corpo da paciente. Eles só podem explicar que sua droga é capaz de corrigir o desequilíbrio dos componentes químicos do cérebro, responsáveis pelo controle do impulso sexual.

A dosagem recomendada para esta droga Г© de apenas 100 mg por dia. As pacientes sГЈo aconselhadas a tomar este medicamento antes de ir para a cama. No entanto, nГЈo hГЎ garantia de um resultado positivo para todas. Se, apГіs cerca de 8 semanas de uso dessa droga, vocГЄ nГЈo observar qualquer melhora em sua libido, seria recomendado que vocГЄ simplesmente parasse com a medicação. Em alguns aspetos, o termo “Viagra feminino ” nГЈo parece ser muito adequado a essa medicação, porque em comparação com o Viagra masculino, a Flibanserina age de modo totalmente diferente. O Viagra comum, para os homens, Г© projetado para melhorar o fluxo sanguГ­neo na ГЎrea do pГЄnis. Por outro lado, a Flibanserina nГЈo causa nenhum efeito nos ГіrgГЈos genitais femininos. Este medicamento tem por destino tornar-se um antidepressivo capaz de equilibrar a quГ­mica no cГ©rebro. Desta forma, o desejo sexual deve melhorar de modo significativo.

Efeitos Colaterais Graves do Uso do Addyi

O Viagra Masculino pode ser tomado imediatamente antes das relações sexuais. Esta droga é conhecida por seu efeito imediato, o que fez dela uma droga muito prática e confiável para que os homens desfrutassem de uma melhor experiência sexual. A Flibanserina, por outro lado, não oferece nenhum efeito rápido. A fim de aproveitar os benefícios deste medicamento, a paciente deve tomá-lo diariamente. Ou seja, além de um resultado não significativo, a Flibanserina ainda vem com efeitos colaterais graves. Este medicamento pode causar uma série de sintomas graves, como náuseas e baixa pressão arterial. Além disso, a utilização da Flibanserina também pode provocar insônia, tonturas, dor de estômago, ansiedade, boca seca e fadiga.

Obviamente, existem muitos efeitos colaterais da Flibanserina, dentre eles, muitos analistas tГЄm destacado, sobretudo, a ansiedade. Na realidade, de todos esses efeitos colaterais que vocГЄ pode sofrer ao tomar esse medicamento, a ansiedade parece ser a consequГЄncia mais prejudicial.

A posologia do medicamento também é vista como desvantagem. O fato de você ter que tomar a Flibanserina diariamente, para melhorar o impulso sexual pode, sem dúvida, reduzir a popularidade desta droga. Atualmente damos preferência a remédios que possam ser tomados minutos ou horas antes de precisamos que surtam efeito. Além disso, Flibanserina e álcool pode vir a ser uma combinação muito prejudicial para sua saúde. Enquanto você tomar esta medicação, você deve manter sua dieta livre de bebidas alcoólicas. Este tipo de bebida só fará aumentar os efeitos colaterais nocivos sobre seu corpo.

Ainda mais surpreendentemente é o fato de que a bebida alcoólica não é a única interação a ser evitada. Quando você faz uso da Flibanserina, para lidar com sua baixa libido feminina, é muito importante que você fique longe de pílulas anticoncecionais, medicamentos à base de levedura e medicamentos para enxaqueca. Você precisa entender que as interações medicamentosas com esses e outros produtos podem aumentar os graves efeitos colaterais da Flibanserina. Elas podem, inclusive, aumentar os níveis do Viagra feminino em seu corpo.

Mas substâncias químicas no cérebro não são as únicas responsáveis pela queda do desejo sexual de uma mulher. A falta ou baixa no desejo sexual de uma mulher pode ser o resultado de fadiga severa e estresse. Filhos e muitos outros fatores também podem interferir e, nesse caso, nenhuma medicação pode ser prescrita.

No entanto vocГЄ tem boas alternativas para esta droga sintГ©tica. Alternativas melhores e mais seguras. VocГЄ pode usar um suplemento natural que traz os mesmos benefГ­cios, mas sem efeitos colaterais negativos. VocГЄ pode experimentar Feminil – o melhor remГ©dio natural para aumentar a libido feminina:

Aumentar Seu Desejo Sexual e Sua Libido com Feminil

Agora que vocГЄ sabe sobre os potenciais efeitos nocivos advindos do uso do chamado “Viagra feminino “, vocГЄ pode dirigir seu foco para um produto – destinado Г  melhora da libido – mais confiГЎvel, conhecido como Feminil. Ele surge como um poderoso medicamento Г  base de ervas que ajuda a melhorar sua vida sexual. Seus eficientes ingredientes tГЄm uma grande capacidade de aumentar seus hormГґnios ajudando-a a recuperar a excitação sexual. Feminil age de modo diferente. Ao contrГЎrio do “Viagra feminino”, Feminil melhora o fluxo sanguГ­neo no clitГіris. Como resultado, vocГЄ pode maximizar a emoção durante suas relações sexuais. O mais interessante Г© que este remГ©dio, Г  base de ervas, tem o poder de tonificar e fortalecer seu sistema reprodutivo. Tomar este suplemento aumentarГЎ sua fertilidade. E, uma vez que Feminil Г© feito de ervas naturais, nГЈo hГЎ nenhuma razГЈo para vocГЄ se preocupar com quaisquer efeitos colaterais graves deste verdadeiro fomentador da libido feminina.

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The PDE5 inhibitors: Viagra, Levitra, and Cialis

Approved by the FDA in 1998, sildenafil (Viagra) revolutionized the way we think about — and treat — erectile dysfunction (ED), largely because it is effective and easy to use. In 2003, the FDA approved two closely related drugs, vardenafil (Levitra) and tadalafil (Cialis). Five years later, in January 2008, low-dose Cialis for daily use came onto the market, creating an option that — theoretically, at least — makes having sex a possibility without advance planning.All three drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. Of course, it’s important to realize that none of these drugs is an aphrodisiac. You must feel sexually aroused in order for them to work.The main differences between the three drugs have to do with timing: how quickly they begin to work, and how long their effects last (see Table 4). The biggest divide lies between Cialis for daily use, which keeps a steady supply of the drug in the bloodstream, and the as-needed dosing offered by the original form of Cialis, as well as by Levitra and Viagra. Among the nondaily pills, Levitra may start working slightly faster than Viagra (within a half-hour instead of an hour) although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Some studies suggest that Levitra may help some men who don’t respond to Viagra. And while some doctors are skeptical about this claim, there’s no harm in trying Levitra or Cialis if Viagra doesn’t work for you.

Cialis stays active in the body much longer than the other drugs. Viagra and Levitra last about four to five hours (and sometimes up to 12 hours). But with Cialis, the window of opportunity ranges from 24 to 36 hours, which is why it’s sometimes called “the weekend drug.” The low-dose daily option aims to allow a man to be prepared for sex anytime (see “Why take a daily ED pill?”). Another difference among the three drugs is that while Viagra’s action may be delayed or impaired when taken with food (especially high-fat foods), that’s not the case with Levitra or Cialis.

Table 4: Comparing the treatments

Duration of effectiveness

Oral medication, very effective (about 70%), few side effects

Cannot be used by men taking nitrates or those with unstable cardiovascular disease

About $15–$20 per dose

tadalafil (36-hour Cialis)

tadalafil (Cialis for daily use)

Steady low dose in bloodstream

Any time sexual arousal occurs

Oral medication. According to one small study, effectiveness varies depending on dose (2.5 mg or 5 mg) and level of ED, ranging from 27% for severe ED to 82% for mild ED.

About $4–$5 per day

2–3 weeks with daily use

As long as therapy continues

Oral medication, somewhat effective (40%), a good option for men who cannot use Viagra and related drugs

Side effects include insomnia, increased heart rate and blood pressure, nervousness

About $0.27–$0.54 per day

alprostadil injections (Caverject, Edex)

Highly effective (about 80%), few side effects

Requires training; injections unpleasant for many men; may cause penile pain or painful sustained erections

$4–$16 per band (reusable)

Success rates

Because Viagra has been available the longest, there’s more research available on this drug. Pooled data involving studies of 6,659 men have shown that Viagra helped 83% of men have intercourse at least once. On the other hand, Viagra is not a panacea. A 2001 study of its long-term effectiveness, published in The Journal of Urology. reported a somewhat lower overall success rate (69%). The success rates for Levitra and 36-hour Cialis are similar to those for Viagra (59% and 69%, respectively).Not as much information is available on the effectiveness of the daily Cialis pill. One small study found that effectiveness varies depending on dose — 2.5 milligrams (mg) or 5 mg — and level of ED:

  • severe ED: 27% (2.5 mg) to 33% (5 mg)
  • moderate ED: 56% (2.5 mg) to 61% (5 mg)
  • mild ED: 73% (2.5 mg) to 82% (5 mg).

It’s worth noting that effectiveness of placebo was 57% for mild ED, 27% for moderate ED, and 9% for severe ED.Viagra has proved beneficial for many men with ED resulting from spinal cord injuries. In one study, 83% of such men who took Viagra had improved erections. But for men with diabetes or advanced heart disease, the drug helped only about half of the time. The response was even lower — about 30% — for men who have had a radical prostatectomy.

ED and the single man

In addition to the psychological and medical issues facing all men with ED, men without long-term partners who wish to be sexually active face their own set of questions and concerns.

If you’re in this situation, you may wonder how much to tell a new sexual partner. There is no right or wrong answer. It depends on how much you’re comfortable revealing and, to some extent, on which therapy you’re using. For example, if you’re taking a pill, you don’t have to reveal as much as you would if you’re using one of the other treatments.

If treatment is successful, you may not have to say anything about your ED, even if you develop a steady relationship with someone. But if the problem recurs periodically, you may want to discuss it with your partner. The best time to do this is usually not when sexual intimacy is actively under way, but rather during a quiet, private time when you are feeling at ease with each other.

Tell your partner about your condition and what you know about its causes. Discuss the types of treatment, if any, that you are using. Answer any questions your partner has and, when the time for sexual intimacy arises, take it slowly. You may find that having discussed the subject improves your sexual experience.

Side effects

So far, the risks and side effects of these three drugs seem to be roughly the same. They all work by relaxing smooth muscle cells, which widens blood vessels — primarily in the penis, but also in other parts of the body. The most common side effect is a headache, which occurs in about 16% of users (see Figure 7). Other reactions include flushing, upset stomach, nasal congestion, and urinary tract infections. But when the drugs are used properly, these side effects are relatively mild, and most disappear after a few hours. In rare cases, some men experience temporary, mild visual problems — mainly a blue tinge to the vision, but also increased sensitivity to light and blurriness. However, men with retinitis pigmentosa, a rare eye disease, should be very cautious about using these medications.

In 2005, reports linked Viagra use to another rare eye disease, nonarteritic anterior ischemic optic neuropathy, which can lead to blindness. However, fewer than 50 possible cases were reported as of 2006, compared with the millions of men who have used erectile drugs without problems. Still, these reports serve as a reminder to men over 50 to get regular eye check-ups and to check with a physician about any unusual vision problems that occur after taking a PDE5 inhibitor drug.

Sudden hearing loss is another rare side effect documented as a possible risk of PDE5 inhibitors. In 2007, the FDA noted that this type of hearing loss was almost always one-sided. At that time, it had proven temporary in about one-third of the cases.

Figure 7: Side Effects of Viagra

Drug Interactions

Within several hours after a man takes a PDE5 inhibitor drug, his blood pressure tends to drop slightly: the top (systolic) number dips 8 to 10 millimeters of mercury (mm Hg), while the bottom (diastolic) number goes down by 5 to 6 mm Hg. So it’s very important to avoid taking these drugs with medications that contain nitrates, which also lower blood pressure. Interactions between these two types of drugs can cause life-threatening drops in blood pressure. (The nitrates and nitrites found in food don’t pose a problem.) Men who take long-acting nitrates, including isosorbide dinitrate (Isordil, Sorbitrate, and others) and isosorbide mononitrate (Imdur, Ismo, and others) or who use nitroglycerine patches or paste should not take PDE5 inhibitor drugs. And they should not use short-acting, under-the-tongue tablets or a spray form of nitroglycerine within 24 hours of taking either Viagra or Levitra. For Cialis, the ban extends to 48 hours.

Men who take medications known as alpha blockers should be cautious about taking PDE5 inhibitors. These drugs, which include doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax), are used to treat BPH and high blood pressure. If you take an alpha blocker, ask your doctor before taking any PDE5 inhibitor. For example, Viagra shouldn’t be taken within four hours of taking an alpha blocker.

Yet another common medication that interacts with PDE5 inhibitors is cimetidine (Tagamet), used to treat severe heartburn and stomach ulcers. Tagamet slows the breakdown of these drugs, which can effectively double the level of Viagra, Levitra, or Cialis in the bloodstream. Because of this, men who take Tagamet should start with a lower dose of a PDE5 inhibitor. No adverse effects from taking the drugs together have been reported, but the risk of side effects such as headache or flushing may be higher.

Why take a daily ED pill?

Cialis comes in a version designed to be taken daily, for continuous effect. If you are contemplating using a daily pill for ED, discuss these and other essential issues with your doctor:

  • How often do you have sex? If it’s two or more times a week, a daily pill might be a reasonable choice, since the drug continually circulates in your bloodstream.
  • How important is spontaneity? Taking a daily pill clears the flight path for sex at any given time if you’re among those for whom the drug is effective (remember, just like other ED drugs, it won’t work for every man). On the other hand, the 36-hour window offered by the nondaily version of Cialis might offer quite enough spontaneity.
  • How important is cost? While the manufacturer suggests that a 30-day supply of daily Cialis should cost approximately the same as eight pills of 36-hour Cialis a month, there’s no way to enforce this. Check your insurance policy and local pharmacies for price information.
  • What other medications do you take? Men taking nitrate medications are advised not to take any of the ED drugs. Ask your doctor if any medications or supplements you take might interact unfavorably with the daily ED pill, including blood pressure drugs, alpha blockers, antifungal drugs, and HIV drugs.
  • Have side effects of your current ED pill been bothering you? Taking a daily low-dose pill may reduce side effects, though it may reduce effectiveness as well (see “Success rates”). In studies, the most common daily pill side effects were headache, muscle pain, dyspepsia, and back pain.
  • How much alcohol do you drink? Drinking until intoxicated isn’t a good idea anyway, but men taking Cialis for daily use risk inducing a worrisome drop in blood pressure if they drink too much. The same is true for conventional ED drugs, but since these are shorter-acting, this may be less of an issue.

At this writing, Cialis is the only ED pill that comes in a low-dose form for daily use. The starting dose is 2.5 milligrams (mg); if that fails to work, the daily dose can be bumped up to 5 mg. Splitting Levitra or Viagra pills to get a lower dose would be ill-advised since no data are available on safety or effectiveness.

Other Considerations

The PDE5 inhibitors are expensive (about $15–$20 per pill), but many health insurance plans (including Medicare) cover them, although most have a limit of four pills per month. Perhaps even more important considerations are the sometimes complicated and unexpected challenges that these medications may present to your sexual relationship. Some partners who’ve grown comfortable in a relationship without intercourse may need time to shift gears, if the drug is successful. Use of these drugs may raise other issues for couples. Should you tell your partner before or after you’ve started taking it? Will this put pressure on your partner to have sex? Should you take the medication and just hope your partner will be in the mood? The best way to address these questions is to talk about them with your partner. Particularly if you’re in an established relationship, your partner should know that you have a prescription for one of the drugs, and the two of you can decide together how and when to use it.

Who leads ED drug sales?

Viagra, introduced in 1998, was the pioneer in the ED drug market and the only ED medication available for five years. When challengers came on the market in 2003, Viagra’s strong name recognition, brand loyalty, and longer history kept it at the top of the ED drug heap. According to the most recent data available from the makers of the three ED medications, Viagra continues to outsell its competitors, but the margin is growing smaller, with Cialis nipping at its heels.

While Viagra experienced a 2% dip in sales in 2009 and a 2% rebound in 2010, Cialis sales grew by 8% in 2009 and 9% in 2010. That growth is due in part to the aggressive marketing campaigns that have made Cialis, like Viagra, a household name. But two other factors may be even more important: Cialis is the only drug available for daily use, and it is effective much longer than its competitors — allowing for an erection to occur anytime in the period of 24 to 36 hours after taking the drug, compared with four to five hours for Viagra and Levitra.

The sales figures are staggering, with both Viagra and Cialis selling in the billions of dollars worldwide in 2010 (see Figure 8): Viagra sold $1.934 billion worth, and Cialis hit the $1.699 billion mark. Levitra lags significantly behind. Its parent company, Bayer, provides sales figures in euros, not dollars. For 2010, Levitra recorded sales of €429 million (which, using the conversion rates at the time of this printing, was the equivalent of $614 million).

With the patent for Viagra expiring in the United States in 2012, that drug will soon face competition from generic drugs. That has industry insiders speculating that Viagra’s reign as king of the ED market may be coming to an end, with Cialis taking over the throne.

Figure 8: Annual Sales of Viagra, Cialis, and Levitra

Viagra and Cialis both sold in the billions of dollars from 2008 to 2010 (the most recent year for which the data are available), while Levitra trails with hundreds of millions in sales.

*Editor’s note: Converted from euros based on rates from July 2011

Source: Annual reports of Eli Lilly and Co. Pfizer, and Bayer.

Comparison of Viagra, Levitra and Cialis

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

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

Three PDE-5 inhibitors

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

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

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

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

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

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

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

Mechanism of action

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

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

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

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

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

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

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

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

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

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

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

Most common side effects:

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

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

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

Precautions and contraindications

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

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

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

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

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

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

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

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Sep. 16, 2011, 12:23 PM

fburton: Nothing. lol: The gist of the ad campaign (there are other ones, like where his classic car breaks down) is that when you’re a man of a certain age you have the confidence and skill to take care of whatever life throws at you. Or something. It’s creating an image of the Viagra user as a strong, confident, handsome fellow rather than the decidedly less flattering adjectives that usually go along with that sort of drug. ;)

I kind of like it just because I always like seeing horses on TV (and I know people who have done that–all those old school cowboys driving their old 2WD pickups in the mountains :lol:), but for some reason all of those commercials just kind of rub me the wrong way. I like the ones with the old couples laughing and dancing together instead. It’s just kind of nicer than the rugged individualist with the wifey waiting at home.

Of course, I’m also not their target audience. don’t really have the right parts for that. lol:

eta: Yeah, I thought the same thing as Katarine when I first saw it–he’s on the plains for goodness sake, and everything around that puddle is totally dry! It’s a bit different than getting stuck on a narrow mountain road, or when the entire thing is flooded and you choose the best spot and still get stuck, or any other scenario that actually makes sense.

Sep. 16, 2011, 12:24 PM

When you get yourself in a tough situation you are able to find the tools/solution to "get the job done?" :lol:

Sep. 16, 2011, 12:25 PM

LOL yeah I really have no idea how the horses relate to viagra, but I just like seeing the Draft horses pull the truck out of the mud.

Sep. 16, 2011, 12:29 PM

When you get yourself in a tough situation you are able to find the tools/solution to "get the job done?" :lol:

Huh. Funny, but I think there are more women (horse women especially) that can get the job done than men. ;)

Sep. 16, 2011, 12:32 PM

Ah, I see. lol: Thanks for the explanations.

Sep. 16, 2011, 12:34 PM

Huh. Funny, but I think there are more women (horse women especially) that can get the job done than men.

Except when it comes to opening tight screw lids on horse supplies. Horsey women are always coming to me for that. yes:

Sep. 16, 2011, 12:44 PM

LOL yeah I really have no idea how the horses relate to viagra, but I just like seeing the Draft horses pull the truck out of the mud.

I think horses, especially draft horses, would make men feel rather inferior.

Sep. 16, 2011, 12:52 PM

You’re too old and loggerheaded to go around the mud puddle LOL

And so lazy, you load your horses back up with the driving gear still on.

Sep. 16, 2011, 01:44 PM

When you get yourself in a tough situation you are able to find the tools/solution to "get the job done?" :lol:
If he was truly a problem-solver, he’d know there are other ways to "get the job done." :lol:

Sep. 16, 2011, 05:31 PM

Except when it comes to opening tight screw lids on horse supplies. Horsey women are always coming to me for that. yes:

Hint:
They may actually be able to do it themselves.

Sep. 16, 2011, 06:20 PM

Except when it comes to opening tight screw lids on horse supplies. Horsey women are always coming to me for that. yes:

Really? Maybe they’re just humoring you. Everyone knows the way to loosen a cap (and the way to get a man’s butt up from in front of the TV) is to knock it against a solid object really hard. )

Sep. 16, 2011, 06:39 PM

Really? Maybe they’re just humoring you. Everyone knows the way to loosen a cap (and the way to get a man’s butt up from in front of the TV) is to knock it against a solid object really hard. )

No, these are real women with a problem that needs to be solved. Just like some of the daily postings here. ;)

Sep. 16, 2011, 06:54 PM

And so lazy, you load your horses back up with the driving gear still on.

It’s not unheard of to haul your work horses dressed. The scenario could have had them already wearing their harness.

As for going around the puddle, it looks as though it’s a small creek crossing/puddle ala carte. There are little embankments to both sides, hardly what you’d want to drag your loaded trailer over.

I thought differently about this commercial after our trip through Nevada this spring, where we saw one stuck truck, one stuck backhoe, one stuck pickup, and one stuck Army tank, all falling afoul of severe mud conditions in a state that is dry as a bone much of the time. (The tank might have thrown a track rather than actually getting stuck, but the mud probably helped that, too.) We went through a lot of puddles with no thought of dodging to the side, even when the terrain allowed – it was obvious it could be worse "out there."

By the time Commercial Cowboy gets his horses put to bed and gets upstairs himself, his wife will have fallen asleep again.

Sep. 16, 2011, 07:57 PM

That’s a Viagra commercial? Really? That part never registered. I like the commercial but I guess it’s a fail if I didn’t even know what it was for.

Sep. 16, 2011, 09:59 PM

That’s a Viagra commercial? Really? That part never registered. I like the commercial but I guess it’s a fail if I didn’t even know what it was for.

I haven’t seen this commercial, but I imagine they say "ask your doctor if Viagra is right for you" without giving any detail. Fun fact: if the commercial says what the drug is for, they have to tell about side effects.

Sep. 16, 2011, 10:23 PM

Anyone notice the upstairs light (bedroom I assume) is off on the first shot of the house but as he pulls closer and they show the house again the light is suddenly on? Cowboy smiles. Hope he doesn’t leave the horses in the trailer while he runs up those stairs to the bedroom. lol:

Sep. 16, 2011, 11:46 PM

I haven’t seen this commercial, but I imagine they say "ask your doctor if Viagra is right for you" without giving any detail. Fun fact: if the commercial says what the drug is for, they have to tell about side effects.

Another fun fact: my boss has a neighbor who did not "ask if Viagra was right for him".

If he had, no doubt his doctor would have told him that crushing Viagra and freebasing it is NOT an approved method of administration. It resulted in a problem that lasted for more than 4 hours.

Twice. There will not be a third episode. eek:

Sep. 17, 2011, 01:11 AM

No, these are real women with a problem that needs to be solved. Just like some of the daily postings here. ;)

Oh, Mike, do I have to spell it out for you? They might be flirting with you. I know, it’s shocking. While I have certainly never pretended to need a guy’s help, I know that a certain segment of the sisterhood is not above that tactic. Heads up big fella.

Sep. 17, 2011, 01:38 AM

Nice to know women posting their problems here are really flirting with the CotH males. cool:

And so lazy, you load your horses back up with the driving gear still on.

It’s not unheard of to haul your work horses dressed. The scenario could have had them already wearing their harness.

As for going around the puddle, it looks as though it’s a small creek crossing/puddle ala carte. There are little embankments to both sides, hardly what you’d want to drag your loaded trailer over.

I thought differently about this commercial after our trip through Nevada this spring, where we saw one stuck truck, one stuck backhoe, one stuck pickup, and one stuck Army tank, all falling afoul of severe mud conditions in a state that is dry as a bone much of the time. (The tank might have thrown a track rather than actually getting stuck, but the mud probably helped that, too.) We went through a lot of puddles with no thought of dodging to the side, even when the terrain allowed – it was obvious it could be worse "out there."

By the time Commercial Cowboy gets his horses put to bed and gets upstairs himself, his wife will have fallen asleep again.

"I couldn’t fix your brakes, so I made your horn louder."

Join Date Dec. 19, 2009 Location Pennsylvania Posts 1,287

That’s a Viagra commercial? Really? That part never registered. I like the commercial but I guess it’s a fail if I didn’t even know what it was for.

Join Date Sep. 7, 2006 Location WNY Posts 6,038

That’s a Viagra commercial? Really? That part never registered. I like the commercial but I guess it’s a fail if I didn’t even know what it was for.

I haven’t seen this commercial, but I imagine they say "ask your doctor if Viagra is right for you" without giving any detail. Fun fact: if the commercial says what the drug is for, they have to tell about side effects.

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