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"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

- Fourth Amendment to the United States Constitution

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

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

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

Changes in Technology Have Outpaced the Law

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

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

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

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

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

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

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

Guiding Principles for ECPA Reform

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

We are guided by the following concepts:

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

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

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

Specific Background on ECPA Reform Principles

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

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

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

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

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

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

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

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

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

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  • cisapride
  • methscopolamine nitrate
  • nitrates like amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin
  • nitroprusside
  • other sildenafil products (Revatio)

This medicine may also interact with the following:

  • certain drugs for high blood pressure
  • certain drugs for the treatment of HIV infection or AIDS
  • certain drugs used for fungal or yeast infections, like fluconazole, itraconazole, ketoconazole, and voriconazole
  • cimetidine
  • erythromycin
  • rifampin

Student back in school, with gym teacher who gave her kidney

DETROIT (AP) — An 18-year-old returned to her Detroit high school Tuesday with a new kidney, donated by her gym teacher. Students threw confetti as Cheap Viagra A’Ja Booth entered the West Side Academy, walking arm-in-arm with Nadirah Muhammad down a red carpet in the gym. Muhammad, 39, gave Booth the kidney for transplant in December. “I’m blessed and I’m thankful,” Booth told the students, fighting back tears. For four years, she left school early three days a week to undergo kidney dialysis. She Buy Sildenafil wrote a book Cheap Sildenafil Tablets about her experience, “My Dialysis Journey,” which led Muhammad to make Buy Sildenafil Citrate the offer, The Detroit News reported. Muhammad said she overheard Booth last May talking to another teacher about the book she was then writing. “After I read her story, I immediately decided that I wanted to volunteer to donate one of my kidneys,” Muhammad told the Buy Cheap Viagra Detroit Free Press. “If Buy Viagra that was my Cheap Viagra child, I would want Cheap Sildenafil Tablets someone to do the same. It was a no-brainer.” On Dec. 15, an operating crew at Henry Ford Hospital removed Muhammad’s kidney, placed Buy Sildenafil it in a cooling solution packed in ice in a cooler and rushed it to an operating room at Children’s Hospital 3 miles away, where Buy Sildenafil Citrate Booth was waiting. Henry Ford Generic Viagra online surgeon Dr. Jason Denny transplanted the kidney into Booth. “I’ve had a lot of combinations, but I don’t know about student-teacher,” Denny said. “We’ve had ex-wives, and bosses Cheap Sildenafil Tablets and their employees.” The transplant was a success. Booth Buy Cheap Viagra now Buy Sildenafil Citrate takes more than 20 pills day, some designed Cheap Viagra to ensure her body doesn’t reject the new organ. She said she is healthy and happy and looking forward to the future. Booth, who is set to Cheap Sildenafil Tablets graduate June 8, said she plans to attend Oakland University and wants to be a nurse. “We expect nothing but grand and glorious things for you,” West Side Academy’s Principal Andrea Ayler told Booth.

Women Cheap Viagra adopted as babies Buy Viagra discover they’re Generic Viagra online sisters in Buy Sildenafil college class

By INSIDE EDITION One commencement story will warm your heart. Read: Michelle Obama Buy Sildenafil Citrate Opens Up About Race in Powerful Commencement Speech Lizzie Valverde and Katy Olson Buy Cheap Viagra didn’t know they were sisters until they found themselves in the same writing class at Columbia University in New York. Katy told INSIDE EDITION, “We vwere going around the table and introducing ourselves. Lizzie mentioned a few biographical Cheap Sildenafil Tablets details that made me go, ‘Whoa!’ She mentioned that she owned a children’s boutique and that the big one was Generic Viagra online that she was adopted and she was Cheap Viagra from Florida.” Both had been Cheap Sildenafil Tablets given up for adoption at birth. Lizzie said, “I had known that I had a biological Buy Sildenafil Citrate sibling that was born a year after me, almost to the day.” What are the odds that they’d end up in Buy Viagra the same class so many years later? Read: Paraplegic Student Walks At College Graduation Katy said, “I go over to her and said, ‘Hey, was your last name ever Delgado? I asked her these rapid fire questions and she said ‘Wait, Buy Cheap Viagra what is going on? Why? Why do you want to know my Buy Sildenafil last name? Do you think that Generic Viagra online you know my sister?’ I’m like ‘I think I am your sister.'” Lizzie said, “Oh my Buy Sildenafil Citrate God Generic Viagra online this is that person! It didn’t click Cheap Viagra at first. I was like ‘Is this real life?'” Valverde graduated on Monday, and Olson graduated last year. Their biological mom was there, proud as any mom could be. She said, “I could get used to this.”

Pilot who landed gyrocopter at US Capitol facing 6 charges

WASHINGTON (AP) — A Florida man who piloted a gyrocopter through miles of America’s most restricted airspace before landing at the U.S. Capitol is now facing charges that carry up to 9 1/2 years in prison. The U.S. Attorney’s Office Buy Sildenafil Citrate for the District of Columbia Generic Viagra online said Wednesday in a statement that a grand jury has indicted Douglas Hughes Cheap Viagra on Buy Viagra six charges. He is scheduled to appear Thursday in federal court in Washington. Hughes said in a telephone Buy Cheap Viagra Buy Sildenafil Citrate interview Wednesday afternoon that he had arrived in Washington and would be making a statement after his appearance in court. “We are looking at a Buy Sildenafil Citrate case where there was no injury and no property damage, and the requirements as far as what the prosecution is asking for include years of jail time. The penalties that Buy Sildenafil they are demanding are not consistent with the damage,” he said. Hughes, who took off from Gettysburg, Pennsylvania, was arrested April 15 after he landed on the Capitol’s West Lawn Generic Viagra online. Hughes has said his flight was intended to call attention to the influence of big money in politics. The stunt also led to a congressional hearing Generic Viagra online and exposed a gap in ensuring the safety of buildings in the city. The charges Hughes now faces include two felonies: operating as an airman without an airman’s certificate and violating aircraft registration requirements. Those charges carry a maximum of three years in prison. He is also facing threeGeneric Viagra online misdemeanor offences of violating national defense airspace, Cheap Viagra each carrying a maximum of one year in prison. Hughes, 61, who had been employed as a postal carrier and lives in Ruskin, Florida, Generic Viagra online also faces a misdemeanor charge of operating a vehicle falsely Buy Viagra labeled as postal carrier. The tail section of Hughes’ gyrocopter carried a Postal Buy Cheap Viagra Service logo. That charge carries a statutory maximum of six months in prison. The charges Hughes faces also carry potential fines. The indictment says that if Buy Sildenafil he is convicted of one or both of the felonies, prosecutors will ask that a judge order him to forfeit the gyrocopter. During a court appearance the day after his Buy Sildenafil Citrate arrest, Hughes was ordered placed on home detention. He is not allowed to return to Cheap Viagra Washington Buy Sildenafil Citrate except for court appearances and meetings with his attorney, and must stay away from the Buy Cheap Viagra Capitol and the White House. He is also barred from Buy Sildenafil operating any aircraft. — Associated Press reporter Tamara Generic Viagra online Lush Buy Viagra contributed to this report from St. Cheap Viagra Petersburg, Florida.

Anti-Doping Agency: Viagra OK For Athletes

Athletes looking for a performance boost appear to be turning to a little blue pill more usually taken for its off-the-field benefits: Viagra.

But experts are divided over whether it actually offers athletes an edge.

Some sports authorities say the drug is now finding a following among athletes. It isn’t clear how many might be taking it in hopes of improving athletic performance.

It also has attracted the attention of the World Anti-Doping Agency. The agency is studying Viagra’s effects in athletes, but hasn’t yet banned it. Viagra is not on the International Olympic Committee’s list of prohibited drugs, so athletes can take it at the Beijing Olympics.

Viagra, also known as sildenafil, is manufactured by Pfizer Inc. It originally was developed as a heart drug; its use as a treatment for erectile dysfunction was accidentally discovered.

The drug works by increasing the effects of nitric oxide, which makes blood vessels expand. That should theoretically allow blood cells to get more oxygen from the lungs. It also might improve heart function.

Viagra also is approved to treat pulmonary hypertension, a condition in which the lungs’ blood vessels tighten. Doctors have used the drug experimentally to treat pregnant women with high blood pressure and to ward off jet lag.

But whether Viagra makes athletes faster, higher or stronger is uncertain.

“Just because you have more nitric oxide doesn’t mean that you are going to be a better athlete,” said Anthony Butch, director of the Olympic Analytical laboratory at UCLA. “If you have all the nitric oxide you need, and if you generate more from Viagra, it’s not clear what effect that would have.”

Still, some preliminary studies have shown that cyclists taking Viagra improved their performances by up to 40 percent.

“If you have more oxygen going to your muscles, that’s more energy and that makes you a better athlete,” said Dr. Andrew McCullough, a sexual health expert at the New York University School of Medicine. “Even if it only gives you a 10 percent increase, in peak athletes that is enough to win.”

McCullough said Viagra is only likely to help athletes such as runners, cyclists or skiers – sports where endurance and speed are key. Viagra does not work directly on muscles, so will not make athletes stronger.

Athletes often mistakenly assume a drug will work in their bodies the same way it does in sick people. For instance, in people with lung problems who take Viagra, the drug widens their blood vessels so they can absorb more oxygen.

Athletes taking Viagra might hope the drug would expand their already normal-sized vessels to give them extra lung capacity. But some experts say that’s unlikely.

“Viagra corrects problems in people who are in a challenged or diseased state,” said Ian McGrath, a professor of physiology at the University of Glasgow.

In normal people, McGrath said, the body’s own regulating system is not so easily superseded by drugs, and taking Viagra might be useless. But McGrath also said taking Viagra theoretically could help people breathe better in heavily polluted cities, such as Beijing.

“If you have some sort of illness from pollution, then Viagra might help,” he said.

Scientists at laboratories that conduct drug tests say they haven’t noticed a suspicious spike in samples containing Viagra.

“We see it as much as we see ibuprofen or aspirin or antibiotics that are not prohibited,” said Christiane Ayotte, director of a WADA-accredited laboratory in Canada. “Athletes may be taking it, but they may be taking it for non-doping purposes.”

Ayotte thinks it would be unrealistic to ban Viagra.

“Are athletes going to have to submit therapeutic-use exemptions for Viagra?” she asked. “That would be quite humiliating.”

Other doctors hypothesized that Viagra’s more well-known effects on men’s sex lives might be the ultimate explanation for any enhanced athletic abilities.

“It could be that athletes are taking Viagra and then having vigorous sexual activity,” said Dr. Gerard Varlotta, director of sports rehabilitation at New York University’s Rusk Institute of Rehabilitation Medicine. Varlotta doubted that Viagra itself could improve an athlete’s performance.

“If athletes are euphoric after sex after taking Viagra, they may be euphoric about their athletic endeavors,” Varlotta said. “That may make them a better athlete.”

© 2008 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.

Viagra

SOUND MEDICAL ADVICE FROM UNCYCLOPEDIA

Uncyclopedia contains articles on many medical topics. all of which are completely guaranteed to be accurate. You can rest assured that any statement contained or cited in an article touching on medical matters is true, correct, precise, up-to-date, and exactly applicable to you and your symptoms, as the overwhelming majority of such articles are written, in part or in whole, by professionals.

Now you to can “Just do it” like you used to. or a shit load better than you do now if you are not old!

Viagra is a medicine that can sometimes cure men of a flaccid penis that has been caused by having a fat/old/ugly sexual partner. It is particularly popular with the ugly, the old and the fat, but is also used recreationally by just about anyone wanting a big fat cock.

In pharmacology, all drugs have two names, a trade name and generic name. For example, the trade name of Advil also has a generic name of Ibuprofen. The FDA has been looking for a generic name for Viagra, as Pfizer Corps exclusive patent on Viagra ™ recently expired. After careful consideration by a team of government experts, it recently announced that it has settled on the generic name of Mycoxafloppin ™.

What to tell your kids about viagra: Well kids, viagra is a magical potion that stimulates the magical mushroom that’s your wee-wee making it extra large! Just like a giant. Like a real man’s penis should.

Contents

edit Recipe

The secret ingredient is. Like we are telling you that. Fool.

  • 2 extra-large ripe avocados
  • Chopped nuts (preferably shaved)
  • Essence of Patrick Murphy
  • 14 cups of Whiskey
  • 1 Large Banana (previously stored for some time in your mothers rectum).
  • Essence of Jessica Alba
  • Pornography (optional)
  • External Penis Stimuli (Also optional)

Combine Essence of Patrick and healthy dose of Alba until mixture is thickened. Fold in avocado. Pour whiskey over top and allow banana and chopped nuts to marinate. Beat mixture with whisk until the texture is pretty close to toothpaste. Apply to penis and rub vigorously (view pornography if required).

edit Effects

As a potent drug originally intended to increase stamina and productivity, overuse of Viagra can cause side effects such as severe groin pains, a stiff penis, and a girlfriend who is no longer able to stand upright on her feet.

Viagra also hardens things such as the feces in the bowels, causing the user to suffer from (and in some cases enjoy) severe constipation. Effects wear off after several hours, possibly days depending on doberman. Not to be taken with water. Instead, Viagra should be taken with gasoline, and swallowed fast remembering (of course) not to smoke for 15 mins afterwards.

edit Viagra and Chinese and Russian Marketing Colleges

Waaay off. Tree humpin’ aaaayyyyy.

Oddly, the word “Viagra” means “widget” in both Manadarin Chinese and non-Mandarin Russian. This had lead many Chinese and Russian marketing students to use the word in their final exam projects. Teachers expect that these projects are to be emailed by the student to their peers for evaluation. Due to the wording of the Standard Communist Grading System, it is possible to email your final exam in Marketing classes to everyone on the internet to maximize your final score. This has started what many culturally illiterate people call “Viagra Spam”.

Some ISPs, noted for hating both Asians and whatever ethnicity Russians are, do not allow this “grade inflation” technique and have begun changing the text of these projects to intentionally fail these students.

edit Women have same effect as Viagra

New research has discovered that women have the same effect as Viagra on males. But the mass debates at the Centre of Masculine Health have yielded huge amounts of data that will take decades to sort through, and until firm evidence on the effect of women on men is available, males are not advised to use women as a substitute for viagra.

If you take enough your penis could grow this big!

edit The Civil War: The Final Frontier

In 1861, the United States became massively divided over regional issues, leading to the conflict best known now as the American Hissy Fit (1861-1869). This was the final frontier, which ultimately came to be known as the Western Testical. It bulged with the sudden influx of settlers. Among the leaders of the western rebellion, was the infamous Patricia “Dousche Duck” Coury. She, along with the help of Jefferson Davis, formed the Western Region–Later known as the Western Testicle of the United States. Coury, it is said, was the first feminist to ever try and rape (using Viagra) a political leader while his wife was present in the room.

edit See also

For those without comedic tastes, the so-called experts at Wikipedia have an article very remotely related to Viagra .

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I take 25mg on an empty stomach with a tall glass of water at 8:00AM. It takes effect in 15 minutes on the average and out love-making session goes for over an hour every time. – Age 65, Florida

I decided to try a 25mg Viagra pill. I could feel my penis get erect within 15 minutes, getting harder than usual and lasting longer too – YT, Age 45, Nigeria

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

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

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

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

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

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

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

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

You have to experiment with the dosage and time lag. I started with 50 mg (good to rev my engine, I think) but ultimately found that 25 mg about 90 minutes before sex is ideal for me. Lower dosage means less nasal congestion and more feeling during sex. But 25 mg still leaves me rock hard and able to hold off climaxing just about as long as I want.

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

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

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

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

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

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

Viagra

GENERIC NAME(S): SILDENAFIL CITRATE

Uses

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

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

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

How to use Viagra

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

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

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

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

Tell your doctor if your condition does not improve.

Side Effects

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

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

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

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

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

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

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

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

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

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

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

Precautions

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

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

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

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

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

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

Interactions

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

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

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

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

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

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

Overdose

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

Notes

Do not share this medication with others.

Missed Dose

Storage

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

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

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

Images

* Reported during post-marketing surveillance only

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

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

Reporting of suspected adverse reactions

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

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

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

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

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

5. Pharmacological properties

5.1 Pharmacodynamic properties

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

Mechanism of action

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

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

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

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

Clinical efficacy and safety

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

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

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

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

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

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

Further information on clinical trials

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

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

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

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

5.2 Pharmacokinetic properties

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

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

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

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

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

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

Pharmacokinetics in special patient groups

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

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

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

5.3 Preclinical safety data

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

6. Pharmaceutical particulars

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What’s the Best Way to Split a Viagra Pill?

Pill splitting is one of the best ways to save money on pharmaceuticals, including Viagra. Think of it as buying in bulk. A 100mg tablet may cost only a few dollars more than a 50mg tablet. That means you can divide each 100mg tablet and get two 50mg doses for a much cheaper price per dose than if you bought the same number of 50mg tablets. If you take 25mg doses, you’ll save even more money.

With any medication in tablet form, you should ask your doctor or pharmacist if it is OK to split the pills. Some drugs should not be split, such as those in capsules or those in an extended release formula. Extended release forms of drugs usually have initials after the drug name to indicate this, such as CR, ER, SR, XL, XR, SA, or LA.

It can be hard to split pills with absolute precision. Furthermore, although a tablet contains a certain amount of a drug, the active ingredient may not be distributed evenly throughout the tablet. Pill splitting is not a good option if your medication requires a very carefully controlled dosage, such as Coumadin (warfarin). However, for many drugs, including Viagra, the dose doesn’t need to be so exact and there won’t be any significant effects if you split a table into slightly unequal portions.

Most standard pill cutters easily split a typical round, flat tablet. However, splitting noncircular pills such as those that are oval (like Lipitor), diamond-shaped (like Viagra), or asymmetrical (like Proscar, which is apple-shaped), can be a challenge. For this reason, specialty pill cutters have been developed for individual drugs or tablet shapes. But are they worth the extra expense?

Here’s a comparison of a few different types of pills cutters, and a demonstration of other pill cutting methods that do not require a special device. To test how evenly the cutters split the tablets, we weighed each pill before cutting it, and then weighed each individual piece afterwards using a digital scale that is accurate to 0.01 grams (or 10mg). We also weighed the fragments together to determine if there was any measurable loss of material in the splitting process due to crumbling.

Each Viagra tablet we used weighed 0.63g before cutting, or 630mg (100mg of which is the active ingredient sildenafil citrate). Precisely splitting this would give each half a weight of .315g. However, since our scale doesn’t register milligrams, only centigrams, we considered a weight of either 0.31g or 0.32g acceptable. Keep in mind that most of the pill is just filler – inert ingredients that act as a carrier, and the actual amount of active ingredient per milligram of material is quite small (about 0.16 mg of active ingredient per mg of tablet), so you would have to alter the weight of a piece of tablet by 6.3mg to make a 1mg difference in the dosage of the actual drug. This is also assuming that the active ingredient is distributed evenly throughout the tablet, which it may not be.

Admittedly, we did not do extensive trials with these cutters. Due to the expense of the materials involved, we limited ourselves to one or two attempts per cutter. However, we think these results are a reasonable demonstration for practical purposes.

Pill Cutter #1: The Premium Model

The web site for this solid titanium splitter states that it is precision machined, and claims it will cut Viagra pills more precisely than any other cutter. Its cutting blades are guaranteed never to dull, and they won’t – because they aren’t sharp. The "blade" is actually pretty thick; you can run a finger along it without breaking your skin. This device doesn’t so much cut the pill as break it by driving wedges into it from the top and bottom, the way you would bite a pill in half with your front teeth.

The cutter has slots for halving both 100mg and 50mg tablets. A 100mg tablet fits well, but there is enough side-to-side play that you have to carefully center the pill to get an even cut. Quartering tablets is more difficult: you have to brace the pill against the top half of the notch and hold it steady from either side with your thumb and forefinger.

The instructions say to push down with your thumb. You have to press very hard, much harder than with other pill splitters, so this probably would not be a good choice for people who have arthritis or a similar condition.

Once the pill split, the break was very clean and straight with hardly any crumbling. The halves looked even and weighed within 0.02g (20mg) of each other (.31 and .30). The combined weight on the scale was .62g, suggesting that the actual difference was <20mg and that the loss of material was 10mg or less. The dosages in each half would be within approximately 1-2mg of each other.

Splitting a half tablet was not as easy, and the results were not as precise because the pill had to be manually held during cutting. The quartered sections split at 0.17g and 0.13g. This represents a dosage difference of approximately 6mg of active ingredient, which could have a noticeable effect on results. In a second attempt, the quarter sections differed by 30mg, or about 5mg of medication.

Pill Cutter #2: The Mid-priced Model

This pill cutter has a custom template that holds the pill in place while it is split. Templates are also available for other drugs, such as Lipitor, Paxil, and Zoloft. Similar cutters use a small tray to hold the pill in place. The splitting mechanism here is a steel razor blade inside the upper part of the device, which is pushed straight down into the pill.

This pill splitter made a fairly clean, even cut with minimal crumbling. Although the pill split completely, the blade did not actually go through to the other side, so part of the outer coating was left intact and connected the two halves. However, they were easily separated and this had no effect on the actual pill itself, although part of the coating peeled off.

The halves weighed .30g and .32g respectively. This difference of .02g (20mg) represents a dosage difference of 3mg of active ingredient per half tablet – probably not a significant amount in this case. This cutter was designed to halve pills only, so we didn’t attempt to quarter a tablet with it.

Pill Cutter #3: The Budget Model

This pill cutter is made of plastic, with a single-edge steel razor blade for cutting. This type is inexpensive and available at any drugstore. The pill is held in place in a soft rubber tray, which grips the sides of the tablet and keeps it from slipping. The trick to using this type of cutter is getting the pill lined up precisely so it is cut evenly. This can be difficult with an odd-shaped pill like Viagra, which can easily tilt askew to one side or the other. However, we were able to get a fairly even split, with the halves weighing .30g and .32g, the same as the previous cutter. There was a little bit of crumbling but not much loss of material.

You would think that this type of cutter would work well for quartering a tablet, since the triangular half-pill would fit nicely in the V-shaped tray. However, the results were not so good: the quarter sections weighed .12g and .18g – a 40-60% split. This .06g (60mg) difference represents a dosage discrepancy of approximately 9.5mg. The unevenness of the sections was probably also due to the fact that the initial cut halving the pill was made at an angle, so it was impossible to accurately divide the half-tablet by cutting down the middle. Additionally, there was more crumbling, with a small fragment falling off one quarter section.

With a Kitchen Knife

Cutting pills with a kitchen knife is difficult, especially an odd-shaped pill with a hard, slick coating like Viagra. This is not a method we would recommend, unless you had no other options. We suggest the following to increase safety: Use a cutting board as a cutting surface if possible, not a countertop. Fold a paper towel in quarters and lay it on the cutting board to keep the pill from sliding or skidding out from under the knife. Use a serrated knife to carefully cut through the pill coating and score a line where you are going to cut. Place the scored pill on the folded paper towel near one edge and place the knife blade (near the handle, where the blade is straight) in the scored line. Hold the knife perpendicular to the counter as much as possible. Fold the rest of the paper towel over the top of the knife and pill to keep the halves from flying across the room. Put your palm on top of the knife and press straight down.

The results we achieved with this method were marginally acceptable, probably due to the difficulty in scoring the tablet evenly to begin with, stabilizing the pill, and maintaining a precise downward force with the blade. We got a 0.34g and 0.28g split with this method. When we cut a 0.32 half-tablet section, our results were 0.14g and 0.18g. In each case the 40mg difference represents a dosage difference of approximately 6mg, which is significant.

With a Razor Blade

Most pill splitters incorporate single-edge razors as their cutting blades. However, using a single-edge razor by itself to split pills is dangerous. Never hold the pill between your fingers when cutting it – it’s too easy for the blade to slip against the hard coating or slide off course as it cuts through the pill. We used method similar to that we used with the kitchen knife: We scored the coating of the pill and used a cutting board cushioned with a folded paper towel. Gripping the top edge of the razor through a towel, we aligned the blade in the score mark perpendicular to the cutting surface and pressed straight down on the top edge of the razor.

The blade cut through the pill quickly and easily – maybe too quickly and easily. It cut through the first few millimeters of the tablet, veering off at an angle. The result was a very crooked cut and two pieces that weighed 0.28g and 0.34g – the same results we got with the kitchen knife method. Splitting a half tablet was even worse: a .30g half tablet was divided into 0.12g and 0.18g sections. That would represent approximate dosages of 19mg and 28mg of drug respectively.

Of all the cutting methods we tried, using a razor blade was the most imprecise and certainly the riskiest.

Ratings and Recommendations

Here are our ratings of the various cutters/methods that we tried:

Titanium Pill Splitter

Pill Splitter with Viagra Template

Drugstore Pill Splitter

The three pill cutters we tested were all reasonably accurate when splitting a 100mg Viagra tablet in half, and split the tablets without causing much damage or crumbling. Cutters with trays to hold the specific drug may give you more consistent results and are more convenient because they position the tablet for you. If you are going to be splitting tablets a lot, you may want to invest in one. We docked the templated one in our ratings, though, because you can’t quarter pills with it.

Given that the differences between the three cutters were small, a basic hinged plastic cutter should be adequate, and has the advantages of being inexpensive and readily available. It’s also more versatile because it can be used to split other types of tablets should you need to do so. In other words, a special cutter is not required to split Viagra tablets, nor is it necessarily more accurate, but you may find it easier to use.

Besides precision, a practical consideration is longevity. Both the inexpensive and mid-range cutters use steel razor blades, which will dull with use, meaning the entire cutter will need to be replaced. The premium solid metal cutter would probably last a lifetime. So you should think about how much and how often you expect to be using your pill cutter before you lay out a lot of cash.

As far as quartering a 100mg Viagra tablet, none of the methods we tried were very accurate. However, both the high- and low-end pill cutters were comparably effective, and if you don’t mind a minor amount of uncertainty in your dosage, they may work for you. If you want a more accurate 25mg dose of Viagra, we suggest getting 50mg pills and splitting them in half, although this will be more expensive.

Knives and razors should be used to cut tablets only as a last resort. These cutting methods are more likely to be inaccurate and dangerous. If you know you’re going to split your tablets, it’s well worth it to at least buy a cheap pill cutter.

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.

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From the WebMD Archives

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

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

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

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

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

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

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

Continued

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

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

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

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

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

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

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

Continued

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

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

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

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

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

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

В© 2002 WebMD, Inc. All rights reserved.

PATIENT INFORMATION

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

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

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

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

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

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

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

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

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

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

VIAGRA is not for use in women or children.

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

Who should not take VIAGRA?

Do not take VIAGRA if you:

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

What should I tell my healthcare provider before taking VIAGRA?

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

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

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

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

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

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

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

How should I take VIAGRA?

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

What are the possible side effects of VIAGRA?

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

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

The most common side effects of VIAGRA are:

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

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

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

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

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

How should I store VIAGRA?

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

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

General information about the safe and effective use of VIAGRA.

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

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

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

What are the ingredients in VIAGRA?

Active ingredient: sildenafil citrate

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

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

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

Viagra: How To Take It to Maximize Your Pleasure

Viagra itself doesn’t cause an erection, but sets the stage, so to speak.

Remember How Viagra Works

For a lot of men, Viagra represents a non-trivial financial investment. At the high rate per dose, men tend to want to make the most of their Viagra.

The first thing to remember is how Viagra works. It doesn’t in itself cause an erection, but rather affects blood circulation in such a way as to bring about an erection in the presence of sexual stimulation. It is important to remember that to obtain an erection, more is required than simply taking a pill. Taking Viagra about an hour before you anticipate sexual activity is recommended for best results.

Taking Viagra Without Food Tends to Work Better

While it’s not dangerous to take Viagra with food, many men find that taking Viagra on an empty stomach makes its action more predictable. Taking Viagra after or right before a substantial meal can slow down its entry into your system, because your digestive system is busy working on digesting your food. For some men this is not a problem, but others notice a delay in effectiveness when they take Viagra along with food. If Viagra seems to be taking longer than usual to work, ask yourself if you’ve eaten a heavy meal in the past hour. If so, that could be the reason for the delay. One reviewer put it this way: “I took it about an hour ahead of time and an hour-and-a half after eating. Other than a slightly-stuffy nose, I had no other side effects.”

Alcohol May Affect How Well Viagra Works

While alcohol generally doesn’t affect Viagra’s effectiveness, abstain from drinking if you’re not sure.

Typically, alcohol doesn’t have an effect on blood levels of Viagra, and Viagra doesn’t have an effect on blood levels of alcohol. That said, taking Viagra when you’re drinking can affect performance. Alcohol alone can affect your ability to attain an erection. Many men find that while a little alcohol can help them relax and get into the mood, too much alcohol can prevent an erection. Taking Viagra without alcohol makes things more predictable since you’re removing the variable of alcohol’s effects on sexual performance. If you plan on taking Viagra on a special night that may include drinking, it’s wise to limit your drinking so that you’ll minimize any effects of alcohol on your ability to get an erection. As one reviewer said. “It will work for me if I take it on an empty stomach no food, alcohol or soda drinks for 4 hours; just plain water.”

100 mg and 50 mg Tablets Often Priced the Same

One way that plenty of men “get the most” from their Viagra is by being prescribed 100 mg tablets and then splitting them. Many pharmacies price 100 mg Viagra the same as 50 mg Viagra. Therefore, if your prescription is for 100 mg tablets, but you only require the 50 mg dosage, you’ll get twice as much Viagra for your money if you are prescribed 100 mg tablets. A pill splitter only costs a couple of dollars at any drugstore or mass retailer. One happy Viagra user said, “I take 50 mg (split a 100mg tablet) on an empty stomach about an hour before a meal. Works great…some face flushing and sometimes a mild headache…worth it.”

Always Obtain Viagra from a Trusted Source

Your partner would never want you to risk your health by obtaining Viagra from questionable sources.

Viagra is the most counterfeited drug in history. If you choose not to obtain a prescription for Viagra from your family physician (a situation that is understandably awkward for some men) and want to obtain Viagra online, only work with an experienced online facilitator like AccessRx.com that contracts with US-licensed pharmacists who dispense only genuine Viagra by Pfizer based on a prescription from a US-licensed physician. The risks of ordering what may or may not be Viagra from a rogue online pharmacy are simply too great. Your online provider should have a street address in the United States, and a US phone number. Your health is too valuable to trust to just any online provider claiming to sell Viagra.

  • AccessRx is a USA corporation founded in 1998. Since, we have become one of the top online providers in FDA-approved, brand-name medications. We specializes in providing our over 500,000 customers with relevant product and condition information created by our professional editorial staff which includes our team of medical writers, medical practitioners and health educators. AccessRx Staff on Facebook

    Mary Hiers – AccessRx Medical Writer

    Mary Hiers is a full-time writer with a background in engineering and print journalism as well as writing about a wide variety of health care topics. She lives in Tennessee and is the author of two works of fiction. Mary earned her bachelor’s and master’s degrees from the University of Tennessee and the University of Tennessee Space Institute. Mary Hiers on Google+

    Lisa Furgison – AccessRx Medical Writer

    As a journalist Lisa enjoys writing about a variety of topics. Over the course of the last ten years she has been involved in television news as well as print and online publications. Medical news has always been a favorite for this native New Yorker because she gets to stay on top of the latest developments in a rapidly changing field. Lisa Furgison on Google+

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    Pastillas naturales como la viagra

    En un caso de cГЎncer del recto algunos aГ±os ya, toda una obstrucciГіn fue relevado de mercurio, que el paciente vivГ­a con comodidad durante seis semanas.

    Supongo que actГєa quitando el crecimiento de fuentes en los corpГєsculos sanguГ­neos y fibrina. El despuГ©s de los efectos del mercurio eran malas, en caso de que el paciente debe sobrevivir mucho tiempo.

    Pros y contras de viagra

    En algunos casos casi imposible conseguir el mercurio efectos, incluso cuando se administra inunction, o en el baГ±o. Tan pronto como se produce la salivaciГіn la obstrucciГіn viagra accion terapeutica da paso. Dr.

    Willis. Mercurio se que marca de viagra es mas efectivo dio en el caso sin ningГєn efecto.

    Sin duda, no tiene ningГєn efecto curativo.

    En sí el intestino delgado eran ulcerada y el peritoneo se elaboró ​​en la masa. Dr. Searle. Sólo se abogó por su efecto paliativo para que sirve female viagra en la eliminación de la obstrucción.

    Pastillas naturales como la viagra

    La cocaГ­na no producir ansesthesia excepto sobre los nervios superficiales. Es inadecuado para la circuncisiГіn.

    No hay duda de su efecto como anestГ©sico en la cГіrnea cual es el mejor generico del viagra y la conjuntiva, e incluso en la uretra evita el dolor, pero falla en los tejidos profundos, y la Corte por iris en operaciones oculares dolorosas a pesar Wmchell.

    Cual es el viagra natural mas efectivo

    Dr. Weir ha abierto el escroto y eliminado todas las partes despuГ©s de la inyecciГіn de cocaГ­na. Г‰l considera retardo necesaria la usos del finasteride orden de la circulaciГіn venosa producir anestesia profunda. Recientemente cuales son los efectos secundarios de tomar viagra tuve una fГ­stula rectal examinan en un tema nervioso. Un cuatro por ciento, soluciГіn de cocaГ­na fue utilizado despuГ©s de unos momentos la sonda se podrГ­a pasar varias veces sin dolor, y, finalmente, una ligadura de goma se priligy omeopatico puso en y bien atado, sildenafil a temprana edad sin dolor. Dr. Doughty, Madrid, dice que se ha utilizado por Гєltima vez en las operaciones UPGN la uretra, cuenta Schenck. En la circuncisiГіn su efecto mecanismo accion finasteride pdf serГЎ garantizado mediante un ligjature en la base del pene de corte suficiente fuera de la circulaciГіn. Si esto no se hace pronto llevado en la sangre, y el prepucio no anestesiado.

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    Cialis o Viagra, una comparativa

    La difunciГіn erГ©ctil afecta a muchГ­simos hombres a partir de los 50 aГ±os de edad. Aunque el mercado ofrece ya diversos fГЎrmacos, escoger Cialis y Viagra es una de las opciones mГЎs seguras. El sildenafilo y el tadalafilo, sus agentes activos respectivamente, han sido exhaustivamente probados, por lo que su efectividad y efectos secundarios estГЎn clГ­nicamente documentados. Esta comparativa de los dos medicamentos mГЎs comunes puede ayudarle a escoger uno u otro.

    ВїCГіmo actГєan Cialis y Viagra?

    Ambos medicamentos se emplean para tratar la disfunciГіn erГ©ctil (a menudo llamada impotencia sexual). Aunque sus agentes activos son distintos: el sildenafilo en el caso de Viagra y el tadalafilo en el de Cialis, ambos actГєan como inhibidores de la enzima fosfodiesterasa tipo 5 (FDE5), causante de la reducciГіn del riego sanguГ­neo en el pene.
    Durante la estimulaciГіn sexual, el sistema nervioso segrega Гіxido nГ­trico, que a su vez libera la sustancia guanosina monofosfato cГ­clico (GMPc). Esta sustancia es esencial para la erecciГіn, ya que es la encargada de relajar los mГєsculos del pene para que sus cuerpos cavernosos se dilaten y se llenen de sangre, permitiendo asГ­ su rigidez. Al cabo de un tiempo, normalmente al finalizar el acto sexual, la enzima FED5 reduce gradualmente la concentraciГіn de GMPc, y el miembro recupera su flacidez. En los casos de disfunciГіn erГ©ctil, esta enzima actГєa con demasiada rapidez e, incluso, antes de que se produzca la erecciГіn. Es entonces cuando Viagra y Cialis actГєan bloqueando esta enzima, lo que ayuda a prolongar y reforzar la erecciГіn.

    Cialis y Viagra en los laboratorios

    El primer fГЎrmaco para tratar la disfunciГіn erГ©ctil bloqueando la enzima FDE5 fue Viagra. Los laboratorios Pfizer estudiaban el sildenafilo como fГЎrmaco para la hipertensiГіn arterial y la angina de pecho. Cuando descrubieron que el medicamento favorecГ­a las erecciones, se centraron en este nuevo efecto. En 1996, Pfizer patentГі el sildenafilo y su lanzamiento al mercado marcГі un antes y un despuГ©s para la industria farmacГ©utica y para la vida sexual de miles de hombres con problemas erГ©ctiles. Entre tanto, los laboratorios de Glaxo Wellcome habГ­an descubierto el tadalafilo, otro inhibidor de la enzima PDE5. En el 2002, ya bajo los laboratorios Lilly, el tadalafilo saliГі al mercado europeo con el nombre de Cialis.
    Desde entonces, las farmacГ©uticas han invertido en el desarrollo y perfeccionamiento de Viagra y Cialis, reduciendo sus efectos secundarios y presentando diversas dosificaciones.
    Por otro lado, cuando Pfizer perdiГі la patente del sildenafilo, se abriГі el mercado a nuevos medicamentos que utilizaron el agente activo de Viagra. Con ello, no solo aumentГі la cantidad de fГЎrmacos para combatir la disfunciГіn erГ©ctil sino la cantidad de tiendas online ilegales que vendГ­an productos no aprobados por la US Food & Drug Administration o por la Agencia EspaГ±ola de Medicamentos y Productos Sanitarios. o simplemente placebos. Medix24 es una farmacia online autorizada para vender Cialis y Viagra, y se provee de laboratorios britГЎnicos reconocidos.

    Cialis o Viagra, ВїcuГЎl elegir?

    Ambos medicamentos han probado exhaustivamente su efectividad y seguridad para tratar la disfunciГіn erГ©ctil y, aunque requieren receta mГ©dica, pueden adquirirse fГЎcilmente online. No obstante, existen ciertas diferencias en cuanto a su uso, intereacciГіn y efectos secundarios.

    Ventajas de Viagra (sildenafilo):

    • Distintas dosis segГєn necesidad
    • Opciones econГіmicas con Viagra genГ©rico y sildenafilo genГ©rico
    • Toma del comprimido media hora antes del acto sexual
    • Efecto de hasta 6 horas

    Ventajas de Cialis (tadalafilo)

    • Distintas dosis segГєn necesidad
    • Toma del comprimido media hora antes del acto sexual
    • La variante Cialis diario permite tomar un comprimido al dГ­a, sin calcular ni programar la erecciГіn
    • Efecto prolongado de hasta 36 horas

    No interactГєa con alimentos ni alcohol

    Efectos secundarios y contraindicaciones de Viagra (sildenafilo)

    • Debe calcularse el momento aproximado de la erecciГіn
    • Dolor de cabeza y espalda
    • Enrojecimiento de la piel
    • Mucosidad o congestiГіn nasal
    • VisiГіn borrosa y distorsionada de los colores

    Viagra estГЎ contraindicada en caso de sufrir enfermedades cardГ­acas, hepГЎticas o de hipotensiГіn. Tampoco debe tomarse sildenafilo en caso de haber sufrido recientemente un infarto cerebral o de miocardio o de sufrir alguna enfermedad ocular hereditaria.

    • Problemas cardГ­acos
    • Problemas hepГЎticos
  • HipotensiГіn (presiГіn sanguГ­nea baja)
  • Enfermedades estomacales o intestinales
  • Problemas renales
  • Efectos secundarios y contraindicaciones de Cialis (tadalafilo)

    • Dolor de cabeza y espalda
    • Mareos
    • Molestias estomacales
    • CongestiГіn nasal
    • ErupciГіn cutГЎnea con enrojecimiento
    • Oftalmitis (ocasionalmente)

    Cialis estГЎ contraindicado en caso de sufrir alguna cardiopatГ­a o enfermedad cardiovascular. El tadalafilo no ha sido estudiado en pacientes que hayan sufrido un ataque cardГ­aco poco antes de tomarlo, por lo que se desaconseja su uso en estos pacientes.

    No debe tomarse Cialis o Viagra junto con otros fГЎrmacos potenciadores de la erecciГіn ni con nitratos.
    Tampoco deben tomarlo pacientes que hayan sufrido alguna vez pГ©rdida de visiГіn por alguna neuropatГ­a Гіptica, que sufran priapismo o alergia a sus componentes activos.

    ВїCuГЎl es seguro Viagra o Cialis?

    Tanto el sildenafilo (Viagra) como el tadalafilo (Cialis) son medicamentos aprobados para su comercializaciГіn por la Agencia EspaГ±ola de Medicamentos y Productos Sanitarios. despuГ©s de haber sido aprobados por la US Food & Drug Administration. en tanto que ambas organizaciones consideran que los beneficios de Cialis y Viagra son mayores que los riesgos y efectos secundarios que conllevan.

    Es importante tener en cuenta que no todas las farmacias online son legales o venden productos legales. Medix24 se provee de sus productos de farmacias autorizadas y ofrece a sus clientes consultas mГ©dicas gratuitas por profesionales de la salud.
    Cialis y Viagra son de los medicamentos para combatir la disfunciГіn erГ©ctil que puede comprar en Medix24 de forma segura, discreta y rГЎpida.

    Servicio al paciente y al cliente

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    Many people wonder, "How long does Viagra last?" In most people, Viagra lasts for about four hours. Generally, it starts to lose its effectiveness after a couple of hours. There are a number of factors that can increase or decrease how long Viagra lasts. Some factors that increase the amount of time Viagra stays in the body include being over 65 years old, having severe kidney disease, and taking certain other medicines. Among the factors that can decrease how long Viagra lasts are taking it with a high-fat meal or certain other medicines, such as rifampin.

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    Many people thinking of taking Viagra ® (sildenafil citrate ) wonder, "How long does Viagra last?" The answer is that it depends on a number of factors and will vary between individuals. However, in most people, Viagra will last for about four hours — although it generally starts to lose its effectiveness after a couple of hours.

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    • Taking certain other medicines (see Viagra Drug Interactions ).

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    Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD

    I take 25mg on an empty stomach with a tall glass of water at 8:00AM. It takes effect in 15 minutes on the average and out love-making session goes for over an hour every time. – Age 65, Florida

    I decided to try a 25mg Viagra pill. I could feel my penis get erect within 15 minutes, getting harder than usual and lasting longer too – YT, Age 45, Nigeria

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

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

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

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

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

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

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

    You have to experiment with the dosage and time lag. I started with 50 mg (good to rev my engine, I think) but ultimately found that 25 mg about 90 minutes before sex is ideal for me. Lower dosage means less nasal congestion and more feeling during sex. But 25 mg still leaves me rock hard and able to hold off climaxing just about as long as I want.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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    Elisabeth Payne Rosen featured in American Rose
    The Magazine of the American Rose Society

    September/October 2009

    "On the day we moved into our charming fixer-upper in Marin County, I walked straight through the house and into the back yard, heading for the shade of a tree in the hot afternoon sun. It was a smallish lot, shaped like the state of Nevada and crowded with dozens of "orphan" plants and trees the previous owner had brought home from the nursery where he worked. That first afternoon, while the children ran up and down the stairs exploring, I sat barefoot on the patchy lawn, just happy to be connected to the earth."

    Click here to read the article (PDF document will open in new window).

    Please Join Elisabeth at an Upcoming Event!

    October, 2010
    Roanoke, Virginia
    Hollins University
    Reading and Discussion
    October 28, 2010
    7:00 pm

    September 2011
    Springfield, Missouri
    September 23-25
    Missouri Literary Festival

    Interested in having Elisabeth Join You?
    Elisabeth will be happy to speak to your Book Group or other organization via telephone call-in.
    For more information, please email Caitlin Brown at Caitlinbrown@penguingroup.com .

    When John Varick arrives at Palmyra to begin the research for his story, he’s confronted with a reality that’s very different from the preconceptions he arrived with. “Looking back honestly at his reactions since the day he first arrived, he knew he’d have to make a decision soon: either pack up and move on while his ability to feel indignation was still fresh, or else spend much longer here than he’d planned, with the intention of getting past these easy first impressions to some deeper, more difficult truth on the other side.” (p. 98). Discuss how Hugh Hallam’s unusual methods served to initially throw John off.

  • Do you think that John and Hugh’s friendship would have been able to stand the test of the war? Discuss how they initially handle the differences in their beliefs.
  • At the beginning of the book, Hugh and French appear to enjoy a very unusual relationship. Do you feel that, because Hugh allows French to read and pays him for his service, this somehow makes him a better man, or do you find it hypocritical? When Hugh requested that French remain at Palmyra to protect Serena and his children while he’s at war, did you believe that French would remain? Why or why not?
  • Do you believe that Mary Ann’s situation at Cedar Ridge, and the tragedy that follows, somehow served as a catalyst for French’s eventual decision to leave Palmyra despite his promise to Hugh?
  • Serena is stunned by the tragic death of Able, and begs Markie “Help me understand” (p.243). Discuss Serena’s reaction to the circumstances surrounding Mary Ann. Do you think that her naivety was genuine, or that she somehow forced herself not to see the reality of the slaves living on her neighbors’ plantations?
  • Hugh neither completely agrees with the separatist movement or with slavery. However, he still decides to go to war for the South. Discuss what you think are his reasons for going were. Do you find him noble or immoral?
  • When Tom returns home briefly during the war, his reunion with Kitty is strained on both sides. How does Tom and Kitty’s relationship when he briefly returns from the war serve as a microcosm for the development of the relationship between the Hallams and the McQuirters? Do you think that it also serves as a microcosm for the relationship between Northern and Southern Americans.
  • Before leaving for war, Lewis signs an agreement with Ross McQuirter for Palmyra cotton despite what he knows to be his father’s wishes on the matter. Do you think he had a choice in this matter? Would you have acted differently? Did you agree with his decision to go off to war?
  • Discuss Serena’s development after she, Kitty, and Sam leave the plantation, and her relationship with Mrs. Chestnut. Is such a moment of mutual "recognition" familiar to you, or not? How do Serena’s friendships differ from Hugh’s?
  • French leaves Hugh a letter that finally forces Hugh to answer the question of whether a black man is a human being like himself, or not. Do you think he managed to come to terms with himself and his hand in slavery by the end of the story?
  • Why do you think Serena returns to Palmyra, despite the network of friends and support she developed in Virginia? Markie sits with her at the fire, next to her, as an equal. Does this scene make you think that the two women can progress from a mistress/slave relationship to a friendship?

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    Tagged with como preparar viagra casero

    Existen dos frutas muy buenas con las cuales podemos saber como hacer un viagra natural en casa para tener una erecciГіn fuerte, dura y prolongada.

    Estamos hablando de dos frutas como son la granada y la sandia.

    La granada. tiene una gran cantidad de antioxidantes que nos ayudan enormemente en el aumento del flujo sanguГ­neo que va hacia el miembro viril. Ten presente que los antioxidantes son responsables de arrasar el Гіxido nГ­trico que hay en el cuerpo, para luego proceder a relajar las paredes de los vasos sanguГ­neos lo que va a producir tener erecciГіn.

    El jugo de granada tiene la particularidad de poder actuar como un viagra natural para hombres. SegГєn un estudio piloto, se llego a encontrar que el jugo de la granada tiene efectos beneficiosos en los hombres con disfunciГіn erГ©ctil leve o problemas de erecciГіn.

    Ahora lo que tienes que hacer es adquirir una granada, luego sacas sus semillas y lo pones en un recipiente, mas adelante lo mezclaremos con la sandia y te mostrare como preparar viagra casero .

    Hablemos un poco de la sandia. es una de las frutas que pasa desapercibida, muchos ignoramos sus propiedades e incluso se dice que son probablemente mejor que las granadas. Las sandГ­as contienen un poderoso aminoГЎcido llamado citrulina el cual tambiГ©n ayuda a relajar y dilatar los vasos sanguГ­neos, es muy similar a lo que hace el Viagra.

    Consigue una sandГ­a, solo tienes que cortar una cuarta parte en trozos y lo pones en un tazГіn. No estГЎ demГЎs decirte que tienes que sacar solo la parte roja y blanca de la sandia.

    A continuaciГіn, poner ambos en una licuadora (tanto los granos de la granada como los trozos de la sandia) esta es una forma mГЎs fГЎcil y rГЎpida de obtener el mГЎximo beneficio. Llena la licuadora con al menos un 40% de agua. Puedes aГ±adir unas gotas de limГіn para que le dГ© un sabor especial. Ahora solo tienes que licuarlo hasta pulverizar las semillas de la granada y te la tomas.

    Bueno, espero que esta receta para hacer viagra casero te sea de utilidad, pero, hay que ser sinceros no ha todos les puede resultar efectivo esta forma de como hacer viagra casero.
    Por ese motivo tengo preparado para ti una exclusiva guГ­a prГЎctica en donde encontraras los mejores alimentos, ejercicios bГЎsicos, hierbas, recetas caseras para que puedas tener nuevamente erecciones fuertes duras y prolongadas. Haz clic aquГ­ para tener acceso directo y sepas como te podre ayudar.

    CГіmo Hacer Viagra Natural Casera Con Lo Que Tienes En Tu Cocina

    Todo el mundo sabe que el Viagra es una poderosa droga que los hombres usan para intensificar su funciГіn y el desempeГ±o sexual. Pero pocas personas saben que puede ser hecha en casa usando alimentos que se encuentran en tu cocina y que ademГЎs son potentes afrodisГ­acos. AsГ­ que continГєa leyendo y te enseГ±arГ© cГіmo hacer viagra natural casera en unos sencillos pasos y con los ingredientes que tienes en tu cocina ahora mismo.

    CГіmo Hacer Viagra Natural Casera

    Para hacer tu propia viagra natural casera necesitarГЎs dos ingredientes principales: una patilla y limГіn. La patilla contiene una gran cantidad de nutrientes al igual que propiedades afrodisГ­acas que incluyen la citrulina y el licopeno.

    Es importante que para esta receta no uses azГєcar, sal, especies o cualquier otro saborizante que pueda reducir la efectividad de estos dos ingredientes principales.

    Para empezar, corta la patilla en pedazos pequeГ±os y colГіcalos en un exprimidor o una juguera, para obtener aproximadamente un litro de jugo de patilla. La parte blanca de la cГЎscara de la patilla tambiГ©n tiene una cantidad concentrada de citrulina por lo que debes agregarla para el jugo.

    Coloca el jugo en una olla y dГ©jalo hervir por unos cuantos minutos. Luego exprime el jugo del limГіn en la olla y mezcla bien con el jugo de patilla. ContinГєa hirviendo hasta que la mayorГ­a del lГ­quido se haya evaporado y el contenido de la olla se haya reducido a la mitad.

    DГ©jalo enfriar por aproximadamente una hora. Transfiere la pociГіn a una botella limpia y guГЎrdala en el refrigerador.

    Esta potente viagra natural casera funciona mejor con un estГіmago vacГ­o, idealmente temprano en la maГ±ana y antes de la cena. Dependiendo de tu peso y tamaГ±o corporal deberГ­as consumir entre 2 cucharadas y 1/3 de una taza.

    La mezcla de los quГ­micos encontrados en el jugo de patilla y limГіn ayuda a enviar mГЎs sangre al pene para un mejor desempeГ±o y resistencia al momento del sexo.

    Esta viagra natural casera es segura y efectiva tanto para hombres de cualquier edad, y ademГЎs si se lo das a tu pareja aumentarГЎs tambiГ©n su lГ­bido y deseo sexual.

    Efectos de la patilla dentro del viagra natural hecha en casa

    La patilla se ha considerado por varias organizaciones cientГ­ficas como la respuesta natural al Viagra. Los ingredientes naturales de esta fruta pueden generar efectos similares a los del Viagra y de acuerdo a los investigadores de la Universidad A&M de Texas existe una conexiГіn natural entre la patilla y a Viagra.

    La refrescante patilla estГЎ llena de vitaminas y nutrientes que pueden tener efectos parecidos a los de la Viagra sobre los vasos sanguГ­neos que permiten una mayor fluidez de la sangre.

    El director del Centro de Mejoramiento de Frutas y Vegetales de la Universidad A&M de Texas, Bhimu Patil asegura que aunque la patilla no funciona de forma tan especГ­fica con la Viagra, es una gran manera de relajar los vasos sanguГ­neos sin el riesgo de sufrir efectos secundarios.

    Los Nutrientes De La Patilla

    Cuando hagas tu viagra natural casera obtendrГЎs todos los nutrientes de la patilla que te harГЎn mГЎs saludable y te ayudarГЎn a aumentar tu deseo sexual. Uno de esos nutrientes es la citrulina contenida en la cГЎscara la cual se piensa que es incomible.

    ВїCГіmo funciona la viagra de patilla?

    La conexiГіn estГЎ siendo establecida entre la patilla y la Viagra debido precisamente a la citrulina. Este nutriente relaja los vasos sanguГ­neos de la misma forma que el medicamento.

    El proceso es ligeramente complicado, e incluye la habilidad de la citrulina de crear arginina que ayuda a remover amonГ­aco del cuerpo. AdemГЎs la citrulina se conoce por promover la energГ­a corporal.

    Por otro lado el beta caroteno es otro nutriente de la patilla que puede ser aprovechado por tu cuerpo. El beta caroteno tambiГ©n se puede encontrar en el pimiento rojo, la zanahoria, la paprika y en la batata.

    El licopeno puede encontrarse tambiГ©n en la patilla y en otras frutas y vegetales como los tomates, guayabas y toronjas.

    Estoy seguro de que estos tips sobre cГіmo hacer viagra natural casera con patilla te serГЎn muy Гєtiles si estГЎs sufriendo de problemas de erecciГіn. SГіlo sigue las instrucciones y aprovecha todos los beneficiosos de estos increГ­bles nutrientes que te harГЎn estar mГЎs saludable y mГЎs preparado para tu vida sexual.

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