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Viagra used to prevent pulmonary edema at high altitudes

In the beginning, it gave hope to older men trying to give their sexual performance a lift.

Now sildenafil, better known by its trade name, Viagra, is gaining popularity for a different use among skiers and mountain climbers. Their concern: avoiding high-altitude pulmonary edema, a potentially deadly condition in which excess fluid collects in the lungs.

Research has been accumulating about sildenafil’s value in nonsex-related uses. The drug has been shown to help some people with high blood pressure in arteries supplying the lungs, a condition known as pulmonary hypertension.

Studies on its use for pulmonary edema include one published in the Annals of Internal Medicine in August. German researchers found that the drug not only prevented this type of edema but also increased the ability to exercise at altitude.

“It’s still preliminary and needs to be better studied,” says Dr. Peter Hackett, a founding member of the Wilderness Medical Society, a Colorado-based association focused on health in remote environments. “People should not just be running out and buying this stuff because they are going” to high altitudes.

Hackett, director of emergency services at the Telluride Medical Center in Colorado, has studied the drug. He says people who have a history of pulmonary edema and are bound for high-altitude hiking or skiing might consider taking sildenafil as a preventive but only with their doctor’s OK. He has used sildenafil to treat pulmonary edema with good results, he says, though he would not routinely recommend the drug.

Sildenafil has not been shown to relieve the more common type of altitude sickness known as acute mountain sickness, or AMS, says Dr. Robert “Brownie” Schoene, past president of the Wilderness Medical Society and professor at UC San Diego School of Medicine. Symptoms include headache, nausea, loss of appetite and difficulty sleeping.

“AMS can occur at altitudes of 6,000 to 8,000 feet,” Schoene says. Descent often helps; if symptoms persist or are severe, medical help is recommended.

By contrast the symptoms of high-altitude pulmonary edema, or HAPE, include shortness of breath, fatigue and cough, sometimes with frothy, pink sputum. Schoene says the condition has been recorded at 8,000 feet but is much more common at 9,000 to 12,000 feet, and the onset is usually two to four days after arrival.

“In our emergency room, we probably see a dozen cases of HAPE a year,” says Dr. Chris Hummel, director of the emergency department at Mammoth Hospital in Mammoth Lakes.

Confirmed diagnoses of acute mountain sickness occur at about the same rate, Hummel says, “but we suspect the number is actually … higher. Many with acute mountain sickness don’t come to the ER.”

Treatment typically involves supplemental oxygen and the drug nifedipine (Adalat, Procardia), which lowers pulmonary artery pressure.

“It’s the same concept as sildenafil, but sildenafil is more potent than nifedipine,” Schoene says. In the lungs, sildenafil keeps the blood vessels dilated, he says. Pressure doesn’t build, and the vessels don’t leak fluid into the lungs’ tiny air sacs.

For mountain climbers, a typical dose of sildenafil is 50 milligrams every eight hours, Hackett says. To treat erectile dysfunction, the usual dose is 50 milligrams before sex, he says.

Unwanted sexual arousal usually is not a problem, Hackett says. “There has to be sexual stimulation, which is usually not available on a mountain-climbing expedition. You are just struggling to survive.”

Healthy Traveler appears every other week. Kathleen Doheny can be reached at kathleen doheny@earthlink.net.

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Sildenafil High Altitude Pulmonary Edema

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

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Viagra May Help Severe Altitude Sickness

From the WebMD Archives

Feb. 1, 2005 — A new use for Viagra may be in the works. The erectile dysfunction drug may help protect against lung problems resulting from high altitudes, say French researchers.

High altitude can sometimes cause illness, especially in people with existing heart and lung problems. The thinner air or lack of oxygen at higher altitudes can cause blood vessels to constrict. When this occurs within the lungs. the constriction of blood vessels can put more force on the heart. leading to life-threatening heart failure. The higher altitude can cause blood vessels in the lung to leak fluid and build up in the lung, interfering with oxygen exchange.

Viagra works by relaxing blood vessels, allowing more blood to flow freely through vessels. The researchers used this drug to block the effects of high altitude on blood vessels on the lung. They looked at whether the use of Viagra would help the lungs continue to get oxygen while ascending to higher altitudes.

In a recent experiment, Viagra was better than a placebo at protecting men’s lungs. The results appear in the February issue of the American Journal of Respiratory and Critical Care Medicine .

This was no ordinary lab test. Instead, 12 men perched on a French mountain about 2.7 miles (4,350 meters) above sea level, pushing their lungs to the limits in the name of science.

The participants were normal, healthy men around 29 years old. They weren’t mountaineers. None was used to high altitudes. The closest any of them had gotten to Mount Everest was probably seeing it in a photo.

But they were in for an adventure when they enrolled in the study.

High-Altitude Tests

Jean-Paul Richalet, MD, PhD, and colleagues wanted to see if Viagra (sildenafil) helped stop dangerous high-altitude health conditions.

High-altitude pulmonary edema (HAPE) occurs when high altitude and low air pressure causes fluid to leak from blood vessels and builds up in the lungs. HAPE has a mortality rate of 44% if untreated, say the researchers. It’s triggered by intense physical exertion at high altitudes that people aren’t accustomed to.

Continued

The study started at sea level, where the men had baseline measurements taken. Then they left their normal lives behind for the mountains.

First stop: Chamonix. The French mountain town is located about 0.6 miles (1,035 meters) above sea level in the Alps, near the Swiss border. The men spent a day there to start adjusting to altitude. The next day, they strapped into a helicopter and soared almost 10,000 feet (3,000 meters) higher to Observatoire Vallot, located just below the summit of Mont Blanc, the highest point in Western Europe.

For five days, they stayed in the mountain observatory. Afterwards, they came back down the mountain for follow-up tests.

While on the mountain, the men filled out surveys checking for signs of acute mountain sickness three times a day. Their breathing was also monitored at rest. In addition, they rode stationary bikes until they couldn’t pedal any more, exercising until exhaustion on their second and fifth days on the mountain.

Half of the men received Viagra. The rest were given a placebo. The Viagra group took 40 milligrams of the drug three times a day, starting on their first day on the mountain.

At first, both groups struggled to adjust. “Subjects suffered from acute mountain sickness until day four,” say the researchers.

High altitudes caused a host of problems. Their blood pressure rose 29% higher than at sea level. Dizziness and stomach problems were similar in both groups.

After one or two days, the Viagra group’s blood pressure started to normalize. By the sixth day, it was 6% lower than before the experiment. But for the placebo group, it remained high, leveling off about 21% higher than normal.

As expected, high altitude made breathing rougher for all of the men. But the Viagra group had less of a setback at rest and during exercise than the placebo group. Side effects were minor, such as muscle pain. say the researchers.

More studies should be done to see if Viagra can replace the current treatment (calcium -channel blockers or steroids ) to treat HAPE, say Richalet and colleagues.

WebMD Health News

Sources

SOURCES: Richalet, J. American Journal of Respiratory and Critical Care Medicine. February 2005; vol 171: pp 275-281. News release, American Thoracic Society. WebMD Medical Reference in collaboration with The Cleveland Clinic: “Heart Disease — A Healthy Heart: How It Works.”

В© 2005 WebMD, Inc. All rights reserved.

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The first spot was to be “Good Morning”, (Quel Beau Matin!) developed by creative team Alan Madill and Terry Drummond at Taxi, Toronto and directed by Martin Granger at Avion Films. The ad starts with an energetic man on his way to work with the soundtrack of “Good morning” from the musical “Singing in the rain.” He bounces down the footpath, past the white picket fence, past the postie and neighbours, hops down the hop skip and jump game, slam dunks a basketball, dances past Mario’s barber’s shop, bounds up the stairs from the train, chases the pigeons, leap frogs the Journal newspaper, cartwheels up to the front door of his office. As he walks into the lift/elevator the word “Viagra” appears on screen, with the encouragement to “Talk to your doctor”.

In “Champions” (2003) a deliriously happy man bounds out the front door of his home and onto the street, taking part in the euphoria of ordinary men who have rediscovered their potency. A woman next door watches with disbelief as she waters her garden with a limp hose. A chap down the street joins in the party as he swerves his hips next to his lathered car. The postie throws the mail into the air and a businessman twirls his briefcase round and round, spilling his paper everywhere. All the way through is the Queen track, “We are the champions”. By the end of the advert the neighbourhood is celebrating on the street. The Viagra pill appears on screen, with the words, “Talk to your doctor”.

Creative direction was provided by Zak Mroueh with Alan Madill and Terry Drummond, with agency producer Louise Bloun. Director Martin Granger worked with producer Marie Walsh and director of photography Barry Parrell at Avion Films. Film editing was done by Chris Parkins at Flashcut. Music and sound was mixed at David Fleury Music .

In 2004, in a move to globalise the Canadian Viagra campaign, Taxi produced “I Did It My Way”, a television commercial featuring men singing in the bath or shower – each giving their rendition of Frank Sinatra’s “I did it my way” in their own language. Note: Sinatra co-wrote the song with Paul Anka.

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Two guys meet in a lift/elevator. “Hey Alan. Running a little late?” “Yeah.” “You look tired. “No. I was up late BEEEEEEEEEEEP.” “Cool.” Click on the image below to play the Elevator video in YouTube

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Taxi’s team for the campaign included creative directors Lance Martin and Zak Mroueh, art director Ron Smrczek, copywriter Irfan Khan and agency producer Jennifer Mete. Director Joachim Back worked with producer Gigi Realini and Link York, director of photography Joaquin Baca-Asay from The Partners Film Company. Mick Griffin from FlashCut was editor. Sound design was arranged at The Eggplant .

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Huws et al. And/or %) Recidivism of Noncastrates Notes The Netherlands (Fischer van Rossum) 267 Unknown Unknown Black women 6 (5) Unknown Unknown. Command hallucinations, compliance, and generalization in behavioral medicine (pp. USA: Elsevier Science; 1999. The Care and Treatment Conference of the reaction of cerebrospinal fluid pleocytosis (16).

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Wireless Innovation Alliance // Jun. 16

Earlier today, Reps. Darrell Issa (R-CA) and Anna Eshoo (D-CA) sent the attached letter to FCC Chairman Tom Wheeler on the importance of establishing the technical rules necessary to allow unlicensed use of the 600 MHz band. The Wireless Innovation Alliance (WIA) released the statement below in response. More

Wireless Innovation Alliance // Apr. 17

The Wireless Innovation Alliance (WIA) released the statement below on today’s FCC Open Meeting where the Commission approved an order to implement a spectrum sharing framework in the 3550-3700 MHz band. More

Wireless Internet Service Providers Association // 10:05 AM EST// Mar. 23

The National Association of Broadcasters (NAB) wants the FCC to declare an “emergency” and shut down the databases that let small businesses and others deliver broadband over vacant spectrum near television channels. More

Wireless Innovation Alliance // 6:06 PM EST// Feb. 10

The Wireless Innovation Alliance (WIA) released the statement below in response to the introduction of the House and Senate Wi-Fi Innovation Act More

Wireless Innovation Alliance // 4:44 PM EST// Jan. 28

The Wireless Innovation Alliance applauds the FCC for telling Marriott International, Inc. – and everyone else – that it is illegal to interfere with lawful communications. More

Wireless Innovation Alliance // 3:00 PM EST// Dec. 15

This October, the FCC found Marriott’s Gaylord Opryland Hotel and Convention Center to be guilty of blocking guests’ personal Wi-Fi hotspots and fined Marriott International $600,000. Lend your social voice to our Thunderclap. More

Wireless Innovation Alliance // 5:47 PM EST// Sep. 4

FCC Chairman Tom Wheeler acknowledged the critical role unlicensed spectrum plays in growing competition in the broadband marketplace stating that the FCC’s “efforts to expand the amount of unlicensed spectrum creates alternative competitive pathways.” More

The Hill // 9:25 AM EST// Jun. 16

CEA released a report, Unlicensed Spectrum and the American Economy, examining the economic impact of unlicensed spectrum on the American economy. More

The Wireless Innovation Alliance (WIA) is a broad-based group of innovators, providers, consumer groups, think tanks and education organizations that believe that more efficient use and expanded access to the nation’s spectrum resources are fundamental to the future of U.S. economic policy and global competitiveness, and that we face potential spectrum scarcities in both licensed and unlicensed bands that must be addressed in order for innovation and investment to move forward.

Spectrum, and specifically, the most efficient and expansive use of this most valuable natural resource, is fundamental to the future of U.S. economic growth, and global competitiveness. United States spectrum policy must also be efficient and flexible as well, so that we can encourage and accommodate new and innovative ways to meet the growing demand for wireless services and applications, and the growing inability – in both licensed and unlicensed bands – to meet that demand.

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A Boots UK spokesperson said: “We can confirm that this is the correct pricing for the private prescription Sildenafil 50mg which is ВЈ2.50 per tablet. Though we cannot disclose our pricing mechanism, we regularly review the prices of our private prescriptions and will continue to do so following this feedback.”

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When we presented Boots with a photo of the tablets’ misleading label they admitted there had been a mistake – but only in the labelling. Boots added: “We apologise if there was any confusion in this instance regarding the printed bag label. These are generated automatically, and for this medicine it shows the minimum cost for a private prescription is ВЈ5. We are looking into this process to make the pricing clearer for our customers and to help avoid this occurrence in future.”

But this doesn’t answer why two other local pharmacies – Rowlands in Hemdean Road – and Day Lewis on Church St charge ВЈ5 and ВЈ8 respectively for the same medication in the same quantity on a private prescription.

A private prescription (like this) could be issued by a private prescriber or by your NHS prescriber, if your treatment is not available under the NHS. As with any privately administered drug, the prescriber may also charge you for writing a private prescription.

Because these tablets have been prescribed on a private basis (as the NHS doesn’t subsidise it), unlike NHS prescriptions which have a set cost of ВЈ8.05, their price is decided by pharmacies, who can charge whatever they like.

Chemists tend to have a “minimum charge” for private prescriptions – for example Boots’ is ВЈ5. But what they choose to charge customers above this level varies wildly, so it pays to shop around – especially if its medication you’re taking regularly.

We found that giant chemist chains – Boots and Superdrug – both charge ВЈ20 for eight tablets of Sildenafil, which is the most expensive we came across. However, as you have already identified, its possible to pick up Sildenafil at a much cheaper price. For example, the Co-op Pharmacy service offers the same medication in the same quantity for just ВЈ4.90 – less than a quarter of the price in Boots and Superdrug, and just 40p more than its minimum charge for private prescriptions, which is ВЈ4.50.

To save yourself trawling around town for the best price, you can call the pharmacist directly and they’ll be able to tell you the price within minutes.

Have you been charged over the odds for medication at a chemist? We want to hear from you. Email katie.morley@telegraph.co.uk

Do you have a question for our experts? Email moneyexpert@telegraph.co.uk or write to Telegraph Money Ask an Expert, 111 Buckingham Palace Road, London, SW1W 0DT.

• For money saving tips, tricks and ideas, sign up to our weekly newsletter by entering your email here

Tesco to sell half-price Viagra over the counter

From next Monday, Viagra will be available at 300 Tesco in-store pharmacies across the country.

Following similar rules to those operated for over-the-counter sales of the drug in Boots, customers will simply be able to put a packet in their shopping basket and go through a till.

Pop in for some Viagra: Customers will be able to put the anti-impotence drug in their shopping basket

Tesco pharmacists have already been trained to help the men potentially eligible, aged 40 to 65, to complete a questionnaire and undergo blood pressure, diabetes and cholesterol tests.

If these tests show they are suitable, the men will be offered the pills.

Pugh cartoon of Viagra in Tesco

Those with abnormal glucose, cholesterol or blood pressure may be refused the drug and referred back to their GPs.

Yesterday Shona Scott, Tesco’s commercial manager for pharmacy services, said: ‘Tesco’s will be the cheapest service in the country for those who don’t have a private prescription from their GP. At the moment only Boots offer a similar service – for which they charge £55 for just four tablets.’

A Tesco source said a special training course had prepared pharmacists for different
types of customers.

‘One scenario saw an older man who was very nervous and couldn’t get his words out,’ the source said.

Others involved a man coming in and sitting down confidently and discussing his problem openly using slang terms.

When Boots first began testing over-the-counter sales a year ago, hundreds of men travelled many miles to buy Viagra.

It is thought that many were simply too embarrassed to ask their doctor for a prescription.

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Study Finds Viagra Works for Women

A new study has found that the impotence drug Viagra could ramp up the sex lives of women who take it, just as it has done for men.

The 12-week study focused on 202 post-menopausal or post-hysterectomy women who complained of female sexual arousal disorder. The women in the group who took Sildenafil — the little blue pill commonly known as Viagra — took notes after each sexual experience, and reported better overall sexual satisfaction compared with those who took a placebo.

Their enhanced sex lives included better arousal, lubrication and orgasm.

The study was conducted by Laura Berman, director of the Berman Center and a professor of OB-GYN and psychiatry at Northwestern University in Chicago, and Dr. Jennifer Berman, director of the Female Sexual Medicine Center at UCLA Medical Center in Los Angeles. The researchers say that the results are preliminary.

“In terms of ability to achieve orgasm, there was a statistically significant movement,” Laura Berman said on ABCNEWS’ Good Morning America.

“It increases blood flow to the genital area, increases the sensation of warmth, tingling and fullness,” she said.

More than 50 million women experience some type of sexual dysfunction.

Jennifer Berman said it’s important for women to remember that this pill can’t overcome mental and emotional barriers to a satisfying sex life.

“At this point, we can say that women with significant emotional or relationship problems and women that have desire problems related to their interest in being sexual might not be the best candidates,” Jennifer Berman said. “It’s for women who were satisfied with their sexual response at one point and now, for whatever medical reason, are no longer able to respond,” she said.

Increased Blood Flow Theory

Women who suffer from female sexual arousal disorder can experience a variety of symptoms, including lack of “excitement,” vaginal dryness, loss of sensation and sensitivity in the genitals and nipples and low blood flow to the genitals. Women in the study were screened to make sure that psychological or relationship issues were not the cause of the problem.

Since Viagra enhances sexual arousal in men by increasing the blood flow to the penis, the Bermans theorized that the drug could have a similar effect on women, increasing the blood flow to the female genitals and thereby producing better arousal, sensation and lubrication in the genital area.

Women in the study were given doses of 50 milligrams, which was increased to 100 milligrams only once during the study based on how well the lower dose was working, and the women’s tolerance to it. The pill was to be taken prior to sexual activity but no more than once daily.

Each patient had to engage in sexual activity at least once a week and keep a personal log about it. During the course of the study, neither the patients nor the doctors knew which patients were receiving the Viagra. Women taking Viagra reported mild to moderate side effects, including headache, flushing, nausea, and vision symptoms — the same side effects reported by men who take the drug.

What Happens When Women Use Viagra?

by LEAH DIPLACIDO, PH.D. Last Updated: Mar 21, 2011

Leah DiPlacido, a medical writer with more than nine years of biomedical writing experience, received her doctorate in immunology from Yale University. Her work is published in “Journal of Immunology,” “Arthritis and Rheumatism” and “Journal of Experimental Medicine.” She writes about disease for doctors, scientists and the general public.

Viagra, the brand name for the medication sildenafil sulfate, is prescribed for treatment of erectile dysfunction (ED) in men. ED is a condition where a man has difficulty getting or maintaining an erection. But what happens when women take Viagra?

Pre-menopausal Women

According to a study in December 2003 from University of Catania in Italy, pre-menopausal woman taking sildenafil reported an increase in sexual arousal, almost twofold over placebo.

Post-menopausal women

A separate study reported on the effects of taking sildenafil by post-menopausal women. This study, completed in March 1999 by researchers at Columbia University in New York, reported that 18.1 percent of women who completed the study found a significant increase in their sexual function, including self-reported sexual arousal.

Heart Rate

Data from a third study on pre-menopausal women in June 2000, by experts from Mount Sinai School of Medicine in New York, demonstrated that sildenafil increased heart rate by approximately four to five beats per minute.

Blood Pressure

Data from the study by Sipski and colleagues also showed that sildenafil decreases blood pressure in women an average of 2-4 mm/Hg.

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Side Effects

Common side effects experienced by women among all three studies were headache and dizziness; these side effects caused some of the women to stop taking the medication.

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Viagra Improves Sex for Some Women

From the WebMD Archives

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

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

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

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

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

Viagra, Genital Sensation, and Sexual Satisfaction

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

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

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

Continued

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

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

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

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

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

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

WebMD Health News

В© 2004 WebMD, Inc. All rights Reserved.

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A que edad el hombre puede tomar viagra
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TODO LO QUE USTED QUERГЌA SABER SOBRE VIAGRA Y NO SE ATREVГЌA A PREGUNTAR

CГіmo se toma? CuГЎntas pastillas se deben ingerir? CuГЎnto dura el efecto? Alrededor de Viagra existen muchos interrogantes. Las respuestas surgidas de la sabidurГ­a popular tienen mucho de cierto, y bastante mГЎs de falso. La Гєnica verdad contundente es que se trata de un medicamento contra la disfunciГіn erГ©ctil o impotencia. Nada mГЎs.

 31 de mayo de 1998

Un nuevo tratamiento, el mГЎs revolucionario segГєn los expertos, parece haberse convertido en la punta del iceberg que destapГі un problema mundial, la impotencia.

Los que siempre habГ­an ocultado su problema, ahora salen a la luz pidiendo con vehemencia la nueva droga, una tableta con forma de diamante, de color azul intenso, que por un lado dice VGR 50 y por el otro Pfizer.

Es tal el revuelo causado por este nuevo medicamento, cuyo principio activo es el Sildenafil, que ya los especialistas se preguntan de dГіnde salieron tantos impotentes (hombres que sufren de disfunciГіn erГ©ctil).

Por supuesto, no era un secreto que habГ­a un subregistro de casos y que muchas personas preferГ­an ocultar su problema a tener que consultar.

SegГєn Alonso AcuГ±a, urГіlogo sexГіlogo de la ClГ­nica Shaio, el problema no ha aumentado, sino que se estГЎ descubriendo. Parece quedar atrГЎs el tabГє o el temor a hablar de Г©l, y Viagra ha dado pie para que esto suceda.

En Estados Unidos y en MГ©xico, en donde el Viagra, ya fue aprobado y estГЎ a la venta, el revuelo ha sido tal que las ventas han superado lo que se presupuestaba para un aГ±o en tan solo dos meses.

En otros paГ­ses como Colombia, en donde apenas se aprobГі hace dos dГ­as y aГєn no estГЎ a la venta, Viagra tambiГ©n ha dado mucho de quГ© hablar. Miles de hombres preguntan en dГіnde se consigue, para quГ© sirve, cГіmo se toma, quГ© efecto tiene.

TambiГ©n se han creado muchas ideas errГіneas: que la duraciГіn es de cuatro horas ( cuatro horas con el pene erecto?), quГ© no es solo para hombres con disfunciГіn erГ©ctil sino que le sirve a cualquiera, que es un nuevo afrodisiaco, que debe tomarse en cuenta la hora en la que se toma, porque a los 25 minutos ya hace efecto ( y si usted no alcanza a llegar a la cita con su novia antes de ese tiempo?).

En fin, Viagra ha dado mucho de quГ© hablar en materia sexual. Por ello, EL TIEMPO ha querido resolver muchas de las inquietudes de la comunidad y para ello consultГі con expertos en urologГ­a, con directivos del Invima (instituciГіn que lo aprobГі hace dos dГ­as) y sobre todo con directivos de Laboratorios Pfizer, la casa farmacГ©utica que lo dio a conocer en el mundo.

QuГ© quiere saber? Estas son las respuestas a las preguntas que mГЎs se hacen los colombianos sobre Viagra, con la asesorГ­a de urГіlogos, estudios, documentos, y de Manuel Enrique Chaves RodrГ­guez, mГ©dico internista, director mГ©dico de Laboratorios Pfizer para Colombia, Venezuela y Ecuador.

QuiГ©nes pueden tomar Viagra? El medicamento estГЎ indicado para personas con disfunciГіn erГ©ctil.

No es para que todo el mundo lo tome y se vuelva super hombre; es para personas que tienen una patologГ­a y, por lo tanto, su uso tiene que ser racional, segГєn las indicaciones del mГ©dico, previo diagnГіstico individual .

SegГєn los expertos, tampoco es una droga recreativa sino un medicamento absolutamente Г©tico que, como todos los de su especie, requiere intervenciГіn del mГ©dico para su uso.

Viagra es un afrodisiaco? Viagra es un medicamento que responde bien en los pacientes con disfunciГіn erГ©ctil (impotencia) sin que haya necesidad de discernir el tipo de disfunciГіn erГ©ctil que tiene la persona.

No importa si la causa es orgГЎnica, sicГіgena o mixta, el producto responde de manera favorable y por lo general, de manera similar. Es un tratamiento para la disfunciГіn erГ©ctil, no es un afrodisiaco.

Se sabe que se va vender bajo fГіrmula mГ©dica. QuiГ©n la puede recetar: un mГ©dico general, un urГіlogo, o cualquiera de los dos? Es un producto que deberГЎ ser manejado por el cuerpo mГ©dico, tanto especialistas como mГ©dicos generales.

Estoy tomando antidepresivos. Puedo tomar Viagra? Viagra no tiene una interacciГіn farmacolГіgica con antidepresivos, ni los antidepresivos con Viagra.

De otra parte, hay que tener en cuenta que un alto porcentaje de hombres con depresiГіn pueden tener un trastorno erГ©ctil.

Un subestudio de Pfizer analizГі a 136 pacientes deprimidos. Mientras que con placebo hubo un porcentaje de mejorГ­a en las erecciones del 21 por ciento, con Viagra fue del 70 por ciento.

CuГЎles medicamentos no se deben combinar con Viagra? Realmente los Гєnicos medicamentos con los que tiene interacciГіn farmacolГіgica clГ­nicamente significativa son los nitratos (medicamentos para el manejo de la angina de pecho, bien sea parches de nitroglicerina o aquellos tomados por vГ­a oral). Si usa estos productos, no debe consumir Viagra.

Tampoco se debe tomar con otras drogas que sean donadores de Гіxido nГ­trico (medicamentos que se utilizan para reducir la presiГіn arterial cuando hay crisis hipertensiva).

Solo se toma por vГ­a oral? El Sildenafil es un medicamento que se administra por vГ­a oral, y es ahГ­ donde estГЎ parte de su secreto y novedad.

Como todo medicamento que se administra por vГ­a oral, tiene que sufrir un metabolismo y actuar sobre una serie de sistemas en el organismo, hasta que empieza su momento de acciГіn. En otras palabras, no es un medicamento de acciГіn inmediata.

Pueden pasar entre 25 minutos y una hora antes de que actГєe. Esto varГ­a de persona a persona, pero hay factores que se deben tener en cuenta. Por ejemplo, si se toma con comidas grasas, disminuye un poco su absorciГіn.

Viagra produce erecciГіn automГЎtica o se requiere estimulaciГіn sexual? Para que haya erecciГіn se debe recibir un estГ­mulo sexual. Cuando esto ocurre, hay una activaciГіn del sistema nervioso en el cerebro, que a su vez envГ­a las Гіrdenes para que se produzca la erecciГіn. Si no hay estГ­mulo no hay erecciГіn.

Cuando se padecen problemas de impotencia y se usa la droga, cuГЎnto puede durar una erecciГіn? Time hablГі de cuatro horas.

La mayorГ­a de las erecciones que se logran con Viagra son muy buenas y permiten una penetraciГіn adecuada. Duran, por lo general, 16 minutos.

Viagra mantiene el ciclo normal de la actividad sexual, pero si todavГ­a hay acciГіn del medicamento y estГ­mulo sexual, el paciente podrГ­a tener otra erecciГіn y luego otra y otra, hasta por cuatro horas.

No es para fabricar erecciones. El hecho de que permita que haya una actividad sexual normal, con sus diferentes fases (estimulaciГіn, fase coital y luego una tercera fase de gratificaciГіn donde finalizГі el coito), hace que se restaure no solo la actividad sexual sino la calidad de la relaciГіn.

Con los mГ©todos existentes hasta hoy para tratar la impotencia, habГ­a el riesgo de una erecciГіn muy prolongada (priapismo) y el paciente debГ­a ser tratado de urgencia. Con Viagra, se calcula la dosis necesaria segГєn el paciente, es decir, hay dosis personalizada. Se corre el riesgo de una erecciГіn indeseada bien prolongada? Finalizada la actividad sexual, el individuo regresa a sus condiciones normales. No permanece con una erecciГіn continuada ni menos aГєn llega a situaciГіn emergencia clГ­nica que es el priapismo.

SegГєn diferentes estudios consultados por EL TIEMPO, con Viagra, en mГЎs de 4.000 analizados, no ha habido un solo caso de priapismo.

CuГЎl es la dosis adecuada? La dosis la determina el mГ©dico segГєn cada caso particular. Sin embargo, la mayorГ­a de estudios dejan ver que con la dosis de 50 miligramos, una vez al dГ­a, es suficiente (hay que aclarar que tambiГ©n hay una dosis de cien miligramos).

En los estudios clГ­nicos se ha visto que los pacientes con disfunciГіn erГ©ctil mejoraron con esta dosis el nГєmero de actividades sexuales exitosas y lograron tener casi seis actividades sexuales por mes, cuando con placebo a duras penas tenГ­an una.

Si el individuo con disfunciГіn erГ©ctil responde bien a Viagra, puede tomar diariamente su dosis recomendada y tener relaciones satisfactorias.

CuГЎles son los efectos secundarios? Los estudios clГ­nicos realizados hasta la fecha seГ±alan los siguientes efectos adversos: cefalea (dolor de cabeza), enrojecimiento de la cara, malestar digestivo y en algunos casos algo de congestiГіn nasal. En general, se trata de efectos relacionados con vasodilataciГіn.

La tasa de deserciГіn (pacientes que dejaron de tomar la droga) por efectos colaterales en los estudios clГ­nicos con Viagra fue del 2,6 por ciento, mientras que con placebo llegГі al 2,3 por ciento.

Algunos pacientes (alrededor del 2,7 por ciento) han sufrido alteraciones de la visiГіn muy transitorias y leves, que fundamentalmente se caracterizan porque ven halos alrededor de los objetos, o porque ven cambios de colores.

Esto se debe tambiГ©n a que el producto, en algГєn pequeГ±o porcentaje de pacientes, puede afectar una fosfodiesterasa (enzima que se encuentran en distintas partes organismo cumpliendo funciones especГ­ficas segГєn su localizaciГіn), diferentes a la 5 (la 6) que se encuentra en la retina, y es la responsable de permitir que el ojo vea los colores en la frecuencia correspondiente.

Esto no significa que Viagra cause ceguera, ni impide que el paciente conduzca, por ejemplo.

QuГ© puede pasar si se abusa de la droga (por ejemplo, si se consumen dos o tres dosis en una sola toma)? Si el paciente omite la prescripciГіn mГ©dica y por su propia cuenta empieza a tomar Viagra y a exceder las dosis, no duplicarГЎ ni aumentarГЎ de manera significativa la efectividad del producto. En cambio, sГ­ se va a aumentar de manera considerable el riesgo de efectos colaterales (los mismos efectos pero con mГЎs frecuencia).

El producto tiene una acciГіn muy especГ­fica sobre la fosfodiesterasa 5 (que se encuentra en el pene y es la enzima que destruye la actividad del Гіxido nГ­trico y permite que el pene vuelva otra vez a su estado de flacidez. Viagra actГєa inhibiendo la fosfodiestereasa 5 y permite por lo tanto mantener la erecciГіn, al aumentar la duraciГіn de la acciГіn del Гіxido nГ­trico).

En condiciones normales, Viagra no afecta otros Гіrganos o sistemas.

Pero si se aumenta la dosis, entonces sГ­ puede empezar a afectar otros sistemas que utilizan fosfodiesterasas (hay seis definidas que actГєan a diferentes niveles).

CГіmo funciona en un enfermo del corazГіn y en casos de problemas renales o hepГЎticos? La pueden utilizar o no? En teorГ­a, no hay contraindicaciГіn, siempre y cuando el mГ©dico haya, inicialmente, evaluado que el paciente pueda tener actividad sexual sin problemas.

Si el mГ©dico ve que su paciente estГЎ en condiciones que no impliquen riesgo, usar Viagra no ofrece inconvenientes.

Pero si estГЎ muy comprometido en su aparato cardiovascular y un sobreesfuerzo fГ­sico lo pone en riesgo, no debe consumirla.

En este caso, el problema no es de Viagra, sino del riesgo propio de la actividad sexual.

El producto no afecta la funciГіn renal ni la funciГіn hepГЎtica, de manera que pacientes con disfunciones de este tipo no tienen contraindicaciones.

Si se consume Viagra bajo el efecto de alcohol o de otros estimulantes, quГ© pasa? En dosis moderadas de alcohol no se presentan interacciones con Viagra. Una o dos copas no afectan la farmacocinГ©tica del producto ni potencian la acciГіn del alcohol.

Obviamente, hay que recordar que el alcohol y el tabaco son nocivos para la salud.

Si uno tiene erecciones normales, que efecto produce tomar Viagra? Algo que es normal no se puede normalizar mГЎs, es decir, no habrГЎ una respuesta mГЎs allГЎ de lo normal. Si hay disfunciГіn erГ©ctil, entonces sГ­ actГєa el medicamento.

Las mujeres lo pueden consumir? QuГ© les pasa si consumen Viagra? No hay estudios en mujeres. No deben usarlo hasta que haya alguna razГіn cientГ­fica que lo avale.

Viagra sustituye totalmente los mГ©todos tradicionales (inyecciones, prГіtesis. ) Viagra es una excelente alternativa para el manejo de pacientes con disfunciГіn erГ©ctil, pero no quiere decir que reemplace el resto de terapias. Es el mГ©dico quien va a orientar al tratamiento.

HabrГЎ casos en donde hay que buscar una alternativa diferente, si el manejo farmacolГіgico es insuficiente, y habrГЎ que recurrir a colocar una prГіtesis.

Los hombres con prГіtesis peneanas pueden recurrir a Viagra y quitГЎrsela (la prГіtesis)? No hay evidencia clГ­nica al respecto. Hay que tener en cuenta que si el paciente tuvo que recurrir a una prГіtesis peneana es porque se han probado otras alternativas y su aparato erГ©ctil estaba tan deteriorado que no iba a poder responder a intervenciones farmacolГіgicas. La prГіtesis es una soluciГіn irreversible.

QuГ© pasa si se toma Viagra y no se tienen relaciones? Si no hay un estГ­mulo sexual no va a pasar nada. Los efectos colaterales pueden aparecer, pero no los beneficios.

Viagra cura la disfunciГіn erГ©ctil? No. Viagra no cura la disfunciГіn erГ©ctil: controla la enfermedad y, segГєn estudios, los pacientes con disfunciГіn erГ©ctil que toman Viagra logran una mejorГ­a significativa, como es lo esperado con el producto.

Si se les suspende Viagra y se les cambia por placebo y concomitante, la mejorГ­a desaparece. Si se vuelve a administrar Viagra, vuelve otra vez a encontrar la mejorГ­a.

Eso no significa que el medicamento genere dependencia; simplemente es la respuesta del medicamento que mejora la funciГіn erГ©ctil, pero no soluciona el problema de base, que es una manifestaciГіn de muchas patologГ­as consideradas factores de riesgo, entre las que se pueden mencionar la diabetes, la hipertensiГіn arterial, la arterioesclerosis, trastornos hormonales, traumas, secuelas de intervenciones quirГєrgicas (prostatectomГ­a radical), trauma medular y tambiГ©n problemas sicolГіgicos que van a llevar a la disfunciГіn erГ©ctil.

Por todo lo anterior, el manejo del tratamiento debe estar a cargo del mГ©dico.

Viagra responde de manera favorable, en mГЎs del 80 por ciento de todos los pacientes con disfunciГіn erГ©ctil.

Hay una edad lГ­mite (mГЎxima y mГ­nima) para tomar Viagra? Mientras que el individuo con disfunciГіn erГ©ctil tenga capacidad fГ­sica y mental para tener actividades sexuales, va a haber posibilidad de usarlo. SegГєn los estudios, responde tan bien en edades menores de 60 aГ±os como en mayores.

Un paciente poco acostumbrado a tener erecciones fuertes puede experimentar dolor? En los estudios clГ­nicos sobre el uso de Viagra, este caso no ha sido reportado como efecto colateral del medicamento.

Se han detectado efectos secundarios a largo plazo? En este momento, Pfizer dispone de estudios en los que se ha seguido a los pacientes por mГЎs de un aГ± o. La eficacia clГ­nica se ha mantenido y la incidencia de efectos colaterales no se ha modificado por el uso continuado del producto.

QuГ© se sabe de las muertes en las que se sospecha que Viagra intervino, en Estados Unidos? Pfizer en Estados Unidos dio a conocer, ayer, un comunicado en el que afirma que se siguen revisando los casos con la AdministraciГіn de Drogas y Alimentos de Estados Unidos (FDA, por su sigla en inglГ©s) y que no va a cambiar ni los empaques ni la presentaciГіn de Viagra.

La informaciГіn que hay hasta el momento sobre estos casos no sugiere que haya ningГєn riesgo para los pacientes, que no estГ©n descritos en las etiquetas del medicamento. dice el informe.

Aclara tambiГ©n que al parecer, los casos atribuidos se relacionan con eventos cardiovasculares asociados con actividad sexual en hombres mayores o a la combinaciГіn de Viagra con nitratos, acciГіn que estГЎ contraindicada en las etiquetas aprobadas por la FDA .

Hay riesgo de que suspendan su venta en Estados Unidos por esta razГіn? No. Todo lo contrario, no hay en este momento ningГєn otro producto, ni ha habido, que en tan poco tiempo haya sido probado por tantas personas.

Si a eso le suman el control de farmacovigilancia tan preciso que hace la FDA, los expertos dicen que se puede tener confianza de la eficacia y la buena tolerabilidad del producto.

QuГ© compuestos tiene? Sildenafil es el principio activo de Viagra. Adicionalmente tiene una serie de sustancias inactivas que acaban de conformar su composiciГіn.

Sildenafil estГЎ en forma de una sal que se llama citrato de sildenafil.

CГіmo el futuro comprador del producto reconoce que es el original y no alguno falsificado? En este momento se sabe que en muchos paГ­ses del mundo se puede conseguir Viagra o un medicamento con el nombre de Viagra, y puede haber falsificaciones importadas de manera ilegal.

Pfizer no se responsabiliza del uso de estas sustancias en Colombia, puesto que hasta la fecha el laboratorio no estГЎ vendiendo el producto.

Estamos haciendo todo lo posible para traer Viagra al mercado Colombiano lo mГЎs pronto, pero lo que hay hasta este momento en el paГ­s no estГЎ autorizado por la casa farmacГ©utica. dice un comunicado de esta firma.

El producto va a tener unas caracterГ­sticas que lo van a identificar de posibles falsificaciones.

Lo mГЎs importante es que cuando el producto salga al mercado se compre en puntos de venta reconocidos.

Al respecto, los directivos de Pfizer y el Invima sostendrГЎn esta semana una reuniГіn para definir los mecanismos de control que regirГЎn la venta de este producto.

Se puede suponer que el grupo poblacional adolescente es muy dado a probar todas las modas. Viagra es indicado para este tipo de personas? Viagra estГЎ contraindicado en niГ±os. Es un producto para la disfunciГіn erГ©ctil y en un adolescente es muy raro que se presente esta enfermedad.

La distribuciГіn del producto en el paГ­s se harГЎ previo o acompaГ±ado de campaГ±as de prevenciГіn y control para su consumo? El producto va a tener que ser prescrito mГ©dicamente y la principal funciГіn del laboratorio, segГєn sus directivos, serГЎ educar a la comunidad cientГ­fica para un buen uso del producto, y a la comunidad en general para apoyar las campaГ±as de educaciГіn sobre disfunciГіn erГ©ctil antes que campaГ±as relacionadas con el medicamento.

CuГЎnto tiempo se ha investigado sobre sus efectos en los seres humanos? En quГ© grupos poblacionales y/o perfil socioeconГіmico?.

Sildenafil es una molГ©cula que lleva en investigaciГіn muchos aГ±os. Las primeras experiencias del uso del medicamento en humanos datan de 1983, y para el manejo en disfunciГіn erГ©ctil desde esta dГ©cada.

Los estudios clГ­nicos se han hecho en diversas partes del mundo, con diferentes razas, perfiles socioeconГіmicos, condiciones patolГіgicas etc. siempre con consistencia en los resultados.

DetrГЎs de Viagra hay una empresa de investigaciГіn con 150 aГ±os de historia que invierte al aГ±o mГЎs de 2.000 millones de dГіlares en investigaciГіn y que incursiona cientГ­ficamente en diversidad de campos, como por ejemplo enfermedades cardiovasculares, sistema nervioso central, diabetes, aparato urogenital, enfermedades infecciosas, y muchas mГЎs.

En las pГЎginas sociales ya saliГі un aviso promocionando Viagra (daban un telГ©fono). Siendo que la droga no ha sido aprobada en Colombia, es legal promocionar su venta? Sobre la disponibilidad actual del producto, en este momento cualquier venta de Viagra o algo parecido, cualquier imitaciГіn de Viagra es, desde luego, ilegal.

El Invima acaba de darle a laboratorios Pfizer en Colombia la autorizaciГіn para que vender el producto en el paГ­s a travГ©s de las farmacias reconocidas de Colombia. Cualquier cosa aparte de esto es considerada un delito.

Con la imagen de Viagra se ha aprovechado de manera poco decorosa el medicamento para promover ventas de otros productos ajenos a la medicina, como camas. Esto no solo es un irrespeto al desarrollo cientГ­fico que hay detrГЎs de una molГ©cula tan importante como Viagra sino a la casa farmacГ©utica que ha invertido tantos aГ±os y tantos recursos para darle a la humanidad un producto como Viagra, afirman los directivos del laboratorio.

Nos gustarГ­a que en Colombia se normatice la publicidad para que situaciones como esta no sucedan .

QuГ© precio va tener en Colombia? En este momento no hay todavГ­a una definiciГіn de precios. Para ponГ©rselo se necesita un proceso, anГЎlisis internos de la compaГ±Г­a y macroeconГіmicos, pero la idea es mantenerse dentro de los estГЎndares internacionales. En Estados Unidos se cobran diez dГіlares por tableta.

Por quГ© viene en dos presentaciones y bajo quГ© parГЎmetros se escoge una u otra? EL TIEMPO pudo establecer que, muy seguramente en Colombia, la dosis que se va a utilizar para empezar es la de 50 miligramos, que se considera como la dosis mГЎs apropiada.

SegГєn los Гєltimos estudios, la dosis de 50 miligramos es la mГЎs recomendada. Es mГЎs, si el paciente responde bien, el mГ©dico puede bajarla a 25, si no, mГЎximo a la de 100.

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