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Nitrate medicines include: Medicines that treat chest pain (angina) Nitroglycerin in any form including tablets, patches, sprays, and ointments Isosorbide mononitrate or dinitrate Street drugs called “poppers” (amyl nitrate or nitrite) Ask your doctor or pharmacist if you are not sure if you are taking a nitrate medicine. 20 mg sildenafil is a prescription medicine used in adults to treat pulmonary arterial hypertension (PAH). With PAH, the blood pressure in your lungs is too high.

Your heart has to work hard to pump blood into your lungs. It improves the ability to exercise and can slow down worsening changes in your physical condition. Sildenafil is not for use in children Adding sildenafil to another medication used to treat PAH, bosentan (Tracleer®), does not result in improvement in your ability to exercise. 20 mg sildenafil tablets contain the same medicine as VIAGRA® (sildenafil), which is used to treat erectile dysfunction (impotence). Do not take 20 mg sildenafil tablets with VIAGRA or other PDE-5 inhibitors.

Who should not take sildenafil 20 mg tablets (Revatio)? Do not take sildenafil if you: Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension.

Your blood pressure could drop to an unsafe level Are allergic to sildenafil, as contained in VIAGRA ® and REVATIO ® You’ve ever had blockage of veins in your lungs, which is called pulmonary veno-occlusive disease Are a women or a child. Before you take sildenafil, 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 NAION Have bleeding problems Have or have had stomach or intestinal ulcers Have liver problems Have kidney problems or are having kidney dialysis Have any problem with the shape of your penis or Peyronie’s disease 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.

Sildenafil may affect the way other medicines work, and other medicines may affect the way sildenafil works, causing side effects.

Especially tell your healthcare provider if you take any of the following: Medicines called nitrates Medicines called guanylate cyclase stimulators such as Adempas ® (riociguat) 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

Sildenafil oral suspension will be mixed for you by your pharmacist.

Do not mix sildenafil oral suspension with other medicine or flavoring. Shake well for at least 10 seconds before each dose.

If you miss a dose, take it as soon as you remember. If it is close to your next dose, skip the missed dose, and take your next dose at the regular time. Do not take more than one dose of sildenafil at a time.

Do not change your dose or stop taking sildenafil on your own.

If you take too much sildenafil, call your doctor or go to the nearest hospital emergency room. What are the possible side effects of sildenafil 20 mg tablets (Revatio)?

Low blood pressure may cause you to feel faint or dizzy. Tell your doctor if you get more short of breath after you start REVATIO. More shortness of breath than usual may be due to your underlying medical condition. decreased eyesight or loss of sight in one or both eyes (NAION). If you notice a sudden decrease or loss of eyesight, talk to your doctor right away. If you notice a sudden decrease or loss of hearing, talk to your doctor right away. It is not possible to determine whether these events are related directly to this class of oral medicines, including REVATIO, or to other diseases or medicines, to other factors, or to a combination of factors.

heart attack, stroke, irregular heartbeats, and death. Most of these happened in men who already had heart problems.

Tell your doctor right away if you have an erection that lasts more than 4 hours.

The most common side effects with sildenafil 20 mg tablets (Revatio) include: Nosebleed Headache upset stomach getting red or hot in the face (flushing) trouble sleeping Fever erection increased respiratory infection Nausea Vomiting Bronchitis Pharyngitis runny nose pneumonia in children. Tell your doctor if you have any side effect that bothers you or doesn’t go away.These are not all the possible side effects of REVATIO. For more information, ask 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. How should I store sildenafil 20 mg tablets (Revatio)?

Store tablets at controlled room temperature, between 20°C -25°C (68°F to 77°F).

Store constituted oral suspension below 30°C (86°F) or in a refrigerator between 2°C to 8°C (36°F to 46°F). General information about sildenafil 20 mg tablets (Revatio) Medicines are sometimes prescribed for purposes that are not in the patient leaflet. Do not use REVATIO for a condition for which it was not prescribed. Do not give REVATIO to other people, even if they have the same symptoms you have.

This patient leaflet summarizes the most important information about REVATIO.

If you would like more information about REVATIO talk with your doctor. You can ask your doctor or pharmacist for information about REVATIO that is written for health professionals.For more information go to www.REVATIO.com or call 1-800-879-3477.

What are the ingredients in sildenafil 20 mg tablets (Revatio)? Active ingredients: sildenafil citrate Inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose monohydrate, and triacetin. Erectile dysfunction (ED) is often a symptom of poor circulation for men.

ED refers to the consistent inability to achieve or maintain an erection.

For an erection to occur, a specific sequence of event needs to take place, allowing blood to enter the penis while restricting the outflow of blood.

The pressure created by this “trapped” blood is what maintains an erection.

If there is a consistent breakdown in any steps in the sequence, erectile dysfunction is the result.

Erectile dysfunction may occur at any age, however, the occurrence of ED is increasingly common as men age. However, it should not be considered a natural part of aging.

In older men, there may be physical or medical conditions that contribute to erectile dysfunction. Erectile dysfunction may be caused by a combination of medical, physical, hormonal, and psychological factors including: High blood pressure Heart disease Diabetes Physical injury Side effects from prescription medications Drug or alcohol use Low Testosterone Smoking Obesity Anxiety and stress Guilt and fear of poor sexual performance.

We will help you zero in on the problem and assist to design a corrective treatment plan.

Erectile dysfunction is diagnosed by evaluating a patient’s medical and psychological history, performing a physical evaluation, and conducting a series of laboratory and radiological tests that may include: Blood tests Lipid profiles Urinalysis Thyroid function tests Testosterone measurements Vascular Ultrasounds. Medication Psychological therapy Arterial or Venous Revascularization Penile implants Hormonal treatments. Not all cases of erectile dysfunction can be prevented, however, Dr.

Dormu may recommend the following lifestyle changes as a precaution: Eat a healthy diet Exercise regularly Stop use of tobacco products Cut back on alcohol use Reduce stress Control of diabetes Manage high blood pressure.

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Treatment is based on the underlying medical issue causing the problem.

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow to the penis and helps the penis to become erect. Sildenafil (Viagra) Tadalafil (Adcirca, Cialis) Vardenafil (Levitra, Staxyn) Avanafil (Stendra) Sexual stimulation or physical stimulation of the penis will cause the release of nitric oxide from your penile nerves. These medications amplify the amount of nitric oxide, the penis to become erect normally. The side effects include: Flushing Nasal congestion Headache Muscle aches Visual changes Backache Stomach upset. Your doctor will help you find the right medication and proper dosage.

DO NOT these medications if you: Take nitrate drugs — usually given for chest pain — like Minitran, Nitro-Dur, Nitrostat, isosorbide mononitrate, and isosorbide dinitrate Have heart disease or heart failure Have very low blood pressure (hypotension) Other Medications. With this method, you use a fine needle to inject medication into the base or side of your penis. Some examples of the different medications that can be injected include papaverine, alprostadil and phentolamine.

Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included). Side effects of the injection can include mild bleeding from the injection site, prolonged erection called priapism which is an emergency and scar tissue at the injection

site

Alprostadil intraurethral therapy called MUSE involves placing a

tiny

Some men have erectile dysfunction because of low testosterone. Testosterone replacement

therapy

Penis pumps or vacuum erection device is a hollow tube with a hand-powered or battery-powered pump to pull blood into the penis.

The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This vacuum creates a force to pull blood into the penis. Once you get an erection, a ring is

placed

The malleable rods keep your penis firm but bendable.

Penile implants are a surgery, there’s a risk of complications, such as infection or mechanical failure of the device.

Usually we like to try all other options before proceeding to the device. The doctor will follow patients through treatment options to make sure the erectile dysfunction is resolving and penis is able to become erect enough to sexual intercourse. I Want To: Connect With Us: About John Wayne Cancer Institute.

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Ohio State urologists treat conditions related to difficulty attaining or sustaining an erection. Home Healthcare Services Urology Erectile Dysfunction. Erectile Dysfunction, sometimes referred to as ED, is a common type of male sexual dysfunction.

The term ED describes difficulty attaining or sustaining an erection. This condition can happen to any man from time to time. It is estimated that between 15 to 30 million American men experience ED, although not all men are equally affected by the condition.

Erectile Dysfunction can result from medical, physical or psychological factors. ED risk factors include: Age over 50 Diabetes High blood pressure High cholesterol Smoking Cardiovascular disease Depression.

Men who experience repeated Erectile Dysfunction should speak to a physician.

Some men may have difficulty speaking with a doctor about sexual activities.

Ohio State urologists offer private discussions and care in comfortable surroundings. Symptoms include the repeated inability to attain or sustain an erection. ED sometimes results in a lack of interest in sexual activity, also known as low libido.

To diagnose this disorder, your Ohio State urologist will ask you questions about your medical and sexual history and conduct a physical examination. Based upon your individual condition, additional tests may be considered, such as blood tests, neurological testing or a psychological evaluation. After a diagnosis has been made, you and your Ohio State urologist can determine a personalized treatment plan. Lifestyle Changes – Quitting smoking, better nutrition and controlling blood pressure and cholesterol through diet, exercise and medication are behavior changes that can increase overall health and lessen risk factors for ED.

Medications – Several medications are available to support erection.

Most work by relaxing blood vessels for increased blood flow.

Your Ohio State urologist will work with you to select the medication that provides you with the best results.

Surgery/Other Options – Additional treatments include: A surgically implanted penile prosthesis to support erection Use of a vacuum erection device to pull blood into the penis Penile injection therapy to deliver drugs that expand blood vessels and increase blood flow Revascularization or ligation to correct blood flow to the penis ? New Treatment for Erectile Dysfunction Uses Soundwaves. Newswise — Statistically speaking, 50% of all men, have experienced erectile dysfunction (ED) at some time or another, and the chance of developing ED increases as you age. The medical management of ED has evolved greatly over the past several decades.

Prior to the introduction of oral phosphodiesterase inhibitors (PDE5i) such as Viagra, Cialis and related medications, doctors could offer patients one of only two definitive treatments for ED: implantation of penile prosthesis and surgical penile revascularization. The introduction of Viagra and related

oral

While these drugs can be very effective, we know

they

An alternative to oral ED medications has been introduced. It is called the GAINSWave™, and it uses high-frequency acoustical waves to treat the root cause of ED.

As a man ages, the blood vessels that supply the blood needed for good erectile function, begin to collapse or break down.

The pulsating soundwaves of the GAINSWave™ improve blood flow by opening existing blood vessels and stimulating the growth of new blood vessels.

Increased blood flow results in improved sexual performance. Shockwave, or acoustical wave therapy represents the latest in an evolution of alternative treatments to oral ED medications that began with pumps and penial injections. The GAINSWave uses technology that is known as “Extracorporeal Shock Wave Therapy,” also known as ESWT. The treatments are also sometimes referred to as Linear Shockwave Therapy, or LSWT, or simply “acoustical wave therapy.” ESWT has been used for several years for the treatment of conditions ranging from orthopedics to urology.

In the case of ED, the procedure uses high-frequency acoustical waves to open and repair blood vessels in the penis that tend to build up with plaque, or otherwise become compromised over time. When used to treat vascular related erectile dysfunction, the mechanism of action for the ESWT is induced angiogenesis and neovascularization in the corpora cavernosa and corpus spongiosum.

The resulting improvement in blood flow, achieved by the creation of new blood vessels and the rejuvenation of existing vessels, increases the patient’s ability to obtain and sustain an erection. Shockwave Therapy for ED has Been Clinically Proven. In clinical trials, ESWT for ED proved to be effective, even for men that did not respond well to other treatments.

A recent study published in the Journal of Sexual Medicine , found that all of the men in the study treated with shockwave therapy showed improved erectile function.

Men in the study who were using Viagra or some other ED medication, achieved significant improvement, and reported that they did not need to use their ED prescription for “several months” after the shockwave treatment. A similar study, this one published in Therapeutic Advances in Urology , concluded “ESWT is a revolutionary treatment for ED, and probably possesses unprecedented qualities that can rehabilitate

erectile

The clinical improvement in erectile function together with the significant improvement in [blood flow] following ESWT confirm that ESWT has unique properties that may create a new standard of care for men with ED.” The technology has been successfully used to treat ED in Europe for 10 years, but it is new to the states.

The GAINSWave™ uses the only device that is approved by the FDA to provide ESWT for erectile dysfunction. As compared to other ED treatments: Acoustical wave therapy for ED is drug-free and surgery free.

The treatment takes less than 30 minutes and is pain-free! It is highly effective, with 80% of men reporting positive results. It is ideal for men who cannot take oral ED drugs, such as those with hypertension, heart disease, or diabetes.

It can be used as a preventive measure to delay, or actually prevent the onset of age-related erectile dysfunction. The numbers of men suffering with some form of ED can be truly staggering, with estimates of over 600,000 new cases every year in the US.

Effective treatment for ED can improve your patients’ quality of life, self-esteem,

and

Erectile Dysfunction (ED) Erectile Dysfunction is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner.