Sildenafil 20 mg coupon

That disconnection can drive an even bigger wedge between men and their emotions, and making users who crave an easy, automatic erection further dependent on medication. Men who see good sex as being synonymous with the presence of an erection — any erection, no matter how emotionally disconnected from it they may be — are especially prone to developing a dependency on erectile dysfunction drugs, says Baum.

These medications can promote an attitude of “If I don’t have to do the work, why should I?” Baum says.

While getting younger men hooked on sildenafil

might

Buying a pill online may feel like an easy alternative — but in the long run, it makes accessing authentic sexual pleasure much more difficult. This information will help you learn to inject medication into your penis.

Penile injections can help you achieve an erection if you have erectile dysfunction (ED).

??? Read this resource carefully before starting injection therapy.

If you don’t follow the instructions in this resource, your doctor or APP may stop prescribing your penile injection medications and supplies.

The tissue that causes you to get an erection (erectile tissue) is a muscle.

Going long periods of time without an erection is unhealthy for erectile tissue and may damage it. We believe that having erections keeps erectile tissue healthy. It works best if it’s given about 5 to 15 minutes before you want an erection. Your advanced practice provider (APP) will review the instructions below with you.

Generally, the training for the injections takes 2 office visits. Please be aware that each visit may take up to 1 hour, so you should plan your schedule on the day of your appointment.

Use this resource to help you the first few times you inject on your own.

Do not take the following medications within 18 hours of injecting (before or after): Sildenafil (Viagra®) - 20 mg to 100 mg Vardenafil (Levitra®) - 10 mg to 20 mg Avanafil (Stendra®) - 50 mg to 200 mg. If you take tadalafil (Cialis ® ) 10 mg or 20 mg, do not inject within 72 hours (3 days) of taking the medication.

If you are using tadalafil (Cialis) 5 mg daily, ask your APP how you should use this medication along with your injections. The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine.

These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection.

Your APP will decide whether Trimix or a different

medication

This can keep the medication good for a few additional months.

If you’re using Bimix or papaverine, you don’t need to keep the medication in your refrigerator because these medications don’t contain alprostadil. Don’t use the medication if: It has particles or is cloudy. After your second training visit, your medication will be delivered directly to your home from the compounding pharmacy (specialized pharmacy). Call the compounding pharmacy to make arrangements for billing and shipping. Gather your supplies: 1 medication vial 1 syringe (one-time use only) 2 alcohol wipes Sharps container. You can use an empty detergent or bleach bottle with a cap, or a metal coffee can with a plastic top.

If you’re using the medication for the first time, take the cap off.

Open an alcohol wipe and wipe the rubber stopper on the top of the vial. You must always wipe the rubber stopper with alcohol before you insert the needle. Be very careful not to let anything touch the needle. If anything touches the needle, you must throw the entire syringe away in the sharps container and use a new one. First, holding the syringe upright so the needle faces the sky, pull the plunger of the syringe back past the dose you were told to inject.

Next, push the plunger back up until the top of the plunger (the thin black line closest to the needle) is at the dose you were told to inject. Turn the syringe downward so the needle is facing the floor. Hold the syringe in your hand like you hold a pen or dart.

Hold the syringe close to the needle with your thumb, index (first) and middle (second) fingers.

This will keep the needle from bending as you insert it into the rubber stopper. Holding the vial upright and the syringe downward, insert the needle through the circle in the center of the rubber stopper. Push the plunger down to inject the air into the vial (see Figure 1). You must replace the amount of medication you remove from the vial with air.

Turn the vial and syringe upside down (see Figure 2). Hold the syringe with the hand you use to write with and the vial with your other hand. Make sure the tip of the needle is in the medication. Rotate the syringe so you’re looking at the numbers and lines on the syringe. You

must

You will give the injection in the middle third of your penis at the 10 o’clock (left side) or the 2 o’clock (right side) position (see Figure 3).

To prevent trauma to your penile tissue, always change sides of your penis each time you inject the medication (right side, then left side). Don’t inject into any vein you can see or feel because it could cause a large bruise on your penis. Don’t inject straight down on the top or the bottom of your penis.

This will allow your penis to be more fully stretched. It’s easiest to inject if your penis is pulled straight

out

This will prevent the needle from going sildenafil 20 mg coupon between the skin and erectile tissue.

For your injection to work, the medication needs to go into the erectile tissue.

Locate the area to be injected (the middle third of your penis).

Let go of the head of your penis and pick up the syringe with 2 hands.

Look at the syringe to make sure the dose is correct and you haven’t pushed any medication out by accident.

Hold the syringe between your thumb, index and middle fingers like a pen or a dart.

Don’t place your index finger or thumb on the plunger.

Once again, grasp the head of your penis and pull it straight out.

Keep pulling on your penis from the time the needle goes into your penis until it comes out. Don’t twist your penis, since this could lead to injecting the wrong area. Touch the needle to your skin and quickly slide it into the shaft of your penis.

Make sure to insert the needle at a slight angle (either the 10 o’clock or 2 o’clock position, as shown in Figure 3).

Move your finger so that your index finger or thumb can push in the plunger. Quickly push down on the plunger to inject the medication into the shaft of your penis.

Be careful not to pull the syringe out as you’re injecting the medication.

Once you have injected all of the medication, quickly pull the needle out of your penis.

Don’t use a twisting or jerking motion, because this may cause bruising. Apply pressure at the injection site for 2 to 3 minutes with your thumb on the injection site and your index finger on the opposite side of your penis.

If you’re taking a blood thinner or aspirin, hold the pressure for 5 minutes. This will help to decrease any bleeding or bruising.

It usually takes a few injections to find the right dose for an erection firm enough to have sex.

It’s important that you follow the treatment plan that your APP gave you.

If you’re adjusting your own medication dosing, the office will no longer be able to prescribe your medication.

Please use

the

Your APP will tell you which dose to try next based on your response.

Please make sure to include the information below in your injection reports. For your first injection: inject ___________ units of ____________________________ while you’re at home.

Use the erection scale above and record your response below.

Call your APP after each injection to report your response.

Keep calling your APP after each injection until we find the right dose for you. Phone number:________________________________________. Do not change your dose without speaking with your APP.

Do not give yourself your next injection until you have reported the result of your last injection. Don’t take more medication than the dose prescribed. Don’t change the dose without speaking to your APP.

Don’t give yourself another injection if the medication doesn’t work. Speak with your APP if you aren’t getting the effects you want. You can inject up to 3 times a week as long as there are 24 hours between each injection. If you’re currently receiving chemotherapy for cancer, ask your oncologist (cancer doctor) when you can safely inject. Don’t take any other medication for ED without speaking to your APP. Do not take the following medications within 18 hours of an injection (before or after): Medication Dose Sildenafil (Viagra) 20 mg to 100 mg Vardenafil (Levitra) 10 mg to 20 mg Avanafil (Stendra) 50 mg to 200 mg. Your APP will order your supplies for you from a compounding pharmacy.

Your

supplies

They will be ordered from a specialty compounding pharmacy approved by MSK: MasterPharm www.masterpharm.com Telephone: 866-630-5600 Fax: 718-529-2780 Other: ______________________ ___________________________ ___________________________ ___________________________.

They will order more supplies for you and will let you know if refills are kroger sildenafil coupon included. If refills are included, you can contact the compounding pharmacy directly to set up your billing and shipping.

Pseudoephedrine HCl (Sudafed) Sometimes, penile injections can cause priapism (an erection that lasts too long). If you have

priapism

Read the instructions in the “Treating Priapism (An Erection That Lasts Too Long)” section for more information.

If you want to buy the pseudoephedrine HCl at your local pharmacy, you don’t need a prescription, but the boxes are kept behind the pharmacy counter. Take the pseudoephedrine HCl card that’s hanging on the shelf to the pharmacist (see Figure 4). You will have to show a photo ID before the pharmacist gives you the box to purchase.

Make sure to have pseudoephedrine HCl with you as long as you’re using the penile injections.

If you have problems with your heart, talk with your cardiologist about whether it’s safe for you to take pseudoephedrine HCl. Treating Priapism (An Erection That Lasts Too Long) Priapism is an erection that lasts too long.

Priapism can develop without sexual stimulation and doesn’t go away after orgasm.

There is a risk of having priapism after penile injection therapy. When you have a full erection, no fresh blood flows into your penis. This means that your penis isn’t getting oxygen, which can damage the tissue and lead to permanent ED. If you have an erection at penetration hardness (a 6 or higher on the erection hardness scale) that lasts 2 hours, take 4 (30 mg) tablets of pseudoephedrine HCl (Sudafed).

Don’t take extended-release or long-acting tablets, such as Sudafed 12 hour.

Ask your pharmacist or APP if you have any questions.

The pseudoephedrine HCl will be shipped by the compounding pharmacy along with the vial of medication and syringes, or you can buy it at your local pharmacy.

For more information, read the “Pseudoephedrine HCl (Sudafed)” section above. If your erection becomes less than penetration hardness within an hour of taking pseudoephedrine HCl, call your doctor’s office the next day to speak with your APP.

You shouldn’t continue to inject with the same dose if you took pseudoephedrine HCl for a prolonged erection.

Your APP will make changes to your penile injection therapy medication dose. If you have an erection that lasts 3 hours (you still have an erection 1 hour after taking the pseudoephedrine HCl), call your APP and plan to go to MSK’s Urgent Care Center or your local emergency room.

Monday through Friday between 9:00 am and 5:00 pm , call your APP. Phone number: __________________________________________ Between 5:00 pm and 9:00 am , during the weekend, and on holidays, call 212-639-2000 and ask to speak to the urologist on call. Go to MSK’s Urgent Care Center at Memorial Hospital (1275 York Avenue, between East 67 th and East 68 th Streets) if you’re less than 30 minutes away.

Your APP will call the Urgent Care Center so they know to expect you. Your APP will give you more instructions during your call. Go to your local emergency room if you’re more than 30 minutes away from MSK’s Urgent Care Center.

Your APP will give you more instructions during your call. If you have an erection that lasts 4 hours and you haven’t talked to your APP, this is a medical emergency. You should treat it with the same urgency as a heart attack. Erections lasting longer than 4 hours can cause permanent damage to your erection tissue.

Go to MSK’s Urgent Care Center if you’re less than 30 minutes away. Ask the guard at

the

If you aren’t treated quickly, it’s possible that you will end up with permanent ED. Give the doctor or nurse the priapism card that was given to you to carry in your wallet.

You can also have the doctor or nurse call us at the numbers listed above.

After Pelvic Surgery for Prostate or Bladder Cancer.

If you have had pelvic sildenafil 20 mg coupon surgery for prostate or bladder cancer within the past year, your doctor may have told you to take a low dose of sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra), or tadalafil (Cialis) every night, except on days or nights you plan to inject. This improves

the

Do not take the following medications within 18 hours of an injection (before or after): Medication Dose Sildenafil (Viagra) 20 mg to 100 mg Vardenafil (Levitra) 10 mg to 20 mg Avanafil (Stendra) 50 mg to 200 mg.

Your response to oral ED medications may improve over the first 18 to 24 months after surgery.

A full dose is one of the following: 100 mg of sildenafil (Viagra) taken on an

empty

200 mg of avanafil (Stendra) taken with or without food. 20 mg of tadalafil (Cialis) taken with or without food.

To achieve the best response, you must be: Relaxed Sexually aroused, either from contact with a partner or from self-stimulation Not tired Back to top. Speak with your APP about how to travel with your injection medication. They can give you a letter explaining your treatment, if needed.

If you need a letter, be sure to ask for it before your travel dates.

For information about storing and disposing of your home medical sharps, read our resource How to Store and Dispose of Your Home Medical Sharps. How is Cialis different from the currently approved products

for

dysfunction

The most commonly reported side effects in patients treated with Cialis during the testing of the product were: headache indigestion back pain muscle pain flushing stuffy nose. Patients who get back pain and muscle aches usually get them 12 to 24 hours after taking Cialis and these usually go away by themselves within 48 hours. A small number of patients taking Cialis also reported abnormal vision.

What important information should you know about Cialis?

CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with any nitrate medication. You could get dizzy, faint or have a heart attack or stroke. Tell your healthcare provider that you take Cialis .

If you need emergency medical care for a heart problem, it will be important for your health care provider to know when you last took Cialis.

After taking a single tablet, some of the active ingredient of Cialis remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha-blockers and antihypertensive medications.

What should I talk to my doctor about when considering if Cialis is right for me? Can Cialis be used with other treatments for impotence? Will Cialis be prescription or OTC (over-the-counter)? How can I report a serious side effect with Cialis to FDA? FDA encourages anyone aware of a serious side effect, including consumers or

patients

Viagra is now being used to treat not only erectile dysfunction (ED) but also pulmonary hypertension.

And the drug may have potential for treating several other conditions, according to a recent report. The three ED medications currently on the market—Viagra, Levitra, and Cialis—all work by the same means, and they have similar side effects. The most common are headaches and facial flushing, which occur in 15% of men. Other reactions include nasal congestion, indigestion, and back pain. The most important worry about ED pills is their ability to widen arteries enough to lower blood pressure.

And men who are taking nitrates should never use any of the ED pills.

Although some of the drugs’ side effects may be troublesome, others may be helpful, and scientists are studying whether ED pills might help treat a variety of nonsexual problems.

Viagra (sildenafil) has been on the market longest and is most studied. It’s yet not clear if the other ED pills offer similar benefits, but Viagra, at least, may prove useful for some other conditions, including these: Pulmonary hypertension. Viagra is now marketed under the name Revatio for this uncommon but serious disorder of high pressure in the blood vessels leading to the lungs. Viagra can reduce pulmonary artery pressure at high altitude and improve the ability to exercise in low oxygen conditions. In affected individuals, exposure to the cold triggers spasm of the small arteries that supply blood to the fingers, toes, or both, which become pale, cold, and painful. Both Viagra and Levitra have been helpful in clinical trials. Studies suggest Viagra might help patients with congestive heart failure or diastolic dysfunction.

Further details are published in the August 2007 issue of Harvard Men’s Health Watch. Why erectile dysfunction meds can have serious side effects. The medical condition—and the drugs used to treat it—should be taken seriously.

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Erectile Dysfunction (ED) Injections: Trimix Penile Implant Vacuum Erection Device (VED) For many years, we have used medication to improve blood vessel circulation in the penis. These medications include papaverine, phentolamine, and prostaglandin E1 — Trimix is a mixture of all three of these drugs. Scientists have found that these drugs can induce a penile erection

when

The FDA approved Prostaglandin E1 for treatment in 1995.

Medications like Viagra, Cialis, or Levitra do not work for every man dealing with erectile dysfunction.

However, penile injection therapy is another viable option.

The thought of injecting a needle into your penis may sound intimidating, but about 70 percent of men are highly satisfied with this therapy. We do the first injection here in our office so we can show you how to do it yourself at home. It also helps us determine the correct dose for your needs. You may increase

your

If you are using 50 units and not getting the erection that you need, call us and we will prescribe you a stronger dose.

We allow a maximum of three injections per week, but you must wait 24 hours before taking another dose.

And make sure you alternate between sides of the penis for each injection.

However, injection therapy is not always a good long-term option for some men and that is when they may want to sildenafil 20 mg coupon consider the penile implant.

Below are step-by-step instructions detailing how to properly use your penile injection at home without a doctor. Tear open an alcohol swab and wipe the rubber top of the bottle to sterilize it. Peel open the syringe carefully and remove the protective cover from the needle.

It is important that you do NOT contaminate the needle with anything but the rubber bottle cap.

Push the needle through the rubber stopper, then flip the ampule (the glass container of medication) upside down. Pull on the plunger until you withdraw 1.0 cc of the medicine. As you continue to hold the ampule upside down, inject whatever air remains in the syringe into the ampule.

Withdraw the fluid until there are no more air bubbles in the syringe and the correct amount of medication is in the syringe.

Pull the needle out of the ampule and lay the syringe on the edge of a flat surface.

Make sure the needle hangs over the edge to keep it from touching anything.

Grasp the head of the penis between the index finger and thumb and gently pull the penis away from your body until the skin is taut.