Best generic sildenafil

[ 11 ] physicians rated that 72% of patients allocated to the sildenafil?tadalafil sequence and 61% allocated to the tadalafil?sildenafil sequence preferred tadalafil; 76% of partners of patients allocated to the sildenafil?tadalafil sequence and 65% allocated to the tadalafil?sildenafil sequence preferred tadalafil. This study is also unique in showing how 6–8% of patients refused both sildenafil and tadalafil, and wanted to try another medication, and 2% preferred to stop any ED medication in a setting resembling routine clinical practice. [ 7 ] was not influenced by age, country, presence of comorbidities, aetiology and severity of ED, previous treatment with sildenafil, titration of sildenafil dose or treatment sequence.

The same was observed in other studies [ 5, 6, 8 ], in which both the pre?study sildenafil dose [ 5, 6, 8 ] and the duration of ED [ 5 ] did not influence the preference rate.

[ 12 ] also conducted a post hoc analysis of the data in an attempt to identify patient characteristics associated with their preference.

The only baseline characteristic that was significantly associated best generic sildenafil with preference was hyperlipidaemia, which increased the preference for sildenafil from 27% to 49% ( P = 0.01); no explanation for this finding is given by the authors.

One possibility is that patients preferred tadalafil because of its more flexible instructions for use (drug to be taken 0.5–24 h before sexual activity, vs 0.5–4 h before, for sildenafil) and efficacy not influenced by food intake. [ 7 ], who found that significantly more patients preferred the instructions for tadalafil (67% vs 33%, P = 0.04). Thus, the difference in instructions for use contributes to the preference for tadalafil. Another possibility is that tadalafil was preferred because it is better tolerated. [ 12 ] showed that the perception of side?effect severity was associated with preference ( P = 0.001).

However, the safety profile of the two drugs is comparable according to the Summary of Product Characteristics (Available at: http://www.emea.europa.eu/humandocs/Humans/EPAR/vigra/vigra.htm; http://www.emea.europa.eu/humandocs/Human/EPAR/cialis/cialis.htm).

The most common events (?2% of patients) are similar with both drugs: headache (the most frequent, occurring in 10.8% of patients with sildenafil and 14.5% with tadalafil), dyspepsia, flushing and nasal congestion, dyspepsia being more common with tadalafil (12.3% vs 3.0%) and flushing being more common with sildenafil (10.9% vs 4.1%); in addition, sildenafil is associated with visual alterations (3.6%), whereas tadalafil is associated with back pain (6.5% and myalgia (5.7%). A third possibility is that tadalafil was preferred because of its efficacy. Two patient?preference studies also collected efficacy information via the International Index of Erectile Function (IIEF) questionnaire [ 8, 9 ]. In both studies there was a trend towards greater improvement in IIEF scores with tadalafil; in the study by Tolra et al. [ 9 ] the median IIEF score increased from 17 at baseline to 29 with sildenafil and to 30 with tadalafil ( P = 0.09), and in the study by Eardley et al.

[ 8 ] the mean difference was 9.6 with sildenafil and 10.1 with tadalafil ( P = 0.08).

An analysis of the difference in IIEF domain scores showed that the trend in favour of tadalafil was due to significantly greater improvement in orgasmic function (difference, +0.28 95% CI 0.02–0.53, P = 0.03) and sexual desire (+0.19 95% CI 0.02–0.35, P = 0.02). The analysis of the association between the change in

IIEF

The hypothesis that some patients preferred tadalafil to sildenafil because of greater efficacy is better discussed considering the three patient?preference trials in which the patients were asked the reasons for their preference.

[ 11 ] physicians provided reasons for patient preference. According to them, the

main

[ 9 ] also showed that the median EDITS

score

The PAIRS questionnaire was administered in the studies by Eardley et al. Tadalafil improved several PAIRS domains to a significantly greater extent vs baseline than did sildenafil: sexual self?confidence (+0.17 95% CI 0.09–0.25, P 13 ]; greater changes in these PAIRS domain scores were significantly associated with patient preference ( P 12 ]. [ 13 ] also evaluated the Drug Attribute Questionnaire, which asked what was the best and second?best reason for the patient’s preference. The main reason for preferring tadalafil (67% of patients) was the ability to obtain an erection, with sexual stimulation, long after the drug was taken (e.g.

16 or 24 h later), followed by the firmness of the erection (35.4%) and the erections that occurred the following

morning

The 150 patients who had justified their preference for tadalafil, and the 12 who had justified their preference for sildenafil by mentioning the possibility of having an erection the following day were then asked to choose a statement sildenafil pills online that explained why this was so important. Nearly half (46%) of the patients chose the following statement: ‘There was less need to plan when my partner and I would have sex’ whereas nearly a third (33%) chose ‘I could take the pill and not worry about when my partner and I might have sex’, and a fifth (21%) ‘It made me feel that my sexual function was like it used to be before I got ED’.

None of the currently available patient?preference studies on PDE5 inhibitors are completely devoid of methodological flaws, so further trials are required.

Of the 7 trials conducted so far according to Mulhall criteria, five comparing tadalafil with sildenafil consistently reported that patients preferred tadalafil to sildenafil, mainly because of the longer duration of action that increases the patient’s freedom in sexual life.

Interestingly, although efficacy measures legal generic viagra failed to detect any clinically relevant difference, in patient perception the efficacy of the two drugs might differ, and this might contribute to explaining patient?preference results for either tadalafil or, in a minority of cases, sildenafil. These observations further outline the need to seriously consider patient’s and partner’s wishes and preferences, to achieve the best clinical results. Finally, one study indicated that patients have no particular preference between vardenafil and sildenafil, and another suggested that tadalafil might also be preferred to vardenafil.

The authors thank Dr Jennifer Hartwig for her contribution to the writing and linguistic revisions of this paper and Filippo Aglietti (Eli Lilly Italy) for his invaluable help in articles selection and retrieval.

Riccardo Sicuteri and Andrea Rossi are full?time employees of Eli Lilly Italy. Francesco Montorsi is a speaker for Eli Lilly Italy and a paid consultant for Pfizer, Pierre Fabre Medicament, AMS, Mipharm and Bayer Schering. Vardenafil is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men.

Vardenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. It works by increasing blood flow to the penis during sexual stimulation. Vardenafil does not cure erectile dysfunction or increase sexual desire.

Vardenafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV). Vardenafil comes as a tablet and a rapidly disintegrating (dissolves in the mouth and is swallowed without water) tablet to take by mouth. It is usually taken as needed, with or without food, 60 minutes before sexual activity.

Vardenafil usually should not be taken more often than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take vardenafil less often. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Do not take more or less of it or take it more often than prescribed by your doctor. If you are taking the rapidly disintegrating tablet, check the blister pack before you take your first dose. Do not use any of the medication from the pack if any of the blisters are torn, broken, or do not contain tablets.

Follow the package directions to remove the tablet from the blister package. After you remove the tablet from the blister package, immediately place it on your tongue and close your mouth. Do not take the rapidly disintegrating tablet with water or other liquids. Your doctor will probably start you on an average dose of vardenafil tablets and increase or decrease your dose depending on your response to the medication. If you are taking the rapidly disintegrating tablets, your doctor will not be able to adjust your dose because the rapidly disintegrating tablets are only available in one strength.

If you need a higher or lower dose, your doctor may prescribe the regular tablets instead.

Tell your doctor if vardenafil is not working well or if you are experiencing side effects. Vardenafil rapidly disintegrating tablets cannot be substituted for vardenafil tablets.

Be sure that you receive only the type of vardenafil that was prescribed by your doctor.

Ask your pharmacist if you have any questions about the type of vardenafil you were given. This medication may be prescribed for other uses; ask your doctor or pharmacist

for

do not take vardenafil if you are taking or have recently taken riociguat (Adempas) or nitrates such as isosorbide dinitrate (Dilatrate-SR, Isordil, in BiDil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others). Nitrates come as tablets,

sublingual

Ask your doctor if you are not sure if any of your medications contain nitrates. do

not

Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax, in Jalyn), and terazosin; amiodarone (Cordarone, Pacerone); antifungals such as fluconazole (Diflucan), itraconazole (Onmel, Sporanox), and ketoconazole (Nizoral); clarithromycin (Biaxin, in Prevpac); disopyramide (Norpace); erythromycin (E.E.S., E-Mycin, Erythrocin); haloperidol (Haldol); HIV protease inhibitors including atazanavir (Reyataz, in Evotaz), indinavir (Crixivan), ritonavir (Norvir, in Kaletra), and saquinavir (Invirase); medications for high blood pressure or irregular heartbeat; other medications or treatments for erectile dysfunction; methadone (Dolophine, Methadose); moxifloxacin (Avelox); pimozide (Orap); procainamide; quinidine (in Nuedexta); sotalol (Betapace, Sorine, Sotylize); thioridazine; and verapamil (Calan, Covera, Verelan, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may interact with vardenafil, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. tell your doctor what herbal products you are taking, especially St.

tell your doctor if you smoke and if you have ever had an erection that lasted more than 4 hours. Also tell your doctor if you have or have ever had a condition that affects the shape of the penis, such as angulation, cavernosal fibrosis, or Peyronie's disease; diabetes; high cholesterol; high or low blood pressure; irregular heartbeat; a heart attack; angina (chest pain); a stroke; ulcers in the stomach or intestine; a bleeding disorder; blood cell problems such as sickle cell anemia (a disease of the red blood cells), multiple myeloma (cancer of the plasma cells), or leukemia (cancer of the white blood cells); seizures; and liver, kidney, or heart disease. Also tell your doctor if you or any of your family members have or have ever had long QT syndrome (a heart condition) or retinitis pigmentosus (an eye disease) or if you have ever had severe vision loss, especially if you were told that the vision loss was caused by a blockage of blood flow to the nerves that help you see. Tell your doctor if you have ever been advised by a health care professional to avoid sexual activity for medical reasons.

you should know that vardenafil is only for use in males. Women should not take vardenafil, especially if they are or could become pregnant or are breast-feeding. If a pregnant woman takes vardenafil, she should call her doctor. if you are having surgery, including dental surgery or any dental procedure, tell the doctor or dentist that you are taking vardenafil.

you should know that sexual activity may be a strain on your heart, especially if you have heart disease. If you have chest pain during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise. tell all your health care providers that you are taking vardenafil. If you ever need emergency medical treatment for a heart problem, the health care providers who treat you will need to know when you last took vardenafil. if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent mental retardation), you should know that the rapidly disintegrating tablets are sweetened with aspartame, a source of phenylalanine. if you have fructose intolerance (an inherited condition in which the body lacks the protein needed to break down fructose,[a fruit sugar found in certain sweeteners such as sorbitol]), you should know that the the rapidly disintegrating tablets are sweetened with sorbitol.

Talk to your doctor about eating grapefruit or drinking grapefruit juice while taking this medicine. Tell your doctor if any of these symptoms are severe or do not go away: headache upset stomach heartburn flushing stuffy or runny nose flu-like symptoms.

If you experience any of the following symptoms , call your doctor immediately: erection that lasts longer than 4 hours sudden severe loss of vision (see below for more information) blurred vision changes in color vision (seeing blue tinge on objects, difficulty telling the difference between blue and green, or difficulty seeing at night) dizziness sudden decrease or loss of hearing ringing in ears swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs hoarseness difficulty breathing or swallowing fainting hives rash.