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Studies with sildenafil, vardenafil, and tadalafil showed that when these agents were given to patients with coronary artery disease during exercise stress testing, there was no exacerbation of ischemia compared with placebo. 43–46 A very important aspect of these studies was that the level of exercise was similar to or exceeded that achieved during sexual intercourse. In a few of these

studies

A study performed in the cardiac catheterization laboratory by Hermann et al 14 observed that when oral sildenafil was administered to patients with severe coronary artery disease, it had no adverse effects on coronary artery

diameter

However, sexual activity itself may be associated with a small but definite increase in risk of myocardial infarction.

48 Patients with ED are more likely to have risk factors for coronary artery disease (such as age ?45, smoking, lipid abnormalities, diabetes, hypertension, and lack of physical activity) or have frank heart disease. 6–8,49 Analysis of double-blind, randomized, controlled studies and open-label studies did not show an increase in the rates of myocardial infarction or death in patients receiving sildenafil versus placebo or when compared with age-matched expected events.

2,50–55 Similar results have been reported with tadalafil 20,21 and vardenafil.

56 Postmarketing surveys in the United Kingdom 54 and in the United States, including 1 by the FDA, 52 did not show a rate of myocardial infarction, ischemic heart disease, or mortality in men who took sildenafil to be greater than expected than in an age-matched population.

In fact, death rates tended to be less in the population taking sildenafil (perhaps suggesting that healthier men were receiving the drug).

Postmarketing data regarding cardiovascular event rates in men taking vardenafil or tadalafil have yet to be reported and will be important. PDE5 inhibitors have potential therapeutic use for a number of cardiovascular disorders, including pulmonary hypertension, congestive heart failure, hypertension, and endothelial dysfunction. There are currently 3 PDE5 inhibitors available for the treatment of ED. All

are

Sildenafil and vardenafil have relatively short half-lives of ?4 hours, whereas the half-life of tadalafil is 17.5 hours.

These agents are all mild vasodilators and have minimal effects on blood pressure.

Sildenafil, vardenafil, and tadalafil are all contraindicated with nitrate use. Should a patient develop chest pain while taking sildenafil or vardenafil, nitrate may be administered under supervision at 24 hours (and possibly earlier); should a patient take tadalafil and develop chest pain, nitrate may not be given until at least 48 hours after the tadalafil dose and then again, only under close monitoring.

?-Blockers are a contraindication to the use of vardenafil. Except for 0.4 mg tamsulosin, ?-blockers are a contraindication to the use of tadalafil. Sildenafil >25 mg should not be given within 4 hours of an ?-blocker. Doses of sildenafil of 25 mg may be administered at any time in relation to an ?-blocker. Vardenafil should not be administered to patients taking class IA or III antiarrhythmic drugs or to patients with congenital QT prolongation. The PDE5 inhibitors do not adversely affect total exercise time or time to ischemia during exercise stress testing.

The PDE5 inhibitors are safe to administer to patients taking antihypertensive medicines (except for the ?-blockers, as described earlier).

The PDE5 inhibitors are effective for the treatment of ED in patients with cardiac disease, including patients with chronic coronary artery disease 57 and hypertension. Data from controlled clinical trials do not suggest an increase in myocardial infarction or death rates in patients taking PDE5 inhibitors. These agents appear safe and effective in most patient populations but have not been studied extensively in patients with baseline severe or unstable cardiac conditions.

An online-only Data Supplement is available at http://www.circulationaha.org.

Dr Kloner is a compensated speaker for and consultant to Pfizer, Bayer-GSK, and Lilly ICOS, and receives research support from Lilly

ICOS

A research team at the University of California, Santa Cruz has evidence that Pfizer’s popular erectile dysfunction drug Viagra can facilitate the release of stem cells from the bone marrow into the bloodstream, which could ease collection. Transplantation practitioners traditionally mobilize stem cells using standard granulocyte-colony stimulating factor (G-CSF)—namely, Amgen’s Neupogen (filgrastim).

The UC Santa Cruz team found that pairing Viagra with Sanofi’s stem cell mobilizer Mozobil (plerixafor) worked almost as well in mice, the team reported in the journal Stem Cell Reports.

“Given that both drugs are FDA approved, they could be relatively quickly tested in human volunteers,” the study’s senior author, Camilla Forsberg, said in a statement.

If successful, it could provide a new strategy for stem cell transplant preparation, she argued.

Even though G-CSF agent works in most donors, it needs to be given for several days before the stem cells can be collected. It’s costly and can cause side effects such as fatigue, nausea and bone pain. The Forsberg lab previously showed that increasing the ability of blood vessel walls to allow molecules through—known as vascular permeability—could help hematopoietic best website to get cialis stem cells escape from bone marrow and into the blood.

So Forsberg and her team hypothesized that Viagra, which relaxes blood vessel walls, might promote stem cell mobilization.

After all, the drug was originally designed to address cardiovascular diseases and is sometimes used to treat pulmonary hypertension.

In mice, a single oral dose of Viagra and an injection of Mozobil induced about 2,500 more hematopoietic stem cells to enter the bloodstream within just two hours, representing a 7.5-fold increase compared to control mice. In contrast, Viagra alone wasn’t effective, and Mozobil monotherapy only showed about a threefold increase. While three days of Viagra yielded slightly better results, the researchers figured the outcome from just one dose could already rival the performance of Neupogen, which is meant to be given for at least four days. The researchers went on to transplant the harvested stem cells into other mice. The animals that received cells resulting from the Viagra-Mozobil combo ended up with superior engraftment of functional, multipotent stem cells than did those given cells from mice that received Mobozil alone, the team reported.

Often dubbed “the little blue pill,” Viagra has been available in the U.S.

to treat erectile dysfunction for about two decades, and scientists are still finding potential new uses for it.

University of Manchester researchers recently found that Eli Lilly’s Cialis (tadalafil), which belongs to the same PDE5 inhibitor class as Viagra, slowed the progression of heart failure in sheep models.

In a 2018 study published in OncoImmunology, scientists at Ottawa Hospital Research Institute showed a combination of Viagra or Cialis plus Seqirus’ flu vaccine Agriflu could significantly reduce the chance of cancer spread post-surgery in mice.

The PDE5 inhibitors could block myeloid-derived suppressor cells and in turn allow natural killer cells to target metastatic cancer cells, the team found.

In recent developments from the Repurposing Drugs in Oncology project, researchers also identified a wide range of mechanisms of action from PDE5 drugs that could be complementary to other drugs in treating cancers, including the notoriously hard-to-treat glioblastoma.

Forsberg and colleagues now plan to work with clinicians to advance their current findings into human studies. The hope is that Viagra-Mozobil could offer a more affordable alternative to G-CSF.

The simplicity of administration and better safety profile “would likely attract more volunteer donors and make [hematopoietic cell transplantation] a reality for additional patient cohorts,” the authors wrote in the study.

7 Expert Tips order cialis online reddit To Know Before Taking Viagra® There is no short­age of infor­ma­tion on the inter­net about erec­tile dys­func­tion; the prob­lem is the infor­ma­tion is not always accu­rate.

Erec­tile dys­func­tion affects an esti­mat­ed 18 mil­lion men in the US alone. One of the main­stays in treat­ing erec­tile dys­func­tion is through oral med­ica­tion, with Via­gra® being one of the most preva­lent and well-known brands on the mar­ket to treat sex­u­al function. Get to know the truth about Via­gra® and if it would be right for you.

Tell your doc­tor if you take nitrates, have chest pain, or suf­fer from low blood pres­sure, have had a heart attack, heart fail­ure, or stroke with­in the last year before start­ing this med­ica­tion.

Via­gra® can cre­ate adverse reac­tions in those that take cer­tain med­ica­tions or have cer­tain health con­di­tions, so be sure to tell your doc­tor all the med­ica­tions that you take and if you have any allergies. You need to plan for a min­i­mum of two hours between the last thing you eat and ingest­ing the tablet. The dose should be tak­en one hour before sex­u­al activity. There are lim­i­ta­tions as to how often you can take Viagra®.

You should NOT take the dose more than once per day.

What and when you eat can impair the effec­tive­ness of Viagra®.

Avoid fat­ty meals on days when you plan on tak­ing Via­gra®.

This can cause Via­gra® to take effect more slow­ly.

Try eat­ing light meals through­out the day before tak­ing Via­gra®, and avoid heavy meals with red meat, fried food and oth­er high-fat components.

While Via­gra® comes in 25 mg, 50 mg and 100 mg tablets, the usu­al rec­om­mend­ed dose is 50 mg. Your doc­tor may rec­om­mend that you take more or less than the aver­age dose depend­ing on your per­son­al sit­u­a­tion. Via­gra® doesn’t always work the first time you take it. Via­gra® isn’t mag­ic; it does require sex­u­al stim­u­la­tion to result in an erec­tion and it may not work the first time. You should allow at least two to three attempts to eval­u­ate whether it is work­ing for you. If you fear it is not work­ing when you are with your part­ner, first try tak­ing it on your own and self-stim­u­lat­ing.

Direct stim­u­la­tion of the penis after tak­ing the tablet can also help. There can be minor or seri­ous side effects when tak­ing Viagra®.

Com­mon side effects that are usu­al­ly not seri­ous include: Dizzi­ness Flush­ing Headache Indi­ges­tion Visu­al disturbances Mus­cle aches Nau­sea Stuffy or run­ny nose.

See a doc­tor imme­di­ate­ly if you encounter any of these seri­ous side effects: Pro­longed or painful erec­tion (if an erec­tion lasts longer than 4 hours).

This is a seri­ous uro­log­ic con­di­tion and you need to head to the emer­gency room imme­di­ate­ly for treatment. Aller­gic reac­tions like skin rash, itch­ing or hives, swelling of the face, lips, or tongue Breath­ing problems Chest pain Fast, irreg­u­lar heartbeat Hear­ing loss

Seizures

Since March this year, the erectile dysfunction drug Viagra - formerly a prescription-only medicine - has been available to buy over the counter. According to Pfizer, which manufactures the drug, this could benefit the estimated 4.3 million men in the UK who experience erectile problems. The drug, which has been rebranded as Viagra Connect (sildenafil), works by increasing blood flow to the genitals, which in men results in an erection. First made available in 1998, it has been credited as transforming countless men's sex lives. Perhaps unsurprisingly, it has piqued the curiosity of many women too - if it works so well for their male partners, might it not 'work' for them too?

Authored by Abi Millar · Reviewed by Dr Sarah Jarvis MBE. The question was first raised in the New York Times , in an article entitled 'Curious women are seeing if Viagra works wonders for them', just months after Viagra became available. It also made its way into an episode of Sex and the City, in which sexually uninhibited character Samantha uses Viagra to shed her inhibitions further still.

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However, despite anecdotal reports of its efficacy (the women in the NYT article describe becoming more 'sensitive' and 'receptive'), the drug is still not available for women 20 years on. You might be able to buy it on behalf of your male partner, if the pharmacist thinks that's appropriate. "Yes there is gentle blood flow improvement - however, that doesn't necessarily equate to sexual enjoyment," says Dr Anand Patel, a GP specialising in sexual problems. "Give Viagra to a man and he's generally pretty happy because his outward sign of arousal is an erection and then he can use that for pleasure.

With a woman, you improve blood flow to the genitals, but there are more factors at play." Mental vs physical arousal.

So why is Viagra not available for women, and what happens to those who take it anyway (against mainstream medical advice)?

According to Dr Karen Morton, consultant gynaecologist and founder of Dr Morton's - the medical helpline, the drug should not be viewed as a simple libido enhancer. "The real reason for men to take Viagra is because they want to have sex and they can’t get or sustain an erection," she says. "It's easy to see how medication could cause a huge increase in blood supply and hence inflation of the blood vessels which cause the erection.

It has nothing to do with 'desire'." She points out that relatively few women are troubled by anything similar. While women do experience increased genital blood flow during sex, it doesn't follow that female arousal difficulties are related to problems here.

"In women, the main problem is not really being interested in sex with their current (or often any) partner," she says.

"So many women tell me they love their men but they would 'rather have a cup of tea'." In fact, low libido in women is a complex issue, with a wide range of potential causes.

These can range from relationship problems to hormonal conditions, and should be addressed on a case-by-case basis. But to put it extremely simply, mental and physical arousal are two different things.

"Both men and women can be genitally aroused without any mental interest," says Patel. "It's a separate mechanism, which allows lubrication in women or blood flow to the penis in men." Is your lifestyle impacting your sex drive?

Many people experienced a drop in libido during lockdown and with restrictions still in place, m.

What this means, then, is that a woman could take Viagra without seeing any real effect on her sexual functioning (depending on how this is defined).

All this said, there have been some studies in which female Viagra users have

reported

The most famous of these, conducted by the UCLA Female Sexual Medical Center in 2003, involved 202 postmenopausal women with female sexual arousal disorder (FSAD). (Importantly, none of these women reported emotional difficulties or problems in their relationships.) Over the course of the 12-week trial, participants took either Viagra or a placebo prior to sexual activity. The Viagra group experienced greater sexual enjoyment overall, and most side-effects were minor. However, follow-up studies have failed to replicate these results, and there have been no large clinical trials in the area.

The evidence base is simply too limited for any real conclusions to be drawn. On a similar note, we can't say definitively how safe the drug is for women. While it has been well tolerated in studies, there isn't much information out there about its long-term effects.

What we do know for sure is that you shouldn't mix it with certain other drugs.

"It's generally a very safe drug, but if you're opening up blood vessels, that

means

In rare cases, combining these two drugs has proven fatal. The quest for a 'female Viagra' So for women experiencing arousal problems, are there any other drugs that might help where Viagra can't?

The answer to this, says Morton, will depend on the nature of the problem. "The most important thing to address is: 'Does it hurt?' There are many gynaecological conditions to consider so get expert advice," she says.

“The majority of postmenopausal women should almost certainly be using oestrogen into the vagina plus good lubrication if they're experiencing vaginal dryness or painful sex." Research suggests that topical oestrogen is generally pretty safe, at least in the short term, but some doctors may be cautious about prescribing such a medication if a woman has a history of oestrogen-positive breast cancer.

In these cases, there are many hormone-free vaginal moisturisers and lubricants available that may provide relief. Patel adds that some postmenopausal women may benefit from small amounts of testosterone in addition to hormone replacement therapy (HRT).

While this is not generally recommended, owing to limited evidence about its efficacy and concerns about side-effects, he says some doctors will prescribe it 'off licence'. Another interesting candidate is Addyi (flibanserin), a medication licensed in the US but not the UK. Intended for women with hypoactive sexual desire disorder (HSDD), it is thought to work on certain chemicals in the brain (serotonin, dopamine and norepinephrine) to increase sexual motivation. This drug was widely dubbed 'female Viagra' when it hit the market in 2015.

However, it was something of a commercial flop, with critics pointing to its frequent side-effects and underwhelming impact.

There is still some controversy as to whether it should be available or not.