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Its effect is more potent on PDE5 than on other known phosphodiesterases 11,12,13,14,15,16,8,9 . In particular, there is a 10-times selectivity over PDE6 which is involved in the phototransduction pathway in the retina 11,12,13,14,15,16,8,9 . There is an 80-times selectivity over PDE1, and over 700-times over PDE 2, 3, 4, 7, 8, 9, 10 and 11 11,12,13,14,15,16,8,9 . And finally, sildenafil has greater than 4,000-times selectivity for PDE5 over PDE3, the cAMP-specific phosphodiesterase isoform involved in the control of cardiac contractility 11,12,13,14,15,16,8,9 . In eight double-blind, placebo-controlled crossover studies of patients with either organic or psychogenic erectile dysfunction, sexual stimulation resulted in improved erections, as assessed by an objective measurement of hardness and duration of erections (via the use of RigiScan®), after sildenafil administration compared with placebo 11,12,13,14,15,16,8,9 . Most studies assessed the efficacy of sildenafil approximately 60 minutes post-dose 11,12,13,14,15,16,8,9 . The erectile response, as assessed by RigiScan®, generally increased with increasing sildenafil dose and plasma concentration 11,12,13,14,15,16,8,9 . The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours 11,12,13,14,15,16,8,9 . Sildenafil causes mild and transient decreases in systemic blood pressure which, in the majority of cases, do not translate into clinical effects 11,12,13,14,15,16,8,9 . After chronic dosing of 80 mg, three times a day to patients with systemic hypertension the mean change from baseline in systolic and diastolic blood pressure was a ... More

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Very disappointing” “I started with Levitra 10 mg almost 3 month ago. The first time I used it it took 90 minutes for the erection. After that it took from 150 to 180 minutes For the erection. Why?” “Having tried 10mg which started to work I tried the 20mg. Took over 90 minutes before it kicked in and started getting aroused .Tried intercourse 5 times but each time lost my erection after a few minutes so very disappointed Apparently they now have a new more recent and improved Levitra called Levitra professional so will try that and see if any better” “I used 10mg Levitra for the first time. Certainly fuller and wider but not longer but still couldn't come. Tiny bit of face flushing but did have 1 large glass of white wine to relax before initiating anything. Think if I had taken 20 mg it would have done the trick as 10mg too weak for me and much better than viagra or Cialis. Will definitely use again but 20mg next time” “Best I've used yet ,definitely” “Experience is generally very positive. Mostly strong results with manageable flushing and head pressure. However there have been a few times that the drug has let me down with good sexual stimulation. I have wondered if the drug interfered with orgasm but maybe that’s just the reality of buy viagra online with prescription being 63. Fortunately I maintained an erection so I was able to please my partner (a lot) which was more important to me viagra tablet online buy than my orgasm. The drug indications are that it can be taken without regard to food but avoid just grapefruit. I am reading a few reviews online that taking it with an empty stomach produces better results. Sometimes when I take it I feel no symptoms at all ... More

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No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "It could help ED, and even if it doesn't, it has other health benefits." Yohimbe . Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. In this modern era, selective phosphodiesterase type 5 inhibitors are the mainstay of treatment for erectile dysfunction. These medications are highly efficacious, are well tolerated, and have favourable safety profiles. But you can’t take an erectile dysfunction drug and expect to get an erection right away. These medications boost the effects of a chemical your body makes called nitric oxide, which relaxes the muscles in your penis. That improves your blood flow and helps you get an erection. For the drugs to work, you need to be sexually aroused. The International Society for Sexual Medicine defines erectile dysfunction as a man’s inability to achieve or maintain an erection suitable for satisfactory sex. In order to understand erectile dysfunction, it is important to understand how erections occur. When a man is ... More

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Inhibition of cGMP catabolism by selective PDE5-Is increases NO levels by increasing the ratio of nitrite to nitrate and by stimulating transcription of mRNA for iNOS, as well as eNOS [17]. In addition, nitric oxide increases in tissues and cells the level of heme oxygenase HO-1 which oxidatively degrades heme into equimolar amounts of CO, biliverdin, and iron. Carbon monoxide activates sGC and elevates cGMP in target tissues, which dilates blood vessels. Through that stimulation, sildenafil may serve a critical growth of cellular cGMP levels [18]. [17] demonstrated that sildenafil stimulates the expression of HO-1 and iNOS in vascular smooth muscle cells (SMCs) via the reactive oxygen species-nuclear erythroid 2-related factor 2 (ROS-Nrf2) and sGC-cGMP pathways, respectively [17]. Transcription factor Nrf2 is responsible for the induction of phase II enzymes of xenobiotics metabolism. It activates transcription of genes encoding cytoprotective proteins which deactivates electrophiles metabolites and reactive oxygen species and stabilizes the redox potential of the cell. Nrf2 controls antioxidant defense genes including HO-1, NAD(P)H:quinone oxidoreductase 1 (NQO1), gluthatione reductase (GR), and gluthatione peroxidase (GPx) [18, 19]. [20] indicate direct effect of sildenafil on cells. Sildenafil treatment of astrocytes prevents and also restores effect of LPS on actin filaments. Changes in actin stress fibres is a result of overactivation of Ca 2+ signaling by LPS. proposed that sildenafil directly influences cell integrity through ankyrin B, a protein which is associated with the cytoskeleton, and interacts with Na + /K + -ATP-ase and IP 3 R connecting the pump to ... More

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You should only take Viagra if it’s been prescribed to you by a doctor who knows your medical history. If you and your doctor determine that Viagra is safe and effective for you, you can likely take it for as long as you continue to need it. Other drugs are available that can treat erectile dysfunction (ED). If you’re interested in finding an alternative to Viagra, talk with your doctor. They can tell you about other medications that may work well for you. Examples of other drugs that may be used to treat ED include: tadalafil (Cialis) vardenafil (Levitra, Staxyn) avanafil (Stendra) alprostadil (Caverject, Caverject Impulse, Edex, Muse) testosterone therapy, which is only used if you have low levels of testosterone. Natural and over-the-counter (OTC) products for treating ED are widely available, especially on the internet. However, none of these products has been tested for safety or effectiveness by the Food and Drug Administration (FDA). And because the products aren’t regulated, the FDA warns that there’s no way to be certain of what these products actually contain. If you want to try a natural or OTC product for ED, you should first discuss it with your doctor. The American Urological Association doesn’t recommend using products that contain yohimbine, ginseng, and l-arginine for ED treatment. (This includes products that contain these ingredients either alone or in combination with other ingredients.) This is because there’s not enough evidence to say whether the products work. Examples of products that contain one or more of these ingredients include Libido-Max and Extenze. You should also avoid products you can buy online without a prescription that claim either ... More

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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 suppository inside your the opening of the penis called the urethra. Side effects can include urethral or penile pain, rarely bleeding at urethra and formation of scar tissue inside your penis. Some men have erectile dysfunction because of low testosterone. Testosterone replacement therapy or other treatments to raise testosterone levels may be given by injection, patch or gel applied to the skin. 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 ... More

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Men who cannot have or maintain an erection at least 75% of the time that they attempt sex are considered to have erectile dysfunction. According to the Massachusetts Male Aging Study, about 40% of men experience some degree of inability to have or maintain an erection at age 40 compared with 70% of men at age 70. And the percentage of men with erectile dysfunction increases from 5% to 15% as age increases from 40 to 70 years. When blood fills two chambers in the penis (known as the corpora cavernosa) an erection occurs. This causes the penis to expand and stiffen, much like a balloon as it is filled with water. The process is triggered by nerve impulses from the brain and genital area. Anything that interferes with these impulses or restricts blood flow to the penis can result in erectile dysfunction. The link between underlying chronic disease and erectile dysfunction is most striking with diabetes. Approximately half of the men with diabetes experience erectile dysfunction. Nevertheless, good blood sugar control can minimize this risk. In addition, the following four diseases can lead to erectile dysfunction by interfering with blood flow or nerve impulses throughout the body. Cardiovascular disease Atherosclerosis (hardening of the arteries) Kidney disease Multiple sclerosis. Lifestyle choices, such as smoking, alcohol abuse, and obesity can impair blood circulation and lead to erectile dysfunction. Smoking, excessive drinking, and drug abuse may damage the blood vessels and reduce blood flow to the penis. Smoking makes men with atherosclerosis even more vulnerable to erectile dysfunction. Smokers have almost twice cheap sildenafil 100 the risk of erectile ... More

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This means they help to relax the muscles and increase blood flow to the body. This makes it easier for blood to get buy sildenafil 20 mg tablets into the penis, and it allows people with erectile dysfunction (ED) to experience a lasting erection during sexual activity. Manufacturers of PDE5 inhibitors recommend taking the pill at least 30 minutes to 1 hour before sexual stimulation, but the timing depends on the drug. How long the effect of each drug lasts is one of the key differences between them: Viagra is a drug that people use only when they need it. A person takes the drug 30 minutes to 1 hour before sexual activity, and the effects typically last for 3-5 hours. Levitra may start working faster than Viagra, but it lasts for about the same amount of time. The effect of a similar dose of Cialis may last up to 36 hours. For this reason, people looking for a long-lasting drug may choose Cialis. Depending on the dose, Stendra will be effective after 15–30 minutes, and research shows it is effective for up to 6 hours. Viagra, Cialis, Levitra, and Stendra all come from the same class of chemicals, and they have many similar side effects and interactions. For instance, manufacturers recommend not taking PDE5 inhibitors with grapefruit or grapefruit juice, because the fruit may affect how the drugs work. Nitrates will also interact with these drugs, so people should not use them together. There are some drug-specific side effects to be aware of, however. The side effects include: headaches stomach pain facial flushing congestion nausea or diarrhea color blindness blurred vision. Interactions with Viagra do occur, and it is important for people to be aware of them before ... More

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Quite a few illnesses can also be linked to erectile dysfunction, e.g. atherosclerosis (narrowing and hardening of the arteries), diabetes (high levels of sugar in the blood), arterial hypertension (high blood pressure), a heart attack, kidney failure, liver cirrhosis, epilepsy, multiple sclerosis, chronic lung diseases, thyroid disease, Peyronie's disease, depression, leukaemia, etc. A number of procedures and traumas can also cause erectile dysfunction, e.g. procedures on the head, spinal cord trauma and surgery, blood vessel surgery (aortoiliac bypass and aortofemoral bypass), bowel operations (low anterior resection, abdominoperineal resection, etc.), surgery on the pelvis and pelvic fractures, urological treatment (complete removal of the prostate, bladder removal). We can use various score lists to diagnose erection problems. The most important list used for this is the IIEF questionnaire . It is also imperative to distinguish the different types of erections. First, the so-called erotic erection, which is the most well-known and can be induced through visual stimulation, auditory stimulation, olfactory stimulation (smell), imagination, contact, etc. The second erection type, the nightly erection, is very important to urologists and andrologists. These erections occur 4 to 6 times a night during the REM sleep and strongly resemble erotic erections. Their function is to give non-sexually active men erections in order to ensure the quality of the corpora cavernosa. Lastly, the reflex erection - such as the morning erection - is much less important from an andrological point of view. As we mentioned earlier, erectile dysfunction covers a lot more than just plain ... More

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