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These include: An erection that can last for more than 4 hours Dizziness Decreased hearing loss Nausea.

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(Reuters Health) - Viagra is the most effective treatment for erectile dysfunction, but it also has a higher rate of side effects than other options, according to an analysis of more than 150 trials. Men concerned about possible side effects of Viagra like headaches, flushing, indigestion and nasal congestion may want to start on Cialis, which is known generically as tadalafil, researchers report in European Urology.

If that’s not effective, men in some countries can try Zydena (udenafil).

Many men have trouble getting or keeping an erection, especially as they age, but erectile dysfunction – also known as ED - is not a natural part of aging, according to the U.S. The new review compares seven common ED therapies, all belonging to a class of medications called phosphodiesterase 5 inhibitors (PDE5i’s).

They work by inhibiting an enzyme that may reduce the potency of an erection.

Viagra, Cialis, Levitra (vardenafil) and Stendra (avanafil) all work this way and are approved for use in the U.S. The additional drugs Zydena, Helleva (lodenafil) and Mvix (mirodenafil) are only approved for use in other countries. PDE5i’s are considered the first-choice therapy for ED, but they’re only effective for 60 to 80 percent of men who try them, and many will stop taking them, according to Dr.

Pastuszak of Baylor College of Medicine’s urology department in Houston, Texas.

Researchers at the University of Zurich, the Swiss Federal Institute of Technology, and Maastricht University Medical Center in the Netherlands reviewed 82 studies of the drugs’ effectiveness and 72 studies exploring side effects.

These treatments are all more effective than placebo for treating erectile dysfunction, and are generally safe and well tolerated, the authors note.

A 50- or 100-milligram (mg) dose of Viagra appeared to be the most effective treatment.

It performed about 50 percent better than a placebo. Stendra, in doses ranging from 50 to 200 mg, was among the least effective - only 20 to 30 percent more effective than a placebo. The 50-milligram dose of Stendra was associated with the lowest rate of side effects of any medication - 8.5 percent of the time. A 20-mg dose of Levitra had the highest rate of side effects: 25 percent.

Higher

doses of Viagra and Cialis tended to cause side effects between 21 and 22 percent of the time. “Viagra has an established efficacy and safety profile and remains an important treatment option for men with erectile dysfunction,” a spokesperson for Pfizer, makers of the drug, told Reuters Health in a statement. “Viagra has been studied for more than 15 years in more than 136 completed and ongoing clinical trials involving more than 23,000 men with ED.” Side effects depend on which drug is used and what other enzymes the drug is able to inhibit, Pastuszak told Reuters Health by email. One of the main side effects of Viagra is visual changes, whereas Cialis more often causes muscle pain.

More generally, these types of ED

drugs

can cause a drop in blood pressure, because they are vasodilators, which open blood vessels, he said. He added that they should not be used with nitrate-based heart medications since they can cause a steep drop in blood pressure.

“Other common side effects include facial flushing, congestion, headache, and upset stomach,” Pastuszak said. “Men complain of side effects, but more often of a lack of complete efficacy,” he said.

“The drugs are not for everyone, as they won’t necessarily help a man with severe erectile dysfunction as much as they would

someone

with mild or moderate ED.” Urologists will already have an understanding of the effectiveness and side effects of the available ED therapies, so the new results will not be a surprise, he said.

Only Cialis is to be taken daily, the other options are all short-acting, so men have the option of trying several to see which one works well, he said. Doctors should carefully discuss expectations and treatment effects of the various options with patients before choosing a therapy, the authors write.

Some ED patients may want immediate stronger efficacy at the cost of higher side effects, while others may not.

Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Sildenafil (Revatio) is used to improve the ability to exercise in adults with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness).

Children should not usually take sildenafil, but in some cases, a doctor may decide that sildenafil (Revatio) is the best medication to treat a child's condition.

Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors.

Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily. If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. Sildenafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV). Sildenafil comes as a tablet and suspension (liquid; Revatio only) to take by mouth. If you are taking sildenafil to treat erectile dysfunction, follow your doctor's directions and the guidelines in this paragraph. The best time to take sildenafil is about 1 generic viagra with dapoxetine hour before sexual activity, but you can take the medication any time from 4 hours to 30 minutes before sexual buy viagra online with prescription activity.

Sildenafil usually should not be taken more than once every 24 hours.

If you have certain health conditions or are taking certain medications, your doctor may tell you to take sildenafil less often.

However, if you take sildenafil with a high-fat meal, it will take longer for the medication to start to work. If you are taking sildenafil to treat PAH, follow your doctor's directions and the guidelines in this paragraph. You will probably take sildenafil three times a day with or without food.

Take sildenafil at around the same times every day, and space your doses about 4 to 6 hours apart. 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.

Shake the liquid well for 10 seconds before each use to mix the medication evenly. Use the oral syringe provided with your medication to measure and take your dose.

Follow the manufacturer's directions to use and clean the oral syringe.

Do not mix the liquid with other medications or add anything to flavor the medication. If you are taking sildenafil for erectile dysfunction, your doctor will probably start you on an average dose of sildenafil and increase or decrease your dose depending on your response to the medication.

Tell your doctor if sildenafil is not working well or if you are experiencing side effects.

If you are taking sildenafil for PAH, you should know that sildenafil controls PAH but does not lady viagra tablet buy online cure it. Do not stop taking sildenafil without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking sildenafil, tell your doctor and pharmacist if you are allergic to buy sildenafil 20 mg tablets sildenafil, any other medications, or any of the ingredients in sildenafil products. do not take sildenafil if you are taking or have recently taken riociguat (Adempas) or nitrates (medications for chest pain) such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others).

Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your doctor if you are not sure whether any of your medications contain nitrates. do not take street drugs containing nitrates such as amyl nitrate and butyl nitrate ('poppers') while taking sildenafil.

tell your doctor viagra tablet online buy and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax, in Jalyn), and terazosin; amlodipine (Norvasc, in Amturnide, in Tekamlo); certain antifungals such as itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral); anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); certain barbiturates such as butalbital (in Butapap, in

Fioricet

, in Fiorinal, others) and secobarbital (Seconal); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal LA, InnoPran); bosentan (Tracleer); cimetidine ; efavirenz (Sustiva, in Atripla); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors including amprenavir (Agenerase; no longer available in the U.S.), atazanavir (Reyataz, in Evotaz), darunavir (Prezista, in Prezcobix), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), and tipranavir (Aptivus); nevirapine (Viramune); other medications or devices to treat erectile dysfunction; medications for

high

blood pressure; certain medications for seizures including carbamazepine (Carbatrol, Epitol, Tegretol, others), phenobarbital, and phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane, in Rifamate, in Rifater).

Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with sildenafil, 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 or plan to take, especially St.

tell your doctor if you smoke, if you have ever had an erection that lasted for several hours, and if you have recently lost a large amount of body fluids (dehydration). This can happen if you are sick with fever, diarrhea, or vomiting; sweat a lot; or do not drink enough liquids. Also tell your doctor if you have or have ever had pulmonary veno-occlusive disease (PVOD; blockage of veins in the lungs); a stomach ulcer; heart, kidney, or liver disease; a heart attack; an irregular heartbeat; a stroke; chest pain; high or low blood pressure; high cholesterol; a bleeding disorder; blood circulation problems;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); conditions affecting the shape of the penis (e.g., angulation, cavernosal fibrosis, or Peyronie's disease); or diabetes.

Also tell your doctor if you or any of your family members have or have ever had an eye disease such as retinitis pigmentosa (an inherited eye condition that causes loss of vision) or if you have ever had sudden 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. if you are a woman and you are taking sildenafil to treat PAH, tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking sildenafil, call your doctor.

if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking sildenafil. if you are taking sildenafil to treat erectile dysfunction, tell your doctor if you have ever been advised by a healthcare professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain

during

sexual activity. Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain, dizziness, or nausea during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise. tell all your healthcare providers that you are taking sildenafil. If you ever need emergency medical treatment for a heart problem, the healthcare providers who treat you will need to know when you last took sildenafil.

Talk to your doctor about eating grapefruit

and

drinking grapefruit juice while taking this medicine.

If you are taking sildenafil for erectile dysfunction, you are unlikely to miss a dose since this medication is taken as needed, not on a regular dosing schedule.

If you are taking sildenafil for PAH, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn diarrhea flushing (feeling of warmth) nosebleeds difficulty falling asleep or staying asleep numbness, burning, or tingling in the arms, hands, feet, or legs muscle aches changes in color vision (seeing a blue tinge on objects or having difficulty telling the difference between blue and green) sensitivity to light. If you experience any of the following symptoms, call your doctor immediately: sudden severe loss of vision (see below for more information) blurred vision sudden decrease or loss of hearing ringing in ears dizziness or lightheadedness fainting chest pain worsening shortness of breath erection that is painful or lasts longer than 4 hours itching or burning during urination rash. Some patients experienced a sudden loss of some or all of their vision after they took sildenafil or other medications that are similar to sildenafil. It is not known if the vision loss was caused by the medication.

If you experience a sudden loss of vision while you are taking sildenafil, call your doctor immediately.

Do not take any more doses of sildenafil or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor.

There have been reports of heart attack, stroke, irregular heartbeat, bleeding in the brain or lungs, high blood pressure, and sudden death in men who took sildenafil for erectile dysfunction. Most, but not all, of these people had heart problems before taking sildenafil. It is not known whether these events were caused by sildenafil, sexual activity, heart disease, or a combination of these and other causes.Talk to your doctor about the risks of taking sildenafil.

Some patients experienced a sudden decrease or loss of hearing after they took sildenafil or other medications that are similar to sildenafil.

The hearing loss usually involved only one ear and did not always improve when the medication was stopped.

It is not known if the hearing loss was caused by the medication.

If you experience a sudden loss of hearing, sometimes with ringing in the ears or dizziness, while you are taking sildenafil, call your doctor immediately. If you are taking sildenafil (Viagra) for erectile dysfunction, do not take any more doses of sildenafil (Viagra) or similar medications such as tadalafil (Cialis) or vardenafil (Levitra) until you talk to your doctor. If you are taking sildenafil (Revatio) for PAH, do not stop taking your medication

until

you talk to your doctor. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed, and

out

of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension at room temperature or in a refrigerator, but do not freeze it.



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