Buy sildenafil 50mg

At Simply Men’s Health, we strive to help patients regain their sexual vitality with a variety of customizable treatment options. We can help you gain control of your sex life

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The patient needs to be honest with us and explain the specific issue they are struggling with. Once we understand the extent of the symptoms and examine the patient’s health, we will be able to customize a treatment plan. At Simply Men’s Health, our team will take time to address any concerns and questions of the patient before beginning the treatment. Our team will also help patients in West Palm Beach, Palm Beach, St Lucie, Broward and Miami Dade County with follow-up appointments when necessary. Erectile dysfunction (ED) is defined by the National Institutes of Health Consensus Panel on Impotence as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.(1)It is the second most common disorder of male sexual dysfunction, with nearly 30 million men affected in the United States.(2)The causes of ED broadly are psychogenic and organic (physical), but many patients have a multifactorial etiology.

Organic causes of ED can include vascular, endocrine,

and

With the availability of effective oral therapy and greater public awareness, more patients are seeking medical help and are asking for effective medication therapy.

The purpose of this article will be to review the major drugs used to treat ED.

Physiology of Erection A good understanding of erectile physiology is necessary in order to understand how medications used to treat ED work. An erection is a vascular process controlled by the central nervous system.

Sympathetic nervous system activation induces erectile tissue contraction, which reduces blood flow through the corpora cavernosa, increases blood flow outside the penis, and results in a flaccid penis. Inhibition of sympathetic tone occurs with sexual stimulation, resulting in smooth muscle relaxation and vasodi-latation in the penile tissue.

Smooth muscle relaxation increases blood flow through the corpora cavernosa, leading to penile rigidity and erection.

Nitric oxide (NO) is an important neurotransmitter involved in erection.

NO release in response to sexual stimuli by endothelial and neural cells catalyzes the production of

cyclic

Other neurotransmitters thought to be involved in the erectile mechanism include prostaglandins, vasoactive intestinal peptide, serotonin, and dopamine. Many drugs used to treat ED work by modulation of these neurotransmitters. Pharmacologic Treatment The 2 principal drugs used to treat ED are sildenafil

and

A summary of agents used to treat ED is shown in Table 1. The choice of drug therapy for ED depends on the etiology.

Phosphodiesterase Inhibitors Sildenafil citrate, the only phospho-diesterase inhibitor currently approved by the FDA for the treatment of ED, is commonly prescribed.

Sildenafil was the 46th most dispensed drug in 2001.(4)Sildenafil acts by inhibiting the cGMP-specific phos-phodiesterase type 5 (PDE5) enzyme in the corpora cavernosa, which prevents the breakdown of cGMP to an inactive compound. The resulting increased availability of cGMP enhances the erectile response, because cGMP is able to relax the penile smooth muscle and vasodilate the penile arteries.

Sildenafil does not directly induce erection of the penis but augments the response to sexual stimulation.

Results vary, depending on the cause of the ED, but studies have shown good efficacy rates for silde-nafil.

A meta-analysis of 27 trials including a total of 6659 patients was 18 recently published.(5)Overall, sildenafil was more efficacious than placebo in improving erectile function. The primary efficacy parameter, successful sexual intercourse attempts, was 57% for men given sildenafil and 21% for men given placebo. The usual dosage range for sildenafil is 25 to 100 mg daily. Sildenafil should be taken as needed 30 to 60 minutes before sexual intercourse, no more than once daily. Patients should be informed that silde-nafil has no effect in the absence of sexual stimulation, and it should not be taken with a fatty meal because this may decrease the onset of action.

Dose adjustment is necessary for men who are over 65 years old, men with hepatic impairment, men with renal impairment (creatinine clearance Alprostadil Alprostadil is a synthetic prostaglandin E1 analogue with alpha-adren-ergic blocking activity.

Alprostadil stimulates cyclic adenosine mono-phosphate (cAMP) production in the corpora cavernosa, and increased levels of cAMP relax smooth muscle and dilate the penile arteries, inducing an erection.

The intracavernosal form of alprostadil is administered with a short needle injected through the side of the penis, directly into the corpus cavernosa. The intraurethral form of alprostadil is administered with a hand-held delivery device. An alprostadil pellet is inserted through the penile opening into the urethra and is absorbed through the urethral mucosa into the surrounding erectile tissue. Alprostadil is highly effective in treating ED, with success rates of approximately 80% with intracaver-nosal injection(8)and 65% with urethral administration.(9) To find the optimal dose for a given patient, alprostadil dose titration is performed in the physician?s office, starting with the lowest dose and increased until erection occurs.

The usual dosage range for the intracaver-nosal form of alprostadil is 1.25 to 2.5 mcg.

The maximum dose is 60 mcg up to 3 times a week, allowing at least 24 hours between each dose. Some adverse effects include penile pain, bruising at the injection site, priapism, hematoma/ecchymosis, hypotension, headache, and dizziness. The usual dosage range for the intraurethral form of alprostadil is 125 to 250 mcg up buy sildenafil 50mg to a dose of 1000 mcg.

It is recommended that this system be administered after urination to facilitate absorption. Adverse effects include penile pain, urethral burning, dizziness, hypotension, minor urethral bleeding/spotting, and female partner burning/itching. Using alprostadil is contraindicated in men with a predisposition to pri-apism, men in whom sexual activity is inadvisable or contraindicated, and men with abnormal penile anatomy/penile implants. Men using the intraurethral form of alprostadil to treat their ED should avoid sexual intercourse with pregnant women because the alprostadil may cause harm to the unborn fetus. Other Therapies Trazodone, which is an atypical antidepressant with serotonergic and alpha-adrenolytic activity, is thought to help erection by indirectly stimulating corporeal smooth muscle relaxation.(10,11)Reports of prolonged erection and improved sexual function have prompted use of trazodone to treat ED. Although preliminary data showed efficacy, double-blind, placebo-controlled trials have shown marginal efficacy of trazodone in treating organic ED.(12)Trazodone also may be considered for patients with psy-chogenic ED. Yohimbine, an indole alkaloid obtained from the bark of the yohimbine tree, is a centrally acting alpha(2) adrenergic-receptor antagonist. It acts at the adrenergic receptors in brain centers associated with libido and erection, and it may facilitate stimulated erections.(10)A meta-analysis of 7 randomized, placebo-controlled studies of men with erectile dysfunction showed that yohimbine was better than placebo in treating ED.

This benefit was most significant, however, in patients with psychogenic ED, and efficacy was only marginal in patients with organic ED.(13)Yohimbine is generally recommended for those with psy-chogenic ED.(14) Papaverine is an opium alkaloid that inhibits phosphodiesterase at the postreceptor level and induces smooth muscle relaxation in the sinusoids and dilation of helicine arteries.(10)It increases cAMP and cGMP concentrations in penile erectile tissue, thus facilitating erection.

It is effective and low in cost but can cause significant priapism and fibrosis when used alone at higher dosages.

This adverse-effect profile limits routine use of papaverine; however, lower dosages can be utilized if used in combination with other vasoactive injection therapy. (Phentolamine, a competitive alpha(1) and alpha(2)adrenergic-receptor blocking agent, dilates arteries and abolishes sympathetic inhibition of erections. Although it does not cause erections alone, it can be used in combination with other vasoactive injection therapy.(10)Significant adverse effects with phentolamine include orthostatic hypotension and tachycardia.

Oral phentolamine has

been

Intracavernous therapy with the lower dosages of combination papaverine and phentolamine is effective in treating ED, is better tolerated, and can be considered for patients who fail with traditional agents. Other combinations include intracavernous therapy with papaverine and alprostadil or with phentolamine and alprostadil.

The most effective combination is intracavernous therapy with papaver-ine, phentolamine, and alprostadil (also known as trimix).

The response rate with trimix may be as high as 90%.(11) Conclusion ED affects a vast number of men in the United States, and it is one of the most common untreated medical disorders. Sildenafil is a major discovery in the treatment of ED.

Although not completely effective in all patients, efficacy rates are high for sildenafil.

Alprostadil is another effective treatment option, but it requires patient acceptance of the route of administration.

A suitable medication therapy can be selected at the discretion of both the physician and the patient. Newer agents, such as vardenafil, will soon be available for use, and other therapies are in clinical development.

Erectile dysfunction and premature ejaculation: underlying causes and available treatments. This review examines the underlying causes associated with ED and PE and evaluates currently available treatment options and those under investigation.

Erectile and ejaculatory disorders comprise the most prevalent sexual disorders in men, with erectile dysfunction (ED) primarily affecting aging men who have coexisting morbidities such as cardiovascular disease and diabetes mellitus.

Premature ejaculation (PE) can affect men of all ages and is not typically associated

with

Although many efficacious treatment options are currently available and recommended for the management of PE, several challenges remain in bringing the first desirable, safe, and effective FDA-approved drug to the US market. This review examines the underlying causes associated with ED and PE and evaluates currently available treatment options and those under investigation. 2010;45:17-27.) Erectile dysfunction (ED) and ejaculatory disorders such as premature ejaculation (PE) are considered the most common types of sexual dysfunction in men. "The inability to achieve or maintain an erection sufficient for satisfactory sexual performance," is a commonly accepted definition of impotence by the National Institutes of Health; however it is now recognized by the American Urological Association (AUA) as ED.

1 ED reportedly affects up to 40% of men between the ages of 40 and 70 and is more likely to develop with aging. 2-4 Despite broad consensus on a single definition, PE is commonly characterized by the inability to delay ejaculation, which occurs before or soon after the initiation of intercourse and is subsequently associated with feelings of distress or frustration.

5,6 Unlike ED which is more prevalent in older men, PE is considered one of the most common male sexual disorders and occurs with similar frequency in men, independent of age.

The penis is comprised of several key structures: the corpus cavernosum encased within the tunica albuginea, the corpus spongiosum containing the urethra, and the extensive vascular system of arteries and veins.

8 In the flaccid state, penile smooth muscle tissue is contracted and arterial blood flow which supplies the sinusoidal cavities within the pair of corpora cavernosa is equal to venous drainage buy the blue pill online from them.

With the exception of nocturnal penile tumescence, a sensory stimulus initiates the erectile process via two coordinated pathways involving vasoactive substances, prostaglandins, and circulating catecholamines. 9,10 Nitric oxide, which is synthesized and released from endothelial cells, crosses into smooth muscle cells and enhances the activity of guanylate cyclase, which catalyzes the formation of cyclic guanosine monophosphate (cGMP) from guanosine triphosphate (GTP). The second pathway involves prostaglandin E 1 -mediated activation of G proteins within smooth muscle cells, followed by stimulation of adenylate cyclase and increased production of cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP).

9 By decreasing intracellular calcium concentrations, both cGMP and cAMP cause smooth muscle relaxation, which leads to increased cavernosal arterial blood flow and decreased venous drainage resulting in an erection. Neurogenic disorders involving the central nervous system (CNS) or peripheral nervous system such as stroke, spinal cord injury, Parkinson's disease, and multiple sclerosis have also been associated with ED. Furthermore, patients with a history of benign prostatic hyperplasia (BPH), Peyronie's disease, hypogonadism, or those who have had a radical prostatectomy secondary to prostate cancer are at greater risk of developing ED. Drug induced causes of erectile dysfunction are common and can complicate the medical management of underlying conditions associated with ED such as hypertension, depression, and BPH (Table 1). Beta blockers, selective serotonin reuptake inhibitors (SSRIs), and the uroselective alpha adrenergic receptor antagonists have been associated with the loss of libido or ejaculatory disorders, which can result in drug discontinuation by patients and suboptimal treatment of these conditions.