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For example, if fatigue is affecting your sexual performance, a pill that makes it easier to achieve an erection is not going to resolve the problem of physical stamina. Similarly, medication alone won't resolve feelings of being unattractive or sexually less desirable that can come from living with a long-term condition. As well as considering medication, treatment may involve counselling and finding new ways of being intimate that are better suited to the your situation. Erectile dysfunction can be treated with a class of drugs known as PDE5 inhibitors. Sildenafil citrate - Viagra is perhaps the most well-known brand of sildenafil citrate, but a number of cheaper versions have been licensed in the last few years Vardenafil (Levitra) Tadalafil (Cialis) Avanafil (Spedra) If these first line drugs are not effective, there are other approaches that can be tried. Alprostadil (Caverject, Viridal Duo, MUSE and Vitaros) - a different type of sildenafil prescription drug that is applied directly to the penis either as an injection, as a pellet or as a cream Vacuum constriction devices (VCDs) - the penis is inserted into a tube and the surrounding air pumped out, causing an erection. A tight band is placed around the base of the penis, trapping the blood and maintaining the erection for up to 30 minutes Surgical implants (prosthesis) - implants create erections mechanically using flexible rods or pouches that are filled with fluid. This is usually only considered when other options have not been successful. Erectile dysfunction (ED) is characterized by reduced rigidity and/or sildenafil 50 mg online duration of erections. It can therefore impact heavily on a man’s satisfaction ... More

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Therefore, inhibitors of these enzymes are expected to reduce vardenafil clearance [see DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS ]. Ketoconazole (200 mg once daily) produced a 10-fold increase in vardenafil AUC and a 4-fold increase in maximum concentration (Cmax) when co-administered with LEVITRA (5 mg) in healthy volunteers. A 5-mg LEVITRA dose should not be exceeded in a 24-hour period when used in combination with 200 mg once daily ketoconazole. Since higher doses of ketoconazole (400 mg daily) may result in higher increases in Cmax and AUC, a single 2.5 mg dose of LEVITRA should not be exceeded in a 24-hour period when used in combination with ketoconazole 400 mg daily. [See DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS .] Indinavir (800 mg t.i.d.) co-administered with LEVITRA 10 mg resulted in a 16-fold increase in vardenafil AUC, a 7-fold increase in vardenafil Cmax and a 2-fold increase in vardenafil half-life. It is recommended not to exceed a single 2.5 mg LEVITRA dose in a 24-hour period when used in combination with indinavir. [See DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS .] Ritonavir (600 mg b.i.d.) co-administered with LEVITRA 5 mg resulted in a 49-fold increase in vardenafil AUC and a 13fold increase in vardenafil Cmax. The interaction is a consequence of blocking hepatic metabolism of vardenafil by ritonavir, a HIV protease inhibitor and a highly potent CYP3A4 inhibitor, which also inhibits CYP2C9. Ritonavir significantly prolonged the half-life of vardenafil to 26 hours. Consequently, it is recommended not to exceed a single 2.5 mg LEVITRA dose in a 72-hour period when used in combination with ritonavir. [See DOSAGE ... More

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FDA Safety Communication: Revatio (sildenafil) In 2012, the U.S. Food and Drug Administration (FDA) advised that Revatio (sildenafil) should not be prescribed to children ages 1 through 17 cipla viagra 100mg price for pulmonary arterial hypertension (PAH), or high blood pressure in the blood vessels leading to the lungs. This recommendation came after a long-term pediatric clinical trial that showed that children taking a high dose of Revatio had a higher risk of death than children taking low doses, and that the lower doses of Revatio were not effective in improving exercise ability in children. The FDA found that most of the deaths that occurred in children taking Revatio were caused by pulmonary hypertension, a broader health condition including PAH, and heart failure. These are among the most common causes of death in children with PAH. Revatio was never approved by the federal agency for use in children, and following the new information from the clinical trial, off-label use (or use not indicated or approved by the FDA) of the drug in pediatric patients was discouraged. These findings were therefore required by the FDA to be added to a new drug label for Revatio. In 2014, the FDA issued an update and clarification of its earlier recommendation. The FDA stated that the purpose of its prior communication was simply to raise awareness as to the higher risk of death in pediatric patients, but the recommendation “was not intended to suggest that Revatio should never be used in children.” The FDA concluded that it was up to health care professionals to consider whether the benefits of treatment are likely to outweigh the potential risks to their patients. The federal ... More

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Currently available substitutes include bupropion, nefazodone, and trazodone. The selective serotonin reuptake inhibitors (eg, fluoxetine, sertraline, paroxetine, citalopram) can also cause difficulties with ED, but they might also have other significant sexual side effects, including decreased libido and anorgasmia. Clinical experience in switching medications to improve ED has been disappointing in that improvement does not often occur. Nonetheless, it is important to try to discontinue possible offending medications before proceeding to more invasive ED treatment options. Oral ED medications have changed the way clinicians discontinue medications in patients with ED and has improved the approach. For example, a patient may develop ED on a thiazide diuretic. The diuretic may be withdrawn, but a trial of oral ED therapy can be initiated during the observation period while the patient is waiting to see if any spontaneous improvement in ED occurs after drug withdrawal. Alternatively, if diuretic therapy is effective, well tolerated, and controlling blood pressure, oral ED therapy can be used on an ongoing basis to treat the side effect of ED. If a trial of oral ED therapy and withdrawal of offending medications prove to be ineffective in restoring erectile function, it is appropriate for most primary care practitioners to consider referral to a specialist for additional evaluation and discussion of alternative treatment options. These include intracavernous injection therapy, vacuum constriction devices, intraurethral therapy, and possible surgery. If a trial of oral therapy and withdrawal of offending medications do not restore erectile function or if a patient has ... More

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The generic is considered to be as safe and effective as the original drug. The following lists contain some of the key side effects that may occur while taking Viagra. These lists don’t include all possible side effects. For more information on the possible side effects of Viagra, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome. Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Viagra, you can do so through MedWatch. Mild side effects of Viagra can include:* headache flushing indigestion mild and temporary vision changes, such as a blue tinge in your vision, blurred vision, and sensitivity to light nasal congestion (stuffy nose) back pain muscle pain nausea dizziness rash. Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist. * This is a partial list of mild side effects from Viagra. To learn about other mild side effects, talk with your doctor or pharmacist, or view the drug’s patient information . Serious side effects from Viagra aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include: Non-arteritic anterior ischemic optic neuropathy (NAION), which is an eye condition that causes damage to your optic nerve. Symptoms can include: sudden decrease in vision in one or both of your eyes sudden ... More

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The responses appear to be best in patients who are taking medications and less successful in more severe types of ED. It appears safe with minimal side effects and very little discomfort. If you or your loved one is struggling with erectile dysfunction or if you have any more questions about the treatment options for erectile dysfunction, then contact the experts at Georgia Urology. We’ll be able to evaluate which one of the treatment options described above are best for you. Erectile Dysfunction can be described as erection that is not sufficient to achieve or maintain the desired performance for a satisfactory sexual experience. Men suffering from low testosterone will often complain of weak erections, or the lack of morning erections, or the inability to maintain an erection. Sometimes ED can be due to psychosomatic issues and this can lead to vasoconstriction ED which can have many causes, testosterone deficiency can be one of them but not the only reason for it and testosterone on its own does not always improve erectile dysfunction. Medications called PDE5 inhibitors like (tadalafil(cialis®), or sildenafil(viagra®) can help relax the smooth muscle in the penis by vasodilating those blood vessels causing you to achieve an erection. Having erectile dysfunction is actually very common around there are estimated to be around 15-30 million men who suffer from it. As you age erectile dysfunction becomes more common and on average 15-25% of men over the age of 65 experience problems maintaining an erection. Unable to get an erection with stimulation Weak or soft erections Short lasting erections lead to unsatisfactory sexual experience Change in Angle of erection Penis ... More

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After a review of findings with the urologist, our clinical director shares our proprietary 65-point patient scorecard that exhibits all the results, how they fare against the norm with other men of the same age – and what our urologists can do to overcome deficiencies – without any surgery or prosthetic, We do our best to offer solutions regardless of available time, health insurance coverage or financial resources. Each treatment plan is custom sildenafil 50 mg online based upon all factors relating to a patient’s personal health. Receive a discreet reply from the Morganstern Health patient care team. We are here to help and will answer your questions discretely. Complete the form below and we will contact you as soon as possible. 5 Best Herbal Supplements to Boost Your Sexual Health. It is quite common for men and women to have sexual problems. The reasons behind the problems can be many, ranging from medical problems to emotional disconnect. As you know, sexual activity is a very important activity in any person’s life. Many relationships end due to dissatisfactions caused by poor sexual performance. In fact, poor sexual performance can make or break relationships. However, you can work on such problems through different processes, exercises, medications and changes in diets. Reasons for Poor Sexual Performance: Stress and anxiety issues are two of the most common reasons for poor sexual performance. People now have a very stressful life due to work pressure and family issues. Sex is something that people look forward in their life and stress can hamper your performance. Fear of failure regarding performing well in bed can cause anxiety issues. The inability to ... More

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Due to the lack of data on the effect of sildenafil indicated for the treatment of pulmonary arterial hypertension (PAH) in pregnant women, sildenafil is not recommended for women of childbearing potential unless also using appropriate contraceptive measures 11,14,15,9 . The safety and efficacy of sildenafil indicated for treating PAH in a woman during labor and delivery have not been studied 11,14,15,9 . Caution should ultimately be exercised when sildenafil is administered to nursing women as it is not known if sildenafil or its metabolites are excreted in human breast milk 11,14,15,9 . The safety and efficacy of sildenafil for the treatment of PAH in children below 1 year of age has not been established as no data is available 15 . Clinical experience with the elderly population in the use of sildenafil for the treatment of PAH has been varied. Some reports suggest that there are no identified differences in responses between elderly and younger patients 11 while others have documented that clinical efficacy as measured by 6-minute walk distance could be less in elderly patients 9 . In general, dose selection for an elderly patient should be cautious, reflecting the cipla viagra 100mg price greater frequency of decreased sildenafil professional 100mg hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy 11 . Conversely, when sildenafil was used to treat erectile dysfunction in healthy elderly volunteers (65 years or over), a reduced clearance of sildenafil was observed 12,8 . This reduction resulted in about 90% higher plasma concentrations of sildenafil and the active N-desmethyl metabolite compared to those seen in healthy younger ... More

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As a second-generation medication, Stendra also seems to have milder side effects than Viagra and the other PDE5 inhibitors that came before it. Side effects commonly caused by Viagra — but not Stendra — include dizziness, vision changes, nausea, and muscle aches. The only common side effect caused by Stendra but not Viagra is a sore throat. Each drug comes with the risk of drug interactions. Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions. All four of these drugs interact with: nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat) certain blood pressure drugs, such as calcium channel blockers alpha blockers, which can treat high blood pressure or an enlarged prostate certain pulmonary hypertension drugs, such as riociguat (Adempas) protease inhibitors, a class of HIV drugs antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox) antibacterial drugs, such as clarithromycin (Biaxin) Drinking excessive amounts of alcohol while on any PDE5 inhibitor should be avoided, and you shouldn’t combine different ED drugs. Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital. For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist. In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors. In other cases, adjusting your dosage of the medication can reduce the possibility of drug interactions while using PDE5 inhibitors. If you have ED, talk to your doctor about Viagra, Cialis, Levitra, and Stendra. Tell your ... More

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Erectile dysfunction is estimated to effect 150 million men worldwide, and more than one million men in Australia.Overall, 25% of Australian men report erectile dysfunction and 8.5% report severe erectile dysfunction. In one study, 9.6% reported ‘occasional’ erectile dysfunction, 8.9% reported erectile dysfunction occurring ‘often’, and 18.6% reported erectile dysfunction occurring ‘all the time’. Of these, only 11.6% had received treatment.In another study, only 14.1% of men reported that they had received treatment, despite experiencing erectile dysfunction for longer than 12 months. Erectile dysfunction is never ‘normal’, however it does become more common and more severe as men age. One Australian study reported the rate of erectile dysfunction in different age groups: 20-29 years: 9.2%; 30-39 years: 8.4%; 40-49 years: 13.1%; 50-59 years: 33.5%; 60-69 years: 51.5%; 70-79 years: 69.2%; 80+ years: 76.2%. Due to the ageing Australian population, erectile dysfunction is expected to become more common. There is no difference between the prevalence of erectile dysfunction between “white-collar” and “blue-collar” workers in Australia. Between 10 and 88% of patients diagnosed with cancer experience sexual problems following diagnosis and treatment. The prevalence varies according to the location and type of cancer, and the treatment modalities used. Sexuality may be affected by chemotherapy, alterations in body image due to weight change, hair loss or surgical disfigurement, hormonal changes, and cancer treatments that directly affect the pelvic region. Sexual problems are reported in many patients with prostate and testicular cancer. They are also reported in patients with ... More

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2007 160 Tadalafil: 20 mg Sildenafil: 50, 100 mg preference, TEAEs 2 El-Meliegy et al. 2013 493 Tadalafil Sildenafil, vardenafil persistence, adherence, IIEF, 2 Taylor et al. 2009 409 Tadalafil Sildenafil, vardenafil TEAEs 2 Rubio-Aurioles et al. 2013 511 Tadalafil Sildenafil, vardenafil persistence, adherence IIEF 2. TEAE treatment–emergent adverse events, IIEF International Index of Erectile Function, OaD once a day, PRN on demand. Egger’s test was conducted to assess the presence of possible publication bias. No evidence of publication bias was found for the IIEF-EF, preference, overall adverse events, back pain, dyspepsia, nasopharyngitis, adherence and persistence (Egger’s test P ? 0.05). The Egger’s test results found publication bias for headache, flushing and nasal congestion ( P ? 0.05). The other parameters were not evaluated using Egger’s test because only two studies included relevant data (Tables 2 , ? ,3; 3 ; Figs. Study quality was evaluated with the Jadad scoring system, and the results are shown in Table 1 . According to a recent network meta-analysis published in 2015 that indirectly compared the efficacy and safety of PDEIs, sildenafil had the greatest efficacy but the highest rate of overall adverse events, whereas tadalafil had intermediate efficacy and the lowest overall rate of all adverse events [15]. However, our study, which differs from previous systematic reviews, is the first meta-analysis to directly compare the efficacy and safety of sildenafil and tadalafil. PDE5-Is selectively block the PDE5 enzyme, which catalyses the hydrolysis of cGMP to GMP and thus prolongs erectile function [32]. PDEIs are the most commonly used drugs to treat ED, ... More

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Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate pathway, PDE5 inhibitors may potentiate the hypotensive effects of nitrates A suitable time interval following PDE5 dosing for the safe administration of nitrates or nitric oxide donors has not been determined. Elicits vasodilatory properties, resulting in mild and transient decreases in blood pressure. Use with caution in patients with anatomic deformation of penis (eg, angulation, cavernosal fibrosis, or Peyronie disease), conditions potentially predisposing to priapism (eg, sickle cell anemia, multiple myeloma, or leukemia), cardiovascular disease, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, multidrug antihypertensive regimens, retinitis pigmentosa, concomitant use of CYP3A4 inhibitors. Pulmonary vasodilators may significantly worsen cardiovascular status of patients with pulmonary veno-occlusive disease. Patient taking alpha blocker should be stabilized before starting phosphodiesterase (PDE)-5 inhibitor, which should be initiated at lowest dose; if patient is already taking optimized dose of PDE-5 inhibitor, alpha blocker should be initated at lowest dose to avoid hypotension. Sudden decrease or loss of hearing, which may be accompanied by tinnitus and dizziness. Viagra: Patients should stop sildenafil and seek medical care if a sudden loss of vision occurs in 1 or both eyes, which could be a sign of nonarteritic anterior ischemic optic neuropathy (NAION); use with caution, and only when the anticipated benefits outweigh the risks, in ... More

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Promethazine, a phenothiazine, is associated with a possible risk for QT prolongation. Phenytoin: (Minor) Vardenafil is metabolized by cytochrome P450 3A4. It can be expected that concomitant administration of CYP3A4 enzyme-inducers, such as phenytoin, will decrease plasma levels of vardenafil, however, no interaction studies have been performed. Pimavanserin: (Major) Pimavanserin may cause QT prolongation and should generally be avoided in patients receiving other medications known to prolong the QT interval. Therapeutic (10 mg) and supratherapeutic (80 mg) doses of vardenafil produce an increase in QTc interval (e.g., 4 to 6 msec calculated by individual QT correction). When vardenafil (10 mg) was given with gatifloxacin (400 mg), an additive effect on the QT interval was observed. The effect of vardenafil on the QT interval should be considered when prescribing the drug. Coadministration may increase the risk for QT prolongation. Pimozide: (Severe) Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes (TdP). Because of the potential for TdP, use of vardenafil with pimozide is contraindicated. Pitolisant: (Major) Avoid coadministration of pitolisant with vardenafil as concurrent use may increase the risk of QT prolongation. Both therapeutic and supratherapeutic doses of vardenafil produce an increase in QTc interval. Posaconazole: (Severe) Concurrent use of posaconazole and vardenafil is contraindicated due to the risk of life threatening arrhythmias such as torsade de pointes (TdP). Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme responsible for the metabolism of vardenafil. These drugs used in combination may result ... More

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It works by inhibiting (blocking) the action of an enzyme called PDE5. (An enzyme is a protein that helps chemical reactions to happen inside your body.) Normally, an erection goes away when PDE5 breaks down the cyclic GMP in your penis. But Viagra blocks the action of PDE5, so it allows cyclic GMP to keep working for a longer period of time than usual. This action improves blood flow to your penis and helps you to have and keep an erection. No, Viagra doesn’t directly increase your sex drive. However, some men find that if Viagra works to treat their erectile problem, it also increases their sexual confidence. Viagra may not work for everyone, and it may not work every time you take it. If you’re sexually aroused, Viagra should work to help you have or keep an erection within 30 minutes to 2 hours. But if you don’t get an erection within 4 hours after taking a dose, Viagra didn’t work for you this time. If the drug doesn’t work for you, you shouldn’t take another dose until at least 24 hours later. And talk with your doctor if you feel Viagra isn’t helping to treat your ED. They may recommend that you try a different medication for your ED. It’s important to remember that Viagra only works if you’re already sexually aroused. Arousal may involve having sexual thoughts, looking at sexual images, masturbating, or engaging in foreplay. But if you feel anxious, nervous, depressed, or stressed, your body may not respond well to sexual stimulation. If this is the case, try to relax, make yourself comfortable, and take your time. In addition, it’s best to avoid drinking a lot of alcohol. This is because consuming large amounts of alcohol can make it more difficult for you to ... More

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Apomorphine can be administered via subcutaneous injection or sublingually. However, studies have shows a lower efficacy for apomorphine compared to oral sildenafil (81,82). Apomorphine has a set role in the management of PD for non-motor symptoms, and has been reported to cause spontaneous erections and possible hypersexuality in PD men (83,84). Its role in the management of ED has been postulated for men with PD but should be considered as an alternative to sildenafil. Intracavernosal injections (ICI) Intracavenosal therapy involves injection of a vasoactive agent into the corpora cavernosa to effect smooth muscle relaxation and tumescence. In 1983, Brindley injected the corpora of several SCI men with phentolamine (85). Two out of the three men had a sufficient erection produced. Since then multiple reports on the efficacy of intracavernosal therapy have been published using, phentolamine, papaverine, prostaglandin, vasoactive intestinal peptide (VIP), and these medications in combination (86-90). These medications have been found to be extremely effective for neurogenic ED due to their ability act locally and essentially bypassing neuronal pathways. Local therapies are usually considered second-line after PDE5i fail to elicit a desired response which can occur in about 25–30% of men with ED, in general (91). Furthermore, the locally delivered medications can be quite dangerous if not used appropriately as priapism and significant pain with injections can occur. These specific occurrences have been suggested as a reason for high discontinuation rates with intracavernosal therapy (92). Papaverine is an opium alkaloid that acts as a non-specific PDEi that increases ... More

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