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ED or impotence is a condition in which a man is unable to achieve or maintain an erection long enough for sexual intercourse. This can be a result of medical conditions such as high blood pressure, diabetes, prostate problems, and heart disease, or a side effect of the medications typically taken for these conditions. Personal lifestyle factors such as stress, alcohol and/or tobacco use can also play a contributing role. During surgery or radiation to the pelvic area (including prostate, bladder, and rectal procedures), damage can occur to the nerves that supply the penis. This can result in either temporary or permanent impotence. Some surgeons perform "nerve-sparing" surgeries in an attempt get viagra no prescription to preserve erectile function. Even in these cases, however, the nerves will suffer some injury, and it can take 18-24 months or longer for erectile function to return. These men should be treated aggressively with oral or injectable medications for ED in order to speed recovery of the nerves and to prevent muscle wasting in the penis. It should be taken around 60 minutes before sex, but can be taken as much as four hours or as few as 30 minutes before sex. Your doctor will determine the dose that is best for you. Some men require dose adjustments to find the dose that works best for them. Men who take sildenafil will not have an erection without sexual stimulation. This drug is not an aphrodisiac and does not affect libido or desire. Having multiple intercourse sessions with one dose has not been buy generic sildenafil online studied. You should not adjust your dose without talking to your provider first. Men who take nitrates, such as nitroglycerin, ... More

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Share this page: Share this page to Facebook Share this page to Twitter Share this page to Google Plus Email this page. Print this page: Disclaimer: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Everything You Need to Know About Erectile Dysfunction (ED) What is erectile dysfunction (ED)? Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as impotence, although this term is now used less often. Frequent ED, however, can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional. ED can occur because of problems at any stage of the erection process. An erection is the result of increased blood flow into your penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with your penis. When a man is sexually excited, muscles in the penis relax. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis. As the chambers fill with blood, the penis grows rigid. An erection ends when the muscles contract and the accumulated blood can flow out through the penile veins. There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include: cardiovascular disease diabetes hypertension, or high blood ... More

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Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for sexual intercourse. Signs of ED vary from a total inability to get an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. Inability to achieve or maintain an erection Inconsistent ability to achieve/maintain erection Tendency to sustain only brief erections. Causes of ED are usually a side effect of physical disease, injury, or drugs. While there are many causes, the most common physical causes include: Diabetes High Blood Pressure Heart Disease Obesity Atherosclerosis Prescription Medications Smoking Alcoholism or Substance Abuse. The most common psychological causes include: Relationship Issues Stress Depression or Anxiety. Your doctor will perform a detailed history exam, asking if you have difficulty achieving an erection, if the erection is suitable for intercourse, if the erection can be maintained, and if ejaculation occurs. During the tests for ED, you will also be asked about any medications you are currently taking, any surgeries in the past, and other disorders (i.e. prostate surgery, history of trauma, radiation exposure, etc.) Other questions may be asked about risk factors such as drug, alcohol, and tobacco usage, indications of depression, relationship with your sexual partner, and other similar inquiries. A physical exam will also be necessary, paying close attention to the genitals and nervous, vascular, and urinary systems. The physical examination will help determine the cause of the erectile dysfunction. Based on the severity of the ED issue, your doctor will suggest treatments from least to most invasive. Something as ... More

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In such instances, nitrates should only be used if conditions for the treatment of a possible severe hypotensive crisis exist. For the treatment of precordial pain no data about drug interactions are available contraindicating the use of sildenafil with aspirin, beta-blockers, calcium channel antagonists, or narcotics. Patients with acute myocardial infarction ? The same previous precautions should be taken. So far, no restraints regarding the use of heparin, cumarin, and thrombolytic agents exist. In the case of hypotension, recovery of proper pressure levels can hinder the progression of myocardial lesions. Unstable angina ? The same guidelines and warnings in relation to the use of nitrates and other medications commonly used in the treatment of this condition apply. Treatment of the hypotension resulting from the interaction of sildenafil with nitrates. The following measures should be employed in sequence: 1) place the patient in the Trendelenburg's position; 2) administer intravenous fluids rapidly; 3) use intravenous alpha-adrenergic agonists, such as phenylephrine, ethylephrine, or metaraminol; 4) if necessary, use an alpha or beta agonist, such as norepinephrine to support blood pressure, but one should be aware of the risk of worsening or inducing myocardial ischemia; 5) install auxiliary support through the intra-aortic balloon. The recommendations here expressed result from a still limited experience in regard to some of the multiple clinical situations of patients with cardiovascular disease, who intend to use sildenafil. Therefore, the risk in face of these not yet tested situations is presumed based on what is known in regard to the pharmacokinetics and ... More

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In the Massachusetts Male Aging Study (4), men with treated diabetes had a 28% age-adjusted prevalence of complete ED (no erections), almost three times higher than the prevalence of complete ED observed in the entire sample of men (10%). Several studies have shown an increased risk of ED in men with diabetes; however, most information refers to the total male diabetic population, and few studies have presented data specifically for type 1 diabetes (5–8). Although the prevalence of ED in the total diabetic population increases with age, smoking, and poor metabolic control, one study reported that men with elevated BMI and type 1 diabetes showed a significantly higher risk of ED than men with elevated BMI and type 2 diabetes (7). The same study also showed that the age-adjusted prevalence of ED was higher in men with type 1 diabetes (51%) than with type 2 diabetes (37%). Although the etiology of ED in patients with diabetes is often complex and can be caused by several mechanisms, organic vasculogenic factors appear to be the most frequent cause of ED in men with diabetes (9), with some studies citing an incidence of up to 87% (10). Within vasculogenic ED, the most common etiology is arterial insufficiency, found more frequently in men with type 1 diabetes (73%) than with type 2 diabetes (61%) (11). Moreover, in men with type 1 diabetes, the severity of arterial insufficiency correlated with the presence of smoking, hypertension, and coronary artery disease, although only those with the latter disease showed a statistically significant reduction in penile blood flow compared with men who had type 2 diabetes (11). Treatment options for men with ED have advanced ... More

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Viagra contains sildenafil, which is the same medicine found in another drug called REVATIO. REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH). Viagra should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil]). Ask your healthcare provider or pharmacist for a list of these medicines, if you are not sure. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. Take Cialis exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Some men can only take a low dose of Cialis or may have to take it less often, because of medical conditions or medicines they take. Do not change your dose or the way you take Cialis without talking to your healthcare provider. Your healthcare provider may lower or raise your dose, depending on how your body reacts to Cialis and your health condition. If you take too much Cialis, call your healthcare provider or emergency room right away. Take Viagra exactly as your healthcare provider tells you to take it. Your healthcare provider will tell you how much Viagra to take and when to take it. Your healthcare provider may change your dose if needed. You may take Viagra between 30 minutes to 4 hours before sexual activity if needed. If you take Viagra after a high fat meal (such as a cheeseburger and french fries), Viagra may take a little longer to start working. If you accidentally take too much Viagra, call your doctor or go to the nearest hospital emergency room right away. Nitrates: Administration of VIAGRA to patients ... More

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Of the CYP3A4 inhibitors that have been studied, ritonavir causes the most significant drug-drug interaction with vardenafil. Table 6 summarizes the effect on mean uncorrected QT and mean corrected QT interval (QT c ) with different methods of correction (Fridericia and a linear individual correction method) at one hour post-dose. No single correction method is known to be more valid than the other. In this study, the mean increase in heart rate associated with a 10 mg dose of LEVITRA compared to placebo was 5 beats/minute and with an 80 mg dose of LEVITRA the mean increase was 6 beats/minute. Mean QT and QT c changes in msec (90% CI) from baseline relative to placebo at 1 hour post-dose with different methodologies to correct for the effect of heart rate. Drug/Dose QT Uncorrected (msec) Fridericia QT Correction (msec) Individual QT Correction (msec) Vardenafil 10 mg -2 (-4, 0) 8 (6, 9) 4 (3, 6) Vardenafil 80 mg -2 (-4, 0) 10 (8, 11) 6 (4, 7) Moxifloxacin a 400 mg 3 (1, 5) 8 (6, 9) 7 (5, 8) a) Active control (drug known to prolong QT) Therapeutic and supratherapeutic doses of vardenafil and the active control moxifloxacin produced similar increases in QT c interval. This study, however, was not designed to make direct statistical comparisons between the drug or the dose levels. The clinical impact of these QT c changes is unknown [see WARNINGS AND PRECAUTIONS ]. In a separate postmarketing study of 44 healthy volunteers, single doses of 10 mg LEVITRA resulted in a placebo- subtracted mean change from baseline of QT c F (Fridericia correction) of 5 msec (90% CI: 2,8). Single doses of gatifloxacin 400mg resulted in a placebo-subtracted mean change from baseline QTcF of 4 ... More

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But keep in mind that a sudden drop in your blood pressure could be dangerous if you have certain heart conditions. Sudden low blood pressure may also be dangerous if you’re taking certain other medications. For example, you shouldn’t take Viagra if you take nitrate medications to treat chest pain. You should also avoid taking Viagra if you take a drug called riociguat (Adempas). Taking Viagra with these medications can cause a dangerous drop in your blood pressure that leads to heart attack or stroke. If you have low blood pressure, taking Viagra could make you feel dizzy or lightheaded, or cause you to faint. You’re also more likely buy generic sildenafil online to have these problems if you take Viagra with certain drugs used to treat high blood pressure or enlarged prostate. If you feel dizzy or faint after taking Viagra, lie down until this feeling passes. If you have a heart problem or low blood pressure, talk with your doctor about whether Viagra is safe for you. For more information about taking Viagra with other medications, see the “Viagra interactions” section below. And for more information about taking Viagra if you have heart or blood pressure problems, see the “Viagra precautions” section below. On rare occasions, some people taking Viagra have had heart attack, stroke, or irregular heartbeat. These conditions mainly occurred in people who already had a heart problem. But sometimes these conditions occurred in people who didn’t have a heart problem. It’s not known for sure if Viagra caused the side effects. If you have chest pain after taking Viagra, you should stop having sexual activity right away. But call 911 if your symptoms feel life threatening, or ... More

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Seeing a psychologist or sex therapist, therefore, can be helpful for many men or couples, even if the origins of sexual dysfunction are physical. A therapist can help an individual or couple to communicate more easily, feel less anxious, and develop realistic expectations for sex. The bottom line is that nearly all men with diabetes who wish to have an erection adequate for sexual intercourse can do so with the therapies currently available. And with commitment and communication, the experience of erectile dysfunction can be changed from a potential personal tragedy to an opportunity for greater emotional intimacy in a couple. Want to learn more about diabetes and sexual health? Read “Sexual Wellness” and “When Diabetes Affects Your Sex Life.” Disclaimer Statements: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information. When selecting your ideal erectile dysfunction (ED) drug, you may be surprised to learn that whether you’ll end up on Viagra ( sildenafil ) or Cialis ( tadalafil ) has as much to do with your insurance company’s preferences as it does your body and its chemistry. “About 75 to 85 percent of the time both Viagra and Cialis are effective drugs for erectile dysfunction,” says James Kashanian, MD , a urologist and assistant professor at Weill Cornell in New York City. “Men have a misconception that one drug works better than the other, but both have the same mechanism of action and the efficacy is ... More

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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 get an erection. If you’re having trouble getting an erection, even while using Viagra, talk with your doctor. Instead, it belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. (A class of drugs describes a group of medications that work in a similar way.) Viagra works by inhibiting (blocking) the action of a certain enzyme in your body. Since Viagra has been released onto the market, there have been a few reports of bleeding in people who’ve taken the drug. However, there’s no evidence that Viagra caused these bleeding problems. It’s not known if Viagra is safe for use by people with a bleeding problem. If you have any bleeding problems, talk with your doctor about whether Viagra is safe for you. Here are answers to some frequently asked questions about Viagra. And for answers to questions related to Viagra’s dosage, see the section “Viagra dosage” above. No, studies haven’t shown that Viagra makes sex last longer. However, the drug can help you to get and keep an erection. And studies have shown that Viagra can increase satisfaction from sex. No, Viagra doesn’t increase the size of a man’s penis. In fact, to date, there aren’t any known ways to permanently increase the size of a man’s penis. Viagra helps you get an erection if you’re sexually aroused. This may temporarily increase the size of your penis, until the erection goes away. But Viagra doesn’t permanently increase the size of your penis. Yes, Viagra is ... More

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The maximum observed decrease in diastolic blood pressure was -17.2 mmHg when sildenafil was co-administered with alcohol versus -11.1 mmHg when alcohol was administered alone. There were no reports of postural dizziness or orthostatic hypotension. The maximum recommended dose of 100 mg sildenafil was not evaluated in this study [ see Drug Interactions (7.5) ]. Effects of VIAGRA on Cardiac Parameters: Single oral doses of sildenafil up to 100 mg produced no clinically relevant changes in the ECGs of normal male volunteers. Studies have produced relevant data on the effects of VIAGRA on cardiac output. In one small, open-label, uncontrolled, pilot study, eight patients with stable ischemic heart disease underwent Swan-Ganz catheterization. A total dose of 40 mg sildenafil was administered by four intravenous infusions. The results from this pilot study are shown in Table 3; the mean resting systolic and diastolic blood pressures decreased by 7% and 10% compared to baseline in these patients. Mean resting values for right atrial pressure, pulmonary artery pressure, pulmonary artery occluded pressure and cardiac output decreased lady era 100mg tablet by 28%, 28%, 20% and 7% respectively. Even though this total dosage produced plasma sildenafil concentrations which were approximately 2 to 5 times higher than the mean maximum plasma concentrations following a single oral dose of 100 mg in healthy male volunteers, the hemodynamic response to exercise was preserved in these patients. Hemodynamic Data in Patients with Stable Ischemic Heart Disease after Intravenous Administration of 40 lady era 100mg tablet mg of Sildenafil Means ± SD At rest After 4 minutes of exercise N ... More

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It has many similarities to sildenafil; in fact, its molecular structure is very similar (Figure), and they share a half-life of ?4 hours. In healthy volunteers, vardenafil caused a transient reduction in supine blood pressure with a mean maximum decrease of 7 mm Hg systolic and 8 mm Hg diastolic. Maximum reduction occurred between 1 and 4 hours after dosing. 19 A 20-mg dose of vardenafil resulted in a mean maximum increase in heart rate of 4 beats/min. Molecular structures of sildenafil, vardenafil, and tadalafil. Note similarity in structure between sildenafil and vardenafil. Reprinted with permission from Rosen RC, Kostis JB. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Tadalafil was the third PDE5 inhibitor to come to market in the United States and was approved by the FDA at the end of 2003. Its chemical structure differs substantially from that of sildenafil and vardenafil, and it has a unique, long half-life of 17.5 hours. In healthy subjects, a single oral dose of 10 or 20 mg of tadalafil did not drop systolic blood pressure significantly compared with placebo. The decrease in systolic blood pressure with 20 mg tadalafil versus placebo was ?0.2 mm Hg (95% confidence interval [CI], ?7.1 to 6.6) in the standing position. 20,21 The mean decrease in diastolic blood pressure compared with placebo was ?4.6 mm Hg (95% CI, ?7.9 to ?1.2) in the standing position. Diastolic blood pressure was generally lower for 12 hours after administration of the drug, but the decrease in pressure get viagra no prescription remained small. Changes were even less marked in the supine position. Standing and supine heart rates were not significantly different from ... More

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Avant d'instaurer un traitement de la dysfonction erectile, les medecins doivent examiner la fonction cardiovasculaire de leurs patients, dans la mesure ou toute activite sexuelle comporte un risque cardiaque (voir rubrique Contre-indications). Le vardenafil a des proprietes vasodilatatrices entrainant des diminutions legeres et transitoires de la pression arterielle (sildenafil citrate tablets 100mg price voir rubrique Proprietes pharmacodynamiques). Les patients presentant une obstruction a l'ejection du ventricule gauche, par exemple stenose aortique, stenose sub-aortique hypertrophique idiopathique, peuvent etre sensibles a l'action de vasodilatateurs dont les inhibiteurs de la phosphodiesterase de type 5. Les medicaments utilises dans le traitement de la dysfonction erectile doivent etre prescrits avec prudence chez les patients presentant une malformation anatomique du penis (comme une angulation, une sclerose des corps caverneux ou la maladie de La Peyronie), ou chez les patients presentant des pathologies susceptibles de les predisposer au priapisme (comme une drepanocytose, un myelome multiple ou une leucemie). La tolerance et l'efficacite de l'association de Levitra, comprime pellicule avec Levitra, comprime orodispersible ou avec d'autres traitements de la dysfonction erectile n'ont pas ete etudiees. Il n'est donc pas recommande de recourir a de telles associations. La tolerance a la dose maximale de 20 mg peut etre diminuee chez les patients ages (? 65 ans) (voir rubriques Posologie et mode d'administration et Effets indesirables). L'administration concomitante d'alpha-bloquants et de vardenafil peut entrainer, chez certains patients, une hypotension ... More

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Deviating even further, drug therapy is moving out of treating diseases to providing enhancements to what had hitherto been seen as normal functioning. This evolution in the use of medications has introduced dilemmas and controversies about what are legitimate conditions and treatments for those concerned with prescription medications: is any deviation from normality fair game for treatment? What about people who have nothing medically wrong with them, but just want to feel better? Who will pay for these therapies, and what are the implications for the way we use health-care resources? Medications that embody these controversies are generally referred to as lifestyle drugs and perhaps the best known of these is sildenafil citrate (Viagra) This article will examine the strategies used by Pfizer, the maker of Viagra, to ensure that the drug was seen as legitimate therapy for almost any man. Pfizer took steps to make sure that Viagra was not relegated to a niche role of just treating men who had ED due to organic causes, such as diabetes or prostate surgery. There is no doubt that Viagra is an effective and quite safe drug in treating ED secondary to these causes, although a systematic review of the evidence found that the drug probably only results in successful intercourse 50%–60% of the time [ 1]. Had Viagra been confined to use only in cases of ED secondary to organic causes, the drug would probably have been a modest success for Pfizer. In order to grow the market, Pfizer had to make Viagra the treatment of choice for a much wider population of men. The perceived prevalence of ED needed to be expanded. The impression had to be created that ED was of significant ... More

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