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It subsequently stimulates the guanylate cyclase enzyme system in penile smooth muscle. This results in increased levels of cyclic guanosine monophosphate (cGMP) and ultimately in smooth muscle relaxation, enhancement of arterial inflow, and veno-occlusion, producing adequate firmness for sexual activity. Recognized risk factors for ED include cardiovascular disease (CVD) (hypertension, atherosclerosis, and hyperlipidemia), diabetes, depression, alcohol use, smoking, pelvic/perineal surgery or trauma, neurologic disease, obesity, pelvic radiation, and Peyronie’s disease. One study suggested that the relationship between arterial disease and ED is very strong, with 49% (147 of 300) of patients with coronary artery disease noted on cardiac catheterization reporting significant erectile dysfunction. 6 Endothelial dysfunction has been indicated as the pathophysiologic mechanism responsible for both CVD and ED. 7 The Boston Area Community Health survey demonstrated a dose-response between smoking and incidence of erectile dysfunction. 8 Animal studies have demonstrated both smooth-muscle disruption and decreased production of neural nitric oxide synthase in cigarette-exposed animals. Some evidence exists to suggest that chronic inflammation associated with metabolic syndrome also plays a role in endothelial dysfunction and erectile function, possibly due to oxidative stress. Examples of common neurologic conditions that can lead to ED include cerebral vascular accident, multiple sclerosis, Parkinson’s disease, and spinal cord injury. Microvascular disease associated with diabetes is thought to compound the endothelial and neural injuries associated with this disease. ... More

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[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 AND ADMINISTRATION and WARNINGS AND PRECAUTIONS .]. Erythromycin (500 mg t.i.d.) produced a 4-fold increase in vardenafil AUC and a 3-fold increase in Cmax when co-administered with LEVITRA 5 mg in healthy volunteers. It is recommended not to exceed a single 5 mg dose of LEVITRA in a 24-hour period when used in combination with erythromycin. [See DOSAGE AND ADMINISTRATION and WARNINGS AND PRECAUTIONS ] Although specific interactions have not been studied, other CYP3A4 inhibitors, including grapefruit juice would likely increase vardenafil exposure. No pharmacokinetic interactions were observed between vardenafil and the following drugs: glyburide, warfarin, digoxin, an antacid based on ... More

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Grapefruit can increase the chance of side effects with this medicine. Vardenafil disintegrating tablets are absorbed differently in the body than vardenafil film-coated tablets. Do not switch from one to the other without consulting your doctor. Tell your doctor if your condition does not improve. Vision changes such as increased sensitivity to light, blurred vision, or trouble telling blue and green colors apart may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Sexual activity may put extra strain on viagra for men without prescription your heart, especially if you have heart problems. If you have heart problems viagra tablet shop near me and experience any of these serious side effects while having sex, stop and get medical help right away: severe dizziness, fainting, chest/jaw/left arm pain, nausea. Rarely, prescription du viagra sudden decreased vision, including permanent blindness, in one or both eyes (NAION) may occur. If this serious problem occurs, stop taking vardenafil and get medical help right away. You have a slightly greater chance of developing NAION if you have heart disease, diabetes, high cholesterol, certain other eye problems ("crowded disk"), high blood pressure, if you are over 50, or if you smoke. Rarely, a sudden decrease or loss of hearing, sometimes with ringing in ... More

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Alprostadil suppository may be inserted into the urethra using a straw-like applicator. These therapies may cause priapism and penile pain. Usually, the doctor guides the man to administer the drug himself during an office visit. After this, men may give themselves these drugs at home. Alprostadil suppository may be combined with an oral phosphodiesterase inhibitor for men in whom oral drugs are not effective. For some men, drug therapy is not effective or acceptable. In these men, surgery to implant a penile prosthesis may be done. Prostheses can take the form of rigid silicone rods or hydraulically operated devices that can be inflated and deflated. Both involve the risks of general anesthesia, infection, and prosthetic prescription du viagra malfunction. Although erectile dysfunction (ED) does increase with aging, it need not be accepted as a normal part of aging. Rather, because older men are more likely to have medical conditions that affect the blood vessels they are also more likely to have ED. Many older couples engage in satisfying sexual activity without erections or intercourse and may not choose to seek treatment. Nevertheless, treatment of ED can be appropriate for older men. ED commonly results from psychologic, nervous system, or blood vessel disorders, from injury, or from the side effects of some drugs or surgery. When considering the causes, doctors consider psychologic and interpersonal factors. Testosterone therapy may help restore erectile function in men with low serum testosterone levels and ED, but a low testosterone level is not a common cause of walmart pharmacy prices sildenafil ED. Most men with ED may be successfully treated with an oral ... More

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According to extensive data available to date, sildenafil citrate has been shown to pose minimal cardiovascular risks to healthy people taking this drug. Some precautions are needed for patients with cardiovascular diseases. However, the only absolute contraindication for sildenafil citrate is the concurrent use of nitrates. This article is intended to review sildenafil citrate's cardiovascular effects, as well as current debates about its arrhythmogenic effects. Key words: Sildenafil citrate, Erectile dysfunction, Sudden cardiac death, Cardiovascular disease, Phosphodiesterase inhibitor, Cardioprotection. Sildenafil citrate was the first oral drug approved for the treatment of erectile dysfunction (ED), which is frequently observed in men with cardiovascular disease (1). ED is defined as the inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity (2). The prevalence of moderate to complete ED has been reported to be >30% in men aged 40 to 70 years (3). Since the approval of sildenafil citrate, several reports of sudden death among patients treated with this drug have raised some concerns regarding its safety in patients with coronary artery disease (4). In the past few years, the cardiovascular effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. In this article we shall review these studies, as well as the current debate about sildenafil citrate's arrhythmogenic effects. ED is a common health concern among patients with cardiovascular disease. According to the Massachusetts Male Aging Study, 34.8% of men aged 40 to 70 years have moderate to complete ED, and 15% of men aged 70 have ... More

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Call your doctor if you have any unusual problems while taking this medication. Some patients experienced a sudden loss of some or all of their vision after they took vardenafil or other medications that are similar to vardenafil. 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 vardenafil, call your doctor immediately. Do not take any more doses of vardenafil or similar medications such as sildenafil (Viagra) or tadalafil (Cialis) until you talk to your doctor. Some patients experienced a sudden decrease or loss of hearing after they took vardenafil or other medications that are similar to vardenafil. The hearing loss usually involved only one ear and may not get better. 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 vardenafil, call your doctor immediately. Do not take any more doses of vardenafil or similar medications such as sildenafil (Viagra) or tadalafil (Cialis) until you talk to your doctor. 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 it at room temperature and away from excess heat and moisture (sildenafil generic over the counter not in the bathroom). Unneeded medications should be disposed of in ... More

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For example, they may recommend that you take 25 mg of the drug rather than 50 mg. Can I take Viagra just for fun, even if I don’t have ED? No, you shouldn’t take Viagra if you don’t have ED. Viagra is a prescription medication that can have serious side effects. And it’s approved only to treat ED, not to be used recreationally. 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 addyi online order 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 ... More

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Plasma concentrations of this metabolite are approximately 40% of those seen for sildenafil, so that the metabolite accounts for about 20% of sildenafil's pharmacologic effects. After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the feces (approximately 80% of administered oral dose) and to a lesser extent in the urine (approximately 13% of the administered oral dose). Similar values for pharmacokinetic parameters were seen in normal volunteers and in the patient population, using a population pharmacokinetic approach. Geriatrics: Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, resulting in approximately 84% and 107% higher plasma AUC values of sildenafil and its lady era pills price active N-desmethyl metabolite, respectively, compared to those seen in healthy younger volunteers (18–45 years). Due to age-differences in plasma protein binding, the corresponding increase in the AUC of free (unbound) sildenafil and its active N-desmethyl metabolite were 45% and 57%, respectively [ see Dosage and Administration (2.5), and Use in Specific Populations (8.5) ] Renal Impairment: In volunteers with mild (CLcr=50–80 mL/min) and moderate (CLcr=30–49 mL/min) renal impairment, the pharmacokinetics of a single oral dose of VIAGRA (50 mg) were not altered. In volunteers with severe (CLcr max compared to age-matched volunteers with no renal impairment [ see Dosage and Administration (2.5), and walmart pharmacy prices sildenafil Use in Specific Populations (8.6) ]. In addition, N-desmethyl metabolite AUC and C max values significantly increased by 200% and 79%, respectively in subjects with severe ... More

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These effects on the metabolite are not expected to be of clinical consequence. In vitro studies: Sildenafil is a weak inhibitor of the CYP isoforms 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 (IC50 >150 µM). Given sildenafil peak plasma concentrations of approximately 1 µM after recommended doses, it is unlikely that VIAGRA will alter the clearance of substrates of these isoenzymes. In vivo studies: No significant interactions were shown with tolbutamide (250 mg) or warfarin (40 mg), both of which are metabolized by CYP2C9. In a study of healthy male volunteers, sildenafil (100 mg) did not affect the steady state pharmacokinetics of the HIV protease inhibitors, saquinavir and ritonavir, both of which are CYP3A4 substrates. VIAGRA (50 mg) did not potentiate the prescription du viagra increase in bleeding time caused by aspirin (150 mg). Sildenafil at steady state, at a dose not approved for the treatment of erectile dysfunction (80 mg t.i.d.) resulted in a 50% increase in AUC and a 42% increase in C max of bosentan (125 mg b.i.d.). 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. Sildenafil was not carcinogenic when administered to rats for 24 months at a dose resulting in total systemic drug exposure (AUCs) for unbound sildenafil and its major metabolite of 20- and 38- times, for male and female rats, respectively, the exposures observed in human males given the Maximum Recommended Human Dose (MRHD) of 100 mg. Sildenafil was not carcinogenic when administered to mice for 18–21 months at dosages up to the Maximum Tolerated Dose (MTD) of 10 mg/kg/day, approximately 0.4 times the MRHD on a mg/m 2 basis in a 50 kg subject. Sildenafil was negative in in vitro bacterial and ... More

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All of the treatments for ED (except for implant surgery) are used as needed for sex and then wear off. The treatments help the symptoms, but do not fix the underlying problem in the penis. If medical treatments don't work as well as hoped: Changing the dosage (for PDE5i, IU or ICI alprostadil) as prescribed by the doctor may help Reviewing the instructions again may reveal a missing step in sildenafil generic cheap a treatment plan Considering a different path may be necessary: emotional/relationship counselling, a vacuum erection device or penile implant are all good alternatives when others methods fail. Health providers now realize that most men have an underlying physical cause of ED. For most patients, there are both physical and emotional factors that lead to ED. It is impossible to prove that there is no psychological part to a man's ED. If I worry about being able to get an erection, can I make a bad condition worse? Worrying about your ability to get an erection can make it difficult to get one. This is called performance anxiety and can be overcome with education and treatment. However, only combine treatments after talking with your health care provider about this. Erections can last too long with drug therapy, which is dangerous. I was fine until I began taking this new drug, what should I do? Never stop or change a prescription medication without sildenafil coupon kroger first talking with your health care provider. Many drugs can cause ED, but some cannot be changed because the drug's benefits are too important for you. If you feel sure that a specific drug has caused the ED problem, ask your health care provider if you can change drugs. If you must stay ... More

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One ED drug, Cialis, is FDA-approved for use daily in a dose of 2.5 or 5 milligrams. This helps to produce erections on demand and may also help relieve urinary problems, like difficulty starting urination, that result from an enlarged prostate. The cost to you for ED drug therapy varies considerably, depending on the pharmacy price, prescription co-pays, and your level of health plan coverage. Even if private insurance covers it, you may be limited to four doses per month. Here are a few things you can do to contain costs: Shop around, because pharmacy prices vary. Various web-based tools can help you compare prices easily. Ask your doctor about pill splitting, where you get the pills at a higher dose than you need and divide them. These allow you to obtain a limited sildenafil goodrx coupon supply of medications not covered by your insurance. ED drugs produce an erection sufficient for intercourse in about 70% of men. But the results vary quite a bit from one individual to another. A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs. "There are some men in whom none of these drugs work," Dr. How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an "on demand" erectile drug; using the others requires more planning. Liou says that some men come to him after getting a prescription from their primary care ... More

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For confirmation, the serum hormone levels were obtained and assessed twice at two different days. The hormonal levels were combined with the cross sectional assessment while clinical evaluation and interviewing with patients and control subjects. Compliance to antiepileptic medications was confirmed by assessment of the serum drug level at least once during the period of the study. The serum levels of AEDs were determined in the Therapeutic Drug Monitoring (TDM) lab, Assiut University Hospital, Assiut, Egypt, using fluorescence polarization immunoassay system of Abbott (EPIA), TDxFLX apparatus (Abbott Lab, Wiesbaden, Germany) as described before [29]. The serum levels of AEDs were measured as part of price of generic viagra at cvs the investigation in batched assays. The approximated therapeutic serum level of CBZ is 4-10 ?g/ ml and that of VPA is 50-100 ?g/ml. Calculations were done with the statistical package SPSS, version 12.0. Data were presented as mean ± SD (standard deviation) when normally distributed and mean (quartiles) when not normally distributed. Kolmogorov-Simirnov test was used to test the parameter distributed. Unpaired two-sided Student’s t test was used for comparison of mean of normally distributed parameters. In all other cases Mann-Whitney U test was used for comparison. Correlations must be assessed using Pearson’s for normally distributed data and Spearman’s methods for non-normally distributed data. What was once acknowledged solely as impotence and smilingly mentioned barely behind closed doors has within the recent years gained immense recognition for the most part partially to the microscopic blue pill created for this? It absolutely was ... More

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If appropriate, our GPs ca prescribe you treatment for Same-Day Collection, Next-Day delivery or FREE Standard Delivery. If you’re unsure which ED treatment will be best for you then take our free ED assessment and our clinicians will help you decide. Sildenafil is the active ingredient in Viagra and is sold without the brand name, sometimes called “generic Viagra” or simply “sildenafil.” These medicines have the same active ingredient and act the same way in the body. The biggest difference when choosing is the dose and cost of these medications. If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment. It’s just one of many options, including generic versions, and yet it’s price of generic viagra at cvs as synonymous with ED as Kleenex is with runny noses. But while ignoring the generic facial tissue for Kleenex will only cost you a couple of bucks, there can be over a $50 difference—per pill—between Viagra and its generic alternative. Erectile dysfunction causes issues getting or maintaining an erection. Viagra is the most well-known prescription medication that treats ED. Sildenafil is the active ingredient in Viagra and is sold without the brand name, sometimes called “generic Viagra” or simply “sildenafil.” These medicines have the same active ingredient and act the same way in the body. The biggest difference when choosing is the dose and cost of these medications. Viagra, and its generic version, are ... More

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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 ... More

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Fortunately, the number of cases is very small in relation to the millions of men who have used ED pills successfully. It's not clear that there is a cause-and-effect relationship between ED pills and NAION. At present, the concern is not great enough to prevent men from using these pills, but all men should use them carefully and responsibly. The most important worry about ED pills is their ability to widen arteries enough to lower blood pressure. It's rarely a problem in healthy men, but it explains a crucial precaution that applies to all three medications. Nitrates are medications that temporarily widen arteries by increasing their supply of nitric oxide. That's how they widen partially blocked coronary arteries in patients with angina. But because the nitrates and ED pills all act on nitric oxide, they do not mix. Men who are taking nitrates should never use any of the ED pills. This ban includes all preparations of nitroglycerin (short-acting, under-the-tongue tablets or sprays); long-acting nitrates ( isosorbide dinitrate, or Isordil, Sorbitrate, and others, and isosorbide mononitrate, Imdur, ISMO, and others); nitroglycerin patches and pastes; and amyl nitrite (so-called poppers, used for sexual stimulation by some men). ED pills are quite safe for men with stable cardiovascular disease who do not take nitrates. This group includes patients with stable angina, previous heart attacks, mild congestive heart failure, well-controlled hypertension, and previous strokes. But men with recent heart attacks and strokes should wait until they have recovered fully, and patients with unstable blood pressure, active angina, or any other complex or unusual problem should hold ... More

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At single oral doses of 100 mg and 200 mg, transient dose-related impairment of color discrimination (blue/green) was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. An evaluation of visual function at doses up to 200 mg revealed no effects of sildenafil citrate on visual acuity, intraocular pressure, or pupillometry. Sildenafil citrate is rapidly absorbed after oral administration, with a mean absolute bioavailability of 41% (25% to 63%). Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil citrate is taken with a high-fat meal, the rate of absorption is reduced, with a mean delay in Tmax of 60 minutes and a mean reduction in Cmax of 29%. The mean steady-state volume of distribution (Vss) for sildenafil is 105 L, indicating distribution into the tissues. Sildenafil and its major circulating N-desmethyl metabolite are both approximately 96% bound to plasma proteins. Protein binding is independent of total drug concentrations. Bioequivalence was established between the 20 mg tablet and the 10 mg/mL oral suspension when administered as a 20 mg single oral dose of sildenafil (as citrate). Sildenafil is cleared predominantly by the CYP3A (major route) and cytochrome P450 2C9 (CYP2C9, minor route) hepatic microsomal isoenzymes. The major circulating metabolite results from N-desmethylation of sildenafil, and is, itself, further metabolized. This metabolite has a phosphodiesterase selectivity profile similar to ... More

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In many cases, yes, erectile dysfunction can be reversed. A study published in the Journal of Sexual Medicine found a remission rate of 29 percent after 5 years. It is important to note that even when ED cannot be cured, the right treatment can reduce or eliminate symptoms. Doctors have identified two types of ED: Primary ED occurs when a man has never been able to have or sustain an erection. Secondary ED occurs in people who once had regular erectile function. Secondary ED can be reversed and is often temporary. Primary ED may require more intensive and medical-based treatments. ED is usually treatable with medication or surgery. However, a person may be able to treat the underlying cause and reverse symptoms with no medication. Some find that traditional treatments, such as surgery or medication, do not work. These men may have success using a penis pump, which draws blood into the penis and induces an erection. Methods for reversing ED fall into three categories: Short-term treatments. These help with achieving or maintaining erections but do not address the underlying cause of ED. For example, sildenafil (Viagra) increases blood flow to the penis, which can provide short-term relief from ED. It may help people with conditions such as diabetes and atherosclerosis to get erections. Primary treatments address the issue that is causing ED. When clogged arteries are responsible, taking medication or exercising more frequently can improve cardiovascular health. This may eliminate ED or reduce the frequency of episodes. Share on Pinterest Psychological treatments may help to reduce anxiety and increase self-confidence. The cause of ED may be psychological, and the ... More

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Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress. It's important to identify the cause of erectile dysfunction and treat any underlying conditions. When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead to erectile dysfunction. Anything that affects the level of sexual desire (libido) can also cause erectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels (chemicals produced by the body). There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are: conditions affecting the flow of blood to your penis – vasculogenic conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic conditions affecting your hormone levels – hormonal conditions affecting the physical structure of your penis – anatomical. Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction. Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury. Examples of vasculogenic conditions that cause erectile dysfunction include: cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) high blood pressure ... More

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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 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) ... More

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