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But it is difficult to be more definitive in evaluating their efficacy, because few studies directly comparing them have been conducted, a common problem with many drugs. Since all four drugs are similarly effective, the answer to which drug is best will depend on other attributes, such as side effects, drug interactions, speed of onset and duration of action. Headache, flushing and upset stomach are the most common side effects. And, in rare cases, all can cause a persistent and sometimes painful erection that will not go down, a condition called priapism that can result in permanent damage if not treated promptly. Drug interactions are largely similar, with the most important interaction being a contraindication to nitrate-containing drugs, such as nitroglycerin, commonly used to treat angina. Time of onset is an important difference between the drugs. While all take effect within an hour, Stendra is the fastest acting, often taking effect within 15 minutes. Duration of action is another important difference between the drugs. Cialis is the longest acting, with a duration of up to 36 hours. Cialis’s long duration means that it can be taken once a day, eliminating the need to take a pill before each sexual encounter. Such once-a-day dosing has been reported to increase sexual self-confidence and spontaneity. Which drug is better depends on your personal situation. For long duration, and perhaps for spontaneity, Cialis may be best. As always, the answer must come from your doctor, who can assess patient-specific factors and help determine which is right for you. The number of men diagnosed with erectile dysfunction has skyrocketed ever since the little blue pill made it ... More

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This condition, known as priapism, is a risk associated with all of these ED drugs. Unlike Viagra and the other PDE5 inhibitors, Cialis is also approved to treat enlarged prostate. Both Viagra and Cialis can be taken 30 minutes before sexual activity. However, Cialis lasts much longer and is noteworthy for the amount of time it remains in your body. You may feel the effects of the drug up to 36 hours after you take it. The fact that it comes in a low-dose (2.5 mg) version also means that Cialis can be taken every day. A daily dose will ensure that the drug’s always in your system. This side effect isn’t associated with any other oral ED drugs. Viagra can take 30 to 60 minutes to work in the body, while Levitra takes 60 minutes. Levitra does have fewer common side effects than Viagra, and it isn’t associated with a rash or muscle aches. While vision changes are considered a common side effect of Viagra, changes to color perception are only a rare side effect of Levitra. Stendra is the newest drug on the market, and no generic version is available for sale yet. The 100-mg and 200-mg doses can be taken as shortly as 15 minutes before sexual activity. 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 buying cialis over the counter lead to ... More

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Risk factors for ED after a prostatectomy – surgical removal of part or all of the prostate. Following a prostatectomy, the risk of erectile dysfunction is influenced by factors including: [12] The skill of the urologist or urological surgeon. The greater their surgical experience and success rate at preserving sexual function, the more likely a given procedure is to conclude with this outcome. Younger men are more likely than older men to keep or regain their erectile abilities. The greater a man’s ability to produce erections before the procedure, the more likely he is to keep or regain it after the procedure. If both bundles of nerves responsible for erections are sufficiently damaged, it may no longer be possible for a man to have spontaneous erections without the aid of devices or medications that assist the bodily process. (For more information about remedies for ED after having a prostatectomy, see treatment.) Diagnosis of erectile dysfunction. The first step in treating ED is getting a diagnosis of the root cause by visiting a doctor, who will typically begin with questions regarding: [13] The symptoms experienced The length of time symptoms have been present General physical and mental health Levels of alcohol and drug intake Whether any other medication is also being taken. It may also be necessary for a person to answer questions about their sex life. These may include: Details of current and past sexual relationships Information about sexual orientation Whether the dysfunction occurs all the time, intermittently or only in certain situations Whether ejaculation is possible Libido, i.e. As narrowed blood vessels are the most common cause of erectile ... More

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Pharmacological properties 5.1 Pharmacodynamic properties 5.2 Pharmacokinetic properties 5.3 Preclinical safety data 6. Pharmaceutical particulars 6.1 List of excipients 6.2 Incompatibilities 6.3 Shelf life 6.4 Special precautions for storage 6.5 Nature and contents of container 6.6 Special precautions for disposal and other handling 7. Date of first authorisation/renewal of the authorisation 10. This information is intended for use by health professionals. Each tablet contains 25 mg, 50 mg or 100 mg of sildenafil (as citrate) Excipient with known effect : Lactose monohydrate. 25 mg: White to off-white, rounded diamond-shaped tablets, of dimensions 9.2 x 6.7 mm, marked ?25? on one side. 50 mg: White to off-white, rounded diamond-shaped tablets, of dimensions 11.2 x 8.1 mm, marked ?50? on one side. 100 mg: White to off-white, rounded diamond-shaped tablets, of dimensions 14.1 x 10.2 mm, marked ?100? on one side. Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. In order for Sildenafil to be effective, sexual stimulation is required. The recommended dose is 50 mg taken as needed approximately one hour before sexual activity. Based on non prescription generic viagra efficacy and tolerability, the dose may be increased to 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day. If Sildenafil is taken with food, the onset of activity may be delayed compared to the fasted state (see section 5.2). Dosage adjustments are not required in elderly patients (? 65 years old). The dosing recommendations described in 'Use in adults' apply to patients ... More

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If all the investigations are ok then ED treatments such as Viagra can help.ED treatments can work in different ways, but the two main routes they take are: improving blood flow to the penis overcoming any performance anxiety you may have. What erectile dysfunction treatment options are there? There are 7 main categories of erectile dysfunction treatment that are proven to work: Erectile dysfunction tablets. Topical treatments (that you apply directly to the penis) Erectile dysfunction exercises. The first-choice treatment option for a lot of people are tablets such as Viagra . These treatments are usually very safe and effective with roughly 75% of men finding they work well. Before taking tablets, and especially if the problem is a new one, you should check your blood pressure, take a diabetes test , and having your medications checked, to ensure this is not the cause of your ED. If your erectile dysfunction is caused by an underlying health problem, or a side effects of your medications, then discussing your options with your doctor may help. What are the different erectile dysfunction tablets? There’s are 4 main types of erectile dysfunction tablets: Sildenafil (used in Viagra, Viagra Connect, and generic Sildenafil) – these are the NHS’s first choice and they’re the most popular. They start working about 30 mins after you take them and last for 4-6 hours. Tadalafil (used in Cialis, Cialis Daily, and generic Tadalafil) – often known as the ‘weekend pill’, tadalafil medications get to work in about 30 mins and can last for up to 36 hours. Vardenafil (used in Levitra and generic Vardenafil) – similar to Viagra, vardenafil medications start after about 30 mins and last ... More

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A generic drug is an exact copy of the active drug in a brand-name medication. 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. ... More

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The first step in the management of ED is a thorough history that includes the following: A physical examination is necessary for every patient, emphasizing the genitourinary, vascular, and neurologic systems. A focused examination entails evaluation of the following: Status of the genitalia and prostate. Abnormalities of the penis (eg, hypospadias, Peyronie plaques) There is a strong correlation between hypertension and ED. There is also a correlation between benign prostatic hyperplasia and ED, though the causality is unclear. Laboratory testing for ED depends on information gathered during the interview; it is necessary for most patients, although not for all. Such testing may include the following: Evaluation of hormonal status (testosterone, serum hormone–binding globulin, luteinizing hormone [LH], prolactin, thyroid-stimulating hormone [TSH]) – Note that the American College of Physicians (ACP) does not recommend for or against routine use of hormonal blood tests or hormonal treatment in ED patients. Screening blood studies (hemoglobin A 1c , serum chemistry panel, lipid profile) Prostate-specific antigen levels, if the patient is a candidate for prostate cancer screening (controversial) Functional tests that may be helpful include the following: Direct injection of prostaglandin E1 (PGE1; alprostadil) into the corpora cavernosa (see the image below) Biothesiometry – Infrequently indicated. Nocturnal penile tumescence testing – Once frequently performed, this is rarely used in current practice, though it can be helpful when the diagnosis is in doubt. Formal neurologic testing – Not needed in the vast majority of ED patients, though it may offer some benefit to ... More

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Examples of drugs used to treat high blood pressure include: If you take a drug for high blood pressure, your doctor might prescribe a dose of Viagra for you that’s lower than the typical dose. If you’re taking a type of blood pressure drug called an alpha-blocker, the extra drop in blood pressure from Viagra could make you feel dizzy or lightheaded. If you’re taking an alpha-blocker, your doctor will recommend a starting dose of 25 mg of Viagra, which is lower than the usual starting dose. Examples of alpha-blocker drugs used for high blood pressure include: If you take one of the drugs listed above, tell your doctor if you feel dizzy or lightheaded, or faint after taking Viagra. You shouldn’t take Viagra with illicit drugs called poppers. Poppers contain nitrate drugs such as amyl nitrate, alkyl nitrate, and butyl nitrate. Taking Viagra with poppers can cause a dangerous drop in your blood pressure that can lead to heart attack or stroke. Viagra hasn’t been tested for use with illicit drugs other than poppers. But it’s possible that taking Viagra with certain other illicit drugs could also have dangerous effects on your heart and blood pressure. Examples of illicit drugs that could have dangerous effects if taken with Viagra include: stimulants, such as cocaine, ecstasy, amphetamines, and speed anabolic steroids. If you’re thinking of using illicit drugs with Viagra, talk with your doctor about whether this price of female viagra is safe for you to do. Certain drugs used to treat benign prostatic hyperplasia (BPH)* can also cause low blood pressure. Taking Viagra with alpha-blockers can cause your blood pressure to drop even lower. This could make you feel dizzy or ... More

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That's why many older lovers move on from intercourse to other pleasures. And if you're no longer having intercourse, erections aren't necessary, so why take a drug? In addition, men don't need erections to have orgasms. You read that right: Given sufficient fondling, a man can have a marvelous orgasm with a semifirm or even flaccid penis. Among men who try erection medications, only half refill their prescriptions. The manufacturers claim the drugs are 70 to 85 percent effective, but research shows their effectiveness to be more in the 50 to 60 percent range; for men with diabetes, heart disease, or high cholesterol or blood pressure, it can be even lower. And wait until you hear how the studies define "effectiveness": We're not talking rock-hard porn-star erections here, but cheap cialis online canadian pharmacy rather any increase in firmness that enables intercourse. That means even drug-fueled erections can be on the soft side, leaving many men feeling disappointed. Bottom line: If you've never tried an erection medication, you're in the majority. But if you use one, you — and your partner — will likely be happiest with one that lasts the longest. For now, according to the latest surveys, that's Cialis. Michael Castleman, publisher of the website GreatSexAfter40.com, writes about sex for AARP. Why long-married couples are splitting up One job where it pays to be in your 60s Affordable Care Act questions? See the AARP home page for deals, savings tips, trivia and more. Viagra (sildenafil) Viagra is a brand-name prescription drug that’s approved to treat erectile dysfunction (ED). With ED, you’re unable to have or maintain an erection. Viagra is approved for this use ... More

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Viagra: Potential for cardiac risk with sexual activity in patients with preexisting cardiovascular disease; therefore, treatment for erectile dysfunction generally should not be instituted in men for whom sexual activity is inadvisable because of their underlying cardiovascular status. May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa. Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy. Revatio: In small, prematurely terminated study of patients with PAH secondary to sickle-cell disease, vaso-occlusive crises requiring hospitalization were more commonly reported by patients who received sildenafil than by those randomized to placebo; effectiveness of sildenafil in PAH secondary to sickle-cell anemia has not been established; the clinical relevance to men treated for erectile dysfunction with sildenafil is not known. Revatio: Not for use in children with PAH; increased mortality with increasing doses (hazard ratio 3.5) was observed in randomized, double-blind, placebo-controlled clinical trial of 234 children (1-17 years) with PAH who had mild-to-moderate symptoms at baseline. Revatio: Epistaxis occurred in 13% of patients with PAH secondary to connective tissue disease (eg, scleroderma); this effect was not seen in idiopathic PAH; incidence was also higher in those receiving concomitant PO vitamin K antagonist therapy (9%) than in those not receiving such therapy (2%) Pregnancy & Lactation. Limited published data from randomized controlled trials, case-controlled trials, and case series do not report a clear association with sildenafil and major birth defects, miscarriage, or ... More

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This reduction resulted in about 90% higher plasma concentrations of sildenafil and the active N-desmethyl metabolite compared to those seen in healthy younger volunteers (18-45 years) 12,8 . Due to age-differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40% 12,8 . 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 29- and 42- times, for male and female rats, respectively, the exposures observed in human males given the Maximum Recommended Human Dose (MRHD) of 100 mg 11,12,13,14,15,16,8,9 . 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 0.6 times the MRHD on a mg/m2 basis 11,12,13,14,15,16,8,9 . Sildenafil was negative in in vitro bacterial and Chinese hamster ovary cell assays to detect mutagenicity, and in vitro human lymphocytes and in vivo mouse micronucleus assays to detect clastogenicity 11,12,13,14,15,16,8,9 . There was no impairment of fertility in rats given sildenafil up to 60 mg/kg/day for 36 days to females and 102 days to males, a dose producing an AUC value of more than 25 times the human male AUC 11,12,13,14,15,16,8,9 . Affected organisms Humans and other mammals Pathways Not Available Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" href="javascript:void(0);"> Lilly's Cialis bites into Viagra's market share. Article Diabetes and psoriasis drugs help Lilly beat forecasts. News Pricing pressure weighs on revenue at ... More

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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 condition itself may lead to anxiety. Psychological treatments can reduce anxiety, increase self-confidence, and improve relationships with sexual partners. Also, these changes may increase the odds that other treatments are effective. Some men find that intense anxiety about sex prevents certain treatments from working. Addressing this anxiety can improve overall results. See a doctor to check for any underlying health issues. ED can be the first sign of diabetes-related nerve damage, cardiovascular disease, or a neurological problem. While the cause of ED may be physical, the condition can still have psychological effects. It may lead to self-consciousness or anxiety, which can make it more difficult to get an erection. A treatment plan may, therefore, include both physical and psychological methods. Adjusting the lifestyle can improve many issues that cause ED, such as diabetes and clogged arteries. Men with underlying health issues should discuss options with their doctors. Lifestyle changes that can help include: using relaxation exercises to manage ED-related stress and control blood pressure exercising to improve blood flow losing weight, when necessary, to lower blood pressure and improve cholesterol and testosterone levels changing the diet, which may especially benefit people with ... More

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Things such as hair pattern can point to hormone problems, which involve the endocrine system. These can include blood counts, urine tests, cholesterol test, and measurements of creatinine and liver enzymes. When low sexual desire is a symptom, checking testosterone in the blood can show problems with the endocrine system. This is used to measure the blood flow in the penis. This is done to help find psychological factors that may be affecting your performance. Treatment for ED is based on the cause of the problem. Some of the treatments that may be used include: Lifestyle changes. These include cutting back on alcohol, quitting smoking, losing weight, and increasing physical activity. You may need to cut back on or change those that may be linked to ED. This may be used to help decrease the stress and anxiety that may be linked to sex. Tell your healthcare provider about all the medicines you are taking. This includes over-the-counter and prescription medicines, vitamins, herbs, and supplements. The medicines used to treat ED can have dangerous interactions with some common medicines. Men should not take these medicines if they have a history of heart attack or stroke, or if they have a bleeding disorder or stomach ulcers. Prescription medicines injected into the penis or put into the urethra. This may improve energy, mood, and increase sexual interest in older men who have low testosterone. It is not advised for men who have normal testosterone levels for their age. That is because there is a risk of prostate enlargement and other side effects. These can be used to create an erection by using a partial vacuum to draw blood into the penis. Then an elastic ring is put ... More

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Stop taking the medication and seek immediate medical attention if any of the following occur: chest pains, an irregular heartbeat, or shortness of breath when starting or following sexual activity (if you have a heart condition) prolonged (longer than 4 hours), painful, or inappropriate erection of penis seizures signs of an allergic reaction (e.g., rash, itching, shortness of breath; swollen face, lips, or throat) signs of bleeding from the lungs (e.g., difficulty breathing, bluish colouring of the lips; and skin, cool, clammy skin) signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort signs of stroke (e.g., sudden or severe headache, sudden loss of coordination, vision changes, sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg) Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication. Are there any other precautions or warnings for this medication? Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication. Alcohol: Consumption of alcohol in large amounts may decrease the ability to get an erection and may also temporarily decrease blood pressure, causing dizziness and fainting. Blood pressure: Tell your doctor if you are taking medications to treat high blood ... More

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I'm in very good condition but was experiencing less than perfect erections. I typically cut a 100mg pill into 4 pieces and take a 25mg piece. For example, eat a normal lunch, come home from work at 5pm, take Viagra just before eating dinner - works for the rest of the evening. For the absolute fastest results, for a little Saturday morning fun, take it right after waking up, wait 15 minutes (time to drink some coffee), and have at it. Vardenafil and tadalafil options for erectile dysfunction. Arnold, MD Associate professor of psychiatry Director, Women’s Health Research Program University of Cincinnati College of Medicine Cincinnati, OH. Two new PDE-5 inhibitors have demonstrated efficacy and tolerability in clinical trials. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil—review of the literature. Cialis (IC351) provides prompt response and extended period of responsiveness for the treatment of men with erectile dysfunction (ED). Earliest time of onset of erections with vardenafil determined in an at-home setting. Chicago, IL: American Urological Association annual meeting, 2003. Minimal time to successful intercourse after sildenafil citrate: results of a randomized, double-blind, placebo-controlled trial. The efficacy and tolerability of vardenafil, a new selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Vardenafil for treatment of men with erectile dysfunction: efficacy and safety in a randomized, double-blind, placebo-controlled trial. Vardenafil, a highly ... More

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GAQ, global assessment question; PDE5I, PDE5 inhibitor; PP, patient preference; PPPQ, physician?rated patient?treatment preference questionnaire; SEP, Sexual Encounter Profile; SIL, sildenafil TAD, tadalafil; TEAE, treatment emergent adverse events; TP, treatment preference; TSS, Treatment Satisfaction Scale; VAR, vardenafil; ITT, intent?to?treat. In the light of the considerations above, the six interventional trials are good, but not ideal, studies, as all of them meet most, but not all of Mulhall’s criteria. Three of the five interventional studies [ 6, 8, 9 ] were open?label studies because of the difficulty in conducting a blind study with these compounds, as there are major differences in their instructions on use. [ 5 ] is reduced by several other shortcomings; it included patients who were not naive to PDE5 inhibitor use, and the comparison of the two compounds was unfair, as tadalafil was given at its regular dose, whereas only the starting dose of sildenafil (50 mg) was given to patients, without the option of titrating to the maximum dose of 100 mg; moreover, the duration of treatment was too short (4 weeks). Thus, the two pivotal patient?preference studies are the double?blind studies by Keitz et al. [ 7 ], which compared tadalafil and sildenafil, and by Rubio?Aurioles et al. In these two studies elaborate measures were taken that put patients in conditions that differed considerably from usual clinical practice. [ 5 ] had an elaborate crossover design; patients were randomized to one of 4 arms (i) tadalafil + tadalafil instructions vs sildenafil + sildenafil instructions; (ii) sildenafil + sildenafil instructions vs tadalafil + tadalafil instructions; (iii) ... More

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