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Topical sildenafil is currently being studied for the treatment of ED. A phase I pharmacokinetic and safety trial has shown good penetration of topical sildenafil without significant side effects (bit.ly/topical-sildenafil). A phase II proof-of-concept study has been completed, although results have not yet been reported. Various formulations of both topical alprostadil and sildenafil are available through online outlets and compounding pharmacies, although tissue penetration and efficacy are likely variable. While promising, considerable investigation of topical agents is still needed. Stem cells have become an attractive therapy for ED, particularly following prostatectomy, where ED is secondary to cavernosal nerve damage. Stem cells for the treatment of ED have been derived from a number of sources, including adipose tissue, bone marrow, urine, placenta, umbilical vein endothelium, and amniotic fluid. Adipose-derived stem cells are the most studied in ED treatment in the rat model, with several studies showing an improvement in intracavernosal pressure in rats injected with stem cells directly into the corpus cavernosum. Additionally, combination treatment with brain-derived neurotrophic factor (BDNF), PDE-5 inhibitors, and adipose-derived stem cells have suggested a synergistic effect in improving erectile function in the rat model (Tissue Eng Part A 2014; 20:2446-54). However, data examining the therapeutic efficacy and safety of stem cells for treatment of ED in humans are limited, and this therapy remains experimental. Platelets play an important role in inflammation, tissue remodeling, and angiogenesis. The use of autologous platelet-rich plasma (PRP) has been ... More

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Viagra is an oral medication taken in anticipation of sex. It can be taken anywhere between 30 minutes and four hours ahead of sexual activity. Though Viagra can start to take effect and help achieve an erection in just 12 minutes, the medication reaches peak levels in your body after 30–120 minutes (Eardley, 2002). It can last in your body for up to four to five hours, but your age, health, and diet all affect the exact amount of time it will work. Viagra is also most effective when taken on an empty stomach. The most common side effects of Viagra include indigestion, headaches, facial flushing, back pain, and stuffy nose. Although not as common, it can potentially cause priapism, a persistent and painful erection that can last more than four hours. Other serious, but less common, side effects include hearing loss (which can be sudden), severe low blood pressure, and vision loss, which can be in one or both eyes. You should not take Viagra if you have low blood pressure, heart problems such as a history of heart attack or chest pain, or uncontrolled high blood pressure. As mentioned, Viagra is the brand name for sildenafil. “Genuine” Viagra is the medication sold under the brand name, while “generic Viagra” is another term for sildenafil. Sildenafil became available as a generic medication in December of 2017. Until then, only two companies (Pfizer and Teva Pharmaceuticals) could create this medication. Now that more companies can produce it, the price of generic sildenafil has been driven down even lower. Just like the branded version, generic Viagra comes in three doses: 25 mg, 50 mg, and 100 mg. But Viagra isn’t the only brand name prescription medication that uses ... More

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If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced to 10 mg every 72 hours when used as needed or 2.5 mg when used daily in order to avoid side effects from high levels of tadalafil. Rifampin, carbamazepine (Tegretol, Tegretol XR, Equerto, Carbatrol), phenytoin (Dilantin, Dilantin-125), and phenobarbital may decrease blood levels of tadalafil, possibly reducing the effect of tadalafil. Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure. Therefore, tadalafil should not be used with nitrates. Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for treating high blood generic viagra super active pressure or enlargement of the prostate (BPH). Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started. In such situations, tadalafil should be started at the lowest dose. If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose. Combining tadalafil with alpha-blockers for treatment of BPH is not recommended. Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and ... More

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Examples of alpha-blockers that are used to treat BPH include: alfuzosin (Uroxatral) doxazosin (Cardura) tamsulosin (Flomax) silodosin (Rapaflo) terazosin. 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. And if you take one of the drugs listed above, tell your doctor if you feel very dizzy, lightheaded, or faint after taking Viagra. Viagra hasn’t been tested for use with Adderall, so it’s not known what effects the drugs would have if taken together. But that doesn’t mean there wouldn’t be an interaction. Adderall, which contains amphetamine salts, is approved to treat attention deficit hyperactivity disorder (ADHD). Adderall has stimulant effects in your body, and it could cause serious heart-related side effects. Viagra, on the other hand, may cause low blood pressure. So it’s possible that taking it with Adderall could have dangerous effects on your heart or blood pressure. If you take Adderall, ask your doctor if it’s safe for you to take Viagra as well. Viagra hasn’t been tested for use with Xanax, so it’s not known what effects the drugs would have if taken together. But that doesn’t mean there wouldn’t be an interaction. Xanax, which is a benzodiazepine, contains the active drug alprazolam. Xanax can sometimes cause low blood pressure, dizziness, and fainting. So it’s possible that taking it with Xanax could have dangerous effects on your heart or blood pressure. If you take Xanax, ask your doctor if it’s safe for you to take Viagra as well. It’s usually fine to take Viagra with antidepressants. It’s important to note that erectile dysfunction (ED) is a common side ... More

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They work equally well if taken on an empty stomach or after a meal. None produce spontaneous erections—no embarrassing bulges in the supermarket. They enhance firmness only in the context of erotic fondling. And their side effects are very similar: headache (16 percent of users), stomach upset (7 percent), and nasal congestion (4 percent). Important note: Never use erection medications if you’re taking nitroglycerin for angina. But while Cialis clearly trumps Viagra and Levitra, the surprising little secret is how few older men use any of them. Sales are only about half of what pundits predicted when “vitamin V” was first approved. Cornell researchers surveyed 6,291 older men on the subject. Almost half—48 percent—reported some erectile dysfunction. One reason is that, compared with women, men are less willing to take medication. But the main reason is that the drugs enhance intercourse, while older couples generally evolve away from the old in-out toward genital hand massage, oral sex, and vibrator play. Even with drugs, men’s erections may be iffy, and despite lubricant, vaginal dryness and/or atrophy cause many women pain during intercourse. So older lovers who remain sexual generally switch from intercourse toward 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. That’s right, with sufficient fondling, men can have marvelous orgasms with semi-firm or even flaccid penises. Among men who try erection medications, only half refill their prescriptions. The manufacturers claim the drugs are 70 to 85 percent effective, but the research shows effectiveness in ... More

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Younger men’s erectile issues often have mental and emotional causes, says TT Baum, a San Francisco-based sex educator who does hands-on work with clients who struggle with sexual issues. For those men, Hims’ promise of embarrassment-free treatment could seem particularly appealing: If you’re overwhelmed by the idea of talking about your anxiety-induced erectile dysfunction, a pill you order online can feel like an easy out. But that doesn’t address the underlying anxiety — and in some cases, pills may make it worse, making users feel their sexual fulfillment requires medication. A post on the Hims blog does note that erectile dysfunction can have psychological causes that aren’t readily resolved by popping a pill, but you have to search to find this information. Its impact is somewhat lessened by the coupon code for Hims that appears at the top of the page. Also, sildenafil is a prescription medication — one that has side effects. Painful, hours-long erections occasionally land users in the hospital (and, in the worst cases, destroy their ability to ever get an erection again). But headaches, loss of vision, indigestion, and diarrhea are also fairly common; rarer side effects include facial swelling, renal problems, laryngitis, and, perversely, an inability to experience orgasm. Those are just the physical side effects; mental ones can occur, too. Using sildenafil regularly can cause a kind of disconnection, where the erection isn’t tied to the “emotional/psychological arousal state,” but is instead fueled by chemical assistance, Donaghue says. That disconnection can drive an even bigger wedge between men and their emotions, and making users who crave an easy, ... More

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(5.3) Patients should stop VIAGRA and seek prompt medical attention in the event of sudden decrease or loss of hearing (5.4) Caution is advised when VIAGRA is co-administered with alpha-blockers or anti-hypertensives. Concomitant use may lead to hypotension (5.5) Decreased blood pressure, syncope, and prolonged erection may occur at higher sildenafil exposures. In patients taking strong CYP inhibitors, such as ritonavir, sildenafil exposure is increased. Decrease in VIAGRA dosage is recommended (2.4, 5.6) ADVERSE REACTIONS. Most common adverse reactions (? 2%) include headache, flushing, dyspepsia, abnormal vision, nasal congestion, back pain, myalgia, nausea, dizziness and rash (6.1) To report SUSPECTED ADVERSE REACTIONS, contact Pfizer at 1-800-438-1985 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . VIAGRA can potentiate the hypotensive effects of nitrates, alpha blockers, and anti-hypertensives (4.1, 5.5, 7.1, 7.2, 7.3, 12.2) With concomitant use of alpha blockers, initiate VIAGRA at 25 mg dose (2.3) CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, itraconazole, erythromycin): Increase VIAGRA exposure (2.4, 7.4, 12.3) Ritonavir: Do not exceed a maximum single dose of 25 mg in a 48 hour period (2.4, 5.6) Erythromycin sildenafil buy cheap or strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, saquinavir): Consider a starting dose of 25 mg (2.4, 7.4) USE IN SPECIFIC POPULATIONS. Geriatric use: Consider a starting dose of 25 mg (2.5, 8.5) Severe renal impairment: Consider a starting dose of 25 mg (2.5, 8.6) Hepatic impairment: Consider a starting dose of 25 mg (2.5, 8.7) See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling. FULL ... More

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If your erectile dysfunction doesn't respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis. Alprostadil is available as: an injection directly into your penis – this is called an intracavernosal injection a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) – this is called urethral application. You may be trained to correctly inject or insert alprostadil. If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra. Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose. In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men. Alprostadil inserted into the urethra is successful for up to two-thirds of men. Alprostadil should not be used: in men at risk of priapism (a painful erection that lasts for several hours) – for example, those with sickle cell anaemia alongside other erectile dysfunction medications if you have a penile implant or if you have been advised to avoid sexual activity. Urethral application may also not be used in: some men who have anatomical problems with their penis (conditions that affect the physical structure of the penis) men who have infections of their penis, such as balantis (inflammation of the head of the penis) Side effects. Alprostadil can cause some side effects including: changes in your blood pressure dizziness headache pain in your penis ... More

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The common risk factors for ED include the following: Advanced age Cardiovascular disease Hypertension Diabetes mellitus High cholesterol Cigarette smoking Recreational drug use Depression or other psychiatric disorders Pelvic surgery, including radical prostatectomy and colorectal surgery Pelvic radiation, such as for prostate cancer and some colorectal cancers Trauma to the pelvis (pelvic fracture), penis (penile fracture), and perineum. Signs and symptoms of erectile dysfunction addyi purchase may include the following: Penile erection occurs, but the penis does not remain hard enough for completion of sex. Penile erections are not hard enough for penetration. One can still achieve an orgasm and ejaculate with erectile dysfunction. Subscribe to MedicineNet's Men's Health Newsletter. By clicking "Submit," I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time. How do health care professionals diagnose erectile dysfunction? Physicians make a diagnosis of erectile dysfunction in men who complain of troubles having a hard enough erection or a hard erection that does not last long enough. It is important as you talk with your doctor that you be candid in terms of when your troubles started, how bothersome your erectile dysfunction is, how severe it is, and discuss all your medical conditions along with all prescribed and nonprescribed medications that you are taking. Your doctor will ask several questions to determine if your symptoms are suggestive of erectile dysfunction and to assess its severity and possible causes. Your doctor will ... More

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