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VIAGRA BLUNTS EFFECTS OF STRESS ON THE HUMAN HEART.

Johns Hopkins Medicine Office of Corporate Communications Media contact: David March 410-955-1534; dmarch1@jhmi.edu October 24, 2005. VIAGRA BLUNTS EFFECTS OF STRESS ON THE HUMAN HEART. Sildenafil citrate (Viagra), a drug used to treat erectile dysfunction (ED) in millions of men, reduces the stimulatory effects of hormonal stress on the heart by half, according to results of a new study by researchers at Johns Hopkins. While sildenafil is more widely known for helping genital blood vessels expand to maintain an erection and, more recently, as a treatment for pulmonary hypertension, it has been thought to have little direct effect on the human heart. In the heart, sildenafil blunts the strengthened heartbeat caused by chemically induced stress, thereby lessening the excess amount of blood and force used to pump it to the body, according to study senior author and cardiologist David Kass, M.D., a professor at The Johns Hopkins University School of Medicine and its Heart Institute.

“Sildenafil effectively puts a ‘brake’ on chemical stimulation of the heart,” says Kass.

The researchers’ findings, which appear in the journal Circulation online Oct.

24, are believed to be the first confirmation in humans that sildenafil has a direct effect on the heart.

Previous research by Kass and his team showed that sildenafil had such effects in mice, blocking the short-term effects of hormonal stress in the heart. Related studies by the group also showed that sildenafil prevents and reverses the long-term effects in the heart from chronic high blood pressure.

Moreover, Kass adds, the latest Hopkins results confirm that sildenafil helps control heart function only when the heart is under duress, but has little impact under normal conditions.

Separate research from Kass and his team published earlier this year in the journal Nature Medicine showed that, in mice, sildenafil could reverse the negative effects on heart muscle weakened by heart failure and enlargement, a condition called hypertrophy.

“But we had no firm evidence as to whether or how this therapy might work in the human heart.

Our latest research provides firm evidence this drug does indeed have an important impact on the heart.” Thirty-five healthy men and women, with an average age of 30 and no previous signs of coronary artery disease, participated in the six-month study. Within a three-hour timeframe, each participant received two separate injections of dobutamine (5 micrograms per kilogram for five minutes), a synthetic, adrenaline-like chemical that increases heart rate and pumping strength. Between injections, study participants were randomly assigned to a group that was treated with sildenafil (100 milligrams taken orally) or to a group given a sugar pill placebo. All participants were then given the second dobutamine injection to see what effects sildenafil or placebo had on the heart. Measurements of heart function were made before and after each injection.

This included blood pressure readings, electrocardiograms and echocardiograms, as well as blood samples to confirm relatively equal levels of sildenafil and other enzymes. Results showed that each dobutamine injection stimulated heart function, increasing heart rate and the force of each heartbeat used to pump blood throughout the body. “This stimulation is similar to the way the nervous system normally increases heart function when triggered by emotional or exercise stress, or in diseases such as heart failure,” adds Kass.

After the first injection of dobutamine, the force of heart contraction increased by 150 percent in both groups.

And in the placebo group, this increase repeated itself after the second injection. However, in the group treated with sildenafil, the increased heartbeat was slowed by 50 percent, resulting in a smaller increase in blood flow and blood pressure generated by the heart in response to chemical stimulation.

Between injections, heart function was not altered in the sildenafil group, demonstrating the absence of adverse side effects on the resting human heart.

“Knowing more about the effects of sildenafil on heart function will allow for safer evaluation of its use as a treatment for heart problems,” says Kass.

“Until now, it was widely thought that drugs like sildenafil had no effects on the human heart and that its only purpose was vasodilation in the penis and the lungs.

“Our results set the stage for further studies of sildenafil’s immediate and long-term effects on the heart and its ability to modify other neurohormonal and stress stimuli, including adrenaline and hypertension,” he adds.

While the precise biological actions of sildenafil in the heart are not fully understood, the drug is known to work by stopping the action of an enzyme, called phosphodiesterase 5 (PDE5A), the researcher says.

This enzyme is involved in the breakdown of a key molecule, cyclic GMP, which helps control stresses and limit overgrowth in the heart. PDE5A is also the biological pathway blocked in the penis by sildenafil to promote the relaxation of blood vessels and maintain erections. Funding for this study was provided by the National Institutes of Health (NIH), the Peter Belfer Laboratory Foundation and the Bernard Family Foundation. The makers of the drug had no involvement in the design or support of the research. These are external links and will open in a new window.

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Amid the fall-out from US President Donald Trump's announcement on Twitter that transgender people will not be able to serve in the US military, one statistic has been frequently raised to draw attention to the comparatively small estimated costs of transgender healthcare.

It refers to the amount the Pentagon spends on erectile dysfunction medication annually: about $84m (?63m), according to the Military Times newspaper. In contrast, the Rand Corporation think tank estimated last year that gender transition-related health care costs for transgender personnel would increase the military's active duty health budget by $8.4m per year at the most.

But why does the US defence department spend so much on erectile dysfunction drugs?

First, it is worth pointing out that the Military Times' February 2015 report based its figure on 2014 data from the Defense Health Agency.

The spend of $84.2m was for that year, but the newspaper also reported that $294m had been spent on Viagra, Cialis and other such medications since 2011. It pointed out that this cost the equivalent of more than a few fighter jets.

In 2014, some 1.18 million prescriptions were filled, mostly for Viagra.

The answer goes some way in explaining the massive spend.

It is true that some of the erectile dysfunction medication went to active-duty personnel.

But the vast majority went to other groups eligible, including millions of military retirees and their family members.

In fact, around 10 million people in total are estimated to be covered by the Pentagon's healthcare system, which cost $52bn in 2012.

It is well known that erectile dysfunction is more common among older men - which would explain a hefty bill for retired service members. In fact, less than 10% of the prescriptions were for active duty personnel, according to the Military Times.

Still, erectile dysfunction among those currently serving in the US military has been increasing since the wars in Iraq and Afghanistan began. 'Psychological causes' A 2014 study by the Armed Forces Health Surveillance Branch (AFHSB) found that 100,248 cases of erectile dysfunction were diagnosed among active service members between 2004 and 2013, with "annual incidence rates" more than doubling in that time period. Nearly half of all the cases were due to psychological causes, according to the study.

A study published in the Journal of Sexual Medicine in 2015 found that male veterans with post-traumatic stress disorder (PTSD) were "significantly more likely than their civilian counterparts to report erectile dysfunction or other sexual problems", according to the US Department of Veterans Affairs.

One study cited found that 85% of male combat veterans with PTSD report erectile dysfunction, nearly four times the rate among those returning from combat who are not diagnosed with a mental health disorder. In 2008, the Rand Corporation reported that one in five US veterans of the wars in Iraq and Afghanistan were suffering from PTSD or major depression.

However, a key statistic buried in the AFHSB study of active duty personnel between 2004 and 2013 suggests one should be cautious of reading too much into the links between America's recent wars, PTSD and erectile dysfunction in relation to the military's massive spend on Viagra. Personnel who had never been deployed were actually more likely to suffer from erectile dysfunction than their counterparts who had been.

Finally, erectile dysfunction is linked to common conditions, including heart disease, high blood pressure, and diabetes. In 2007, it was estimated that the prevalence of erectile dysfunction among US men was 18%. In summary: it is a common condition, and the US military pays for the healthcare of millions of men, meaning it spends a lot on Viagra and other such drugs.

Levitra (vardenafil hydrochloride) and Viagra (sildenafil) are erectile dysfunction drugs that work by blocking a certain enzyme (phosphodiesterase-PDE5) used to treat erectile dysfunction (impotence).

headache, flushing (warmth or redness in your face, neck, or chest), runny or stuffy nose, stomach upset, heartburn, dizziness, back pain, or nausea. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Common side effects of Viagra include: warmth or redness in the face, neck, or chest, stuffy nose, headaches, stomach pain, upset stomach, nausea, diarrhea, memory problems, back pain, an inability to differentiate between the colors green and blue, loss of hearing, ringing in the ears, and dizziness. Levitra is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.

ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his doctor for help if the condition bothers him.

Levitra may help a man with ED get and keep an erection when he is sexually excited.

Viagra is a prescription medicine used to treat erectile dysfunction (ED). You will not get an erection just by taking this medicine. Viagra helps a man with erectile dysfunction get and keep an erection only when he is sexually excited (stimulated).

It is not known if Viagra is safe and effective in women or children under 18 years of age. Levitra may interact with other medications for erectile dysfunction, conivaptan, imatinib, isoniazid, antidepressants, antibiotics, antifungals, drugs to treat high blood pressure or a prostate disorder, heart or blood pressure medications, or HIV/AIDS medicines. Viagra may interact with other medications for erectile dysfunction, conivaptan, imatinib, isoniazid, antidepressants, antibiotics, antifungals, drugs to treat high blood pressure or a prostate disorder, heart or blood pressure medications, or HIV/AIDS medicines.

Some men can only take a low dose of Levitra because of medical conditions or medicines they take. Your doctor will prescribe the dose that is right for you.

If you are older than 65 or have liver problems, your doctor may start you on a lower dose of Levitra. If you have prostate problems or high blood pressure, for which you take medicines called alpha-blockers, your doctor may start you on a lower dose of Levitra.

If you are taking certain other medicines your doctor may prescribe a lower starting dose and

limit

Take 1 Levitra tablet about 1 hour (60 minutes) before sexual activity.

Some form of sexual stimulation is needed for an erection to happen with Levitra. Do not change your dose of Levitra without talking to your doctor. Your doctor may lower your dose or raise your dose, depending on how your body reacts to Levitra.

Call your doctor or emergency room immediately if you accidentally took more Levitra than prescribed.

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 Do not take Viagra more than 1 time a day.

If you accidentally take too much Viagra, call your doctor or go to the nearest hospital emergency room right away. Viagra, Cialis, Levitra, and Stendra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names: sildenafil (Viagra) tadalafil (Cialis) vardenafil (Levitra) avanafil (Stendra) About 30 million American men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many men turn to these oral ED medications.

However, there are also some key differences, such as when you take them, how long they work, and what their side effects are.

Viagra, Cialis, Levitra, and Stendra are all in a class of drugs called PDE5 inhibitors.

These drugs work by blocking an enzyme called phosphodiesterase type 5. They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax.

Relaxed muscles allow blood to flow freely so that when you’re aroused, you can get an erection. It also helps you maintain the erection long enough to have sex. Here are the basic features of each of these drugs: Brand name Viagra Cialis Levitra Stendra What’s the generic name of this drug?

sildenafil tadalafil vardenafil avanafil Is a generic version available? oral tablet oral tablet oral tablet oral tablet What strengths does it come in? 25 mg, 50 mg, 100 mg 2.5 mg, 5 mg, 10 mg, 20 mg 5 mg, 10 mg, 20 mg 50 mg, 100 mg, 200 mg What’s the typical dosage? 50 mg 10 mg (when used as needed); 2.5 mg (when used daily) 10 mg; 5 mg (for men 65 years old and up) 100 mg When do I take it? 30-60 minutes before sex 30 minutes before sex 60 minutes before sex 15 minutes before sex (for 100 mg and 200 mg); 30 minutes before sex (for 50 mg) How long does it work? 4 hours up to 36 hours 4-5 hours 6 hours How do I store it?

Around room temperature, between 68°F to 77°F (20°C to 25°C) At 25°C (77°F) At 25°C (77°F) Around room temperature, between 68°F to 77°F (20°C to 25°C) The drugs are available in a variety of doses, ranging from 2.5 milligrams (mg) to 200 mg.

However, taking these drugs after eating a high-fat meal does slow the rate of absorption.

Most of them stay in your bloodstream for about four to five hours.

Cialis is the exception, as it remains in your bloodstream for up to 36 hours.

The length of time a drug stays in your system may be important if you’re taking other medications. You shouldn’t take any of these drugs more than once in a 24-hour period.

Viagra, Cialis, Levitra, and Stendra are usually stocked at most pharmacies. In general, most health insurance companies won’t cover their costs. However, if you have certain medical conditions, your health plan may pay for the drug with prior authorization.

The exact price you pay for any drug will depend on your insurance plan and your pharmacy. Generic versions of Viagra, Cialis, Levitra can cost half as much as their brand-name counterparts, if not less. The side effects of these medications are mostly similar.

Below are the drugs’ most common side effects, according to their manufacturers: Side effect Viagra Cialis Levitra Stendra Stuffy or runny nose x x x x Headache x x x x Dizziness x x Upset stomach x x x Nausea x Indigestion x x Vision changes x Rash x Flushing x x x x Back pain x x x x Pain in the limbs x Muscle aches x x Sore throat x.

Tell your doctor if you have any side effects that linger and don’t go away on their viagra 1 tablet price own.

If you have an erection that lasts longer than four hours, call your doctor right away. 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 viagra online overnight shipping 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 lead to similar interactions.

All four of these drugs interact with: nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat) certain blood pressure drugs, such as calcium channel blockers alpha blockers, which can treat high blood pressure or an enlarged prostate certain pulmonary hypertension drugs, such as riociguat (Adempas) protease inhibitors, a class of HIV drugs antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox) antibacterial drugs, such as clarithromycin (Biaxin) Drinking excessive amounts of alcohol while on any PDE5 inhibitor should be avoided, and you shouldn’t combine different ED drugs.

Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital.

For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.

In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors.

In other cases, adjusting your dosage of the medication can reduce the possibility of drug interactions while using PDE5 inhibitors.

If you have ED, talk to your doctor about Viagra, Cialis, Levitra, and Stendra.

Tell your doctor if you take other over-the-counter or prescription drugs or supplements.

Be sure to mention all other health conditions you have. When used correctly, each of these drugs has been shown to help men with ED.