What is erectile dysfunction?

Viagra:Male erectile dysfunction is common and frustrating after the age of forty years. Erectile dysfunction is a cause of misery, relationship difficulties, and significantly reduced quality of life. Sildenafil citrate (Viagra) has shown promising results in recently published clinical trials. Sildenafil is a potent and competitive inhibitor of cGMp specific phosphodiesterase-5, predominant isoenzyme in the human corpus cavernosum.

It is effective in erectile dysfunction of diverse origin, however it requires a patent vascular system to be effective. It is not effective in patients with endocrinal impotence, loss of libido, premature ejaculation or infertility. Its main adverse effects are headache, flushing, dyspepsia, diarrhoea, nasal congestion, indigestion, visual disturbances, dizziness and rash.

Ventricular tachycardia and acute myocardial infraction have been reported in patients of ischemic heart disease after consumption of sildenafil. Six deaths have been reported in patients taking nitrates. In India it is likely to be prescribed by a primary care physician without complete evaluation of patient on complaint of impotence. Hence the ethical question of who should prescribe this drug should be addressed by medical fraternity and proper guidelines formulated to avoid misuse of sildenafil. Phosphodiesterase is distributed in nerve, central nervous system, and systemic vasculature, hence long-term effects of drug on these tissues has to be ascertained. It should be made mandatory to report all adverse drug reactions to ADR monitoring centers. It is a wonder for those who require it, but has potentially dangerous adverse effects and drug interactions and hence is and not a wonder pill for all kinds of impotence.

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What are the possible side effects of Viagra?

Viagra may cause serious side effects including:

  • chest pain or pressure,
  • pain spreading to your jaw or shoulder,
  • nausea,
  • sweating,
  • vision changes,
  • sudden vision loss,
  • an erection that is painful or lasts longer than 4 hours,
  • severe shortness of breath,
  • cough with foamy mucus,
  • ringing in your ears,
  • sudden hearing loss,
  • irregular heartbeat,
  • swelling in your hands, ankles, or feet,
  • seizure (convulsions), and
  • lightheadedness

Get medical help right away, if you have any of the symptoms listed above.

The most common side effects of Viagra include:

  • flushing (warmth, redness, or tingly feeling),
  • headache,
  • dizziness,
  • abnormal vision,
  • blurred vision,
  • changes in the color of your vision,
  • sleep problems (insomnia),
  • runny or stuffy nose,
  • nosebleed,
  • muscle pain,
  • back pain, and
  • upset stomach

Tell the doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Viagra. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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Dosage Information

For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, VIAGRA may be taken anywhere from 30 minutes to 4 hours before sexual activity. The maximum recommended dosing frequency is once per day.

Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg.

Use with Food

VIAGRA may be taken with or without food.

Dosage Adjustments In Specific Situations

VIAGRA was shown to potentiate the hypotensive effects of nitrates and its administration in patients who use nitric oxide donors such as organic nitrates or organic nitrites in any form is therefore contraindicated [see CONTRAINDICATIONS, DRUG INTERACTIONS, and CLINICAL PHARMACOLOGY].

When VIAGRA is co-administered with an alpha-blocker, patients should be stable on alpha-blocker therapy prior to initiating VIAGRA treatment and VIAGRA should be initiated at 25 mg [see WARNINGS AND PRECAUTIONS, DRUG INTERACTIONS, and CLINICAL PHARMACOLOGY].

Dosage Adjustments in Special Populations

Consider a starting dose of 25 mg in patients > 65 years, patients with hepatic impairment (e.g., cirrhosis), and patients with severe renal impairment (creatinine clearance < 30 mL/minute) because administration of VIAGRA in these patients resulted in higher plasma levels of sildenafil [see Use in Specific Populations and CLINICAL PHARMACOLOGY].

Dosage Forms and Strengths

VIAGRA is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to 25 mg, 50 mg, or 100 mg of sildenafil. Tablets are debussed with PFIZER on one side and VGR25, VGR50 or VGR100 on the other to indicate the dosage strengths.

Storage and Handling

VIAGRA (sildenafil citrate) is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to the nominally indicated amount of sildenafil and debossed on the obverse and reverse sides

History

Sildenafil, the chemical name for Viagra, is an artificial compound that was originally synthesized and studied to treat hypertension (high blood pressure) and angina pectoris (a form of cardiovascular disease). Chemists at the Pfizer pharmaceutical company found, however, that while the drug had little effect on angina, it could induce penile erections, typically within 30 to 60 minutes. Seeing the economic opportunity in such a biochemical effect, Pfizer decided to market the drug for impotence. Sildenafil was patented in 1996, and a mere two years later–a stunningly short time compared to other drugs–it was approved by the FDA for use in treating “erectile dysfunction,” the new clinical name for impotence. Though unconfirmed, it is believed the drug was invented by Peter Dunn and Albert Wood.

Viagra’s massive success was practically instantaneous. In the first year alone, the $8-$10 pills yielded about a billion dollars in sales. Viagra’s impact on the pharmaceutical and medical industries, as well as on the public consciousness, was also enormous. Though available by prescription only, Viagra was marketed on television, famously touted by ex-presidential candidate Bob Dole, then in his mid-70s. Such direct-to-consumer marketing was practically unprecedented for prescription drugs (now, sales and marketing account for approximately 30 percent of the pharmaceutical industry’s costs, in some cases more than research and development).

An estimated 30 million men in the United States suffer from erectile dysfunction and a wave of new Viagra competitors, among them Cialis (tadalafil) and Levitra (vardenafil), has blown open the market. Drug companies are now not just targeting older men like Dole, but men in their 30s and 40s, too. As with many drugs, the long-term effects of Viagra on men’s health are still unclear (Viagra does carry warnings for those who suffer from heart trouble), but its popularity shows no signs of slowing.

April 28, 2003 — A new study has found that the impotence drug Viagra could ramp up the sex lives of women who take it, just as it has done for men.

The 12-week study focused on 202 post-menopausal or post-hysterectomy women who complained of female sexual arousal disorder. The women in the group who took Sildenafil — the little blue pill commonly known as Viagra — took notes after each sexual experience, and reported better overall sexual satisfaction compared with those who took a placebo.

Their enhanced sex lives included better arousal, lubrication and orgasm.

The study was conducted by Laura Berman, director of the Berman Center and a professor of OB-GYN and psychiatry at Northwestern University in Chicago, and Dr. Jennifer Berman, director of the Female Sexual Medicine Center at UCLA Medical Center in Los Angeles. The researchers say that the results are preliminary.

“In terms of ability to achieve orgasm, there was a statistically significant movement,” Laura Berman said on ABCNEWS’ Good Morning America.

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“It increases blood flow to the genital area, increases the sensation of warmth, tingling and fullness,” she said.

More than 50 million women experience some type of sexual dysfunction.

Jennifer Berman said it’s important for women to remember that this pill can’t overcome mental and emotional barriers to a satisfying sex life.

“At this point, we can say that women with significant emotional or relationship problems and women that have desire problems related to their interest in being sexual might not be the best candidates,” Jennifer Berman said. “It’s for women who were satisfied with their sexual response at one point and now, for whatever medical reason, are no longer able to respond,” she said.

Increased Blood Flow Theory

Women who suffer from female sexual arousal disorder can experience a variety of symptoms, including lack of “excitement,” vaginal dryness, loss of sensation and sensitivity in the genitals and nipples and low blood flow to the genitals. Women in the study were screened to make sure that psychological or relationship issues were not the cause of the problem.

Since Viagra enhances sexual arousal in men by increasing the blood flow to the penis, the Bermans theorized that the drug could have a similar effect on women, increasing the blood flow to the female genitals and thereby producing better arousal, sensation and lubrication in the genital area.

Women in the study were given doses of 50 milligrams, which was increased to 100 milligrams only once during the study based on how well the lower dose was working, and the women’s tolerance to it. The pill was to be taken prior to sexual activity but no more than once daily.

Each patient had to engage in sexual activity at least once a week and keep a personal log about it. During the course of the study, neither the patients nor the doctors knew which patients were receiving the Viagra. Women taking Viagra reported mild to moderate side effects, including headache, flushing, nausea, and vision symptoms — the same side effects reported by men who take the drug.

How should I take Viagra?

Take one tablet one hour before you plan to have sex. Don’t take more than one tablet in 24 hours. The medicine comes in tablets of 25 mg, 50 mg and 100 mg. Most patients start with 50 mg.

Even if you take Viagra, you still need physical and mental stimulation and desire to have an erection. If your first dose of Viagra doesn’t help, call your doctor. Your doctor may want to change your tablet size.

Can everyone use Viagra?

You shouldn’t use Viagra if you take any of these forms of nitroglycerin or any other nitrates:

Isosorbide mononitrate (brand names: Ismo, Monoket, Imdur)

Isosorbide dinitrate (brand names: Isordil, Sorbitrate)

Sublingual nitroglycerin tablets or spray (brand names: Nitrostat, Nitrolingual Spray)

Transdermal nitroglycerin patches or paste (brand names: Minitran, Nitro-Dur, Transderm-Nitro TTS)

If you use Viagra and get chest pains, be sure to tell the paramedics, nurses or doctors at the hospital how long ago it was that you last took Viagra.

Can everyone use Viagra?

You shouldn’t use Viagra if you take any of these forms of nitroglycerin or any other nitrates:

Isosorbide mononitrate (brand names: Ismo, Monoket, Imdur)

Isosorbide dinitrate (brand names: Isordil, Sorbitrate)

Sublingual nitroglycerin tablets or spray (brand names: Nitrostat, Nitrolingual Spray)

Transdermal nitroglycerin patches or paste (brand names: Minitran, Nitro-Dur, Transderm-Nitro TTS)

If you use Viagra and get chest pains, be sure to tell the paramedics, nurses or doctors at the hospital how long ago it was that you last took Viagra.

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