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HOW TO USE: This drug is taken by mouth as needed between four hours and one-half hour before sexual activity (about one hour before is most effective). Take only as directed, usually once daily as needed. Sildenafil works along with sexual stimulation to help achieve an erection. SIDE EFFECTS: Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness might occur. If these effects persist or worsen, notify your doctor promptly. Unlikely but report promptly: painful or other urination problems, vision problems, skin rash. Very unlikely but report promptly: chest pain, fainting, foot or ankle swelling. If you experience a painful or prolonged erection (lasting longer than 4 hours), stop using this drug and seek immediate medical attention. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Before using this drug, tell your doctor your medical history, including: allergies (especially drug allergies), penis conditions such as fibrosis/scarring (e.g., Peyronie's disease), history of painful/prolonged erection (priapism), sickle cell anemia, blood system cancers (such as leukemia or myeloma), eye problems (retina diseases), kidney or liver disease, bleeding disorders, active stomach ulcers, heart disease, stroke, very high or low blood pressure. Limit alcohol intake, as it may aggravate side effects of this drug. Since this drug may cause dizziness, caution is advised when performing tasks requiring alertness (e.g., driving). To avoid dizziness and lightheadedness when rising from a seated or lying position, get up slowly. This drug is not to be used in women or children. The elderly may be more sensitive to the side effects of this drug, therefore caution is advised in this group. DRUG INTERACTIONS: Tell your doctor of all nonprescription and prescription medication you may use, especially of: nitrate medications (e.g., nitroglycerin, isosorbide dinitrate), nitroprusside (any "nitric oxide donor" medicines), cimetidine, erythromycin, azole antifungals (e.g., itraconazole, ketoconazole), mibefradil, rifamycins (e.g., rifampin), high blood pressure medicines, certain HIV protease inhibitors (such as saquinavir, ritonavir, amprenavir), delavirdine. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include severe dizziness, fainting, or prolonged erection. NOTES: Do not share this medication with others, since they may have a problem that is not effectively treated by this drug. Use of this drug does not protect against sexually transmitted diseases (e.g., HIV, Hepatitis B, gonorrhea, syphilis). MISSED DOSE: Not applicable. STORAGE: Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from light and moisture. VIAGRA is prescribed to treat erectile dysfunction (ED). If you take any medicines that have nitrates in them (like nitroglycerin for chest pain)—every day or even once in a while—you should NOT take VIAGRA. Discuss your general health status with your doctor to ensure that you are healthy enough to engage in sexual activity. If you experience chest pain, nausea, or any other discomforts during sex, seek immediate medical help. The most common side effects of VIAGRA are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including VIAGRA) reported a sudden decrease or loss of vision. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including VIAGRA, and call a doctor right away. Although erections lasting for more than 4 hours may occur rarely with all ED treatments in this drug class, to avoid long-term injuries, it is important to seek immediate medical help. If you are older than age 65, or have serious liver or kidney problems, your doctor may start you at the lowest dose (25 mg) of VIAGRA. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend a 25-mg dose and may limit you to a maximum single dose of 25 mg of VIAGRA in a 48-hour period. 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 VIAGRA. Remember to protect yourself and your partner from sexually transmitted diseases. VIAGRA is one of many options for treating ED that you and your doctor can consider. Please see full prescribing information for VIAGRA (25-mg, 50-mg, 100-mg) tablets. Back to top Pfizer is a licensee of the TRUSTe Privacy Program. Copyright © 2001-2006 Pfizer Inc. All rights reserved. Terms of Use Privacy Policy Contact Us Site Map The blue diamond tablet shape is a registered trademark of Pfizer Inc. What are you waiting for?™ is a trademark of Pfizer Inc. The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided in this site is intended for residents of the United States. The products discussed herein may have different product labeling in different countries. Last updated: August 2, 2006 VIAGRA is prescribed to treat erectile dysfunction (ED). If you take any medicines that have nitrates in them (like nitroglycerin for chest pain)—every day or even once in a while—you should NOT take VIAGRA. Discuss your general health status with your doctor to ensure that you are healthy enough to engage in sexual activity. If you experience chest pain, nausea, or any other discomforts during sex, seek immediate medical help. The most common side effects of VIAGRA are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including VIAGRA) reported a sudden decrease or loss of vision. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including VIAGRA, and call a doctor right away. Although erections lasting for more than 4 hours may occur rarely with all ED treatments in this drug class, to avoid long-term injuries, it is important to seek immediate medical help. If you are older than age 65, or have serious liver or kidney problems, your doctor may start you at the lowest dose (25 mg) of VIAGRA. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend a 25-mg dose and may limit you to a maximum single dose of 25 mg of VIAGRA in a 48-hour period. 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 VIAGRA. Remember to protect yourself and your partner from sexually transmitted diseases. VIAGRA is one of many options for treating ED that you and your doctor can consider. Why VIAGRA Why VIAGRA? Because that look she gives is only meant for you. Because an empty nest is the chance to fall in love all over again. Because reading the Sunday paper doesn’t take all day. If you have ED, you’ve already got plenty of reasons to choose VIAGRA. But here are some more that you should know about. The benefits of VIAGRA Helps most men with ED achieve harder erections Helps most men with ED maintain an erection during sex Can work in as little as 14 minutes* Partners were satisfied with how well VIAGRA improved erections of their men with ED† Has a proven safety record Works for men with ED who also have a wide range of health issues * Based on a study with 228 men who had had success with VIAGRA in the past, each taking 100 mg at least 2 hours after eating. For most men, VIAGRA works in just 30 minutes. † Results from a study with 37 partners of men with ED who took VIAGRA 25-mg, 50-mg, and 100-mg doses. VIAGRA is prescribed to treat erectile dysfunction (ED). If you take any medicines that have nitrates in them (like nitroglycerin for chest pain)—every day or even once in a while—you should NOT take VIAGRA. Discuss your general health status with your doctor to ensure that you are healthy enough to engage in sexual activity. If you experience chest pain, nausea, or any other discomforts during sex, seek immediate medical help. The most common side effects of VIAGRA are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including VIAGRA) reported a sudden decrease or loss of vision. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including VIAGRA, and call a doctor right away. Although erections lasting for more than 4 hours may occur rarely with all ED treatments in this drug class, to avoid long-term injuries, it is important to seek immediate medical help. If you are older than age 65, or have serious liver or kidney problems, your doctor may start you at the lowest dose (25 mg) of VIAGRA. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend a 25-mg dose and may limit you to a maximum single dose of 25 mg of VIAGRA in a 48-hour period. 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 VIAGRA. Remember to protect yourself and your partner from sexually transmitted diseases. VIAGRA is one of many options for treating ED that you and your doctor can consider. Please see full prescribing information for VIAGRA (25-mg, 50-mg, 100-mg) tablets. Back to top Pfizer is a licensee of the TRUSTe Privacy Program. Copyright © 2001-2006 Pfizer Inc. All rights reserved. Terms of Use Privacy Policy Contact Us Site Map The blue diamond tablet shape is a registered trademark of Pfizer Inc. What are you waiting for?™ is a trademark of Pfizer Inc. The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided in this site is intended for residents of the United States. The products discussed herein may have different product labeling in different countries. Last updated: August 2, 2006 VIAGRA is prescribed to treat erectile dysfunction (ED). If you take any medicines that have nitrates in them (like nitroglycerin for chest pain)—every day or even once in a while—you should NOT take VIAGRA. Discuss your general health status with your doctor to ensure that you are healthy enough to engage in sexual activity. If you experience chest pain, nausea, or any other discomforts during sex, seek immediate medical help. The most common side effects of VIAGRA are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including VIAGRA) reported a sudden decrease or loss of vision. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including VIAGRA, and call a doctor right away. Although erections lasting for more than 4 hours may occur rarely with all ED treatments in this drug class, to avoid long-term injuries, it is important to seek immediate medical help. If you are older than age 65, or have serious liver or kidney problems, your doctor may start you at the lowest dose (25 mg) of VIAGRA. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend a 25-mg dose and may limit you to a maximum single dose of 25 mg of VIAGRA in a 48-hour period. 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 VIAGRA. Remember to protect yourself and your partner from sexually transmitted diseases. VIAGRA is one of many options for treating ED that you and your doctor can consider. Please see full prescribing information for VIAGRA (25-mg, 50-mg, 100-mg) tablets. Back to top Pfizer is a licensee of the TRUSTe Privacy Program. sildenafil Sildenafil relaja los mъsculos y permite el aumento de circulaciуn de la sangre en lugares especнficos en el cuerpo. Viagra Sildenafil relaja los mъsculos y permite el aumento de circulaciуn de la sangre en lugares especнficos en el cuerpo. Revatio Sildenafil relaja los mъsculos y permite el aumento de circulaciуn de la sangre en lugares especнficos en el cuerpo. Related Documents The results below are produced using fuzzy logic and may be relevant to your search as they contain a word, or words related to your search term. Rescriptor Delavirdine es un medicamento antiviral. Se encuentra en la categorнa de medicinas contra el virus de inmunodeficiencia humana (VIH), llamadas inhibid... Nitroglyn E-R La nitroglycerin se encuentra clasificada en la clase de medicamento llamado nitratos. La nitroglycerin dilata (ensancha) los vasos sanguнneos (arteri... Tadalafil Tadalafil relaja los mъsculos dentro del pene. Esto permite que haya mбs flujo de sangre al pene, lo cual es necesario para alcanzar a tener y mantene... Nitrostat La nitroglycerin se encuentra clasificada en la clase de medicamento llamado nitratos. La nitroglycerin dilata (ensancha) los vasos sanguнneos (arteri... delavirdine Delavirdine es un medicamento antiviral. Se encuentra en la categorнa de medicinas contra el virus de inmunodeficiencia humana (VIH), llamadas inhibid... Nitrogard La nitroglycerin se encuentra clasificada en la clase de medicamento llamado nitratos. La nitroglycerin dilata (ensancha) los vasos sanguнneos (arteri... Nitro-Time La nitroglycerin se encuentra clasificada en la clase de medicamento llamado nitratos. La nitroglycerin dilata (ensancha) los vasos sanguнneos (arteri... Nitrocot La nitroglycerin se encuentra clasificada en la clase de medicamento llamado nitratos. La nitroglycerin dilata (ensancha) los vasos sanguнneos (arteri... Nitrolingual La nitroglycerin se encuentra clasificada en la clase de medicamento llamado nitratos. La nitroglycerin dilata (ensancha) los vasos sanguнneos (arteri... 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USA pharmacy. www.medsforcost.com (sponsored listing) Next Results >> Viagra 100mg (10 pills) 93.98 Viagra 100mg (20 pills) 184.98 Viagra 100mg (3 pills) 29.98 Viagra 100mg (30 pills) 272.98 Viagra 100mg (4 pills) 39.98 Viagra 100mg (40 pills) 359.98 Viagra 100mg (5 pills) 48.98 Viagra 100mg (50 pills) 450.98 Viagra 100mg (60 pills) 539.98 Viagra 50mg (10 pills) 94.98 Viagra 50mg (15 pills) 139.98 Viagra 50mg (20 pills) 184.98 Viagra 50mg (30 pills) 272.98 Viagra 50mg (60 pills) 539.98 IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. SILDENAFIL - ORAL (sill-DEN-uh-fil) COMMON BRAND NAME(S): Viagra USES: This medication is used to treat male sexual function problems (erection problems). HOW TO USE: This drug is taken by mouth as needed between four hours and one-half hour before sexual activity (about one hour before is most effective). Take only as directed, usually once daily as needed. Sildenafil works along with sexual stimulation to help achieve an erection. SIDE EFFECTS: Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness might occur. If these effects persist or worsen, notify your doctor promptly. Unlikely but report promptly: painful or other urination problems, vision problems, skin rash. Very unlikely but report promptly: chest pain, fainting, foot or ankle swelling. If you experience a painful or prolonged erection (lasting longer than 4 hours), stop using this drug and seek immediate medical attention. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Before using this drug, tell your doctor your medical history, including: allergies (especially drug allergies), penis conditions such as fibrosis/scarring (e.g., Peyronie's disease), history of painful/prolonged erection (priapism), sickle cell anemia, blood system cancers (such as leukemia or myeloma), eye problems (retina diseases), kidney or liver disease, bleeding disorders, active stomach ulcers, heart disease, stroke, very high or low blood pressure. Limit alcohol intake, as it may aggravate side effects of this drug. Since this drug may cause dizziness, caution is advised when performing tasks requiring alertness (e.g., driving). To avoid dizziness and lightheadedness when rising from a seated or lying position, get up slowly. This drug is not to be used in women or children. The elderly may be more sensitive to the side effects of this drug, therefore caution is advised in this group. DRUG INTERACTIONS: Tell your doctor of all nonprescription and prescription medication you may use, especially of: nitrate medications (e.g., nitroglycerin, isosorbide dinitrate), nitroprusside (any "nitric oxide donor" medicines), cimetidine, erythromycin, azole antifungals (e.g., itraconazole, ketoconazole), mibefradil, rifamycins (e.g., rifampin), high blood pressure medicines, certain HIV protease inhibitors (such as saquinavir, ritonavir, amprenavir), delavirdine. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include severe dizziness, fainting, or prolonged erection. NOTES: Do not share this medication with others, since they may have a problem that is not effectively treated by this drug. Use of this drug does not protect against sexually transmitted diseases (e.g., HIV, Hepatitis B, gonorrhea, syphilis). MISSED DOSE: Not applicable. STORAGE: Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from light and moisture How Zenerx® Works Increases Blood Flow To The Penis Like Viagra® Plus 9 Benefits Critical To Top Sexual Health Causing Large, Hard Erections & Strong Libido An erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed. Viagra® works by increasing the body's effectiveness at using Nitric Oxide a key chemical required to produce an erection. Viagra® is designed to treat ED just this one way. While Viagra® is a very good drug treatment for many men with ED, doctors know that there are many different causes of ED, small weak erections or a weak libido. The herbal ingredients in Zenerx's unique formulation work like Viagra® (PDE-5 Inhibitors) plus have multi-faceted positive effects demonstrated in medical studies on your erection, blood flow and key areas of your overall health required to have large strong erections (see ingredients for more details). They provide nutrients to help all aspects of male sexual performance (not just increase blood flow to the penis) as well as aid prevention of many conditions that can cause ED and weak male sexual performance. All without nasty drug side effects. "I tried viagra and other drugs and they all had side effects that I could'nt deal with such as headaches and dizzyness. So far everything has been great with Zenerx." - D. S. The Ingredients in Zenerx Provide Multiple Benefits To Help Every Aspect of Total Male Sexual Performance and Health Ingredients Benefit Effect on Sexual Performance Viagra® Zenerx Better usage of Nitric Oxide A key chemical required to produce a large erection and increase blood flow to the penis Increased testosterone Required for a healthy libido, strong performance, faster recovery, greater strength and more energy Decreases prolactin High levels of prolactin can cause erectile dysfunction Increase circulatory health Required for strong blood flow to the Penis Increase sperm production and motility Creates large, strong ejaculations and healthy sperm Increase skin tissue and muscle health Increased sensitivity, control, stamina and minimal recovery time Increased health of the nervous system Required for maximum sensitivity, sensation and pleasure Calms and sharpens the mind Reduce performance stress and anxiety, creates increased confidence and positive mental state Protects against diabetes, hypertension, atherosclerosis, & heart disease These medical conditions are often the cause of impotence, erectile dysfunction or weak performance Anti-oxidant and Human Growth Hormone (HGH) stimulator Creates "Fountain of Youth Effect", regenerates and protects the body providing more energy and stamina These statements have not been evaluated by the Food and Drug Administration and are for informational purposes only and should not be considered medical advice. Always consult a doctor for medical advice. This Product is not intended to diagnose, treat, cure, or prevent any disease. We understand the Critical IMPORTANCE of your overall health and all aspects that affect your sexual performance. That's why we use only the finest, safe, all natural ingredients that not only help your erection size and quality, your sex drive but promote your overall health in the critical areas that promote healthy sex life and performance. You and your lady deserve more than just an erection. PATRICIA BLOOM, MD: Because the patient may have diabetes or hypertension or be taking a medication that they just never told their doctor about, but which is causing their impotence. DAVID KAUFMAN, MD: Or atherosclerosis, or heart disease. I can't tell you how many men I've diagnosed for impotence who were then set on the road to diagnosis for very serious medical conditions. Everything really needs to be looked at. Source: ABC Special Report; Viagra® Side Effects: Not Just a Medical Problem We recommend that you use Zenerx as part of an overall healthy life style. The Immediate and Long-Term "Zenerx Effect" For immediate results take Zenerx 30 - 45 minutes before sex. Your most noticeable gains begin in weeks 2 - 3 after you begin to use Zenerx daily. Take Zenerx once a day just like your vitamins. The long-term effects are cumulative over time. By month 4 in many cases you can reduce your intake of Zenerx or stop taking it all together. Because everyone is different your results will vary. Weeks 1 - 4 Your erection will be larger, fuller and last longer. You begin to notice increased libido and sexual stamina. As you and your partner notice a bigger and bigger difference your confidence will increase. Weeks 5 - 8 You experience a more noticeable, profound increase in erection size, girth, strength, stamina, and overall control. You are more confident and in command, your sex partner notices a drastic difference in your performance. Weeks 9+ You are amazed at the large, hard, long lasting erections, tremendously heightened sensations and maximum pleasure. You are now having the best sex of you life while feeling more confident than ever before. The vital nutrients necessary for lasting peak sexual performance and enhanced health supplied by ZenerxTM are now producing maximum results. You can increase your sexual performance with natural Zenerx™ the results are backed by our 100% RISK FREE Money-back Guarantee. You Deserve Only The Best! Now is The Time To Say Goodbye to Erectile Dysfunction, Low Libido, Small Size and Mediocre Performance Forever! "Viagra & The Most Popular Herbal Impotence Treatments Compared" (Viagra, Orexis, VigRx Vipra, Zenerx) One of the most asked questions about impotence... Finally Answered! Question: "Do natural herbal remedies really work like Viagra and if so which ones should I use." This is a really important question for men all over world considering; Over 30 million men have impotence Prescription drug costs are sky-high The Increased health concerns regarding the use of prescription drugs Greater understanding of the importance of overall health Worldwide evidence supporting the effectiveness of herbal treatments for many medical conditions is greater than ever. Even medical doctors, typically resistant to herbal and naturopathic healing, now endorse natural formulas for male impotence and sexual enhancement. Herbal supplements are used by 150 million Americans to treat medical conditions and promote health Let's take a look at how these products do the job, compare with Viagra and what makes them effective for hundreds of thousands of men. Quality impotence/enhancement pills contain a number of natural ingredients that come from around the world, with proven anecdotal records of success in increasing libido, empowering sexual drive and function, and creating greater stamina and erection hardness. However, in researching this article we focused on ingredients that produce male impotence results backed by scientific research. In our quest to find the answer, we scoured medical research to find any side by side human studies comparing Viagra to other commonly used herbs or herbal supplement products. Unfortunately, we were unable to find any side by side studies. Next we reviewed impotence research studies for; The overall effect various herbal ingredients had on male impotence If an herb has a demonstrated effect as a PDE-5 inhibitor (Viagra, Cialis & Levitra are PDE-5 Inhibitors). If an herb facilitated the effect of nitric oxide which is necessary for an erection (PDE-5 inhibitors facilitate the effect of Nitric Oxide). The effect various herbs had on specific body functions that are required to produce a strong, firm erection and a strong sex drive. (i.e. circulatory, vascular, nervous, endocrine system, muscular system) We found research studies reported by well respected Institutes: Sloan-Kettering Cancer Institute; Institute of Pharmacology, Toxicology and Pharmacy, Munich, Germany; University of Peking; National University of Mexico; and others that demonstrate the positive effect that the proper herbal ingredients provide treating impotence. How Viagra Works During sexual excitation the erection is mediated by nitric oxide released from nerve endings close to the blood vessels of the penis. Relaxation of these vessels causes blood to pool producing an erection. Viagra works by inhibiting the breakdown of nitric oxide and thus enhances its effect. Summary of Viagra Compared to Herbal Treatments (Read Findings For Details) Criteria Viagra Herbal Formula's How often is it taken? 1 tablet 30 minutes prior to sex. 1 or 2 times daily like vitamins depending on ingredient or formulation. Enhances the body's use of nitric oxide Very effective and specifically design to do only this. Effective but depends on the actual herb in each formulation. Immediate Effect Effect typically happens in 30 - 45 minutes. Men will have an increased ability to have an erection when aroused. Viagra immediate effect tends to be more potent in the short term. Reported as 45 minutes to 1 1/2 hour depending on herb. Men will have an increased ability to have an erection when aroused. Typically full impotence benefits are achieved over time. Long term Effect Lasts 24 hours no long term positive effect reported. The effects are typically cumulative and the greatest benefit happen over extended daily use in most instances 4 weeks Other Benefits That Help Treat Impotence No other physical benefits Depending on the herb benefits helping impotence can vary and include increased cardiovascular health, increased testosterone, Side Effects Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness, painful or other urination problems, vision problems, skin rash. Should not be used if you are using and M.A.O. inhibitors. Depending on the ingredient No side effects or very few minor side effects. Typical 4 Month Cost $480 $120 - $226 Summary of Popular Herbal Products Containing Impotence Effective Herbs Described in Findings Herb Orexis(2) Vig RX(3) Vipra(2) Zenerx(4) Shilajit (1) Horny Goat Weed (1) Allium Sativum (1) Ashwagandha Mucuna Pruriens Tribulus Terrestris Tongkat Ali (1) Herb has demonstrated Nitric Oxide enhancement effect as Viagra, Cialis, Levitra. (2) Even though Orexis and Vipra ingredients provide positive benefits for impotence they also contain Yohimbe which is potentially dangerous thus we do not recommend either product. (3) VigRX contains safe ingredients. However. in our research we have found a issues which give us concern over their business practices. They have a high number of complaints files with the Better Business Bureau A class action lawsuit has been filed because they do not honor their product guarantee, They are a foreign company using foreign credit card processor. This decreases the likelihood of ever collecting on their guarantee and increases credit card security concerns. All of which make purchasing VigRX a riskier proposition than from any of the other manufacturers in this review. (4) Out of the 4 herbal supplements Zenerx is our recommended choice. Click Here For Product Information Findings Ingredients That Enhance Nitric Oxides Effect Like Viagra If you are looking for herbal alternatives to Viagra here are three herbs that you should look for that have a demonstrated effect on the body's Nitric Oxide usage like Viagra. Horny Goat Weed Horny goat weed contains a prominent flavonoid called icariin. Icariin is a cGMP-specific PDE5 inhibitor like Viagra, Cialis and Levitra. This was demonstrated in a 1984 University of Peking study which concluded: "Icariin is a cGMP-specific PDE5 inhibitor that can be developed into an oral effective agent for the treatment of ED." Horny goat weed has been used for for over 2000 years as an sexual and reproductive tonic. It's acts in multiple ways to increase erection ability, size, and fullness. Besides it's PDE-5 inhibitor characteristics it also has positive effects on the endocrine system functioning as an adaptogen by increasing levels of epinephrine, norepinephrine, serotonin, and dopamine when they are low - promoting energy, but reduces cortisol levels when they are elevated (an anti-stress effect). High stress conditions, increase cortisol levels causing fatigue and depressing sex drive. It also helps restore low levels of both testosterone and thyroid hormone back to normal - improving sex drive. Allium Sativum (Garlic) Yes, Good old garlic. In two different 1998 studies from the National University of Mexico and one from the Institute of Pharmacology, Toxicology and Pharmacy, Munich, Germany to Garlic was show "activate nitric oxide synthase" or enhances the nervous systems ability to react to nitric oxide. Also there are multiple studies compiled at the Sloan-Kettering Cancer Institute which demonstrate Garlic’s assistance in both preventing and assisting in curing several medical conditions which are often the cause of ED. These include high blood pressure, heart disease, hypertension and artherosclerosis. Shilajit Studies in India showed that Shilajit provided protection to methacrylate against hydroxyl radical induced polymerization and acted as a reversible nitric oxide-captodative agent. These findings are consistent with the therapeutic uses of Shilajit against oxidative stress and geriatric complaints of erectile dysfunction. Herbal Nutrients That Promote All Aspects of Male Health & Naturally Treat Many of The Conditions That Cause ED There are multiple causes of sexual dysfunction and low sex drive which may range from mild (low sex drive, weak erections, lack of energy, slow and weak ejaculation) to severe (total inability to achieve erection and complete lack of sexual desire). These include: Cardiovascular Renal or urological Nutritional (malnutrition, vitamin deficiency) Endocrine (hormonal, i.e. low testosterone or high prolactin are causes Impotence) Neurological Psychological (stress, anxiety, etc.) Pharmacological (alcohol, smoking, recreational and prescription drugs) Environmental toxins (lead, herbicides) General systemic health problems By increasing your health in the above areas you are often able resolve sexual dysfunction issues. This is perhaps where the greatest benefit that natural herbal supplements provide to a mans total sexual performance. Four Herbs Shown to Be Highly Effective Enhancing Libido & Treating Conditions That Cause Impotence Ashwagandha Here is what the Sloan-Kettering Cancer Center had to say in their Ashwagandha Clinical Summary. "It (Ashwagandha) is also used as a general tonic, to increase energy and improve health and longevity... Ashwagandha has been shown to exhibit antioxidant effects in the brain and to have a tranquilizing effect on the central nervous system in animals... Human study's suggest Ashwagandha may promote growth in children and improve hemoglobin concentration, red blood cell count and sexual performance in adults." Mucuna Pruriens Mucuna Pruriens increases testosterone, stimulates the production of human growth hormone and acts as a prolactin inhibitor. Increased levels of prolactin are considered responsible for up to 70% of erection failure in males. In 2002 a U.S. patent was filed on the use of mucuna pruriens to stimulate the release of growth hormone in humans. Studies in this patent showed that the high levels of L-dopa in the mucuna seed are converted to dopamine which stimulates the release of growth hormone by the pituitary gland. L-dopa and dopamine are also effective prolactin inhibitors. In one another study, Mucuna Pruriens was taken by 56 human males and resulted in improved erection, duration of coitus, and post-coital satisfaction after only four weeks of treatment. It also showed fertility promoting and spermatogenic effects in men, improving sperm count and motility. Tribulus Terrestris Tribulus is a natural testosterone enhancer and also said to be an excellent circulatory system tonic and can help build muscles and strength. Clinical studies on the sexual activity-enhancing effect of tribulus have shown the herb to contain protodioscin, a saponin constituent, improving libido in men with impotence due to various causes; libido in women with menopausal symptoms; and sperm motility in infertile and subfertile men. In another study involving 59 men, ages 22-67, suffering from a range of sexual dysfunctions. An increase of sexual desire and fantasies, as well as sexual self-confidence, were reported in almost all of the patients. The subjective experience of pleasure, joy and satisfaction was reported in 80% of the men; erection improved in over 75% of the men; and the duration of intercourse before ejaculation was prolonged in 25% of the men. Tongkat Ali (Eurycoma longfolia) Eurycoma longifolia tree root (long jack root) is a traditional remedy for fatigue, loss of sexual desire, and impotence used for centuries in Malaysia. This amazing plant has only recently been recognized in the west for it's potency helping sexual performance issues. The bioactive Glygopeptide compounds in Tongkat ali are shown to increase free testosterone and decrease SHBG levels in human clinical trials. Both effects assist a mans erection ability, performance and sex drive. In the study by Ismail Tamby, MD, head of the Human Reproductive Specialist Center in Kuala Lumpur, 90% of the men given Tongkat ali extract (100 to 1) reported a boost in their libido and 73.3% reported improved sexual function. In human studies results occur after taking Tongkat Ali for more than one week. As an added benefit Tongkat Ali contains superoxide dimutase, a powerful anti-oxidant enzyme that inhibits the chain reaction of free radicals harmful to the body. What to Look for With An Herbal Impotence Supplement With so many herbal "Male Enhancement/Enlargement/Sexual Performance/ Impotence" products that are advertised, it can get difficult to choose products that can actually help and are safe. Also some supplements contain herbs that can be dangerous. Look for ingredients that help your overall health and conditions as well as the ingredients targeted strictly for ED and enhanced performance. This may help treat an health issue which may be causing your impotence or erection quality. Look for products where the herbs are used in extract form. Make sure it is manufactured in and shipped from the US Review the ingredients looking for herbs where research substantiates claims such as the herbs we have listed above. Watch out for potentially dangerous ingredients that are listed on the FDA's "Ingredients of Concern" such as Yohimbe Look for chemical additives All products should be guaranteed The above herbs listed represent ones that have positive demonstrated effects helping treat ED, increasing libido and energy. As so many men have discovered herbal supplements may be the perfect Viagra alternative for you. Summary Viagra has proven to be an excellent prescription drug for men with impotence. Positives: Fast acting and tends to have stronger 24 hour effect than herbs specifically at enabling an erection. Negatives: Costs, side effects, short term (24 hours) and it only treats the symptom of impotence but does nothing help causes of impotence, low sex drive or improved body functions. Specific herbal ingredients contained Herbal Impotence & Enhancement Products have a demonstrated positive effect on male impotence. Some herbs act similar to Viagra at enhancing the body's use of Nitric Oxide. Positives: Cost, minimal or no side effects, the positive effects tend to accumulate and become more produced over time. Dosages can be skipped and benefits are retained. Herbal formulations have positive benefits on multiple body functions (cardiovascular, endocrine, muscular and nervous system) that are essential to a strong erection and sex drive. Negatives: Immediate short term effect is not as pronounced as Viagra. Are Herbal Treatments right for you? Based on the evidence, there are a number ingredients that have proven effective for men. However, as with any prescription drug, medical treatment or supplement individual results vary. Reputable nutraceutical companies recognize this by providing a money back guarantee and honoring it. So in many case you can try a supplement to see if it works for your condition. Zenerx (See Product Information) a herbal product that contains multiple herbs that have proven to be beneficial to men with Impotence and enhance the body's use of Nitric Oxide like Viagra. They also have no reported consumer complaints. Giovanni Magnotti GM@impotenceguide.info Recommended Herbal Impotence Products Zenerx Click For More Info

Before using Viagra (Sildenafil Citrate) Do not start or stop any medicine without doctor or pharmacist approval. Inform your doctor or any other medical conditions including penis problems, history of painful or prolonged erection, sickle cell anemia, blood system cancers (such as leukemia or myeloma), vision problems (such as retinitis pigmentosa) or a history of vision loss, kidney or liver disease, bleeding disorders, active stomach ulcers, heart problems, irregular heartbeat, stroke, very high or low blood pressure, or allergies. Do not take Viagra if you have been told by your healthcare provider to not have sexual activity because of certain health problems, especially heart problems. Don’t use Viagra when you are already using nitroglycerin, (such as tablet, patch, or ointment dose forms) or other nitrates (such as isosorbide), nitroprusside (or any "nitric oxide donor" medicine), or recreational drugs called "poppers" containing amyl or butyl nitrate because very serious interactions may occur. Common Viagra (Sildenafil Citrate) uses Viagra is a phosphodiesterase inhibitor used to treat sexual function problems such as impotence or erectile dysfunction. In combination with sexual stimulation, Viagra works by helping the blood flow into the penis to achieve and maintain an erection viagra is not intended for use in women or children. You can buy viagra online. How to take Viagra (Sildenafil Citrate)? Take Viagra (Sildenafil Citrate) by mouth as needed 1 hour before sexual activity or as directed by your doctor. Do not take Viagra more often than once daily as needed. If you are taking certain other medicines you may only be able to take this medicine one time every three days. Contact your doctor or pharmacist for more information. This medicine may be taken on an empty stomach or with food. Ask your doctor, nurse, or pharmacist any questions that you may have about Viagra (Sildenafil Citrate) Viagra (Sildenafil Citrate) Common Side effects Tell your doctor or pharmacist if any of the following occurs: headache, flushing, stomach upset or nausea, heartburn, stuffy or runny nose, diarrhea, dizziness, or lightheadedness. An allergic reaction to this medicine is unlikely but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, unusual swelling, severe dizziness, or trouble breathing How to Storage Viagra (Sildenafil Citrate) Store Viagra at room temperature 77 degrees F (25 degrees C) in a tightly-closed container, away from heat and light. Brief storage between 59 and 86 degrees F (15 and 30 degrees C) is permitted. You can buy Viagra online as you require, or as prescribed by the doctor. Before Using Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. DO NOT TAKE THIS MEDICINE if you are also taking or using nitroglycerin or other nitrates in any form. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking cimetidine, erythromycin, ketoconazole, itraconazole, mibefradil, or an HIV protease inhibitor. Inform your doctor of any other medical conditions or allergies. USE OF THIS MEDICINE IS NOT RECOMMENDED if you have a history of heart conditions, high or low blood pressure, stroke, or retinitis pigmentosa. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine. Directions Follow the directions for using this medicine provided by your doctor. TAKE THIS MEDICINE about 1 hour before sexual activity, although it may be taken from 30 minutes to 4 hours before sexual activity. STORE THIS MEDICINE at room temperature between 59 and 86 degrees F (15 and 30 degrees C) in a tightly-closed container, away from heat and light. Cautions DO NOT EXCEED THE RECOMMENDED DOSE without checking with your doctor. DO NOT TAKE THIS MEDICINE MORE THAN once a day. DO NOT TAKE THIS MEDICINE IF YOU TAKE OR USE NITROGLYCERIN, including nitroglycerin tablets, patches, or ointment, OR OTHER NITRATES, such as isosorbide. If you are not sure whether a certain medicine is a nitrate, contact your doctor or pharmacist. USE OF THIS MEDICINE WILL NOT PREVENT the spread of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). BEFORE YOU BEGIN TAKING ANY NEW MEDICINE, either prescription or over-the-counter, check with your doctor or pharmacist. Possible side effects SIDE EFFECTS that may occur while taking this medicine include headache, flushing, upset stomach, stuffy nose, diarrhea, blurred vision, changes in blue or green vision, or increased light sensitivity. If they continue or are bothersome, check with your doctor. CHECK WITH YOUR DOCTOR AS SOON AS POSSIBLE if you experience prolonged abnormal, painful erections. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. Drug interactions Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Use our drug interaction checker to find out if your medicines interact with each other. If you take too much If overdose is suspected, contact your local poison control center or emergency room immediately. Additional information If your symptoms do not improve or if they become worse, check with your doctor. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS PRODUCT out of the reach of children. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out. Please note: at times products might be shipped loose and not in blister packs due to high demand or lack of stock and in order to allow for the best possible prices. Viagra is een receptgeneesmiddel voor de behandeling van erectieproblemen. Viagra ontspant indirect de bloedvaten in de penis. Zo kan er makkelijker bloed in de penis stromen als je seksueel opgewonden wordt. Daardoor kun je gemakkelijker een erectie krijgen. Lees meer >> I have been taking Viagra for over two years since I started to have erection problems. At first I didn't tell my wife about pills and I remember that first time. She was giving me a blowjob for nearly an hour. She loves doing it thankfully. When I finally came I exploded with such a force that she almoust choked. I told her then, that I started to take Viagra. Now, before each act of making love, she makes shure that I have been taken the pill. I think that Viagra is great! Marcell, age 46. When you buy and take Pfizer Viagra, there is no need to worry about anything. You don't have to tkink which Viagra to choose, what may be difficult because of many different offers which some of them might be fake. I have a big experience with buying Viagra and I advice everyone to be very carefull with it! You can not recognize which one is real and fake. They look the same, the names are -Viagra and the price might be similar. But remember, when you order it by Web site, check if they write the address. If there is Generic Viagra is also O.K. but I buy Pfizer Viagra in the first place. I am very satisfied and if you do the same, you will feel well. Bill, the user of Viagra. Do you want to buy Viagra pills and don't know where to do it? That simple - just order it online! But remember, you must be very careful because there are a lot of Web sites selling fake Viagra pills! To be sure always buy Pfizer Viagra, which is dedicated to public health. I remember my first time with Viagra which I was given by a doctor who is reputed to be the best specialist. The result was immediately and I didn't have to worry that something would have been wrong. In this connexion I advice everyone buy Pfizer Viagra online. Edward, age 61. Viagra This page contains drug information on Viagra. The information provided includes the following: what is Viagra the possible side effects of Viagra what happens if you miss a dose of Viagra what happens if you overdose with Viagra the most important information about Viagra how to use Viagra other drugs that may affect Viagra what to avoid while using Viagra Generic Name: sildenafil (oral) (sil DEN uh fil) Brand Names: Revatio, Viagra What is the most important information I should know about sildenafil? • If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). • A small number of patients have had a sudden loss of eyesight after taking sildenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether sildenafil is the actual cause of such vision loss. • Stop using sildenafil if you have any loss in your eyesight and seek medical help right away. What is sildenafil? • Sildenafil relaxes muscles and increases blood flow to particular areas of the body. • Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. • Sildenafil may also be used for purposes other than those listed here. What should I discuss with my healthcare provider before taking sildenafil? • Taking sildenafil together with a nitrate medicine can cause a serious decrease in blood pressure. Before taking sildenafil, tell your doctor if you take a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). • A small number of patients have had a sudden loss of eyesight after taking sildenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether sildenafil is the actual cause of such vision loss. This loss of vision has occurred most often in people with heart disease, diabetes, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. • Stop using sildenafil if you have any loss in your eyesight and seek medical help right away. • Before taking sildenafil, tell your doctor if you have: · a recent history (in the last 6 months) of a heart attack, angina, congestive heart failure, stroke, or life-threatening irregular heartbeats; · high or low blood pressure; · coronary artery disease; · retinitis pigmentosa (an inherited condition of the eye); · a bleeding disorder such as hemophilia; · a stomach ulcer; · a physical deformity of the penis (such as Peyronie's disease); · a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia. • If you have any of these conditions, you may not be able to use sildenafil or you may need a dosage adjustment or special tests during treatment. • FDA pregnancy category B: This medication is not expected to be harmful to an unborn baby. Do not use sildenafil without telling your doctor if you are pregnant or plan to become pregnant during treatment. • It is not known if sildenafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take sildenafil? • Take sildenafil exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. • Revatio is usually taken three times each day, about 4 to 6 hours apart. • Viagra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day. • Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions. • If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Store this medication at room temperature away from moisture and heat. What happens if I miss a dose? • Viagra is used as needed, so you are not likely to miss a dose. • If you miss a dose of Revatio, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? • Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a sildenafil overdose may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting. What should I avoid while taking sildenafil? • Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor. What are the possible side effects of sildenafil? • Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. • Stop using sildenafil and call your doctor at once if you have any of these serious side effects: · pain or tight feeling in your chest; · numbness or tingling in your chest, arms, neck, or jaw; · irregular heartbeat; · swelling in your hands, ankles, or feet; · shortness of breath; · feeling light-headed, fainting; or · penis erection that is painful or lasts 4 hours or longer. • Other, less serious side effects are more likely to occur. Continue using sildenafil and talk with your doctor if you have: · warmth or redness in your face, neck, or chest; · nosebleed, stuffy nose; · headache; · upset stomach; · sleep problems (insomnia); or · diarrhea. • Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect sildenafil? • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers"). • Before taking sildenafil, tell your doctor if you are using any of the following medications: · bosentan (Tracleer); · cimetidine (Tagamet, Tagamet HB); · an antibiotic such as erythromycin (E-Mycin, Eryc, Ery-Tab) or clarithromycin (Biaxin); · doxazosin (Cardura), prazosin (Minipress), Terazosin (Hytrin); · HIV medicines such as amprenavir (Agenerase), tipranavir (Aptivus), efavirenz (Sustiva), nevirapine (Viramune), indinavir (Crixivan), saquinavir (Invirase, Fortovase), lopinavir/ ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept); · an antifungal medication such as itraconazole (Sporanox) or ketoconazole (Nizoral); · carbamazepine (Tegretol), phenobarbital (Luminal), or phenytoin (Dilantin); or · rifampin (Rifadin, Rimactane) or rifabutin (Mycobutin). • If you are using any of these drugs, you may not be able to take sildenafil, or you may need dosage adjustments or special tests during treatment. • There may be other drugs not listed that can affect sildenafil. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Where can I get more information? • Your pharmacist has additional information about sildenafil written for health professionals that you may read. -------------------------------------------------------------------------------- • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/ or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Why VIAGRA? Because that look she gives is only meant for you. Because an empty nest is the chance to fall in love all over again. Because reading the Sunday paper doesn’t take all day. If you have ED, you’ve already got plenty of reasons to choose VIAGRA. But here are some more that you should know about. VIAGRA is prescribed to treat erectile dysfunction (ED). If you take any medicines that have nitrates in them (like nitroglycerin for chest pain)—every day or even once in a while—you should NOT take VIAGRA. Discuss your general health status with your doctor to ensure that you are healthy enough to engage in sexual activity. If you experience chest pain, nausea, or any other discomforts during sex, seek immediate medical help. The most common side effects of VIAGRA are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including VIAGRA) reported a sudden decrease or loss of vision. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including VIAGRA, and call a doctor right away. Although erections lasting for more than 4 hours may occur rarely with all ED treatments in this drug class, to avoid long-term injuries, it is important to seek immediate medical help. If you are older than age 65, or have serious liver or kidney problems, your doctor may start you at the lowest dose (25 mg) of VIAGRA. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend a 25-mg dose and may limit you to a maximum single dose of 25 mg of VIAGRA in a 48-hour period. 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 VIAGRA. Remember to protect yourself and your partner from sexually transmitted diseases. VIAGRA is one of many options for treating ED that you and your doctor can consider. On me demande souvent ce que je pense de l'apparition de ce nouveau medicament qui acclame revolutionner la sexualite masculine. Cette petite pilule bleue en forme de diamant va-t-elle vraiment presenter une solution miracle aux hommes souffrant d'impuissance erectile d'ici la fin de l'ete? (La vente du Viagra au Canada est prevue pour juillet 1998) Voici quelques donnees sur Viagra, telles que presentees lors d'un reportage televise sur un reseau americain: Aux Etats-Unis, entre 3000 et 4000 hommes ont participe a une recherche controlee sur un nouveau medicament ayant comme vertu d'eliminer les problemes d'erections peniennes. Selon les donnees americaines, plus de 30,000 hommes souffrent d'impuissance erectile et depuis que la FDA (Food and Drug Administration) a approuve l'usage de Viagra par les americains, plus de 200,000 prescriptions par semaines sont emises par les medecins. On parle de 600,000 prescriptions lors du premier mois de la presence de Viagra en pharmacie. Au cout de 10.00$ US par dose, Viagra promet d'engraisser les coffres de la compagnie Pfizer d'un milliard de dollars d'ici la fin de l'annee. Le Viagra est disponible en dosages de 25mg, 50mg et 100mg. On raconte que la dose moyenne de 50mg est la plus frequente. La dose inferieure sera utilisee principalement chez les hommes vieillissants ainsi que ceux qui presentent d'autres problemes de sante qui pourraient etre amplifies par les effets secondaires attribuables au Viagra. Quant a la plus forte dose, elle sera administree seulement si la dose moyenne n'offre pas les effets escomptes. QUI PEUT BENEFICIER DU VIAGRA? Selon les dires des medecins presents a l'emission televisee, Viagra semble etre prescrit principalement aux hommes souffrant d'impuissance erectile organique, tel que le diabete, l'hypertension, un taux de cholesterol eleve, le cancer de la prostate, les varices au niveau des veines peniennes et autres problemes de circulation sanguine. Viagra n'est pas un aphrodisiaque, ni un amplificateur du desir sexuel! Le contact physique et emotif a un-e partenaire de choix, le desir d'avoir un rapprochement intime, la stimulation visuelle et physique et le contexte erotique sont absolument necessaires, sinon Viagra n'aura aucun effet sur l'erection. Cela est d'autant plus vrai chez l'homme vieillissant puisque meme dans les meilleures conditions, les preliminaires et un contact tactile continu lui sont absolument essentiels afin d'obtenir et de maintenir une erection. Viagra ne rendra pas a l'homme de 60 ans, ses prouesses d'adolescent. Alors avis a tous ceux qui croient que le Viagra entrainera une erection automatique sans preliminaires sexuels... detrompez-vous! COMMENT FONCTIONNE VIAGRA? Le medicament doit etre ingurgite par voie orale, entre 30 et 45 minutes avant la relation sexuelle. Viagra sert a augmenter la circulation sanguine dans les arteres du penis et la region pelvienne en general ainsi qu'a assouplir les muscles lisses, caracteristiques du mecanisme physiologique normal de l'erection. Viagra n'a AUCUN effet positif chez un homme ayant deja un mecanisme erectile fonctionnel a 100%; En d'autres termes, Viagra n'a pas la pretention de faire des surhommes avec personne! Les composantes chimiques de Viagra demeurent dans le sang de l'usager pendant environ 4 heures. Ce qui ne signifie pas que l'erection dure 4 heures mais bien que l'homme continue a fonctionner normalement pendant cette periode. Le mecanisme erectile suivi d'une periode refractaire (de repos) est present comme chez l'homme fonctionnel. L'homme ayant pris Viagra pourra donc maintenir le rapprochement sexuel durant quelques heures, sans avoir a ingurgiter une dose supplementaire. A ce prix, on aurait peut-etre avantage a en profiter... dans le respect et le consentement des deux partenaires bien sur... QUELLES SONT LES CONTRE-INDICATIONS A L'UTILISATION DE VIAGRA? Selon les medecins, les principales contre-indications sont celles-ci: Les hommes qui prennent des medicaments contenant des Nitrates (comme les "nitro" utilisees par les patients atteints de maladies cardiaques) doivent s'abstenir de prendre Viagra. De plus, Viagra risque de ne pas fonctionner chez les hommes souffrant d'un diabete exceptionnellement severe, d'une hypertension tres grave et ceux ayant subi une intervention chirurgicale ayant endommage serieusement les nerfs de la region pelvienne. On suggere egalement aux hommes tres sedentaires depuis une longue periode de ne pas entreprendre des activites sexuelles frequentes et essoufflantes de facon drastique. Il pourrait en resulter d'autres problemes de sante. QUELS SONT LES EFFETS SECONDAIRES LES PLUS PROBABLES? Selon les etudes menees sur Viagra, les effets secondaires les plus frequents sont les maux de tete, les rougeurs de la peau, les nausees, les problemes de vision (confusion entre certaines couleurs telles que les tons de verts et bleus - surtout avec le dosage de 100mg) et les problemes d'estomac. Contrairement par contre aux autres traitements chimiques des troubles erectiles, Viagra n'est pas associe au priapisme (erection prolongee tres grave, pouvant mener a une amputation du penis). Le seul facteur pouvant causer un priapisme avec Viagra serait l'utilisation combinee d'une medication contre la leucemie. Il est donc essentiel que l'homme soit totalement honnete lors de la consultation avec le medecin, afin de ne pas omettre des informations sur son etat de sante qui pourraient occasionner des consequences desastreuses. LES FEMMES PEUVENT-ELLES PRENDRE VIAGRA? Le FDA n'a pas encore approuve l'utilisation de Viagra par les femmes, mais des recherches cliniques sont en cours aux Etats-Unis. Les benefices et effets secondaires sont sensiblement les memes que chez les hommes; C'est-a-dire que Viagra n'a aucun effet sur le desir sexuel mais joue un role dans le processus d'excitation sexuelle (lubrification vaginale et augmentation de la circulation sanguine de la region pelvienne). Et pour certaines femmes, cela permet d'atteindre plus facilement l'orgasme. VIAGRA DOIT BIEN AVOIR DES LIMITES? Disons d'abord que Viagra n'a pas le meme effet chez tous les hommes. Certains ressentent les effets secondaires avec une telle intensite que la relation sexuelle ne leur apparait pas aussi invitante qu'anticipee. Une erection bien ferme accompagnee d'une migraine et de nausees risque d'en decourager certains... mais il semblerait que les effets secondaires tendent a se dissiper avec le temps et la prise reguliere du medicament. Mais la limite la plus importante a mes yeux (et a la survie de ma carriere de sexologue!) est la suivante: Viagra n'a AUCUN effet positif sur les troubles erectiles causees par des difficultes relationnelles, conjugales, psychologiques et emotionnelles. Ce n'est pas une pilule miracle qui repare les relations de couples dysfonctionnelles. Viagra ne remplace pas la communication intime, la validation des sentiments et emotions vecus dans le couple ni ne repare les disputes qui minent la qualite de la vie sexuelle. La prise de Viagra devrait etre une decision de couple, dans la mesure ou elle affectera la dynamique relationnelle. Et souvenez-vous que Viagra ne guerit pas l'impuissance erectile... Viagra traite l'impuissance erectile. Selon moi, une demarche en sexologie pourrait tres bien accompagner la prise de Viagra. Nous savons tres bien que tout facteur entrainant une modification au niveau de la dynamique relationnelle, aussi positif qu'il puisse paraitre, risque de bousculer les partenaires impliques. Nous pouvons penser que si un couple n'a pas eu de vie sexuelle active depuis de nombreuses annees, la dynamique a su s'adapter en consequence. Une modification importante de cette dynamique risque d'entrainer des situations problematiques au sein du couple et ce dernier risque de ne pas savoir comment les regler de facon appropriee. Autre point interessant: Selon une etude americaine toujours, 70% des femmes s'opposeraient a ce que leur conjoint prenne Viagra, meme si un medecin jugeait la medication necessaire. On pourrait croire que plusieurs femmes, (principalement dans la population agee) craignent de voir leur mari de 65 ans redevenir pimpant et plein de vigueur retrouvee, et d'etre forcee a reprendre des activites sexuelles qu'elles ne desirent plus. CONCLUSION Je crois sincerement que Viagra aura une grande utilite pour un grand nombre d'hommes aux prises avec des problemes erectiles d'origine organique, mais ce n'est pas une pilule miracle. La societe Nord-Americaine cherche malheureusement a tout enrayer avec des comprimes et la rapidite de l'eclair. Je crois que cette caracteristique convient a un bon nombre de personnes mais heureusement, d'autres cherchent a mieux se connaitre et se comprendre plutot que d'avaler une pilule qui enrayera tous leurs maux. Viagra represente la solution ideale pour bien des hommes et leurs partenaires. Mais comme il ne s'adresse pas a tous les hommes et possede ses limites (comme tout autre traitement), je crois qu'il restera toujours place a une certaine demarche therapeutique dans les cas d'impuissance erectile. La sexotherapie a elle seule ne permet pas aux hommes souffrant d'impuissance erectile organique de retrouver leur fonctionnalite, mais peut s'averer tres benefique dans l'apprentissage a la vie sexuelle sans erection. L'homme peut y apprendre a elargir son repertoire erotique et sensuel, ainsi que se decouvrir des zones erogenes jusque la inconnues ou du moins inexplorees. Avec Viagra, certains hommes pourront retrouver leur fonctionnalite erectile mais continueraient a trouver des outils interessants a un tel apprentissage a la sensualite. Car apres tout, ce n'est pas parce qu'un homme retrouve son erection qu'il n'a plus avantage a utiliser le reste de son corps dans l'expression de sa sexualite... Alors avant de vous lancer a la poursuite du diamant bleu et d'investir quelques dizaines de dollars americains par semaine afin de vous sentir a la hauteur de la situation, informez-vous convenablement. Il importe que vous puissiez identifier clairement les causes de votre incapacite erectile. Une decision eclairee vous permettra de trouver LA solution ideale POUR VOUS. Et par consequent, vous trouverez le meilleur chemin a prendre afin de vivre pleinement et de facon epanouie, la vie sexuelle qui fait partie integrante de votre etre, dans toute sa globalite. Et n'oubliez jamais que la valeur d'un homme (et d'un bon amant) ne se mesure pas qu'a la fermete de son erection... The effectiveness of generic Viagra is the same as the name brand. Generic Viagra can bring lasting happiness in your sex life by giving you long and sustainable erections every time you use the drug. Generic Viagra online to reignite your love life Take the drug one hour before sexual intimacy. But one thing you must be aware of. Sildenafil won’t work without sexual stimulation. For any complications get in touch with your doctor or pharmacist! Generic Viagra can be purchased from our online pharmacy with up to 75-90% discounts. Viagra® is one of the best-known drugs of all time: Google lists over 17 million Web pages that use the word "Viagra." For comparison, Google lists only 3.3 million pages containing the word "aspirin" and only 936,000 containing the word "Tylenol." Billions of spam e-mail messages advertise Viagra® every day. There is so much Viagra spam, in fact, that Pfizer (the maker of Viagra) has a page addressing the problem, called Avoid Fake Viagra: The Facts About Spam, prominently listed on Viagra.com. Pfizer has spent untold millions of dollars advertising Viagra®, so you see advertisements for the drug constantly on TV. Pfizer claims on its Web site that nine Viagra® pills are dispensed every second -- nearly 300 million tablets per year. The name recognition of Viagra® is so good that nearly every adult in America has heard of the drug and can tell you what it does. What Viagra® does is simple: When it works as intended, Viagra® causes a man who is sexually stimulated to get an erection. How does Viagra® do that? And why does Viagra® work only if the man is sexually stimulated? For that matter, what causes an erection in the first place? In this article, we'll answer all of those questions and more... For many people, talking about the penis is tough. This area of the body is considered private and is usually not discussed publicly. However, the penis is simply a part of the male anatomy designed to accomplish a task, and we'll treat it that way here. Think of the corpora cavernosa as balloon-like tubes. Arteries bring blood into these two tubes, and veins carry blood away from them. The penis can be either limp or erect, depending on the flow of blood: In a non-erect state, the arteries that bring blood into the corpora cavernosa are somewhat constricted, while the veins that drain the blood from the penis are open. There is no way for pressure to build inside the penis. In this state, the penis is limp. When a man becomes aroused, the arteries leading into the penis open up so that pressurized blood can enter the penis quickly. The veins leaving the penis constrict. Pressurized blood is trapped in the corpora cavernosa, and this blood causes the penis to elongate and stiffen. The penis is erect. If the arteries leading to the penis do not open up properly, it is difficult or impossible for a man to become erect. This problem is the leading cause of erectile dysfunction. To solve an erection problem when the cause is poor blood flow, you need to open the arteries. Let's take a look at how this can be done -- and how it was done before Viagra... The first real breakthrough in the treatment of erectile dysfunction came in 1983. Prior to that time, it was thought that erectile dysfunction -- the inability to achieve an erection -- was primarily mental. That concept came crashing down at the 1983 American Urological Association meeting in Las Vegas when Dr. Giles Brindley injected his penis with the drug phentolamine. Following the injection, Dr. Brindley appeared on stage and dropped his pants to display one of the first drug-induced erections to the incredulous audience of urologists. What did the phentolamine do? It relaxed a muscle. Here's how: Inside the body there are several kinds of muscle: Skeletal - Skeletal muscles are the muscles we see at the Olympics -- bulging biceps and so on. cardiac - Cardiac muscle powers the heart. smooth - Smooth muscle can be found in things like blood vessels, the intestines and the stomach and usually acts involuntarily. Smooth muscle plays a key role in every erection, and Phentolamine is a drug that relaxes smooth muscle. The reason why an injection of phentolamine gave Brindley an erection was especially interesting in 1983 because no one had really thought about it before. Here's what happened: The arteries of a limp penis are constricted, and they keep blood from entering the corpora cavernosa. Brindley's injection relaxed the smooth muscle in the artery walls inside his penis, causing them to open up. Blood surged into the corpora cavernosa, and the blood pressure inflated his penis, giving him an instant erection. Starting in the mid-1980s, it became common for men with erectile dysfunction to inject smooth-muscle-relaxing drugs as a treatment for the problem. Viagra® makes the process a whole lot easier by doing the same kind of thing with a pill instead of an injection. Another advantage of Viagra® over an injection of phentolamine is that Viagra® only causes an erection when the man is sexually aroused. Phentolamine, by contrast, causes an immediate and uncontrolled erection. How can a pill work only on the smooth muscle in the penis and not the entire body, and only when the man is aroused? The answers to these questions begin with an understanding of how blood flow works in the body, so let's start there. Viagra® uses method number three -- it eliminates the PDE that is decomposing the cGMP, so cGMP builds up in the penis and has a larger effect on the artery walls. The greater the amount of cGMP the greater the blood flow, and the greater the blood flow the greater the degree of the erection. The reason that Viagra® uses this technique is because of an interesting quirk of PDE. It turns out that the human body has at least 11 different kinds of PDE that it produces. Only one of those kinds of PDE -- PDE5 -- is found primarily in the penis. Once scientists discovered this fact, the creation of Viagra® was relatively simple. All that Pfizer needed to find was a chemical that would selectively block PDE5 and nothing else. With the PDE5 blocked, cGMP could build up in the penis and increase the blood flow there without affecting other parts of the body. If there were not a unique type of PDE found in the penis, we would not have Viagra® today. So how does Viagra® block PDE5? PDE5 is what is known as an enzyme. An enzyme is a specially folded protein that can speed up a chemical reaction. For example, the article How Cells Work describes the maltase enzyme. Maltase is shaped so that a maltose molecule can fit right in, and when it does, the maltase enzyme breaks the maltose molecule into two glucose molecules, as shown here: Viagra® contains sildenafil citrate packaged as a pill. When a man takes a Viagra® pill, the sildenafil citrate flows throughout his body, but it really only affects the PDE5 enzyme in the penis. The drug stays in the bloodstream for about four hours, and then it is washed out of the blood by the liver and kidneys. And that's the end of the "how it works" part of the Viagra® story: A man takes a Viagra® pill. The sildenafil citrate enters his bloodstream and flows throughout his body. The sildenafil citrate attaches to the PDE5 enzyme in his penis and disables most of it. When the man becomes sexually aroused, the brain sends the normal message to the NANC cells in his penis, which produce nitric oxide as usual. The nitric oxide creates cGMP, which starts relaxing the arteries in his penis. Since the PDE5 has been disabled, the cGMP in the penis does not break down. Instead, it builds up and lets the arteries in the penis fully dilate. His penis inflates with blood, and the man gets a full erection. VIAGRA is rapidly absorbed after oral administration, with absolute bioavailability of about 40%. Its pharmacokinetics are dose-proportional over the recommended dose range. It is eliminated predominantly by hepatic metabolism (mainly cytochrome P450 3A4) and is converted to an active metabolite with properties similar to the parent, sildenafil. The concomitant use of potent cytochrome P450 3A4 inhibitors (e.g., erythromycin, ketoconazole, itraconazole) as well as the nonspecific CYP inhibitor, cimetidine, is associated with increased plasma levels of sildenafil (see DOSAGE AND ADMINISTRATION ). Both sildenafil and the metabolite have Absorption and Distribution: VIAGRA is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When VIAGRA is taken with a high fat meal, the rate of absorption is reduced, with a mean delay in T max of 60 minutes and a mean reduction in C max 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. Based upon measurements of sildenafil in semen of healthy volunteers 90 minutes after dosing, less than 0.001% of the administered dose may appear in the semen of patients. Metabolism and Excretion: Sildenafil is cleared predominantly by the CYP3A4 (major route) and 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 PDE selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50% of the parent drug. 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. Pharmacokinetics in Special Populations Geriatrics: Healthy elderly volunteers (65 years or over) had a reduced clearance of sildenafil, with free plasma concentrations approximately 40% greater than those seen in healthy younger volunteers (18-45 years). Renal Insufficiency: 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=<30 mL/min) renal impairment, sildenafil clearance was reduced, resulting in approximately doubling of AUC and C max compared to age-matched volunteers with no renal impairment. Hepatic Insufficiency: In volunteers with hepatic cirrhosis (Child-Pugh A and B), sildenafil clearance was reduced, resulting in increases in AUC (84%) and C max (47%) compared to age-matched volunteers with no hepatic impairment. Therefore, age >65, hepatic impairment and severe renal impairment are associated with increased plasma levels of sildenafil. A starting oral dose of 25 mg should be considered in those patients (see DOSAGE AND ADMINISTRATION ). Pharmacodynamics Effects of VIAGRA on Erectile Response: In eight double-blind, placebo-controlled crossover studies of patients with either organic or psychogenic erectile dysfunction, sexual stimulation resulted in improved erections, as assessed by an objective measurement of hardness and duration of erections (RigiScan®), after VIAGRA administration compared with placebo. Most studies assessed the efficacy of VIAGRA approximately 60 minutes post dose. The erectile response, as assessed by RigiScan®, generally increased with increasing sildenafil dose and plasma concentration. The time course of effect was examined in one study, showing an effect for up to 4 hours but the response was diminished compared to 2 hours. Effects of VIAGRA on Blood Pressure: Single oral doses of sildenafil (100 mg) administered to healthy volunteers produced decreases in supine blood pressure (mean maximum decrease in systolic/diastolic blood pressure of 8.4/5.5 mmHg). The decrease in blood pressure was most notable approximately 1-2 hours after dosing, and was not different than placebo at 8 hours. Similar effects on blood pressure were noted with 25 mg, 50 mg and 100 mg of VIAGRA, therefore the effects are not related to dose or plasma levels within this dosage range. Larger effects were recorded among patients receiving concomitant nitrates (see CONTRAINDICATIONS ). In a double-blind study, 144 patients with erectile dysfunction and chronic stable angina limited by exercise, not receiving chronic oral nitrates, were randomized to a single dose of placebo or VIAGRA 100 mg 1 hour prior to exercise testing. The primary endpoint was time to limiting angina in the evaluable cohort. The mean times (adjusted for baseline) to onset of limiting angina were 423.6 and 403.7 seconds for sildenafil (N=70) and placebo, respectively. These results demonstrated that the effect of VIAGRA on the primary endpoint was statistically non-inferior to placebo. Effects of VIAGRA on Vision: 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 twice the maximum recommended dose revealed no effects of VIAGRA on visual acuity, intraocular pressure, or pupillometry. Clinical Studies In clinical studies, VIAGRA was assessed for its effect on the ability of men with erectile dysfunction (ED) to engage in sexual activity and in many cases specifically on the ability to achieve and maintain an erection sufficient for satisfactory sexual activity. VIAGRA was evaluated primarily at doses of 25 mg, 50 mg and 100 mg in 21 randomized, double-blind, placebo-controlled trials of up to 6 months in duration, using a variety of study designs (fixed dose, titration, parallel, crossover). VIAGRA was administered to more than 3,000 patients aged 19 to 87 years, with ED of various etiologies (organic, psychogenic, mixed) with a mean duration of 5 years. VIAGRA demonstrated statistically significant improvement compared to placebo in all 21 studies. The studies that established benefit demonstrated improvements in success rates for sexual intercourse compared with placebo. The effectiveness of VIAGRA was evaluated in most studies using several assessment instruments. The primary measure in the principal studies was a sexual function questionnaire (the International Index of Erectile Function - IIEF) administered during a 4-week treatment-free run-in period, at baseline, at follow-up visits, and at the end of double-blind, placebo-controlled, at-home treatment. Two of the questions from the IIEF served as primary study endpoints; categorical responses were elicited to questions about (1) the ability to achieve erections sufficient for sexual intercourse and (2) the maintenance of erections after penetration. The patient addressed both questions at the final visit for the last 4 weeks of the study. The possible categorical responses to these questions were (0) no attempted intercourse, (1) never or almost never, (2) a few times, (3) sometimes, (4) most times, and (5) almost always or always. Also collected as part of the IIEF was information about other aspects of sexual function, including information on erectile function, orgasm, desire, satisfaction with intercourse, and overall sexual satisfaction. Sexual function data were also recorded by patients in a daily diary. In addition, patients were asked a global efficacy question and an optional partner questionnaire was administered. The effect on one of the major end points, maintenance of erections after penetration, is shown in Figure 3, for the pooled results of 5 fixed-dose, dose-response studies of greater than one month duration, showing response according to baseline function. Results with all doses have been pooled, but scores showed greater improvement at the 50 and 100 mg doses than at 25 mg. The pattern of responses was similar for the other principal question, the ability to achieve an erection sufficient for intercourse. The titration studies, in which most patients received 100 mg, showed similar results. Figure 3 shows that regardless of the baseline levels of function, subsequent function in patients treated with VIAGRA was better than that seen in patients treated with placebo. At the same time, on-treatment function was better in treated patients who were less impaired at baseline. Subgroup analyses of responses to a global improvement question in patients with psychogenic etiology in two fixed-dose studies (total n=179) and two titration studies (total n=149) showed 84% of VIAGRA patients reported improvement in erections compared with 26% of placebo. The changes from baseline in scoring on the two end point questions (frequency of successful penetration during sexual activity and maintenance of erections after penetration) were highly statistically significantly in favor of VIAGRA. Diary data in two of the studies (n=178) showed rates of successful intercourse per attempt of 70% for VIAGRA and 29% for placebo. A review of population subgroups demonstrated efficacy regardless of baseline severity, etiology, race and age. VIAGRA was effective in a broad range of ED patients, including those with a history of coronary artery disease, hypertension, other cardiac disease, peripheral vascular disease, diabetes mellitus, depression, coronary artery bypass graft (CABG), radical prostatectomy, transurethral resection of the prostate (TURP) and spinal cord injury, and in patients taking antidepressants/antipsychotics and antihypertensives/diuretics. Analysis of the safety database showed no apparent difference in the side effect profile in patients taking VIAGRA with and without antihypertensive medication. This analysis was performed retrospectively, and was not powered to detect any pre-specified difference in adverse reactions. Physicians should advise patients to stop use of all PDE5 inhibitors, including VIAGRA, and seek medical attention in the event of a sudden loss of vision in one or both eyes. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, that has been reported rarely post-marketing in temporal association with the use of all PDE5 inhibitors. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators, such as PDE5 inhibitors (see POST-MARKETING EXPERIENCE / Special Senses ). Physicians should warn patients that prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently since market approval of VIAGRA. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result. Physicians should advise patients that simultaneous administration of VIAGRA doses above 25 mg and an alpha-blocker may lead to symptomatic hypotension in some patients. Therefore, VIAGRA doses above 25 mg should not be taken within four hours of taking an alpha-blocker. The use of VIAGRA offers no protection against sexually transmitted diseases. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including the Human Immunodeficiency Virus (HIV), may be considered. When a single 100 mg dose of VIAGRA was administered with erythromycin, a specific CYP3A4 inhibitor, at steady state (500 mg bid for 5 days), there was a 182% increase in sildenafil systemic exposure (AUC). In addition, in a study performed in healthy male volunteers, coadministration of the HIV protease inhibitor saquinavir, also a CYP3A4 inhibitor, at steady state (1200 mg tid) with VIAGRA (100 mg single dose) resulted in a 140% increase in sildenafil C max and a 210% increase in sildenafil AUC. VIAGRA had no effect on saquinavir pharmacokinetics. Stronger CYP3A4 inhibitors such as ketoconazole or itraconazole would be expected to have still greater effects, and population data from patients in clinical trials did indicate a reduction in sildenafil clearance when it was coadministered with CYP3A4 inhibitors (such as ketoconazole, erythromycin, or cimetidine) (see DOSAGE AND ADMINISTRATION ). Serious cardiovascular, cerebrovascular, and vascular events, including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertension, subarachnoid and intracerebral hemorrhages, and pulmonary hemorrhage have been reported post-marketing in temporal association with the use of VIAGRA. Most, but not all, of these patients had preexisting cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of VIAGRA without sexual activity. Others were reported to have occurred hours to days after the use of VIAGRA and sexual activity. It is not possible to determine whether these events are related directly to VIAGRA, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors (see WARNINGS for further important cardiovascular information).

Sildenafil citrate, sold under the names Viagra, Revatio and generically under various other names, is a drug used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH), developed by the pharmaceutical company Pfizer. Viagra pills are blue and diamond-shaped with the words "Pfizer" on one side and "VGR xx" (with xx representing 25, 50 or 100, the dose of that pill in milligrams) on the other. Its primary competitors on the market are tadalafil (Cialis), and vardenafil (Levitra). History Sildenafil (compound UK-92,480) was synthesized by a group of pharmaceutical chemists working at Pfizer's Sandwich, Kent research facility. It was initially studied for use in hypertension (high blood pressure) and angina pectoris (a form of ischaemic cardiovascular disease). Phase I clinical trials under the direction of Ian Osterloh suggested that the drug had little effect on angina, but that it could induce marked penile erections [1][2]. Pfizer therefore decided to market it for erectile dysfunction, rather than for angina. The drug was patented in 1996, approved for use in erectile dysfunction by the Food and Drug Administration on March 27, 1998, becoming the first pill approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year [3]. It soon became a great success: annual sales of Viagra in the period 1999–2001 exceeded $1 billion. The British press portrayed Peter Dunn and Albert Wood as the inventors of the drug, a claim which Pfizer disputes.[4]. Their names are on the manufacturing patent application drug, but Pfizer claims this is only for convenience. Even though sildenafil is only available by prescription from a doctor, it was advertised directly to consumers on US TV (famously being endorsed by Bob Dole). Numerous sites on the Internet offer Viagra for sale after an "online consultation," a mere web questionnaire. The "Viagra" name has become so well known that many fake aphrodisiacs now call themselves "herbal Viagra" or are presented as blue tablets imitating the shape and colour of Pfizer's product. Viagra is also informally known as "Vitamin V", "the Blue Pill", and goes by various other nicknames. Pfizer's worldwide patents on sildenafil citrate will expire in 2011–2013. The UK patent held by Pfizer on the use of PDE5 inhibitors (see below) as treatment of impotence has been invalidated in 2000 because of obviousness; this decision was upheld on appeal in 2002. Mechanism of action Part of the physiological process of erection involves the parasympathetic nervous system causing the release of nitric oxide (NO) in the corpus cavernosum of the penis. NO binds to the receptors of the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophosphate (cGMP), leading to smooth muscle relaxation (vasodilation) in the corpus cavernosum, resulting in increased inflow of blood and an erection. Sildenafil is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum. The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of cGMP in the corpus cavernosum, resulting in better erections. Without sexual stimulation and no activation of the NO/cGMP system, sildenafil should not cause an erection. Other drugs that operate by the same mechanism include tadalafil (Cialis®) and vardenafil (Levitra®). Sildenafil is metabolised by hepatic enzymes and excreted by both the liver and kidneys. If taken with a high fat meal, there may be a delay in absorption of sildenafil and the peak effect might be reduced slightly as the plasma concentration will be lowered. Some reports have claimed sildenafil causes enhanced sexual pleasure for women by increasing blood flow to the sexual organs, this lacks firm evidence. Dosage and price As with all prescription drugs, proper dosage is at the discretion of a licensed medical doctor. The dose of sildenafil is 25 mg to 100 mg taken once per day between 30 minutes to 4 hours before sexual intercourse. It is usually recommended to start with a dosage of 50 mg and then lower or raise the dosage as appropriate. The drug is sold in three dosages (25, 50, and 100 mg), all three costing about US$10 per pill. Sildenafil is not scored and it is not advisable to cut it to change dosage since the active compound is not distributed homogenously in the tablet. Contraindications and side effects Contraindications include: When taking nitric oxide donors, organic nitrites and nitrates, such as glyceryl trinitrate, sodium nitroprusside, amyl nitrite ("poppers")[5] In men for whom sexual intercourse is inadvisable due to cardiovascular risk factors Severe hepatic impairment (decreased liver function) Severe impairment in renal function Hypotension (low blood pressure) Recent stroke or heart attack Hereditary degenerative retinal disorders (including genetic disorders of retinal phosphodiesterases) Amongst sildenafil's serious adverse effects are: priapism, severe hypotension, myocardial infarction, ventricular arrhythmias, sudden death, stroke and increased intraocular pressure. Common side effects include sneezing, headache, flushing, dyspepsia, prolonged erections, palpitations and photophobia. Visual changes including blurring of vision and a curious bluish tinge have also been reported. Care should be exercised by patients who are also taking Protease inhibitors for the treatment of HIV. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side-effects. It is recommended that patients using protease inhibitors limit their use of sildenafil to no more than one 25-mg dose every 48 hours. Some Viagra users have complained of blurriness and loss of peripheral vision. In May of 2005, the U.S. Food and Drug Administration found that sildenafil could lead to vision impairment[6] and a number of studies have linked Viagra use with nonarteritic anterior ischemic optic neuropathy[ Viagra and Women Viagra is used to treat erectile dysfunction in men by increasing blood flow to the genital organs. Unfortunately all the diseases that cause decreased blood flow in men also affect women, and although the drug has not yet been FDA approved for female sexual dysfunction many are using it for increasing pelvic blood flow, i.e. arousal disorders. At this time there is a pivotal international study going on to determine the effectiveness of Viagra in women with arousal disorders. The side effects of Viagra in women is the same as men, i.e. headaches, flushing, rhinitis, GI upset and abnormal vision, and there are several studies indicating improvement in sexual spots and arousal in women using antidepressants, postmenopausal women, and others with sexual arousal disorders. Viagra should not be used in women taking any form of nitrates since this can be lethal with decrease in blood pressure and major cardiovascular collapse. Women who are unable to tolerate sexual activity or have retinitis pigmentosa should also not use the drug. Lastly, if women are on alpha blockers for hypertension the drug should not be used with the alpha blocker within four hours. In the near future newer more potent and specific PDE-5 inhibitors similar to Viagra will be introduced and may be useful in female sexual arousal disorders. Levitra (vardenafil) and Cialis (tadalafil) are drugs about to be FDA approved for men. Recently research on drugs that specifically affect the subtype-2 dopaminergic centers in the brain (periventricular nuclei) may be helpful for women in the future not only for arousal disorders, but possibly for desire problems as well. Melanocyte agonists may also play a similar role on the central nervous system.[13] Pulmonary hypertension As well as erectile dysfunction, sildenafil citrate is also effective in the rare disease pulmonary arterial hypertension (PAH). It relaxes the arterial wall, decreasing pulmonary arterial resistance and pressure, and thus the strain on the right side of the heart thus improving symptoms of right-sided heart failure. Because the distribution of PDE-5, which is primarily in the arterial wall smooth muscle in the lungs and penis, sildenafil acts selectively in both these areas without inducing vasodilation in other areas of the body. Pfizer submitted an additional registration for sildenafil to the FDA, and sildenafil was approved for this indication in June 2005. The preparation is named Revatio, avoiding confusion with Viagra, and the 20 milligram tablets are white and round. Sildenafil joins bosentan and prostacyclins therapies for this condition[14]. Raynaud's phenomenon In 2005, Dr. Roland Fries and colleagues reported that sildenafil cut the frequency of Raynaud's phenomenon attacks, reduced their duration by roughly one half, and more than quadrupled the mean capillary blood velocity. This was a double-blind, placebo-controlled crossover trial and the patients had both the primary and secondary forms and had all discontinued the more conventional treatments for this[15]. Cognitive enhancement A recent study performed at the National Institute on Aging's Gerontology Research Center shows that sildenafil citrate may help to attenuate cognitive deficits associated with aging. Scientists found that in rats, administration of sildenafil citrate partially reversed the memory impairment produced by L-NAME, a nitric oxide synthase inhibitor implicated in the same cGMP signal transduction pathway as sildenafil. While it is too early to draw a firm conclusion, researchers seem optimisitic about the drug's promise in treating age-related neurodegeneration (PMID 16320087). Analgesia Several studies have determined that sildenafil citrate demonstrates anti-nociceptive properties in rodents. While the effect seems to be greatest in diabetic animals, non-diabetic animals, too, show significant elevation in pain threshold (PMID 15452368). Current evidence seems to suggest that the cGMP that accumulates as a result of Phosphodiesterase 5 inhibition interacts with the cholinergic system to mediate this pain-reducing effect Drug abuses Aphrodisiac Sildenafil is commonly and increasingly used as an aphrodisiac. While there is no clinical evidence that it has aphrodisiac activity, many seem to believe it will improve sexual performance as well as erectile function and enhance the sexual experience. Recreational use Viagra's popularity with young adults have increased over the years[16]. It is sometimes used recreationally. Some users mix Viagra with methylenedioxymethamphetamine (MDMA, ecstasy), a combination known as Sextasy. Tadalafil (Cialis) Vardenafil (Levitra) References ^ Boolell M, Allen MJ, Ballard SA, Gepi-Attee S, Muirhead GJ, Naylor AM, Osterloh IH, Gingell C (1996). "Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction". Int J Impot Res 8 (2): 47-52. PMID 8858389. ^ Terrett, N. K. et al. Sildenafil (Viagra), a potent and selective inhibitor of Type 5 cGMP phosphodiesterase with utility for the treatment of male erectile dysfunction. Bioorg. Med. Chem. Lett. 1996, 6, 1819-1824. ^ Kling J. From hypertension to angina to Viagra. Mod Drug Discov 1998;1:31-38. Fulltext. ^ Bellis, Mary. "Viagra, the patenting of an aphrodisiac." About.com. ^ Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, Zusman RM (1999). "ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association". Journal of the American College of Cardiology 33 (1): 273-82. PMID 9935041. ^ Alert for Healthcare Professionals Sildenafil citrate (marketed as Viagra) (07/2005)[1] ^ Pomeranz HD, Bhavsar AR. "Nonarteritic ischemic optic neuropathy developing soon after use of sildenafil (viagra): a report of seven new cases." J Neuroophthalmol. 2005 Mar;25(1):9-13. PMID 15756125. ^ Egan R, Pomeranz H. "Sildenafil (Viagra) associated anterior ischemic optic neuropathy." Arch Ophthalmol. 2000 Feb;118(2):291-2. PMID 10676804. ^ Pomeranz HD, Smith KH, Hart WM Jr, Egan RA. "Sildenafil-associated nonarteritic anterior ischemic optic neuropathy." Ophthalmology. 2002 Mar;109(3):584-7. PMID 11874765. ^ Cunningham AV, Smith KH. "Anterior ischemic optic neuropathy associated with viagra." J Neuroophthalmol. 2001 Mar;21(1):22-5. PMID 11315976. ^ Boshier A, Pambakian N, Shakir SA. "A case of nonarteritic ischemic optic neuropathy (NAION) in a male patient taking sildenafil." Int J Clin Pharmacol Ther. 2002 Sep;40(9):422-3. PMID 12358159. ^ Akash R, Hrishikesh D, Amith P, Sabah S. "Case report: association of combined nonarteritic anterior ischemic optic neuropathy (NAION) and obstruction of cilioretinal artery with overdose of Viagra." J Ocul Pharmacol Ther. 2005 Aug;21(4):315-7. PMID 16117695. ^ Female Sexual Dysfunction by Dr Myron I. Murdoch ^ Pfizer, Inc. (June 6, 2005). FDA Approves Pfizer's Revatio as Treatment for Pulmonary Arterial Hypertension. 2005 News Releases. Pfizer. Retrieved on December 27, 2005. ^ Fries, Roland, Kaveh Shariat, Hubertus von Wilmowsky, and Michael Bohm (November 8, 2005). "Sildenafil in the treatment of Raynaud's phenomenon resistant to vasodilatory therapy". Circulation 112 (19): 2980-5. PMID 16275885. ^ Peterson, Karen. "Young men add Viagra to their drug arsenal." USAToday.com 21 Mar 2001. Tablets Chemical Name: SILDENAFIL (sil-DEN-a-fil) Common uses This medicine is a phosphodiesterase inhibitor used to treat erectile dysfunction (ED). Before Using Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. DO NOT TAKE THIS MEDICINE if you are also taking or using nitroglycerin or other nitrates in any form. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking cimetidine, erythromycin, ketoconazole, itraconazole, mibefradil, or an HIV protease inhibitor. Inform your doctor of any other medical conditions or allergies. USE OF THIS MEDICINE IS NOT RECOMMENDED if you have a history of heart conditions, high or low blood pressure, stroke, or retinitis pigmentosa. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine. Directions Follow the directions for using this medicine provided by your doctor. TAKE THIS MEDICINE about 1 hour before sexual activity, although it may be taken from 30 minutes to 4 hours before sexual activity. STORE THIS MEDICINE at room temperature between 59 and 86 degrees F (15 and 30 degrees C) in a tightly-closed container, away from heat and light. Cautions DO NOT EXCEED THE RECOMMENDED DOSE without checking with your doctor. DO NOT TAKE THIS MEDICINE MORE THAN once a day. DO NOT TAKE THIS MEDICINE IF YOU TAKE OR USE NITROGLYCERIN, including nitroglycerin tablets, patches, or ointment, OR OTHER NITRATES, such as isosorbide. If you are not sure whether a certain medicine is a nitrate, contact your doctor or pharmacist. USE OF THIS MEDICINE WILL NOT PREVENT the spread of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). BEFORE YOU BEGIN TAKING ANY NEW MEDICINE, either prescription or over-the-counter, check with your doctor or pharmacist. Possible side effects SIDE EFFECTS that may occur while taking this medicine include headache, flushing, upset stomach, stuffy nose, diarrhea, blurred vision, changes in blue or green vision, or increased light sensitivity. If they continue or are bothersome, check with your doctor. CHECK WITH YOUR DOCTOR AS SOON AS POSSIBLE if you experience prolonged abnormal, painful erections. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. Drug interactions Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Use our drug interaction checker to find out if your medicines interact with each other. If you take too much If overdose is suspected, contact your local poison control center or emergency room immediately. Additional information If your symptoms do not improve or if they become worse, check with your doctor. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS PRODUCT out of the reach of children. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out. Please note: at times products might be shipped loose and not in blister packs due to high demand or lack of stock and in order to allow for the best possible prices. Viagra This page contains drug information on Viagra. The information provided includes the following: what is Viagra the possible side effects of Viagra what happens if you miss a dose of Viagra what happens if you overdose with Viagra the most important information about Viagra how to use Viagra other drugs that may affect Viagra what to avoid while using Viagra Generic Name: sildenafil (oral) (sil DEN uh fil) Brand Names: Revatio, Viagra What is the most important information I should know about sildenafil? • If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). • A small number of patients have had a sudden loss of eyesight after taking sildenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether sildenafil is the actual cause of such vision loss. • Stop using sildenafil if you have any loss in your eyesight and seek medical help right away. What is sildenafil? • Sildenafil relaxes muscles and increases blood flow to particular areas of the body. • Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. • Sildenafil may also be used for purposes other than those listed here. What should I discuss with my healthcare provider before taking sildenafil? • Taking sildenafil together with a nitrate medicine can cause a serious decrease in blood pressure. Before taking sildenafil, tell your doctor if you take a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). • A small number of patients have had a sudden loss of eyesight after taking sildenafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether sildenafil is the actual cause of such vision loss. This loss of vision has occurred most often in people with heart disease, diabetes, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. • Stop using sildenafil if you have any loss in your eyesight and seek medical help right away. • Before taking sildenafil, tell your doctor if you have: · a recent history (in the last 6 months) of a heart attack, angina, congestive heart failure, stroke, or life-threatening irregular heartbeats; · high or low blood pressure; · coronary artery disease; · retinitis pigmentosa (an inherited condition of the eye); · a bleeding disorder such as hemophilia; · a stomach ulcer; · a physical deformity of the penis (such as Peyronie's disease); · a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia. • If you have any of these conditions, you may not be able to use sildenafil or you may need a dosage adjustment or special tests during treatment. • FDA pregnancy category B: This medication is not expected to be harmful to an unborn baby. Do not use sildenafil without telling your doctor if you are pregnant or plan to become pregnant during treatment. • It is not known if sildenafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take sildenafil? • Take sildenafil exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. • Revatio is usually taken three times each day, about 4 to 6 hours apart. • Viagra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day. • Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions. • If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of sildenafil. • Store this medication at room temperature away from moisture and heat. What happens if I miss a dose? • Viagra is used as needed, so you are not likely to miss a dose. • If you miss a dose of Revatio, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? • Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a sildenafil overdose may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting. What should I avoid while taking sildenafil? • Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor. What are the possible side effects of sildenafil? • Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. • Stop using sildenafil and call your doctor at once if you have any of these serious side effects: · pain or tight feeling in your chest; · numbness or tingling in your chest, arms, neck, or jaw; · irregular heartbeat; · swelling in your hands, ankles, or feet; · shortness of breath; · feeling light-headed, fainting; or · penis erection that is painful or lasts 4 hours or longer. • Other, less serious side effects are more likely to occur. Continue using sildenafil and talk with your doctor if you have: · warmth or redness in your face, neck, or chest; · nosebleed, stuffy nose; · headache; · upset stomach; · sleep problems (insomnia); or · diarrhea. • Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect sildenafil? • Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers"). • Before taking sildenafil, tell your doctor if you are using any of the following medications: · bosentan (Tracleer); · cimetidine (Tagamet, Tagamet HB); · an antibiotic such as erythromycin (E-Mycin, Eryc, Ery-Tab) or clarithromycin (Biaxin); · doxazosin (Cardura), prazosin (Minipress), Terazosin (Hytrin); · HIV medicines such as amprenavir (Agenerase), tipranavir (Aptivus), efavirenz (Sustiva), nevirapine (Viramune), indinavir (Crixivan), saquinavir (Invirase, Fortovase), lopinavir/ ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept); · an antifungal medication such as itraconazole (Sporanox) or ketoconazole (Nizoral); · carbamazepine (Tegretol), phenobarbital (Luminal), or phenytoin (Dilantin); or · rifampin (Rifadin, Rimactane) or rifabutin (Mycobutin). • If you are using any of these drugs, you may not be able to take sildenafil, or you may need dosage adjustments or special tests during treatment. • There may be other drugs not listed that can affect sildenafil. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Where can I get more information? • Your pharmacist has additional information about sildenafil written for health professionals that you may read. Sildenafil (sil-DEN-a-fil) belongs to a group of medicines that delay the enzymes called phosphodiesterases from working too quickly. The penis is one of the areas where these enzymes work. Sildenafil is used to treat men who have erectile dysfunction (also called sexual impotence). By controlling the enzyme pho