Steps before trying Viagra

Know that, despite their success, erection drugs also have limitations. They are ineffective in about 25 percent of cases. As severity of ED increases, their effectiveness decreases. For example, the drugs work well in many men with the beginnings of diabetic ED, but less well in diabetics with considerable cardiovascular and neurological damage. In men with mild erection balkiness, these drugs may not work in some situations—if a man feels particularly stressed, distracted or alienated from the sexual experience.

Be aware that if you take any nitrate drug such as nitrate medication for heart disease, nitroglycerine for angina, or the party drug, amyl nitrate (“poppers”), you should not use erection drugs such as Viagra, **** or ****. The combination of Viagra and nitrate drugs can cause a precipitous drop in blood pressure and possibly death. Before this problem was identified, the combination of Viagra and nitrate medication killed more than 500 men.

Take erection drugs according to your doctor’s recommendations; this is extremely important. Viagra comes in 25, 50 and 100 mg pills. Side effects are more likely with a higher dose. The same appears to be true of **** and ***.

Be prepared to take more over time. The latest studies suggest that some men need to increase their dose over time. University of Alabama researchers tracked 150 men who took Viagra regularly for two years or more. During that period one-third increased their dose from 50 to 100 mg.

Inform yourself before you start trying Viagra

1.Learn about possible side effects. For most, but not all men, these drugs are quite safe. The only significant side effects are headache (16 percent of users), flushing (10 percent), upset stomach (7 percent), nasal congestion (4 percent), and rarely, visual disturbances (mostly in men with chronic eye conditions such as macular degeneration)

2.Research your insurance coverage. Some health insurers cover erection medications, but many provide only partial coverage, or none at all. However, even without insurance coverage these drugs are quite affordable. The Viagra dose most men take, 50 mg, costs about $10—a modest price to pay for an amorous evening free from erection worries!

3.Know that, despite their success, erection drugs also have limitations. They are ineffective in about 25 percent of cases. As severity of ED increases, their effectiveness decreases. For example, the drugs work well in many men with the beginnings of diabetic ED, but less well in diabetics with considerable cardiovascular and neurological damage. In men with mild erection balkiness, these drugs may not work in some situations—if a man feels particularly stressed, distracted or alienated from the sexual experience.

How erection medications work?

Know how erection medications work. Currently there are four prescription drugs available for erection problems: Viagra, ****, **** and Yohimbine. They all essentially work the same way. Sexual arousal stimulates release of a compound, nitric oxide (NO), in the ****. Nitric oxide, in turn, triggers synthesis of cGMP, which relaxes the ****’ smooth muscle tissue, and allows extra blood to flow into the organ’s spongy central erectile tissues. Erection drugs enhance this smooth muscle relaxation, spurring greater blood flow into the ****.

Depending on the medication, erection drugs are taken two to 36 hours before lovemaking, so the woman need not know you’re using a drug. These prescription drugs help men with ED caused by both physical illness and stress/anxiety problems. Most studies show that they produce erections in 75 percent of those who use them, with even greater effectiveness among men with only mild or occasional problems. They raise erection only with normal sexual stimulation. No walking around with an embarrassing bulge in your pants that signals you have taken a drug.

How to Use Viagra and Other Erection Drugs?

Viagra is used for treatment of erection impairment, now medically called erectile dysfunction (ED). Viagra was not the first drug treatment for erection impairment, but it was the one that captured the public’s imagination. Today, Viagra is one of the most successful drugs ever marketed. More than 10 million men have taken more than 125 million tablets. Annual sales approach $2 billion. The future of the little blue pill—and other erection medications—looks bright.
Be aware the erection medication is not the answer to every man’s erection problem, though erection medication certainly has a place in treatment of ED. Many erection difficulties are caused by sexual anxiety, and resolve when men learn more about sex, relax about it, and adopt a less ****-centered, holistic and sensual approach to lovemaking. Other erection difficulties are caused by medical problems and resolve when the illnesses are treated. Many erection problems are caused by drugs (notably alcohol and cigarettes) and drug side effects and can be helped by cutting back on alcohol, quitting smoking, or tinkering with prescriptions.

Cialis

GENERIC NAME: tadalafil

BRAND NAME: Cialis

DRUG CLASS AND MECHANISM: Tadalafil is an oral drug that is used for treating impotence (the inability to attain or maintain a penile erection). It is in a class of drugs called phosphodiesterase inhibitors that also includes sildenafil (Viagra) and vardenafil (Levitra).
Erection of the penis is caused by the filling of the penis with blood. Filling occurs because the blood vessels that bring blood to the penis increase in size and deliver more blood to the penis, and, at the same time, the blood vessels that take blood away from the penis decrease in size and remove less blood from the penis.
Sexual stimulation that leads to an erection causes the production and release of nitric oxide in the penis. The nitric oxide causes an enzyme, guanylate cyclase, to produce cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for increasing and decreasing the size of the blood vessels carrying blood to and from the penis, respectively, and causing the erection. When the cGMP is destroyed by another enzyme, phosphodiesterase-5, the blood vessels return to their normal size, blood leaves the penis, and the erection ends. Tadalafil prevents phosphodiesterase-5 from destroying cGMP so that cGMP stays around longer. The persistence of cGMP leads to a more prolonged engorgement of the penis with blood.
Tadalafil was approved by the FDA in November, 2003
GENERIC AVAILABLE: No.
PREPARATIONS: Tablets: 5, 10, and 20 mg.
STORAGE: Store at room temperature between 15-30°C (59-86°F).
PRESCRIBED FOR: Tadalafil is used for the treatment of impotence.
DOSING: For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity. Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.
DRUG INTERACTIONS: The breakdown and elimination of tadalafil from the body may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs may increase the levels of tadalafil in the blood. If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced in order to avoid side effects from high levels of tadalafil.
Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, e.g. nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure. Therefore, tadalafil should not be used with nitrates. Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs e.g., terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate. Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started. In such situations, tadalafil should be started at the lowest dose. If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose. Tadalafil and alcohol both lower blood pressure. Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches and increased heart rate.
PREGNANCY: Tadalafil is not approved for use in women.
NURSING MOTHERS: Tadalafil has not been evaluated in women who are breastfeeding.
SIDE EFFECTS: The most common side effects of tadalafil are facial flushing (reddening), headaches, stomach upset, diarrhea, flu-like symptoms and nausea. Tadalafil also may cause low blood pressure, blurred vision and changes in color vision, and abnormal ejaculation. Tadalafil has been associated with prolonged erections or priapism (painful erections lasting more than 6 hours). Patients should seek immediate medical help if they experience an erection lasting more than 4 hours. Use of tadalafil, most often in patients with pre-existing heart disease, has been associated with chest pain, heart attacks, death, strokes, palpitations and increased heart rate; however, it is not clear whether these side effects are due to tadalafil, concurrent use of nitrates, or the sexual activity itself. Rare cases of sudden loss of hearing have been reported with phosphodiesterase inhibitors such as tadalafil, sometimes associated with ringing in the ears and dizziness. If changes in hearing occur, patients should stop their tadalafil and seek immediate medical attention.

Viagra

GENERIC NAME: sildenafil

BRAND NAME: Viagra, Revatio

DRUG CLASS AND MECHANISM: It has been estimated that impotence affects 140 million men worldwide. Over half of all men with impotence are thought to have some physical (medical) cause. The remainder are believed to have psychogenic causes of impotence. Medical causes of impotence include diabetes and circulatory, neurological or urological conditions.
Penile erection is caused by the engorgement of the penis with blood. This engorgement occurs when the blood vessels delivering blood to the penis increase the delivery of blood and the blood vessels carrying blood away from the penis decrease the removal of blood. Under normal conditions, sexual stimulation leads to the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis.
Sildenafil also reduces the pressure in the pulmonary artery in a serious condition called pulmonary arterial hypertension.
Sildenafil inhibits an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP. Thus, sildenafil prevents the destruction of cGMP and allows cGMP to accumulate and persist longer. The longer cGMP persists, the more prolonged the engorgement of the penis.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Viagra is a blue, film-coated, rounded, diamond-shaped tablets that comes in 25, 50, and 100 mg tablets for treating impotence. Revatio comes in a 20 mg tablet and is used for treating pulmonary arterial hypertension..
STORAGE: Tablets should be kept at room temperature, 15- 30°C (59-86°F).
PRESCRIBED FOR: Sildenafil is used for the treatment of erectile dysfunction of either organic (medical condition) or psychogenic (psychological) cause and for pulmonary arterial hypertension.
DOSING: Sildenafil 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 sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour.
DRUG INTERACTIONS: Sildenafil increases the effects of the blood pressure lowering medications. It also increases the blood pressure lowering effects of nitrates, e.g. isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating angina. Patients taking nitrates should not receive sildenafil.
Cimetidine (Tagamet), erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox) and mibefradil (Posicor) can cause marked increases in the amount of sildenafil in the body. Patients taking these medications should be observed carefully if sildenafil is used.
It is expected that rifampin will decrease blood levels of sildenafil and probably reduce its effectiveness.
PREGNANCY: Although extensive testing in animals has demonstrated no negative effects on the fetus, sildenafil has not been studied in pregnant women. There is no effect on sperm count or motility of sperm in men.
NURSING MOTHERS: It is not known whether sildenafil is excreted into breast milk.
SIDE EFFECTS: Approximately 15% of persons taking sildenafil experience side effects. The most common side effects are facial flushing (1 in 10), headaches (1 in 6), stomach pain, nasal congestion, nausea, diarrhea, and an inability to differentiate between the colors green and blue. Rare cases of sudden loss of hearing have been reported with phosphodiesterase inhibitors such as sildenafil, sometimes with ringing in the ears and dizziness. If changes in hearing occur, patients should discontinue their sildenafil and seek immediate medical attention.

About Levitra

GENERIC NAME: vardenafil

BRAND NAME: Levitra

DRUG CLASS AND MECHANISM: Vardenafil is an oral drug that is used to treat impotence (the inability to attain or maintain a penile erection.). It is a phosphodiesterase inhibitor that is similar to sildenafil (Viagra).
Penile erection is caused by the engorgement of the penis with blood. This engorgement occurs when the blood vessels delivering blood to the penis increase in size and increase the delivery of blood to the penis. At the same time, the blood vessels carrying blood away from the penis decrease in size and decrease the removal of blood from the penis. Sexual stimulation that leads to the engorgement and erection causes the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase to produce cyclic guanosine monophosphate (cGMP). The cGMP is primarily responsible for increasing and decreasing the size of the blood vessels carrying blood to and from the penis, respectively. Vardenafil prevents an enzyme called phosphodiesterase-5 from destroying cGMP so that cGMP persists longer. The longer cGMP persists, the more prolonged the engorgement of the penis. Vardenafil was approved by the FDA in August, 2003.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 2.5, 5, 10 and 20 mg
STORAGE: Vardenafil should be stored at room temperature between 15-30°C (59-86°F).
PRESCRIBED FOR: Vardenafil is used for the treatment of impotence.
DOSING: For most individuals, the recommended dose of vardenafil is 10 mg per day taken 60 minutes before intercourse. If there is no response or side effects, the dose may be increased to 20 mg or, if there are side effects, it may be reduced to 5 mg. Individuals 65 years of age or older should begin therapy with 5 mg. Individuals who are taking medications that increase the blood levels of vardenafil should start treatment with 2.5 to 5 mg of vardenafil. (See drug interactions.)
DRUG INTERACTIONS: The breakdown and elimination of vardenafil from the body is inhibited by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs increase the concentration of vardenafil in the blood. If these drugs are being used at the same time as vardenafil, the dose of vardenafil should be reduced in order to avoid side effects from vardenafil.
Vardenafil reduces the concentration of ritonavir and indinavir and may reduce the effect these drugs.
Vardenafil increases the heart rate and also exaggerates the blood pressure lowering effects of nitrates (e.g. nitroglycerine). In patients who take nitrates for chest pain (angina), vardenafil could cause chest pain by increasing heart rate and lowering blood pressure. Therefore, patients with angina should not use vardenafil. Vardenafil also exaggerates the blood pressure lowering effects of alpha-blocking drugs, e.g. terazosin (Hytrin), and should not be used by individuals who also use alpha-blockers.
PREGNANCY: Vardenafil is not approved for use in women.
NURSING MOTHERS: Vardenafil has not been evaluated in women who are breastfeeding.
SIDE EFFECTS: The most common side effects of vardenafil are facial flushing (reddening), headaches, stomach upset, diarrhea, flu like symptoms and nausea. Vardenafil also may cause chest pain, low blood pressure, blurred vision and changes in color vision, abnormal ejaculation and priapism (painful erection). Rare cases of sudden loss of hearing have been reported with phosphodiesterase inhibitors such as vardenafil, sometimes associated with ringing in the ears and dizziness. If changes in hearing occur, patients should discontinue their vardenafil and seek immediate medical attention.