My doctor: 10/10/08

Friday, October 10, 2008

When You Should See Your Doctor About Erectile Dysfunction

Erectile Dysfunction may occur within a man's life for a variety of reasons. Some of these
reasons are related to non-medical causes and do not warrant a visit to your physician or
health care professional. Some issues such as fatigue or excessive drinking may cause
temporary Erectile Dysfunction (ED) that will clear up as soon as the man is rested or becomes
sober. However, some situations may arise that signal that the Erectile Dysfunction a man may
be experiencing may be caused by more serious factors. Knowing when you should see a
doctor could help relieve the anxiety commonly associated with ED.
One way to determine whether or not you are experiencing significant Erectile Dysfunction is
to assess how much Dysfunction you are experiencing. A brief stint here and there is not cause
for alarm, but if you are experiencing ED more than 25% of the time, you should schedule an
appointment with your doctor. Some men feel uncomfortable discussing the condition with their
doctor. If this is the case then ask your physician for a recommendation to an urologist. An
urologist specializes in treating ED and will have access to tests and treatments that your
doctor may not have.
If you have a predetermined health condition and begin to experience Erectile Dysfunction, it
is imperative that you see your doctor or urologist right away. Some conditions may increase
your chances of developing ED and your doctor or urologist will be able to offer various
treatments and remedies. Diabetes, high blood pressure, hardening of the arteries, and
heart disease can increase your risk of developing Erectile Dysfunction. Your urologist can
prescribe medications or other erectile dysfunction treatment that will help improve your sexual
health.
Sometimes Erectile Dysfunction is the cause of emotional issues, such as anxiety, fear, and
depression. Often these emotional issues will subside naturally. However, if the emotional
issues seem to increase or if they begin to affect your daily life, then you should contact your
doctor right away. There are a number of medications that may be prescribed to help treat
depression and anxiety disorders and seeking the advice of your health care professional is
instrumental restoring your emotional health. Your doctor may also recommend that you see a
psychiatrist or psychologist as well and you should not find this discouraging. Treating depression and other anxiety disorders are not just beneficial to your sexual health, but
untreated depression and anxiety disorders can lead to life threatening issues.
If you are suffering with depression or other anxiety issues that lasts for longer than 2 weeks,
schedule an appointment with your health care professional immediately.
Only a qualified health care professional can assess the exact cause of your Erectile
Dysfunction. Though there are many benign causes, the fact that ED can signify a serious
underlying health condition makes it a necessity to seek treatment. Also, if you are taking
medications for another condition, it is possible that the medication that you are currently being
prescribed is contributing to the Erectile Dysfunction. Only a qualified health care worker can
make the adjustments necessary to either change your dosage or prescribe a different
medication entirely. Though you may feel uncomfortable discussing your sexual health with
your doctor, you will feel better once you have determined the cause of the problem and have
appropriated methods to resolve Erectile Dysfunction.

Erectile Dysfunction Treatment

Erectile Dysfunction Treatment

There are many types of treatments for erectile dysfunction, everything from medications,

simple mechanical devices to psychological counseling & therapy. The only way to manage
and solve erectile dysfunction problems is to get to the root of the cause. By understanding the
cause factors and severity of the condition could help in determining the best treatment or
combination of treatments.
Here is a rundown of some treatment to erectile dysfunction.
Medical Treatment
Erectile dysfunction (ED) is now easily treated with oral medication such as Sildenafil
Citrate or its popular name - Viagra. Viagra is an example of the category of drugs called
PDE5 inhibitors, and it treats ED by relaxing the smooth muscles of the penis during arousal,
leading to a successful and sustained erection. Viagra can produce this effect for 4 hours from
the time of ingestion. This small blue pill has a proven safety record and has been beneficial
for men with ED who have had wide ranging health issues.
The huge success of Viagra led to further research and soon other drugs like Cialis, which is
Viagra's greatest competitor, were introduced. Cialis is one of the most successful anti-ED drugs that can help men with erectile dysfunction (ED) get and keep an erection satisfactory
for sexual activity. Cialis should be taken an hour before sexual intercourse, it sometimes
starts working within 16 minutes and its effects lasts for 24 to 36 hours, several times longer
than other anti-ED drugs such as, Viagra. Because of its extended period of effectiveness, you
do not have the pressure to perform within a few hours. You and your partner can relax and
choose the suitable moment that is right for both of you.
However, Viagra and Cialis is only beneficial to some men.
Although these medications can help many people, not all men can or should take them to
treat erectile dysfunction. If you are under other medications, these drugs are not at all
advisable. This is because these drugs, on combining with the medications that are taken
everyday may cause blood pressure problems and heart attacks. Don't take Viagra or Cialis
with nitrate medications, such as the heart drugs nitroglycerin (Nitro-Bid, others), isosorbide
mononitrate (Imdur) and isosorbide dinitrate (Isordil). The combination of these medications,
which work to widen (dilate) blood vessels, can cause side effects such as dizziness, low
blood pressure and heart problems.
Though, there is another alternative like Zenerx can undo the side-effects. Zenerx works to
increase blood flow to the penis (similar to Viagra and Cialis), but it provides you with even
more. The herbal ingredients in Zenerx’s unique formulation is 100% natural which is what
sets it apart from products like Viagra, Cialis, Levitra and others. Zenerx is 100% herbal and
chemical free which means, all the benefits of better health is the key areas that most improve
and impact sexual ability and performance - only without any unpleasant side effects. Zenerx
has more advantages on treating erectile dysfunction than other well known brand in the
market. You can find more information on Zenerx at Zenerx.com
Others such as vacuum devices, injections, penile implants and blood vessel repair are
also options to treat Erectile Dysfunction (ED). Remember, all medical conditions can be
treated.
Therapy & Counseling
In cases where the sexual function has been inhibited by psychological reasons, therapy and
counseling can help address the feelings of anxiety and guilt. An open dialogue with your
doctor can help you overcome such anxieties and over time, release you from such inhibitions.
Some people think that it might be embarrassing to talk about sexual health to doctor. Just
remember that erectile dysfunction is a common problem, and your doctor won’t be surprised
when you mention the topic. Discussing it with your doctor before a problem occurs can help
you prevent or delay erectile dysfunction. Being open with your doctor can also help determine
the best treatment for you.
Communication
Men who suffer from poor sexual health such as erectile dysfunction may find themselves
distancing from their partners; physically and emotionally. This can give the mistaken
impression that they've lost interest or no longer find their partner attractive. If you find yourself
relating to such a scenario, learn to communicate with your partner. As in all relationships,
communication is the key, so address the issue with your partner. It takes two for a healthy
sexual relation and that means being open and frank about your needs and concerns.
Communication is an important part of sexuality and close relationships. It involves talking
clearly, listening carefully and fully understanding each other. Bridge the gap between you and
your partner and you will discover that not only will she be the support that you need; you will most likely be more open to explore new ways to enjoy an even more healthy and stimulating
sex life.
Lifestyle Modifications
Lifestyle modifications such as reducing the intake of alcohol, avoid smoking tobacco,
ensuring a proper diet, control your blood sugar, managing work stress and spending
quality time with your family will likely to decrease chances of erectile dysfunction. Learn to
prevent erectile dysfunction before it happen to you.
Re-Examine Your Attitude
As you grow older, two of the things that brought you the greatest joy - your children and your
career are no longer prevalent in your every day life. This means that your personal
relationship takes an increased importance. This is the time for you to re-examine your
attitude towards sex. Sensual closeness and sexual intimacy is a way to affirm the love of
life. It is an expression of the satisfaction gained from the present. It expresses the closeness
of your relationship and is an important measure of the quality of life. Ageing just signals a
change in sexual life - not the end of it.

PSYCHOLOGICAL FACTORS erectile dysfunction

PSYCHOLOGICAL FACTORS

Experts believe that 10% to 20% of cases of erectile dysfunction are caused by
psychological (emotional) factors. This doesn't necessarily mean that you are losing your mind,
but rather your emotional well-being is being affected by certain circumstances that are
plaguing your life which in turn affect your sexual health.
Here's a rundown of some of these psychological factors.
I ) Depression
In patients with depression, the causes of erectile dysfunction may by psychological, physical
or a combination of both. For many men, erectile dysfunction creates additional depression,
loss of self-esteem, poor self-image, anxiety and tension between themselves and their
partners. These emotional disturbances can create physical conditions that lead to increased
difficulty in getting an erection.
ii ) Lack of emotional well-being
Sex is not just a physical function - it is also an emotional experience. Just as how 'feeling
good' can stimulate sexual appetite, and negative feelings can have the exact opposite effect.
Feelings such as anxiety, fear, anger, sadness and resentment are just some of the
negative feelings that can overcome you in some stage in your life thus resulting in
psychological impotence. The very fear of impotence can be enough to cause the problem.
Once a problem occurs, fear of failure can add worry.iii ) Stress
Stress is any demand or pressure that induces physical or mental tension. Stress in itself is
not negative but too much stress is bad for us. Symptoms such as headaches, heartburn,
dizziness, muscle spasm, chest pains, cold sweats and loss of sex drive are some of the
most common symptoms faced by people who are stressed. Stress and sex don't mix as it can
adversely affect arousal and intimacy.
iv ) Poor sexual self-esteem
Good sexual self-esteem is about feeling confident about your own individual sexuality. It's
about identifying your own needs, wants and desires and communicating them to your partner.
It's also about having pleasurable sexual thoughts and fanning your flames of desire to feeling
confident about your body and making the most out of it.
v ) Inadequate sex education
There is a certain people are taught by their parents and other caregivers that sex is bad, and
sexual feelings are wrong. The cultural situation may also not allow for free talk on sexuality
thus inhibiting one's desire and freedom. Cultural and religious taboos relating to sex have also
been known to have an impact on sexual activity especially among older couples who have
passed their reproductive cycles.
LIFESTYLES FACTORS
It's bad for us but we do it anyway – smoking (tobacco) and excessive drinking (alcohol)
often cause erectile dysfunction and with decreased sexual drive. Smoking in addition to
causing cancer adversely affects circulation, and it also affects blood flow in veins and arteries.
Drinking can sedate your nervous system and interfere with your ability to get an erection.
Prolonged heavy drinking can damage the nerves and liver which further causes hormonal
abnormality.
Both of these can lead to erectile dysfunction.
In addition to numerous other health risks, the use of drugs such as marijuana and cocaine
has been reported to cause erectile dysfunction.

What is Erectile Dysfunction?

What is Erectile Dysfunction?

Experiencing erectile dysfunction is never easy. But in most cases, erectile dysfunction can
be treated, and it need to be treated on time. It is a problem that should be addressed and not
hidden. So men who are suffering from erectile dysfunction do not bear it in shame. It should
be understood that most men will experience this and that there are ways and methods to cure
and treat erectile dysfunction.
However, there are lot of imitation drugs out there that claim can heal erectile problems.
Beware of these claims and only get prescriptions from the expert or medical doctor. Generic
brand imitations of reputed pharmaceutical drugs can sometimes be more dangerous than
helpful in the long run as they may be manufactured in countries where high quality and safety
standards are not followed, or they may include controversial and at times harmful chemical
ingredients.

Cause of Erectile Dysfunction
“Not tonight dear, I have headache…”
You need not suffer in silence because there is a reason for erectile dysfunction. The
following paragraphs will give you an insight on the medical, emotional and lifestyle factors
that cause erectile dysfunction.

SYMPTOMS OF LOW TESTOSTERONE

How would you know if you weren’t
making enough testosterone? Some
symptoms are more or less common
depending on when the shortage
occurs. If the deficiency occurs during
puberty, a boy might not grow as tall
or as muscular as his friends, and he
might not grow pubic or body hair. In
a few, the breast tissue might begin to
develop, a condition called gyneco-
mastia. In adult men, the picture looks
a bit different because they previously
had normal levels that have declined
or are declining relative to what was
normal for them at a younger age. As
a result, they may experience none,
some or all of the following symptoms:
Lower libido (sex drive)
Erectile dysfunction (ED)
Poor concentration
Fatigue
Increased body fat
Muscle weakness
Osteoporosis (weakness of the
bones)
Loss of body hair (including soft-
ening or loss of the beard)
Depression
Hot flashes
Other mood problems.

Libido

Libido in men (and women) is driven by testosterone. Desire disorders
may present as hypoactive desire disorder (often lifelong), inhibited
desire (may be situational) and desire discrepancy (an increasingly
common disorder in couples)
Desire problems in younger men mostly have a psychological basis
(often around commitment issues). Older men experience a slow
decline in testosterone levels at about one per cent a year from
the age of 40. This may not only reduce libido but may also result
in a controversial condition called partial androgen defciency in the
ageing male (PADAM). As men age, higher levels of sex hormone
binding globulin reduce the amount of bioavailable testosterone.
The clinical symptoms of PADAM are said to be deceased libido,
ED, depression, fatigue, decreased muscle mass, decreased bone
density and increased visceral fat. Yet men who are depressed
may be accused of having PADAM due to the similarity of
presenting symptoms.
Testosterone is a requirement for nocturnal erections but appears
to play only a minor role in the quality of sexually induced erections.
Testosterone, through its receptor sites in cavernosal tissue, helps
improve the action of PDE5 inhibitors which otherwise have poor
results in hypogonadal men. Treatment with testosterone may
increase libido and provides an improved sense of wellbeing.
However, it may also aggravate prostate disorders, raise haematocrit
and aggravate symptoms of sleep apnoea.

A note about ED post Radical Prostatectomy

Surgery for prostate cancer is a now a common procedure. If the neuro-vascular bundle on each side of the prostate cannot be saved, then ED will inevitably follow. Treatment with oral PDE5 inhibitors does not work without intact nerves due to the lack of neurotransmitters. Even with intact neurovascular bundles, the return of erectile function may take from six to 36 months to occur (if ever). The quality of erections also depends on the pre-surgery erectile function. Initial treatment is PGE1 injection therapy, however, some men respond early to oral medication. It is important to keep testing with oral medication from time to time because as soon as oral medication becomes efective, injections may stopped. There is some evidence of beneft being on continuous oral medication in the presence of neuropraxia due to the positive efect of PDE5 inhibitors on the endothelium within the cavernosal tissues.

What does SILDENAFIL(VIAGRA) TABLET contain?

What does SILDENAFIL TABLET contain?
The active ingredient is known as Sildenafil. Each tablet contains Sildenafil Citrate corresponding to
50 or 100 mg Sildenafil. SILDENAFIL TABLET also contains other inactive substances.
What does SILDENAFIL TABLET look like?
SILDENAFIL TABLETS are round, blue colored with two deep score lines for easy splitting on one
side and the words SILDENAFIL and 50mg (or 100mg) on the other.
What is SILDENAFIL TABLET?
SILDENAFIL TABLET is the first of a new group of medication which allows adequate sexual
stimulation, relaxes the blood vessels of the penis and helps erection.
SILDENAFIL TABLET does not increase sexual desire or fertility.
Who should not take SILDENAFIL TABLET?
Whosoever has an allergic reaction to Sildenafil, whosoever is receiving donor medicines of nitric
oxide or nitrates, which are used among other things, in certain cases of angina should not take
Sildenafil. The most commonly used nitrates are nitroglycerin pieces and monoitrate and dinitrate
substances of isosorbid. If you suffer from angina and are not sure whether your actual treatment
corresponds to some of the medicines mentioned above, consult your doctor before taking
SILDENAFIL TABLET.
What precautions should I take before having SILDENAFIL TABLET?
Inform your doctor if you have any penal illness, if you have had painful erections, if you have been
diagnosed with a rare hereditary ophthalmic illness known as retinosis pigmentosis, or peptic ulcer or
any problem of the blood coagulation. Also inform your doctor if you are taking any treatment for
erectile dysfunction.
What special advice should be given to aged patients?
The aged patients should start treatment with the minimal dose advised (25mg/day)
Can SILDENAFIL TABLET be administered to children?
SILDENAFIL TABLET should not be given to children. Keep the medication away from the reach of
children.
Is there any special advice for patients with kidney or liver disease?
Persons suffering from severe liver or kidney disease should take SILDENAFIL TABLET with
precaution, starting treatment with minimal recommended dose, i.e., 25mg

Does the ability to drive vehicles or operate machines reduce by taking SILDENAFIL
TABLET?
SILDENAFIL TABLET does not reduce the ability to drive vehicles or use machines.
Can SILDENAFIL TABLET be taken simultaneously with other medicines?
SILDENAFIL TABLET should not be given simultaneously with nitrates or nitric oxide donors nor
with mononitrate or dinitrate substances of Isosorbid. The combination of SILDENAFIL with other
medicines requires to be approved by the doctor treating you, especially Cimetidine, Erythromycin
and Ketoconazol.
How is SILDENAFIL TABLET taken?
The most convenient dose is decided by your doctor. For most men, the dose is 50 mg one hour
before sexual activity. SILDENAFIL TABLET should not be taken more than once a day. The effect
of SILDENAFIL TABLET is only obtained with a satisfactory sexual stimulation. SILDENAFIL
TABLET is not an aphrodisiac. The time necessary of SILDENAFIL TABLET to exercise its action
varies from half an hour to one hour and this period may be extended if SILDENAFIL TABLET is
taken with meals. Large quantities of alcohol are not recommended before taking SILDENAFIL
TABLET. Any change in the dose prescribed should be done by the doctor treating you.
Does SILDENAFIL TABLET produce side effects?
Just like the majority of medicines, it is possible that SILDENAFIL TABLET may have side effects,
which are usually light and temporary. The most common side effects are headache and facial
reddening. Other side effects reported but rarely seen are indigestion, dizziness, clogged nose and
effects on vision (including changes in the visual perception of colours, increase of brightness of
light and blurred vision).
How should SILDENAFIL TABLET be stored?
Keep the SILDENAFIL TABLETS in their original packing, at temperature which is below 30
degrees centigrade.
What is the shelf-life of TADALAFIL TABLET?
The shelf life of Tadalafil is 2 years

Got the Viagra Blues?

Charles Dickens stated in A Tale of Two Cities, “It was the best of times. It was the worst of times”.
How true is this statement today! Instead of two cities, we have the bedroom representing two places: a
place to sleep and a place to make love. With the introduction of Viagra, we had hoped that the bedroom
would become the best of times. However, when medications are not effective, the bedroom can represent
the worst of times.

It is estimated that more than 20 million men in the United States are affected by erectile
dysfunction (ED). In the majority of these cases, the actual cause is related to poor circulation and blood
flow in the penis. Just think of it. The coronary arteries surrounding the heart are four times the size of
the arteries feeding the penis. If there should be any degree of hypertension, elevated cholesterol, or
diabetes, blood flow problems affecting the heart lag way behind any adverse effects these diseases have
on the flow of blood into the penis. Patients who have been treated for prostate cancer by surgery or by
various forms of radiation have compromises of their blood flow into the penis.
Viagra and its newer “me too” concoctions can resurrect successful erections in about 70% of men.
Therefore a large number of sufferers of ED will require a more advanced treatment option. Currently the
best option for men who do not respond to Viagra is the internal penile pump. The internal penile pump
makes my patients feel as normal as possible and allows men to regain their confidence and security in the
bedroom.
Many of my patients who have used the pump for over 15 years are constantly thanking me for
recharging their sex life and enabling them to enjoy spontaneous lovemaking again.
The internal penile pump is an inflatable, saline-filled device. During the course of a 45-minute
outpatient procedure, the pump in inserted through a one-inch opening in the scrotum. Squeezing the
pump, which is completely in the scrotal sac, for less than one minute, brings fluid into the penis that
causes a lasting erection. The erection is maintained until the man squeezes the pump again so that the
fluid retreats and the penis can return to its original state. The patient controls the duration of the erection.
If a patient has an orgasm too quickly, the erection is not lost, and the patient is able to maintain it until
this partner is satisfied. Men between the ages of 45 and 90 years old, sexually motivated and active, men
who have had prostate, bladder, or colon cancer treatment, and men who have penile deformity and/or
atrophy are all excellent candidates for the internal pump. Men are excited and relieved for the
opportunity for spontaneous sexual activity. The pump is under the skin, totally concealed and eliminates
self-consciousness. The penis feels and performs naturally, and men are thrilled to have a young, plump
penis once again, like they had when they were 25. Once in place, there is no maintenance required for
the pump, which can remain inserted and useful for a lifetime.
The highlight of this treatment is that it restores the patient’s control over his own body, so that he is
able to obtain and maintain an erection at his disposal. Normal sensation, including orgasm and
ejaculation, is not affected. Compared to Viagra, the internal penile pump is the best long term option for
patients with advanced erectile dysfunction. The internal penile pump enables men who suffer from
advanced erectile dysfunction to resume a normal, spontaneous sex life. For these men, it represents a
cure. The procedure is covered by most insurance policies, including Medicare.

WHAT SIDE EFFECTS CAN VIAGRA CAUSE?

Headache, flushing, stomach upset, heartburn, nasal stuffiness, diarrhea, dizziness, or lightheadedness may occur.
Vision changes such as increased sensitivity to light, blurred vision, or impaired blue/green color discrimination may
also occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side
effects. Many people using this medication do not have serious side effects.
Rarely, a sudden loss of eyesight in one or both eyes (NAION) may occur. This may or may not be due to sildenafil. If
this serious problem occurs, seek immediate medical attention. You have a slightly greater chance of developing this
serious eye problem if you have heart disease, diabetes, high cholesterol, certain eye problems ("crowded disk"),
high blood pressure, are over 50 years of age, or if you smoke.
Sexual activity may put extra strain on your heart, especially if you have heart problems. If you have heart problems
and experience any of these serious side effects while having sex, stop and tell your doctor immediately of: severe
dizziness, fainting, chest pain, nausea.
For males, in the very unlikely event you have a painful or prolonged erection lasting 4 or more hours, stop using this
drug and seek immediate medical attention, or permanent problems could occur.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a
serious allergic reaction include: rash, itching, unusual swelling, severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or
pharmacist.

WHAT SHOULD I DO IN THE EVENT OF AN OVERDOSE?

If overdose is suspected, contact your local poison control center, US National Poison Hotline at 1-800-222-1222, or
emergency room immediately.
Symptoms of overdose may include severe dizziness, fainting, or prolonged erection.

IS THERE ANY GENERAL INFORMATION I SHOULD KNOW?

Do not share this medication with others, since they may have a problem that is not effectively treated by this drug, or
they may have a condition that is complicated by this drug.
Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59
and 86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from
children and pets.

WHAT PRECAUTIONS DO I NEED TO BE AWARE OF BEFORE USING VIAGRA?

WHAT PRECAUTIONS DO I NEED TO BE AWARE OF BEFORE USING VIAGRA?

Before taking sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: penis conditions (e.g.,
angulation, fibrosis/scarring, Peyronie's disease), history of painful/prolonged erection (priapism), sickle cell anemia,
blood system cancers (e.g., leukemia or myeloma), eye problems (e.g., retina diseases like retinitis pigmentosa),
kidney disease, liver disease, bleeding disorders, active stomach ulcers, heart problems (e.g., recent heart attack or
serious arrhythmia within past 6 months, heart failure, coronary artery disease with unstable angina, aortic stenosis,
idiopathic hypertrophic subaortic stenosis), recent stroke within past 6 months, very high or low blood pressure.
This drug may make you dizzy or cause vision changes; use caution engaging in activities requiring alertness such as
driving or using machinery. Limit alcoholic beverages.
To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.
Do not take this medication with any other product that contains sildenafil or other similar medications for erection
problems (e.g., tadalafil, vardenafil).
Caution is advised when using this drug in the elderly because they may be more sensitive to the side effects of the
drug.
This drug is not indicated for use in women or children.

WHAT ARE POSSIBLE INTERACTIONS WITH THE USE OF VIAGRA?

See also How To Use section for drug-food interactions.
This drug should not be used with the following medications because very serious (possibly fatal) interactions may
occur: nitrates (e.g., nitroglycerin, isosorbide), nitroprusside (or any "nitric oxide donor" drugs), recreational drugs
called "poppers" containing amyl or butyl nitrite.
If you are currently using any of these medications, tell your doctor or pharmacist before starting sildenafil.
Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may
use, especially of: alpha-blocker medication (e.g., doxazosin, prazosin, terazosin), other medications for impotence,
azole antifungals (e.g., itraconazole, ketoconazole), bosentan, cimetidine, erythromycin, rifamycins (e.g., rifampin),
high blood pressure medicines, delavirdine.
If you are taking an HIV protease inhibitor (e.g., ritonavir, saquinavir), do not take more than a 25mg dose of sildenafil
in a 48 hour period.
If you are taking more than a 25mg dose of sildenafil and are also taking an alpha-blocker medication (e.g.,
doxazosin, prazosin, terazosin) for various conditions (e.g., enlarged prostate), separate the time between taking
these medications by more than 4 hours.
This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or
pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor
and pharmacist.

WHY HAS VIAGRA BEEN PRESCRIBED TO ME?

WHY HAS VIAGRA BEEN PRESCRIBED TO ME?

Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction) by blocking a certain
enzyme (phosphodiesterase-PDE5) in the body. In combination with sexual stimulation, sildenafil works by helping
the blood flow into the penis to achieve and maintain an erection.
This drug is not indicated for use in women.
Use of this drug does not protect against sexually transmitted diseases (e.g., HIV, hepatitis B, gonorrhea, syphilis).
Practice "safe sex" such as using latex condoms. Consult your doctor or pharmacist for more details.

HOW SHOULD I USE VIAGRA?

This drug is taken by mouth as needed, at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour
before is the most effective). Do not take more often than once daily, and take as directed.
A high fat meal may delay the time of onset of this drug.
Avoid eating grapefruit or drinking grapefruit juice while you are being treated with this medication unless your doctor
instructs you otherwise.
The dosage is based on your medical condition, response to therapy, and other medications you may be taking (see
also Drug Interactions section). Consult your doctor or pharmacist for more details.

How much to take and when to take it. Viagra online pharmacy

How much to take and when to take it

For most patients the recommended dose is 50 mg. taken approximately
one hour before sexual activity. The highest dose is not to exceed 100 mg.
Patients greater than 65 years of age, those with significant liver disease or
kidney disease, should start on a 25 mg. dose to be safe. Patients taking
Erythromycin and Ketoconazole should start at a 25-50 mg. dose to be
safe as well. The dose can always be increased if the desired effect doesn’t
quite happen. Regardless of the strength of medication, patient is not to
use more than the advised dose in a 24-hour period.
• The highest levels of action in the penis occur in 30 minutes to two hours
after the pill is taken. The pills can be taken up to four hours prior to
activity with adequate results in many patients.

Important information you should really know

Viagra is not and aphrodisiac. It will not increase your sexual desire.
• Viagra will not improve an erection if you already have adequate
erections. It will not prolong erections if erections are fully hard and
lasting a normal length of time for you as an individual. That is easy to
say, if it is not broken it is not going to fix it.
• It is really, really important to understand that Viagra needs your input to
work effectively. That means that just taking a Viagra tablet with little
additional sexual stimulation is unlikely to cause a good rigid penis.
Viagra only improves the function of your penis and requires appropriate
sexual stimulation to help bring about a useful erection for lovemaking.
All the good old inputs are necessary and might include your partner, your
mood, the setting, music, smell and other erotic stimuli. Each of these may
enhance that quality of the erection, the lovemaking, and the overall
experience.
You need to give the medication four or five tries to have a good idea as to
whether it will help you or not. This is partly because just the anticipation
of trying a new pill, the anxiety of the situation and expectations for your
performance can make the first attempts at lovemaking less than perfect.
Remember, Viagra only enhances the normal pathways that can cause an
erection. It does not increase your sexual desire and it is not a sexual
device or stimulant.
• Just one more favor- If Viagra does not work for you, please be assured
that there are many other opportunities for overcoming erection problems.
In fact, there is virtually no patient who can’t get satisfactory treatment
nowadays. There a host of other options available and these should be
thoroughly discussed with a physician who is knowledgeable and really
cares about your condition. Just because Viagra doesn’t work on you
doesn’t mean that one of the other options won’t give an excellent result
of improper desire or lack of love.
• All couples may benefit from counseling to discuss intimacy and other
sexual issues

What is Viagra and how does it work?

What is Viagra

A chemical by the name of Sildenafil citrate.
• Viagra can be thought of as a medication that improves blood flow to the
erection chambers within the penis and keeps it flowing. These events are
the basis for creating and continuing an erection. At the end of a greater
than one year study, 88% of patients reported that Viagra improved their
erections, however, many of these patients did not have an erection
adequate for penetration on a number of occasions.

What should I worry about, Doctor?

• In general you should know there is a degree of heart risk with any sexual
activity.
• A thorough medical history and physical examination by a physician
should be undertaken to make sure that no other dangerous diseases are
causing your loss of erection function.
• Viagra should not be combined with other medications for treatment of
erection problems because studies have not been done yet.
• Viagra absolutely should not be taken with medications called organic
nitrates. Some specific examples of organic nitrates include, Nitroglycerin,
Nitro-Bid, Nitro-Dur, Nitropaste or basically anything with nitro in it. You
absolutely should check with your pharmacist if there is any uncertainty
whatsoever. To take Viagra together with a nitrate may lead to severe drop
in blood pressure and other problems, possibly even a stroke. Some other
medications can interact with it and can cause a greater potential for side
effects. These include Tagamet (cimetidine), and two antibiotics,
erythromycin and ketoconazole among others.
• Viagra is not indicated for use in women or children.
• Side effects from the medication include headache in approximately 16%,
flushing in 10%, stomach upset in 10%, nasal congestion in 4%, and
abnormal vision in 3% of patients The abnormal vision is usually mild and
short lived, predominately involving a color tinge to vision. These side
effects typically occur at higher doses, however, only a few patients
experience them to such a degree that they need to stop the medication.

My doctor

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