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VIAGRA – a drug for the treatment of erectile disorders. Acts on the natural viagra prank mechanisms of erection. It is used in men suffering from erectile dysfunction of various origins (vascular, nervous erection disorders).

A prerequisite online viagra for the effectiveness of sildenafil is sexual stimulation.

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Indications

Treatment of erectile dysfunction, characterized by the inability to achieve or maintain an erection of the penis, sufficient for satisfactory sexual intercourse.

The drug Viagra is effective only in the presence of sexual stimulation.

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Contraindications

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– Hypersensitivity to any component of the drug.

– Use in patients receiving constantly or intermittently nitric oxide donators, organic nitrates or nitrites in any best place to buy generic viagra online form.

– Age up to 18 years.

– Not intended for use in women.

Precautions: anatomical deformity of the penis, a disease predisposing to priapism (leukemia, thrombocythemia), diseases accompanied by bleeding, worsening over the counter viagra substitute of peptic ulcer disease, hereditary pigmentary retinitis, heart failure, unstable angina, transferred in the last 6 months of myocardial infarction, stroke.

Dosage and administration

The drug is taken orally.

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For most patients, the recommended dose women viagra is 50 mg; the drug is taken, if necessary, about 1 hour before sexual activity. Given the efficacy and tolerability, the dose may be increased to 100 mg or reduced to 25 mg.

The maximum recommended dose of 100 mg.

The maximum recommended frequency of use is 1 time per day.

Side effects

Adverse events are usually transient and mild or moderately severe. The frequency of adverse events viagra ingredients increases with increasing dose.

Asthenia, pain, abdominal pain, back pain, infection, flu-like syndrome, diarrhea, nausea, joint pain, muscle generic viagra cost pain, dizziness (side effect reported in clinical studies), increased muscle tone, insomnia, nasal congestion, pharyngitis , rhinitis (a side effect viagra and alcohol reported in clinical studies), sinusitis, respiratory tract infections, impaired respiratory function, rash, vision changes: mild and transient, conjunctivitis, urinary tract infections, impaired prostate function.

Overdose

With a single dose of Viagra® in a dose of up to 800 mg, adverse events were the same as when taking the drug in lower doses, but were buy viagra more common.

Symptomatic treatment. Hemodialysis does not accelerate the clearance of sildenafil, since the latter is actively associated with plasma proteins and is not excreted by the kidneys.

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To diagnose erectile dysfunction, determine their possible causes, and select an adequate treatment, it is necessary to gather a full medical history and conduct a thorough physical examination. Erectile dysfunction treatment should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis, Peyronie’s disease), or in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia).

During postmarketing studies, cases of prolonged erection and priapism have been reported. If an erection persists for more than 4 hours, the patient should immediately seek medical attention. If priapism therapy was not carried out immediately, it can cause damage to the tissues of the penis and irreversible loss of potency.

Drugs for treating erectile dysfunction should where to buy viagra not be given to men for whom sexual activity is undesirable.

Sexual activity poses a certain risk in the presence of heart disease, so before starting any therapy for erectile dysfunction, the doctor should refer the patient to an examination of the state of the cardiovascular system. Sexual activity is undesirable in patients with heart failure, unstable angina, suffered myocardial infarction or stroke in the last 6 months, life-threatening arrhythmias, arterial hypertension (BP> 170/100 mm Hg) or hypotension (BP <90/50 мм рт.ст.). Прием силденафила у таких пациентов противопоказан. В клинических исследованиях показано отсутствие различий в частоте развития инфаркта миокарда (1.1 на 100 человек в год) или частоте смертности от сердечно-сосудистых заболеваний (0.3 на 100 человек в год) у пациентов, получавших препарат Виагра, по сравнению с пациентами, получавшими плацебо.

Cardiovascular complications

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Post-marketing use of sildenafil for the treatment of erectile dysfunction reported adverse events such as serious cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, and an arthritis, transient ischemic attack. hypotension), which had a temporary relationship with the use of sildenafil. Most of these patients, but not all of them, had risk factors for cardiovascular complications. Many of these adverse events were observed shortly after sexual activity, and some of them is viagra government funded were observed after taking sildenafil without subsequent sexual activity. It is not possible to establish the existence of a direct connection between the observed adverse events and the specified or other factors.

Hypotension

Sildenafil has a systemic vasodilating effect, leading to a transient decrease in blood pressure, which is not a clinically significant effect and does not lead to any consequences in most patients. However, before prescribing Viagra, a doctor should carefully best place to buy viagra online evaluate the risk of possible undesirable manifestations of vasodilating action in patients with appropriate diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the excretory tract of the left ventricle (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as with rarely encountered multiple systemic atrophy syndrome, manifested by a severe dysregulation of blood pressure in the autonomic nervous system.

Since the combined use of sildenafil and alpha-blockers can lead to symptomatic hypotension in certain sensitive patients, Viagra should be used with viagra canada caution in patients taking alpha-blockers. To minimize the risk of postural hypotension in patients taking alpha blockers, taking Viagra should be started only after stabilization of hemodynamic parameters in these patients is achieved. It should also consider the feasibility of reducing the initial dose of the drug Viagra. It is necessary to inform patients about what actions should be taken in case of symptoms of postural hypotension.

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Visual impairment

In rare cases, during post-registration use of all PDE5 inhibitors, including sildenafil, nonarteritis anterior ischemic optic neuropathy (NPINZN) – a rare disease and cause of loss or loss of vision was reported. Most of these patients had risk factors, in particular a decrease in the ratio of excavation diameters and optic nerve head (“stagnant disc”), over 50 years of age, diabetes free viagra, hypertension, coronary artery disease, hyperlipidemia, and smoking. In an observational study, it was evaluated whether the recent use of drugs of the FDE5 inhibitor class is associated with an acute onset of NPINSN. The results indicate an approximately twofold increase in the risk of NPINZN within 5 elimination half-lives after the use of the PDE5 inhibitor. According to published literary data, the annual incidence of NPINSN is 2.5-11.8 cases per 100,000 men ge; 50 years in the general population. Patients should be advised to discontinue sildenafil therapy in the event of a sudden loss of vision and consult a physician immediately. Persons who have already had a case of an NPINZN have an increased risk of a recurrence of an NPINZN. Therefore, the physician should discuss this risk with such patients and discuss with them the potential chance of adverse effects from PDE5 inhibitors. PDE5 inhibitors, incl. Sildenafil, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk. In patients with episodes of development teva generic viagra of NPINZN with loss of vision in one eye, sildenafil is contraindicated.

A small number of patients with hereditary retinitis pigmentosa have genetically determined abnormalities of retinal phosphodiesterase functions. Information about the safety of the drug Viagra in patients with retinitis pigmentosa is absent, therefore, sildenafil should be used with caution.

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Hearing loss

In some post-marketing and clinical studies reported cases of sudden deterioration or hearing loss associated with the use of all PDE5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or hearing loss. There is no causal relationship between the use of PDE5 inhibitors and the sudden deterioration of hearing or hearing loss. In the event of a sudden deterioration in hearing or hearing order viagra online loss while taking sildenafil, the patient should immediately consult a doctor.

Bleeding

Sildenafil enhances the antiplatelet effect of sodium nitroprusside, a nitric oxide donator, on human platelets in vitro. Data on the safety of sildenafil in patients with a tendency to bleeding or exacerbation of gastric ulcer and duodenal ulcer are not available, therefore, Viagra in these patients should be used with caution. The incidence of nasal bleeding in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (sildenafil 12.9%, placebo 0%) than in patients with primary pulmonary hypertension (sildenafil 3%, placebo 2.4%). In patients receiving sildenafil in combination with a vitamin K antagonist, the frequency of nosebleeds was higher (8.8%) than in patients not taking viagra samples a vitamin K antagonist (1.7%).

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Use in conjunction with other erectile dysfunction treatments.

The safety and efficacy of Viagra together with other PDE5 inhibitors or other drugs for the treatment of pulmonary hypertension containing sildenafil (for example, Revazio), or other means of treating erectile dysfunction have not been studied, so the use of such combinations is not recommended.

Influence on ability to drive motor transport and control mechanisms

Against womens viagra the background of sildenafil intake, there was no negative effect on the ability to drive a car or other technical means. However, since the administration of sildenafil may cause dizziness, a decrease in blood pressure, the development of chromatopsia, blurred vision and other side effects, caution should be exercised when driving and doing other potentially dangerous activities that require increased concentration and psychomotor speed. You should also be attentive to the individual action of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.

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In April 1998, the drug Sildenafil citrate was approved for clinical use. It was widely known under the trade name Viagra. This moment has not just become the starting point for the existence of the next drug in the pharmacological market. It turned out to be the beginning of a new era in the field of sexual medicine, marked by a real breakthrough in the fundamental and clinical spheres, as well as in the public perception of sexual pathology.

Viagra has become the first effective and safe oral medication for the treatment of erectile dysfunction (ED). The attitude of medicine to this disease has undergone dramatic changes over the past hundred years. Currently, there is no doubt that erectile dysfunction, previously considered as a consequence of psychological problems, in most cases is a manifestation of an organic lesion, often of a systemic nature [1]. The main stages of the development of sexual medicine in the XX century are presented in table 1.

The history of the discovery of Viagra is an example of how random observation can have a huge impact on the viagra patent expiration progress of scientific progress. During the clinical trials of a new antianginal drug, Pfizer Inc. researchers noted that although the medication is not accompanied by a significant clinical improvement in the course of angina, in many patients it leads to the development of a kind of “side effect”, which consists in improving erectile function [2]. This observation has led to the study of the possibility of using this substance in the treatment of ED.

However, we should not think that the discovery of Viagra was a simple success. It was preceded by the accumulation of knowledge about the role of nitric oxide NO in ensuring the normal functional state of the cardiovascular system, initiated by Furchgott and Zawadski [3]. The authors, who received further the Nobel Prize for their discoveries, found that, in the presence of an intact endothelium, the effects of acetylcholine lead to a dose-dependent relaxation of an isolated segment of the arteries as a result of exposure to an endothelial relaxing factor. Further studies have shown that this factor is NO, which is synthesized from L-arginine by the enzyme NO – synthase (NОС) [4]. Standing out from the endothelial cells, NO diffuses into the underlying smooth muscle tissue, where the enzyme guanylate cyclase is activated, as a result of which the amount of cyclic guanosine monophosphate (cGMP) sharply increases in cells, which in turn leads to a decrease in intracellular calcium ion concentration and relaxation. The destruction of cGMP, which limits the vasorelaxant effect of NO, is effected by the enzyme phosphodiesterase (PDE). Currently, 11 types of this enzyme are known, while in the destruction of cGMP in vascular smooth muscle cells the main role is played by PDE of 1,3 and 5 types [5]. Thus, inhibition of PDE leads to increased effects of nitric oxide.

An erection of the penis is a hemodynamic phenomenon, the first stage of which is the relaxation of smooth muscle cells of the cavernous arteries and trabeculae, leading to the filling of the cavernous bodies with blood. The relaxation of the smooth muscle tissue of the latter, as in other vascular systems, is provided by the action of NO, released from the endothelium and non-cholinergic non-adrenergic nerve endings [6]. The discovery of Viagra, a selective type 5 PDE inhibitor (PDE-5), has led to many fundamental studies that have shown that this type of enzyme dominates cavernous tissue, which ensures the selectivity of the drug [7]. It should be noted that these studies also allowed to find out the mechanisms of action of other drugs that have been used in clinical practice for a long time, in particular, papaverine and prostaglandin E1 [8], and significantly expand knowledge of the mechanism of erection and its disorders leading to ED.

The emergence of Viagra has had a great influence on clinical research in the field of sexual medicine. In recent years, the terminology has been clarified and new definitions of various forms of sexual disorders have been developed. Clinical trials of Viagra became an incentive to create new diaries and generic viagra without a doctor prescription questionnaires to assess the state of the sexual function of men. Analysis of the demographic indicators of participants in large-scale clinical trials revealed risk factors for ED, which, in turn, contributed to an understanding of its pathogenesis [9].

The emergence of Viagra had a huge public outcry. A large number of patients with erectile dysfunction who had not previously visited a doctor received hope for a cure, and by now millions of men around the world have returned to a normal sex life thanks to taking this drug.

The clinical efficacy of Viagra has been evaluated in numerous studies conducted in the world. Carson et al. pooled data from 11 double-blind, placebo-controlled trials involving a total of almost 3,000 patients with ED [10]. 12 weeks after starting the drug, 76% of men who received Viagra and 22% who received placebo noted an improvement in erection. The percentage of successful attempts at sexual intercourse was 66% and 26% in the first and second groups, respectively. The effectiveness of various doses of Viagra was 65% for 25 mg, 74% for 50 mg and 82% for 100 mg. The high efficiency of Viagra has been noted in different age groups. Thus, among patients younger and older than 65 years, the efficiency of Viagra was 77.6% and 69.2%, respectively. Significantly higher efficiency of Viagra compared with placebo also occurred in patients with ED of varying severity and different etiologies (Table 2).

Arterial hypertension (AH) is one of the risk factors for ED. Although Viagra has some antihypertensive effects, this drug is safe in patients with hypertension as receiving and not receiving antihypertensive drugs [11,12]. The effectiveness of Viagra in patients with ED, suffering from hypertension, is high. Among patients with hypertension of various origins, placebo and Viagra were accompanied by an improvement in erection in 18% and 70% of patients, respectively. Among men who took two or more antihypertensive drugs, these figures were 17.6% and 71% [12].

Another well-known risk factor for ED is smoking. The effectiveness of Viagra among smokers was not inferior to that among non-smokers (80% and 74% respectively), as well as among those who smoked earlier (74%) [10].

Many epidemiological studies have shown that depression is the second most common cause of the development of ED after cardiovascular risk factors [13,14]. In addition, the presence of ED aggravates depressive symptoms [15]. Viagra treatment among patients with depression not only was highly effective in improving erectile function, but was also accompanied by a decrease in the severity of depressive manifestations [15,16].

Various neurological diseases can also cause ED. According to studies, the effectiveness of Viagra among patients with parkinsonism, multiple sclerosis and spinal cord injuries exceeds 80%, which corresponds to the data obtained in the general population of patients with ED [17-21].

Special groups of patients with erectile dysfunction, difficult to treat, are viagra without a doctor prescription patients with diabetes mellitus (DM) and undergoing radical prostatectomy (RP).

In patients with diabetes, the effectiveness of Viagra depends on the severity of the course of diabetes and the presence of its complications. So, in the study of Carson et al. among patients with diabetes without complications, an improvement in erection was noted by 8% of patients who received placebo and 69% who received Viagra. With one complication, these figures were 12% and 43%, and two – 10% and 43%, respectively [10]. In all groups, the effectiveness of Viagra was significantly higher compared with placebo.

The effectiveness of the treatment of ED after RP is determined by a number of factors, including the procedure for performing the operation (non-nervous, one-sided and bilateral nerve-saving), the age of patients, the state of erectile function before the operation, the stage of prostate cancer, the size of the prostate, the qualifications of the surgeon, and socio-economic factors such as the level of education and income of the patient [22-28]. Thus, according to Raina et al., Viagra treatment was effective in 71.7% of patients after a bilateral nerve-saving RP, in 50% after a unilateral nerve-saving RP, and only in 15% of patients with ED after a non-nerve-saving ED [29].

In addition, the peculiarity of the course of erectile dysfunction in such patients is the possibility of a progressive improvement in erection for up to 4 years after surgery [30], and therefore the final ineffectiveness of a particular treatment can be judged only a few years after surgery. This is confirmed by the data of Hong et al., Who examined 316 patients with ED after RP, in 95% of cases wore a bilateral nerve-saving character. The effectiveness of Viagra was 26% during the first 6 months, 36% from 6 to 12 months, 50% from 12 to 18 months and 60% from 18 to 24 months after surgery [31].

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Elucidation of the features of the pathogenesis of ED after RP, including the role of fibrotic changes arising on the background of decreased oxygenation of cavernous tissues, became the basis for the use of pharmacologic prophylaxis of ED in patients undergoing PRP. Given the importance of nocturnal erections in providing trophism of the cavernous bodies, as well as data from previous studies of Viagra use at bedtime, which showed an improvement in the quality of nocturnal erections in patients with various forms of ED [32], Padma Nathan et al. studied the effectiveness of Viagra in the prevention of ED after RP [33]. During the study, patients who underwent bilateral nerve-saving RP and did not suffer from ED before surgery, starting from the second month of the postoperative period, received Viagra at doses of 100 and 50 mg or placebo before going to bed for 36 weeks. Eight weeks after discontinuation of treatment, 27% of men who received sildenafil and only 4% who received placebo does viagra make you last longer reported about the possibility of a normal sex life [33]. Thus, the appointment of Viagra can be an effective method for the prevention of ED in patients after RP as a result of improving the blood supply to the cavernous tissue, preventing the development of fibrous changes in it.

Despite the high efficacy of Viagra, a certain number of patients remain in whom the intake of this drug does not lead to an improvement in erection. In many cases, this is due to improper medication [34]. Patients, especially at the beginning of treatment, should be advised to take Viagra on an empty stomach at least 30 minutes before the start of sexual activities. It is also important to explain to patients that the effect of the drug develops only against the background of adequate sexual arousal and largely depends on it. In many cases, treatment should begin with 100 mg, which will allow you to get the maximum response at the beginning of treatment and inspire patients with confidence in the success of treatment. In addition, studies have shown that in some patients, the maximum effect of Viagra is achieved by 6-8 reception, and therefore in many patients the final assessment of the effectiveness of the drug should be made after several attempts to use it.

Currently, discussions are continuing about the long-term effectiveness of Viagra and the possibility of developing tachyphylaxis. El – Galley et al. conducted a telephone survey of 82 patients 2 years after the appointment of Viagra. Among the respondents, 41 (59%) continued to take Viagra, while 37% were forced to increase the initial dose of the drug due to a decrease in efficiency. Stopped admission due to a decrease in the effectiveness of 17% of patients [35]. The long-term efficacy of Viagra was also investigated by Montorsi et al., Interviewed 2618 patients who took the drug for 3 years [36]. In general, 96% of respondents were satisfied with the treatment and only 1.6% stopped it due to low efficiency. Laboratory studies also did not confirm the existence of the effect of tachyphylaxis when taking Viagra [37,38]. Thus, the existing data do not confirm the presence of the effect of tachyphylaxis with long-term use of Viagra.

An important characteristic of any pharmacological drug is its side effects. The most frequent side effects of taking Viagra include headache (7% of cases), facial flushing (7%), dizziness (2%), dyspepsia (1.8%), nasal congestion (1.4%) and disorders of sight, usually in the form of blue coloring of objects (1.2%) [39]. In most studies, the incidence of side effects and refusals of treatment as a result of their development were comparable in the groups of patients receiving Viagra and placebo. It should also be noted that the frequency of side effects decreases as the drug is taken. Thus, in the Carson study, the frequency of all side effects, except for visual impairment and dyspeptic disorders, decreased during the course of taking the drug. Headaches at the beginning of the study reported 7% of patients with ED, and after 16 weeks less than 1%, the frequency of vertigo also decreased from 7% to less than 1%, and nasal congestion from 1.4% to less than 0.5% [40 ]. An important fact is also the fact that two thirds of patients in the process of conducting this study increased the dose of Viagra. Thus, with prolonged use, the frequency of most side effects of Viagra does not when will generic viagra be available exceed that for placebo.

The attention of Viagra on the cardiovascular system deserves special attention. Zusman et al. investigated the effect of Viagra on blood pressure in patients with ED, taking and not taking antihypertensive drugs [41]. Although the authors noted a slight decrease in pressure in all groups of patients, statistically significant differences occurred in only a small number of cases. The men participating in the how to take viagra study took diuretics, b – blockers, a – blockers, calcium antagonists, and angiotensin-converting enzyme inhibitors. The most pronounced decrease in blood pressure occurred in patients who did not take antihypertensive drugs, as well as in those who received calcium antagonists. At the same time, pressure reduction in none of the groups was not dangerous for the patients [41].

Hermann et al. studied the effect of Viagra on exercise tolerance in patients with angina pectoris [42]. The results showed that Viagra not only does not reduce the functional ability of the heart, but even has a positive effect on its blood supply, which, however, is not surprising given the previously described history of the appearance of this drug.

Long-term use of Viagra not only does not lead to an increase in mortality from myocardial infarction, which was a subject of concern in the early stages of the drug, but even, apparently, somewhat reduces the latter. Thus, according to Padma – Nathan et al., The frequency of fatal myocardial infarction is 0.26 per 100 patients taking Viagra per year, while the similar indicator for men of the same age from the general population is 0.6 [39].

In recent years, the possibility of using Viagra in various diseases, in addition to ED has attracted increasing interest.

In the study of Sairam et al. The effect of Viagra on the severity of urination disorders in patients with ED was evaluated. At 1 and 3 months after the start of treatment, a significant decrease in the severity of lower urinary tract symptoms was observed, which correlated with an improvement in erectile function [43].

Acceptance of Viagra leads to an improvement in the condition of patients with primary and secondary pulmonary hypertension. Several studies have shown a decrease in pressure in the pulmonary trunk and the reaction of the pulmonary vessels to hypoxia when using Viagra as monotherapy and in combination with iloprost, which was accompanied by an increase in exercise tolerance and the quality of life of patients [44–46].

One of the possible directions of future research of Viagra is the use of this drug in the treatment of endothelial dysfunction. The concept of endothelial dysfunction has arisen as a result of the accumulation of data that the endothelial cells lining the lumen of all vessels of the body not only form a barrier between the blood and surrounding tissues, but also have a number of regulatory functions, the implementation of which is extremely important to maintain the anatomical and functional integrity of the vessels . Among the most important functions of the endothelium are the regulation of vascular tone, the effect on the blood coagulation system, the ability to counteract the adhesion of blood cells and the proliferation of smooth muscle cells [47]. All of these functions endothelium performs as a result of the development of various mediators, which occurs in response to chemical and mechanical effects on endothelial cells. The main among these mediators is nitric oxide NO, which has a vasodilating effect, as well as reducing the adhesion of blood cells to the vascular wall, inhibiting the proliferation of vascular smooth muscle cells and preventing the secretion of tissue factors that increase the likelihood of thrombus formation. Endothelial dysfunction is currently regarded as an early stage of atherosclerosis. The presence of endothelial dysfunction is accompanied by a significant increase in the risk of developing severe cardiovascular complications, primarily heart attacks and strokes, as well as death due to these diseases [48].

As mentioned above, Viagra, inhibiting the activity of PDE-5, enhances the effects of NO on vascular smooth muscle cells, which may be accompanied by an improvement in their endothelial function. This is especially important for patients with ED, since the latter is in most cases of arteriogenic origin and is accompanied not only by dysfunction of the endothelium of the cavernous arteries, but also by systemic endothelial dysfunction [49].

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The effect of Viagra on the endothelial function of the coronary and brachial arteries has been studied in several papers. The use of Viagra in doses of 25 to 100 mg was free viagra samples accompanied by an improvement in endothelial function in patients with heart failure, diabetes mellitus, ischemic heart disease and smokers [50–53]. Also shown is the ability of the drug to eliminate the short-term deterioration of endothelial function caused by smoking [54]. In studies of patients with heart failure, Viagra administration, in addition to correcting the endothelial dysfunction of the brachial and coronary arteries, also led to an improvement in pulmonary hemodynamics and had a moderate antiplatelet effect [55]. The combined use of Viagra and the ACE inhibitor ramipril in this group of patients was accompanied by potentiation of the beneficial effect of both drugs on endothelial function [56].

Thus, Viagra became the first effective oral medication for the treatment of ED, with the advent of which a new era in the development of sexual medicine began, thanks to which in recent years it has become an independent section of modern urology. The clinical efficacy of Viagra has been evaluated in a large number of studies conducted in many countries around the world. The drug leads to an improvement in erectile function in patients of different ages, regardless of the etiology, severity and duration of the course of ED. The effectiveness of the drug is long-term viagra substitute in nature, and the vast majority of patients continue taking Viagra years after the start of treatment. Side effects of Viagra in most cases have moderate severity and their frequency decreases during the course of taking the drug. Acceptance of Viagra does not adversely affect the state of the cardiovascular system, moreover, it is accompanied by an improvement in the functional state of the vascular endothelium, disorders of which play an important role in the pathogenesis of various cardiovascular diseases. The possibility of correcting endothelial dysfunction with the use of Viagra in the future may lead to increased indications for the use of this drug.

Literature

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2. Campbell SF. Science, art and drug discovery: a personal perspective. Clin Sci 2000; 99: 255–60

3. Furchgott RF, Zawadski JV. Arterial smooth muscle by acetylcholine. Nature. 1980; 288: 373–376

4. Ignarro LJ, Byms RE, Buga GM, Wood KS. Endothelium – derived relaxation factor from those of NO and NO. Circ Res 1987; 61: 866–879

5. Rybalkin SD, Yan C, Bornfeldt KE et al. Cyclic GMP phosphodiesterases and regulation of smooth muscle function. Circ Res 2003; 93: 280–291

6. Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev 1995; 75: 191–236

7. Wallis RM, Corbin JD, Francis SH, Ellis P. Tissue pathway, in vitro. Am J Cardiol 1999; 83: 3–12

8. Stief CG, Uckert S, Becker AJ, Truss MC, Jonas U. In vitro and in vivo cavernous caustic in vitro and in vivo. J Urol 1998; 159: 1390–1393

9. Krane RJ. Changes in ED therapy in the Viagra era. World J Urol2001; 19: 23–24

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10. Carson CC, Burnett AL, Levine LA, Nehra A. The efficacy of Sildenafil citrate (Viagra) in patients with erectile dysfunction. Urology 2002; 60: 1227

11. Vandi Y, Klein L, Nassar S et al. Effects of Sildenafil citrate onblood pressure in normotensive and hypertensive men. Urology 2002; 59: 747752

12. Kloner RA, Brown M, Prisant LM et al. Effects of Sildenafil in patients with erectile dysfunction taking antihypertensivetherapy. Sildenafil Study Group. Am 1 Hypertens 2001; 14: 7073

13. Feldman AR Goldstein I, Hatzichristou DC et al. Correlation of the Massachusetts Male Aging Study. J Urol 1994; 151: 5461

14. Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North Am 1995; 22: 699709

15. Numberg HG, Seidman SN, Gelenberg AJ et al. Depression, antidepressant therapies, and erectile dysfunction: Sildenafil citrate (Viagra) treated and untreated patients with depression. Urology 2002; 60: 5866

16. Seidman SN, Roose SP, Menza MA et al. Treatment of erectile dysfunction in men with depressive symptoms: a result of a controlled trial with Sildenafil citrate. Am J Psychiatry 2001; 158: 16231630

17. Zesiewicz TA; Helal M; Hauser RA. Sildenafil citrate (Viagra) for Parkinson’s disease. Mov Disord 2000; 15: 305–308

18. Hussain IF, Brady CM, Swinn MJ et al. Treatment of erectile dysfunction with sildenafil citrate (Viagra) in parkinsonism due to orthostatic hypotension. J Neurol Neurosurg Psychiatry 2001; 71: 371–4

19. Fowler CJ, Miller JR, Sharief MK et al. A double blind, randomized study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 2005; 76: 700–705

20. Sanchez Ramos A, Vidal J, Jauregui ML et al. Efficacy, safety and prediction factors for patients with different spinal cord injuries. Spinal Cord 2001; 39: 637–643

21. Schmid DM, Schurch B, Hauri D. Sildenafil in spinal cord – injured male patients. Eur Urol 2000; 38: 184–193

22. Noldus J, Michl U, Graefen M et al. Patient – ​​reported sexual function after nerve – sparing radical retropubic prostatectomy. Eur Urol 2002; 42: 118–124

23. Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1870 consecutive radical retropubic prostatectomies. J Urol 1999; 162: 433–438

24. Quinlan DM, Epstein JI, Carter BS, Walsh PC. Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles. J Urol 1991; 145: 998–1002

25. Gralnek D, Wessels H, Cul H, Dalkin BL. It is a spontaneous retropubic prostatectomy. J Urol 2000; 163: 1166–1170

26. Rabbani F, Stapleton AMP, Kattan, MW et al. Factors predicting recovery of erections after radical prostatectomy. J Urol 2000; 164: 1929–34

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27. Geary ES, Dendinger DE, Freiha FS, Stamey TA. Nerve sparing radical prostatectomy: A different view. J Urol 1995; 154: 145–149

28. Hollenbeck BK, Dunn RL, Wei JT et al. Determinants of long – term prostatectomy measured by a validated instrument. J Urol 2003; 169: 1453–1457

29. Raina R, Laken MM, Agarwal A et al. Longterm effect of Sildenafil citrate how long does it take for viagra to work on erectile dysfunction after radical prostatectomy: a 3year followup. Urology 2003; 62: 110 115

30. Begg CB, Riedel ER, Bach PB et al. Variations in morbidity after radical prostatectomy. N Engl J Med 2002; 346: 11381144

31. Hong EK, Lepor H, McCullough AR. Time-dependent patient care for erectile dysfunction after nerve spilling radical retropubic prostatectomy. Int J Impot Res 1999; 11 (suppl.1): 15–22

32. Montorsi F, Maga T, Strambi LF et al. Sildenafil taken at bedtime significantly increases nocturnal erections: results of a placebo – controlled study. Urology 2000; 20 (56): 906–11

33. Padma – Nathan H. McCullough A, Forest C. Erectile dysfunction of the retrospective prostatectomy: comparative phosphodiesterase – 5 inhibitor. Curr Urol Rep 2004; 5: 467–471

34. McCullough AR, Barada JH, Fawzy A et al. Achieving treatment optimization with Sildenafil citrate in patients with erectile function. Urology 2002; 60: 2837

35. El Galley R, Rutland H, Talic R et al. Longterm efficacy of Sildenafil and tachyphylaxis effect. J Urol 2001; 166: 927931

36. Montorsi F, MeDermott TE, Morgan R et al. Sildenafil in the treatment of erectile dysfunction of various etiologies. Urology 1999; 53: 10111018

37. Steers WD. Tachyphylaxis and phosphodiesterase type 5 inhibitors. J Urol 2002; 168: 207–209

38. Boolell M, Alien MI, Ballard SA et al. Sildenafil: an orally active type 5 cyclic GMP specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 1996; 8: 47–52

39. Padma Nathan H, Eardley I, Kloner RA et al. A 4 year update on Sildenafil citrate (Viagra). Urology 2002; 60: 67–90

40. Carson CC. Sildenafil citrate treatment for erectile dysfunction: rate of adverse effects. J Urol 2002; 167 (suppl): 179–183

41. Zusman RM, Prisant LM, Brown MJ. Effect of Sildenafil citrate on blood pressure and concomitant antihypertensive medication. J Hypertens 2000; 18: 18651869

42. Herrmann HC, Chang G, Klugherz BD et al. Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Engl J Med 2000; 342: 16221626

43. Sariam K, Kulinsbaya E, McNicholas TA et al. Sildenafil influences lower urinary tract canadian viagra symptoms. BIU Int 2002; 90: 836–839

44. Ghofrani HA, Rose F, Schermuly RT et al. Oral Sildenafil as long – term adjunct therapy for inhaled iloprost in severe pulmonary arterial hypertension. J Am Coll Cardiol 2003; 42: 158–164

45. Sebkhi A, Strange FM, Phillips SC et al. Phosphodiesterase type 5 as a target for the treatment of hypoxia – induced pulmonary hypertension. Circulation 2003; 107: 32320–32325

46. ​​Laupland KB, Helmersen D, Zygun DA, Viner SM. Sildenafil treatment of primary pulmonary hypertension. Can Respir J 2003; 1: 4850.

47. Vane J, Anggard E, Botting R. Regulatory function of the vascular endothelium. N Engl J Med 1990; 323: 27–36

48. Celermajer DS. Endothelial dysfunction: Does it matter? Is it reversible? Am Coll Cardiol 1997; 30: 325–333

49. Mazo E, Gamidov S, Andranovich SV, Iremashvili V. Testing endothelial function of brachial and cavernous arteries in patients with erectile dysfunction. J Sex Med 2006 in press.

50. Katz SD, Balidemaj K, Homma S, et al. Acute type 5 phosphodiesterase inhibition with sildenafil enhances flow – mediated vasodilation in patients with chronic heart failure. J Am Coll Cardiol 2000; 36: 845–851

51. Desouza C, Parulkar A, Lumpkin D et al. Prolonged effects of sildenafil on brachial artery flow – mediated dilatation in type 2 diabetes. Diabetes Care 2002; 25: 1336–1339

52. Park JW, Mrowietz C, Chung N, Jung F. Sildenafil, a monocentric, prospective, double – blind, placebo – controlled, randomized cross – over study. Clin Hemorheol Microcirc 2004; 31: 173–183

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53. Kimura M, Higashi Y, Hara K et al. PDE5 inhibitor sildenafil citrate augments endothelium – dependent vasodilation in smokers. Hypertension 2003; 41: 1106–1110

54. Vlachopoulos C, Tsekoura D, Alexopoulos N et al. Type 5 phosphodiesterase inhibition by sildenafil acute smoking-induced endothelial dysfunction Am J Hypertens 2004; 17: 1040–1044

55. Halcox JP, Nour KR, Zalos G et al. The effect of sildenafil on human vascular function, platelet activation, and myocardial ischemia. J Am Coll Cardiol 2002; 40: 1232–1240

56. Hryniewicz K, Dimayuga C, Hudaihed A et al. Inhibition of angiotensin – converting enzyme and phosphodiesterase type 5 improves endothelial function in heart failure. Clin Sci 2005; 108: 331–338

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Scientists natural viagra for men have developed a new drug to increase blood flow to the heart muscle and lower blood pressure. However, he did not meet expectations. But it was noted that this drug provides a significant blood flow to the male genital organs, and, as a result, the quality of erection improves. This drug was named “Viagra”.

The active ingredient of the drug is sildenafil. Currently in the Russian Federation already registered many drugs that have this active substance. It acts only when a man experiences a natural sexual arousal, and when sexual intercourse is completed, the penis naturally returns to a relaxed state. In other words, the drug only affects the natural does viagra work mechanisms of erection. It was precisely in this that her indisputable novelty and secret of the enormous popularity of Viagra was.

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people taking a variety of medicines at the same time, etc.

But, unfortunately, the drug cannot cure all types of erectile dysfunction. In any case, before taking any drugs, you need to consult with your doctor.

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About Sildenafile or Viagra everyone has heard a lot. But few people know about the side effects and the serious consequences of uncontrolled reception.

Caution in the use of sildenafil is necessary for people who are going after the reception to manage various kinds of mechanisms. Sometimes after taking is viagra covered by insurance the drug, a person may experience a rapidly passing change in color perception with a predominance of blue colors. In this regard, the leadership of one of the American airlines has banned its pilots to take Viagra an hour before the flight.

Especially careful is to be people with severe cardiovascular diseases (heart failure, angina, impaired cerebral circulation). They need constant medical supervision. Sexual intercourse is a serious exercise for a person with cardiac problems. This should be remembered if symptoms such as pains in the heart occur during physical exertion and / or at rest, memory and mental performance problems that have progressed over the past few months. A serious approach to the question is also for those who have suffered a heart buy viagra online attack or stroke. This means that it is imperative that you consult with your doctor about the appropriateness of taking sildenafil.

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There are some men who should not take this drug. Since sildenafil is involved in biochemical processes associated with the exchange of nitric oxide, it can interact with other drugs called nitrates, which are used non prescription viagra to treat heart disease. Therefore, any man who takes nitrates in any form should not take sildenafil under any circumstances.

Caution should be exercised in those patients who have previously had priapism. Although to date there have not been a single report of the occurrence of priapism while taking sildenafil, patients who have a predisposition to its occurrence also need serious medical supervision.

As for the effect of sildenafil on healthy men who have heard about the female viagra prank miraculous drug and want to satisfy curiosity, then, according to experts of Pfizer, the developer of Viagra, the drug has no effect on them! That is, if using a Viagra pill you felt some sort of revolutionary breakthrough in your own sexuality, then it seems that you should go for a consultation with an andrologist. This does not necessarily mean the presence of any disease, but the examination does not hurt buy real viagra online.

The most common side effects are:

headache (15.8%);

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These side effects were, as a rule, transient in nature, mild and moderately severe, and did not dictate the need to discontinue treatment.

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Erectile dysfunction treatments should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis, Peyronie’s disease), or in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia). During post-marketing how long does viagra last studies, it was reported about the development of prolonged erection and priapism. If an erection persists for more than 4 hours, the patient should immediately seek medical attention. If priapism therapy was not performed immediately, it can cause damage to the tissues of the penis and irreversible loss of potency. Preparations for treating erectile dysfunction should not be given to men for levitra vs viagra whom sexual activity is undesirable. Sexual activity presents a certain risk in the presence of heart disease, therefore, before starting any therapy for erectile dysfunction, the doctor should refer the patient to an examination of the cardiovascular system. Sexual activity is undesirable in patients with heart failure, unstable viagra 100mg angina, suffered myocardial infarction or stroke in the last 6 months, life-threatening arrhythmias, arterial hypertension (BP> 170/100 mm Hg) or hypotension (BP 50 years in the general population.

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Should advise patients to discontinue sildenafil therapy in the event of a sudden loss of vision and immediately consult with a physician. Persons who have already had a case of NPINZN have an increased risk of relapse of NPINZN.Therefore, the doctor should discuss This risk with such patients, as well as discuss with them the potential chance viagra canada of adverse effects of PDE inhibitors 5. PDE5 inhibitors, including sildenafil, in these patients should be used with caution and only in situations where the expected benefit outweighs the risk. Patients with hereditary retinitis pigmentosa are genetically determined dysfunctions of retinal phosphodiesterase.The safety information on the use of Viagra in patients with retinitis pigmentosa is absent, therefore ildenafil should be used with ostorozhnostyu.Narusheniya Slukhai some post-marketing and clinical studies have reported cases of sudden hearing loss or degradation associated viagra connect usa with the use of PDE5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or hearing loss. There is no causal relationship between the use of PDE5 inhibitors and the sudden deterioration of hearing or hearing loss female viagra pill. In case of sudden hearing loss or hearing loss with sildenafil intake, the patient should immediately consult with a physician.

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Sildenafil increases the antiplatelet effect of sodium nitroprusside, a nitric oxide donor, on human platelets in vitro. Data on the safety of sildenafil in patients with a tendency to bleeding or exacerbation of gastric ulcer and duodenal ulcer are not available, therefore, Viagra in these patients should be used with caution. The incidence of nasal bleeding in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (sildenafil 12.9%, placebo 0%) than in patients with primary cheap viagra pulmonary hypertension (sildenafil 3%, placebo 2.4%). Patients who received sildenafil in combination with a vitamin K antagonist had a higher incidence of nasal bleeding (8.8%) than patients who did not take a vitamin K antagonist (1.7%). Use with other erectile dysfunctions with other medications other PDE5 inhibitors or other drugs for the treatment of pulmonary hypertension containing viagra pill sildenafil (for example, Revacio) or other means of treating erectile dysfunction have not been studied, therefore the use of such combinations is not recommended The impact on the ability to drive vehicles and control mechanisms. Against the background of taking Viagra, there was no negative effect on the ability to drive a car or other technical means. However, since the admission of the drug may reduce blood pressure viagra otc, the development of chromatopsia, blurred vision, should be attentive to the individual action of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.

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When metastases appeared in rodents, the scientists removed viagra side effects some of the tumors and injected large doses of Viagra in combination female viagra with one of the popular flu vaccines, which served as a kind of bait for immunity.

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Those who have experienced erection problems at least once know that they are ready to give any money, if only everything was good and they could return to life. For men, it is extremely important to get satisfaction during sex, so buying Viagra for many is considered an excellent solution. In a sense, this is true, but additional consultation of the doctor does not hurt. If you have temporary problems with potency, then Viagra will remove them, but if there are problems in the body, then the drug will not be able to help you, it only removes the symptoms. Viagra or sildenafil is enough this means to increase potency. Viagra (sildenafil) increases the pressure in the body leads to the lightening of which actually increases the erectile function. Viagra is necessary to buy herbal viagra those who feel disruptions in their erectile function and want to remove their manifestations.

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After taking viagra (sildenafil), it quickly begins to act on the human body. Together with the simultaneous intake of fatty foods, the effect of the drug is significantly reduced, therefore, it is not recommended to use it with such food. The substance is metabolized, mainly in the liver, so it is worth buying Viagra to those who have no complications with the liver or after consultation and with the permission of the doctor. People in old age who do not have health problems often experience potency problems. An indication for the treatment of erection problems is the inability to achieve or maintain an erection that is sufficient for sexual intercourse. (Sildenafil) Viagra is preferred by those men who want to make their sexual intercourse longer and give the woman as much pleasure as possible, but we must remember that the drug can have an effect on the body if there is an appropriate mood for intimacy and sexual arousal.

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Contraindications

Degree of contraindication

Any problems or heart disease

Contraindicated

If a person has had a heart sildenafil vs viagra attack and stroke

Contraindicated

Transferred diseases of the circulatory system

Contraindicated

Patient takes nitrates

Contraindicated

Incompatibility with alcohol

It is extremely forbidden to combine with alcohol

You have problems with high blood pressure.

Very careful

If the patient is less than 18 years old

Contraindicated

There are problems with the internal organs namely (liver, kidney)

Very careful

There is a stomach ulcer.

Very careful

Any blood diseases

Contraindicated

Below we consider the possible side effects after the use of Viagra. It is worth noting that the manifestation of side effects is purely individual, for someone, they may manifest themselves for someone else, or they may appear stronger or weaker. It all depends on the characteristics of the body and dosages. The table with the list of side effects is shown below:

Table of side effects after the use of Viagra and the frequency of their manifestation:

Side effects

Frequency of manifestation

Dizziness

Often

Headaches

Often

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Often

Heartburn

Infrequently

Nausea

Infrequently

Indigestion

Infrequently

Pain when urinating

Infrequently

Vision problems

Infrequently

Skin redness

Infrequently

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Surely there is no such person who would not hear about such a drug as Viagra. This tool is of high quality and was originally developed as a drug for the heart and lowering blood pressure in hypertensive patients otc viagra. He did not have a visible result in this direction, but it was noted that the erectile function is significantly improved and the man receives a significant increase in potency by increasing the blood pressure in the sexual organ. Viagra price is a question that many people care about before buying, we try to make the lowest prices for Viagra for our customers and on our viagra.best online store to order Viagra without a prescription, absolutely all men who have impaired potency can afford. It is important to know that viagra (sildenafil) can have an effective effect only if the man is agitated. The component is not considered an aphrodisiac that causes sexual desire, therefore its action is completely different. After the end of sexual intercourse, the drug ceases to act, but immediately after the man feels sexual arousal, the remedy viagra price begins to act again and the man can repeat. This fact has always pleased those who could complete only 1 sexual intercourse on their own, and the second lacked the strength and capabilities.

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Chemically, “Viagra” is a substance side effects of viagra sildenafil, an inhibitor of phosphodiesterase Viagra. . This means that we have in the best place to buy generic viagra online body the enzyme phosphodiesterase, which affects the blood flow in the cavernous bodies of the penis viagra over the counter walmart and in the vessels. If this enzyme is blocked, not allowed to act, then this very blood flow will generic viagra cost increase.

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Sildenafil works this way: it relaxes smooth muscles, blood vessels and increases blood flow to the penis how to get viagra. And it already helps to keep it in an erect state. “Viagra” does not cure Sildenafil. cause of dysfunction, it simply eliminates the consequences.

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