Viagra (Sildenafil Citrate) Reviews and Drug Information

People love new things. They find those more effective and useful. Especially when it goes about saving their time. Progress takes place in all spheres of life including the sphere of healthcare. New medications along with new devices turn up. In most cases they lead to better results and sooner healing. However, as researches of certain new medications go on, people often find out that with the growth of efficiency side effects multiply as well. That is why before trying some new medications people take care of checking out if the medications are totally safe to health and if proper researches have been held over those medications. Or else, before trying some new medications for men’s health improvement like Viagra they dig over the Internet to check out what ways of men’s health enhancement were applied before Viagra turned up.

Basic Reasons of Men’s Health Disorders

Reasons of men’s health disorders can be of two natures:

• psychological;
• organic.
Every physically healthy man experiences a spontaneous erection at night and in the morning. If you notice that your erection turns up rarer and rarer or if it fails to turn up at all, then you have been dealing with impotence of organic nature. A gradually decreasing erection can be the result of the following hidden diseases:

• diabetes;
• nerve system disorder;
• blood circulation disorder;
• low level of male hormone – testosterone.

Unexpected rare erections at night and in the morning can tell you about the psychological nature of impotence. In this case, sufferers can even experience difficulties to maintain erection, and it often fails in a few seconds after turning up. Such condition can be caused by the following psychological reasons:

• depression;
• fears;
• lack of self-confidence.

Comparatively Ancient Ways of Impotence Treatment

So, before Canadian Pharmacy offered such an easy and effective medication for impotence treatment as Viagra, people stuck to the ways on the natural basis.

• herbal medications;
• massages;
• and even leechcraft (as leeches influence blood circulation troubles).

Herbal Treatment

This includes treatment with certain herbs, vegetables, bark and so on. Many men can find it cheaper than Viagra because among vegetables there are so frequently used onions, carrots and garlic. As for herbs, parsley, coriander, motherwort and hop were quite popular. Even nuts can be used for men’s health enhancement. Walnut is recommended as the most effective one.

Massages

Penis is actually a muscle which must be regularly trained. Thus, massaging it you actually train it. Though, penis massage must in no way be understood as masturbation because the final results are different. In old times massages were not much popular but certain healers tried to insist on their efficiency. Modern researches prove that it was true.

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Well, it’s true that medications on the natural basis are good and safe. But are they that effective? No way. No matter how many onions with garlic and parsley you eat, you will rather scare your partner away than have any chance to boast of your perfect erection and durable sexual contact. Herbal treatment never performs instant results as Viagra online does. It is a long process that should begin when you have noticed erection failure for the first time and go on for the rest of your life.

You should look over the side effects expected from such effective medications for men’s health improvement as Viagra offered by Canadian Pharmacy once again and consider the co-relation of effectiveness and range of those effects. In fact, those that just do not feel that bold to leave their attempts of improving their health by old methods should take a closer look at Viagra consisting of natural ingredients. This is a wonderful alternative to herbs because it is more effective and causes fewer side effects than pills based on chemical ingredients.

Viagra is an oral prescription medication approved to treat erectile dysfunction in men. Manufactured by Pfizer, Viagra has helped several men across the globe with their erection and sexual problems.

Viagra can help men with erectile dysfunction to attain and maintain their erection when sexual stimulation complements it; a Viagra pill alone does not help men to increase their sex drive. It is not an aphrodisiac as many first time users think about it.

Ingredients of Viagra

Active ingredient in Viagra is sildenafil. It works as a PDE5 inhibitor, and acts by increasing the flow of blood to the penis and results in harder erection that complements men’s smooth sexual activity.

Strengths of Viagra

Viagra is a blue coloured pill and is available in three potential strengths – 25 mg, 50 mg and 100 mg. It should be swallowed whole with water.

Always consult your doctor as he will prescribe you the best suitable dose as an over dose of viagra may result in severe side effects and may also prove to be fatal.

Side effects of Viagra or kamagra from Kamagraaustraliashop.com

Like most prescription medications, Viagra also has few side effects. The most common side effects include headache, facial flushing, and stomach upset. These effects are usually minor and are easily treatable; they will not last for a long time. However, if the symptoms persist, patient should immediately seek medical help.

Some reports also suggest that Viagra may cause blurred vision, sensitivity to light, or sight disturbance. These cases are rare, but if they persist, a medical aid should be sought immediately to prevent serious consequences.

If patients after taking Viagra experience an erection that lasts more than four hours, they should take immediate help from doctor to avoid possible damage to their penis and its tissues.

Who can take Viagra?

Viagra is available only on a valid prescription; only men who suffer from impotence or erectile dysfunction should take Viagra. Those men who feel occasional difficulties in getting or maintaining an erection may prefer Viagra. Men who suffer from severe cases of impotence can also take doses of Viagra after consulting a doctor.

Viagra is not a regimen drug and should not be taken for pleasure by healthy men. Also those patients suffering from intense hypertension should not take Viagra. Men on medications containing nitrates cannot be prescribed Viagra as this combination may lead to a serious drop in the blood pressure.

Availability of Viagra

Viagra is approved by the FDA and is available in the most pharmacies in the UK and EU. Many websites working as online clinics also sell Viagra online by adhering to proper prescription methods. Doctors prescribe Viagra after examining his medical details given by filling in the medical consultation forms.

The online method of buying Viagra also proves to be cost effective and saves time and energy of people by delivering the drug at their doorsteps. These factors have lead people to turn towards buying Viagra online.

Why choose Viagra out of other erectile dysfunction drugs?

Viagra is one of the pioneer drugs for treating erectile dysfunction in men. Ever since its launch in the market, this drug has never lost its popularity among men. Viagra is the most frequently used keyword on the Google search engine, which shows its popularity among men who wish to buy Viagra online.

Viagra is effective with or without food. However, to get the quickest results, men should avoid high-fat meals at least two hours before taking Viagra as fatty meals such as cheese, burgers and fries may slow down body’s ability to absorb this drug.

Selective Serotonin Reuptake Inhibitors Selective serotonin reuptake inhibitors (SSRIs) have gained notoriety as a common cause of several manifestations of sexual dysfunction. SSRI-induced ED rather than sexual dysfunction, though, is rarely reported in the literature and is limited mostly to case reports.

Antihypertensive Agents Several antihypertensive agents have been implicated in ED, yet the evidence is limited. Older thiazide diuretic treatments have been associated with mild effects on erectile function.

Many of these studies have limited clinical implications as they were conducted with chlorthalidone, a thiazide-like diuretic. A recent study suggested that beta-blocker-induced ED is likely psychogenic rather than organic. Clonidine is reported to cause ED in both human and animal studies through agonism of central alpha-2 adrenoreceptors.

Statins Statins are HMG-CoA reductase inhibitors that are a commonly used medication for the treatment of hyperlipidemia. Do et al. conducted a study to investigate the association between exposure to statins and the occurrence of ED. The study was limited to males age 18–30. They found a statistically significant association for statins with induction and worsening of ED. Further studies are needed to distinguish the severity of the effect on ED between the many different statin drugs that are currently in use.

In cases of ED and hypogonadism, recent randomized controlled trials suggest that patients who are initially refractory to type V phosphodiesterase (PDE5) inhibitors (sildenafil, vardenafil, and tadalafil) can be rescued by the concurrent administration of testosterone with PDE5 inhibitors. The administration of testosterone alone, without PDE5 inhibitors, has also been shown to improve erectile function in hypogonadal men. Androgen deficiency has been shown to result in penile tissue atrophy, increased adipose tissue within the subtunical region, and severe venous leak resulting in ED. All of these effects can potentially be reversed by the administration of testosterone. A number of distinct pathways of the endocrine system lead to ED when functioning abnormally. Several studies show that hypogonadism of any cause is an uncommon cause of ED.

The role of testosterone and other androgens in the achievement and maintenance of penile erection is controversial due to the lack of standardization in defining low testosterone. A recent study found that the prevalence of “low testosterone” in men with ED was largely dependent on the accepted definition of this disease state. Reported prevalence increased from 7% to 47% for definitions of testosterone level less than 200 ng/dL versus less than 400 ng/dL, respectively.

The role of androgens in erectile physiology as demonstrated in the animal model is to potentiate the effects of neurologic and vascular/ endothelial mechanisms of erection. Although tumescence is possible with decreased testosterone, the quality of the erection may be diminished. Importantly, the efficacy of PDE5 inhibitors is greatly diminished in the absence of androgens. Furthermore, in rats, dihydrotestosterone is the primary androgen responsible for erectile physiology at the level of the endothelial cell. Mexican Viagra Online

This decline in serum testosterone level can be age-related or the result of hypogonadism of any cause. A recently published study evaluated the prevalence of both hypogonadism and depression in men presenting to an ED clinic. They also tested the correlation of hypogonadism and the presence of depressive symptoms. They indeed found hypogonadal men to be more likely to have overt depression scores compared to eugonadal controls. The authors derived the conclusion that depression symptoms are strongly associated with hypogonadism and that physicians should consider the evaluation of testosterone levels in men with overt symptoms of depression.

Testicular Failure In recent years, there has been increasing interest in the study of aging males. Testicular failure increases with age as serum testosterone levels gradually decline. This process is not universal. When it does occur, there is significant variability in the age at the onset and the degree of the androgen decline associated with age.

Androgen Deficiency The estimated prevalence of androgen deficiency among men 40–70 years of age ranges from 12% to 45%. Approximately 481,000 new cases of androgen deficiency are diagnosed yearly in the USA.

Physiologic levels of testosterone support several critical processes involved in penile erectile response, including the maintenance of libido and energy levels, in addition to the cascade of events mediated by nitric oxide leading to arteriolar dilatation and relaxation. Screening for hypogonadism in men initially presenting with ED can help identify these men. Drug-Induced ED Erectile dysfunction is a common adverse effect of a number of drugs, and it often has a great effect on patient compliance.

This subject as a risk factor is lightly discussed here and further discussed in more detail later in the textbook. It is important to recognize that many of the drugs associated with ED are used to treat conditions that are themselves risk factors for ED, thus the interpretation of ED in the setting of pharmacological therapy is often difficult in the clinical setting.

KQ 1. The clinical utility of routine blood tests—testosterone, prolactin, LH, FSH – in identifying and affecting therapeutic outcomes for treatable causes of ED was examined using reports of measurements of serum testosterone, FSH, LH, prolactin, and/or other hormone levels, (but not gonadotrophin-releasing hormone [GnRH], Inhibin, Activin, or Follistim). It was also examined in reports of the prevalence of reversible hormonal disorders in males with erectile dysfunction. The study selection criteria included the following:

• Source: Primary study report published in English
• Study design: Any (prevalence studies)
• Population: Adults (age ≥ 18 years) diagnosed with ED with or without concurrent endocrinopathy (i.e., hypogonadism, hyperprolactinemia, abnormal levels of LH/FSH)
• Intervention (experimental): Hormonal blood tests (i.e., testosterone/prolactin/LH/FSH)
• Outcomes: Prevalence of endocrinopathies (i.e., hypogonadism, hyperprolactinemia, abnormal levels of LH/FSH)

KQ 2. Benefits of pharmaceutical treatments (e.g. oral, injections, hormonal, topical, intra-urethral suppositories) in males with ED. To address how patient specific characteristics (e.g. specific symptoms/origin, duration, severity of ED/comorbid conditions) affect prognosis/treatment success for ED patients. Evidence on the following treatment modalities was excluded from this review: Natural health products (e.g. herbals), yohimbine, vacuum constriction devices, and sex or surgical therapies (e.g. penile prosthesis implantation, penile arterial reconstructive surgery). Study selection criteria included the following:

• Source: Primary study report published in English
• Study design: RCTs (comparative efficacy and harms studies)
• Population: Adults (age => 18 years) diagnosed with ED (with or without comorbidities)
• Interventions (experimental/control): Oral (PDE–5 inhibitors, sublingual) injections (IC, cream)
• Outcomes: Clinically relevant efficacy measures (i.e., scores for the IIEF “EF” domain, IIEF–Q3/Q4, SEP-Q2/Q3, GAQ-Q1, EDITS)

KQ 3. Harms of pharmaceutical treatments (e.g. oral, injections, hormonal, topical, intra-urethral suppositories) in males with ED. Evidence on the following treatment modalities was excluded from this review: Natural health products (e.g. herbals), yohimbine, vacuum constriction devices, and sex or surgical therapies (e.g. penile prosthesis implantation, penile arterial reconstructive surgery). Study selection criteria included the following:

• Source: Primary study report published in English
• Study design: RCTs (comparative efficacy and harms studies)
• Population: Adults (age ≥ 18 years) diagnosed with ED (with or without comorbidities)

Antipsychotics Antipsychotic medications are also implicated in ED. These drugs exert their effects primarily by antagonism of dopamine receptors but have effects on several other receptors.

In addition, dopamine antagonism causes hyperprolactinemia which contributes to the sexual dysfunction associated with these drugs. Antiandrogens Antiandrogens are a well-known cause of sexual dysfunction and ED. In recent studies, finasteride has been shown to cause minimal ED at higher doses (5 mg) for prostate cancer prevention, and almost no effect on erectile function at low doses (1 mg) for the treatment of alopecia Illicit Substances and Nicotine Several illicit substances cause ED. In addition, men on methadone maintenance therapy for heroin dependence have been reported to have significant impairment of erectile function.

The use of tobacco products, and specifically nicotine, is associated with ED in both chronic and acute exposure. Nicotine produces vasoconstriction through its actions on endothelial cells through a likely underproduction and degradation of nitric oxide.

A recent study of healthy men between the ages of 18 and 27 reported that the use of nicotine gum immediately decreased erectile response to visual stimuli despite unchanged subjective measurements of sexual arousal. This study may imply an immediate neurogenic and hemodynamic response of the penile tissue to nicotine. Furthermore, chronic cigarette smoking is also associated with an independently increased risk of ED and clinically significant damage to penile vasculature

Ethanol
The role of ethanol, while classically thought to impede erectile function, has been less clear in the literature. Despite the association of alcohol consumption and sexual activity, very little objective evidence exists on the effect of acute ethanol intoxication on erectile function. The data on chronic ethanol exposure is also mixed. Ethanol exposure in an animal model showed histologic evidence of both endothelial damage and metabolicdysfunction.

Impairment of smooth muscle relaxation due to endothelial dysfunction was pronounced while neurogenic smooth muscle relaxation remained intact. Age and Chronic Illness There is no consensus as to whether ED is a nonpathologic, natural aspect of aging in healthy males, though older males do have higher rates of ED. The association between naturally declining testosterone level in older males, socalled andropause, and ED, is complex, but no clear association is found to date.

Interestingly, penile vibrotactile sensation of the penis decreases significantly with age, but this has not been directly linked with ED.

Approximately 82% of men with chronic renal failure (CRF) on hemodialysis have some degree of erectile function, with 45% having severe ED. Additionally, regardless of treatment, patient with CRF have significantly decreased mean nocturnal penile tumescence when compared to both normal and chronically ill controls. The pathophysiology of ED in patients with CRF is complex. A majority of men with CRF have hyperprolactinemia. Uremia also interferes with the HPA such that oligospermia, azoospermia, and impaired steriodogenesis with elevations in LH are common in uremic men.

Zinc deficiency has also been postulated as a potential cause of ED in uremic men and has been targeted for possible therapeutic interventions.

While hyperprolactinemia is often clinically associated with the existence of ED and hypoactive sexual desire, the prevalence and pathophysiology of this association are debated in the literature. The prevalence of hyperprolactinemia in men with ED or sexual dysfunction ranges from 1.5% to 10% in recent literature.

While several studies support the classic hypothesis that hyperprolactinemia causes ED through the suppression of GnRH, there is no consensus as of yet.
While severe hyperprolactinemia is a risk factor for sexual dysfunction, the role of moderate hyperprolactinemia in the pathophysiology of ED is unclear.

Thus, as with androgens, it is unclear if pathophysiologic findings from clinical studies and animal models are applicable to the clinical evaluation of ED. There is also evidence that prolactin may have a dichotomous role in erectile physiology. A recent study found that men with prolactin levels below 5 ng/mL had increased prevalence of arteriogenic ED, while men with hyperprolactinemia only had an increased prevalence of hypoactive sexual desire.

Thyroid Disease Both hypothyroid and hyperthyroid states are associated with ED, though the specific pathophysiology remains elusive. A recent study compared men with thyroid dysfunction to controls and reported that men with both hypothyroidism and hyperthyroidism had significantly increased the prevalence of and more severe ED. Overall, 79% of men with thyroid dysfunction had ED compared to 34% of controls. Both hyperthyroid and hypothyroid men had a prevalence of ED that exceeded the prevalence of ED in the control group. Additionally, both groups had significant response to treatment.

While extrapolation of specific physiologic mechanisms from clinical treatment is limited, these findings suggest that thyroid dysfunction acts at multiple sites to cause ED. There is some evidence that hypothyroidism causes a decline in both testosterone and steroid hormone binding globulin (SHBG).

Interventions (experimental/control): Oral (PDE–5 inhibitors, sublingual) injections (IC, SC), hormonal (e.g. testosterone), intra-urethral suppositories, CPAP, and/or topical (e.g. patch, cream)

Outcomes: Any adverse events, serious adverse events, withdrawals due to adverse events, and specific adverse events.

KQ 3a. The incidence of specific harms such as Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) and penile fibrosis associated with use of PDE–5 inhibitor and injection therapies, respectively. The review included reports of non-RCTs or observational studies. For identification of data on fibrosis related to use of injection therapies, only studies with at least 6 months of followup were included.

Study selection criteria included the following:

Source: Primary study report published in English

Study design: Non-RCTs (experimental or observational case-control and cohort studies, case reports and case-series)

Population: Adults (age ≥ 18 years) diagnosed with ED (with or without comorbidities) Interventions (experimental/control): Oral (PDE–5 inhibitors), injections (IC, SC)

Outcomes: NAION, penile fibrosis Systematic and narrative reviews, case reports, editorials, commentaries or letters to the editor were excluded for all questions except Q3–a (specific harms). Studies evaluating interventions such as penile implant devices or natural health products used for the treatment of ED were also excluded.

The results of the literature search were uploaded to the software program TrialStat SRS version 4.0 along with screening questions developed by the review team and any supplemental instructions. A calibration exercise was undertaken to pilot and refine the screening process. One reviewer screened bibliographic records (i.e., title, authors, key words, abstract) using broad screening criteria (Appendix B). All potentially relevant records and those records that did not contain enough information to determine eligibility (e.g. no abstract was available) were retained. The reasons for exclusion are noted in the QUOROM flow diagram. Two reviewers independently performed full-text relevance screening. Disagreements were resolved by consensus.

Relevant studies were then evaluated to determine study design and were categorized accordingly for inclusion by question. The level of eligible evidence on efficacy was limited to RCTs, since systematic bias is minimized in RCTs compared with all other study designs (e.g. cross-sectional, retrospective cohort).