Everyone has heard of 
Viagra is the brand name of the famous blue pill which contains a drug called sildenafil. This was developed by the pharmaceutical company Pfizer. Sildenafil is in a class of medications known as phosphodiesterase type 5 inhibitors (PDE-5). (1) However, something that is not widely known is that this drug was not originally developed to treat ED. When in development, sildenafil was hoped by Pfizer to be a new treatment for a cardiovascular disease called angina, which is when chest pain occurs because arteries supplying blood to the heart muscle are restricted. The aim of sildenafil was to be able to cause relaxation in these arteries and therefore increase the blood flowing through them and prevent pain because of the limited supply of oxygen-rich blood. The clinical trials using this medication to treat angina produced discouraging results and so Pfizer was going to give up on sildenafil completely and move onto other trials, however, an unexpected side effect was occurring and being reported in many of the men being treated. This side effect was an increase in sustained erections. Instead of abandoning testing as had been planned, testing switched to investigate the use of this medication as a treatment for ED. Up to this point, there were no oral medications available to men suffering from this condition. Choices were severely limited to injections or prosthetic implants, both of which are not very patient-friendly, to say the least. There was a huge demand for a more convenient and effective treatment and Viagra was able to fill this demand. This trial, therefore, represented a huge step forward in the treatment of ED, allowing men to have more control and choice over their own health and treatment of their condition. These trials carried out with Viagra were obviously hugely successful with it being one of the most prescribed drugs worldwide to date. (2) Straight after its launch in America, it was being prescribed at a rate of ten thousand tablets per day. (3)
Description
How does Viagra and Sildenafil work?
Viagra (Sildenafil) helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis when you are sexually excited.
How do I take it?
You should take Viagra (Sildenafil) approximately 1 hour before planning to have intercourse. Within a window of between 30 minutes and 4 hours after you take the medicine, it will be easier to keep and maintain an erection when you are sexually excited. If you take this medicine after a meal with a high fat content it may take a little longer to start working. This medicine will only work when you are sexually excited. You won’t get an erection just by taking Viagra (Sildenafil).
Dosage
The standard recommended dose for Viagra (Sildenafil) is 50mg and this will be suitable for most people. If this dose is not effective, you can try 100mg and if 50mg gives you side effects you can also reduce the dose to 25mg tablets.
You must not take more than 100mg daily of Sildenafil/ Viagra. Clinical trials have been conducted in patients taking up to 200mg sildenafil and it was found that ‘doses of 200mg did not result in increased efficacy but did increase the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, and altered vision).’
In addition, in patients taking more than 100mg daily, there have been reports of rhabdomyolysis (a breakdown in skeletal muscle tissue the byproducts of which can lead to kidney failure), visual perception changes, vertebral artery dissection (a tear in the artery supplying blood to the brain), heart attacks and aggressive behaviour.
If the 100mg strength doesn’t work for you, there may be alternatives you can try and we recommend that you call us for a free consultation with our pharmacist or doctor to discuss any underlying conditions you may have. We recommend that all men taking medicine for erectile dysfunction have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances. For instance, it may be that by fixing a hormone imbalance such as testosterone, your Viagra medication will be even more effective.
In addition, drug manufacturers do not advise patients to split tablets in half to get the correct dosage as they cannot guarantee that the active ingredient will be distributed evenly throughout the tablet. For instance, if you cut a 100mg tablet in two, you may find that you get 80mg in one half of the tablet and 20mg in the other half leading to either an overdose (increased risk of side effects) or a suboptimal dose (the medication may not work).
It is important that you choose the correct dose for you. If you wish to talk to our pharmacist or doctor about this, please contact us in the pharmacy on 01625 460621 or email [email protected].
Side Effects
Viagra (Sildenafil) is normally well tolerated, however, side effects can include:
- Headache
- Dizziness
- Nausea
Side effects normally subside after a few hours, however, if you experience a prolonged or painful erection (longer than 4 hours), then you must contact your doctor immediately.
Drug interactions
There are a number of medicines which interact with Sildenafil/ Viagra. For an exhaustive list please see the patient information leaflet (see section below) or call us in the pharmacy to discuss your specific situation. The main drug interactions are listed here:
Recreational drugs such as ‘poppers’ or amyl nitrate
Alpha blockers used for urinary retention or blood pressure problems (eg Flomax or Cardura)
Anti- arrhythmic drugs such as disopyramide
Antibiotics such as erythromycin
Antifungals such as itraconazole
Antivirals such as drugs used to treat HIV
Bosentan
Cobicistat
Calcium channel blockers to treat blood pressure and angina such as amlodipine
Dapoxetine (Priligy – used to treat premature ejaculation)
Grapefruit juice**
Nicorandil
Nitrates
Riociguat
Cimetidine (to treat stomach ulcers)
Please do not take Sildenafil/Viagra if you have taken any of the above drugs within the last 60 days without first consulting with either us in the Pharmacy ([email protected] / 01625 460621) or via email with our doctor [email protected].
**We advise not to take Sildenafil/Viagra with grapefruit juice as the blood concentration of Sildenafil will possibly be increased resulting in side effects.
Patient Information Leaflets
Please click here for the patient information leaflet for Viagra.
For Actavis Sildenafil please see the following leaflets: 100mg, 50mg, 25mg.
Storing Medicines Safely
Please keep your medicine out of the reach of children and store at room temperature. Unwanted medicine can be disposed of by returning it to any local pharmacy or indeed to us here for us to dispose of it for you.
To understand how Viagra works we must first look at the mechanics of getting an erection. An erection occurs when a man is sexually stimulated which causes the nervous system in the erectile tissue of the penis to release nitric oxide (NO) into the corpus cavernosum of the penis. This penetrates into smooth muscle cells and binds to an enzyme, guanylate cyclase, causing a conformational change which then produces messenger cyclic guanosine monophosphate (cGMP). This chemical causes the relaxation of smooth muscle cells in the vicinity and is the intracellular trigger for penile erection. (7) The result is that the arteries in the penis can dilate and the blood flow into the penis is enhanced. In addition to this, the erectile tissue fills with blood, causing rigidity of the tissue. These two processes lead to an erection.
The last point to consider is how is Viagra taken to give it the best chance of successful results. Viagra has been proven to be an effective drug for the treatment of ED. When compared to placebo, as shown by clinical studies, Viagra and other PDE-5 inhibitors result in significant improvement of erectile function. To achieve these results, however, Viagra must be taken as advised by your healthcare professional, a GP or pharmacist. This medication should usually be taken around one hour before sexual activity. If it is taken with food the onset of action may be slightly delayed as compared to taking on an empty stomach. (6) Viagra should only be taken once in a 24 hour period and the effects of the drug last for between four and six hours. (1) If Viagra does not work for you the first time it may be tempting to take another tablet but this should not be done unless under the recommendation of the doctor. Viagra can have side effects and so the dose used should be under the control of the doctor to ensure patient safety. If the medication does not work there are many reasons that this could be. It may be because of something as simple as more time was needed until the medication could work; there was too long between taking the medication and sexual activity, or perhaps the dose was not high enough, or there was not enough sexual stimulation. (4) If after several doses, on different days, the medication still does not work, another consultation with the doctor is recommended. At this point, the dose may be increased if this is suitable for the individual man. Careful use of Viagra in the way that it is meant to be used should ensure that issues such as timings are not interfering with the effects of the medication.
To finish off, I hope you are now more knowledgeable about erectile dysfunction and the use of Viagra to treat this common condition. This knowledge should allow you to have more confidence in yourself and to understand that ED is a condition that can be treated, much more easily now than in the 1990s when oral treatments were only beginning to be available. Viagra is one of the most common medications available to produce erections in men who have difficulty achieving them, usually because of underlying medical conditions such as diabetes or heart and blood vessel problems. Viagra works in a complex way by affecting the blood vessels in the penis. The end result is that blood flow is increased specifically in the penis and so allows the filling of erectile tissue with blood causing rigidity and an erection hard enough for satisfying sexual intercourse. By working specifically on the blood vessels in the penis the side effects are minimised, therefore making this medication on the most part fairly side-effect free. Viagra is taken orally as a tablet around one hour before sex and so is a simple way to have your sex life return to normal. If you are suffering from ED and have not yet seen a doctor because of embarrassment, anxiety or any other reason, now is the time to take the next step. You can 
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