What Does Viagra Do And How Does It Do It?

Ok so you’ve been sat around having a lad’s night in and the topic of the goings on in bedroom department comes up. This is a slightly touchy subject for you and you simply cannot admit but things may not be going quite to plan and the fireworks display on New Year’s Eve didn’t quite go as well as expected. So you just sit and mostly listen to your mates rabbiting on about how wonderfully they function for their Mrs and the Earth really does move. There’s always one friend who claims to be Don Juan DeMarco – the world’s greatest lover (watch the 1995 Johnny Depp movie and you’ll understand what I mean). Don claims he will never ever need Viagra as he’s working mighty fine. So you quickly make your excuses and leave as you think you could do with some Viagra but you don’t really know much about it.

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Impotent man worrying about his penis and erection failure , Surprised young man havingtrouble with potency and prostate

 

What’s the problem?

All is not lost, whether it’s affecting you or your partner firstly you need to understand what’s going on.  Did you know that approximately 10 % of men have a problem related to having sex? These problems can affect any man (even Don Juan DeMarco), whether he is straight, gay, bisexual or transgender.

Premature ejaculation is ejaculating sooner than a man wants to during sex, however, it’s only a problem if it bothers him or his partner. Causes can include anxiety about sexual performance, stress, unresolved issues in a relationship, or depression.

Erectile dysfunction (impotence) is when a man can’t get or maintain an erection.  Lots of men experience it at some point in their life, and the causes can be physical- such as heart disease, diabetes, raised blood pressure, alcohol, smoking and illegal drugs, as well as some prescription medicines. The causes can also be psychological such as worrying about work, money, relationships, family, and even stressing about not getting an erection can all be factors.

Loss of sex drive, or libido, is also common. It can be linked to a number of factors, including relationship issues, stress, anxiety and side effects of medication.

Equipping yourself with knowledge around this sensitive subject will leave you more confident and less likely to allow anxiety or low self-esteem to impact upon your sex life, thereby increasing your chances of successfully treating the condition.

 

Which medicines cause erectile dysfunction?

Your healthcare professional should check if any of your current medication could potentially be causing problems. Medicines which can lead to erectile dysfunction include:

  • Antidepressants (commonly the selective serotonin reuptake inhibitors)
  • Drugs used to treat high blood pressure
  • Certain antihistamines
  • Antipsychotics
  • Drugs used for benign prostatic hypertrophy (BPH)
  • Anti-HIV drugs

 

Which medical conditions can cause erectile dysfunction?

  • Diabetes
  • Heart conditions
  • Obesity
  • Parkinson’s disease

So I hear you asking what is the point of this blog, well the clue is in the title.  Going back to Don Juan DeMarco who claimed never to need Viagra, so what exactly is this drug and what does it do?

 

Tabletten zur PotenzsteigerungFirstly what is it?

Viagra-the brand name for the drug Sildenafil is one of the most common medications used today in the treatment of erectile dysfunction in men. This is a blue rounded diamond-shaped film-coated tablets, marked “PFIZER” on one side and the strength on the other.  The manufacturers are PFIZER and they say “VIAGRA is indicated in adult men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance”… sound familiar, if not then read no further, if yes read on.  PFIZER also say that “in order for VIAGRA to be effective, sexual stimulation is required”. So that sums up this blue diamond-shaped tablet.

 

 

How did VIAGRA come about?

Well, this blue diamond shaped wonder is probably the world’s most successful accident. The discovery that sildenafil could lead to an erection was an unplanned event. In the eighties, the sildenafil compound was originally developed by Pfizer scientists in Kent of all places, for the treatment of hypertension (high blood pressure) and angina pectoris (chest pain due to heart disease). During the heart clinical trials, in the early nineties, researchers discovered that the drug had a common side effect– it caused erections rather than treating angina. Pfizer realised that treating erectile dysfunction with oral therapy was an unmet medical need and a major opportunity to make lots of money.

In 1998, the FDA (the American drug regulatory body) approved Viagra, the first oral treatment for erectile dysfunction ever arriving in UK and Europe shortly after. The rest is history.

 

What does Viagra do & how does it do it?

In Pharmacist lingo, we call this the mode of action, so here goes in a nutshell:

Firstly we need to look at how an erection occurs and how VIAGRA acts in the body.  Nitric Oxide (NO) is a signalling molecule in humans; it dilates (widens) blood vessels, raises and lowers blood pressure. It is released when a man is aroused from nerve endings and cells in the spongy erectile tissue of the penis.  An enzyme then converts guanosine triphosphate-GTP (an energy-rich molecule, generally, when such molecules are hydrolysed, the free energy of hydrolysis is used to drive reactions that otherwise are energetically unfavourable) into cyclic guanosine monophosphate –cGMP, a messenger molecule. cGMP causes the smooth muscle to relax,  allowing a greater blood flow, which then leads to an erection. cGMP is then hydrolysed back to the inactive GMP by phosphodiesterase type 5 (PDE5)

The levels of cGMP are therefore controlled by the activation of cyclic nucleotide cyclase- the enzyme and the breakdown by PDE5. It is the latter that sildenafil acts upon. Men who suffer from erectile dysfunction often produce too little amounts of nitric oxide. This means that the small amount of cGMP they produce is broken down at the same rate and therefore doesn’t have the time to accumulate and cause a prolonged vasodilation effect.

Viagra and other PDE5 inhibitors like Cialis, Levitra, Stendra and Staxyn treat erectile dysfunction but do not directly increase a man’s sexual desire. However, knowing that one can perform better in bed may indirectly boost libido

 

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Product 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.

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So where does VIAGRA/Sildenafil fit in?

This drug works by inhibiting the enzyme PDE5 by occupying its active site. This means that cGMP is not hydrolysed as fast and this allows the smooth muscle to relax. Sildenafil is basically a potent and highly selective inhibitor of PDE5. Due to the way in which sildenafil works, it does not result in an erection, therefore, it has no effect in the absence of sexual stimulation when used at the recommended doses.

Viagra works in response to sexual stimulation to increase the blood flow to the penis leading to an erection.

 

How is Viagra supposed to be taken?

Your GP, Pharmacist or other healthcare professional will advise on how to take this blue diamond. The manufacturers say to take the tablet by mouth usually initially as a 25 mg dose tablet one hour before sexual activity. However, Viagra may be taken within a range of one-half hour to four hours before sex. The dose may be adjusted based on doctor recommendations, but it should not exceed 100 mg per dose and should not be taken more than once per day. Your healthcare professional will advise on your specific dose.

Your pharmacist will check for drug interactions, too. Men who use nitrates such as nitroglycerin or isosorbide – usually used to treat angina Happy man showing medicine pillshould never use Viagra or other PDE5 inhibitors due to severe, possibly fatal hypotension (low blood pressure).

 

You’re thinking information overload or what!! Well with any luck you’re equipped with enough information to make an informed choice as to whether you feel you would benefit from this treatment or not. As explained above you’re absolutely not alone so don’t be embarrassed… ask for help! There is lots of help available, so speak to your GP or Pharmacist.  Still embarrassed? Well don’t be, it won’t be the first time they’ve heard about it and it certainly won’t be the last.  It’s time to take the next step. Erectile dysfunction is a well-understood condition and the treatments have been developed hugely in the past 20 years with Viagra being a huge success story in the pharmaceutical world. A consultation with a doctor will allow a diagnosis to be made and treatment can be commenced straight away, returning to an amazing fireworks display in the bedroom department and no more embarrassing conversations with the Don Juan DeMarco’s of this world.

 

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References

  1. https://www.nhs.uk/livewell/goodsex/pages/malesexualdysfunction.aspx
  2. https://www.medicines.org.uk/emc/product/1072
  3. https://bnf.nice.org.uk/drug/sildenafil.html
  4. http://www.ch.ic.ac.uk/local/projects/p_hazel/mode2.html
  5. https://www.sciencedirect.com/topics/neuroscience/guanosine-triphosphate
  6. https://www.drugs.com/slideshow/viagra-little-blue-pill-1043

 

Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected].