What should I do if Viagra doesn’t work?

Viagra (Sildenafil) can be referred to as a wonder drug when it comes to Erectile Dysfunction. It is considered as a first line, standard drug treatment for erectile dysfunction. The molecule Sildenafil was originally discovered to treat cardiovascular diseases but in the 1990s its role in E.D. (erectile dysfunction) almost revolutionized its treatment. Viagra has the longest safety profile among all the E.D. drugs. Thus making it a preferred choice of drug for most of the people. It has mild side effects when taken in proper dose and as prescribed by the doctor. The usual side effects that a man can experience are redness of the skin, a headache, and an upset stomach.

Attractive man feeling disappointed and depressed because of erectile dysfunction, looking at his penis under white cover, doesn't know what's the problem, angry wife lying next to him and waiting

However, we need to understand that the same drug can act differently in different patients. It might not show similar effects or its efficacy may be reduced in some due to various factors. And sometimes just popping the blue pill isn’t an answer for some men. Viagra usually works where the E.D. is organic in nature. Organic impotence is when the blood flow to the penis is not sufficient due to various reasons. Whereas secondary E.D. is also called as psychogenic impotence, it is a sexual dysfunction due to psychological factors such as depression, anxiety, stress etc.  There are various factors that cause E.D. and it is very important to understand the nature of sexual dysfunction.

Let’s first explore erectile dysfunction and the factors that cause it and then we can explain why Viagra doesn’t work for some people and usually in what cases.

 

 

 

 

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ERECTILE DYSFUNCTION:

E.D. is a condition when a man finds it regularly difficult getting or keeping a firm enough erection to be able to have sex. Some men can also have problems with erection occasionally due to various reasons like stress, workload etc. but that is not considered as E.D.

E.D. is a condition where man finds it persistently hard to achieve a satisfactory erection and it interferes with sexual performance.

Since the discovery of Viagra, we now know that it is a treatable condition. However, there are certain factors that cause it. These factors can be psychological and physical. Lifestyle issues such as smoking and alcohol, obesity, a sedentary lifestyle can cause E.D but this kind of dysfunction is secondary in nature and doesn’t require Viagra for it. Changes in lifestyle can reverse the condition. There are usually two types of erectile dysfunctions. One is Primary in nature and other is secondary in nature.

 

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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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Physical Factors that Cause Erectile Dysfunction;

  • Decreased blood supply to the penis :

Sometimes the blood vessels surrounding the penis narrow or constrict resulting in a decreased blood supply. A decreased blood supply will result in difficulty in erection. Erection naturally happens when during arousal blood flushes to the groin. If blood supply is insufficient over a long period of time this can result in E.D. This kind of dysfunction is organic in nature and is considered as a primary dysfunction. Some of the causes of decreased blood supply are,

  1. Smoking
  2. Alcohol
  3. Obesity, an increased weight and fat content in the body will decrease blood circulation
  4. Sedentary lifestyle, inactivity is like new smoking of this era. It is also considered a fourth risk factor that contributes to mortality rates all over the world.
  5. Tumour, a tumour in the groin area can also cause dysfunction.
  6. Cycling (if cycling is done more than three hours in a day)
  7. Prostate cancer
  • Hormonal Disorders:

Testosterone is the main hormone responsible for all the sexual activity and characteristics in men. Low testosterone in males can result in a lack of sexual desire that can, in turn, result in a lack of erection. A hormonal imbalance in the body such as low testosterone and high prolactin combined with abnormal thyroid levels can cause E.D.

Providing a sufficient hormonal treatment can reverse the effects.

  • Heart diseases:

We know that a plane cannot take off without a fully functioning engine. Heart disease’s role in E.D. is like that of an engine too. If the heart is not functioning properly it will cause a sexual dysfunction. Sometimes a sexual dysfunction is an underlying diseased heart. Usually, when a patient comes for buying over the counter Viagra our pharmacists at Assured pharmacy make sure that the person doesn’t have a heart disease.

Viagra doesn’t increase any heart disease risk in healthy individuals. But it increases the risk of a heart attack in men who already have a heart disease. Viagra is known to have a clumping effect on platelets, that is, it can cause blood clots in already damaged blood vessels. Plus Viagra cannot be taken with nitrates that are usually prescribed for heart diseases because nitrates and Viagra both drop blood pressure rate,  this can sometimes cause a very dangerous drop in blood pressure that can become fatal.

 

Psychological Factors that Cause Erectile Dysfunction

ED due to psychological factors is sometimes also referred to as psychogenic impotence and is usually due to anxiety, guilt, low self-image etc. Erectile dysfunction caused by psychological factors is secondary E.D.

  • Depression / Anxiety:

    Worried businessman sitting at office desk full with books and papers being overloaded with work.

Depression, anxiety and stress can manifest itself in different forms. Unlike anxiety and stress, depression is in itself a condition that requires medication and treatment. The secondary manifestation of depression can show itself as a lack of sex drive, lack of sexual pleasure, and in turn an inability to have sex.

Similarly stresses at work, job, and relationships can affect brain sections that deal with pleasure and arousal. When the brain is dealing with stress or is in a state of chronic stress it becomes harder to focus on coitus or sex. Cortisone hormone released due to chronic stress in body puts the body in a fight and flight mode that causes a sexual dysfunction 5.

In this case, doctors can recommend Behavioural cognitive therapy combined with sex therapy to deal with the problem. Viagra is safe to be taken with anti-depressants and is known to improve libido in patients with depression. But it doesn’t improve the quality of life of patients with depression.

  • Addictions:

Medication abuse, drug abuse, and even pornography have known to cause secondary erectile dysfunction. Alcohol at low doses is known to cause sexual arousal but indulging in too much alcohol can also cause temporary impotence 6.

Drugs like heroin, ecstasy, cocaine can cause various changes to sexual function from difficulty in achieving an erection to a delayed ejaculation time. These drugs can sometimes even give painful erections. Using opioids over a long period of time can cause various androgen-deficiencies and other hormonal imbalances 7.

  • Problems with self-image, guilt, confidence etc.

We now have enough insight into causes of erectile dysfunction, let’s now explore how Viagra works and why it is considered as a first line drug of treatment for E.D.

 

How Viagra works

Viagra is classified as a Phosphodiesterase 5 inhibitor. PDE 5 is an enzyme. By inhibiting this enzyme blood flow to the penis is increased that results in an erection. Viagra has a direct physical action that resolves E.D. It is usually prescribed to treat organic impotence.

Cases in which Viagra doesn’t work;

  1. Secondary E.D.
  2. Taking it with contraindicated drugs
  3. When other health conditions are present, such as an ailing heart
  4. Using it as a recreational drug or with alcohol.

 

 

What should I do if Viagra doesn’t work?

We have explored the various reasons for sexual dysfunction. Now we know that sometimes taking the pill isn’t the answer to the problem. The same drug doesn’t have the same effect and efficacy for all the people. It is very important to adopt a right mindset and understand that this blue pill doesn’t magically turn you into a sexually vibrant version of yourself. However, the good news is that for non-responders right counselling and lifestyle modification can salvage them from the curse of erectile dysfunction.Doctor preparing online internet prescription selective focus

  • Take medication on Dr or pharmacist recommendation:

Your doctor/pharmacist is the best person to recommend the drug to you. They are going to examine your condition properly and then prescribe you the medication.

  • Absorption of drug:

Drug absorption in the stomach is a very important factor in determining the working of the drug.8 A heavy meal should not be eaten before taking Viagra. Fatty foods, junk foods, and sour drinks such as grapefruit juice should be avoided as it interferes with the absorption of Viagra that decreases the efficacy of the drug.

  • Change of E.D medication :

In some people, a change of medication may be desired. Viagra is taken 30-60 min before sex, some people may find it hard to pop the pill just before sex, in this case, you could try Cialis (tadalafil) because it can be taken daily. It stays in the blood for a longer period of time and gives time for spontaneity and foreplay which can be very important for some couples.

  • Changing the dose of Medication:

Sometimes Viagra for some men works at a higher dose. But the dose should always be increased on the recommendation of either a pharmacist or a doctor. It comes in different doses of 25mg, 50mg, 100mg but should not be taken more than one in a day.

  • Take Time:

Viagra works only when you are sexually stimulated. Don’t rush straight away after taking the medication. Give at least 30-60 min for medication to work, although it can be safely taken up to 4 hours before coitus/intercourse.

  • Counterfeit Drug:

Counterfeit medicine is fake medicine. It may be contaminated or contain the wrong or no active ingredient. They could have the right active ingredient but at the wrong dose. Counterfeit drugs are illegal and may be harmful to your health 9. Viagra is the world’s most counterfeited drug. A counterfeit drug can never work and is a waste of money and time. Always take your medicine from a GPhC (general pharmacy council) approved pharmacies. And never purchase over unofficial sites from the internet or other places etc.

  • Taking vitamins:

Some vitamins are known to help the body build up testosterone hormones naturally. These vitamins include;

  1. Vitamin C
  2. Selenium
  3. Chromium
  4. Zinc
  5. Grape seed extracts
  • Testosterone boosting activities:

Some natural activities can help with testosterone levels and massively increase the overall health of a man. These activities include,

  1. Taking rest; Yes, you have heard it right! Taking rest can help man rebuild his testosterone levels. Recovery is very important. Stress, exercise all these activities utilize the testosterone stores and it is important to restore those levels. A little rest in a day can go long way!
  2. Reduce sugar intake; Sugar in any form of glucose and fructose does a damage to the male hormone stores in the body and therefore should be reduced in the diet. Also avoid colas, soft drinks, packaged juices, biscuits, cakes, bagels.
  3. Exercise; A high-intensity exercise followed by appropriate rest and recovery is very important and help rebuild testosterone in the body. The human body is wired for high physical activity in daily life like our ancient ancestors. Sedentary lifestyles due to computers, video games, and mobile phones cause us to sit more and move around less often. Inactivity is the fourth leading cause of mortality around the world.
  4. Diet; supplementing the diet with Vitamin D, Zinc can help a lot. Taking certain superfoods like coconut, maca powder, spirulina powder, olive oil (or in any form), dates and even Ghee have miraculous effects on testosterone levels in the body.

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Reference Table

1 https://www.medicalnewstoday.com/articles/5702.php
2 https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
3 Organic Impotence https://www.ncbi.nlm.nih.gov/books/NBK297/
4 https://www.hormone.org/diseases-and-conditions/mens-health/erectile-dysfunction
5 https://www.treated.com/erectile-dysfunction/psychological-causes-of-ed
6 http://alcoholrehab.com/drug-addiction/sexual-dysfunction-substance-abuse/
7 https://drugabuse.com/does-opioid-dependency-cause-sexual-dysfunction-in-men/
8 https://www.menshealth.com/health/common-erectile-dysfunction-medication-mistakes/slide/4
9 Counterfeit Drug FDA https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/CounterfeitMedicine/
10 John Gray, Men’s sexual health. https://www.marsvenus.com/blog/john-gray/erectile-dysfunction-hard-facts-about-the-soft-truth

 

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].