Short Facts about Viagra
- Viagra is probably the World’s Most Popular Male Sexual Performance Drug.
- Also, it is one of the most counterfeited drugs in the world.
- Viagra is a legend due to the fact that it was the first of its generation of innovative drugs, treating erectile dysfunction
- Viagra is marketed for twenty years (since 1998).
- Viagra is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours.1
How erections occur?
When a man is sexually aroused, nerves and chemicals work together to relax smooth muscle tissue and widen arteries so that the penis can fill with blood. Veins constrict to keep the blood inside the penis, forming the erection. Once the man ejaculates, the blood is released back into the body.
What is Erectile Dysfunction?
Erectile dysfunction (ED) is a man’s inability to achieve or maintain an erection that is satisfactory for sex. An ED problem can be transitory, can be influenced by emotional problems or the intake of some specific medication. It can appear in order men but is common in young men too. A venous leak is often a cause of ED in younger men. Problems with blood vessels are a common cause of erectile dysfunction. The term venous leakage refers to veins in the penis, the Blood vessels are important for erections. When a man becomes sexually aroused, the arteries in his penis expand to allow blow to flow in, making the erection firm. However, to keep the erection rigid, blood needs to stay in the penis until the man ejaculates. To accomplish this, veins constrict to trap the blood inside. (This process is called venous-occlusion.) Once the man climaxes, or if sexual stimulation ends, the veins widen and blood flows back into the body.2 If the veins do not constrict enough, blood will “leak” back into the body, softening the erection. Many men with this type of ED find that they can get a firm erection at first, but gradually lose the firmness.
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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.
Causes of erectile dysfunction onset
ED can happen for many reasons, both physical and psychological.
- Poor blood flow to the penis. This is one of the most common causes of ED and can be the result of diabetes, heart disease, high cholesterol, and high blood pressure.
- Nerve damage. When a man is sexually aroused, his brain sends messages to his penis to start the erection process. But if there is nerve damage, these messages cannot be transmitted properly. Thus, conditions that affect the nervous system – like diabetes, spinal cord injury, multiple sclerosis, and stroke – can lead to ED. Erectile nerves can also be damaged during cancer treatments, like radiation therapy or radical prostatectomy (removal of the prostate gland).
- Hormonal issues. Men with low testosterone or thyroid disorders may have trouble with erections.
- Medication side effects. ED is a side effect of some medications, such as those prescribed for high blood pressure, heart disease, peptic ulcers, insomnia, and depression. Not all medications in these categories have sexual side effects, however. For example, some antidepressants do, but other antidepressants do not.
- Psychological and emotional issues. Fighting with a partner, anxiety, depression, stress, past sexual abuse, and concerns about sexual performance can all affect one’s sexual well-being. In these cases, sessions with a sex therapist or counsellor may help.
Can smoking impact erectile dysfunction?
Smoking can have a huge impact on a man’s erections. In fact, in 2014 the acting U.S. Surgeon General added erectile dysfunction (ED) to the list of conditions that can be caused by smoking.
It appears that smoking can make erectile dysfunction worse, especially if the amount of smoked cigarettes is high. Smokers are also at higher risk of developing erectile dysfunction, due to several mechanisms:
- the decrease of nitric oxide needed for a good circulatory flow into the penis,
- increased stiffness of the smooth muscle tissue caused by the toxicity of the carbon monoxide and other substances inhaled during smoking.
For a healthy life and for not being exposed to the risk of developing erectile dysfunction, it is recommended to quit smoking immediately.
What is Viagra and how can it treat erectile dysfunction?
Viagra is a medicinal product, containing sildenafil and indicated in the treatment of adult men with erectile dysfunction. Sildenafil is a highly selective inhibitor of PDE type 5.3,4 It enhances NO-mediated relaxation of human corpus cavernosum in vitro. Sildenafil, by inhibiting phosphodiesterase, increases the intracellular concentrations of cyclic guanosine 3’,5’ monophosphate (cGMP), causing an amplification of the endogenous NO-cGMP signalling pathway. It is considered a vasodilator agent, acting by increasing blood flow to the penis and thus it restores impaired erectile function.
In order for Viagra to be effective, it requires sexual stimulation in a natural setting.
Viagra’s brief history
Viagra originally entered into clinical studies as a medication intended for lowering high blood pressure. Results confirmed that it did not significantly reached its intended purpose and was discontinued. When patients were asked to return their unused medicine, however, they all refused. Investigating the reasons why the patients were so fond of the new medication, was revealed a very interesting effect: it improved men’s erection. And so Viagra was born, and the men’s’ hopes along with it.
How should I use Viagra?
Viagra is administered orally, once a day.
The recommended dose in adults is 50 mg taken as needed approximately one hour before sexual activity. To be effective, sexual stimulation is required.
Please read carefully the following sections before jumping into action.
Should I take caution when using Viagra?
Yes, please consider your degree of cardiac risks associated with the sexual activity. If you are in the case of co-administering substances known to lead to symptomatic hypotension (blood pressure <90/50 mmHg), do not take Viagra. If using alpha- blockers, you should address to your doctor prior to taking Viagra. Viagra cannot be administrated with nitric oxide donors or nitrated in any form (Nitroglycerin Isosorbide, Nitroprusside, Amyl nitrite or amyl nitrate). Nitrate esters are commonly used in the treatment of angina pectoris, or “chest pain”, myocardial infarction, and congestive heart failure. The combination of nitrates and Viagra can lead to a dangerous fall in your blood pressure.7
Also, do not take nitrate-containing medicines up to 24 hours after you take Viagra.5 If you are not certain, it is better to ask the doctor or the pharmacist. Do not take Viagra if you are taking riociguat used to treat high pressure in the lungs and high pressure in the lungs secondary to blood clots, as their hypotensive effects may be increased by Viagra. If you have a severe heart problem of you suffered from a stroke or heart attack, or if you have a severe liver problem, it is better to refer to your doctor or pharmacist.
How to take Viagra?
Do not take Viagra from unknown sources. Buy Viagra from the pharmacy. There is a high rate of Viagra counterfeit reported. Also, you should not use Viagra with any other local or oral treatments for erectile dysfunction. Viagra takes longer to start working if you take it with a heavy meal and drinking alcohol can temporarily impair your ability to get an erection. We are advising not to drink excessive amounts of alcohol if you desire an immediate and efficient effect of Viagra.
You should not take Viagra more than once a day. Take Viagra about one hour before you are planning to have sex. Swallow the tablet whole with a glass of water
Is Viagra safe?
Yes, Viagra is a safe drug. Safety was proven in a number of clinical studies. Sildenafil was administered to more than 9500 patients aged 18-87.6 Despite this, remember that it is a medicine released by prescription. The safety of Viagra has not been studied and therefore is contraindicated in the following groups: patients with severe hepatic impairment, patients with hypotension (blood pressure <90/50 mmHg), a recent history of stroke and known hereditary degenerative retinal disorders such as retinitis pigmentosa. The most common adverse reactions include a headache, flushing, dyspepsia, nasal congestion, dizziness, nausea and altered vision. As dizziness was reported in clinical trials, it is better not to drive or to manipulate any operating machinery immediately after taking Viagra.
What were the results obtained in clinical studies?
In a comparative study, evaluating the onset of penile rigidity in men with ED treated with Sildenafil Citrate and Tadalafil (Cialis), Viagra’s median time of action for the patients who obtained erections for sexual intercourse was 25 minutes with a range of 12-37 minutes.8 In a separate study, Viagra was still able to produce an erection in response to sexual stimulation 4-5 hours post administration.9 Viagra proved effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy.
What Viagra looks like?
Viagra film-coated tablets are blue, with a rounded diamond shape. They are marked “PFIZER” on one side and “VGR 50” on the other side. Also, Viagra is marketed in 3 different doses, 25, 50 and 50 mg, film-coated tablets.
Is Viagra often being counterfeiting?
Being one of the most counterfeited drugs in the world, Viagra is sold often from unknown, unverified sources. These counterfeited Viagra has posed severe risks to patients’ health because is often of a poor quality and is unhealthy and unsafe. Moreover, it does not comply with the health and safety rules that the original product observes. Nor does it meet the same requirements for quality and materials. Counterfeit of drugs are a real problem to our society as trade in counterfeit products is used to finance other types of organized crime. This is pointed out in a new report on trade in counterfeit products in the EU prepared in by Europol and the European Observatory on Infringements of Intellectual Property Rights. Between 2015 and 2016, £11m of fake erectile dysfunction drugs were seized in the UK – the highest ever recorded.10
Doctor Helen Webberley, an expert in sexual health, affirmed that they found several cases of chalk, detergents and talcum powder being used to bulk up drugs and tablets. There are also several and often cases of overdose due to the fact that the counterfeited Viagra is not tested, or dose’s that have no effect. “If you or a friend has taken counterfeit ED medication, then you should keep any that you have in case they are needed by a toxicology laboratory and seek medical advice from your GP.”, Dr. Webberley advises her patients.
Usually, the fake site won’t require a prescription.
Consumers of illicit PDE-5i often do not realize they are using counterfeit products and placing themselves at an unnecessary health risk. Others seek to bypass the legitimate healthcare system due to either embarrassment of the underlying condition or desire for cheaper alternatives. However, taking illicit PDE-5i may harm consumers directly, as many illicit products contain detrimental contaminants and inaccurate amounts of the active ingredient without the appropriate warnings. Counterfeit PDE-5i often contain contaminants. These are used either as bulking agents to lower production costs or to imitate the appearance and physical qualities of the genuine product. In those samples seized in the United Kingdom, Italy, and Indonesia, there were contaminants such as gypsum, non-purified talc, amphetamine, commercial grade paints, paracetamol, and metronidazole. 12 These non-pharmaceutical ingredients can have toxicities of their own. Non-declared pharmaceuticals can have drug interactions and side effects such as gastrointestinal symptoms and nausea when combining metronidazole and alcohol. Counterfeiters do not declare these ingredients or warnings of possible deleterious interactions on their packaging.11
Can I take Viagra without a prescription?
No. Viagra is medicinal product issued only by medical prescription.
To order Viagra from Assured Pharmacy, you must complete an online questionnaire and afterwards a GMC regulated doctor will issue a prescription that allows you to acquire Viagra in an efficient, safe and regulated manner.
This prescription is sent directly to our pharmacy where it is checked by a qualified pharmacist to ensure the treatment is suitable.
Through an online consultation, Assured Pharmacy can help you deal with your health problem and you can both access quality pharmaceutical products online and have high-quality medical services. You can save time and effort and, in the meantime, stay confident that your healthcare professional will give you the right solution to your problem.
If you are intending to use Viagra, or if you have questions related to side-effects, please call us on 01625 460 621, where there is a Pharmacist Mon-Fri 9-5, or consult our site https://www.assuredpharmacy.co.uk.
You can trust that when using our services or products, you:
- Buy Safely & in Confidence
- Have complete discretion and privacy
- Get free delivery
So, what should be my real expectations after taking Viagra for the first time?
Viagra will not make your penis larger and neither will it decrease premature ejaculation. It will, however, decrease your refractory time, the time required to achieve a subsequent erection after ejaculation. And it will allow a firmer erection with less stimulation and will make possible a few more erections during the interval of 4-5 hours postdose.
References:
- K Hatzimouratidis- Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence;
- http://www.issm.info//sexual-health-qa/#erectile-dysfunction
- M Boolell M, MJ Allen, SA Ballard, S Gepi-Attee, GJ Muirhead, AM Naylor, IH Osterloh, C Gingell – Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction;
- E Gbekor, S Bethell and L Fawcett- Selectivity of sildenafil and other phosphodiesterase types 5 (PDE5) inhibitors against all human phosphodiesterase families;
- Rodríquez Vela L, Gonzalvo Ibarra A, Pascual Regueiro D, Rioja Sanz LA.- Erectile Dysfunction;
- http://www.ema.europa.eu/Viagra- Summary of product characteristics;
- KE Torfgård, J Ahlner – Mechanism of actions of nitrates;
- https://clinicaltrials.gov/ A Randomized, Open-Label, Crossover, Multicenter, Single Dose Comparator Study Evaluating Onset Of Penile Rigidity In Men With Erectile Dysfunction Who Are Treated With Sildenafil And Tadalafil;
- https://clinicaltrials.gov/ A Randomized Double-Blind, Placebo-Controlled Balanced 4-Way Crossover Study To Assess The Efficacy Of Single Oral Doses Of PF-00592379 On Erectile Function, Using 100mg Sildenafil As A Positive Control.
- http://www.huffingtonpost.co.uk/entry/fake-viagra-side-effect- dangerous_uk_573987b1e4b01359f6871803
- Chiang et al. The dangers of sexual enhancement supplements and counterfeit drugs to “treat” erectile dysfunction
- Stecher VJ, Jackson G, Banks I, et al. Analysis of Pharmaceuticals Seized by Authorities for Suspicion of Being Counterfeit Viagra® (Sildenafil Citrate). Lyon, France: European Society for Sexual Medicine, 2009.
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]
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