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The latter affects 52% of men between the ages of 40 and 70, including mild, moderate and complete forms of ED.

Organic or physical causes for sexual dysfunction in men include vascular, hormonal and neurologic factors. Concerning vascular causes, the risk factors for atherosclerosis (including smoking, high blood pressure, diabetes (diabetics do not respond well to pills like sildenafil (Viagra)) and high cholesterol are ALSO risk factors for erectile dysfunction. Since a straddle injury or use of a narrow saddle can obstruct and impair arteries to the penis, bicycle riding is also considered a risk factor for erectile

dysfunction

Little attention has been paid to endocrine factors. Testosterone modulates desire, arousal and orgasmic function. Concerning the orgasmic response, testosterone modulates the integrity of genital sensory receptors.

Concerning the arousal response, decreased testosterone blood levels can influence the efficacy of sildenafil (Viagra). If the sildenafil response is not reliably improving erection, the physician should first check if the patient is taking the pill correctly.

The physician should also check the patient’s testosterone level.

One investigator in Italy gave testosterone to patients with low testosterone who did not respond to sildenafil (Viagra). When daily testosterone was given, subsequent sildenafil (Viagra) use resulted in IIEF (the International Index of Erectile Function questionnaire used to determine erectile function) scores improving significantly.

Other risk factors for erectile dysfunction include neurologic problems (multiple sclerosis, stroke), depression and medications for treating diabetes, hypertension, heart disease and depression.

There are many oral therapies for erectile dysfunction, but the only approved medication in the US is the PDE 5 enzyme inhibitor sildenafil (Viagra). Unapproved therapies, some of which are available in the US and some elsewhere, some of which have data to prove efficacy and some not, include tadalafil (Cialis), vardenafil (Levitra), yohimbine, phentolamine, trazodone, apomorphine and neutraceuticals.

PDE5 inhibitors act to relax penile erectile tissues with sexual stimulation thus enhancing your ability to get an erection. Sildenafil (Viagra) is effective for all sorts of erectile dysfunction in 69% of people. In some cases the erection is not hard enough, sometimes sildenafil (Viagra) just doesn’t work.

Structurally vardenafil (Levitra) is similar to sildenafil, while tadalafil (Cialis) is very different. Vardenafil (Levitra) is almost 10 times more biochemically potent than sildenafil, therefore a lower dose is needed to facilitate the penile erection, potentially resulting in less side effects.

Selectivity is the ability of the drug to attach to the specific enzyme PDE 5 found in penile tissues.

Vardenafil (Levitra) is more selective than sildenafil and tadalafil (Cialis) to PDE5, which again means a lower dose is needed with potentially less side effects.

Tadalafil is very specific for PDE5 and is also very specific for the enzyme PDE11.

Unfortunately, we don’t know much about PDE11, which is found in the heart, in the pituitary gland in the brain and in the testicles.

Pharmacokinetics, half-life, is how long the medication stay s in the blood.

Sildenafil (Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours.

This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known.

Tadalafil (Cialis) has the longest half-life and allows you to take the medication and not relate the sexual activity to the immediate use of the medication.

The drawback is if you need nitrates after using tadalafil (Cialis), this medication lasts a long time in your blood stream and may place you at a higher risk. Younger people might do well treated with tadalafil, (Cialis) while older people with other health issues might be better off using sildenafil (Viagra) or vardenafil (Levitra) but more data are needed.

The side effects of vardenafil (Levitra) are potentially less than sildenafil (Viagra), but more data are needed. In a recent study on men with erectile dysfunction and diabetes, vardenafil (Levitra) improved their erectile dysfunction. Tadalafil (Cialis) is as effective as sildenafil (Viagra), and vardenafil (Levitra) with similar side effects except for back pain that occurs occasionally with tadalafil, probably because of the long half-life.

Many people stop taking drugs because they are experiencing side effects, they no longer have a partner, or they are worried about safety. Sexual activity is not a major contributor to the risk of a heart attack. Sexual activity, with or without sildenafil (Viagra) increases the chance of an MI during sexual activity by only 0.1%. If pills fail, there are vacuum devices, Muse, injections, bypass surgery and implants. The patient making a presentation has had penile bypass surgery.

In addition he takes testosterone and sildenafil as needed.. This is a classic example of why people with ED need complete care: a psychological exam, history and physical exam, and diagnostic studies with long term follow-up care.

Patients with ED should not just be prescribed sildenafil (Viagra) and then be lost to follow-up.

Tadalafil and vardenafil are phosphodiesterase-5 (PDE5) inhibitor used to treat impotence (the inability to attain or maintain a penile erection) Tadalafil is also used to treat symptoms of benign prostatic hyperplasia (BPH). Brand names for tadalafil include Adcirca and Cialis. Brand names for vardenafil include Levitra and Staxyn ODT.

Side effects of tadalafil and vardenafil that are similar include facial flushing (reddening), headaches, stomach upset, diarrhea, flu-like symptoms, nausea, low blood pressure, blurred vision, changes in color vision, and abnormal ejaculation. Side effects of vardenafil that are different from tadalafil include chest pain and priapism (painful erection lasting more than 6 hours). Tadalafil is a phosphodiesterase-5 (PDE5) inhibitor used to treat impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH).

Other PDE5 inhibitors include sildenafil (Viagra) and vardenafil (Levitra).

Sexual stimulation that leads to an erection causes the production and release of nitric oxide in the penis, which causes the enzyme guanylate cyclase to produce cyclic guanosine monophosphate (cGMP). cGMP is responsible for increasing and decreasing the size of blood vessels carrying blood to and from the penis and causing an erection. When phosphodiesterase-5 enzyme destroys cGMP, the blood vessels return to their normal size, blood leaves the penis, and the erection ends.

Tadalafil prevents PDE5 from destroying cGMP so cGMP stays around longer which leads to a more prolonged erection. It is unclear how tadalafil improves symptoms of BPH, but PDE5 is also present in the muscles of the bladder and the prostate, and it is believed that the relaxation of these muscles may make the passage of urine less difficult by reducing the pressure in the muscle surrounding the opening to the urethra that controls the flow of urine from the bladder.

Vardenafil is a phosphodiesterase-5 (PDE5) inhibitor used to treat impotence, the inability to attain or maintain a penile erection.

It has a mechanism of action that is similar to sildenafil (Viagra), and tadalafil (Cialis). Penile erection is caused by the engorgement of the penis with blood that occurs when the blood vessels delivering blood to the penis increase in size and blood vessels carrying blood away from the penis decrease in size.

Sexual stimulation that leads to the engorgement and erection causes the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme guanylate cyclase to produce cyclic guanosine monophosphate (cGMP) that is primarily responsible for increasing and decreasing the size of the blood vessels carrying blood to and from the penis. Vardenafil prevents an enzyme called phosphodiesterase-5 (PDE-5) from destroying cGMP so that cGMP persists longer. The longer cGMP persists, the more prolonged the engorgement of the penis.

What are the side effects of tadalafil and vardenafil?

facial flushing (reddening), headaches, stomach upset, diarrhea, flu-like symptoms, and nausea.

Tadalafil also may cause low blood pressure, blurred vision, changes in color vision, and abnormal ejaculation.

The most common side effects of vardenafil are facial flushing (reddening), headaches, stomach upset, diarrhea, flu like symptoms, and nausea. Vardenafil also may cause chest pain, low blood pressure, blurred vision and changes in color vision, abnormal ejaculation and priapism (painful erection lasting more than 6 hours). Patients should seek immediate medical help if they experience an erection lasting more than 4 hours.

Rare cases of sudden loss of hearing have been reported with phosphodiesterase inhibitors such as vardenafil, sometimes associated with ringing in the ears and dizziness. If changes in hearing occur, patients should discontinue their vardenafil and seek immediate medical attention.

For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity (tadalafil for use as needed).

Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day.

Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). For once daily use without regard to sexual activity the recommended dose is 2.5 to 5 mg daily.

Tadalafil should not be taken more than once daily. The recommended dose for BPH, or BPH and ED is 5 mg daily taken about the same time each day.

Tadalafil may be taken with or without food since food does not affect its absorption from the intestine. The dose of tadalafil may require adjustment for patients with reduced kidney or liver function. For most individuals, the recommended dose of vardenafil regular tablets is 10 mg per day taken 60 buy kamagra soft tablets minutes before intercourse.

If there is no response or side effects, the dose may be increased to 20 mg or, if there are side effects, it may be reduced to 5 mg. Individuals 65 years of age or older should begin therapy with 5 mg. Individuals who are taking medications that increase the blood levels of vardenafil should start treatment with 2.5 to 5 mg of vardenafil.

(See drug interactions.) Orally disintegrating tablets (ODT) are not interchangeable with regular vardenafil tablets because they are better absorbed and produce higher blood levels than regular tablets. The recommended dosing when using ODT is one tablet 60 minutes before intercourse. It should be placed on the brand viagra no prescription tongue until it disintegrates and should viagra tablets online purchase not be swallowed with water.

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Cold Stages of Lyme Disease Flu Shot Alopecia Areata Chiggers Bites. The breakdown and elimination of tadalafil from the body may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir).

Therefore, these drugs may increase the levels of tadalafil in the blood.

If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced to 10 mg every 72 hours when used as needed or 2.5 mg when used daily in order to avoid side effects from high levels of tadalafil.

Rifampin, carbamazepine (Tegretol, Tegretol XR, Equerto, Carbatrol), phenytoin (Dilantin, Dilantin-125), and phenobarbital may decrease blood levels of tadalafil, possibly reducing the effect of tadalafil. Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure.

Therefore, tadalafil should not be used with nitrates.

Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate (BPH). Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started.

In such situations, tadalafil should be started at the lowest dose.

If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose.

Combining tadalafil with alpha-blockers for treatment of BPH is not recommended.

Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches, and increased heart rate.

PDE5 inhibitors may affect platelet function and therefore prolong bleeding.

Tadalafil should be used cautiously in patients with bleeding disorders or active ulcers.

Tadalafil should not be combined with Adcirca (another form of tadalafil) or other PDE5 inhibitors, for example, vardenafil (Levitra) or sildenafil (Viagra, Revatio). The breakdown and elimination of vardenafil from the body is inhibited by erythromycin, clarithromycin (Biaxin), ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan), ritonavir (Norvir), atazanavir (Reyataz), grapefruit juice.

Therefore, these drugs increase the concentration of vardenafil in the blood and should not be combined with vardenafil. Vardenafil reduces the concentration of ritonavir and indinavir and may reduce the effect these drugs.

Vardenafil increases heart rate and also exaggerates blood pressure lowering effects of nitrates (for example, nitroglycerine). In patients with chest pain (angina), particularly those who take nitrates,, vardenafil can cause chest pain by increasing heart rate and lowering blood pressure.

Therefore, patients with angina should not use vardenafil. Vardenafil also exaggerates the blood pressure lowering effects of alpha-blocking drugs, for example, terazosin (Hytrin), and should not be used by individuals who also use alpha-blockers.

Vardenafil also adds to the blood pressure reducing effect of other medications.

Are tadalafil and vardenafil safe to use while pregnant or breastfeeding? Tadalafil is not approved for women and has not been evaluated in women who are breastfeeding. Vardenafil has not been evaluated in women who are breastfeeding.

Cialis (tadalafil) and Levitra (vardenafil) are phosphodiesterase-5 (PDE5) inhibitor used to treat impotence (the inability to attain or maintain a penile erection). Tadalafil is

also

Learn about erectile dysfunction causes and treatments such as drugs.

Erectile Dysfunction (Impotence) Quiz: Causes & Treatment. Did you know that certain medical condition may be responsible for ED? Some causes of impotence are medically treatable and. Erectile Dysfunction (ED, Impotence) Erectile dysfunction (ED, impotence) is the failure to achieve or maintain an erection. There are many potential underlying causes of erectile dysfunction, including stress and emotional problems, brain dysfunction, problems with blood supply to the penis, and structural problems with the penis.

Erectile dysfunction is diagnosed by taking the patient's history and physical exam. Blood tests measuring kidney function and blood sugar, cholesterol, hormone, and prostate-specific antigen (PSA) levels may be ordered. Urinalysis, ultrasound, and other more sophisticated tests may be required.

The treatment of erectile dysfunction depends on the underlying cause.

Medications, penile injections, penile implants, and vacuum devices may be used.

Treatment for erectile dysfunction is usually successful. The patient should manage heart disease risk factors (high blood pressure, high cholesterol, diabetes) as they are related to erectile dysfunction risk.

Impotence Erectile Dysfunction FAQs 8 Natural Remedies for Erectile Dysfunction (ED) Erectile Dysfunction Drugs: Drug Interactions Erection Protection: Is Erectile Dysfunction (ED) Prevention Possible? Effective Erectile Dysfunction Treatments: What to Do After an Impotence Diagnosis What Causes Erectile Dysfunction (Impotence)? Viagra (sildenafil) tadalafil (erectile dysfunction) - oral, Cialis vardenafil - oral, Levitra tadalafil, Cialis, Adcirca vardenafil (Levitra, Staxyn ODT) Cialis Levitra.

High Blood Pressure: When Is It Erectile Dysfunction?

Erectile Dysfunction: A Womans Point of View Erectile Dysfunction (ED) Quiz Erectile Dysfunction Related Depression Erectile: The Race to Erection - Levitra vs Viagra Cialis For Erectile Dysfunction.

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Viagra, Cialis, Levitra, and Stendra are oral medications used to treat erectile dysfunction (ED). You may also know them by their generic names: sildenafil (Viagra) tadalafil (Cialis) vardenafil (Levitra) avanafil (Stendra) About 30 million American men occasionally have a problem with getting or keeping an erection, according to the Urology Care Foundation. When ED becomes a problem, many men turn to these oral ED medications.

However, there are also some key differences, such as when you take them, how long they work, and what their side effects are. Viagra, Cialis, Levitra, and Stendra are all in a class of drugs called PDE5 inhibitors.

These drugs work by blocking an enzyme called phosphodiesterase type 5. They also boost a chemical in your body called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed

muscles

It also helps you maintain the erection long enough to have sex. Here are the basic features of each of these drugs: Brand name Viagra Cialis Levitra Stendra What’s the generic name of this drug?

sildenafil tadalafil vardenafil avanafil Is a generic version available?

oral tablet oral tablet oral tablet oral tablet What strengths does it come in? 25 mg, 50 mg, 100 mg 2.5 mg, 5 mg, 10 mg, 20 mg 5 mg, 10 mg, 20 mg 50 mg, 100 mg, 200 mg What’s the typical dosage?

50 mg 10 mg (when used as needed); 2.5 mg (when used daily) 10 mg; 5 mg (for men 65 years old and up) 100 mg When do I take it? 30-60 minutes before sex 30 minutes before sex 60 minutes before sex 15 minutes before sex (for 100 mg and 200 mg); 30 minutes before sex (for 50 mg) How long does it work?

4 hours up to 36 hours 4-5 hours 6 hours How do I store it? Around room temperature, between 68°F to 77°F (20°C to 25°C) At 25°C (77°F) At 25°C (77°F) Around room temperature, between 68°F to 77°F (20°C to 25°C) The drugs are available in a variety of doses, ranging from 2.5 milligrams (mg) to 200 mg. However, taking these drugs after eating a high-fat meal does slow the rate of absorption.

Most of them stay in your bloodstream for about four to five hours. Cialis is the exception, as it remains in your bloodstream for up to 36 hours.

The length of time a drug stays in your system may be important if you’re taking other medications.

You shouldn’t take any of these drugs more than once in a 24-hour period. Viagra, Cialis, Levitra, and Stendra are usually stocked at most pharmacies.

In general, most health insurance companies won’t cover their costs.

However, if you have certain medical conditions, your health plan may pay for the drug with prior authorization.

The exact price you pay for any drug will depend on your insurance plan and your pharmacy.

Generic versions of Viagra, Cialis, Levitra can cost half as much as their brand-name counterparts, if not less.

The side effects of these medications are mostly similar.