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Giles Brindley and Drug Therapy for ED Modern drug therapy for ED was advanced enormously in 1983 when British physiologist Giles Brindley, Ph.D.

dropped his trousers and demonstrated to a shocked AUA audience his phentolamine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered, established the fundamentals for the later development of specific, safe, orally-effective drug therapies, ie, PDE-5 inhibitors.

PDE Inhibition and Smooth Muscle Relaxation Phosphodiesterase (PDE) is an enzyme that causes breakdown of cyclic GMP, which is the direct sildenafil citrate pills for sale intracellular mediator in the nitric oxide (nonadrenergic, noncholinergic) pathway.

Discovery of this pathway led to a Nobel Prize in 1998 for the scientists responsible.

The nitric oxide system causes relaxation of smooth muscle in blood vessel walls, ie, vasodilation, in various organ systems.

The direct intracellular mediator of the nitric oxide pathway is cGMP. This pathway is active in numerous organ systems, and as of this writing, a number of different PDEs are known. The various PDEs differ in their physiologic roles and tissue distribution.

Type 5 PDE is concentrated in the penile smooth muscle of the corpus cavernosum, where its normal function is to inhibit erection by degradation of cGMP, the mediator of erection. Viagra and the new drugs Cialis and Levitra all inhibit PDE-5, which is an inhibitor for corporal smooth muscle relaxation, resulting in increased blood flow in the penis in response to sexual stimulation. Comparison of Viagra, Cialis, & Levitra No head-to-head trial comparing the 3 PDE inhibitors has been performed. However, some differences between the 3 are basic: a table has been created to illustrate the major differences. An obvious proviso is that extensive data are available on Viagra (more than 20 million men treated, more than 1100 peer-reviewed articles as of Feb. Tubingen in Germany have compared the three drugs via literature review (Eur. 7:435, 2002) In brief, efficacy is approximately 70% with all 3 drugs.

The side effect profile is similar among the 3 drugs, except that blue discoloration of vision (overlap with PDE-6 in the retina) is seen only with Viagra ( Peer-reviewed References.

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Pfizer RxPathways connects eligible patients to a range of assistance programs to help them access their Pfizer prescriptions. Eligible patients can register for valuable savings offers for nearly 40 brand name medications. Search for Clinical Trials by condition, keyword or trial number. Share your location or enter your city or zip code to find studies near you. sildenafil (injection) Pronunciation: sil DEN a fil. What is the most important information I should know about injectable sildenafil? Some medicines can cause unwanted or dangerous effects when used with sildenafil. Tell your doctor about all your current medicines, especially riociguat (Adempas).

Do not use

sildenafil

Do not use sildenafil injection with Viagra similar medications such as avanafil (Stendra), tadalafil (Cialis) or vardenafil (Levitra). Tell your doctor about all medications you use for erectile dysfunction. Get emergency medical help if you have ringing in your ears, sudden hearing loss, or sudden vision loss.

Sildenafil relaxes muscles of the blood vessels and increases blood flow to particular areas of the body.

Sildenafil injection (Revatio) is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women.

Another brand of sildenafil is Viagra , which is used to treat erectile dysfunction (impotence) in men. Revatio is used to treat PAH in both men and women. Do not use sildenafil injection while also taking Viagra or other erectile dysfunction medications, unless your doctor tells you to.

Sildenafil injection may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before using injectable sildenafil? You should not use sildenafil injection if you are allergic to it, or: if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas). Do not use sildenafil buy viagra for women injection if you are also taking a nitrate drug for chest pain or heart problems.

This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers").

Using sildenafil

with

To make sure this medicine is safe for you, tell your doctor if you have ever had: heart disease or heart rhythm problems, angina (chest pain), coronary artery disease, circulation problems; a condition called pulmonary veno-occlusive disease; a heart attack, stroke, or congestive heart failure; high or low blood pressure; liver or kidney disease; a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia; a bleeding disorder such as hemophilia; a stomach ulcer; retinitis pigmentosa (an inherited condition of the eye), or a history of vision loss; a physical deformity of the penis (such as Peyronie's disease). Sildenafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss.

This has occurred in a small number of people using sildenafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoked or were over 50 years old. It is not clear whether sildenafil is the actual cause of vision loss.

This medicine is not expected to harm an

unborn

It is not known whether sildenafil passes into breast milk or if it could harm a nursing baby.

Do not give this medication to anyone under 18

years

Do not use this medicine in larger or smaller amounts or for longer than recommended.

Prepare your dose only when you are ready to give an injection.

Do not use if the medicine has changed colors or has particles in it.

Use a disposable needle only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it).

Keep this container out of the reach of children and pets.

Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. These conditions may cause very low blood pressure. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Store at room temperature away from moisture and heat. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using injectable sildenafil?

Avoid using other medicines to treat impotence without your doctor's advice. What are the possible side effects of injectable sildenafil? Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sildenafil and get emergency medical help if you have: heart attack

symptoms

feet

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

You may report side effects to FDA at 1-800-FDA-1088. What other drugs will affect injectable sildenafil? Do not use Revatio with Viagra or similar medications such as avanafil (Stendra), tadalafil (Cialis) or vardenafil (Levitra). Tell your doctor about all medications you use for erectile dysfunction.

Tell your doctor about all your current medicines and any you start or stop using, especially: drugs to treat high blood pressure or a prostate disorder; an antibiotic --clarithromycin, erythromycin, or telithromycin; antifungal medicine --ketoconazole or itraconazole; or medicine to treat HIV/AIDS --atazanavir, indinavir, ritonavir, or saquinavir.

Other drugs may interact with sildenafil, including prescription and over-the-counter medicines, vitamins, and herbal products.

Not all possible interactions are listed in this medication guide. Your pharmacist can provide more information about sildenafil injection. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect.

Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient.

Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. oral suspension (Revatio) 10mg/mL (when reconstituted) Erectile Dysfunction.

1 hr before sexual activity; however, may be taken anywhere from 30 min to 4 hr before sexual activity. Based on effectiveness and toleration, may increase dose to maximum of 100 mg or decrease to 25 mg. IV: 2.5-mg or 10-mg bolus TID if patient is temporarily unable to take PO.

Adding Revatio to bosentan does not have any beneficial effect on exercise capacity. Severe (eg, cirrhosis): Consider initial dose of 25 mg. Mild or moderate (Child-Pugh A or B): Clearance reduced, resulting in increases in AUC (84%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment Severe (Child-Pugh C): Not studied. Mild or moderate (CrCl 30-80 mL/min): No dose adjustment required Severe (CrCl Enter a drug name and sildenafil.

Vaso-occlusive crisis (PAH secondary to sickle-cell anemia) Nonarteritic anterior ischemic optic neuropathy (NAION) Warnings.

Soluble guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension. Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate pathway, PDE5 inhibitors may potentiate the hypotensive effects of nitrates A suitable time interval following PDE5 dosing for the safe administration of nitrates or nitric oxide

donors

Elicits vasodilatory properties, resulting in mild and transient decreases in blood pressure.

Use with caution in patients with anatomic deformation of penis (eg, angulation, cavernosal fibrosis, or Peyronie disease), conditions potentially predisposing to priapism (eg, sickle cell anemia, multiple myeloma, or leukemia), cardiovascular disease, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, multidrug antihypertensive regimens, retinitis pigmentosa, concomitant use of CYP3A4 inhibitors. Pulmonary vasodilators may significantly worsen cardiovascular status of patients with pulmonary veno-occlusive disease. Patient taking alpha blocker should be stabilized before starting phosphodiesterase (PDE)-5 inhibitor, which should be initiated at

lowest

should