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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 dose; if patient is already taking optimized dose of PDE-5 inhibitor, alpha blocker should be initated at lowest dose to avoid hypotension. Sudden decrease or loss of hearing, which may be accompanied by tinnitus and dizziness. 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Revatio: In small, prematurely terminated study of patients with PAH secondary to sickle-cell disease, vaso-occlusive crises requiring hospitalization were more commonly reported by patients who received sildenafil than by those randomized to placebo; effectiveness of sildenafil in PAH secondary to sickle-cell anemia has not been established; the clinical relevance to men treated for erectile dysfunction with sildenafil is not known. Revatio: Not for use in children with PAH; increased mortality with increasing doses (hazard ratio 3.5) was observed in randomized, double-blind, placebo-controlled clinical trial of 234 children (1-17 years) with PAH who had mild-to-moderate symptoms at baseline. Revatio: Epistaxis occurred in 13% of patients with PAH secondary to connective tissue disease (eg, scleroderma); this effect was not seen in idiopathic PAH; incidence was also higher in those receiving concomitant PO vitamin K antagonist therapy (9%) than in those not receiving such therapy (2%) Pregnancy & Lactation. Limited published data from randomized controlled trials, case-controlled trials, and case series do not report a clear association with sildenafil and major birth defects, miscarriage, or adverse maternal or fetal outcomes when sildenafil is used during pregnancy; there are risks to mother and fetus from untreated pulmonary arterial hypertension. Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death. Limited published data from a case report describe presence of sildenafil and its active metabolite in human milk; there is insufficient information about effects of sildenafil on breastfed infant and no information on effects of sildenafil on milk production; limited clinical data during lactation preclude a clear determination of risk of drug to an infant during lactation. Controlled studies in pregnant women show no evidence of fetal risk. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. How do these erectile dysfunction medications compare? How do these erectile dysfunction medications compare? Viagra Connect, Viagra, and Sildenafil are all medications used to treat erectile dysfunction (ED) in men. They are closer related than some other ED medications, but why? Find out the link between these medications, how they are similar, and what differences there are that would help you choose between them. How are Viagra Connect, Viagra, and Sildenafil related? They are the same from a medical point of view – Viagra Connect, Viagra and Sildenafil are all related because they contain the same active ingredient, sildenafil citrate. As a result they all have the exact same effect during treatment. The only difference is branding: Sildenafil is a generic medicine and produced by several manufacturers Viagra, is the branded version of Sildenafil patented by the company, Pfizer Viagra Connect is 'over-the-counter Viagra', which is also made by Pfizer. Sildenafil was invented first, by accident – sildenafil citrate (the active ingredient in all 3 medications) was discovered as a treatment for ED by accident. The researchers who discovered it were originally testing new treatments for high blood pressure (hypertension). Sildenafil, however, didn’t relieve the symptoms of hypertension properly. Instead 80% of 4000 male participants found they got an erection more easily when they took sildenafil. Therefore, the drug was subjected to testing and was later approved by the Food and Drug Administration (FDA) for the treatment of ED. The patent for sildenafil medication was created by Pfizer – Viagra was born from the discovery of sildenafil as an ED treatment. Although they both contain the same active ingredient, Viagra is the brand name for the sildenafil produced and sold by the company, Pfizer. This get generic viagra was until viagra price in mercury drugstore the patent expired and Sildenafil could be sold as a cheaper generic medication. Viagra Connect was then approved as a pharmacy medication (P) – it works in the same way as Sildenafil and Viagra, but it does not require a prescription. The reason for creating Viagra Connect was to reduce the number of men buying Viagra from illegal sources, possibly because they don't want to go to their GP for a prescription. They can all be bought online in the same way – you can buy all 3 versions using our online service. To order, you will need to complete a short online questionnaire which will assess your suitability for the treatment. One of our doctors will then check your request and make sure it is the right choice for you and safe for you to take. If agreed, our pharmacy team will prepare your medication and will post it directly to your door, free of charge. You can also choose to collect in store if you prefer. Buying generic or branded – Viagra is the brand name for generic Sildenafil. Both of these medications have been proven to be equally effective for the treatment of erectile dysfunction. Sildenafil citrate is the active ingredient in Viagra and Sildenafil. The main difference between them is pricing – Sildenafil is the cheaper of the two. The reasons for the the best generic viagra difference in pricing – in 2013, the producers of Viagra, Pfizer, lost their patent allowing generic manufacturers to begin producing their own version. As Sildenafil is generic, its price is not under the control of a single manufacturer, and as it is produced by several different companies, the price is more competitive. Viagra, however, is a well-known brand name so it can command a premium price. POM vs PMed – when buying in person, prescription-only medications (POMs) such as Viagra and Sildenafil require you to get a prescription from your GP, whereas pharmacy medication (PMeds) like Viagra Connect can be purchased over the counter at your local pharmacy following a consultation with the pharmacist. They can also be bought from online providers such as Superdrug Online Doctor. When you buy from a pharmacy, you still need to discuss your symptoms and medical history with the pharmacist as you would your GP, but you can avoid visiting your GP to get a prescription. Some men would prefer not to see their regular GP for problems like erectile dysfunction. – you will need to pay the full price of the medication if you opt for pharmacy medication such as Viagra Connect. This is also true if you acquire a private prescription for a POM. If you are eligible for an NHS prescription you will only need to pay the current NHS charge, which is usually cheaper than the cost of the medication. This is usually only for Sildenafil as branded medications aren't normally covered by NHS prescription. Overall, Sildenafil is still the cheapest option with a private prescription, because it is non-branded. Though you may prefer one medication to the other, Viagra, Viagra Connect and Sildenafil are all thought to produce the same outcome at the same dosage, but if you need a lower or higher dosage than standard, Viagra and Sildenafil are more suitable. This is because you can get 25mg or 100mg dosages of these two medications. Apart from available dosages, are they all as good as each other? They work in the same amount of time (usually 30 minutes), last the same length of time (around 4 hours), and all require arousal to work. The side effects for all 3 types are also all the same. The only difference is price and the fact that Sildenafil and Viagra are available in a wider range of dosages. – the 25mg dosages are suitable for men who only need a low dose or are unable to take the standard 50mg dose due to existing medical conditions. The higher dose of 100mg should never be exceeded but may be given to men who find the 50mg tablet is ineffective at treating their ED symptoms. Viagra Connect is only available in the 50mg dosage – unlike the other two, Viagra Connect is currently only available in one dosage. This means you can't get 25mg or 100mg Viagra Connect, even if those dosages would suit you better. There are several factors which may influence which type you will choose, including: Price : Generic Sildenafil tends to be cheaper NHS prescription is cheaper than a private prescription, but usually only available for Sildenafil Viagra and Viagra Connect are branded, so they command premium prices Method of purchase : Face-to-face visit either a GP (Viagra and Sildenafil) or pharmacist (Viagra Connect) Online (all 3): Simple, quick online consultation/questionnaire You may feel more comfortable ordering online Which dosage works for you : 50mg is the right dosage (all 3) viagra rx coupon 50mg is not the right dosage (Viagra or Sildenafil have other dosages but not Viagra Connect) Which one does the UK government recommend? All 3 medications are approved for treatment for ED in the UK to the same standards. Sildenafil is prescribed more readily on the NHS – if you get a prescription from your GP for ED treatment, it is more likely that you will be prescribed generic Sildenafil. According to NHS guidance, generic Sildenafil is available on an NHS prescription for all eligible men who have ED. Whereas, branded Sildenafil (Viagra) should only be prescribed on a private prescription, or with an NHS prescription to few with very specific health problems. Viagra Connect has been introduced by the UK government to improve men's access to ED treatment – Viagra Connect was authorised as the first over-the-counter medicine by the MHRA. The black market for Viagra is huge and the MHRA report that they seized ?50 million of counterfeit and unlicensed ED medications in the 5 years before the release of Viagra Connect. Therefore, to clamp down on the illegal trading of Viagra, Viagra Connect is intended to encourage men to purchase the drug safely. Fun fact Pfizer is reported to have produced up to 90% of the penicillin that was taken ashore to treat allied soldiers on D Day. Sildenafil Citrate for Treatment of Erectile Dysfunction in Men With Type 1 Diabetes. Murphy , MD 3, Francesco Montorsi , MD 4, Ates Kadioglu , MD 5, Fadlo Fraige , MD 6, Pilar Manzano , MD 7 and Chaicharn Deerochanawong , MD 8 1 Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia 2 Hospital Carlos Durand, Buenos Aires, Argentina 3 Health Sciences Centre, Winnipeg, Canada 4 IRCCS H San Raffaele, Milan, Italy 5 University of Istanbul, Istanbul, Turkey 6 Hospital da Beneficencia, Sao Paulo, Brazil 7 Hospital Puerta de Hierro, Madrid, Spain 8 Rajavithi Hospital, Bangkok, Thailand. OBJECTIVE —In the 5–10% of diabetic men with type 1 diabetes, erectile dysfunction (ED) may be a particularly common and unwanted complication. This is the first study focusing exclusively on the effects of sildenafil in men with type get generic viagra 1 diabetes and ED. RESEARCH DESIGN AND METHODS —A total of 188 patients were entered into a double-blind, placebo-controlled, parallel-group, flexible-dose study and were randomized to receive sildenafil (25–100 mg; n = 95) or placebo ( n = 93) for 12 weeks. Efficacy was evaluated using questions three (Q3; achieving an erection) and four (Q4; maintaining an erection) from the International Index of Erectile Function (IIEF), a global efficacy question (GEQ; “Did treatment improve your erections?”), and a patient event log of sexual activity. RESULTS —Improvements in mean scores from baseline to end-of-treatment for IIEF Q3 (35.7 vs. 26.5%) were significant in patients receiving sildenafil compared with those receiving placebo ( P = 0.0001). Moreover, the percent of improved erections (GEQ, 66.6 vs. 33%) was significantly increased with sildenafil compared with placebo. Improvements in sexual function were seen irrespective of the degree of ED severity. Adverse events were generally mild to moderate in severity, with headache (20 vs. 1%) reported more often in the sildenafil than in placebo-treated patients. CONCLUSIONS —Treatment with sildenafil for ED was effective, resulting in an increased percentage of successful attempts at intercourse, and was well tolerated among men with type 1 diabetes. ED, erectile dysfunction EF, erectile function GEQ, Global Efficacy Question IIEF, International Index of Erectile Function. According to the World Health Organization, the number of adults with diabetes was ?135 million in 1995, which corresponds to a worldwide prevalence of 4% (1). It is estimated that 5–10% of diagnosed cases are type 1 diabetes (2). A common complication of diabetes is erectile dysfunction (ED), with an estimated prevalence of 20–85% (ranging from mild to complete ED) (3), which occurs at an earlier age than in nondiabetic men. In the Massachusetts Male Aging Study (4), men with treated diabetes had a 28% age-adjusted prevalence of complete ED (no erections), almost three times higher than the prevalence of complete ED observed in the entire sample of men (10%). Several studies have shown an increased risk of ED in men with diabetes; however, most information refers to the total male diabetic population, and few studies have presented data specifically for type 1 diabetes (5–8). Although the prevalence of ED in the total diabetic population increases with age, smoking, and poor metabolic control, one study reported that men with elevated BMI and type 1 diabetes showed a significantly higher risk of ED than men with elevated BMI and type 2 diabetes (7). The same study also showed that the age-adjusted prevalence of ED was higher in men with type 1 diabetes (51%) than with type 2 diabetes (37%). Although the etiology of ED in patients with diabetes is often complex and can be caused by several mechanisms, organic vasculogenic factors appear to be the most frequent cause of ED in men with diabetes (9), with some studies citing an incidence of up to 87% (10). Within vasculogenic ED, the most common etiology is arterial insufficiency, found more frequently in men with type 1 diabetes (73%) than with type 2 diabetes (61%) (11). Moreover, in men with type 1 diabetes, the severity of arterial insufficiency correlated with the presence of smoking, hypertension, and coronary artery disease, although only those with the latter disease showed a statistically significant reduction in penile blood flow compared with men who had type 2 diabetes (11). Treatment options for men with ED have advanced significantly during the past 10–15 years, and a number of approaches have been used for men with diabetes (12–14). However, efficacy and/or long-term satisfaction with most of these treatment options have been suboptimal. Sildenafil citrate (Viagra; Pfizer, New York) has in past studies demonstrated efficacy in men with diabetes (2,7,8,15,16); the aim of this study was to assess its efficacy exclusively in men with type 1 diabetes and ED. This was a double-blind, randomized, placebo-controlled, multicenter, parallel-group, flexible-dose study that included 188 patients with type 1 diabetes and ED. Following a 4-week run-in period, during which baseline data on sexual function were collected, patients were randomized to sildenafil (50 mg) or matching placebo and entered a 12-week double-blind treatment period with follow-up visits after 2, 4, 8, and 12 weeks of treatment. Dosage adjustments to 100 or 25 mg sildenafil or matching placebo were made according to efficacy and tolerability. This study included male patients of age 18 years or older with a clinical diagnosis of ED of more than 6 months’ duration and in a stable relationship with a female partner of more than 6 months’ duration. Patients had a clinical diagnosis of type 1 diabetes of at least 1 year’s duration as defined by the National Diabetes Data Group (17) and had required insulin within 1 month of diagnosis. Diabetes had to be generally stable for 6 months before study entry, with HbA 1c levels 66% of patients reported improved erections (compared with 29% in the placebo group), and the number of successful intercourse attempts with sildenafil (63%) was significantly higher compared with placebo (33%). These data are in agreement with an earlier study, where sildenafil was shown to be an effective and well-tolerated treatment in a group of 268 men with ED and concomitant diabetes (type 1 and 2) (2). In this patient group, efficacy of sildenafil was independent of age, duration of ED, and duration of diabetes, and erections were improved in 56% of patients receiving sildenafil compared with 10% of patients taking placebo. Similarly, a recent study in 219 patients exclusively with type 2 diabetes demonstrated that sildenafil was well tolerated and effective in improving ED in this patient group (65% of patients reported improved erections compared with 11% in the placebo group), even in cases with poor glycemic control and chronic complications (16).
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