Teva sildenafil citrate

You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Revatio В® Viagra В® AHFS В® Patient Medication Informationв„ў.

The American Society of Health-System Pharmacists В® , 4500 East-West Highway, Suite 900, Bethesda, Maryland.

Duplication for commercial use must be authorized by ASHP. Which Drug for Erectile Dysfunction Is Better: Viagra or Cialis? Four drugs have been approved for erectile dysfunction. Which is best depends on your individual needs and desires.

The Food and Drug Administration has approved four similar drugs for erectile dysfunction, sold under such names as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) and Stendra (avanafil).

They all work the same way, producing an erection by increasing blood flow to the penis.

Which drug is best may depend on your preference for quick onset versus long duration and your individual medical needs. The discovery of Viagra is one of the classic stories of serendipity in drug development. In the 1980s, the pharmaceutical company Pfizer began studying sildenafil, the generic name for Viagra, as a treatment for heart disease. It didn’t work, but the men in the study developed unusually strong, long-lasting erections. All four of the currently approved drugs seem to be equally good at producing erections.

But it is difficult to be more definitive in evaluating their efficacy, because few studies directly comparing them have been conducted, a common problem with many drugs.

Since all four drugs are similarly effective, the answer to which drug is best will depend on other attributes, such as side effects, drug interactions, speed of onset and duration of action.

Headache, flushing and upset stomach are the most common side effects.

And, in rare cases, all can cause a persistent and sometimes painful erection that will not go down, a condition called priapism that can result in permanent damage if not treated promptly. Drug interactions are largely similar, with the most important interaction being a contraindication to nitrate-containing drugs, such as nitroglycerin, commonly used to treat angina.

Time of onset is an important difference between the drugs.

While all take effect within an hour, Stendra is the fastest acting, often taking effect

within

Duration of action is another important difference between the drugs. Cialis is the longest acting, with a duration of up to 36 hours.

Cialis’s long duration means that it can be taken once a day, eliminating the need to take a pill before each sexual encounter. Such once-a-day dosing has been reported to increase sexual self-confidence and spontaneity.

Which drug is better depends on your personal situation. For long duration, and perhaps for spontaneity, Cialis may be best. As always, the answer must come from your doctor, who can assess patient-specific factors and help determine which is right for you.

Nitrates: Administration of VIAGRA to patients using nitric oxide donors, such as organic nitrates or organic nitrites in any form either regularly and/or intermittently, is contraindicated.

VIAGRA was shown to potentiate the hypotensive effect of teva sildenafil citrate nitrates.

Concomitant Guanylate Cyclase (GC) Stimulators: Do not use VIAGRA in patients who are using a GC stimulator, such as riociguat.

PDE5 inhibitors, including VIAGRA, may potentiate the hypotensive effects of GC stimulators. Hypersensitivity Reactions: VIAGRA is contraindicated in patients with a known hypersensitivity to sildenafil, as contained in VIAGRA and REVATIO, or any component of the tablet.

Hypersensitivity reactions have been reported including rash and urticaria. Cardiovascular: Patients should not use VIAGRA if sexual activity is inadvisable due to cardiovascular status. Physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by the vasodilatory effects of VIAGRA, especially in combination with sexual activity. There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with the following characteristics: recent serious cardiovascular events, hypotension, or uncontrolled hypertension; if prescribed, this should be done with caution.

Prolonged Erection: Prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance. If priapism is not treated immediately, penile tissue damage and permanent loss of potency could result.

Use VIAGRA with caution in patients predisposed to priapism.

Effects on the Eye: Patients should stop VIAGRA and seek medical care if a sudden loss of vision occurs in one or both eyes, which could be a sign of non-arteritic anterior ischemic optic neuropathy (NAION). VIAGRA should be used with caution, and only when the anticipated benefits outweigh the risks, in patients with a history of NAION. Patients with a "crowded" optic disc may also be at an increased risk of NAION. There are no controlled clinical data on the safety or efficacy of VIAGRA in patients with retinitis pigmentosa; if prescribed, this should be done with caution. Hearing Loss: Sudden decrease or loss of hearing has been reported in temporal association with the intake of PDE5 inhibitors, including VIAGRA.

(It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors.) Physicians should advise patients to stop taking PDE5 inhibitors, including VIAGRA, and seek prompt medical attention in the event of sudden decrease or loss of hearing. Potential Drug Interactions: VIAGRA can potentiate the hypotensive effects of nitrates, alpha-blockers, and antihypertensives. Initiate VIAGRA at 25 mg with concomitant use of alpha-blockers.

CYP3A4 inhibitors (eg, ritonavir, ketoconazole, itraconazole, erythromycin) increase VIAGRA plasma exposure.

Do not exceed 25 mg of VIAGRA in a 48-hour period with ritonavir. Consider sildenafil 20 coupon a starting dose of 25 mg of VIAGRA with erythromycin or strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, saquinavir). Decreased blood pressure, syncope, and prolonged erection may occur at higher sildenafil exposures. Specific Populations: Consider a starting dose of 25 mg of VIAGRA for patients age >65, patients with hepatic impairment, or severe renal impairment.

Sexually Transmitted Diseases: Use of VIAGRA offers no protection against sexually transmitted diseases, including the human immunodeficiency virus (HIV); therefore, physicians should consider counseling their patients about protective measures. Adverse Reactions: The most common adverse reactions (?2%) with VIAGRA 25 mg, 50 mg, 100 mg vs placebo, respectively, include headache (16%, 21%, 28% vs 7%), flushing (10%, 19%, 18% vs 2%), dyspepsia (3%, 9%, 17% vs 2%), abnormal vision (1%, 2%, 11% vs 1%), nasal congestion (4%, 4%, 9% vs 2%), back pain (3%, 4%, 4% vs 2%), myalgia (2%, 2%, 4% vs 1%), nausea (2%, 3%, 3% vs 1%), dizziness (3%, 4%, 3% vs 2%), and rash (1%, 2%, sildenafil for sale near me 3% vs 1%).

VIAGRA ® (sildenafil citrate) is indicated for the treatment of erectile dysfunction (ED). By participating in the VIAGRA Savings Offer Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below: This Savings Offer is not valid for prescriptions that are reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, Veterans Affairs healthcare, or any other federal or state healthcare program (including any state prescription drug assistance program), or the Government Health Insurance Plan available in Puerto Rico (formerly known as "La Reforma de Salud") The value of this Savings Offer is limited to $350 per use or the amount of your co-pay, whichever is less This Savings Offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf This Savings Offer is limited to 50% savings off the amount of your co-pay or your out-of-pocket cost, whichever is less, with a maximum savings of $350 off each prescription for up to 12 prescriptions in a calendar year. Total maximum savings for this Savings Offer are $4,200 You must be 18 years of age or older to redeem this Savings Offer Patients who are enrolled in Medicare, Medicaid, or another state or federal healthcare program may use this Savings Offer if paying for the prescription covered by this Savings Offer outside of their government insurance benefit, and no claim is submitted to Medicare, Medicaid, or any federal or state healthcare program.

Such patients must not apply any out-of-pocket expenses incurred using this Savings Offer toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D true out-of-pocket (TrOOP) costs You are responsible for reporting use of this Savings Offer to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using this Savings Offer, as may be required.

You should not use this Savings Offer if your insurer or health plan prohibits use of manufacturer Savings Offers This Savings Offer is not valid for Massachusetts or California residents whose prescriptions are covered, in whole or in part, by third-party insurance This Savings Offer is not valid where prohibited by law This Savings Offer cannot be combined with any other rebate/offer, free trial, or similar offer for the specified prescription This Savings Offer will be accepted only at participating pharmacies This Savings Offer is not health insurance This Savings Offer is good only in the U.S. and Puerto Rico This Savings Offer is

limited

The Savings Offer and Program expire on 12/31/2021 For further information, call 1-855-842-4722, visit VIAGRA.com , or write: Pfizer Inc., 235 E 42nd Street, New York, NY 10017. If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this Savings Offer.

Pay for your VIAGRA prescription and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: VIAGRA Savings Offer, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.

Be sure to include a copy of the front of your VIAGRA Savings Card, your name, and mailing address.

Please expect up to 4 to 6 weeks for reimbursement.

The combination of nitrates (and drugs such as nicorandil) with sildenafil is contraindicated. This combination must be avoided as it can produce significant hypotension and is potentially fatal.

The guidance from the Committee on Safety of Medicines (CSM) regarding nitrates and sildenafil states (1): sildenafil and nitrates - it is stated that these should not be used concurrently.

Nitrates are stated as those used for cardiovascular disease, e.g.

amyl nitrate sildenafil should not be used in men for whom sexual activity is inadvisable e.g.

patients with severe cardiovascular disorders such as severe heart failure or unstable angina.

The British Heart Foundation have addressed the use of GTN spray and nitrate tablets and phosphodiesterase (PDE5) inhibitors (sildenafil, tadalafil, verdenafil) (2):

nitrate

Resuscitation with intravenous fluids should be initiated as soon as possible. GTN spray should not be used within 24 hours of taking sildenafil or vardenafil and within 48 hours of taking tadalafil note though that coital angina is not common and nitrates can often be safely discontinued or substituted in stable patients if a patient has stable angina and erectile dysfunction then a reassessment of the need for nitrates should be undertaken before denying

treatment

although PDE5Is are safe with most antihypertensive agents, coadministration with nitrates or alpha-blockers poses a risk of severe hypotension (4,5) all alpha-blockers can cause vasodilation and orthostatic hypotension, and coadministration with PDE5Is increases the risk of a clinically significant decrease in BP (5) only after patients are on stable alpha-blocker therapy should PDE5Is be initiated, starting with a low dose (5) Referral to specialist is appropriate if severe CVD which makes sexual activity unsafe or a situation when PDE5 inhibitor use contra- indicated (6) from a therapeutical point of view, intracavernous injections of PGE1 (alprostadil) are efficient and safe second line in the treatment of erectile dysfunction in the cardiac population, whatever the origin. No drug interactions with the various treatment used in cardiology, notably derived nitrates, has been reported other treatment options include vacuum devices, insertion of transurethral alprostadil (MUSE), intracavernosal alprostadil (Caverjet) nitrates are contraindicated within 24 hours of sildenafil and vardenafil and within 48 hours of tadalafil. Only after patients are on stable alph-blocker therapy should PDE5Is be initiated, starting with a low dose potent cytochrome P450 3A4 inhibitors, including erythromycin, clarithromycin, ketoconazole, itraconazole, and HIV protease inhibitors, increase PDE5I plasma concentrations.

PDE5I drug interactions have the potential to cause life-threatening hypotension in patients with coexisting cardiac disease requiring nitrates or alpha blockers (5) "uroselective" alpha-blockers (tamsulosin, alfuzosin) preferentially inhibit alpha 1A and alpha 1D receptors found primarily in the prostate and benefit patients with benign prostatic hypertrophy.

Other alpha-blockers (terazosin) are less selective, and some (doxazosin) are used as third-line agents for hypertension because of their higher affinity for alpha -1B receptors, which are abundant in the peripheral vasculature (5) Viagra and health: Beyond ED.

When the history of men's health is written, 1998 will go down as a banner year. That's when sildenafil (Viagra) was approved by the FDA to treat erectile dysfunction (ED). But when the history of sildenafil is written, 2005 will also be special. That's when the FDA approved the medication that revolutionized male sexuality for a nonsexual condition.

The illness is pulmonary hypertension, and sildenafil is prescribed for it under the brand name Revatio.

Sildenafil was the first effective oral medication for ED.

In 2003 it was joined by vardenafil (Levitra) and tadalafil (Cialis). Although there are some differences between these drugs (vardenafil starts working sooner and tadalafil works longer), they all act in exactly the same way to combat ED. The three drugs are so

similar

To understand why blocking PDE-5 improves sexual function, however, you have to know how erections develop. Normal erections require a receptive state of mind, adequate levels of testosterone, and healthy arteries, veins, and nerves.

But they also require a tiny chemical messenger called nitric oxide (NO). It serves two crucial functions: transmitting the impulses of arousal between nerves and relaxing the smooth muscle cells in the arteries, allowing them to widen and admit more blood to the penis. Nitric oxide is essential because it signals the arterial cells to produce cyclic guanosine monophosphate (cGMP), the chemical that increases the flow of blood to the penis.

But the tissues of the penis also produce PDE-5, the enzyme that breaks down cGMP.

In normal circumstances, the penis generates enough cGMP to produce a rigid erection and enough PDE-5 to end the erection when ejaculation is complete. In many men with ED, this intricate system is out of balance, but one of the three oral medications can often make it right. By inhibiting PDE-5, they increase the supply of cGMP, which for many men will allow erections to develop.

In test tubes, vardenafil and tadalafil inhibit PDE-5 a bit more effectively than sildenafil does.

But laboratory potency doesn't necessarily predict clinical activity. In this case, it means that lower doses of the newer drugs will achieve comparable results to the older drug's success rate. Vardenafil is marketed in 2.5-, 5-, 10-, and 20-milligram (mg) tablets; tadalafil in doses of 5, 10, and 20 mg; and sildenafil, 25, 50, and 100 mg.

Each produces better results at higher doses, but the top doses are also more likely to cause sildenafil for sale online side effects.

And all the drugs are more effective in men with mild ED than in those who are severely impaired. Doctors have had more clinical experience with sildenafil than its newer rivals.

Still, all three drugs seem to achieve similar results. The response is best in men with no identifiable organic cause of ED (about 90%), but it's less favorable for diabetics (about 50%), and it's hard to predict for men who have been treated for prostate cancer.

If PDE-5 were found exclusively in the penis, the side effects of these drugs would be limited to that obdurate organ; in fact, a rare side effect is priapism, painful prolonged erections that require urgent treatment.

But small amounts of PDE-5 are found in blood vessels in other parts of the body. In addition, PDE-5 is just one of 11 enzymes in the phosphodiesterase family.

The others are concentrated in different parts of the body.

While the ED pills have a much greater affinity for PDE-5 than the other PDEs, they have some ability to inhibit those closely related enzymes. Both factors explain why the ED pills sometimes produce side effects in many parts of the body. The most common side effects are headaches and facial flushing, which occur in about 15% of men.

Other reactions include nasal congestion, indigestion, and back pain; blue-tinged vision is even less common.

In almost every case, these side effects are mild and transient.

But new information has added a rare eye disease to the list.

Nonarteritic anterior ischemic optic neuropathy (NAION) is a poorly understood disorder that can cause

blindness

Fortunately, the number of cases is very small in relation to the millions of men who have used ED pills successfully.

It's not clear that there is a cause-and-effect relationship between ED pills and NAION.

At present, the concern is not great enough to prevent men from using these pills, but all men should use them carefully and responsibly.