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The medications used to treat these problems and other ailments can also contribute to impotence. Hormonal abnormalities are less common, but they are particularly important to detect since they can be corrected. That's also true of the psychological problems that cause up to 15% of impotence; table 1 below summarizes some of the differences between psychological and physical impotence. For many men, the hardest thing is to admit the problem. Every man experiences erectile dysfunction from time to time, but doctors define impotence as the inability to get and keep an erection satisfactorily for penetration on at least 25% of attempts. It's a good definition, but it should not be used to exclude men with less severe difficulties from getting treatment. A simple questionnaire can help you determine if you are having erectile dysfunction (see below). If so, talk to a primary care doctor, urologist, or endocrinologist. 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 15 minutes. 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 buy generic viagra tablets always, the answer must come from your doctor, who can assess patient-specific factors and help determine which is right for you. Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Sildenafil (Revatio) is used to improve the ability to exercise in adults with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness). Children should not usually take sildenafil, but in some cases, a doctor may decide that sildenafil (Revatio) is the best medication to treat a child's condition. Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily. If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. Sildenafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (viagra purchase no prescription HIV). Sildenafil comes as a tablet and suspension (liquid; Revatio only) to take by mouth. If you are taking sildenafil to treat erectile dysfunction, follow your doctor's directions and the guidelines in this paragraph. The best time to take sildenafil is about 1 hour before sexual activity, order prescription viagra but you can take the medication any time from 4 hours to 30 minutes before sexual activity. Sildenafil usually should not be taken more than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take sildenafil less often. However, if you take sildenafil with a high-fat meal, it will take longer for the medication to start to work. If you are taking sildenafil to treat PAH, follow your doctor's directions and the guidelines in this paragraph. You will probably take sildenafil three times a day with or without food. Take sildenafil at around the same times every day, and space your doses about 4 to 6 hours apart. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the liquid well for 10 seconds before each use to mix the medication evenly. Use the oral syringe prescription de viagra provided with your medication to measure and take your dose. Follow the manufacturer's directions to use and clean the oral syringe. Do not mix the liquid with other medications or add anything to flavor the medication. If viagra purchase no prescription you are taking sildenafil for erectile dysfunction, your doctor will probably start you on an average dose of sildenafil and increase or decrease your dose depending on your response to the medication. Tell your doctor if sildenafil is not working well or if you are experiencing side effects. If you are taking sildenafil for PAH, you should know that sildenafil controls PAH but does not cure it. Do not stop taking sildenafil without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. Before taking sildenafil, tell your doctor and pharmacist if you are allergic to sildenafil, any other medications, or any of the ingredients in sildenafil products. do not take sildenafil if you are taking or viagra purchase no prescription have recently taken riociguat (Adempas) or nitrates (medications for chest pain) such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others). Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your doctor if you are not sure whether any of your medications contain nitrates. do not take street drugs containing nitrates such as amyl nitrate and butyl nitrate ('poppers') while taking sildenafil.
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