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The mean age of the study group was 59.6 11.2 y.13 54 24 had arteriogenic ED, 16 54 30 had mixed vasculogenic ED, 9 54 17 had cavernosal veno Nature Valley Pomegrenade Pills Curedy Ed occlusive dysfunction, 11 54 20 had post radical retropubic prostatectomy ED and 5 54 9 had psychogenic ED.13 54 24.1 responded to sildenafil at a median maximal dose of 200 mg, 4 13 required 150 mg and 9 13 required Define Impotent 200 mg.41 54 76 failed to respond to sildenafil.Mean IIEF question 3 and 4 scores were 1.5 and 1.4 at baseline, 2.2 and 1.9 with sildenafil 100 mg, 2.8 and 2.5 with sildenafil 150 Things To Help Get An Erection mg and 3..0 and 2.9 with sildenafil 200 mg, respectively.After 4 weeks, treatment was regarded as having improved their erections by 37 , 46.3 and 68 of patients with sildenafil 100 mg, 150 mg and 200 mg, respectively.34 54 63 reported adverse effects with maximal dose sildenafil comprising headache 19 , facial flushing 32 , dyspepsia 14 , nasal congestion 11 , dizziness 5 and visual disturbances 5.4 13 31 responders refused Define Impotent to continue treatment due to adverse effects.In conclusion, sildenafil at doses of up to 200 mg is an effective salvage therapy for 24.1 of previous sildenafil non responders but is Psychology And Erectile Dysfunction limited by a significantly higher incidence of adverse effects and a 31 treatment discontinuation rate.IntroductionErectile dysfunction ED is the inability to achieve and maintain an erection of sufficient rigidity for satisfactory sexual intercourse.1 Community based epidemiological studies suggest that sexual dysfunction, particularly ED, is a common disorder in patients and is associated with reduced quality of life.2,3,4,5Sildenafil citrate ViagraTM, Pfizer, UK , a potent, competitive phosphodiesterase type 5 iso enzyme PDE 5 inhibitor, is the first oral medication to demonstrate significant and reliable efficacy in most patients with ED.6 Following activation of the nitric oxide cGMP pathway by How To Increase Your Sexual Desire sexual Define Impotent arousal, inhibition of PDE 5 isoenzyme by sildenafil results in increased corporal levels of cGMP and an augmented penile erection.7 Sildenafil appears effective in restoring erectile function and improving intercourse success rates in a wide range of patients, including those with Define Impotent hypertension, diabetes, spinal cord Nature Valley Pomegrenade Pills Curedy Ed injury, other concomitant medical conditions, and in those patients taking a wide variety of concomitant medications.Its efficacy appears Define Impotent related to the extent and Things To Help Get An Erection severity of ED, with significantly reduced efficacy demonstrated in patients with severe vasculogenic ED, Things To Help Get An Erection diabetic ED and post radical prostatectomy ED.6,8,9,11Jarow et al reported a sildenafil response rate of 65 , How To Increase Your Sexual Desire significant improvement in quality of life and a 35 incidence of adverse effects.9 Virag reported similar results with a 60 response rate and a 26.75 incidence of adverse effects.10 McMahon et al reported a similar response rate of 67.5 but a higher incidence of adverse effects of 53.6.11 These authors report a similar efficacy rate but a higher incidence of adverse effects compared to that reported by the Sildenafil Study Group.6The maximum dose of sildenafil recommended by the manufacturer is 100 mg.A study was designed to prospectively review a group of patients with chronic ED, unresponsive to sildenafil 100 mg, who How To Increase Your Sexual Desire were treated in a home setting with Things To Help Get An Erection doses of sildenafil in excess of the recommended maximum dose 150 mg and 200 mg.Treatment efficacy, safety and tolerance was evaluated using serial physician interviews and the patient self administered IIEF questionnaire.Materials and methodsFifty four fully evaluated Things To Help Get An Erection patients with chronic ED who had previously failed to respond to Things To Help Get An Erection a home trial of sildenafil 100 mg with erections suitable for sexual intercourse were studied.All patients had received focussed sildenafil usage education and had been re titrated to confirm their non responder status.The mean number of sildenafil uses prior to enrolment in this study was 7 tablets range 5 C16.All patients had been previously assessed using a standardised protocol and the etiology of their ED How To Increase Your Sexual Desire determined.This protocol included a history and physical examination, determination of fasting lipids, glucose and free testosterone, vibratory penile biothesiometry and penile colour duplex Doppler Nature Valley Pomegrenade Pills Curedy Ed ultrasonography CDU before and after intracavernous vasoactive drug challenge 20 mg alprostadil.Rigiscan nocturnal penile tumescence testing, dynamic infusion cavernosometry and cavernosography DICC and phallopharmacoangiography were performed Things To Help Get An Erection where clinically indicated.Patients with Nature Valley Pomegrenade Pills Curedy Ed unstable coronary artery disease, low output congestive cardiac failure, hypertension treated with three or more drugs, currently prescribed organic nitrate medication or those with any other contraindication to renewed sexual intercourse or sildenafil were excluded from the study.Each man was treated at home with escalating doses of sildenafil citrate 100 mg, 150 mg and 200 mg taken 1 hour before planned sexual activity until either Psychology And Erectile Dysfunction maximal response or intolerable adverse effects occurred.The primary efficacy end point was the response to the questions 3 and 4 of the erectile function domain of the International Index of Erectile Function IIEF after a trial of each dose of sildenafil.The secondary efficacy end point was the response to the global assessment question Has this treatment improved your erections after 4 weeks of treatment.Results were analysed using standard statistical analysis including descriptive statistics and Student s t test.ResultsFifty four patients with chronic ED and Define Impotent a mean age of 59.6 11.2 y were enrolled in the study group.The etiology of ED was psychogenic in 5 patients 9 , arteriogenic in 13 patients 24 , cavernosal veno occlusive dysfunction CVOD in 9 patients 17 , MVED in 16 patients 30 and post radical retropubic prostatectomy ED in 11 patients 20.The mean duration of ED was 16..6 months Nature Valley Pomegrenade Pills Curedy Ed range 4 C32.Twenty four patients had diabetes mellitus, 27 had hypertension, 26 had dyslipidaemia Psychology And Erectile Dysfunction and 20 smoked cigarettes.Two or more vascular risk factors were present in 46 patients Table 1.Table 1 Patient Define Impotent demographics, intercurrent illness and life style factors overall and according to aetiology of EDFull size tableErections of sufficient rigidity and duration for satisfactory sexual intercourse occurred in 13 patients 24.1 at a median maximal dose of 200 mg.Four patients 7.4 required 150 mg and comprised 2 patients with psychogenic ED and 2 Nature Valley Pomegrenade Pills Curedy Ed patients with arteriogenic Psychology And Erectile Dysfunction ED.The remaining 9 patients 16.7 required 200 mg and comprised 2 patients with psychogenic ED, 3 Define Impotent patients with arteriogenic ED, 2 patients with cavernosal veno occlusive dysfunction and 2 patients with Define Impotent post radical prostatectomy ED.Nine of the 13 patients 69 who responded chose to continue therapy with sildenafil.Overall, high dose sildenafil was effective in 4 out of 5 patients 80 with psychogenic ED and 9 out of 49 patients 18.4 with How To Increase Your Sexual Desire organic ED Table 2.Of the 11 patients How To Increase Your Sexual Desire with post radical prostatectomy ED, 2 patients had undergone a bilateral nerve sparing radical retro pubic prostatectomy NSRRP and one had undergone a unilateral procedure and the remainder non nerve sparing procedures.The mean interval Nature Valley Pomegrenade Pills Curedy Ed between surgery and treatment was 5.2 months.High dose sildenafil was effective in 1 man treated with bilateral NSRRP and in 1 man treated with a unilateral NSRRP.Table 2 Response rate for sildenafil 150 mg, sildenafil 200 mg and sildenafil overallFull size table.Mean responses to questions 3 and 4 of the IIEF Nature Valley Pomegrenade Pills Curedy Ed erectile function domain, the primary end point, were 1.5 and 1.4 at baseline, 2.2 and 1.9 with sildenafil 100 mg, 2.8 and 2.5 with sildenafil 150 mg and 3.0 and 2.9 with sildenafil 200 mg.The mean score for Q3 and Q4 for Things To Help Get An Erection sildenafil was statistically superior to baseline, overall, in all etiological groups and at all doses P 0.001.The overall mean score for Q3 and Q4 for sildenafil 200 mg was statistically superior to sildenafil 100 mg P 0.05 but not to sildenafil 150 mg.The mean score for Q3 and Q4 for sildenafil 200 mg was statistically superior to sildenafil 100 mg P 0.05 for all etiological groups except post radical prostatectomy ED Figures 1 and 2.The global assessment by patients whether treatment improved their erections, the secondary end point, was answered in the affirmative at week 4 by Nature Valley Pomegrenade Pills Curedy Ed 37 on 100 mg, 46.3 on 150 mg and 68 on 200 mg Figure 3.The incidence of affirmative responses was statistically superior at sildenafil 200 mg compared to 100 mg P 0.05.Viagra is taken as a single tablet, 1 hour before sexual How To Increase Your Sexual Desire Things To Help Get An Erection activity.Only 1 dose should be taken in any 24 hour period.The onset of the effect may be delayed if taken with food.Viagra is supplied in boxes of 4 tablets..THE PRICES LISTED ARE FOR MEDICATION DISPENSED ON A PRIVATE PRESCRIPTION.SOME PATIENTS,HOWEVER, MAY BE Psychology And Erectile Dysfunction ELIGIBLE TO OBTAIN THIS MEDICATION ON AN NHS PRESCRIPTION.YOUR DOCTOR WILL BE ABLE TO ADVISE YOU WHICH TYPE OF PRESCRIPTION YOU REQUIRE.VIAGRA sildenafil citrate is a cGMP specific phosphodiesterase type 5 PDE5 inhibitor, used for the treatment of male erectile dysfunction.The physiological mechanism responsible for erection of the penis involves the release of nitric oxide NO in the corpus cavernosum in response to sexual stimulation.Nitric oxide then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate cGMP , producing smooth muscle relaxation in the How To Increase Your Sexual Desire corpus cavernosum and allowing inflow of blood.Sildenafil has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of NO by inhibiting PDE5, which is responsible How To Increase Your Sexual Desire for the biodegradation of cGMP in the corpus cavernosum.When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil produces increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and increased inflow of blood to the corpus cavernosum.Sildenafil, at recommended doses, has no effect in the absence of sexual stimulation.Studies Nature Valley Pomegrenade Pills Curedy Ed in How To Increase Your Sexual Desire vitro have shown that sildenafil has between 10 and 10,000 fold greater selectivity for PDE5 than for other phosphodiesterase isoforms namely PDEs 1, 2, 3, 4, and 6 and greater than Psychology And Erectile Dysfunction 700 fold effect on PDE7 PDE11.In particular, sildenafil has greater than Psychology And Erectile Dysfunction 4,000 fold selectivity for PDE5 over PDE3, the Nature Valley Pomegrenade Pills Curedy Ed cAMP specific phosphodiesterase isoform involved in the control of cardiac contractility.Sildenafil is about 10 fold as potent for PDE5 compared Define Impotent to PDE6, an isoenzyme found in the retina this lower selectivity is thought to be the basis for colour vision abnormalities observed Psychology And Erectile Dysfunction with higher doses or plasma levels of sildenafil see WARNINGS Psychology And Erectile Dysfunction AND PRECAUTIONS, DETAILED PHARMACOLOGY.PDE5 Define Impotent is Nature Valley Pomegrenade Pills Curedy Ed also found in lower concentrations in platelets, vascular and visceral smooth muscles, and skeletal muscle.The sildenafil induced inhibition of PDE5 in these tissues appears to be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed Define Impotent in vitro, and inhibition of platelet thrombus formation in vivo, and peripheral arterial venous dilation in How To Increase Your Sexual Desire vivo see WARNINGS AND PRECAUTIONS.PharmacodynamicsEffects of VIAGRA on Blood Pressure BP Single oral doses of sildenafil Psychology And Erectile Dysfunction 100 Psychology And Erectile Dysfunction mg administered to healthy volunteers produced Psychology And Erectile Dysfunction decreases in supine blood pressure mean maximum decrease of 8.3 5.3 mm Hg.The decrease in blood pressure was most notable approximately 1 2 hours after dosing.The effects are not related to dose or plasma levels.Larger effects were recorded among patients receiving concomitant nitrates see CONTRAINDICATIONS.Effects of VIAGRA How To Increase Your Sexual Desire on Cardiac Parameters Single oral doses of VIAGRA up to 100 mg in healthy volunteers produced no clinically relevant effects on ECG.Effects of VIAGRA on Erectile Response VIAGRA was studied in clinical trials Things To Help Get An Erection of various designs.In fixed dose clinical trials, 62 Define Impotent , 74 , and 82 of patients on Nature Valley Pomegrenade Pills Curedy Ed 25 mg, 50 mg and Nature Valley Pomegrenade Pills Curedy Ed 100 mg of VIAGRA, respectively, reported an improvement in their erections, compared to 25 on placebo p 0.0001, see CLINICAL TRIALS.In eight double blind, placebo controlled, cross over Psychology And Erectile Dysfunction studies using RigiScan a device used to Define Impotent objectively measure penile rigidity and duration of erections , erections during sexual stimulation improved significantly on VIAGRA compared to placebo.These studies included patients with organic etiologies such as spinal cord injury and diabetes mellitus , and patients without an established organic cause.Most studies assessed the efficacy of VIAGRA approximately 60 minutes post dose.All eight studies investigating the effects of sildenafil on penile plethysmography RigiScan after visual sexual stimulation VSS under laboratory conditions, consistently showed that doses of up to 100 mg resulted in statistically significant improvements in duration of erections of 60 rigidity considered hard enough Nature Valley Pomegrenade Pills Curedy Ed for penetrative sexual How To Increase Your Sexual Desire intercourse , compared with placebo.In patients who respond, the median time to onset of erections 60 rigidity in response to VSS, was 25 minutes after an oral dose of 50 mg Psychology And Erectile Dysfunction sildenafil.The mean total duration of erections 60 rigidity at Define Impotent the base Define Impotent of the penis was 3, 24 and 32 minutes for subjects receiving placebo, 25 mg and 50 mg doses, respectively, when exposed Psychology And Erectile Dysfunction to VSS for 2 hours.VIAGRA increases couples ability to have sexual intercourse see CLINICAL TRIALS.Pharmacokinetics.Absorption Sildenafil is rapidly absorbed.Maximum observed plasma concentrations are reached within 30 to 120 minutes median 60 minutes of oral dosing in the fasted state.The mean absolute bioavailability is 41 range 25 63.The oral pharmacokinetics of VIAGRA is proportional over the recommended dose range studied 25 mg to 100 mg.Sildenafil inhibits the human PDE5 enzyme in vitro by 50 at a concentration of 3.5 nM.In man, the mean maximum free plasma Define Impotent Things To Help Get An Erection concentration of sildenafil following a single oral dose of 100 mg is approximately 18 ng mL, or 38 nM.When VIAGRA was administered with a high fat meal, the rate of absorption was significantly decreased, with a 29 reduction in Cmax and a 60 minute delay in Tmax..The patient may find that it takes longer to Things To Help Get An Erection work if taken with Psychology And Erectile Dysfunction a high Things To Help Get An Erection fat meal.However, although it was statistically significant AUC decreased by 11 Define Impotent , the decrease in the extent of absorption was not clinically relevant.The relative bioavailability fed fasted was 89 90 CI 84 94 see DRUG INTERACTIONS.Distribution The mean steady state volume of distribution Vss for sildenafil is 105 litres, Nature Valley Pomegrenade Pills Curedy Ed indicating distribution into the tissues.Sildenafil Psychology And Erectile Dysfunction and its major circulating N desmethyl metabolite are both approximately 96 bound to plasma proteins.Protein binding is independent of total drug concentrations.Based upon measurements of Psychology And Erectile Dysfunction sildenafil in the semen of healthy volunteers, less than 0.001 of the ingested dose may appear in the semen of patients 90 minutes after drug intake.Metabolism Sildenafil is cleared predominantly by the CYP3A4 major route and CYP2C9 minor route hepatic microsomal isoenzymes.The major circulating metabolite results from N demethylation of sildenafil How To Increase Your Sexual Desire at the N methyl piperazine moiety.This metabolite Psychology And Erectile Dysfunction has Nature Valley Pomegrenade Pills Curedy Ed a PDE selectivity profile Define Impotent similar How To Increase Your Sexual Desire to sildenafil and an in vitro potency against PDE5 approximately 50 that of the parent drug.Plasma concentrations of this metabolite Psychology And Erectile Dysfunction are approximately 40 of those seen for sildenafil.The N desmethyl metabolite is further metabolised, with a terminal half life of approximately 4 hours.Excretion The total body clearance of sildenafil is 41 L h with a resultant terminal phase half life of 3 5 hours.After either oral or intravenous administration, sildenafil is excreted as metabolites predominantly in the feces approximately 80 of administered dose and to a Psychology And Erectile Dysfunction lesser extent in the urine approximately 13 of the administered Nature Valley Pomegrenade Pills Curedy Ed dose.Special Populations and ConditionsGeriatrics Healthy elderly subjects 65 years or older had a reduced clearance of Define Impotent sildenafil, resulting in approximately 90 higher plasma concentrations of sildenafil and the active N desmethyl metabolite compared to those seen in healthy younger volunteers 18 45 years.Due to age differences in Define Impotent plasma protein binding, the corresponding increase in free sildenafil plasma concentration was approximately 40.Hepatic Insufficiency In volunteers with hepatic cirrhosis Child Pugh A and B , sildenafil clearance was reduced, resulting in increases in AUC 85 and Cmax 47 compared to age matched volunteers with no hepatic impairment.The pharmacokinetics of sildenafil in patients with severe hepatic impairment Child Pugh class C have not Things To Help Get An Erection been studied.Since sildenafil clearance is reduced in geriatric patients 65 years or older Nature Valley Pomegrenade Pills Curedy Ed , patients with renal impairment or patients with hepatic impairment, a starting dose Define Impotent of 25 mg should be considered.Based Things To Help Get An Erection on efficacy and toleration, the dose may be increased How To Increase Your Sexual Desire to 50 mg or 100 mg see WARNINGS AND PRECAUTIONS, DOSAGE How To Increase Your Sexual Desire AND ADMINISTRATION.Renal Insufficiency In volunteers with mild CLcr 50 80 mL min and moderate CLcr 30 49 mL min renal impairment, the pharmacokinetics of a single oral dose of VIAGRA 50 mg were not altered.In volunteers with Things To Help Get An Erection severe Define Impotent CLcr 30 mL min renal impairment, sildenafil clearance was reduced, resulting in increases in AUC 100 and Cmax 88 compared to age matched volunteers with no renal impairment.In addition, N desmethyl metabolite How To Increase Your Sexual Desire AUC and Cmax values were significantly increased by 200 and 79 respectively in subjects with severe renal impairment compared to subjects with normal renal function.Sildaforce 100mg Generic Viagra Tablets are a very popular, successful and widely accepted treatment for erectile dysfunction.Sildaforce 100mg is produced to a high quality standard to ensure safety and effectiveness.Patients using Sildaforce 100mg Nature Valley Pomegrenade Pills Curedy Ed regularly report successful intercourse and generally continue to use the treatment.The effective treatment time of Sildaforce 100mg is 4 6 hours but many GPs report longer effective times