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Home Health from A to Z Useful information Viagra (Sildenafil)
Date of publication: 04/04/2016
until January 31
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How should you take sildenafil?
Follow your doctor's instructions. Usually a man takes one tablet an hour before possible sexual intercourse. You should not take more than 1 tablet per day. This medicine is available in tablets of 25, 50 and 100 mg. Most patients start with 50 mg.
Even if you take sildenafil, you still need physical and mental stimulation and desire to get an erection. If the first dose of Viagra does not help you, contact your doctor. Your doctor may change your dose.
Sildenafil causes a number of common side effects:
- headache
- blood flow to the skin of the face and upper torso and, as a result, redness and increased temperature of these parts of the body
- stomach upset
- runny nose
- changes in vision (objects appear blue)
Headache
– the most common side effect. Changes in vision are the least common. Talk to your doctor if you experience any side effects that bother you.
Viagra, 12 pcs., 100 mg, film-coated tablets
To diagnose erectile dysfunction, determine its possible causes and select adequate treatment, it is necessary to obtain a complete medical history and conduct a thorough physical examination. Erectile dysfunction treatments should be used with caution in patients with anatomical penile deformity (angulation, cavernous fibrosis, Peyronie's disease) or risk factors for priapism (SCD, multiple myeloma, leukemia) (see Precautions
).
During post-marketing studies, cases of prolonged erection and priapism have been reported. If an erection persists for more than 4 hours, you should immediately seek medical help. If treatment for priapism is not carried out immediately, it can lead to damage to the tissue of the penis and irreversible loss of potency.
Medicines intended to treat erectile dysfunction should not be prescribed to men for whom sexual activity is undesirable.
Sexual activity poses a certain risk in the presence of heart disease, therefore, before starting any therapy for erectile dysfunction, the doctor should refer the patient to an examination of the cardiovascular system. Sexual activity is not advisable in patients with heart failure, unstable angina, myocardial infarction or stroke in the last 6 months, life-threatening arrhythmias, hypertension (BP >170/100 mmHg) or hypotension (BP <90/50 mmHg) .). Taking sildenafil in such patients is contraindicated (see “Contraindications”). Clinical studies have shown no difference in the incidence of myocardial infarction (1.1 per 100 people per year) or the incidence of death from cardiovascular diseases (0.3 per 100 people per year) in patients receiving Viagra® compared with patients receiving placebo.
Cardiovascular complications
During post-marketing use of sildenafil for the treatment of erectile dysfunction, adverse events such as severe cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, hypertension and hypotension) have been reported ), which had a temporary association with the use of sildenafil. Most of these patients, but not all of them, had risk factors for cardiovascular complications. Many of these adverse events occurred shortly after sexual activity, and some of them occurred after taking sildenafil without subsequent sexual activity. It is not possible to establish a direct connection between the observed adverse events and these or other factors.
Hypotension
Sildenafil has a systemic vasodilating effect, leading to a transient decrease in blood pressure, which is not a clinically significant phenomenon and does not lead to any consequences in most patients. However, before prescribing Viagra®, the doctor must carefully assess the risk of possible undesirable manifestations of the vasodilating effect in patients with relevant diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the left ventricular outflow tract (aortic stenosis, HOCM), as well as with the rare syndrome of multiple system atrophy, manifested by severe dysregulation of blood pressure on the part of the autonomic nervous system.
Since the combined use of sildenafil and α-blockers can lead to symptomatic hypotension in some sensitive patients, Viagra® should be prescribed with caution to patients taking α-blockers (see “Interactions”). To minimize the risk of developing postural hypotension in patients taking α-blockers, Viagra should be started only after hemodynamic parameters have stabilized in these patients. You should also consider the advisability of reducing the initial dose of Viagra® (see “Dosage and Administration”). The physician should inform patients about what actions to take if symptoms of postural hypotension occur.
Visual impairment
In rare cases, during post-registration use of all PDE-5 inhibitors, incl. sildenafil, reported NPINSID, a rare disease and cause of decreased or loss of vision. Most of these patients had risk factors, including decreased papilledema/disc ratio (congestive disc), age over 50 years, diabetes mellitus, hypertension, coronary artery disease, hyperlipidemia, and smoking. An observational study assessed whether recent use of the PDE5 inhibitor class of drugs was associated with acute onset of NPINSID. The results indicate an approximately 2-fold increase in the risk of NPINI within 5T1/2 after use of a PDE5 inhibitor. Published literature estimates the annual incidence of NPINSID to be 2.5–11.8 cases per 100,000 men aged ≥50 years in the general population. In case of sudden loss of vision, patients should be advised to stop sildenafil therapy and consult a doctor immediately.
Individuals who have already had a case of NPIND have an increased risk of recurrent NPIND. Therefore, the physician should discuss this risk with such patients, as well as the potential for adverse effects from PDE5 inhibitors. PDE-5 inhibitors, incl. sildenafil should be used with caution in such patients and only in situations where the expected benefit outweighs the risk. In patients with episodes of NPINS development with loss of vision in one eye, sildenafil is contraindicated (see “Contraindications”).
A small number of patients with hereditary retinitis pigmentosa have genetically determined dysfunction of the retinal PDE. There is no information on the safety of using Viagra® in patients with retinitis pigmentosa, therefore sildenafil should not be used in such patients (see “Contraindications”).
Hearing impairment
Some post-marketing and clinical studies have reported cases of sudden deterioration or loss of hearing associated with the use of all PDE5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or loss of hearing. A cause-and-effect relationship between the use of PDE5 inhibitors and sudden hearing loss or deterioration has not been established. If there is a sudden deterioration in hearing or hearing loss while taking sildenafil, you should consult your doctor immediately.
Bleeding
Sildenafil enhances the antiplatelet effect of sodium nitroprusside, a nitric oxide donor, on human platelets in vitro
.
There are no data on the safety of sildenafil in patients with a tendency to bleeding or exacerbation of gastric and duodenal ulcers, so Viagra should be used with caution in these patients (see Caution )
.
The incidence of epistaxis in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (sildenafil - 12.9%, placebo - 0%) than in patients with primary pulmonary arterial hypertension (sildenafil - 3%, placebo - 2. 4%). Patients receiving sildenafil in combination with a vitamin K antagonist had a higher incidence of epistaxis (8.8%) than patients not taking a vitamin K antagonist (1.7%).
Use in conjunction with other drugs for the treatment of erectile dysfunction
The safety and effectiveness of Viagra® in combination with other PDE5 inhibitors or other drugs for the treatment of pulmonary arterial hypertension containing sildenafil (for example, Revazio®), or other drugs for the treatment of erectile dysfunction, therefore the use of such combinations is not recommended (see. "Contraindications").
Influence on the ability to drive a car and operate machinery.
While taking sildenafil, no negative effects on the ability to drive a car or use other technical equipment were observed. However, since when taking sildenafil, it is possible to develop dizziness, decrease in blood pressure, develop chromatopsia, blurred vision, etc. side effects, caution should be exercised when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. You should also be careful about the individual effect of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.
Can everyone take sildenafil?
No. You should not use this drug if you are taking any of the following nitro medications:
- isosorbide mononitrate (Ismo, Monoket, Imdur)
- isosorbide dinitrate (Isordil, Sorbitrate)
- sublingual nitroglycerin tablets or sprays (Nitrostat, Nitrolingual spray)
- transdermal nitroglycerin pastes (Minitran, Nitro-Dur, Transderm-Nitro)
If you take sildenafil and experience chest pain, be sure to tell your doctor that you are using it and when you last took it.
Information provided by the American Academy of Family Physicians
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Power and size
An extremely successful advertising campaign raised sales of “domestic Viagra” to the skies: according to DSM Group, in 2010 it increased sales by 1.5 times and rose from fifth place to third in the ranking of the largest Russian manufacturers of dietary supplements. Sales of Alicapsa that year almost doubled, and Sealex Forte by more than one and a half times. Year after year, the company increased its lead over its competitors. In 2013, sales of Panda increased by a third, and again this was due to drugs for men. Sales volume of Sealex Forte in monetary terms amounted to 1.36 billion rubles (plus 27 percent to the results of 2012), Alicapsa - 917 million rubles (plus 41 percent).
In 2013, the Russian authorities tightened their opposition to unfair advertising on television, as a result of which the airtime of Russian television was significantly reduced. But the company did not pay attention to this: sales, and with them income, continued to grow. In 2014, Sealex Forte confidently took first place among brands of dietary supplements, its sales increased by 20 percent and amounted to 1.62 billion rubles, Alicaps - by 17 percent, to one billion rubles.
Photo: Amr Nabil/AP
Inspired by the successes of RIA Panda, it actively invested in expanding production. In 2015, the company completed the construction of a plant in the Leningrad region with a capacity of one billion tablets and capsules per year. “We are probably the only company that grew in 2015 in our market, in our segment. “Everyone else showed a rollback,” said Panda president Dergachev. The company's profit in 2015 amounted to 500 million rubles, turnover in 2014 was 4.7 billion rubles, and in 2015 - already 5.3 billion.
In January 2015, the law on combating the trafficking of counterfeit medicines, medical devices and dietary supplements came into force. The document introduced the term “falsified dietary supplements containing prohibited components” into legal practice. Translated into normal language, these are preparations to which components prohibited for use in Russian dietary supplements were deliberately added. Responsibility for manufacturers and distributors of such counterfeits has become stricter and has been established in the form of a fine of up to 5 million rubles or imprisonment of up to 12 years.
Deputies of the State Duma finally paid attention to the intrusive advertising of dietary supplements, which, as we know, rarely ends well. “The Russian anthem is just beginning to be played, when suddenly the Terminator jumps out on the screen and offers me to buy some pills,” State Duma deputy Igor Zotov was annoyed. These are tough times for supplements that “eliminate erectile dysfunction.”
