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Sildenafil, sold under the brand name buy effective viagra 100mg online, is used to treat erectile dysfunction and pulmonary arterial hypertension.

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Sildenafil, sold under the brand name buy effective viagra 100mg online among others, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. It is unclear if it is effective for treating sexual dysfunction in women. It is taken by mouth or by injection into a vein. Onset is typically within 20 minutes and lasts for about 2 hours.

buy effective viagra 100mg online acts by blocking phosphodiesterase 5 (PDE5), an enzyme that promotes breakdown of cGMP, which regulates blood flow in the penis. It requires sexual arousal to work. It also results in dilation of the blood vessels in the lungs.

buy effective viagra 100mg online originally discovered the medication in 1989 while looking for a treatment for heart-related chest pain. It was approved for medical use in the United States and in the European Union in 1998. In 2017, it was the 217th most commonly prescribed medication in the United States, with more than two million prescriptions. That same year, it also became available as a generic medication after final patents by Pfizer expired. In the United Kingdom, it is available over the counter. Most of the Active Pharmaceutical Ingredient (API) in Sildenafil, Sildenafil citrate, is produced in Pfizer’s Ringaskiddy complex, County Cork, which is Pfizer’s largest production facility outside of the United States

Although it proved to be very effective in treating men, the treatment of erectile dysfunction Viagra is not suitable for women. There are some anecdotal evidence that Viagra can increase sexual pleasure in women, but so far medical tests have not provided convincing evidence that they work for women.

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The most promising research so far has been a study conducted by the Women’s Sexual Medical Center UCLA in Los Angeles. The study participants reported that the adoption of Viagra improved their sexual pleasure, which led to a further study of the possible use of Viagra as a treatment for women. Scientists have suggested that, like the effect it has on men, Viagra can increase blood flow to the female genitalia, thereby improving sexual experience.

However, further studies failed to reproduce the successful outcome of the first study, and the researchers concluded that women who have experienced a positive result can simply do so by accident.

Since there has never been a widespread medical study of Viagra in women, the exact effects that the drug may have on female patients are unknown. It is currently unclear whether Viagra is safe for women or what side effects and long-term effects it may have for the female body. Thus, Viagra is licensed only for men.

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method of administration 

for oral use of buy effective viagra 100mg online

Consistent with its known effects on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway , sildenafil was shown to potentiate the hypotensive effects of nitrates, and its co-administration with nitric oxide donors (such as amyl nitrite) or nitrates in any form is therefore contraindicated.

The co-administration of PDE5 inhibitors, including sildenafil, with guanylate cyclase stimulators, such as riociguat, is contraindicated as it may potentially lead to symptomatic hypotension.

Agents for the treatment of erectile dysfunction, including sildenafil, should not be used in men for whom sexual activity is inadvisable (e.g. patients with severe cardiovascular disorders such as unstable angina or severe cardiac failure).

buy effective viagra 100mg online is contraindicated in patients who have loss of vision in one eye because of non-arteritic anterior ischaemic optic neuropathy (NAION), regardless of whether this episode was in connection or not with previous PDE5 inhibitor exposure.

The safety of buy effective viagra 100mg online has not been studied in the following sub-groups of patients and its use is therefore contraindicated: severe hepatic impairment, hypotension (blood pressure < 90/50 mmHg), recent history of stroke or myocardial infarction and known hereditary degenerative retinal disorders such as retinitis pigmentosa (a minority of these patients have genetic disorders of retinal phosphodiesterases).

common side effects of buy effective viagra 100mg online

Common side effects include headachesheartburn, and flushed skin. Caution is advised in those with cardiovascular disease. Rare but serious side effects include a prolonged erection (priapism) that can lead to damage to the penis, vision problems, and hearing loss. Sildenafil should not be taken by people on nitrates such as nitroglycerin (glycerin trinitrate), as this may result in a serious drop in blood pressure. Sildenafil should not be taken within four hours of taking an alpha blocker.

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ardiovascular risk factors

Prior to initiating any treatment for erectile dysfunction, physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity. Sildenafil has vasodilator properties, resulting in mild and transient decreases in blood pressure. Prior to prescribing sildenafil, physicians should carefully consider whether their patients with certain underlying conditions could be adversely affected by such vasodilatory effects, especially in combination with sexual activity. Patients with increased susceptibility to vasodilators include those with left ventricular outflow obstruction (e.g., aortic stenosis, hypertrophic obstructive cardiomyopathy), or those with the rare syndrome of multiple system atrophy manifesting as severely impaired autonomic control of blood pressure.

buy effective viagra 100mg online potentiates the hypotensive effect of nitrates.

Serious cardiovascular events, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular haemorrhage, transient ischaemic attack, hypertension and hypotension have been reported post-marketing in temporal association with the use of buy effective viagra 100mg online. Most, but not all, of these patients had pre-existing cardiovascular risk factors. Many events were reported to occur during or shortly after sexual intercourse and a few were reported to occur shortly after the use of buy effective viagra 100mg online without sexual activity. It is not possible to determine whether these events are related directly to these factors or to other factors.

Priapism

Agents for the treatment of erectile dysfunction, including sildenafil, should be used with caution in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia).

Prolonged erections and priapism have been reported with sildenafil in post-marketing experience. In the event of an erection that persists for 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.

Concomitant use with other PDE5 inhibitors or other treatments for erectile dysfunction

The safety and efficacy of combinations of sildenafil with other PDE5 inhibitors, or other pulmonary arterial hypertension (PAH) treatments containing sildenafil (REVATIO), or other treatments for erectile dysfunction have not been studied. Therefore the use of such combinations is not recommended.

Effects on vision

Cases of visual defects have been reported spontaneously in connection with the intake of sildenafil and other PDE5 inhibitors. Cases of non-arteritic anterior ischaemic optic neuropathy, a rare condition, have been reported spontaneously and in an observational study in connection with the intake of sildenafil and other PDE5 inhibitors. Patients should be advised that in the event of any sudden visual defect, they should stop taking buy effective viagra 100mg online and consult a physician immediately.

Concomitant use with ritonavir

Co-administration of sildenafil with ritonavir is not advised.

Concomitant use with alpha-blockers

Caution is advised when buy effective viagra 100mg online is administered to patients taking an alpha-blocker, as the co-administration may lead to symptomatic hypotension in a few susceptible individuals. This is most likely to occur within 4 hours post sildenafil dosing. In order to minimise the potential for developing postural hypotension, patients should be hemodynamically stable on alpha-blocker therapy prior to initiating sildenafil treatment. Initiation of sildenafil at a dose of 25 mg should be considered. In addition, physicians should advise patients what to do in the event of postural hypotensive symptoms.

Effect on bleeding

Studies with human platelets indicate that buy effective viagra 100mg online potentiates the antiaggregatory effect of sodium nitroprusside in vitro. There is no safety information on the administration of buy effective viagra 100mg online to patients with bleeding disorders or active peptic ulceration. Therefore buy effective viagra 100mg online should be administered to these patients only after careful benefit-risk assessment.

The film coating of the tablet contains lactose. buy effective viagra 100mg online should not be administered to men with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.

Posology

Use in adults

The recommended dose is buy effective viagra 100mg online taken as needed approximately one hour before sexual activity. Based on efficacy and tolerability, the dose may be increased to 100 mg or decreased to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended dosing frequency is once per day. If buy effective viagra 100mg online is taken with food, the onset of activity may be delayed compared to the fasted state.

Special populations

Elderly

Dosage adjustments are not required in elderly patients (> 65 years old).

Renal impairment

The dosing recommendations described in “Use in adults” apply to patients with mild to moderate renal impairment (creatinine clearance = 30-80 mL/min).

Since buy effective viagra 100mg online clearance is reduced in patients with severe renal impairment (creatinine clearance < 30 mL/min) a 25 mg dose should be considered. Based on efficacy and tolerability, the dose may be increased step-wise to 50 mg up to 100 mg as necessary.

Hepatic impairment

Since buy effective viagra 100mg online clearance is reduced in patients with hepatic impairment (e.g. cirrhosis) a 25 mg dose should be considered. Based on efficacy and tolerability, the dose may be increased step-wise to 50 mg up to 100 mg as necessary.

Paediatric population

buy effective viagra 100mg online is not indicated for individuals below 18 years of age.

Use in patients taking other medicinal products

With the exception of ritonavir for which co-administration with sildenafil is not advised a starting dose of 25 mg should be considered in patients receiving concomitant treatment with CYP3A4 inhibitors.

In order to minimise the potential of developing postural hypotension in patients receiving alpha-blocker treatment patients should be stabilised on alpha-blocker therapy prior to initiating buy effective viagra 100mg online treatment. In addition, initiation of sildenafil at a dose of 25 mg should be considered.

Summary of the safety profile

The safety profile of buy effective viagra 100mg online is based on 9,570 patients in 74 double blind placebo-controlled clinical studies. The most commonly reported adverse reactions in clinical studies among sildenafil treated patients were headache, flushing, dyspepsia, nasal congestion, dizziness, nausea, hot flush, visual disturbance, cyanopsia and blurred vision.

Adverse reactions from post-marketing surveillance has been gathered covering an estimated period >10 years. Because not all adverse reactions are reported to the Marketing Authorisation Holder and included in the safety database, the frequencies of these reactions cannot be reliably determined.

Tabulated list of adverse reactions

In the table below all medically important adverse reactions, which occurred in clinical trials at an incidence greater than placebo are listed by system organ class and frequency (very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to, 1/1,000).

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

Table 1: Medically important adverse reactions reported at an incidence greater than placebo in controlled clinical studies and medically important adverse reactions reported through post-marketing surveillance

System Organ Class Very common

(> 1/10)

Common

(> 1/100 and <1/10)

Uncommon

(> 1/1,000 and <1/100)

Rare

(> 1/10,000 and <1/1,000)

Infections and infestations Rhinitis
Immune system disorders Hypersensitivity
Nervous system disorders Headache Dizziness Somnolence,

Hypoaesthesia

Cerebrovascular accident,

Transient ischaemic attack,

Seizure*,

Seizure recurrence*,

Syncope

Eye disorders Visual colour distortions**,

Visual disturbance,

Vision blurred

Lacrimation disorders***,

Eye pain,

Photophobia,

Photopsia,

Ocular hyperaemia,

Visual brightness,

Conjunctivitis

Non-arteritic anterior ischaemic optic neuropathy (NAION)*,*

Retinal vascular occlusion*,

Retinal haemorrhage,

Arteriosclerotic retinopathy,

Retinal disorder,

Glaucoma,

Visual field defect,

Diplopia,

Visual acuity reduced,

Myopia,

Asthenopia,

Vitreous floaters,

Iris disorder,

Mydriasis,

Halo vision,

Eye oedema,

Eye swelling,

Eye disorder,

Conjunctival hyperaemia,

Eye irritation,

Abnormal sensation in eye,

Eyelid oedema,

Scleral discoloration

Ear and labyrinth disorders Vertigo,

Tinnitus

Deafness
Cardiac disorders Tachycardia,

Palpitations

Sudden cardiac death*, Myocardial infarction,

Ventricular arrhythmia*,

Atrial fibrillation,

Unstable angina

Vascular disorders Flushing,

Hot flush

Hypertension,

Hypotension

Respiratory, thoracic and mediastinal disorders Nasal congestion Epistaxis,

Sinus congestion

Throat tightness,

Nasal oedema,

Nasal dryness

Gastrointestinal disorders Nausea,

Dyspepsia

Gastro oesophageal reflux disease,

Vomiting,

Abdominal pain upper,

Dry mouth

Hypoaesthesia oral
Skin and subcutaneous tissue disorders Rash Stevens-Johnson Syndrome (SJS)*,*

Toxic Epidermal Necrolysis (TEN) *

Musculoskeletal and connective tissue disorders Myalgia,

Pain in extremity

Renal and urinary disorders Haematuria
Reproductive system and breast disorders Penile haemorrhage,

Priapism*,

Haematospermia,

Erection increased

General disorders and administration site conditions Chest pain,

Fatigue,

Feeling hot

Irritability
Investigations Heart rate increased

*Reported during post-marketing surveillance only

**Visual colour distortions: Chloropsia, Chromatopsia, Cyanopsia, Erythropsia and Xanthopsia

***Lacrimation disorders: Dry eye, Lacrimal disorder and Lacrimation increased

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

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Absorption

buy effective viagra 100mg online 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 oral bioavailability is 41% (range 25-63%). After oral dosing of buy effective viagra 100mg online AUC and Cmax increase in proportion with dose over the recommended dose range (25-100 mg).

When sildenafil is taken with food, the rate of absorption is reduced with a mean delay in tmax of 60 minutes and a mean reduction in Cmax of 29%.

Distribution

The mean steady state volume of distribution (Vd) for sildenafil is 105 l, indicating distribution into the tissues. After a single oral dose of 100 mg, the mean maximum total plasma concentration of sildenafil is approximately 440 ng/mL (CV 40%). Since sildenafil (and its major circulating N-desmethyl metabolite) is 96% bound to plasma proteins, this results in the mean maximum free plasma concentration for sildenafil of 18 ng/mL (38 nM). Protein binding is independent of total drug concentrations.

In healthy volunteers receiving buy effective viagra 100mg online(single dose), less than 0.0002% (average 188 ng) of the administered dose was present in ejaculate 90 minutes after dosing.

Biotransformation

buy effective viagra 100mg online 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. This metabolite has a phosphodiesterase selectivity profile similar to sildenafil and an in vitro potency for PDE5 approximately 50% that of the parent drug. Plasma concentrations of this metabolite are approximately 40% of those seen for buy effective viagra 100mg online. The N-desmethyl metabolite is further metabolised, with a terminal half life of approximately 4 h.

Elimination

The total body clearance of buy effective viagra 100mg online is 41 L/h with a resultant terminal phase half life of 3-5 h. After either oral or intravenous administration, buy effective viagra 100mg online is excreted as metabolites predominantly in the faeces (approximately 80% of administered oral dose) and to a lesser extent in the urine (approximately 13% of administered oral dose).

Pharmacokinetics in special patient groups

Elderly

Healthy elderly volunteers (65 years or over) had a reduced clearance of buy effective viagra 100mg online, 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 plasma protein binding, the corresponding increase in free buy effective viagra 100mg online plasma concentration was approximately 40%.

Renal insufficiency

In volunteers with mild to moderate renal impairment (creatinine clearance = 30-80 mL/min), the pharmacokinetics of buy effective viagra 100mg online were not altered after receiving a 50 mg single oral dose. The mean AUC and Cmax of the N-desmethyl metabolite increased up to 126% and up to 73% respectively, compared to age-matched volunteers with no renal impairment. However, due to high inter-subject variability, these differences were not statistically significant. In volunteers with severe renal impairment (creatinine clearance < 30 mL/min), sildenafil clearance was reduced, resulting in mean increases in AUC and Cmax of 100% and 88% respectively compared to age-matched volunteers with no renal impairment. In addition, N-desmethyl metabolite AUC and Cmax values were significantly increased by 200% and 79% respectively.

Hepatic insufficiency

In volunteers with mild to moderate hepatic cirrhosis (Child-Pugh A and B) buy effective viagra 100mg online clearance was reduced, resulting in increases in AUC (84%) and Cmax (47%) compared to age-matched volunteers with no hepatic impairment. The pharmacokinetics of sildenafil in patients with severely impaired hepatic function have not been studied.

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