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The mean Virmax Male Enhancer Review age of the study group Benefits Of Penis Pump 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 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 200 mg.41 54 76 failed to respond to sildenafil.Mean IIEF question 3 and 4 scores were 1.5 and 1.4 Virmax Male Enhancer Review at baseline, 2.2 and 1.9 with sildenafil 100 mg, 2.8 and 2.5 with sildenafil 150 mg and 3..0 Male Enhancement Pill Adonis and 2.9 with sildenafil 200 mg, respectively.After 4 weeks, treatment was Male Enhancement Pill Adonis 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 Ed Pills Porn Star , Virmax Male Enhancer Review dizziness 5 and visual disturbances 5.4 13 31 responders refused 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 Benefits Of Penis Pump responders but is limited by Ed Pills Porn Star 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 Male Enhancement Pill Adonis 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 Benefits Of Penis Pump associated with reduced Male Enhancement Pill Adonis quality of life.2,3,4,5Sildenafil citrate ViagraTM, Pfizer, UK , a potent, competitive phosphodiesterase Benefits Of Penis Pump 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 sexual arousal, inhibition of PDE 5 isoenzyme by sildenafil results in increased corporal levels Prescription For Low Libido 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 hypertension, Ed Pills Porn Star diabetes, spinal cord injury, other concomitant medical conditions, and in Benefits Of Penis Pump those patients taking a wide variety of concomitant medications.Its Virmax Male Enhancer Review efficacy appears related to the extent and severity of ED, with significantly reduced efficacy demonstrated in patients with severe vasculogenic ED, diabetic ED and post radical prostatectomy ED.6,8,9,11Jarow et al reported a sildenafil response rate of 65 , 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 Male Enhancement Pill Adonis a group of patients with chronic ED, unresponsive to Virmax Male Enhancer Review sildenafil 100 mg, who were treated in a home setting with 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 Ed Pills Porn Star fully evaluated patients with chronic ED who had previously failed to respond to a home trial of sildenafil 100 mg with erections suitable for sexual Prescription For Low Libido intercourse were studied.All patients had received focussed sildenafil usage education and had been re titrated Ed Pills Porn Star to confirm their non responder status.The mean number of sildenafil uses prior to enrolment Prescription For Low Libido 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 determined.This protocol included a history Male Enhancement Pill Adonis and physical examination, determination of Benefits Of Penis Pump fasting lipids, glucose and free testosterone, vibratory penile biothesiometry and penile colour duplex Doppler ultrasonography CDU before and after intracavernous vasoactive drug challenge 20 mg Benefits Of Penis Pump alprostadil.Rigiscan nocturnal penile tumescence testing, dynamic infusion cavernosometry and cavernosography DICC and phallopharmacoangiography were performed where clinically indicated.Patients with unstable coronary artery disease, low output congestive cardiac failure, hypertension Benefits Of Penis Pump 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 Benefits Of Penis Pump 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 maximal response or intolerable adverse effects occurred.The Male Enhancement Pill Adonis primary efficacy end point was the response to the questions Prescription For Low Libido 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 Ed Pills Porn Star end point was the response to the global assessment question Has this treatment improved your erections Virmax Male Enhancer Review after 4 weeks Prescription For Low Libido of treatment.Results were analysed using standard statistical analysis including descriptive statistics and Student s t test.ResultsFifty four patients with chronic ED Virmax Male Enhancer Review and a mean age of 59.6 Prescription For Low Libido 11.2 y were enrolled in the study group.The etiology of ED was psychogenic in 5 patients 9 Benefits Of Penis Pump , arteriogenic in 13 patients 24 , cavernosal veno occlusive dysfunction CVOD in 9 patients 17 , MVED Male Enhancement Pill Adonis in 16 patients 30 Ed Pills Porn Star and post radical retropubic prostatectomy ED in 11 patients 20.The mean duration of ED was 16..6 months range 4 C32.Twenty four patients had diabetes mellitus, 27 had hypertension, 26 Male Enhancement Pill Adonis had dyslipidaemia and 20 smoked cigarettes.Two or more vascular risk factors were present in 46 patients Table 1.Table 1 Patient 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 Virmax Male Enhancer Review 200 mg.Four patients 7.4 required 150 mg and comprised 2 patients with psychogenic ED and 2 patients with arteriogenic ED.The remaining 9 patients 16.7 required 200 mg and comprised 2 patients with psychogenic ED, 3 patients with arteriogenic ED, 2 patients with cavernosal veno Ed Pills Porn Star occlusive dysfunction and 2 patients with Ed Pills Porn Star 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 Virmax Male Enhancer Review with psychogenic ED and 9 out of 49 patients 18.4 with organic ED Table 2.Of the 11 patients 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 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 Male Enhancement Pill Adonis 150 mg, sildenafil 200 mg Male Enhancement Pill Adonis and sildenafil overallFull Virmax Male Enhancer Review size table.Mean responses to questions 3 and 4 of the IIEF 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 Prescription For Low Libido 3.0 and 2.9 with sildenafil 200 mg.The mean score for Q3 and Q4 for Ed Pills Porn Star sildenafil was statistically superior to baseline, overall, in all etiological groups and at all doses P 0.001.The overall mean score Benefits Of Penis Pump 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 Male Enhancement Pill Adonis whether treatment improved their erections, the secondary end point, was answered in the affirmative at week 4 by Virmax Male Enhancer Review 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 activity.Only Ed Pills Porn Star 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 ELIGIBLE TO OBTAIN THIS MEDICATION ON AN NHS PRESCRIPTION.YOUR DOCTOR WILL BE ABLE TO Ed Pills Porn Star ADVISE YOU WHICH TYPE OF PRESCRIPTION YOU REQUIRE.VIAGRA sildenafil citrate is a cGMP specific phosphodiesterase type Prescription For Low Libido 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 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 for the biodegradation of cGMP in the corpus cavernosum.When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil Benefits Of Penis Pump produces increased levels of cGMP in the corpus cavernosum, resulting Virmax Male Enhancer Review 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 in vitro have shown that sildenafil has between 10 and 10,000 fold Ed Pills Porn Star greater selectivity for PDE5 Prescription For Low Libido than for other Male Enhancement Pill Adonis phosphodiesterase isoforms namely PDEs 1, 2, 3, 4, and 6 and greater than 700 fold effect on PDE7 PDE11.In particular, sildenafil has greater than 4,000 fold selectivity for PDE5 over PDE3, the cAMP specific phosphodiesterase isoform involved in the control of cardiac contractility.Sildenafil is about 10 fold as potent for PDE5 compared to Virmax Male Enhancer Review PDE6, an isoenzyme found in Prescription For Low Libido the retina this lower selectivity is thought to be Male Enhancement Pill Adonis the basis for colour vision abnormalities observed with higher doses or plasma levels of sildenafil see WARNINGS AND PRECAUTIONS, Benefits Of Penis Pump DETAILED PHARMACOLOGY.PDE5 is 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 Male Enhancement Pill Adonis for the enhanced platelet antiaggregatory activity of nitric oxide observed in Prescription For Low Libido vitro, and inhibition of platelet thrombus Benefits Of Penis Pump formation in vivo, and peripheral arterial venous dilation in vivo see WARNINGS AND PRECAUTIONS.PharmacodynamicsEffects of VIAGRA on Blood Pressure BP Single oral doses of sildenafil 100 mg administered to healthy volunteers produced decreases in supine blood pressure mean maximum decrease Male Enhancement Pill Adonis 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 on Cardiac Parameters Single oral doses Ed Pills Porn Star 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 of various designs.In fixed dose clinical trials, 62 , 74 , and 82 of patients on 25 mg, 50 mg and 100 mg of VIAGRA, respectively, reported Ed Pills Porn Star an improvement in their erections, compared to 25 on placebo p 0.0001, see CLINICAL TRIALS.In eight Prescription For Low Libido double blind, placebo controlled, cross over Benefits Of Penis Pump studies Male Enhancement Pill Adonis using RigiScan a device used to objectively measure penile rigidity and duration of erections , erections during sexual stimulation improved significantly on VIAGRA compared to placebo.These studies Benefits Of Penis Pump included patients with organic etiologies such as spinal cord injury and diabetes mellitus Prescription For Low Libido , 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 Male Enhancement Pill Adonis in statistically significant improvements in duration of erections of 60 rigidity Prescription For Low Libido considered hard enough for penetrative sexual 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 sildenafil.The mean total duration of erections Ed Pills Porn Star 60 rigidity at the base of the penis was 3, 24 and 32 minutes for subjects receiving placebo, 25 mg and 50 mg doses, respectively, when exposed to VSS for 2 hours.VIAGRA increases couples ability to have sexual intercourse see CLINICAL TRIALS.Pharmacokinetics.Absorption Ed Pills Porn Star 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 concentration of sildenafil following a single oral dose of 100 mg is Virmax Male Enhancer Review 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 Prescription For Low Libido delay in Tmax..The patient may find that it takes longer to work if taken with a high fat meal.However, although it was statistically significant AUC decreased by 11 , the decrease in the extent of Virmax Male Enhancer Review absorption was not clinically relevant.The relative bioavailability fed fasted was 89 90 CI 84 94 see DRUG INTERACTIONS.Distribution The Ed Pills Porn Star mean steady state volume of distribution Vss for sildenafil is 105 litres, indicating distribution into the tissues.Sildenafil and its major circulating N desmethyl metabolite are both approximately 96 bound to plasma proteins.Protein binding is independent of Virmax Male Enhancer Review total drug concentrations.Based upon measurements Virmax Male Enhancer Review of Benefits Of Penis Pump sildenafil in the semen of healthy volunteers, less than 0.001 of the Prescription For Low Libido ingested dose may appear in the semen of patients 90 minutes after drug intake.Metabolism Virmax Male Enhancer Review Sildenafil is cleared predominantly by the CYP3A4 Benefits Of Penis Pump major route and CYP2C9 minor route hepatic microsomal isoenzymes.The major circulating metabolite results from N demethylation of sildenafil at the N methyl piperazine moiety.This metabolite has a PDE selectivity profile similar to sildenafil and an in vitro potency against PDE5 approximately 50 that of the parent drug.Plasma concentrations of this metabolite 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 Benefits Of Penis Pump 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 lesser extent in the urine approximately 13 of Virmax Male Enhancer Review the administered dose.Special Populations and ConditionsGeriatrics Male Enhancement Pill Adonis Healthy elderly subjects 65 years or older had a reduced clearance of 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 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 Virmax Male Enhancer Review 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 been studied.Since sildenafil clearance is reduced in geriatric patients 65 years or older , patients with renal impairment or patients with hepatic impairment, a starting dose of 25 mg should be Male Enhancement Pill Adonis considered.Based on efficacy and toleration, the dose may be increased to 50 mg or 100 mg see WARNINGS AND PRECAUTIONS, DOSAGE 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 severe CLcr 30 mL min renal impairment, sildenafil clearance was reduced, resulting in Benefits Of Penis Pump increases in AUC 100 and Cmax 88 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 Prescription For Low Libido in subjects with Prescription For Low Libido 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 regularly report successful intercourse and generally continue to use the treatment.The effective treatment time of Sildaforce 100mg is Prescription For Low Libido 4 6 hours but many GPs report longer effective times

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