Viagra 25 mg instructions for use. Viagra instructions for use, contraindications, side effects, reviews

The most famous drug for the rapid strengthening of erection in men, the first to appear on the pharmaceutical market, is Viagra, which includes sildenafil.

This active component helps to relax the smooth muscles of the penis, which leads to a more voluminous filling with blood. As a result - persistent potency, increased sexual desire, long-lasting erection. A more complete description of the action and features of the drug is contained in the instructions for its use.

The active ingredient of the drug is sildenafil citrate. Additional composition of Viagra includes:

calcium hydrogen phosphate anhydrous;
magnesium stearate;
croscarmellose sodium;
titanium dioxide;
treacetin;
cellulose microcrystalline;
hypromellose;
dye.

Also in Viagra, the composition of the tablet includes lactose. The presence of this component should be taken into account for people suffering from allergic reactions, because. it can cause intolerance reactions.

Release form

The drug is available in the form of blue film-coated tablets. Each Viagra pill contains the active ingredient in a volume of 50 or 100 mg. Tablets are diamond-shaped, the edges of which are cut off or slightly rounded.

They are convex on both sides, each has its own engraving: the name of the manufacturer "Pfizer" (Pfizer) and the dosage of the active substance that is part of this Viagra tablet.

The pills are packaged in aluminum blisters in one or four pieces. These blisters are enclosed in a cardboard package along with an annotation to the medicine.

Pharmacodynamics

During sexual arousal, chemical reactions are triggered in a man's body. Sexual attraction experienced to the female sex provokes irritation of the cavernous bodies of the penis and the release of nitric oxide.

This effect provokes the synthesis of guanylate cyclase, a special enzyme that increases the level of cGMP (cyclic guanosine monophosphate). The task of cGMP is to relieve spasm from the smooth muscles of the penis in order to provide more blood flow to them.

Viagra contains sildenafil, an effective component that belongs to the group of selective phosphodiestrase type 5 inhibitors (PDE5). These substances actively affect cyclic guanosine monophosphate, contributing to its breakdown in the cavernous bodies and the release of nitric oxide.

If any of the pharmacological processes in a man's body are disturbed, this affects his sexual health. The use of Viagra helps to normalize them, thereby restoring the natural functions of the genital organs.

It is worth considering that without nitric oxide, no other reactions in the sex glands will start, which means that taking the medicine will be useless. In order for the pills to work, the guy must be turned on, because. it is sexual arousal that gives impetus to the beginning of the oxidation reaction.

As various clinical studies show, the drug is easily and positively tolerated by patients of different ages who do not have chronic diseases. Changes in the results of blood tests with a single use of one hundred milligrams of sildenafil were not observed.

Pharmacokinetics

After entering the stomach, the tablets dissolve, and their contents are very quickly absorbed into its walls. When combined with light meals or after applying it on an empty stomach, the effect occurs on average after an hour.

According to clinical trials, the time for the appearance of a persistent erection varies from 30 to 120 minutes and depends on the individual characteristics of the patient's body.

If you take a pill at a hearty dinner flavored with fatty dishes, it will slow down the absorption of the active ingredient, and the reaction to it will occur later, on average, by one more hour. The metabolism of the drug is 80% performed by the liver and excreted by the intestines along with the feces. About 13% more leaves the body with urine, the remaining metabolites are excreted with sweat.

Absorption, distribution and excretion of Viagra metabolites in patients over 65 years of age and men with kidney disease did not change. In guys with liver failure and pathologies of the hematopoietic organ, an increase in the timing of decay and excretion of the components of the drug is noted.

In the stronger sex, suffering from cirrhosis of the liver and acute liver failure, such studies have not been conducted, therefore, treatment with sildenafil for this category of persons is not recommended.

Indications for use

The use of Viagra is indicated for men who have problems with erectile function: weak, short-term erection, premature ejaculation, reduced potency. But the drug can help only those patients in whom such disorders are caused by the following reasons:

age-related changes in the body: after 40 years, the work of most organs and systems of the body slows down in the representatives of the stronger sex. In this regard, the synthesis of the sexual androgen, testosterone, decreases, which leads to difficulties in intimate life;
bad habits: nicotine, narcotic substances, alcoholic beverages have a destructive effect;
stressful situations: prolonged depression, overwork, psychological stress and other similar factors disrupt psycho-emotional health, which affects the ability to achieve a full erection;
sedentary lifestyle: leads to impaired blood circulation in the pelvis, the appearance of stagnant processes, which worsens the functioning of the entire genitourinary system;
lack of sleep: especially in a chronic form, it affects the functioning of the brain and the synthesis of sex hormones, a lack of testosterone reduces sexual function;
urinary tract infections: prostatitis, urethritis, cystitis, etc.;
malnutrition: a deficiency of vitamins and useful trace elements in the diet leads to a slowdown in the work of all important organs, incl. and reproductive system;
psychological factors: unsuccessful sexual experience, embarrassment, self-doubt, phobias and fears associated with intimate relationships, etc.

All these reasons do not prevent the guy from feeling sexual arousal - the main condition for the successful action of the drug. Potency and erections are also directly present, only in a more weakened state.

If sexual disorders are caused by serious pathologies of the pelvic organs, anomalies in their structure or health disorders, in which the stronger sex is not able to experience sexual desire, the use of Viagra will be meaningless.

Instructions for use

The drug is recommended to be taken at a dosage of 50 mg per day. The standard dosage can be reduced by half (up to 25 mg) if the patient has a painful and prolonged, more than six hours, erection, and other undesirable reactions of the body.

Also, the doctor can double the dose, up to one hundred milligrams, if the result from taking the standard dose does not meet the patient's expectations, while there are no side effects and the person feels good.

The maximum allowable daily dose is 100 mg of sildenafil. When prescribing it, the doctor takes into account the risks associated with the potential benefit to the patient and the possible harm that the drug will bring to the body.

Tablets should be taken one hour before the intended intimate intercourse. If the evening involves a hearty dinner with fatty dishes, it is advisable to take the pill an hour earlier.

Contraindications for use

Taking Viagra is strictly prohibited for men who have an individual intolerance to any component that is part of the drug, because. this will provoke severe allergic reactions. Also, absolute contraindications include pathologies of the anatomical structure or development of the genital organs: penis deformities, Peyronie's disease, cavernous fibrosis, and others.

predisposition to bleeding, especially of an internal nature;
gastric or duodenal ulcer, which are in the acute stage;
liver pathology of a severe nature (cirrhosis, acute failure, etc.);
diseases of the hematopoietic system: blood cancer, myeloma, anemia, priapism;
low or high blood pressure in severe form;
diseases of a cardiovascular nature: rhythm disturbances, insufficiency, a history of myocardial infarction, etc.

From the moment of transferring a heart attack or stroke, at least six months must pass. It is also strictly forbidden to prescribe medicine to children under 18 years of age, as well as to men who, according to medical indications, are forbidden to have sex.

Adverse reactions

In most cases, the drug is well tolerated by patients, especially in cases where the recommended dosage is not exceeded. But in very rare cases, side effects were still recorded. These include the following reactions:

neurological: disorders of the central nervous system, sleep disturbance, dizziness, increased muscle tone;
heart muscle and circulatory system: sudden hot flashes, headaches, relaxation and spasms of smooth muscles in the stacks of veins and arteries (vasodilation);
musculoskeletal system: joint pain, muscle spasms, muscle aches;
digestive system: nausea, vomiting, diarrhea, constipation, heartburn, increased flatulence;
allergic reactions: skin rash (urticaria), itching, burning, redness;
dysfunction of the sense organs: deterioration in visual acuity, reactions to bright light, impaired perception of colors, inflammatory processes of an infectious nature (conjunctivitis);

upper respiratory tract: breathing difficulties, viral infections of the throat, nose and trachea, sinus congestion, etc.;
organs of the genitourinary system: prostate dysfunction, bacterial infections of the urinary tract, fungal diseases.

There have also been cases when taking Viagra provoked the development of seasonal viral diseases due to weakened immunity, the appearance of pain in the lower back and back, discomfort in the abdominal cavity. Perhaps such a phenomenon as priapism is a sudden strong erection that lasts for six hours or more, in which the patient feels pain.

Overdose

The daily dose of sildenafil should not exceed 100 milligrams. If the patient has accidentally taken too much of a dosage, he should immediately seek medical help, regardless of the presence of severe reactions of the body.

Interaction with other chemicals

The components that make up Viagra are not compatible with all chemicals, and therefore may cause a change in the action of other drugs. Before starting treatment with sildenafil, you should inform your doctor about all medications taken to treat other diseases or chronic pathologies.

It is strictly forbidden to take Viagra at the same time as medicines containing nitrates. This cannot be done even if they are treated from time to time and are not permanent.

Chemical processes that are triggered in the body when PDE5 inhibitors and nitrates come into contact disrupt the functioning of the cardiovascular system. This threatens a sharp decrease in blood pressure, which can lead to death. Less "harmless" consequences of such a combination include dizziness, loss of consciousness, myocardial infarction, stroke.

Most often, nitrates are contained in medicines intended for the treatment of cardiac pathologies, as well as "light" drugs sold in nightclubs. If a man is not sure whether his medicine contains nitrates, he should clarify its compatibility with Viagra from his doctor.

Deterioration of well-being can occur with simultaneous treatment with sildenafil and alpha-blockers, which are the basis of drugs intended for the treatment of arterial hypertension and inflammatory processes in the prostate.

Incompatibility is manifested by a drop in blood pressure, general weakness, dizziness. In this case, treatment should begin with a minimum dose of 25 mg of the active ingredient.

HIV-positive patients taking antiretroviral therapy should also be careful when taking PDE-5 inhibitors. For such patients, an individual selection of dosage is required, it should start with a minimum.

Do not drink Viagra along with other pharmaceutical products that increase potency or are intended for the treatment of erectile dysfunction. Moreover, the shape of these products does not matter; tablets, injections, vacuum pumps, implants, etc. fall under the ban.

Interaction with alcohol

Ethanol, which is included in any alcoholic drink, has an extremely negative effect on the work of all internal organs, and first of all, on the bloodstream.

This fermentation product slows down the movement of biological fluid, as a result of which the genitals are filled worse, which is reflected in the strength of the erection. In such a situation, the use of reverse-acting drugs (which include Viagra) is simply useless.

There are also cases when the simultaneous use of sildenafil and alcohol led to a general deterioration in well-being, impaired coordination of movement, tachycardia, and chest pain. For these reasons, taking Viagra and alcohol is not recommended.

Drug analogues

Drugs that can replace Viagra include drugs with a similar composition (direct analogue) or with the same therapeutic effect.

Medicines, the basis of which is sildenafil, are:

Vectra;
Viasil;
Wigrande;
Jenagra;
Dynamico;
Viagra Soft.

The latter drug is also produced by Pfizer, the difference from the original is that it is allowed to be taken along with small doses of alcohol.

Analogues for therapeutic action include medicines that have other active substances. They are usually prescribed to patients with intolerance to sildenafil. The following pharmaceutical products are considered the most popular and effective.

Cialis. It also contains a PDE5 inhibitor, but of a different type - tadalafil. Designed to increase potency and strengthen erections in men. It has a faster effect, on average, an erection occurs 15-20 minutes after taking the pill.

Impaza. The active ingredient is affinity-purified antibodies to human endothelial NO synthase, a mixture of homeopathic dilutions of C12, C30 and C200. The drug is prescribed to men suffering from erectile dysfunction of various kinds.

Suitable for patients taking nitrate-containing drugs and suffering from pathologies of the heart and blood vessels. It has no side effects and contraindications, except for hypersensitivity to the components.

Verona. Natural preparation, which is based on extracts of medicinal plants: creeping crusts, sleeping pills, beautiful argyrea, itchy velvet beans. This dietary supplement is prescribed for erectile dysfunction and impaired spermogenesis.

A course of 1-2 capsules per day is indicated, the duration of therapy is determined by the attending physician.

Levitra. The active substance is vardenafil. It has a number of contraindications and side effects, therefore, it requires a mandatory medical consultation. It is taken 25-60 minutes before the intended intimate contact, the action lasts for 4-5 hours.

According to clinical studies, the effect of the use of similar pharmaceutical products is almost the same. And this makes it possible to choose the safest and most effective drug for a man at an affordable cost.

It is strictly forbidden to replace the prescribed agent with an analogue on your own. The choice of a substitute should be entrusted to a specialist who will take into account the peculiarities of the patient's state of health and his wishes.

Herbal analogue of Viagra

Speman is considered a combination drug that is ready to compete with the popular Viagra. It is based on the following medicinal herbs:

orchis;
asterkant long-leaved;
wild lettuce;
burning dolichos;
suvarnavanga;
beautiful argyrea;
creeping anchors;
mesh leptadenia;
pearl parmelia.

This tool is intended to improve the patient's reproductive abilities: increase the synthesis of sperm, their activity, sperm viscosity, eliminate congestion in the pelvis.

And this effect has a positive effect on potency. Treatment with Speman is long, at least 4-6 months. 6 tablets should be taken per day - two three times a day.

The result is not only an increase in the quality of intimate life, but also strengthening of immunity, healthy blood flow, restoration of prostate functions, and an increase in the overall tone of the body.

The drug has practically no contraindications and side effects, with the exception of individual intolerance to the components and allergic reactions to them.

Features of the drug

Viagra is produced by the German pharmaceutical company Pfizer. The shelf life is 2 years from the date of issue. The medicine should be stored in its original packaging, in a cool, dry place out of the reach of children. Released by prescription.

Viagra - pills, the action of which is aimed at the natural sexual arousal in men. The drug is commonly used to eliminate erectile dysfunction. The active ingredient of sildenafil tablets causes an increase in blood circulation in the genital area, resulting in increased and prolonged erection, as well as orgasmic experiences. Today in pharmacies under this name there are dietary supplements with natural ingredients, drugs to enhance libido and other means.

Viagra for men appeared on sale in 1998 and was intended to treat problems associated with potency. However, the drug was developed for completely different purposes. Initially, it was proposed to be used for patients with hypertension. But as it turned out during the study, he does not reduce pressure, but the men noted that after taking the pills they had a long erection.

More about pills for male strength, urologist Iskander Abdullin:

Later, the same effect was confirmed by other men. Therefore, it was decided to use the drug as a remedy for sexual impotence.

Over time, other manufacturers began to produce analogues (generics), which are still not always able to give the same effect that occurs after using Viagra.

The action of Viagra

How does Viagra work? The use of these tablets for men increases blood circulation in the penis. This is precisely the main secret of the effectiveness of the drug, since it is the violation of blood flow to the organ that can cause a lack of erection.

There is an opinion that after taking the pill, the erection will last a very long time. However, this is not quite true. The fact is that the action of Viagra begins only when a man is sexually aroused. If earlier he had arousal, but the erection was absent or was insignificant, then after using the drug, the penis reaches its natural size and the hardness necessary for sexual intercourse. Thanks to the pills, sexual intercourse is lengthened (), but after ejaculation, the erection disappears and can only occur when the man is re-excited. The duration of Viagra is about 4 hours, which will be enough for several full-fledged sexual acts.

Some "insurance" for a man is that the pill starts to act only under the condition of natural arousal, that is, it cannot start working at an inconvenient moment for this. In addition, a woman will not be able to suspect a man of using the drug.

It is important to note that the effect of the use of the drug may decrease if a large amount of alcohol is consumed. At the same time, the effect of Viagra will be stronger with moderate food intake.

Time of action

Those who decide to use this drug are interested in the question: “How long does the pill work”? The effect of the use of "Viagra" can be seen on average 15-60 minutes after ingestion. Although for some men this figure may vary. Knowing when Viagra starts to work and how long Viagra lasts, a man can schedule her intake in time.

Indications for use

The maximum daily dose of the drug for a healthy man is 100 mg. You need to start using tablets with 50 mg. For certain groups of patients (men over 65 years of age, patients with pathology of the kidneys, liver or cardiovascular system), this dosage is reduced to 25 mg. How to take Viagra correctly can tell the doctor after a detailed examination of the man. Do not exceed the dose recommended by your doctor.

How to take medication for the treatment of erectile disorders? This question will be answered by the host of the program “Live is great!” Elena Malysheva and Professor, Doctor of Medical Sciences, Director of the University Clinic of Lomonosov Moscow State University Kamalov Armais Albertovich:

How to take Viagra? Taking into account the principle of action of Viagra, it is recommended to drink the pill with a sufficient amount of water, which will reduce the time of its penetration into the blood. If you take the drug during a plentiful feast, then the effect of it can be reduced, since food, especially fatty foods, prevents its absorption.

Contraindications

Like all drugs, Viagra has its own contraindications for use. All of them are due to the possibility of side effects of the drug in the presence of certain diseases. Viagra contraindications are:

Hypersensitivity to the components that make up Viagra.
Reception of any means, which contain nitrates. According to studies, their simultaneous use can lead to a sharp decrease in pressure in a man.
Severe disorders in the liver.

Medicines with PDE-5 inhibitors. The ban on their simultaneous use is associated with the lack of clinical trials and the inability to predict the effect of tablets in this case.
Age up to 18 years.

According to the instructions, there are a number of conditions in which taking pills is allowed only under medical supervision and with extreme caution:

Features of the anatomy of the penis, which can be both congenital and acquired, in which blood circulation in the penis can be impaired. In such a situation, the effect of the drug cannot be predicted.
Pathologies associated with priapism (involuntary erection for several hours without prior sexual stimulation).

Leukemia.
thrombocytemia.

Blood leukemia is a tumor of the hematopoietic system that primarily affects the hematopoietic cells of the bone marrow.

Myeloma.
Genetic determination of retinol.
Exacerbation of peptic ulcer.
Pathology of the heart and other disorders in the work of the organ that were observed in a man in the past. Male Viagra and other arousal stimulants are not recommended for those who have had a heart attack, stroke or angina pectoris.

Even a single dose of the drug is possible only after consulting a doctor. The above list of contraindications is far from complete. Side effects of "Viagra" can occur when used simultaneously with other medicines.

Indications for use, contraindications and methods of using Viagra and its analogues are very similar. Do not rely on the reviews of other people who have taken them, as this can lead to negative consequences. Before you start using this or that drug, you should consult your doctor.

Possible Complications

The dosage of the drug affects the possibility of side effects. Investigating the possible harm of Viagra, doctors have identified a number of side effects:

Redness of the skin associated with increased blood circulation.
Headache.
Visual impairment (hypersensitivity to bright light, fog, etc.).

Candidate of Medical Sciences Elena Ivanovna Adamenko will talk about what dyspepsia is:

Dizziness.
An increase in heart rate.
Dyspepsia.

Nasal congestion.
Seizures.
Arrhythmia.

Arrhythmia - any disturbance of the regularity or frequency of the normal heart rhythm, as well as the electrical conduction of the heart

Nose bleed.
Fainting.
A sharp drop in blood pressure.

Overdose

If you use Viagra for potency in high doses, you may experience unpleasant symptoms:

From the side of the cardiovascular system: redness of the skin, headache, dizziness, nosebleeds, tachycardia.
From the digestive system: indigestion.
Seizures.

Arsen Tonyan - urologist-andrologist, candidate of medical sciences will talk about the action of Viagra:

In order to prevent their occurrence, it is important for a man to know how often Viagra can be taken and at what dose.

viagra gel

To restore erectile function in men, you can use not only tablets, but also a preparation in the form of a gel. "Viagra gel" has the same composition and properties, but due to the gel form, it starts to act faster. Therefore, it can be considered an effective alternative to the known means.

Price

Any drugs intended to increase the potency of a man can only be bought at a pharmacy. You don't need a prescription for Viagra.

The cost of Viagra in a pharmacy may vary. Basically, its price depends on the manufacturer.

Table 1. The cost of "Viagra"

Remedy at home

Since Viagra is quite expensive and has many contraindications, the question arises: “Is it possible to replace it with something”? It turns out that at home you can prepare a remedy that will be no less effective. Since this alternative to Viagra is made on the basis of natural ingredients, it is suitable for almost all men and does not cause unpleasant consequences.

To prepare such products, you can use products - aphrodisiacs, which can naturally increase male potency. Among them:

Black chocolate.
Natural coffe.
Beekeeping products.
Bananas.
Nuts.
Strawberry.
Seafood, especially mussels, oysters, caviar and shrimp.

Dear readers, in this video we will talk about products to improve erection in men:

Ginseng.
Olive oil.
Garlic.
Celery.
Horseradish.
Asparagus.
Dill.

Of course, they will not lead to an instant reaction, but if you include most of these products in your diet, then soon a man will not need any potency stimulants.

Watermelon remedy

"Viagra" at home can be made from ordinary watermelon. For this you need:

Wash a ripe watermelon and carefully cut off its rind, leaving the white part on the pulp.
Cut the berry into pieces and squeeze the juice with a juicer or blender.
Place 1 liter of squeezed juice in a saucepan and boil.

Preparation of "Homemade" Viagra from watermelon and lemon juice

Add the squeezed juice from 1 lemon to the boiled liquid.
Evaporate half of the liquid over very low heat.
After cooling, send the liquid to the refrigerator.

Every morning you should drink a few tablespoons of the medicine received.

nettle recipe

A product based on dried fruits and fresh nettles has a good effect. To prepare it, you need to take:

50 g nettle.
1 cup boiling water.
Honey to taste.

Pour chopped nettles in a thermos with boiling water. After 30 minutes, strain the liquid and mix with natural honey. To make the effect even better, before drinking the medicine, you need to take a few sips of red wine or natural pomegranate juice.

The use of dried fruits

A useful and effective remedy can be made on the basis of dried fruits. This will require:

Dried apricots.
Prunes.
Nuts.
Raisin.
Figs.

All components are taken in the same amount (250 g each). They must be crushed using a mortar. Every day, a man needs to eat 2 tablespoons of such a mixture, washed down with kefir.

Natural juices are no less effective: carrot, cucumber and beetroot. It is recommended to mix them in equal proportions and drink before meals.

The photo shows a crushed mixture of dried fruits.

Viagra is recognized as a fairly effective drug that helps improve erection. But what happens if an absolutely healthy man drinks it? It turns out that nothing will happen. If a man has a good erection, then it is unlikely to improve it. But if it is slightly reduced as a result of fatigue, stress or another reason, then the effect of the pill will definitely be.

Male power has always been the pride of any member of the stronger sex. But, for various reasons, it can worsen. In this case, various medications can come to the rescue, one of which is Viagra. It is recommended to buy it exclusively in a pharmacy, where the tablets have all the necessary documents. But before doing this, it is important to consult a doctor. The doctor will help not only choose the required dose of medication, but also check if the patient has any contraindications to its use.

Viagra is a pharmaceutical drug designed to correct erectile dysfunction. An interesting fact is that this remedy was developed by Pfizer specialists as a cardiological medicine, but as it was later noticed, the effect on the cardiovascular system was minimal, and further use was dictated by an exceptionally unusual side effect.

By the way, the developers of this tool, later, were awarded the Nobel Prize, and this discovery fell into the same rank with such random inventions as x-rays and penicillin. That is why it is important for us to talk with you today about the drug Viagra, the method of using this medication.

Viagra - instructions for use:

Composition and form of release

The only active ingredient in this drug is sildenafil. This chemical compound blocks the uptake and utilization of nitric oxide by inhibiting the activity of the enzyme phosphodiesterase-5.

In addition to the main active ingredient, each tablet contains other components needed to shape and so on. The list of additional chemical elements: microcrystalline cellulose, croscarmellose sodium, magnesium stearate, calcium hydrogen phosphate, titanium dioxide, lactose, and some others.

The drug is produced in tablet form, in the form of bluish tablets, slightly elongated with rounded edges. Pfizer is engraved on one side and VGR 50 on the other.

Supplied in blister packs containing 1 to 4 tablets containing 25 or 50 mg active ingredient. It is sold in pharmacies, and a prescription is not required for the purchase.

pharmachologic effect

Viagra is a selective inhibitor of an enzyme called phosphodiesterase-5. This substance is responsible for the processes of nitric oxide metabolism in the human body, which has a vasodilating effect. It is on this property that the developers of the drug were counting.

Viagra acts on the smooth muscle tissue of the cavernous body, contributing to its relaxation. As a result, much more blood enters the penis through the vessels that supply blood to the genitals of a man, contributing to the appearance of a pronounced erection.

It is believed, at least as stated by the manufacturer, that an erection will occur only in the case of sexual stimulation. In all other cases, the desired effect will not be achieved. So such scenes in comedy films are nothing more than a fiction of screenwriters.

The duration of erection can vary over a fairly wide range, from 30 minutes to several hours, and is determined by the dosage of the drug, as well as the residual ability to physiological function.

Indications for use

The use of Viagra is indicated only in one case - the correction of erectile dysfunction, in order to obtain a stable erection sufficient for a satisfactory sexual intercourse. Once again, I draw your attention to the fact that sexual stimulation is necessary to achieve the desired effect, in all other cases there will be no effect from the use of the drug.

Contraindications for use

Of course, Viagra is not indicated in all cases. There are diseases in the presence of which its use is undesirable, and perhaps even unacceptable. True, there are not so many such states. Below I will list the most common of them.

Individual intolerance to any of the components of Viagra;
The use of nitric oxide donators (organic nitrates);
The use of other erection stimulants;
In the presence of severe deformation of the penis, it is prescribed with caution;
In diseases accompanied by increased bleeding, caution should be exercised;
When transferred in the recent past (no more than 6 months) myocardial infarction and decompensated ischemic disease. Here the problem is not even in Viagra itself, but in the load that it implies.

Although Viagra is sold without a doctor's prescription, it is strongly recommended that you visit your doctor before using it. Perhaps he will help you choose the right, and therefore safe dosage, or prescribe a number of necessary examinations.

Application and dosage

Tablets should be taken one hour before the intended sexual intercourse. Reception begins with 50 mg, in the absence or insufficiency of the desired effect, the dosage can be increased to 100 mg per dose.

With poor tolerance, the dosage should be reduced to 25 mg, while monitoring the performance of the cardiovascular system. The maximum daily dose should not exceed 100 mg. In the elderly, in the absence of restrictions, as a rule, correction of the amount of the drug used is not required.

In case of pathology of the liver and kidneys, occurring against the background of a decrease in the function of these organs, the dosage of the drug is reduced to 25 mg.

Side effects

As always, unwanted effects should be considered depending on the organ system involved. From the organs of the central nervous system, headache, dizziness can sometimes occur, in some cases convulsions are possible.

From the side of the cardiovascular system: a drop in blood pressure, palpitations, fainting.

From the digestive system: nausea, vomiting, stool changes. Other side effects also occur: allergic reactions, blurred vision, and others.

Analogues

Viagra can be replaced by the following drugs: Levitra, Cialis,

Conclusion

Of course, Viagra allows you to prolong sexual activity even at a very advanced age. But when taking it, you should follow certain rules regarding the dosage and method of use, as well as periodically visit your doctor.

INN: Sildenafil

Manufacturer: Fareva Amboise

Anatomical-therapeutic-chemical classification: Sildenafil

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 012218

Registration period: 02.05.2018 - 02.05.2023

Instruction

Tradename

Viagra ®

International non-proprietary name

Sildenafil

Dosage form

Film-coated tablets 50 mg, 100 mg

Compound

One tablet contains

active substance - sildenafil citrate 70.225 mg and 140.450 mg (equivalent to sildenafil 50 mg and 100 mg),

auxiliary substances: microcrystalline cellulose, anhydrous calcium hydrogen phosphate, croscarmellose sodium, magnesium stearate,

Shell composition: Opadry blue OY-LS-20921 (hypromellose, lactose, triacetin, titanium dioxide (E 171) and indigo carmine aluminum varnish (E132)), Opadry transparent YS-2-19114 A (hypromellose and triacetin).

Description

Film-coated tablets, blue, biconvex, in the form of a rounded diamond marked "Pfizer" on one side and "VGR 50" (for a dosage of 50 mg) or "VGR 100" (for a dosage of 100 mg) on the other side.

Pharmacotherapeutic group

Preparations for the treatment of urological diseases. Other drugs for the treatment of urological diseases, including antispasmodics. Preparations for the treatment of erectile dysfunction. Sildenafil.

ATX code G04BE03

Pharmacological properties

Pharmacokinetics

Suction

Sildenafil is rapidly absorbed after oral administration. Peak plasma concentrations (Cmax) of sildenafil are reached within 30 to 120 minutes (median 60 minutes) after oral administration on an empty stomach. The mean absolute oral bioavailability is 41% (with a range of 25-63%). After oral administration of sildenafil in the recommended dose range (25-100 mg), the area under the pharmacokinetic curve (AUC) and Cmax increase in direct proportion to the dose taken.

When taking sildenafil with food, the absorption rate decreases with an average delay in the time to reach maximum plasma concentrations (tmax) of 60 minutes and an average decrease in Cmax by 29%.

Distribution

The mean equilibrium volume of distribution (Vd) for sildenafil is 105 L, indicating its distribution in body tissues.

After oral administration of sildenafil at a single dose of 100 mg, the mean maximum total plasma concentration of sildenafil is approximately 440 ng/ml (with a coefficient of variation of 40%). Due to the fact that sildenafil (and its main circulating metabolite, N-desmethyl metabolite) is 96% bound to plasma proteins, the average maximum concentration of free sildenafil in plasma is 18 ng / ml (38 nM). Protein binding is independent of total drug concentrations.

In healthy volunteers who received sildenafil once at a dose of 100 mg, less than 0.0002% (average 188 ng) of the dose of the drug was determined in the ejaculate 90 minutes after taking the dose.

Metabolism

Research in vitro

The metabolism of sildenafil is carried out mainly with the participation of microsomal liver isoenzymes CYP3A4 (main pathway) and CYP2C9 (secondary pathway) of cytochrome P450. For this reason, inhibitors of these isoenzymes can reduce, and inducers of these isoenzymes - increase the clearance of sildenafil.

By N-demethylation, the main circulating metabolite of sildenafil is formed, which undergoes further metabolism with a final elimination half-life of approximately 4 hours. The metabolite is characterized by a phosphodiesterase selectivity profile comparable to that of sildenafil, and the activity of the metabolite in vitro in relation to phosphodiesterase type 5 (PDE-5) is approximately 50% of the activity of the original substance of the drug.

Plasma concentrations of this metabolite are approximately 40% of sildenafil concentrations.

Sildenafil is a weak inhibitor of cytochrome P450 isoforms 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 (IC > 150 µM). Provided that the maximum concentration of sildenafil in blood plasma after taking the recommended doses of the drug is approximately 1 μm, it is unlikely that sildenafil will change the clearance of substrates of these isoenzymes.

breeding

The total clearance of sildenafil is 41 l / h, and the final half-life is from 3 to 5 hours. After oral administration, sildenafil is excreted as metabolites mainly in the faeces (about 80% of the oral dose) and to a lesser extent in the urine (about 13% of the oral dose).

Pharmacokinetics in special groups of patients

Elderly patients

In healthy elderly volunteers (aged 65 years or older), there was a decrease in the clearance of sildenafil, causing an increase in plasma concentrations of sildenafil and its active N-demethylated metabolite by approximately 90% compared with those in healthy younger volunteers (18-45 years old) . Due to age-related differences in plasma protein binding, the corresponding increase in free sildenafil plasma concentration is approximately 40%.

In patients with mild or moderate renal dysfunction (creatinine clearance 30-80 ml / min), the pharmacokinetics of sildenafil after a single oral dose of 50 mg does not change. The increase in the average AUC and Cmax of the N-demethylated metabolite was up to 126% and up to 73%, respectively, compared with such indicators in people of the same age without impaired renal function. However, due to the high inter-patient variability, these differences were not statistically significant. In patients with severely impaired renal function (creatinine clearance< 30 мл/мин) клиренс силденафила снижался, что приводило к средним повышениям показателей AUC и Cmax, соответственно на 100 % и 88 % по сравнению с пациентами аналогичного возраста без нарушений функции почек. Кроме того, значения AUC и Cmax для N-деметилированного метаболита также значительно повышались - на 200 % и 79 %, соответственно.

In patients with mild to moderate liver cirrhosis (Child-Pugh stages A and B), sildenafil clearance was reduced, resulting in an increase in AUC (by 84%) and Cmax (by 47%) compared with volunteers of the same age without liver dysfunction.

The pharmacokinetics of sildenafil in patients with severe hepatic impairment has not been studied.

Pharmacodynamics

Mechanism of action

Viagra®, an oral drug for the treatment of erectile dysfunction, that is, during sexual stimulation, it restores impaired erectile function by increasing blood flow to the penis.

The physiological mechanism of penile erection involves the release of nitric oxide (NO) in the cavernous bodies upon sexual stimulation. Nitric oxide activates the enzyme guanylate cyclase, which leads to increased levels of cyclic guanosine monophosphate (cGMP), followed by relaxation of smooth muscle in the corpus cavernosum and increased blood flow.

Sildenafil is a strong and selective inhibitor of cGMP-specific phosphodiesterase type 5 (PDE-5), which is responsible for the breakdown of cGMP in the cavernous bodies. Sildenafil has a peripheral effect on erection. Sildenafil does not have a direct relaxing effect on the isolated human corpus cavernosum, but significantly enhances the relaxing effect of NO on this tissue. When the NO/cGMP metabolic pathway is activated, as occurs during sexual stimulation, PDE-5 inhibition by sildenafil results in an increase in cGMP levels in the cavernous bodies. Therefore, for sildenafil to provide the desired productive pharmacological action, sexual stimulation is necessary.

Pharmacodynamic effects

In vitro studies

Sildenafil selectively acts on PDE-5, which is involved in the regulation of the erection process. The action of Viagra® on PDE-5 is stronger than on other known phosphodiesterases. This effect of Viagra® action is 10 times stronger than the effect on PDE-6, which takes part in phototransformation processes in the retina. When used in the maximum recommended doses, the selectivity of sildenafil to PDE-5 is 80 times higher than its selectivity to PDE-1, more than 700 times - selectivity to PDE-2, PDE-3, PDE-4, PDE-7, PDE-8 , PDE-9, PDE-10 and PDE-11. In particular, the selectivity of sildenafil to PDE-5 is 4000 times higher than its selectivity to PDE-3, a cAMP-specific isoform of phosphodiesterase involved in the regulation of heart contractions.

Clinical efficacy and safety

The safety and efficacy of sildenafil have been confirmed by data from long-term studies.

Indications for use

Erectile dysfunction, characterized by the inability to achieve or maintain an erection of the penis sufficient for satisfactory intercourse.

Viagra® is effective only with sexual stimulation.

Dosage and administration

For oral use.

Viagra ® may be taken with or without food. However, for the start of action of Viagra ® may take longer if taken with food.

Dosing regimen

Use in adults

Recommended dose of Viagra ® is 50 mg orally approximately 1 hour before sexual intercourse. Based on efficacy and tolerability, the dose may be increased to 100 mg. The maximum recommended dose is 100 mg.

The tablet should be swallowed whole with a glass of water.

Special patient groups

Elderly patients

In elderly patients (≥ 65 years), dose adjustment is not required.

Patients with impaired renal function

With mild to moderate renal dysfunction (creatinine clearance 30-80 ml / min), dose adjustment is not required. Due to a decrease in the clearance of sildenafil in patients with severe renal impairment (creatinine clearance< 30 мл/мин), следует рассмотреть возможность применения Виагры® в дозе 25 мг. Исходя из эффективности и переносимости препарата при необходимости, его дозу можно увеличивать поэтапно до 50 мг и до 100 мг.

Patients with impaired liver function

Due to the fact that the clearance of sildenafil is reduced in patients with impaired liver function (for example, cirrhosis), the possibility of using the drug at a dose of 25 mg should be considered. Based on the effectiveness and tolerability of the drug, if necessary, its dose can be increased in stages up to 50 mg and up to 100 mg.

Patients of childhood and adolescence

Sildenafil is not indicated for use in children (< 18 лет).

Use in patients taking other medicinal products

In order to reduce the risk of developing postural arterial hypotension in patients treated with alpha-blockers, the condition of patients receiving alpha-blockers should / stabilize the condition of patients receiving alpha-blockers before starting treatment with sildenafil. In addition, the possibility of using sildenafil should be considered, starting with a dose of 25 mg.

Side effects

When using Viagra®, undesirable effects were registered, which were classified according to the frequency of their manifestation as follows: very often (≥ 1/10), often (from ≥ 1/100 to< 1/10) , infrequently (from ≥ 1/1000 to< 1/100) and rare (≥ 1/10,000 and< 1/1000) .

Often

- headache

Often

Dizziness

Color distortions of vision (chloropsia, chromatopsia, cyanopsia, erythropsia, xanthopsia), visual disturbance, blurred vision

Hyperemia, hot flashes

- nasal congestion

Dyspepsia, nausea

Infrequently

Hypersensitivity

Drowsiness, hypoesthesia

Lacrimation disorders (dry eyes, lacrimal gland dysfunction, increased lacrimation), eye pain, photophobia, photopsia, ocular hyperemia, visual brightness, conjunctivitis

Spatial disorientation (vertigo), tinnitus

Tachycardia, palpitations

Arterial hypertension, arterial hypotension

Epistaxis, sinus congestion

Pain in the upper abdomen, gastroesophageal reflux disease, vomiting, dry mouth

Myalgia, pain in the extremities

Hematuria

Chest pain, fatigue, feeling hot

Elevated heart rate

Rarely

- acute cerebrovascular accident, transient ischemic attack, seizure*, seizure recurrence*, syncope

Anterior non-arteritic ischemic optic neuropathy*, retinal vascular occlusion*, retinal hemorrhage, arteriosclerotic retinopathy, retinal disease, glaucoma, visual field defect, diplopia, decreased visual acuity, myopia, asthenopia, vitreous floaters, iris disease, mydriasis, presence of iridescent circles in the field of vision, swelling of the eye, swelling of the eye, visual disturbance, conjunctival hyperemia, eye irritation, unusual sensation in the eye, swelling of the eyelids, discoloration of the sclera

Deafness

- sudden cardiac death*, myocardial infarction, ventricular arrhythmia*, atrial fibrillation, unstable angina

Feeling of tightness in the throat, swelling of the nose, dryness of the nasal mucosa

Oral hypoesthesia

Stevens-Johnson syndrome*, toxic epidermal necrolysis*

Bleeding from the penis, priapism*, hematospermia, increased erection - irritability

*adverse events recorded only during post-marketing surveillance.

Reporting Suspected Adverse Reactions

Communication of information about suspected adverse reactions identified after registration of the medicinal product is of great importance. This allows continued monitoring of the benefit/risk balance of the medicinal product.

Healthcare professionals and patients are asked to report any adverse reactions to the address provided at the end of this package leaflet.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Simultaneous administration of drugs that are donors of nitric oxide (amyl nitrite) or nitrates in any form

Simultaneous administration with guanylate cyclase stimulants (riociguat)

severe liver failure

Hereditary degenerative diseases of the retina (eg, hereditary retinitis pigmentosa (a small number of these patients have hereditary disorders of retinal phosphodiesterases))

Loss of vision in one eye due to anterior non-arteritic ischemic optic neuropathy, regardless of whether this episode was associated with previous use of a PDE-5 inhibitor or not

Arterial hypotension (BP< 90/50 мм рт. ст.)

Severe cardiovascular disease (eg, severe heart failure, unstable angina)

Myocardial infarction in the last 6 months

Stroke in the last 6 months

Concomitant use with CYP3A4 isoenzyme inhibitors (eg, ketoconazole, itraconazole, ritonavir, erythromycin, saquinavir, clarithromycin)

Concomitant use of drugs for the treatment of pulmonary arterial hypertension (bosentan, iloprost) and drugs containing sildenafil or any other PDE-5 inhibitor

Men with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption syndrome

Concomitant use with other oral or topical agents for the treatment of erectile dysfunction

Carefully:

anatomical deformity of the penis (including angulation, cavernous fibrosis, or Peyronie's disease)

conditions that predispose to priapism (such as sickle cell anemia (an abnormality of red blood cells), multiple myeloma (cancer of the bone marrow), or leukemia (cancer of the blood cells))

blood clotting problems (hemophilia)

bleeding disorders

exacerbation of peptic ulcer of the stomach or duodenum

simultaneous administration with drugs of the alpha-adrenergic blocking group

According to the registered indication, the drug is not intended for use in children and adolescents under the age of 18 years and in women.

Drug Interactions

Effect of other medicinal products on sildenafil

Research in vivo

With the simultaneous administration of sildenafil with CYP3A4 inhibitors (such as ketoconazole, erythromycin and cimetidine), a decrease in the clearance of sildenafil is observed. In this group of patients, there is no increased frequency of side effects, however, it is necessary to start treatment with Viagra® at an initial dose of 25 mg.

Simultaneous administration of the HIV protease inhibitor ritonavir, which is a strong inhibitor of cytochrome P450, in an equilibrium state (500 mg twice a day) with sildenafil (100 mg single dose) leads to an increase in the maximum concentration (Cmax) of sildenafil by 300% (4-fold), as well as an increase in plasma AUC of sildenafil by 1000% (11-fold). After 24 hours, plasma levels of sildenafil are approximately 200 ng/mL compared to approximately 5 ng/mL after sildenafil alone. These data are consistent with the pronounced effects of ritonavir on a wide range of cytochrome P450 substrates. Based on the above data, the concomitant use of sildenafil with ritonavir is not recommended.

Viagra does not affect the pharmacokinetics of ritonavir.

The maximum dose of sildenafil should not, under any circumstances, exceed 25 mg in 48 hours.

Simultaneous administration of the HIV protease inhibitor saquinavir, which is an inhibitor of CYP3A4, at steady state (1200 mg three times a day) with sildenafil (100 mg single dose) leads to an increase in Cmax of sildenafil by 140%, as well as an increase in AUC of sildenafil by 210%. Sildenafil does not affect the pharmacokinetics of saquinavir. Stronger CYP3A4 inhibitors, such as ketoconazole and itraconazole, have a more pronounced effect.

With a single dose of sildenafil at a dose of 100 mg together with erythromycin, a moderate inhibitor of CYP3A4, at steady state (500 mg twice a day for 5 days), there is an increase in systemic exposure of sildenafil by 182% (determined by the AUC value).

Azithromycin (at a dose of 500 mg per day for 3 days) does not affect the AUC, Cmax, Tmax, elimination rate constant or subsequent half-life of sildenafil or its main circulating metabolite.

The simultaneous use of cimetidine (800 mg), which is an inhibitor of cytochrome P450 and a non-specific inhibitor of CYP3A4 with sildenafil (at a dose of 50 mg) in healthy volunteers, causes an increase in plasma concentrations of sildenafil by 56%.

Grapefruit juice is a weak inhibitor of CYP3A4-mediated metabolism in the intestinal wall and may cause a moderate increase in plasma levels of sildenafil.

A single dose of an antacid (magnesium hydroxide / aluminum hydroxide) does not affect the bioavailability of sildenafil.

CYP2C9 inhibitors (tolbutamide, warfarin and phenytoin) receptors and inducers of P450 metabolic activity (rifampicin, barbiturates) do not affect the pharmacokinetics of sildenafil.

Co-administration of the endothelin antagonist bosentan (a moderate inducer of CYP3A4, CYP2C9 and probably CYP2C19) at steady state (125 mg twice daily) with sildenafil at steady state (80 mg three times daily) resulted in a decrease in AUC and Cmax for sildenafil by 62.6% and 55.4% respectively. Thus, it is believed that simultaneous use with strong CYP3A4 inducers, such as rifampin, causes a more pronounced decrease in plasma concentrations of sildenafil.

Simultaneous use with other PDE-5 inhibitors or other treatments for erectile dysfunction

The safety and efficacy of sildenafil in combination with other PDE5 inhibitors or other medicinal products containing sildenafil for the treatment of pulmonary arterial hypertension (PAH) or other drugs for the treatment of erectile dysfunction have not been studied. In this regard, the use of such combinations of drugs is not recommended.

Nicorandil is a hybrid of a potassium channel activator and nitrate. Due to the nitrate component, it is potentially capable of entering into serious interactions with sildenafil.

Effect of sildenafil on other medicinal products

Research in vitro

Data on the interaction of sildenafil with non-specific phosphodiesterase inhibitors, such as theophylline or dipyridamole, are not available.

In vivo studies

Consistent with the known action of sildenafil on the NO/cGMP signaling pathway, sildenafil is capable of enhancing the hypotensive effect of nitrates, namely a significant reduction in blood pressure. Therefore, its simultaneous use with nitric oxide donors (amyl nitrite) or nitrates in any form is contraindicated.

Riociguat

In clinical studies, riociguat enhanced the hypotensive effect of PDE-5 inhibitors. Data on a favorable clinical effect with the use of this combination in the studied population were absent. The simultaneous use of riociguat with PDE-5 inhibitors, including sildenafil, is contraindicated.

Simultaneous reception with alpha-blockers

It is recommended to use sildenafil with caution in patients taking a drug of the alpha-blocker group, since their simultaneous use can lead to symptomatic arterial hypotension in some sensitive patients. Most likely, this can be observed within 4 hours after taking a dose of sildenafil. To reduce the risk of developing postural arterial hypotension, a state of hemodynamic stability should be achieved in patients receiving treatment with alpha-blockers before starting treatment with sildenafil. The possibility of using sildenafil should be considered, starting with a dose of 25 mg. In addition, clinicians should instruct patients on what to do if symptoms of postural hypotension occur.

With the simultaneous use of sildenafil and doxazosin in patients stabilized with doxazosin therapy, rare cases of symptomatic arterial hypotension, dizziness and presyncope, but not syncope, have been reported.

With the simultaneous use of sildenafil (at a dose of 50 mg) with tolbutamide (at a dose of 250 mg) or warfarin (at a dose of 40 mg), both of which are metabolized by CYP2C9, no significant interactions were found.

Sildenafil (at a dose of 50 mg) does not contribute to an increase in bleeding time caused by taking acetylsalicylic acid (at a dose of 150 mg).

Sildenafil (at a dose of 50 mg) does not increase the hypotensive effect of alcohol in healthy volunteers at an average maximum blood alcohol level of 80 mg / dL.

Combining the following classes of antihypertensive drugs: diuretics, beta-blockers, ACE inhibitors, angiotensin II antagonists, antihypertensive drugs (vasodilators and centrally acting), adrenergic neuroblockers, calcium channel blockers and alpha-adrenergic blockers - did not reveal a difference in the side effect profile in patients taking sildenafil compared with patients receiving placebo. In special drug interaction studies in which sildenafil (at a dose of 100 mg) was used simultaneously with amlodipine in patients with arterial hypertension, an additional decrease in systolic blood pressure in the supine position was 8 mm. rt. Art. The corresponding additional reduction in diastolic blood pressure in the supine position was 7 mm. rt. Art. These additional blood pressure reductions were similar in magnitude to those observed when sildenafil was used in healthy volunteers as monotherapy.

Sildenafil (at a dose of 100 mg) does not affect the pharmacokinetics at steady state of the HIV protease inhibitors saquinavir and ritonavir, both of which are CYP3A4 substrates.

When used simultaneously with bosentan, sildenafil at steady state (80 mg three times a day) causes an increase in the AUC and Cmax of bosentan (125 mg twice a day) by 49.8% and 42%, respectively, in healthy male volunteers.

special instructions

To diagnose erectile dysfunction and determine its possible underlying causes, a medical history and physical examination should be performed before pharmacological treatment is considered.

Risk factors for cardiovascular disease

Before starting treatment for erectile dysfunction, the attending physician should assess the cardiovascular status of their patients, since there is a certain degree of risk of cardiac complications associated with sexual activity.

Before prescribing sildenafil, physicians should carefully consider the possibility of adverse effects of the vasodilating effect of this drug on the condition of patients with certain underlying diseases, especially in combination with sexual activity. The group of hypersensitivity to vasodilators includes patients with left ventricular outflow tract narrowing (for example, aortic valve stenosis, hypertrophic obstructive cardiomyopathy), as well as patients with a rare multiple system atrophy syndrome, manifested as a severe degree of impaired autonomic control of blood pressure.

Sildenafil leads to a slight and short-term decrease in blood pressure, which in most cases has no clinical manifestations. The average maximum decrease in systolic blood pressure in the supine position after oral administration of sildenafil at a dose of 100 mg was 8.4 mm Hg. Art. The corresponding change in diastolic blood pressure in the supine position was 5.5 mm. rt. Art. These reductions in blood pressure are consistent with the vasodilating effects of sildenafil, possibly due to increased levels of cGMP in vascular smooth muscle. A single oral dose of sildenafil up to 100 mg in healthy volunteers did not cause any clinically significant ECG changes.

In patients with severe ischemic heart disease (CHD), sildenafil at a dose of 100 mg did not affect cardiac output and did not reduce blood flow through stenotic coronary arteries.

Viagra® enhances the hypotensive effect of nitrates.

According to the action of Viagra ® on the metabolic pathway "nitric oxide / cyclic guanosine monophosphate (cGMP)", sildenafil is capable of enhancing the hypotensive effect of nitrates, therefore its simultaneous use with nitric oxide donators (such as amyl nitrite) or nitrates is contraindicated in any form.

During the post-registration period, cases of serious cardiovascular complications have been reported, including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, cerebrovascular bleeding, transient ischemic attack, arterial hypertension and arterial hypotension during the use of sildenafil. Most, but not all, of these patients had prior cardiovascular risk factors. Many of these events have been reported during or shortly after sexual intercourse, and several have been reported shortly after taking sildenafil without sexual activity. It is not possible to determine whether these events were directly related to the use of sildenafil, to sexual activity, to existing cardiovascular disease, to a combination of these factors, or to other factors.

Priapism

Medicinal products for the treatment of erectile dysfunction, including sildenafil, should be used with caution in patients with anatomical deformity of the penis (such as angulation, cavernous fibrosis, or Peyronie's disease), as well as in patients with diseases predisposing to the development of priapism (such as falciform cell anemia, multiple myeloma, or leukemia).

During the post-registration use of sildenafil, cases of prolonged erection and priapism have been reported. In the event of an erection lasting more than 4 hours, the patient should seek urgent medical attention. If left untreated, priapism can lead to damage to the tissues of the penis and irreversible loss of potency.

Impact on vision

There have been cases of visual impairment in connection with the intake of sildenafil and other PDE-5 inhibitors, namely a rare disease - anterior non-arteritic ischemic optic neuropathy. In case of any defects in visual acuity, you must stop taking Viagra® and consult a doctor.

Effect on blood clotting

Research in vitro using human platelets indicate that sildenafil enhances the antiaggregatory effect of sodium nitroprusside. There are no data on the safety of sildenafil in patients with bleeding disorders or active peptic ulcer, so sildenafil should be used after a careful assessment of the benefit/risk ratio.

Viagra should not be used in men with rare hereditary galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption syndrome, due to the lactose content in the drug shell.

Pregnancy and lactation

Viagra® is not indicated for use by women.

Appropriate and strictly controlled studies of the use of Viagra® in pregnant and lactating women have not been conducted.

reproductive function

The effect of the drug on sperm motility or morphology after a single oral dose of sildenafil at a dose of 100 mg was not found.

Features of the influence of the drug on the ability to drive a motor vehicle or potentially dangerous mechanisms

The effect of sildenafil on the ability to drive vehicles or operate potentially dangerous machinery has not been studied.

Before driving vehicles or working with mechanisms, patients should find out how their body reacts to taking Viagra®, due to side effects of the drug, such as dizziness and impaired visual perception.

Overdose

Adverse reactions reported in studies with a single dose of the drug at a dose of up to 800 mg with the participation of volunteers were comparable to those observed with lower doses of the drug, but their frequency and severity were higher. Taking higher doses of Viagra® (200 mg) does not lead to an increase in the effectiveness of the drug, but only to an increase in the frequency of adverse reactions (headache, hyperemia, dizziness, dyspepsia, nasal congestion and impaired visual perception).

In case of overdose, standard symptomatic measures should be taken.

Viagra is the drug that optimally affects the restoration of erectile dysfunction in men, which has developed against the background of disorders of the vascular or nervous system, overwork, stress, age-related changes. A man, even at an age, using a medication, is able to feel an erection, having an urgent need for this.

The correct use of the drug is the key to successful sexual intercourse. How to take Viagra should be explained by the doctor. The drug affects the blood flow in the pelvic organs, increases libido, restores erection, and also prolongs sexual intercourse.

general information

The active substance of the drug is sildenafil. After taking it, blood flow to the cavernous bodies of the penis increases only in the stage of sexual arousal. As a result, a natural erection occurs. The advantages of the drug is that, knowing how to take Viagra correctly, you can awaken only the natural physiological processes that manifest themselves in the male body during sexual desire.

The medicine is synthetic, its properties are visible only if there is a stimulus, that is, a stimulus of desire, this is evidenced by more than one review of men. Pills are able to correct erectile dysfunction, which was provoked by various factors: psychological, organic, physiological.

How to take

Before trying the remedy, it is important to read the instructions in detail in order to know exactly how to take Viagra correctly. It should be used 60 minutes before intimacy. Although it happens that its effect manifests itself earlier. It depends on the individual characteristics of the organism.

Every pharmacy sells medicine without a prescription.

About 4 hours after taking Viagra, it has the proper effect on male power, but only if there is sexual excitability, as well as the right mood for sexual intercourse. You should not wait for an erection if you just take a pill without having the appropriate factors for further continuation. After sex, the erection disappears, but after a while it returns again.

Excitation for 4 hours will be repeated as many times as the man wants. The maximum daily dose is 100 mg. Increasing it has a side effect. It is possible to use daily. If the effect is not achieved, you should consult a doctor who will reconsider the choice of dose.

Dosage and age

100 mg of the drug per day will be safe for middle-aged men who do not have pathological manifestations of the kidneys and liver. But doctors advise for those who use Viagra for the first time to take no more than 50 mg. If the effect is not enough, then the dosage can be increased. You should not buy a far from cheap other option that replaces the medication, you just need to consult a doctor.

For older men, it is worth knowing how to take Viagra. In this case, the daily dose should range from 25 to 50 mg, no more. When the drug is used frequently, more than 4 times a week, then the daily dose should be reduced for men of any age to 25 mg. It is also worth consulting with a doctor if the patient is taking vasodilator medications.

Application features

Taking the right medicine will help you feel a surge of male power.

Therefore, it is important to familiarize yourself with the features of using Viagra:

Reception is carried out one hour before the start of the act.
Washed down with warm water or other liquid that does not contain alcohol.
The tablet is drunk regardless of food.
During treatment, it is not recommended to eat those foods that have a high fat content (more than 30%).
It is forbidden to take the medication along with drugs containing inhibitors, nitrates, nitric oxide donators, alpha-blockers. The break between taking these drugs and Viagra should be at least 3 weeks.

Viagra: dosage, compatibility with alcohol and other drugs, reviews

Before the patient receives a prescription for the possibility of oral use of the drug, he must undergo a thorough examination, which will establish the causes of erectile dysfunction. A special place is given to pathologies of the cardiovascular system, since with problems in this area, excessive sexual activity is prohibited, as well as taking the remedy. If there are no contraindications for the use of Viagra, the dosage is prescribed according to the instructions.

Today, the medicine is on everyone's lips, men trust it, it is the most popular way to save the stronger sex from male impotence. But so that the effect of the drug is not impaired, Viagra should be taken exclusively according to the dosage and in accordance with all the requirements that should be remembered!

Can Viagra be taken with alcohol and food?

In fact, a tandem pill and alcohol can lead to serious negative consequences. This phenomenon provokes the effect of alcohol on the heart muscle. The pulse increases several times, doubling the load on the body. Moreover, even a healthy person can suddenly feel weakness, depression, anxiety, pain in the heart.

The following manifestations may occur:

increase in blood pressure;
headache resembling a hangover;
blurred consciousness;
allergy on the skin of the face.

As for fatty foods, it only affects the time before an erection. So, it can increase from an hour to an hour and a half or more.

What to do if Viagra does not work

The drug is a salvation for many men, but only if the correct dosage is chosen, if Viagra does not have the proper effect, it is necessary to look for the cause of such a problem.

Such a reason may be:

There is no object of desire. Sildenafil is not a magic pill that will do the unthinkable in 10 minutes. When there is no causative agent of the penis, then its vessels, dilated from the action of the drug, will not properly fill with blood. As a result, an erection will not occur.
Tablets have a certain time interval from the beginning of exposure to the end. Each man is endowed with his own interval, but the standard is 4-6 hours. The onset of influence is manifested 50-60 minutes after ingestion.
Having inattentively studied the instructions, men combine alcohol with the use of Viagra, which is strictly prohibited. It is also important to understand that pre-eaten fatty foods can increase the time to effect.
It often happens that the drug begins to have an effect only after 3-4 uses, naturally in different periods. Do not despair if it didn’t work out the first time, perhaps the dosage of Viagra was chosen incorrectly, or rather, the attending physician can correct it.

How often can you take Viagra

When using Viagra, one should not forget that taking more than 1 tablet per day (100 mg) is strictly prohibited. The frequency of use of the drug without harm to health - from 2 to 4 times a week. Otherwise, undesirable consequences may develop.