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Viagra - instructions for use, reviews, analogues (generics) and release forms (tablets 25, 50 and 100 mg) of the drug for the treatment of erectile dysfunction in men. Use in Women

Viagra - instructions for use, reviews, analogues (generics) and release forms (tablets 25, 50 and 100 mg) of the drug for the treatment of erectile dysfunction in men. Use in Women

In this article, you can read the instructions for using the drug Viagra. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Viagra in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues or generics of Viagra in the presence of existing structural analogues. Use to treat erectile dysfunction in men, as well as the possibility of using in women.

 

Viagra - is a potent selective inhibitor of cGMP-specific phosphodiesterase type 5 (PDE-5).

 

The realization of the physiological mechanism of erection is associated with the release of nitric oxide (NO) in the cavernous body during sexual stimulation. This, in turn, leads to an increase in the level of cGMP, subsequent relaxation of the smooth muscle tissue of the cavernous body and an increase in blood flow.

 

Sildenafil does not have a direct relaxing effect on an isolated cavernous body in humans, but enhances the effect of NO by inhibiting PDE-5, which is responsible for the degradation of cGMP.

 

A mandatory condition for the effectiveness of Sildenafil is sexual stimulation.

 

Composition

 

Sildenafil citrate + excipients.

 

Pharmacokinetics

 

The pharmacokinetics of sildenafil in the recommended dose range is linear. After ingestion, Viagra is rapidly absorbed. When taken in combination with fatty foods, the rate of absorption decreases.

 

Sildenafil is metabolized mainly in the liver.

 

After ingestion, Viagra is excreted as metabolites, mainly with feces (approximately 80% of the dose) and, to a lesser extent, with urine (approximately 13% of the dose).

 

In healthy elderly people (over 65 years), the clearance of sildenafil is reduced, and the concentration of free active substance in the plasma is approximately 40% higher than its concentration in young (18-45 years) patients.

 

Indications

  • treatment of erectile dysfunction characterized by an inability to achieve or maintain an erection penis sufficient for a satisfactory sexual intercourse.

 

Viagra is effective only in the presence of sexual stimulation.

 

Forms of release

 

Tablets coated with 25 mg, 50 mg and 100 mg.

 

Instructions for use and dosage

 

The drug is taken orally.

 

For most patients, the recommended dose is 50 mg approximately 1 hour before sexual activity. With regard to efficacy and tolerability, the dose can be increased to 100 mg or reduced to 25 mg.

 

The maximum recommended dose is 100 mg. The maximum recommended frequency of application is 1 time per day.

 

In elderly patients, dose adjustment is not required.

 

To minimize the risk of postural hypotension in patients taking alpha-adrenoblockers, Viagra should be started only after hemodynamics stabilization in these patients has been achieved.You should consider the advisability of reducing the initial dose of Viagra.

 

Side effect

  • headache, dizziness;
  • vasodilation (tides of blood to the face);
  • rhinitis (nasal congestion);
  • dyspepsia;
  • skin rash;
  • convulsions;
  • tachycardia, decreased blood pressure, syncope;
  • vomiting;
  • Pain in the eyes.

 

Contraindications

  • hypersensitivity to sildenafil or to any component of the drug;
  • use in patients who receive continuously or intermittently donators of nitric oxide, organic nitrates or nitrates in any form, since sildenafil enhances the hypotensive effect of nitrates.

 

The drug is not intended for use in children and adolescents aged 18 years, in women. The use of the so-called female Viagra, which one can find mention in the forums - is nothing more than a myth designed for gullible consumers.

 

Application in pregnancy and lactation

 

According to the registered indication, the drug Viagra is not intended for use in women.

 

Use in children

 

The drug is not intended for use in children and adolescents aged 18 years.

 

Application in elderly patients

 

In elderly patients, dose adjustment is not required.

 

special instructions

 

To diagnose erectile dysfunction, determine their possible causes and choose an adequate treatment, you must collect a complete medical history and conduct a thorough physical examination. Erectile dysfunction treatment agents should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis, Peyronie's disease), or in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia).

 

During postmarketing studies, cases of development of prolonged erection and priapism were reported. If the erection persists for more than 4 hours, the patient should immediately seek medical help. If priapism therapy has not been performed immediately, it can lead to damage to the penile tissue and an irreversible loss of potency.

 

Drugs intended for the treatment of erectile dysfunction should not be prescribed to men for whom sexual activity is undesirable.

 

Sexual activity represents a certain risk in the presence of heart disease, so before starting any therapy for erectile dysfunction, the doctor should refer the patient to a cardiovascular system examination.Sexual activity is undesirable in patients with heart failure, unstable angina, suffered in the last 6 months by myocardial infarction or stroke, life-threatening arrhythmias, hypertension (blood pressure more than 170/100 mm Hg), or hypotension (blood pressure less than 90/50 mm Hg. st.). In clinical studies, there was no difference in the incidence of myocardial infarction (1.1 per 100 people per year) or cardiovascular death rate (0.3 per 100 people per year) in patients receiving Viagra, compared with patients receiving placebo.

 

Cardiovascular complications

 

During the postmarketing use of sildenafil for the treatment of erectile dysfunction, adverse events such as severe myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, hypertension and hypotension), which had a temporary connection with the use of sildenafil. Most of these patients, but not all of them, had risk factors for cardiovascular complications.Many of these adverse events were observed soon after sexual activity, and some of them were noted after taking sildenafil without subsequent sexual activity. It is not possible to establish the presence of a direct link between the observed undesirable phenomena and these or other factors.

 

Hypotension

 

Sildenafil has a systemic vasodilating effect, resulting in a transient decrease in blood pressure, which is not a clinically significant effect and does not lead to any consequences in most patients. Nevertheless, before the appointment of Viagra, the doctor should carefully evaluate the risk of possible undesirable manifestations of vasodilating action in patients with the corresponding diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as with a rare syndrome of multiple systemic atrophy, manifested severe violation of the regulation of blood pressure from the autonomic nervous system.

 

Since the combined use of sildenafil and alpha-blockers can lead to symptomatic hypotension in selected sensitive patients, Viagra should be administered with caution to patients taking alpha-blockers. To minimize the risk of postural hypotension in patients taking alpha-adrenoblockers, Viagra should be taken only after stabilization of hemodynamics in these patients has been achieved. You should also consider the advisability of reducing the initial dose of Viagra. It is necessary to inform patients about what actions should be taken in case of symptoms of postural hypotension.

 

Visual disorders

 

In rare cases, during the post-marketing application of all PDE-5 inhibitors, incl. sildenafil, reported non-arteritis in the anterior ischemic optic nerve neuropathy (NPINZN) - a rare disease and the reason for the reduction or loss of vision. Most of these patients had risk factors, in particular, a reduction in the ratio of the diameter of the excavation and the optic disc ("stagnant disk"), age over 50 years, diabetes, hypertension, IHD, hyperlipidemia and smoking.In the observational study, it was assessed whether the recent use of preparations of the class of PDE-5 inhibitors with the acute onset of NPINZN was associated. The results indicate an approximately 2-fold increase in the risk of NPINZ within 5 half-lives after the use of the PDE-5 inhibitor. According to the published literature, the annual incidence of NPINZN is 2.5-11.8 cases per 100 000 men aged over 50 years in the general population. It should be recommended to patients in the event of a sudden loss of vision to stop sildenafil therapy and immediately consult a doctor. Persons who already had a case of NPINZ have an increased risk of recurrence of NPINZN. Therefore, the physician should discuss this risk with such patients, and discuss with them the potential for adverse effects of PDE-5 inhibitors. Inhibitors of PDE-5, incl. sildenafil, these patients should be used with caution and only in situations where the expected benefit outweighs the risk.

 

A small number of patients with hereditary pigment retinitis have genetically determined impairments of the functions of the retina phosphodiesterase.Information about the safety of the use of Viagra in patients with retinitis pigmentosa absent, so sildenafil should be used with caution.

 

Hearing Impairment

 

Some post-marketing and clinical studies report cases of sudden deterioration or hearing loss associated with the use of all PDE5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or loss of hearing. The causal relationship between the use of PDE5 inhibitors and sudden deterioration of hearing or loss of hearing is not established. In the event of sudden deterioration of hearing or hearing loss with sildenafil, the patient should consult a doctor immediately.

 

Bleeding

 

Sildenafil enhances the antiplatelet effect of sodium nitroprusside, a donator of nitric oxide, on human platelets in vitro. Data on the safety of sildenafil in patients with a tendency to bleeding or exacerbation of peptic ulcer of the stomach and duodenum are absent, therefore, the Viagra preparation in these patients should be used with caution.The incidence of nasal bleeding in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (sildenafil 12.9%, placebo 0%) than in patients with primary pulmonary hypertension (sildenafil 3%, placebo 2.4%). In patients who received sildenafil in combination with a vitamin K antagonist, the incidence of nasal bleeding was higher (8.8%) than in patients who did not take a vitamin K antagonist (1.7%).

 

Application in conjunction with other treatments for erectile dysfunction

 

The safety and efficacy of Viagra, together with other PDE5 inhibitors or other drugs for the treatment of pulmonary hypertension containing sildenafil (eg, Revazio), or other means of treating erectile dysfunction have not been studied, so the use of such combinations is not recommended.

 

Fertility function

 

According to recent unverified clinical studies, prolonged use of Viagra may affect reproductive function in men, leading to the formation of spermatozoa with an immature head, which reduces fertility and the possibility of fertilization.

 

Impact on the ability to drive vehicles and manage mechanisms

 

Against the background of taking Viagra, there was no adverse effect on the ability to drive a car or other technical means. However, since taking a drug can reduce blood pressure, the development of chromatopsy, blurred vision, you should carefully consider the individual effect of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.

 

Drug Interactions

 

The effect of other drugs on the metabolism of sildenafil

 

Metabolism of sildenafil occurs mainly in the liver under the action of isoenzymes CYP3A4 (the main way) and CYP2C9, therefore inhibitors of these isoenzymes can reduce the clearance of sildenafil, and inductors, respectively, increase the clearance of sildenafil.

 

With the simultaneous use of CYP3A4 inhibitors (such as ketoconazole, erythromycin, cimetidine), a decrease in sildenafil clearance was noted.

 

Cimetidine (800 mg), which is a non-specific inhibitor of CYP3A4, while taking with Viagra (at a dose of 50 mg) causes an increase in the concentration of sildenafil in plasma by 56%.

 

A single intake of sildenafil in a dose of 100 mg concomitantly with Erythromycin - a specific inhibitor of CYP3A4 (when taking erythromycin by 500mg 2 times a day for 5 days) - against the background of achieving a constant concentration of erythromycin in the blood leads to an increase in the AUC of sildenafil by 182%.

 

With the simultaneous use of sildenafil (once in a dose of 100 mg) and saquinavir (1200 mg dose 3 times a day), which is both an inhibitor of the HIV protease and an inhibitor of CYP3A4, in the presence of a constant concentration of saquinavir in the blood, Cmax sildenafil in the blood was increased by 140%, and the AUC increased by 210%. Sildenafil had no effect on the pharmacokinetic parameters of saquinavir.

 

More potent inhibitors of the CYP3A4 isoenzyme, such as Ketoconazole or itraconazole, can cause more pronounced changes in the pharmacokinetics of sildenafil.

 

Simultaneous use of sildenafil (once in a dose of 100 mg) and ritonavir (500 mg twice a day), which is an inhibitor of HIV protease and a strong inhibitor of cytochrome P450 isozymes, against the background of achieving a constant concentration of ritonavir in the blood leads to an increase in Cmax of sildenafil by 300 % (4 times), and AUC by 1000% (11 times). After 24 h of sildenafil plasma concentration was approximately 200 ng / ml (a single application of sildenafil - 5 ng / ml).

 

If Viagra is taken at recommended doses, patients receiving concomitant strong inhibitors of CYP3A4, Cmax of free sildenafil does not exceed 200 nM, and the drug is well tolerated.

 

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

 

In studies involving healthy volunteers, concurrent use of an endothelin receptor antagonist, bosentan (isoenzyme inducer CYP3A4 (moderate), CYP2C9 and possibly CYP2C19) at an equilibrium concentration of 125 mg twice daily and sildenafil at an equilibrium concentration of 80 mg 3 times per day) there was a decrease in AUC and C max sildenafil by 62.6% and 52.4%, respectively. Sildenafil increased AUC and Cmax bosentan by 49.8% and 42%, respectively. It is assumed that the simultaneous use of sildenafil with powerful inducers of the CYP3A4 isoenzyme, such as rifampicin, may lead to a greater decrease in the concentration of sildenafil in the blood plasma.

 

CYP2C9 isoenzyme inhibitors (such as tolbutamide, warfarin), CYP2D6 isoenzymes (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazides and thiazide-like diuretics, ACE inhibitors and calcium antagonists have no effect on the pharmacokinetics of sildenafil.

 

Simultaneous administration of Azithromycin (500 mg per day for 3 days) does not affect AUC, Cmax, Tmax, rate of elimination rate and T1 / 2 sildenafil or its main circulating metabolite.

 

Effect of sildenafil on other drugs

 

Sildenafil is a weak inhibitor of cytochrome P450 - 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 isoenzymes (the IK50 is more than 150 μmol). When sildenafil is used in recommended doses, its Cmax is about 1 μmol, so it is unlikely that sildenafil can affect the clearance of the substrates of these isoenzymes.

 

Sildenafil enhances the hypotensive effect of nitrates both for long-term use and for acute use. In this regard, the use of sildenafil in combination with nitrates or donators of nitric oxide is contraindicated.

 

With simultaneous administration of alpha-adrenoblocker Doxazosin (4 mg and 8 mg) and sildenafil (25 mg, 50 mg and 100 mg) in patients with benign prostatic hyperplasia with stable hemodynamics, the mean additional decrease in systolic / diastolic blood pressure in the supine position was 7 / 7 mm pt.c., 9/5 mm Hg. and 8/4 mm Hg. respectively, and in the standing position - 6/6 mm pt.c., 11/4 mm pt.ct.and 4/5 mm Hg. respectively. We report rare cases of development in these patients of symptomatic postural hypotension, manifested as dizziness (without syncope). In individual sensitive patients receiving alpha-blockers, simultaneous use of sildenafil can lead to symptomatic hypotension.

 

Signs of significant interaction of sildenafil with tolbutamide (250 mg) or Warfarin (40 mg), which are metabolized by CYP2C9, have not been identified.

 

Viagra in a dose of 100 mg does not affect the pharmacokinetic parameters of HIV protease inhibitors at their constant concentration in the blood, such as saquinavir and ritonavir, which are simultaneously substrates of CYP3A4.

 

Simultaneous use of sildenafil in an equilibrium state (80 mg 3 times a day) leads to an increase in AUC and Cmax bosentan (125 mg twice a day) by 49.8% and 42%, respectively.

 

Sildenafil in a dose of 50 mg does not cause an additional increase in bleeding time when taking Acetylsalicylic acid in a dose of 150 mg.

 

Sildenafil in a dose of 50 mg does not increase the hypotensive effect of ethanol in healthy volunteers with a maximum level of ethanol in the blood at an average of 0.08% (80 mg / dL).

 

In patients with hypertension, there was no evidence of interaction between sildenafil (100 mg dose) and amlodipine. The average additional decrease in blood pressure in the prone position is 8 mm Hg. (systolic) and 7 mm Hg. (diastolic).

 

The use of sildenafil in combination with antihypertensive drugs does not lead to additional side effects.

 

Analogues of the drug Viagra

 

Structural analogs for the active substance:

  • Viagra soft (lingual chewing);
  • Viassan LF;
  • Vizarsin;
  • Dynamics;
  • Maxigra;
  • Malegra;
  • Revacio;
  • Sildenafil;
  • Potenciagram;
  • Fielden (lingual chewing);
  • Eregra.

Similar medicines:

Other medicines:

Reviews (18):
Guests
Don
All other generics of this drug are *** complete. Use a proven original and you will be happy. And all sorts of tales about death from cardiovascular are either fictions, or stories of those who do not read instructions and receive an unsatisfactory final result.
Guests
diric
Really worth it and does not bend :) The remedy for impotence is that it's necessary and the age here has nothing to do with this age of stress only stimulants and you can support yourself regardless of age, but here you have to have Viagra.
Guests
MACHO
Recently, the grandfather died on the floor below, his grandfather was good, clockwork, the girls in the yard were pinching. It turned out that he was sitting on some Viagra generic, telling me himself. As a result, died of heart failure, had sex with one of the passions on this anabolic and moved his legs. So I would be afraid to indulge in this medicine.

PS Although the death of the grandfather took a decent, like a man. Rusty the state :)
Guests
santo
The drug is distinguished by a rapid start and rapid damping of the effect, so that I would choose better natural plant "fixers" rather than short-term chemistry.
Guests
div4ina
I thought that only I stumble on the Internet for serious side effects from this drug, but judging by the reviews, I'm not the only one!
Guests
Denis R.
I believe that Viagra is the drug that has long occupied a strong place in the pharmaceutical market. Despite its popularity and dignity, I personally noted shortcomings, for example, my friend who used Viagra had heart problems. So I can think of using this drug, but neatly.
Guests
Valentine
Viagra is a normal means to ensure that in sex everything was fine. I myself accept, since the force is not the same. I'm not complaining about my heart and blood pressure, although they are jumping, but this is in life, as some people say that they take heart directly - it's probably a Chinese counterfeit they take, so they get heart problems. On health, you can not save, all these generics are bullshit.
Guests
Valentin Ivanovich Petrenko
The best viagra that I saw on the Internet (generic course) is on the site *** advertising is prohibited ***. I tried the whole assortment there - I liked the best Cialis after all - it works soothingly, does not load the cardiovascular system. And about the comments above, where a lot of people died - guys,the original and the generic Viagra have the same contraindications - diseases of the cardiovascular system: it is impossible to assign it to yourself! The doctor must do this!
Guests
giant
A good drug. Stojak keeps as it should be about 5-6 hours exactly. Sometimes there is a morning breakdown, apparently the residual phenomena taken on the eve of tablets. Tablets can be divided (I gnaw out the piece I need, usually a quarter) and wash it down with water. You can use generics, which are now full, but you need to find a quality supplier (with this recently very tightly), because the original Viagra costs on orders of magnitude more generic.
Guests
Ivan
After the army, nerves started with problems with a member, read at forums, took Viagra (expensive) for testing, and a more profitable Vizrasin. The girl with the army oh, how she waited. Sex all night engaged.
Guests
whitey
Recently I tried another cool thing called Super Viagra - this is when a combination of Viagra and Dapoxetin is combined in one tablet, as a result, a good solid riser is obtained, like a young one, plus I can not stop for a long time, thanks to the depot in the composition.I will not say a specific manufacturer, most likely some kind of Indian generic was, I bought in an Internet shop. All successful spiers-wigs :-)
Guests
a lion
Tried about 15 years ago. The result is "0". I just feared meeting a woman began to doubt, screwed myself, decided to buy. But if the organism gives energy, then it takes something from somewhere ... And then, as in the commentary above, forward with your feet.
Guests
Marmot
Viagra itself gives an effect, I agree. But if there are complaints about the heart, I would not take it. I do not accept, I've known for a long time about Alikaps, Sealex - they are harmless, because on grasses. But there is one more point. They want to withdraw from production, Pfizer is actively lobbying, because our bada - a powerful competitor of Viagra. Therefore, from the principle I will not buy Viagra!
Guests
Marat
I do not know how about generics, I did not risk it. But Viagra, despite the recommended 50-milligram dose, it helped me quite effectively at 25 milligrams. 4 hours of sekas and full riser to the very end.
Visitors
sadovod878
Heart healthy, but damned emphysema of the lungs ... What will you advise?
Administrators
admin
sadovod878, Viagra is not contraindicated in emphysema. If there is no other pathology and the drug is recommended by the attending physician, it can be used as described in the instructions and recommendations of a specialist. This drug was originally developed to combat pulmonary hypertension, which often takes place during emphysema, so that it is a blessing and pleasure.
Visitors
rebenok
Yes Viagra at the right time, especially when your day was tense and we say there were many stresses, then it comes to the aid of Viagra))
Guests
Husband
Husband, Post your feedback to the drug Vizarsin, where it is more appropriate.
admin

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