Viagra and health: Beyond ED

High altitudes produce low blood-oxygen levels.

Side effects

If PDE-5 were found exclusively in the penis, the side effects of these drugs would be limited to that obdurate organ; in fact, a rare side effect is priapism, painful prolonged erections that require urgent treatment. But small amounts of PDE-5 are found in blood vessels in other parts of the body. In addition, PDE-5 is just one of 11 enzymes in the phosphodiesterase family. The others are concentrated in different parts of the body. While the ED pills have a much greater affinity for PDE-5 than the other PDEs, they have some ability to inhibit those closely related enzymes.

What should I do if I accidentally use too much sildenafil?

Both factors explain why the ED pills sometimes produce side effects in many parts of the body. The most common buy soft viagra side effects are headaches and facial flushing, which occur in about 15% of men. Other reactions include nasal congestion, indigestion, and back pain; blue-tinged vision is even less common. In almost every case, these side effects are mild and transient. But new information has added a rare eye disease to the list. In turn, low oxygen produces a narrowing of the pulmonary arteries.

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The heart must therefore work harder, reducing the capacity to exercise.

Chemical synthesis

The three drugs are so similar because they share a common target, an enzyme called phosphodiesterase-5 (PDE-5). To understand why blocking PDE-5 improves sexual function, however, you have to know how erections develop. Normal erections require a receptive state of mind, adequate levels of testosterone, and healthy arteries, veins, and nerves. But they also require a tiny chemical messenger called nitric oxide (NO). It serves two crucial functions: transmitting the impulses of arousal between nerves and relaxing the smooth muscle cells in the arteries, allowing them to widen and admit more blood to the penis.

Who should not take sildenafil?

Nitric oxide is essential because it signals the arterial cells to produce cyclic guanosine monophosphate (cGMP), the chemical that increases the flow of blood to the penis. But the tissues of the penis also produce PDE-5, the enzyme that breaks down cGMP. In normal circumstances, the penis generates enough cGMP to produce a rigid erection and enough PDE-5 to end the erection when ejaculation is complete. In many men with ED, this intricate system is out of balance, but one of the three oral medications can often make it right. By inhibiting PDE-5, they increase the supply of cGMP, which for many men will allow erections to develop. To find out if it might improve exercise capacity in low oxygen conditions, scientists tested 14 healthy mountain climbers in a lab in Germany and again at a Mount Everest base camp.

What special precautions should I follow?

But because the nitrates and ED pills all act on nitric oxide, they do not mix. Men who are taking nitrates should never use any of the ED pills. This ban includes all preparations of nitroglycerin (short-acting, under-the-tongue tablets or sprays); long-acting nitrates (isosorbide dinitrate, or Isordil, Sorbitrate, and others, and isosorbide mononitrate, Imdur, ISMO, and others); nitroglycerin patches and pastes; and amyl nitrite (so-called poppers, used for sexual stimulation by some men). ED pills are quite safe for men with stable cardiovascular disease who do not take nitrates. This group includes patients with stable angina, previous heart attacks, mild congestive heart failure, well-controlled hypertension, and previous strokes.

Interactions with other medications

But men with recent heart attacks and strokes should wait until they have recovered fully, and patients with unstable blood pressure, active angina, or any other complex or unusual problem should hold off and get specific medical guidance. And men who take alpha blockers (particularly terazosin, or Hytrin, and doxazosin, or Cardura) for hypertension or benign prostatic hyperplasia (BPH) should use ED pills (particularly vardenafil or tadalafil) with great caution, if at all. Studies also suggest that sildenafil may increase respiratory distress in men with severe sleep apnea and that it slows gallbladder function, which might increase the risk of gallstones. Scientists who noticed that the ED pills can produce side effects in many parts of the body are asking if they can also serve therapeutic roles beyond male (or female) sexuality. Because of its seniority, most of the research has used sildenafil, so it's not clear if the newer medications will fill similar roles. In the lab, the volunteers breathed 10% oxygen through a mask; on the mountain, they breathed natural air. Under both conditions, a 50-mg sildenafil tablet decreased pressures in the lungs' blood vessels and increased the maximum exercise capacity.

Society and culture

Nonarteritic anterior ischemic optic neuropathy (NAION) is a poorly understood disorder that can cause blindness. In March 2005, doctors reported that seven men experienced visual impairment within hours of using sildenafil. Since then, additional cases have been reported to the FDA related to sildenafil, tadalafil, and vardenafil. Fortunately, the number of cases is very small in relation to the millions of men who have used ED pills successfully. It's not clear that there is a cause-and-effect relationship between ED pills and NAION.

Related treatment guides

At present, the concern is not great enough to prevent men from using these pills, but all men should use them carefully and responsibly. The most important worry about ED pills is their ability to widen arteries enough to lower blood pressure. It's rarely a problem in healthy men, but it explains a crucial precaution that applies to all three medications. Nitrates are medications that temporarily widen arteries by increasing their supply of nitric oxide. That's how they widen partially blocked coronary arteries in patients with angina. It's a small study, and it's too soon to say if sildenafil will help prevent or treat acute mountain sickness. Still, a study of 29 climbers reported that tadalafil can also reduce pulmonary artery pressure at a high altitude. In affected individuals, exposure to the cold triggers spasm of the small arteries that supply blood to the fingers, toes, or both. Temporarily deprived of adequate blood flow, the involved digits become pale, cold, and very painful. It's a common condition, affecting up to 8% of men and 17% of women.

Recommended reading

But for sildenafil, at least, some new uses appear promising. It's the only nonsexual condition that has earned FDA approval for sildenafil. But since it's a serious problem, any benefit is most welcome. When we think of blood pressure, we usually think of the systemic circulation, of the blood pumped from the heart's left ventricle to the aorta and then to the smaller arteries that carry oxygen-rich blood throughout the body. But to pick up vital oxygen, blood must first pass from the less powerful right ventricle through the pulmonary artery to the lungs, then back to strongest viagra pill the left side of the heart.

Top How Young Can You Be for Viagra Related Articles

The pressures in the pulmonary artery are much lower (about 20/10 millimeters of mercury, or mm Hg) than in the aorta (lower than 120/80 mm Hg is considered healthy). Exercise is the most common cause of rising pulmonary artery pressure, but the elevation is mild and subsides promptly with rest. High altitudes are another cause, which can lead to mountain sickness (see below). Far more serious are the large number of lung diseases, vascular diseases, heart disorders, and miscellaneous conditions that can cause pulmonary hypertension. And in primary pulmonary hypertension, no underlying cause is evident. In the vast majority, there are no underlying diseases (primary Raynaud's), and patients do well simply by minimizing their exposure to cold.

• Viagra is a prescription medication used to treat erectile dysfunction in men.
• The active ingredient in Viagra is sildenafil citrate.
• Viagra works by increasing blood flow to the penis during arousal.
• It is typically taken 30 to 60 minutes before sexual activity.
• Common side effects include headaches, flushing, and nasal congestion.
• Viagra should not be used with nitrates or certain medications.
• It is effective for about 4 to 6 hours after ingestion.

But secondary Raynaud's can complicate collagen-vascular diseases or certain other conditions.

Risk	Description	Severity	Prevention/Treatment
Priapism	Painful, prolonged erection	Serious	Seek immediate medical attention
Vision disturbances	Blur or color vision changes	Mild to moderate	Stop use and consult doctor
Hearing loss	Sudden decrease or loss of hearing	Rare but serious	Medical emergency, discontinue use
Allergic reactions	Rash, itching, swelling	Mild to severe	Discontinue and seek medical help

It's not common, but secondary Raynaud's can be very painful and difficult to treat.

• Viagra can help improve the quality of your sexual relationship.
• People should inform their doctor about any allergies before use.
• Viagra is part of a broader class of medications called PDE5 inhibitors.
• Sexual desire is still necessary for Viagra to be effective.
• Regular health check-ups can monitor the effects of the medication.
• Some users report improved self-esteem with proper use.
• Proper hydration can help reduce side effects like headaches.

Many medications have been used without consistent success.

• Viagra is one of the most well-known medications for erectile dysfunction.
• The drug may cause mild indigestion or muscle pain as side effects.
• Consult your doctor for personalized advice about Viagra use.
• Some users may develop a tolerance over time, reducing effectiveness.
• Combining Viagra with recreational drugs can be dangerous.
• Routine medical tests may be needed during long-term use.
• Never share your medication with others or buy it from unverified

But a 2005 study of 16 patients with severe Raynaud's phenomenon that had not responded to other medications reported benefit from sildenafil in a dose of 50 mg twice a day.

In case of emergency/overdose

Pulmonary hypertension causes shortness of breath, first during exertion but eventually at rest if the condition progresses. A variety of treatments are available, depending on the underlying problem. And the FDA has approved sildenafil (Revatio) in a dose of 20 mg three times a day for men and women with pulmonary hypertension. Clinical trials have demonstrated improved exercise tolerance with few side effects. Pulmonary hypertension is a feature of acute mountain sickness. And a 2006 study of 40 Raynaud's patients reported similar benefits from vardenafil in a dose of 10 mg twice a day. Sildenafil was discovered by scientists looking for a new medication to dilate coronary arteries.

• Viagra is available in various dosages, usually 25mg, 50mg, and 100mg.
• It is important to follow a healthcare provider’s dosage instructions.
• Viagra is not an aphrodisiac and requires sexual stimulation to work.
• The medication can be affected by certain foods, such as high-fat meals.
• Overuse can lead to increased side effects or reduced effectiveness.
• Do not take Viagra more than once within a 24-hour period.
• Consult a doctor if you experience persistent erections or pain.

It does that, but because it widens healthy coronary arteries more than diseased vessels, it has not been successful in treating angina. But it may have other benefits for cardiac patients. In the first years of the Viagra era, research on sildenafil and the heart was devoted to making sure the drug was safe for the circulation.

Brand names

In test tubes, vardenafil and tadalafil inhibit PDE-5 a bit more effectively than sildenafil does. But laboratory potency doesn't necessarily predict clinical activity. In this case, it means that lower doses of the newer drugs will achieve comparable results to the older drug's success rate. Vardenafil is marketed in 2.5-, 5-, 10-, and 20-milligram (mg) tablets; tadalafil in doses of 5, 10, and 20 mg; and sildenafil, 25, 50, and 100 mg. Each produces better results at higher doses, but the top doses are also more likely to cause side effects.

What’s the youngest age for which Viagra is safe to use?

And all the drugs are more effective in men with mild ED than in those who are severely impaired. Doctors have had more clinical experience with sildenafil than its newer rivals. Still, all three drugs seem to achieve similar results. In broad terms, about 70% of men benefit. The response is best in men with no identifiable organic cause of ED (about 90%), but it's less favorable for diabetics (about 50%), and it's hard to predict for men who have been treated for prostate cancer.