Category: Viagra

Q. Over the last year or so, my erectile function has gone downhill rapidly. I’m in a monogamous relationship with a longtime girlfriend, and I’m sure she’s noticed the changes in me, but I’m finding it difficult to discuss the matter with her. Does it make sense for me to man up and confront the elephant in the room?

A. By all means, you should talk to your partner about your erection problems. She almost certainly is as aware as you are of your problems getting and keeping an erection. If you don’t discuss it frankly and explain that it’s not your lack of desire but a physiological problem that’s at the root of your problem, she may mistakenly believe that you no longer find her sexually exciting. Enlisting the help of your intimate partner can also help you fight the problem.

When you are having difficulty getting an erection, she can supply the needed stimulation — manually or orally — to help you achieve as full an erection as possible. If the problem has gone beyond the ability to you and your girlfriend to overcome it, you can both discuss the use of ED drugs and how that might resolve matters.

She’ll need to know that you can’t be quite as spontaneous as you might have been in the past and will need to pop a pill 30 to 60 minutes before you’re able to perform sexually.

Q. I’m in my mid-40s and have always found it easy to get an erection, but lately it seems to take longer to get hard and I tend to go soft quicker than I did in the past. Is this something that’s to be expected at my age? Would Viagra help or should I take some other steps to improve erectile function?

A. The early signs of erectile dysfunction serve as a helpful signal that things will probably get worse unless you take proactive steps to improve your overall health. Eating a healthy diet, such as the so-called Mediterranean diet, can be a good way to start.

Such diets are high in heart-healthy nutrients and fats but lower in refined sugars and grains, as well as the unhealthy fats found in red meats, high-fat dairy foods, lard, and tropical oils, such as coconut and palm oils. If you take action quickly enough, you may be able to regain more normal erectile function without resorting to prescription medications.

Other important lifestyle choices include a regular regimen of physical activity, which can begin slowly with brisk walking and progress to more advanced forms of exercise as you gain strength. If you smoke, stop as soon as you can, and if you don’t smoke, don’t start.

Work with your doctor to manage those underlying ailments such as atherosclerosis and diabetes that can increase the risk of ED. Alcohol is all right in moderation, but drinking in excess can make it difficult or even impossible to get an erection.

If you would prefer the convenience and confidentiality of ordering your drugs online, there is a safe alternative. Secure Medical Inc., based in Tempe, Arizona, operates a network of online drugstores that sell only FDA-approved drugs, all of which are sourced from licensed U.S. pharmacies.

Websites in the Secure Medical network include AccessRx.com, eDrugstore.com, and Viamedic.com. All sell a full range of ED medications, as well as a number of other prescription and OTC drugs.

For those who have a prescription from their doctors, they can fax it or scan and email it along with their order. However, if you don’t have a prescription, each of these websites can arrange a complimentary online consultation with a member of its team of licensed U.S. physicians.

You will be required to complete a questionnaire covering your current symptoms, medical history, and a list of all prescription and OTC drugs you’re now taking. If the doctor concludes that you’re an appropriate candidate for Viagra or another of the prescription drugs these websites offer, he or she will authorize a prescription.

Teva Pharmaceuticals USA is scheduled to introduce its generic formulation of Viagra beginning in December 2017. Likely to follow soon thereafter is a generic version of the drug from Mylan. Under FDA regulations, all generic substitutes for Viagra — or any brand-name drug, for that matter — must contain the same active ingredients as the branded drug.

The offerings from Teva and Mylan will be sold under the generic name sildenafil citrate, as will all generic versions of the drug that may follow.

FDA regulations do not require that a generic drug’s inactive ingredients replicate those in the brand-name drug, but since such ingredients are chemically inert, it has no real effect on the consumer. The primary effect of generic competition for Viagra will be to exert downward price pressure on the brand-name drug, as Pfizer seeks to continue to appeal to some buyers who’d prefer to stick with the original little blue pill.

As more and more generic versions hit the market, competitive pressures will increase, pushing average prices for the drug still lower.

Unless you know the reputation of an online vendor, buying Viagra and other ED drugs online can be a very risky proposition. It’s been estimated that roughly 90 percent of the ED drugs advertised online are counterfeit.

More importantly, many of these drugs contain potentially toxic ingredients, including dry wall material used as filler and printing ink used as a coloring agent. It’s true that some of these drugs have been found to contain the active ingredients in brand-name ED drugs but at levels that are either too low to be effective or so high that they could be dangerous.

Such ingredients are not listed on the drugs’ labels, so the consumer has no way of knowing the amount of active ingredient he may be getting. Unless you know you’re ordering from a trustworthy online supplier, it’s best to avoid buying ED drugs online.

Doctors who specialize in the treatment of cancer have long sought ways to attack cancer cells that ironically are sometimes protected by the body’s immune system. Researchers at Virginia Commonwealth University in Richmond, Virginia, found that combining sildenafil with a derivative of celecoxib, a nonsteroidal anti-inflammatory drug sometimes marketed as Celebrex, successfully killed brain cancer stem cells.

The combination works by targeting a protein known as GRP78, a so-called chaperone protein that serves to protect the integrity of certain cells, including certain cancer cells.

The combination succeeded in doing an end run around GRP78 to attack and kill the cancer cells. Moreover, the combination of sildenafil with the celecoxib derivative called OSU-03012, also known as AR-12, has potent antimicrobial properties.

Scientists said this combination drug could also prove effective in treating viral infections such as influenza, hepatitis, and Ebola, as well as antibiotic-resistant bacteria such MRSA (methicillin-resistant Staphylococcus aureus).

Doctors who specialize in the treatment of cancer have long sought ways to attack cancer cells that ironically are sometimes protected by the body’s immune system. Researchers at Virginia Commonwealth University in Richmond, Virginia, found that combining sildenafil with a derivative of celecoxib, a nonsteroidal anti-inflammatory drug sometimes marketed as Celebrex, successfully killed brain cancer stem cells.

The combination works by targeting a protein known as GRP78, a so-called chaperone protein that serves to protect the integrity of certain cells, including certain cancer cells.

The combination succeeded in doing an end run around GRP78 to attack and kill the cancer cells. Moreover, the combination of sildenafil with the celecoxib derivative called OSU-03012, also known as AR-12, has potent antimicrobial properties.

Scientists said this combination drug could also prove effective in treating viral infections such as influenza, hepatitis, and Ebola, as well as antibiotic-resistant bacteria such MRSA (methicillin-resistant Staphylococcus aureus).

Viagra is probably your best bet if you suffer from impotence caused by vascular insufficiency, but other options are available for those who find that the drug doesn’t work for them or who suffer from ED that stems from other causes. Others may find that they can’t tolerate some of Viagra’s side effects, which are usually mild but can be particularly bothersome to those sensitive to the drug’s effects.

Other options for the treatment of ED include penile injection therapy, which involves the injection of a vasodilating drug — alprostadil most often — directly into the penis minutes before sexual activity is expected to begin.

This form of treatment has a very high success rate but isn’t for those who find it difficult, if not impossible, to picture themselves injecting a needle into the penis. Other options include penile implants, which range in sophistication from a flexible rod surgically implanted that can be manipulated into place for sexual activity to more advanced systems. The latter usually consist of plastic cylinders that replace the penis’s corpora cavernosa — twin columns of spongy erectile tissue — and can be filled on demand with fluid pumped from a reservoir implanted under the skin of the lower abdomen.

Q. Does Viagra effectively treat ED regardless of its cause? Or is it intended only for some forms of impotence?

A. Viagra and the other oral ED drugs that followed in its wake are all designed to treat ED that’s caused by insufficient blood flow to the penis, the largest single cause of impotence. If your ED has its origins in psychological causes or results from a congenital or traumatic injury to the arteries that supply blood to the pelvic region, your doctor can recommend alternative therapies.

It is possible that Viagra might have a placebo effect on men whose ED is not vascular in nature, but it probably won’t work over the long haul in such situations. Those who are suffering from ED that is psychological in origin would be better served through psychological counseling, while surgical intervention might be required to resolve injury to the arteries in the pelvic region.

Q. Apart from nitrate-based drugs, which medications interact adversely with Viagra? If I’m taking one of those drugs that make it difficult for Viagra to do its job, what alternatives do I have?

A. As with nitrates, there are a handful of other drugs that are totally incompatible with Viagra because taken together they lower blood pressure sharply and could cause extreme dizziness, fainting, and possible loss of consciousness. These drugs would include other PDE5 inhibitors, such as Cialis, Levitra, Staxyn, and Stendra, as well as riociguat, which is sold under the brand name Adempas and is prescribed to treat two different forms of pulmonary hypertension.

Still, other types of drugs that can interact adversely with Viagra include certain antibiotics, such as clarithromycin (Biaxin) and erythromycin (EryPed), and antifungals, such as fluconazole (Diflucan) and itraconazole (Sporanox). Also known to interact poorly with Viagra are some heart and blood pressure medications, such as amlodipine (Norvasc) and amiodarone (Cordarone, Nexterone, Pacerone), and the tuberculosis drug isoniazid.

Adverse interactions have also been recorded between Viagra and cimetidine (Tagamet), bosentan (Tracleer), imatinib (Gleevec), nefazodone (Serzone), St. John’s wort, boceprevir (Victrelis), ritonavir (Norvir), amprenavir (Agenerase), and atazanavir (Reyataz).

If you are taking one of these medications, you can check with your doctor to see if he can switch you to an alternative drug that doesn’t interact adversely with Viagra. Absent that, it probably bests that you stay away from Viagra or any other PDE5 inhibitor until your primary health issue is resolved.