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MALE FERTILITY AND SEXUAL MEDICINE
VIAGRA (SILDENAFIL) PATIENT INFORMATION DOCUMENT
Viagra is quite possibly one of the most exciting medications of all time. When
one considers that it was discovered by accident, it makes this novel new drug
even more interesting. That’s right, the drug was initially tested for heart disease
and failed. When researchers asked for it back, the test patients did not want to
return it because of unexpected benefits in the bedroom. Boy, what a way to start
This information is meant to help you understand what this medication is and
what is can and cannot do for you. The goal of the Male Fertility and Sexual
Medicine Specialists is to inform the public about male health issues and
What is Viagra and how does it work?
• A chemical by the name of Sildenafil citrate.
• Viagra can be thought of as a medication that improves blood flow to the
erection chambers within the penis and keeps it flowing. These events are
the basis for creating and continuing an erection. At the end of a greater
than one year study, 88%
of patients reported that Viagra improved their
erections, however, many of these patients did not have an erection
adequate for penetration on a number of occasions.
What should I worry about, Doctor?
• In general you should know there is a degree of heart risk with any sexual
• A thorough medical history and physical examination by a physician
should be undertaken to make sure that no other dangerous diseases are
• Viagra should not be combined with other medications for treatment of
erection problems because studies have not been done yet.
• Viagra absolutely should not be taken with medications called organic
nitrates. Some specific examples of organic nitrates include, Nitroglycerin,
Nitro-Bid, Nitro-Dur, Nitropaste or basically anything with nitro in it. You
absolutely should check with your pharmacist if there is any uncertainty
whatsoever. To take Viagra together with a nitrate may lead to severe drop
in blood pressure and other problems, possibly even a stroke. Some other
medications can interact with it and can cause a greater potential for side
effects. These include Tagamet (cimetidine), and two antibiotics,
erythromycin and ketoconazole among others.
• Viagra is not indicated for use in women or children.
• Side effects from the medication include headache in approximately 16%,
flushing in 10%, stomach upset in 10%, nasal congestion in 4%, and
abnormal vision in 3% of patients The abnormal vision is usually mild and
short lived, predominately involving a color tinge to vision. These side
effects typically occur at higher doses, however, only a few patients
experience them to such a degree that they need to stop the medication.
How much to take and when to take it.
• For most patients the recommended dose is 50 mg. taken approximately
one hour before sexual activity. The highest dose is not to exceed 100 mg.
Patients greater than 65 years of age, those with significant liver disease or
kidney disease, should start on a 25 mg. dose to be safe. Patients taking
Erythromycin and Ketoconazole should start at a 25-50 mg. dose to be
safe as well. The dose can always be increased if the desired effect doesn’t
quite happen. Regardless of the strength of medication, patient is not to
use more than the advised dose in a 24-hour period.
• The highest levels of action in the penis occur in 30 minutes to two hours
after the pill is taken. The pills can be taken up to four hours prior to
activity with adequate results in many patients.
Important information you should really know.
• Viagra is not and aphrodisiac. It will not increase your sexual desire.
• Viagra will not improve an erection if you already have adequate
erections. It will not prolong erections if erections are fully hard and
lasting a normal length of time for you as an individual. That is easy to
say, if it is not broken it is not going to fix it.
• It is really, really important to understand that Viagra needs your input to
work effectively. That means that just taking a Viagra tablet with little
additional sexual stimulation is unlikely to cause a good rigid penis.
Viagra only improves the function of your penis and requires appropriate
sexual stimulation to help bring about a useful erection for lovemaking.
All the good old inputs are necessary and might include your partner, your
mood, the setting, music, smell and other erotic stimuli. Each of these may
enhance that quality of the erection, the lovemaking, and the overall
• You need to give the medication four or five tries to have a good idea as to
whether it will help you or not. This is partly because just the anticipation
of trying a new pill, the anxiety of the situation and expectations for your
performance can make the first attempts at lovemaking less than perfect.
Remember, Viagra only enhances the normal pathways that can cause an
erection. It does not increase your sexual desire and it is not a sexual
• Just one more favor- If Viagra does not work for you, please be assured
that there are many other opportunities for overcoming erection problems.
In fact, there is virtually no patient who can’t get satisfactory treatment
nowadays. There a host of other options available and these should be
thoroughly discussed with a physician who is knowledgeable and really
cares about your condition. Just because Viagra doesn’t work on you
doesn’t mean that one of the other options won’t give an excellent result
• All couples may benefit from counseling to discuss intimacy and other
Male Fertility and Sexual Medicine Specialists
Phizer Inc. has confirmed the deaths of at least eighteen patients on Viagra (sildenafil)
since the drug’s approval in April 1998. Although Viagra is considered to be safe when
taken as indicated by appropriate patients, the FDA is currently investigating whether the
deaths were caused by Viagra. Viagra is contraindicted in participants who are taking
nitrates. Viagra was shown to potentiate the effects of nitrate, causing blood pressure to
Commonly used nitrates include:
Nitostat, Nitrolingual, Nitrogard, Nitrong, Nitro-Bid.
Minitran, Nito-Dur, Transderm-Nitro, Deponit, Nitrodisc.
Isordil, Sorbitrate, Dilatrate-SR
Monoket, ISMO, Imdur.
Please take active measures to ensure that your patients are aware of the contraindicted
drug combination of Viagra and nitrates, and consider any necessary changes in therepy.
Please remember that many patients are under the care of more than one physician and
may be receiving persciptions from more than one perscribing source.
Thank you for your assitance in providing safe, high-quality pharmaceutical care to Blue
Cross of California members. Please feel free to contact the Pharmacy Management
Department at (818) 610- 4818 if you have any questions or need further information.
Vice President, Blue Cross of California Pharmacy Management
MEMORANDUM SUBJECT: INTRODUCTION OF THE NORTHWEST TERRITORIES INTERCHANGEABILITY DEPARTMENT OF HEALTH AND SOCIAL SERVICES, GNWT We are pleased to introduce to you the Northwest Territories Interchangeability Formulary (NWT IC Formulary) which can be found on-line at http://www.nwticformulary.com . This NWT IC Formulary reflects changes in the new Pharmacy Act in the Northwest Terr
NeLM news service DOH “Quality, Innovation, Productivity and Prevention (QIPP)” 2010/11 report on medicines management Source: Department of Health (DH) Date published: 28/07/2010 16:02 Summary by: Sheetal Ladva In response to the challenges of the current economic climate within the NHS, the Department of Health’s has focussed on identifying areas where it can simultane