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MALE FERTILITY AND SEXUAL MEDICINE
SPECIALISTS
VIAGRA (SILDENAFIL) PATIENT INFORMATION DOCUMENT
INTRODUCTION
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 VIAGRA ALERT
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:
Nitroglycerin:
Oral: Nitostat, Nitrolingual, Nitrogard, Nitrong, Nitro-Bid.
Transdermal: Minitran, Nito-Dur, Transderm-Nitro, Deponit, Nitrodisc.
Topical: Nitrol, Nitro-Bid.
Isosorbide Dinitrate: Isordil, Sorbitrate, Dilatrate-SR
Isosorbide Mononitrate: 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

Source: http://www.malefertility.md/pdf/Viagra%20Information.pdf