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Sildenafil , sold as the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. Common side effects include headaches , heartburn , and flushed skin.

Sildenafil acts by blocking phosphodiesterase 5 PDE 5 , an enzyme that promotes breakdown of cGMP , which regulates blood flow in the penis. Pfizer originally discovered the medication in while looking for a treatment for heart-related chest pain. The primary indication of sildenafil is treatment of erectile dysfunction inability to sustain a satisfactory erection to complete intercourse. Its use is now one of the standard treatments for erectile dysfunction, including for men with diabetes mellitus.

Tentative evidence suggests that sildenafil may help men who experience antidepressant -induced erectile dysfunction. While sildenafil improves some markers of disease in people with pulmonary arterial hypertension , it does not appear to affect the risk of death or serious side effects as of [update]. Sildenafil and other PDE5 inhibitors are used off-label to alleviate vasospasm and treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon ; [12] [13] these drugs have moderate efficacy for reducing the frequency and duration of vasospastic episodes.

Sildenafil has been studied for high-altitude pulmonary edema , but its use is currently not recommended for that indication. In clinical trials , the most common adverse effects of sildenafil use included headache , flushing , indigestion , nasal congestion , and impaired vision, including photophobia and blurred vision. In July , the FDA found that sildenafil could lead to vision impairment in rare cases, [16] and a number of studies have linked sildenafil use with non-arteritic anterior ischemic optic neuropathy.

Rare but serious adverse effects found through postmarketing surveillance include prolonged erections , severe low blood pressure , myocardial infarction heart attack , ventricular arrhythmias , stroke , increased intraocular pressure , and sudden hearing loss. Care should be exercised by people who are also taking protease inhibitors for the treatment of HIV infection. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects.

Contraindications include: [2] : Sildenafil should not be used if sexual activity is inadvisable due to underlying cardiovascular risk factors [21]. Sildenafil's popularity with young adults has increased over the years. In one study, a mg dose was shown to cause no significant change in erectile quality, but did reduce the postejaculatory refractory time.

Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs. Agostino, Santiago A. Plano, and Diego A. Golombek of Universidad Nacional de Quilmes , Argentina, for their discovery that sildenafil helps treat jet lag recovery in hamsters.

Professional athletes have been documented using sildenafil, believing the opening of their blood vessels will enrich their muscles. In turn, they believe it will enhance their performances. Acetildenafil and other synthetic structural analogs of sildenafil which are PDE5 inhibitors have been found as adulterants in a number of "herbal" aphrodisiac products sold over-the-counter.

However, at least one court case has resulted in a product being taken off the market. The US FDA has banned numerous products claiming to be Eurycoma longifolia that, in fact, contain only analogs of sildenafil. Nitric oxide NO in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of cGMP, leading to smooth muscle relaxation vasodilation of the intimal cushions of the helicine arteries. This smooth muscle relaxation leads to vasodilation and increased inflow of blood into the spongy tissue of the penis, causing an erection.

Furchgott , Ferid Murad , and Louis Ignarro won the Nobel Prize in Physiology or Medicine in for their independent study of the metabolic pathway of nitric oxide in smooth muscle vasodilation. This kinase is activated by cGMP and it phosphorylates multiple targets in the smooth muscle cells, namely myosin light chain phosphatase , RhoA , IP3 receptor , phospholipase C , and others. The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and better erections.

Other drugs that operate by the same mechanism include tadalafil Cialis and vardenafil Levitra. Sildenafil is broken down in the liver by hepatic metabolism using cytochrome p enzymes, mainly CYP 3A4 major route , but also by CYP2C9 minor route hepatic isoenzymes.

The major product of metabolisation by these enzymes is N-desmethylated sildenafil, which is metabolised further. If taken with a high-fat meal, absorption is reduced; the time taken to reach the maximum plasma concentration increases by around one hour, and the maximum concentration itself is decreased by nearly one-third. There are also mouth spray preparations of sildenafil for faster onset of action.

The preparation steps for synthesis of sildenafil are: [44]. Sildenafil compound UK, was synthesized by a group of pharmaceutical chemists working at Pfizer's Sandwich, Kent , research facility in England.

It was initially studied for use in hypertension high blood pressure and angina pectoris a symptom of ischaemic heart disease. The first clinical trials were conducted in Morriston Hospital in Swansea. Numerous sites on the Internet offer Viagra for sale after an "online consultation", often a simple web questionnaire. Viagra is also informally known as "vitamin V", "the blue pill", or "blue diamond", as well as various other nicknames. In February , it was announced that Boots , the UK pharmacy chain, would try over-the-counter sales of Viagra in stores in Manchester , England.

Men between the ages of 30 and 65 would be eligible to buy four tablets after a consultation with a pharmacist. While the sale remains subject to a consultation with a pharmacist, the other restrictions from the trial have been removed, allowing customers over the age of 18 to purchase an unlimited number of pills [62] The decision was made, in part, to reduce online sales of counterfeit and potentially dangerous erectile dysfunction treatments.

On 6 May , Pfizer , which manufactures Viagra, told The Associated Press they will begin selling the drug directly to patients on its website. Pfizer's patents on Viagra expired outside the US in ; in the US they were set to expire, but Pfizer settled litigation with each of Mylan and Teva which agreed that both companies could introduce generics in the US on 11 December As of , the U.

Food and Drug Administration has approved 15 drug manufacturers to market generic sildenafil in the United States. Seven of these companies are based in India. This is likely to lead to dramatic price reductions. Counterfeit Viagra, despite generally being cheaper, [70] can contain harmful substances or substances that affect how Viagra works, such as blue printer ink, amphetamines , metronidazole , boric acid , and rat poison.

Viagra is one of the world's most counterfeited medicines. There were 2,, prescriptions for Sildenafil in in England, compared with 1,, in In , Viagra Connect, a particular formulation of Sildenafil marketed by Pfizer, became available for sale without a prescription in the UK, [62] in an attempt to widen availability and reduce demand for counterfeit products.

Sildenafil is available as a generic drug in the United States, labelled for pulmonary arterial hypertension. In the United States, Pfizer received two patents for sildenafil: one for its indication to treat cardiovascular disease marketed as Revatio and another for its indication to treat erectile dysfunction marketed as Viagra. The substance is the same under both trade names. In , Pfizer filed a patent covering the substance sildenafil and its use to treat cardiovascular diseases.

The patent was published in and expired in The patent on Revatio indicated for pulmonary arterial hypertension rather than erectile dysfunction expired in late Generic versions of this low-dose form of sildenafil have been available in the U. In , Pfizer filed a patent covering the use of sildenafil to treat erectile dysfunction.

This patent was published in and will expire in Teva sued to have the latter patent invalidated, but Pfizer prevailed in an August federal district court case. In Canada , Pfizer's patent 2,, for Revatio sildenafil used to treat pulmonary hypertension was found invalid by the Federal Court in June , on an application by Ratiopharm Inc.

On 8 November , the Supreme Court of Canada ruled that Pfizer's patent 2,, on Viagra was invalid from the beginning because the company did not provide full disclosure in its application.

The decision, Teva Canada Ltd. Pfizer Canada Inc. Staff posts include associate editor and news editor of GP newspaper, news editor of Pulse, and reporter at Australian Doctor, based in Sydney. She has a degree in Biological Sciences specialising in Genetics. The trained pharmacists will have to use a screening tool, and men who report heart problems and certain cardiovascular risk factors, including diabetes, will not be eligible for the drug.

The reclassification was pushed for by Douglas Pharmaceuticals, which launched a generic sildenafil in June after Viagra Pfizer came off patent. The company launched Viagra in New Zealand in the s when Pfizer products were marketed there through Douglas Pharmaceuticals. New Zealand is an early adopter of policy allowing an erectile dysfunction drug to be accessed directly from a pharmacy.

Spain and Greece already allow this, and others are likely to follow. Lilly, the manufacturer of another erectile dysfunction drug, Cialis tadalafil , has agreed a deal with Sanofi to allow the French firm to buy exclusive rights to apply to sell Cialis as a non-prescription medicine in Europe, the United States, Canada and Australia after certain patents expire.

John Atkinson 1 FEB Why discriminate against over 70 year olds. Unsuitable or offensive? Report this comment. For commenting, please login or register as a user and agree to our Community Guidelines.

You will be re-directed back to this page where you will have the ability to comment. This book on basic statistics has been specifically written for pharmacy students. Explains the methodology and requirements of pre-clinical safety assessments of new medicines. Includes registration requirements and pharmacovigilance. Pharmaceutical Calculations Workbook contains practice calculations and answers, similar to those in pharmacy exams and in practice.

In what is the most comprehensive comparison of 14 commonly prescribed antidepressant drugs to date, researchers found that only one brand was more effective at relieving symptoms of depression than a placebo. Another popular drug, venlafaxine, was shown increase the risk users engaging in suicidal thoughts and attempts at suicide.

Researchers at the Baptist Health South Florida Clinic in Miami focused on seven areas of controllable heart health and found these minority groups were particularly likely to be smokers and to have poorly controlled blood sugar.

A major pressure group has issued a fresh warning about perilously high amounts of sugar in breakfast cereals, specifically those designed for children, and has said that levels have barely been cut at all in the last two and a half decades. New guidance by the National Institute for Health and Care Excellence NICE , the body which determines what treatment the NHS should fund, said lax road repairs and car-dominated streets were contributing to the obesity epidemic by preventing members of the public from keeping active.

A new class of treatments for women going through the menopause is able to reduce numbers of debilitating hot flushes by as much as three quarters in a matter of days, a trial has found. Melissa Whiteley, an year-old engineering student from Hanford in Stoke-on-Trent, fell ill at Christmas and died in hospital a month later.

The Government has pledged to review tens of thousands of cases where women have been given harmful vaginal mesh implants. Human trials have begun with a new cancer therapy that can prime the immune system to eradicate tumours.

The treatment, that works similarly to a vaccine, is a combination of two existing drugs, of which tiny amounts are injected into the solid bulk of a tumour. Mothers living within a kilometre of a fracking site were 25 per cent more likely to have a child born at low birth weight, which increase their chances of asthma, ADHD and other issues.

Thousands of cervical cancer screening results are under review after failings at a laboratory meant some women were incorrectly given the all-clear. Most breast cancer patients do not die from their initial tumour, but from secondary malignant growths metastases , where cancer cells are able to enter the blood and survive to invade new sites.

Asparagine, a molecule named after asparagus where it was first identified in high quantities, has now been shown to be an essential ingredient for tumour cells to gain these migratory properties.

A record number of nursing and midwifery positions are currently being advertised by the NHS, with more than 34, positions currently vacant, according to the latest data. Demand for nurses was 19 per cent higher between July and September than the same period two years ago. CBD has a broadly opposite effect to deltatetrahydrocannabinol THC , the main active component in cannabis and the substance that causes paranoia and anxiety.

The numbers of people accepted to study nursing in England fell 3 per cent in , while the numbers accepted in Wales and Scotland, where the bursaries were kept, increased 8. The paper found that there were 45, more deaths in the first four years of Tory-led efficiencies than would have been expected if funding had stayed at pre-election levels.

On this trajectory that could rise to nearly , excess deaths by the end of , even with the extra funding that has been earmarked for public sector services this year.

Hours of commuting may be mind-numbingly dull, but new research shows that it might also be having an adverse effect on both your health and performance at work.

Longer commutes also appear to have a significant impact on mental wellbeing, with those commuting longer 33 per cent more likely to suffer from depression. It is not possible to be overweight and healthy, a major new study has concluded. The study of 3. When you feel particularly exhausted, it can definitely feel like you are also lacking in brain capacity.

Now, a new study has suggested this could be because chronic sleep deprivation can actually cause the brain to eat itself. David Lloyd Gyms have launched a new health and fitness class which is essentially a bunch of people taking a nap for 45 minutes.

The class is therefore predominantly aimed at parents but you actually do not have to have children to take part. Tobacco and alcohol companies could win more easily in court cases such as the recent battle over plain cigarette packaging if the EU Charter of Fundamental Rights is abandoned, a barrister and public health professor have said.

A major new study into the side effects of the cholesterol-lowering medicine suggests common symptoms such as muscle pain and weakness are not caused by the drugs themselves.

New research has found that babies born to fathers under the age of 25 or over 51 are at higher risk of developing autism and other social disorders. The study, conducted by the Seaver Autism Center for Research and Treatment at Mount Sinai, found that these children are actually more advanced than their peers as infants, but then fall behind by the time they hit their teenage years. Cycling to work is linked to a lower risk of developing cancer by 45 per cent and cardiovascular disease by 46 per cent, according to a study of a quarter of a million people.

Walking to work also brought health benefits, the University of Glasgow researchers found, but not to the same degree as cycling. They asked half of the patients to briefly recall the incident and then play the classic computer game, the others were given a written activity to complete.

The researchers, from Karolinska Institute in Sweden and the University of Oxford, found that the patients who had played Tetris reported fewer intrusive memories, commonly known as flashbacks, in the week that followed.

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