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The mean age of the study group was 59.6 11.2 y.13 54 24 had arteriogenic ED, What To Take To Increase Female Libido Bigger Penise 16 54 30 had Info On Male Enhancement Noxitril mixed vasculogenic ED, 9 54 Bigger Penise 17 had cavernosal veno occlusive dysfunction, 11 54 20 had post radical retropubic prostatectomy ED and 5 54 9 had psychogenic ED.13 54 24.1 responded to sildenafil at a median maximal dose of 200 mg, 4 13 required 150 mg and 9 13 required 200 mg.41 54 76 failed to respond Overweight Small Penis to sildenafil.Mean IIEF question 3 and 4 scores were 1.5 and 1.4 Bigger Penise at baseline, 2.2 and 1.9 with sildenafil 100 mg, 2.8 and 2.5 with sildenafil 150 mg and 3..0 and 2.9 with sildenafil 200 mg, respectively.After 4 What To Take To Increase Female Libido weeks, treatment was regarded as having improved their erections by 37 , 46.3 and 68 of patients with sildenafil 100 mg, 150 mg and 200 mg, respectively.34 54 63 reported adverse effects with maximal dose sildenafil comprising headache 19 , facial flushing 32 , dyspepsia Magic Penis Growth 14 , nasal congestion 11 , dizziness 5 and visual disturbances 5.4 13 31 responders refused to continue treatment due to adverse effects.In conclusion, sildenafil at doses of up to 200 mg is an effective salvage therapy for 24.1 of previous sildenafil non responders but is limited by a significantly higher incidence of adverse effects and a 31 treatment discontinuation rate.IntroductionErectile dysfunction ED is the inability to achieve and maintain an erection of sufficient Bigger Penise rigidity for satisfactory sexual intercourse.1 Community based epidemiological studies suggest that sexual dysfunction, particularly ED, is a common disorder in patients and is associated with reduced quality of life.2,3,4,5Sildenafil citrate ViagraTM, Pfizer, UK , a potent, competitive phosphodiesterase type 5 iso enzyme PDE 5 inhibitor, is the first oral medication to demonstrate significant and reliable efficacy in Info On Male Enhancement Noxitril most patients with ED.6 Following activation of the nitric oxide cGMP pathway by sexual arousal, inhibition of PDE 5 isoenzyme by sildenafil results in increased corporal levels of cGMP and an augmented penile erection.7 Sildenafil appears effective in restoring erectile function and improving intercourse success rates in What To Take To Increase Female Libido a wide range of patients, including those with hypertension, diabetes, Bigger Penise spinal cord injury, other concomitant medical conditions, and in those patients taking a wide variety of concomitant medications.Its efficacy appears related to the extent and severity of ED, with significantly reduced efficacy demonstrated in patients with severe vasculogenic ED, diabetic ED and post radical prostatectomy ED.6,8,9,11Jarow et al reported a sildenafil response rate of 65 , significant improvement in quality of life and a 35 incidence of adverse effects.9 Virag reported similar results with a 60 response rate and a 26.75 incidence of adverse effects.10 McMahon et al reported a similar response rate of 67.5 but a higher incidence of adverse effects of 53.6.11 These authors Magic Penis Growth report a similar efficacy rate but a higher incidence of adverse effects compared to that reported by the Sildenafil Study Group.6The maximum dose Info On Male Enhancement Noxitril of sildenafil What To Take To Increase Female Libido recommended Overweight Small Penis by the manufacturer is 100 mg.A study was Overweight Small Penis designed to prospectively review a group of patients with chronic ED, unresponsive to sildenafil 100 mg, who were treated in a home setting with doses Bigger Penise of sildenafil in excess of the recommended maximum dose 150 mg and 200 mg.Treatment efficacy, safety Bigger Penise and tolerance was evaluated using Bigger Penise Info On Male Enhancement Noxitril serial physician interviews and the Magic Penis Growth patient self administered IIEF questionnaire.Materials and methodsFifty four fully evaluated patients with chronic ED who had previously failed to respond to a home trial of sildenafil 100 mg with erections suitable for sexual intercourse were studied.All Overweight Small Penis patients had received focussed sildenafil usage education and had been re titrated to confirm their non responder status.The mean number of sildenafil uses prior to enrolment in this study was 7 tablets range 5 C16.All patients Info On Male Enhancement Noxitril had been previously assessed using a standardised protocol and the etiology of their ED determined.This protocol included Overweight Small Penis a history and physical examination, determination of fasting lipids, glucose and free testosterone, vibratory penile biothesiometry and penile colour duplex Doppler ultrasonography CDU before and after intracavernous vasoactive drug Info On Male Enhancement Noxitril challenge 20 mg alprostadil.Rigiscan nocturnal penile tumescence testing, dynamic infusion cavernosometry and cavernosography DICC and phallopharmacoangiography were performed where clinically indicated.Patients with unstable coronary artery disease, Magic Penis Growth low output congestive cardiac failure, hypertension treated with three or more drugs, currently prescribed organic nitrate medication or those with any other contraindication to renewed sexual intercourse or sildenafil were excluded from the study.Each man was treated at home with escalating doses of sildenafil citrate 100 mg, 150 mg and 200 mg taken 1 hour before planned sexual activity until either maximal response or intolerable adverse effects occurred.The primary efficacy end point was the response to the questions 3 and 4 of the erectile function What To Take To Increase Female Libido domain of Magic Penis Growth the International Index of Erectile Function IIEF after a trial of each dose of sildenafil.The secondary efficacy end point was the response to the global assessment question Has this treatment improved your Bigger Penise erections after Magic Penis Growth 4 weeks of treatment.Results were analysed using standard statistical analysis including descriptive statistics and Student s t test.ResultsFifty four patients with chronic ED and a mean age of 59.6 11.2 y were enrolled in the study group.The etiology of ED was psychogenic in 5 patients 9 , arteriogenic in 13 patients 24 , cavernosal veno occlusive dysfunction CVOD in 9 patients 17 , MVED in 16 Overweight Small Penis patients 30 and post radical retropubic prostatectomy ED in Bigger Penise 11 patients 20.The mean duration of ED was 16..6 months range 4 C32.Twenty Magic Penis Growth four patients had diabetes mellitus, 27 had hypertension, Overweight Small Penis 26 had dyslipidaemia and 20 smoked cigarettes.Two or more vascular risk factors were present in 46 patients Table 1.Table 1 Patient demographics, intercurrent illness and life style factors overall and according to aetiology of EDFull size tableErections of sufficient rigidity and duration for satisfactory sexual intercourse occurred in 13 patients 24.1 at What To Take To Increase Female Libido a median maximal dose of 200 mg.Four patients 7.4 required 150 mg and comprised 2 patients with psychogenic ED and 2 patients with arteriogenic ED.The remaining 9 patients 16.7 required 200 mg and comprised 2 patients with psychogenic ED, 3 patients with arteriogenic ED, 2 patients with cavernosal veno occlusive dysfunction and 2 patients with post radical prostatectomy ED.Nine of the 13 patients 69 who responded chose to continue therapy with sildenafil.Overall, high dose sildenafil was effective in 4 out of 5 patients 80 with psychogenic ED and 9 out of 49 patients 18.4 with organic ED Table 2.Of the 11 patients with post radical prostatectomy ED, 2 patients had undergone a bilateral nerve sparing radical retro Overweight Small Penis pubic prostatectomy NSRRP and one had undergone a unilateral procedure and the remainder non nerve sparing procedures.The mean interval between surgery and treatment was 5.2 months.High dose sildenafil was effective in What To Take To Increase Female Libido 1 man treated with bilateral NSRRP and in 1 man treated with a unilateral NSRRP.Table 2 Response rate for sildenafil 150 mg, sildenafil 200 mg and sildenafil overallFull size table.Mean responses to questions 3 and 4 of the Bigger Penise IIEF erectile function domain, the primary end point, were 1.5 and 1.4 at baseline, 2.2 and 1.9 with sildenafil 100 mg, 2.8 and What To Take To Increase Female Libido 2.5 with sildenafil 150 mg and 3.0 and 2.9 with sildenafil 200 mg.The mean score for Q3 and Q4 for sildenafil was statistically Magic Penis Growth superior to baseline, overall, in all etiological groups and at all doses P 0.001.The overall mean score for Q3 and Q4 for sildenafil 200 mg was statistically superior to sildenafil 100 mg P 0.05 but not to What To Take To Increase Female Libido sildenafil 150 mg.The mean score for Q3 and Q4 for sildenafil 200 mg was statistically superior to sildenafil 100 mg P 0.05 for all etiological groups except post radical prostatectomy ED Figures 1 and Info On Male Enhancement Noxitril 2.The global assessment by patients whether treatment improved their erections, the secondary end point, was answered in the affirmative at week 4 by 37 on Magic Penis Growth 100 mg, 46.3 on Bigger Penise 150 mg and 68 on What To Take To Increase Female Libido 200 mg Figure 3.The incidence of affirmative responses was statistically superior at sildenafil 200 mg compared to 100 mg P 0.05.Viagra is taken as a single tablet, 1 hour before sexual activity.Only 1 dose should be taken in any 24 hour period.The onset of the effect may be delayed if taken with food.Viagra is supplied in boxes of 4 Magic Penis Growth tablets..THE Overweight Small Penis PRICES LISTED ARE FOR MEDICATION DISPENSED ON A PRIVATE PRESCRIPTION.SOME PATIENTS,HOWEVER, MAY BE ELIGIBLE TO OBTAIN THIS MEDICATION ON AN NHS PRESCRIPTION.YOUR DOCTOR WILL BE ABLE TO ADVISE YOU Info On Male Enhancement Noxitril WHICH TYPE OF PRESCRIPTION YOU REQUIRE.VIAGRA Overweight Small Penis sildenafil citrate is a cGMP specific phosphodiesterase type 5 PDE5 inhibitor, used Overweight Small Penis for the treatment of male erectile dysfunction.The physiological mechanism responsible for Overweight Small Penis erection of the penis Bigger Penise involves Magic Penis Growth the release of nitric oxide NO in the corpus cavernosum in response to sexual stimulation.Nitric oxide then activates the enzyme guanylate Info On Male Enhancement Noxitril cyclase, which results in increased levels of cyclic guanosine monophosphate cGMP , producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood.Sildenafil has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of NO by inhibiting PDE5, which is responsible for the biodegradation of cGMP in the corpus cavernosum.When sexual stimulation causes Info On Male Enhancement Noxitril local release of NO, Overweight Small Penis inhibition of PDE5 by sildenafil produces increased levels Info On Male Enhancement Noxitril of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and increased inflow of blood to the corpus cavernosum.Sildenafil, at recommended doses, has no effect in the absence of sexual stimulation.Studies in vitro have shown that sildenafil has between 10 and 10,000 fold greater selectivity for PDE5 than for other phosphodiesterase isoforms namely PDEs 1, 2, Overweight Small Penis 3, 4, and 6 and greater than 700 fold effect on What To Take To Increase Female Libido PDE7 PDE11.In particular, sildenafil has greater than 4,000 fold selectivity for PDE5 over PDE3, the cAMP specific phosphodiesterase isoform involved in the control of cardiac contractility.Sildenafil is about 10 fold as potent for PDE5 compared to PDE6, an isoenzyme found in the retina this lower selectivity is thought to be the basis for Overweight Small Penis colour vision abnormalities observed with higher doses or plasma levels of sildenafil see WARNINGS AND PRECAUTIONS, DETAILED PHARMACOLOGY.PDE5 is also found in lower concentrations in platelets, vascular and visceral smooth muscles, and skeletal muscle.The sildenafil induced inhibition of PDE5 in these tissues appears to be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed in vitro, Info On Male Enhancement Noxitril and inhibition of Bigger Penise platelet thrombus formation in vivo, and peripheral arterial venous dilation in vivo see WARNINGS AND PRECAUTIONS.PharmacodynamicsEffects Magic Penis Growth of VIAGRA on Blood Pressure Bigger Penise BP Single oral doses of sildenafil 100 mg administered to Overweight Small Penis healthy volunteers produced decreases in supine blood pressure mean maximum decrease of 8.3 5.3 mm Hg.The decrease in blood Bigger Penise Bigger Penise pressure was Info On Male Enhancement Noxitril most notable approximately 1 2 hours after Magic Penis Growth dosing.The effects are not related to dose or plasma levels.Larger effects were recorded among patients receiving What To Take To Increase Female Libido concomitant nitrates see CONTRAINDICATIONS.Effects of VIAGRA on Cardiac Parameters Single oral doses of VIAGRA up to 100 mg in healthy volunteers produced no clinically relevant Magic Penis Growth effects on ECG.Effects of VIAGRA on Erectile Response VIAGRA was studied in clinical trials of various designs.In Info On Male Enhancement Noxitril fixed dose clinical trials, 62 , 74 , and 82 Info On Male Enhancement Noxitril of patients on 25 mg, 50 mg and 100 mg of VIAGRA, respectively, reported an improvement in their erections, compared to 25 on placebo p 0.0001, see What To Take To Increase Female Libido CLINICAL TRIALS.In eight double blind, placebo controlled, cross over studies using RigiScan a device used to objectively measure penile rigidity and duration of erections , erections during sexual stimulation improved significantly on VIAGRA compared to placebo.These studies included patients with organic etiologies such as spinal cord injury and diabetes mellitus , Overweight Small Penis and What To Take To Increase Female Libido patients without an established organic cause.Most studies assessed the efficacy of VIAGRA approximately 60 minutes post dose.All eight studies investigating the effects of sildenafil on penile plethysmography RigiScan after visual sexual stimulation VSS under laboratory conditions, consistently Bigger Penise showed that doses of up to 100 mg resulted in statistically significant improvements in duration of erections of 60 rigidity considered hard enough for penetrative sexual intercourse , compared with placebo.In Info On Male Enhancement Noxitril patients who respond, the median time to onset of What To Take To Increase Female Libido erections 60 rigidity in response to VSS, was 25 minutes after an oral dose of 50 mg sildenafil.The mean total duration of erections 60 What To Take To Increase Female Libido rigidity at the base of the penis was 3, 24 and 32 minutes for subjects receiving placebo, 25 mg and 50 mg doses, respectively, when exposed to VSS for 2 hours.VIAGRA increases couples ability to have sexual intercourse see CLINICAL TRIALS.Pharmacokinetics.Absorption Sildenafil is rapidly absorbed.Maximum observed plasma concentrations are reached within Overweight Small Penis 30 to 120 minutes median 60 minutes of oral dosing in the fasted state.The mean absolute bioavailability is 41 range 25 63.The oral pharmacokinetics of VIAGRA is proportional Bigger Penise over the recommended dose range studied 25 mg Overweight Small Penis to 100 mg.Sildenafil Magic Penis Growth inhibits Magic Penis Growth the human PDE5 enzyme in vitro by 50 at a concentration of 3.5 nM.In man, the mean maximum free plasma Info On Male Enhancement Noxitril Info On Male Enhancement Noxitril concentration of sildenafil following a single oral dose of 100 mg is approximately 18 ng mL, or 38 nM.When VIAGRA was administered with a high fat meal, the rate of absorption was significantly decreased, with a 29 reduction in Cmax and a 60 minute delay in Tmax..The patient may find that it takes longer to work if taken with a What To Take To Increase Female Libido high fat meal.However, although it was statistically significant AUC decreased by 11 , the decrease in the Magic Penis Growth extent of absorption was not clinically relevant.The relative What To Take To Increase Female Libido bioavailability fed Info On Male Enhancement Noxitril fasted was 89 90 CI 84 94 see DRUG INTERACTIONS.Distribution The Overweight Small Penis mean steady state volume of distribution Vss for sildenafil is 105 litres, indicating distribution into the tissues.Sildenafil Magic Penis Growth and its major circulating N desmethyl metabolite Overweight Small Penis are both approximately 96 bound to plasma proteins.Protein binding is independent of total drug concentrations.Based upon measurements of sildenafil in the semen of healthy volunteers, less than 0.001 of the ingested dose may appear in the semen of patients 90 minutes after drug intake.Metabolism Sildenafil Info On Male Enhancement Noxitril is cleared predominantly by the CYP3A4 major route and CYP2C9 minor route hepatic microsomal isoenzymes.The major circulating metabolite results from N demethylation of sildenafil at the N methyl piperazine moiety.This metabolite has a PDE Bigger Penise selectivity profile similar to sildenafil and an in vitro potency against PDE5 approximately 50 that of the parent drug.Plasma concentrations of this metabolite are approximately 40 of those seen for sildenafil.The N desmethyl metabolite is further metabolised, with a terminal half life of approximately 4 hours.Excretion The total body clearance of sildenafil is Bigger Penise 41 L h with a Bigger Penise resultant terminal phase half life of 3 5 hours.After either oral or intravenous administration, sildenafil is excreted as Bigger Penise metabolites predominantly Info On Male Enhancement Noxitril in the feces approximately 80 of administered dose and to a lesser extent in the urine approximately 13 of the administered dose.Special Populations and Overweight Small Penis ConditionsGeriatrics Healthy elderly subjects 65 years or older had a reduced clearance of sildenafil, resulting in approximately 90 higher plasma concentrations of sildenafil and the Magic Penis Growth active N desmethyl metabolite compared to those seen in healthy younger volunteers 18 45 years.Due to age differences in plasma protein binding, the corresponding increase in free sildenafil plasma Overweight Small Penis concentration was approximately 40.Hepatic What To Take To Increase Female Libido Insufficiency In volunteers with hepatic cirrhosis Child Pugh A and B , sildenafil clearance was reduced, resulting in Overweight Small Penis increases in AUC 85 and Cmax 47 compared to age matched volunteers with no hepatic impairment.The pharmacokinetics of sildenafil in patients with severe hepatic impairment Child Info On Male Enhancement Noxitril Pugh class C have not been studied.Since sildenafil clearance is reduced in geriatric patients 65 years or older , patients with renal impairment or patients with hepatic impairment, a starting dose of 25 mg should be considered.Based on efficacy and toleration, the dose may be increased to 50 mg or 100 mg see WARNINGS AND PRECAUTIONS, DOSAGE AND ADMINISTRATION.Renal Insufficiency In volunteers with mild CLcr 50 80 mL min and moderate Magic Penis Growth CLcr 30 49 mL min renal impairment, the pharmacokinetics of a single oral dose of VIAGRA 50 mg were not altered.In volunteers with severe CLcr 30 mL min renal impairment, sildenafil clearance was reduced, resulting in increases in AUC 100 and Cmax 88 compared to age matched volunteers with no renal impairment.In addition, N desmethyl metabolite AUC and Cmax values were significantly 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