New Levitra - a new era in the treatment of erectile dysfunction

What is erectile dysfunction, what causes it and how common is it?

Erectile dysfunction (ED) can be defined as the inability of a man to achieve or maintain an erection sufficient to insert the penis into the vagina and perform satisfactory sexual intercourse.
The incidence of ED varies depending on age. If in the age group from 20 to 40 years it averages 3%, then in the age group from 40 to 60 years it occurs in 15 - 20% of men. Over the age of 70, erectile dysfunction can affect up to 30% of men. At any age, ED is not the norm, because... the ability to have a regular and satisfactory sex life is one of the essential functions of a man of any age. Erection disorders can be caused by two groups of reasons: psychological (psychogenic) and somatic (organic). Research over the past 20 years has shown that ED is quite rarely caused by purely psychological reasons (stress, depression, behavioral characteristics, etc.). At the same time, it became known that about 80% of all cases of erectile dysfunction are caused by some physical (somatic, organic) conditions. These include: diabetes mellitus, high blood pressure, high blood cholesterol and vascular atherosclerosis, renal and liver failure, thyroid diseases, hormonal disorders, consequences of operations on the prostate gland and rectum, trauma and diseases of the spinal cord and brain (stroke , Alzheimer's disease, etc.), consequences of pelvic injuries, Peyronie's disease. Erection disorders can also be caused by taking certain medications. Persistent erectile dysfunction can develop due to bad habits such as drinking alcohol, smoking and taking drugs.

What place do erection pills occupy among ED treatment methods?

Currently, there are 5 groups of methods for treating erectile dysfunction:

1. Psychotherapy and sex therapy, which is used only for so-called psychologically caused or psychogenic ED, less often as an auxiliary method for somatic or organic ED.
2. Taking tablets or Viagra tablets for an erection: Cialis, Levitra. It is used as a first choice (first line of therapy) for all forms of organic ED, regardless of its cause.
3. Injection pharmacotherapy or “erection on demand”. It is used as a second-line treatment for all forms of ED in cases where erection pills do not provide the desired effect or their use is contraindicated. Erection pills and injections of vasodilators into the penis can be used together as a combination treatment option for ED.
4. Vacuum erection therapy or the use of vacuum erectors of various models and modifications to obtain or maintain an erection. It is a type of second-line treatment for organic and, less commonly, psychogenic forms of ED. — 90% efficiency; — There is no need to use medications that have side effects; — Non-aggressive method of treatment; - Helps create an erection while maintaining all precautions.
5. Surgical methods of treatment: operations on the vessels of the penis and penile prosthesis. The first group of interventions is divided into operations on the veins (limiting venous outflow) and arteries (increasing arterial inflow) of the penis. Vein surgery can be used effectively in selected cases of ED, especially in combination with erection pills. Surgeries on arteries are ineffective and are used less and less. Penile prosthesis is the most effective and radical of all types of treatment for ED, the only method that provides a complete cure for organic ED. Surgical methods, as a rule, are used only in cases of organic ED when conservative therapy has failed.

So, erection pills are the first-line therapy, which most often begins in the treatment of any form of ED. Viagra, Cialis and Levitra are today the only tablet drugs available in the world that are truly effective in treating ED. The effectiveness of all other advertised tablets, as a rule, is invented (and absolutely not proven) by their manufacturers and is no different from a pacifier. All these domestic “impazs”, “golden skates”, foreign “veromaxes”, “superyochimbe extracts” and many others. other drugs are nothing more than means of making money based on people who trust primitive advertising.

How do erection pills work? How harmful are they? Is it possible to become addicted to erection pills? What are the side effects and contraindications? What are the known drug interactions?

Viagra, Cialis and Levitra have exactly the same mechanism of action and are selective (selective) inhibitors of the activity of the enzyme - phosphodiesterase type 5 (PDEס). This enzyme, in turn, inhibits the production of cyclic guanosine monophosphate (CGMP) in smooth muscle tissue, which is formed from guanosine monophosphate (GMP) under the influence of nitric oxide (NO). The main function of CGMP is to relax the smooth muscles of the cavernous (cavernous) bodies of the penis. When the action of PDE is inhibited, a significantly larger amount of CGMP accumulates in the corpora cavernosa, their smooth muscles relax much better and a significantly larger amount of blood rushes to the penis, which causes an erection.

Drugs in this group act selectively in the vascular tissue of the penis and are practically harmless. They do not cause lasting negative consequences with long-term and regular use. No addiction to erection pills develops. With the exception of purely psychological dependence. Having once tried an erection pill and felt its significantly better quality, feeling the lost voluptuousness, a man sometimes does not want to give up Viagra pills. This is similar to how a driver who has once driven a high-quality foreign car tends to never drive a Zhiguli again.

The main side effects of Viagra. Cialis and Levitra and their frequency are summarized in Table 1.

Table 1. Frequency of side effects of certain dosages (mg) of erection pills in %.

The frequency of side effects depends on the dose of the drug and individual sensitivity. It also depends on what you eat the day before using erection pills. On a full stomach, the frequency of side effects, as well as the effectiveness of the drugs, is lower.

An absolute contraindication to taking erection pills is their intolerance (allergy) and the simultaneous use of organic nitrates (Nitroglycerin, Sustak, Nitrong, Nitrosorbide, Erinit, etc.). When taking erection pills and organic nitrates simultaneously, a fatal decrease in blood pressure can occur. It is extremely undesirable and potentially dangerous to prescribe erection pills from the group of PDE inhibitors to patients with the following diagnoses:

• Coronary heart disease with frequent attacks of chest pain.
• Congestive heart failure and significant decrease in blood pressure.
• Significant decrease in cardiac output.
• Complex complex drug therapy for hypertension.
• Drug therapy that can slow down the removal of PDE inhibitors from the body.

The described cases of deaths associated with taking Viagra were most often caused by the combined use of this drug with organic nitrates.

Drugs such as ketoconazole and erythromycin inhibit the removal of PDE inhibitors from the body. Individuals taking these drugs should reduce their dose of erection pills or avoid taking them altogether. Significantly enhances the effectiveness of erection pills, especially in persons with hypogonadism or male menopause (andropause), the simultaneous use of male sex hormones (testosterone).

Compound

How and when are erection pills used and what is the difference between Viagra, Cialis and Levitra?

Erection pills from the group of PDE inhibitors (Viagra, Cialis, Levitra) are the first choice for any form of organic ED. They are prescribed immediately before sexual intercourse in a period of time from 30 minutes to 1 hour before planned sex. In some cases, drugs are prescribed regularly before each sexual intercourse, sometimes they are recommended to be taken only in cases where, in the opinion of the patient, there is the greatest chance of failure. These drugs have differences that are useful to know. Viagra has the greatest clinical experience, because. has been in use since 1998. This drug has already helped more than 16 million people worldwide and is the most well-studied of all erection pills. Viagra should be taken 1 hour before sexual intercourse, it works for up to 4 hours and is more likely to cause side effects after taking it compared to newer PDE inhibitors. Before taking Viagra, it is not recommended to eat rich fatty foods, because... it reduces the effectiveness of the drug. Levitra can be taken 15㪶 minutes before planned sex, its duration of action is slightly longer than that of Viagra, and the frequency of side effects is less. Cialis is taken 30 minutes before intended sexual intercourse; fatty foods do not affect its activity, and it lasts up to 36 hours and sometimes more. For this reason, Cialis is called a weekend pill, because... one tablet allows you to stay “in good shape” the whole weekend. To compare the side effect profile of all 3 drugs, you can refer again to Table 1.

What is the effectiveness of erection pills and is it possible to completely get rid of ED with their help?

The effectiveness of PDE inhibitors for various forms of ED ranges from 60 to 85%, according to various clinical studies. The tablets are designed to be taken before each sexual intercourse, i.e. when you take the pill, the erection improves; without the pill, the erection will be the same as it was recently before the start of treatment. In recent years, there have been reports that regular daily use of relatively small doses of erection pills for at least 12 weeks has a certain healing effect, i.e. improves the quality of your own natural erections. To enhance the effect of PDE inhibitors, they are used in conjunction with male sex hormones, injections of vasodilators into the penis, and operations to limit venous outflow from the penis.

What to do if erection pills don't work?

In such cases, under the supervision of a doctor, it makes sense to try second-line therapy or injections of vasodilators into the penis. If this does not help, you should resort to one of the surgical treatment options. It should be remembered that penile prosthesis has the highest effectiveness among all methods of treating ED.

The Andros clinic presents all modern methods of diagnosing and treating ED without exception. The most accurate diagnosis helps to individualize treatment and make it more effective. Mastery of the technique of implanting all types of penile prostheses allows us to achieve restoration of sexual activity even in the most seemingly hopeless cases. Contact only professionals armed with the entire arsenal of remedies and methods for treating erectile dysfunction available in the world!

Levitra™ drug interactions

The safety and effectiveness of vardenafil in combination with other drugs to eliminate erectile dysfunction have not been established, therefore the use of such combinations is not recommended. A decrease in the clearance of vardenafil occurred with the simultaneous use of selective inhibitors of enzymes of the cytochrome P450 CYP 3A4 system (such as cimetidine, ketoconazole, itraconazole, indinavir, ritonavir, erythromycin). If combination with any of these drugs is necessary, the daily dose of Levitra should not exceed 5 mg. Concomitant use of vardenafil with α-adrenergic blockers may cause the development of symptomatic hypotension, so Levitra should be used no earlier than 6 hours after their administration. CYP 2C9 inhibitors (tolbutamide, warfarin), CYP 2D6 (selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazides and thiazide-like diuretics, loop and potassium-sparing diuretics, ACE inhibitors, calcium antagonists, β-adrenergic blockers and inducers of CYP 450 metabolism (rifampicin , barbiturates) do not affect the pharmacokinetics of vardenafil. There were no signs of clinically significant interaction of vardenafil with tolbutamide (250 mg) or warfarin (40 mg), which are metabolized by CYP 2C9. A single dose of an antacid (magnesium/aluminum hydroxide) did not affect the bioavailability of vardenafil.