Sildenafil - action, indications, contraindications, side effects

Sildenafil is a drug used to treat erectile dysfunction. It was originally prescribed to patients with pulmonary hypertension, but its effect on sexuality was quickly noticed. It is now a drug regularly recommended for men who are struggling with the problem of impotence. What you need to know about Sildenafil?

1. What is Sildenafil?

The main drugs for the treatment of erectile dysfunction are phosphodiesterase type 5 inhibitors (PDE-XNUMX). The most famous drug of this type is Viagra.

It was originally introduced in 1998 to the US market and has since been available almost everywhere in the world. However, it should be remembered that there are many more drugs with the same mechanism of action. The most famous:

• Sildenafil
• tadalafil,
• Vardenafil.

The introduction of Sildenafil and the entire range of drugs from this group was quite random. Initially, sildenafil was prescribed to patients with pulmonary arterial hypertension. His erection enhancement effect was quickly noticed by patients, which led to a change in the indications for the use of this drug.

Before the era of sildenafil, men used and often use many others, the so-called popular, specific. It is safe to say that in every culture there is a certain substance that should improve potency. And yes, people have been using the following treatments for erectile dysfunction for centuries:

• rhino horn powder is very popular in China,
• in other cultures it was the blood of a bat, the testicles of a fox and a deer, the brain of a cat,
• wormwood, verbena, ginger, garlic, lovage, nutmeg, cloves.

It should be emphasized that most of these substances do not have a proven mechanism of action. Their effectiveness is based solely on magical faith in their action.

2. How Sildenafil Works

Sildenafil was first patented in 1996 and hit the market two years later. Currently, it is a drug for potency, with primary pulmonary hypertension (III functional class) and with some diseases of the connective tissue.

Medicines contain 25-100 milligrams of sildenafil citrate. Sildenafil contains in its structure a piperazine motif and a guanine analogue, 1H-pyrazolo[4,3-d]pyrimidine. The central phenol system is structurally equivalent to ribose, and the sulfone residue corresponds to the phosphate group of the nucleotide.

This compound in the body inhibits mainly phosphodiesterase type 5 (PDE5) - the affinity for other types of this enzyme is much lower. PDE5 cleaves cGMP, which is responsible for smooth muscle relaxation and increased blood flow to the cavernous bodies.

During sexual stimulation, nerve cells begin to produce nitric oxide (NO), which makes it possible to use cGMP. Blocked by sildenafil, PDE5 allows you to "maintain" an erection.

However, in many men, due to neurosis, mental stress, hormonal imbalance or disorders of the sympathetic nervous system, the production of nitric oxide by nerve cells is too weak, which leads to weak and too short erections. The most rapid absorption occurs after taking the drug on an empty stomach. It is excreted mainly with faeces (about 80%) and to a lesser extent with urine.

3. Indications for the use of Sildenafil

Ten drug for potency allows men to achieve a permanent erection and have sexual intercourse. The advantage of this drug is the fact that an erection does not occur immediately after taking the pill, but sexual stimulation is required (unlike prostaglandin drugs).

The drug is recommended to be taken one to six hours before the planned sexual intercourse. After the doctor assesses the degree and nature of impotence, the doctor selects the dose of the drug (25, 50 or 100 mg), which allows you to maintain an erection from 30 minutes to an hour. The drug is recommended to be taken once a day. For people with severe renal insufficiency, a dose reduction is recommended.

4. Contraindications

This medicine should not be taken by men under the following conditions:

• coronary artery disease,
• malignant hypertension,
• circulatory failure (NYHA class III and IV),
• with a recent heart attack (first two weeks),
• obstructive cardiomyopathy
• with ventricular arrhythmias (malignant, caused by exercise, stress, emotions),
• with severe valvular disease
• severe liver and kidney failure,
• after a stroke
• with degenerative changes in the retina (for example, retinitis pigmentosa),
• hypotension,
• with hypersensitivity to the components of the drug.

Siledenafil It has a vasodilatory effect and can be dangerous for people taking cardiovascular and vascular drugs. An absolute contraindication to taking the drug is taking Nitrate and Molsidomine.

Differences in the metabolism of this drug should also be taken into account. It is broken down in the liver, which means that the excretion of this drug is reduced in people with damaged livers and over 65 years of age, and higher doses can be dangerous. Drugs known to interact with siledenafil include:

• assimilate,
• erythromycin,
• ketoconazole,
• rifampicin and many others.

Sildenafil, due to the vasodilating mechanism, lowers blood pressure. To date, deaths due to the use of sildenafil have occurred in people taking cardiovascular drugs such as, for example, nitrates or other drugs to lower blood pressure.

This drug is not recommended for use in impotence in men under 18 years of age and in anatomical defects of the penis (such as bending, cavernous fibrosis or Peyronie's disease) after penile prosthesis and with conditions that predispose them to priapism (eg, sickle cell anemia, multiple myeloma, or leukemia). The drug is not used as part of combination therapy for the treatment of erectile dysfunction.

5. Side effects after taking sildenafil

Sildenafil is a drug well tolerated by most men. It happens though side effects of sildenafil, These include:

• headache and dizziness
• redness of the face
• dyspepsia (stomach disorders),
• blurred vision).

Less common side effects of taking siledenafil are:

• swelling of the nasal mucosa,
• bladder and urethra infections,
• muscle and joint pain.

The above side effects of sildenafil are reported by approximately 35 percent. Patients. The appearance of these symptoms is associated with blocking PDE type 5, as well as other types in certain organs. People with abnormal heart rhythms, high blood pressure, and a tendency to have heart attacks can experience serious complications, including myocardial infarction and death (due to the release of nitric oxide).

Abuse of the drug by healthy men can cause further difficulties in achieving an erection (without taking the drug), painful swelling of the penis, inflammation and destruction of the corpora cavernosa.

Excessive consumption can keep an erection up to 6 hours. Due to the possibility of visual impairment and dizziness after taking the drug, you should refrain from driving vehicles and working with mechanisms.

6. Causes of impotence

Impotence (ED) is defined as “a sexual dysfunction that manifests lack of erection or ejaculate despite excitement and satisfying foreplay." Impotence is not the absence of an erection during casual sexual intercourse, which is usually accompanied by stress.

We can talk about sickness when erection problems and ejaculation appear many times, despite the existing connection between the partners. This disease can be divided into primary and secondary (occurring after a period of normal sexual activity).

The root cause of difficulties in a full sexual life can be mental (psychogenic impotence) and organic (somatic) factors.

The first group includes: fear of intercourse, fear of unwanted pregnancy, complexes, guilt, sinfulness, stress, psychosexual development disorders, introversion (tendency to focus on oneself). Usually in such situations, during sleep or masturbation, reactions are normal.

Physical causes of impotence include diseases (diabetes mellitus, multiple sclerosis, tetraplegia, ALS, heart defects, severe hypertension, phimosis, flushing, Peyronie's disease) or age-related changes (andropause) that prevent erections. Some stimulants (alcohol, amphetamines) and drugs (SSRIs, SNRIs) can also cause impotence.

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