Information Regarding Our ED Medication

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Viagra Tablets

Viagra (Sildenafil) is commonly prescribed for:
- Treatment of erectile dysfunction
- Dosage strengths of Viagra (Sildenafil) available:
  - 25mg 50mg 100mg
- Dosage form of Viagra is Tablets. See manufacturer for details.
- Pharmacologic Category: Anti-erectile dysfunction agent
What is this medicine used for?

Treatment of erection problems in men and pulmonary hypertension

Who should not take this medicine?

Do not take this medicine with any of the following medications: cisapride; methscopolamine nitrate; nitrates like amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin; nitroprusside; other medicines for erectile dysfunction like tadalafil, vardenafil; other sildenafil products

Key warnings before taking this medicine?

Your health care provider needs to know if you have any of these conditions: bleeding disorders; eye or vision problems, including retinitis pigmentosa; Peyronie’s disease, or history of priapism; heart disease, angina, a history of heart attack, irregular heartbeats, or other heart problems; high or low blood pressure; history of blood diseases; history of stomach bleeding; kidney disease; liver disease; stroke; an unusual or allergic reaction to sildenafil or other products. If you notice any changes in your vision while taking this drug, call your healthcare provider immediately. If you experience symptoms of nausea, dizziness, chest pain or arm pain upon initiation of sexual activity after taking this medicine, you should refrain from further activity and call your healthcare provider immediately. Do not use alcohol while using this medicine. Using this medicine does not protect you or your partner against HIV infection or other sexually transmitted infections.

What are the precautions when taking this medicine?

Possible interactions include: certain drugs for high blood pressure; certain drugs for the treatment of HIV infection or AIDS; certain drugs used for fungal or yeast infections, like fluconazole, ketoconazole, and voriconazole; cimetidine; erythromycin; rifampin. This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Some items may interact with your medicine.

How is it best taken?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. The dose is usually taken 1 hour before sexual activity. Do not take your medicine more often than directed. Talk to your pediatrician regarding the use of this medicine in children as this medicine is not used in children for this condition.

What do I do if I miss a dose?

If you are taking this medicine as needed, this does not apply. Do not take two doses at the same time.

What are some possible side effects of this medicine?

Back pain; dizziness; flushing; headache; indigestion; muscle aches; nausea; stuffy or runny nose. This list may not describe all possible side effects. Call your doctor for medical advice about side effects. Call your healthcare provider immediate if you experience signs of an allergic reaction like skin rash, itching or hives, swelling of the face, lips, or tongue; breathing problems; changes in hearing; changes in vision; chest pain; erection lasting more than 4 hours; fast, irregular heartbeat; seizures

How should I store this medicine?

Store this medication at 59°F to 86°F (15°C to 30°C) and away from heat, moisture and light. Keep all medicine out of the reach of children. Throw away any unused medicine after the expiration date. Do not flush unused medications or pour down a sink or drain.

General statements:

Do not share or take any one else's medicine. Talk with your healthcare provider before starting any new medicine, including over-the-counter, natural products, or vitamins. The capsule formulation was compounded specifically for you. This patient information summarizes the most important information about your medication; if you would like more information, talk with your doctor.
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Cialis Tablets

Cialis is commonly prescribed for:
- Treatment of erectile dysfunction
- Dosage strengths of Tadalafil:
  - 2.5mg 5mg 10mg 20mg
- Dosage form of Viagra is Tablets. See manufacturer for details.
- Pharmacologic Category: Anti-erectile dysfunction agent
What is this medicine used for?

Treatment of erection problems in men. It is also used for enlargement of the prostate gland in men, a condition called benign prostatic hyperplasia (BPH). This medicine improves urine flow and reduces BPH symptoms. This medicine can also treat both erection problems and BPH when they occur together.

Who should not take this medicine?

Do not take this medicine with any of the following medications: nitrates like amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin; other medicines for erectile dysfunction like avanafil, sildenafil, vardenafil; other tadalafil products

Key warnings before taking this medicine:

Your health care provider needs to know if you have any of these conditions: bleeding disorders; eye or vision problems, including retinitis pigmentosa; Peyronie’s disease, or history of priapism (painful and prolonged erection); heart disease, angina, a history of heart attack, irregular heart beats; high or low blood pressure; history of blood diseases; history of stomach bleeding; kidney disease; liver disease; stroke; an unusual or allergic reaction to tadalafil. If you notice any changes in your vision while taking this drug, call your doctor or health care professional as soon as possible. Stop using this medicine and call your healthcare provider right away if you have a loss of sight in one or both eyes. Contact your healthcare provider right away if the erection lasts longer than 4 hours or if it becomes painful. If you experience symptoms of nausea, dizziness, chest pain or arm pain upon initiation of sexual activity after taking this medicine, you should refrain from further activity and call your healthcare provider immediately. Do not drink alcohol when taking this medicine as alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate or lowering your blood pressure. Using this medicine does not protect you or your partner against HIV infection or other sexually transmitted infections.

What are the precautions when taking this medicine?

Possible interactions include certain drugs for high blood pressure; certain drugs for the treatment of HIV infection or AIDS; certain drugs used for fungal or yeast infections, like fluconazole, ketoconazole, and voriconazole; certain drugs used for seizures like carbamazepine, phenytoin, and phenobarbital; grapefruit juice; macrolide antibiotics; medicines for prostate problems; rifabutin, rifampin or rifapentine. This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

How is it best taken?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. You may take this medicine with or without meals. When this medicine is used for erection problems, your doctor may prescribe it to be taken daily or as needed. If you are taking the medicine as needed, you may be able to have sexual activity 30 minutes after taking it and for up to 36 hours after taking it. Whether you are taking the medicine as needed or once daily, you should not take more than one dose per day unless directed. If you are taking this medicine for symptoms of BPH or to treat both BPH and an erection problem, take the dose once daily at about the same time each day. Do not take your medicine more often than directed.

What do I do if I miss a dose?

If you are taking this medicine as needed, this does not apply. If you miss a dose while taking this medicine once daily for an erection problem, benign prostatic hyperplasia or both, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Take your next regularly scheduled dose. Do not take two doses at the same time.

What are some possible side effects of this medicine?

Back pain; dizziness; flushing; headache; indigestion; muscle aches; nausea; stuffy or runny nose. This list may not describe all possible side effects. Call your healthcare provider immediate if you experience signs of an allergic reaction like skin rash, itching or hives, swelling of the face, lips, or tongue; breathing problems; changes in hearing; changes in vision; chest pain; erection lasting more than 4 hours; fast, irregular heartbeat; seizures

How should I store this medicine?

Store this medication at 59°F to 86°F (15°C to 30°C) and away from heat, moisture and light. Keep all medicine out of the reach of children. Throw away any unused medicine after the expiration date. Do not flush unused medications or pour down a sink or drain.

General statements:

Do not share or take any one else's medicine. Talk with your healthcare provider before starting any new medicine, including over-the-counter, natural products, or vitamins. The capsule formulation was compounded specifically for you. This patient information summarizes the most important information about your medication; if you would like more information, talk with your doctor.
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Tadalafil Citrate Soft Tabs

What important information should you know about TADALAFIL TROCHES (CIALIS)?

Tadalafil (CIALIS) can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.

Do NOT take TADALAFIL (CIALIS) if you:
- Take any medicines called nitrates.
- Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite. (See “Who should not take TADALAFIL (CIALIS)?”)
Tell your health care providers that you take TADALAFIL (CIALIS). If you need emergency medical care for a heart problem, it will be important for your health care provider to know when you last took TADALAFIL (CIALIS).

After dissolving a half or whole troche (sublingual tablet), some of the active ingredient TADALAFIL remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications.

What is TADALAFIL (CIALIS)?

TADALAFIL TROCHES (CIALIS) is a prescription medicine dissolved in the mouth for treatment of erectile dysfunction (ED) in men. ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he can not keep an erection. A man who has trouble getting or keeping an erection should see his doctor for help if the condition bothers him. TADALAFIL (CIALIS) may help a man with ED get and keep an erection when he is sexually excited.

TADALAFIL (CIALIS) does not: Cure ED. Increase a man’s sexual desire. Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your doctor about ways to guard against sexually transmitted diseases. Serve as a male form of birth control. TADALAFIL TROCHES (CIALIS) is only for men with ED. TADALAFIL (CIALIS) is not for women or children. TADALAFIL TROCHES (CIALIS) must be used only under doctor’s care.

Do not take TADALAFIL TROCHES (CIALIS) if you:
- Take any medicines called nitrates. Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm. Medicines called nitrates include nitroglycerin that is found in tables, sprays, ointments, pastes or patches. Nitrates can also be found in other medicines such as isosorbide nitrate or isororbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite. Do not use TADALAFIL TROCHES (CIALIS) if you are using these drugs. Ask your doctor or pharmacist if you are not sure if any of your medicines are nitrates.
- You have been told by your healthcare provider to not have sexual activity because of health problems. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.
- Are allergic to TADALAFIL (CIALIS) or any of its ingredients.
What should you discuss with your doctor before taking TADALAFIL TROCHES (CIALIS)?

Before taking TADALAFIL TROCHES (CIALIS), tell your doctor about all your medical problems, including if you: Have heart problems such as angina, hear failure, irregular heartbeats, or have had a heart attack. Ask your doctor if it is safe for you to have sexual activity. Have low blood pressure or have high blood pressure that is not controlled or have had a stroke. Have liver problems, have kidney problems or require dialysis. Have retinitis pigmentosa, a rare genetic (runs in families) eye disease. Have stomach ulcers. Have a bleeding problem. Have a deformed penis shape or Peyronie’s disease. Have had an erection that lasted more than 4 hours. Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia.

Can other medications affect TADALAFIL TROCHES (CIALIS)?

Tell your doctor about all the medicines you take including prescription and non- prescription medicines, vitamins and herbal supplements. TADALAFIL TROCHES (CIALIS) and other medicines may affect each other. Always check your doctor before starting or stopping any medicines. Especially tell your doctor if you take any of the following:
- Medicines called nitrates (See “What important information should you know about TADALAFIL TROCHES (CIALIS)?”)
- Medicines called alpha blockers. These include Hytrin, (trazosin HCl), Flomax, (tamsulsosin HCl), Cardura, (doxasosin mesylate), Minipress, (prazosin HCL) or Uroxatral, (alfazosin HCl). Alpha blockers are sometimes prescribed for prostate problems or high blood pressure. If TADALAFIL (CIALIS) is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
- Ritonavir (Novir) or Indinavir (Crixivan) Ketoconazole or itraconazole (such as Nizoral or Sporanox) Erythromycin
- Other medicines or treatments for ED
How should you take TADALAFIL TROCHES (CIALIS)?

Use TADALAFIL TROCHES (CIALIS) exactly as your doctor prescribes. TADALAFIL TROCHES (CIALIS) comes in a 10mg round scored tablet that dissolves in the mouth under the tongue. For most men, the recommended dose is ½ a troche (5mg) dissolved in the mouth with minimal swallowing to allow rapid absorption. Some men may require the whole 10mg TADALAFIL TROCHE. TADALAFIL TROCHES (CIALIS) should not be taken more than once a day. Some men can only take the tablet every two days as it is so effective.

Dissolve one half to one troche (tablet) before sexual activity. In some patients, the ability to have sexual activity was improved at 10 minutes after taking the sublingual troche of TADALAFIL (CIALIS). The ability to have sexual activity was improved up to 36 hours after taking TADALAFIL (CIALIS). Some form of sexual stimulation is needed for an erection to happen with TADALAFIL (CIALIS). TADALAFIL TROCHES (CIALIS) may be taken with or without meals; however, never while in the process of eating or drinking liquids or chewing gum or other candy. The only thing in the mouth should be the TADALAFIL TROCHES (CIALIS).

Do not drink alcohol to excess when taking TADALAFIL TROCHES (CIALIS) (for example, 5 glasses of wine or 5 shots of whiskey). When taken in excess, alcohol can increase your chances of getting headache or getting dizzy, increasing your heart rate or lowering your blood pressure. If you take too much TADALAFIL TROCHES (CIALIS), call your doctor or emergency room right away.

What are the possible side effects of TADALAFIL TROCHES (CIALIS)?

The most common side effects with TADALAFIL TROCHES (CIALIS) are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose. These side effects usually go away after a few hours. Patients who get back pain and muscle aches usually get it 12 to 24 hours after taking TADALAFIL TROCHES (CIALIS). Back pain and muscle aches usually go away by themselves within 48 hours. Call your doctor if you get a side effect that bothers you or one that will not go away.

TADALAFIL TROCHE (CIALIS) may uncommonly cause:
- Erections that won’t go away (priapism) that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis including the inability to have erections.
- Vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.
- These are not all side effects of TADALAFIL TROCHES (CIALIS). For more information ask your doctor or pharmacist.
General information about TADALAFIL TROCHES (CIALIS):

Do not use TADALAFIL TROCHES (CIALIS) for a condition for which it was not prescribed. Do not give TADALAFIL TROCHES (CIALIS) to other person, even if they have the same symptoms that you have. It may harm them.
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Sildenafil Citrate Soft Tabs

How Does Sildenafil Citrate Work?

When a man is sexually aroused, the arteries in the penis relax and widen, allowing increased blood-flow. As these arteries expand, the veins that normally carry blood away from the penis become compressed, restricting the blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges, resulting in an erection.
If the nerves or blood vessels associated with this process aren't working properly, a man may not be able to get an erection. Sildenafil Citrate increases blood flow to the penis so that when a man is sexually aroused, he can attain and maintain an erection.

How Do Sildenafil Citrate soft tabs Work So Fast?

By eliminating the digestive process required by regular, swallowable Viagra® tablets, the time required for Sildenafil Citrate soft tabs to work is drastically reduced. Sildenafil Citrate soft tabs begin working in about 15 minutes! This is accomplished by a revolutionary compounding process developed especially for this medication, taking crushed Viagra® tablets and compounding them into a new, faster form, the soft tab!

How have these soft tabs improved and is there really a better sildenafil citrate soft tab?

The latest version of these tabs is in an exclusive new shape designed for the best possible packaging and administration. The Pharmacy uses Pfizer's Viagra® purchased from main channel pharmaceutical distributors supplied directly by Pfizer. Additionally, The pharmacy only uses pharmaceutical grade compounding bases and flavorings..

How are these soft tabs made?

Unlike the other sites now flooding the market, once your medical questionnaire is approved by a licensed physician and an official prescription issued, a licensed pharmacy employing a highly skilled Compounding Pharmacist custom compounds your medication.
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Pharmacological Classifications: Phosphodiesterase Inhibitor

General Information

Vardenafil belongs to the phosphodiesterase type 5 (PDE5) inhibitors drug class, a class of drugs commonly indicated for treatment of erectile dysfunction (ED). It is a selective phosphodiesterase (PDE) type 5 inhibitor similar to sildenafil and tadalafil. This class of drugs does not inhibit prostaglandins as do some agents for treating ED (e.g., alprostadil). Vardenafil and tadalafil are more selective for PDE5 than PDE6, which is present in the retina. This leads to less visual adverse effects such as those reported in sildenafil-treated patients. The advantage of vardenafil may be that it achieves maximum plasma concentration sooner than sildenafil and tadalafil which may result in a faster onset of action. In an analysis of 580 patients, erections improved in 80% of men, and the ability to complete sexual intercourse with ejaculation was increased. Efficacy in treating diabetics and radical prostectomy patients has also been demonstrated. According to ED treatment guidelines, oral phosphodiesterase type 5 inhibitors (PDE5 inhibitor) are considered first-line therapy.[1] Vardenafil was approved by the FDA in August 2003 for erectile dysfunction. An orally disintegrating tablet was approved by the FDA in June 2010.

Mechanism of Action

Vardenafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. Nitric oxide then activates the enzyme guanylate cyclase, which results in increased levels of cGMP. Cyclic guanosine monophosphate causes smooth muscle relaxation in the corpus cavernosum thereby allowing inflow of blood; the exact mechanism by which cGMP stimulates relaxation of smooth muscles has not been determined. Phosphodiesterase type 5 is responsible for degradation of cGMP in the corpus cavernosum. Vardenafil enhances the effect of NO by inhibiting PDE5, thereby raising concentrations of cGMP in the corpus cavernosum. Vardenafil has no direct relaxant effect on isolated human corpus cavernosum and, at recommended doses, has no effect in the absence of sexual stimulation. Vardenafil has a greater selectivity for PDE5 versus PDE6, an enzyme found in the retina and involved in phototransduction. Sildenafil, another PDE inhibitor, has a lower selectivity for PDE5 vs PDE6 and is associated with abnormalities related to color vision with higher doses or plasma concentrations of the drug.

Phosphodiesterase type 5 is also abundant in lung tissue and esophageal smooth muscle. Inhibition of PDE5 in lung tissue results in pulmonary vasodilation which can be effective in treating pulmonary hypertension. Inhibition of esophageal smooth muscle PDE5 can cause a marked reduction in esophageal motility as well as in lower esophageal sphincter (LES) tone. These effects may be beneficial in certain motor disorders involving the esophagus such as diffuse spasm, nutcracker esophagus, and hypertensive LES. However, the reduction in LES tone can worsen the symptoms of gastroesophageal reflux disease (GERD). Dyspepsia is one of the more common adverse reactions associated with PDE inhibitor therapy.

Pharmacokinetics

Vardenafil is extensively distributed throughout the body. Protein binding is approximately 95%. Clearance is primarily via the hepatic cytochrome P450 isoenzyme CYP3A4 with minor metabolism by CYP3A5 and CYP2C. The major metabolite, designated M1, is the result of desethylation at the piperazine moiety of vardenafil and is further metabolized. M1 has phosphodiesterase selectivity similar to that of vardenafil and an in vitro inhibitory potency for phosphodiesterase 5 (PDE5) that is 28% of that of vardenafil. M1 also accounts for about 7% of the total pharmacological activity. Vardenafil is excreted as metabolites predominantly in the feces (approximately 91—95% of an oral dose) and to a lesser extent in the urine (about 2—6% of an oral dose). The elimination half-life of vardenafil and M1 is about 4—5 hours with the use of the film-coated tablets. The elimination half-life of vardenafil is 4—6 hours and the elimination half-life of MI is 3—5 hours with the use of the orally disintegrating tablets.[2] [3]

Route-Specific Pharmacokinetics

Sublingual (Troche) Administration: The orally disintegrating vardenafil tablets provide a higher systemic exposure than the film-coated tablets. In a study of patients with erectile dysfunction, the mean AUC was increased by 21—29% and the mean Cmax was decreased by 19% in elderly patients (>=65) and 8% in younger patients (18—45 years) as compared to the 10 mg film-coated tablets. In a study of healthy male volunteers (18—50 years), the mean Cmax was 15% higher and the mean AUC was 44% higher as compared to the 10 mg film-coated tablets. The median time to reach Cmax in a fasted stated was 1.5 h. High fat meals had no effect on vardenafil AUC or Tmax in healthy volunteers, but reduced the Cmax by 35%. When the orally disintegrating vardenafil tablets were administered with water, the vardenafil AUC was reduced by 29% and the median Tmax was shortened by 60 minutes, while Cmax was not affected.[4]