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Viagra® (Sildenafil) information for patients; How to avoid getting ripped off when you buy Viagra online; also how does Viagra work; Viagra cost, Viagra side effects, dose, mechanism of action, warnings; price comparison; what is a PDE5 Enzyme Inhibitor?

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Please Note: We do not accept ads for generic Viagra on this page.

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We only sell genuine Viagra made in the USA
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Pictue of a generic Viagra tablet (100 mg)  alongside a genuine 50 mg Viagra tablet - note the color and characteristic diamond shape of the Viagra tablet.

Figure 1: Picture of so-called generic Viagra 100 mg tablet alongside a genuine Viagra 50 mg tablet (greatly magnified).  Note the characteristically colored, diamond shaped Pfizer Viagra tablet compared to the round, larger and thicker silendafil 100 mg tablet. 

(The silendafil 100mg tablet was obtained over the internet without a doctor's prescription is believed to have been manufactured in India).

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Internet Drug News'

Viagra Information Database

People always ask "Where's the best place to buy Viagra?"  We
investigated the top websites that sell Viagra before we wrote
this page.  We learned what to look for in order to find legitimate Viagra websites.

You need to know that:

- Half the Viagra sold on the internet is fake.
- Most of the websites that sell Viagra are located in 3rd world countries  but they lie and pretend to be American or Canadian.

Illegal Viagra Leads 24% Jump in Counterfeit Medicine Seizures … fewer than 300 online pharmacies in Canada authorized by government agencies, more than 11,000 fake Canadian pharmacies are operating online from overseas jurisdictions … [Bloomberg]

There is no such thing as an FDA approved generic Viagra.  The government considers generic Viagra to be an illegal substance. 

The Feds are concerned that it may be unsafe because you have no way of determining the quality control that went into making the generic Viagra. They don't go after the people who buy it, but postal inspectors will confiscate it if they find it. 

There are lots of websites that sell generic Viagra without a prescription.  Some people swear by it but you are taking a chance with your health if you take generic silendafil, especially if you do so without the knowledge of your doctor.

Things To Be Suspicious Of:

- You want to
make sure there is a physical address on the
website selling the Viagra. 
It should be a real address, not a P.O.
box
.  If there is no address that is a bad sign. 

Why would someone want to hide their address?  No address means
that they are deliberately making it hard for you to track them down
in case there is a problem.

************************************************************
COMPARISON SHOP  sites that  sell real Viagra. Make them compete for your business.             
Click Here to Comparison Shop For Viagra
************************************************************

Buying Viagra; Tips

- The website selling the Viagra  should have a toll free telephone number.  If something goes  wrong you want to be able to speak to a real live person.  It is very  frustrating to only be able to communicate by e-mail when you have  a problem.

-
Test the telephone number before you place your order.  Ask
the person who answers the phone where the product is shipped from.
If they don't answer to your satisfaction, it's a bad sign. 

-
Do they have a 24-hour chat or IM customer service?  The reliable, established internet pharmacies all have this service integrated into their sites.  If they have such a service, test drive it. 

How long does it take for the person on the other end to respond?  Ask them some questions such as: "how long have you been in business?  Who is the manufacturer of your Viagra? Where is it shipped from? How long does it take to get my shipment.

-
Ask them if they do the shipping and handling or if they only do the billing

There is a good chance that the person on the other end of the phone
is just a go-between; a clerk in front of a credit card machine, doing the billing for hundreds of Viagra websites.

In many instances, they have no idea who the Viagra merchant is; all
they know is that once a month they get a commission check from
someone they have never seen or met in person.

Their job is answering the phone and ringing up your sale.  After your
credit card has been charged, the relationship is over. 

-
You get what you pay for.  If it seems too good to be true, it
probably is too good to be true.  You are better off paying $10.00 per
pill at your local drugstore and getting genuine American Viagra than paying $6.00 for a so-called generic Viagra on the internet and getting a fake. 

-
Your first purchase should be for a small quantity of pills.  Don't start of with thirty tablets.  Buy five or ten.  Make sure the Viagra is legit and the shipping and billing goes smoothly before you make a large purchase.

You should
never deal with a site from Russia or Nigeria, places where identity theft is common.  Scammers in these countries have been known to set up sham Viagra web sites just so they could steal your credit card information.

Did you know that Pfizer (the only legitimate manufacturer of Viagra) has a program whereby they offer one free Viagra tablet for every 3 pills you buy?  Click Here to view the Pfizer Value Card.

Who does this site recommend

If you are looking for
brand-name Viagra manufactured by Pfizer Laboratories, without a prescription, I recommend AccessRx.com.  They have been in business since 1999.  They are located in the USA in Tempe Arizona.  They offer overnight shipping. 

They have a 24 hour telephone number for customer service.  They even have licensed physicians and pharmacists on staff to answer your medical questions.

I can vouch for AccessRx.com because I am friends with AccessRx.com's director of Marketing, Richard Bernstein.  Mr. Bernstein takes his business seriously and takes pride in his company's track record and reputation.

Their prices are higher than the generics but you are assured of getting brand-name, American, FDA-Approved Viagra delivered to your door in a couple of days without having to go to a doctor.

Where does fake Viagra come from?

Most of the  fake Viagra comes from China and South America where the laws regarding pharmaceuticals are lax. 

Most of the Viagra selling websites are fly-by-night operations looking
to make a quick buck.  They often masquerade as American or
Canadian internet pharmacies but they are usually located outside the law in countries such as Cambodia or Bulgaria. 

How does Pfizer Deter Counterfeit Viagra?

Pfizer is trying to fight the introduction of fake Viagra into the pharmaceutical supply chain.  Pfizer uses redundant high tech security features to make it easy to detect counterfeit Viagra pills and packaging:

-  Beginning On December 15th, 2005, all bottles of Viagra have had a very small identification microchip (known as a RFID) embedded into the bottle.   The bottles are embedded with a Tagsys Flexible Module passive high-frequency (13.56 MHz) tag.  This means that every bottle of Viagra has a special electronic fingerprint so that pharmacists and wholesalers can track the pedigree of the tablets inside to ensure that they are authentic and obtained legally.

- Each Viagra label also contains a special two-dimensional barcode that works hand in hand with the RFID chip so that pharmacists and wholesalers can track the Viagra from the factory, through the supply chain down to the individual consumer.

- The labels on the Viagra bottles (as well as many other Pfizer products such as Lipitor and Celebrex) are printed with a color shift ink bar which is hard to fake but easy to recognize with the naked eye, similar to what you see with paper money.

Real or Fake? What's The Big Deal?

Many sites sell counterfeit Viagra to unsuspecting people at highly
inflated prices.

Sometimes they sell you a little baggie of half-tablets and Viagra
crumbs.  And when you try to call the "1-800" telephone number on
the site you brought the pills from to complain, all you get is the
run-around.

A common scheme is that people try to sell you sell so-called
generic Viagra that contains no active ingredient.  The poorer the country is, the easier it is to bribe local officials to look the other way. 

One hundred dollars goes a long way out in the boondocks of China or Mexico.  If you live in one of these countries, it is easy to open a pill factory to manufacture fake Viagra. 

These little factories are like meth labs - they stay open a short while, manufacture several thousand bootleg or counterfeit pills and move on before they get caught.

In the US, Viagra costs no more than $9.00 or $10.00 per pill.  When you buy Viagra on the internet prices vary by as much as 50% so it pays to comparison shop.

If you buy a larger quantity you should pay less per pill.  If you buy a
smaller quantity you will pay more per pill. 

In general, the farther away the Viagra seller is, the easier it is for
them to rip you off. 

Avoid buying Viagra from Asia, South America, Mexico and the
Caribbean
because that's where a lot of the fake Viagra comes from.

Another reason to avoid buying Viagra from outside the United States
is the pills might be confiscated by postal authorities when they reach
the United States.

This is happening more and more each day as the FDA and the DEA
crack down on the illegal importation of drugs into the USA.

Viagra History: Discovery Timeline

1989
-Pfizer Scientists synthesize silendafil citrate and give it the code name UK-92, 480.
-Experimental compound UK-92,480 is believed to be useful as a high blood pressure and angina treatment.  The scientists hope it may act as a vasodilator and be useful in treating cardiovascular ailments such as hypertension and angina.   

1991
- Researchers at Pfizer's Sandwich, England research facility (Peter Ellis and Nick Terret) observe that drugs that inhibit the PDE5 enzyme may be helpful in reversing erectile dysfunction.
- Early Phase 1 trials regarding the use of Viagra for angina are unremarkable.

1992
- A second Phase 1 angina trial reveals that the drug has an unusual side effect; penile erections.
- Phase 2 clinical study is conducted testing silendafil citrate's usefulness as an angina treatment reveals.

1993
- Pilot study using silendafil citrate as a treatment for erectile dysfunction is conducted in Bristol, England.  Test subjects take it three times a day for a week.  The studies had only 28 men involved.

1994
- Second pilot study on silendafil as an Erectile dysfunction treatment demonstrates that a once per day dose is able to produce an erection.
- Pfizer realizes it has something important; it accelerates the program examining silendafil citrate for erectile dysfunction.

1994 - 1997
- 21 clinical trials are conducted involving 4,500 men demonstrate that Viagra (as it is now known) is safe and effective.

1997
- Pfizer files a New Drug Application for Viagra (NDA 020895)
with the United States FDA.  FDA agrees to give it a priority review.

1998
- FDA approves Viagra as the first oral treatment for erectile dysfunction.  It was approved with a starting dose of 50 mg with the option to increase the dose to 100mg or reduce it to 25 mg.
     
Misc:
-FDA lists two patents for Viagra.  Patent number 5250534 expires on March 27, 2012.  Patent number 6469012 (patent use code U-155; TREATMENT OF ERECTILE DYSFUNCTION) is set to expire on Oct 22, 2019.

How did they come up with the name VIAGRA?

The name Viagra is believed to be an amalgam of two words: 

- The
"Vi-" part is associated  with the words vigor (physical or mental strength, energy, or force) or vital (necessary to the continuation of life; life-sustaining).

The
"-igra" part of the name Viagra is associated with Niagra Falls, the iconic American  waterfall; a metaphor for a massive powerful natural phenomenon.

Why Does The Viagra Tablet Have An Unusual Shape

Unlike most tablets, the Viagra tablet has an unusual rounded-diamond-shape.  It is believed that one reason Pfizer employs this tablet design is to make it harder to split the tablet with common tablet splitters. 

A 100 mg tablet of Viagra retails for $13.00.  A 50 mg tablet of Viagra sells for approximately the same price.  When people buy 100 mg tablets and split them into two 50 mg portions they save about 50% per dose.

The diamond shaped Viagra tablet will not fit into the typical tablet splitter which is designed to split round tablets.  Since its launch in 1998, specially designed Viagra tablet splitters have become available.

(Incidentally, another erectile dysfunction drug, Cialis also has an irregular shaped tablet that discourages pill splitting).
 

Viagra Information On The Internet:

Viagra Price Comparison: There is a lot of competition between sites
that sell Viagra.  This competition drives down the prices. 
Our editors have searched the internet.  You should be
able to get a good price on genuine Viagra if you comparison shop.

Viagra.com
Official website; Geared to patients; all about Viagra and erections. 
Includes an offer for 6 free pills of Viagra.

ViagraMD.com
Official Viagra website for healthcare professionals;  How to start and
maintain patients on Viagra, Multimedia presentation, prescribing
information, etc.  This site also has a section where you can report an
adverse regarding Viagra.

Official Viagra Prescribing Information
(Package Insert); dose, mechanism of action, side effects, precautions,
warnings; patient information; very technical, don't get scared when
you come to the section on warnings and side effects.

- Viagra FDA Consumer Information
Who should avoid Viagra, precautions, side effects.

- Viagra Scientific Papers
National Library Of Medicine; automated Medline search; a listing of
scientific papers in condensed form regarding Viagra.

- Viagra Versus Levitra
From Forbes magazine 10/06/03; M. Herper
and A. Lagorce;
Side by side comparison of various characteristics;
cost, pharmacokinetics, marketing tactics, etc.

- Viagra Versus Cialis
From Forbes magazine 12/03/03; M. Herper;
side by side comparison of various characteristics in slide show
format.

- Viagra News
(from Google) ; recently published news regarding
Viagra.

What Is Viagra and How Does It Work?

All three of the erectile dysfunction drugs (Viagra, Levitra and Cialis)
are similar in action.  They block an enzyme that causes an erection
to go flaccid.  Although these drugs are similar in action, their dose,
onset of action time and duration of action differ.

Viagra (Sildenafil) is a member of a family of drugs called PDE5
Inhibitors.  Viagra was the first PDE5 inhibitor on the market.  FDA
was  approved Viagra on March 27, 1998.  The team of scientists
who discovered Viagra won the Nobel Prize.


The BIG Discovery: cyclic guanosine monophosphate (cGMP)

Some very smart scientists discovered that cyclic guanosine
monophosphate (cGMP) was the key to sustaining an erection. 

They discovered that when a man gets sexually stimulated, a chain
reaction occurs in the tissue of the penis that results in elevated levels
of  a substance called cyclic guanosine monophosphate (cGMP).   

As long as there are sufficient levels of cGMP, the penis can remain
erect.  The more cGMP, the more robust and durable the erection.

If you inhibit the degradation (breakdown) of cGMP it stays around in
the penis longer, producing a more durable erection. 

Another way you can think of Viagra (and all other similar medicines)
is that it preserves the elevated levels of cGMP that are created when
a man is sexually stimulated for a stronger, more lasting erection.

That's how Viagra works - Viagra blocks the enzyme
phosphodiesterase-5 (PDE5) which is responsible for the neutralization
of cGMP.  Viagra (Sildenafil) is a highly selective inhibitor of PDE5.  (PDE5 is not the only phosphodiesterase involved in the erectile
physiology but it appears to be the most important one). 

The nice thing about PDE5 blockers is that they shouldn't cause
erections at inappropriate times because they only block degradation
of cGMP produced in reaction to sexual stimulation, such as thinking
about something sexy. 

If you are not being sexually stimulated, there is no cGMP to protect,
so the drug remains in the background.

Viagra Research: Recent Scientific Papers


  • Use of Sildenafil to Facilitate Weaning from Inhaled Nitric Oxide in Children with Pulmonary Hypertension following Surgery for Congential Heart Disease. … purpose of this study was to evaluate the use of sildenafil in facilitating weaning from inhaled nitric oxide after congenital cardiac surgery in patients who had previously failed weaning, and to compare the effects of sildenafil on pulmonary and systemic hemodynamics … Journal of Intensive Care Medicine 2008, doi:10.1177/0885066608321389; Jaclyn E. Lee, Pharm.D.1, Simon C. Hillier, MD2, and Chad A. Knoderer, Pharm.D.1*
  • Editor's Note: Children with congenital cardiac abnormalities requiring surgical intervention often suffer pulmonary hypertension as a complication of surgery.  Usually they use nitric oxide gas as a treatment for the pulmonary hypertension but you have to wean the kids off of the nitric oxide gas gradually to avoid adverse effects  In this experiment, after treatment with nitric oxide gas they tried Viagra by mouth as a step-down therapy to wean them off of the gas successfully.
  • Clinical implications: In the abstract, you notice that the reduction in Mean pulmonary artery and systemic arterial pressure was associated with a pValue of 0.066.  Since this p-Value is greater than 0.05, the results should not be considered clinically significant.  Therefore the clinical implications are unkown; more studirs are warranted.


Non-Sexual Uses For Viagra:

The active ingredient in Viagra (silendafil) is useful in treating a rare, potentially deadly condition known as pulmonary hypertension. 

In this use, Viagra's Phosphodiesterase 5 blocking activity is thought to be beneficial in relaxing the smooth muscle tissue found in the lungs by increasing the levels of cyclic guanasine monophosphate (cGMP).

  • Viagra Classified As Performance Enhancing Drug
      Viagra Joins Hall of Performance-Enhancing Infamy …  Viagra helped
      improve lung function and blood flow to cyclists' muscles during
      training at high altitudes …[Wall Street Journal; FREE]

Pfizer sells a tablet called Revatio for this use.  Each Revatio tablet contains 20mg of silendafil (the active ingredient in Viagra) and it is taken 3 times a day aproximately 4-6 hours apart. 

Absorption, Bioavailability

Viagra is rapidly absorbed. Maximum observed plasma concentrations
of Viagra are reached within 30 to 120 minutes (median 60 minutes) of
oral dosing in the fasted state. Viagra is about 40% biovailable. Viagra
is highly protein bound (96%). When Viagra is taken with a high fat
meal, the rate of absorption is reduced. 

Metabolism, Half Life, Excretion

Viagra is mostly metabolized in the liver by an enzyme known as
CYP3A4 and to a lesser extent CYPC229.  Viagra breakdown products
are  excreted in the feces (80%) and in the urine (approximately 13%).  Viagra's mean half life is about 4 hours. 

If you are going to take any of the PDE5 inhibitors such as Viagra, it is
very important that your doctor be aware if you have a liver condition
(such as cirrhosis) or kidney condition ( such as if you are on dialysis)
because you may need a special dosage adjustment. 

Likewise, if you try to obtain Viagra on the internet, please make sure
that the person authorizing your prescription knows the true status of
your liver function and your kidney function.

Dose:

For most patients, the recommended dose of Viagra is 50mg taken about 1 hour prior to anticipated sexual activity. However, the Viagra label states that it can be taken anywhere from 1/2 hour to 4 hours
prior to sexual activity.

The dose of Viagra may be increased to 100mg or decreased to 25 mg
depending on efficacy and side effects.  Sometimes people buy the
100mg tablets and break them in half to save money.

Viagra is available 25mg and 50mg  and 100mg tablets.

The maximum recommended dose is one pill per day.

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