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Viagra, Levitra, Cialis
Viagra, Levitra, and Cialis are medicines called phosphodiesterase inhibitors. They work the same way and are generally similar to each other with some differences. They block an enzyme which normally breaksdown a chemical that is involved in relaxing smooth muscles in the penis which contributes to erections. Theycan work in erectile dysfunction of any cause and are effective in around 70% of men. Be aware that whenthey are found to help a man they may not work 100% of the time. They are not a "cure" as most men willneed to continue to take them.
These medicines do not cause erections but allow you to get one when stimulated. Usually there is a 30 to 60 minute delay in onset of action from when you take them. They should not be taken more than oncein 24 hours.
Usually you try one and if doesn’t work then you could try another. When trying one, start with the starting dose (as on the other side) -- give it two or three tries. If not effective (or not fully effective) you canincrease the dose (usually by taking 2 at a time). If the starting dose is effective, you could try cutting it in half.
They all cost about the same and all dose sizes cost the same. Thus, to save money if there is a (two times) higher dose form than the dose you need, you could get the higher dose and cut them in half (forexample, if 50mg works well, getting a 100mg pill and cutting in ½ will save money).
1) if you have heart problems or chest pains, shortness or breath this should be evaluated before using these medicines (the strain on the heart from sexually activity is felt to be similar to thatfrom going up 2 flights of stairs).
2) Rarely these medicines can cause “priapism” - painful erections that persist. If you develop an erection that lasts more than 4 hours you should go to the ER (emergency room) immediately.
3) There have been reports of vision loss occurring in people taking these medicines - these are rare and it is not clear whether these medicines were involved or whether this was a coincidence.
The type of vision loss is called NAION (Non-arteritic Anterior Ischemic Optic Neuropathy).
NAION usually occurs as a sudden decrease in vision in one or both eyes (often noticed uponawakening from sleep). People at highest risk for NAION are usually >50 years old, havecardio-vascular risk factors (smoking, hypertension, cholesterol, diabetes), and/or a particularabnormality on eye exam (small cup to disc ratio). Those who have had NAION may not wantto use these medicines. If you experience a sudden loss of vision in one or both eyes, seekmedical attention and do not take any more Viagra, Levitra, or Cialis.
Interactions with other medications
Nitroglycerin (NTG) is the most important -- you should never take Viagra, Levitra, or Cialis with NTG (of
any form - pills, patches, creams, inhalers) as there is the potential for significant lowering of the bloodpressure which can potentially cause death.
NTG and Viagra/Levitra/Cialis should not be taken within a  Alpha blockers - these are a class of blood pressure medicines often prescribed for enlarged prostate These include Cardura (generic name: doxazosin), Flomax (tamsulosin), Hytrin (terazosin),
Minipress (prazosin), Uroxatral (alfuzosin) These should be used with caution with Viagra, Levitra, or
Cialis. The dose of your alpha blocker should be stable (i.e., not changing) and you should start with the
lowest dose of Viagra, Levitra or Cialis.
Watch for possible low blood pressure - feeling dizzy, light-  Alcohol - alcohol along with Viagra, Levitra, Cialis can potentially lower the blood pressure significantly;
thus alcohol use should be limited when using these medicines.
 There are many medications that potentially could interact with these medicines. You might want to review all your medicines with your pharmacist. If there is a potential interaction, choices are to not use thesemedicines, use them at lower doses (and increase if no problems and lower dose doesn’t help). Many ofthese are listed with each medicine on the other side.
Viagra (generic: sildenafil)
 Starting dose: 50mg (25mg if over 65 years old, significant kidney or liver disease, or using the following medicines: alpha blocker (see other side), erythromycin, Nizoral (ketoconazole), Sporonox (itraconazole),saquinavir)  Maximum dose: 100mg (if on Ritonavir: 25 mg every 48 hours)  Other medicines: Viagra may interact with: Erythromycin, Diflucan (fluconazole), Amiodarone, Diltiazem, Losartin, Nifedipine, statins (cholesterol medicines), Xanax (alprazolam), Zoloft (sertraline), Tylenol  Food: food (especially fatty foods) may delay onset of effect … so take on empty stomach or with low-fat Levitra (generic: vardenafil)
 Starting dose: 10 mg (5 mg if over 65 years old, significant liver disease, or taking an alpha-blocker (see  Maximum dose: 20 mg (10 mg if significant liver disease)  Other medicines: dosage of Levitra should be reduced if used with erythromycin, Nizoral (ketoconazole),  Should not be used in certain heart problems (long QT) or if using certain anti-arrhythmia medications (Quinidine, Procainamide, Amiodarone, Sotalol)  Food: can take with or without food (a high fat meal may delay onset) Cialis (generic tadalafil)
 Dose sizes: 2.5, 5, 10, 20 mg
 Starting dose: 10 mg (5mg if moderately severe kidney disease or taking an alpha blocker (see other side))  Maximum dose: 20 mg (10 mg per 48 hours if moderately severe kidney disease; 10 mg per 24 hours if mild-moderate liver disease, do not use in severe liver disease)  Other medicines: use only once (10 mg maximum) in 3 days when taking Nizoral (ketoconazole), Ritonavir  Cialis may last longer (up to 36 hours) than Viagra or Levitra. A potential negative aspect of this is that any side-effects or drug interactions would last longer; it may also take longer until it begins working  Alternatively, Cialis can be taken on a daily basis (take at the same time every day). For this use the 2.5mg size increasing to 5mg if 2.5mg isn’t effective (note: taking two 2.5mg pills may be less expensivethan taking one 5mg).
This is general information and may or may not apply to a specific person. Before acting on any
of this information you should consult your physician. Keep in mind that medical knowledge changes
over time and data is subject to different interpretations by different physicians.

Source: http://www.samslonimmd.com/viagra.pdf

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