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best generic cialis Comment: Consider that this drug has shown to improve erectile dysfunction up to 36 hours following dosing, when used as needed. Serve as a male form of birth control.Although Viagra (sildenafil) does not directly interact with coumadin, Betapace (sotalol), Lanoxin (digoxin), or enalapril, it should be used cautiously in patients with underlying heart conditions. Because Viagra dilates the blood vessels and can reduce the blood pressure, it may increase the blood pressure-lowering effect (hypotension) caused by enalapril and Betapace. There have been a few isolated reported incidents of heart problems in patients taking Viagra. The incidents include abnormal heart rhythm (atrial fibrillation and ventricular arrhythmia), low blood pressure, myocardial infarction, and blood clots (thromboembolism). Because of these possible events, the patients should be monitored closely. The best option is treat erectile dysfunction non-pharmacologically.

How A Little Blue Pill Changed The WorldPenile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum. Nitric oxide activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in erection. The tissue concentration of cGMP is regulated by both the rates of synthesis and degradation via phosphodiesterases (PDEs). The most abundant PDE in the human corpus cavernosum is the cGMP-specific phosphodiesterase type 5 (PDE5); therefore, the inhibition of PDE5 enhances erectile function by increasing the amount of cGMP. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation.