Information on erection problems and treatment with Avigra (sildenafil citrate) 1,2,3

(sildenafil citrate)
Information on erection problems
and treatment with Avigra
What is Avigra?
Avigra is a medicine used to treat erection difficulties,
known as erectile dysfunction (ED). It is made by Pfizer, the
same company that makes Viagra®. In fact, both Avigra and
Viagra have the same chemical makeup (sildenafil citrate).
Avigra offers the same highly effective results as Viagra
with the added benefit of reduced cost, which is why
Avigra gives you more bang for your buck.1,2,3
About erection problems
Many men will find it difficult to get or keep an erection at
some time in their lives. The occasional let-down, though,
is different from having erection problems most of the
time. Constant erection problems not only undermine your
confidence, but prevent you from having a satisfying sex life.
If you are unable to get or keep an erection long enough
for satisfying sex, you may have the medical condition
that GPs call ‘erectile dysfunction’ or ‘ED’. This medical
condition affects men of many different ages.
Erection problems are common
It is estimated that around one third of men over the age
of 40 will experience some sort of erection problem.4 The
fact is, guys at any age can experience erection problems
and knowing that millions of men have received treatment
for erection problems already should put your mind at ease
that you are not alone.
You should be able to enjoy a satisfying sex life whatever
your age. While all men notice that their sexual response
slows down as they get older, erection problems are not an
inevitable part of ageing. Sometimes medical conditions that
often accompany older age, such as high blood pressure,
may cause erection problems and may need to be treated.
Erection problems:
There are many causes
Erection problems are often due to a combination of
physical factors and psychological causes. And it can be
a vicious cycle – having an erection problem might reduce
your desire to have sex because you’re not confident you
can get an erection or your erection will last long enough
for satisfying sex.
Talking to your GP to work out what may be causing
erection problems is the first step to helping you enjoy sex
like you used to.
Erection problems often occur alongside other common
medical conditions, such as disorders of:
• the heart and blood vessels (cardiovascular disorders)
• the nerves (neurological disorders)
• blood sugar (diabetes)
An erection problem may be a
treatable medical condition
Having an erection problem – being unable to get or keep
an erection long enough for satisfying sex – is common.
It’s also a medical condition that can be treated.
Erection problems may happen once in a while, or all the
time. There are many different causes, and treating the
cause may be all that’s needed to put the problem right.
At other times, specific treatment may be needed.
Either way, your GP can help you to find the treatment that
may work best for you. So take the first step in improving
your sex life and getting your confidence back: talk to
your GP.
In addition, issues such as excessive drinking of alcohol,
smoking, relationship and stress related issues can
contribute to erection problems. It may be that you
need treatment for another condition that’s causing your
erection problems.5
Certain medicines can cause or contribute to erection
problems. Because of this you should tell your GP about all
medicines you’re taking, even if you don’t think they could
be causing the problem.
You should not stop taking any medicine your GP has
prescribed; it may not be the cause of the problem. If you
are concerned that your medicine is affecting your sex life,
talk to your GP.
Medical conditions that affect the blood vessels
Part of getting an erection involves blood vessels in the
penis relaxing and widening so that the penis can fill with
blood. Any condition that makes your blood vessels less
likely to relax and widen can make getting an erection
difficult, no matter how much you may want it to happen.
Hardening of the arteries
One condition that impairs blood flow to the penis is
hardening of the arteries (atherosclerosis), where fat builds
up on the inside of blood vessels, making them narrow and
more rigid.
Conditions affecting the heart and blood vessels
Other conditions affecting the heart and blood vessels can
also indicate that the blood vessels in your body are not as
healthy as they once were and can increase the likelihood
of erection problems. These include:
• high blood pressure (hypertension)
• heart disease
• some types of stroke
• previous heart attack
Ongoing illnesses5
Up to nine out of ten men with depression may also have
problems with their erections.
• high cholesterol
Kidney or liver disease
If you have diabetes, you are more likely to have problems
with erections than men who do not have diabetes. This
may be due to the damage that diabetes does to small
nerves and blood vessels over time. To get and keep
erections long enough for satisfying sex you need healthy
blood vessels and healthy nerves.
If you have diabetes you may have problems with erections
at a younger age than men without diabetes.
Men with kidney disease can have problems getting and
keeping an erection, as can men with liver disease. These
diseases affect a range of body functions, including erections.
Medical conditions that affect the nerves
For the blood vessels of the penis to relax, a healthy nerve
supply is needed. Therefore, conditions that affect the
nerves also affect your erections.
Spinal cord injury and conditions such as Parkinson’s
disease or multiple sclerosis could potentially cause
erection problems.
Problems with the prostate
How can I be sure I have a problem?
Erection problems are common after treatment for prostate
cancer, such as radiation therapy or surgery. Untreated
prostate cancer can also contribute to erection problems.
Avigra may assist with the return of erectile function after
procedures on the prostate. Talk to your GP or Urologist
about whether this could be an option for you.6
Tick the answer that best describes your own situation
during the past 6 months.
Are you confident that you can usually get and keep an
When you have an erection, is it usually fully hard and rigid?
Having low levels of male hormones or a
hormone imbalance
Occasionally, a hormone imbalance is the cause of
erection problems. This imbalance could be due to low
levels of the male hormone testosterone, or higher than
normal levels of prolactin, a hormone produced by the
pituitary gland.5
Can you usually keep your erection until you’ve finished
sexual intercourse or activity?
Sometimes, the cause of erection problems can be a
physical injury or a deformity of the penis. These can be
caused by surgery or direct injury to the penis. Physical
problems may also be due to a disease called Peyronie’s
disease, which causes scarring within the penis.
Are you satisfied with your ability to get and maintain an
Physical problems with the penis
Rate your erections using the
Erection Hardness Grading Scale4
Grade 1
Penis is larger but not hard.
Grade 2
Penis is hard, but not hard enough
for penetration.
Grade 3
Penis is hard enough for penetration,
but not completely hard.
Grade 4
Penis is completely hard and fully rigid.
If you answered ‘no’ to any one of the above questions or
you are not getting a Grade 4 erection, you may want to
discuss this with your GP.
Target a Grade 4 erection with Avigra for optimal hardness
and satisfaction.4-7††
††Improvements in self esteem, confidence and sexual relationship
satisfaction when moving from a Grade 3 erection to a Grade 4 erection
when treated with Avigra.7
You and your partner are both affected
Although erection problems usually have a physical cause,
they can have a significant effect on a couple’s emotional
life. It is vital that you do not let sexual problems raise a
barrier between you and your partner. You are more likely
to resume a satisfying sex life if you involve your partner in
understanding your erection problems and in the process
of getting treatment.
What should I expect from my GP?
The discussion of erection problems may be new for you
but it certainly isn’t for your GP. This is a familiar area
of men’s health for GPs so there is no need to feel shy
or concerned about the discussion. Because erection
problems may be an early warning signal for general
health issues, GPs are happy to discuss not only treatment
options but also check on your wider health.
You can expect a GP to assess or re-check your general
health when discussing erection problems. This is to try
and understand the cause, or causes of your erection
problems. Your GP may want to do some routine blood
tests and check your blood pressure. The GP will normally
talk through different treatment options and may offer you
samples of Avigra to test.
What are the treatment options?5
Erection problems can be treated! You don’t have to put
up with an unsatisfying sex life. Depending on the cause,
your GP may suggest one or more of the following
treatment options:
Avigra is a medicine used to treat erection difficulties,
known as erectile dysfunction (ED). It is made by Pfizer, the
same company that makes Viagra. In fact, both Avigra and
Viagra have the same chemical makeup (sildenafil citrate).
The only difference is the name, and the price.
• Replacing existing medicines: Replacing medicines
that can cause erection problems with ones that are less
likely to cause this side effect may be all that’s needed.
• Lifestyle changes: Lifestyle changes may mean cutting
down on smoking and alcohol or managing stress.
• Counselling: You can have counselling either with or
without your partner, and it may help ease any anxiety
you have about sex.
• Medicines: Tablets to treat erection problems can
help increase blood flow to the penis, improving
erectile function.
• Hormone treatment: When erection problems are
caused by irregular levels of sex hormones like
testosterone, hormone therapy can restore the balance
and improve erectile function.
• Other treatments: There are more treatments for
erection problems. Your GP will be able to tell you
about these.
Talk to your GP about what treatments are available to
help you achieve a satisfying sex life.
Since it first became available in 1998, Viagra has helped
more than 37 million men around the world improve
their sex lives.8 Amazingly, approximately 6 tablets are
dispensed every second worldwide.8 No other oral therapy
for ED has been studied as much or has the same amount
of real-world experience as Viagra since its launch.8
Avigra comes in three tablet strengths, 25mg, 50mg,
and 100mg. The most commonly used sildenafil citrate
strength in New Zealand is the 100mg.9 Avigra can be
used once a day.2
How does AVIGRA work?
Avigra is a medicine that treats the physical ED problem by
increasing blood flow where you need it. With Avigra, you
must be sexually excited to get an erection.2
Here’s what usually happens when a man is sexually
1. The arteries in the penis relax and widen (this allows
more blood to flow into the penis).
2. The increased blood flow causes the penis to become
hard and erect.
3. The veins that normally carry blood away from the
penis get compressed (this restricts the blood flow
out of the penis).
4. More blood begins flowing in and less flows out,
making the penis larger. This causes an erection.
For men with erection problems the nerves or blood
vessels that play a part in this process may not work
properly. Avigra helps to re-establish this process of
improved blood flow to the penis.
Most men on Avigra achieve Grade 4 erections (penis is
completely hard and fully rigid) regardless of their erection
grade prior to treatment.10♂
Another treatment aspect with Avigra is the predictable
and rapid response men get from the medication. Studies
have shown that for some men it begins working as early
as 14 minutes and for most men within 30 minutes.2,10
Avigra works for at least 4 hours so you can have sex
within a natural time frame.2,11
♂ From a 6 week randomised (n=307 men), double blind placebo
controlled trial of flexible dose sildenafil with a six week open label
extension. In the open label extension 61% of patients who switched
from placebo to Avigra and 67% of patients who initially started on
Avigra achieved a Grade 4 erection.10
Important safety information
Avigra has been shown to successfully treat ED in many
men. But remember, no medicine is for everyone. If you
use nitrate medication, often used to control chest pain
(also known as angina) don’t take Avigra as this can lower
your blood pressure to unsafe levels.2
Remember to discuss your general health status with your
GP to ensure that you are healthy enough to engage in
sexual activity.
If you experience chest pain, nausea, or any other
discomforts during sex, or an erection that lasts longer
than 4 hours, seek immediate medical help.
The most common side effects of Avigra are headache, facial
flushing, and upset stomach. Less commonly bluish vision,
blurred vision, or sensitivity to light may briefly occur.2
How can I get Avigra?
Avigra can only be supplied after consultation with your
GP. If you suspect you have some problems achieving or
maintaining erections, you are not alone. Talk to your GP
now. Do not put it off. Beware of buying Avigra off the
internet – it could be a counterfeit product and may not be
safe. Only buy Avigra from a reputable Pharmacy.
Things to remember when using Avigra
Avigra works only when you are sexually aroused.2
Orgasm and ejaculation occur as normal and the erection
should subside in the natural way.
Avigra works as early as 14 minutes for some men, and for
most within 30 minutes.2,11
For most men Avigra works on the first or second attempt.
For some, Avigra may work better the third or fourth time
you take it, so keep trying.5
Familiarity with the treatment enhances response.5
Up to 8 out of 10 men achieve successful intercourse
with Avigra.2,4,5
Avigra is effective for at least 4 hours, allowing you to
engage in sexual activity within a natural timeframe.2,11
Avigra is there when you need it, and in most men gone
from your system within 24 hours.2,11
For best results avoid excess alcohol.2 Drinking can make
sex difficult, with or without Avigra.
Avoid eating a high fat meal before taking Avigra as it may
slow absorption.2
Take Avigra as directed and if your response seems
unsatisfactory, talk to your GP.
AVIGRA® (sildenafil citrate, 25, 50 and 100 mg) Tablets
AVIGRA (sildenafil citrate) is an unfunded prescription medicine
for use by men in the treatment of erection problems resulting
in a natural response to sexual stimulation. You will need to pay
for this medicine and normal doctor’s fees apply.
Do not use Avigra if you: are being treated for angina (chest
pain) or other heart conditions with medicines called nitrates;
are using amyl nitrite; have heart or blood vessel problems
that make sexual intercourse inadvisable; have suffered a
heart attack or stroke in the last 6 months; have severe liver
problems; have unusually high or low blood pressure that is
not effectively treated; have loss of vision in one or both eyes
from an eye disease called non-arteritic anterior ischaemic
optic neuropathy (NAION); have an eye disease called retinitis
pigmentosa; have an allergy to AVIGRA or similar medications.
Side effects include headache, dizziness, flushing, indigestion,
nasal congestion, temporary changes in vision, diarrhoea,
urinary tract infection or rash. If symptoms continue or you have
side effects, see your doctor. If any of the following happen,
tell your doctor immediately or go to Accident and Emergency
at your nearest hospital: signs of allergy such as shortness of
breath, wheezing or difficulty breathing; swelling of the face,
lips, tongue or other part; chest pain; sudden decrease or
loss of hearing; seizures, fits or convulsions; a persistent and
painful erection; loss of eyesight in one or more eyes.
Use strictly as directed. Consult your doctor to see if AVIGRA
is right for you.
Contains sildenafil citrate 25 mg, 50 mg & 100 mg.
Further information on AVIGRA is available from or from Pfizer New Zealand Ltd,
Auckland, Ph: 0800 736 363.
REFERENCES 1. Viagra Data Sheet. 2. Avigra Data Sheet. 3.
Viagra/Avigra RRP document. 4. Goldstein I et al. N Engl J Med
1998; 338: 1397-1404. 5. McCullough AR et al. Urology 2002; 60
(Suppl 2B): 28-38. 6. Padma Nathan et al. Int J Impotence Res
2006 18, 423-431. 7. Mulhall J et al. J Sex Med 2007; 4:448464. 8. Pfizer data on file. 9. IMS Data Feb 2011. 10. Eardley I
et al. Br J Clin Pharmacol 2002; 53: 61S-65S. 11. Althof et al. J
Gen Intern Med 2006; 21: 1069-1074. 12. Dean et al. European
Urology Supplements 5 (2006) 761-766. 13. Dean et al. European
Urology Supplements 5 (2006) 773–778. 14. Montorsi. J Sex
Med 2005; 2: 658-667. 15. Kadioglu A et al. J Sex Med 2008; 5:
726-734. TAPS NA4905. R&A3749. BCG2-H. AVI0008.