1,2,3 (sildenafil citrate) Information on erection problems and treatment with Avigra What is Avigra? 1,2,3 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 Medicines 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 Depression Up to nine out of ten men with depression may also have problems with their erections. • high cholesterol Kidney or liver disease Diabetes 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 erection? Yes No 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 Yes Can you usually keep your erection until you’ve finished sexual intercourse or activity? Yes 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. No Are you satisfied with your ability to get and maintain an erection? Yes Physical problems with the penis No No 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 About AVIGRA 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 aroused: 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: MORE BANG FOR YOUR BUCK1,2,3 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 www.medsafe.govt.nz or from Pfizer New Zealand Ltd, Auckland, www.pfizer.co.nz 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.
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