There are top three oral medicines that are approved for the erectile dysfunction treatment. They are sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). All three belong to the drug family of phosphodiesterase 5 (PDE5) inhibitors. These medications help the smooth muscles of the penis to relax and boost blood flow, by blocking (inhibiting) the PDE5 enzyme.
Yet, PDE5 inhibitors are not appropriate for some patients. Let us walk you through major contraindications to Viagra and other PDE5 inhibitors. Those men who are prescribed organic nitrates for angina must avoid taking PDE5 drugs. Organic nitrates include long-acting or short-acting nitroglycerin, amyl nitrate, isosorbide mononitrate, isosorbide dinitrate, and others. Since organic nitrates boost cyclic guanosine monophosphate GMP (cGMP) production while PDE5 inhibitors lower cyclic GMP breakdown, there is a risk of a synergistic drop in blood pressure when PDE5 inhibitors are taken with organic nitrates resulting in hypotension in some patients. In other words, when using PDE5 inhibitors nitrates should be avoided.
But what if a patient has already taken one of the PDE5 inhibitors and then experiences chest pain, is it safe to resume taking nitroglycerin after a while? According to the guidelines of the American Heart Association, 24 h must pass before nitrate medications are given to a patient who has already taken sildenafil (4-hour half-life). There is a study suggesting an absence of interaction with nitrate drugs at 24 h after vardenafil, whose half-life constitutes 4 hours. Finally, another study reports an interaction between tadalafil, whose half-life is 17.5 hours, and nitroglycerin that was registered at 24 h after taking a dose of tadalafil but the absence of thereof by 48 h and beyond. Thus, despite the facts that all three PDE5 inhibitors are clearly contraindicated in patients prescribed either long-acting or short-acting nitrates, should a male patient with ED take a PDE5 inhibitor and afterwards develop angina, nitroglycerin (and other nitrate drugs) should not be administered until after 24 h for vardenafil or sildenafil and until after 48 h for tadalafil.
PRE5 drugs are also not recommended with certain varieties of alpha-blockers for hypertension and benign form of prostatic hyperplasia. The PDE5 inhibitors are not quite effective in patients undergoing a prostate cancer treatment and in patients with diabetes. Patients who are using GC (guanylate cyclase) stimulators, such as riociguat should avoid using PDE5 drugs since the latter may potentiate the hypotensive effects of GC stimulators.
Patients with the conditions listed below should avoid PDE5 inhibitors without prior recommendation from their doctors and, even then, take them with caution:
- Severe forms of heart failure;
- Severe forms of heart disease, such as arrhythmias, unstable angina, a recent case of heart attack (patients with heart disease will benefit from an exercise check to define whether resuming sexual activity escalates the threat of a heart attack);
- Very low blood pressure (hypotension);
- Uncontrolled high blood pressure (hypertension);
- Uncontrolled diabetes
- Recent history of stroke
- Retinitis pigmentosa (patients affected by this genetic disease do not produce phosphodiesterase-5 in the first place and thus cannot possibly respond to PDE5 inhibitors).
Vardenafil, when taken in orally disintegrating tablet (ODT) formulation, contains phenylalanine and should be taken with caution by patients suffering phenylketonuria. Patients with inherited intolerance to fructose should better exercise restraint with the ODT formulation of vardenafil because it contains sorbitol.
Alternatives to PDE5 Inhibitors
If you were advised against PDE5 inhibitors, take a look at an alternative in the form of a remedy called alprostadil. Being an artificial hormone. alprostadil drives blood flow to the genital area and can enable an erection within 5-10 minutes. Alprostadil injections have been reported to deliver successful erection in 8-9 men out of 10 who are dissatisfied with PDE5 drugs. Also available as a tiny pellet to be placed straight inside the urethra, alprostadil has been successful in two-thirds of those patients who found PDE5 drugs non-effective.
Vacuum pumps represent another alternative to PDE5 inhibitors. When used correctly, pumps allow 9 out of 10 men to attain an erection by forming a vacuum layer around a penis that prompts the blood to rush in. Once achieved, the erection can last as long as 30 minutes thanks to applying a band around the base of the penis. Possible side effects in the form of bruising are not to be excluded, but they happen in less than one third of patients. Sadly, this method is not suitable for anyone taking anticoagulants or anyone suffering a bleeding disorder.
Herbal ED treatment known as Yagara is a 100% natural remedy that has become one of the best natural Viagra alternatives due to its power to make a positive impact on male erectile dysfunction, similar to those of synthetic ED medications. Moreover, with Yagara, you can mitigate the problem without side effects. Yagara cures erectile dysfunction and boosts stamina and vitality in males. Some patients have even reported that Yagara had positively impacted their psychological state, although one can reason that this rather looks like an upside of its main effect!
Herbal Viagra Ingredients
The totally safe and powerful Yagara capsules include manually-picked herbs that several generations of Asians have valued for their erotic desire and sexual performance boosting characteristics. Yagara capsules are factory-made from the pesticide-free plant and mineral materials to ensure the highest health benefits. Patients feel superior when replacing synthetic ED drugs with Yagara. The all-natural ingredients improve overall health — and the best part is that Yagara is prescription-free! Our partner factory complies to the strictest sanitation and manufacturing standards.
Each individual Yagara capsule contains the following ingredients:
- Ashwagandha extract 50 mg – libido enhancer;
- Kavach Beej 50 mg – testosterone raiser;
- Shilajit 50 mg – control keeper;
- Jay Phal (Nutmeg) 50 mg – testosterone stimulating capabilities;
- Vidhara Beej 50 mg – spermatogenic, and aphrodisiac capabilities;
- Lata Karanj 50 mg – anxiety relief;
- Akkal Kara 25 mg – blood flow / libido enhancer.
Herbal Viagra Results
Natural Viagra alternatives deliver selected effects of Viagra, as it follows from patient reviews and clinical trials. Although herbal replacements can be as solid support for a healthy erection, one cannot anticipate from herbal treatment the equal 70-80% success rate provided by contemporary synthetic ED medications. When beginning a herbal Viagra treatment, prepare to feel a long-term and systemic positive effect on your wellbeing, as opposed to instant and localized. Hence, if you expect a 100% erection achievement here and now, you cannot entirely rely on the administration of natural Viagra replacement products.
Get Your Herbal Viagra Online at Smart Canadian Pharmacy
When planning a treatment with herbal PDE5 substitutes, be cautious not to dash out to the very first drugstore on your way to purchase anything with a label “herbal Viagra” on it. Some of those “herbal” products may be quite hazardous and cause a greater harm to your health than synthetic equivalents, due to the undeclared components that might very well include synthetic ED components in weird amounts.
At Smart Canadian Pharmacy, we are dedicated to serving our customers in fully transparent and professional manner. We source all our inventory from the internationally certified factories that can guarantee, in written form, the quality of their products, and we state the precise content of the medications we sell.
Yagara, one of the best natural herbal Viagra alternatives on the market, that you can buy from Smart Canadian Pharmacy aggregator www.smartcanadianpharmacy.com, is the TRUE herbal Viagra as it comprises six natural active herbs and one natural mineral substance, each improving a particular aspect of male sexual function. You can read about the properties of each individual component and be confident that it is included in the Yagara capsule in the exact amount stated on the label.
To inquire about the advantages of Yagara and its suitability to your needs, just give us a call – our professional consultants will provide you with comprehensive free advice.