Saturday, May 28, 2016

Why glutathione is important to us

Why glutathione is important to us
Some nutritional supplements that can increase glutathione levels include milk thistle (seen here), pine bark extract, alpha lipoic acid and grape extract. Photo: Wikimedia Commons
One important protein that appears in every human cell is a tripeptide known as glutathione.
Found in the highest concentrations in the liver, it consists of three amino acids: glutamic acid, L-cysteine and L-glycine.
The first record of glutathione was in 1888, but it was not until 1984 that its function in the body began to be researched in detail.
It turns out that glutathione serves as an antioxidant and detoxifier that protects cells from free radicals and oxidative stress, thus, improving the immune system.
But glutathione levels in human cells begin to decline after you turn 20. In order to produce more glutathione, supplementation of L-cysteine is recommended.
In the absence of glutathione, the body will experience several things. All the cells in the body would face premature death, causing the liver, which cleanses your body of toxic materials, to malfunction.
Worse, the entire immune system will break down – in other words, without glutathione, humans would cease to exist.
How glutathione works
Glutathione is the only antioxidant that is intracellular, meaning that it acts inside the cells. This helps to resist disease by neutralising free radicals and keeping other antioxidants like vitamins C and E in their active form.
Many scientists believe there is a link between low glutathione levels and cell death, which could be why the levels of glutathione in patients with serious diseases such as AIDS and cancer, are typically very low.
On the other hand, clinical observations of people aged 100 and more in various countries like Poland, Italy and Denmark, have found very high levels of glutathione in their cells.
Other functions of this protein include helping to process toxins in the liver; DNA and protein synthesis; and regulating the nitric oxide cycle and the metabolism of iron.
Key benefits of glutathione
Decreased levels of glutathione have several consequences that are linked to a number of age-related illnesses. This includes:
• Alzheimer’s disease and macular degeneration – A University of Alabama study in the United States revealed that the red blood cells in male Alzheimer’s patients indicated a significant lack of glutathione.
A study of patients with heart disease found that the lower their levels of glutathione, the higher the likelihood of them experiencing a heart attack. Photo: AFP
A study of patients with heart disease found that the lower their levels of glutathione, the higher the likelihood of them experiencing a heart attack. Photo: AFP
• Heart disease – A study of patients with heart disease found that the lower their levels of glutathione, the higher the likelihood of them experiencing a heart attack.
• Cancer – While glutathione is not able to cure cancer, several studies suggest that the growth of new cancer cells may be reduced. Its strong antioxidant properties make it suitable as a supplement.
This is why some doctors recommend it as a supplement to treat cancer, as it improves the effectiveness of chemotherapy drugs and reduces their side effects.
• Psychiatric illnesses, including bipolar disorder, schizophrenia and depression – These have been linked to low levels of glutathione. The lack of antioxidant abilities in the brain can cause oxidative stress.
Glutathione has also been used to treat Parkinson’s disease, sickle cell anaemia, idiopathic pulmonary fibrosis and poisoning, as it is able to cleanse the body of unhealthy metals such as mercury.
Glutathione has been found to improve the quality of the human male sperm. This is achieved by the lowering of blood pressure and decreasing oxidative stress on the sensitive sperm cells, hence, minimising damage to their DNA cargo.
Couples who are trying to conceive should look for micronutrient supplements, especially n-acetyl-cysteine (NAC), which is used in the body to produce L-glutathione.
The aspiring father could also benefit from consuming scientifically-proven nutrients such as arginine, carnitine and pine bark extract.
How to best consume glutathione
This amino acid should be taken together with selenium, zinc and magnesium, in order to maximise the oxidative effects.
Many foods contain these minerals, but they can be found in high amounts in vegetables that contain high amounts of sulphur, such as cabbage, broccoli, garlic, kale and cauliflower.
The only problem is that many of the vitamins and minerals in these vegetables are killed when they are cooked, so try to eat them raw wherever possible.
Some nutritional supplements can also increase glutathione le- vels. Pine bark extract, alpha lipoic acid, milk thistle and grape extract are some of those supplements.
Because it is a protein, a fair amount of glutathione that you ingest is broken down in your gut and eliminated before reaching the cells.
In severe cases, you can opt for intravenous infusion in order to maximise the absorption of glutathione in the body, which is often done in cases of critical illnesses.
The most effective way to increase glutathione levels, in addition to consuming healthy meals and having regular exercise, is to ingest a precursor.
This contains the molecules needed to stimulate the body to produce glutathione, rather than the protein itself.
One example of a precursor is NAC. This has been used for many years to break up mucous in the lungs of patients suffering from cystic fibrosis, asthma and bronchitis, and is often used by HIV pa- tients to boost their immune system.
Unbonded L-cysteine, or free cysteine, is destroyed in the gut by enzymes and pepsins, but if the cysteine molecules are bonded, it will be absorbed into the bloodstream and enter cells.
When there, it can bond with glycine and glutamate to make more glutathione.
This bonded cysteine can also be found in human breast milk, and can be replicated with raw cow’s milk in the form of denatured whey protein.
Big doses of NAC are often administered in cases of painkiller overdose because it prevents liver failure.
Vitamin C has also been found to increase the production of glutathione when daily doses of 500 milligrams or more are consumed.
And finally, if not synthesised in the body, L-glutathione is produced via fermentation, which is the industrial processing of plant-based foods using enzymes.
L-glutathione can be stored easily for up to five years at room temperature in a dry room that is protected from sunlight.
While a healthy diet and lifestyle can help to prolong your body’s functions and slow down decline, a supplement of glutathione precursors can help the body produce more of the protein, resulting in longer-lasting good health and a slower ageing process.

And as a final note on this powerful antioxidant: there are many gluthatione supplements available on the market, but not all are trustworthy products. Always do your research, and seek recommendations from a trusted doctor before purchasing.

Introducing Gluthathione from KOHJIN Japan
Price: RM93.30 per box of 30s

Wednesday, May 25, 2016

Top 10 Reasons To Breastfeed

1. It releases bonding hormones.
Just like kangaroo care (skin-to-skin contact), breastfeeding releases the “bonding hormone” oxytocin. The same hormone that’s released when you hug or kiss a loved one, oxytocin provides a feeling of closeness between you and baby while it moves milk toward the front of your breasts — the process known as letdown.

2. It may lower the risk of childhood cancers…
On top of giving baby a healthy start with your breast milk’s antibodies, which help protect baby from the cold and flu, breastfeeding may even boost his ability to fight off more serious stuff. A study published in the Journal of Human Lactation found high levels of the cancer-fighting TNF-related apoptosis inducing ligand (TRAIL) in human milk. This means better protection against illnesses like lymphoblastic leukemia and Hodgkin’s disease.

3. ...and breast cancer in moms!
Get this: Moms who breastfed were 1.5 times less likely to be diagnosed with breast cancer than those who didn’t in a study from Columbia University. And the more children they breastfed, the lower their risk became. According to the National Cancer Institute, breastfeeding is associated with decreased risk of ovarian cancer too.

4. It may boost baby’s brainpower.
 Add breastfeeding to the list of ways to get an edge on the SATs. A study published in JAMA Psychiatry followed nearly 14,000 children over the course of six-and-a-half years, and the kids who were exclusively breastfed had a significantly higher average IQ test score than those who weren’t. Plus, on average, they received higher ratings from their teachers.

5. You could save on braces.
The longer you breastfeed, the lower the likelihood that baby will suffer from malocclusion — a fancy word for misalignment of the teeth and dental arches. A study from Brazil suggests that breastfeeding for more than nine months is the most effective way to prevent malocclusion.

6. Diaper changes won’t be as stinky.
Moms in our circle swear that breastfed babies have sweeter smelling poop than formula-fed babies, whose stools smell more like, well, adult poop. Formula isn’t quite as easily digested, and the remnants that are left behind make the poop bulkier and pungent.


7. Allergies and ailments are no biggie.
According to the American Academy of Pediatrics, food allergies, eczema and asthma are less common in babies breastfed for at least four months — likely due to colostrum and breast milk’s influence on immune responses in a newborn’s lymphoid tissue. Translation: fewer trips to the doctor’s office.

8. It’s super-convenient.
Breastfeeding allows you to dole out the perfect portion of ready-to-serve milk at baby’s beck and call. There’s no boiling or mixing necessary. You’ve just become the most efficient short-order cook around.


9. Oh, and it'll save you a ton of cash too.
 Believe it or not, formula and supplies for just six months can cost upwards of $1,500. While double electric breast pumps can be pricey — some go for more than $200 — many insurance plans will cover them.

10. You may fit into your skinny jeans faster!
Breastfeeding burns an average of 500 calories a day. And while not every nursing mom drops back into their pre-pregnancy weight in a flash, plenty give breastfeeding props for helping them lose some of the pounds.


7 Myths About Medication and the Facts Behind Them

7 Myths About Medication and the Facts Behind Them
Misconceptions about medicine are as common as pills on a pharmacy shelf.
We could all use a healthy dose of the truth.

Myth no. 1: If you’re really hurting, you can ignore the label and take more pills.

Fact: When you’re in severe pain, you may look at the dose on the pain reliever label and think, “an extra dose can’t possibly hurt me.” But the truth is, yes, it can. The recommended dose of an over-the-counter (OTC) or prescription drug isn’t just a suggestion — it’s a careful calculation. Pharmaceutical companies work hard to develop the appropriate dose of each and every medicine.
Taking more than the listed dose can rob you of the medicine’s benefits and increase the risk of serious side effects — leaving you feeling worse. Also pay attention to how pills should be taken. Pills meant to be swallowed should not be chewed. If you have trouble swallowing pills, talk to your doctor or pharmacist about alternatives.

Myth no. 2: Once you feel better, you don’t have to keep taking medication.

Fact: If your symptoms are gone but you have a week left on your medication, you may be tempted to stop taking the pesky pills. However, if you stop taking your medication early, it can increase your chance of relapsing into illness.
If you’ve considered stopping your medication because it costs too much, talk to your doctor or pharmacist about ways to reduce the cost. Your doctor prescribed that medicine because you need it. There are many ways to make medications more affordable.

Myth no. 3: Natural supplements are always a safer choice.

Fact: Natural supplements may seem safer and healthier than medications. But since the standards for supplements are not as strict, the amount of each ingredient may vary between products. Potential side effects may not be mentioned on the label.
Furthermore, some supplements may increase the risk of side effects with certain medications. If you’re interested in natural supplements, talk to your doctor or pharmacist about which ones are safe to use.

Myth no. 4: Antibiotics are the answer for every illness.

Fact: Antibiotics are only helpful in illnesses caused by bacteria, such as Strep throat. Most illnesses, like colds and sore throats, are caused by viruses that don’t respond at all to antibiotics. Even though you’re feeling miserable, OTC medications will usually relieve your symptoms until the virus is gone. Ask your doctor or pharmacist about which ones are safe to take — if you have hypertension, for example, Sudafed® (pseudoephedrine) can elevate your blood pressure.
If you’re not feeling a lot better in 10 to 14 days, call your doctor. You may have developed a secondary bacterial infection — and that’s when antibiotics will help you. Doctors don’t want to prescribe antibiotics when they aren’t needed because overusing them may lead to resistant, hard-to-treat infections.

Myth no. 5: Your doctor doesn’t need to know which vitamins you take.

Fact: When prescribing a new medication or suggesting an OTC remedy, your doctor needs to know about all the OTC and prescription medications, vitamins and supplements you are taking. This helps your doctor ensure that any new medication will not interact with your current regimen in a dangerous way. Somemedications, vitamins or supplements can hinder the way your body absorbs, breaks down and eliminates medicine.

Myth no. 6.: It’s best to keep medication handy, by the bathroom or kitchen sink.

Fact: Putting medications where you’ll see them every day may seem like a good way to remember to take them. However, storing medications and supplements by a bathroom or kitchen sink exposes them to damage from dampness and light. Unless you’re told otherwise, store medications in a dry area, away from heat and direct light. Store them in the original container or in a pill box that can’t be opened by little hands. And always keep medications and supplements where children and pets can’t reach them.

Myth no. 7: It doesn’t matter how you swallow a pill as long as it gets where it needs to go.

Fact: Pills should always be taken with water. Taking pills with alcohol is especially harmful, as alcohol can seriously interfere with the way your body absorbs medication. Rather than taking a sip and then throwing back the pill, swallow enough water to keep the pill from dissolving before it reaches your stomach. This will avoid irritating your throat. And always check whether to take medication on a full versus an empty stomach.
Following these guidelines and reading medication labels carefully will ensure that your medicine can do its job — and keep you and your loved ones healthy and safe.


Saturday, May 21, 2016

Femara 2.5mg (Leftrozole) in Malaysia

     What is Femara - Letrozole?

Femara is a form of hormone therapy known as an aromatase inhibitor, which works by reducing the amount of estrogen produced in the bodies of postmenopausal women. Femara has been approved for:
black bulletTreatment of postmenopausal women with hormone
receptor-positive or unknown advanced breast cancer that was progressing after anti-estrogen therapy—in 1997
black bulletFirst-line treatment of postmenopausal women with hormone receptor-positive or unknown locally advanced or metastatic breast cancer—in 2001
black bulletExtended adjuvant treatment of postmenopausal women with early breast cancer who have received prior standard adjuvant tamoxifen therapy—in 2004
Femara has been available for over 10 years and research by Novartis Oncology has continued during this time.
Femara® (letrozole) 2.5 mg tablets are approved for the adjuvant (following surgery) treatment of postmenopausal women 
with hormone receptor-positive early stage breast cancer.
Important Safety Information
Femara is only indicated in postmenopausal women. You should not take Femara if you are premenopausal. Your doctor should 
discuss the need for adequate birth control if you have the potential to become pregnant, if you are not sure of your postmenopausal status, 
or if you recently became postmenopausal. You should not take Femara if you are pregnant as it may cause harm to an unborn child. 
You should also discuss with your doctor what to do if you are nursing a child.
The use of Femara may cause decreases in the density of your bones, increases in bone fractures and osteoporosis. Monitoring 
of the density of your bones may be required.
Some patients taking Femara had an increase in cholesterol. Your doctor may require the monitoring of cholesterol in your blood.
Some women reported fatigue, dizziness and drowsiness with Femara. Until you know how it affects you, use caution before driving
or operating machinery.
Some women had moderate, temporary decreases in white blood cell counts. The medical significance of this is not known.
The most serious side effects seen with Femara are bone effects (fractures, decreased bone density and osteoporosis) and 
in cholesterol. Other common side effects seen with Femara include joint pain, nausea, weight decrease, vaginal irritation, and pain 
in the extremities. Other important less commonly reported side effects include blood clots, other cancers, stroke, heart attack and
 endometrial cancer.
Femara is a once-daily, convenient prescription tablet. Your doctor may tell you to take Femara every other day if you have severe liver disease. Always take your medicine exactly as prescribed by your doctor.
For full prescribing information, please click here.

Reference Price: RM750 for 30s

Victoza Pen in Malaysia

The injectable Type 2 diabetes drug Victoza works by stimulating insulin production. The drug may be linked to serious side effects, including pancreatitis, thyroid cancer and pancreatic cancer.

Victoza (liraglutide) is a once-a-day drug manufactured by Novo Nordisk. It was approved by the Food and Drug Administration (FDA) in January 2010. Victoza is similar to Amylin Pharmaceuticals’ injectable diabetes drug Byetta (exenatide) in that it aims to lower blood sugar by mimicking a hormone called GLP-1. As of March 2013, almost 1 million Americans took Victoza or another GLP-1 mimetic.
Novo Nordisk reported $475.8 million in Victoza sales in the first quarter of 2013, up 36 percent from a year earlier. Victoza is the company’s hottest product by far. Worldwide Victoza sales for 2012 topped out at $1.7 billion, accounting for more than 12 percent of Novo Nordisk’s full-year sales. A month’s supply of Victoza, at the average dose, costs about $500 without insurance; in comparison, Byetta costs about $170 per month.
Celebrity chef Paula Deen was a spokeswoman for Victoza until June 2013, when Novo Nordisk cut ties with her after she admitted having used racist language. She originally signed a $6 million, two-year contract. Though it is effective in controlling blood sugar, Victoza may be linked to dangerous side effects, including pancreatitis and thyroid cancer. Product liability lawsuits are expected to follow.

How Does Victoza Work?

Victoza works by stimulating natural insulin production in the pancreas, and is used alongside a healthy diet and exercise routine. Victoza may be prescribed alongside oral diabetes medications such as Actos, Avandia, Amaryl (glimepiride) and metformin, but may impact the absorption of these drugs since it delays gastric emptying. Victoza is not an insulin product; it is 97 percent similar to a bodily hormone called GLP-1 (glucagon-like peptide-1). This hormone affects the liver, pancreas and gut and helps control glucose, insulin and gastric emptying. When a person eats, the small intestine releases this hormone, which helps the pancreas release the appropriate amount of insulin to help regulate blood sugar. More specifically, GLP-1 activates pancreatic cells called beta cells that make insulin.
By the time most people are diagnosed with Type 2 diabetes, about half of their beta cells aren’t working properly. Patients take Victoza once a day inserting the prescription pen into their thigh, upper arm or stomach. Their doctor teaches them how to use the Victoza pen. The pre-filled 32-gram pens can last up to 30 days or more, depending on the daily dosage (0.6 mg, 1.2 mg or 1.8 mg.

Clinical Studies

During one 52-week clinical trial, 6,090 patients who received Victoza once a day as a stand-alone treatment saw a 1.1 percent decrease in A1C (which measures the average glucose concentration over a two- to three-month period) when taking 1.8 mg of the drug; patients taking 1.2 mg averaged a 0.8 percent decrease. Patients lost an average 5.5 pounds with a 1.8 mg dosage; for patients taking a 1.2 mg dosage, the average weight loss was 4.6 pounds. Another 52-week trial found that patients experienced about a 20 percent reduction in FPG (fasting glucose level) when taking 1.8 mg of Victoza daily, while blood-glucose levels in patients taking 1.2 mg dropped about 16 percent. The FPG levels began to decline within two weeks.

Side Effects

The possible side effects of Victoza are pancreatitis and thyroid tumors, both of which can be fatal. The Institute for Safe Medication Practices (ISMP) reported that the FDA’s clinical safety reviewer originally voted against approving the drug because of its link to thyroid tumors, insufficient study to rule out increased heart attack and stroke risk, as well as an increased risk for pancreatitis. In 2011, the FDA published a warning that doctors weren’t fully aware of thyroid risks associated with Victoza. That notice also mentioned that clinical trials suggested an increased risk of pancreatitis in Victoza patients.
The most common side effects, reported by more than 5 percent of patients using Victoza, are diarrhea, nausea, constipation and headache.


Pancreatitis occurs when the pancreas swells and becomes inflamed. Severe cases of pancreatitis can require hospitalization, and can be fatal. Victoza has not been studied in patients who have a history of pancreatitis, but the medication guide warns that pancreatitis is one of the severe side effects. The Institute for Safe Medication Practices (ISMP) reported that within the first nine months after approval, the FDA received reports of more than 100 cases of acute pancreatitis and pancreatitis linked to the drug.
Only one other drug in the same class has more reported cases of pancreatitis: Byetta. The ISMP contacted Novo Nordisk about its findings, and the company responded by pointing out that people with diabetes already have a 2.8-4.2 times higher risk of pancreatitis than those without diabetes. Further, the company said it already has an FDA-approved plan to educate patients and doctors about the risks of Victoza, including pancreatitis.
suffered from pancreatitis while taking Victoza in clinical trials than patients treated with comparable drugs. According to a 2012 study by Franks, et al. published in the Annals of Pharmacotherapy, clinical trials showed 11 cases of pancreatitis reported from patients taking Victoza, with one case resulting in death. In March 2013, the FDA announced it had received data from unpublished studies pointing to a possible link between pancreatic cancer and drugs like Victoza, Januvia and Byetta.
Researchers studied a small sampling of pancreatic tissue samples from patients who died of unspecified causes and were treated with an incretin mimetic. The data showed pre-cancerous cells in the pancreas. Then in July 2013, the European Medicines Agency (EMA) announced that it did not feel the studies presented enough data to conclude incretin mimetics increase the risk of pancreatitis and pancreatic cancer. The FDA agreed with the EMA and said it would not change the official labeling. However, the FDA’s investigation is ongoing.

Thyroid Cancer

Novo Nordisk found that Victoza causes tumors of the thyroid gland in rats, including malignant tumors. Since the drug is fairly new and since thyroid cancer is rare in humans (with just 600 U.S. cases reported per year), the FDA has stated that it’s difficult to say whether the drug can cause thyroid cancer in humans.
Victoza does come with a black-box label that warns of the risk of thyroid C-cell tumors and possible thyroid cancer. The black box warns that Victoza (liraglutide) “causes thyroid C-cell tumors at clinically relevant exposures in rodents,” and goes on to state that it’s unknown whether Victoza causes these tumors, including cancer (medullary thyroid carcinoma, or MTC), in humans.

Additional Warnings

The FDA also warns people with or a family history of thyroid (especially medullary thyroid) cancer or Multiple Endocrine Neoplasia syndrome Type 2 against taking Victoza.
The makers of Byetta and Januvia are facing numerous lawsuits that claim the drugs caused pancreatitis and pancreatic cancer. Because Victoza is in the same class of drugs, similar lawsuits against Novo Nordisk are expected to follow. Patients injured by Victoza are likely to claim that they were not warned of the serious side effects.
There is a petition to have all incretin mimetic lawsuits consolidated into a single federal multidistrict litigation (MDL). The petition quotes Dr. Sidney Wolfe, director of the health and research group at the nonprofit Public Citizen: “Although we have previously petitioned the FDA to ban Victoza (liraglutide) because of concerns about pancreatic disease and thyroid cancer, it is clear that all of the drugs in this family are associated with an increased risk of pancreatic cancer and it is likely that they will all have to be removed from the market.”
Reference Price: RM650 for 6mg/ml x 3ml 2s

Viagra, Cialis and Levitra – which is best?

Image result for viagra cialis and levitra which is better

Part 1 of 6: Overview

Three of a Kind?

Tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra) are oral remedies for erectile dysfunction (ED). About half of all men over age 40 occasionally have a problem with erections, according to the Urology Care Foundation. When ED becomes an ongoing problem, many turn to oral ED medications. Results are generally favorable.
Cialis, Levitra, and Viagra are all in a similar class of drugs and work in much the same way. However, there are some differences. Read about their similarities and differences, understand their side effects, and find out if one may be right for you.
Part 2 of 6: How They Work

How They Work

Cialis, Levitra, and Viagra are all PDE-5 inhibitors. They work by blocking an enzyme called phosphodiesterase type 5 and by boosting a naturally occurring chemical called nitric oxide. This action encourages the muscles in your penis to relax. Relaxed muscles allow blood to flow freely so that when you’re aroused, you can get an erection —  and maintain it long enough to have sex.
Levitra and Viagra stay in your bloodstream for about four to six hours, while Cialis remains in your bloodstream for 17 to 18 hours or longer. The length of time a medication stays in your system may be important if you are taking other medications or have prolonged side effects.
A brand called Staxyn is another version of vardenafil (Levitra). It comes in tablet form and can be dissolved on your tongue.
All three medications have good results. However, it sometimes takes a little time and patience to get it right. If one drug doesn’t work or produces unpleasant side effects, you can try another. It may take a few adjustments to arrive at the correct dose of the correct medication. Tell your doctor if you take other over-the-counter or prescription medications or supplements. Be sure to mention any other health conditions.
Part 3 of 6: Admin Differences

How and When Comparison

Cialis, Levitra, and Viagra all require a doctor’s prescription and are available in different strengths, so you can start out with the lowest dose and adjust accordingly.
Cialis is available in a daily pill that can be taken with or without food. You should plan on taking it about 30 to 60 minutes before sex. It can stay active in your body for up to eight hours. Cialis is also available in a 24-hour dose; take it only once a day, with or without food. 
If your doctor prescribes Levitra, take it once a day on an empty stomach. It works best if you take it about 30 to 60 minutes before sex, and it can stay active for as long as eight hours.
Viagra works best on an empty stomach. Keep in mind that high-fat foods can interfere with Viagra, resulting in it taking longer to work. Take the pill about 30 to 60 minutes before sex. It usually stays active for about four to five hours. However, it can sometimes last eight hours or more.
All three medications are generally very effective when taken as directed.
Part 4 of 6: Side Effects

Side Effects

The side effects of these oral ED medications are similar. Most men have only mild side effects, but persistent problems should be reported to your doctor.
Potential side effects of Cialis include:
  • back pain
  • muscle aches
  • headache
  • upset stomach
  • stuffy or runny nose
Potential side effects of Levitra and Viagra include:
  • changes in vision
  • flushing
  • headache
  • upset stomach
  • stuffy or runny nose
Rarely, these medications can cause dizziness or fainting. Another rare complication is an erection that won’t go away (priapism). An erection lasting longer than four hours requires immediate medical intervention.
Part 5 of 6: Interactions


Each drug comes with the possibility of negative drug interactions. As PDE-5 inhibitors that work on the body in similar ways, the drugs come with similar interactions. However, they also have some differences. Read about how other medications and chemicals may interact with each drug.


Viagra, Cialis, and Levitra are all contraindicated with nitrates. Contraindication means that mixing the two could lead to potential harm. Nitrates work by widening arteries. This increases blood flow and reduces strain on the heart. All three ED drugs increase the effects of nitrates, which can lead to a problematic decrease in blood pressure (hypotension).


Similar to nitrates, alpha-blockers improve blood flow. This class of drug helps to keep blood vessels relaxed and open. Alpha-blockers can be used to treat high blood pressure. Because they help relax other parts of the body, they can also be used to help urine flow in men with prostate cancer. All three ED medications can further lower blood pressure if used with alpha-blockers. The National Institutes of Health (NIH) urges caution if using PDE-5 inhibitors along with alpha-blockers.

Other Antihypertensives

Cialis, Levitra, and Viagra all dilate blood vessels, which can cause a drop in blood pressure. They all come with the risk of lowering blood pressure. According to the NIH, Viagra has been shown to further lower blood pressure when used with amlodipine. Furthermore, Cialis has been shown to further lower blood pressure when used with amlodipine, angiotensin II receptor blockers, bendrofluazine, enalapril, and metoprolol. The NIH states that, in general, Levitra may also further lower blood pressure when used with antihypertensives.


Alcohol is another chemical that dilates blood vessels. According to the NIH, neither Viagra nor Levitra strengthened the hypotensive effects of alcohol. However, when it’s mixed with substantial amounts of alcohol, Cialis could lead to potential low blood pressure symptoms when you stand up. These symptoms include dizziness and headache. The NIH also points out that Cialis and Levitra, when taken with alcohol, do not lead to a change in the levels of alcohol or the drug in the blood.

Ritonavir and CYP3A4 Inhibitors

According to the NIH, the amounts of Viagra in the blood are increased when taken with CYP3A4 inhibitors, including ritonavir. Ritonavir is an HIV medication used to reduce levels of the virus in a person’s blood. The NIHsuggests that a person taking Viagra and CYP3A4 inhibitors shouldn’t exceed a dose of 25 milligrams (mg) of Viagra in a 48-hour period.
Part 6 of 6: Outlook


Each of these three popular ED medications has been shown to help men with ED when they’re used appropriately. Talk to your doctor about these medications. You and your doctor can make decision based on side effects, administration, drug interactions, and other factors that can help determine which drug may be best for you.

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