Fildena (Fildena) is the third oral medicine approved by the U.S. FDA for the treatment of erectile dysfunction. Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin an antibiotic, ketoconazole Nizoral , a medication for fungal/yeast infections, and protease inhibitors medications used to treat AIDS ). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects.

When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled. Vardenafil (Levitra) was the second oral medicine approved by the U.S. FDA for the treatment of erectile dysfunction.

Therefore, in men over 65 years of age, in men with significant kidney and liver disease, and in men who also are taking medications called protease inhibitors, the doctor will initiate Fildena at a lower dose (25 mg) to avoid accumulation of Fildena in the body. In randomized controlled trials, an estimated 60% of men with diabetes, and 80% of men without diabetes experienced improved erections with Fildena. In short, Fildena increases blood flow into the penis and decreases blood flow out of the penis.

Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. Fildena (Fildena) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Thus your doctor will need to carefully watch your blood pressure when you start the PDE5 inhibitor.

Nitrates are used most commonly to relieve angina ( chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate and isosorbide mononitrate Other nitrates such as amyl nitrate and butyl nitrate also are found in some recreational drugs called "poppers." When the effect on PDE5 decreases, the cGMP levels go down and the muscle in the penis contracts, causing less blood to flow into the penis and allowing the veins to open up and drain blood out of the penis. As the penis fills with blood, the veins in the penis are compressed, and this results a hard erection.

When the muscle is relaxed, more blood can flow into the penis and fill the spaces in the penis. On the other hand, other medications (such as angiotensin receptor blockers ARB including losartan Cozaar and valsartan Diovan ) may actually help with erections. Some of these medications can cause troubles with erections.

Adjusting medications that may cause or contribute to erectile dysfunction. Working with doctors to modify current medications to select medications that do not cause troubles with erectile function when possible.
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