Vizarsin: instructions for use, reviews from men, how long does the tablet last?

Composition and pharmacological action of Vizarsin

The active component of the drug is sildenafil citrate. Additionally, the medication contains form- and volume-forming substances.

Auxiliary connections are:

• microcrystalline cellulose – Avicel RN102;
• calcium dihydrogen phosphate;
• microcrystalline cellulose - Avicel PH101;
• croscarmellose sodium;
• magnesium stearate;
• hypromellose.

The film shell contains titanium dioxide, lactose monohydrate, triacetin and hypromellose as components.

The active component, being a strong selective inhibitor of cGMP-specific phosphodiesterase type 5, has a powerful vasodilating effect and restores erectile function.

The mechanism of action of sildenafil is due to the release of NO in the corpus cavernosum. During sexual stimulation, which leads to an increase in cGMP levels with subsequent relaxation of the smooth muscle tissue of the corpus cavernosum, blood flow to it increases. For the development of the therapeutic effect of sildenafil and the onset of erection, sexual stimulation is necessary.

After taking the Vizarsin tablet orally, the active substance is absorbed from the gastrointestinal tract into the blood within 20-30 minutes. The maximum concentration is reached after 60 minutes.

Metabolization of the compound is carried out by liver tissue cells with the formation of breakdown products, which are mostly excreted from the body with feces and partly by the kidneys in urine.

pros

• High efficiency of the drug
• Possibility of obtaining a rapid therapeutic effect
• Convenient dosage form of the drug
• The product has a fairly affordable price compared to analogues

Minuses

• Dispensing medication according to a doctor's prescription
• The presence of a large number of contraindications and side effects
• High likelihood of side effects and adverse reactions
• The presence of side effects that prevent you from driving a vehicle
• May interact with many medications
• Incompatible with drinking alcoholic beverages

Consequences of an overdose of Vizarsin

In case of an overdose of Vizarsin, various symptoms characteristic of this drug, associated with its mechanism of action, may be observed. consequences may occur :

• collapse (acute disruption of the blood supply to vital organs);
• deafness;
• retinal damage or blindness;
• damage to the penis due to prolonged erection;
• heart attack (myocardial infarction).

To avoid the above health effects, you should always consult a medical professional before taking Visarsin. You also need to follow all the doctor’s instructions and read the instructions for the drug.

Instructions for use of the drug

Before using the drug, it is advisable to consult a urologist or sexologist to find out the causes of erectile dysfunction.

The instructions for use of Vizarsin recommend using only as prescribed by the attending physician and in strict accordance with his recommendations. Independent use of the drug for self-medication is strictly prohibited.

Indications for use

According to the instructions, Visarsin is recommended to be prescribed for drug correction of erectile dysfunction, which is characterized by the inability to achieve or maintain an erection of the penis sufficient for full sexual intercourse.

Method of use

The Vizarsin tablet is taken orally, as a whole. It is advisable to take on an empty stomach, as in this case the absorption of the active substance increases. After taking the drug, it is recommended to take the tablet with a sufficient amount of liquid.

In accordance with the annotation for the drug, the recommended dosage is 50 mg once a day. A larger number of doses of the drug is not permissible. If necessary, the daily dose can be increased to 100 mg, which are also taken at a time. To obtain a sufficient therapeutic effect, sexual stimulation is necessary, otherwise an erection will not develop.

When conducting therapy in elderly patients, no adjustment of the recommended dose is required. If the patient has pathologies in the liver and kidneys, the dosage is reduced to 25 mg per day.

Contraindications of the drug

When using Vizarsin for drug therapy, it is necessary to take into account the possible presence of contraindications for the patient.

The use of tablets is contraindicated in certain pathological and physiological conditions of the body.

It is prohibited to use the drug for:

1. Individual hypersensitivity or intolerance to sildenafil or auxiliary components of the tablets.
2. Simultaneous use of Vizarsin with drugs that act as nitric oxide donors or nitrates. This combination provokes a pronounced decrease in blood pressure.
3. The presence of pathology of the retina, which is manifested by its ischemia due to disruption of blood supply processes.
4. Arterial hypotension.
5. Brain stroke and myocardial infarction.
6. Coronary heart disease, severe atherosclerosis, hypertension, when taking the drug and sexual activity increase the risk of developing a vascular accident.
7. Any pathology of the liver, accompanied by its severe functional failure.
8. Congenital angiopathy.
9. Under 18 years of age.

The medicine is also not used for women. Before prescribing the drug, you must ensure that there are no contraindications to its use.

Side effects

In the process of drug therapy, the patient may develop undesirable reactions from various organs and their systems.

Side effects of therapy are:

• attacks of nausea and vomiting, dry mouth, dyspepsia, manifested by bloating and unstable stools;
• a feeling of flushing in the face, less often an increase in the number of heart contractions with a corresponding sensation of palpitations, pressing pain in the heart area due to insufficient blood supply to the myocardium;
• priapism;
• blurred vision, transient changes in color perception, narrowing of visual fields, circulatory disorders of the retina, tinnitus;
• headache, attacks of dizziness, drowsiness during the day, insomnia at night, in rare cases, fainting, transient ischemic attack;
• runny nose, feeling of nasal congestion, in rare cases, nosebleeds;
• muscle pain;
• allergic reactions in the form of a skin rash, itching, a characteristic rash and swelling of the skin, reminiscent of a nettle burn.

When the first signs of side effects or adverse reactions are detected in the patient, the drug is stopped.

If the recommended dosage is exceeded, the patient experiences characteristic symptoms.

An overdose of the drug is manifested:

1. nausea;
2. vomiting;
3. dizziness;
4. flushes of blood to the skin of the face;
5. nasal congestion;
6. dysfunctions of the visual organs.

To eliminate the consequences of the harmful effects of an overdose, gastric and intestinal lavage is used, as well as methods of symptomatic therapy. The use of hemodialysis is ineffective.

Modern view on the use of sildenafil citrate

Journal "Experimental and Clinical Urology" Issue No. 1 for 2015

Efremov E.A., Kasatonova E.V., Melnik Ya.I.

Erectile dysfunction (ED) is characterized by a persistent inability to achieve or maintain an erection sufficient for successful sexual intercourse. This erectile dysfunction is widespread and according to KK Chew et al. by 2025, it is estimated to affect 322 million men worldwide [1].

Data from the latest separate study on the prevalence of ED in 6 regions of the Russian Federation were obtained in 2012 based on an analysis of survey data from 1225 respondents. When analyzing the IIEF-5 questionnaire, it was revealed that only 10.1% of surveyed men had no signs of ED, while a mild degree of ED was noted in 71.3%, a moderate degree in 6.6% and a severe degree in 12 % of respondents. Thus, out of 1225 men surveyed, symptoms of ED were present in 1101 (89.9%) respondents [2].

For many decades, treatment of ED was carried out by specialists who did not have sufficient knowledge of the pathophysiology and mechanisms of erection. Thus, in 1668, intracavernosal injections of salt solutions were first performed, then numerous options for oral therapy with various tinctures (for example, from animal testicles) were used; in the 19th century, subcutaneous injections of ejaculate were proposed; in 1936, the first penile implantation was performed [3 ].

Currently, in the treatment of ED, the polyetiological nature of the disease is taken into account, but the first line of therapy, despite the variety of causes of ED, are phosphodiesterase type 5 inhibitors (PDE-5 inhibitors). The noninvasive nature of PDE5 inhibitor therapy has increased the availability of treatment compared to other treatment modalities, which include intracavernous injections of vasoactive drugs, vacuum devices, penile prostheses, and surgical vascular reconstructions [3].

The history of the use of PDE-5 inhibitors began in March 1998, when the drug sildenafil was approved for use by the Food and Drug Administration (FDA) in the United States of America. With the appearance on the market of this first effective tablet drug for the treatment of ED, sildenafil rightfully became the flagship and gold standard of first-line treatment for ED. Vardenafil and tadalafil, which were introduced somewhat later, are also known as selective PDE5 inhibitors. Thus, sildenafil is the most studied drug among PDE-5 inhibitors in terms of safety and effectiveness.

Sildenafil citrate provides an increase in the concentration of cyclic guasine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum of the penis, which, in turn, leads to an increase in the level of nitric oxide (NO) in these cells and, as a result, to the relaxation of these cells and increased blood flow in the penis. When the NO-cGMP chain is activated, which is observed during sexual arousal, inhibition of PDE5 leads to an increase in cGMP in the corpus cavernosum. The pharmacological effect is achieved only in the presence of sexual stimulation [4].

USE OF SILDENAFIL IN PATIENTS WITH CARDIOVASCULAR DISEASES

In the American Massachusetts Male Aging Study, the incidence of ED in men aged 40-70 years was 52%. In the German study Cologne Male Survey, when analyzing the population, the incidence of ED was 10% in men aged 40-49 years, 16% in men aged 50-59 years, 34% in men aged 60-69 years and more than 50% in men aged from 70 to 80 years [5-7]. Thus, the main group of patients with erectile dysfunction are men over 50 years old; at this age, the incidence of cardiovascular diseases, including myocardial infarction and stroke, increases. Sexual dysfunction in men with cardiovascular disease is common. Many patients stop sexual activity due to fear that physical efforts during sexual activity will be complicated by recurrent myocardial infarction. However, there are a number of studies proving the safety and effectiveness of sildenafil citrate in a group of patients with ED and cardiovascular diseases [8-9].

In a phase II/III, double-blind, open-label study conducted by the FDA, more than 3,700 patients received sildenafil for ED and nearly 2,000 received placebo. Approximately 25% of patients had hypertension and were taking antihypertensive drugs, and 17% had diabetes. In these studies, the incidence of major cardiovascular events was similar in the sildenafil and placebo groups. 28 patients who suffered myocardial infarction during the study were registered. The incidence of myocardial infarction was 1.7% in the sildenafil group and 1.4% in the placebo group. There were no differences in the incidence of cardiovascular disease between the two groups, and no deaths were related to treatment. Histomorphological studies did not find any traces of PDE-5 inhibitors in the area of ​​necrosis and tissue of the ventricles of the heart, but traces of PDE-5 inhibitors were found in the atria [10].

In studies by M. Guazzi et al. It was found that sildenafil improves the condition of the endothelium. The authors noted flow-dependent dilatation of the brachial artery in patients with heart failure and type 2 diabetes mellitus [11].

In patients with heart failure due to ischemic or non-ischemic heart disease without pulmonary disease, a single dose of 50 mg of sildenafil caused a significant increase in cardiac index and a decrease in pulmonary vascular resistance both at rest and during exercise. In patients with coronary artery diseases, a positive effect of sildenafil on skin microcirculation has been established [12].

The vasodilator effect of sildenafil affects both arteries and veins, so the most common side effects are headache and facial flushing. Sildenafil causes a slight decrease in systolic and diastolic blood pressure, but clinically significant hypotension is rare, while co-administration of sildenafil and nitrates causes a more significant drop in blood pressure. For this reason, sildenafil is contraindicated for use in patients within 24 hours after taking short-acting nitrates. Meanwhile, about 5.5 million men require constant intake of nitrates, which leaves the question of further research on the joint use of these substances open [9].

USE OF SILDENAFIL IN PATIENTS WITH DIABETES MELLITUS

In the practice of a therapist, a pressing issue is the use of sildenafil for diabetes mellitus, since in patients suffering from type 1 and type 2 diabetes mellitus, erectile dysfunction occurs three times more often than in the general patient population. Moreover, erectile dysfunction can be considered as an early marker of diabetes mellitus. Thus, 12% of men suffering from erectile dysfunction were diagnosed with diabetes mellitus for the first time during examination. An additional 50% are expected to develop ED within 5–10 years of diagnosis [13]. The mechanism of ED in men with diabetes mellitus is predominantly caused by organic factors: vasculogenic and neurological. Goldstein et al. A study of sildenafil citrate 50 mg in patients with diabetes reported a 52% improvement in erectile function compared with placebo [14]. Similar data were obtained by MS Rendell et al. They noted an improvement in erectile function in 56% of patients taking sildenafil at a dosage of 100 mg versus 10% in the placebo group. Thus, sildenafil is effective and well tolerated in the treatment of organic ED in men with diabetes mellitus [15].

USE OF SILDENAFIL IN PSYCHOTHERAPY PRACTICE

Erectile dysfunction is a polyetiological disease and in some cases can be caused by various psychogenic factors that require specialized therapy. ED can both cause depression and be its consequence.

It has been noted that with monotherapy with antidepressants, antidepressant-induced ED occurs in 37% of cases, manifested by decreased libido, difficult ejaculation and anorgasmia. In a 12-week randomized, double-blind, placebo-controlled study in 20 urology clinics, the effect of sildenafil on erectile dysfunction in men with mild to moderate depressive disorders was assessed. Not only has sildenafil been shown to be an effective drug for the treatment of erectile dysfunction, but it has also been associated with a marked reduction in depressive symptoms and an improvement in quality of life: 60 (90.9%) of 66 men taking sildenafil reported that the treatment improved their erections and 59 (89.4%) %) noted an improvement in the ability to perform sexual intercourse, compared with 8 (11.4%) and 9 (12.9%) of 70 men receiving placebo, respectively [16-17].

A meta-analysis of 9 randomized studies was conducted involving 398 men with ED of mixed etiology who received various treatments: 141 patients used psychotherapy only, 109 only sildenafil, 68 patients used psychotherapy in combination with sildenafil, 20 people used vacuum devices and 59 people included to the control group. The best rates of successful treatment were obtained for a group of patients in which psychotherapeutic treatment was combined with sildenafil [18].

Another study assessed the effect of sildenafil on couple mental health using the Self-Esteem And Relationship (SEAR) questionnaire. According to the results of the survey, after a year of taking the drug, indicators such as general well-being, self-control, and satisfaction in relationships increased significantly. The authors recommend taking the drug to improve the overall mental health of not only the man, but also the couple as a whole [19].

SELECTED ISSUES OF THE APPLICATION OF SILDENAFIL IN VARIOUS UROLOGICAL DISEASES

Currently, the world has extensive experience in the use of sildanafil for various urological diseases complicated by ED.

Lower urinary tract dysfunction and ED

There are several clinical studies demonstrating the effectiveness of PDE5 inhibitors in the treatment of lower urinary tract dysfunction (LUTS). JP Mulhall et al. studied the effect of sildenafil on LUTS in men referred for sexual dysfunction. After the administration of sildenafil, 60% improved their IPSS questionnaire scores. The mean decrease in IPSS scores per week was 2 ± 0.6. The authors concluded that sildenafil helps improve urination in men with mild to moderate forms of LUTS and ED [20].

Many studies have been devoted to studying the role of PDE-5 inhibitors in combination with α-blockers in improving sexual function. SAKaplan et al. reported the results of their experimental work demonstrating the safety and effectiveness of combination treatment with the blocker alfuzosin and sildenafil compared with monotherapy groups in the treatment of LUTS and ED. After 12 weeks of therapy, patients in all groups showed an improvement in IPSS, Qmax and IIEF scores, but the best results were obtained in the combination therapy group. The researchers concluded that treatment with sildenafil in combination with an adrenergic blocker was safe and effective in the treatment of both LUTS and ED [21]. In another randomized, double-blind, placebo-controlled study performed by K. McVary et al. similar results were noted. In this 12-week study, 366 men over 45 years of age with IIEF-5 scores less than 25 and IPSS scores greater than 12 received sildenafil 50 and 100 mg or placebo. The results showed a reduction in mean IPSS score of 6.32 points in the sildenafil group compared to 1.93 in the placebo group. On the IIEF-5 scale, an improvement in the mean score was found by 9.17 compared to 1.86 points when taking placebo (p < 0.0001) [22].

Thus, the use of sildenafil, either alone or in combination with alpha-blockers, has demonstrated efficacy and safety in the treatment of LUTS caused by benign prostatic hyperplasia (BPH) and erectile dysfunction.

Prostate Cancer and ED

Treatment of erectile dysfunction with sildenafil in patients undergoing radiation therapy for prostate cancer (PCa) was initially shown to be effective in uncontrolled studies and later confirmed in a controlled study. 50 patients with ED after radiation therapy for localized prostate cancer took 50 mg of sildenafil. At the same time, a significant improvement in erection was noted by 66-74% of patients [23, 24].

The most significant prognostic factors for the restoration of erectile function after radical prostatectomy are bilateral preservation of the neurovascular bundles and the absence of erectile disorders before surgical treatment. According to M. Tutolo et al. The effectiveness of sildenafil for the treatment of ED in 170 men after radical nerve-sparing prostatectomy was 80% [25]. In a randomized, double-blind, placebo-controlled study, H. Padma-Nathan et al. report that early administration of a PDE5 inhibitor increases the recovery of spontaneous erections, with the effectiveness of sildenafil increasing over time, with better results observed 12–24 months after surgery [26].

Pelvic trauma and ED

Injuries to the pelvis and perineum can cause erectile dysfunction. PJ Harwood et al. noted that as a result of pelvic fracture and urethral injury, 30% and 42% of patients, respectively, had erectile dysfunction [25]. OZ Shenfield et al. reported that after urethroplasty, the administration of sildenafil at a dosage of 100 mg significantly reduced the manifestation of ED in 47% of patients. It has been noted that the drug is most effective for injuries of the genitourinary organs with preserved innervation and blood supply [27-28].

Fertility and ED

Equally important is the assessment of the effect of sildenafil on male fertility. After sildenafil entered the pharmaceutical market, many scientific works were devoted to studying the effect of the drug on the characteristics of sperm in vitro. Research by A.O. Kulikova et al., conducted at the Federal State Budgetary Institution "Research Institute of Urology" of the Ministry of Health of Russia in 2013, showed that in vitro conditions revealed a sharp increase in total sperm motility (A + B) when exposed to sildenafil at a concentration of 25 ng/ml (p < 0.001 ) and a tendency towards inhibition of general mobility (A+B) at drug concentrations above 250 ng/ml (p=0.09). This may indicate the presence of a stimulating effect on spermatogenesis and sperm maturation at a low dose of the drug. According to the data obtained, the author recommends avoiding maximum therapeutic dosages of sildenafil in patients planning pregnancy [29].

Currently, in addition to the original drug sildenafil, a generic Erexezil, produced in Hungary, has appeared on the Russian market. The results of the studies show that the effectiveness and safety of the drug Erexesil is comparable to that of the original drug [30]. Studies have noted a significant positive effect of Erexesil on erectile function. There was an improvement in the quality of life of patients taking this drug [31]. Available release forms of 50 mg and 100 mg No. 1 and No. 4 allow effective dosing of the drug, which ensures an individual approach to the treatment of each patient.

LITERATURE

1. Chew KK, Earle CM, Stuckey BGA, Jamrozik K, Keogh EJ. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. // Int J Impot Res. 2000. Vol. 12. P. 41–45.
2. Pushkar D.Yu., Kamalov A.A., Al-Shukri S.H., Erkovich A.A., Kogan M.I., Pavlov V.N., Zhuravlev V.N., Bernikov A.N. Analysis of the results of an epidemiological study of the prevalence of erectile dysfunction in the Russian Federation // Urology. 2012. N 6. P. 5–9.
3. Jonas U. The history of erectile dysfunction management. // Int J Impot Res. 2001. Vol. 3. P. 3-7.
4. Boswell-Smith V, Spina D, Page CP. Phosphodiesterase inhibitors. //Br J Pharmacol. 2006. Vol. 147. P. 252–257.
5. Stolk EA, Busschbach JJ. Are patients and the general public likeminded about the effect of erectile dysfunction on quality of life? // Urology. 2003. Vol. 61, N 4. P. 810-815.
6. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. // J Urol. 1994. Vol. 151, N 1. P. 54-61.
7. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the “Cologne Male Survey”. // Int J Impot Res. 2000. Vol. 12, N 6. P. 305-311.
8. Cakir O. The frequencies and characteristics of men receiving medical intervention for erectile dysfunction: Analysis of 6.2 million patients. // 28th Annual EAU congress, 15-19 March, 2013. Milan. Italy, abst. N 126.
9. American Heart Association. 1998 Heart and Stroke Statistical Update. Dallas, Tx: American Heart Association; 1997.
10. Zusman RM. Cardiovascular data on sildenafil citrate. // Am J Cardiol. 1999. Vol. 83(1). P. 44.
11. Guazzi M, Tumminello G, Di Marco F, Guazzi MD. Influences of Sildenafil on lung function and hemodynamics in patients with chronic heart failure. //Clin Pharmacol Ther. 2004. Vol. 76. P. 371–8.
12. Lewis GD, Lachmann J, Camuso J, Lepore JJ, Shin J, Martinovic ME, Systrom DM, Bloch KD, Semigran MJ. Sildenafil improves exercise hemodynamics and oxygen uptake in patients with systolic heart failure. // Circulation. 2007. Vol. 115. P. 59-66.
13. Shabsigh R, Perelman M, Lue TF, Broderick GA, Lockhardt D. Men's health issues: prevalence and correlates of erectile dysfunction. //Jurol. 2005. Vol. 174. P. 662–667.
14. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. //N Engl J Med. 1998. Vol. 338. P.1397-1404.
15. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. // JAMA. 1999. Vol. 281, N 5. P. 421-426.
16. Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC. Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. //Am J Psychiatry. 2001. Vol. 158. P. 1623–1630.
17. Zajecka J, Mitchell S, Fawcett J. Treatment-emergent changes in sexual function with selective serotonin reuptake inhibitors as measured with the Rush Sexual Inventory. //Psychopharmacol Bull. 1997.Vol. 33. P. 755-760.
18. Melnik T, Soares B, Nasello AG. Psychosocial interventions for erectile dysfunction. //Cochrane Database of Systematic Reviews. 2007. Vol 3.
19. O'Leary MP, Althof SE, Cappelleri JC, Crowley A, Sherman N, Duttagupta S. Selfesteem, confidence and relationship satisfaction of men with erectile dysfunction treated with sildenafil citrate: a multicentre, randomized, parallel group, double-blind, placebo controlled study in the United States. // J Urol. 2006. Vol. 175. P. 1058–1062.
20. Mulhall JP, Guhring P, Parker M, Hopps C. Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. //J Sex Med. 2006. Vol. 3, N 4. P. 662-667.
21. Kaplan SA, Gonzalez RR, Ogiste J, et al. Combination of an alpha-blocker, alfuzosin SR, and a PDE-5 inhibitor, sildenafil citrate, is superior to monotherapy in treating lower urinary tract symptoms (LUTS) and sexual dysfunction. //Jurol. 2006. Vol.175, Suppl. 4 P. 528. Abstract 1638
22. McVary K, Camps J, Henry G, Camps JL, Jr, Young JM, Tseng LJ, van den Ende G. Sildenafil improves erectile function and urinary symptoms in men with erectile dysfunction and concomitant lower urinary tract symptoms. // J Urol. 2006. Vol. 175, Suppl. 4. P. 527–528. Abstract 1637
23. Zelefsky MJ, Mckee AB, Lee H, Leibel SA. Efficacy of oral sildenafil in patients with erectile dysfunction after radiotherapy for carcinoma of the prostate. //Urology. 1999. Vol. 53. P. 775–778.
24. Merrick GS, Butler WM, Lief JH, Stipetich RL, Abel LJ, Dorsey AT. Efficacy of sildenafil citrate in prostate brachytherapy patients with erectile dysfunction. //Urology. 1999. Vol. 53. P. 1112–1116.
25. Tutolo M, Briganti A, Suardi N, Gallina A, Abdollah F, Capitanio U, Bianchi M, Passoni N, Nini A, Fossati N, Rigatti P, Montorsi F. Optimizing postoperative sexual function after radical prostatectomy. // Ther Adv Urol. 2012. Vol. 4, N 6. P. 347-365.
26. Padma-Nathan H, McCullough AR, Levine LA, Lipshultz LI, Siegel R, Montorsi F, Giuliano F, Brock G; Study Group. Randomized, double-blind, placebo-controlled study of postoperative nightly sildenafil citrate for the prevention of erectile dysfunction after bilateral nerve sparing radical prostatectomy. // Int J Impot Res. 2008. Vol. 20, N 5. P. 479-86.
27. Harwood PJ, Grotz M, Eardley I, Giannoudis PV. Erectile dysfunction after fracture of the pelvis. // J Bone Joint Surg Br. 2005. Vol. 87, N 3. P. 281-90.
28. Shenfield OZ, Gofrit OD, Gdor Y, Landau I, Katz R, Pode D. The role of sildenafil in the treatment of erectile dysfunction with pelvic fracture urethral disruption. // J Urol. 2004. Vol. 172. P. 2350–2352
29. Kulikov A.O. The influence of phosphodiesterase type 5 inhibitors on spermatogenesis: Diss. Ph.D. honey. Sci. Moscow. 2013. 178 p.
30. Randomized, open label, 2-way crossover, bioequivalence study of sildenafil 100 mg tablet and Viagra (reference) following a 100 mg dose in healthy subjects under fasting conditions. // Final integrated clinical and statistical report. Version Date: 2007-02-26.
31. Instructions for medical use of the drug Erexesil. // URL: https://www.egis.ru/images/science/bioequivalencestudy_2007.pdf

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Journal "Experimental and Clinical Urology" Issue No. 1 for 2015

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Drug interactions and special instructions

When using Vizarsin in combination with other drugs, the compatibility of the drugs should be taken into account.

When prescribing the drug with:

• inhibitors of cytochrome P450 isoenzymes - CYP3A4 may reduce drug clearance;
• Ritonavir increases the concentration of sildenafil in plasma by an order of magnitude;
• with grapefruit juice a moderate increase in the plasma concentration of Vizarsin is recorded;
• There are no changes in the bioavailability of the drug with antacids;
• inhibitors of the isoenzyme CYP2C9, CYP2D6, thiazide and similar diuretics, potassium-sparing and loop diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, inducers of the CYP450 isoenzyme do not affect the pharmacokinetics of sildenafil;
• Nicorandil may experience undesirable interactions with the drug due to the presence of a nitrate component in the composition;
• donors of nitric oxide, nitrates in any dosage form have a negative effect in the form of an increase in the hypotensive effect;
• alpha-blockers may cause symptomatic hypotension in susceptible patients.

The drug is prescribed only after a clinical examination to diagnose and identify possible causes of decreased potency. The state of the cardiovascular system is also assessed, since sexual activity in the presence of pathologies in the functioning of the heart and blood vessels may pose a certain risk.

The systemic vasodilating effect of sildenafil causes a slight transient decrease in blood pressure, so patients with relevant pathologies should take into account the risk of developing possible undesirable vasodilatory effects against the background of sexual activity before taking Visarsin.

The use of Vizarsin in combination with other drugs for the treatment of erectile dysfunction is not recommended. Caution should be exercised in patients with anatomical deformation of the genital organ.

Visual disturbances are possible during the use of Vizarsin. Due to the possible development of dizziness and visual impairment, caution should be exercised when operating machinery or vehicles.

For active peptic ulcers or bleeding, the potential risks and expected benefits of using the drug should be weighed before starting therapy.

Taking the drug is incompatible with drinking alcohol; therefore, it is recommended to abstain from alcoholic beverages throughout the entire period of drug therapy.

What you need to know before you start taking Vizarsin

Do not take Vizarsin if you have an allergic reaction to it or if you are taking medications to treat pulmonary hypertension (for example, Adempas is an antihypertensive drug that stimulates the enzyme guanylate cyclase).

You should also not take Vizarsin if you are taking nitrate drugs (for example, nitroglycerin, isosorbide dinitrate) to treat heart pain, since the mechanism of action of the latter is also associated with the release of the NO factor. As a result of this combined interaction, vasodilation may increase and this will lead to a sharp drop in blood pressure with possible loss of consciousness.

Before taking Vizarsin, you should consult a doctor to take your medical history to make sure you do not have conditions such as:

• problems with the cardiovascular system (arrhythmia, arterial hypo- or hypertension);
• problems with blood circulation;
• retinitis pigmentosa (hereditary eye disease);
• visual impairment;
• blood diseases (for example, anemia, leukemia);
• pulmonary veno-occlusive disease (complications of pulmonary hypertension, which affects small pulmonary veins);
• liver and/or kidney diseases;
• physical deformation of the penis (for example, Peyronie's disease).

This medicine is only for men.

Vizarsin is approved for use from 18 years of age.

Reviews about Vizarsin

Vizarsin, according to reviews from men who used it to improve potency, is an excellent drug. Positive feedback about the effect of the drug is left not only by men, but also by their sexual partners.

Patient review

The drug can really significantly improve erection. Patients testify that the medication begins to exhibit its therapeutic effect within an hour after taking it and helps ensure a stable and long-lasting erection, which is necessary for full sexual intercourse.

The vast majority of patients recommend that before using the medicine, consult a doctor about its use, which is due to the presence of quite serious contraindications for the medicine and a high probability of developing side effects and unwanted reactions.

As advantages of the drug, users cite its affordable cost compared to, for example, Viagra and the possibility of obtaining a quick therapeutic effect.

Many men consider the disadvantage that the drug has a large number of contraindications and side effects, as well as the possibility of purchasing the drug only with a prescription from the attending physician.

What are the side effects of Vizarsin?

Common side effects from Visarsin include:

• dizziness, headache, fog;
• heartburn, nausea, indigestion;
• abnormal vision (blurry vision, changes in color vision)
• runny nose and/or nasal congestion, nosebleeds;
• problems sleeping (insomnia);
• muscle pain, back pain.

If you experience any of the following conditions after taking Visarsin, you should immediately seek medical help :

• pressing pain in the heart, which can radiate to the arm, shoulder, jaw;
• hard breath;
• changes in vision or sudden loss of vision;
• painful erection that lasts more than 4 hours (prolonged erection can damage the penis);
• ringing in the ears or sudden hearing loss;
• arrhythmia (pulse changes);
• swelling of the arms, ankles, or feet;
• convulsions;
• feeling like you might lose consciousness.

Analogues of the drug

If side effects occur during the use of Visarsin or if the patient has contraindications to its use, the doctor may suggest the use of drug analogues that have a similar therapeutic effect on the body.

Common substitutes are:

1. Sildenafil is a drug for the treatment of erectile dysfunction. The medication is available in the form of film-coated tablets with a biconvex, diamond-shaped shape. The medicine has a blue outer color and a white inner color. The active compound in the medication is sildenafil citrate. Microcrystalline cellulose, anhydrous calcium hydrogen phosphate, croscarmellose sodium, magnesium stearate, opadry II blue and opadry transparent are used as auxiliary components. The shelf life of the drug is 3 years. The medicine must be stored at a temperature not exceeding 25 degrees Celsius. Dispensing is carried out by prescription. The cost of the medicine is about 530 rubles per package, which contains 10 tablets.
2. Maxigra is a drug used in the treatment of erectile dysfunction. Available in tablet form. The active ingredient is sildenafil. Excipients include sodium lauryl sulfate, colloidal silicon dioxide, magnesium stearate, mannitol, corn starch, crospovidone and povidone. The medicine is available by prescription. The shelf life is 4 years. The medication should be stored at a temperature not exceeding 30 degrees. The price of the drug in pharmacies ranges from 297 to 774 rubles, depending on the dosage and number of tablets in the package.

Additionally, Viagra, Dynamico and Cialis can be used as substitutes with similar effects.

Symptoms of Vizarsin overdose

When taking Vizarsin in the above prescribed dosages prescribed by a doctor, or in a dose exceeding the daily dose, symptoms of an overdose of this medicine may be observed:

• chest pain, which can radiate (give) to other parts of the body;
• dyspnea;
• painful erection that does not go away for more than 4 hours;
• tinnitus;
• interruptions in heart rhythm;
• orthostatic hypotension (a sharp drop in blood pressure);
• visual impairment.

If you observe such symptoms, you must stop subsequent use of Vizarsin and seek help from a specialist.