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In 2017, it was the 217th most commonly prescribed medication in the United States, with more than two million prescriptions. In 2017, it became available as a generic medication after final patents by Pfizer expired. Most of the Active Pharmaceutical Ingredient in Sildenafil, Sildenafil citrate, is produced in Pfizer’s Ringaskiddy complex, County Cork, which is Pfizer’s largest production facility outside of the United States. Manufacture and sale of sildenafil citrate drugs is common in China, where Pfizer’s patent claim is not widely enforced. Food and Drug Administration has approved fifteen drug manufacturers to market generic sildenafil in the United States. When taken by mouth sildenafil for erectile dysfunction results in an average time to onset of erections of 27 minutes .

The primary indication of sildenafil is treatment of erectile dysfunction . Its use is now one of the standard treatments for erectile dysfunction, including for men with diabetes mellitus. For those who dont know, Kamagra is a popular medication that is sold online. kamagra bestellen

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Sildenafil is excreted as metabolites predominantly in the feces (about 80% of administered oral dose) and to a lesser extent in the urine (around 13% of the administered oral dose). If taken with a high-fat meal, absorption is reduced; the time taken to reach the maximum plasma concentration increases by around one hour, and the maximum concentration itself is decreased by nearly one-third. The use of sildenafil and an α1 blocker at the same time may lead to low blood pressure, but this effect does not occur if they are taken at least 4 hours apart. While sildenafil improves some markers of disease in people with pulmonary arterial hypertension, it does not appear to affect the risk of death or serious side effects.

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The molecular structure of sildenafil is similar to that of cGMP and acts as a competitive binding agent of PDE5 in the corpus cavernosum, resulting in more cGMP and increased penile response to sexual stimulation. Without sexual stimulation, and therefore lack of activation of the NO/cGMP system, sildenafil should not cause an erection. Other drugs that operate by the same mechanism include tadalafil and vardenafil . Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs. Sildenafil is sometimes used to counteract the effects of other substances, often illicit. kamagra bestellen

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In the US, even though sildenafil is available only by prescription from a doctor, it was advertised directly to consumers on TV (famously being endorsed by former United States Senator Bob Dole and football star Pelé). Numerous sites on the Internet offer Viagra for sale after an “online consultation”, often a simple web questionnaire. The Viagra name has become so well known that many fake aphrodisiacs now call themselves “herbal viagra” or are presented as blue tablets imitating the shape and colour of Pfizer’s product.

Sildenafil is available as a generic drug in the United States, labeled for pulmonary arterial hypertension. As of 2016 branded pills cost about 50 times more than generic ones. In the United States as of 2015 the branded 50 mg pill cost is between 25.17 and US$37.88.

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