Erectile Dysfunction Medical Treatment

Size: px
Start display at page:

Download "Erectile Dysfunction Medical Treatment"

Transcription

1 1

2 Erectile Dysfunction Medical Treatment Alireza Ghoreifi Assistant of Urology Mashhad University of Medical Sciences March

3 Treatment of ED Unknown cases of ED First-line therapy Second-line therapy Third-line therapy Three lines 3

4 Treatment of ED First-line therapy Oral pharmacotherapy Topical pharmacotherapy Vacuum constriction devices VCD 4

5 Treatment of ED Second-line therapy 1. Intracavernous injections 2. Intraurethral alprostadil PGE 1 5

6 Treatment of ED Third-line therapy Penile prothesis 6

7 First line Treatment of ED Oral pharmacotherapy PDE5 inhibitors The PDE5 enzyme hydrolyses cyclic guanosine monophosphate (cgmp) in the cavernosum tissue of the penis. 7

8 PDE 5 inhibitors Mechanism of action Inhibition of PDE5 reduce the degradation of cgmp that effect on nitric oxide Vasodilatation Smooth muscle relaxation Penile erection 8

9 PDE 5 inhibitors - Sildenafil * - Tadalafil * - Vardenafil * * European Medicines Agency EMEA Approval 9

10 PDE 5 inhibitors new generation Avanafil: currently has no trademarked Lodenafil: (Helleva), not FDA approved Mirodenafil: (Mvix), not FDA approved Udenafil:( Zydena), not FDA approved 10

11 Sildenafil Iaunched in 1998 First PDE5 inhibitor erection and rigidity sufficient for vaginal penetration Effective: min after administration and T max = 0.8 to 1 hour Heavy meal prolonged absorption reduce of efficacy 11

12 Sildenafil Starting dose = 50 mg and then adapt according to the: - Patients response - Side-effects Efficacy maintain for up to 12h 12

13 Sildenafil After 24 weeks of treatment and in a dose-response study Pre-market ; improved erections: mg = 56% mg = 77% mg = 84% 4. Placebo = 25% In diabetics: - Improved erection= 66.6% / 28.6% - Successful intercourse= 63% / 33% 13

14 Tadalafil Licensed for the treatment of ED = Feb 2003 Effective = 30 min with peak efficacy = 2h Efficacy is maintained for up to 36h and is not affected by food. Recommended starting dose = 10 mg and then adapt 14

15 Tadalafil After 12 weeks of treatment and in a dose - response study, Pre-market improved erections: 1-10 mg = 67% 2-20 mg = 81% 3- Placebo = 35% Diabetic = 64% / 25% 15

16 Vardenafil Commercially available as of March 2003 Effective = 30 min, reduce effect by a heavy fatty meal (>57%) and Tmax = 0.9h Recommended starting dose = 10 mg ( mg) Improved erections in difficult-to-treat subgroups. 16

17 Vardenafil 5 mg = 66% 10 mg = 76% 20 mg = 80% Placebo = 30% Diabetic patients =72% / 13% 17

18 PDE5 inhibitors : Not 100% effective to everyone, every time 18

19 Choice or preference between the different PDE5 inhibitor To date, no data are available Choice of drug will depend on: - The frequency of intercourse (occasional use or regular therapy, 3-4 times weekly) - Patients personal experience Patients need to know whether a drug is short or longacting, possible disadvantages and how to use it 19

20 On-demand or continuous therapy (daily) of PDE5 inhibitors? Tadalafil 5 mg once daily is an alternative to on-demand for couples who prefer spontaneous rather than scheduled sexual activities or who anticipate frequent sexual activity Tadalafil 2.5 and 5 mg/daily is efficacious and well tolerate However, when patients have the choice, it seems that they prefer on-demand rather than continuous therapy. 20

21 Safety issues for PDE5 inhibitors In patients receiving PDE5 inhibitors, myocardial infarction rates does not increase. PDE5 inhibitors may improve exercise tests, and dose not alter cardiac contractility, and cardiac out-put 21

22 Absolute contraindications with the use of PDE5 inhibitors Agents used to treat angina: - Organic nitrates: nitroglycerine isosorbide mononitrate isosorbide dinitrate - Other nitrate preparations Agents used for recreation: - Amyl nitrite or amyl nitrate 22

23 If a PDE5 inhibitors is taken and the patients develops: Chest pain = nitroglycerine must be withheld for at least 24h for use of sildenafil and vardenafil and 48h for use of tadalafil Angina = other agents may be given instead of nitroglycerine until the appropriate time has (above) passed. 23

24 Alpha-blocker interactions All PDE5 inhibitors show some interaction with alpha-blockers orthostatic hypotension. 24

25 Alpha-blocker interactions Sildenafil (50 or 100mg ) should not be taken within 4h following treatment with an alpha-blocker 25

26 Alpha-blocker interactions Co-administration of vardenafil with tamsulosin is not associated with clinically significant hypotension 26

27 Alpha-blocker interactions In the USA, vardenafil is absolutely contraindicated with alpha-blocker 27

28 Alpha-blocker interactions Tadalafil is contraindicated in patients taking alpha-blockers, except for tamsulosin, 0/4mg 28

29 Dosage adjustment Lower doses Ketoconazole, itraconazole, erythromycine, clarythromycin increase blood levels of PDE5 inhibitors so that lower doses of PDE5 inhibitors are necessary. 29

30 Dosage adjustment higher doses Rifampin, phenobarbital, phenytoin and carbamazepine enhance the breakdown of PDE5 inhibitors so that higher doses of PDE5 inhibitors are required 30

31 Dosage adjustment Severe kidney or hepatic dysfunction may require dose adjustments or warnings 31

32 Ways of improving efficacy 1- Medication of associated risk factors. 2- Treatment of associated hypogonadisem. 3- Changing to another PDE5 inhibitor. 4- Continuous use daily of a PDE5 inhibitor. 32

33 Non-responders to PDE5 inhibitors Reasons 1- Incorrect drug use= the main reason is inadequate counseling from his physician. 2- Inefficacy of the drug 33

34 Management of non-responders to PDE5 inhibitors Check by physician Using a licensed medication (black market) The main ways in which a drug may be incorrectly used are: - Failure to use adequate sexual stimulation - Failure to use an adequate dose - Failure to wait an adequate amount of time between taking the medication and attempting sexual intercourse 34

35 PDE5 inhibitors Time between taking and intercourse All three drugs have an onset of action in some patients within 30 min of oral ingestion, most patients require a longer time with at least: 60 min for sildenafil and vardenafil 2h for tadalafil 35

36 PDE5 inhibitors food and delay of absorption Sildenafil = Heavy meal Vardenafil = Fatty meal Tadalafil = Is less affected 36

37 Side effects of PDE5 inhibitors Flushing and headache (mild to moderate in severity) Myalgia, back pain, leg pain, vision disturbances 37

38 ED and dyslipedemia In hypercholesteromic men with erectile dysfunction not initially responsive to sildenafil sildenafil Atorvastatine improves the response to LDL > 120 mg/100cc 40 mg atorvastatin 100 mg On-demand sildenafil for 12 weeks. 27 Nov

39 Treatment of ED First-line therapy Apomorphine sublingual is a centrally acting dopamine agonist Enhancing the natural central erectile signals that occur during sexual stimulation improve erectile erection 39

40 Apomorphine Has been approved in several countries but not in the USA 40

41 Apomorphine Dose = 2 or 3 mg sublingually Efficacy rate = 28.5% to 55%. Due to rapid absorption, 71% of erections are achieved within 20 min 41

42 Apomorphine Most common adverse effects Nausea 7% Headache 6.8% Dizziness 4.4% Are generally mild in nature and self-limited. Severe events such as syncope, are extremely rare = < 0.2% 42

43 Apomorphine Apomorphine is not contraindicated in patients that taking nitrates or antihypertensive drugs (of all classes) and is a first-line treatment in patients, who use nitrates. Does not effect on vital signs. 43

44 Apomorphine It is use is limited to patients with mild to moderate ED or psychogenic causes of sexual dysfunction due to reduce efficacy rates. 44

45 Treatment of ED Other oral treatment Yohimbine and Trazodone Randomized trials have shown that yohimbine and trazodone have a similar efficacy to placebo in patients with organic causes of ED. 45

46 Other oral agents Red korea ginseng Is a formulation with an unknown mechanism of action (though it may possibly act as a nitric oxide donor) Efficacy data on red korea ginseng suggested it might have a role in treatment of ED 46

47 Other oral agents Phentolamine Oral formulation of phentolamine (non selective alpha-adrenergic antagonist) had efficacy rates (erections sufficient for intercourse) of about 50%, but possible carcinogenesis in animal models stopped further development. 47

48 Other oral agents l-argenine is a nitric oxide donor Nalmefene / naltrexone is an opioid-receptor antagonist Limaprost is an alprostadil derivative for oral use There are no efficacy data on these drugs 48

49 Treatment of ED First-line therapy Topical pharmacotherapy No topical therapy has been approved and currently these agents have no role in treatment of ED. 49

50 Treatment of ED First-line therapy Vacuum therapy More acceptable to older patients with infrequent sexual intercourses Efficacy is as high as 90% Satisfactory rate range = 27% and 94% Long-term use decreases to 50% - 64% after 2 years Most men who discontinue use of VCDs do so within 3 months 50

51 Vacuum therapy The commonest adverse events Occur in less than 30% of patients: Penis pain, petechiae, bruising, numbness, inability to ejaculate, and delayed ejaculation 51

52 Treatment of ED Second-line therapy 1. Intracavernous injections - Monotherapy Alprostadil PGE 1 - Combination therapy: * Papaverine + Phentolamine * Papaverine + Phentolamine + PGE 1 2. Intraurethral alprostadil PGE 1 52

53 Treatment of ED Second-line monotherapy therapy Alprostadil PGE1 Is the first and only approved for intracavernous ED treatment in general ED papulation and patients subgroups diabetes, cardiovascular disease. 53

54 Alprostadil Efficacy rate > 70 % Satisfaction rate = 87% % in patients and 86% -90.3% in partners Doses : 5-4µg and erection appears after 5-15 min Drop-out rate : 41% - 68% particularly within the first 2-3 months 54

55 Alprostadil Complications: * Pain 50% after 11% of injections * Prolonged erection 5% * Priapism 1% * Fibrosis 2% * Hypotension is uncommon 55

56 Alprostadil Contraindications History of hypersensitivity to alprostadil Men at risk of priapism Men with bleeding disorders 56

57 Intracavernous injections Combination therapy 1) Papaverine mg + Phentolamine mg 2) Papaverine 8-16mg + Phentolamine mg+ Alprostadil 10-20µg Penile pain due to decrease of dose of Alprostadil and fibrosis for Phentolamine and mild hepatotoxicity with Papaverine 57

58 Intracavernous injections Combination therapy Efficacy rate = 92% If not respond to combination therapy sildenafil + triple combination regimen 58

59 Treatment of ED Second-line therapy Intraurethral alprostadil µg in a medicated pellet Erection sufficient for intercourse = 30% % Adverse events: * Local pain 29% - 41% * Dizziness 1.9% - 14% * Penile fibrosis and priapism < 1% * Urethral bleeding 5% * Urinary tract infections 0.2% 59

60 Third-line therapy Penile prothesis Do not respond to pharmacotherapy Who prefer a permanent solution to their problem Malleable (semi-rigid) and inflatable: - Two piece - Three piece 60

61 Penile prothesis Complications Mechanical failures < 5% at 5 years fallow up Infection = 2-3% but with antibiotic -impregnated prothesis or hydrophilic coated prothesis = 1% In spinal cord injuries : infection and erosions = 9% 61

62 when infection occurred: 1) Removed the prothesis, antibiotic administration and re-implantation after 6-12 months. 2) Removed and re-implantation at the same time, after copious irrigation of the corpora with multi-drug solutions, had an 82% success rate. 62

63 63

GUIDELINES ON ERECTILE DYSFUNCTION

GUIDELINES ON ERECTILE DYSFUNCTION GUIDELINES ON ERECTILE DYSFUNCTION (Text updated March 2005) E. Wespes (chairman), E. Amar, D. Hatzichristou, K. Hatzimouratidis, F. Montorsi, J. Pryor, Y. Vardi 88 Erectile Dysfunction Eur Urol 2001;40:97-101

More information

GUIDELINES ON ERECTILE DYSFUNCTION

GUIDELINES ON ERECTILE DYSFUNCTION 16 GUIDELINES ON ERECTILE DYSFUNCTION E. Wespes (chairman), E. Amar, D. Hatzichristou, Dr. F. Montorsi, J. Pryor, Y. Vardi Eur Urol 2002;41:1-5 1. Background, definition and classification Male erectile

More information

Erectile dysfunction. By Anas Hindawi Supervised by Dr Khalid AL Sayyid

Erectile dysfunction. By Anas Hindawi Supervised by Dr Khalid AL Sayyid Erectile dysfunction By Anas Hindawi Supervised by Dr Khalid AL Sayyid ED is the persistent/recurrent inability to attain and/or maintain a penile erection rigid enough for satisfactory sexual intercourse

More information

Managing Erectile Dysfunction

Managing Erectile Dysfunction Managing Erectile Dysfunction Lewis E. Harpster MD, FACS Urology of Central PA 4/23/16 1 Objectives 1. Review physiologic mechanism of erection 2. Discuss medical management of ED 3. Discuss surgical management

More information

Evidence Review for Surrey Prescribing Clinical Network. Treatment: Oral and non-oral combination therapy for erectile dysfunction

Evidence Review for Surrey Prescribing Clinical Network. Treatment: Oral and non-oral combination therapy for erectile dysfunction Evidence Review for Surrey Prescribing Clinical Network Treatment: Oral and non-oral combination therapy for erectile dysfunction Prepared by: Linda Honey Topic Submitted by: Prescribing Clinical Network

More information

MALE SEXUAL DYSFUNCTION. Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara

MALE SEXUAL DYSFUNCTION. Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara MALE SEXUAL DYSFUNCTION Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara DEFINITION The inability to achieve a satisfactory sexual relationship May involve : - inadequacy

More information

, David Stultz, MD. Erectile Dysfunction. David Stultz, MD September 10, 2001

, David Stultz, MD. Erectile Dysfunction. David Stultz, MD September 10, 2001 Erectile Dysfunction David Stultz, MD September 10, 2001 Case Presentation A 66 year old male presents to your office requesting Viagra. He states that for the past year he has had difficulty forming

More information

Guidelines on Erectile Dysfunction

Guidelines on Erectile Dysfunction Guidelines on Erectile Dysfunction E. Wespes, E. Amar, D. Hatzichristou, K. Hatzimouratidis, F. Montorsi, J. Pryor, Y. Vardi European Association of Urology 2006 TABLE OF CONTENTS PAGE 1. BACKGROUND 4

More information

GUIDELINES ON MALE SEXUAL DYSFUNCTION: Erectile Dysfunction and Premature Ejaculation

GUIDELINES ON MALE SEXUAL DYSFUNCTION: Erectile Dysfunction and Premature Ejaculation GUIDELINES ON MALE SEXUAL DYSFUNCTION: Erectile Dysfunction and Premature Ejaculation (Text update March 2009) E. Wespes, E. Amar, I. Eardley, F. Giuliano, D. Hatzichristou, K. Hatzimouratidis, F. Montorsi,

More information

IC351 (tadalafil, Cialis): update on clinical experience

IC351 (tadalafil, Cialis): update on clinical experience (2002) 14, Suppl 1, S57 S64 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir IC351 (tadalafil, Cialis): update on clinical experience 1 * 1 Urological practice,

More information

Canadian Undergraduate Urology Curriculum (CanUUC): Erectile Dysfunction

Canadian Undergraduate Urology Curriculum (CanUUC): Erectile Dysfunction Canadian Undergraduate Urology Curriculum (CanUUC): Erectile Dysfunction Last reviewed July 2014 Objectives 1. Define erectile dysfunction 2. List and classify the risk factors for erectile dysfunction

More information

Treatment for ED. Education and couple assessment. Lifestyle advice. Patient Information. Page 1 / 10. Patient Information - Treatment for ED

Treatment for ED. Education and couple assessment. Lifestyle advice. Patient Information. Page 1 / 10. Patient Information - Treatment for ED Patient Information English 3 Treatment for ED The underlined terms are listed in the glossary. Erectile dysfunction (ED) is a common condition. Although it is not life threatening, it can negatively affect

More information

ED treatments: PDE5 inhibitors, injections and vacuum devices

ED treatments: PDE5 inhibitors, injections and vacuum devices ED treatments: PDE5 inhibitors, injections and vacuum devices Martin Steggall Clinical Nurse Specialist (Erectile Dysfunction and Premature Ejaculation) Barts Health NHS Trust; Associate Dean, Director

More information

Erectile Dysfunction: A Primer for Primary Care Providers

Erectile Dysfunction: A Primer for Primary Care Providers Erectile Dysfunction: A Primer for Primary Care Providers Jeanne Martin, DNP, ANP-BC Objectives 1. Understand the definition, incidence and prevalence of Erectile Dysfunction in the U.S. 2. Understand

More information

SEXUAL HEALTH. Erectile Dysfunction

SEXUAL HEALTH. Erectile Dysfunction SEXUAL HEALTH Erectile Dysfunction Don t Let Erectile Dysfunction Keep You from a Satisfying Sex Life. What Is Erectile Dysfunction or ED? Who Gets ED? Men who have ED have a problem getting or keeping

More information

Sexual Function for Men with Spinal Cord Injury

Sexual Function for Men with Spinal Cord Injury Sexual Function for Men with Spinal Cord Injury A spinal cord injury (SCI) affects a man's sexuality both physically and psychologically. The type and level of injury both can play a role on the impact

More information

Erectile Dysfunction; It s Not Just About Sex

Erectile Dysfunction; It s Not Just About Sex Erectile Dysfunction; It s Not Just About Sex Disclosures Conflict of interest: I am not paid by Boston Scientific but once in a while they buy me a tasty meal. I do routinely use their products without

More information

Treatment for ED. Education and couple assessment. Lifestyle advice. Patient Information. Page 1 / 9. Patient Information - Treatment for ED

Treatment for ED. Education and couple assessment. Lifestyle advice. Patient Information. Page 1 / 9. Patient Information - Treatment for ED Patient Information English 3 Treatment for ED The underlined terms are listed in the glossary. Erectile dysfunction (ED) is a common condition. Although it is not life threatening, it can negatively affect

More information

About Erectile Dysfunction. Causes, self-test and treatment

About Erectile Dysfunction. Causes, self-test and treatment About Erectile Dysfunction Causes, self-test and treatment 2015 One Way S.r.l. All rights reserved. Gift copy for physicians. Illustrated by Davide Ceccon With an unrestricted grant from Recordati About

More information

Managing the Patient with Erectile Dysfunction: What Would You Do?

Managing the Patient with Erectile Dysfunction: What Would You Do? Managing the Patient with Erectile Dysfunction: What Would You Do? Florida A & M University College of Pharmacy and Pharmaceutical Sciences 42 nd Annual Clinical Symposium Wayne A. Sampson, M.D. Cross

More information

CIALIS (See-AL-iss) (tadalafil) tablets

CIALIS (See-AL-iss) (tadalafil) tablets 1 Patient Information CIALIS (See-AL-iss) (tadalafil) tablets Read this important information before you start taking CIALIS and each time you get a refill. There may be new information. You may also find

More information

Jan Farrell. Nurse Consultant Urology Department of Urology Rotherham General Hospital NHS FT

Jan Farrell. Nurse Consultant Urology Department of Urology Rotherham General Hospital NHS FT Jan Farrell Nurse Consultant Urology Department of Urology Rotherham General Hospital NHS FT Aims of session To promote discussion / interaction Opportunity to discuss with peers Promote learning / share

More information

for ED and LUTS/BPH Pierre Sarkis, M.D. Assistant Professor Fellow of the European Board of Urology

for ED and LUTS/BPH Pierre Sarkis, M.D. Assistant Professor Fellow of the European Board of Urology Tadalafil 5 mg once daily for ED and LUTS/BPH Pierre Sarkis, M.D. Assistant Professor Fellow of the European Board of Urology Why this conference? Not promotional but educational The pharmacist regularly

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT CIALIS 10 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 10 mg tadalafil For excipients,

More information

Package leaflet: Information for the user. Tadalafil Sigillata 20 mg film-coated tablets. tadalafil

Package leaflet: Information for the user. Tadalafil Sigillata 20 mg film-coated tablets. tadalafil Package leaflet: Information for the user Tadalafil Sigillata 20 mg film-coated tablets tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT VIAGRA 25 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 25 mg sildenafil as citrate.

More information

ERECTILE DYSFUNCTION. Prof. Khan Abul Kalam Azad. Head, Department of Medicine, Dhaka Medical College President, Bangladesh Society of Medicine

ERECTILE DYSFUNCTION. Prof. Khan Abul Kalam Azad. Head, Department of Medicine, Dhaka Medical College President, Bangladesh Society of Medicine ERECTILE DYSFUNCTION Prof. Khan Abul Kalam Azad Head, Department of Medicine, Dhaka Medical College President, Bangladesh Society of Medicine Bangladesh Society of Medicine Department of Medicine Dhaka

More information

Package leaflet: Information for the user. Tadalafil Sigillata 5 mg film-coated tablets. tadalafil

Package leaflet: Information for the user. Tadalafil Sigillata 5 mg film-coated tablets. tadalafil Package leaflet: Information for the user Tadalafil Sigillata 5 mg film-coated tablets tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important information

More information

Phosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary

Phosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary Phosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary FDA APPROVED INDICATIONS AND DOSAGE 1-4,23 Agent FDA Approved Dosage and Administration Indication Cialis (tadalafil) (ED) ED; As needed:

More information

Psychopharmacological Treatment of Sexual Dysfunction. American Society Clinical Psychopharmacology

Psychopharmacological Treatment of Sexual Dysfunction. American Society Clinical Psychopharmacology Psychopharmacological Treatment of Sexual Dysfunction American Society Clinical Psychopharmacology 2005 Teaching Points 1. Sexual dysfunction is highly prevalent in the general population 2. Sexual dysfunction

More information

Jan Farrell Nurse Consultant Urological Services Department of Urology Rotherham General Hospital NHS FT

Jan Farrell Nurse Consultant Urological Services Department of Urology Rotherham General Hospital NHS FT Jan Farrell Nurse Consultant Urological Services Department of Urology Rotherham General Hospital NHS FT Aims of session To promote discussion / interaction Opportunity to discuss with peers Promote learning

More information

Update on Erection Dysfunction. Seacourses Eastern Caribbean December 30, 2017 January 6, 2018 Stacy Elliott MD

Update on Erection Dysfunction. Seacourses Eastern Caribbean December 30, 2017 January 6, 2018 Stacy Elliott MD Update on Erection Dysfunction Seacourses Eastern Caribbean December 30, 2017 January 6, 2018 Stacy Elliott MD Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced,

More information

VIAGRA connect Pharmacy Introduction

VIAGRA connect Pharmacy Introduction VIAGRA connect Pharmacy Introduction February 2018, PP-PHE-GBR-0046 COECT Agenda Agenda References Understanding Erectile Dysfunction (ED) Introducing VIAGRA connect Supplying VIAGRA connect Summary Essential

More information

VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology VI.2.2 Summary of treatment benefits

VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology VI.2.2 Summary of treatment benefits VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Pulmonary arterial hypertension (a high blood pressure in the blood vessels in the lungs) is a rare disease. Historically, the

More information

Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D.

Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D. Physiology and disturbances of sexual functions Prof. Jolanta Słowikowska-Hilczer, M.D., Ph.D. Department of Andrology and Reproductive Endocrinology Medical University of Łódź, Poland SEXUALITY Sexuality

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT CIALIS 2.5 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 2.5 mg tadalafil. Excipients:

More information

** REGULATORY ALERT **

** REGULATORY ALERT ** Complete Summary GUIDELINE TITLE The management of erectile dysfunction: an update. BIBLIOGRAPHIC SOURCE(S) Erectile Dysfunction Guideline Update Panel. The management of erectile dysfunction: an update.

More information

TADAFLO 5 Tablets (Tadalafil)

TADAFLO 5 Tablets (Tadalafil) Published on: 16 Sep 2016 TADAFLO 5 Tablets (Tadalafil) Composition TADAFLO 5 Tablets Each tablet contains: Tadalafil.5 mg Dosage Form Tablet Pharmacology Pharmacodynamics Mechanism of Action Penile erection

More information

CIALIS. Data Sheet. Name of Medicine. Presentation. Uses. 2.5 mg, 5 mg, 10 mg and 20 mg film-coated tablets. Actions.

CIALIS. Data Sheet. Name of Medicine. Presentation. Uses. 2.5 mg, 5 mg, 10 mg and 20 mg film-coated tablets. Actions. Data Sheet Name of Medicine CIALIS 2.5 mg, 5 mg, 10 mg and 20 mg film-coated tablets. Presentation 2.5 mg: Each light orange-yellow, film coated, almond shaped tablet contains 2.5 mg tadalafil and is marked

More information

A review of phosphodiesterase type 5 inhibitors

A review of phosphodiesterase type 5 inhibitors A review of phosphodiesterase type 5 inhibitors Abstract Schellack N, BCur, BPharm, PhD(Pharmacy), Senior Lecturer Agoro A, BPharm, Academic Intern Department of Pharmacy, Faculty of Health Sciences, University

More information

Erectile Dysfunction. written by Harvard Medical School.

Erectile Dysfunction. written by Harvard Medical School. Erectile Dysfunction written by Harvard Medical School www.patientedu.org Until treatment became widely available in the 1990s, erectile dysfunction (ED) was called impotence and few men faced up to the

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synopsis This file is posted on the Bayer HealthCare Clinical Trials Registry and Results website or on the website www.clinicalstudyresults.org hosted by the Pharmaceutical Research and

More information

MODULE 4: ERECTILE DYSFUNCTION

MODULE 4: ERECTILE DYSFUNCTION MODULE 4: ERECTILE DYSFUNCTION KEYWORDS: Erectile dysfunction, phosphodiesterase inhibitors, sexual dysfunction LEARNING OBJECTIVES At the end of this clerkship, the medical student will be able to: 1.

More information

Erectile dysfunction

Erectile dysfunction Erectile dysfunction the persistent inability to attain and maintain an erection sufficient for satisfactory sexual performance Incidence difficult to define US population 52% of males aged 50-70yrs (Massachusets

More information

Erectile Dysfunction An overview. Lorraine Montgomery Specialist Nurse Practitioner Urology

Erectile Dysfunction An overview. Lorraine Montgomery Specialist Nurse Practitioner Urology Erectile Dysfunction An overview Lorraine Montgomery Specialist Nurse Practitioner Urology BAUN Essential Urology Study Day Centre for life: Newcastle. 20/9/2017 What is erectile dysfunction? The persistent

More information

Patient Information ERECTILE DYSFUNCTION. Department of Urology

Patient Information ERECTILE DYSFUNCTION. Department of Urology ERECTILE DYSFUNCTION What is erectile dysfunction? Erectile dysfunction (impotence) is the inability to get or keep an erection sufficient for sexual intercourse. One in ten men (10%) suffer from impotence

More information

Clinical Commissioning Policy Proposition:

Clinical Commissioning Policy Proposition: Clinical Commissioning Policy Proposition: Penile prosthesis surgery for end stage erectile dysfunction Version Number: NHS England B14X10/01 Information Reader Box (IRB) to be inserted on inside front

More information

ERECTION MISDIRECTION: PENILE REHABILITATION & TREATMENTS FOR ERECTILE DYSFUNCTION. Gregory Harochaw Pharmacy Manager Tache Pharmacy (204)

ERECTION MISDIRECTION: PENILE REHABILITATION & TREATMENTS FOR ERECTILE DYSFUNCTION. Gregory Harochaw Pharmacy Manager Tache Pharmacy (204) ERECTION MISDIRECTION: PENILE REHABILITATION & TREATMENTS FOR ERECTILE DYSFUNCTION Gregory Harochaw Pharmacy Manager Tache Pharmacy (204) 233-3469 Nerve Function After careful prostatectomy where the erectile

More information

Package leaflet: Information for the patient. Tadalafil Mylan 5 mg film-coated tablets Tadalafil

Package leaflet: Information for the patient. Tadalafil Mylan 5 mg film-coated tablets Tadalafil PACKAGE LEAFLET 1 Package leaflet: Information for the patient Tadalafil Mylan 5 mg film-coated tablets Tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains

More information

Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis

Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis (2003) 15, 318 322 & 2003 Nature Publishing Group All rights reserved 0955-9930/03 $25.00 www.nature.com/ijir Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction

More information

ASSESSMENT OF PREMATURE EJACULATION AND ERECTILE DYSFUNCTION

ASSESSMENT OF PREMATURE EJACULATION AND ERECTILE DYSFUNCTION ASSESSMENT OF PREMATURE EJACULATION AND ERECTILE DYSFUNCTION Dr Michael Gillman St Andrews Hospital Wickham Terrace Spring Hill Mater Private Clinic, South Brisbane Shore St West Medical Centre, Cleveland

More information

Quality of life issues after treatment for prostate cancer

Quality of life issues after treatment for prostate cancer Quality of life issues after treatment for prostate cancer Christopher Saigal MD, MPH Associate Professor, UCLA Department of Urology Definition of Health not merely the absence of disease or infirmity,

More information

Men s Health Topics. Learning Objectives. BPH Definition. The Prostate Gland. I have nothing to disclose. Mindi Miller, Pharm. D.

Men s Health Topics. Learning Objectives. BPH Definition. The Prostate Gland. I have nothing to disclose. Mindi Miller, Pharm. D. I have nothing to disclose Men s Health 2016 Mindi Miller, Pharm. D., BCPS Topics Benign Prostatic Hyperplasia Erectile Dysfunction Learning Objectives Describe common lower urinary tract symptoms (LUTS)

More information

Package leaflet: Information for the user. Tadalafil 5 mg film-coated tablets. tadalafil

Package leaflet: Information for the user. Tadalafil 5 mg film-coated tablets. tadalafil Package leaflet: Information for the user Tadalafil 5 mg film-coated tablets tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important information

More information

Erectile Dysfunction (ED) Shawn McGee M.D. CentraCare Adult and Pediatric Urology January 30 th, 2016

Erectile Dysfunction (ED) Shawn McGee M.D. CentraCare Adult and Pediatric Urology January 30 th, 2016 Erectile Dysfunction (ED) Shawn McGee M.D. CentraCare Adult and Pediatric Urology January 30 th, 2016 Erectile dysfunction: The inability to attain or maintain penile erection sufficient for satisfactory

More information

Package leaflet: Information for the patient. Vardenafil Krka 20 mg film-coated tablets. Vardenafil

Package leaflet: Information for the patient. Vardenafil Krka 20 mg film-coated tablets. Vardenafil PACKAGE LEAFLET Package leaflet: Information for the patient Vardenafil Krka 5 mg film-coated tablets Vardenafil Krka 10 mg film-coated tablets Vardenafil Krka 20 mg film-coated tablets Vardenafil Read

More information

Management of Post-Prostatectomy Urinary Incontinence and Sexual Dysfunction

Management of Post-Prostatectomy Urinary Incontinence and Sexual Dysfunction Management of Post-Prostatectomy Urinary Incontinence and Sexual Dysfunction Robert C. Eyre, MD, FACS Associate Clinical Professor of Surgery (Urology) Harvard Medical School Post-prostatectomy Incontinence

More information

If you have questions or want more information on VIAGRA, talk to your doctor, visit or call viagra ( ).

If you have questions or want more information on VIAGRA, talk to your doctor, visit  or call viagra ( ). You ve been prescribed VIAGRA to treat erectile dysfunction (ED). Below is some important information to help you get the most out of VIAGRA. VIAGRA works by increasing blood flow to the penis, which helps

More information

Erectile Dysfunction National Kidney and Urologic Diseases Information Clearinghouse

Erectile Dysfunction National Kidney and Urologic Diseases Information Clearinghouse Erectile Dysfunction National Kidney and Urologic Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health

More information

6.2 Elements for a Public Summary

6.2 Elements for a Public Summary 6.2 Elements for a Public Summary 6.2.1 Overview of disease epidemiology Invicorp is to be used for erectile dysfunction, also known as impotence, the inability to get and maintain an erection that is

More information

Erectile Dysfunction

Erectile Dysfunction Erectile Dysfunction WWW.RN.ORG Reviewed May, 2017, Expires May, 2019 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2017 RN.ORG, S.A., RN.ORG, LLC Erectile

More information

Package leaflet: information for the user. Sildenafil 25 mg, 50 mg and 100 mg film-coated tablets Sildenafil

Package leaflet: information for the user. Sildenafil 25 mg, 50 mg and 100 mg film-coated tablets Sildenafil Package leaflet: information for the user Sildenafil 25 mg, 50 mg and 100 mg film-coated tablets Sildenafil Read all of this leaflet carefully before you start taking this medicine because it contains

More information

Daily vs. on-demand PDE-5 inhibitors for management of erectile dysfunction following treatment for prostate cancer

Daily vs. on-demand PDE-5 inhibitors for management of erectile dysfunction following treatment for prostate cancer Daily vs. on-demand PDE-5 inhibitors for management of erectile dysfunction following treatment for prostate cancer Lead author: Nancy Kane Regional Drug & Therapeutics Centre (Newcastle) February 2018

More information

Labeled Uses: Treatment of erectile dysfunction (impotence) 1,2,3, min hr

Labeled Uses: Treatment of erectile dysfunction (impotence) 1,2,3, min hr Brand Name: Stendra Generic Name: avanafil Manufacturer: Vivus, Inc. 1 Drug Class: Phosphodiesterase-5 Enzyme Inhibitor 1,2,3,4 Uses: Labeled Uses: Treatment of erectile dysfunction (impotence) 1,2,3,4

More information

BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE. Bulletin 169: Daily Tadalafil (Cialis ) for penile rehabilitation following radical prostactectomy

BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE. Bulletin 169: Daily Tadalafil (Cialis ) for penile rehabilitation following radical prostactectomy BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE September 2012 Review date: September 2014 Bulletin 169: Daily Tadalafil (Cialis ) for penile rehabilitation following radical prostactectomy JPC Recommendation:

More information

Disclosure Slide. Dr Michael Gillman IMPOTENCE ERECTILE DIFFICULTIES. Do Men Really Care??? 15/10/2014 ASSESSMENT OF ERECTILE DYSFUNCTION

Disclosure Slide. Dr Michael Gillman IMPOTENCE ERECTILE DIFFICULTIES. Do Men Really Care??? 15/10/2014 ASSESSMENT OF ERECTILE DYSFUNCTION ASSESSMENT OF ERECTILE DYSFUNCTION Dr Michael Gillman St Andrews Hospital North St Specialist Suites Mater Hospital 3 rd Floor Mater Private Clinic Wesley Hospital Suite 5 Level 9 Evan Thomson Bld Cleveland-

More information

aviptadil / phentolamine 25 micrograms / 2mg solution for injection (Invicorp ) SMC No 1284/17 Evolan Pharma AB

aviptadil / phentolamine 25 micrograms / 2mg solution for injection (Invicorp ) SMC No 1284/17 Evolan Pharma AB aviptadil / phentolamine 25 micrograms / 2mg solution for injection (Invicorp ) SMC No 1284/17 Evolan Pharma AB 10 November 2017 The Scottish Medicines Consortium (SMC) has completed its assessment of

More information

Schemi terapeutici complessi per la gestione della disfunzione erettile post trattamento del carcinoma prostatico: non solo PDE5i

Schemi terapeutici complessi per la gestione della disfunzione erettile post trattamento del carcinoma prostatico: non solo PDE5i Schemi terapeutici complessi per la gestione della disfunzione erettile post trattamento del carcinoma prostatico: non solo PDE5i M. Lazzeri MD-PhD Department of Urology Ist. Clinico Humanitas IRCCS Schema

More information

KEYWORDS: Erectile dysfunction, phosphodiesterase inhibitors, sexual dysfunction.

KEYWORDS: Erectile dysfunction, phosphodiesterase inhibitors, sexual dysfunction. NATIONAL MEDICAL STUDENT CURRICULUM ERECTILE DYSFUNCTION (ED) This document was amended in July 2016 to reflect literature that was released since the original publication of this content in May 2012 and

More information

Erectile Dysfunction (ED) or Impotence

Erectile Dysfunction (ED) or Impotence Erectile Dysfunction (ED) or Impotence Introduction Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction"

More information

With My Heart, Can or Should I Take Erectile Dysfunction Drugs?

With My Heart, Can or Should I Take Erectile Dysfunction Drugs? With My Heart, Can or Should I Take Erectile Dysfunction Drugs? Timothy R. Malinowski MD, FACC UMG Carolina Cardiology Consultants Greenville Health System Definition of Erectile Dysfunction 1992 NIH Consensus

More information

Diagnosis and management of sexual dysfunction. Dr Chris Simpson Consultant Psychiatrist

Diagnosis and management of sexual dysfunction. Dr Chris Simpson Consultant Psychiatrist Diagnosis and management of sexual dysfunction Dr Chris Simpson Consultant Psychiatrist What are we talking about? Male Erectile dysfunction Premature ejaculation Delayed ejaculation Sexual aversion Paraphilia

More information

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. Diseases and Conditions Erectile dysfunction By Mayo Clinic Staff Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. Having erection trouble from time to

More information

Drug Treatment of Ischemic Heart Disease

Drug Treatment of Ischemic Heart Disease Drug Treatment of Ischemic Heart Disease Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine, The University of Jordan November, 2014 Categories of Ischemic Heart Disease Fixed "Stable, Effort Angina Variant

More information

Overview. Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia. Iain McAuley September 15, 2014

Overview. Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia. Iain McAuley September 15, 2014 Urology Dine and Learn: Erectile Dysfunction & Benign Prostatic Hyperplasia Iain McAuley September 15, 2014 Overview Review of the most recent guidelines for ED and BPH ED Guidelines CUA 2006 AUA 2011

More information

Urinary tract disorders

Urinary tract disorders Urinary tract disorders Medicines Formulary Contents: 1. Urinary retention 1 2. Urinary incontinence 2 3. Urethral pain prevention during catheterisation 3 4. Indwelling catheters maintenance of patency

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT CIALIS 2.5 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 2.5 mg tadalafil. Excipient

More information

Clinical Monograph for Drug Formulary Review: Erectile Dysfunction Agents

Clinical Monograph for Drug Formulary Review: Erectile Dysfunction Agents FORMULARY MANAGEMENT Clinical Monograph for Drug Formulary Review: Erectile Dysfunction Agents HELEN ELOISE CAMPBELL, BS, PharmD ABSTRACT BACKGROUND: Significant advances in the pharmacologic treatment

More information

ERECTILE DYSFUNCTION TREATMENTS

ERECTILE DYSFUNCTION TREATMENTS ERECTILE DYSFUNCTION TREATMENTS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage

More information

10/ / /2011

10/ / /2011 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use safely and effectively. See full prescribing information for. (tadalafil) tablets, for oral use Initial

More information

Alphagra 100mg CH 3 O N CH 2 CO 2 H HOOC OH H S N O 2. GENERIC NAME Sildenafil Citratel

Alphagra 100mg CH 3 O N CH 2 CO 2 H HOOC OH H S N O 2. GENERIC NAME Sildenafil Citratel GEERIC AME CEMICAL AME oxo-3-propyl-1-pyrazolo[4,3-d]pyrimidin MLECULAR FRMULA C223064 C687 MLECULAR WEIGT PRPRIETARY AME: Alphagra DAGE FRM: 100mg ildenafil tablet for oral administration CMPITI Alphagra

More information

Package leaflet: Information for the user. CIALIS 2.5 mg film-coated tablets Tadalafil

Package leaflet: Information for the user. CIALIS 2.5 mg film-coated tablets Tadalafil Package leaflet: Information for the user CIALIS 2.5 mg film-coated tablets Tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important information

More information

Review Articles. Erectile Dysfunction: Clinical Guidelines (2) SAFARINEJAD MR*, HOSSEINI SY ABSTRACT

Review Articles. Erectile Dysfunction: Clinical Guidelines (2) SAFARINEJAD MR*, HOSSEINI SY ABSTRACT Urology Journal UNRC/IUA Vol. 1, No. 4, 227-239 Autumn 2004 Printed in IRAN Review Articles Erectile Dysfunction: Clinical Guidelines (2) SAFARINEJAD MR*, HOSSEINI SY Urology/Nephrology Research Center,

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Tadalafil Mylan 2.5 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 2.5 mg tadalafil.

More information

Sexual function and dysfunction in men

Sexual function and dysfunction in men Georges A. de Boccard,, M.D. Consultant Urologist F.E.B.U. Sexual function and dysfunction in men Geneva Foundation for Medical Education and Research Training Course in Reproductive Health / Sexual Health

More information

Package leaflet: Information for the user. CIALIS 10 mg film-coated tablets Tadalafil

Package leaflet: Information for the user. CIALIS 10 mg film-coated tablets Tadalafil Package leaflet: Information for the user CIALIS 10 mg film-coated tablets Tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important information for

More information

Package leaflet: Information for the user. CIALIS 2.5 mg film-coated tablets Tadalafil

Package leaflet: Information for the user. CIALIS 2.5 mg film-coated tablets Tadalafil Package leaflet: Information for the user CIALIS 2.5 mg film-coated tablets Tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important information

More information

Pharmacology. Drugs affecting the Cardiovascular system (Antianginal Drugs)

Pharmacology. Drugs affecting the Cardiovascular system (Antianginal Drugs) Lecture 7 (year3) Dr Noor Al-Hasani Pharmacology University of Baghdad College of dentistry Drugs affecting the Cardiovascular system (Antianginal Drugs) Atherosclerotic disease of the coronary arteries,

More information

Package leaflet: Information for the patient. Sildenafil 25 mg, 50 mg and 100 mg film-coated tablets Sildenafil

Package leaflet: Information for the patient. Sildenafil 25 mg, 50 mg and 100 mg film-coated tablets Sildenafil Package leaflet: Information for the patient Sildenafil 25 mg, 50 mg and 100 mg film-coated tablets Sildenafil Read all of this leaflet carefully before you start taking this medicine because it contains

More information

ERECTILE DYSFUNCTION. & Current Therapies. GP Conference, Rotorua 7-10 June 2012

ERECTILE DYSFUNCTION. & Current Therapies. GP Conference, Rotorua 7-10 June 2012 ERECTILE DYSFUNCTION & Current Therapies GP Conference, Rotorua 7-10 June 2012 Jan Burns & Annie Woodsford Jan: EN, RCpN, BHSc, RPN (USA),MHSc, Member of the Sexual Medicine Society Urology Nurse Specialist

More information

Sexuality and Sexual Health in MS

Sexuality and Sexual Health in MS Sexuality and Sexual Health in MS February 13, 2018 Presented by: Sanofi Genzyme Genentech Type in your questions using the Questions/Chat box If box is closed, click + to expand Go-To-Webinar Attendee

More information

Erectile dysfunction (ED) is a common male sexual. Clinical Guidelines

Erectile dysfunction (ED) is a common male sexual. Clinical Guidelines Clinical Guidelines Annals of Internal Medicine Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis Alexander Tsertsvadze, MD, MSc;

More information

Package leaflet: Information for the user. CIALIS 5 mg film-coated tablets Tadalafil

Package leaflet: Information for the user. CIALIS 5 mg film-coated tablets Tadalafil Package leaflet: Information for the user CIALIS 5 mg film-coated tablets Tadalafil Read all of this leaflet carefully before you start taking this medicine because it contains important information for

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Vivanza 5 mg film-coated tablets. Vivanza 10 mg film-coated tablets Vivanza 20 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE

More information

Package leaflet: Information for the patient

Package leaflet: Information for the patient Package leaflet: Information for the patient Sildenafil Pharmathen 25 mg film-coated tablets Sildenafil Pharmathen 50 mg film-coated tablets Sildenafil Pharmathen 100 mg film-coated tablets Sildenafil

More information

See available DOSAGES and PACKAGES. View prices

See available DOSAGES and PACKAGES. View prices See available DOSAGES and PACKAGES View prices Levitra Generic SUMMARY OF PRODUCT CHARACTERISTICS NAME OF THE MEDICINAL PRODUCT Levitra Generic film-coated tablets User Information Levitra Generic orodispersible

More information