For other uses, see. Sildenafil, sold as the brand name. Viagra among others, is a medication used to treat erectile dysfunction and viagra mechanism of action pulmonary viagra mechanism of action arterial hypertension. 3, its effectiveness for treating sexual dysfunction in women has not been demonstrated. 3, common side effects fucking on viagra include headaches and heartburn, as well as flushed skin. Caution is advised in those who have cardiovascular disease. Rare but serious side effects include prolonged erections, which can lead viagra mechanism of action to damage to the penis, and sudden-onset hearing loss. Sildenafil should not be taken by people who take nitrates such as nitroglycerin (glycerin trinitrate as this may result in a severe and potentially fatal drop in blood pressure. 3, sildenafil acts by inhibiting cGMP-specific phosphodiesterase type 5 (phosphodiesterase 5, PDE5 an enzyme that viagra mechanism of action promotes degradation of cGMP, which regulates blood flow in the penis. Pfizer scientists, andrew Bell, David Brown, and Nicholas Terrett originally discovered sildenafil as a treatment for various cardiovascular disorders. 4 5, since becoming available in 1998, sildenafil has been a common treatment for erectile dysfunction; its primary competitors are tadalafil (trade name Cialis) and vardenafil (Levitra). Contents Medical uses 50mg tablets of sildenafil Sexual dysfunction The primary indication of sildenafil is treatment of erectile dysfunction (inability to sustain a satisfactory erection to complete intercourse). Its use is now one viagra ice cream of the standard treatments for erectile dysfunction, including for men with diabetes mellitus. 6 Antidepressant-associated sexual dysfunction Tentative evidence suggests that sildenafil may help men who experience antidepressant -induced erectile dysfunction. 7 Pulmonary hypertension 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 as of 2014. 8 Raynaud's phenomenon Sildenafil and other PDE5 inhibitors are used off-label to alleviate vasospasm and treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon ; 9 10 these drugs have moderate efficacy for reducing the frequency and duration. 9 As of 2016, their role more generally in Raynaud's was not clear. 10 Adverse effects In clinical trials, the most common adverse effects of sildenafil use included headache, flushing, indigestion, nasal congestion, and impaired vision, including photophobia and blurred vision. 2 Some sildenafil users viagra casero have complained of seeing everything tinted blue ( cyanopsia ). 11 Some complained of blurriness and loss of peripheral vision. In July 2005, the FDA found that sildenafil could lead to vision impairment in rare cases 12 and a number of studies have linked sildenafil use with non-arteritic anterior ischemic optic neuropathy. 13 Rare but serious adverse effects found through postmarketing surveillance include prolonged erections, severe low blood pressure, myocardial infarction (heart attack ventricular arrhythmias, stroke, increased intraocular pressure, and sudden hearing loss. 2 In October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including sildenafil, required a more prominent warning of the potential risk of sudden hearing loss. 14 Interactions Care should be exercised by people who are also taking protease inhibitors for the treatment of HIV infection. Protease inhibitors inhibit the metabolism of sildenafil, effectively multiplying the plasma levels of sildenafil, increasing the incidence and severity of side effects. Those using protease inhibitors are recommended to limit their use of sildenafil to no more than one 25 mg dose every 48 hours. 2 Other drugs that interfere with the metabolism of sildenafil include erythromycin and cimetidine, both of which can also lead to prolonged plasma half-life levels. The use of sildenafil and an 1 blocker (typically prescribed for hypertension or for urologic conditions, such as benign prostatic hypertrophy ) at the same time may lead to low blood pressure, but this effect does not occur if they are taken at least. 15 Contraindications Contraindications include: 2 :11 Concomitant use of nitric oxide donors, organic nitrites and nitrates, 16 such as: Concomitant use of soluble guanylyl cyclase stimulators, such as riociguat Known hypersensitivity to sildenafil Sildenafil should not be used if sexual activity is inadvisable due. Citation needed Nonmedical use Recreational use Sildenafil's popularity with young adults has increased over the years. 17 Sildenafil's trade name, Viagra, is widely recognized in popular culture, and the drug's association with treating erectile dysfunction has led to its recreational use. 18 The reasons behind such use include the belief that the drug increases libido, improves sexual performance, 18 or permanently increases penis size. 19 Studies on the effects of viagra when used recreationally are limited, but suggest it has little effect when used by those not suffering from erectile dysfunction. In one study, a 25-mg dose was shown to cause no significant change in erectile quality, but did reduce the postejaculatory refractory time. 20 This study also noted a significant placebo effect in the control group. 20 Unprescribed recreational use of sildenafil and other PDE5 inhibitors is noted as particularly high among users of illegal drugs. 21 Sildenafil is sometimes used to counteract the effects of other substances, often illicit. 18 Some users mix it with methylenedioxymethamphetamine ( mdma, ecstasy other stimulants, or opiates in an attempt to compensate for the common side effect of erectile dysfunction, a combination known as " sextasy "rockin' and rollin or "trail mix". 18 Mixing with amyl nitrite is particularly dangerous and potentially fatal. 18 Jet lag research The 2007 Ig Nobel Prize in Aviation went viagra mechanism of action to Patricia.

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  1. An interesting view. However the councillors received a clear mandate to vote against the merger from the survey despite its apparent bias in its questions in favour of the merger, displaying it as a done deal. It seems they chose to ignore that clear mandate, and by ignoring the expressed will of their constituents have left themselves open to having this explained to them at the ballot box.

    Democracy is about understanding that power is delegated to the councillors by the electors and that they need to understand what their electors wish to happen and handle themselves accordingly.

    The support by a parish council for a district council’s motions is invalid. The support of the individual electors is the only thing that counts. That is what real democracy is about.

    Joining the two councils together was simply unacceptable to South Hams electors. It seems West Devon didn’t like the idea much either.

    Now perhaps SHDC can get on with meeting the needs of its customers, the residents and business of the South Hams, and stop fanciful schemes that go nowhere at great cost

    • Actually Tim 4% participation is not convincing and you know what Dartmouth is like, only the negative views ever get aired. The silent majority say nothing. I voted for my Councillor on the basis that he (or she) will use their best efforts to run the Council well. Many other mergers are going ahead because they understand the cost savings long term. We have missed that opportunity and our services long term will suffer as a result. It may take some time but we will see.

      • I expected the 4% to be used as an argument. That 96% said nothing is simply interesting. I do know what Dartmouth is like, but I dispute the fact that only negative views get aired. If one says that often enough then it takes on a life of its own, like Mr Trump’s Fake News, or Mr Johnson’s £350 squillion a week going to the NHS if we leave the EU.

        4% made their views abundantly clear. It requires an educated statistician to determine whether that is a statistically significant sample. I suspect that is neither you nor me.

        It was, however, the only mandate they got.

        Would we still be leaving the EU if the turnout had been 4% and the voting split has been the same? I suspect we would

        If our councillors could not state the putative savings in a manner that attracted the electorate one should ask, instead, why they believe that they are suitable for office. If there was a true opportunity there then it should have been shouted for the rooftops, and our award winning Town Crier been engaged to put the message across. Ok, perhaps that is a step too far.

        The major problem is that we, constrained, too, by central government, pay too little for our services. This is exemplified by all the cuts that may or may not have pulled the nation out of the self created financial crisis. We need to bite the taxation bullet and pay for the services we wish to receive.

        SHDC has streamlined based upon the assumption that it was to merge with West Devon. That was a foolishness, based upon assumptions of success. That set of assumptions in itself will have contributed to those who answered the survey saying no. I know it contributed to my own answers.

        Our councillors needed to listen to their electorate. Yes, listening to the silence, too. That silence proved that the message had not got across, or, that which had got across had turned people off from contributing.

  2. increasing taxes is a disincentive for growth of both business startups and individuals. We are living beyond our means and need to be strong in mamnaging our finances. Even though we are cutting costs employment is at record levels. That is the best way to increase tax income.
    I dont blame SHDC for trying to save costs but I do blame them for failing to sell the merger to the electorate. Sadly typical of the west country which has a big blind spot where marketing communications should be. Have you heard anything about Mayflower 400 Dartmouth lately? sadly another marketing communications failure.

    • There comes a point with taxation, disincentive or not, when it is too low. There is a minimum level below which the district, the county, and the nation cannot function. The political dogma of low taxation is great up to, but not beyond, that point. When we cannot afford national services like the NHS, local services like Dartmouth Hospital, simple services like returning to the excellent street cleaning of previous years, then there is something wrong. For the avoidance of doubt I am not criticising the folk who do the cleaning but their masters who dictate what they may and may not do.

      There are many things we do poorly. Love or hate the concept of the Business Improvement District, once voted for people should have striven to make it a success. The concept arrived by democratic process, and could have made a major difference. The Mayflower celebrations I have heard very little about, save for some tree planting said to be taking place. I don’t want to dilute the SHDC issue by going off on one regarding th M400 opportunity.

      It is right to criticise councillors. Not only is it right to do so, it is proper to do so. I wonder whether it is right for Town Councillors to use a council session to criticise District Councillors, however strongly they may feel as individuals. I expect our Town Council to be concerned with the direct matters of our town. Where these intersect with the District Council then DTC may create policy, well argued, well presented. But individuals using the forum to criticise the District Councillors is not playing the game. I agree with the criticism, as reported by you (I did not hear what was said), but I disagree with the mode and forum of its delivery.

  3. Not sure that the person on the the Clapham omnibus fully understood the argument and its ramifications either way or perhaps it’s just me.

    • I think we are all still waiting to hear with precision with why it is a bad idea that the councils remain separate, and why our elected representatives failed to tell us so in clear and simple terms, Michael

      I join you on that veritable omnibus in not having been given the information on which to base a decision other than “No! This merger shall not come to pass!”. Forgive me if I appear to make assumptions about your own position in the matter.

      While our councillors are often excellent, in this matter they have fallen short, both in the ‘explain this to the electorate’ department and in the ‘following the mandate they sought by dint of survey’ department.

        • From that, Paul, I think we can conclude that SHDC did not actually want the merger, or, worse, had not done correct due diligence and quantified those putative savings. Presenting a cost with no benefit is the surest way to have the survey go against taking the hit with the extra cost.

          Perhaps we need to return to “Our our elected councillors fit for purpose?”

          Did the bunch, mainly conservative, that voted for the merger actually know something no-one else did? Or was this a party political point made by them?

          If they knew, why did they not campaign correctly for it?

          More than that, if these putative savings are real, and a huge benefit, why did they require a costly survey process?

          And, if these savings are real, why was SHDC expected to pay through the nose to obtain them? Our services were not about to improve but our council tax was to rise.

          And why did West Devon run away? If those savings were real they would have run towards the merger.

          No, something is very perturbing about all of this. I suggest that the electorate who chose to express an opinion saw through it.

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