INTRODUCTION

Sildenafil, which is widely known by people as “Viagra”, is a medication that has emerged in the early 1990s. Sildenafil is one of the most potent drugs in the treatment of Erectile Dysfunction (also called impotency which is the inability of the man to keep an erection.) in men. It is considered by many men as the “magical pill” due to it’s amazing properties and capabilities which allows men to finally have a healthy sexual life with their partners without feeling any shame anymore.

In this article, we’re going to uncover information about sildenafil, starting from what it is and how it works reaching to how to use it efficiently.

What is sildenafil?

Sildenafil is considered one of the drugs classified under the phosphodiesterase inhibitors class of drugs. As the name implies, the function of these medications is to inhibit the phosphodiesterase enzymes which play a role in regulating cell functions by breaking down cAMP and cGMP, which are called “second messengers”.

The main function of these so called second messengers are responsible for decreasing the level of calcium in the cell.

Therefore, by inhibiting these enzymes, these second messengers no longer break down and therefore accumulate increasing in number. This leads to a decrease in the level of calcium in the cells and ultimately leads to vasodilation in the target tissue as well as smooth muscle relaxation.

Each phosphodiesterase inhibitor targets a specific target tissue. For example, PDE4 inhibitors target the airway, causing dilation of the vessels and smooth muscle relaxation and allowing the treatment of many pulmonary diseases.

The target tissue for PDE5 inhibitor is the penis, which contains two parts on the side of your ureter, “Corpus Cavernosum” and “Corpus Spongiosum”. These parts contain blood vessels that make your penis erected when they get engorged with blood.

When the PDE5 inhibitor works, the blood vessels of the penis dilate, allowing more blood to fill the penis and voila! The penis is now erected.

Nowadays, sildenafil is almost sold in every pharmacy all over the world with different doses and trade names. It goes by many names and there is no doubt that it is now considered one of the most potent drugs that enhances your sexual activity to the roof of your imaginations!

Sildenafil is able to provide treatment for physical Erectile Dysfunction, not psychological.

What is Erectile Dysfunction? Why does it happen?

Erectile Dysfunction is defined as the inability of the male to maintain his penile erection or even achieve erection which is sufficient enough for a satisfactory sexual performance. There are many types and causes of erectile dysfunction which are further classified into physical and psychological causes.

-Physical Causes:

• Vascular Erection Dysfunction Causes: These happen due to a defect in the blood vessels of the penile area that hold the blood inside of them. It is the most common type of erectile dysfunction and it is probably the best type to be treated with sildenafil.
• Neurogenic Erectile Dysfunction: This happens due to a nerve disorder, the nerves that were responsible for transferring signals to the penis to dilate the vessels so that they could engorge with blood are defective. This can happen due to radiation therapy or a spinal disease affecting these nerves.
• Hormonal Erectile Dysfunction: This type is most likely to be associated with a decrease or a deficiency in the testosterone level, the male barely has any libido for sexual activity and does not get turned on by any visual or tactile stimulus. It could also happen due to thyroid problems but testosterone deficiency remains the most common of this type. This type responds pretty well to sildenafil as well as exogenous testosterone with different dosages from the usual use of sildenafils.

-Psychological or Psychogenic causes:

These are due to psychological conditions such as stress or any condition that affects your thoughts, feelings or behavior. These cannot be treated by sildenafil.

What is the usual age for Erectile Dysfunction?

Providers and medical researchers estimate that erectile dysfunction affects over 50% of people who identify as male between the ages of 40 and 70. Those number may not be correct because many don’t seek help for the condition due to embarrassment or shame so it cannot be clearly estimated.

Dosage and administration

Dosage Form

Sildenafil (Kamagra) is available as oral tablets with different dosages varying from 25mg to 100mg. The suitable dosage for you depends on your medical health conditions.

Other drugs similar to sildenafil has emerged with different dosage forms available, such as Tadalafil, which is now available in an orodispersable tablets or films placed under the tongue.

How to take sildenafil

Sildenafil is taken an hour or half an hour before the sexual intercourse. It is preferable that you do not take sildenafil with a high-fat meal as this will cause the drug to take more time to work. High fat meals cause a reduction in the absorption of the drug.

Special precautions before taking sildenafil

Before you take sildenafil, there are some notes that you should be wary of:

• if you are taking nitrates (medications for chest pain) such as isosorbide dinitrate, isosorbide mononitrate and nitroglycerin.
• Before starting, stopping, or changing any medications while taking sildenafil, please get the advice of your doctor or pharmacist.
• if you smoke, if you have had heart surgery within the last 6 months.
• if you have ever had an erection that lasted for more than 4 hours, and if you have recently lost a large amount of body fluids (dehydration). This can happen if you are sick with fever, diarrhea, or vomiting; sweat a lot; or do not drink enough liquids.
• Take sildenafil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
• If you are taking sildenafil for erectile dysfunction, your doctor will probably start you on an average dose of sildenafil and increase or decrease your dose depending on your response to the medication. Tell your doctor if sildenafil is not working well or if you are experiencing side effects.

Side effects

Sildenafil, just like every other drug, obviously has side effects. But luckily, since it is taken for a short duration and not multiple times a day in case of treatment of erectile dysfunction, it rarely causes these side effects so there’s no need to worry about it!

Some side effects you may face:

• Headaces
• Nausea
• Dizziness
• Indigestion
• Flushing(Redness of the face)

It is common to face these side effects and there’s no need to worry about any of them.

One of the most serious side effects that you should be wary of is priapism. Priapism is a disorder in which the penis maintains a prolonged, rigid erection even in the absence of appropriate stimulation for more than 4 HOURS. In case your erection lasts for more than 4 hours, you should move to the hospital as soon as possible for further evaluation. It is rare to find this kind of complication from sildenafil, as the drug barely lasts for 4 hours then it becomes inactive.

Another serious complication and a deadly side effect of taking sildenafil is severe drop of blood pressure. This only happens if you are taking blood vessels dilating drugs such as nitrates. If you are a normal person who does not take any drugs such as nitrates, you’re safe.

Psychological impact of sildenafil

Sildenafil was not only able to treat erectile dysfunction, it was able to bond families, fix many relationships that were on the verge of breaking due to dissatisfaction of the sexual activity. It was able to fix the self-esteem of men who were not able to provide satisfaction to their partners and it was able to provide confidence to new grooms who were feeling self-conscious about their sexual capabilities.

Some men who were suffering from erectile dysfunction suffered from depression as a consequence of erectile dysfunction. Sildenafil was able to relieve their stress and pump up their self-esteem back to place.

Sildenafil VS Other medications

As of lately, new drugs have emerged that are similar to sildenafil but with less side effects. Such as:

• Tadalafil: Lasts for a longer duration up to 36 hours.
• Vardenafil: Quicker onset.
• Avanafil: Fast onset and fewer side effects.

Sildenafil is a lot more advantageous than these drugs in terms of

• A well-studied drug that has been available ever since 1990, so emergence of newer side effects is unlikely unlike the other new drugs which are still not well-studied.
• Affordable and can be found anywhere.
• Widely known, which makes it easier to ask for them without shame or disgrace or fear of misunderstandings.

In conclusion, Sildenafil is a PDE5 inhibitor drug that works on dilation of the blood vessels of the penile area and smooth muscle relaxation, engorging them with blood and causing erection, which is necessary for the process of sexual intercourse between a man and a woman. Sildenafil rarely causes side effects in a normal person but it is necessary to seek medical guidance in terms of dosage and if there are any contra-indications to consumption of the drug. Sildenafil has been a great blessing for the men suffering from ED all over the world and was able to solve many conflicts and problems on the psychological level and allowed more bonding in the relationships.

References

• Boswell-Smith, V., Spina, D., & Page, C. P. (2009). Phosphodiesterase inhibitors. British Journal of Pharmacology, 147(Suppl 1): S252–S257. DOI: 10.1038/sj.bjp.0706495
• Elhwuegi A. S. (2016). The Wonders of Phosphodiesterase-5 Inhibitors: A Majestic History. Annals of Medical and Health Sciences Research, 6(3): 139–145. DOI: 10.4103/2141-9248.183943
• American Urological Association. What Is Erectile Dysfunction (https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed%29)? Updated 6/2018. Accessed 8/28/2023.
• https://www.osmosis.org/answers/phosphodiesterase-inhibitors
• Alexandria Faculty of Medicine Urology and Pharmacology Textbook

INTRODUCTION

Obesity is a dreadful disease that has been on the rise for the past few years, affecting millions of people worldwide. In the past, it only used to affect adults more commonly and rarely affected teenagers or children but nowadays, it is a global disease affecting people of all age groups with no exceptions. It is defined as a disease that occurs due to the excessive gaining of weight and fat accumulation with severe morbid complications that follow. People are classified according to BMI into four categories; Underweight, Normal, Overweight and Obese.

A person with a BMI ranging from 25 to 29.9 is NOT OBESE. A person with that range is considered overweight, while a BMI of 30 or above is considered obesity. Obesity is a major risk factor for a wide variety of chronic diseases, such as Type II Diabetes Mellitus, cardiovascular diseases, and even certain diseases such as PCOS for women. It affects the quality of life and the longevity of the person and even your health on a psychological level. That is why it is necessary to understand the causes of obesity in order to provide appropriate treatment.

Obesity is a multi-factorial disease that happens due to a change in behavior, diet, due to certain health disorders and due to physical activity changes.

Diet

A severe change has occurred in the common dietary patterns worldwide as of the past few years.

People are moving towards the harmful patterns of diet, such as sugary beverages and sugary food such as donuts, milkshakes and other drinks and foods that contribute to weight gain without providing a sense of fullness and therefore, more carbohydrates to gain.

Due to the stresses people are facing currently in the whole world, stress-eating has become a habit to many people which is not a useful habit. Frequent snacking of chips and sodas and candies has also unfortunately helped in the rise of obesity.

Physical Activity

In a world full of phones, computers, screens, easier ways of transportation and office-related jobs, sedentary lifestyle has been the norm for many people. People nowadays rarely think about brisk walking or hitting the gym.

Health Disorders

Some health disorders are linked to a sudden increase in weight in a short duration of time, such as hypothyroidism which causes severe weight gain in a short amount of time or increased intake of exogenous corticosteroids or diseases related to the adrenal gland. These diseases lead to dreadful complications if not resolved by medical treatment and evaluation by a specialist.

Obesity is a serious disease of adults and children, women and men worldwide. It’s drastic effects can cause the following complications on the long run:

Type II Diabetes Mellitus

Type II Diabetes Mellitus is the inability of the body to utilize the insulin provided by the pancreatic beta cells of Langerhans to move glucose into the cells, and therefore, the glucose stays elevated in the bloodstream, leading to more insulin being squeezed out of the pancreatic cells in order to hopefully decrease the glucose level in the bloodstream, also known as “Insulin Resistance”.

Serious long-term complications can occur due to type 2 DM, such as neuropathy which is weakness of the nerves of the body and peripheral numbness, Retinopathy which is a pathology concerning the eye, which causes diminution of eyesight later on, as well as Nephropathy which is a pathology concerning the kidneys and it may present as frothy urine with significant proteinuria on urine analysis. DM Type II is not diagnosed within the first few years and the patient remains diseased without actually knowing that he had became diabetic, therefore not controlling it especially if the diet stayed as unsuitable as before.

Respiratory issues

Obesity can also significantly impact respiratory health. Obese adults and children are at higher risk for obstructive sleep apnea, a condition where the airway becomes blocked during sleep, leading to disrupted breathing and poor-quality sleep. The reason an obese person is risked for this condition is because an obese person has a wider neck diameter with larger fat and muscles than normal, blocking the airway passages upon sleeping. This condition is associated with various health issues, including daytime sleepiness, learning difficulties, and behavioral problems especially in children of school age. The excess weight can contribute to asthma exacerbations and other respiratory complications.

PCOS

One of the complications of obesity is the disease of Polycystic Ovary Syndrome, which is a disease that happens in obese women with a certain degree of insulin resistance. The woman usually complains of hirsutism(facial hair) and interrupted periods as well as infertility, which is the inability to conceive a child. An obese woman can be free from PCOS if she decides to lose weight and can even be fertile once again.

Obesity is a hard to bear disease, especially with all of these complications piling up one on another. That’s why it is necessary to choose the appropriate regimen and diet for your body.

Dieting and regimens

Although dieting and regimens may be effective for some people, it needs consistency which may not be possible. Also, other people may not find it useful or may be searching for quicker methods to lose weight.

Methods such as dieting or doing physical activity may not be suitable for everyone, especially people above a certain weight where mobility becomes nearly impossible.

That’s why other methods started to emerge as of lately, such as medical treatments and surgical methods of treatment.

That’s why in this article, we will provide you with one of the most potent and successful drugs in decreasing your body weight by a huge number of pounds in a very short duration without the need for surgeries or insensible diets, Sibutramine.

One of the newest and most potent treatments available for obesity is Sibutramine, which has emerged in the 21^st century, changing the concepts of dieting and losing weight.

What is Sibutramine?

Sibutramine is a norepinephrine, serotonin and dopamine reuptake inhibitor indicated to assist with weight loss in obesity. It is considered a sympathomimetic drug which means that it mimics the actions of the sympathetic system, acting on the central nervous system reducing the food intake by providing a sense of fullness. Also attenuates the fall in metabolic rate associated with weight loss. It was approved by the FDA for the use as a weight loss drug which showed great efficacy.

How does Sibutramine work?

Sibutramine – as a reuptake inhibitor – inhibits the reuptake of serotonin and norepinephrine which are two neurotransmitters which are associated and involved in the process of regulating mood, appetite and energy balance. By inhibiting the reuptake of these neurotransmitters, the number of neurotransmitters available accumulate and therefore suppresses the appetite and increase the energy expenditure of the body.

It also affects the hypothalamus, which is a part of the brain which sends the signals of “Hunger” of “Thirst” to your body. Sibutramine reduces these food hunger signals.

What is the dosage of Sibutramine?

Sibutramine should be taken orally once daily with a dosage of 10mg per day. This dose can be increased up to 15mg per day depending on the patient’s medical health condition and under the supervision of a specialist.

Side effects of Sibutramine?

As previously mentioned, sibutramine is a sympatho-mimetic drug which means that it mimics your sympathetic system which is the system responsible for your “Fight or flight responses”. It can cause the following side effects:

• Tachycardia
• Increased blood pressure (Hypertension)
• Dry mouth
• Headache due to raised intracranial pressure(due to hypertension)
• Being anxious
• Seizures – although very rare.
• Mood changes due to the alterations of the neurotransmitters of the brain.

These side effects rarely occur if the person is normal and not suffering from any complications or other diseases.

In conclusion, obesity is a multi-factorial dreadful disease that threatens the whole world that occurs due to a sedentary lifestyle and an unhealthy diet in both adults and children nowadays. Sibutramine is a great option for every obese patient looking to lose weight in a short duration of time without the need to abide to insensible diets and fasting regimens that prevent you from eating what you really like. Sibutramine is a norepinephrine and serotonin reuptake inhibitor that works on the central nervous system and regulates appetite as well as changes the signals of the hypothalamus to hunger. It is a very effective and appropriate method of losing weight and it is approved by the FDA. In case of suffering from any side effects – which is rare – consult your specialist regarding the use of sibutramine.

References

• Prevalence of overweight and obesity among adults: United States, 1999. Hyattsville, Md.: National Center for Health Statistics, Health E-Stats, 2000. (Accessed December 7, 2001, at http://www.cdc.gov/ nchs/products/pubs/pubd/hestats/obese/obse99.htm
• Finer N. Sibutramine: its mode of action and efficacy. Int J Obes Relat Metab Disord. 2002 Dec;26 Suppl 4:S29-33. doi: 10.1038/sj.ijo.0802216. PMID: 12457297
• https://go.drugbank.com/drugs/DB01105
• Alexandria Faculty of Medicine Pharmacology Textbook