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Kamagra (Generic Viagra) [sildenafil citrate], manufactured by Ajanta Pharma, Ltd, this drug is the first cyclic guanosine monophosphate [cGMP] specific phosphodiesterase type 5 enzyme inhibitor. This enzyme helps in regulating the blood circulation in the penile tissue. This leads to better penile *****ion.

Kamagra (Generic Viagra) is primarily indicated in the treatment of impotence [*****ile dysfunction]

The compound sildenafil was synthesized in Pfizer’s research lab in Kent, England. Believe it or not, sildenafil was actually being studied for the treatment of hypertension and angina pectoris. Angina pectoris, or chest pain, caused by an insufficient supply of oxygen and decreased blood flow to the heart muscle. Angina is frequently the first sign of ischemic heart disease. However, during the phase 1 clinical trials, it was found that instead of having a remarkable action on angina, this drug was very effective in inducing penile *****ions, the main pathology behind *****ile dysfunction.

The drug was patented in 1996, approved for use in *****ile dysfunction by the Food and Drug Administration on March 27, 1998, becoming the first oral treatment approved to treat *****ile dysfunction in the United States

Needless to say, this drug has become a household hit.

Erectile dysfunction:

Erectile dysfunction (ED) is defined as the inability of a man to achieve or maintain an *****ion sufficient for his ***ual needs or the needs of his partner

Erection of the penis during coitus or otherwise is a result of increase in the blood flow of the arteries of the penis and simultaneous relaxation of the smooth muscle of corpora cavernosum. This whole process is due to the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP in turn, relaxes smooth muscle and resulting in an increase in the blood flow to the corpus cavernosum.

In *****ile dysfunction, enough blood does not flow in the arteries of the penis to cause a sufficient *****ion.

Causes of *****ile dysfunction:

With reduced libido:

hypogonadism

depression

With intact libido:

psychological problems, including anxiety

vascular insufficiency [atheroma]

neuropathic [diabetes mellitus, alcohol excess, multiple sclerosis]

drugs [beta blockers, thiazide diuretics]

.An organic cause can be found out in about 50% of the cases of *****ile dysfunction; the rest are either psychogenic in origin or are due to a psychiatric illness such as depression which requires appropriate drug treatment. Systemic diseases like chronic liver or kidney diseases and drug addiction are important causes and should be looked for. In case of any psychogenic problem, even the partner should be actively involved in the counseling therapy

The physiologic mechanism of *****ion of the penis involves release of nitric oxide (NO) in the corpus cavernosum of the penile tissue during ***ual stimulation. Nitric oxide then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Kamagra (Generic Viagra) [sildenafil citrate] has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When ***ual stimulation causes local release of nitric oxide, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of ***ual stimulation.

There are many types of PDE, each having varied function. The plus point of Kamagra  (Generic Viagra) [sildenafil citrate] is that it is PDE 5 selective, though it can also act on the other types of PDE. In fact higher doses or plasma levels of the drug is thought to be associated with defects in color vision due to its action on PDE 6.

Kamagra (Generic Viagra) [sildenafil citrate] has a 4,000-fold selectivity for PDE5 versus PDE3, which is concerned with cardiac contractility.

Indications:

Erectile dysfunction. This is the main indication whereas for the indications given below, sildenafil is not in the first line treatment regimen.

pulmonary arterial hypertension

prevention of high altitude pulmonary edema associated with altitude sickness

treatment of benign prostatic hypertrophy [BPH]-associated lower urinary tract symptoms [LUTS]

Indications under investigation:

Relieving female ***ual dysfunction. Several studies have indicated the drug may be effective in improving libido and arousal in women taking selective serotonin uptake inhibitors (SSRIs)

Treatment of infertility. Women who have had repeated failures with in vitro fertilization (IVF) due to poor development of the endometrium [tissue that lines the uterus] may benefit from treatment with vaginal suppositories containing sildenafil.

Esophageal motility dysfunction (achalasia), since it can enhance nitric oxide production.

Contraindications:

 - patients on nitric oxide drugs since sildenafil potentiate the hypotensive effects of  nitrates, and its administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is therefore contraindicated.

 - There is a degree of cardiac risk associated with ***ual activity, especially in elderly people above the age of 60 years. There is increase incidence of mortality and morbidity with KAMAGRA (GENERIC VIAGRA) [sildenafil]

 - Severe hepatic impairment (decreased liver function)

 - Severe impairment in renal function

 - Hypotension (low blood pressure)

 - History of stroke or heart attack

 - Hereditary degenerative retinal disorders (including genetic disorders of retinal phosphodiesterases)

Side effects:

The most commonly reported side effects of KAMAGRA (GENERIC VIAGRA) are headache, flushing of the face, upset stomach, and nasal congestion.

Other less common side effects include, but are not limited to:

• vision problems, including sensitivity to light, blurred vision, and a color tinge to vision
• urinary tract infection
• diarrhea
• dizziness
• rash

Dosage:

Administered in the dose of 50 mg one hour before the intended ***ual activity. Based on effectiveness and toleration, it can be increased to 100 mg or decreased to 25 mg.

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