Sildenafil
Sildenafil, commonly known as Viagra, is a member of the phosphodiesterase type 5 (PDE5) inhibitors class of medications.
Mechanism of Action
- Sildenafil inhibits the enzyme PDE5, preventing the breakdown of cyclic guanosine monophosphate (cGMP). This action enhances the levels of cGMP during sexual arousal, leading to relaxation of smooth muscles in the blood vessels, thereby improving blood flow to the penis.
- This physiological process facilitates both the attainment and maintenance of an erection.
Indications
- The primary indication for sildenafil is the management of erectile dysfunction in men.
- Additionally, it may be utilized in treating arterial hypertension under the brand name Revatio.
Onset of Action
- Sildenafil typically begins to take effect within 30 minutes post-ingestion, though it may take up to 1 hour in some users.
Duration of Action
- The effects of sildenafil can last from 4 to 5 hours, sufficient for achieving and sustaining an erection.
Dosage
- The standard initial dose of sildenafil is 50 mg, adjustable based on individual response.
- It is recommended to take the dosage about 30 minutes to 1 hour before anticipated sexual activity.
Side Effects
- Common adverse reactions include headache, facial flushing, digestive issues (e.g., nausea, diarrhea), visual disturbances (e.g., blurred vision, altered color perception), elevated blood pressure, and, on rare occasions, hearing impairment.
Contraindications
- Sildenafil is contraindicated in conjunction with nitrates (such as nitroglycerin) due to the risk of significant blood pressure reduction.
- It is not advised for individuals with severe cardiac conditions or those who have experienced a recent heart attack or stroke.
Duloxetine
Duloxetine, known by the brand name Cymbalta, belongs to a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SSNRI).
Mechanism of Action
- Duloxetine enhances serotonin and norepinephrine levels in the central nervous system, which can improve mood and alleviate pain perception.
Indications
- Approved for treating various conditions including depressive disorders.
- Generalized Anxiety Disorder (GAD).
- Neuropathic pain, such as diabetic peripheral neuropathy and pain linked to fibromyalgia.
- Chronic pain in individuals suffering from chronic back conditions.
Onset of Action
- Full effects of duloxetine for depression may not be apparent for several weeks. However, relief for anxiety or pain can occur more rapidly in some patients.
Dosage
- Doses typically start low, with gradual adjustments based on tolerance and response.
- For depression, the standard dosage ranges from 40 to 60 mg daily.
- A common prescription for pain associated with diabetic peripheral neuropathy or fibromyalgia is 60 mg daily.
Side Effects
- Common side effects include: hot flashes, dry mouth, gastrointestinal disturbances (e.g., constipation, diarrhea), insomnia, drowsiness, reduced appetite, headaches, heightened anxiety, and sexual dysfunction.
Contraindications
- This medication should be avoided in patients with specific liver diseases or those taking monoamine oxidase inhibitors (MAOIs).
- Pregnant women should apply caution when using duloxetine, particularly during the final trimester.
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