Sildenafil
Sildenafil is a renowned phosphodiesterase type 5 (PDE5) inhibitor commonly marketed as Viagra. This potent medication is primarily utilized for its effectiveness in treating erectile dysfunction.
Mechanism of Action
- Sildenafil inhibits PDE5, preventing the breakdown of cyclic guanosine monophosphate (cGMP). Sexual arousal prompts increased production of nitric oxide (NO), leading to elevated cGMP levels that facilitate the relaxation of blood vessels, enhancing blood flow to the penis.
- This mechanism aids in achieving and sustaining an erection.
Indications
- Primarily prescribed for managing erectile dysfunction in men.
- Also indicated for treating pulmonary arterial hypertension under the name Revatio.
Onset of Action
- Effects typically commence within 30 minutes of ingestion, although it may take up to 1 hour for some individuals.
Duration of Action
- The efficacy of sildenafil lasts between 4 to 5 hours, allowing adequate time for achieving and maintaining an erection.
Dosage
- The recommended starting dosage is 50 mg, adjustable based on the individual’s response.
- Intake should be approximately 30 minutes to 1 hour before sexual activity.
Side Effects
- Common adverse effects include headache, facial flushing, indigestion (such as nausea and diarrhea), visual disturbances (blurred vision or color vision changes), elevated blood pressure, and, in rare cases, hearing loss or changes.
Contraindications
- Avoid combining sildenafil with nitrates (e.g., nitroglycerin) due to a risk of severe hypotension. Not suitable for individuals with significant cardiac conditions, or recent myocardial infarction or stroke.
Fluoxetine
Fluoxetine, an effective selective serotonin reuptake inhibitor (SSRI), is marketed under the brand Prozac.
Mechanism of Action
- It elevates serotonin levels in the brain by preventing its reuptake, thus enhancing serotonin availability for receptor interactions.
Indications
- Approved for managing various depressive disorders.
- Also beneficial for conditions such as obsessive-compulsive disorder (OCD), bulimia nervosa, and occasionally generalized anxiety disorder (GAD).
Onset of Action
- Full therapeutic effects may take several weeks to manifest, with gradual improvements in mood, anxiety, and behavioral changes.
Dosage
Typical dosing varies based on the indication:
- For depression, initiation typically begins at 20 mg daily, adjustable as necessary.
- For OCD, starting doses range from 20 mg to 60 mg daily.
- For bulimia nervosa, initial dosage typically starts at 60 mg daily.
Side Effects
- Potential side effects encompass nervousness, insomnia or drowsiness, indigestion (nausea and diarrhea), decreased appetite, irritability, weight loss, and sexual function changes.
Contraindications
- Use is contraindicated with MAO inhibitors due to the risk of severe interactions and serotonin syndrome.
- Not advised for patients with severe liver disease or an allergy to fluoxetine.
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