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To: MEDICAL EDITORS

Contact: John Murphy, +1-507-284-5005 (days), +1-507-284-2511 (evenings), e-mail: newsbureau@mayo.edu

ROCHESTER, Minn., Oct. 4 /Viagra price comparison
/ — Although medication
can help extend the lives of men with chronic heart failure, several factors
associated with this disease can interfere with a person’s ability to engage
in and enjoy sexual activities. Fatigue, depression, medication side effects
and the fear of damaging the heart can cause people with chronic heart failure
to lose interest in sex or wonder whether this activity is safe for them.

A literature review published in the October issue of Mayo Clinic
Proceedings finds that with proper screening and treatment, many patients with
chronic heart failure can safely engage in sexual activity.

Methods

Co-authors Stacy Mandras, M.D., Patricia Uber, Pharm. D., and Mandeep
Mehra, M.D., conducted systematic independent literature searches using the
MEDLINE database and examined a broad range of medical research that focused
on chronic heart failure, sexual activity and sexual dysfunction. This
literature included data from patient surveys and clinical trials.

Findings

Many people with chronic heart failure worry that having sex will place
too great a strain on the heart. To address this issue, Drs. Mandras and Mehra
analyzed studies that showed the impact of sexual activity on heart rate,
blood pressure and respiratory rates, which typically increase during sexual
activity and other forms of exertion.

One study the authors reviewed measured these changes in middle-aged men
with and without coronary artery disease. This study found that the peak heart
rate during intercourse was lower than heart rates measured during the
patients’ normal daily activities. The study participants’ peak oxygen
buying cialis generic
levels during intercourse were moderate — comparable to their
oxygen consumption levels during moderate activities such as walking on level
ground at 3 to 4 miles per hour, climbing stairs slowly or doing general
housework such as vacuuming.

The authors also addressed how to counsel and treat chronic heart failure
patients who are coping with erectile dysfunction, difficulty achieving or
maintaining an erection. Researchers estimate that erectile dysfunction
affects 60 percent to 70 percent of people who have chronic heart failure.

The authors observe that multiple factors may be involved. In addition to
decreased exercise capacity, patients with chronic heart failure have blood
vessel and circulation abnormalities that can reduce blood flow into the penis
and interfere with the ability to maintain an erection. And erectile
dysfunction can be caused or worsened by many of the medications that are
commonly prescribed to treat chronic heart failure.

Currently, the preferred treatment for erectile dysfunction includes
sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). However,
numerous experts have raised concerns about the use of these drugs in patients
with chronic heart failure who also take nitrates (or other medications that
relax and widen blood vessels). This drug combination has been shown to be

dangerous, because it can increase the risk for a life-threatening drop in
blood pressure.

To further explore this potential risk, the authors reviewed results from
a variety of studies in which male patients with congestive heart failure took
sildenafil. The authors observed that more data are needed to determine the
safety of the newer drugs, vardenafil and tadalafil, for these patients.

“Taken together, these studies show that erectile dysfunction in patients
with mild to moderate chronic heart failure can be safely and effectively
treated with sildenafil, provided that patients are appropriately screened
before therapy,” say the authors.

For those patients who cannot take erectile dysfunction medications, the
authors counsel that an exercise training regimen may be an appropriate
substitute therapy to enhance sexual function and quality of life. The authors
stress that clinicians should focus on the sexual activity history of chronic
heart failure patients and not ignore it, since addressing this element can
substantially improve their quality of life.

Background about chronic heart failure

Chronic heart failure often develops after other cardiac problems have
damaged or weakened the heart, leaving it too weak or too stiff to fill and
pump efficiently. Many underlying heart conditions can lead to heart failure.
It can develop quickly after damage caused by a heart attack, or it can
develop gradually after years of high blood pressure or coronary artery
disease.

A peer-review journal, Mayo Clinic Proceedings publishes original
articles, reviews and editorials dealing with clinical and laboratory
medicine, clinical research, basic science research and clinical epidemiology.
Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical
Education and Research as part of its commitment to the medical education of
physicians. The journal has been published for more than 80 years and has a
circulation of 130,000 nationally and internationally. Articles are available
online at http://www.mayoclinicproceedings.com.

To obtain the latest news releases from Mayo Clinic, go to
http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com) is
available as a resource for your health stories.

SOURCE Mayo Clinic

-0-

STORAGE
Tablets should be kept at room temperature between 15-30 C (59-86 F).

PRESCRIBED FOR
Tadalafil is used for the treatment of erectile dysfunction, or impotence.

DOSAGE
The recommended initial dose of Tadalafil is 10 mg per day, which have to be taken orally before sexual activity. This prescribed amount is a usual daily dose for the majority of men. This dose can be increased up to 20 mg or decreased to 5 mg per day depending on the feedback or side effects. The maximal duration of the Tadalafil's effect is 36 hours. Patients who take medicines extending the level of Tadalafil in the blood shouldn't surpass a total dose of 10 mg in 72 hours (See “DRUG INTERACTIONS”). As food doesn't influence on absorption of Tadalafil from the intestine the drug can be taken while eating as well as on an empty stomach.

DRUG INTERACTIONS
The following medicines can diminish the ability of the organism to destroy and eliminate Tadalafil: erythromycin, generic cialis tadalafil price comparison
(Nizoral), drug dysfunction erectile
(Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Hence these medications can heighten the level of Tadalafil in the blood. If these medicines have to be taken simultaneously with Tadalafil, its dose has to be reduced to avoid side effects, which can be provoked with high level of Tadalafil in the blood. When being taken simultaneously with nitrates, such as nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro), which are usually prescribed for treatment of heart pain (angina), Tadalafil strengthens heart rate and lowers blood pressure. If the patient takes nitrates for angina, Tadalafil can become a reason of heart pain or perhaps even a heart attack as a result of strengthening of heart rate and lowering of blood pressure. So it's highly recommended not to take Tadalafil together with nitrates. Tadalafil can also heighten the blood pressure as it lessens effects of some alpha-blocking medicines, such as terazosin (Hytrin), which are principally used for treatment of high blood pressure or increment of the prostate. The patients, who take the erectile dysfunction drugs
, have to take the stable dose of these drugs before starting to take Tadalafil. In these cases at the initial stage the lowest doses of Tadalafil should be taken. In cases of taking Tadalafil, the alpha-blockers should be taken beginning with the lowest dose. As Tadalafil like alcohol lower blood pressure it's highly recommended not to mix these substances, because as a result of such mixing there can be dizziness, headaches and increased heart rate.

PREGNANCY
The drug isn't approved for usage by women.

NURSING MOTHERS
Numero cas tadalafil
mothers were not testing for taking Tadalafil.

SIDE EFFECTS
When using Tadalafil the following accompanying effects can take place: headache, facial flushing (reddening), nausea, stomach upset, diarrhea, and flu-like symptoms. Tadalafil can also become the cause of low blood pressure, spasm of accommodation, breach of color perception and anomalistic ejaculation.
There were cases of continuous erections, or priapism (aching erection that lasts more than six hours) fixed after taking Tadalafil. If erection lasts more than four hours you have to recourse. There is causation between using of Tadalafil and chest pain, heart attack, palpitation, hastened heart rate, stroke and death, but it's not confirmed if these side effects are result of using Tadalafil or they are direct outcome of sexual activity itself.

Tadalafil should be taken orally. This medicine is used for therapy of erectile dysfunction, or impotence, consisting in lacking of ability to reach and keep in existence a penile erection. The drug class, which Tadalafil belongs to, is called generic cialis tadalafil
inhibitors. Sildenafil (Viagra) and Viagra on line order
(Levitra) belong to this drug class too. When a penis is filling up with blood there a penile erection springs up. The blood vessels, which are cheapest tadalafil for bringing blood to male reproductive organs, extend in size what causes filling the penis up with large quantity of blood. While the blood vessels, responsible for uso continuo tadalafil
blood away from the penis, diminish in size, what causes taking much less blood away from the penis than under usual circumstances. Sexual excitement leading to a sterling erection determines the production and ejection of nitric oxide in the male genital organs. The nitric oxide provokes the production of an enzyme called guanylate cyclase that is a necessary condition for production of cyclic guanosine monophosphate (cGMP). This chemical compound controls extending and reducing of the size of the blood vessels that transport blood to and from the male reproductive organs. These changes of sizes condition erection.

Afterwards one more enzyme, which is called phosphodiesterase-5, demolishes the cGMP what makes blood vessels take their usual sizes, blood go away from the penis and thus the erection is over. Mechanism of action of Tadalafil consists in preventing phosphodiesterase-5 to ruin cGMP so the last one exists longer. The extended thus life of cGMP makes blood flow to the penis for longer period of time. The U.S. FDA approved Tadalafil in November, 2003.

Before talking about the Cialis's case history it's necessary to remember the famous Pfizer's medication Viagra. After on the 27th of March 1998 The U. S. Food and Drug Administration approved Viagra, this prescription was a success, and just for the first year of marketing Pfizer sold medicines, total cost of which drugs tadalafil
one billion dollars. Unfortunately for Pfizer the situation was altered significantly after the FDA authorized Levitra on the 19th of August, 2003 and Cialis on the 21st of November, 2003 too. In 1993 the pharmaceutical company Icos started to examine a PDE5 enzyme inhibitor called IC351 as it was essentially the process through which the erectile dysfunction medicines affected. In 1994 during clinical researches of some cardiac medication Pfizer's researches descried the sildenafil citrate, a white crystal powder, which was a part of the medicine, caused the tadalafil soft tablet
, taking part in the researches, to have erections as it blocked the enzyme that was cialis tadalafil for the production of the chemical substation causing erection, normalizing thus erectile function of the penis for some time.

Despite the fact that the investigators were not attempting the chemical mix IC351 for erectile dysfunction therapy, the mixture appeared to have an accompanying effect that could possibly cost millions or even billions of dollars. In 1994 at the nearest opportunity Icos got the exclusive right to IC351, and during 1995 the medical researches of the first phase were taking place. In 1997 the second phase of the medical studies was started and for the first time Icos tested its medicine on patients with erectile dysfunction. The second phase continued for about two years and when it was over the third phase was commenced.

In 1998 ICOS Corporation and Eli Lilly & Company decided exploiting the preparation for erectile dysfunction for financial profit and in two years they registered a new medicine application with the U.S. FDA for IC351; they made a decision to name the medicine Cialis this time though. In May of 2002, Icos and Eli Lilly & Company informed the American Urological Association that the researches carried out in the third phase showed that Cialis's effect lasted for about 36 hours. In a year U.S. FDA approved Cialis. In comparison with Viagra Cialis has one essential advantage. The matter is that the half life of Tadalafil (Cialis), is 17.5 hours so this medicine works up to 36 hours, even if there is still about a quarter of the absorbed dose in the body by that time. As to Sildenafil (Viagra), its half life is just 4 hours.
In 2006 Eli Lilly bought ICOS Corporation for $2.1 billion dollars.

After a two year investigation into the murky world of on line pharmacies and Internet “cheap cigarettes”, Americas Watchdog and its Global Piracy & Counterfeiting Consultants have a worldwide recommendation to all consumers. This can be summed up in three words: “Don't Do It”. The investigation concluded that the “on line drugs and cigarettes could be lethal or you could get charged for something you never get”. By doing business with a on line cigarette or drug “retailer”, a consumer may have just given their credit information to the Russian Mafia or organized crime.

(PRWEB) May 21, 2007 — Americas Watchdog is one of the premier consumer advocacy groups in the United States. The group has formed a piracy & counterfeiting task force to take on sellers of “on line” counterfeit drugs or cigarettes. The group is warning all consumers worldwide to avoid doing business with “on line” pharmacies or cigarette “retailers” unless they can provide credentials. Aside from potential lethal counterfeit drugs or cigarettes, consumers expose them selves to possible identity theft or paying for something they never get. “Who wants to do business with the Russian Mafia or organized crime”? Americas Watchdog's Global Piracy & Counterfeiting Consultants are seeking corporate partnerships to curb this growing worldwide problem with buy operations designed to expose the viagra free consultation
or their “retail” outlets. The two areas to be targeted are:

*Counterfeit Cigarettes
British American Tobacco has reported that more than one in 20 cigarettes smoked worldwide is either smuggled or counterfeit.

The cigarette industry, like many other industries, faces an unprecedented challenge from counterfeit products. The WCO estimates that 190 billion counterfeit cigarettes are produced each year in China, making it “a major source country for European/US markets”.

Americas Watchdog and its Global Piracy & Counterfeit Consultants warn that counterfeit cigarettes, which may look identical to those purchased legitimately over the counter, can contain hazardous levels of damaging toxins, including arsenic. The black-market cigarettes have higher levels of tar, nicotine and carcinogenic chemicals from contaminated tobacco leaves. In other words, counterfeit cigarettes could be dangerous.

Americas Watchdog and its Global Piracy & Counterfeiting Consultants are warning consumers not to purchase counterfeit cigarettes or “on line cigarettes” as they could be a serious health hazard. In addition by purchasing counterfeit cigarettes a consumer may actually be enriching terrorists or organized crime. Americas Watchdog would welcome the opportunity to work directly with British Tobacco, the Altria Group, Reynolds American, Altadis or other cigarette manufacturers in order to curb and or disrupt the manufacturing or distribution of counterfeit cigarettes.

*Counterfeit Drugs
The FDA recommends that consumers who have purchased drugs from certain web sites not use the products because they may be unsafe. Laboratory analyses are underway for intercepted products that were destined for the U.S. market. Preliminary laboratory results to date have found counterfeits of the following drug products: Lipitor” /> News News Photos Images Web

” />

Lipitor, Diovan, Actonel, Nexium, Hyzaar, Ezetrol (known as Zetia in the United States), Crestor, Celebrex, Arimidex and Propecia. All of these medications require a prescription from a licensed health care provider to be legally dispensed.

DRUG NAME
USE(S)

LIPITOR
Cholesterol disorders

CRESTOR
Cholesterol disorders

ZETIA (US name) / EZETROL (Canadian name)
Cholesterol disorders

DIOVAN
High blood pressure

HYZAAR
High blood pressure

ACTONEL
Osteoporosis in buy cheap tadalafil
women

NEXIUM
Alternative natural viagra
reflux disease (GERD)

CELEBREX
Arthritis-related pain

ARIMIDEX
Breast cancer

PROPECIA
Male-pattern baldness

According to the FDA, drug counterfeiters defraud consumers by selling products that resemble legitimate drugs but may contain inactive or incorrect ingredients; contain improper doses of active ingredients; or be otherwise contaminated. Purchasing ED products on line from illegitimate websites involve risks such as::

— Fake or “generic” ED drugs may be manufactured in unregulated factories, often in regions of the world that do not share the same rigorous standards for pharmaceutical manufacturing applied in the U.S.

— The drugs may contain dangerous additives

— The illegal drugs may not work as claimed, or at all

— Illegitimate pharmacies may take payment but not ship ordered products, or shipped products may be seized by the U.S. government because they are illegal

— Web sites that distribute counterfeit ED pills, including “generic Viagra”, Cialis and Levitra have been found to abuse credit card information.

Americas Watchdog and its Global Piracy & Counterfeiting Consultants (Http://GP-CC.Com ) strongly encourage consumers in the US and worldwide to stay away from Internet cigarette “retailers”, Internet pharmacies or computer pop ups for ED or other medical conditions. According to Americas Watchdog's President, “these counterfeit drugs could actually kill you. If a consumer wants to be safe, consult a physician or a licensed pharmacy, rather than trusting someone you don't know anything about on the Internet.” As a part of one of their investigations, Americas Watchdog ordered a sedative from an “on line pharmacy”, and they were sent a blood thinner instead.

Americas Watchdog wants to shut down all illegal Internet pharmacies and assist in the prosecution of illegal “on line pharmacies” or counterfeit drug manufacturers and counterfeit cigarette manufactures or “retailers”. If you are an executive or a law firm representing Pfizer, GlaxoSmithKline, Merck, Astrozeneca, Aventis, Johnson & Johnson, Novartis, Bristol Meyers or any other pharmaceutical company or an executive or law firm representing Altria, Reynolds American, British American Tobacco or other cigarette manufacturers, please contact America's Watchdog's Global Piracy & Counterfeiting Consultants to learn more about our global anti-counterfeiting initiatives. If you are a consumer, a law firm representing a corporate client or a corporate executive and would like more information about Americas Watchdog's worldwide counterfeiting initiatives, please contact them at their web site Http://GP-CC.Com or call 866-714-6466.

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Americas Watchdog
THOMAS MARTIN
866-714-6466
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