CAVERTA is Ranbaxy's brand of "sildenafil citrate". Sildenafil is the latest oral drug introduced for the treatment of a condition known as "erectile dysfunction" (ED). CAVERTA can help many men who have ED, get and keep an erection when they become sexually stimulated.

Erectile dysfunction, or ED is the inability to get and/or keep an erection sufficient for satisfactory sexual activity. Erectile dysfunction is a common problem experienced by many men. Yet, due to shyness and embarrassment this problem does not receive proper medical attention.

The co-ordination of psychological, hormonal, neurological, vascular and cavernosal factors is required for normal erectile function, and dysfunction occurs when alterations in one or more of these factors occurs.

Organic causes are thought to account for about 70 percent of cases of erectile dysfunction, with psychological or mixed causes making up the remainder.

Erectile dysfunction occurs in men with chronic systemic illnesses such as diabetes mellitus, heart disease and hypertension. It is common in those suffering from depression. In approximately 25 percent of patients with erectile failure, this problem is associated with certain medications like antihypertensives, diuretics and antidepressants drugs. Spinal injuries or prostate surgery can also lead to ED.

In younger men, a psychogenic cause ('performance anxiety') is the most likely cause of intermittent erectile dysfunction. This may also be a problem in older men, secondary to an organic cause (mixed ED).

CAVERTA enables many men with ED to respond to sexual stimulation. When a man is sexually aroused, the arteries in the penis relax and widen, allowing more blood to flow into the penis. As the arteries in the penis expand and harden, the veins that normally carry blood away from the penis become compressed, restricting the blood flow out of the penis. With more blood flowing in and less flowing out, the penis enlarges, resulting in an erection.

If the nerves or blood vessels associated with this process aren't working properly, a man may not be able to get an erection. CAVERTA increases blood flow to the penis, so that when a man is sexually aroused, he can get and keep an erection. When the sexual act is over, the erection goes away.

Sildenafil inhibits the enzyme phosphodiasterase type 5 (PDE 5). Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. This results in better and longer-lasting erection.

Sildenafil (CAVERTA) improves erections in up to 80% of men who take it; regardless of how long they have had ED, what caused it, or how old they are.

Sildenafil has been proven to be an effective treatment in patients with impotence of no known organic cause (psychogenic), with response rates of 65% to 93%. The drug also has a role in patients with erectile dysfunction associated with a definable cause. For example, sildenafil has been shown to be effective in 50% of patients with erectile dysfunction associated with diabetes mellitus. In addition, the drug has shown efficacy in elderly patients and those with a broad range of underlying diseases such as controlled hypertension, spinal cord injury or depression.

Sildenafil also appears to improve the quality of life of both patients and their sexual partners.

CAVERTA needs to be taken about 1 hour before engaging in sexual activity. However it may be taken from 30 minutes to 4 hours before sexual activity. For most patients, action begins in about 30 minutes.

CAVERTA can help achieve erection only if the person is sexually excited.

No! With CAVERTA, one must be sexually aroused to get an erection. If someone takes CAVERTA and is not sexually stimulated, nothing will happen - he won't get an erection just by taking the tablet. CAVERTA is not a hormone. It is not an aphrodisiac. It's a prescription medicine that can improve the erectile function of most men with erection problems.

CAVERTA is taken as and when needed. It can be taken anywhere from half-an-hour to 4 hours before sexual activity.

Generally, it is taken 1 hour before sexual activity. CAVERTA comes in different strengths (25 mg, 50 mg, and 100 mg). The recommended dose is 50 mg and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The maximum dose is 100 mg, which can be given to patients who do not respond to 50mg and who do not have cardiovascular disease. The drug should not be used more than once a day.

If a patient is older than 65 years, has a serious liver or kidney problem, or is taking cytochrome P450 inhibitors such as ritonavir, sanquinavir, ketoconazole, erythromycin or cimetidine, the doctor may start the patient at the lowest (25 mg) dose of CAVERTA.

For most patients, CAVERTA should not be taken more than once a day. In patients taking certain protease inhibitors e.g. ritonavir, sanquinavir, (for the treatment of HIV), it is recommended not to exceed a maximum single dose of 25 mg of CAVERTA in a 48-hour period.

Sildenafil citrate (CAVERTA) is considered as a breakthrough in the treatment of erectile dysfunction because it is the first effective oral drug for the treatment of ED, regardless of its cause. Other drugs like yohimbine, dopamine and serotonin agonists are not as effective.

Other treatments like penile injections or intra-urethral drugs are associated with many unwanted side effects such as persistent and painful erection (priapism), scarring etc. Mechanical devices are cumbersome and surgical implants may get infected.

Drinking alcohol can temporarily impair the ability to get an erection. To get the maximum benefit it is advisable not to drink large amounts of alcohol before taking CAVERTA.

Yes, but taking CAVERTA after a high-fat meal (such as a pav bhaji and French fries) may cause CAVERTA to take a little longer to start working.

CAVERTA is only for patients with ED. CAVERTA is not for children or women. CAVERTA must be used only under a doctor's supervision.

CAVERTA is contraindicated in patients with a known hypersensitivity to any component of the tablet.

Patients who are using organic nitrates, either regularly and/or intermittently, in any form should not take CAVERTA. Nitrates are used for the treatment of angina and IHD, and include nitroglycerin (sprays, ointments, skin patches or pastes, and tablets that are swallowed or dissolved in the mouth), isosorbide mononitrate and isosorbide dinitrate (tablets that are swallowed, chewed, or dissolved in the mouth). Nitrates are also found in recreational drugs such as amyl nitrate or nitrite ("poppers").

Sexual activity carries a potential risk in patients with existing cardiovascular disease. Therefore, treatments for erectile dysfunction, including CAVERTA, should not be generally used in:

Patients who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months;

Patients with resting hypotension (BP <90/50) or hypertension (BP >170/110);

Patients with cardiac failure or coronary artery disease causing unstable angina;

Patients with retinitis pigmentosa (pigmentary degeneration of retina).

The safety of CAVERTA is unknown in patients with bleeding disorders and patients with active peptic ulceration.

CAVERTA should be used with caution in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie's disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anemia, multiple myeloma, or leukemia). The safety and efficacy of combinations of CAVERTA with other treatments for erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended.

Nitrates lower blood pressure. Simultaneous use of CAVERTA with nitrates may cause sudden and marked lowering of blood pressure. This can cause dizziness and may precipitate angina or heart attack in certain patients.

Like all medications, CAVERTA can cause some side effects. These are usually mild and don't last longer than a few hours. Some of these side effects are more likely to occur with higher doses of CAVERTA. With CAVERTA, the most common side effects are headache, facial flushing, dyspepsia and nasal congestion. CAVERTA may also briefly cause bluish or blurred vision, or sensitivity to light. Rarely, an erection lasting more than 4 hours may occur and if it occurs, immediate medical help should be sought.

Elderly patients who do not suffer from serious cardiac problems & do not have any other contraindication mentioned above can take CAVERTA. They should be given lower dose (25mg) of CAVERTA.

Patients with hepatic or renal impairment can take lower dose (25mg) of CAVERTA.

In studies upto 2 years, sildenafil has maintained its clinical efficacy. Good tolerability and low withdrawal rates were seen during 2 years' treatment. Headache, flushing, dyspepsia were the most common adverse events. Abnormal vision occurred in 2% of patients. No long-term vision problems were noted.

Interaction between sildenafil and organic nitrates contraindicates the simultaneous use of these drugs. Anti-HIV drugs ritonavir and sanquinavir, cytochrome P450 enzyme CYP3A4 inhibitors cimetidine, ranitidine, macrolides, ketoconazole & itraconazole are expected to increase sildenafil AUC; Patients receiving these drugs should be given lower dose (25 mg) of CAVERTA. Rifampicin, a CYP3A4 inducer, is expected to decrease sildenafil plasma concentration.

CAVERTA does not cure ED. It helps patients to achieve & maintain erection whenever it is taken. Cure of ED is achieved only when its primary cause is successfully tackled.