1. Sildenafil Citrate: Viagra By: John F. Payne

2. What is Sildenafil Citrate Discovery Mechanism of Action Pharmacokinetics Analogs and Other Options

3. The History of Viagra Pfizer originally sought for a PDE inhibitor that might act as a new antihypertensive and antianginal drug. Studies were done to see what side effects would come from increased dosages. Volunteers reported back with side effects like head aches, visual problems, and prolongment of penile erections. According to the British Press, but not Pfizer, Peter Dunn and Albert Wood invented sildenafil.

4. The History of Viagra Pfizer’s medicinal research team is actually credited with the invention of Viagra. Nicholas Terret, one of Pfizer’s chief medicinal chemists, is considered to be the father of Viagra.

5. The Synthesis of Sildenafil The Synthesis of Sildenafil 1.Methylation of 3-propylpyrazole-5-carboylic acid ethyl ester with hot dimethy sulfate. 2.Hydrolysis with NaOH 3.Nitration with fuming Nitric Acid 4.Carboxamide formation with refluxing thionyl chloride/ NH 4 OH 5.Reduction of Nitro group to Amino 6.Acylation with 2-ethoxybenzoyle chloride 7.Cyclization 8.Sulfonation to the chlorosulfonyl derivative 9.Condesation with 1-methylpiperazine

7. How does an erection work? An erection can be caused by local stimulation or centrally by erotic thought.

8. Mechanics of an Erection Upon sexual stimulation, the terminals of parasympathetic nerves release nitric oxide. The nitric oxide diffuses into the smooth muscle cells and bind with the enzyme guanylate cyclase. Guanylate cyclase converts guanosine triphosphate (GTP) into cyclic guanosine monophosphate (cGMP).Guanylate cyclase

10. Mechanics of an Erection cGMP binds to Protein Kinase G (PKG) which causes the smooth muscle cells to relax, allowing for an inflow of blood. PKG works by many mechanisms, including lowering the cellular Ca +2 levels. The inflow of blood causes the sinusoids of the corpus cavernosum to enlarge, which compresses the penile veins. Therefore, there becomes a collection of blood inside the penis smooth muscle tissue.

11. How does Viagra Work?? How does Viagra Work?? Phosphodiesterase 5 (PDE 5) is the enzyme that catalyzes the hydrolysis of cGMP back into GTP. Viagra acts competitively with cGMP at the active site of PDE 5. So, if Viagra inhibits PDE 5, then there will be an accumulation of cGMP in smooth muscle cells until the Viagra is metabolized (mainly by cytochromes in hepatic metabolism).

13. Viagra shows good competitive kinetics with cGMP because of the structural similarities.

14. kinetics Pharmaco kinetics Viagra is rapidly absorbed after oral administration - Total Bioavailability: 40% Its pharmacokinetics are dose proportional over the recommended range Viagra is metabolized mainly by hepatic metabolism and excreted mainly in the feces.

15. Selectivity Sildenafil is very selective for PDE 5, which a great advantage because there are over 10 classes of PDE’s. The exact IC50 values are not given for PDE 2, PDE 4, and PDE 6. But, the ratios for PDE 5 versus these isozymes are given above.

16. How did Scientists Tests Subjects Scientists assessed erections using an instrument called Rigiscan, which measures hardness and duration of erections. Also, each subject was given a survey, which measured the ability to achieve erections for sufficient sexual intercourse, and the ability to maintain erections after penetration. Also, some subjects were asked to create a diary to write down any feelings or side effects they might have had.

17. Clinical Results Erectile dysfunction was attributed to organic (58%), psychogenic (17%), or mixed etiologies (24%). After 6 months of Viagra treatment, the percentages of men reporting improvement in their erections are below: Organic = 63% Psychogenic = 74% Mixed = 82%

18. Is this a wonder drug, or are there side effects? One side effect of Viagra comes from the relatively high selectivity for PDE 6. At peak plasma levels of Viagra, some subjects cannot distinguish between green and blue. In placebo controlled studies, only 2.5% of users discontinued the use of Viagra because of negative side effects.

19. Side Effects Some side effects of Viagra: Headache Flushing Dyspepsia Nasal Congestion Diarrhea Urinary Tract Infections

20. A Major Concern Because Viagra is a vasodilator (although mainly locally), it needs to be used cautiously because it lowers blood pressure. Viagra should not be given to patients who are taking nitrates, because nitrates are also a strong vasodilator. The use of both could cause major heart problems. Also, the use of CYP3A4 or P450 inhibitors (which are the cytochromes responsible for Viagra metabolism), greatly increases the risk of negative side effects. Some CYP3A4 inhibitors include Erythromycin, Cimetidine. One major P450 inhibitor is Ritonavir

21. New Analogs and Alternatives If you thought that Viagra worked, wait until you have seen Tadalafil, which is a new experimental drug being used in Europe. The effects on erectile dysfunction last for 24 hours and the onset of effects take approximately 16 minutes.

22. Tadalafil Erectile dysfunction is a common complication related to diabetes (affecting 27 to 75% of men with the disease), and diabetes ED is harder to treat than regular ED for many factors. However, 76% of men with diabetes ED reported an improvement in erection achievement and maintenance. 81% of men with regular ED reported an improvement in their erections.

23. Tadalafil Another major benefit of Tadalafil is that it is not significantly affected by the impact of age, renal impairment, diabetes, or liver function. “These findings suggest that dosing for Tadalafil should be simple and uncomplicated, which is important from a health care professional standpoint.”

24. Selectivity of Tadalafil The IC50 ratios for: PDE 5 vs. PDE 1 through PDE 4 = 10,000 PDE 5 vs. PDE 7 through PDE 10 = 10,000 PDE 5 vs. PDE 6 = 780 So, there are no serious cardiovascular adverse effects nor color vision disturbances.

25. Vardenafil Vardenafil is an experimental drug that is designed to help ED in men who have undergone prostate surgery. In one of the first clinical studies, Vardenafil helped over 50% of men with ED after prostate surgery. Tadalafil and Vardenafil are considered to be the second generation of drugs used for ED.

26. Does Viagra Really Work??