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The narcissist stimulates his self habitually in order to derive pleasure and gratification discount ivermectin 3mg with amex. The narcissist prefers fantasy to reality cheap ivermectin 3mg with visa, grandiose self-conception to realistic appraisal buy ivermectin 3mg without prescription, masturbation and sexual fantasies to mature adult sex and daydreaming to real life achievements. Carl Gustav Jung (1875-1961) pictured the psyche as a repository of archetypes (conscious representations of adaptive behaviors). Fantasies are a way of accessing these archetypes and releasing them. In Jungian psychology, regressions are compensatory processes intended to enhance adaptation, not methods of obtaining or securing a steady flow of gratification. Introversion is indispensable to narcissism, while extroversion is a necessary condition for orienting to a libidinal object. Freud regards introversion as an instrument in the service of a pathology. Jung, in contrast, regards introversion as a useful tool in the service of the endless psychic quest for adaptation strategies (narcissism being one such strategy). Nevertheless, even Jung acknowledged that the very need for a new adaptation strategy means that adaptation has failed. So although introversion per se is by definition not pathological, the use made of it can be pathological. Jung distinguished introverts (those who habitually concentrate on their selves rather than on outside objects) from extroverts (the opposite). Introversion is considered a normal and natural function in childhood, and remains normal and natural even if it dominates later mental life. To Jung, pathological narcissism is a matter of degree: it is exclusive and all-pervasive. Heinz Kohut said that pathological narcissism is not the result of excessive narcissism, libido or aggression. It is the result of defective, deformed or incomplete narcissistic (self) structures. Kohut postulated the existence of core constructs which he named: the Grandiose Exhibitionistic Self and the Idealised Parent Imago. Children entertain notions of greatness (primitive or naive grandiosity) mingled with magical thinking, feelings of omnipotence and omniscience and a belief in their immunity to the consequences of their actions. Without the appropriate responses, grandiosity, for instance, cannot be transformed into adult ambitions and ideals. To Kohut, grandiosity and idealisation are positive childhood development mechanisms. Even their reappearance in transference should not be considered a pathological narcissistic regression. Kohut says that narcissism (subject-love) and object-love coexist and interact throughout life. He agrees with Freud that neuroses are accretions of defence mechanisms, formations, symptoms, and unconscious conflicts. But he identified a whole new class of disorders: the self-disorders. These are the result of the perturbed development of narcissism. Self disorders are the results of childhood traumas of either not being "seen", or of being regarded as an "extension" of the parents, a mere instrument of gratification. Such children develop to become adults who are not sure that they do exist (lack a sense of self-continuity) or that they are worth anything (lack of stable sense of self-worth, or self-esteem). Horney said that personality was shaped mostly by environmental issues, social or cultural. Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on. Horney argued that anxiety is a primary reaction to the very dependence of the child on adults for his survival. Children are uncertain (of love, protection, nourishment, nurturance), so they become anxious. Defenses such as narcissism are developed to compensate for the intolerable and gradual realisation that adults are merely human: capricious, unfair, unpredictable, non-dependable. Defences provide both satisfaction and a sense of security. Otto Kernberg (1975, 1984, 1987) is a senior member of the Object Relations school in Psychology (comprising also Kohut, Klein, and Winnicott). Kernberg regards as artificial the division between Object Libido (energy directed at people) and Narcissistic Libido (energy directed at the self). Whether the child develops a normal or a pathological form of narcissism depends on the relations between the representations of the self (the image of the self that the child forms in his or her mind) and the representations of objects (the images of other people that the child forms in his or her mind). It is also dependent on the relationship between the representations of the self and real objects. The development of pathological narcissism is also determined by instinctual conflicts related both to the libido and to aggression. The Self is dependent upon the unconscious, which exerts a constant influence on all mental functions. Pathological narcissism, therefore, reflects a libidinal investment in a pathologically structured Self and not in a normal, integrative structure of the Self. The narcissist suffers from a Self, which is devalued or fixated on aggression. All object relations of such a pathological Self are detached from the real objects (because they often cause hurt and narcissistic injury) and involve dissociation, repression, or projection onto other objects. Narcissism is not merely a fixation on an early developmental stage. It is not confined to the failure to develop intra-psychic structures. It is an active, libidinal investment in a deformed structure of the Self. Fred - Narcissism: Socrates, the Frankfurt School and Psychoanalytic Theory - New Haven and London, Yale University Press - 1988 ISBN 0300040644Fairbairn, W. Davis, contributor) - Disorders of Personality: DSM IV and Beyond - 2nd ed. Psychoanalytic Association - 22 (1974): 292-305Stern, Daniel - The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology - New York, Basic Books, 1985 ISBN 0465095895Vaknin, Sam - Malignant Self Love - Narcissism Revisited - Skopje and Prague, Narcissus Publications, 1999-2005 ISBN 8023833847Zweig, Paul - The Heresy of Self-Love: A Study of Subversive Individualism - New York, Basic Books, 1968 ISBN 0691013713 The narcissist is an actor in a monodrama, yet forced to remain behind the scenes. He feeds off other people who hurl back at him an image that he projects to them. This is their sole function in his world: to reflect, to admire, to applaud, to detest - in a word, to assure him that he exists. Otherwise, they have no right to tax his time, energy, or emotions - so he feels. According to the legend of Narcissus, this Greek boy fell in love with his own reflection in a pond. Presumably, this amply sums up the nature of his namesakes: narcissists. The mythological Narcissus rejected the advances of the nymph Echo and was punished by Nemesis, consigned to pine away as he fell in love with his own reflection - exactly as Echo had pined away for him. Narcissists are punished by echoes and reflections of their problematic personalities up to this very day. My book, Malignant Self Love - Narcissism Revisited , offers a detailed, first-hand account of what it is like to have a Narcissistic Personality Disorder (NPD). It offers new insights and an organized methodological framework using a new psychodynamic language. Inside this site, and through my book, I survey the main body of research about narcissism. I warn you though, Narcissism is a slippery subject: only with great difficulty can it be captured with words. A new vocabulary had to be invented to account for the myriad of facets and appearances - false and true - of this disease. I recommend that you start with the Table of Contents so that you can take fully advantage of the extensive information presented here.

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Nateglinide is available with a prescription under the brand name Starlix order 3mg ivermectin. Other brand or generic formulations may also be available discount 3 mg ivermectin with mastercard. Ask your pharmacist any questions you have about this medication order ivermectin 3mg without a prescription, especially if it is new to you. Starlix 60 mg - round, pink tabletsStarlix 120 mg - oval, yellow tabletsHTTP/1. Tolbutamide is a pure, white, crystalline compound which is practically insoluble in water. The chemical name is benzenesulfonamide, N-[(butylamino)-carbonyl]-4-methyl-. Its structure can be represented as follows:Tolbutamide is supplied as compressed tablets containing 500 mg of Tolbutamide, USP. Each tablet for oral administration contains 500 mg of Tolbutamide and the following inactive ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate and sodium starch glycolate. Tolbutamide appears to lower the blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. The mechanism by which Tolbutamide lowers blood glucose during long-term administration has not been clearly established. With chronic administration in Type II diabetic patients, the blood-glucose-lowering effect persists despite a gradual decline in the insulin secretory response to the drug. Extrapancreatic effects may be involved in the mechanism of action of oral sulfonylurea hypoglycemic drugs. Some patients who are initially responsive to oral hypoglycemic drugs, including Tolbutamide, may become unresponsive or poorly responsive over time. Alternatively, Tolbutamide may be effective in some patients who have become unresponsive to one or more of the other sulfonylurea drugs. When administered orally, Tolbutamide is readily absorbed from the gastrointestinal tract. Absorption is not impaired and glucose lowering and insulin releasing effects are not altered if the drug is taken with food. Detectable levels are present in the plasma within 20 minutes after oral ingestion of a 500 mg Tolbutamide tablet, with peak levels occurring at 3 to 4 hours and only small amounts detectable at 24 hours. As Tolbutamide has no p-amino group, it cannot be acetylated, which is one of the common modes of metabolic degradation for the antibacterial sulfonamides. However, the presence of the p-methyl group renders Tolbutamide susceptible to oxidation, and this appears to be the principal manner of its metabolic degradation in man. The p-methyl group is oxidized to form a carboxyl group, converting Tolbutamide into the totally inactive metabolite 1-butyl-3-p-carboxy-phenylsulfonylurea, which can be recovered in the urine within 24 hours in amounts accounting for up to 75% of the administered dose. The major Tolbutamide metabolite has been found to have no hypoglycemic or other action when administered orally and IV to both normal and diabetic subjects. This Tolbutamide metabolite is highly soluble over the critical acid range of urinary pH values, and its solubility increases with increase in pH. Because of the marked solubility of the Tolbutamide metabolite, crystalluria does not occur. A second metabolite, 1-butyl-3-(p-hydroxymethyl) phenyl sulfonylurea also occurs to a limited extent. The administration of 3 grams of Tolbutamide to either nondiabetic or Tolbutamide-responsive diabetic subjects will, in both instances, occasion a gradual lowering of blood glucose. Increasing the dose to 6 grams does not usually cause a response which is significantly different from that produced by the 3 gram dose. Following the administration of a 3 gram dose of Tolbutamide solution, non-diabetic fasting adults exhibit a 30% or greater reduction in blood glucose within one hour, following which the blood glucose gradually returns to the fasting level over 6 to 12 hours. Following the administration of a 3 gram dose of Tolbutamide solution, Tolbutamide responsive diabetic patients show a gradually progressive blood glucose lowering effect, the maximal response being reached between 5 to 8 hours after ingestion of a single 3 gram dose. The blood glucose then rises gradually and by the 24hour has usually returned to pretest levels. The magnitude of the reduction, when expressed in terms of percent of the pretest blood glucose, tends to be similar to the response seen in the nondiabetic subject. Tolbutamide tablets are indicated as an adjunct to diet to lower the blood glucose in patients with non-insulin-dependent diabetes mellitus (type II) whose hyperglycemia cannot be controlled by diet alone. In initiating treatment for non-insulin-dependent diabetes, diet should be emphasized as the primary form of treatment. Caloric restriction and weight loss are essential in the obese diabetic patient. Proper dietary management alone may be effective in controlling the blood glucose and symptoms of hyperglycemia. The importance of regular physical activity should also be stressed, and cardiovascular risk factors should be identified and corrective measures taken where possible. If this treatment program fails to reduce symptoms and/or blood glucose, the use of an oral sulfonylurea or insulin should be considered. Use of Tolbutamide tablets must be viewed by both the physician and patient as a treatment in addition to diet, and not as a substitute for diet or as a convenient mechanism for avoiding dietary restraint. Furthermore, loss of blood glucose control on diet alone may be transient, thus requiring only short-term administration of Tolbutamide tablets. During maintenance programs, Tolbutamide tablets should be discontinued if satisfactory lowering of blood glucose is no longer achieved. Judgments should be based on regular clinical and laboratory evaluations. In considering the use of Tolbutamide tablets in asymptomatic patients, it should be recognized that controlling the blood glucose in non-insulin dependent diabetes has not been definitely established to be effective in preventing the long-term cardiovascular or neural complications of diabetes. Tolbutamide tablets are contraindicated in patients with:1. The administration of oral hypoglycemic drugs has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. This warning is based on the study conducted by the University Group Diabetes Program (UGDP), a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. The study involved 823 patients who were randomly assigned to one of four treatment groups (Diabetes, 19 (supp. UGDP reported that patients treated for 5 to 8 years with diet plus a fixed dose of Tolbutamide (1. A significant increase in total mortality was not observed, but the use of Tolbutamide was discontinued based on the increase in cardiovascular mortality, thus limiting the opportunity for the study to show an increase in overall mortality. Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning. The patient should be informed of the potential risks and advantages of Tolbutamide and of alternative modes of therapy. Although only one drug in the sulfonylurea class (Tolbutamide) was included in this study, it is prudent from a safety standpoint to consider that this warning may also apply to other oral hypoglycemic drugs in this class, in view of their close similarities in mode of action and chemical structure. All sulfonylurea drugs are capable of producing severe hypoglycemia. Proper patient selection, dosage, and instructions are important to avoid hypoglycemic episodes. Renal or hepatic insufficiency may cause elevated blood levels of Tolbutamide and the latter may also diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemic reactions. Elderly, debilitated or malnourished patients, and those with adrenal or pituitary insufficiency are particularly susceptible to the hypoglycemic action of glucose-lowering drugs. Hypoglycemia may be difficult to recognize in the elderly, and in people who are taking beta-adrenergic blocking drugs. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose-lowering drug is used. When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue Tolbutamide and administer insulin.

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Store this medicine at room temperature buy ivermectin 3 mg low price, in a tighly-closed container discount ivermectin 3mg on line, away from heat and light order ivermectin 3mg without prescription. If you miss a dose of this medicine and you are using it regularly, take it as soon as possible. If you are taking 1 dose at bedtime and do not remember until the next morning, skip the missed dose and go back to your regular dosing schedule. Additional Information:: Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. For Adults: the average daily oral dose of 25 to 75 mg (mild cases) or 75 to 150 mg (more severe cases) in 2-4 divided doses. It is occasionally necessary to give a higher dosage which, when increased gradually, can reach 900 mg or more per day in some psychiatric patients. Optimum therapeutic response may not occur for weeks or months. Once the optimum dosage has been reached, it is maintained as long as necessary for the control of symptoms during the critical phase of the illness. Eventually, however, it should be gradually reduced so that the patient can be maintained on the lowest effective dosage. Elderly: Elderly and debilitated patients should start with initial doses at the lowest end of the dosage range (e. Such patients are more susceptible to hypotension and CNS effects and special caution should be exercised when using chlorpromazine in this age group. During maintenance treatment, if it becomes desirable to reduce the number of daily drug administrations, the dosage may be administered once or twice daily, with the largest dose at bedtime. This dose may be repeated every 4 to 6 hours as necessary. NOTE:: This information is not intended to cover all possible uses, precautions, interactions, or adverse effects for this drug. If you have questions about the drug(s) you are taking, check with your health care professional. Find out why Thorazine is prescribed, side effects of Thorazine, Thorazine warnings, effects of Thorazine during pregnancy, more - in plain English. Thorazine is used for the treatment of schizophrenia (severe disruptions in thought and perception). It is also prescribed for the short-term treatment of severe behavioral disorders in children, including explosive hyperactivity and combativeness; and for the hyperenergetic phase of manic-depressive illness (severely exaggerated moods). Thorazine is also used to control nausea and vomiting, and to relieve restlessness and apprehension before surgery. It is used as an aid in the treatment of tetanus, and is prescribed for uncontrollable hiccups and acute intermittent porphyria (attacks of severe abdominal pain sometimes accompanied by psychiatric disturbances, cramps in the arms and legs, and muscle weakness). Thorazine may cause tardive dyskinesia--a condition marked by involuntary muscle spasms and twitches in the face and body. This condition may be permanent, and appears to be most common among the elderly, especially women. Ask your doctor for information about this possible risk. If taking Thorazine in a liquid concentrate form, you will need to dilute it with a liquid such as a carbonated beverage, coffee, fruit juice, milk, tea, tomato juice, or water. Puddings, soups, and other semisolid foods may also be used. Thorazine will taste best if it is diluted immediately prior to use. Do not take antacids such as Gelusil at the same time as Thorazine. Leave at least 1 to 2 hours between doses of the two drugs. If you take Thorazine once a day, take the dose you missed as soon as you remember. If you do not remember until the next day, skip the dose, then go back to your regular schedule. If you take more than 1 dose a day, take the one you missed as soon as you remember if it is within an hour or so of the scheduled time. If you do not remember until later, skip the dose, then go back to your regular schedule.. Since the liquid concentrate form of Thorazine is light-sensitive, it should be stored in a dark place, but it does not need to be refrigerated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Thorazine. You should not take Thorazine if you have ever had an allergic reaction to any major tranquilizer containing phenothiazine. You should use Thorazine cautiously if you have ever had: asthma; a brain tumor; breast cancer; intestinal blockage; emphysema; the eye condition known as glaucoma; heart, kidney, or liver disease; respiratory infections; seizures; or an abnormal bone marrow or blood condition; or if you are exposed to pesticides or extreme heat. Stomach inflammation, dizziness, nausea, vomiting, and tremors may result if you suddenly stop taking Thorazine. Thorazine can suppress the cough reflex; you may have trouble vomiting. This drug may impair your ability to drive a car or operate potentially dangerous machinery. Do not participate in any activities that require full alertness if you are unsure about your ability.. Thorazine can cause a group of symptoms called Neuroleptic Malignant Syndrome, which can be fatal. Some symptoms are extremely high body temperature, rigid muscles, mental changes, irregular pulse or blood pressure, rapid heartbeat, sweating, and changes in heart rhythm. If you are on Thorazine for prolonged therapy, you should see your doctor for regular evaluations, since side effects can get worse over time. If Thorazine is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Thorazine with the following:Antacids such as GelusilAntiseizure drugs such as DilantinAntispasmodic drugs such as CogentinBarbiturates such as phenobarbitalBlood-thinning drugs such as CoumadinDiuretics such as DyazideLithium (Lithobid, Eskalith)MAO inhibitors (antidepressants such as Nardil and Parnate)Narcotics such as PercocetExtreme drowsiness and other potentially serious effects can result if Thorazine is combined with alcohol and other mental depressants such as narcotic painkillers like Demerol. Because Thorazine prevents vomiting, it can hide the signs and symptoms of overdose of other drugs. The effects of Thorazine during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, notify your doctor. Pregnant women should use Thorazine only if clearly needed. Thorazine appears in breast milk and may affect a nursing infant. If this medication is essential to your health, your doctor may advise you not to breastfeed until your treatment is finished. Dosage recommendations shown here are for the oral and rectal forms of the drug. For certain problems, Thorazine is also given by injection. Schizophrenia and Mania Your doctor will gradually increase the dosage until symptoms are controlled. You may not see full improvement for weeks or even months. Initial dosages may range from 30 to 75 milligrams daily. The amount is divided into equal doses and taken 3 or 4 times a day. If needed, your doctor may increase the dosage by 20 to 50 milligrams at semiweekly intervals.

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Aripiprazole and other antipsychotic drugs should be used cautiously in patients at risk for aspiration pneumonia [see WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS (6 buy ivermectin 3 mg without a prescription. Clinical experience with ABILIFY in patients with certain concomitant systemic illnesses is limited [see Use In Specific Populations ] order 3mg ivermectin free shipping. ABILIFY has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease buy discount ivermectin 3 mg on line. Patients with these diagnoses were excluded from premarketing clinical studies [see WARNINGS AND PRECAUTIONS ( 5. The following are discussed in more detail in other sections of the labeling:Use in Elderly Patients with Dementia-Related Psychosis [see Boxed Warning andThe most common adverse reactions in adult patients in clinical trials ( ?-U 10%) were nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, insomnia, and restlessnessThe most common adverse reactions in the pediatric clinical trials ( ?-U 10%) were somnolence, extrapyramidal disorder, headache, and nausea. A total of 3390 patients were treated with oral aripiprazole for at least 180 days and 1933 patients treated with oral aripiprazole had at least 1 year of exposure. Aripiprazole has been evaluated for safety in 514 patients (10 to 17 years) who participated in multiple-dose, clinical trials in Schizophrenia or Bipolar Mania and who had approximately 205 patient-years of exposure to oral aripiprazole. A total of 278 pediatric patients were treated with oral aripiprazole for at least 180 days. The conditions and duration of treatment with aripiprazole (monotherapy and adjunctive therapy with antidepressants or mood stabilizers) included (in overlapping categories) double-blind, comparative and noncomparative open-label studies, inpatient and outpatient studies, fixed-and flexible-dose studies, and short- and longer-term exposure. Adverse events during exposure were obtained by collecting volunteered adverse events, as well as results of physical examinations, vital signs, weights, laboratory analyses, and ECG. Adverse experiences were recorded by clinical investigators using terminology of their own choosing. In the tables and tabulations that follow, MedDRA dictionary terminology has been used to classify reported adverse events into a smaller number of standardized event categories, in order to provide a meaningful estimate of the proportion of individuals experiencing adverse events. The stated frequencies of adverse reactions represent the proportion of individuals who experienced at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. There was no attempt to use investigator causality assessments; ie, all events meeting the defined criteria, regardless of investigator causality are included. Throughout this section, adverse reactions are reported. These are adverse events that were considered to be reasonably associated with the use of ABILIFY (aripiprazole) (adverse drug reactions) based on the comprehensive assessment of the available adverse event information. A causal association for ABILIFY often cannot be reliably established in individual cases. The figures in the tables and tabulations cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatment, uses, and investigators. The cited figures, however, do provide the prescriber with some basis for estimating the relative contribution of drug and nondrug factors to the adverse reaction incidence in the population studied. The following findings are based on a pool of five placebo-controlled trials (four 4-week and one 6-week) in which oral aripiprazole was administered in doses ranging from 2 mg/day to 30 mg/day. Adverse Reactions Associated with Discontinuation of TreatmentOverall, there was little difference in the incidence of discontinuation due to adverse reactions between aripiprazole-treated (7%) and placebo-treated (9%) patients. The types of adverse reactions that led to discontinuation were similar for the aripiprazole-treated and placebo-treated patients. The only commonly observed adverse reaction associated with the use of aripiprazole in patients with Schizophrenia (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) was akathisia (aripiprazole 8%; placebo 4%). The following findings are based on a pool of 3-week, placebo-controlled, Bipolar Mania trials in which oral aripiprazole was administered at doses of 15 mg/day or 30 mg/day. Overall, in patients with Bipolar Mania, there was little difference in the incidence of discontinuation due to adverse reactions between aripiprazole-treated (11%) and placebo-treated (10%) patients. The types of adverse reactions that led to discontinuation were similar between the aripiprazole-treated and placebo-treated patients. Commonly Observed Adverse ReactionsCommonly observed adverse reactions associated with the use of aripiprazole in patients with Bipolar Mania (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) are shown in Table 5. Table 5: Commonly Observed Adverse Reactions in Short-Term, Placebo-Controlled Trials of Adult Patients with Bipolar Mania Treated with Oral ABILIFY MonotherapyPercentage of Patients AripiprazoleReporting Reaction PlaceboExtrapyramidal DisorderTable 6 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks in Schizophrenia and up to 3 weeks in Bipolar Mania), including only those reactions that occurred in 2% or more of patients treated with aripiprazole (doses ?-U 2 mg/day) and for which the incidence in patients treated with aripiprazole was greater than the incidence in patients treated with placebo in the combined dataset. Table 6: Adverse Reactions in Short-Term, Placebo-Controlled Trials in Adult Patients Treated with Oral ABILIFY (aripiprazole)Percentage of Patients Reporting ReactionSystem Organ Class Preferred TermGastrointestinal DisordersGeneral Disorders and Administration Site ConditionsMusculoskeletal and Connective Tissue DisordersMusculoskeletal StiffnessNervous System DisordersRespiratory, Thoracic, and Mediastinal DisordersPharyngolaryngeal PainAdverse reactions reported by at least 2% of patients treated withoral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. An examination of population subgroups did not reveal any clear evidence of differential adverse reaction incidence on the basis of age, gender, or race. Adult Patients with Adjunctive Therapy with Bipolar ManiaThe following findings are based on a placebo-controlled trial of adult patients with Bipolar Disorder in which aripiprazole was administered at doses of 15 mg/day or 30 mg/day as adjunctive therapy with lithium or valproate. In a study of patients who were already tolerating either lithium or valproate as monotherapy, discontinuation rates due to adverse reactions were 12% for patients treated with adjunctive aripiprazole compared to 6% for patients treated with adjunctive placebo. The most common adverse drug reactions associated with discontinuation in the adjunctive aripiprazole-treated compared to placebo-treated patients were akathisia (5% and 1%,respectively) and tremor (2% and 1%, respectively). The commonly observed adverse reactions associated with adjunctive aripiprazole and lithium or valproate in patients with Bipolar Mania (incidence of 5% or greater and incidence at least twice that for adjunctive placebo) were: akathisia, insomnia, and extrapyramidal disorder. Less Common Adverse Reactions in Adult Patients with Adjunctive Therapy in Bipolar ManiaTable 7 enumerates the incidence, rounded to the nearest percent, of adverse reactions that occurred during acute treatment (up to 6 weeks), including only those reactions that occurred in 2% or more of patients treated with adjunctive aripiprazole (doses of 15 mg/day or 30 mg/day) and lithium or valproate and for which the incidence in patients treated with this combination was greater than the incidence in patients treated with placebo plus lithium or valproate. Table 7: Adverse Reactions in a Short-Term, Placebo-Controlled Trial of Adjunctive Therapy in Patients with Bipolar DisorderSalivary HypersecretionInfections and InfestationsAdverse reactions reported by at least 2% of patients treated withoral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. Pediatric Patients (13 to 17 years) with SchizophreniaThe following findings are based on one 6-week placebo-controlled trial in which oral aripiprazole was administered in doses ranging from 2 mg/day to 30 mg/day. The incidence of discontinuation due to adverse reactions between aripiprazole-treated and placebo-treated pediatric patients (13 to 17 years) was 5% and 2%,respectively. Commonly observed adverse reactions associated with the use of aripiprazole in adolescent patients with Schizophrenia (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) were extrapyramidal disorder, somnolence, and tremor. Pediatric Patients (10 to 17 years) with Bipolar ManiaThe following findings are based on one 4-week placebo-controlled trial in which oral aripiprazole was administered in doses of 10 mg/day or 30 mg/day. The incidence of discontinuation due to adverse reactions between aripiprazole-treated and placebo-treated pediatric patients (10 to 17 years) was 7% and 2%,respectively. Commonly observed adverse reactions associated with the use of aripiprazole in pediatric patients with Bipolar Mania (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) are shown in Table 8. Table 8: Commonly Observed Adverse Reactions in Short-Term, Placebo-Controlled Trials of Pediatric Patients (10 to 17 years) with Bipolar Mania Treated with Oral ABILIFY (aripiprazole)Table 9 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks in Schizophrenia and up to 4 weeks in Bipolar Mania), including only those reactions that occurred in 1% or more of pediatric patients treated with aripiprazole (doses ?-U 2 mg/day) and for which the incidence in patients treated with aripiprazole was greater than the incidence in patients treated with placebo. Table 9: Adverse Reactions in Short-Term, Placebo-Controlled Trials of Pediatric Patients (10 to 17 years) Treated with Oral ABILIFY (aripiprazole)Metabolism and Nutrition DisordersSkin and Subcutaneous DisordersOrthostatic HypotensionAdverse reactions reported by at least 1% of pediatric patients treated with oral aripiprazole, except adverse reactions which had an incidence equal to or less than placebo. Adult Patients Receiving ABILIFY as Adjunctive Treatment of Major Depressive DisorderThe following findings are based on a pool of two placebo-controlled trials of patients with Major Depressive Disorder in which aripiprazole was administered at doses of 2 mg to 20 mg as adjunctive treatment to continued antidepressant therapy. The incidence of discontinuation due to adverse reactions was 6% for adjunctive aripiprazole-treated patients and 2% for adjunctive placebo-treated patients. The commonly observed adverse reactions associated with the use of adjunctive aripiprazole in patients with Major Depressive Disorder (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo) were: akathisia, restlessness, insomnia, constipation, fatigue, and blurred vision. Less Common Adverse Reactions in Adult Patients with Major Depressive DisorderTable 10 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (up to 6 weeks), including only those adverse reactions that occurred in 2% or more of patients treated with adjunctive aripiprazole (doses ?-U 2 mg/day) and for which the incidence in patients treated with adjunctive aripiprazole was greater than the incidence in patients treated with adjunctive placebo in the combined dataset. Table 10: Adverse Reactions in Short-Term, Placebo-Controlled Adjunctive Trials in Patients with Major Depressive DisorderUpper Respiratory Tract InfectionMusculoskeletal and ConnectiveTissue DisordersDisturbance in AttentionAdverse reactions reported by at least 2% of patients treated with adjunctive aripiprazole, except adverse reactions which had an incidence equal to orless than placebo. Patients with Agitation Associated with Schizophrenia or Bipolar Mania (Intramuscular Injection)The following findings are based on a pool of three placebo-controlled trials of patients with agitation associated with Schizophrenia or Bipolar Mania in which aripiprazole injection was administered at doses of 5. Overall, in patients with agitation associated with Schizophrenia or Bipolar Mania, there was little difference in the incidence of discontinuation due to adverse reactions between aripiprazole-treated (0. There was one commonly observed adverse reaction (nausea) associated with the use of aripiprazole injection in patients with agitation associated with Schizophrenia and Bipolar Mania (incidence of 5% or greater and aripiprazole incidence at least twice that for placebo). Less Common Adverse Reactions in Patients with Agitation Associated with Schizophrenia or Bipolar ManiaTable 11 enumerates the pooled incidence, rounded to the nearest percent, of adverse reactions that occurred during acute therapy (24-hour),including only those adverse reactions that occurred in 2% or more of patients treated with aripiprazole injection (doses ?-U 5. Table 11: Adverse Reactions in Short-Term, Placebo-Controlled Trials in Patients Treated with ABILIFY (aripiprazole) InjectionAdverse reactions reported by at least 2% of patients treated with aripiprazole injection, except adverse reactions which had an incidence equal to or less than placebo. Dose response relationships for the incidence of treatment-emergent adverse events were evaluated from four trials in adult patients with Schizophrenia comparing various fixed doses (2 mg/day, 5 mg/day, 10 mg/day, 15 mg/day, 20 mg/day, and 30 mg/day) of oral aripiprazole to placebo. This analysis, stratified by study, indicated that the only adverse reaction to have a possible dose response relationship, and then most prominent only with 30 mg, was somnolence [including sedation]; (incidences were placebo, 7. In the study of pediatric patients (13 to 17 years of age) with Schizophrenia, three common adverse reactions appeared to have a possible dose response relationship: extrapyramidal disorder (incidences were placebo,5.

Approximately 85% of males with sexual dysfunction chose to continue treatment buy ivermectin 3 mg on-line. Weight Changes: In controlled studies of OCD buy ivermectin 3 mg on line, weight gain was reported in 18% of patients receiving clomipramine ivermectin 3mg sale, compared with 1% of patients receiving placebo. In these studies, 28% of patients receiving clomipramine had a weight gain of at least 7% of their initial body weight, compared with 4% of patients receiving placebo. Several patients had weight gains in excess of 25% of their initial body weight. Conversely, 5% of patients receiving placebo had weight losses of at least 7% of their initial body weight. Surgery: Prior to elective surgery with general anesthetics, therapy with clomipramine HCl should be discontinued for as long as is clinically feasible, and the anesthetist should be advised. Use in Concomitant Illness: As with closely related tricyclic antidepressants, clomipramine should be used with caution in the following:Hyperthyroid patients or patients receiving thyroid medication, because of the possibility of cardiac toxicity;Patients with increased intraocular pressure, a history of narrow-angle glaucoma, or urinary retention, because of the anticholinergic properties of the drug;Patients with tumors of the adrenal medulla (e. Withdrawal Symptoms: A variety of withdrawal symptoms have been reported in association with abrupt discontinuation of clomipramine, including dizziness, nausea, vomiting, headache, malaise, sleep disturbance, hyperthermia, and irritability. In addition, such patients may experience a worsening of psychiatric status. While the withdrawal effects of clomipramine have not been systematically evaluated in controlled trials, they are well known with closely related tricyclic antidepressants, and it is recommended that the dosage be tapered gradually and the patient monitored carefully during discontinuationInformation for Patients:Physicians are advised to discuss the following issues with patients for whom they prescribe clomipramine:The relatively high incidence of sexual dysfunction among malesSince clomipramine HCl may impair the mental and/or physical abilities required for the performance of complex and hazardous tasks and since clomipramine HCl is associated with a risk of seizures, patients should be cautioned about the performance of complex and hazardous tasksPatients should be cautioned about using alcohol, barbiturates, or other CNS depressants concurrently, since clomipramine HCl may exaggerate their response to these drugs;Patients should notify their physician if they become pregnant or intend to become pregnant during therapy;Patients should notify their physician if they are breast-feeding. There are no adequate or well-controlled studies in pregnant women. Withdrawal symptoms, including jitteriness, tremor, and seizures, have been reported in neonates whose mothers had taken clomipramine until delivery. Clomipramine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. The safety and effectiveness in children below the age of 10 have not been established. Therefore, specific recommendations cannot be made for the use of clomipramine in children under the age of 10. No unusual age-related adverse events have been identified in this elderly population, but the data is insufficient to rule out possible age-related differences, particularly in elderly patients who have concomitant systemic illnesses or who are receiving other drugs concomitantly. Patients should be warned that, while taking clomipramine, their responses to alcoholic beverages, other CNS depressants (e. When tricyclic antidepressants are given in combinations with anticholinergics or neuroleptics with an anticholinergic action, hyperexcitation states or delirium may occur, as well as attacks of glaucoma. Tricyclic antidepressants should not be employed in combination with anti-arrhythmic agents of the quinidine type. Clomipramine should not be used with MAO inhibitors. Since clomipramine may diminish or abolish the antihypertensive effects of guanethidine, clonidine, reserpine, methyldopa, patients requiring concomitant treatment for hypertension should be given antihypertensives of a different type (e. Clomipramine should be discontinued prior to elective surgery, for as long as clinically feasible, since little is known about the interaction between clomipramine and general anesthetics. If administered concomitantly with estrogens, the dose of clomipramine should be reduced since steroid hormones inhibit the metabolism of clomipramine. Because clomipramine is highly bound to serum proteins, the administration of clomipramine to patients taking other drugs that are highly bound to protein (i. Conversely, adverse reactions may result from the displacement of protein bound clomipramine by other highly bound drugs. BEFORE USING THIS MEDICINE: INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. This includes carbamazepine, cimetidine, dicumarol, clonidine, mibefradil, paroxetine, tramadol, other medicines for depression or emotional disorders, and medicines for seizures. Inform your doctor of any other medical conditions including heart conditions, allergies, pregnancy, or breast-feeding. The most commonly observed adverse events associated with the use of clomipramine HCl and not seen at an equivalent incidence among placebo-treated patients were gastrointestinal complaints, including dry mouth, constipation, nausea, dyspepsia, and anorexia; nervous system complaints, including somnolence, tremor, dizziness, nervousness, and myoclonus; genitourinary complaints, including changed libido, ejaculatory failure, impotence, and micturition disorder; and other miscellaneous complaints, including fatigue, sweating, increased appetite, weight gain, and visual changes. The following list of adverse reactions have also been observed with clomipramine. Neurological: Extrapyramidal effects such as ataxia, also headache, delirium, speech disorders, muscle weakness, muscle hypertonia, tinnitus, paresthesias of the extremities, convulsions, EEG changes, hyperpyrexia. Peripheral neuropathy has been reported with other tricyclic antidepressants. Cardiovascular: Hypotension, particularly orthostatic hypotension with associated vertigo, sinus tachycardia, palpitations. A quinidine-like effect and other reversible ECG changes in patients with normal cardiac status (such as flattening or inversion of T-waves, depressed S-T segments). Hematologic: Leukopenia, agranulocytosis, thrombocytopenia, eosinophilia and purpura. Gastrointestinal: Vomiting, abdominal pain, diarrhea, taste perversion, elevated transaminases, obstructive jaundice, hepatitis with or without jaundice. Endocrine: Weight loss, breast enlargement and galactorrhea in the female, inappropriate antidiuretic hormone (ADH) secretion syndrome, gynecomastia in the male, changes in blood sugar levels, increase in prolactin levels, menstrual irregularity. Allergic: Allergic skin reactions (skin rash, urticaria), photosensitization, pruritus, edema, drug fever. Withdrawal Symptoms: Abrupt cessation of treatment with tricyclic antidepressants after prolonged administration may occasionally produce nausea, vomiting, abdominal pain, diarrhea, insomnia, nervousness, anxiety, headache and malaise. Since children may be more sensitive than adults to acute overdosage with tricyclic antidepressants, and since fatalities in children have been reported, effort should be made to avoid potential overdose particularly in this age group. Signs and symptoms vary in severity depending upon factors such as the amount of drug absorbed, the age of the patient, and the time elapsed since drug ingestion. Blood and urine levels of clomipramine may not reflect the severity of poisoning: they have chiefly a qualitative rather than quantitative value, and they are unreliable indicators in the clinical management of the patient. The first signs and symptoms of poisoning with tricyclic antidepressants are generally severe anticholinergic reactions. CNS abnormalities may include drowsiness, stupor, coma, ataxia, restlessness, agitation, delirium, severe perspiration, hyperactive reflexes, muscle rigidity, athetoid and choreiform movement, and convulsions. Cardiac abnormalities may include arrhythmia, tachycardia, ECG evidence of impaired conduction, and signs of congestive heart failure, and in very rare cases, cardiac arrest. Respiratory depression, cyanosis, hypotension, shock, vomiting, hyperpyrexia, mydriasis, oliguria or anuria, and diaphoresis may also be present. Patients in whom overdosage is suspected should be admitted to hospital without delay. No specific antidote is available and treatment is essentially symptomatic and supportive. Gastric lavage or aspiration should be performed promptly and is recommended up to 12 hours or even more after the overdose, since the anticholinergic effect of the drug may delay gastric emptying. Administration of activated charcoal may help to reduce absorption of the drug. As clomipramine is largely protein bound, forced diuresis, peritoneal dialysis and hemodialysis are unlikely to be of value. In the alert patient, the stomach should be emptied promptly by lavage. In the obtunded patient, the airway should be secured with a cuffed endotracheal tube before beginning lavage (do not induce emesis). Instillation of activated charcoal slurry may help reduce absorption of CMI. External stimulation should be minimized to reduce the tendency for convulsions. If anticonvulsants are necessary, diazepam and phenytoin may be useful. Adequate respiratory exchange should be maintained, including intubation and artificial respiration, if necessary. In severe hypotension or shock, the patient should be placed in an appropriate position and given a plasma expander, and, if necessary, a vasopressor agent by intravenous drip. The use of corticosteroids in shock is controversial and may be contraindicated in case of overdosage with tricyclic antidepressants. Digitalis may increase conduction abnormalities and further irritate an already sensitized myocardium. If congestive heart failure necessitates rapid digitalization, particular care must be exercised.

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The choice you make will affect your diet purchase 3mg ivermectin visa, your ability to work cheap ivermectin 3mg, and other life style issues purchase ivermectin 3mg online. You have the right to refuse or withdraw from treatment if you choose. Medicare and Medicaid pay much of the cost of treatment for kidney failure. Learning as much as you can about your treatment will help make you an important member of your health care team. Almost 24 million people, or about 8 percent of all Americans, currently have diabetes. If you are one of them or suspect you might have diabetes or pre-diabetes, comprehensive information about the types of diabetes, symptoms and causes of diabetes, diabetes complications, as well as diabetes prevention, can be found here. Diabetes treatment consists of:regular monitoring of blood sugar levelsfollowing a well-balanced healthy dietregular aerobic exercise program recommended by your health care providerDiabetics, especially, should not smoke. Preventing, monitoring, and treating any coexisting medical conditions, such as hypertension and high cholesterol, is also a major part of diabetic treatment. Scientists are looking for new ways to give insulin. Some new insulin pumps are being developed and tested. A new type 1 diabetes treatment option is pancreatic islet transplantation. This experimental surgery transplants insulin-producing beta cells from a donor into the pancreas of a person with type 1 diabetes. A diabetic diet recommended by your doctor and exercise are other key components of a type 1 diabetes treatment program. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications for type 2 diabetes are used. If oral diabetes medications are still insufficient, treatment with insulin is considered. The American Diabetes Association (ADA) guidelines for a diabetic diet call for a balanced, nutritious diet that is low in fat, cholesterol, and a small amount of simple sugars. The total daily calories are evenly divided into three meals. The other important treatments for diabetes are weight reduction and exercise. Nearly 6 million people in the United States have type 2 diabetes and do not know it. Diabetes symptoms can also be so mild that you might not even notice them. Some people have symptoms but do not suspect diabetes. Diabetic symptoms include:increased urination, especially at nightMany people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. If you find out early that you have diabetes, then you can get treatment to prevent damage to your body. Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight ?see the BMI (body mass index) chart (pdf)* ? getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider getting tested. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes. Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. In 2007, at least 57 million American adults had pre-diabetes. Having pre-diabetes also means you are at risk for getting type 2 diabetes and heart disease. However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss through healthy eating and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years. Physical activity, exercise, is a key tool for managing diabetes. Diabetes means your blood glucose, also called blood sugar, is too high. But having too much glucose in your blood can hurt you. A major Government study, the Diabetes Prevention Program (DPP), showed that modest weight loss of 5 to 7 percent?for example, 10 to 15 pounds for a 200-pound person?can delay and possibly prevent type 2 diabetes. People in the study used diet and exercise to lose weight. For more information about the study, read: Diabetes Prevention Program. Or call the National Diabetes Information Clearinghouse at 1-800-860-8747 to request a printed copy. You canbe extra active every dayBeing extra active can increase the number of calories you burn. Try these ways to be extra active, or think of other things you can do. Get up to change the TV channel instead of using the remote control. For example, make two trips to take the laundry downstairs instead of one. Park at the far end of the shopping center parking lot and walk to the store. At work, walk over to see a co-worker instead of calling or emailing. Stretch or walk around instead of taking a coffee break and eating. During your lunch break, walk to the post office or do other errands. Aerobic exercise is activity that requires the use of large muscles and makes your heart beat faster. You will also breathe harder during aerobic exercise. Doing aerobic exercise for 30 minutes a day at least 5 days a week provides many benefits. You can even split up those 30 minutes into several parts. For example, you can take three brisk 10-minute walks, one after each meal. Talk with your doctor about how to warm up and stretch before you exercise and how to cool down after you exercise. Add a little more time each week, aiming for at least 150 minutes per week. According to the American Diabetes Association, people with diabetes spend an average of $11,744 a year on health care expenses?more than twice the amount spent by people without diabetes. Many people who have diabetes need help paying for their care. For those who qualify, a variety of governmental and nongovernmental programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources. The following options are available:Medicare Advantage Plans?such as health maintenance organizations (HMOs) or preferred provider organizations (PPOs)other Medicare health plansOriginal Medicare. Original Medicare, managed by the Federal Government, has two parts: Medicare Part A is hospital insurance and Medicare Part B is medical insurance.

In fact buy 3 mg ivermectin, two vascular approaches developed over past decades to restore penile blood flow disrupted by disease or trauma are viable for only a select few:Penile arterial revascularization: This procedure is designed to keep blood flowing by rerouting it around a blocked or injured vessel proven ivermectin 3mg. Indicated only for young men (under 45) with no known risk factors for atherosclerosis cheap ivermectin 3 mg otc, this procedure is aimed at correcting any vessel injury at the base of the penis caused by adverse events such as blunt trauma or pelvic facture. When such an event leaves a penile vessel too injured or blocked to transfer blood, the surgeon may microscopically connect a nearby artery to get around the site, clearing the pathway so enough blood can be supplied to the penis to enable an erection. Venous ligation surgery: This procedure focuses on binding leaky penile vessels that are causing penile rigidity to diminish during erection. Because venal occlusion, necessary for sufficient firmness, depends on arterial blood flow and relaxation of the spongy tissue in the penis, this approach is designed to intentionally block off problematic veins so that there is enough blood trapped in the penis to create an appropriate erection. Since long-term success rates are less than 50 percent, this technique is rarely achoice for correcting ED. In fact, you are not a candidate for either penile vascular surgeries if you have insulin-dependent diabetes or widespread atherosclerosis. You are also not suited if you still use tobacco or experience consistently high blood serum cholesterol levels. Neither of these surgeries will work if you have injured nerves or diseased and/or generalized damaged blood vessels. Also, if you are a candidate, be aware that vascular surgeries are still considered experimental by some urologists and may also not be covered by your insurance. Most of the best known treatments for ED have excellent track records for being both effective and safe. But in making your choice, make sure to discuss the potential complications of each option with your doctor. For instance, the good news about a penile prosthesis is that it does not usually affect urination, sex drive, orgasm or ejaculation. But on rare occasions, these semi-rigid, silicone-covered metal rods or hydraulic devices can cause pain or reduced sensation. While injections can initiate erections within 15 minutes to several hours, be aware that they also can produce prolonged or painful ones, not to mention a hardening of connective penile tissue (fibrosis). At the same time, a vacuum constriction device should take only one to three minutes to do the job, usually with no serious side effects if used properly and limited to 30 minutes. Sildenafil citrate (Viagra) has a 75 percent success rate, primarily because it is a subtle solution that works within the hour. But on rare occasions it can cause headaches, flushing and indigestion. Also, if you have heart disease or low blood pressure, the Food and Drug Administration (FDA) cautions a thorough examination before getting a prescription. Penile arterial revascularization can restore function in men, although only a small percentage of them undergo the procedure. While few patients experience postoperative complications, side effects can include penile scarring, numbness and shortening all of which can cause further impotence. Venous ligation surgery, although rare, is also known to cause penile shortening, along with other problems. Also, improvements with venous ligation surgery may be temporary. It has been most successful in young men with abnormally draining veins since birth who have never had a full erection. It has also been used in some patients with an injury to the covering tunica albuginea or the corpora cavernosa. If you meet the criteria mentioned previously, you will want to find a specialist with a track record of having done these microsurgical techniques. Be aware, however, that penile vascular solutions are still experimental; few specialized urologists or vascular surgeons are trained to do either procedure. If your doctor is not one of them, you will need to ask for a referral. You will also want to get a second opinion if this treatment option is recommended, given that there are few patients who are good candidates. Once you have found a surgeon, ask about his or her experience and outcome record with penile arterial revascularization. Make sure that you understand the potential outcomes and possible complications. Also, ask how the particular approach stacks up against other treatment choices for you. For instance, vacuum devices and oral or injection therapies still work for some people. Penile prostheses, the most widely used surgical technique for ED, usually have a more favorable outcome than vascular techniques. Data suggest that while not an inevitable part of aging, the risk of impotence increases as we grow older. About 5 percent of men at age 40 complain of the problem, while between 15 and 25 percent at age 65 experience it. Some experts suggest the numbers may be underreported since men are still embarrassed by this physical and psychological issue. However, the reassuring news is that it is treatable in all age groups. Impotence, or the consistent inability to sustain and maintain an erection, is a widespread problem. It may affect as many as 50 percent of men between ages 40 and 70. Luckily, doctors can identify physical causes involving blood flow, nerves or other mechanical issues involving the penis, which can also be addressed with modern technology. In fact, oral drugs, vacuum devices, injectable medications, psychotherapy and even surgery have made impotence very treatable. The promising news is that new drugs are sure to join existing non-invasive treatments while other experimental options, such as gene therapy, are on the horizon. Erectile dysfunction (ED) is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. Fortunately, most men who have ED only lose the ability to have satisfactory erections. In other words, for most of these men, penile sensation is normal and the ability to have an orgasm and ejaculate remains. Today, there are several treatment options available to men suffering from this disorder. For most men, the initial treatment will be an oral medication such as sildenafil citrate (Viagra). If this treatment is unsuccessful, second-line treatment options are ordinarily considered. These include using a vacuum erection device, intraurethral medication or penile injection therapy. If these second-line treatments fail or if the patient and his partner reject them, then the third-line treatment option, penile prosthesis implantation, is considered. Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse. Neither the operation to implant a prosthesis nor the device itself will interfere with sensation, orgasm or ejaculation. There are two erection chambers (corpora cavernosa) in the penis. All penile prostheses have a pair of components that are implanted within both of these erection chambers. The simplest penile prostheses consist simply of paired flexible rods that are usually made of medical-grade silicone, and produce a degree of permanent penile rigidity that enables the man to have sexual intercourse. A malleable rod prosthesis can be bent downward for urination or upward for intercourse. Inflatable penile prostheses are fluid-filled devices that can be inflated for erection.

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