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Metabolism (breakdown) of sildenafil is slowed by aging, liver and kidney dysfunction, and concurrent use of certain medications (such as erythromycin -- an antibiotic, and protease inhibitors, for HIV). Slowed breakdown allows sildenafil to accumulate in the body and potentially may increase the risk of side effects. Therefore in men over 65, in men with substantial kidney and liver disease, and in men who also are taking protease inhibitors, the doctor will initiate sildenafil at a lower dose (25 mg) to avoid accumulation of sildenafil in the body. A protease inhibitor ritonavir (Norvir) is especially potent in increasing the accumulation of sildenafil, thus men who are taking Norvir should not take sildenafil doses higher than 25 mg and at a frequency of no greater than once in 48 hours. So, even if the nerves or blood vessels going to your penis are not working so well, a tablet can cause the blood flow to increase in your penis, and cause an erection. Tablets can treat ED caused by various underlying conditions. Note: none of these tablets will cause an erection unless you are sexually aroused. Sildenafil should be used cautiously in men on alpha blockers such as doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax). There have been occasional reports of low blood pressure in men who have taken the two classes of drugs simultaneously and therefore it is recommended that there be at least a span of four to six hours between the ingestion of sildenafil and alpha blockers. Erectile dysfunction can occur if one or more of these requirements are not met. The following are causes of erectile dysfunction: cheap viagra online without prescritpion buy viagra online ordering cialis online buy cialis online Many common medications for treating hypertension, depression, and high blood lipids can contribute to erectile dysfunction (see above). Treatment of hypertension is an example. There are many different types (classes) of anti-hypertensive medications (medications that lower blood pressure); these include beta-blockers, calcium channel blockers, diuretics (medications that increase urine volume), angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). Anti-hypertensives may be used alone or in combination to control blood pressure. Different classes of anti-hypertensives have different effects on erectile function. Inderal (a beta blocker) and hydrochlorothiazide (a diuretic) are known to cause erectile dysfunction, while calcium channel blockers and ACE inhibitors do not seem to affect erectile function. On the other hand, angiotensin receptor blockers (ARBs) such as losartan (Cozaar) and valsartan (Diovan) may actually increase sexual appetite, improve sexual performance, and decrease erectile dysfunction. Therefore, choosing an optimal anti-hypertensive combination is an important part of treating erectile dysfunction. cialis canada online pharmacy no prescription viagra buy viagra online For example, one study found that after a course of pelvic floor exercises, about 4 in 10 men with ED had regained normal erectile function, just over 3 in 10 men had improved, but there was no improvement in just under 3 in 10 men. The exercises were done for a time every day for three months. Those found least likely to improve were those with other significant problems such as heart disease, diabetes, or those who drank a lot of alcohol. The conclusion of this study was that pelvic floor muscle exercises should be considered a treatment option for many people with ED. cialis canada February 2011: Men who use non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3 months are at a 22 percent increased risk of erectile dysfunction. A link between NSAID use and erectile dysfunction still existed for different age, race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary diasease and other health problems. But due to benefit of NSAID, it's too early for men to avoid NSAIDs based solely on the research stated at Journal of Urology.