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Viagra Canadian Pharmacy Return to top Vascular diseases are those that affect the blood vessels. These diseases restrict blood flow to organs such as the heart, brain, and kidneys. In cases of ED, vascular diseases restrict blood flow to the penis. Vascular diseases may be responsible for causing ED in as much as 50% to 70% of men who develop the condition. At least 7 PDE classes are known, many with subtypes identified by structure and function. PDE-5 is cGMP-specific and is a major cGMP-hydrolyzing enzyme in the vascular smooth muscle of the penis. The newer agents, vardenafil and tadalafil, are more specific and potent cGMP inhibitors than sildenafil. Both of the newest agents are PDE-5 inhibitors, which are significantly more selective in their inhibition. Concurrent administration with potent CYP3A4 inhibitors (eg, ketoconazole, ritonavir): Not to exceed 10 mg PO q72h prn; no difference in safety or efficacy has been demonstrated in men >65 y compared with younger men

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