Assurans (Sildenafil Citrate 20mg)

Assurans general information

What is Assurans used for?

Assurans tablets 20mg are used to treat pulmonary arterial hypertension (PAH), which is a form of high blood pressure that occurs in the pulmonary arteries that deliver blood from the right side of the heart to the lungs.  There are several WHO (World Health Organisation) classifications for PAH and Assurans tablets 20mg are indicated for class 1 PAH, which is associated with narrowing of the small blood vessels in the lung and often has no known cause.  Risk factors for class 1 PAH include family history of the condition, other conditions such as connective tissue disease, HIV infection, sickle cell anaemia, and some drugs like use of cocaine.  Assurans tablets 20mg help improve exercise ability and delay worsening of debilitating symptoms, which include dyspnoea (shortness of breath), syncope (dizziness or fainting), fatigue, chest pain, oedema (swelling of the legs) and tachycardia (rapid heartbeat).  Assurans tablets 20mg are also used to treat erectile dysfunction (ED) or impotence in men, which is inability to achieve or maintain a hard erect penis suitable for sexual activity, due to insufficient blood flow into the penis.  Assurans tablets 20mg relax the blood vessels in the penis increasing blood flow and causing an erection, which is the natural response to sexual stimulation.  However, Assurans tablets 20mg will only work if you are sexually aroused.

How does Assurans work?

Assurans tablets 20mg contain sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor that is used to treat pulmonary arterial hypertension.  The enzyme PDE5 is found in vascular smooth muscle cells (in the walls of blood vessels) and is present in particularly high levels in the lung.  PDE5 causes the breakdown of cyclic guanosine monophosphate (cGMP), an intracellular signalling molecule that is increased by nitric oxide, produced by vascular endothelial cells (cells that line blood vessel walls) and this causes relaxation of blood vessels (vasodilation), resulting in increased blood flow.  Sildenafil in Assurans tablets 20mg inhibits the action of PDE5, which increases the amount of cGMP in the pulmonary vascular smooth muscle cells.  This action causes vasodilation of the small arteries in the lung and results in reduced pulmonary arterial blood pressure. 

Assurans tablets 20mg are also used to treat erectile dysfunction, by acting directly on the erectile tissue of the penis to increase blood flow which causes an erection.  During sexual stimulation nitric oxide is released in the erectile tissue of the penis which activates the enzyme guanylate cyclase.  This enzyme increases levels of cGMP, which relaxes the blood vessels in the penis and allows blood to fill the spongy erectile tissues to cause an erection.  PDE5 prevents blood flow into the penis, which causes loss of an erection.  Sildenafil in Assurans tablets 20mg inhibits the action of PDE5 which resolves erectile dysfunction by allowing the natural process of sexual stimulation to activate the cGMP mechanism for achieving and maintaining an erection. 

What does Assurans contain?

Assurans tablets 20mg contain the active ingredient sildenafil citrate which is used to treat pulmonary arterial hypertension and also erectile dysfunction.    

Treating pulmonary arterial hypertension with Assurans

Assurans tablets 20mg contain sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor that is used to treat class 1 pulmonary arterial hypertension (PAH), a form of high blood pressure that occurs in the pulmonary arteries of the heart and lung and with usually no obvious cause.  Sildenafil in Assurans tablets 20mg inhibits the action of PDE5, which increases the amount of cGMP an intracellular signalling molecule that is increased by vascular nitric oxide, and this causes relaxation of blood vessels (vasodilation), resulting in increased blood flow.  Sildenafil in Assurans tablets 20mg inhibits the action of PDE5, which increases the amount of cGMP in the pulmonary vascular smooth muscle cells.  This action causes vasodilation of the small arteries in the lung and results in reduced pulmonary arterial blood pressure, which increased the ability to exercise and relieves symptoms like dyspnoea (shortness of breath), syncope (dizziness or fainting), fatigue, chest pain, oedema (swelling of the legs) and tachycardia (rapid heartbeat). 

Treating erectile dysfunction with Assurans

Assurans tablets 20mg contain sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor that is used to treat erectile dysfunction (impotence), by acting directly on the erectile tissue of the penis to increase blood flow which causes an erection.  During sexual stimulation nitric oxide is released in the erectile tissue of the penis which activates the enzyme guanylate cyclase.  This enzyme increases levels of cGMP, which relaxes the blood vessels in the penis and allows blood to fill the spongy erectile tissues to cause an erection.  PDE5 prevents blood flow into the penis, which causes loss of an erection.  Sildenafil in Assurans tablets 20mg inhibits the action of PDE5 which resolves erectile dysfunction by allowing the natural process of sexual stimulation to activate the cGMP mechanism for achieving and maintaining an erection. 

What are the side effects of Assurans?

The most commonly reported side effects when taking Assurans tablets 20mg include headache, dizziness, insomnia, flushing, indigestion, diarrhoea, nasal congestion, sinusitis, epistaxis (nosebleed), erythema (reddening of the skin), paraesthesia (tingling sensation).  More serious side effects include changes in vision such as blurring, a blue colour to your vision or a greater awareness of light; also, retinal haemorrhage.  Priapism (painful erection that lasts longer than 4 hours) is an uncommon but serious side effect.

When should Assurans not be used?

You should not use Assurans tablets 20mg if you:

• are allergic to sildenafil or any ingredients in Assurans
• you are pregnant or breastfeeding (for PAH), without discussion with your doctor
• have liver disease
• have severe low blood pressure
• have a recent history of heart attack or stroke
• have a condition where sexual intercourse is inadvisable due to cardiovascular or heart problems (for ED)
• have an eye disease like non-arteritic anterior ischaemic optic neuropathy (NAION), which causes loss of vision or if you have retinitis pigmentosa
• have a bleeding disorder or peptic ulcer as Assurans could increase risk of bleeding
• are taking any nitrate medication, such as nitroglycerin for angina, as it may lead to a severe drop in blood pressure
• are taking medication that may interact with Assurans or may increase your risk for side-effects, including cimetidine for treating ulcers, antibiotics like erythromycin and rifampicin, verapamil or diltiazem (for high blood pressure), ritonavir or saquinavir (for HIV), the antifungals itraconazole or ketoconazole, alpha-blockers like amlodipine for high blood pressure.

What medications interact with Assurans?

Several medications interact with Assurans tablets 20mg and should either not be taken while you are taking Assurans or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Assurans: any nitrate medication, such as nitroglycerin for angina
• Drugs that affect Assurans: cimetidine for treating ulcers, antibiotics like erythromycin and rifampicin, the antifungals itraconazole or ketoconazole, ritonavir or saquinavir for HIV
• Drugs that are affected by Assurans: alpha-blockers like amlodipine for high blood pressure

How should Assurans be taken?

For PAH

You should take your Assurans tablets 20mg with a glass of water three times daily and approximately 4-6 hours apart with or without food.  Doses greater than 20mg three times daily are not recommended for PAH.  You should continue to take your Assurans tablets 20mg for as long as recommended by your doctor.

For erectile dysfunction

You should take your Assurans tablet 20mg with a glass of water approximately one hour before sexual activity and without food.  If you have a large meal before taking your Assurans 20mg tablets it may take longer to work.  You should take no more than one tablet a day and only if you plan to have sex.

Missed dose of Assurans

For PAH

If you miss a dose of Assurans 20mg tablets take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose. 

For erectile dysfunction

You should only take an Assurans 20mg tablets when you plan to have sex; it is not intended as a regular medication. 

How should Assurans be stored?

You should store your Assurans tablets 20mg below 25°C in a cool dry place.