Hezkue

Hezkue is a mouth spray containing the active ingredient sildenafil for the treatment of erectile dysfunction. The suspension is sprayed onto the tongue with the dosing pump and swallowed immediately with saliva.

The advantage over tablets: Use is discreet and does not require water.

Sildenafil is the active ingredient in Viagra and belongs to the group of PDE-5 inhibitors, which support erection during sexual arousal.

Sildenafil as a PDE-5 inhibitor:

Mechanism of action: 1. During sexual arousal, nitric oxide (NO) is released 2. NO activates guanylate cyclase → cGMP rises 3. cGMP relaxes the muscles of the erectile tissue 4. Sildenafil inhibits PDE-5 (which breaks down cGMP) 5. cGMP remains effective for longer → stronger erection

Special feature of the spray:

• Oral suspension: spray onto the tongue and swallow immediately with saliva

Time course:

• Onset of action: in a study in fasting patients, on average within 25 minutes (12 to 37 minutes)
• Duration of action: 4-6 hours
• Sexual stimulation is still required!

Hezkue is suitable for:

• Erectile dysfunction in adult men
• Men who do not like swallowing tablets
• Discreet use

Advantages:

• No water needed to swallow
• Discreet use

Not suitable:

• With concurrent use of nitrates!
• Severe cardiovascular disease
• Recent stroke or heart attack

Hezkue mouth spray:

• 12.5 mg sildenafil per spray

Recommended dose:

• Starting dose: 4 sprays (50 mg); depending on efficacy and tolerability, a reduction to 2 sprays (25 mg) is possible
• Maximum single dose: 8 sprays (100 mg)
• About one hour before sexual intercourse

Note:

• Maximum 1 use per 24 hours
• Adjust the dose individually

How to use: 1. Remove the protective cap 2. Spray onto the tongue 3. Swallow immediately with saliva 4. About one hour before sexual intercourse

Important information:

• Sexual stimulation is still required
• Heavy meals can delay the effect
• Alcohol in moderation
• No more than 1x daily

CONTRAINDICATED in:

• Use of nitrates (nitroglycerin, isosorbide) – life-threatening drop in blood pressure!
• Severe heart failure
• Recent heart attack or stroke (< 6 months)
• Severe hepatic impairment
• Hypotension (blood pressure < 90/50 mmHg)
• Retinitis pigmentosa

Caution in:

• Penile deformities (Peyronie's disease)
• Leukemia, sickle cell anemia (risk of priapism)
• Bleeding tendency

Warning signs: If an erection lasts > 4 hours (priapism), call an emergency doctor immediately!

Common (1-10%):

• Headache
• Facial redness (flushing)
• Stuffy nose
• Indigestion
• Visual disturbances (bluish tinge to vision)
• Dizziness

Uncommon:

• Palpitations
• Muscle pain
• Nausea
• Skin rash

Rare but serious:

• Priapism (> 4 hours)
• Sudden hearing loss
• Sudden loss of vision (NAION)

Note: Most side effects are mild and temporary.

CONTRAINDICATED:

• Nitrates and NO donors – LIFE-THREATENING!
• Riociguat

Caution with:

• Alpha blockers – drop in blood pressure
• CYP3A4 inhibitors (ketoconazole, ritonavir) – increased sildenafil levels
• Other PDE-5 inhibitors – do not combine

Note: If needed, take alpha blockers and sildenafil at staggered times.