Erectile Dysfunction (ED) wasn’t actually known until the discovery of phosphodiesterase-5 (PDE-5) inhibitors for the condition. Only when these PDE5-inhibitors were discovered the awareness for ED grew among the patient population and the medical field raised. “Oral Pharmacotherapy and the Contemporary Evaluation and Management of Erectile Dysfunction”, a study by Broderick G. (2003) mentioned that after the PDE5 discovery, research expanded and included the determination of the etiologies of ED and its risk factors .
Now, that the patients are more aware of the condition and now seeking treatment for the condition, the need for PDE5-inhibitors like Sildenafil Citrate (SC) arose . There are current brand-name treatments available, like the legendary Viagra, but sometimes, patients aren’t able to afford the treatment cost for the medication. Due to that concern, pharmaceutical companies like Ajanta Pharma and others made their own FDA-approved generic versions of SC. Ajanta Pharma, one of the leading international pharmaceutical companies (based in India) came up with its own branded generic products which included the commonly known market label Kamagra. Kamagra is not only one single product, it is made up of a number of products with SC as an active ingredient, and takes up several forms like Oral Jellies, Polos, Soft (Chewable) Pills, Effervescent Tablets, and the regular film-coated tablet form.
Kamagra Gel is offered by Ajanta Pharma in gel form and containing 100 mg of SC per gel pack. It is described by sellers as fundamentally a “generic Viagra” version but in gel form . It is also different from the regular tablet/pill form not only because it’s in a more viscous form, but because it also comes in several flavors: strawberry, banana, apple, caramel, pineapple, cherry, and others  which makes it more tolerable or easier to take in than the regular SC tablet form. Though the product is in a peculiar form, the product’s effectiveness is not diminished, as the same dose of the active ingredient is present in every gel sachet as the regular Kamagra /generic/brand-name pills.
About India’s Ajanta Pharma
What is most admirable in Ajanta Pharma Limited (the manufacturer of Kamagra products) is that its focus is mainly Research and Development for its products. The company has products which were the first of their kind mostly in the area of Branded Generics Business.
The company’s generic drugs currently have approvals from the famed US FDA. Ajanta Pharma has 16 products which were approved by the US FDA, and the products, if not yet commercialized, are in the process of commercialization . Ajanta Pharma, according to its company information, plans to file for 8-12 ANDA approvals every year. Presently, the company has 2 tentatively approved ANDAs, and 11 under review by the US FDA . It is seldom that a company gets its products approved by the internationally acclaimed US FDA, so the US FDA approvals for Ajanta mean high-quality product production on their part. It was not known which of Ajanta’s meds were approved, though.
Ajanta Pharma Limited is currently expanding globally, penetrating markets in Asia, Africa, Europe, and recently, the USA. The company is expecting that their New Jersey subsidiary will further facilitate the company’s growth in the international market .
Sildenafil Citrate (SC) Research
According to “Phosphodiesterase type 5 inhibitors as a treatment for erectile dysfunction: Current information and new horizons”, which is a research by James Ferguson (2013), PDE5-inhibitors like SC (and vardenafil and tadalafil) have revolutionized the treatment of ED . The research  also mentioned that the PDE5-inhibitors available in the market are indeed effective and well-tolerated by the patients, even by patients who have undergone radical prostatectomy. Aside from being able to treat existing ED in patients PDE5i (PDE5-inhibitors) like SC and Tadalafil are also known to prevent ED in patients after prostatectomy. The research mentioned that SC daily intake after the radical surgery significantly improved the patients’ erectile function 7x . The only issue the patients had for the maintenance of SC was its high cost, which caused them to stop the treatment .
Because of the high costs of the brand-name, US FDA approved treatments in the market, some patients are forced to resort to cheaper alternatives which are commonly found on the web. There are actually generic drugs approved for manufacturing by the US FDA and the WHO and there are reliable, quality-adherent, and well-accredited pharmaceutical companies in the generics business like Ajanta Pharma, but the internet is flooded by generic drug counterfeits especially for the sexual enhancers.
For this reason, the US FDA has given out cautions regarding these counterfeit sexual enhancers on the internet pharmacy market for the concern of patient safety. The study “Quantification of active pharmaceutical ingredient and impurities in sildenafil citrate obtained from the Internet” by Veronin et.al. (2014) aimed to determine whether the SC tablets from internet pharmacies are as potent and has the same composition as the US innovator product (Viagra) . 15 SC tablets were tested (14 generic samples from online pharmacies plus Viagra) using high-performance liquid chromatography to see the API (active pharmaceutical ingredient) strength and impurity level and compared them against International Conference on Harmonisation (ICH) standards . Results were alarming as the researchers determined that 4/15 had >1% impurity for the MDD (maximum daily dose), 4/15 contained higher impurity B levels than the assigned ICH threshold, and 8/15 possessed C impurity levels higher than the threshold. 6/15 also did not reach the quota for the 5% assay limit . The results led the researchers to suggest that most of the internet SC medications they tested from the internet were not at par with the US innovator product due to the difference in manufacturing/storage process . It was recommended that the patients should take caution when dealing with Internet drugs as the quality of these medications is not guaranteed.
Research on counterfeit drugs is also conducted as counterfeit drugs had been a growing problem, especially that the counterfeiters are targeting the market for the PDE5i (“Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks” by Jackson et.al. (2010)) . According to the research, 44%-90% of the PDEi products on the Internet are counterfeit and 67% of the ED purchasing population purchases their ED meds from the Web . Counterfeit products pose serious health threats so this counterfeit problem needs to be resolved and requires cooperation down to the local prescribing level .
How Sildenafil Citrate Works
It was mentioned in the research “Erectile dysfunction – an update of current practice and future strategies” by Kalsi and Muneer (2013) that penile erection is facilitated by NO (Nitric oxide) which was generated in response to non-adrenergic non-cholinergic (NANC) neurotransmitters . NO (which is released after sexual arousal) has a resulting effect of cavernosal smooth muscle relaxation, plus vasodilation . The erectile response is primarily regulated by pro/anti-erectile mediators, like PDE5. SC’s primary function is to inhibit the action of PDE5, which works by degrading the cyclic GMP, which is a major factor in maintaining the erection response. Since SC acts as a PDEi, it stops the degradation of cGMP which allows the erection response to prolong, therefore causing the desired effect for the patients.
Kamagra Oral Jelly contains 100 mg SC which is considered an effective dosage for ED treatment and it works the same way as described by the mentioned research since it contains the same active ingredient.
Sildenafil Marked Effects
Since SC-containing drugs promote vasodilation on the penile tissue caused by the relaxation of the smooth muscle cells of the corpus cavernosum, so the patients can expect their erectile function restored by the drug. Research already proved the effectiveness of SC in eliciting the erectile response in the patients so users of the drug can indeed benefit from the erection-inducing function of SC.
Regarding Kamagra Oral Jelly, the manufacturer and the vendors claim that the product is much easier to use than its Kamagra pill counterparts  as it is already dissolved in the buccal cavity. Also, the product is said to take effect in about 20 minutes, which is generally faster than the effect of regular oral Kamagra SC pills .
Recommended Doses and Duration of Therapy
Dosing for SC products are always determined by the assessing physician as the dosage needs to be titrated according to the specific medical need of a patient. But the most common dosage recommendations for patients are 25, 50, or 100 mg per use.
The advised dose of Kamagra Jelly is similar to the regularly advised dosage for the common SC pill. The 100 mg packet is recommended to be taken at least 30 minutes before any planned sexual activity, though older patients and patients with other medical conditions are advised to take only half of the amount (50 mg) .
Kamagra Oral Jelly is not a maintenance medication, and its use is only on an as-needed frequency. It is prohibited for patients to take more than 1 dose of any SC medication in a day.
Side effects and Warnings
According to the vendor info, the frequent/chronic use of Kamagra Oral Jelly or any SC-containing medication leads to symptoms of mild side effects . Frequently observed side effects among the users of SC drugs are headaches and facial flushing . Also, side effects like dyspepsia, GI problems, clogged sinuses, and dizziness may be observed . These are actually manageable symptoms, but it is recommended for patients and users to consult their doctors in the event of persistence and increased intensity of these side effects.
SC products like Ajanta Pharma’s Kamagra oral jelly product is not recommended for patients with several medical considerations. For starters, the jelly medication may not be used by women and children under 18. The product may not be also used by patients with severe angina, arrhythmia, coronary heart disease, terminal renal failure, MI, chronic vascular hypotension, and other medical considerations.
SC-containing drugs are strictly prescription due to their propensity to interact with a large pool of medication. A total of 2048 generic and brand-name drugs are known to interact with SC with intensity ranging from minor to major . The most common drug and severe interactions are noted for Nitrates, so any form of nitrate-containing medication (even the harmless patch or topical meds) are strictly contraindicated for SC. Some of the few well-known drugs that interact (possibly) devastatingly with SC are furosemide, hydrochlorothiazide, amlodipine, losartan, other ED medications, nitrates, and many others .
Although SC products are almost always effective, Kamagra Gel had mixed reviews from clients on Erectiemiddelenshop.nl. A good number of users were happy and satisfied with how Kamagra Gel helped them have their desired erectile effect, and most of the patients were admiring the product’s quick effect (relative to the hard pill type).
Others also commented how the oral jelly did not give them side effects. But there was a certain user, who was 74 claiming that he did not find the product effective. He rated the product only 1 star out of 5 because according to him, the product did not work.
Even so, the product seems to be recommendable as the frequency of good reviews exceeds that of the negative. Also, at the user’s age of 74, there may be a number of factors affecting the efficacy of SC in Kamagra Gel, and this may just be an isolated case, as most of the users and patients testify to the effectiveness of SC in Kamagra Gel.
Kamagra Gel Price, Available Forms and Dosage
Buyers may find the prices for Kamagra Gel different from one site to another because there isn’t really a standard pricing for generic ED medication on the Internet. For instance, Pharm-usa-se.com sells 20 sachets of Kamagra Gel for $58.17 while Promedline.com sells them for $69.99.
It actually gets confusing as other Internet pharmacies sell the same product in erratic prices. The main qualification for the sites to be a viable drug source are their trust factors, so patients tend to go for trusted online sites even with their higher-than-usual drug prices.
Shipping rates to USA, Australia, Canada vary too, depending on the generosity of a certain drugstore. Some websites offer free shipping, while some charge for the basic Airmail shipping from $10 up. If users want faster shipping service, they should be willing to pay more, as the stores charge more for faster courier services. It is notable that the stores charge depending on the courier used by the buyer and really not depending on the place the parcels will go to. International rates are the same no matter where the parcel will go to.
Conclusion and Rating
There is actually no more issue on the effectiveness of Sildenafil Citrate as a treatment for Erectile Dysfunction, as its effects are long been established in the medical field. If there’s anything that the researchers are working on regarding the drug, it is its other applications in the medical field, as SC has great potential in curing other medical conditions and diseases which in time (and with more research and testing) will be made available in the market.
Also, another concern with SC is its distribution in the International market. Since SC has been quite effective, it had been the subject of counterfeit activity, especially by Internet pharmacies. Some research focused on the density of counterfeit products circulating in the market and found out that 44%-90% of the SC-containing products circulating the Internet market are fake, so patients should take caution in purchasing ED drugs or any medication online. Aside from that discovery, several SC-containing meds are found to be contaminated as a result of poor manufacturing processes by some generic makers.
Even if that’s the case, I think Kamagra products like Kamagra Gel are not to be feared since they were manufactured by an internationally-acclaimed, multi-awarded company with various accreditations on its portfolio. The patients’ reviews also tell it all, as the users were all praises for the drug’s effectiveness, although there was one who was unable to feel the effect of the oral jelly. But to be fair, the user is already 74 years old and beyond the range of the recommended age of SC users. Kamagra Gel deserves 4 out of 5 for being effective and manufactured by a well-known company. But since there is not much information on the US FDA approval of the medication, I still left out a point for consideration.
Kamagra Gel Wiki Facts
- Brand: Kamagra Oral Jelly
- Active Ingredient: Sildenafil
- Treatment: Erectile Dysfunction
- Manufacturer: Ajanta
- Country of Manufacture: India
- Availability: USA, UK, India, Australia, EU, New Zealand, ++
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