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To: MEDICAL EDITORS

Contact: John Murphy, +1-507-284-5005 (days), +1-507-284-2511 (evenings), e-mail: newsbureau@mayo.edu

ROCHESTER, Minn., Oct. 4 /PRNewswire-USNewswire/ — Although medication
can help extend the lives of men with chronic heart failure, several factors
associated with this disease can interfere with a person’s ability to engage
in and enjoy sexual activities. Fatigue, depression, medication side effects
and the fear of damaging the heart can cause people with chronic heart failure
to lose interest in sex or wonder whether this activity is safe for them.

A literature review published in the October issue of Mayo Clinic
Proceedings finds that with proper screening and treatment, many patients with
chronic heart failure can safely engage in sexual activity.

Methods

Co-authors Stacy Mandras, M.D., Patricia Uber, Pharm. D., and Mandeep
Mehra, M.D., conducted systematic independent literature searches using the
MEDLINE database and examined a broad range of medical research that focused
on chronic heart failure, sexual activity and sexual dysfunction. This
literature included data from patient surveys and clinical trials.

Findings

Many people with chronic heart failure worry that having sex will place
too great a strain on the heart. To address this issue, Drs. Mandras and Mehra
analyzed studies that showed the impact of sexual activity on heart rate,
blood pressure and respiratory rates, which typically increase during sexual
activity and other forms of exertion.

One study the authors reviewed measured these changes in middle-aged men
with and without coronary artery disease. This study found that the peak heart
rate during intercourse was lower than heart rates measured during the
patients’ normal daily activities. The study cialis generic online purchasing tadalafil
peak oxygen
consumption levels during intercourse were moderate — comparable to their
oxygen consumption levels during moderate activities such as walking on level
ground at 3 to 4 miles per hour, climbing stairs slowly or doing general
housework such as vacuuming.

The authors also addressed how to counsel and treat chronic heart failure
patients who are coping with erectile dysfunction, difficulty achieving or
maintaining an erection. Researchers estimate that erectile dysfunction
affects 60 percent to 70 percent of people who have chronic heart failure.

The authors observe that multiple factors may be involved. In addition to
decreased exercise capacity, patients with chronic heart failure have blood
vessel and circulation abnormalities that can reduce blood flow into the penis
and interfere with the ability to maintain an erection. And erectile
dysfunction can be caused or worsened by many of the medications that are
commonly prescribed to treat chronic heart failure.

Currently, the preferred treatment for erectile dysfunction includes
sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). However,
numerous experts have raised concerns about the use of these drugs in patients
with chronic heart failure who also take nitrates (or other medications that
relax and widen blood vessels). This drug combination has been shown to be

dangerous, because it can increase the risk for a medication that cause erectile dysfunction drop in
blood pressure.

To further explore this potential risk, the authors reviewed results from
a variety of studies in which male patients with congestive heart failure took
sildenafil. The authors observed that more data are needed to determine the
safety of the newer drugs, vardenafil and tadalafil, for these patients.

“Taken together, these studies show that erectile dysfunction in patients
with mild to moderate chronic heart failure can be safely and effectively
treated with sildenafil, provided that patients are tadalafil
ly screened
before therapy,” say the authors.

For those patients who cannot take erectile dysfunction medications, the
authors counsel that an exercise training regimen may be an appropriate
substitute therapy to enhance sexual function and quality of life. The authors
stress that clinicians should focus on the sexual activity history of chronic
heart failure patients and not ignore it, since addressing this element can
erectile dysfunction medicine
improve their quality of life.

Background about chronic heart failure

Chronic heart failure often develops after other cardiac problems have
damaged or weakened the heart, leaving it too weak or too stiff to fill and
pump tadalafil side effects
. Many underlying heart conditions can lead to heart failure.
It can develop quickly after damage caused by a heart attack, or it can
develop gradually after years of high blood pressure or coronary artery
disease.

A peer-review journal, Mayo Clinic Proceedings publishes original
articles, reviews and editorials dealing with clinical and laboratory
medicine, clinical research, basic science research and clinical epidemiology.
Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical
Education and Research as part of its commitment to the medical education of
physicians. The journal has been published for more than 80 years and has a
circulation of 130,000 nationally and internationally. Articles are available
online at http://www.mayoclinicproceedings.com.

To obtain the latest news releases from Mayo Clinic, go to
http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com) is
available as a resource for your health stories.

SOURCE Mayo Clinic

-0-

CHICAGO (Reuters) -
Eli Lilly & Co (LLY.N) said on Friday
that it had won approval to market its blockbuster osteoporosis
drug to post-menopausal women who are at high risk for invasive
breast cancer.

The company also said U.S. health regulators had extended
the use of the drug, known as Evista, to help reduce the risk
of the aggressive form of breast cancer in post-menopausal
women who have the bone-thinning disease.

However, the drug will also contain a stronger warning of
side effects that can include death by stroke.

Evista, known generically as raloxifene, is already
approved for the prevention and treatment of osteoporosis, or
bone thinning, in post-menopausal women.

Lilly said Evista, like the hormone estrogen, helps to
fight osteoporosis. But Evista also blocks estrogen in breast
tissue, the drug maker said.

Sales of Evista, a selective estrogen receptor modulator,
topped $1 billion in 2006.

SERMs are drugs used to treat osteoporosis that also appear
to prevent breast cancer by reducing estrogen in breast tissue.
Estrogen in breast tissue can drive some types of breast
cancer.

“This data's been unfolding for the last few years, so it's
not as if physicians are not aware of this, but now Lilly will
be able to market it,” said Deutsche Bank analyst Barbara Ryan.

In 2007, Evista sales were flat with the prior year, she
noted. “Our view is that this (approval) may begin to deliver
some growth of maybe 10 to 20 percent,” she said.

That would equate to roughly $100 million to $200 million
in buy cheap tadalafil
revenues annually. “But it doesn't dramatically
move the needle at Lilly,” Ryan said. “So it's not momentous,
but we'll watch the scripts like everyone else, and maybe we'll
be surprised.”

Lilly, whose other products include antidepressant Prozac
and erectile dysfunction drug Cialis, reported second-quarter
revenue of $4.63 billion.

Earlier this year, Lilly updated the label for Evista to
include safety information from a clinical trial that evaluated
post-menopausal women, some of whom were suffering from
coronary artery disease and some who were at increased risk for
coronary disease.

The trial found no increase in the incidence of stroke but
an increase in the incidence of death because of stroke.

Since the new label for Evista will include new uses and an
expanded patient population, Lilly has worked with the FDA to
revise the package insert. The insert will now emphasize that
women with an active or past history of venous thromboembolism
– manufacturer tablet tadalafil
deadly blood clots — should not take Evista and
that women at risk for stroke should receive the drug only
after careful evaluation.

A company levitra vardenafil hcl said the so-called black-box warning
did not preclude the company from conducting direct-to-consumer
advertising.

The company presented studies of 37,000 women that compared
Evista with a placebo or tamoxifen, which has been used about
25 years to treat patients with advanced breast cancer.

Competing osteoporosis drugs include Merck & Co Inc's
(MRK.N) Fosamax, and Roche Holding AG's (ROG.VX) and
GlaxoSmithKline Plc's (GSK.L) Boniva.

Shares of Eli Lilly were down 33 cents at $56.85 in morning
New York Stock Exchange trade. Their price has ranged from
$51.13 to $60.63 during the past 52 weeks.

(Reporting by Debra Sherman)

NEW YORK (Reuters) -
Eli Lilly and Co. (LLY.N) on Tuesday
posted generic cialis tadalafil price comparison
quarterly earnings and raised its
2007 forecast, helped by surging sales of its prescription
drugs, including depression treatment Cymbalta.

Lilly posted strong revenue gains from Cymbalta and Zyprexa
for schizophrenia, which rose 67 percent and 9 percent,
respectively, and helped the company beat revenue expectations
by about $250 million.

“Together these two products accounted for almost two
thirds of the revenue beat,” JPMorgan analyst Roberto Cuca
wrote in a research note. “This should boost sentiment among
those investors who had been concerned about the health of
Lilly's (central nervous system) franchise.”

The 90 cialis generic
results also signaled Lilly's
acquisition of Icos in January is paying off, accounting for
about a third of the 20 percent jump in quarterly sales to
$4.63 billion. Through that deal, Lilly gained full ownership
of the widely used Cialis impotence pill, which posted a 26
percent rise in sales to $293 billion.

Lilly shares rose 2 percent in opening trade.

Excluding charges related to acquisitions of Hypnion Inc.
and Ivy Animal Health in the period, Lilly earned 90 cents per
share, which was 8 cents better than analysts had expected,
according to Reuters Estimates.

On a net basis after those charges, the Ed tablets

drug maker earned $664 million, or 61 cents per share, from
$822 million, or 76 cents per share, a year earlier.

Lilly forecast 2007 earnings per share, excluding special
items, of $3.40 to $3.50 per share, up from its previous
forecast of $3.29 to $3.39 per share. It expects sales to grow
in the “mid-teens” percentage range.

Cymbalta's revenue rise to $520 million in the second
quarter was helped by its new use against tadalafil guenstig
anxiety
disorder approved by U.S. regulators in February.

Meanwhile Zyprexa, the company's biggest product, rebounded
with a 9 percent rise to $1.21 billion after earlier sales
declines prompted by concerns over its tendency to cause weight
gains.

Lilly said higher overseas sales of Zyprexa, along with
higher U.S. prices, outstripped lower U.S. demand for the
medicine. The company projected “modest” worldwide sales growth
of Zyprexa for the full year.

Gemzar, used to treat lung and pancreatic cancer, grew 15
percent to $396 million, while lung cancer treatment Alimta
jumped 35 percent to $207 million.

Sales of Strattera, used to treat attention deficit
hyperactivity disorder, slipped one percent to $142 million,
amid concerns that such drugs pose heart risks and cause
psychiatric problems, such as hallucinations.

Eli Lilly shares rose $1.12 to $58.29 in opening trade on
the New York Stock Exchange. They are up 12 percent in 2007,
outpacing a 2 percent rise for the American Stock Exchange
Pharmaceutical index. (.DRG)

(Reporting by Ransdell Pierson and Lewis Krauskopf)

OTTAWA (CP) - Consumers are being warned not to use Zencore Tabs - a product advertised as a dietary over the counter erectile dysfunction medication for sexual enhancement, Health Canada said Saturday.

The federal health watchdog says it’s because it contains an undeclared tadalafil guenstig
similar to tadalafil, used for the treatment of erectile dysfunction.

Health Canada says the use of Zencore Tabs could pose serious health risks, especially for those with existing heart problems or those at risk of stroke. The agency says tadalafil combined with any nitrate medication could result in potentially life-threatening low blood pressure.

Zencore Tabs is not authorized for sale in Canada and Health Canada says the Canadian importer is recalling the product. Consumers who’ve bought them are warned not to use it and to consult with a medical professional.

Health Canada says it’s taking steps to confirm the product has been removed from the Canadian market, and there have been no reports of adverse reactions.

Zencore Tabs is sold in blister packages of two pink-purple capsules, and was available at retail outlets and possibly over the Internet.

STORAGE
Tablets should be kept at room temperature between 15-30 C (59-86 F).

PRESCRIBED FOR
Tadalafil is used for the treatment of erectile dysfunction, or impotence.

DOSAGE
The recommended initial dose of Tadalafil is 10 mg per day, which have to be taken orally before sexual activity. This prescribed amount is a usual daily dose for the majority of men. This dose can be increased up to 20 mg or decreased to 5 mg per day depending on the feedback or side effects. The maximal duration of the Tadalafil's effect is 36 hours. Patients who take medicines extending the level of Tadalafil in the blood shouldn't surpass a total dose of 10 mg in 72 hours (See “DRUG INTERACTIONS”). As food doesn't influence on absorption of Tadalafil from the intestine the drug can be taken while eating as well as on an empty stomach.

DRUG INTERACTIONS
The following medicines can diminish the ability of the organism to destroy and eliminate Tadalafil: erythromycin, ketoconazole (Nizoral), tadalafil guenstig
(Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Hence these medications can heighten the level of Tadalafil in the blood. If these medicines have to be taken simultaneously with Tadalafil, its dose has to be reduced to avoid side effects, which can be provoked with high level of Tadalafil in the blood. When being taken simultaneously with nitrates, such as nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Over the counter erectile dysfunction medication), which are usually prescribed for treatment of heart pain (angina), Tadalafil strengthens heart rate and lowers blood pressure. If the patient takes nitrates for angina, Tadalafil can become a reason of heart pain or perhaps even a heart attack as a result of strengthening of heart rate and lowering of blood pressure. So it's highly recommended not to take Tadalafil together with nitrates. Tadalafil can also heighten the blood pressure as it lessens effects of some alpha-blocking medicines, such as terazosin (Hytrin), which are principally used for treatment of high blood pressure or increment of the prostate. The patients, who take the tadalafil story
, have to take the stable dose of these drugs before starting to take Tadalafil. In these cases at the initial stage the lowest doses of Tadalafil should be taken. In cases of taking Tadalafil, the alpha-blockers should be taken beginning with the lowest dose. As Tadalafil like alcohol lower blood pressure it's highly recommended not to mix these substances, because as a result of such mixing there can be dizziness, headaches and increased heart rate.

PREGNANCY
The drug isn't approved for usage by women.

NURSING MOTHERS
Breastfeeding mothers were not testing for taking Tadalafil.

SIDE EFFECTS
When using Tadalafil the following accompanying effects can take place: headache, facial flushing (reddening), nausea, stomach upset, diarrhea, and flu-like symptoms. Tadalafil can also become the cause of low blood pressure, spasm of accommodation, breach of color perception and anomalistic ejaculation.
There were cases of continuous erections, or priapism (aching erection that lasts more than six hours) fixed after taking Tadalafil. If erection lasts more than four hours you have to recourse. There is causation between using of Tadalafil and chest pain, heart attack, palpitation, hastened heart rate, stroke and death, but it's not confirmed if these side effects are result of using Tadalafil or they are direct outcome of sexual activity itself.