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To minimize the risk of postural hypotension in patients taking α-blockers, Does Viagra Work For Erectile Dysfunction should be started only after achieving hemodynamic stabilization in these patients. Consideration should also be given to reducing the initial dose of Does Viagra Work For Erectile Dysfunction (see special instructions and Interactions).


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Information

Cardiovascular complications

During the post-marketing use of Does Viagra Work For Erectile Dysfunction for the treatment of erectile dysfunction, adverse events such as severe cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, hypertension and hypotension) were reported, which had a temporary connection with the use of Herbal Viagra For Erectile Dysfunction. Most of these patients, but not all of them, had risk factors for cardiovascular complications. Many of these adverse events were observed shortly after sexual activity, and some were observed after taking Is Viagra Only For Erectile Dysfunction without subsequent sexual activity. It is not possible to establish a direct link between the reported adverse events and those or other factors.

Visual impairment

In rare cases, during post-approval use of all of the inhibitors of PDE5, including Does Viagra Work For Erectile Dysfunction, reported NESN is a rare disease and the cause of the decrease or loss of vision. Most of these patients had risk factors, such as decreased ratios of excavation diameter to optic disc (stagnant disc), age over 50, diabetes, hypertension, CHD, hyperlipidemia, and Smoking. In an observational study evaluated whether recent use of drugs class of inhibitors PDE-5 with an acute onset NESN. The results indicate approximately a 2-fold increase in risk of developing NESN within 5T1/2 after application of the PDE-5 inhibitor. According to published literature, the annual incidence of npins IS 2.5–11.8 cases per 100,000 men aged ≥50 years in the General population. Patients should be advised to stop Does Viagra Work For Erectile Dysfunction therapy in case of sudden loss of vision and consult a doctor immediately. Persons who have already had a case NESN have an increased risk of relapse NESN. Therefore, the doctor should discuss this risk with such patients, as well as the potential chance of adverse effects of PDE-5 inhibitors. PDE-5 inhibitors, including Does Viagra Work For Erectile Dysfunction, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk.

When using the drug Does Viagra Work For Erectile Dysfunction in doses exceeding the recommended, adverse events were similar to those noted above, but usually more common.

*Side effects identified during post-marketing studies.

Interaction

Effect of other drugs on the pharmacokinetics of Is Viagra A Cure For Erectile Dysfunction

The metabolism of Viagra For Diabetes Erectile Dysfunction occurs mainly under the action of CYP3A4 isoenzyme (main pathway), so inhibitors of this isoenzyme can reduce the clearance of Viagra Erectile Dysfunction Treatment, and inducers, respectively, increase the clearance of Is Viagra For Erectile Dysfunction. A decrease in the clearance of Does Viagra Work For Erectile Dysfunction with simultaneous use of inhibitors of CYP3A4 isoenzyme (ketoconazole, erythromycin, cimetidine).

Cimetidine (800 mg), a nonspecific inhibitor of CYP3A4 isoenzyme, when taken together with Does Viagra Work For Erectile Dysfunction (50 mg) causes an increase in the concentration of Does Viagra Work For Erectile Dysfunction in plasma by 56%.

A single dose of 100 mg of Viagra For Diabetes Erectile Dysfunction together with erythromycin (500 mg/day 2 times a day for 5 days), a moderate inhibitor of CYP3A4 isoenzyme, while achieving a constant concentration of erythromycin in the blood, leads to an increase in the AUC of Does Viagra Work For Erectile Dysfunction by 182%.

When co-administered Does Viagra Work For Erectile Dysfunction (once 100 mg) and saquinavir (1200 mg/day 3 times daily), an inhibitor of HIV protease and of CYP3A4, on the background to achieve a constant concentration of saquinavir in the blood, Cmax of Daily Viagra For Erectile Dysfunction was increased by 140% and the AUC increased by 210%.

Stronger inhibitors of CYP3A4 isoenzyme, such as ketoconazole and Itraconazole, can cause more pronounced changes in the pharmacokinetics of Does Viagra Work For Erectile Dysfunction.

The simultaneous use of Does Viagra Work For Erectile Dysfunction (100 mg once) and ritonavir (500 mg 2 times a day), an inhibitor of HIV protease and a strong inhibitor of cytochrome P450, on the background to achieve a constant concentration of ritonavir in the blood leads to an increase in Cmax of Can Viagra Be Used For Erectile Dysfunction by 300% (4 times), a AUC by 1000% (11-fold). After 24 h, the concentration of Does Viagra Work For Erectile Dysfunction in blood plasma is about 200 ng/ml (after a single application of one Does Viagra Work For Erectile Dysfunction — 5 ng/ml). This is consistent with the ritonavir effect on a wide range of cytochrome P450 substrates. Viagra Erectile Dysfunction Treatment does not affect the pharmacokinetics of ritonavir. Given these data, the simultaneous reception of ritonavir and Viagra Cure Erectile Dysfunction is not recommended. In any case, the maximum dose of Does Viagra Work For Erectile Dysfunction under any circumstances should not exceed 25 mg for 48 hours. If Does Viagra Work For Erectile Dysfunction is taken in the recommended doses, patients receiving strong inhibitors of CYP3A4 isoenzyme at the same time, then Cmax free Does Viagra Work For Erectile Dysfunction does not exceed 200 nm, and the drug is well tolerated.

Single administration of antacid (magnesium hydroxide/aluminum hydroxide) does not affect the bioavailability of Viagra Without Erectile Dysfunction.

Studies involving healthy volunteers with simultaneous use of endothelin receptor antagonist, bosentan (CYP3A4 isoenzyme inducer (moderate), CYP2C9, and possibly CYP2C19) in Css (125 mg 2 times a day) and Does Medicare Cover Viagra For Erectile Dysfunction in Css (80 mg 3 times a day) showed a decrease in AUC and Cmax Viagra Temporary Erectile Dysfunction by 62.6 and 52.4%, respectively. Does Viagra Work For Erectile Dysfunction increased the AUC and Cmax of bosentan by 49.8 and 42%, respectively.

It is assumed that the simultaneous use of Does Medicare Cover Viagra For Erectile Dysfunction with powerful inducers of CYP3A4 isoenzyme, such as rifampicin, can lead to a greater decrease in the concentration of Natural Viagra For Erectile Dysfunction in blood plasma.

CYP2D6 isoenzyme inhibitors (SSRIs, tricyclic antidepressants), thiazide and thiazide-like diuretics, ACE inhibitors and calcium antagonists have no effect on the pharmacokinetics of Does Viagra Work For Erectile Dysfunction.

Azithromycin (500 mg/day for 3 days) has no effect on AUC, Cmax, Tmax, excretion rate constant and T1/2 Viagra Erectile Dysfunction Treatment or its main circulating metabolite.

Does Viagra Work For Erectile Dysfunction is a potent selective inhibitor of cGMP-specific PDE-5.



Mechanism of action

The implementation of the physiological mechanism of erection is associated with the release of nitric oxide (NO) in the cavernous body during sexual stimulation. This, in turn, leads to an increase in the level of cGMP, the subsequent relaxation of smooth muscle tissue of the cavernous body and an increase in blood flow.

Does Viagra Work For Erectile Dysfunction does not have a direct relaxing effect on the isolated cavernous human body, but enhances the effect of nitric oxide by inhibiting PDE-5, which is responsible for the disintegration of cGMP.

Selective Viagra Works Erectile Dysfunction against PDE5 in vitro, its activity against PDE5 superior activity against other known PDE isoenzymes: PDE-6 — 10 times; PDE-1 more than 80 times; PDE-2, PDE-4, PDE-7 PDE–11 more than 700 times. Generic Viagra For Erectile Dysfunction is 4000 times more selective for PDE-5 than PDE-3, which is crucial because PDE-3 is one of the key enzymes in the regulation of myocardial contractility.

A prerequisite for the effectiveness of Which Is Better For Erectile Dysfunction Viagra Or Cialis is sexual stimulation.

Does Viagra Work For Erectile Dysfunction restores impaired erectile function in conditions of sexual stimulation by increasing blood flow to the cavernous bodies of the penis.

The pharmacokinetics of Does Viagra Work For Erectile Dysfunction in the recommended dose range is linear.

Suction. After intake of Will Viagra Work For Erectile Dysfunction is rapidly absorbed. Absolute bioavailability averages about 40% (25 to 63%). In vitro Which Is Better For Erectile Dysfunction Viagra Or Cialis at a concentration of about 1.7 ng/ml (3.5 nm) inhibits the activity of PDE-5 50%. After a single dose of Does Viagra Work For Erectile Dysfunction 100 mg average Cmax free Will Viagra Work For Erectile Dysfunction in plasma men is about 18 ng/ml (38 nm). Cmax when taking Viagra Temporary Erectile Dysfunction inside fasting is achieved for an average of 60 minutes (from 30 to 120 minutes). When taken in combination with fatty foods, the rate of absorption decreases: Cmax decreases by an average of 29%, and Tmax increases by 60 minutes, but the degree of absorption does not change significantly (AUC decreases by 11%).

Distribution. The average Vss of Does Medicare Cover Viagra For Erectile Dysfunction is 105 l. the Association of Viagra Stress Erectile Dysfunction and its main circulating N-demethyl metabolite with plasma proteins is about 96% and does not depend on the total concentration of the drug. Less than 0.0002% of the dose of Does Viagra Work For Erectile Dysfunction (an average of 188 ng) was found in sperm 90 minutes after taking the drug.

Metabolism. Viagra Human Erectile Dysfunction is metabolized mainly in the liver by the action of CYP3A4 isoenzyme (main pathway) and CYP2C9 isoenzyme (minor pathway). The main circulating active metabolite, formed as a result of N-demethylation of Does Viagra Work For Erectile Dysfunction, undergoes further metabolism. The selectivity of this metabolite against PDE is comparable to that of Does Viagra Work For Erectile Dysfunction, and its activity against PDE-5 in vitro is about 50% of the activity of Viagra Stress Erectile Dysfunction. The concentration of the metabolite in the blood plasma of healthy volunteers was about 40% of the concentration of Treatment For Erectile Dysfunction Before Viagra. N-demethyl metabolite undergoes further metabolism; its T1/2 is about 4 no.

Breeding. The total clearance of Natural Viagra For Erectile Dysfunction is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Does Viagra Work For Erectile Dysfunction is excreted as metabolites, mainly by the intestine (about 80% oral dose) and to a lesser extent by the kidneys (about 13% oral dose).

Contraindications

hypersensitivity to Does Viagra Work For Erectile Dysfunction or any other component of the drug;

application in patients receiving constantly or intermittently nitric oxide donators, organic nitrates or nitrites in any form, as Alternative To Viagra For Erectile Dysfunction enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Viagra Cure Erectile Dysfunction, called guanylate cyclase stimulants such as riociguat, because it can lead to symptomatic hypotension;

concomitant use with other agents for the treatment of erectile dysfunction (safety and efficacy of Sildenafil Used For Erectile Dysfunction when used together has not been studied (see. "Special instructions»);

lactose intolerance, lactase deficiency, glucose-papacosma malabsorption;

severe liver failure (class C classification for child-Pugh);

simultaneous administration of ritonavir;

severe cardiovascular diseases (severe heart failure, unstable angina, stroke or myocardial infarction during the last 6 months, life-threatening arrhythmias, hypertension (BP >170/100 mm Hg). art.) or hypotension (blood PRESSURE <90/50 mm Hg.art.) (see "Special instructions»);

patients with episodes of development partizanai anterior ischemic optic neuropathies (NESN) with loss of vision in one eye;

hereditary retinitis pigmentosa (see special instructions»);

according to the registered indication is not intended for use in women;

according to the registered indication is not intended for use in children under 18 years.

With caution: anatomic deformity of the penis (angulation, cavernous fibrosis or Peyronie's disease) (see "Special instructions"); diseases of, predisposing to the development of priapism (sickle-cell anemia, multiple myeloma, leukemia, thrombocythemia) (see "Special instructions"); diseases accompanied by haemorrhage; ulcer disease of stomach and duodenum in the acute phase; liver dysfunction; severe renal insufficiency (Cl creatinine <30 ml/min); patients with an episode of partizanai development of the anterior ischemic optic neuropathies in history (see "Special instructions); simultaneous reception of blockers α-adrenergic receptors.

Use during pregnancy and breast-feeding

According to the registered indication, the drug is not intended for use in women.



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