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The use of Sildenafil Btc Pharmacy Online in doses up to 100 mg did not lead to clinically significant ECG changes in healthy volunteers. The maximum decrease in systolic pressure in the supine position after taking Sildenafil Btc Pharmacy Online at a dose of 100 mg was 8.3 mm Hg.art., and diastolic pressure — 5.3 mm Hg.a More pronounced, but also transient effect on blood PRESSURE was observed in patients taking nitrates (see "Contraindications" and "Interaction").


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Information

The pharmacokinetics of Sildenafil Btc Pharmacy Online in the recommended dose range is linear.

Suction. After intake of Sildenafil Btc Pharmacy Online is rapidly absorbed. Absolute bioavailability averages about 40% (25 to 63%). In vitro Generic Sildenafil For Btc at a concentration of about 1.7 ng/ml (3.5 nm) inhibits the activity of PDE-5 50%. After a single dose of Sildenafil Btc Pharmacy Online 100 mg average Cmax free Buy Kamagra Btc in plasma men is about 18 ng/ml (38 nm). Cmax when taking Buy Viagra Online Btc Or Credit Card 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 Generic Sildenafil For Btc is 105 l. the Association of Kamagra For Btc 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 Sildenafil Btc Pharmacy Online (an average of 188 ng) was found in sperm 90 minutes after taking the drug.

Metabolism. Sildenafil Btc Pharmacy Online 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 Sildenafil Btc Pharmacy Online, undergoes further metabolism. The selectivity of this metabolite against PDE is comparable to that of Sildenafil Btc Pharmacy Online, and its activity against PDE-5 in vitro is about 50% of the activity of Sildenafil Btc Pharmacy Online. The concentration of the metabolite in the blood plasma of healthy volunteers was about 40% of the concentration of Sildenafil Btc Pharmacy Online. N-demethyl metabolite undergoes further metabolism; its T1/2 is about 4 no.

Breeding. The total clearance of Buy Sildenafil With Btc Or Credit Card is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Pay For Female Viagra With Btc is excreted as metabolites, mainly by the intestine (about 80% oral dose) and to a lesser extent by the kidneys (about 13% oral dose).

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In rare cases, during post-approval use of all of the inhibitors of PDE5, including Buy Sildenafil With Btc, 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 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 Buy Kamagra Btc 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 Sildenafil Btc Pharmacy Online, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk. In patients with episodes of development PINZN with loss of vision in one eye receiving Sildenafil Btc Pharmacy Online is contraindicated (see "Contraindications").

A small number of patients with hereditary retinitis pigmentosa have genetically determined disorders of the PDE of the retina. Information about the safety of the drug Sildenafil Btc Pharmacy Online in patients with retinitis pigmentosa absent, so these patients should not be used Sildenafil Btc Pharmacy Online (see "Contraindications").

Dosage and administration

Inside, can be taken with or without water. When taking the drug, you should put a tablet, dispersed in the oral cavity, on the tongue, after which it will quickly dissolve, and it can be swallowed. The tablet should be taken immediately after opening the blister. Patients who are recommended a dose of Pay For Kamagra With Btc 100 mg, the second tablet of Discount Red Viagra With Btc 50 mg should be taken after complete dissolution of the first tablet.

The recommended dose for most adult patients is 50 mg approximately 1 hour before sexual activity. Taking into account the effectiveness and tolerability of the dose can be increased to 100 mg or reduced to 25 mg (only tablets coated with a film, the appropriate dosage). The maximum recommended dose is 100 mg. Patients who are recommended a dose of Sildenafil Btc Pharmacy Online 100 mg, it is necessary to take 2 table., dispersible in the oral cavity, dosage 50 mg consecutively one after another. The maximum recommended frequency of use — 1 time per day. It should be borne in mind that the absorption of Sildenafil Btc Pharmacy Online significantly slows down when used in combination with fatty foods.

Special patient groups

Renal impairment. In mild to moderate renal failure dose adjustment is not required, in severe renal failure (Creatinine CL <30 ml/min) Pay For Viagra With Btc dose should be reduced to 25 mg.

Hepatic impairment. Since the excretion of Sildenafil Btc Pharmacy Online is disturbed in patients with liver damage (in particular, cirrhosis), the dose of Buy Sildenafil With Btc Or Credit Card should be reduced to 25 mg.

Joint application with other drugs. Joint use with ritonavir is not recommended. In any case, the maximum dose of Sildenafil Btc Pharmacy Online under any circumstances should not exceed 25 mg, and the frequency of application — 1 time in 48 h (see "Interaction").

When combined with inhibitors of CYP3A4 isoenzyme (erythromycin, saquinavir, ketoconazole, Itraconazole), the initial dose of Buy Viagra With Btc should be 25 mg (see "Interaction").

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

Old age. Adjustment of the dose of Buy Viagra Online Btc Or Credit Card is not required.

Cardiovascular complications

During the post-marketing use of Cheap Viagra Accept Btc 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 Buy Viagra Online Btc Or Credit Card. 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 Sildenafil Btc Pharmacy Online without subsequent sexual activity. It is not possible to establish a direct link between the reported adverse events and those or other factors.

Hypotension

Kamagra For Btc has a systemic vasodilating effect, leading to a transient decrease in blood PRESSURE, which is not clinically significant and does not lead to any consequences in most patients. However, before prescribing Sildenafil Btc Pharmacy Online, the doctor should carefully assess the risk of possible undesirable manifestations of vasodilating action in patients with relevant diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the output tract of the left ventricle (aortic stenosis, GOCMP), as well as with the rare syndrome of multiple systemic atrophy, manifested by a severe violation of the regulation of blood PRESSURE from the autonomic nervous system.

Since the combined use of Sildenafil Btc Pharmacy Online and α-blockers can lead to symptomatic hypotension in some sensitive patients, Sildenafil Btc Pharmacy Online should be used with caution in patients taking α-blockers (see "Interaction"). To minimize the risk of postural hypotension in patients taking α-blockers, the drug Sildenafil Btc Pharmacy Online should be started only after achieving stabilization of hemodynamic parameters in these patients. It should also consider reducing the initial dose of Sildenafil Btc Pharmacy Online (see. "Dosage and administration"). The doctor should inform patients about what actions should be taken in case of symptoms of postural hypotension.



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