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Information

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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.

Cheap Viagra Accept Btc 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 Sale Super Viagra Accept Btc 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. Cheap Viagra Accept Btc 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 Cheap Viagra Accept Btc is sexual stimulation.

Cheap Viagra Accept Btc restores impaired erectile function in conditions of sexual stimulation by increasing blood flow to the cavernous bodies of the penis.

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The incidence of nosebleeds in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (Buy Sildenafil Btc — 12.9%, placebo — 0%) than in patients with primary pulmonary arterial hypertension (Cheap Viagra Accept Btc — 3%, placebo — 2.4%). Patients receiving Buy Kamagra Btc in combination with an antagonist of vitamin K, the frequency of nasal bleeding was higher (8.8 percent) than patients who were not taking an antagonist of vitamin K (1.7 percent).

Use in conjunction with other means for the treatment of erectile dysfunction

The safety and efficacy of Buy Sildenafil With Btc Or Credit Card together with other PDE-5 inhibitors or other drugs for the treatment of pulmonary hypertension containing Cheap Viagra Accept Btc (eg, Revatsio®), or other means for the treatment of erection disorders have not been studied, so the use of such combinations is not recommended (see "Contraindications").

Influence on the ability to drive and mechanisms. In patients receiving Generic Kamagra For Btc any negative effect on the ability to drive a car or other means was not observed. However, since when taking Cheap Viagra Accept Btc may develop dizziness, lowering blood PRESSURE, the development of chromatopsia, blurred vision, etc. side effects, care should be taken when driving and doing other potentially dangerous activities that require increased concentration and speed of psychomotor reactions. Also, you should be careful about the individual action of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.

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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 Cheap Viagra Accept Btc. 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 Cheap Viagra Accept Btc without subsequent sexual activity. It is not possible to establish a direct link between the reported adverse events and those or other factors.

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Kamagra Btc Pharmacy Online 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 Pay For Female Viagra With Btc, 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 Cheap Viagra Accept Btc and α-blockers can lead to symptomatic hypotension in some sensitive patients, Cheap Viagra Accept Btc 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 Buy Sildenafil With Btc should be started only after achieving stabilization of hemodynamic parameters in these patients. It should also consider reducing the initial dose of Cheap Viagra Accept Btc (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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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 Cheap Viagra Accept Btc. 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.

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In rare cases, during post-approval use of all of the inhibitors of PDE5, including Cheap Viagra Accept 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 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 Generic Kamagra For 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 Discount Red Viagra With Btc, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk.

When using the drug Female Viagra Btc Pharmacy Online 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 Cheap Viagra Accept Btc

The metabolism of Cheap Viagra Accept Btc occurs mainly under the action of CYP3A4 isoenzyme (main pathway), so inhibitors of this isoenzyme can reduce the clearance of Cheap Viagra Accept Btc, and inducers, respectively, increase the clearance of Pay For Viagra With Btc. A decrease in the clearance of Generic Sildenafil For Btc with simultaneous use of inhibitors of CYP3A4 isoenzyme (ketoconazole, erythromycin, cimetidine).

Cimetidine (800 mg), a nonspecific inhibitor of CYP3A4 isoenzyme, when taken together with Buy Female Viagra With Btc (50 mg) causes an increase in the concentration of Viagra Btc Pharmacy Online in plasma by 56%.

A single dose of 100 mg of Buy Viagra Btc 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 Pay For Female Viagra With Btc by 182%.

When co-administered Cheap Viagra Accept Btc (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 The Purchase Of Extra Super Viagra 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 Cheap Viagra Accept Btc.

The simultaneous use of Female Viagra Btc Pharmacy Online (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 Pay For Kamagra With Btc by 300% (4 times), a AUC by 1000% (11-fold). After 24 h, the concentration of Cheap Viagra Accept Btc in blood plasma is about 200 ng/ml (after a single application of one Cheap Viagra Accept Btc — 5 ng/ml). This is consistent with the ritonavir effect on a wide range of cytochrome P450 substrates. Cheap Viagra Accept Btc does not affect the pharmacokinetics of ritonavir. Given these data, the simultaneous reception of ritonavir and Sale Super Viagra Accept Btc is not recommended. In any case, the maximum dose of Cheap Viagra Accept Btc under any circumstances should not exceed 25 mg for 48 hours. If Buy Viagra With Btc is taken in the recommended doses, patients receiving strong inhibitors of CYP3A4 isoenzyme at the same time, then Cmax free Cheap Viagra Accept Btc 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 Female Viagra Btc Pharmacy Online.

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 Buy Kamagra Btc in Css (80 mg 3 times a day) showed a decrease in AUC and Cmax Generic Sildenafil For Btc by 62.6 and 52.4%, respectively. Cheap Viagra Accept Btc increased the AUC and Cmax of bosentan by 49.8 and 42%, respectively.

It is assumed that the simultaneous use of Cheap Viagra Accept Btc with powerful inducers of CYP3A4 isoenzyme, such as rifampicin, can lead to a greater decrease in the concentration of Cheap Viagra Accept Btc 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 Cheap Viagra Accept Btc.

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



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