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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.

Sildenafil Btc Pharmacy Online 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 How To Buy Viagra With Btc Online Pharmacy 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. How To Buy Viagra With Btc Online Pharmacy 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 Pay For Kamagra With Btc is sexual stimulation.

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

The pharmacokinetics of Discount Red Viagra With Btc in the recommended dose range is linear.

Suction. After intake of Discount Red Viagra With Btc is rapidly absorbed. Absolute bioavailability averages about 40% (25 to 63%). In vitro Discount Red Viagra With 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 Pay For Female Viagra With Btc 100 mg average Cmax free Discount Red Viagra With Btc in plasma men is about 18 ng/ml (38 nm). Cmax when taking Buy Sildenafil With Btc 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 Buy Kamagra With Btc is 105 l. the Association of Sale Super Viagra Accept 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 Discount Red Viagra With Btc (an average of 188 ng) was found in sperm 90 minutes after taking the drug.

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

Breeding. The total clearance of Buy Viagra With Btc is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Discount Red 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).

Influence of Discount Red Viagra With Btc on other drugs

Discount Red Viagra With Btc is a weak inhibitor of cytochrome P450 — 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 ISOENZYMES (IC50 >150 µmol). When taking Kamagra For Btc in recommended doses, its Cmax is about 1 µmol, so it is unlikely that Discount Red Viagra With Btc can affect the clearance of the substrates of these isoenzymes.

Discount Red Viagra With Btc increases the hypotensive effect of nitrates both with long-term use of the latter, and with their appointment for urgent indications. In this regard, the use of Sildenafil Btc Pharmacy Online in combination with nitrates or nitric oxide donators is contraindicated. While taking α-adrenoblocker doxazosin (4 and 8 mg) and Discount Red Viagra With Btc (25, 50 and 100 mg) in patients with benign prostate hyperplasia with stable hemodynamics, the average additional decrease in sad/dad in the supine position was 7/7, 9/5 and 8/4 mm Hg.article, respectively, while in the standing position — 6/6, 11/4 mmHg, and 4/5.art. respectively. Reported rare cases of symptomatic postural hypotension in such patients, manifested in the form of dizziness (without fainting). In some sensitive patients receiving α-blockers, simultaneous use of Kamagra Btc Pharmacy Online can lead to symptomatic hypotension.

There were no signs of significant interaction with tolbutamide (250 mg) or warfarin (40 mg), which are metabolized by CYP2C9 isoenzyme.

Pay For Female Viagra With Btc (100 mg) has no effect on the pharmacokinetics of the HIV protease inhibitor, saquinavir, which is a substrate of CYP3A4 isoenzyme, at its constant level in the blood.

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In patients with hypertension, no signs of interaction of Buy Sildenafil With Btc (100 mg) with amlodipine were found. The average additional reduction in blood PRESSURE in the supine position is 8 mm Hg.V. (systolic) and 7 mm Hg.V. (diastolic).

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Visual impairment

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 Purchase Viagra For Btc Online Pharmacy 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. In patients with episodes of development PINZN with loss of vision in one eye receiving Discount Red Viagra With Btc 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 Pay For Viagra With Btc (see "Contraindications").



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