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Information

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

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

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

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

Buy Viagra With Btc 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.

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

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

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 Buy Viagra Btc 100 mg, the second tablet of Buy 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 Buy Sildenafil Btc 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 Buy Female Viagra With Btc 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) Buy Sildenafil Btc dose should be reduced to 25 mg.

Hepatic impairment. Since the excretion of Generic Kamagra For Btc is disturbed in patients with liver damage (in particular, cirrhosis), the dose of Buy Sildenafil Btc 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 Buy Sildenafil Btc 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 Sildenafil Btc should be 25 mg (see "Interaction").

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

Old age. Adjustment of the dose of Buy Sildenafil With Btc is not required.

Cardiovascular complications

During the post-marketing use of Kamagra For 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 Sildenafil 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 Buy Sildenafil Btc 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 Buy Female Viagra 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 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 Viagra Btc Pharmacy Online 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 The Purchase Of Extra Super Viagra, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk.

When using the drug Buy Sildenafil Btc 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 Buy Sildenafil Btc

The metabolism of Buy Viagra With Btc occurs mainly under the action of CYP3A4 isoenzyme (main pathway), so inhibitors of this isoenzyme can reduce the clearance of Buy Sildenafil Btc, and inducers, respectively, increase the clearance of Buy Sildenafil Btc. A decrease in the clearance of Buy Sildenafil 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 Purchase Viagra For Btc Online Pharmacy (50 mg) causes an increase in the concentration of Buy Sildenafil Btc in plasma by 56%.

A single dose of 100 mg of Buy Sildenafil 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 Buy Viagra With Btc by 182%.

When co-administered How To Buy Viagra With Btc Online Pharmacy (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 Buy Sildenafil Btc.

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

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

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

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



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