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Information

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 Purchase Viagra For Bitcoin Online Pharmacy 100 mg, the second tablet of Purchase Viagra For Bitcoin Online Pharmacy 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 Purchase Viagra For Bitcoin Online Pharmacy 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 Purchase Viagra For Bitcoin Online Pharmacy 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) Purchase Viagra For Bitcoin Online Pharmacy dose should be reduced to 25 mg.

Hepatic impairment. Since the excretion of Purchase Viagra For Bitcoin Online Pharmacy is disturbed in patients with liver damage (in particular, cirrhosis), the dose of Purchase Viagra For Bitcoin Online Pharmacy 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 Pay For Kamagra With Bitcoin 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 Viagra Bitcoin Pharmacy Online should be 25 mg (see "Interaction").

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

Old age. Adjustment of the dose of Pay For Viagra With Bitcoin is not required.

Clinical data

Cardiac studies. The use of Purchase Viagra For Bitcoin Online Pharmacy 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 Cheap Viagra Professional Accept Bitcoin 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").

In a study of the hemodynamic effect of Female Viagra Bitcoin Pharmacy Online in a single dose of 100 mg in 14 patients with severe coronary artery disease (more than 70% of patients had stenosis of at least one coronary artery), systolic and diastolic resting pressure decreased by 7 and 6%, respectively, and pulmonary systolic pressure decreased by 9%. Purchase Viagra For Bitcoin Online Pharmacy did not affect cardiac output and did not interfere with blood flow in stenotic coronary arteries, and also led to an increase (by about 13%) of adenosine-induced coronary flow in both stenotic and intact coronary arteries. In a double-blind placebo-controlled study of 144 patients with erectile dysfunction and stable angina, taking antianginal drugs (except nitrates), exercise was performed until the severity of symptoms of angina increased. The duration of the exercise was significantly longer (19.9 seconds; 0.9–38.9 seconds) in patients taking Purchase Viagra For Bitcoin Online Pharmacy in a single dose of 100 mg, compared with patients receiving placebo.

In a randomized double-blind placebo-controlled study, the effect of changing the dose of Purchase Viagra For Bitcoin Online Pharmacy (up to 100 mg) in men (n=568) with erectile dysfunction and hypertension, taking more than two antihypertensive drugs, was studied. Purchase Viagra For Bitcoin Online Pharmacy improved erection in 71% of men compared to 18% in the placebo group. The frequency of adverse effects was comparable to that in other groups of patients, as well as in those taking more than three antihypertensive drugs.

Studies of visual impairment. In some patients, 1 h after taking Pay For Sildenafil With Bitcoin at a dose of 100 mg with the Farnsworth-Mansell test 100 revealed a slight and transient violation of the ability to distinguish shades of color (blue/green). After 2 hours after taking the drug, these changes were absent. It is believed that color vision impairment is caused by inhibition of PDE-6, which is involved in the process of color transmission in the retina. Purchase Viagra For Bitcoin Online Pharmacy had no effect on visual acuity, contrast perception, electroretinogram, IOP or pupil diameter.

Contraindications

hypersensitivity to Purchase Viagra For Bitcoin Online Pharmacy 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 Pay For Female Viagra With Bitcoin enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Purchase Viagra For Bitcoin Online Pharmacy, 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 Pay For Female Viagra With Bitcoin 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.

The pharmacokinetics of Purchase Viagra For Bitcoin Online Pharmacy in the recommended dose range is linear.

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

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

Breeding. The total clearance of Purchase Viagra For Bitcoin Online Pharmacy is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Purchase Viagra For Bitcoin Online Pharmacy 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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