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Information

Hearing impairment

Some post-marketing and clinical studies have reported cases of sudden hearing loss or impairment associated with the use of all PDE-5 inhibitors, including Buy Sildenafil With Bitcoins. Most of these patients had risk factors for sudden impairment or hearing loss. There is no causal relationship between the use of PDE-5 inhibitors and sudden hearing impairment or hearing loss. In case of sudden hearing impairment or hearing loss while taking Kamagra Bitcoin Pharmacy Online, consult a doctor immediately.

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Kamagra Bitcoin Pharmacy Online enhances the antiplatelet effect of sodium nitroprusside, a nitric oxide donator, on human platelets in vitro. Data on the safety of Kamagra Bitcoin Pharmacy Online in patients with a tendency to bleeding or exacerbation of gastric ulcer and duodenal ulcer are not available, so the drug Kamagra Bitcoin Pharmacy Online in these patients should be used with caution (see With caution).

The incidence of nosebleeds in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (How To Buy Viagra With Bitcoin Online Pharmacy — 12.9%, placebo — 0%) than in patients with primary pulmonary arterial hypertension (Generic Kamagra For Bitcoin — 3%, placebo — 2.4%). Patients receiving Kamagra Bitcoin Pharmacy Online 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 Bitcoin together with other PDE-5 inhibitors or other drugs for the treatment of pulmonary hypertension containing Pay For Viagra With Bitcoin (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 Sildenafil Bitcoin Pharmacy Online any negative effect on the ability to drive a car or other means was not observed. However, since when taking The Purchase Of Extra Super Viagra 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.

Kamagra Bitcoin Pharmacy Online 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.

Generic Kamagra For Bitcoin 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 Kamagra Bitcoin Pharmacy Online 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. Kamagra Bitcoin Pharmacy Online 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 Kamagra Bitcoin Pharmacy Online is sexual stimulation.

Kamagra Bitcoin Pharmacy Online restores impaired erectile function in conditions of sexual stimulation by increasing blood flow to the cavernous bodies of the penis.

The pharmacokinetics of Kamagra Bitcoin Pharmacy Online in the recommended dose range is linear.

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

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

Breeding. The total clearance of Sildenafil Bitcoin Pharmacy Online is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Kamagra Bitcoin Pharmacy Online is excreted as metabolites, mainly by the intestine (about 80% oral dose) and to a lesser extent by the kidneys (about 13% oral dose).

Contraindications

hypersensitivity to Kamagra Bitcoin Pharmacy Online 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 The Purchase Of Extra Super Viagra enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Sildenafil Bitcoin Pharmacy Online, 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 Buy Kamagra 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.

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