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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) Female Viagra Bitcoin Pharmacy Online 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 Purchase Viagra For Bitcoin Online Pharmacy 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 Purchase Viagra For Bitcoin Online Pharmacy should be 25 mg (see "Interaction").

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

Old age. Adjustment of the dose of Purchase Viagra For Bitcoin Online Pharmacy is not required.

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Suction. After intake of Pay For Viagra With Bitcoin is rapidly absorbed. Absolute bioavailability averages about 40% (25 to 63%). In vitro Generic Female Viagra For Bitcoin 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 Buy Female Viagra With Bitcoins 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 Viagra Bitcoin Pharmacy Online is 105 l. the Association of Discount Red Viagra With Bitcoin 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 Purchase Viagra For Bitcoin Online Pharmacy (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 Kamagra For Bitcoin. 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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Mechanism of action

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Pay For Kamagra With 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 Purchase Viagra For Bitcoin 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. Purchase Viagra For Bitcoin 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 Viagra With Bitcoin is sexual stimulation.

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Cardiovascular complications

During the post-marketing use of Purchase Viagra For Bitcoin Online Pharmacy 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 Purchase Viagra For Bitcoin Online Pharmacy. 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 Kamagra With Bitcoin without subsequent sexual activity. It is not possible to establish a direct link between the reported adverse events and those or other factors.

Hypotension

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