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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 Bitcoin. 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 Buy Sildenafil Bitcoin, consult a doctor immediately.

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The incidence of nosebleeds in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (Buy Sildenafil Bitcoin — 12.9%, placebo — 0%) than in patients with primary pulmonary arterial hypertension (Buy Sildenafil Bitcoin — 3%, placebo — 2.4%). Patients receiving Buy Sildenafil Bitcoin 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 Buy Sildenafil 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 Pay For Kamagra With Bitcoin any negative effect on the ability to drive a car or other means was not observed. However, since when taking Buy Sildenafil Bitcoin 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.

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 Kamagra Bitcoin Pharmacy Online enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Buy Sildenafil Bitcoin, 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 Sildenafil 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 Buy Sildenafil Bitcoin in the recommended dose range is linear.

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

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

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

Visual impairment

In rare cases, during post-approval use of all of the inhibitors of PDE5, including Buy Sildenafil Bitcoin, 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 Generic Female Viagra For Bitcoin 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 Buy Sildenafil Bitcoin, 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 Buy Kamagra With Bitcoin 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 Buy Sildenafil Bitcoin in patients with retinitis pigmentosa absent, so these patients should not be used Viagra Bitcoin Pharmacy Online (see "Contraindications").

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