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Clinical data

Cardiac studies. The use of Pay For Female Viagra With Bitcoin 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 How To Buy Viagra With Bitcoin Online Pharmacy 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 Buy Viagra With Bitcoins 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%. Pay For Female Viagra With Bitcoin 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 Female Viagra Bitcoin Pharmacy Online 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 Buy Viagra With Bitcoin Or Credit Card (up to 100 mg) in men (n=568) with erectile dysfunction and hypertension, taking more than two antihypertensive drugs, was studied. Buy Viagra Bitcoin 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 Buy Viagra 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. Buy Female Viagra With Bitcoin had no effect on visual acuity, contrast perception, electroretinogram, IOP or pupil diameter.

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 Kamagra With Bitcoin 100 mg, the second tablet of Cheap Viagra Professional Accept Bitcoin 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 Kamagra With Bitcoins 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 Viagra Bitcoin 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 Viagra Bitcoin dose should be reduced to 25 mg.

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

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

Old age. Adjustment of the dose of Generic Sildenafil For Bitcoin is not required.

Cardiovascular complications

During the post-marketing use of Buy Viagra Bitcoin 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 Viagra Bitcoin. 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 Viagra Bitcoin 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 Viagra 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 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 Buy Viagra 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 Viagra Bitcoin, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk.

When using the drug Buy Viagra Bitcoin 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 Female Viagra With Bitcoins

The metabolism of Buy Viagra Bitcoin occurs mainly under the action of CYP3A4 isoenzyme (main pathway), so inhibitors of this isoenzyme can reduce the clearance of Buy Viagra Bitcoin, and inducers, respectively, increase the clearance of Buy Viagra Bitcoin. A decrease in the clearance of Pay For Female Viagra With Bitcoin with simultaneous use of inhibitors of CYP3A4 isoenzyme (ketoconazole, erythromycin, cimetidine).

Cimetidine (800 mg), a nonspecific inhibitor of CYP3A4 isoenzyme, when taken together with Pay For Female Viagra With Bitcoin (50 mg) causes an increase in the concentration of Buy Viagra Online Bitcoin Or Credit Card in plasma by 56%.

A single dose of 100 mg of Buy Viagra Bitcoin 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 Bitcoins by 182%.

When co-administered Buy Female Viagra With Bitcoin (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 Sildenafil Bitcoin Pharmacy Online 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 Kamagra With Bitcoin.

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

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

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

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

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 Generic Viagra For 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 With Bitcoin, consult a doctor immediately.

Bleedings

Pay For Sildenafil With Bitcoin enhances the antiplatelet effect of sodium nitroprusside, a nitric oxide donator, on human platelets in vitro. Data on the safety of Discount Red Viagra With Bitcoin in patients with a tendency to bleeding or exacerbation of gastric ulcer and duodenal ulcer are not available, so the drug Buy Female Viagra With Bitcoins 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 (Buy Viagra Bitcoin — 12.9%, placebo — 0%) than in patients with primary pulmonary arterial hypertension (Buy Kamagra Bitcoin — 3%, placebo — 2.4%). Patients receiving Buy Viagra 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 Female Viagra With Bitcoins together with other PDE-5 inhibitors or other drugs for the treatment of pulmonary hypertension containing Kamagra Bitcoin Pharmacy Online (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 Buy Viagra Bitcoin any negative effect on the ability to drive a car or other means was not observed. However, since when taking Buy Female Viagra With Bitcoins 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.

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