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The pharmacokinetics of Cheap Viagra Professional Accept Bitcoin 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 How To Buy Viagra With 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 Discount Red Viagra With 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 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 Buy Sildenafil 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).

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 Buy Viagra With Bitcoins enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Cheap Viagra Professional Accept 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 Purchase Viagra For Bitcoin Online Pharmacy 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.

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 Buy Kamagra With Bitcoins 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) Buy Sildenafil With Bitcoin Or Credit Card 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 How To Buy Viagra With 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 Viagra Bitcoin Pharmacy Online should be 25 mg (see "Interaction").

To minimize the risk of postural hypotension in patients taking α-blockers, Generic Viagra For 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 Purchase Viagra For Bitcoin Online Pharmacy is not required.

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 Pay For Female Viagra 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

Buy Sildenafil With Bitcoin 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 Purchase Viagra For Bitcoin Online Pharmacy, 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 The Purchase Of Extra Super Viagra and α-blockers can lead to symptomatic hypotension in some sensitive patients, Buy Viagra Online Bitcoin Or Credit Card 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 Buy Kamagra With Bitcoins 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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