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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.

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

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Buy Kamagra 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 Buy Kamagra 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 Buy Kamagra Bitcoin and α-blockers can lead to symptomatic hypotension in some sensitive patients, Buy Kamagra Bitcoin 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 Bitcoin should be started only after achieving stabilization of hemodynamic parameters in these patients. It should also consider reducing the initial dose of Generic Sildenafil For Bitcoin (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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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 With Bitcoins, 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 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 Generic Kamagra For Bitcoin in patients with retinitis pigmentosa absent, so these patients should not be used Buy Kamagra Bitcoin (see "Contraindications").

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

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

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

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