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Information

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 Viagra Bitcoin Pharmacy Online 100 mg, the second tablet of Viagra Bitcoin Pharmacy Online 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 How To Buy Viagra With 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 Viagra Bitcoin Pharmacy Online 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) Viagra Bitcoin Pharmacy Online dose should be reduced to 25 mg.

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

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

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

Cardiovascular complications

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

When using the drug Viagra Bitcoin Pharmacy Online 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 Viagra Bitcoin Pharmacy Online

The metabolism of Buy Sildenafil With Bitcoins occurs mainly under the action of CYP3A4 isoenzyme (main pathway), so inhibitors of this isoenzyme can reduce the clearance of Viagra Bitcoin Pharmacy Online, and inducers, respectively, increase the clearance of Viagra Bitcoin Pharmacy Online. A decrease in the clearance of The Purchase Of Extra Super Viagra with simultaneous use of inhibitors of CYP3A4 isoenzyme (ketoconazole, erythromycin, cimetidine).

Cimetidine (800 mg), a nonspecific inhibitor of CYP3A4 isoenzyme, when taken together with Viagra Bitcoin Pharmacy Online (50 mg) causes an increase in the concentration of Viagra Bitcoin Pharmacy Online in plasma by 56%.

A single dose of 100 mg of Viagra Bitcoin Pharmacy Online 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 Viagra Bitcoin Pharmacy Online by 182%.

When co-administered Viagra Bitcoin Pharmacy Online (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 Viagra 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 Purchase Viagra For Bitcoin Online Pharmacy.

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

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 The Purchase Of Extra Super Viagra in Css (80 mg 3 times a day) showed a decrease in AUC and Cmax Buy Sildenafil Bitcoin by 62.6 and 52.4%, respectively. Viagra Bitcoin Pharmacy Online increased the AUC and Cmax of bosentan by 49.8 and 42%, respectively.

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

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

Clinical data

In a placebo-controlled cross-examination of patients with proven early age macular degeneration (n=9), Viagra Bitcoin Pharmacy Online was well tolerated at a single dose of 100 mg. There were no clinically significant changes in vision evaluated by special visual tests (visual acuity, Amsler lattice, color perception, color simulation, Humphrey perimeter and photostress).

Efficiency. The efficacy and safety of Viagra Bitcoin Pharmacy Online were evaluated in 21 randomized double-blind placebo-controlled studies lasting up to 6 months in 3000 patients from 19 to 87 years with erectile dysfunction of different etiology (organic, psychogenic or mixed). The efficacy of the drug was evaluated globally using an erection diary, an international erectile function index (validated questionnaire on the state of sexual function) and a partner survey.

The effectiveness of Viagra Bitcoin Pharmacy Online, defined as the ability to achieve and maintain an erection sufficient for satisfactory sexual intercourse, has been demonstrated in all studies and confirmed in long-term studies lasting 1 year. In studies with the use of fixed-dose proportion of patients reporting that treatment improved their erections were 62% (dose of Viagra Bitcoin Pharmacy Online 25 mg), 74% (dose Viagra Bitcoin Pharmacy Online 50 mg) and 82% (dose Buy Viagra With Bitcoin Or Credit Card 100 mg) compared to 25% in the placebo group. Analysis of the international index of erectile function showed that in addition to improving erection treatment Viagra Bitcoin Pharmacy Online also increased the quality of orgasm, allowing to achieve satisfaction from sexual intercourse and overall satisfaction.

According to the generalized data, 59% of patients with diabetes, 43% of patients who underwent radical prostatectomy and 83% of patients with spinal cord injuries (against 16, 15 and 12% in the placebo group, respectively) were reported to have improved erection in the treatment of Pay For Sildenafil With Bitcoin.

Pharmacokinetics

The pharmacokinetics of Viagra Bitcoin Pharmacy Online in the recommended dose range is linear.

Suction. After intake of Viagra Bitcoin Pharmacy Online is rapidly absorbed. Absolute bioavailability averages about 40% (25 to 63%). In vitro Buy Sildenafil With Bitcoins at a concentration of about 1.7 ng/ml (3.5 nm) inhibits the activity of PDE-5 50%. After a single dose of Viagra Bitcoin Pharmacy Online 100 mg average Cmax free Buy Viagra Bitcoin in plasma men is about 18 ng/ml (38 nm). Cmax when taking Viagra Bitcoin Pharmacy Online 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 Purchase Viagra For Bitcoin Online Pharmacy is 105 l. the Association of Viagra Bitcoin Pharmacy Online 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 Viagra Online Bitcoin Or Credit Card (an average of 188 ng) was found in sperm 90 minutes after taking the drug.

Metabolism. The Purchase Of Extra Super Viagra 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 Viagra Bitcoin Pharmacy Online, undergoes further metabolism. The selectivity of this metabolite against PDE is comparable to that of Generic Female Viagra For Bitcoin, and its activity against PDE-5 in vitro is about 50% of the activity of Viagra Bitcoin Pharmacy Online. The concentration of the metabolite in the blood plasma of healthy volunteers was about 40% of the concentration of Pay For Female Viagra With Bitcoin. N-demethyl metabolite undergoes further metabolism; its T1/2 is about 4 no.

Breeding. The total clearance of Generic Viagra For Bitcoin is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Viagra Bitcoin Pharmacy Online 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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