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Generic Viagra Online: Viagra instruction, price in pharmacies on Viagra

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Instructions for Viagra: composition and the form of release, indications for use. Average price: 164.08 – 1625.36 UAH. Full information on the website apteka911.com.ua

Composition:

The main active substance is sildenafil, presented in the form of citrate.

As excipients, anhydrous calcium hydrogen phosphate, magnesium stearate, croscarmellose sodium, titanium dioxide (E 171), triacetin, MCC, hypromellose, indigo carmine aluminum varnish (E 132), lactose are used.

Release form:

Viagra is distributed in the form of coated tablets. Tablets are in a blister made of aluminum foil, which in turn is located in a carton.

Pharmaceutical action

Pharmacodynamics. Viagra is an oral medication that is used to treat erectile dysfunction in men. The drug is a citrate salt of Sildenafil, a selective cGMP viagra generic name inhibitor of specific PDE-5.

The physiological mechanism of penile erection is the release of nitric oxide (NO) in the cavernous body during sexual stimulation. NO activates the enzyme guanylate cyclase, which causes an increase in cGMP, relaxation of the smooth muscles of the cavernous body, and an increase in blood flow to them.

Sildenafil does not have a direct relaxing effect on the isolated cavernous body of a person, however, it significantly increases the effectiveness of NO by inhibiting PDE-5, which is responsible for the splitting of cGMP in the cavernous body. When the local release of NO occurs during sexual stimulation, the inhibition of PDE-5 by sildenafil leads to an increase in the concentration of cGMP in the cavernous body, resulting in relaxation of the smooth muscle and an increase in blood flow to the cavernous body. The use of sildenafil in recommended doses will be ineffective without sexual stimulation.

In vitro studies have established that sildenafil has selectivity for PDE5. Its effect on PDE-5 is more pronounced than in relation to other known PDEs (10 times stronger than in relation to PDE-6, 80 times compared to PDE-1, 700 times compared to PDE-2, PDE-3, PDE-4, PDE-7 – PDE-11. In particular, sildenafil has a 400 times better selectivity for PDE-5 than PDE-3, cGMP specific PDE isoform, which participates in the processes of heart contraction.

Visual impairment. When using Sildenafil at a dose of 100 mg in some patients, after 1 h, a slight transient disturbance of color distinction (blue / green) was detected using the Famsworth-Munsell 100 test; 2 hours after taking the drug, these disorders disappear. A possible mechanism for the violation of color vision is considered to be the inhibition of PDE-6, which takes part in the process of transmitting light in the retina. The in vitro results show that the effect of Sildenafil on PDE-6 is 10 times less than its activity relative to PDE-5. Sildenafil does not affect visual acuity, perception contrast, electroretinogram, intraocular pressure, or pupilometry.

Efficiency. The effectiveness of Sildenafil, which was evaluated relative to the ability of the drug to ensure the onset and preservation of an erection sufficient for sexual intercourse, was demonstrated and maintained with prolonged use of the drug (1 year).

In the study when taking sildenafil in doses of 25, 50, 100 mg, an improvement in erection was observed in 62, 74, 82%, respectively. In addition to improving erectile function, an analysis of the international index of erectile function showed that treatment with sildenafil enhances orgasm and a sense of satisfaction from sexual intercourse. In the treatment with Sildenafil, improvement was noted in 59% of patients with diabetes mellitus; in patients with radical prostatectomy – 43%, in patients with spinal cord injury – 83%.

Pharmacokinetics. Within the recommended dose range, Sildenafil pharmacokinetics is proportional to dose. The drug is eliminated from the body primarily by biotransformation in the liver (mainly with the participation of cytochrome P450 3A4) with the formation of an active metabolite with properties similar to sildenafil.

Suction. Sildenafil is rapidly absorbed after oral administration with an absolute bioavailability of 41% on average (25–63%). Sildenafil inhibits PDE-5 enzyme in vitro up to 50% at a concentration of 3.5 nM. The average concentration in the blood plasma after the use of Sildenafil at a dose of 100 mg is approximately 18 ng / ml or 38 nM. The maximum plasma concentration is reached in 30–120 minutes (on average 60 minutes) after oral administration on an empty stomach. Absolute bioavailability when administered orally is 40% (within 25–63%). If the drug is taken with fatty foods, the absorption rate decreases and the time to reach maximum plasma concentration increases by an average of 60 minutes, and the maximum plasma concentration decreases by an average of 29%, but the degree of absorption is not affected (AUC decreased by eleven%).

Distribution. The average distribution of Sildenafil in the equilibrium state (Vss) is 105 liters over the counter viagra substitute, which indicates its penetration into the tissue. Both sildenafil and its main circulating N-dismethyl metabolite are approximately 96% bound to plasma proteins.

Protein binding does not depend on total concentrations of the drug.

In healthy volunteers who received Sildenafil (1 time in a dose of 100 mg), 90 minutes after taking the drug in the ejaculate were registered le; 0.0002% of the substance (average 188 ng) of the dose taken.

Metabolism. Sildenafil is metabolized mainly by liver isoenzymes localized in microsomes, CYP 3A4 (main route) and CYP 2C9 (secondary route).

The main circulating metabolite is formed due to N-dimethylation of Sildenafil. This metabolite is characterized by selectivity to PDE-5, similar to sildenafil, but its activity relative to PDE-5 in vitro is approximately 50% of the selectivity of the original preparation. Plasma concentrations of this metabolite make up approximately 40% of the respective concentrations of sildenafil. The N-dismethyl metabolite is metabolized and in the future, its final elimination half-life is approximately 4 hours.

Inference. The overall clearance of sildenafil is 41 l / h, the half-life is 3-5 hours. When administered orally, sildenafil is excreted as metabolites, mainly with feces (approximately 80% of the dose taken) and, to a lesser extent, with urine (approximately 13% of the dose taken) ).

Pharmacokinetics in special groups of patients.

Elderly patients. Elderly healthy volunteers (65 years and older) had reduced clearance of sildenafil, and concentrations of sildenafil and its N-dismethyl metabolite were approximately 90% higher than in healthy young volunteers (18–45 years). Given the age dependence in protein binding, the increase in plasma concentration of free sildenafil is almost 40%.

Patients with kidney failure. In volunteers with mild (creatinine clearance 50–80 ml / min) and moderately expressed (creatinine clearance 30–49 ml / min) insufficiency of the renal function, the pharmacokinetics of sildenafil after oral administration in a single dose of 50 mg did not change. In volunteers with severe (creatinine clearance le; 30 ml / min) insufficient renal function; clearance of sildenafil decreased, leading to an increase in AUC (by 100%) and an increase in the maximum blood concentration (by 88%) compared to volunteers of the same age without any renal impairment. In addition, AUC values ​​and maximum blood concentrations for Nu; -dismetilovogo metabolite significantly increased (respectively by 200% and 79%) in patients with severe impaired renal function compared with patients with normal renal function.

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Patients with liver failure. In volunteers with mild and moderate liver cirrhosis (functional class A and B according to Child-Pugh classification), the clearance of sildenafil decreased, which led to an increase in AUC (by 84%) and an increase in the maximum plasma concentration (by 47%) compared to those of volunteers of the same age without liver failure. The pharmacokinetics of sildenafil in patients with severely impaired liver function has not been studied (Child-Pugh class C).

The results of preclinical studies, which were based on generally accepted studies of safety, toxicity of doses that are repeated, genotoxicity, carcinogenicity, and toxic effects on reproduction, revealed no particular risk to humans.

Indications

treatment of erectile dysfunction, which is defined as the inability to achieve and maintain an erection of the best place to buy viagra online penis, necessary for successful sexual intercourse. For effective action of Viagra you need sexual arousal.

Dosage

tablets are intended for oral administration. To implement the effect of Sildenafil, sexual arousal is necessary.

Use in adults. The recommended dose for adults is 50 mg, which is taken as needed approximately 1 hour before sexual activity. Given the effectiveness and tolerability, the dose can be increased to 100 mg or reduced to 25 mg.

The maximum recommended dose is 100 mg. The maximum recommended frequency of admission – 1 time per day. The time of displaying the activity of Viagra can be increased when taken with food as compared with fasting viagra samples.

Use in patients with impaired renal function. In patients with mild to moderate renal insufficiency (creatinine clearance 30–80 ml / min), the dosing regimen does not change. Since patients with severe renal failure (creatinine clearance le; 30 ml / min) the clearance of sildenafil is reduced, the use of the drug should be started with a dose of 25 mg.

Use in patients with impaired liver function. Since in patients with hepatic insufficiency the clearance of sildenafil is reduced, for example, in case of cirrhosis, the use of the drug should be started with a dose of 25 mg.

Use in patients who use other treatments. Given the degree of interaction in patients who receive concomitant ritonavir therapy, it is recommended not to exceed the maximum single dose of 25 mg Sildenafil for 48 hours. The starting dose of 25 mg should be recommended for patients who receive concomitant treatment with CYP 3A4 inhibitors (for example, erythromycin, saquinavir, ketoconazole, itraconazole) ).

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In order to reduce the risk of postural hypotension, patients should be stabilized during therapy. α-blockers before using Viagra. In addition, the appointment of the drug should begin with lower doses.

Use in children. Viagra is not indicated for use by persons under 18 years of age.

Use for patients of advanced age. For elderly patients, a change in dosage is not required.

Contraindications

Viagra use is contraindicated in patients with hypersensitivity to the active substance or to any other component of the drug.

Due to its effect on the exchange of NO / cGMP, sildenafil enhances the hypotensive effect of nitrates when used once or for a long time, therefore its simultaneous use with NO donators, organic nitrates or organic nitrites in any form is permanently or periodically contraindicated.

Drugs for the treatment of erectile dysfunction, including sildenafil, should not be used in patients for whom sexual activity is undesirable (for example, patients with severe cardiovascular diseases such as unstable angina or severe heart failure).

Viagra administration is contraindicated in patients with vision loss in one eye due to non-arterial anterior ischemic optic neuropathy, regardless of whether this has occurred viagra prank as a result of taking a PDE-5 inhibitor or not.

The safety of Sildenafil has not been studied in such subgroups of patients, and therefore its use is contraindicated: for patients with severely impaired liver function, with arterial hypotension (BP) le; 90/50 mmHg Art.), with a recent stroke or myocardial infarction and with known hereditary degenerative diseases of the retina, such as retinitis pigmentosa (a smaller proportion of these patients have a genetic disease of retinal PDE).

Side effects

were transient, light or moderately pronounced. During the study, the frequency and severity of side effects increased with increasing doses. The nature of side effects in variable dose studies, which to a large extent reflected the recommended dosing regimen, was similar to fixed dose studies. The most frequent side effects were headache and flushing.

Very frequent side effects (1/10)

On the part of the nervous system: headache.

Since the cardiovascular system: vasodilation (hot flashes).

Frequent (1 / 100–1 / 10)

From the nervous system: dizziness.

On the part of the organ of vision: abnormal vision (blurred vision, hypersensitivity to light), chromatopsia (moderate degree, transient, mainly color vision).

Since the cardiovascular system: palpitation (palpitations).

On the part of the respiratory system: rhinitis (nasal congestion).

On the part of the digestive tract: dyspepsia.

When using the drug in doses exceeding the recommended, side effects are similar, but occur more often.

The use of Sildenafil does not affect the incidence of myocardial infarction and the rate of mortality from cardiovascular diseases.

During the post-registration period, atypical or uncommon reactions were observed while taking the drug:

Immune system disorders: hypersensitivity reactions (including skin rashes).

On the part of the nervous system: an epileptic seizure, a relapse of an epileptic seizure.

Since the cardiovascular system: tachycardia, hypotension, syncope, nosebleeds.

On the part of the digestive tract: vomiting.

On the part of the organ of vision: pain in the eyes, redness of the eyes.

Reproductive system: prolonged erection and / or priapism.

special instructions

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To diagnose erectile dysfunction, determine the possible causes of the disease and assign adequate treatment, it is necessary to carefully study the patient’s medical history and conduct a thorough medical examination. For effective action of Viagra, sexual stimulation is necessary.

Some degree of risk is associated with sexual activity due to the possibility of a heart attack. Before starting the course of any treatment of erectile dysfunction, the doctor must check the patient’s cardiovascular system. Drugs intended to treat erectile dysfunction should not be used in patients for whom sexual activity is undesirable.

In the period after the introduction of the drug into a wide medical practice, serious cardiovascular complications were reported, which over time coincide with the intake of sildenafil. These include myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage and transient ischemic attack. Most of these patients had a history of cardiovascular risk factors. The prevailing number of such cases was observed during or immediately after the sexual load, a small part – after a short period after taking Sildenafil without sexual activity. Other cases occurred within hours or days after using sildenafil and sexual activity. Thus, it is impossible to establish a direct dependence of such cases with the use of Sildenafil, sexual load, with concomitant cardiovascular diseases, a combination of these factors or other factors. In healthy volunteers with a single dose of sildenafil in doses up to 100 mg, no clinically significant changes in the ECG were detected. The average maximum decrease in systolic blood pressure in a horizontal position after oral administration of the drug at a dose of 100 mg was 8.34 mm Hg. Art. The corresponding change in diastolic blood pressure in a horizontal position was 5.3 mmHg. Art. Lower than ever, but briefly, blood pressure cost of viagra decreased in patients who simultaneously took nitrates.

In studies, Sildenafil showed a systemic vasodilating effect, which led to a transient decrease in blood pressure. This effect is of little or no effect at all in most patients. However, when prescribing Sildenafil, the physician must carefully weigh the risk of adverse effects of the vasodilating action of the drug in patients with certain concomitant diseases, especially against the background of sexual activity. Hypersensitivity to vasodilators is observed in patients with left ventricular obstruction (aortic stenosis, obstructive hypertrophic cardiomyopathy), as well as with multiple manifestations of systemic atrophy, which are observed in isolated cases and manifest severe violations of autonomic control of blood pressure.

Viagra at a dose of 100 mg 1 time per day when taken orally in patients with severe heart disease (stenosis of 70% of at least one coronary artery) reduces the average systolic rest BP and diastolic BP by 7% and 6%, respectively, compared with the initial level. The mean pulmonary systolic pressure is reduced by 9%. Sildenafil has no effect on cardiac output and blood flow in stenotic coronary arteries due to an improvement (approximately 13%) in adenosine-stimulated blood flow reserve (in coronary arteries with and without stenosis).

In patients with erectile dysfunction and canadian viagra stable angina, who regularly took antianginal drugs (with the exception of nitrates) and used Sildenafil 100 mg 1 time per day, there was an increase in the duration of the treadmill test (19.9 s; 95% confidence interval 0.9 –38.9 c) and the average exercise time until exacerbation of angina pectoris is 423.6 and 403.7 s compared to placebo.

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In patients with concomitant hypertension who take 2 or more antihypertensive drugs at the same time, Sildenafil at a dose of 100 mg 1 time per day orally improved erection by 71%, increased the number of successful sexual attempts by 62%. The number of side effects was the same compared with patients in other populations who took 3 or more antihypertensive drugs.

In all studies using PDE-5 inhibitors, including Sildenafil, non-arterial anterior ischemic optic neuropathy (NAION) has been reported, which is the cause of reduced or loss of vision. Most of these patients had such risk factors as a reduced depth / area ratio (“stagnant disc”), age over 50 years, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking. No causal link has been established between the use of PDE-5 inhibitors and the occurrence of NAION. The physician should warn patients who have already had manifestations of NAION about a possible recurrence of NAION. Patients should be warned of the need to immediately consult a doctor in the event of a sudden deterioration of vision.

In patients with age-related retinal degeneration, Sildenafil at a dose of 100 mg 1 time per day was well tolerated and did not cause a clinical effect in the study of visual functions in tests (visual acuity, Amsler mesh, color recognition, artificial light flow, Gamfrey perimetry and photo-stress ).

Sildenafil is recommended to be used with caution to patients who simultaneously apply αβ-blockers, as in some cases it can lead to symptomatic hypotension. In order to minimize the risk of postural hypotension, stabilization of blood pressure should be achieved by α-blockers before applying sildenafil. Sildenafil should be started with low doses. In addition, doctors should tell patients what to do in case of symptoms of postural hypotension.

Some patients with congenital retinitis pigmentosa have genetic defects in retinal PDE. There is no information regarding the safety of prescribing Sildenafil to patients with retinitis pigmentosa, therefore, this group of patients should be prescribed Sildenafil with caution.

An in vitro human platelet study suggests that sildenafil enhances the antiaggregation effect of sodium nitroprusside (NO donator). There is no safety information regarding the administration of Sildenafil to patients with a tendency to bleeding or with acute gastric ulcer, therefore, this group of patients should be prescribed Sildenafil with caution.

Preparations for treating erectile dysfunction should be used with caution in patients with anatomical deformities of the penis (such as angulations, cavernous fibrosis, or Peyronie’s disease) or in patients with diseases that may lead to the development of priapism (such as sickle cell anemia, multiple myeloma, or leukemia ).

The safety and efficacy of combinations of Sildenafil with other types of treatment for erectile dysfunction have not been studied, so the use of such combinations is not recommended.

After oral administration of a single dose of 100 mg of Sildenafil, no effect on the motility and morphological properties of spermatozoa was viagra and alcohol observed in healthy volunteers.

A sudden decline and loss of hearing was reported in a small number of cases in post-marketing studies with the use of PDE-5 inhibitors, including sildenafil.

Most of these patients had risk factors for sudden hearing loss or loss. The causal relationships of the use of PDE-5 inhibitors and the sudden decrease and hearing loss in patients have not been established. In the event of a sudden decrease and hearing loss, patients should be advised to discontinue Sildenafil and consult a physician immediately.

During pregnancy and breastfeeding. Viagra is not intended for use in women.

Children. Viagra is not indicated for use by persons under 18 years of age.

The ability to influence the reaction rate when driving or working with other mechanisms. Studies of the effect of the drug on the ability to drive and work with mechanisms were not performed. Since dizziness and visual impairment were observed during a clinical trial of Sildenafil, patients should know their reaction to taking Viagra before driving or working with mechanisms.

Interaction

Effect of other drugs on sildenafil.

In vitro studies: Sildenafil metabolism is mediated mainly by cytochrome P450 (CYP), in particular its ZA4 isoforms (primary pathway) and 2C9 (minor pathway) isoforms. Thus, inhibitors of these isoenzymes can reduce the elimination of Sildenafil, and the inducers of these enzymes can increase its excretion.

In vivo studies: a population-based pharmacokinetic analysis of the results of a clinical trial demonstrated a decrease in the clearance of sildenafil while it was used with inhibitors of CYP 3A4 (such as ketoconazole, erythromycin, cimetidine). Cimetidine (800 mg), an inhibitor of cytochrome P450 and a nonspecific inhibitor of CYP 3A4, with simultaneous administration to healthy volunteers at a dose of 50 mg, caused an increase in plasma concentration of Sildenafil by 56%. In the case of Viagra in a dose of 100 mg simultaneously with erythromycin, a specific CYP 3A4 inhibitor (500 mg 2 times a day for 5 days), an increase in AUC of Sildenafil by 182% was observed.

The simultaneous administration of HIV protease inhibitor saquinavir (1200 mg 3 times daily), which is also an inhibitor of CYP 3A4 and sildenafil, led to an increase in the maximum serdenafil concentration in blood serum by 140% and an increase in AUC by 210%. Viagra does not affect saquinavir pharmacokinetics. Strong inhibitors of CYP 3A4, such as ketoconazole and itraconazole, exhibit a more pronounced effect.

Simultaneous administration of ritonavir, an HIV protease inhibitor that is a highly viagra connect specific inhibitor of P450, in equilibrium (500 mg 2 times a day) with sildenafil (100 mg once) leads to an increase of up to 300% (4 times) in the maximum serden Sildenafil concentration to an increase of 1000% (11 times) AUC of sildenafil in the blood plasma. After 24 h, the concentration of Sildenafil in the blood plasma was approximately 200 ng / ml, whereas in the case of receiving only Sildenafil, its concentration was 5 ng / ml. This is due to the effect of ritonavir on P450 isoenzymes. Sildenafil does not affect ritonavir pharmacokinetics. When the dose of Sildenafil for subjects who received a CYP 3A4 inhibitor was applied as recommended, the concentration of Sildenafil in the blood plasma did not exceed 200 nM for any patient, and the drug had good tolerance.

A single antacid (magnesium hydroxide / aluminum hydroxide) does not affect the bioavailability of sildenafil.

CYP 2C9 inhibitors (such as tolbutamide, warfarin), CYP 2D6 inhibitors (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and thiazide-like diuretics, ACE inhibitors, calcium channel blockers, did not affect the pharmacokinetics of hearths, diuretics, ACE inhibitors, calcium channel blockers, had no effect on the pharmacokinetics of hearths, diuretics, ACE inhibitors, calcium channel blockers, had no effect on the pharmacokinetics of hearths;

In healthy volunteers, the effect of azithromycin (500 mg / day for 3 days) on AUC, the maximum concentration in the blood and the time to achieve it, the clearance and the half-life of sildenafil and its major metabolites have not been proven.

The effect of Viagra on other drugs.

In vitro studies: Sildenafil is a weak inhibitor of the cytochrome P450 isoforms, namely, the 1A2, 2C9, 2C19, 2D6, 2E1 and ZA4 isoenzymes (IK50 150 mu; M). In the case of its use in recommended doses, the maximum concentration of Sildenafil in the blood plasma reaches about 1 mu; M, because it is unlikely that Viagra is able to change the pharmacokinetics of the substrates of these isoenzymes.

In vivo studies: Sildenafil enhances the hypotensive effect with short-term and long-term use of nitrates, therefore one-time or course use of NO donators, organic nitrates generic viagra online or organic nitrites in any form with Sildenafil is contraindicated.

When sildenafil (25; 50 and 100 mg) was used in patients with benign prostatic hyperplasia simultaneously with therapy α-Blocker doxazosin (4 and 8 mg), which was maintained at a stable level, was followed by an additional decrease in blood pressure at 7/7 Hg. Art. 9/5 Hg. Art. and 8/4 Hg. Art. respectively, the average additional reduction of blood pressure of 6/6 Hg. Art. 11/4 Hg. Art. and 4/5 Hg. Art. respectively. When sildenafil and doxazosin were administered simultaneously to patients resistant to doxazosin therapy, infrequent cases of symptomatic postural hypotension were observed. Its signs are dizziness and incoordination under the action of light, but without loss of consciousness. Concomitant Treatment with Sildenafil Patients Who Apply α-adrenergic blocking therapy may cause symptomatic hypotension in some patients.

There are no signs of significant interaction of Sildenafil (50 mg) with tolbutamide (250 mg) or warfarin (40 mg), each of which is metabolized by CYP 2C9.

Sildenafil (100 mg) does not change the equilibrium state of the pharmacokinetics of HIV protease inhibitors, saquinara and ritonavir, which are CYP 3A4 inhibitors.

Sildenafil (50 mg) does not lead to an increase in the duration of bleeding caused by acetylsalicylic acid (150 mg).

Sildenafil (50 mg) did not potentiate the hypotensive effect of alcohol in healthy volunteers, who had a maximum blood alcohol level of 0.08% (80 mg / dl).

Sildenafil (100 mg) and amlodipine interactions were not observed in patients with hypertension. The average additional reduction in systolic blood pressure is 8 mmHg. Art. and 7 mm Hg. Art. – diastolic.

The safety analysis showed no difference in the profile of adverse reactions in patients taking sildenafil as monotherapy and in combination with antihypertensive drugs.

Overdose

in studies on healthy volunteers with a single dose of the drug in doses up to 800 mg, the side effects were similar to those observed when taking Viagra in lower doses, but their incidence and severity increased. In case of overdose, maintenance therapy is necessary as necessary. Dialysis does not accelerate the elimination of the drug, since Sildenafil binds strongly to plasma proteins and is not excreted in the urine.

Storage conditions

at a temperature up to 25 ° C.

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How To Get Viagra: Viagra instructions for use indications, contraindications, side effects description Viagra tab., Pokr. film coated, 100 mg 1, 2 or 4 pcs. (2226) - Directory of drugs and drugs

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The drug is taken orally.

For most patients, the recommended dose is 50 mg approximately 1 hour before sexual activity. Given the efficacy and tolerability, the dose may be increased to 100 mg or reduced to 25 mg.

The maximum recommended dose is 100 mg. The maximum recommended frequency of use is 1 time / day.

In renal failure, mild and moderate severity (CK 30-80 ml / min) dose adjustment is not required, in case of severe renal failure (CK<30 мл/мин) дозу силденафила следует снизить до 25 мг.

Since the elimination of sildenafil is impaired in patients with liver damage (for example, in case of cirrhosis), the dose should be reduced to 25 mg.

Elderly patients dose adjustment is not required.

Combined use with other drugs

When combined with ritonavir, the maximum single dose of Viagra® should not exceed 25 mg, the frequency of use – 1 time in 48 hours.

When used together with CYP3A4 isoenzyme inhibitors (erythromycin, saquinavir, ketoconazole, itraconazole), the initial dose of Viagra® should be 25 mg.

To minimize the risk of postural hypotension in patients taking alpha blockers, the use of Viagra® should be started only after hemodynamic stabilization has been achieved in these patients. The feasibility of reducing the initial dose of sildenafil should be considered.

Side effect

The most frequent side effects were headache and hot flashes.

Side effects are usually mild or moderate and transient.

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In studies using a fixed dose, it has been found that the frequency of some adverse events increases with increasing dose.

The frequency of undesirable reactions is defined as follows: very often (ge; 10%), often (ge; 1% and <10%), нечасто (≥0.1% и <1%), редко (≥0.01% и <0.1%), очень редко (<0.01%), частота неизвестна (невозможно определить на основе имеющихся данных).

On the part of the immune system: rarely – hypersensitivity reactions (including skin rash), allergic reactions.

On the part of the organ of vision: often – blurred vision, blurred vision, cyanopsy; infrequently – eye pain, photophobia, photopsia, chromatopsia, eye redness / scleral injection, change in brightness of light perception, mydriasis, conjunctivitis, hemorrhage in the eye tissue, cataract, disruption of the lacrimal apparatus; rarely – swelling of the eyelids and surrounding tissues, feeling of dryness in the eyes, presence of rainbow circles in the field of view around the light source, increased eye fatigue, seeing objects in yellow (xantopsia), seeing objects in red (erythropsy), conjunctival hyperemia, irritation of the mucous membrane eye discomfort in the eyes; unknown frequency – nonarteritis anterior ischemic optic nerve neuropathy (NPINZN), retinal vein occlusion, visual field defect, diplopia *, temporary loss of vision or reduced visual acuity, increased intraocular pressure, retinal edema, vascular retinal disease, vitreous detachment / vitreous traction.

On the part of the organ of hearing: infrequently – a sudden decline or loss of hearing, noise in the ears, pain in the ears.

Since the cardiovascular system: often – “tides”; infrequently – tachycardia, palpitations, decreased blood pressure, increased heart rate, unstable angina, AV blockade, myocardial ischemia, cerebral thrombosis, cardiac arrest, heart failure, abnormalities in ECG, cardiomyopathy; rarely – atrial fibrillation, sudden cardiac death *, ventricular arrhythmia *.

From the hemopoietic system: infrequently – anemia, leukopenia.

Metabolism and nutrition: infrequently – feeling of thirst, edema, gout, uncompensated diabetes mellitus, hyperglycemia, peripheral edema, hyperuricemia, hypoglycemia, hypernatremia.

On the part of the respiratory system: often – nasal congestion; infrequently – nasal bleeding, rhinitis, asthma, dyspnea, laryngitis, pharyngitis, sinusitis, bronchitis, increase in the volume of discharge of sputum, increased generic viagra without a doctor prescription cough; rarely – a feeling of tightness in the throat, dryness of the mucous membrane of the nasal cavity, swelling of the nasal mucosa.

On the part of the digestive system: often – nausea, dyspepsia; infrequently – gastroesophageal reflux disease, vomiting, abdominal pain, dry mouth, glossitis, gingivitis, colitis, dysphagia, gastritis, gastroenteritis, esophagitis, stomatitis, abnormal liver function tests, rectal bleeding; rarely – hypoesthesia of the oral mucosa.

On the part of the musculoskeletal system: often – back pain; infrequently – myalgia, pain in the limbs, arthritis, arthrosis, tendon rupture, tenosynovitis, bone pain, myasthenia, synovitis.

On the part of the genitourinary system: infrequently – cystitis, nocturia, an increase in the mammary glands, urinary incontinence, hematuria, impaired ejaculation, swelling of the genitals, anorgasmia, hematospermia, damage to the tissues of the penis; rarely, prolonged erections and / or priapism.

From the central and peripheral nervous system: very often – headache; often – dizziness; infrequently – drowsiness, migraine, ataxia, hypertonia, neuralgia, neuropathy, paresthesia, tremor, vertigo, symptoms of depression, insomnia, unusual dreams, increased reflexes, hypoesthesia; seldom – spasms *, repeated spasms *, syncope.

On the part of the skin and subcutaneous tissues: infrequently – skin rash, urticaria, herpes simplex, pruritus, sweating, skin ulceration, contact dermatitis, exfoliative dermatitis; frequency is unknown – Stevens-Johnson syndrome, toxic epidermal necrolysis.

Other: infrequently – fever, swelling of the face, photosensitivity reactions, shock, asthenia, fatigue, pain of different localization, chills, accidental falls, pain in the chest, accidental injuries; rarely irritability.

* Side effects identified during post-marketing studies.

Cardiovascular complications

The post-marketing use of sildenafil for the treatment of erectile dysfunction reported adverse events such as severe cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic stroke, I, I, I haven’t put a template, transient ischemic heart attack, I have an unpleasant heart attack, ventricular arrhythmia, hemorrhagic stroke, transient ischemic stroke, and I have an unpleasant heart attack, sudden heart death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic stroke, transient ischemic attack, and I have already applied a cardiac abnormality. ), which had a temporary connection with the use of sildenafil. 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 of them were observed after taking sildenafil without subsequent sexual activity. It is not possible to establish the existence of a direct connection between the observed adverse events and the specified or other factors.

Visual impairment

In rare cases, during post-registration use of all PDE5 inhibitors, including sildenafil, nonarteritis anterior ischemic optic neuropathy (NPINZN) – a rare disease and cause of loss or loss of vision was reported. Most of these patients had risk where to buy viagra factors, in particular a decrease in the ratio of excavation diameters and optic nerve head (“stagnant disc”), over 50 years of age, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking. In an observational study, it was evaluated whether the recent use of drugs of the FDE5 inhibitor class is associated with an acute onset of NPINSN. The results indicate an approximately twofold increase in the risk of NPINZN within 5 elimination half-lives after the use of the PDE5 inhibitor. According to published literature data, the annual incidence of NPINSN is 2.5-11.8 cases per 100,000 men aged> 50 years in the general population. Patients should be advised to discontinue sildenafil therapy in the event of a sudden loss of vision and consult a physician immediately. Persons who have already had a case of an NPINZN have an increased risk of a recurrence of an NPINZN. Therefore, the physician should discuss this risk with such patients and discuss with them the potential chance of adverse effects from PDE5 inhibitors. PDE5 inhibitors, incl. Sildenafil, in these patients should be used with caution and only in situations where the expected benefit exceeds the risk.

At use of the drug Viagra® in the doses exceeding recommended, the undesirable phenomena were similar with noted above, but usually met more often.

Contraindications

severe liver failure (Child-Pugh class C);

severe cardiovascular diseases (severe heart failure, unstable stenocardia, a stroke or myocardial infarction, life-threatening arrhythmias, arterial hypertension (BP> 170/100 mm Hg) or hypotension (BP) <90/50 мм рт.ст.));

episodes of the development of non-arteritis anterior ischemic optic neuropathy with vision loss in one eye;

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hereditary retinitis pigmentosa;

use in patients who constantly or intermittently donate nitric oxide, organic nitrates or nitrites in any form, since sildenafil enhances the hypotensive effect of nitrates;

the combined use of PDE5 inhibitors, including sildenafil, with guanylate cyclase teva generic viagra stimulants, such as riociguat, because this can lead to symptomatic hypotension;

simultaneous use of the drug with other drugs for the treatment of erectile dysfunction (the safety and efficacy of combination therapy has not been studied);

simultaneous use of ritonavir;

lactose intolerance, lactase deficiency, glucose-galactose malabsorption;

children and adolescents up to 18 years;

use in women;

hypersensitivity to sildenafil or to any other component of the drug.

With care: anatomic deformation of the penis (angulation, cavernous fibrosis or Peyronie’s disease); diseases predisposing to the development of priapism (sickle cell anemia, multiple myeloma, leukemia, thrombocythemia); diseases involving bleeding; peptic ulcer and duodenal ulcer in the acute phase; abnormal liver function; severe renal failure (CC less than 30 ml / min); an episode of development of anterior non-arteritis ischemic neuropathy of the optic nerve in history; simultaneous reception of alpha adrenergic blockers.

Use during pregnancy and lactation

According to the registered indication the drug is not intended for use in women.

Application for violations of the liver

Contraindicated use of the drug in severe liver failure (class C on the classification of Child-Pugh).

Precautions should be prescribed the drug for violations of the liver.

Application for violations of renal function

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Precautions should be prescribed in severe renal failure (CC less than 30 ml / min).

Use in children

The drug is not intended for use in children and adolescents under order viagra online the age of 18 years.

Use in elderly patients

Elderly patients dose adjustment is not required.

special instructions

To diagnose erectile dysfunction, determine their possible causes, and select an adequate treatment, it is necessary to gather a full medical history and conduct a thorough physical examination. Erectile dysfunction treatment should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis, Peyronie’s disease), or in patients with risk factors for priapism (sickle cell anemia, multiple myeloma, leukemia).

During postmarketing studies, cases of prolonged erection and priapism have been reported. If an erection persists for more than 4 hours, the patient should immediately seek medical attention. If priapism therapy was not carried out immediately, it can cause damage to the tissues of the penis and irreversible loss of potency.

Drugs for treating erectile dysfunction should not be given to men for whom sexual activity is undesirable.

Sexual activity poses a certain risk in the presence of heart disease, so before starting any therapy for erectile dysfunction, the doctor should refer the patient to an examination of the state of the cardiovascular system. Sexual activity is undesirable in patients with heart failure, unstable angina, suffered myocardial infarction or stroke in the last 6 months, life-threatening arrhythmias, arterial hypertension (BP> 170/100 mm Hg) or hypotension (BP <90/50 мм рт.ст.). Прием силденафила у таких пациентов противопоказан. В клинических исследованиях показано отсутствие различий в частоте развития инфаркта миокарда (1.1 на 100 человек в год) или частоте смертности от сердечно-сосудистых заболеваний (0.3 на 100 человек в год) у пациентов, получавших препарат Виагра®, по сравнению с пациентами, получавшими плацебо.

Cardiovascular complications

Post-marketing use of sildenafil for the treatment of erectile dysfunction reported adverse events such as serious cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, and an arthritis, transient ischemic attack. hypotension), which had a temporary relationship with the use of sildenafil. 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 of them were observed after taking sildenafil without subsequent sexual activity. It is not possible to establish the existence of a direct connection between the observed adverse events and the specified or other factors.

Hypotension

Sildenafil has a systemic vasodilating effect, leading to a transient decrease in blood pressure, which is not a clinically significant effect and does not lead to any consequences in most patients. However, before when will generic viagra be available prescribing Viagra®, the doctor should carefully evaluate the risk of possible undesirable manifestations of the vasodilating action in patients with appropriate diseases, especially against the background of sexual activity. Increased susceptibility to vasodilators is observed in patients with obstruction of the excretory tract of the left ventricle (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as with rarely encountered multiple systemic atrophy syndrome, manifested by a severe dysregulation of blood pressure in the autonomic nervous system.

Since the combined use of sildenafil and alpha-blockers may lead to symptomatic hypotension in individual sensitive patients, Viagra® should be used with caution in patients taking alpha-blockers. To minimize the risk of postural hypotension in patients taking alpha blockers, taking Viagra® should be started only after stabilization of hemodynamic parameters in these patients is achieved. It should also consider the feasibility of reducing the initial dose of Viagra®. It is necessary to inform patients about what actions should be taken in case of symptoms of postural hypotension.

Visual impairment

In rare cases, during post-registration use of all PDE5 inhibitors, including sildenafil, nonarteritis anterior ischemic optic neuropathy (NPINZN) – a rare disease and cause of loss or loss of vision was reported. Most of these patients had risk factors, in particular a decrease in the ratio of excavation diameters and optic nerve head (“stagnant disc”), over 50 years of age, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking. In an observational study, it was evaluated whether the recent use of drugs of the FDE5 inhibitor class is associated with an acute onset of NPINSN. The results indicate an approximately twofold increase in the risk of NPINZN within 5 elimination half-lives after the use of the PDE5 inhibitor. According to published literary data, the annual incidence of NPINSN is 2.5-11.8 cases per 100,000 men ge; 50 years in the general population. Patients should be advised to discontinue sildenafil therapy in the event of a sudden loss of vision and consult a physician immediately. Persons who have already had a case of an NPINZN have an increased risk of a recurrence of an NPINZN. Therefore, the physician should discuss this risk with such patients and discuss with them the potential chance of adverse effects from PDE5 inhibitors. PDE5 inhibitors, incl. Sildenafil, 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 of NPINZN with loss of vision in one eye, sildenafil is contraindicated.

A small number of patients with hereditary retinitis pigmentosa have genetically determined abnormalities of retinal phosphodiesterase functions. There is no information about the safety viagra substitute of Viagra® in patients with retinitis pigmentosa, therefore, sildenafil should be used with caution.

Hearing loss

In some post-marketing and clinical studies reported cases of sudden deterioration or hearing loss associated with the use of all PDE5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or hearing loss. There is no causal relationship between the use of PDE5 inhibitors and the sudden deterioration of hearing or hearing loss. In the event of a sudden deterioration in hearing or hearing loss while taking sildenafil, the patient should immediately consult a doctor.

Bleeding

Sildenafil enhances the antiplatelet effect of sodium nitroprusside, a nitric oxide donator, on human platelets in vitro. There are no data on the safety of sildenafil in patients with a tendency to bleeding or exacerbation of gastric ulcer and duodenal ulcer, therefore Viagra® should be used with caution in these patients. The incidence of nasal bleeding in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (sildenafil 12.9%, placebo 0%) than in patients with primary pulmonary hypertension (sildenafil 3%, placebo 2.4%). In patients receiving sildenafil in combination with a vitamin K antagonist, the frequency of nosebleeds was higher (8.8%) than in patients not taking a vitamin K antagonist (1.7%).

Use in conjunction with other erectile dysfunction treatments.

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The safety and efficacy of Viagra® together with other PDE5 inhibitors or other drugs for the treatment of pulmonary hypertension containing sildenafil (for example, Revacio®) or other means of treating erectile dysfunction have not been studied, so the use of such combinations is not recommended.

Influence on ability to drive motor transport and control mechanisms

Against the background of sildenafil intake, there was no negative effect on the ability to drive a car or other technical means. However, since the administration of sildenafil may cause dizziness, a decrease in blood pressure, the development of chromatopsia, blurred vision and other side effects, caution should be exercised when driving and doing other potentially dangerous activities that require increased concentration and psychomotor speed. You should also be attentive to the individual action of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.

Overdose

With a single dose of Viagra® at a dose of up to 800 mg, adverse events were comparable to those at lower doses, but were more common.

The viagra without a doctor prescription use of the drug at a dose of 200 mg did not lead to an increase in the effectiveness of the drug, however, the frequency of adverse reactions (headache, hot flashes, dizziness, dyspepsia, nasal congestion, blurred vision) increased.

Treatment: symptomatic therapy. Hemodialysis does not accelerate the clearance of sildenafil, since the latter is actively associated with plasma proteins and is not excreted in the urine.

Drug interactions

The effect of other drugs on the metabolism of sildenafil

Sildenafil metabolism occurs mainly in the liver under the action of CYP3A4 isoenzymes (main route) and CYP2C9, therefore inhibitors of these isoenzymes can reduce the clearance of sildenafil, and inductors, respectively, increase the clearance of sildenafil.

With simultaneous use of CYP3A4 inhibitors (ketoconazole, erythromycin, cimetidine), a decrease in the clearance of sildenafil was noted.

Cimetidine (at a dose of 800 mg), which is a nonspecific CYP3A4 inhibitor, when taken concomitantly with sildenafil (at a dose of 50 mg) causes an increase in plasma concentration of sildenafil by 56%.

A single dose of sildenafil in a dose of 100 mg simultaneously with erythromycin – a specific inhibitor of CYP3A4 (500 mg 2 times / day for 5 days) – against the background of achieving a constant concentration of erythromycin in the blood leads to an increase in AUC of sildenafil by 182%.

With simultaneous use of sildenafil (once at a dose of 100 mg) and saquinavir (at a dose of 1200 mg 3 times / day), which is both an HIV protease inhibitor and a CYP3A4 inhibitor, against the background of achieving a constant concentration of saquinavir in the blood, Cmax of sildenafil in the blood increased by 140%, and the AUC increased by 210%. Sildenafil had no effect on the pharmacokinetic parameters of saquinavir.

More potent inhibitors of the isoenzyme CYP3A4, such as ketoconazole or itraconazole, can cause more pronounced changes in the pharmacokinetics of sildenafil.

The simultaneous use of sildenafil (once in a dose of 100 mg) and ritonavir (500 mg 2 times / day), which is an HIV protease inhibitor and does viagra make you last longer a strong inhibitor of cytochrome P450 isoenzymes, against the background of achieving a constant concentration of ritonavir in the blood leads to an increase in Cmax of sildenafil by 300 % (4 times), and AUC by 1000% (11 times). After 24 h, the concentration of sildenafil in the blood plasma was approximately 200 ng / ml (with a single application of sildenafil alone – 5 ng / ml). This is consistent with the effect of ritonavir on a wide range of cytochrome P450 substrates. Sildenafil does not affect ritonavir pharmacokinetics. Given these data, the simultaneous reception of ritonavir and sildenafil is not recommended. In any case, the maximum dose of sildenafil should under no circumstances exceed 25 mg within 48 hours.

If sildenafil is taken in recommended doses by patients receiving simultaneously strong inhibitors of CYP3A4, then Cmax of free sildenafil does not exceed 200 nM, and the drug is well tolerated.

A single antacid (magnesium hydroxide / aluminum hydroxide) does not affect the bioavailability of sildenafil.

In studies involving healthy volunteers with simultaneous use of an antagonist of endothelin receptors, bosentan (inducer of isoenzyme CYP3A4 (moderate), CYP2C9, and possibly CYP2C19) in equilibrium concentration (125 mg 2 times / day) and sildenafil in equilibrium concentration (80 mg 3 times / day) there was a decrease in AUC and Cmax of sildenafil by 62.6% and 52.4%, respectively. Sildenafil increased AUC and Cmax of bosentan by 49.8% and 42%, respectively. It is assumed that the simultaneous use of sildenafil with potent inducers of CYP3A4 isoenzyme, such as rifampicin, can lead to a greater decrease in plasma concentration of sildenafil.

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CYP2C9 isoenzyme inhibitors (such as tolbutamide, warfarin), CYP2D6 isoenzyme (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazides and thiazide-like diuretics, ACE inhibitors and calcium antagonists have no effect on pharmacokinetics.

Simultaneous administration of azithromycin (500 mg / day for 3 days) does not affect the AUC, Cmax, Tmax, elimination rate constant, and T1 / 2 of sildenafil or its main circulating metabolite.

The effect of sildenafil on other drugs

Sildenafil is a weak inhibitor of isoenzymes of the cytochrome P450 system – 1A2, 2C9, 2C19, 2D6, 2E1, and 3A4 (IK50> 150 μmol how much does viagra cost). When using sildenafil in recommended doses, its Cmax is about 1 μmol, so it is unlikely that sildenafil can affect the substrate clearance of these isoenzymes.

Sildenafil enhances the hypotensive effect of nitrates in case of long-term use, and when used for acute indications. In this regard, the use of sildenafil in combination with nitrates or nitric oxide donors is contraindicated.

While taking alpha-adrenergic blocker doxazosin (4 mg and 8 mg) and sildenafil (25 mg, 50 mg and 100 mg) in patients with benign prostatic hyperplasia with stable hemodynamics, the average additional decrease in systolic / diastolic blood pressure in the supine position was 7 / 7 mm Hg, 9/5 mm Hg and 8/4 mm Hg. respectively, and in the standing position – 6/6 mm pt.st., 11/4 mm pt.st. and 4/5 mm Hg respectively. Rare cases of the development of symptomatic postural hypotension, manifested in the form of dizziness (without fainting), are reported in these patients. In individual sensitive patients receiving alpha-blockers, the simultaneous use of sildenafil can lead to symptomatic hypotension.

There were no signs of significant interaction of sildenafil with tolbutamide (250 mg) or warfarin (40 mg), which are metabolized by CYP2С9.

Sildenafil at a dose of 100 mg does not affect the pharmacokinetic parameters of the HIV protease inhibitor saquinavir, a substrate of CYP3A4, at its constant concentration in the blood.

The simultaneous use of sildenafil in the equilibrium state (80 mg 3 times / day) leads to an increase in AUC and Cmax of bosentan (125 mg 2 times / day) by 49.8% and 42%, respectively.

Sildenafil at a dose of 50 mg does not cause an additional increase in bleeding time when taking acetylsalicylic acid at a dose of 150 mg.

Sildenafil at a dose of 50 mg does not enhance the hypotensive effect of ethanol in healthy volunteers with an average level of ethanol in the blood of an average of 0.08% (80 mg / dL).

In patients with arterial hypertension, there was no evidence of interaction of sildenafil (in a dose of 100 mg) with amlodipine. The average additional decrease in blood pressure in the supine position is 8 mm Hg. (systolic) and 7 mm Hg. (diastolic).

The use of sildenafil in combination with antihypertensive drugs does not lead to additional side effects.

Viagra® storage conditions

The drug should be stored out of the reach of children at a temperature not higher than 30 ° C.

Expiration date Viagra®

Shelf life – 5 years. Do not use after the expiration date printed on the package.

Terms of implementation

The drug is available on prescription.

Contact information

PFIZER

(USA)

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Because of the how to use viagra mess in the Medicaid poor insurance system, 50 registered sexual rapists, that is, New Yorkers who served for this crime, received $ 60,000 in medical erectile dysfunctions.

Because of the mess in the Medicaid poor insurance system, 50 registered sexual rapists, that is, residents of New York who served viagra coupons for this crime, received $ 60,000 in medical erectile dysfunction. This is stated in a state auditor report released Wednesday.

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Federal and state laws prohibit the free viagra samples payment of such funds to all Medicaid customers, and not just to sexual abusers, but in this case, the error does not look funny, but offensive how to take viagra.

A review of Thomas DiNapoli’s subordinates showed that Medicaid viagra patent expiration paid for such medical care to 47 perverts, including 30 second and third level.

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“Bureaucratic mistakes are unavoidable in such a large system as Medicaid,” says Di Napoli, “but this is a direct violation of federal and state laws, as well as complicity with criminals, which cheap viagra online canadian pharmacy should not happen at all.”

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During the verification of documents for active ingredient in viagra the years 2012-2018, it was also found that Medicaid paid for medications to restore erection in the total amount of $ 285,641.

As for the sexual abusers who were prescribed this remedy, the auditors found that only one of them really needed this remedy, the rest viagra without a doctor prescription usa could have done without it.

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According to DiNapoli, such an oversight occurred due to the fact that in 2011 the recipe check was removed from the structure of the state health department and transferred to the teva generic viagra cost organizations of “managed how much is viagra medical care”, which is now engaged in the supervision of government insurance spending.

The results, like the 2005 test, were even worse – then 198 second-level rapists received Viagra via Medicaid.

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Generic Viagra Online: Viagra in low doses reduces the risk of intestinal cancer - News. Science

Viagra in low doses reduces the risk of intestinal cancer – News. Science

Legendary drug with a difficult fate: initially Viagra was created as a means to treat angina and ischemia, then the drug was recognized as the best tool in the fight against impotence, and now it turned out that it also reduces the risk of developing colorectal cancer. However, Viagra is not suitable is viagra covered by insurance for the treatment of oncology: we are talking only about prevention.

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Perhaps the most popular means to increase potency viagra porn – Viagra – as it turned out, is capable of more.

American researchers have found that the daily intake of small doses of this drug reduces the risk of developing colorectal cancer (tumors of different parts of the colon and rectum). According to experts, this type of cancer ranks third among the sad “oncological mortality rating”.

Recall that Viagra is the most well-known trademark under which the drug Sildenafil is produced. Initially, this drug was synthesized in order to improve blood flow in the myocardium and to treat angina and ischemia, but in 1992 during clinical trials it was found that its effect on cardiac blood flow buy real viagra online is minimal.

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But Viagra showed a different effect: a pronounced effect on the blood flow in the pelvic organs. The drug homemade viagra relaxes the smooth muscles around the blood vessels, which causes more blood to flow into the latter.

By the way, not only erectile dysfunction is treated in this way, but also pulmonary hypertension in premature babies. And now doctors have found the drug another useful application.

Biochemists have found that Viagra prevents the formation of polyps in the intestines – abnormal clusters of cells on its walls, which in most cases develop into cancer cells. According to experts does viagra work, the growth of such formations can begin in adolescence and take place at different speeds. Thus, the average age at which patients are diagnosed with colon cancer is 39 years today.

As the head of the research team, Darren Browning (Darren Browning), explained, the team conducted the first experiments on animal models. Scientists have created modified mice with natural viagra for men a genetic predisposition to the development of colorectal cancer: they had a mutation that accelerated the growth of polyps. The same mutation often occurs in humans.

The researchers gave their experimental daily drinking water with a small dose of sildenafil, and the control group was left without medication. Soon, experts saw that the animals that took Viagra had two times fewer polyps on the intestinal walls compared with the control group.

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The authors explain that in this case, the effect is not provided non prescription viagra by the relaxation of smooth muscles. The drug triggers another mechanism: it stimulates the synthesis of cyclic guanosine monophosphate, which is contained in the cell membranes that form the intestinal inner “lining” – the epithelium.

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Observations have shown that at elevated levels of cyclic guanosine monophosphate, excessive cell proliferation is suppressed — their proliferation by division, which causes polyps to appear. It is the proliferating cells that are most susceptible to mutations that cause cancer.

In addition, with the constant intake of the drug, apoptosis is also pfizer viagra triggered – the natural elimination of defective cells from which the cancer cells develop how long does viagra take to work.

Researchers point out an important point: Viagra has no effect on polyps that have already formed in the intestines, but it inhibits the growth of new ones. In other words, the drug can be used more likely not to treat, but to prevent the occurrence of colorectal cancer.

The team now plans to conduct clinical trials of sildenafil with patients who have an increased risk of developing this type of cancer. Among female viagra prank the factors that can increase this risk, scientists have named heredity, already existing multiple polyps in the intestines, as well as chronic inflammation of the intestines.

By the way, to avoid the occurrence of intestinal cancer, it is necessary to limit cholesterol intake, because it accelerates the development of tumors a hundred times.

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Employees buy viagra online of the University of Augusta opened a new side of one of the most famous means to increase potency – Viagra. It turned out the blue pill …

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Scientists around the world are looking for effective remedies for treating cancer. We recently viagra online talked about the amazing discovery of the staff of the Free University of Brussels. They found that a common flower of narcissus can win in the fight against cancer. This familiar plant contains gemantamine alkaloid, which natural viagra not only inhibits the growth of tumor cells, but also destroys them.

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But biologists at the University of Augusta, Georgia, were not looking for new sources for drug development. They drew attention to the already available drug Viagra, and, as it turned out, not in vain: perhaps the most well-known tool for the treatment of erectile dysfunction has viagra for men proved itself with a new side. During tests in laboratory rodents, it was found that small daily doses of miracle pills reduce the risk of developing colorectal cancer – a malignant tumor in the colon. Viagra viagra for women prevents the formation of polyps in the intestines, which quite often develop into malignant neoplasms. According to the results of the experiments, therapy reduced the over the counter viagra number of polyps by 50%.

Over the past 20 years, Viagra has been studied “far and wide”, but not everyone knows that the blue pill, in addition to treating sexual dysfunction, also helps with other viagra generic ailments. Sildenafil, namely the so-called medicine, manufactured under the brand name Viagra, is used for pulmonary hypertension. At one time, sildenafil was considered as an effective anti-obesity drug and an effective remedy for time zone syndrome.

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As for the future of the drug, scientists from Georgia are thinking about the imminent transition to the next stage – to clinical trials in patients with a high risk of developing colorectal cancer female viagra. The downside to this therapy is the price. Now viagra government funded the cost of Viagra from Pfizer, depending on the dosage of sildenafil (25, 50, 100 mg) and the number of tablets in the package varies from 19 to 102 rubles. However, blue tablets should soon become cheaper, since the patent expires in 2019.

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A drug for treating erectile dysfunction in men Viagra Connect in Britain can now be bought without a prescription. What are the features of Viagra Connect and what should potential buyers consider?

Both that and other how long does viagra last preparation contain the same active ingredient – sildenafil citrate, but in different doses.

Sildenafil citrate is an inhibitor of type 5 phosphodiesterase (PDE-5), whose effect is expressed in that it (by blocking a certain enzyme) expands blood circulation in the pelvic organs and thus contributes to achieving erection.

The usual drug Viagra is sold in tablets of 25 mg, 50 mg and 100 mg (in blisters of 4-16 tablets).

Viagra Connect is available exclusively in a dosage of 50 mg (in blisters of 4-8 tablets), which is precisely the most optimal dose.

Who is recommended Viagra Connect? Viagra Connect is a drug recommended exclusively for men with impotence viagra pill.

It is not recommended for adolescents under the age of 18 (and they still will not be able to buy it in British pharmacies), but women will viagra 100mg be able to purchase it for their partners.

It is also not recommended for men who, for health reasons, should not have sex, for example, those with serious cardiovascular diseases.

As a general rule: men who start to choke when performing simple physical exercises – for example, when climbing stairs – should not take the drug for erectile dysfunction.

How and where to buy Viagra Connect viagra connect usa? You can buy the drug in most pharmacies, but it will not be on the shelf like aspirin.

You will need to go to the pharmacist and ask you to give you the drug, while the pharmacist will have to ask a number of questions to make sure that it is not harmful for you to take it, and to answer your questions, if any.

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To do this, it will be possible to retire to the consultation room, which are available in most pharmacies.

A pack of 4 tablets will cost 19 pounds 99 pence (approximately 23 euros or 1 614 rubles).

How effective is this drug? In many cases it helps to cope with erectile dysfunction, but not always and not at all.

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Sildenafil citrate helps to dilate blood vessels, increase blood flow to the viagra coupon penis, and achieve an erection in response to sexual stimulation.

But it must be borne in mind that the drug itself may not cause an erection if there is no natural attraction to the partner.

Viagra Connect can be taken without regard to food intake, but its effect may slow down if you have just female viagra pill eaten well and then took a pill.

This drug should be taken approximately one hour before sexual intercourse.

Do not combine Viagra Connect with grapefruit or grapefruit juice, as this may interfere with the normal action of the drug.

It is recommended to take no more than 1 tablet of 50 mg per day.

If you have not had an erection for quite a long time, then you may need several attempts to achieve it even with Viagra Connect.

Taking a lot of alcohol can also make it difficult to achieve an erection.

What if an erection lasts too long? There were rare cases when men taking this drug reported a painful or excessively long erection that lasted more than 4 hours.

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If this can women take viagra happens to you, consult a doctor immediately.

What could be a side effect? Most common (may occur in more than 1 person out of 10):

headache

Often (<1 из 10-ти случаев):

dizziness

blurred vision or cyanopsy (impaired color perception, in which a person begins to see everything in blue)

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tides

nasal congestion

nausea

Stop taking the drug and immediately seek medical attention if you have such serious side effects as:

chest pain

sudden deterioration or complete buy generic viagra online loss of vision

allergic reaction (shortness of breath, wheezing, swelling of the lips, eyelids or the whole face)

convulsions or loss of consciousness

Interaction with other drugsPatients who take antianginal drugs against stenocradia should not take Viagra Connect.

The same applies to those who use stimulants (the so-called “poppers” such as amyl nitrite sildenafil vs viagra) for recreational purposes.

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The concomitant use of Viagra Connect with ryociguat and ritronavir for the treatment of HIV / AIDS is not recommended.

When buying Viagra Connect, list to the pharmacist all the medications you take on a regular basis.

Sometimes erectile dysfunction can be a symptom of some disease, for example, cardiovascular or diabetes, so if the problem does not go away, then after six months of taking Viagra Connect you should consult a doctor.

Can I buy Viagra Connect online? Some UK network pharmacies viagra side effects will sell this drug online after an online consultation.

A drug purchased from an unlicensed seller may be counterfeit and, at best, ineffective, and at worst harm your health.

In Russia, Viagra, as a rule, is sold by prescription.

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Viagra 50mg number 1 TB. – Pharmacy Evalar

Composition:

Active viagra price ingredient: sildenafil (as sildenafil citrate) 50 mg;

auxiliary substances: microcrystalline cellulose, calcium phosphate (anhydrous), croscarmellose sodium, magnesium stearate,

film coating Opadry blue and Opadry transparent.

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Release form:

Tablet, 1 pc.

Pharmacological properties:

Acts on the natural mechanisms free viagra of erection. It is used in men suffering from erectile dysfunction of various origins (vascular, nervous erection disorders).

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Sildenafil is a potent and selective inhibitor of cGMP-specific phosphodiesterase type 5 (PDE5).

The physiological mechanism of penile erection involves the release of nitric oxide (NO) in the cavernous body during sexual stimulation.

Nitric oxide activates the otc viagra enzyme guanylate cyclase, which leads to an increase in the level of cyclic guanosine monophosphate (cGMP), relaxation of the smooth muscles of the cavernous body, and increased blood flow in the penis.

Sildenafil viagra samples free by mail does not have a direct relaxing effect on the isolated cavernous body of a person, but actively enhances the relaxing effect of NO on this tissue by inhibiting PDE5, which is responsible for the breakdown of cGMP in the cavernous body.

When cheap viagra sexually aroused, the local release of NO under the influence of sildenafil leads to the inhibition of PDE5 and an increase in the level viagra for sale of cGMP in the cavernous body, resulting in relaxation of smooth muscles and increased blood flow in the cavernous body.

A prerequisite for the effectiveness of sildenafil is sexual stimulation.

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Dosage and administration:

The drug is taken orally.

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For most patients, the recommended dose is 50 mg; the drug is taken, if necessary, about 1 hour before sexual activity. Given the efficacy and tolerability, the dose viagra over the counter may be increased to 100 mg or reduced to 25 mg.

The maximum recommended dose of 100 mg.

The maximum recommended frequency of use is 1 time per day.

Not recommended

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Hypersensitivity to any component of the drug.

Use in patients receiving constantly or intermittently nitric oxide donators, organic viagra otc nitrates or nitrites in any form.

Age up to 18 years.

Not intended for use in women.

Precautions: anatomical deformity of the penis (including angulation, cavernous fibrosis generic for viagra or Peyronn disease), diseases predisposing to the development of priapism (such as sickle cell anemia, multiple myeloma, leukemia, thrombocythemia), bleeding disorders, exacerbation diseases, hereditary retinitis pigmentosa, heart failure, unstable angina, suffered myocardial infarction, stroke or life-threatening levitra vs viagra arrhythmias, arterial hypertension in the last 6 months (Blood pressure> 170/100 mm Hg. Art.) Or hypotension (blood pressure < 90/50 мм рт. ст.).

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Composition

Description

Pharmacological properties

Clinical data

Pharmacokinetics

Indications for use

Contraindications

Dosage and administration

Side effect

Overdose

Release form

Storage conditions

Shelf life

Pharmacy sales terms

Trade name of the medicinal product: Viagra

International non-proprietary name: Sildenafil

Dosage Form: film-coated tablets

Composition

1 tablet, film coated, contains:

Active substance:

sildenafil citrate (equivalent to 25 mg, 50 mg or 100 mg of sildenafil)

Excipients:

microcrystalline cellulose, calcium phosphate, croscarmellose sodium,

magnesium stearate; film shell: opadry blue OY-LS-20921 (contains hypromellose, lactose, triacetin, titanium dioxide (E171) and aluminum varnish based on indigo carmine (E132)) and opadry transparent YS-2-19114-A (contains hypromellose and triacetin)

Up to 30 μg / g of vanillin and / or biotin can be added to the blue film coating; the content of one or both components in the film coating will be up to 0.75 μg, 1.5 μg and 3.0 μg for dosages of 25 mg, 50 mg and 100 mg, respectively.

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Description

Blue tablets, film-coated, diamond-shaped, slightly biconvex, with cut and rounded edges, engraved with Pfizer on one side and VGR 25, VGR 50 or VGR 100 on the other side, respectively.

Pharmacotherapeutic group: means of treating erectile dysfunction FDE5 inhibitor

ATX code: G04BE03

Pharmacological properties

Pharmacodynamics

Sildenafil is a potent selective cycloguanosine monophosphate (cGMP) inhibitor of type 5 phosphodiesterase (PDE5).

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 viagra over the counter walmart, subsequent relaxation of the smooth muscle tissue of the cavernous body and an increase in blood flow.

Sildenafil does not have a direct relaxing effect on the isolated cavernous body of a person, but it enhances the effect of nitric oxide (NO) by inhibiting PDE5, which is responsible for the breakdown of cGMP.

Sildenafil is selective for in vitro PDE5, its activity against PDE5 exceeds that for other known phosphodiesterase isoenzymes: PDE6 – 10 times; PDE1 – more than 80 times; PDE2, PDE4, PDE7-PDE11 – more than 700 times. Sildenafil is 4,000 times more selective with respect to PDE5 compared with PDE3, which is of paramount importance, since PDE3 is one of the key enzymes in the regulation of myocardial contractility.

A prerequisite for the effectiveness of sildenafil is sexual stimulation.

Clinical data

Cardiological studies

The use of sildenafil 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 sildenafil at a dose of 100 mg was 8.3 mm Hg. Art., and the diastolic pressure of 5.3 mm Hg. Art. A more pronounced, but also a transient effect on blood pressure (BP) was observed in patients taking nitrates (see sections Contraindications and Interaction with other drugs).

In a study of the hemodynamic effect of sildenafil in a single dose of 100 mg in 14 patients with severe coronary heart disease (CHD) (more than 70% of patients had stenosis of at least one coronary artery), the systolic and diastolic pressure at rest decreased by 7 % and 6%, respectively, and pulmonary systolic pressure decreased by 9%. Sildenafil did not affect cardiac output and did not disturb the blood flow in the stenotic coronary arteries, and also led to an increase (by approximately 13%) of adenosine-induced coronary flow in both stenotic and intact coronary arteries.

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In a double-blind, placebo-controlled study, 144 patients with erectile dysfunction and stable angina, taking antianginal drugs (except nitrates) performed physical exercises until the moment when the herbal viagra severity of symptoms of angina pectoris decreased. The duration of the exercise was significantly longer (19.9 seconds; 0.9 – 38.9 seconds) in patients taking sildenafil in a single dose of 100 mg compared with patients who received placebo.

In a randomized, double-blind, placebo-controlled study, the effect of varying doses of sildenafil (up to 100 mg) in men (n = 568) with erectile dysfunction and arterial hypertension taking more than two antihypertensive drugs was studied. Sildenafil improved erections in 71% of men compared with 18% in the placebo group. The frequency of adverse effects was comparable to that in other groups of patients, as well as in individuals taking more than three antihypertensive drugs.

Studies of visual impairment

Some buy viagra patients 1 hour after taking sildenafil at a dose of 100 mg using the Farnsworth-Munsel 100 test revealed a slight and transient violation of the ability to distinguish between shades of color (blue / green). 2 hours after taking the drug, these changes were absent. It is believed that the violation of color vision is caused by inhibition of PDE6, which is involved in the process of transmitting light in the retina. Sildenafil had no effect on visual acuity, contrast perception, electroretinogram, intraocular pressure, or pupil diameter.

In a placebo-controlled, cross-sectional study of patients with proven early-age macular degeneration (n = 9), sildenafil in a single dose of 100 mg was well tolerated. There were no clinically significant changes in vision, as assessed by special visual tests (visual acuity, Amsler grid, color perception, color passage modeling, Humphrey perimeter, and photostress).

Efficiency

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The efficacy and safety of sildenafil was evaluated in 21 randomized, double-blind, placebo-controlled study of up to 6 months in 3,000 patients aged 19 to 87, with erectile dysfunction of various etiologies (organic, psychogenic or mixed). The efficacy of the drug was evaluated globally using an erection diary, an international index of erectile function (validated questionnaire on the state of sexual function) and a partner survey.

The effectiveness of sildenafil, defined as the ability to achieve and maintain an erection sufficient for satisfactory sexual intercourse, has been demonstrated in all the studies performed and has been confirmed in long-term studies lasting for 1 year. In studies using a fixed dose, the ratio of patients who reported that therapy improved their erection was: 62% (dose of sildenafil 25 mg), 74% (dose of sildenafil 50 mg) and 82% (dose of sildenafil 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 with sildenafil also increased the quality of orgasm, allowed to achieve satisfaction from sexual intercourse and overall satisfaction.

According to the generalized data, among patients who reported improved erection with sildenafil treatment were 59% of patients with diabetes, 43% of patients undergoing radical prostatectomy, and 83% of patients with spinal cord injuries (against 16%, 15% and 12% in the what does viagra do placebo group, respectively ).

Pharmacokinetics

The pharmacokinetics of sildenafil in the recommended dose range is linear.

Suction

After ingestion, sildenafil is rapidly absorbed. Absolute bioavailability averages about 40% (from 25% to 63%). In vitro, sildenafil at a concentration of about 1.7 ng / ml (3.5 nM) inhibits human PDE5 activity by 50%. After a single dose of sildenafil in a dose of 100 mg, the average maximum concentration of free sildenafil in the blood plasma (Cmax) of men is about 18 ng / ml (38 nM). Cmax when taking sildenafil inside on an empty stomach is achieved on average within 60 minutes (from 30 minutes to 120 minutes). When taken in combination with fatty foods, the absorption rate decreases: Cmax decreases by an average of 29%, and the time to reach the maximum concentration (Tmax) increases by 60 minutes, but the degree of absorption does not significantly change (the area under the pharmacokinetic concentration-time curve (AUC) decreases by 11%).

Distribution

The volume of distribution of sildenafil in the equilibrium state is on average 105 liters.

The relationship of sildenafil 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 a dose of sildenafil (an average of 188 ng) was detected in semen 90 minutes after taking the drug side effects of viagra.

Metabolism

Sildenafil is metabolized mainly in the liver by the action of the cytochrome CYP3A4 isoenzyme (main pathway) and the cytochrome CYP2C9 isoenzyme (minor pathway). The main circulating active metabolite resulting from

N-demethylation of sildenafil, undergoes further metabolism. The selectivity of this metabolite with respect to PDE is comparable to that of sildenafil, and its activity against PDE5 in vitro is about 50% of the activity of sildenafil. The metabolite concentration in the blood plasma of healthy volunteers was about 40% of the concentration of sildenafil. The N-demethyl metabolite undergoes further metabolism; its half-life (T) is about 4 hours.

Removal

The total clearance of sildenafil is 41 l / h, and the final T – 3-5 hours. After ingestion, as well as after intravenous administration, sildenafil is excreted as metabolites, mainly by the intestine (about 80% of the oral dose) and, to a lesser extent, by the kidneys (about 13% of the oral dose).

Pharmacokinetics in Special Patient Groups

Elderly patients

In healthy elderly patients (over 65 years), the clearance of sildenafil is reduced, and the concentration of free sildenafil in the blood plasma is about 40% higher than in young people (18-45 years). Age does not have a clinically significant effect on the incidence of side effects.

Renal dysfunction

With a light (creatinine clearance (CK) 50-80 ml / min) and moderate (CK 30-49 ml / min) degree of renal failure, the pharmacokinetics of sildenafil after a single dose of 50 mg are not changed. With severe renal failure (CC 30 ml / min), the clearance of sildenafil is reduced, which leads to an approximately twofold increase in AUC (100%) and Cmax (88%) compared with those in normal renal function in patients viagra cost of the same age group.

Liver function disorders

In patients with cirrhosis of the liver (stages A and B according to Child-Pugh classification), the clearance of sildenafil is reduced, which leads to an increase in the AUC value (84%) and Cmax (47%) compared with those in normal liver function in patients of the same age groups. The pharmacokinetics of sildenafil in patients with severe hepatic impairment (Child-Pugh stage C) has not been studied.

Indications for use

Treatment of erectile dysfunction, characterized by the inability to achieve or maintain an erection of the penis, sufficient for satisfactory sexual intercourse.

Sildenafil is effective only with sexual stimulation.

Contraindications

Hypersensitivity to sildenafil or to any other component of the drug.

Use in patients who constantly or intermittently donate nitric oxide, organic nitrates or nitrites in any form, because sildenafil enhances the hypotensive effect of nitrates (see the section on Interaction with Other Medicines)

The safety and efficacy of the drug Viagra when used together best place to buy generic viagra online with other means of treating erectile dysfunction have not been studied, so the use of such combinations is not recommended (see section Special Instructions)

According to the registered indications, the drug Viagra is not intended for use in children under 18 years of age.

According to the registered indication of the drug Viagra is not intended for use in women

Carefully

Anatomical deformity of the penis (angulation, cavernous fibrosis, or Peyronie’s disease) (see section Special Instructions)

Diseases predisposing to the development of priapism (sickle cell anemia, multiple myeloma, leukemia, thrombocythemia) (see section Special instructions)

Bleeding disorders

Aggravation of peptic ulcer

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Hereditary retinitis pigmentosa (see section Special instructions)

Heart failure, unstable stenocardia, myocardial infarction, stroke or life-threatening arrhythmias, arterial hypertension (BP 170/100 mm Hg) or hypotension (BP 90/50 mm Hg) in the last 6 months (see Special instructions)

Pregnancy and lactation period

According to the registered indication the drug is not intended for use in women.

Dosage and administration

Inside

The recommended dose for most adult patients is 50 mg approximately 1 hour before sexual activity. Given the efficacy and tolerability, the dose may be increased to 100 mg or reduced to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended frequency of use is once a day.

Renal dysfunction

With mild and moderately severe renal failure (CK 30-80 ml / min), dose adjustment is not required; with severe renal failure (CK 30 ml / min), the dose of sildenafil should be reduced to 25 mg.

Liver function disorders

Since the elimination of sildenafil is impaired in patients with liver damage (in particular, with cirrhosis), the dose of the drug Viagra should be reduced to 25 mg.

Combined use with other medicines

When combined with ritonavir, the maximum single dose of Viagra should not exceed 25 mg, and the frequency of use 1 time in 48 hours (see the Interaction with other drugs section).

When combined with cytochrome CYP3A4 isoenzyme inhibitors (erythromycin, saquinavir, ketoconazole, itraconazole), the initial dose of Viagra should be 25 mg (see section Interaction with other drugs).

To minimize the risk of postural hypotension in patients taking β-adrenoblockers, taking Viagra should be started only after hemodynamic what happens if a woman takes viagra stabilization has been achieved in these patients. It should also consider the feasibility of reducing the initial dose of sildenafil (see sections Special Instructions and Interaction with other drugs).

Elderly patients

Adjustment of the dose of the drug Viagra is not required.

Side effect

Usually the side effects of the drug Viagra are mild or moderate and are transient.

In studies using a fixed dose, it was shown that the frequency of some adverse events increases with increasing dose.

Organs and organ systems Side effectsSildenafil,% Placebo,% Most frequent side effects (1/10) Nervous system Headache 10,82,8 Cardiovascular system Vazodilatation (flushing

to the skin of the face) 10,91,4 Frequent side effects (1/100 and 1/10) Nervous system Headache 2.91 Sight organ Changing vision (blurred vision, changing sensitivity

to light) 2,50,4 Chromatopsia (light and transient, mainly a change in the perception of color shades) 1,10,03 Cardiovascular system Heart palpitations 1,500 Respiratory system Viagra drug in doses exceeding the recommended, adverse events were similar to those noted above, but usually met more frequently.

General condition disorders: hypersensitivity reactions (including skin rash).

Changes in the central and peripheral nervous system: convulsions.

Changes in the cardiovascular system: tachycardia, lowering blood pressure, fainting, nosebleeds.

Gastrointestinal disturbances: vomiting.

Changes in the organ of vision: pain in the eyes, redness of the eye / scleral injection.

Reproductive system disorders: prolonged erection and / or priapism.

Overdose

With a single dose of Viagra at a dose of up to 800 mg, adverse events were comparable to those at a lower dose, but there were thicket

Release form

Tablets, film coated 25 mg, 50 mg or 100 mg

1, 2, 4, 8 or 12 tablets in a blister of PVC / polyethylene / aclar / aluminum foil

1, 2 or 3 blisters in a carton box along with instructions viagra meme for use

Storage conditions

List B. Store in a dry place at a temperature not exceeding 30 ° C

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Keep out of the reach of children

Shelf life

5 years

Do not use after the expiration date printed on the package.

Pharmacy sales terms

On prescription

Viagra Cost: VIAGRA (SILDENAFIL). INSTRUCTIONS FOR MEDICAL APPLICATION OF THE PREPARATION

Content:

Viagra Cost: VIAGRA (SILDENAFIL). INSTRUCTIONS FOR MEDICAL APPLICATION OF THE PREPARATION

VIAGRA (SILDENAFIL). INSTRUCTIONS FOR MEDICAL APPLICATION OF THE PREPARATION

It contains important information about the drug VIAGRA. It does not replace the advice of your doctor. Read this information carefully before taking Viagra. Ask your doctor or pharmacist if something is not clear to you, or if you want to learn more about Viagra than stated in this manual.

This medicine can help most men womens viagra if taken as prescribed by a doctor. However, VIAGRA is not for everyone. It is intended for use only by men with erectile dysfunction.

VIAGRA should never be taken by men who ever take medicines containing nitrates in any form, including nitroglycerin. If you take VIAGRA along with any drug containing nitrates, your blood pressure may suddenly drop to life-threatening values.

When and how to take How Much Does Viagra Cost in powder and in capsules

WHAT IS CONTAINED IN ANY PACKAGING OF VIAGRA?

The name of your drug VIAGRA. VIAGRA is produced in the form of blue, film-coated tablets of a diamond shape, slightly biconvex with cut and rounded edges, applied on one side“Pfizer”, another – “VGR 50” or “VGR 100”according to the content of the active substance.

The composition of the tablets include: active ingredient: sildenafil (as sildenafil citrate) 50 or 100 mg; excipients: microcrystalline cellulose, calcium hydrogen phosphate (anhydrous), sodium croscarmellose, magnesium stearate, Opadry® blue film coating and Opadry® transparent.

Each package contains 1 blister containing 1 tablet or 4 tablets with instructions for use.

WHAT IS VIAGRA?

VIAGRA is a pill used to treat erectile dysfunction (impotence) in men. It helps most men with erectile dysfunction to achieve an erection and keep it from sexual arousal. VIAGRA refers to the pharmacotherapeutic group “Means for treating erectile dysfunction – phosphodiesterase inhibitors (PDE) -5”, ATX code: G04BE03.

You will not have an erection if you just take this drug. Viagra will help a man with erectile dysfunction to achieve an erection only if he is sexually excited.

WHAT HAPPENS IN THE ORGANISM DURING SEX?

When a man is sexually aroused, blood enters the penis more than usual. This increases the penis and becomes harder. This condition is called an erection. After intercourse, this excess blood rush to the penis stops. An erection disappears. If an erection continues for a long time (more than 6 hours), this condition may permanently damage your penis. You should immediately consult a doctor if your erection does not disappear over a long period of time (more than 4 hours).

Some women viagra diseases and taking a number of drugs disrupt the process of natural occurrence of an erection. In these cases, the blood circulation in the penis is insufficient. Therefore, a man can not achieve full erection. If this condition occurs frequently and repeatedly, it is called erectile dysfunction.

During intercourse, your heart is working harder. Therefore, sexual activity is not recommended for people with heart problems. Before you start treating erectile dysfunction by any method, ask your doctor if your heart is healthy enough to endure physical exertion viagra connect during sex. If you feel chest pain, dizziness or nausea while having sex, you should stop it and immediately inform your doctor about the health problems that you have.

WHAT IS VIAGRA APPLIED FOR?

VIAGRA enables many men with erectile dysfunction to get a natural response to sexual arousal. When a man is sexually aroused, VIAGRA helps to improve the blood supply to the penis, allowing it to fill with blood sufficiently to cause an erection. After the completion of intercourse, the erection disappears.

VIAGRA RECEPTION IS CONTRAINDICATED IF:

If you had manifestations of hypersensitivity to Viagra, to any of its components or a similar drug.

If you are taking any medications containing nitrates – regularly or if necessary – you should never take VIAGRA. If you take VIAGRA with any drug containing nitrates, your blood pressure may suddenly drop to life-threatening values. You may feel dizzy, weak, or even have a heart attack or stroke. Nitrates are found in many prescription drugs used to treat angina (chest pain associated with cardiovascular disease). These drugs are:

• nitroglycerin (inhalers, ointments, skin patches or pastes, or tablets for oral administration, chewing or sucking in the mouth);

• isosorbide mononitrate or isosorbide dinitrate (tablets for oral administration, chewing or sucking in the mouth).

Nitrates can also be found in light club drugs, such as amyl nitrate or nitrite (“poppers”).

If you are unsure whether nitrates contain the drug you are taking, or you do not understand which substances are nitrates, ask your doctor or pharmacist.

Since this is discussed above (WHAT IS HAPPENING IN THE ORGANISM DURING SEX?), Ask your doctor if your heart is healthy enough for sexual activity.

VIAGRA is intended only for patients with erectile dysfunction. VIAGRA is not intended viagra alternative for newborns, children or women. Do not allow another person to take your Viagra.

WHAT DOES VIAGRA NOT DO?

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VIAGRA does not cure erectile dysfunction. This remedy is for the symptomatic treatment of erectile dysfunction.

VIAGRA does not protect you and your partner from sexually transmitted diseases through HIV infection, the virus that causes the development of AIDS.

VIAGRA is not a hormone, and not an aphrodisiac.

WHAT TO INFORM THE DOCTOR BEFORE HOW TO START TO TAKE VIAGRA?

Only a doctor can certainly decide whether VIAGRA is the right drug for you. VIAGRA can cause a slight temporary decrease in blood pressure. You may need to undergo a medical examination to establish a diagnosis of erectile dysfunction. And also find out that you can take Viagra without danger to your health, including with other viagra prices medicines prescribed for you. The doctor must determine whether your heart can handle the stress of having sex.

Be sure to tell your doctor:

• If you have ever had any heart problems (for example, angina, chest pain, heart failure, heart rhythm disturbances, heart attack, or aortic valve narrowing);

• If you had a stroke;

• If you have had low or high blood pressure;

• If you ever had a severe vision loss;

• If you have a rare congenital eye disease, retinitis pigmentosa (retinitis pigmentosa);

• If you had kidney problems;

• If you had liver problems;

• If you have had blood problems, including sickle cell anemia or leukemia;

• If you have an allergy to sildenafil or any other ingredient of Viagra tablets;

• If you have a penile deformity, Peyronie’s disease, or have ever had an erection lasting more than 4 hours;

• If you have had ulcerative bleeding or any other bleeding;

• If you are taking any other medicines.

VIAGRA AND OTHER MEDICATIONS

Some drugs can change the effect of Viagra. Tell your doctor about any medications you are taking. Do not start or stop taking any medication without consulting your doctor or pharmacist. This applies to both prescription and non-prescription drugs and revatio vs viagra medicines:

• Remember that VIAGRA should never be co-administered with medications containing nitrates (see VIAGRA NOT FOR EVERYONE).

• If you are taking an alpha blocker medication to treat hypertension (high blood pressure) or problems with the prostate gland, your blood pressure may drop dramatically. You may feel weak or dizzy.

• If you are taking protease inhibitors, you may need a dose selection (please read the section SELECTING THE RIGHT DOSE FOR YOU).

• VIAGRA should not be used in conjunction with any other drugs that cause an erection. These are pills; injections; drugs that are injected into the penis; implants or vacuum pumps.

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VIAGRA is available in several dosages (50 mg and 100 mg). If you do not get the expected result after taking the dose, consult your doctor. You and your doctor will determine the dose that will give you the best effect.

• Do not take a dose of Viagra more than the doctor prescribed.

Viagra Cost: VIAGRA (SILDENAFIL). INSTRUCTIONS FOR MEDICAL APPLICATION OF THE PREPARATION

• If, in your opinion, you need to increase the dose of VIAGRA, check with your doctor.

• VIAGRA should be taken no more than once a day.

The doctor may prescribe a lower dose of Viagra, for example:

• If you are over 65 years old, or you have severe kidney or liver disease, the doctor will recommend starting with the lowest dose (25 mg) of Viagra.

• If you are taking protease inhibitors used to treat HIV infection, your doctor may recommend a dose of 25 mg and may limit Viagra for you to a maximum single dose of 25 mg for 48 hours.

• If you have prostate problems or high blood pressure, and you are taking alpha blockers in this regard, the doctor may recommend starting with a lower dose of VIAGRA.

HOW TO TAKE VIAGRA?

Take a pill VIAGRA your dosage approximately 1 hour before planned sex. After about 30 minutes after taking the pill to 4 hours, VIAGRA will help you achieve an erection if you are sexually excited. You will not have an erection if you just take a pill inside. If you take VIAGRA after a meal that contains a lot of fat, the medicine can begin its action a little later.

POSSIBLE SIDE EFFECTS

Like all medications, VIAGRA can cause some side effects. These effects are usually mild or moderate, and last no more than a few hours. Some of these side effects are more likely to occur with higher doses. The most frequent side effects of Viagra are headache, facial flushing, indigestion. Less common were such side what is viagra effects as: impaired color vision (such as the inability to distinguish between blue and green objects or the vision of all objects with a shade of blue); changing the sensitivity of the eyes to light; blurry vision; cardiopalmus; nasal congestion; stomach upset.

When using VIAGRA in doses higher than recommended, adverse events were similar to those indicated above, but were usually more common. There were also reports of the development of such side effects as: hypersensitivity reactions (including skin rash), convulsions, decrease in blood pressure, fainting, nosebleeds, vomiting.

Very rarely, men taking PDE-5 inhibitors (a group of drugs for treating erectile dysfunction for oral administration, including VIAGRA) reported a sudden decrease or loss of vision in one or both eyes. It is impossible to determine whether these cases were directly related to taking these drugs, or to the influence of other factors, such as high blood is viagra government funded pressure or diabetes, or a combination of all factors. If you have a sudden decrease or loss of vision, stop taking PDE-5 inhibitors, including VIAGRA, and immediately consult a doctor.

Very rarely men reported an erection that lasted several hours. You should see a doctor immediately if you have an erection lasting more than 4 hours. If no action is taken immediately, irreversible damage to the penis can develop (see WHAT IS HAPPENING IN THE ORGANISM DURING SEX?).

Rarely reported sudden loss or decrease in hearing, sometimes accompanied by tinnitus and dizziness, in people taking PDE-5 inhibitors, including VIAGRA. It is not possible to determine whether these factors are directly related to the intake of PDE-5 inhibitors, other diseases or the use of other drugs, other factors, or a combination of factors.

If you have these symptoms, stop taking Viagra and immediately consult a doctor.

VIAGRA can cause other side effects than those listed in this manual. If you need more information, or you have side effects or symptoms that bother viagra ingredients you, consult your doctor.

RANDOM OVERDOSE

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In case of overdose, consult a doctor immediately.

VIAGRA STORAGE

Shelf life 5 years. Do not use tablets after the expiration date printed on the package.

Keep VIAGRA out of the reach of children at a temperature not exceeding 30 ° C.

CONDITIONS FOR HOLIDAY FROM DRUGSTORES

On prescription

MANUFACTURER

Pfizer PGM, France

IF YOU NEED MORE INFORMATION ABOUT VIAGRA

VIAGRA is a prescription drug used to treat erectile dysfunction. Only your doctor can decide if it is for you. This manual is only a brief description. If you have questions, or need more information about VIAGRA, ask your doctor or pharmacist, go to www.viagra.com, or call the representative office “PFIZER H.C.P. CORPORATION” in the Republic of Belarus by phone + 375-17-218-14-80.

CDS 190 12/20/2007

Viagra Pills: Viagra (Viagra) – instructions for use, composition, drug analogs, dosages, side effects

Content:

Viagra Pills: Viagra (Viagra) - instructions for use, composition, drug analogs, dosages, side effects

Viagra® (Viagra®) – instructions for use, composition, drug analogues, dosages, side effects

Description of the drug how much does viagra cost Viagra® (Viagra®): composition and instructions for use, contraindications, prices in the Encyclopedia of drugs radar

To diagnose erectile dysfunction, determine their possible causes, and select an adequate treatment, it is necessary to gather a full medical history and conduct a thorough physical examination. Erectile dysfunction treatment should be used with caution in patients with anatomical deformation of the penis (angulation, cavernous fibrosis, Peyronie’s disease) or risk factors for the development of priapism (SKA, multiple myeloma, leukemia) (see Precautions).

During postmarketing studies, cases of prolonged erection and priapism have been reported. If an erection persists for more than 4 hours, you should immediately seek medical attention. If priapism therapy was not carried out immediately, it can cause damage to the tissues of the penis and irreversible loss of potency.

Drugs for treating erectile dysfunction should not be given to men for whom sexual activity is undesirable.

Sexual activity poses a certain risk in the presence of heart disease, therefore, before starting any therapy for erectile dysfunction, the doctor should refer the patient to an STS examination. Sexual activity is undesirable in patients with heart failure, unstable angina, suffered myocardial infarction viagra and alcohol or stroke, life threatening arrhythmias, hypertension (BP> 170/100 mm Hg) or hypotension (BP) in the last 6 months. <90/50 мм рт.ст.). Прием силденафила у таких пациентов противопоказан (см. «Противопоказания»). В клинических исследованиях показано отсутствие различий в частоте развития инфаркта миокарда (1,1 на 100 человек в год) или частоте смертности от сердечно-сосудистых заболеваний (0,3 на 100 человек в год) у пациентов, получавших препарат Виагра®, по сравнению с пациентами, получавшими плацебо.

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Cardiovascular complications

The post-marketing use of sildenafil for the treatment of erectile dysfunction reported adverse events such as severe cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic stroke, I, I, I haven’t put a template, transient ischemic heart attack, I have an unpleasant heart attack, ventricular arrhythmia, hemorrhagic stroke, transient ischemic stroke, and I have an unpleasant heart attack, sudden heart death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic stroke, transient ischemic attack, and I have already applied a cardiac abnormality. ), which had a temporary connection with over the counter viagra substitute the use of sildenafil. 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 of them were observed after taking sildenafil without subsequent sexual activity. It is not possible to establish the existence of a direct connection between the observed adverse events and the specified or other factors.

Viagra Pills: Viagra (Viagra) - instructions for use, composition, drug analogs, dosages, side effects

Hypotension

Sildenafil has a systemic vasodilating effect, leading to a transient decrease in blood pressure generic viagra online, which is not a clinically significant event and does not lead to any consequences in most patients. However, before prescribing Viagra®, the doctor should carefully evaluate the risk of possible undesirable manifestations of the 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 left ventricular output tract (aortic stenosis, GOKMP), as well as rarely occurring syndrome of multiple systemic atrophy, manifested by severe dysregulation of blood pressure by the autonomic nervous system.

Since the combined use of sildenafil and α-blockers can lead to symptomatic hypotension in individual sensitive patients, Viagra® should be prescribed with caution to patients taking α-blockers (see “Interaction”). To minimize the risk of postural hypotension viagra samples in patients taking α-adrenergic blockers, taking Viagra® should be started only after stabilization of hemodynamic parameters in these patients is achieved. It should also be considered the feasibility of reducing the initial dose of the drug Viagra® (see “Dosage and administration”). The physician should inform the patient about what action should be taken in case of symptoms of postural hypotension.

Visual impairment

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In rare cases, during post-registration use of all PDE-5 inhibitors, incl. Sildenafil, reported NPINZN – a rare disease and the reason for the reduction or loss of vision. Most of these patients had risk factors, in particular a decrease in the ratio of excavation diameters and optic nerve head (congestive disc), over 50 years of age, diabetes, hypertension, coronary heart disease, hyperlipidemia and smoking. In an observational study, it was evaluated whether the recent use of drugs of the class of PDE-5 inhibitors is related to the acute onset of NPINSN. The results indicate an approximately 2-fold increase in the risk of NPINZN within 5T1 / 2 after the use of a PDE-5 inhibitor. According to published literature data, the annual incidence of NPINSN is 2.5–11.8 cases per 100,000 men ge; 50 years in the viagra prank general population. Patients should be advised to discontinue sildenafil therapy in the event of a sudden loss of vision and consult a physician immediately.

Persons who have already had a case of an NPINZN have an increased risk of a recurrence of an NPINZN. Therefore, the physician should discuss this risk with such patients, as well as the potential chance of adverse effects of PDE-5 inhibitors. PDE-5 inhibitors, incl. Sildenafil, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk viagra generic name. In patients with episodes of development of NPINZN with loss of vision in one eye, sildenafil is contraindicated (see “Contraindications”).

A small number of patients with hereditary retinitis pigmentosa have genetically determined dysfunctions of the retinal PDE. Information about the safety of Viagra® in patients with retinitis pigmentosa is absent, so sildenafil should not be used in these patients (see “Contraindications canadian viagra”).

Viagra Pills: Viagra (Viagra) - instructions for use, composition, drug analogs, dosages, side effects

Hearing loss

In some post-marketing and clinical studies reported cases of sudden deterioration or loss of hearing associated with the use of all PDE-5 inhibitors, including sildenafil. Most of these patients had risk factors for sudden deterioration or hearing loss. A causal relationship between the use of PDE-5 inhibitors and a sudden deterioration in hearing or hearing loss has not been established. In case of sudden hearing loss or hearing loss with sildenafil intake, you should immediately consult with your doctor.

Bleeding

Sildenafil enhances the antiplatelet effect of sodium nitroprusside, a nitric oxide donator, on human platelets in vitro. There are no data on the safety of using sildenafil in patients with a tendency to bleeding or exacerbation of gastric ulcer and duodenal ulcer, therefore Viagra® should be used with caution in these patients (see With caution).

The frequency of nasal bleeding in patients with pulmonary hypertension associated with diffuse connective tissue diseases was higher (sildenafil – 12.9%, placebo – 0%) than in patients with primary pulmonary arterial hypertension (sildenafil – 3%, placebo – 2, four%). In patients receiving sildenafil in combination with a vitamin K antagonist, the frequency of nosebleeds was higher (8.8%) than in patients not taking a vitamin K antagonist (1.7%).

Use in conjunction with other treatments for erectile dysfunction.

The safety and efficacy of Viagra® together with other PDE-5 inhibitors or other drugs for the treatment of pulmonary arterial hypertension how to get viagra containing sildenafil (for example, Revacio®), or other means for generic viagra cost treating erectile dysfunction have not been studied, therefore the use of such combinations is not recommended (see “Contraindications”).

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Influence on the ability to drive and mechanisms. Against the background of sildenafil intake, there was no negative effect on the ability to drive a car or other technical means. However, since the administration of sildenafil may develop dizziness, lower blood pressure, the development of chromatopsia, blurred vision, etc. side effects, caution should be exercised when driving and engaging in other potentially hazardous activities that require increased concentration and psychomotor reactions. You should also be attentive to the individual action of the drug in these situations, especially at the beginning of treatment and when changing the dosage regimen.