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Natural Viagra: Buy Viagra coated tablets 100mg 1 (Sildenafil) in an online pharmacy

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Natural Viagra: Buy Viagra coated tablets 100mg 1 (Sildenafil) in an online pharmacy

Buy Viagra tablets coated 100mg №1 (Sildenafil) in the online pharmacy Zhivika city of Kurgan at a low price.

Indications: 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 viagra samples free by mail 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, since sildenafil enhances the hypotensive effect of nitrates (see the section “Interaction with other drugs”).

Combined use of PDE5 inhibitors, including sildenafil, with guanylate cyclase stimulants, such as riociguat, as this can lead to symptomatic hypotension.

The safety and efficacy of Viagra® when used together with other means of treating erectile dysfunction have not been studied, therefore, the use of such combinations is not recommended (see section “Special Instructions”).

Lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

Severe hepatic impairment (Child-Pugh class C).

Simultaneous administration of ritonavir.

Severe cardiovascular diseases (severe heart failure, unstable angina, suffered a stroke or myocardial infarction, life-threatening arrhythmias, hypertension (BP> 170/100 mm Hg) or arterial hypotension (BP less than 90/50 mm) Hg)) (see the section “Special Instructions”).

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

Hereditary retinitis pigmentosa (see section “Special instructions”).

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

According to the registered indication, Viagra® is not intended for use in women.

Carefully

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

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

– Diseases accompanied by bleeding.

When and how to take How To Use Viagra in powder and in capsules

– Peptic ulcer and duodenal ulcer in the acute stage.

– Liver dysfunction.

– Severe renal failure (CC less than 30 ml / min).

– Patients with an episode of development of anterior non-arteritis ischemic neuropathy of the optic nerve in history (see section “Special Instructions).

– Simultaneous reception of alpha-adrenoreceptor blockers.

Pregnancy and lactation period

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

Active substance: sildenafil.

Product form: tablets, film coated 100 mg №1.

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 moderate renal failure (CC 30-80 ml / min) dose adjustment is not required, with severe renal failure (CC < 30 мл/мин) – дозу силденафила следует снизить до 25 мг.

Liver function disorders

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

Combined use with other medicines

Combined use with ritonavir is not recommended. In any case, the maximum dose of Viagra® under no circumstances should not exceed 25 mg, and the frequency of use – 1 time in 48 hours (see the section “Interaction with other drugs”).

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 alpha blockers, taking Viagra® should be started only after hemodynamic stabilization has cheap viagra been achieved in these patients. It is also necessary to consider the expediency of reducing the initial dose of sildenafil (see the sections “Special Instructions” and “Interaction with Other Medicines”).

Elderly patients

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

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Drug interactions: Effects of other drugs on the pharmacokinetics of sildenafil

Sildenafil metabolism occurs mainly under the action of cytochrome CYP3A4 isoenzymes (main route) and CYP2С9, therefore inhibitors of these isoenzymes can reduce the clearance of sildenafil, and inductors, respectively, increase the clearance of sildenafil. A marked decrease in the clearance of sildenafil with simultaneous use of cytochrome CYP3A4 isoenzyme inhibitors (ketoconazole, erythromycin, cimetidine). Cimetidine (800 mg), a non-specific inhibitor of the cytochrome CYP3A4 isoenzyme, when taken together with sildenafil (50 mg) causes an increase in plasma concentration of sildenafil by 56%. A single dose of 100 mg of sildenafil together with erythromycin (500 mg / day, 2 times a day for 5 days), a moderate inhibitor of the cytochrome CYP3A4 isoenzyme, while achieving a constant concentration of erythromycin in the blood, leads to an increase in AUC of sildenafil by 182%. When coadministration of sildenafil (once 100 mg) and saquinavir (1200 mg / day 3 times a day), HIV protease inhibitor and cytochrome CYP3A4 isoenzyme, while achieving a constant concentration of saquinavir in the blood, Cmax of sildenafil increased by 140%, and AUC increased by 210%. Sildenafil has no effect on the pharmacokinetics of saquinavir. More potent inhibitors of cytochrome CYP3A4 isoenzyme, such as ketoconazole and itraconazole, can also cause stronger changes in the pharmacokinetics of sildenafil.

The simultaneous use of sildenafil (once 100 mg) and ritonavir (500 mg 2 times a day), an HIV protease inhibitor and a strong inhibitor of cytochrome P450, while achieving a constant concentration of ritonavir in the blood leads to an increase in Cmax of sildenafil by 300% (4 times ), and the AUC is 1000% (11 times). After 24 hours, the concentration of sildenafil in the blood plasma is about 200 ng / ml (after a single application of one sildenafil – 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 buy generic viagra online under no circumstances exceed 25 mg within 48 hours.

If sildenafil is taken in recommended doses by patients receiving simultaneously strong inhibitors of the cytochrome CYP3A4 isoenzyme, then C max 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 the simultaneous use of an antagonist of endothelin receptors, bosentan (inducer of CYP3A4 isoenzyme (moderate), CYP2C9 and, possibly, CYP2C19) in equilibrium concentration (125 mg twice a day) and sildenafil in equilibrium concentration (80 mg three times per 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.

Cytochrome CYP2C9 isoenzyme isoenzyme (tolbutamide, warfarin), cytochrome CYP2D6 isoenzyme (selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and thiazide-like diuretics, ACF inhibitors and calcium antagonists, they cannot apply.

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Azithromycin (500 mg / day for 3 days) has no effect on 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 cytochrome P450 isoenzymes – 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4 (IC50> 150 μmol). When taking sildenafil at recommended doses, its Cmax is about 1 micromol, so it is unlikely that sildenafil can affect the substrate clearance of these isoenzymes.

Sildenafil enhances the hypotensive effect of nitrates, both with prolonged use of the latter, and with their appointment 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 mean additional decrease in systolic / diastolic blood pressure in the supine position was 7 / 7 mm Hg Art., 9/5 mm Hg. Art. and 8/4 mm Hg. Art., respectively, and in the standing position – 6/6 mm Hg. Art., 11/4 mm Hg. Art. and 4/5 mm Hg. Art., respectively. Rare cases of the development of symptomatic postural how long does viagra last hypotension, manifested in the form of dizziness (without fainting), are reported in these patients. Individual Sensitive Patients Receiving

alpha-blockers, the simultaneous use of sildenafil can lead to symptomatic hypotension.

There were no signs of significant interaction with tolbutamide (250 mg) or warfarin (40 mg), which are metabolized by the cytochrome CYP2C9 isoenzyme.

Sildenafil (100 mg) has no effect on the pharmacokinetics of the HIV protease inhibitor, saquinavir, which is a substrate of the cytochrome CYP3A4 isoenzyme, at its constant level in the blood.

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

Sildenafil (50 mg) does not cause an additional increase in bleeding time when taking acetylsalicylic acid (150 mg).

Sildenafil (50 mg) does not enhance the hypotensive effect of alcohol in healthy volunteers with an average blood alcohol concentration of 0.08% on average (80 mg / dl).

In patients with hypertension, signs of the interaction of sildenafil (100 mg) with amlodipine were not detected. The average additional decrease in blood pressure in the prone position is 8 mm Hg. Art. (systolic) and 7 mm Hg. Art. (diastolic).

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

Side Effects: The most frequent side effects were headache and hot flashes.

Typically, the side effects of the drug Viagra “mild or moderately expressed and are transient in nature.

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

The frequency of adverse reactions is presented according to the following classification:

Very often> 10%

Often> 1% and <10%

Infrequently> 0.1% and <1%

Seldom> 0.01% and <0,1%

Very rarely <0,01%

Frequency unknown – cannot be determined based on available data.

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 – non-arthritic anterior ischemic optic neuropathy, retinal vein occlusion, visual field defect, diplopia *, temporary loss of vision or reduced visual acuity, increased intraocular pressure, retinal edema, retinal vascular 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, feeling of heartbeat, lowering blood pressure, increasing heart rate, unstable angina, atrioventricular block, myocardial infarction, cerebral thrombosis, cardiac arrest, heart failure, abnormalities in electrocardiogram readings, cardiomyopathy; rarely – atrial fibrillation, sudden cardiac death *, ventricular arrhythmia *.

From the side of blood and lymphatic system: infrequently – anemia, leukopenia.

Metabolism sildenafil vs viagra 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 cough; rarely – a feeling of tightness in the throat, dryness of the mucous membrane of the nasal cavity, swelling of the mucous membrane of the nasal cavity.

On the part of the gastrointestinal tract: often – nausea, dyspepsia; infrequently – gastroesophageal reflux disease, vomiting, abdominal pain, dryness of the oral mucosa, glossitis, gingivitis, colitis, dysphagia, gastritis, gastroenteritis, esophagitis, stomatitis, deviation of “liver” functional tests from the norm, rectal bleeding; rarely – hypoesthesia of the oral mucosa.

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

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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 reaction, shock, asthenia, fatigue, pain of different localization, chills, accidental fall, pain in the chest, accidental injury; 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 viagra pill, 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 nerve neuropathy (NPINZN) was reported – a rare disease and cause of loss 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 (“stagnant disk”), 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 FDE5 inhibitor class is associated with an acute onset of NPINSN. The results indicate an approximately 2-fold increase in the risk of NPINZN within 5 elimination half-lives after the use of the PDE5 inhibitor. According to published literature, 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, including sildenafil, in these patients should be used with caution and only in situations where the expected benefit outweighs the risk.

When using Viagra® at doses higher than recommended, adverse events were similar to those noted above, but were usually more frequent.

Special instructions: To diagnose erectile dysfunction, determine their possible causes and select an adequate treatment, it is necessary to collect a full medical history and conduct a thorough physical examination. Erectile dysfunction treatments 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) (see the “Precautions” section). ).

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 viagra otc.

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 viagra for sale last 6 months, life-threatening arrhythmias, hypertension (BP> 170/100 mmHg) or hypotension (BP < 90/50 мм рт. ст.). Прием силденафила у таких пациентов противопоказан (см. раздел «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.

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.

Hypotension

Sildenafil has a systemic vasodilating effect, leading to a transient decrease in blood pressure, 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 appropriate 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, hypertrophic obstructive cardiomyopathy), as well as with rarely occurring 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-adrenergic blockers can lead to symptomatic hypotension in individual sensitive patients, Viagra® should be prescribed with caution to patients taking alpha-adrenergic blockers (see section “Interaction with other drugs”). 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 is also necessary to consider the feasibility of reducing the initial dose of Viagra® (see the section “Route of administration and doses”). The physician should inform the patient about what action 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 nerve neuropathy (NPINZN) was reported – a rare disease and cause of loss or loss of vision. Most of these patients had female viagra pill risk factors, in particular a decrease in the ratio of excavation diameters and optic nerve head (“stagnant disc”), age over 50 years, diabetes, hypertension, coronary heart 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 2-fold 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, including sildenafil, in these 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 (see section “Contraindications”).

A small number of patients with hereditary retinitis pigmentosa have genetically determined abnormalities of retinal phosphodiesterase functions. There is no information about the safety of Viagra® in patients with retinitis pigmentosa, so sildenafil should not be used in such patients (see section “Contraindications”).

Hearing loss

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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 case can women take viagra 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 the section “With caution”). The frequency of nasal bleeding in patients with PH associated with diffuse connective tissue diseases was higher (sildenafil 12.9%, placebo 0%) than in patients with primary pulmonary arterial hypertension (sildenafil 3.0%, 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.

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

Impact on the ability to drive 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 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.

Storage conditions

Store at a temperature not higher than 30 * C

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