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What Is Viagra: Viagra 50 mg tablets 1- manual, composition, analogs, reviews. Low price in Good Day Pharmacy (Add.ua)

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What Is Viagra: Viagra 50 mg tablets 1- manual, composition, analogs, reviews. Low price in Good Day Pharmacy (Add.ua)

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Viagra 50 mg tablets # 1 CODE: 3867 ✅ Available viagra pills. Buy at a price of 168.00 UAH. ⚡ Tel. ☎ 0 (800) 500-129. ✅ Low prices ✅ Always available | Instructions for the drug, composition, reviews, indications for use – Pharmacy Good Day

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

What Is Viagra: how to take, reviews

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