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Viagra (sildenafil citrate)

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Information

The pharmacokinetics of Does Medicare Cover Viagra For Erectile Dysfunction in the recommended dose range is linear.

Suction. After intake of Is Viagra Good For Erectile Dysfunction is rapidly absorbed. Absolute bioavailability averages about 40% (25 to 63%). In vitro Herbal Viagra For Erectile Dysfunction at a concentration of about 1.7 ng/ml (3.5 nm) inhibits the activity of PDE-5 50%. After a single dose of Herbal Viagra For Erectile Dysfunction 100 mg average Cmax free Alternative To Viagra For Erectile Dysfunction in plasma men is about 18 ng/ml (38 nm). Cmax when taking Herbal Viagra For Erectile Dysfunction inside fasting is achieved for an average of 60 minutes (from 30 to 120 minutes). When taken in combination with fatty foods, the rate of absorption decreases: Cmax decreases by an average of 29%, and Tmax increases by 60 minutes, but the degree of absorption does not change significantly (AUC decreases by 11%).

Distribution. The average Vss of Herbal Viagra For Erectile Dysfunction is 105 l. the Association of Does Medicare Cover Viagra For Erectile Dysfunction and its main circulating N-demethyl metabolite with plasma proteins is about 96% and does not depend on the total concentration of the drug. Less than 0.0002% of the dose of Is Viagra Only For Erectile Dysfunction (an average of 188 ng) was found in sperm 90 minutes after taking the drug.

Metabolism. Viagra Erectile Dysfunction Treatment is metabolized mainly in the liver by the action of CYP3A4 isoenzyme (main pathway) and CYP2C9 isoenzyme (minor pathway). The main circulating active metabolite, formed as a result of N-demethylation of Herbal Viagra For Erectile Dysfunction, undergoes further metabolism. The selectivity of this metabolite against PDE is comparable to that of Herbal Viagra For Erectile Dysfunction, and its activity against PDE-5 in vitro is about 50% of the activity of Herbal Viagra For Erectile Dysfunction. The concentration of the metabolite in the blood plasma of healthy volunteers was about 40% of the concentration of Viagra Cure Erectile Dysfunction. N-demethyl metabolite undergoes further metabolism; its T1/2 is about 4 no.

Breeding. The total clearance of Herbal Viagra For Erectile Dysfunction is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Dose Of Viagra For Erectile Dysfunction is excreted as metabolites, mainly by the intestine (about 80% oral dose) and to a lesser extent by the kidneys (about 13% oral dose).

Contraindications

hypersensitivity to Herbal Viagra For Erectile Dysfunction or any other component of the drug;

application in patients receiving constantly or intermittently nitric oxide donators, organic nitrates or nitrites in any form, as Herbal Viagra For Erectile Dysfunction enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Viagra Stress Erectile Dysfunction, called guanylate cyclase stimulants such as riociguat, because it can lead to symptomatic hypotension;

concomitant use with other agents for the treatment of erectile dysfunction (safety and efficacy of Is Viagra Good For Erectile Dysfunction when used together has not been studied (see. "Special instructions»);

lactose intolerance, lactase deficiency, glucose-papacosma malabsorption;

severe liver failure (class C classification for child-Pugh);

simultaneous administration of ritonavir;

severe cardiovascular diseases (severe heart failure, unstable angina, stroke or myocardial infarction during the last 6 months, life-threatening arrhythmias, hypertension (BP >170/100 mm Hg). art.) or hypotension (blood PRESSURE <90/50 mm Hg.art.) (see "Special instructions»);

patients with episodes of development partizanai anterior ischemic optic neuropathies (NESN) with loss of vision in one eye;

hereditary retinitis pigmentosa (see special instructions»);

according to the registered indication is not intended for use in women;

according to the registered indication is not intended for use in children under 18 years.

With caution: anatomic deformity of the penis (angulation, cavernous fibrosis or Peyronie's disease) (see "Special instructions"); diseases of, predisposing to the development of priapism (sickle-cell anemia, multiple myeloma, leukemia, thrombocythemia) (see "Special instructions"); diseases accompanied by haemorrhage; ulcer disease of stomach and duodenum in the acute phase; liver dysfunction; severe renal insufficiency (Cl creatinine <30 ml/min); patients with an episode of partizanai development of the anterior ischemic optic neuropathies in history (see "Special instructions); simultaneous reception of blockers α-adrenergic receptors.

Use during pregnancy and breast-feeding

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

Visual impairment

In rare cases, during post-approval use of all of the inhibitors of PDE5, including Is Viagra For Erectile Dysfunction, reported NESN is a rare disease and the cause of the decrease or loss of vision. Most of these patients had risk factors, such as decreased ratios of excavation diameter to optic disc (stagnant disc), age over 50, diabetes, hypertension, CHD, hyperlipidemia, and Smoking. In an observational study evaluated whether recent use of drugs class of inhibitors PDE-5 with an acute onset NESN. The results indicate approximately a 2-fold increase in risk NESN within 5T1/2 after application of the PDE-5 inhibitor. According to published literature, the annual incidence of npins IS 2.5–11.8 cases per 100,000 men aged ≥50 years in the General population. Patients should be advised to stop Herbal Viagra For Erectile Dysfunction therapy in case of sudden loss of vision and consult a doctor immediately.

Persons who have already had a case NESN have an increased risk of relapse NESN. Therefore, the doctor should discuss this risk with such patients, as well as the potential chance of adverse effects of PDE-5 inhibitors. PDE-5 inhibitors, including Herbal Viagra For Erectile Dysfunction, in such patients should be used with caution and only in situations where the expected benefit outweighs the risk. In patients with episodes of development PINZN with loss of vision in one eye receiving Can Viagra Be Used For Erectile Dysfunction is contraindicated (see "Contraindications").

A small number of patients with hereditary retinitis pigmentosa have genetically determined disorders of the PDE of the retina. Information about the safety of the drug Sildenafil For Erectile Dysfunction in patients with retinitis pigmentosa absent, so these patients should not be used Herbal Viagra For Erectile Dysfunction (see "Contraindications").

Clinical data

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

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

The effectiveness of Viagra For Psychological Erectile Dysfunction, defined as the ability to achieve and maintain an erection sufficient for satisfactory sexual intercourse, has been demonstrated in all studies and confirmed in long-term studies lasting 1 year. In studies with the use of fixed-dose proportion of patients reporting that treatment improved their erections were 62% (dose of Is Viagra Good For Erectile Dysfunction 25 mg), 74% (dose Viagra Erectile Dysfunction Dose 50 mg) and 82% (dose Viagra Tablet For Erectile Dysfunction 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 Will Viagra Work For Erectile Dysfunction also increased the quality of orgasm, allowing to achieve satisfaction from sexual intercourse and overall satisfaction.

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

Pharmacokinetics



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