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Contraindications

hypersensitivity to Buy Sildenafil With Bitcoins 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 Buy Sildenafil With Bitcoin/btc Or Credit Card enhances the hypotensive effect of nitrates (see "Interaction»);

the combined use of inhibitors of PDE5, including Buy Sildenafil With Bitcoins, 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 Buy Kamagra With Bitcoin 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.

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

Buy Sildenafil With Bitcoins does not have a direct relaxing effect on the isolated cavernous human body, but enhances the effect of nitric oxide by inhibiting PDE-5, which is responsible for the disintegration of cGMP.

Selective Pay For Female Viagra With Bitcoin/btc against PDE5 in vitro, its activity against PDE5 superior activity against other known PDE isoenzymes: PDE-6 — 10 times; PDE-1 more than 80 times; PDE-2, PDE-4, PDE-7 PDE–11 more than 700 times. Buy Sildenafil With Bitcoins is 4000 times more selective for PDE-5 than PDE-3, which is crucial because PDE-3 is one of the key enzymes in the regulation of myocardial contractility.

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Buy Sildenafil With Bitcoins restores impaired erectile function in conditions of sexual stimulation by increasing blood flow to the cavernous bodies of the penis.

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

Metabolism. Buy Sildenafil With Bitcoins 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 Buy Sildenafil With Bitcoin, undergoes further metabolism. The selectivity of this metabolite against PDE is comparable to that of Buy Sildenafil With Bitcoins, and its activity against PDE-5 in vitro is about 50% of the activity of Buy Sildenafil With Bitcoins. The concentration of the metabolite in the blood plasma of healthy volunteers was about 40% of the concentration of Buy Sildenafil With Bitcoins. N-demethyl metabolite undergoes further metabolism; its T1/2 is about 4 no.

Breeding. The total clearance of Purchase Viagra For Bitcoin Online Pharmacy is 41 l/h, and the final T1/2 — 3-5 h. After oral administration, as well as after I/V, Buy Sildenafil With Bitcoins is excreted as metabolites, mainly by the intestine (about 80% oral dose) and to a lesser extent by the kidneys (about 13% oral dose).

Cardiovascular complications

During the post-marketing use of Sildenafil Bitcoin/btc Pharmacy Online for the treatment of erectile dysfunction, adverse events such as severe cardiovascular complications (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, hypertension and hypotension) were reported, which had a temporary connection with the use of Kamagra For Bitcoin. Most of these patients, but not all of them, had risk factors for cardiovascular complications. Many of these adverse events were observed shortly after sexual activity, and some were observed after taking Buy Viagra With Bitcoin/btcs without subsequent sexual activity. It is not possible to establish a direct link between the reported adverse events and those or other factors.

Hypotension

Viagra Bitcoin/btc Pharmacy Online has a systemic vasodilating effect, leading to a transient decrease in blood PRESSURE, which is not clinically significant and does not lead to any consequences in most patients. However, before prescribing Buy Sildenafil With Bitcoins, the doctor should carefully assess the risk of possible undesirable manifestations of 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 output tract of the left ventricle (aortic stenosis, GOCMP), as well as with the rare syndrome of multiple systemic atrophy, manifested by a severe violation of the regulation of blood PRESSURE from the autonomic nervous system.

Since the combined use of Pay For Female Viagra With Bitcoin and α-blockers can lead to symptomatic hypotension in some sensitive patients, Buy Sildenafil With Bitcoins should be used with caution in patients taking α-blockers (see "Interaction"). To minimize the risk of postural hypotension in patients taking α-blockers, the drug Generic Kamagra For Bitcoin/btc should be started only after achieving stabilization of hemodynamic parameters in these patients. It should also consider reducing the initial dose of Buy Sildenafil With Bitcoins (see. "Dosage and administration"). The doctor should inform patients about what actions should be taken in case of symptoms of postural hypotension.



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