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canadian drugs cialis

canadian drugs cialis

Tadalafil works on FDE5 more active than on other types of phosphodiesterases. Substance is 10000 times more powerful influence on FDE5 than on FDE1, FDE2 and FDE4, which are produced in the heart, brain, blood vessels, liver and other internal organs. Tadalafil blocks FDE5 in 10000 times more active than FDE3-enzyme vrabatawatisa in the heart and blood vessels, that is very important, because this enzyme is involved in the reduction of heart muscle. Moreover, tadalafil behaves approximately 700 times more in relation to FDE5 than to FDE6, which is produced in the retina and is responsible for fotoperedacu.

Also tadalafil in 10000 times more powerfully affects the FDE5 compared to the effects on FDE7-FDE10.

Important: Use discount viagra has no effect in the absence of sexual stimulation.

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The drug improves erections and the ability to conduct a successful sexual intercourse. Sialis action lasts for 36 hours.
Effect (when there is sexual stimulation) becomes noticeable after about 16 minutes after taking cialis.
As a result comparison discount viagra and placebo was a minimal impact on the change of systolic and diastolic pressure in healthy individuals (mean reduction in pressure 1.6/0.8 mmHg, respectively).

In addition, tadalafil has no effect on the change in heart rate (HR), as well as to recognize colors, Visual acuity, intraocular pressure, pupil size and elektroretinogrammu.

In preparation admission amounting to a daily dose of 10 mg in influencing the quantity and concentration of sperm morphology and sperm motility was not detected.

Pharmacokinetic properties:

Induction
Tadalafil is rapidly absorbed after taking inwards. Average maximum concentration (Cmax) in plasma achieved an average of 2:00 after the use of the drug.
Because the speed and degree of suction cialis does not depend on the meals, the drug can be taken before meals and after. Office hours (morning or evening) in the study showed no clinically significant effect on the speed and the intake of the drug.

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Cialis pharmacokinetics in healthy individuals is linear with respect to time and dose. In the range of doses from 2.5 mg to 20 mg of area under the curve of concentration versus time increases in proportion to the dose. Equilibrium concentration in plasma achieved within 5 days when receiving the drug once a day.

Cialis pharmacokinetics in patients with erectile dysfunction is absolutely no different from pharmacokinetics in individuals without an erection dysfunction. Metabolism
Tadalafil is mainly metabolized with the participation of izofermenta (CYP) 3A4 zitohroma r450. The major circulating metabolite becomes metilkateholglukuronid. This metabolite in 13000 times less active compared to FDE5 than tadalafil. Therefore, you can assume that this metabolite is not clinically significant in the observed concentrations.

Inferring
In healthy individuals the average clearance cialis ingestion is 2.5 l/h, and the average elimination half-life is 17.5 hours. Tadalafil is excreted in the form of inactive metabolites: the main part with faeces (approximately 61% dose), the remainder in the urine (approximately 36% of dose).

Pharmacokinetics special groups of patients:

Older people
When studying the drug healthy elderly (65 years and over) had lower clearance cialis ingestion, resulting in an increase in the area under the curve of concentration versus time at 25% compared with healthy persons aged 19 to 45 years. However, this difference is not clinically significant and does not require dose selection.

Renal failure
In patients with mild (creatinine clearance is 51-80 mL/min) or moderate (creatinine clearance 31-50 mL/min) renal insufficiency area under the curve of concentration-time "more than in healthy individuals. In patients with severe renal insufficiency (creatinine clearance 30 mL/min) tadalafil has not been investigated.

Failure of the liver
Because cialis pharmacokinetics in people with low and moderate hepatic insufficiency is similar to that of healthy persons given patients a special selection of dose is not required.

Patients with diabetes mellitus
In patients with diabetes mellitus, Sialis when applying the area under the curve of concentration versus time is less than approximately 19%, than in healthy individuals. This distinction special dose selection does not require.

Indications: erectile dysfunction.
Contraindications:
-hypersensitivity to active substances and preparation;
-Joint reception with drugs with containing organic nitrates;
-age below the age of 18 years;
-not intended for use in women.
Dosage and administration: taken orally as required.
Use in middle-aged men:
For this category of recommended daily dose is 20 mg once a day. Cialis taken inside before the alleged sex act, regardless of the meal. Because the effect begins to occur in approximately 16 minutes after receiving sialis, it should take 16 minutes before the anticipated intimacy.

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The possibility of carrying out sexual intercourse lasts for 36 hours. Use in the elderly and in patients with compromised renal function or liver: Special recommendations for use and the dosage is not required. Use in children: Denied admission to persons under the age of 18 years. Side effects: The drug is well tolerated in recommended doses. Of the most common side effects are marked by headache, dyspepsia (indigestion), myalgia (muscle pain, swelling), nasal congestion, back pain and dilation of blood vessels of the face. Rare manifestations of such side effects as pain in the eyes, swelling of the eyelids, conjunctival hyperemia, as well as dizziness. But as the manifestation of drug reduces side effects. Overdose (due to tadalafilom): The possibility of an overdose unlikely. Studies have shown that a single application of healthy male cialis dose to 500 mg and multiple use of up to 100 mg/day a patient with erectile dysfunction side effects were the same as when using lower doses.

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In the case of an overdose should conduct standard symptomatic treatment.
Interaction:
Effect of other drugs on Tadalafil
Tadalafil is metabolized, for the most part, with the participation of the enzyme CYP3A4. Selective CYP3A4 inhibitor, ketoconazole, increases the area under the curve of concentration versus time at 107% and rifampicin reduces it, in turn, at 88%.

Thus, despite the lack of studies of specific interactions, it can be assumed that the protease inhibitors such as ritonavir and saquinavir, as well as the CYP3A4 inhibitors, such as erythromycin and intrakonazol increase the activity of cialis.

Simultaneous reception of Sialis and antacida (magnesium hydroxide, aluminum hydroxide) decreases the suction speed given tadalafil without altering the area under the curve for pharmacokinetic Sialis.

An increase in gastric pH associated with taking H2-antagonist nizatidine, does not affect the farmakokinetiku cialis.
The effect of cialis on other drugs
As a result of research became aware that tadalafil increases the effect of hypotensive action of nitrates. This is due to the additive actions of cialis and nitrates on metabolism (nitric oxide and cGMP). Consequently, the application of Sialis along with nitrates is contraindicated.

Cialis has no clinically meaningful action on the ground of medicine, metabolism which takes place with the participation of izofermenta P450 cytochrome. Research confirmed that Tadalafil is not inhibited and not induces CYP3A4, CYP1A2, CYP2D6, and CYP2C9 Cyp2ะต1 isoenzymes. Tadalafil has no clinically significant impact on farmakokinetiku S-warfarin or R-warfarin. Tadalafil has no effect on the action of warfarin against prothrombin time.

Tadalafil increases duration of bleeding caused by acetylsalicylic acid.
Tadalafil is not clinically meaningful interaction with core classes antigipertenziveh funds, including calcium channel blockers (amlodipine), angiotensin-converting enzyme inhibitors (enalapril), beta blockers-drenergiceskih receptors (metoprolol), alpha blockers, thiazide diuretics (bendofluazid) and Angiotensin II Receptor Blockers, used in various doses as monotherapy or in combination.

Tadalafil has no clinically significant effect on farmakokinetiku or
pharmacodynamic theofillina.
Effects on ability to drive and use the technique:
No special requirement.
Special instructions:
Because sexual activity there is a probable risk to the cardiovascular system, patients suffering from erectile dysfunction, diseases of this kind is worth deleting stimulant medications, including Cialis. Therefore, you should take into account the possibility of complications in sexual activity in patients with cardiovascular disease: myocardial infarction within the last 90 days.