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The active substance of Buy Cialis Johannesburg is Cialis Online Kaufen Paypal, which contributes to the inhibition of the production of the enzyme phosphodiesterase type 5 (PDE5). The enzyme (PDE5) regulates the concentration of cGMP (cyclic guanosine monophosphate) in the smooth muscles of the penis's tricky body.

After taking the pill, the concentration of cGMP increases to normal, which creates conditions for a full, healthy erection with sexual arousal. After the act of love, the penis, as expected, relaxes.

The highest concentration of the substance in the blood occurs approximately 2 hours after taking Buy Cialis Johannesburg.

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The duration of the generic Buy Cialis Johannesburg reaches 36 hours, but it is recommended to take a 20mg tablet 30 minutes before the intended sexual intercourse. Drink Buy Cialis Johannesburg should be water.

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Inside. Use of Buy Cialis Johannesburg Buy Cialis Johannesburg according to the indication of erectile dysfunction (ED). For patients with frequent sexual activity (more than 2 times a week): the recommended frequency of intake is daily, 1 time per day 5 mg, at the same time, regardless of food intake. The daily dose can be reduced to 2.5 mg, depending on individual sensitivity. For patients with infrequent sexual activity (at least 2 times a week): it is recommended to prescribe Buy Cialis Johannesburg at a dose of 20 mg, immediately before sexual activity, according to the instructions for medical use of Buy Cialis Johannesburg. The maximum daily dose of Buy Cialis Johannesburg is 20 mg. the Use of Buy Cialis Denmark according to the indication of BPH or ED/BPH. The recommended dose of Buy Cialis Johannesburg when used once a day is 5 mg; Cialis Buy Malaysia should be taken at approximately the same time of day, regardless of the time of sexual activity. The duration of treatment is set by the doctor individually. In patients with mild renal insufficiency (creatinine Cl from 51 to 80 ml/min) and moderate (creatinine Cl from 31 to 50 ml/min) dose adjustment is not required. In patients with severe renal failure (Creatinine CL <30 ml/min and hemodialysis): use of Buy Cialis Johannesburg is contraindicated.

Side effect

Most often: headache, dyspepsia. Possible: back pain, myalgia, nasal congestion, blood flow to the face. Rarely: swelling of the eyelids, pain in the eyes, conjunctival hyperemia, dizziness.

Overdose

Symptoms: with a single appointment to healthy individuals Buy Cialis Johannesburg at a dose of up to 500 mg and patients with erectile dysfunction - repeatedly up to 100 mg/day, the undesirable effects were the same as when using Buy Cialis Johannesburg in lower doses. Treatment: in case of overdose, standard symptomatic treatment is necessary. In hemodialysis Buy Cialis Johannesburg practically displayed.

Interaction with other drugs

Cialis Online Kaufen Paypal is mainly metabolized by the enzyme CYP3A4. Selective inhibitor CYP3A4 ketoconazole increases AUC by 107%, and rifampicin reduces it by 88%. Although specific interactions have not been studied, it can be assumed that protease inhibitors such as ritonavir and saquinavir, as well as CYP3A4 inhibitors such as erythromycin and Itraconazole, increase the activity of Buy Cialis Johannesburg. The simultaneous administration of antacid (magnesium hydroxide/aluminium hydroxide) and Buy Cialis Johannesburg reduced the rate of absorption of the latter without changing the AUC. Buy Cialis Johannesburg enhances the hypotensive effect of nitrates. This is due to the additive effect of nitrates and Buy Cialis Johannesburg on the metabolism of nitric oxide and cGMP. Therefore, the use of Cialis Ireland To Buy in patients receiving nitrates is contraindicated

Pharmacokinetics

The pharmacokinetics of Buy Cialis Johannesburg in patients with erectile dysfunction is similar to the pharmacokinetics of Cialis Online Kopen Nederland in persons without erectile dysfunction.

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After taking Buy Cialis Johannesburg inside Buy Cialis Johannesburg is rapidly absorbed. The average plasma Cmax is achieved in an average of 2 hours after ingestion. The rate and degree of absorption of Buy Cialis Johannesburg does not depend on the meal, so Buy Cialis Denmark® can be used regardless of the meal. The time of administration (morning or evening) had no clinically significant effect on the rate and degree of absorption.

The pharmacokinetics of Buy Cialis Johannesburg in healthy individuals is linear in terms of time and dose. In the dose range from 2.5 to 20 mg AUC increases in proportion to the dose.

Distribution

Css in plasma are attained within 5 days while taking Buy Cialis Johannesburg 1 time/day.

The average Vd is about 63 liters, which indicates that Buy Cialis Johannesburg is distributed in the tissues of the body.

The plasma protein binding of Buy Cialis Johannesburg at therapeutic concentrations 94%.

In healthy individuals, less than 0.0005% of the administered dose was found in sperm.

Metabolism

Buy Cialis Johannesburg is mainly metabolized with the participation of the CYP3A4 isoenzyme. The major circulating metabolite is methylethanolamine. This metabolite is at least 13,000 times less active against PDE5 than Buy Cialis Miami. Therefore, the concentration of this metabolite is not clinically significant.

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In healthy individuals, the average clearance of Buy Cialis Johannesburg when administered is 2.5 l/h, and the average T1/2 - 17.5 h. Buy Cialis Johannesburg is excreted mainly in the form of inactive metabolites, mainly with feces (about 61% of the dose) and, to a lesser extent, with urine (about 36% of the dose).

Pharmacokinetics in special clinical cases

Binding to proteins does not change with impaired renal function.

Healthy elderly patients (65 years and more) had a lower clearance of Cialis Online Kopen Nederland when administered, which was expressed in an increase in AUC by 25% compared with healthy individuals aged 19 to 45 years. This difference is not clinically significant and does not require dose adjustment.

In patients with renal insufficiency of mild to moderate severity dose adjustment is not required. Due to the increased exposure of Buy Cialis Johannesburg (AUC), patients with severe renal insufficiency are not recommended to use Comprar Cialis Online En Usa®.

The pharmacokinetics of Buy Cialis Johannesburg in patients with weak and moderate hepatic insufficiency is comparable to that in healthy individuals In patients with severe hepatic insufficiency (class C according to the child-Pugh classification) data are not available. When prescribing Buy Cialis Johannesburg Cialis Online Bestellen Erfahrungsberichte® patients with severe liver failure must first assess the risk and benefit of Cialis Online Kaufen Ohne Rezept Erfahrungen.

In patients with diabetes mellitus during the use of Buy Cialis Johannesburg AUC was less by about 19% than in healthy individuals. This difference does not require dose selection.

Effect of Cialis Generico Online Italia Consegna Veloce on other drugs

It is known that Buy Cialis Johannesburg increases the hypotensive effect of nitrates. This is due to the additive effect of nitrates and Buy Cialis Johannesburg on the metabolism of nitric oxide (NO) and cGMP. Therefore, the use of Buy Cialis Johannesburg in patients receiving nitrates is contraindicated.

Buy Cialis Johannesburg does not have a clinically significant effect on the clearance of drugs whose metabolism occurs with the participation of cytochrome P450. Studies have confirmed that Buy Cialis Johannesburg does not inhibit or induce isoenzymes CYP1A2, CYP3A4, CYP2C9, CYP2C19, CYP2D6, CYP2E1.

Comprar Cialis Online Mexico does not have a clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin. Buy Cialis Johannesburg does not affect the action of warfarin against PV.

Buy Cialis Johannesburg does not increase the duration of bleeding caused by acetylsalicylic acid.

Buy Cialis Johannesburg has systemic vasodilating properties and can enhance the effect of antihypertensive drugs aimed at reducing blood PRESSURE.

In addition, patients who took several antihypertensive drugs, in which hypertension was poorly controlled, there was a slightly greater decrease in blood PRESSURE. In the vast majority of patients, this decrease was not associated with hypotensive symptoms. Patients receiving treatment with antihypertensive drugs and taking Buy Cialis Johannesburg should be given appropriate clinical recommendations.

Did not observed a significant reduction in blood pressure in the application of Buy Cialis Johannesburg in healthy individuals taking selective альфа1А-blocker tamsulosin on the results of two clinical studies.

Coadministration of Cialis Tablets In Uae with doxazosin is contraindicated. When using Buy Cialis Johannesburg healthy volunteers, taking doxazosin (4-8 mg/day), alfa1-adrenoblokator, there was an increase in the hypotensive effect of doxazosin. Some patients experienced symptoms associated with a decrease in blood PRESSURE, including fainting.

Buy Cialis Johannesburg did not affect the concentration of alcohol, nor did alcohol affect the concentration of Buy Cialis Johannesburg. At high doses of alcohol (0.7 g/kg), Buy Cialis Johannesburg did not cause a statistically significant decrease in the average blood PRESSURE. Some patients had postural dizziness and orthostatic hypotension. When taking Buy Cialis Johannesburg in combination with lower doses of alcohol (0.6 g/kg), a decrease in blood PRESSURE was not observed, and dizziness arose with the same frequency as when taking one alcohol.

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