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Order V-gel online

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V-Gel is a herbal gel that is used for the treatment of vaginitis, cervicitis, leucorrhea.

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INDICATIONS
V-gel is a powerful antibacterial, antifungal and anti-inflammatory agent; It provides a sense of comfort and security; It softens and moisturizes the vaginal mucosa; quickly heals minor damage.
Intimate gel eliminates burning and itching, regenerates and normalizes vaginal microflora.
Intimate gel is effective in the treatment of cervicitis and vaginitis.
Gel – gel lubricant V- relieves inflammation of the cervix and vagina, enhances the recovery process, eliminating the itching.
The gel helps with vaginitis avoid unwanted secretions.
Cleansing Gel – helps to maintain the purity of the female genital organs, eliminates the excessive dryness and unpleasant odor.
V- gel for intimate hygiene support useful microflora of the vagina, protects against infections, restores tissue after injection or removal of an intrauterine device.
INSTRUCTIONS1 to 2 gm applied deep inside the vagina twice a day through the calibrated applicator for 7 to 14 days.
DOSAGE
V – gel applied with an applicator (see Image B instructions to the gel), or as recommended by the therapist.
Apply evenly deep inside 2 times a day for 1-2 grams of gel in the morning and evening.
The treatment course is 7-14 days, the course must be 1-2 Packing V-gel.
Side effects: V-gel, as is known, has no – or side effects if used according to the prescribed dosage.
Note: V-gel is water soluble and easily washed brown spots. Color gel caused by herbal extracts. During the application of the gel can sometimes appear a sense of light burning, which is replaced by a cooling and soothing effect. For external use only.
STORAGEStore at the room temperature away from moisture and sunlight. Keep out of reach of children.
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V型凝膠是用於陰道炎,子宮頸炎,白帶治療草藥凝膠。
令V-凝膠在線
V-Gel je bylinný gel, který se používá k léčbě záněty pochvy, děložního hrdla, Leucorrhea.
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V-Gel on taimne geel, mida kasutatakse raviks tupepõletiku, emakakaelapõletik leucorrhea.
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V-Gel είναι ένα φυτικό γέλη που χρησιμοποιείται για τη θεραπεία της κολπίτιδας, τραχηλίτιδα, λευκόρροιες.
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V-ゲルは膣炎、子宮頸管炎、白帯下の治療のために使用されるハーブのゲルです。
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ವಿ ಜೆಲ್ ಯೋನಿ ನಾಳದ ಉರಿಯೂತ, cervicitis, leucorrhea ಚಿಕಿತ್ಸೆಗಾಗಿ ಬಳಸಲಾಗುತ್ತದೆ ಒಂದು ಮೂಲಿಕೆ ಜೆಲ್ ಹೊಂದಿದೆ.
ಆರ್ಡರ್ ವಿ ಜೆಲ್ ಆನ್ಲೈನ್
V-젤 질염, 자궁 경부염, leucorrhea의 치료에 사용되는 허브 젤입니다.
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V-gel é um gel à base de plantas que é utilizado para o tratamento da vaginite, cervicite, leucorreia.
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Buy Yasmin (Dihydrospirenone) online

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Instructions for use of the drug for medical use Yasmin

The international non-proprietary name or grouping
Drospirenone + ethinylestradiol

Dosage form
Tablets film-coated

Composition
Each tablet film coating contains:
The tablet core:
Active substances
Ethinyl estradiol – 30 micrograms
Drospirenone – 3 mg
Excipients: lactose monohydrate – 48.170 mg, corn starch – 14,400 mg, corn starch pregelatinized – 9,600 mg, povidone K25 – 4,000 mg, magnesium stearate – 800 mcg.
Tablet Coating: Hypromellose (hydroxypropyl) – 1.0112 mg macrogol 6000 – 202.4 g talc (magnesium silicate) – 202.4 mg, titanium dioxide (E 171) – 556.5 g, iron (II) oxide ( E 172) – 27.5 mcg.

Description
Film-coated tablets, light yellow color, with one side etched hexagon within which «DO» letters.

Pharmacotherapeutic group
Contraceptives (estrogen + progestogen)

ATC code
G03AA12

Pharmacological properties

Pharmacodynamics
The drug Yasmin – low-dose monophasic oral combined estrogen-progestin contraceptive drug.
Yasmin contraceptive effect of the drug is mainly carried out by means of complementary mechanisms, the most important of which include inhibition of ovulation and increased the viscosity of cervical secretions, whereby it becomes impenetrable to sperm.
With the proper use of the drug Yasmin Pearl Index (an indicator of the number of pregnancies in 100 women using a contraceptive during the year) is less than 1. When skipping pills or incorrect use Pearl Index may increase.
The increased risk of venous thromboembolism (VTE), which is associated with the use of combined oral contraceptives (COCs), refers primarily to the estrogen component. Currently ongoing scientific debate about the modulating effect of progestin, a member of the COC, in relation to the risk of VTE. Comparative epidemiological studies of the risk of VTE when using COCs containing ethinylestradiol / drospirenone and risks when using levonorgestrel-containing COCs have shown different results – from the lack of differences in the degree of risk, the risk increases to three times. In most studies, the drug was studied Yasmin.
To evaluate the risk of VTE in applying Yasmin drug (ethinylestradiol / drospirenone at doses of 0.03 mg / mg 3), two studies were conducted post-registration. The first prospective observational study showed that the incidence of VTE in women using the drug Yasmin, in the presence or absence of other risk factors for VTE was in the same range as that for women who use levonorgestrel-containing COCs and others. The second prospective controlled trial database in which conducted a comparative assessment of women using the drug Yasmin, with women using other COCs also confirmed a similar incidence of VTE among all cohorts of women.
Women using COCs, the cycle becomes more regular, less frequently observed bleeding menstrualnopodobnye painful, reduce the intensity and duration of bleeding, thereby reducing the risk of iron deficiency anemia. Also, there is evidence of reducing the risk of endometrial and ovarian cancer while taking COCs.
Drospirenone, which is part of the preparation Yasmin, has anti-mineralocorticoid activity and can prevent weight gain and other symptoms (eg, edema) associated with estrogen-dependent fluid retention. Drospirenone also has antiandrogenic activity and helps to reduce acne (acne), oily skin and hair (seborrhea). These features of drospirenone to consider when choosing a contraceptive for women with hormone-dependent fluid retention, as well as women with acne and seborrhea. According to its characteristics drospirenone similar to natural progesterone, produced by the female body.

Pharmacokinetics
Drospirenone
Absorption
When administered drospirenone is rapidly and almost completely absorbed. After receiving a single maximal concentration (Cmax) in plasma drospirenone is equal to 38 ng / ml, achieved after 1-2 hours. Food does not affect the bioavailability of which ranges from 76 to 85%.
Distribution
Drospirenone is bound to albumin in blood plasma and does not bind to globulin, sex hormone binding (SHBG) or corticosteroid-binding globulin (CBG). Only 3.5% of the total concentration of substances present in blood plasma in the form of free hormone, 95-97% of the material non-specifically bind to albumin. SHBG ethinylestradiol induced increase does not affect the binding of plasma proteins drospirenone. Average apparent volume of distribution is 3,7 ± 1,2 l / kg.
Metabolism
After oral administration drospirenone is completely metabolized. Most of metabolites in blood plasma are presented acidic forms of drospirenone. Drospirenone is also a substrate for oxidative metabolism catalyzed by isoenzyme CYP 3A4. The metabolic clearance rate of drospirenone from plasma is 1.5 ± 0.2 ml / min / kg.
breeding
The concentration in the blood plasma decreases dwuhfazno drospirenone. Second, the final phase has a half-life (T1 / 2) of about 31 hours. In unmodified form drospirenone excreted in trace amounts. Its metabolites are excreted through the gastrointestinal tract and kidneys in a ratio of about 1.2: 1.4. The half-life of metabolites of drospirenone is about 40 hours.
equilibrium concentration
SHBG concentration does not affect the pharmacokinetics of drospirenone. With daily use of the drug inside the drospirenone plasma concentration increases by 2-3 times, the equilibrium concentration is reached after 8 days of treatment.
If the kidney function
Studies have shown that concentrations of drospirenone in serum of women with mild renal impairment (creatinine clearance (CC) – 50-80 ml / min) when it reaches an equilibrium state, and in women with preserved renal function (creatinine clearance – 80 ml / min) are comparable . However, in women with moderate renal impairment (creatinine clearance – 30-50 ml / min), the average concentration in the blood plasma of drospirenone was 37% higher than that in patients with intact renal function. There was no change in the potassium concentration in blood plasma when applied drospirenone.
If abnormal liver function
In women with moderate hepatic impairment (class B on a scale Child-Pugh) area under the curve “concentration-time» (AUC) is comparable with the corresponding index in healthy women with similar values ​​of Cmax in the absorption phase and distribution. T1 / 2 drospirenone in patients with moderate hepatic impairment appeared to 1.8 times higher than in healthy volunteers.
In patients with moderate hepatic impairment drospirenone clearance decreased by approximately 50% as compared with healthy women, while there was no difference in the potassium concentration in blood plasma in the studied groups. In identifying diabetes and concomitant use of spironolactone (both states are regarded as factors predisposing to hyperkalemia), increasing the concentration of potassium in the blood plasma is not established. Thus, it can be concluded that drospirenone tolerated in women with mild to moderate hepatic impairment good (class B on a scale Child-Pugh).
Ethnicity
Do not set the influence of ethnicity (research conducted on cohorts of Caucasian women and Japanese women) on the pharmacokinetic parameters of drospirenone and ethinylestradiol.

Ethinylestradiol
Absorption
After oral administration, ethinylestradiol is rapidly and completely absorbed. Cmax – 100 pg / ml is reached within 1-2 hours. During the suction and the “first pass” through the liver is metabolized ethinylestradiol, whereby its oral bioavailability averages about 45% of interindividual variability at high – from 20 to 65%. Simultaneous food intake, in some cases accompanied by a decrease ethinylestradiol bioavailability of 25%.
Distribution
Ethinylestradiol nonspecifically but closely associated with albumin in blood plasma (approximately 98%) and induces an increase in the plasma concentration of SHBG. The estimated volume of distribution of 5 l / kg.
Metabolism
Ethinylestradiol undergoes significant primary metabolism in the intestine and liver. Ethinyl estradiol and its oxidative metabolites initially conjugated to glucuronides or sulfate. The metabolic clearance rate of ethinyl estradiol is about 5 ml / min / kg.
breeding
Reducing the ethinyl estradiol concentration in blood plasma is biphasic; the first phase is characterized by a half-life of about 1 hour, the second – 20 hours. Ethinylestradiol hardly excreted unchanged. ethinyl estradiol metabolites are excreted via the kidneys and intestines in a ratio of 4: 6. The half-life of metabolites is about 24 hours.
equilibrium concentration
The equilibrium state is reached in the second half cycle of dosing, when the concentration of ethinyl estradiol in the blood plasma is increased by 40-110% as compared with a single dose.

Indications

Contraception.

Contraindications

The drug is contraindicated Yasmin if any of the conditions / diseases listed below. If any of these conditions / diseases develop for the first time in patients receiving the drug should be immediately repealed.
• Thrombosis (venous and arterial) and thromboembolism (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders – now or in history.
• Conditions prior thrombosis (including transient ischemic attack, angina pectoris) now or in history.
• Identification of acquired or hereditary predisposition for venous or arterial thrombosis, including resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein deficiency of the S, hyperhomocysteinemia, antibodies to phospholipids (cardiolipin antibodies, lupus anticoagulant).
• The presence of high-risk venous or arterial thrombosis (see section “Special Instructions”).
• Migraine with focal neurological symptoms in the present or in history.
• Diabetes mellitus with vascular complications.
• Pancreatitis with severe hypertriglyceridemia now or in history.
• Liver failure and severe liver disease (liver function tests before normalization).
• liver tumors (benign or malignant) now or in history.
• Severe or acute renal failure.
• Identified hormone malignancies (including genital or mammary glands) or are suspected.
• Bleeding from the vagina of unknown origin.
• Pregnancy or suspicion of it.
• The period of breastfeeding.
• Hypersensitivity to any component of the drug Yasmin.
• Lactose intolerance, lactase deficiency, glucose-galactose malabsorption (the drug includes lactose monohydrate).

Carefully

You should carefully weigh the potential risks and expected benefits of the use of COCs in each individual case in the presence of the following diseases / conditions and risk factors:
• Risk factors for thrombosis and thromboembolism: smoking; obesity; dislipoproteinemia controlled hypertension; migraine without focal neurological symptoms; valvular disease; a genetic predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in any of the next of kin);
• Other medical conditions, which may occur when peripheral circulatory disorders: diabetes; systemic lupus erythematosus; hemolytic-uremic syndrome; Crohn’s disease and ulcerative colitis; sickle cell anemia; phlebitis of superficial veins;
• Hereditary angioedema;
• Hypertriglyceridemia;
• Liver disease not related to the contraindications (see section “Contraindications”.);
• Diseases caused or aggravated first time during pregnancy, or on the background of the previous use of sex hormones (eg, jaundice and / or pruritus related to cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes during pregnancy, Sydenham’s chorea);
• Postpartum.

Application of pregnancy and during breastfeeding

Yasmin drug is contraindicated during pregnancy and lactation.
If pregnancy is detected during the reception Yasmin drug, the drug should be immediately abolished. Extensive epidemiological studies have revealed no increased risk of defects in children born to women treated with hormones prior to pregnancy or teratogenic effects in cases of use of sex hormones for negligence in the early stages of pregnancy. At the same time, the available data on the use of the drug during pregnancy Yasmin limited, which does not allow any conclusions about the negative effects of the drug on pregnancy, health of the fetus and newborn child. At present any significant epidemiological data available.
The drug can reduce the amount of breast milk and change its composition, so the use of the drug is contraindicated until weaning. A small amount of sex hormones and / or metabolites thereof can penetrate into breast milk and influence the health of the baby.

Dosing and Administration

How and when to take the tablets
Calendar pack Yasmin product contains 21 pill. Each tablet in the package is marked with the day of the week that it should be adopted. The tablets should be taken orally every day for 21 days in the order specified on the package, about the same time, with a little water. Receiving the next pack of tablets is started after a 7-day interval, during which usually develops menstrualnopodobnoe bleeding (bleeding “cancel”). Usually, it starts on day 2-3 after the last tablet and may not end before you start taking tablets from a new package. After a 7-day interval start pills from a new package is required even if the bleeding is not yet menstrualnopodobnoe stopped. This means that start taking tablets from a new package must be in the same day of the week, and every month the bleeding “cancel” will advance approximately one and the same day of the week.

Receiving tablets of the first package of the drug Yasmin
• When no hormonal contraceptive has not been applied in the previous month
Admission Yasmin preparation should begin on the first day of the menstrual cycle (ie the first day of menstrual bleeding). It is necessary to take the pill, which is marked with the corresponding day of the week. This is followed by taking pills in order. Allowed to start taking the drug on day 2-5 of the menstrual cycle, but in this case within the first 7 days of the first package of tablets is recommended to use an additional barrier method of contraception.
• When switching from other drugs combined contraceptive (COC, vaginal ring or transdermal patch)
Preferably Yasmin start taking the drug the next day after taking the last active tablet of the previous package, but in any case not later than the day after the usual 7-day break (for products containing 21 tablets), or after the last inactive tablet (for products containing 28 tablets per pack). Admission Yasmin drug should be started on the day of removal of the vaginal ring or patch, but not later than the day when it should be inserted a new ring or pasted a new patch.
• When switching from contraceptives containing only progestin ( “mini-pill”, an injectable form, implant) or intrauterine therapeutic system with the release of progestogen
Go to the “mini-pill” for the drug Yasmin possible any day (without a break), with an implant or intrauterine device with progestin – the date of their removal from the injection mold – the day when the next injection should be done. In all these cases during the first 7 days of tablet Yasmin drug must also use a barrier method of contraception (eg, condoms).
• After an abortion (including spontaneous) in the first trimester of pregnancy.
Start taking the drug can be immediately. Subject to this condition, additional contraceptive measures are required.
• After childbirth (in the absence of breastfeeding) or abortion (including spontaneous) in the second trimester of pregnancy.
Start taking the drug at the recommended 21-28 days after birth (no breastfeeding) or abortion in the second trimester of pregnancy. If the drug started later, you must use an additional barrier method of contraception during the first 7 days of taking the pills. If intercourse took place before you start taking the drug Yasmin, pregnancy must be excluded.

Admission missed tablets
If the delay in receiving the drug was less than 12 hours, contraceptive protection is not reduced. It is necessary to take the missed pill as the next tablet is taken at the usual time as soon as possible.
If the delay in the pill was more than 12 hours, contraceptive protection is reduced. The more missed tablets and the closer to the pass 7-day tablet-free interval, the higher the chance of pregnancy.
It should be remembered:
• The drug should never be interrupted for more than 7 days.
• 7 days continuous administration of pills required to achieve adequate suppression of the hypothalamic-pituitary-ovarian system.
Accordingly, if the delay in the pill exceeding 12 hours (from the time interval of receiving the last tablet – 36 hours), depending on the week, when a tablet is missed, it is necessary:
• The first week of taking the drug
It should take the last missed tablet as soon as possible, as soon as she remembers about it (even if it is necessary to take two tablets at the same time). The next tablet should be taken at the usual time. Over the next 7 days should additionally be used a barrier method of contraception (such as a condom). If intercourse took place during the 7 days before skipping pills, you need to consider the possibility of pregnancy.
• The second week of taking the drug
It should take the last missed tablet as soon as possible, as soon as she remembers about it (even if it is necessary to take two tablets at the same time). The next tablet should be taken at the usual time. Provided that if a woman is on the pill correctly within the preceding 7 days, there is no need to use additional contraceptive measures. Otherwise, as well as skipping of two or more tablets must also use barrier contraception (such as a condom) for the next 7 days.
• The third week of taking the drug
Risk reduction of contraceptive reliability is imminent because of the forthcoming tablet-free interval. In this case, you must adhere to the following algorithms:
– If during the 7 days preceding the first missed tablet, taken all the tablets correctly, there is no need to use additional methods of contraception. When you receive a missed tablets refer to paragraphs 1 and 2.
– If during the 7 days preceding the first missed tablet, tablets are taken properly, for the next 7 days is necessary to additionally use a barrier method of contraception (eg, condoms), and in this case should be guided by paragraph 1 for receiving the missed tablets.
1. It is necessary to take the missed pill as soon as possible, as soon as she remembers about it (even if this means taking two tablets at the same time). The next tablet at the usual time taken until the end tablets from the current package. Taking the pills from the next pack should be started immediately without the usual 7-day break. Bleeding “cancel” is unlikely until the end of the second tablet package, but can be marked “smearing” of isolation and / or “breakthrough” bleeding during treatment.
2. It is also possible to interrupt taking the tablets from the current package, make a break for 7 days or less (including the days pass pills), and then begin taking pills from a new package.
If a woman misses pills, and during a break in the reception she has no bleeding, “cancellation”, it is necessary to exclude pregnancy.

Are allowed to take no more than two tablets in one day.

Recommendations in the gastro-intestinal disorders
In severe gastrointestinal disorders, drug absorption may not be complete, so you should use additional methods of contraception.
If within 3-4 hours after taking the tablet marked vomiting or diarrhea, you should be guided by the recommendations by skipping pills mentioned above, depending on the week of dosing. If a woman does not want to change their usual dosage regimen and move the start of menstruation to another day of the week, an extra tablet to be taken from another package.

Stopping the drug Yasmin
Admission Yasmin drug can be discontinued at any time. If a woman is not planning a pregnancy, you should take care of other contraceptive methods. If you are planning a pregnancy, you should simply stop taking the drug and wait Yasmin natural menstrual bleeding.

Delaying the start of bleeding menstrualnopodobnoe
In order to delay the onset of menstrualnopodobnoe bleeding, you need to continue further pills from a new package of the drug Yasmin without 7-day break. Tablets of the new package may be made as long as necessary, including up until tablets are completed package. Against the background of the drug from the second package may be marked “smearing” bloody discharge from the vagina and / or “breakthrough” uterine bleeding. Reactivate the drug Yasmin of a pack should be after the usual 7-day break.

Changing the date of commencement menstrualnopodobnoe bleeding
In order to move the first day of bleeding menstrualnopodobnoe on another day of the week, the woman should be reduced (but not lengthen) the next 7-day tablet-free interval for as many days, on how much a woman wants. For example, if the cycle usually starts on a Friday and in future she wants it began on Tuesday (3 days earlier), tablet-taking from the next pack should start on 3 days earlier than usual. The shorter the tablet-free interval, the higher the probability that menstrualnopodobnoe bleeding does not occur, and while taking tablets from the second package will be observed “smearing” of isolation and / or “breakthrough” bleeding.

Use in specific patient groups
In children and adolescents
The drug Yasmin shown only after menarche. Available data do not require dose adjustment in this group of patients.
elderly
Not applicable. The drug is not shown Yasmin after menopause.
If abnormal liver function
Yasmin The drug is contraindicated for use in women with severe liver disease as long as liver function tests have not come back to normal. See. Also “Contraindications” and “Pharmacological properties”.
When violations of renal function
Yasmin drug is contraindicated for women with severe renal insufficiency or acute renal failure. See. Also “Contraindications” and “Pharmacological properties”.

Rated frequency according to epidemiological studies, covers a group of COCs.
Venous and arterial thromboembolic events were combined following nosologic forms: occlusion of peripheral deep vein thrombosis and thromboembolism / pulmonary vascular occlusion, thrombosis, embolism, and heart attack / myocardial infarction / cerebral infarction, and stroke is not classified as hemorrhagic.
For venous and arterial thromboembolism, migraine cm. Also “Contraindications” and “Cautions”.

The following are adverse reactions at very low frequency of occurrence or the development of delayed symptoms that are considered to be related to the COC group (see also “Contraindications”, “Cautions”.)
Tumors
• In women using COCs, very slightly increased incidence of breast cancer. Because breast cancer is rare in women younger than 40 years, increased cancer incidence in women using COCs, slightly relative to the total risk of breast cancer. A causal relationship with the use of COCs is not known.
• liver tumors (benign or malignant).
Other state
• Erythema nodosum.
• Women with hypertriglyceridemia (increased risk of pancreatitis when using COCs).
• Increased blood pressure.
• The onset or worsening of conditions in which the connection with the use of COCs is not uncontested: jaundice and / or pruritus related to cholestasis; formation of gallstones; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; chorea; herpes during pregnancy; hearing loss associated with otosclerosis.
• In women with hereditary angioedema exogenous estrogens may induce or exacerbate symptoms of angioedema.
• Violations of the liver.
• Impaired glucose tolerance or effect on peripheral insulin resistance.
• Crohn’s disease, ulcerative colitis.
• Chloasma.
• Hypersensitivity (including symptoms such as rash, urticaria).
Interaction
Due to the interaction of other drugs (enzyme inducers) with oral contraceptives may experience “breakthrough” bleeding and / or reduction of the contraceptive effect (see. “Interaction with other medicinal products” section).

Overdose

Serious violations were reported in overdose. Based on the cumulative experience of the COC symptoms that may occur with overdose include nausea, vomiting, spotting from the vagina, metrorrhagia.
No specific antidote, symptomatic treatment should be conducted.

Interaction with other drugs

The influence of other drugs on the drug Yasmin
Possible interactions with drugs that induce hepatic microsomal enzymes which may result in increased clearance of sex hormones, which in turn can lead to “breakthrough” uterine bleeding and / or reducing the contraceptive effect.
Women who receive treatment such preparations, in addition to the drug Yasmin, it is recommended to use a barrier method of contraception or select a non-hormonal method of contraception. Barrier contraceptive method should be used during the reception period of concomitant medications as well as 28 days after their withdrawal. If the period of use of a barrier method of contraception ends later than tablets in a package of the drug Yasmin should start taking pills Yasmin preparation of the new packaging without interruption in the reception of tablets.
• Substances that increase clearance of the drug Yasmin (weaken the effectiveness of the enzymes by induction):
phenytoin, barbiturates, primidone, carbamazepine, rifampicin and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin, and preparations containing St. John’s wort.
• Substances with a different effect on the clearance of the drug Yasmin
In a joint application with preparation Yasmin many HIV protease inhibitors or the hepatitis C virus and nenukliozidnye reverse transcriptase inhibitors may both increase and decrease the concentration of estrogen or progestin in the blood plasma. In some cases, this effect can be clinically significant.
• Substances that reduce the clearance of COCs (enzyme inhibitors)
Moderate and strong inhibitors of CYP3A4, such as azole antifungals (e.g., itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem and grapefruit juice may increase the plasma concentrations of estrogen or progestin, or both.
It was shown that at doses etoricoxib 60 and 120 mg / day coadministered with a COC containing 0.035 mg of ethinyl estradiol, ethinyl estradiol increases the concentration in plasma of 1.4 and 1.6 times, respectively.

Effect of the drug on Yasmin other drugs
COC may affect the metabolism of other drugs, which leads to an increase (e.g., cyclosporin) or decrease (eg lamotrigine) in their blood plasma concentration and tissue.
In vitro, drospirenone is able to weakly or moderately inhibit the enzymes of the cytochrome P450 CYP1A1, CYP2C9, CYP2C19 and CYP3A4.
Based on the in vivo interaction studies in female volunteers taking omeprazole, simvastatin or midazolam as marker substrates it can be concluded that a clinically significant effect of 3 mg of drospirenone drug metabolism mediated by the enzyme cytochrome P450, it is unlikely.
In vitro ethinyl estradiol is a reversible inhibitor of CYP2C19, CYP1A1 and CYP1A2, as well as an irreversible inhibitor of CYP3A4 / 5, CYP2C8 and CYP2J2. In clinical studies assignment hormonal contraceptive containing ethinylestradiol, did not lead to any increase or resulted in only a slight increase in CYP3A4 substrate concentrations in plasma (e.g. midazolam), while plasma CYP1A2 substrate concentration may increase slightly (e.g., theophylline ) or moderately (e.g., tizanidine and melatonin).

Other forms of interaction
Patients with intact renal function and drospirenone combined use of ACE inhibitors or nonsteroidal antiinflammatory drugs has no significant effect on the potassium concentration in the blood plasma. However, the combined use of the drug Yasmin with aldosterone antagonists or potassium-sparing diuretics has not been studied. When co-administered with these drugs potassium concentration in the blood plasma is necessary to control for the first intake cycle (see. “Special Instructions” section).

Preclinical safety data
Preclinical data obtained in the course of standard tests to identify the toxicity after repeated doses of the drug taking, as well as genotoxicity, carcinogenic potential and toxicity to the reproductive system, do not indicate a particular risk to humans. Nevertheless, we should remember that sex hormones may promote the growth of certain hormone-dependent tissues and tumors.
Laboratory tests
Receiving Yasmin drug can affect the results of some laboratory tests including liver function tests, renal, thyroid, adrenals, concentration in plasma transport proteins, carbohydrate metabolism, blood clotting parameters and fibrinolysis. Changes do not usually go beyond the normal range. Drospirenone increases plasma renin activity and aldosterone concentration, due to its antimineralokortikoidnym effect.
decline in efficiency
Efficacy Yasmin drug may be reduced in the following cases: when skipping tablets, gastro-intestinal disorders or as a result of drug interactions.
The frequency and severity of bleeding menstrualnopodobnoe
While taking the drug could experience Yasmin irregular (acyclic) bleeding from the vagina ( “smearing” spotting and / or “breakthrough” uterine bleeding), especially during the first months of use. Therefore, the evaluation of any irregular bleeding menstrualnopodobnoe should be carried out after a period of adaptation of approximately three cycles. If irregular bleeding menstrualnopodobnye recur or occur after previous regular cycles, you should conduct a thorough examination to exclude malignancy or pregnancy.
Some women during the tablet-free interval may not develop bleeding “cancel.” If the drug Yasmin taken according to the recommendations, it is unlikely that the woman is pregnant. However, the irregular use of the drug and the absence of two consecutive menstrualnopodobnoe bleeding, the drug can not be extended to exclude pregnancy.
Medical examinations
Before the start or resumption of use of the drug Yasmin should be familiar with the history of life, a family history of the women, to conduct a thorough general medical and gynecological examination to exclude pregnancy. The volume of research and the frequency of control examinations should be based on existing standards of medical practice with the need to consider the individual characteristics of each patient. As a rule, measured blood pressure, heart rate, determined by the body mass index, checked the state of the mammary glands, abdomen and pelvic organs, including cytology cervical epithelium (Papanicolaou test). Typically, control examinations should be carried out at least 1 time in 6 months.

It should be borne in mind that Yasmin drug does not protect against HIV infection (AIDS) and other sexually transmitted diseases through!

Effects on ability to drive vehicles and mechanisms
Not found.

Storage conditions
Store at temperatures not above 25 ° C.
Keep out of the reach of children.

Shelf life
3 years. Do not use after the expiration date!

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WHAT YOU NEED TO KNOW ABOUT Lexapro?
What is Lexapro?
Lexapro belongs to the class of selective serotonin reuptake inhibitors. Lexapro affects unbalanced chemicals in the brain, causing depression.
Lexapro is used for treating depression.
Lexapro may be used for other purposes not listed in this medication guide.

APPLICATION Lexapro:
Take Lexapro exactly as directed by your doctor. To clarify the indications for use, contact your doctor or pharmacist.
Take each dose with a full glass of water (200 ml).
In order to accurately measure the dose, use a measuring spoon or cup, not a regular table spoon. Ask your pharmacist where you can get scoop / cup, if they do not.
Lexapro may be taken with or without food.
Typically, Lexapro taken once a day. Follow your doctor’s instructions. Take the medicine on a daily basis in the bottom and at the same time.
Do not stop taking Lexapro without consulting your doctor. Improvement can occur within a few weeks.
Store Lexapro at room temperature away from moisture and heat.

What should be discussed with your doctor before taking Lexapro?
Do not start treatment Lexapro if you are taking a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), tranylcypromine (Parnate), or phenelzine (Nardil) in the last 2 weeks. The interaction of these drugs with Lexapro can be dangerous.
Before taking Lexapro, tell your doctor if you have:
liver disease
kidney disease
or cramps
mania or suicidal thoughts.

You will not be able to take Lexapro, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Lexapro should not be taken at the same time c citalopram (tseleksoy). If you have an allergic reaction to citalopram (tseleksu), an allergic reaction can occur, and after taking Lexapro. Do not start taking this medication without first talking to your doctor if in the past you have an allergic reaction to similar medications.
Lexapro belongs to category C classification FDA pregnancy. This means that the harmful effects of the drug on the fetus has not been proved. Do not take Lexapro if you are pregnant or could become pregnant during treatment medication without first talking to your doctor.
Lexapro passes into breast milk and may affect a nursing infant. If you are breast-feeding, do not take Lexapro without consulting your doctor.

PRECAUTIONS FOR ADMISSION Lexapro
Use caution when driving, operating machinery, or performing other hazardous activities. Lexapro may cause dizziness. If you have dizziness, avoid these activities.
Caution must be exercised in the use of alcohol. Alcohol may increase drowsiness and dizziness caused by Lexapro or affect your condition.

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Zithromax is used to treat many different types of infections caused by bacteria, such as respiratory infections, skin infections, ear infections, and sexually transmitted diseases. In children, it is used to treat middle ear infection, pneumonia, tonsillitis, and strep throat.

 Product description

INDICATIONS

Zithromax is used for treating mild to moderate infections caused by certain bacteria. It may also be used alone or with other medicines to treat or prevent certain infections in persons with advanced HIV infection. Zithromax is a macrolide antibiotic. It slows the growth of, or sometimes kills, sensitive bacteria by reducing the production of important proteins needed by the bacteria to survive.

INSTRUCTIONS

Use Zithromax as directed by your doctor.

  • Take Zithromax by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • Do not take an antacid that has aluminum or magnesium in it within 1 hour before or 2 hours after you take Zithromax.
  • Zithromax works best if it is taken at the same time each day.
  • To clear up your infection completely, use Zithromax for the full course of treatment. Keep using it even if you feel better in a few days.
  • If you miss a dose of Zithromax, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Zithromax.

STORAGE

Store Zithromax below 86 degrees F (30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Zithromax out of the reach of children and away from pets.

MORE INFO:

Active Ingredient: Azithromycin.

Safety information

Do NOT use Zithromax if:

  • you are allergic to any ingredient in Zithromax, to other macrolide antibiotics (eg, erythromycin), or to ketolide antibiotics (eg, telithromycin)
  • you are taking dofetilide, nilotinib, pimozide, propafenone, or tetrabenazine.

Contact your doctor or health care provider right away if any of these apply to you.

Some medical conditions may interact with Zithromax. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:if you are pregnant, planning to become pregnant, or are breast-feedingif you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplementif you have allergies to medicines, foods, or other substancesif you have liver or kidney problems, myasthenia gravis, or abnormal heart rhythms.Some medicines may interact with Zithromax. Tell your health care provider if you are taking any other medicines, especially any of the following:Antiarrhythmics (eg, disopyramide, dofetilide ), arsenic, astemizole, cisapride, domperidone, maprotiline, methadone, paliperidone, pimozide, propafenone, quinolone antibiotics (eg, levofloxacin), terfenadine, or tetrabenazine because the risk of heart problems, including irregular heartbeat, may be increasedNelfinavir because it may increase the risk of Zithromax’s side effectsRifampin because it may decrease Zithromax’s effectivenessAnticoagulants (eg, warfarin), carbamazepine, cyclosporine, digoxin, ergot derivatives (eg, ergotamine), nilotinib, phenytoin, rifampin, theophylline, triazolam, or tyrosine kinase receptor inhibitors (eg, dasatinib) because the risk of their side effects may be increased by Zithromax.This may not be a complete list of all interactions that may occur. Ask your health care provider if Zithromax may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Important safety information:

  • Zithromax may cause drowsiness, dizziness, blurred vision, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Zithromax with caution. Do not drive or perform other possible unsafe tasks until you know how you react to it.
  • Zithromax may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Zithromax. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
  • Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with your doctor.
  • Tell your doctor or dentist that you take Zithromax before you receive any medical or dental care, emergency care, or surgery.
  • Long-term or repeated use of Zithromax may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.
  • Be sure to use Zithromax for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.
  • Zithromax only works against bacteria; it does not treat viral infections (eg, the common cold).
  • Zithromax should not be used in children; safety and effectiveness in children have not been confirmed.
  • Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Zithromax while you are pregnant. It is not known if Zithromax is found in breast milk. If you are or will be breast-feeding while you use Zithromax, check with your doctor. Discuss any possible risks to your baby.
  • Side effects
  • All medicines may cause side effects, but many people have no, or minor, side effects.

    Check with your doctor if any of these most common side effects persist or become bothersome:

    Diarrhea; headache; loose stools; nausea; stomach pain; upset stomach; vomiting.

    Seek medical attention right away if any of these severe side effects occur:

    Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bloody stools; changes in hearing or hearing loss; chest pain; eye or vision problems; irregular heartbeat; muscle weakness; pounding in the chest; red, swollen, blistered, or peeling skin; ringing in the ears; seizure; severe diarrhea; stomach cramps/pain; trouble speaking or swallowing; yellowing of the skin or eyes.

    This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider.

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Characteristics:

Each tablet contains 100 mg of sildenafil

Duration: 4-6 hours

Onset of action: After 30-40 minutes

Active substance: Sildenafil (Sildenafil)

Description: Designed to address female sexual desire disorder and female sexual dysfunction. Created to satisfy the sexual needs and prolong pleasure.

Dosing: Action female Viagra begins 30 minutes after administration and lasts for a minimum of 4 hours. Most patients can take Female Viagra daily.

Female Viagra – the first generic, designed specifically for women. This drug helps to enhance libido, to fully enjoy the sexual life and contributes to obtaining orgasm. The active ingredient – Sildenafil. Generic comes in tablet form with a pink envelope.

Indications
• Reduced sex drive
• No response to stimulation
• Discomfort during intercourse due to dryness and the lack of excitement
• Sexual dysfunction
• menopause

The action of the drug
Female Viagra – a very effective generic, helps to restore normal physiological characteristics of the female body in sexual terms. After the drug returns natural lubrication and swelling of the labia, the clitoris is enhanced sensitivity. And all of these functions back on when there is sexual stimulation and without addiction to generics.
Tablets enhances the feeling directly during intercourse and orgasm strength. Women of all ages, to test female Viagra, noted the positive sensations of sexual contact, even if they previously had difficulty reaching orgasm. This is achieved thanks to sildenafil, which is an inhibitor of PDE-5. His action of this substance improves blood circulation of the vascular system in the pelvis. It has beneficial effects on the smooth muscle of arteries leading to the natural swelling of the labia minora and clitoris
In addition, the generic functionality improves the mucous glands, whereby the lubricant is released in the vagina. Such effects of the drug on the body eliminates the problem of dryness and discomfort during intercourse. The effect of one tablet lasts up to 5 hours. So, enjoy a full sex life and get maximum pleasure can any woman, even in the period of menopause.

Instructions for use
The drug is used to enhance libido in about 40-60 minutes prior to prospective sexual intercourse. Once the active ingredient gets into the bloodstream, it will work effectively in the next 5 hours. The optimum daily dose – 100 mg. You can start taking pills to 25-50 mg per day. If Generic Female Viagra is well absorbed by the body, but does not give the maximum effect, the daily dose increased to 100 mg. It is not desirable to increase the dose. If necessary, consult a doctor. Tablets can be taken no more often than once per day.

Contraindications

Generic Female Viagra should not be taken during pregnancy and lactation, and in the following diseases:
• rhythm disorders, and other cardiovascular diseases
• Anemia
• Hypertension
• Oncological diseases
• Problems with kidney or liver
• Stroke, heart attack or heart attack, brought over the last year

If the first reception of pills cause an allergic reaction, you must stop it and consult a physician.

As generic interacts with other medications?
With regular use of any other drugs, it is desirable to consult with your doctor. As a general rule, the specialist ban take Female Viagra in combination with nitrate or nitrite drugs. For example, nitroglycerin, Nitrosorbid etc. It is impossible to combine the generic with poppers.
If you start taking Viagra for women with the above drugs, the problem can start with pressure, and heart, until a stroke or heart attack.

Possible side effects

Testing generic found that a side effect of the drug is minimized. In rare cases, can be observed the following reactions:
• Vomiting and nausea
• Vertigo
• redness of the face
• Chest pain and headaches
• Indigestion.

Storage conditions
Viagra for women should be stored out of reach of pets and small children at room temperature. Expiry date is indicated on each blister.

Efficacy
Female Viagra allows you to be more sensitive to sexual stimulation and affection. The product provides maximum pleasure from intimate process that helps women improve their health and improve your mood. This is especially important for older women who are or have been through a difficult period of menopause.
However, it is understood that the female Viagra – the drug exclusively for women. Its composition is specially designed for the female body, so taking this drug should be strictly in accordance with your gender. For men developed many other medicines that can successfully deal with erectile dysfunction.

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This drug belongs to the group of corticosteroids. It has anti-allergic, anti-inflammatory, antishock action. Appoint patients with adrenal suppression, the bark of which can not alone produce enough steroid hormones.
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Application. Recommended taken with food to avoid the effect of the active substance to the gastrointestinal tract. The dosage regimen determined by a physician. In the opinion, the likelihood of side effects Prednisone is directly related to dose, so its definition must be approached very cautiously. Not recommended for use in severe liver disease, but an absolute contraindication to receiving the drug is only idiosyncrasy of the active ingredient.
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Pharmacodynamics: Amoxicillin – broad-spectrum antibiotic from the group aminopenicillins. It has a bactericidal mode of action that is in the suppression of cell wall synthesis of susceptible bacteria. Active against such microorganisms: Gram-positive bacteria – Staphylococcus spp. (except for strains producing penicillinase), Streptococcus spp., (including Streptococcus pneumoniae), Bacillus anthracis, Corynebacterium diphtheriae (most strains), Erysipelothrix rhusiopathiae, Listeria monocytogenes; Gram-negative bacteria: Borrelia burgdorferi, Escherichia coli, Haemophilus influenzae, Klebsiella spp., Leptospira spp., Moraxella (Branhamella catarrhalis) (most strains), Neisseria gonorrhoeae, Neisseria meningitidis; Proteus mirabilis, Salmonella spp., Shigella spp., Treponema pallidum, Treponema pertenue; anaerobic bacteria: Eubacterium spp., Clostridium perfringens, Clostridium tetani, Peptostreptococcus spp., Peptococcus spp., Streptococcus faecalis.
In combination with metronidazole exhibits activity against Helicobacter pylori.
To amoxicillin-resistant microorganisms producing penicillinase. Inactive against mycobacteria, mycoplasma, Rickettsia, fungi, amoeba, plasmodium, viruses and also Pseudomonas aeruginosa and Proteus spp. (except P. mirabilis).

Pharmacokinetics Following oral administration of amoxicillin is well absorbed, reaching a maximum serum concentrations at 2 hours after administration. The half – 1.5 hours. Excreted unaltered by the kidneys (60 – 70%).
Method of use and dosage

The drug is taken by a doctor. Amoxil is prescribed inside (regardless of the meal). The dosage regimen of the drug individually. Single dose for adults and children over 10 years (with a body weight greater than 40 kg) is 250 – 500 mg in severe illness – 1 year
In patients with impaired renal function at creatinine clearance 15 – 40 ml / min. interval between doses should be increased to 12 hours; when anurii daily dose should not exceed 2 g in combination with metronidazole (1.5 g / day) daily dose of Amoxil tablets of 2.25 g (3 admission). Patients with severe renal impairment (creatinine clearance less than 30 ml / min.) And / or liver appoint 1 g per day of metronidazole and amoxicillin 1.5 g (2 admission).
For eradikatsii Helicobacter pylori prescribed amoxicillin 1 g 2 times a day with 0.5 grams metronidazole (or clarithromycin 0.5 g 2 times a day) and lansoprazole (omeprazole) in a standard dose of 7 days.

Children: For children aged 5 – 10 years the single dose is 250 mg; between the ages of 2 and 5 years – 125 mg; children under 2 years of drug administered in a daily dose of 30 mg / kg body weight. The maximum dose – 60 mg / kg per day.
For adults and children interval between doses of 8 hours.
Side effects
In applying Amiksina possible:
• allergic reactions (urticaria, erythema, angioedema, rhinitis, conjunctivitis and in rare cases – fever, joint pain, eosinophilia; very rarely – anaphylactic shock);
• the part of the digestive tract (nausea, vomiting, diarrhea), development of superinfection.
When used in combination with metronidazole are possible:
• nausea, vomiting, anorexia, diarrhea, constipation, epigastric pain, glossitis, stomatitis, and in rare cases hepatitis, pseudomembranous colitis, interstitial nephritis, disorders of hematopoiesis;
• long-term use at high doses – dizziness, ataxia, loss of consciousness, depression, recurrent neuropathy, seizures.
Indications for use

Amoxil is prescribed for the treatment of infections caused by sensitive microorganisms including:
• upper respiratory tract infections (otitis, tonsillitis, sinucit);
• lower respiratory tract infections (bronchitis, pneumonia);
• infections of the biliary tract and the gastrointestinal tract;
• urinary tract infections (cystitis, pyelonephritis, asymptomatic bacteriuria in pregnant women);
• acute uncomplicated gonorrhea;
• infections of skin and soft tissue.
In combination with metronidazole or clarithromycin is used to treat diseases of the digestive tract, associated with Helicobacter pylori (chronic gastritis, peptic ulcer and 12 duodenal ulcer).
Interaction with other drugs

Amoxicillin decreases the effect of estrogensoderjath contraceptives. Strengthens the absorption of digoxin. Decreases clearance and increases the toxicity of methotrexate. Excretion by the kidneys slows aspirin, indomethacin, sulfinperazonom, oxyphenbutazone, phenylbutazone.
Overdose

Symptoms of overdose include nausea, vomiting, diarrhea, disruption of water and electrolyte balance.

Treatment: gastric lavage, the use enterosorbents (activated charcoal), saline laxatives, correction fluid and electrolyte balance, if necessary, apply hemodialysis.

Features of use

Precautions should be prescribed during pregnancy. Excreted in breast milk, which may lead to sensitization of the child.
If the kidney function dose Amoxil should be set based on creatinine clearance.

Product Overview

Shelf life: Store in a dry, dark place at a temperature of 15 ° C to 25 ° C. Shelf life – 2 years.
Keep out of the reach of children.

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doxycycline

Clinico-pharmacological group
The antibiotic tetracycline

Pharmachologic effect
Semisynthetic tetracycline, bacteriostatic broad-spectrum antibiotic. Penetrating inside the cell, acts on intracellular pathogens located. It inhibits protein synthesis in the microbial cell, breaks communication transport of aminoacyl tRNA to the 30S ribosomal subunit of the membrane.
To this highly sensitive Gram-positive bacteria: Staphylococcus spp. (including Staphylococcus aureus, Staphylococcus epidermidis), Streptococcus spp. (including Streptococcus pneumoniae), Clostridium spp., Listeria spp .; Actinomyces israeli; and gram-negative organisms: Neisseria gonorrhoeae, Neisseria meningitidis, Haemophilus influenzae, Klebsiella spp., Escherichia coli, Shigella spp., Enterobacter, Salmonella spp., Bordetella pertussis. Bacteroides spp., Treponema spp. (including strains resistant to others. antibiotics, such as penicillins and cephalosporins date). The most susceptible Haemophilus influenzae (91-96%) and intracellular pathogens.

Doxycycline is active against most dangerous infectious diseases: plague (Yersinia spp.), Tularemia (Francisella tularensis), anthrax bacteria (Bacillus anthracis), Legionella (Legionella spp.), Brucella (Brucella spp.), Cholera (Vibrio cholera) , Rickettsia (Rickettsia spp.), glanders pathogens (Actinobacillus mallei), chlamydia (pathogens psittacosis (Chlamydia psittaci), psittacosis (Rickettsiaformis psittacosi), trachoma (Chlamydia trachomatis ;, venereal granuloma (Calymmatobacterium granulomatis), malaria (Plasmodium falciparum), amoebic dysentery (Entamoeba histolytica).
He acts on most strains of Proteus, Pseudomonas aeruginosa, and fungi.

To a lesser degree than other tetracycline antibiotics inhibits intestinal flora which is different from the more complete absorption and longer duration of action. According to the degree of antibacterial activity of doxycycline superior natural tetracyclines. In contrast to tetracycline and oxytetracycline has a higher therapeutic efficiency, manifested by treatment in 10-fold lower doses and longer duration of action. There is cross-resistance to other tetracyclines and penicillin.

Pharmacokinetics
Absorption – fast and high (nearly 100%). Food intake does not significantly influence the extent of absorption. It has high lipid solubility and low affinity binding of calcium ions (Ca2 +). Following oral administration of 200 mg of time to reach maximum plasma concentration – 2.5 h, the maximum plasma concentration – 2.5 mg / ml at 24 hours after administration – 1.25 g / ml.

Relationship to plasma proteins – 80-93%. Well into the organs and tissues; 30-45 minutes after ingestion found in therapeutic concentrations in the liver, kidney, lung, spleen, bones, teeth, prostate, eye tissues, pleural and ascites fluid, bile, synovial exudate, exudate maxillary and frontal sinuses, in the liquid sulcus. Penetrates poorly into cerebrospinal fluid (10-20% of plasma levels). It penetrates through the placental barrier, determined in breast milk. The volume of distribution – 0.7 l / kg.

It is metabolized in the liver of 30-60%. Half-life of – 10-16 hrs (mainly – 12-14 hours on average – 16.3 h). Repeated administration of the drug may accumulate. It accumulates in the reticuloendothelial system and bone. The bones and teeth forms insoluble complexes with ions of calcium (Ca2 +). Excreted in the bile, which is found in high concentrations. Treated enterohepatic recycling output intestine (20-60%); 40% of the dose is excreted by the kidneys within 72 hours (of which 20-50% – unchanged), with severe chronic renal failure – only 1-5%.
In patients with impaired renal function or azotemia is an important route of elimination gastrointestinal secretion.

Dosage
Inside, adults and children over 12 years weighing more than 45 kg of average daily dose – 200 mg on the first day (divided into 2 doses – 100 mg 2 times a day), followed by 100 mg / day.
In chronic infections of the urinary system – 200 mg / day throughout the treatment period.
In the treatment of gonorrhea appoint one of the following schemes: acute uncomplicated urethritis – course dose of 500 mg (1 reception – 300 mg, the next 2 – 100 mg every 6 hours) or 100 mg / day until complete healing (women), or 100 mg 2 times a day for 7 days (males); in complicated forms of gonorrhea course dose -800-900 mg, which is distributed on 6-7 receptions (300 mg – 1 reception, and then every 6 hours for 5-6 later).

In the treatment of syphilis – 300 mg / day for at least 10 days.
In uncomplicated infections of the urethra, cervix and colon caused by Chlamydia trachomatis, administered at 100 mg two times a day for at least 7 days.
Infections of the male reproductive organs – 100 mg 2 times a day for 4 weeks. Treatment of malaria resistant to chloroquine, – 200 mg / day for 7 days (in conjunction with shizontotsidnymi drugs – quinine); malaria prevention -100 1 mg once a day for 1-2 days before the trip, then daily during the trip and for 4 weeks after return;
Diarrhea “travelers” (prevention) – 200 mg on the first day of the trip (1 reception or 100 mg 2 times a day) 100 mg 1 time per day during their stay in the region (no more than 3 weeks).
Treatment of leptospirosis – 100 mg orally 2 times a day for 7 days; prevention of leptospirosis – 200 mg 1 time per week for staying in disadvantaged areas and 200 mg at the end of the trip.
Preventing infections after medical abortion – 100 mg for 1 h before treatment and 200 mg – 30 minutes after.
When acne – 100 mg / day, the course – 6-12 weeks.
The maximum daily dose for adults – 300 mg / day or 600 mg / day for 5 days with severe gonococcal infections.
If you have severe liver failure requires reduction of the daily dose of doxycycline, as this is a gradual accumulation of it in the body (the risk of hepatotoxicity).

Overdose
Symptoms: If high doses, especially in patients with impaired liver function may cause neurotoxic reactions, dizziness, nausea, vomiting, seizures, impaired consciousness due to increased intracranial pressure.
Treatment: removal of the drug, gastric lavage with activated charcoal, symptomatic therapy, orally administered antacid and magnesium sulphate to prevent the absorption of doxycycline. There is no specific antidote. Hemodialysis and peritoneal dialysis are ineffective.

Drug Interactions
Absorbance decrease antacids containing salts of aluminum (Al3 +), calcium (Ca2 +) and magnesium (Mg2 +), preparations of iron (Fe), sodium hydrogen carbonate, laxatives containing magnesium salt (Mg2 +), cholestyramine and colestipol, and therefore their use must be divided at 3 hour intervals.
Due to suppression of intestinal microflora reduces the prothrombin index, which require dose adjustment of indirect anticoagulants.
When combined with antibacterial antibiotics disturb the cell wall synthesis (penicillins, cephalosporins), the effectiveness of the latter decreases. It reduces the reliability of contraception and increases the frequency of bleeding “breakthrough” in patients receiving oral contraceptives estrogensoderjath.
Ethanol, barbiturates, rifampicin, carbamazepine, phenytoin, and others. Stimulants microsomal oxidation accelerating metabolism doxycycline reduce its concentration in plasma.
In an application with methoxyflurane may develop acute renal failure or death.
Simultaneous application of retinol improves intracranial pressure.

Pregnancy and lactation
Use of the drug during pregnancy is contraindicated because, penetrating through the placenta, the drug can disrupt the normal development of the teeth, cause inhibition of growth of bones of the fetus and cause fatty liver.
During lactation the use of doxycycline is contraindicated. If necessary, the drug, the period of treatment should discontinue breastfeeding.

Side effects
From the nervous system: a benign intracranial hypertension (decreased appetite, vomiting, headache, swelling of the optic nerve), a toxic effect on the central nervous system (dizziness or instability)
Metabolic disorders: anorexia.
From the hearing and vestibular: tinnitus.
For part of the vision: blurred vision, diplopia, scotoma, and as a result of increased intracranial pressure.
From the digestive system: nausea, constipation or diarrhea, abdominal pain, glossitis, dysphagia, esophagitis (including erosive) gastritis, ulceration of the stomach and duodenum 12, pseudomembranous colitis, enterocolitis (due to the proliferation of drug-resistant strains of staphylococci ).
Allergic reactions: maculopapular rash, pruritus, flushing of the skin, angioedema, anaphylactoid reactions, drug lupus, erythematous rash, exfoliative dermatitis, urticaria, anaphylaxis, anaphylactic shock, anaphylactoid reactions, Stevens-Johnson syndrome.
Cardio-vascular system: pericarditis, lower blood pressure, tachycardia, erythema multiforme.
From the side of hematopoiesis: hemolytic anemia, thrombocytopenia, neutropenia, leukopenia, eosinophilia, decrease in prothrombin index.
On the part of the hepatobiliary system: abnormal liver function, increased liver enzymes, autoimmune hepatitis, cholestasis.
Musculoskeletal: arthralgia, myalgia.
Violation of the kidney and urinary tract: increased BUN.
Other: photosensitivity, superinfection; stable discoloration of tooth enamel, inflammation in the anogenital area. Candidiasis (vaginitis, glossitis, stomatitis, proctitis), goiter, a syndrome similar to serum sickness, toxic epidermal necrolysis.

Conditions and terms
In a dry, dark place at a temperature no higher than 25 ° C. Keep out of the reach of children. Shelf life – 4 years.

Indications
– Infectious and inflammatory diseases caused by susceptible organisms: respiratory infections (pharyngitis, bronchitis, acute and chronic, tracheitis, bronchopneumonia, lobar pneumonia, lung abscess, empyema);
– Upper respiratory tract infections (otitis, tonsillitis, sinusitis, etc.);
– Infections of the genitourinary system (cystitis, pyelonephritis, prostatitis, urethritis, urethrocystitis, urogenital mycoplasmosis, endometritis, endocervicitis acute orhiepididimit, gonorrhea);
– Infections of the biliary tract and the gastrointestinal tract (cholecystitis, cholangitis, gastroenterocolitis, bacillary dysentery, diarrhea, “traveler”); infections of skin and soft tissue (cellulitis, abscesses, furunculosis, whitlow, infected burns, wounds, and others.);
– Infectious eye disease, syphilis, yaws, yersiniosis, legionellosis, rickettsial disease, chlamydia different localization (including prostatitis, proctitis), Q fever, Rocky Mountain spotted fever, typhus (including typhus, tick, return) Lyme disease (I st. – erythema migrans), bacillary and amoebic dysentery, tularemia, cholera, actinomycosis, malaria; in a combination therapy – leptospirosis, trachoma, psittacosis, psittacosis, granulocytic ehrlichiosis; whooping cough, brucellosis, osteomyelitis; sepsis, subacute bacterial endocarditis, peritonitis;
– Prevention of postoperative septic complications; Malaria, caused by Plasmodium falciparum, during short trips (less than 4 months) in an area where common strains resistant to chloroquine and / or pyrimethamine-sulfadoxine;
– As a drug “first” number is assigned to 65 patients during exacerbation of chronic bronchitis (including on the background of asthma) without concomitant diseases (these are often caused by acute Haemophilus influenzae). Effective with the exacerbation of bronchopulmonary infection (usually staphylococcal etiology) in patients with cystic fibrosis, chlamydial arthritis, granulocytic ehrlichiosis. Older patients used for acute treatment of prostate and urinary infection caused by Escherichia coli.

Contraindications
– Hypersensitivity to doxycycline, the drug, other tetracyclines;
– Lactase deficiency;
– Lactose intolerance;
– Galactose malabsorption glucose;
– Porphyria;
– Severe hepatic impairment;
– Leukopenia;
– Children’s age (up to 12 years – the possibility of the formation of insoluble complexes with calcium ions (Ca 2+) deposition in the bone skeleton, enamel and dentin of the teeth);
– Children over the age of 12 years with a body weight up to 45 kg.

Special instructions
To prevent irritant action (esophagitis, gastritis, ulceration of the mucosa of the gastrointestinal tract) is recommended reception in the daytime with many liquid food. In connection with the possible development of photosensitivity need to limit sun exposure during treatment and 4-5 days after it. With prolonged use, requires periodic monitoring of liver function of the blood. May mask the symptoms of syphilis, in connection with the possibility of mixed infection is necessary to monthly serological analysis for 4 months. All tetracyclines form stable complexes with ions of calcium (Ca2 +) in any kostnoobrazuyuschey tissue. In this connection, in the reception period of tooth development may cause lasting tooth staining in the yellow-gray-brown color, as well as hypoplasia of enamel. Perhaps falsely elevated levels of catecholamines in the urine when determining the fluorescence method. When biopsy thyroid gland in patients receiving long-term doxycycline may dark brown staining tissue slides without disrupting its function.

The experiment found that doxycycline may have a toxic effect on fetal development (delayed skeletal development) – Blocks metalloproteinases (enzymes that catalyze the degradation of collagen and proteoglycans) in the cartilage, reduces lesions in deforming osteoarthritis. After increasing the dose above 4 g pharmacokinetics of doxycycline is not dependent on the dose and blood concentration does not increase.
When applying the preparation, while receiving and 2-3 weeks after cessation of treatment may develop diarrhea caused by Clostridium difficile. In mild cases enough to discontinuation of treatment and the use of ion exchange resins (cholestyramine, colestipol), in severe cases, loss of refund shown fluid, electrolytes and protein, the appointment of vancomycin, metronidazole or bacitracin. Do not use medicines which inhibit peristalsis.
Effects on ability to drive vehicles and management mechanisms
Patients should refrain from all activities that require attention, rapid mental and motor.

If abnormal liver function
Contraindicated in severe hepatic insufficiency. If you have severe liver failure requires reduction of the daily dose of doxycycline, as this is a gradual accumulation of it in the body (the risk of hepatotoxicity).

Application in childhood
It is contraindicated in children under 12 years (possibility of forming insoluble complexes with calcium ions (Ca 2+) deposition in the bone skeleton, enamel and dentin of the teeth); and children after the age of 12 years with a body weight up to 45 kg.
Application is possible in children over 12 years weighing more than 45 kg according to the dosage regimen.
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Inderal

 

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Sponding substance
Propranolol * (Propranolol *)
ATX
Propranolol C07AA05
Therapeutic
Beta-blockers
Nosological classification (ICD-10)
C74 Malignant neoplasm nadpochechnikaE05 thyrotoxicosis [hyperthyroidism] F41 Other anxiety rasstroystvaG25.0 tremorG43 MigrenI10 Essential Essential (primary) gipertenziyaI15 Secondary gipertenziyaI20 angina [angina] I42.1 Obstructive hypertrophic kardiomiopatiyaI49.9 Irregular heartbeat neutochnennoeR07.2 pain in the heart
Structure and Composition
1 film-coated tablet contains 40 mg of propranolol hydrochloride, in a plastic bottle and 50 100 pcs., In a cardboard box 1 vial.

Pharmachologic effect
Mode of action – antihypertensive.
Beta-adrenoceptor blocking.

Indications of the drug Inderal
Essential and renal hypertension, angina, arrhythmia, migraine, anxiety, essential tremor, hyperthyroidism, hypertrophic obstructive cardiomyopathy, pheochromocytoma (alpha-blockers).

Contraindications
Hypersensitivity, cardiogenic shock, bronchospasm and asthma history, metabolic acidosis, peripheral arterial circulatory disorders, bradycardia, AV block, sick sinus syndrome, decompensated heart failure, Prinzmetal angina, hypotension, pregnancy, lactation.

Side effects
Hallucinations, psychoses, bradycardia, thrombocytopenia, visual disturbances, withdrawal syndrome, heart failure, impairment of conduction, orthostatic hypotension, cold extremities, intermittent claudication, Raynaud’s syndrome, dizziness, insomnia, hypoglycemia, diarrhea disorders, psoriasis, paresthesia, bronchoconstriction, alopecia.

Dosing and Administration
Inside. Hypertension: the initial dose – 80 mg 2 times a day, the average dose – 160-320 mg / day (maximum 640 mg / day) – angina, anxiety, migraine, tremor: initial dose – 40 mg 2-3 times per day, the average dose of 80-240 mg / sut- arrhythmias obstructive cardiomyopathy, thyrotoxicosis: 10-40 mg 3-4 times a day (up to 240 mg / day) – pheochromocytoma – 30 mg / day.

Children under 12 years: arrhythmia, pheochromocytoma, thyrotoxicosis – 0,25-0,5 mg / kg 3-4 times daily, migraine – 20 mg 2-3 times a day.

Storage conditions of the drug Inderal
In the dark place at room temperature.
Keep out of the reach of children.

Shelf-life of the drug Inderal
5 years.
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