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Active Ingredient: Sildenafil

Sublingual Viagra is used for the treatment of erectile dysfunction in men.

INDICATIONS
Sublingual Viagra is indicated for the treatment of erectile dysfunction in men. It works by helping the blood flow into a penis to achieve and maintain an erection.

INSTRUCTIONS
Use Sublingual Viagra as directed by your doctor.
Take Sublingual Viagra by mouth. The pill has to be placed under the tongue. It’s absorbed directly in to the blood stream from the mouth’s mucus membrane.
Sublingual Viagra should be taken 30 minutes to 1 hour before sexual activity; however, it may be taken anywhere from 4 hours to a half hour before sexual activity. Talk with your doctor about the best way to take  Sublingual Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Do not take more than the recommended dose or take it more often than once daily, or as directed by your doctor.
If you miss a dose of Sublingual Viagra and you still intend to engage in sexual activity, take it as soon as you remember. Continue to take it as directed by your doctor.
Ask your health care provider any questions you may have about how to use Sublingual Viagra.

STORAGE

Sublingual Viagra is to be kept in its original container. It is to be stored at room temperature between 59 and 86 degrees F (15-30 degrees C) away from moisture, heat and light and out of the reach of children.

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✦ Levitra Professional 20 mg (active ingredient Vardenafil 20 mg) is an innovative preparation of a new generation of drugs successfully coping with any problems associated with erectile dysfunction. Its unique feature is that it works effectively with alcohol and various stimulants.

✦ Country of origin: India
✦ Action period: up to 8 hours
✦ Admission: 20-30 minutes before sexual intercourse
✦ Alcohol: works well with alcohol
✦ Recommended daily dose: not more than 1 tablet
✦ International name: Vardenafil Tablets
✦ Pharmacological group: PDE5 inhibitor
✦ Active substance: Vardenafil
✦ Dosage form: round tablets, coated

Levitra Professionaℓ
Levitra Professional 20 mg has a more perfect formula that allows you to combine the use of the drug with small doses of alcohol, in addition, it does not affect the positive effect of the drug on fatty foods, which gives significant advantages to this drug over the usual drugs to normalize the potency. Levitra Professional 20 mg works much faster and longer than standard drugs, and the possible side effects are minimized.

A good potency is provided by complex hemodynamic and chemical processes, with a key role played by cGMP, special chemicals that block the relaxation of the smooth muscles of the cavernous bodies of the penis, resulting in their rapid filling with blood, which ensures a reliable and qualitative erection. The active ingredient of vardenafil acts selectively on the vessels of the reproductive system, without affecting the vessels of the retina of the eyes and the heart vessels, which not only enhances the positive effect of the drug, but also further increases the safety of its use.

Vardenafil destroys cGMP by blocking PDE5, and thus helps to relax the smooth muscles of the penis and provides a reliable erection. However, the effect of the drug occurs only in the presence of sexual stimulation, this is the main condition for the successful action of the drug. Levitra Professional begins to operate after 15-20 minutes, the peak of activity occurs after an hour and lasts up to five hours, then the activity of the drug begins to decrease and after ten hours is completely eliminated from the body.

Advantages of the drug:

The active ingredient of the drug vardenafil, guarantees a lasting result of complete elimination of male impotence. For today, this remedy is considered one of the best, effective, and most importantly safe with prolonged use;
Levitra Professional 20mg has higher quality characteristics;
The perfect formula of the drug allows you to get a longer lasting positive effect, on average, it lasts for 10 hours;
The drug acts quickly and has a complex positive effect on male sexual health, which has not a one-time effect, but persists for a long time;
The positive effect of the drug and the speed of its onset do not depend on the intake of food and alcoholic beverages.
Men for complete recovery from impotence or with temporary failures of potency at any age from adulthood to 80 years. Often, the drug is a means of choice in patients with severe diabetes mellitus or in conditions of the operated prostate gland.

As you know, sexual activity is associated with certain risks for the cardiovascular system, so it is so important not only to fully assess the state of health before taking the means to combat erectile dysfunction, but also to choose an adequate dosage of Levitra Professional. Only Professionaℓ medical advice will help to adequately assess all risks and prescribe the right dosage for safe permanent reception.

Levitra Professionaℓ 20 mg for ingestion, it is necessary to start the initial reception of the drug with 10 mg, and if there are serious problems with the work of the liver or heart, it is more appropriate to take 5 mg.

The daily maximum dose is 20 mg or one Levitra Professional 20 mg tablet. The drug is well tolerated with prolonged use and has a minimal set of possible side effects. After taking the medication, it is activated after 15-20 minutes, if there is an obligatory condition in the form of strong sexual arousal.

Directions for use: Levitra Professionaℓ
Pharmachologic effect

The main mechanism of action of Levitra Professional 20 mg is based on the relaxing effect of nitric oxide on the smooth muscles of the reproductive system of men, which leads to increased local blood flow and increased potency. It should be remembered that Levitra’s action consists only in providing a qualitative potency, and not an exciting action. Therefore, to obtain a good result, sexual arousal is necessary, then Levitra will begin its stimulating action to increase the potency in response to sexual stimulation. The main distinguish the usual Levitra from Levitra Professional is the rapid onset of a positive result and combining with small doses of alcohol.

✦ Indications for use

Successful treatment of problems associated with a violation of potency, regardless of the causes of its causes. The remedy is effective in the presence of sexual stimulation.

Contraindications

Do not allow the drug to men under the age of 18, as well as individuals with individual intolerance to individual components of the drug. Do not use Levitra Professional with medicines containing organic nitrates and nitrogen donors. With caution, it is necessary to apply the drug in the presence of hypertension, hypotension, arrhythmia, cardiovascular system, with curvature of the penis, with oncological diseases, with diseases of the retina.

Side effects

Despite the excellent tolerability of the drug in numerous clinical trials, minor side effects of the drug were revealed, mainly they were manifested with increasing dosage and appeared as standard negative drugs for most medicines. Of the most frequent manifestations can be identified headache, flushes to the face. Nausea, very rarely vomiting, drowsiness and allergic rhinitis.

Mode of application

It is recommended to take no more than one tablet per day, given the high speed of the onset of a positive result, you need to consume the medication 15-20 minutes before intimacy. The peculiarity of using Levitra Professional 20 mg is the possibility of combining with a moderate amount of alcohol and high-calorie food. The minimum dose for taking the drug is 5 mg, the recommended dosage per day is 10 mg and the maximum allowable is 20 mg. The remedy is active for 8 hours.

✦ Interaction with other drug groups

Before Levitra is used, a compulsory medical consultation is necessary, some types of medicines may have a negative effect on Levitra’s action, or may increase the risk of adverse events. The main thing is that you must completely exclude Levitra Professional 20 mg with nitrate preparations, alpha blockers and nitrogen donors.

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Other names for this medication:
Apetamin-p, Apeton, Apitup, Arictin, Axoprol, Cipla-actin, Ciplactin, Cipractin, Cipractine, Ciproeptadina, Ciproheptadina, Ciprolisina, Ciprovit, Ciptadine, Complamin, Covitasa b12, Cuplactin, Cyproatin, Cyprodin, Cyprogin, Cyproheptadin, Cyproheptadinum, Cypromin, Cyprotol, Dronactin, Dynamogen, Ennamax, Esprocy, Glocyp, Glutodina, Heptagyl, Heptasan, Ifrasal, Kulinet, Lexahist, Lupactin, Nuran, Oractine, Pangavit, Periactine, Periactinol, Poncohist, Practin, Prakten, Prohessen, Pronicy, Sipraktin, Triactin, Trimetabol, Viternum.

Active Ingredient: Cyproheptadine.
Periactin is used to treat sneezing, itching, watery eyes, runny nose, and other symptoms of allergies.

Pharmachologic effect:
Periactin has antihistamine activity (blocks H1 receptors), but at the same time it is a strong anti-serotonin substance (it reduces the spasmogenic and other effects caused by serotonin). It also has anticholinergic activity. It has an anti-allergic effect, and is especially effective for itchy dermatoses (possibly due to antiserotonin action). The drug blocks somatotropin hypersecretion in acromegaly and ACTH secretion in Itsenko Cushing’s syndrome.

Indications for use:
It is used for allergic diseases (acute and chronic urticaria, serum sickness, pollinah, vasomotor rhinitis, contact dermatitis, neurodermatitis, Quincke’s edema, allergic reactions to medications, etc.), as well as for migraines (mainly due to the antiserotonin effect) , with loss of appetite of various nature (neurogenic anorexia, chronic diseases, etc.).

Due to the fact that histamine and serotonin enhance the secretion of pancreatic juice, it is also proposed to use periactin in the complex treatment of chronic pancreatitis.

Application Technique:
Assign inside: adults 4 mg (1 tablet) 3-4 times a day, children in smaller doses in accordance with age. At the age of 6 months to 2 years, it is prescribed with caution in a daily dose of up to 0.4 mg / kg, from 2 to 6 years – up to 6 mg per day (1/2 tablet 3 times a day), from 6 to 14 years – up to 12 mg per day (1 tablet 3 times a day). Daily doses should not exceed 32 mg in adults, 8 mg in children 2–6 years old, 12 mg in 6–14 years old.

Adverse events:
When using the drug, drowsiness, dry mouth are possible, in rare cases – anxiety, ataxia, dizziness, nausea, skin rash.

Contraindications:
Glaucoma (increased intraocular pressure), stomach ulcer, pregnancy, urinary retention, predisposition to edema, an attack of bronchial asthma, old age. The drug is not prescribed for children under 2 years of age.

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❇Active Ingredient: Clobetasol Propionate

❇Description ℴf active ingredient Clobetasol

▶Formula: C22H28ClFO4, chemical name: (11beta, 16beta) -21-Chloro-9-fluoro-11,17-dihydroxy-16-methylpregna-1,4-diene-3,20-dione (and as propionate).
Pharmacological group: hormones and thℯir antagonists / corticosteroids / glucocorticoids.
Pharmacological action: glucocorticoid, antiallergic, anti-inflammatory, antipruritic.

❇Armacological properties
Clobetasol induces thℯ formation ℴf lipocortin proteins that inhibit phospholipase A2, slows thℯ formation ℴf arachidonic acid and thℯ products ℴf its metabolism – leukotrienes, prostaglandins. Clobetasol at thℯ site ℴf application eliminates flushing, swelling, itching. Possible absorption ℴf Clobetasol in thℯ systemic circulation with local use. With thℯ use ℴf Clobetasol in large areas ℴf thℯ skin, absorption is more pronounced. Clobetasol is metabolized mainly in thℯ liver; a small part ℴf thℯ drug is metabolized in thℯ kidneys. Clobetasol is excreted in thℯ urine.
When tested in mice teratogenicity ℴf Clobetasol, its fetotoxicity was shown when administered subcutaneously with a maximum dose ℴf 1 mg / kg, when administered at doses ℴf more than 0.03 mg / kg, teratogenicity ℴf Clobetasol was detected. thℯse doses are approximately 33% and 1%, respectively, ℴf thℯ recommended topical dose ℴf Clobetasol ointment for human use. thℯ following developmental defects were observed: split skull, cleft palate, othℯr disorders ℴf skeletal development. Teratogenic activity was also established when laboratory animals administered a relatively low dose. It was also found that some glucocorticosteroids have teratogenic activity when applied to thℯ skin by laboratory animals. With topical use, teratogenic activity ℴf Clobetasol has not been studied. But, given thℯ ability ℴf Clobetasol to be absorbed through thℯ skin, studies were performed in vivo with subcutaneous administration ℴf thℯ drug. In thℯse studies, pronounced teratogenicity ℴf Clobetasol in rabbit mice was established. Preparations ℴf Clobetasol have a higher teratogenic potential than preparations ℴf glucocorticosteroids with less activity. Long-term studies ℴf thℯ carcinogenicity ℴf Clobetasol have not been conducted. thℯ mutagenic activity ℴf Clobetasol was not detected in thℯ Ames test, using thℯ method ℴf accounting for gene conversions in yeasts ℴf thℯ species Saccharomyces cerevisiae. In studies on rats, more than 50 mg / kg per day ℴf Clobetasol was administered. thℯre was a decrease in thℯ number ℴf viable fetuses, an increase in thℯ cases ℴf embryo resorption.

❇Indications
Ointment, cream: chronic eczema, psoriasis (with thℯ exception ℴf common plaque and pustular), discoid lupus erythℯmatosus, lichen planus, skin diseases that are resistant to treatment with less active glucocorticoids for external use.
Shampoo: prevention and treatment ℴf relapses ℴf psoriasis ℴf thℯ scalp in adults (except for common plaque and pustular).

❇Method ℴf administration ℴf Clobetasol and dose
Clobetasol is used topically. Apply a thin layer ℴf cream or ointment 1 – 2 times a day to thℯ affected skin before improvement. With persistent skin lesions (especially with hyperkeratosis), thℯ effect ℴf Clobetasol is enhanced by thℯ application ℴf an occlusive dressing for thℯ night. Ointment is recommended for use in skin lesions, which are accompanied by dryness, thickening, hyperkeratosis, since thℯ ointment base contributes to thℯ preservation ℴf moisture in thℯ skin. thℯ cream is recommended for use in processes that are accompanied by severe inflammation and wetting. Shampoo should be applied only to thℯ scalp.
Clobetasol is recommended for short-term use only. It is possible to conduct short repeated courses if necessary. Atrophic changes in thℯ skin as a result ℴf prolonged use ℴf local glucocorticoids can appear on thℯ face more ℴften than in othℯr parts ℴf thℯ body. Avoid contact with ointment or cream in thℯ eyes (risk ℴf increased intraocular pressure). Before applying a fresh bandage, thℯ skin needs to be cleaned, since moisture and heat, which are created by hermetically sealed bandages, contribute to thℯ development ℴf a bacterial infection. Do not allow shampoo to get on thℯ ulcerated skin or eyelids and eyes (a danger ℴf cataracts, glaucoma). Shampoo is used only for thℯ treatment ℴf psoriasis ℴf thℯ scalp and should not be applied to othℯr parts ℴf thℯ body. In particular, shampoo should not be applied to eyelids, facial skin, folded skin areas (anal and genital area, axillary cavities) and to damaged areas ℴf thℯ skin, as thℯ risk ℴf developing local adverse events such as telangiectasia, atrophic skin changes or dermatitis increases. If Clobetasol ointment has caused irritation, thℯn it is necessary to cancel Clobetasol and take thℯ necessary thℯrapeutic measures. It should be borne in mind that thℯ development ℴf contact allergic dermatitis usually indicates thℯ lack ℴf thℯrapeutic effect from thℯ use ℴf thℯ drug, while with contact allergic dermatitis on topical preparations that do not contain corticosteroids, exacerbation ℴf thℯ course ℴf thℯ underlying disease is observed. thℯ allergic origin ℴf changes from thℯ skin should be confirmed with appropriate skin tests. thℯ duration ℴf treatment in patients who use potent glucocorticosteroids should not exceed 14 days. When applying Clobetasol ointment to small areas, longer use ℴf thℯ drug is possible. Ointment ℴf Clobetasol inhibited thℯ hypothalamic-pituitary-adrenal system when used in doses less than 2 g per day for 7 days in patients with eczema. When using Clobetasol, attention should be paid to thℯ accompanying skin lesions ℴf an infectious origin. You also need to know about thℯ risk ℴf developing such changes when using thℯ drug. In thℯse cases, appropriate fungicidal or antibacterial drugs must be used. If thℯre is no fast positive dynamics against thℯ accompanying skin lesions ℴf infectious nature against thℯ backdrop ℴf specific treatment, it is necessary to cancel thℯ Clobetasol ointment until sufficient control is achieved over thℯ infectious process. Do not use Clobetasol ointment for thℯ thℯrapy ℴf perioral dermatitis and rosacea. Also, do not apply it in thℯ face, groin, axillae. thℯre is no data on thℯ efficacy and safety ℴf Clobetasol ointment in children. It is not recommended to use thℯ drug in children under 12 years old. With thℯ use ℴf local glucocorticosteroids, thℯ development ℴf oppression ℴf thℯ hypothalamic-pituitary-adrenal system, Cushing’s syndrome in children is higher than in adults because ℴf a higher ratio ℴf thℯ surface area ℴf ​​thℯ body to its mass. For thℯ same reason, in children, thℯ risk ℴf developing adrenal insufficiency is higher during treatment, as well as after its termination. thℯre is information about thℯ development ℴf some adverse reactions, including thℯ formation ℴf striae, when using glucocorticosteroids in ℴff-label situations for topical application to newborns and children. thℯre is information about thℯ development ℴf Cushing’s syndrome, oppression ℴf thℯ hypothalamic-pituitary-adrenal system, increased intracranial pressure, delayed rates ℴf weight gain and growth in children who received local glucocorticosteroids. Manifestations ℴf adrenal insufficiency in children were revealed by a low level ℴf cortisol in thℯ blood serum, thℯ lack ℴf an adequate response to stimulation ℴf thℯ adrenal cortex with adrenocorticotropic hormone. Increase in intracranial pressure was detected by headaches, bulging fontanelles, bilateral edema ℴf thℯ optic disc.

❇Contraindications for use
Hypersensitivity, youth acne, acne, skin cancer, viral, bacterial and fungal skin infections (including chicken pox, herpes simplex, actinomycosis), perioral dermatitis, perianal and genital itching, skin tuberculosis, age under 18 years (shampoo) and up to 1 year (ointment, cream).

❇Application in pregnancy and lactation
thℯ use ℴf Clobetasol in pregnancy is possible if thℯ expected benefit to thℯ mothℯr is greater than thℯ possible risk to thℯ fetus. For thℯ duration ℴf Clobetasol thℯrapy, breastfeeding should be discontinued.

❇Side effects ℴf Clobetasol
Local reactions: skin itching, burning, acne, striae, dry skin, telangiectasia and skin atrophy, hypertrichosis, weakening ℴf skin barrier function, pigmentation disorder, development ℴf pustular psoriasis, hypopigmentation, allergic contact dermatitis, perioral dermatitis, secondary infection, phenomena irritation, sweating, ulceration, erythℯma, cracking ℴf thℯ skin, folliculitis, numbness in thℯ fingers.
Possible systemic reactions: ulceration ℴf thℯ mucous membrane ℴf thℯ gastrointestinal tract, gastritis, increased intraocular pressure, allergic reactions, symptoms ℴf hypercorticism, Cushing’s syndrome.

❇thℯ interaction ℴf Clobetasol with othℯr substances
It has been shown that thℯ sharing ℴf drugs that are capable ℴf inhibiting CYP3A4 (eg, itraconazole, ritonavir), depresses thℯ metabolism ℴf glucocorticosteroids and leads to an increase in thℯir systemic exposure. thℯ degree ℴf clinical significance ℴf this interaction depends on thℯ activity ℴf thℯ inhibitor CYP3A4 and thℯ method and dose ℴf glucocorticosteroids.

❇Overdose
With an overdose ℴf Clobetasol, signs ℴf hypercortisy develop. It is necessary to cancel Clobetasol under thℯ supervision ℴf a doctor.

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Avanafil – innovation among agents for the treatment of erectile dysfunction
Even faster effect, and even fewer side effects
Avana-100 – the very generic “young” for the treatment of impotence Stendra. The drug is actually able to “outdo” all brand tablet for the treatment of impotence.

Avanafil – the quick cure of all: it takes effect within 15 minutes after the decision. Other advantages Avana-100 is its power (one tablet of 100 mg Avanafil does not lose its effectiveness even in severe forms of impotence) and the almost complete absence of side effects (principally new technologies have allowed drug makers to reduce the level of such effects to 1%). Time of the drug – 6 hours.

What is Avana 100 mg?
Avana 100 mg – a drug for the latest generation of an erection. He developed a small company Vivus Inc, which is headquartered in Mountain View (Calif., USA). The drug has been declared as the first tool that can completely restore control over an erection within 15 minutes. Following approval in April 2012 FDA Avanafil went on sale under the trade names Spedra (in Europe) and Stendra (in the US). It has established itself as a safe and reliable fast-acting drug. Widespread prevented just too high a price.

The well-known pharmaceutical company in our Sunrise Remedies decided to make medicine more affordable. Scientists from this company created a generic drug Stendra, which is a complete analog of the “original”. From the American Indian Avanafil it differs only in a very low price. All other characteristics of the drug Stendra (generic) are similar. Thanks to the efforts of “Sunrise” men in the world had the opportunity to take advantage of high-quality medicines at a reasonable price.

What is better – or Stendra Avana?
As we have said, Stendra – US drug developed by Vivus. Avana – Indian counterpart. Essentially, the drug is one manufactured by different manufacturers. Avana-100 (Stand) gained more widespread due to the lower price. The efficiency and speed are the same as the “original” preparation. It is no wonder that most men prefer to Avana. Reviews confirm the high popularity of the drug.

Avana (generic): principle of action
The most high-speed drug for erectile considered generic Stendra. Guide says that it belongs to the group of PDE-5 inhibitors. Like other active substances from this category Avanafil inhibits specific enzyme phosphodiesterase (type 5). Healthy men PDE5 need to go to the quiet state after sex. If you have sexual dysfunction, an enzyme found in the blood constant.

To enhance erection quality needed to increase blood flow to the penis and relax the smooth muscles of the corpora cavernosa. This “engaged” cyclic guanosine monophosphate. The level of cGMP is constantly decreasing the enzyme PDE-5. Before scientists were challenged to create a drug that blocks the action of phosphodiesterase. As a result, the drug was invented Avana (generic). Responses indicate that high efficiency of the tool has a unique degree of security.

How long does the effect of 100 mg pills Avana?
Searching for a cure, which in a few minutes to restore an erection? Try generic Avana. Reviews about this drug is always only positive. It is rapidly absorbed and becomes effective immediately. The effect of the reception Avanafil in 75% of cases after 15 minutes. Avanafil concentration in the blood reaches a maximum at 1-1.5 h. The validity period of 5-6 hours.

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Generic Stendra: indications for use
One of the newest drugs to improve erections – generic Stendra. Reviews show that Avanafil starts to act faster than other drugs. It is used to treat erectile dysfunction. It is a special condition of the body, in which a man is not able to achieve an erection. There are also cases when the excitement of the reproductive system occurs, but the penis does not reach the desired hardness. Erectile dysfunction is also called impotence. Previously, it was considered an incurable disease. Today it is easy to cope Avanafil. Reviews of generic Stendra indicate that the drug is like a lot of men.

Can I take Avana100 women?
Many people wonder if the solution to raise the female libido Avana-100. Reviews of some women talking about the effectiveness of drugs in this direction. In particular, women often say that after taking Avanafil significantly enhanced sexual desire and orgasm becomes stronger. But special research studied the effects of the drug on women, was conducted. It is unknown how Avanafil affects lactating and pregnant women. Therefore, at this time Avana-100 is indicated for use only men who have reached 18 years of age.

Generic Avana: how to use
High speed and efficiency has generic Avana 100. Buy at the lowest price you can online pharmacy “ShopStoyal”. We always have the most advantageous offers for regular customers and new customers. Dosing of the drug:

Take Avana 100 mg 15 minutes before anticipated sexual intimacy.
minimum dose – ½ tablet.
The recommended dose – 1 tablet.
During the reception, you can use alcohol (in small amounts), and fatty foods.
Reviews Generic Stendra show that abundant and fatty food on Avanafila performance is not affected.

Avana100: Dosage
For preparation Avana-100 daily dose should not exceed 200 mg of active ingredient (two tablets). Doctors recommend at the initial stages of erectile dysfunction limited to 50 mg (half tablet). Only if the effect will not be possible to pass on the whole tablet Avana. The drug has a high degree of safety and almost never cause side effects. However, when exceeding the maximum daily dose (200 mg) adverse reactions are not only more frequent, but also increase.

Stendra (Avana): CONTRAINDICATIONS
Before you buy Avana 100 mg, check the list of contraindications. The drug is banned for use to people who have sexual activity can lead to a heart attack or fainting.

There are also diseases in which you need to carefully take the drug Avana-100. Instruction is one of them:

stomach ulcer or bowel;
stroke or myocardial infarction;
uncontrolled high or low blood pressure;
Penis deformation (fibrosis, injury, Peyronie’s disease, etc.);
ischemic optic neuropathy;
multiple myeloma.
Note that one of the safest drug is generic Stendra. Customer reviews show that it can still create a situation ugrozhayuschuie health when combined with other drugs.

Therefore it is impossible to combine the technique with Avanafil:

medications containing nitrates;
inhibitors of CYP3A4;
medicines for high blood pressure;
alpha-blockers;
antihypertensive agents.
We have tried to collect as much information about the drug generic Avana. Price, location, reviews, the principle of action – on this page there are all the necessary information. However, over the reception Avanafila must always consult a doctor.

Avana 100mg: Compatibility with alcohol
The manufacturer allows the use of small doses of alcoholic beverages while taking pills generic Avana 100. Responses indicate that a moderate amount of ethanol does not interact with the drug. But do not abuse alcohol. Alcohol promotes vasodilation. Avanafil has the same effect. As a result, blood pressure (especially in people with hypotension) may drop dangerously. In addition, the combination with alcohol drink Stendry can cause more severe side effects.

Generic Stendra: side effects
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  • Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill.
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Analogs of: Dutas Avodart.
Other names of Avodart: 

Avidart, Duagen, Duodart, Duprost, Dutasterid, Dutasterida, Dutasteridum, Zytefor.

Clinico-pharmacological group
Drug for the treatment of benign prostatic hyperplasia. An inhibitor of 5α-reductase.

Composition, structure and packing
Soft gelatin capsules, yellow, oblong, opaque, marked with the code * “GX CE2”.
1 caps. 500 mg dutas
Excipients: mono- and diglycerides of caprylic / capric acid – 349.5 mg BHT – 35 micrograms.
The composition of the capsule shell: gelatin – 144.8 mg, glycerol – 70.8 mg of titanium dioxide – 1.78 mg iron oxide yellow – 127 g, medium-chain triglycerides – qs, lecithin – qs, red ink for printing ** – qs
10 pieces. – Blisters (3) – packs cardboard.
10 pieces. – Blisters (9) – packs cardboard.
* Application code “GX CE2” in red ink used for printing in the manufacture of the finished dosage form production site Catalent France Beinheim SA (France); application code “GX CE2” gray with cold UV laser is used in the manufacture of the finished dosage form production site GlaxoSmithKline SA Rharmaceuticals (Poland).
** Red ink for printing used in the manufacture of the finished dosage form production site Catalent France Beinheim SA (France) and are not used in the manufacture of the finished dosage form production site GlaxoSmithKline SA Rharmaceuticals (Poland). The amount of ink in each capsule is less than 0.28 mg; materials remaining on the capsule are polyvinyl acetate phthalate, polyethylene glycol, propylene glycol, iron oxide red (E172, CI77491).

Pharmachologic effect
Drug for the treatment of benign prostatic hyperplasia. dutas – dual inhibitor of 5α-reductase. Inhibits the activity of 5α-reductase isozymes 1 and type 2, which is responsible for the conversion of testosterone to 5α-dihydrotestosterone (DHT). DHT is the primary androgen responsible for hyperplasia of glandular tissue of the prostate gland.
The maximum impact of dutas to reduce the concentration of DHT is dose dependent and is observed within 1-2 weeks after starting treatment. After 1 and 2 weeks dutas dose of 500 mg / day average dihydrotestosterone concentration in serum is reduced by 85% and 90%.

Pharmacokinetics
Suction
After a single dose of the drug in a dose of 500 mg of dutas serum Cmax is reached within 1-3 hours. The absolute bioavailability is about 60% relative to a 2-hour / infusion. The bioavailability of dutas is not dependent on food intake.

Distribution
Pharmacokinetic data obtained after single and multiple dutas, Vd indicates a large (300 to 500 liters). dutas has a high degree of binding to plasma proteins (> 99.5%).
When taken daily dutas concentration in serum reaches 65% of the steady-state level after 1 month and approximately 90% of that level in 3 months. Stationary dutas concentration in serum (Css), equal to about 40 ng / ml, achieved after 6 months of daily administration of 500 micrograms of the drug. Sperm as serum, dutas stationary concentrations also reached after 6 months. After 52 weeks of treatment, dutas concentrations in semen averaged 3.4 ng / ml (range 0.4 to 14 ng / ml). From the serum in the sperm gets approximately 11.5% of dutas.

Metabolism
In vitro dutas is metabolized by CYP3A2 isoenzyme to form two small monogidroksilirovannyh metabolites; however, it does not apply isoenzymes CYP2C9, CYP1A2, CYP2A6, CYP2E1, CYP2C8, CYP2B6, CYP2C19 and CYP2D6. After reaching Css dutas, serum using mass spectrometric method exhibit unchanged dutas, 3 major metabolite (4′-gidroksidutasterid, 1,2-digidrodutasterid gidroksidutasterid and 6) and two small metabolite.

Withdrawal
In humans, dutas is extensively metabolized. After oral administration in a daily dose of dutas 500 mg to achieve Css from 1% to 15.4% (average 5.4%) of the dose is excreted through the intestines unchanged. The remaining part is excreted in the form of four major metabolites, constituting 39%, 21%, 7% and 7%, respectively, and 6 small metabolites (the share of each of which is less than 5%).
After a person has kidney excreted trace amounts of unchanged dutas (less than 0.1% of the dose).
When receiving therapeutic doses of dutas its final T1 / 2 of 3-5 weeks.
dutas is detected in serum (at concentrations greater than 0.1 ng / ml) up to 4-6 months after discontinuation.

Linearity / non-linearity
Pharmacokinetics dutas can be described as a process of first order absorption and elimination of the two parallel processes, a saturated (m. E. Depending on concentration) and one saturable (m. E. Does not depend on the concentration). At low concentrations in serum (less than 3 ng / ml) dutas rapidly excreted via elimination of two processes. After receiving a single dose of 5 mg or less, dutas is rapidly eliminated from the body and has a short half-life equal to 3-9 days.
At concentrations in serum above 3 ng / ml is slower clearance of dutas (0.35-0.58 l / h), primarily through the unsaturated linear process of elimination with the final T1 / 2 of 3-5 weeks. At therapeutic concentrations, against a background of daily intake of 500 micrograms prevails slower clearance of dutas; total clearance is linear and concentration-dependent character.

Older men
Pharmacokinetics and pharmacodynamics of dutas were studied in 36 healthy men aged 24 to 87 years after a single dose (5 mg) of the drug. Between the different age groups was not statistically significant differences in pharmacokinetic parameters such as AUC and Cmax. There were no statistically significant differences in the values of T1 / 2 of dutas men between the age groups 50-69 years and above 70 years, which includes the majority of men with benign prostatic hyperplasia.
Between different age groups had no significant differences in the degree of reducing the levels of DHT. These results demonstrate the absence of the need to reduce the dose of dutas in elderly patients.

Dosage
The drug can be taken regardless of meals.
The capsules should be swallowed whole, do not chew and do not open, because the contents of the capsule may cause irritation of the mucous membrane of the oropharynx.
Benign prostatic hyperplasia (BPH)
Adult males (including the elderly) The recommended dose of Avodart drug – 1 capsule (500 mg) 1 time / day. The capsules should be taken as a whole.
While improved during treatment with the drug comes pretty quickly, treatment should continue for at least 6 months in order to objectively evaluate the therapeutic effect.
For the treatment of BPH drug Avodart may be appointed as a monotherapy or in combination with alpha 1-blockers.
Special groups of patients
When receiving 500 mg / day via the kidneys excrete less than 0.1% of the dose, so there is no need to reduce the dose in patients with impaired renal function.
There is currently no data on the use of the drug Avodart in patients with impaired hepatic function. Because dutas is extensively metabolized and its half-life of 3-5 weeks, caution should be exercised in treating patients with drug Avodart impaired liver function.

Overdose
When assigning dutas to 40 mg / day once (up to 80 times higher than the therapeutic dose) for 7 days, significant side effects were noted. In clinical studies, patients within 6 months dutas received 5 mg daily, with no additional side-effects to those observed in patients receiving 500 mg of dutas, have been discovered.
dutas no specific antidote, so if you suspect an overdose quite symptomatic and supportive care.

Drug Interactions
In vitro dutas is metabolized by CYP3A4 isoenzyme cytochrome P450 enzyme system. In the presence of inhibitors of CYP3A4 dutas concentration in the blood can increase.
With simultaneous use of dutas with CYP3A4 inhibitors verapamil and diltiazem there is a decrease in clearance of dutas. However, amlodipine, another calcium channel blocker, does not reduce the ground clearance of dutas. The reduction in clearance of dutas and the subsequent increase in its concentration in the blood, while the use of this drug and CYP3A4 inhibitors is not significant due to the wide range of security boundaries dutas, so there is no need to reduce the dose.
In vitro dutas is not metabolized following cytochrome P450 isozymes person: CYP1A2, CYP2A6, CYP2E1, CYP2C8, CYP2C9, CYP2C19 and CYP2D6.
dutas does not inhibit the enzyme in vitro system of human cytochrome P450 involved in the metabolism of drugs.
In vitro dutas does not displace warfarin, acenocoumarol, phenprocoumon, diazepam and phenytoin from their binding sites to plasma proteins, and these drugs are, in turn, do not displace dutas.
When conducting studies of the interaction of dutas with tamsulosin, terazosin, warfarin, digoxin and kolestiraminom a person of any clinically significant pharmacokinetic or pharmacodynamic interactions were observed.
In the application of dutas in conjunction with lipid-lowering drugs, ACE inhibitors, beta-blockers, calcium channel blockers, corticosteroids, diuretics, NSAIDs, inhibitors of phosphodiesterase type 5 and quinolone antibiotics any significant drug interactions were observed.

Pregnancy and lactation
Effects on fertility
Effect of dutas in a daily dose of 500 micrograms of sperm characteristics was studied in healthy volunteers aged 18-52 years. By 52 weeks of treatment the mean percent reduction in total sperm count, semen volume and sperm motor activity were 23%, 26% and 18% respectively compared to baseline. The concentration of spermatozoa and their morphological characteristics do not change.
After 24 weeks of observation of the average value of the percentage change in total sperm count in the group of dutas remained 23% lower compared to the baseline. The average value for all semen parameters at all time points remained within the normal range and did not meet the criteria for a clinically significant change (30%) at the 52 th week of treatment in two volunteers in a group of dutas total sperm count was reduced by more than 90% of Compared with baseline, with partial recovery at the 24 week follow-up.
Therefore, the clinical significance of the effect of dutas on the performance of individual sperm and fertility of the patient is unknown.

Pregnancy
dutas is contraindicated in women. dutas was not studied in women because Preclinical data suggest that inhibition of DHT levels can cause inhibition of the development of the external genitalia of the fetus.

Lactation
No data on the penetration of dutas passes into breast milk.

Side effects
Adverse events reported below are listed according to the anatomical and physiological classification and frequency of occurrence. The frequency of occurrence is defined as follows: very common (≥1 / 10), commonly (≥1 / 100 and <1/10), uncommon (≥1 / 1000 and <1/100), rarely (≥ 1/10 000 and < 1/1000), very rare (<1/10 000, including isolated cases). Frequency categories were formed on the basis of clinical studies and post-marketing drug surveillance.
The incidence of adverse events, formed the basis of post-marketing surveillance at.

On the part of the immune system
Very rarely allergic reactions (including rash, pruritus, urticaria, localized edema) and angioedema
Skin and subcutaneous fat
Rarely, alopecia (hair loss mainly on the body), or hypertrichosis
Mental Disorders
Very rarely, depression
Reproductive system
Very rarely testicular pain, testicular swelling
The incidence of adverse events, formed on the basis of clinical trial data (adverse events related to the use of dutas monotherapy)
In the third phase, placebo-controlled trials with dutas compared with placebo, the researchers evaluated adverse events associated with taking dutas:
Adverse events of adverse events in the 1st year of application of adverse events in the 2nd year of application
Placebo
(n = 2158) dutas
(n = 2167) Placebo
(n = 1736) dutas
(n = 1744)
Erectile disfunktsiya2 3% 6% 1% 2%
Reduced libido2 2% 4% <1% <1%
Violation eyakulyatsii2 <1% 2% <1% <1%
Violations by zhelez1 infants <1% 1% <1% 1%
1 – including pain and breast enlargement.
2 – adverse effects from the reproductive system and mammary glands associated with the use of dutas (as monotherapy or in combination with tamsulosin). These adverse effects may persist after cessation of treatment and the effect of dutas on data retention adverse events is unknown.
Adverse events associated with the use of dutas in combination with tamsulosin
The following adverse events were reported in the study CombAT (comparison of dutas and tamsulosin 500 mg 400 mg 1 time / day as monotherapy or in combination for four years) and evaluated by researchers from the cumulative effect of ≥1%).
Adverse events of adverse events during the period of application of tamsulosin in combination with dutas
1st year 2nd year 3rd year 4th year
Kombinatsiya1 (n) (n = 1610) (n = 1428) (n = 1283) (n = 1200)
dutas (n = 1623) (n = 1464) (n = 1325) (n = 1200)
Tamsulosin (n = 1611) (n = 1468) (n = 1281) (n = 1112)
Erectile disfunktsiya3
A combination of 6% 2% <1% <1%
dutas 5% 2% <1% <1%
Tamsulosin 3% 1% <1% <1%
Reduced libido3
The combination of 5% <1% <1% 0%
dutas 4% 1% <1% 0%
Tamsulosin 2% <1% <1% <1%
Violation eyakulyatsii3
The combination of 9% 1% <1% <1%
dutas 1% <1% <1% <1%
Tamsulosin 3% <1% <1% <1%
Violations of the thoracic zhelez2
The combination of 2% <1% <1% <1%
dutas 2% 1% <1% <1%
Tamsulosin <1% <1% <1% 0%
Dizziness
The combination of 1% <1% <1% <1%
dutas <1% <1% <1% <1%
Tamsulosin 1% <1% <1% 0%
1 – = combination of dutas 500 mg 1 time / day + tamsulosin 400 mg 1 time / day;
2 – including pain and breast enlargement;
3 – adverse effects from the reproductive system and mammary glands associated with the use of dutas (as monotherapy or in combination with tamsulosin). These adverse effects may persist after cessation of treatment. Effect of dutas on data retention adverse events is unknown.

Conditions and terms
The drug should be stored out of reach of children at or above 30 ° C. Shelf life – 4 years.
Indications
– As monotherapy for the treatment and prevention of the progression of benign prostatic hyperplasia by reducing its size, relief of symptoms, improved urination, reduce the risk of acute urinary retention and the need for surgical intervention;
– As a combination therapy with alpha 1-blockers for the treatment and prevention of the progression of benign prostatic hyperplasia by reducing its size, alleviation of symptoms, improvement of urination, decrease the risk of acute urinary retention and the need for surgical intervention. Mainly I studied the combination of dutas and tamsulosin alpha1-blocker.

Contraindications
– Hypersensitivity to dutas, and other ingredients;
– Hypersensitivity to other inhibitors of 5α-reductase.
Avodart is contraindicated in women and children.
Precautions should be prescribed the drug for liver failure.

Special instructions
dutas is absorbed through the skin, so women and children should avoid contact with damaged capsules. In case of contact with damaged capsules should immediately rinse the appropriate site with soap and water.
Abnormal liver function
There is currently no data on the use of the drug Avodart in patients with impaired hepatic function. Because dutas is extensively metabolized and its half-life of 3-5 weeks, caution should be exercised in treating patients with drug Avodart impaired liver function.
Heart failure is the combined use of dutas and tamsulosin
The two 4-year clinical trials, the incidence of heart failure was higher in patients treated with the combination of dutas and alpha1-adrenergic blocker, primarily tamsulosin, than patients who had not received the combined treatment. In these two studies, the incidence of heart failure has remained low (≤ 1%) with some variability in between. But overall performance discrepancies frequency side effects of the cardiovascular system were noted. A causal relationship between treatment with dutas (alone or in combination with alpha1-blocker) and the development of heart failure has been established.
The impact on the identification of prostate-specific antigen (PSA) and prostate cancer (PCa)
Patients need to carry out a digital rectal examination, as well as use other methods of investigation of the prostate prior to treatment with dutas and repeat them periodically during treatment to rule out prostate cancer development.
Determination of the concentration of PSA in serum is an important component of screening aimed at identifying prostate cancer. After 6 months of therapy with dutas average serum PSA level is reduced by about 50%. Patients taking dutas should be defined a new basic PSA levels after 6 months of therapy. In the future, it is recommended to regularly monitor PSA levels.
The use of dutas did not affect the diagnostic value of PSA as a marker of prostate cancer. Any confirmed increase in PSA with respect to the least of its value in the treatment of dutas may indicate the development of prostate cancer (particularly prostate cancer with a high degree of differentiation by Gleason score) or nonadherence dutas should be carefully evaluated, even if the PSA levels remain within the normal range for this age group of patients not taking inhibitors of 5α-reductase.
Total PSA level returns to its original value within 6 months after discontinuation of dutas.
The ratio of free to total PSA remains constant even during therapy with dutas. If the determination of the percentage of free PSA fraction is further used to detect prostate cancer in men receiving dutas, correction of this magnitude is not required.
Effect of long-term use of dutas on the development of breast cancer in men
There were no long-term effect of dutas on the development of breast cancer in men.
Prostate cancer and high-grade tumors graduation
In the 4-year study (REDUCE) compared the use of placebo and dutas have 8231 volunteers aged 50 years to 75 years, with a negative biopsy in the presence of prostate cancer and a PSA level of 2.5 ng / ml to 10 ng / ml at the initial examination .
In the study, 6706 patients underwent a needle biopsy of the prostate gland and on the basis of the results determined by the degree of malignancy of prostate cancer Gleason. 1517 patients in the study were diagnosed with prostate cancer. In most cases, as in the dutas group and in the placebo group were diagnosed with well-differentiated prostate cancer (score Gleason 5-6). Differences in the number of prostate cancer cases with the assessment of 7-10 points Gleason in the dutas group and the placebo group were absent (p = 0.81).
4, it was observed more cases of breast cancer with the evaluation 8-10 Gleason dutas group (n = 29; 0.9%) compared with the placebo group (n = 19; 0.6%) (p = 0.15). When evaluating biopsy 1-2, the number of patients diagnosed with prostate cancer with an estimate 8-10 Gleason was comparable in groups dutas (n = 17; 0.5%) or placebo (n = 18; 0.5%). In assessing biopsy for 3-4 years it was diagnosed more cases of prostate cancer with the assessment of 8-10 points Gleason in the dutas group (n = 12; 0.5%) compared with the placebo group (n = 1, <0.1%) (p = 0.0035). The percentage of patients diagnosed with prostate cancer with an estimate 8-10 Gleason was stable during all time slots (the period of 1-2 years, and 3-4) in the group of dutas (0.5% in each period), while in placebo percentage of patients diagnosed with prostate cancer with 8-10 evaluation was lower for 3-4 years, 1-2 years than (<0.1% compared to 0.5% respectively).
In the 4-year study (CombAT) patients with BPH, in which prostate biopsy to all participants has not been determined protocol, and all diagnoses of prostate cancer based on a biopsy if indicated, with evaluation 8-10 prostate cancer Gleason was diagnosed in 8 patients (<0.5%) at dutas, 11 patients (<0.7%) with tamsulosin and 5 patients (<0.3%) in the combination therapy with tamsulosin and dutas.
A causal relationship between dutas and the development of prostate cancer a high degree of gradation is not established.
Men taking dutas should undergo regular examinations for assessing the risk of developing prostate cancer, including a PSA.
Effects on ability to drive vehicles and management mechanisms
dutas does not affect driving or using machinery.
If the kidney function
If the kidney function dose reduction is required (because while taking the drug at a dose of 500 mg / day with urine allocated less than 0.1% of the dose).
If abnormal liver function
It should be used with caution on patients with impaired liver function since dutas undergoes extensive metabolism in the liver, and its T1 / 2 of 3-5 weeks.

Precautions should be prescribed the drug for liver failure.
The use in the elderly

No dose adjustment is required.
Application in childhood
Avodart is contraindicated in children.

02.02.2015 | | Hair Loss, Male health

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31.01.2015 | | Bestsellers, Male health

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