Buy Cenforce 200 | sildenafil 200mg sildenafil Citrate 200 mg Sildenafil Citrate 200 mg
|Active substance||sildenafil Citrate|
|Receiving||For 1 h. to act|
|Time steps||5-6 hours|
|Daily intake||100 mg|
|Compatible with alcohol||No|
H1 – Cenforce 200
H2 – Cenforce 200
H3 – Cenforce 200
H4 – Cenforce 200
What is Cenforce-200?
Cenforce-200 – enhanced formula of generic Viagra. Active ingredient — sildenafil contained in a dosage that exceeds the usual dose at 2 times (200 mg sildenafil, 100 mg is for generic generic Viagra). Generic Viagra is used to restore the counter erections during sexual intercourse. Sildenafil is not intended to treat underlying causes of erectile dysfunction (age, high cholesterol, diabetes, etc), its effect is to stimulate blood circulation in the penis, which lasts while the drug is active (4-8 hours). Addictive is missing.
indication for the use Cenforce 200
Generic Cenforce-200 is indicated for weak erection or no erectile response when sexual acts that occurred repeatedly. The drug is not intended for the treatment of major causes of erectile dysfunction (diabetes, low levels of sex hormones, chronic fatigue and others) and shown exclusively in the framework of a temporary stimulant potency.
the Primary active agent Cenforce-200 — sildenafil citrate 200 mg Accompanying ingredients: HPMC, glycerol triacetate, lactose monohydrate (dry dispersion), croscarmellose sodium, hyprolose ultrafine grinding, microcellulose.
Pharmacological action sildenafil
Erection, as a mechanism, has a very complex chain of events in the physiology of men. Understanding the action of inhibitors of phosphodiesterase-5 (IPDE5), should be considered in the framework of the comprehensive mechanism of penile erection in General. Physiologically, erection, as a mechanism, can be divided into some conventional stages, which in turn are divided into many discrete. The first stage is the process of excitation — as a consequence of sexual stimulation, that is, the excitation triggers the entire sequence of events leading to an erection.
Sexual stimulation can be of different nature: mechanical (tactile stimuli), imagination, visual impact, various combinations of the above and more. The point is that erotic signals coming into the brain, going to and transmitted by the messengers (chemicals) in various organs and tissues. A huge role in the excitation processes of the whole mechanism of stimulation of sexual desire played by androgens — male hormones of a steroid nature.
Subsequent stage of the signal transmission from the brain through the neurons to the penis. Under the influence of the impact signals of the cerebral cortex in the cells of the penis there is an active production of NO (nitric oxide) that leads to the action of one particular enzyme guanylate cyclase. Under the influence of the latter, leads to the formation of cyclic guanosine monophosphate (cGMP).
Under normal, unexcited condition in the cells of the manhood, there is an excess of ions of Ca+, which maintain the tone of smooth muscles of blood vessels of manhood that impedes the blood flow to it and as a result of his penis is in a relaxed state. Under the influence (cyclic forms guanosine monophosphate), CGMP and the subsequent decrease in the concentration of calcium ions, occurs relaxation of smooth of blood vessels, increasing the lumen of the cavernous arteries and sinusoids of the penis, which leads to an erection and increased blood flow in the penis and consequently, erection.
human Physiology is a complex system based on antagonistic principles. The body normally functioning individual may not be always in potency, it is influenced by the impact of compensating mechanisms, the synthesis of a particular enzyme phosphodiesterase-5, required for the chemical destruction of cyclic guanosine monophosphate. Under the action of the enzyme PDE-5 is the accumulation of cells of a member of the calcium ions and as a result is a weakening of potency. At different deviations in the male body (age, drug and alcohol abuse, vascular diseases, psychological stress, excessive consumption of drugs and antidepressants, physical fatigue and other diseases) synthesis by the body PDE-5 may be redundant in nature, which in turn leads to sluggish potency, or the rapid fall of the penis immediately after an erection or the erection does not occur. It is in these situations and are prescribed by doctors phosphodiesterase inhibitors-5 (PDE5I) — tadalafil (Cialis), sildenafil (Viagra) and vardenafil (Levitra).
Molecular structure of sildenafil is largely reminiscent of cyclic guanosine monophosphate, which has a high affinity for phosphodiesterase-5. PDE-5 instead of having to interact with cyclic guanosine monophosphate, temporarily reacts with sildenafilom. The inhibition of PDE-5 leads to a temporary (5-8 hours) vasodilation and maintenance of penile blood flow is enhanced, by virtue of the level of cyclic guanosine monophosphate in the cavernous tissue and vessels. After a certain period of time sildenafil the same way as cyclic guanosine monophosphate amenable to chemical degradation by the enzyme PDE5 and sildenafil, the action stops. This process is similar to the natural recycling of cGMP, this explains the lack of habituation to sildenafilo.
Based on this process, it can be concluded that blockers of PDE-5 does not lead to spontaneous erections and increased libido. For the pharmacological effects of the drug need sexual stimulation, the drug does not cause erection itself. An erection occurs only under the action of cyclic guanosine monophosphate, which is synthesized by the body in the presence of the object of sexual desire. Sildenafil performs exclusively the role of a security guard that opens the gate (expands the lumen of the vessels) to enter the car (the smooth passage of blood through the vessels).
sildenafil, inactivating phosphodiesterase-5, stimulates the quality of erectile function, sufficient for carrying out one or more sexual acts.
Method of administration and effective dosages
Cenforce-200, including all other generics on the basis of sildenafil, it is undesirable to take along with heavy fatty foods. Fatty food inhibits the flow and absorption of sildenafil from the gastrointestinal tract into the blood. Do not use dosages of sildenafil that are superior to the standard 100 mg. at Least in the generic Cenforce 200 contains dosage is two times superior therapeutic, take one tablet Cenforce-200 is strongly recommended. Experienced users to purchase this generic solely because of the financial benefits, because in terms of sildenafil the cost therapeutic dose will be much cheaper. Taking a whole tablet Cenforce-200, you are risking side-effects, so before taking the generic pill advisable to divide with a knife into several pieces and only take half or quarter tablets. Do not take more than once a day and do not combine it with alcohol.
Age of patients cannot be a reason for dose adjustment. If other contraindications dosage for sildenafil for patients in years should be chosen the same as in other cases, up to 100 mg sildenafil.
Certain drugs and chronic diseases able to cause side effects and worsen the patient's condition. Talk to your doctor and inform about current chronic diseases and medications that are assigned at this time.
has Not been proven the efficacy and safety of sildenafil Cenforce-200 for patients with a predisposition to peptic ulcer disease and gastrointestinal bleeding. People with an open form of peptic ulcer disease should not take sildenafil because the in vitro studies sildenafil have a negative effect on platelet aggregation and blood rheology. In human studies, this fact was not confirmed, but it is necessary to adopt and to best protect themselves.
co-administration with inhibitors of CYP3A4 can extend the half-life of sildenafil. The initial recommended dosage of sildenafil should be reduced to 25 mg during use with CYP3A4 inhibitors. Avoid drinking grapefruit juice or grapefruit products because they similarly affect the primary path of metabolism for sildenafil (via CYP3A4).
do Not use any medications for treating male impotence (alprostadil yohimbine, etc.) without prior consultation with the attending physician.
Patients with pulmonary veno-occlusive disease (LOB), it is not recommended to take sildenafil with drugs as pulmonary vasodilators can lead to complications of the cardiovascular condition of the patient.
use caution, prescribing sildenafil to men with the syndrome of prolonged QT interval (including patients with congenital elongation QT interval and people who use certain substances, lengthening the interval QT), hypertrophic cardiomyopathy and aortic stenosis.
do Not take Cenforce-200, if in the history of the disease are the diseases of the organs of vision, including and hereditary, for example, cases of ischemic anterior partiitions neuropathies (NAION), retinitis pigmentosa, degeneration of the corpus luteum.
sildenafil is not indicated for the use of persons active sex life is banned because of health and women (including during pregnancy and breastfeeding) and children under 18 years.
Prohibited joint use of typical therapeutic doses of sildenafil in conjunction with HIV protease inhibitors (indinavir, ritonavir) because such use significantly increases the plasma concentration and time system actions (AUC) of sildenafil (300% and 1000%, respectively). The co-administration of such drugs leads to a significant increase in the risk of undesirable side effects (hyperemia, vasodilatation, dizziness, headache, nosebleed, etc.).
sildenafil is contraindicated if the patient was previously the situation which lead to priapism (painful and prolonged erection) or when the patient there are diseases that increase the risk of priapism: anatomical deformation of the drive (for example, cavernous fibrosis, angulation, Peyronie's disease), blood disease (multiple myeloma, thrombocytopenia, acute leukemia, sickle cell anemia).
Renfors 200 is contraindicated in arterial hypertension (systolic over 170 mm Hg. art., diastolic blood pressure over 110 mm Hg. art.), severe liver damage, severe stage of kidney failure (KK less 30 ml/min) and significant hypotension (less than 90/50 mm of mercury. calendar).
Prohibited integrated use of sildenafil together with stimulants is called guanylate cyclase (riociguat), because of a significant reduction in arterial blood pressure. Do not take other inhibitors of PDE-5 or any other medication that also contains in its composition of sildenafil citrate. It is forbidden to combine with drugs from the group of alpha-blockers and especially drugs based on nitrates for treatment of angina heart pain. Avoid sharing the use of some antiarrhythmic drugs — procainamide, amiodarone, quinidine, sotalol (see “Interaction”).
sildenafil is contraindicated in heart attack, apoplexy, which have been for the last 6 months, and in the presence of serious heart disease: aetiology (less 50 beats per minute), coronary heart disease (CHD), cardiac tamponade, angina pectoris, heart failure.
do Not take sildenafil if you have individual intolerance to the drugs based on it (swelling of the throat, lips, face or tongue, difficult breathing, including anaphylactic shock).
Was recorded a small number of events in which citrate sildenafil, probably, was the cause for loss of vision. The cause of the vision loss was caused by a lack of blood supply to the optic nerve due to partiitions anterior ischemic neuropathy (NAION). Almost all patients had at the time of reception sildenafil related diseases and aggravating factors: diabetes, edema of the optic disc, vascular complications, problems of vision, which was the place to be earlier, high cholesterol, high blood pressure, Smoking and age older than 50 years. On account of the provocation sildenafil such severe consequences, there have been discussions in the medical community, since the statistics of the occurrence of such complications in this group of patients is comparable to that, if sildenafil had not been taken.
Interactions with other drugs
Blockers of alpha adrenergic receptors. Aggregate treatment with blockers of alpha-adrenergic receptors with sildenafilom leads to a significant increase in the probability of hypotension and its associated unwanted side effects: syncope, confusion, dizziness and injuries (resulting drops). Of all the blockers of alpha adrenergic receptors only alfuzosin and tamsulosin did not exert undesirable effects on the subjects and can be considered relatively harmless in joint use.
Stimulants called guanylate cyclase. a Significant number of patients with PAH who were assigned to combination therapy sildenafilom (three times a day 20 mg sildenafil) and riociguat (0.5 mg and 1 mg) stopped therapy because of excessive hypotension and increase the likelihood of undesirable spillover effects: headache, loss of consciousness, flushing of skin, fainting, dizziness etc.
Derivatives of morphine.
the Combined intake of opiates and sildenafil can induce priapism. This side effect was recorded specifically for Dihydrocodeine, but can occur with other opiates. Two individuals that used sildenafil as a treatment for erectile dysfunction, reported prolonged erections, lasting from 2 to 5 hours during the first 7 days after initiation of treatment with Dihydrocodeine. One subject stopped treatment with Dihydrocodeine, subsequently, his potency returned to normal. The second patient continued treatment for another two weeks, but no complaints.
Drugs that induce cytochrome isoenzymes CYP3A4 and CYP2C9. Inducer of the isoenzyme cytochrome CYP3A4 rifampicin in the therapeutic dosage is 600 mg, which was prescribed daily from sildenafilum, did not significantly increase the clearance of sildenafil. The decrease in AUC was 88%, and the maximum concentration is 46%, compared to sildenafilom at the same dose, but without rifampicin. Other interaction with such drugs has not been studied. There are suggestions that other inducers of CYP3A4, such as nevirapine, cyproterone, modafinil can also increase the clearance of sildenafil. Dosage adjustment for sildenafil is not provided.
barbituric acid Derivatives.
the co-administration of sildenafil with barbiturates may decrease the maximum concentration of the latter in the blood (Cmax) and/or decrease the value of the area under the curve “concentration-time”. In turn, such interaction can lead to a decrease in the effectiveness of sildenafil. The recommended dose sildenafil may be adjusted after the recommendations of a physician and under his personal supervision. In order to safely use both medications, ask your doctor to prescribe alternative treatment options.
Antacid medicines. substances Such as calcium carbonate, aluminum hydroxide, magnesium oxide, magnesium hydroxide, Almagel may affect absorption of drugs, thereby delaying in time their physiological effects.
Inhibitors of HIV protease. Receiving sildenafil in combination with such strong non-selective inhibitors of cytochrome as ritonavir, saquinavir, indinavir, and others, can rapidly improve the content of sildenafil in the blood.
NO Donators, organic nitrates and nitrites. absolutely contraindicated reception sildenafil persons who use medical organic nitrates, including the donators of nitrogen oxide. There is clearly fixed boundaries of time between doses of these medications and sildenafil, in which the reception of medical nitrates can be safe. Medical nitrates (in the same way as the inhibitors PDE-5), have their own exceptional time of pharmacological activity, which depends directly from the active substance and forms of its release (sublingually sprays, ointments, plasters, capsules, drops or tablets). For example, the makers of sildenafil, need to withstand at least a 12 hour time interval after the last dose of sildenafil before taking sublingual nitroglycerin.
Inhibitors of cytochrome P450.
strong inhibitors of CYP450 3A4 that may increase the Cmax and area under the kinetic curve “concentration-time” (AUC) of sildenafil. Potent selective inhibitor of CYP2C9 and CYP3A4 — ketoconazole (400 mg per day), increased maximum peak concentration in plasma (Cmax) and area under pharmacological curve (AUC) of sildenafil in 3 and 10 times, respectively, compared with the use of only one sildenafil. Similar values of the average maximum plasma concentration (Cmax) and AUC were of Itraconazole. This suggests that substances inhibiting cytochrome, such as amoxicillin, delavirdine, erythromycin, esomeprazole, rabeprazole, etc., can increase the time of pharmacological activity and the frequency of adverse side effects to sildenafil, however, laboratory tests were not conducted. With erectile dysfunction, patients receiving the combined treatment with strong inhibitors of cytochrome P450 (isoform 3A4), such as voriconazole, Itraconazole, telithromycin, pantoprazole, esomeprazole and HIV protease inhibitors, the recommended therapeutic dosage of sildenafil must not be more than 25 mg of sildenafil per day.
the PDE5 Inhibitors. Tell your doctor about all medicines, dietary supplements and even herbal tinctures that you take together with sildenafilom. Do not take a combination of several medicines for impotence, including of the same type, especially if in their composition contain sildenafil, tadalafil, udenafil, vardenafil, pentoxifylline, theophylline, or avanafil. The combined data usage of medicines can increase the risk of side effects.
In the clinical research sildenafil was attended by more than 20,000 volunteers. The result of these studies proved that sildenafil has, though not the best among all the inhibitors PDE-5 but good enough safety profile. Adverse reactions the majority of retreat for a few hours after treatment and are transient in nature. The most pronounced manifestation of undesirable side reactions, as a rule, coincides with the maximum concentration (Cmax) of the active substance in the blood. In General the drug is well tolerated by the body and only in very unlikely cases, you may have complications (for more details see Side effects based on drugs sildenafilum):
- From GIT: inflammation of the lining of the esophagus, dyspepsia, numbness of the mouth, nausea, anal bleeding, inflammation of the stomach and small intestine, hemorrhoids.
- CNS: headache, anxiety, numbness of body parts, abnormal dreams, insomnia, somnolence, tremor.
- From other systems and organs: priapism, abnormal liver function tests, hematuria.
- the respiratory system: sore throat, runny nose, cough, sore throat, inflammation of sinusitis, asthma.
- With the skin and dermis: contact dermatitis, allergic rashes, herpes, exfoliative dermatitis, redness, itching.
- From the organs of hearing and sight: visual color distortions, eye and ear pain, bleeding in the retina, dryness of the cornea, atherosclerotic retinopathy, glare in eyes, hemorrhagic syndrome, eye swelling, discoloration of the sclera, tinnitus, blurred fibers of the vitreous body.
- From the side of musculoskeletal system: a tendon rupture, joint pain, tendon inflammation, muscular weakness, back pain, bone pain, myalgia.
- From the side of cardiovascular system: postural hypotension, ventricular arrhythmia, cerebrovascular serious cardiovascular and vascular complications, AV-blockade, atrial fibrillation, thrombosis, cardiomyopathy, heart failure and unstable angina.
- From the hematopoietic function: leukopenia, anemia.
Alcoholic beverages and Cenforce 200
sildenafil in combination with alcohol can lower blood pressure. Significantly increases the tendency to such symptoms as tachycardia, dizziness, redness of the eyes, fainting, headache and flushing to the face. Alcohol does not affect the pharmacokinetic parameters sildenafil in the plasma area under the curve “concentration-time” (AUC) and the elimination rate of substances from the body. Anyway, you should avoid or limit alcohol intake during therapy sildenafilom.
an Overdose of drugs based on sildenafil causes the same side effects as standard recommended doses. However, their probability of occurrence and the strength of the manifestations is significantly greater. When overdoses sildenafilum conduct standard maintenance treatment aimed at relief and eliminate the root manifest symptoms. In severe cases seek urgent medical help.
Tablets Cenforce-200 available 10 pieces in a blister foil. The batch number, expiry date and the content of the active ingredients printed on the package.
Recommendations for storage
Temperature regime of storage from 0 to 30 °C. the Final date of storage of the drug Cenforce-200 is listed on convolute. Cenforce 200 keep out of reach of children.