Cialis Online Without Prescription

International name: cialis

The composition and form of issue. 1 tablet contains: tadalafil - 20 mg. excipients: lactose monohydrate - 245.195 mg hyprolose (hydroxypropyl cellulose) - 8.05 mg croscarmellose sodium - 22.4 mg, microcrystalline cellulose is 52.5 mg, magnesium stearate - 0.875 mg sodium lauryl sulfate - 0.98 mg.

The film composition of the shell: Opadry II yellow (lactose monohydrate, hypromellose, titanium dioxide, triacetin, dye iron oxide yellow) - 14 mg.

Available in the form of tablets, film-coated yellow, almond-shaped, marked "C 20" on one side and 2.5, 5 or 20 mg, packing for 1, 2, 4, 8, 14, 28 PCs

Pharmacological action.

Remedy, increase the potency. Is an effective, reversible, selective inhibitor of specific PDE5 (an enzyme found in smooth muscles of the corpus cavernosum, blood vessels of internal organs, skeletal muscle, platelets, kidney, lung and cerebellum) cGMP. The effect on PDE5 is 10,000 times more powerful than FDE1-4 and FDE7-10, which localized in heart, brain, blood vessels, liver and other organs, and about 700 times more active against FDE5 than for PDE6 found in the retina and is responsible for photoperiodic.

On the background of sexual arousal local release of NO inhibition of PDE5 tadalafil leads to increased levels of cGMP in the cavernous body of the penis. The result is relaxation of smooth muscles of arteries and blood flow to the tissues of the penis, accompanied by erection. Tadalafil has no effect in absence sexual stimulation. Improvement of erection and the possibility of successful sexual intercourse is shown already through 16 mines and can be observed within 36 h after administration of the drug. Does not affect BP and HR, visual identification of colors (blue/green), visual acuity, electroretinogram, intraocular pressure and pupil size. When used in a daily dose of 10 mg, no clinically significant effect of the drug on the amount and concentration of sperm, motility and morphology of sperm.

Pharmacokinetics. Suction. After oral tadalafil is rapidly absorbed. The average Cmax in plasma is reached after an average of 2 hours after ingestion. The rate and extent of absorption of tadalafil are independent of food intake, so the drug Cialis can be applied regardless of the meal. Time of admission (morning or evening) had no clinically significant effect on the rate and extent of absorption.

The pharmacokinetics of tadalafil at healthy persons is linear in regard to time and dose. In the dose range of 2.5 to 20 mg AUC increases proportionally with dose.

The pharmacokinetics of tadalafil in patients with erectile dysfunction are similar to pharmacokinetics of the drug in individuals without erectile dysfunction.

Distribution. Css in plasma are attained within 5 days while taking the drug 1 time per day.

Average Vd is about 63 liters, indicating that tadalafil is distributed in body tissues.

At therapeutic concentrations 94% of tadalafil in plasma is associated with proteins.

In healthy persons less than 0.0005% of administered dose detected in semen.

Metabolism. Tadalafil is mainly metabolized with the participation of isoenzyme CYP3A4 of cytochrome P450. The major circulating metabolite is methylethanolamine. This metabolite is at least 13000 times less active against PDE-5 than tadalafil. Consequently, the concentration of this metabolite is not clinically significant.

Excretion. In healthy individuals the average clearance of tadalafil ingestion is 2.5 l/h, and среднийТ1/2 — 17,5 hours Tadalafil appears mainly as inactive metabolites, mainly with feces (about 61% of the dose) and to a lesser extent from the urine (approximately 36% of the dose).

Special groups

Elderly patients. Healthy elderly patients (65 years and over) had a lower clearance of tadalafil ingestion, which was reflected in the increase in AUC by 25% compared with healthy individuals aged 19 to 45 years. This difference is not clinically significant and does not require dose adjustment.

Patients with renal insufficiency. Patients with renal insufficiency mild to moderate severity dose adjustment is not required. Due to increased tadalafil exposure (AUC), patients with severe renal impairment is not recommended to use Cialis.

Patients with hepatic insufficiency. The pharmacokinetics of tadalafil in persons with mild to moderate hepatic insufficiency is comparable to that in healthy subjects. In patients with severe liver failure (class C classification for child-Pugh) data are not available. In the appointment of Cialis to patients with severe hepatic insufficiency you first need to assess the risks and benefits of treatment.

Patients with diabetes mellitus. In patients with diabetes mellitus on the background of the use of tadalafil AUC was lower by about 19% than in healthy subjects. This difference does not require dose adjustment.

Readings when taking cialis. The lower urinary tract symptoms in patients with benign prostatic hyperplasia, erectile dysfunction (ED); erectile dysfunction in patients with lower urinary tract symptoms on the background of benign prostatic hyperplasia.

Contraindications when using cialis. Simultaneous reception of the preparations containing any organic nitrates; childhood and adolescence till 18 years; hypersensitivity to tadalafil.

Dosing regimen and method of administration. The middle-aged men advised to take the dose of 20 mg at least 16 minutes before anticipated sexual activity, regardless of the meal. Patients can carry out attempt of sexual intercourse at any time within 36 hours after admission in order to establish the optimal response time to receive tadalfil. The maximum frequency of reception - 1 time/day.