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♻ Analog ♻

Cialis tablets contain 5 mg of tadalafilum, lactose (in the form of monohydrate) and spray dried lactose monohydrate, giprolose and extra thin giprolose, sodium lauryl sulfate, Mcc, croscarmellose Na, plant stearate Mg.
the composition of the p / o: Opadry yellow (hypromellose, triacetin, ti dioxide, lactose monohydrate, dye E172 (yellow)).

Form of issue
Tablets in p / o.5 mg. Packing No. 14 and No. 28.
the tablets are almond-shaped, covered with a light yellow film membrane. On one side is engraved “c 5”.

Pharmachologic effect
Improves erectile function.

Pharmacodynamics and pharmacokinetics What is Cialis?
Cialis (tadalafilum) is a drug that reversibly and selectively suppresses specific PDE-5 cGMP (cyclic guanosine monophosphate).
Wikipedia says that the drug is designed to treat disorders in which a man is not able to achieve and maintain the necessary erection for sexual intercourse.

With sexual excitement, local release of nitric oxide occurs, and due to the suppression of PDE-5, the concentration of cyclic guanosine monophosphate in the cavernous body of the penis increases.
As a result, the smooth muscles of the arteries relax, the blood flow to the tissues of the penis increases and an erection occurs. In the absence of sexual arousal, there is no such effect.
Elevated concentrations of cGMP are also observed in the smooth muscles of the bladder, the prostate and supplying them with blood vessels.
Relaxation of the musculature of the vessels promotes an increase in perfusion (passage) of blood in these organs and a reduction in the manifestation of BPH symptoms, and relaxation of the smooth muscles of the bladder and prostate further enhances vascular effects.
Improving the erection, tadalafilum thus increases the possibility of carrying out PA (sexual intercourse).
In healthy men, compared with placebo, there is no significant change in the change in DAD, SAD, and heart rate, does not affect the electroretinogram, visual acuity, IOP and pupil size, does not violate the ability to recognize colors (green / blue).

After taking the pill tadalafilum well absorbed in the body. the concentration of the substance in the blood plasma reaches peak values ​​2 hours after ingestion. Food and time of taking the drug do not have a clinically significant effect on the rate of absorption of tadalafilum and its bioavailability.
About 94% of the substance is in the state associated with plasma proteins. It is metabolized in the liver with the participation of the cYP3A4 isoenzyme. the main circulating metabolite in comparison with tadalafilum shows at least 13 thousand times less activity in relation to PDE-5.
the average half-elimination period in healthy men is 17.5 hours. the drug is excreted mainly in the form of pharmacologically inactive metabolites. About 61% of the accepted dose is excreted with feces, about 36% – with urine.

Indications for use
The drug is used for ED (erectile dysfunction); With MRSA (symptoms of the lower urinary tract) in patients with BPH; With ED in patients with LUtS with BPH.

Cialis is not prescribed for:
♂Hypersensitivity to tadalafilum or auxiliary components of tablets;
♂Simultaneous use of any organic nitrate-containing preparation;
♂Simultaneous use of doxazosin or preparations for the treatment of ED;
♂The presence of contraindications to sexual activity in men with cardiac and vascular pathologies (unstable angina, suffered during the last three months of MI, angina pectoris, cHF II-IV classes according to the NYHA classification, AH, uncontrolled arrhythmias, transferred during the last six months ischemic stroke);
♂Associated or unrelated to the use of PDION-5 inhibitors NAION (anterior ischemic optic nerve neuropathy);
♂Lactose intolerance, lactase deficiency, glucose / galactose malabsorption.
♂In addition, the drug is contraindicated to persons under the age of eighteen, and can not be used more than 2 rubles a week. In men with renal damage, in which clcr is below 30 ml / min.

Relative contraindications
Because of the lack of data on patients with hepatic insufficiency, which is classified in the child-Pugh c-class classification, caution should be exercised when using tadalafilum in this group of patients.
With caution, Cialis is prescribed to persons who are on treatment with α1-adrenoreceptor blockers. this is due to the fact that with the simultaneous use of tadalafilum with these drugs has a risk of symptomatic arterial hypotension (SAG).
Clinical studies of the pharmacological properties of tadalafilum in a group of healthy men have shown that a single dose of a standard dose of Cialis does not lead to SAG with simultaneous application of α1A-adrenoblocker tamsulosin. the study involved 18 people.

Other restrictions apply:
☞Predisposition to priapism;
☞Anatomical deformation of the penis;
☞Simultaneous administration of antihypertensive drugs, as well as drugs that suppress the isoenzyme cYP3A4 (Erythromycin, Saquinavir, Itraconazole, Ritonavir, Ketoconazole).

Diagnosis of ED should include identifying the main cause of impotence, conducting an appropriate examination and determining adequate therapy.

Side effects
With dysfunction of erection, the use of Cialis is most often accompanied by pain in the muscles or back, headache, flushing of the face, dyspepsia, nasal congestion.
In patients with ED / BPH, pain in the extremities and / or muscles, headache, gastroesophageal reflux (GER), dyspepsia were most often recorded.

Other possible adverse reactions:
☞Often – dizziness;
☞Infrequently, hypersensitivity reactions, blurred perception of visual images, pain in the eyeball, tachycardia, palpitations, increased or decreased blood pressure (the latter is possible in people who have already taken antihypertensive drugs), shortness of breath, nasal congestion, GER, abdominal pain, hyperhidrosis, rash ;
☞Rarely – a stroke (including acute damage to the blood circulation of the brain with a rupture of the vessel and hemorrhage (HMNc through hemorrhagic type)), transient amnesia, epileptic seizure, eyelid swelling, visual field disturbance, injection of the vessels of the sclera of the eyeball, myocardial infarction, nosebleeds, Urticaria, a prolonged erection.

In patients with previously existing risk factors for cVD, there were:
☞Infrequently – chest pain;
☞In rare cases – fainting, migraines, transient ischemic attacks, sudden cardiac death.

However, to be precise, these phenomena are associated with the use of tadalafilum, risk factors for cVD, sexual arousal, other factors or a combination of factors, or not, can not.
there are also reports of isolated cases of sudden hearing loss when using PDE-5 inhibitors (including tadalafilum) during clinical and post-marketing studies.

Side effects that occurred during postmarketing studies, but were not found in clinical placebo-controlled studies:
☞Swelling of the face;
☞Occlusion of the vessels of the retina;
☞Unstable angina;
☞Ventricular arrhythmias;
☞Exfoliative dermatitis;
☞Stevens-Johnson syndrome;
☞Sudden cardiac death.

Instructions for use Cialis How to take Cialis with ED?
♂Patients with frequent sexual activity, when PA occurs more than 2 rub / week, 5 mg tablets are recommended to be taken daily, one at a time, at the same time.

♂Depending on the individual tolerance, it is possible to reduce the dosage of tadalafilum up to 2.5 mg.
♂If PA occurs less often than 2 p. / Week, it is recommended to take tablets immediately before coition at a dose of 20 mg.
the permissible upper limit of the daily dose of Cialis  20 mg.

♂Instructions for the use of Cialis according to ED / BPH or BPH
With these pathologies, the patient is prescribed a drug of 1 r./day for one tablet at the same time (any, regardless of the time of ingestion and the time of sexual activity).

♂The duration of the course of treatment Cialis 5 mg is determined individually.

♂When the kidneys are affected, when the clcr score is 31-80 ml / min, there is no need for correction of the dose. Patients with severe renal lesions, in which clcr does not exceed 30 ml / min, daily use of the drug is contraindicated.

Single administration of up to 0.5 g of tadalafilum by a healthy person and repeated application up to 100 mg / day. ♂Tadalafilum in patients with erectile dysfunction is accompanied by side effects similar to those that occur with the use of a lower drug.
♂In case of an overdose, standard symptomatic therapy is performed. Cialis is practically not excreted in hemodialysis.

Interaction of other drugs on tadalafilum
♂Biotransformation of Cialis is carried out with the participation of the isoenzyme cYP3A, and therefore drugs inhibiting this isoenzyme increase the value of cmax and AUc of tadalafilum.
♂Despite the fact that specific studies were conducted only on the interaction of tadalafilum with ketoconazole and ritonavir, it can be assumed that such drugs as Itraconazole and Erythromycin are also capable of increasing the activity of tadalafilum.

♂Rifampicin, which is an inducer of cYP3A, reduces the exposure of a single dose of the drug and the value of cmax. Most likely, the simultaneous use of other drugs from the group of cYP3A inducers should help reduce the plasma concentration of tadalafilum.
♂The use of Cialis in combination with antacids (hydroxide Al / Mg hydroxide) helps to reduce the rate of absorption of the active substance of the drug without changing the AUc for tadalafilum.
✌Drugs that increase the index of the acidity of the stomach (pH), and, in particular, the H2-blocker nizatidine, do not affect the pharmacokinetic parameters of tadalafilum.

✌A study of the safety and efficacy of Cialis  combination with other methods of treating erectile ✌dysfunction (including in combination with other PDE5 inhibitors) has not been carried out, and it is therefore recommended that such combinations be avoided.
Tadalafilum does not contribute to an increase in bleeding time caused by ASA.

✌Effect of tadalafilum on other drugs
Tadalafilum  able to enhance the hypotensive effect of nitrates, because of what these drugs are not prescribed in combination.

✌The substance has no significant effect on the clearance of drugs that are metabolized with the participation of the cytochrome P450 system.

In the course of the studies it was found that tadalafilum:
☞Does not suppress or induce isoenzymes cYP3A4, cYP1A2, cYP2c19, cYP2c9, cYP2t1 and cYP2D6;
☞Does not have a significant effect on the pharmacokinetics of S- or R-warfarin, as well as on the effect of warfarin on PtV (prothrombin time);
☞Does not increase the duration of bleeding caused by ASA;
☞causing a systemic vasodilator effect, is able to intensify the hypotensive effect of the funds intended for lowering blood pressure (in patients taking several antihypertensive drugs in poorly controlled hypertension, the blood pressure decreased more pronounced, and in most patients this phenomenon was not associated with hypotensive symptoms);
☞Does not have a significant effect on the pharmacodynamics and pharmacokinetic profile of teofillin.

✌The results of two studies show that the use of the drug in healthy men in combination with tamsulosin (α1A-adrenoblocker) does not cause a significant decrease in blood pressure.

✌The use of a drug with α1-adrenoblocker Doxazosin (provided that the latter is taken at a dose of 4 to 8 mg / day) was accompanied by augmentation of the hypotensive effect of doxazosin.

✌Individual patients experienced pressure-related symptoms, including fainting.

☑Storage conditions
☞three years.
☞tablets should be stored at temperatures below 30° c.

☑Special instructions
Sexual activity can be dangerous in a number of pathologies of the heart and blood vessels. In connection with this, men with diseases that require restriction of sexual activity, treatment of erectile dysfunction, including tadalafilum, is contraindicated.

☑There are reports of cases of priapism (long, unrelated to sexual arousal, involuntary erection) against treatment with PDE-5 inhibitors.
Patients should be informed of the urgent need to see a doctor if the erection persists for four (or more) hours.

☑In the absence of timely assistance, such conditions lead to irreversible impotence.

☑Like other inhibitors of PDE-5, the drug causes systemic vasodilation, which can trigger a transient decrease in blood pressure. Before appointing tadalafilum, the physician should make sure that the patient with cardiac / vascular pathology does not undergo undesirable effects due to this effect.

☑Non-arterial AION is one of the causes of visual impairment (in some cases, before its complete loss). In the course of postmarketing observations, reports were recorded of rare cases of development of this pathology (cases were time-related with the use of PDE-5 inhibitors).

☑Determine exactly whether there is a direct link between tadalafilum and NAION treatment, to date it is impossible.

☑In case of sudden loss of vision, tadalafilum should be discontinued and seek medical attention.

☑The patient should also be warned that the people who have undergone NAION have a high risk of re-development of optical neuropathy.

☑If a patient is suspected of having BPH, he should undergo an additional examination to rule out prostate cancer.

☑Despite the fact that dizziness with the admission of tadalafilum occurred with the same frequency as when taking placebo, during the treatment should be careful when driving and machinery.

Other names for this medication
Apcalis, Regalis, Tadalafilo, Tadalafilum, Tadalis.

➡ Symptoms of impotence in men ⚠

➡ Increase the potency of folk remedies ⚠

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Antibiotics for inflammation of the appendages 5/5 (2)

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Antibiotics for inflammation of the appendages should be given to the patient immediately after an accurate diagnosis is established. At this time, studies can be carried out to determine the type of pathogen, but this is not reflected in the initial treatment. Antibacterial drugs are relevant if the inflammatory process proceeds in an acute form. In some cases, antibiotics are given to patients with an exacerbation of a chronic disease.

  • Types of antibiotics for inflammation of the appendages;
  • Indications for the use of antibiotics;
  • Pharmacodynamics of antibiotics;
  • Pharmacokinetics of antibiotics;
  • Treatment of inflammation of the appendages during pregnancy;
  • Contraindications to the use of antibiotics;
  • Side effects of antibiotics;
  • How to take antibiotics for inflammation of the appendages;
  • Overdose of antibiotics;
  • Interactions of antibiotics with other drugs.

For the treatment of inflammation of the appendages, drugs with a wide spectrum of action are relevant, that is, they kill a number of bacteria that usually lead to diseases of the genitourinary system. Doctors need to remember that the antibiotics chosen for the treatment of the patient must be active against ureaplasma, chlamydia and mycoplasma, because most often it is these organisms that cause the inflammatory process.

The treatment is adjusted after the result of the study, if it is found that another drug is better suited to destroy the identified pathogen. The drug and / or dosage should be changed if the patient’s condition has not improved in a few days, that is, there has been no progress in symptoms and laboratory data.

Types of antibiotics for inflammation of the appendages

In recent years, a number of pathogens have acquired resistance to popular antibacterial drugs of the tetracycline series. It is also worth considering that drugs in this group have a large number of side effects. Specialists in most cases treat inflammation of the appendages with doxycycline (which has minimal side effects and is excreted by the body in a short time).

Another group of effective drugs for the problems under consideration are macrolides. They are not destroyed in the stomach, have a long half-life, therefore they accumulate in the body and thus speed up recovery. The effectiveness of sumamed and klacid has been proven in practice today. Antibacterial drugs from the macrolide group destroy, among other things, organisms that settle inside cells, leading to inflammation.

Fluoroquinolines are the next group that is relevant in the treatment of inflammation of the appendages. The “addiction” of pathogens to these drugs is very, very slow, so there will be no need to change the drug often. If the patient has no contraindications to taking fluoroquinolines, one of these drugs is prescribed:

For the treatment of diseases of the genitourinary system, two or more drugs are used, monotherapy is not indicated. The reason is that the pathogens are often two or more microorganisms, both anaerobes and aerobes. For the destruction of the latter, drugs such as metronidazole and tinidazole are relevant.

Indications for the use of antibiotics

Infectious inflammation of the ovarian appendages is known as adnexitis. For therapy, the use of antibacterial drugs of various forms of release is mandatory. Injectable forms are mostly relevant (into a muscle, into a vein, as well as drugs are available in the form of powders for dilution or ready-made solutions). After a course of injections, the doctor prescribes tablet forms of drugs. Also, in some cases, suppositories or suspensions of antibacterial agents may be prescribed.

The main antibiotics that are prescribed for the inflammatory process in the appendages:

Effective drugs from the group of nitromidazoles:

The doctor prescribes aminoglycosides only if the disease is very severe, or if the infection has spread throughout the body, moving to other organs.

Pharmacodynamics of antibiotics

Antibiotics, which are classified as tetracyclines, kill the ability of the pathogen to multiply. They are effective against such flora:

  • gonococci;
  • streptococci;
  • staphylococci;
  • enterobacteria;
  • whooping cough;
  • salmonella;
  • klebsiella;
  • spirochetes;
  • mycoplasmas;
  • chlamydia;

Antibacterial drugs from the group of fluoroquinols inhibit DNA gyrase and topoisomerase, disrupt DNA synthesis, and through these mechanisms they help to cope with the disease. If the pathogen is resistant to 1st generation quinolines (which is detected during therapy), then the doctor prescribes one of the fluoroquinolones. Kill mycobacteria, mycoplasma and pneumococci drugs of this group, but the 3rd and 4th generation, and the 2nd generation is less effective. Some enterococci can also be destroyed by fluoroquinolones.

Pharmacokinetics of antibiotics

Approximately seventy percent of the taken drug from a number of tetracyclines, which are prescribed by physicians in the diagnosis of inflammation of the appendages, is absorbed in the gastrointestinal tract. The active substance “disperses” through tissues and fluids, and during pregnancy it enters both the placenta and the fetus. Tetracycline antibiotics are excreted unchanged from the body in the urine and feces.

Absorption can be greater or lesser, depending on the type of drug and its form, as well as whether it is taken before, during or after a meal. This point should be indicated by the attending physician when developing a treatment regimen. Especially carefully you need to calculate the time of eating and taking ezithromycin. Josamycin and clarithromycin can be taken without regard to lunch/dinner hours.

Macrolides are collected in large quantities in the blood serum and tissues of the body. During inflammation in the body, macrolides spread well in the air, getting inside the cells and concentrating there. These drugs do not cross the hematoophthalmic barrier. Macrolides break down into simpler elements in the human liver, and are excreted through the gallbladder. The half-life is different for all drugs in the group, but the period is at least 1 hour, maximum 55 hours. Renal failure when taking drugs from the macrolide group does not change the above half-life figures.

The absorption of drugs from the fluoroquinolone group occurs to a large extent in the gastrointestinal tract after the patient drinks the pill. 2 hours after ingestion, the highest concentration of the drug in the patient’s blood occurs. These antibiotics can also affect the fetus, so pregnancy is a contraindication for taking. These drugs are excreted mainly by the kidneys, the gallbladder also plays a small role.

Fluoroquinolones, with the exception of norfloxacin, accumulate in the organs and tissues of the human body. Different drugs from this group have different degrees of disintegration into smaller particles, pefloxacin disintegrates the most. Drugs are excreted by 50% in 3-14 hours, the maximum half-life in some cases is twenty hours. If the patient’s kidney function is impaired, then the drugs are excreted longer, this issue should be clarified with the attending physician and be sure to inform him of all diseases, in addition to inflammation of the appendages. When determining the desired therapeutic dose, one must take into account severe renal failure, if it is present in a patient with inflammation of the appendages.

Treatment of inflammation of the appendages during pregnancy

Pregnancy is a contraindication for the appointment of tetracycline drugs, because these drugs pass through the placenta into the fetus, can be collected in its organs and tissues. Because of this, the unborn child will develop the skeleton incorrectly. Some macrolides are also not used during pregnancy. Clarithromycin has been shown to be harmful to the fetus. And the action of roxithromycin and midecamycin has not been sufficiently studied today.

Relatively safe for the treatment of inflammation of the appendages of pregnant women are such drugs:

If no other treatment is possible, and inflammation of the appendages in a pregnant woman is severe, doctors may resort to prescribing azithromycin. Preparations from the group of fluoroquinolones during pregnancy are prohibited.

Contraindications to the use of antibiotics

Contraindications to the appointment of tetracyclines are:

  • kidney failure
  • hypersensitivity to this drug
  • diagnosis of leukopenia
  • if the patient is less than 8 years old
  • when breastfeeding
  • when carrying a child

Contraindications for treatment with macrolides:

  • pregnancy (only part of the drugs)
  • breastfeeding (clarithromycin and others)

Contraindications for fluoroquinolone therapy:

  • gestation
  • lactation
  • lack of glucose-6-phosphate dehydrogenase
  • the appearance of allergic manifestations in response to taking the drug
  • not suitable for children

Side effects of antibiotics

Tetracycline antibiotics can lead to an increase in pressure inside the skull, to dizziness. In the blood, the number of neutrophils, platelets, and hemoglobin changes. Other side effects of these drugs include:

  • nausea;
  • loss of appetite;
  • inflammation in the gastrointestinal tract;
  • diarrhea or constipation;
  • violation of the functioning of the kidneys;
  • allergic manifestations;
  • anaphylactic shock.

Some of these antibiotics, prescribed for inflammation of the appendages, lead to candidiasis, the development of excessive susceptibility to ultraviolet rays. Tetracyclines in babies can disrupt the formation of bones, including teeth, the shade of enamel changes.

Macrolides can lead to such side effects:

  • allergic manifestations;
  • reinfection with pathogen resistance to erifomycin;
  • pain in the gastrointestinal tract;
  • nausea;
  • drooping of the upper eyelid;
  • vision problems;
  • a significant expansion of the pupil;
  • paralysis of the oculomotor muscles.

Fluoroquinolones also cause a number of side effects, one or some of which may be noted in the patient:

  • loss of appetite;
  • pain in the gastrointestinal tract;
  • diarrhea or constipation;
  • nausea;
  • poor sleep, or awakenings in the middle of the night;
  • headache;
  • convulsions;
  • trembling in the body;
  • decreased vision;
  • Allergy manifestations.

Rare side effects of taking fluoroquinolones include:

  • inflammation in the tendons, joints;
  • negative impact on the functioning of the kidneys;
  • tendon ruptures;
  • problems with heart rhythm;
  • diseases of the large intestine;
  • oral candidiasis;
  • thrush in female patients.

How to take antibiotics for inflammation of the appendages

Medicines classified as tetracyclines should be taken after meals or with meals. For adult patients, the doctor prescribes 100 mg of the drug, the dose is divided into three or four doses. If the child is over 8 years old, the dose for him is calculated according to the formula for a maximum of 25 mg / kg. The course of treatment with drugs of this group is 5-7 days, no more. But this should be indicated directly by your attending physician, self-medication with antibiotics is life threatening!

Treatment with tetracycline antibacterial drugs is canceled if a person develops such manifestations of allergies as burning, itching, redness of the skin. It is better not to take these drugs with milk or products based on it (kefir, fermented baked milk), otherwise the product will be absorbed much worse.

A number of macrolide antibiotics should be taken 2 hours after or 60 minutes before a meal. Erythromycin is recorded with water in an amount of more than two hundred milligrams. Suspensions for internal use must be diluted, before use, read the instructions, which indicate the features of administration and dosage. The doctor prescribes a specific treatment regimen that must be strictly followed. The medicine is taken at certain time intervals, and this plan cannot be deviated from, only in this way the desired concentration of the medicine in the blood and tissues is achieved.

Macrolides are not taken with antacids. The latter are prescribed in the presence of acid-dependent diseases of the gastrointestinal tract. Fluoroquinolones are also washed down with water in large quantities, taken 2 hours before meals. When treating with antibiotics, you need to drink one and a half liters of water or more per day.

Antibiotic overdose

If an overdose of tetracyclines occurs, the side effects of the drugs become stronger. Side effects are listed above. Treatment consists of taking medications to relieve symptoms. An overdose of antibiotics from a number of macrolides is not life-threatening. There are stool disorders, nausea, the heart rhythm changes.

Fluoroquinols in excessive dosage for the life of the patient do not pose a threat. The resulting symptoms are treated outside the hospital. Very rarely, epileptic seizures can occur. An overdose of these drugs affects the joints, liver, cardiovascular system and tendons.

Interactions of antibiotics with other drugs
Tetracyclines should not be combined with therapy with drugs containing such substances:

  • calcium;
  • magnesium;
  • iron;
  • zinc;
  • other metal ions.

The effect of tetracycline drugs is adversely affected by concurrent therapy with barbiturates and carbamazepine. It should be borne in mind that antibiotics from this series reduce the effectiveness of oral contraceptive pills. It is impossible to combine treatment with macrolides and aminoglycosides. Tetracyclines and chloramphenicol or lincomycin are not prescribed together. There are a number of other features of the interaction of antibiotics and other drugs that the attending physician should talk about, given the patient’s medical history and current diseases, in addition to inflammation of the appendages.


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The main component of Penegra is Sildenafil.

SildenafiL affects the response to sexual stimulation. It acts by enhancing smooth muscle relaxation using nitric oxide, a chemical that is normally released in response to sexual stimulation. This smooth muscle relaxation allows increased blood flow into certain areas of the penis, which leads to an erection.

Sildenafil is applied for the treatment of erectile dysfunction (impotence) in men and pulmonary arterial hypertension.

Sildenafil may also be used for other purposes not listed above.

Dosage and direction

It is taken by mouth with a glass of water approximately 0,5-1 hour before sexual activity. Penegra should not be taken more than once a day.

A high fat meal may delay the time of the effect of this drug.

Try not to eat grapefruit or drink grapefruit juice while you are being treated with Sildenafil.


Before you start taking Sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.

Aged people may be more sensitive to the side effects of the drug.


Penegra is contraindicated in patients taking another medicine to treat impotence or using a nitrate drug for chest pain or heart problems.

This medicine should not be taken by women and children as well as in patients with a known hypersensitivity to any component of the tablet.

Possible side effect

The most common side effects are headache, flushing, heartburn, stomach upset, nasal stuffiness, lightheadedness, dizziness or diarrhea.

A serious allergic reaction to this drug is very rare, but seek immediate medical help if it occurs.

Many people using this medicine do not have serious side effects.

In case you notice any side effects not listed above, contact your doctor or pharmacist.

Drug interaction

This drug should not be used with nitrates and recreational drugs called “poppers” containing amyl or butyl nitrite; alpha-blocker medications; other medications for impotence; high blood pressure medicines, etc.

Consult your doctor or pharmacist for more details.

Missed dose

PenegrA is used as needed, so you are unlikely to be on a dosing schedule.


If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.


Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store the drugs in the bathroom. Keep all drugs away from reach of children and pets.


We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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Active Ingredient: Amitriptyline. Elavil is used for the relief of symptoms of mental depression. It is also used to treat bulimia (an eating disorder), to control chronic pain, to prevent migraine headaches, and to treat a pathological weeping and laughing syndrome associated with multiple sclerosis.

Analogs of Elavil: Amitriptyline, Endep.

Other names for this medication:
Amineurin, Amitril, Amitrip, Amitriptilina, Amitriptylinum, Anapsique, Apo-amitriptyline, Deprelio, Eliwel, Laroxyl, Lentizol, Levate, Loxaryl, Mutabase, Mutabon, Novoprotect, Novotriptyn, Redomex, Saroten, Sarotena, Sarotex, Syneudon, Triptanol, Tryptacab, Tryptanol, Tryptizol.

Detailed description of the drug:

  1. Important information
  2. Before taking this medicine
  3. How should i take elavil?
  4. Elavil Dosage Information
  5. What happens if I miss a dose?
  6. What happens if I overdose?
  7. What should I avoid while taking Elavil?
  8. Side effects of Elavil
  9. What other drugs will affect Elavil?
  10. Where can I get more information?

What is Elavil?
Elavil (amitriptyline) is a tricyclic antidepressant.
Elavil acts on chemicals in the brain that may be unbalanced in people with depression.
Elavil is used to treat symptoms of depression.

Important information
You should not use Elavil if you have recently had a heart attack.

Do not use Elavil if you have used an MAO inhibitor in the past 14 days, such as isocarboxazide, linezolid, methylene blue injection, phenelzine, razagilin, selegiline, or tranylcypromine.

Before taking Elavil, tell your doctor if you have used the SSRI antidepressant in the last 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil) , or sertraline (Zoloft).

You ballplayer get opinions of killer when you basic first entrancing an medicine much as Elavil , largely whether you are below 24 age aged. Your dr. desire require to analysis you with fixture gos, at littlest during the basic 12 hebdomads of treatment of behaviour towards.

Report any new or worsening symptoms to your doctor, such as changes in mood or behavior, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, anxious, hyperactive (mentally or physically), more Depressed or thinking of suicide or self-harm.

Before taking this medicine
You should not use Elavil if you are allergic to amitriptyline, or if you have recently had a heart attack.

Do not use Elavil if you have used an MAO inhibitor in the past 14 days. Dangerous drug interactions may occur. MAO inhibitors include isocarboxazide, linezolid, methylene blue injection, phenelzine, razagilin, selegiline, tranylcypromine and others.
To make sure Elavil is safe for you, tell your doctor if you have:

  • Bipolar disorder (manic depression) or schizophrenia;
  • a history of mental illness or psychosis;
  • liver disease;
  • Heart disease;
  • a history of heart attack, stroke, or seizures;
  • Diabetes (amitriptyline may increase or decrease blood sugar);
  • Glaucoma;
  • Problems with urination.

Any adolescent humans get dangerous opinions when they basic capture an medicine. Your dr. should analysis your progression with fixture sojourns. Your kinfolk or additional caregivers should furthermore be knowing of substitution in your condition or evidence.

Whatever juvenile man move unsafe impressions when they fundamental hire an prescription. Your dr. should review your circuit with mend stay. Your kinsfolk or extra caregivers should moreover be learned of exchange in your shape Elavil .

Amitriptyline can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Elavil.

Elavil is not approved for use by anyone younger than 12 years old.

How should i take elavil?
Take Elavil exactly as prescribed by your doctor. Follow all directions on the recipe label. Do not take this medicine in larger or smaller amounts, or for longer than recommended.

It may take up to 4 weeks before your symptoms improve. Continue to use the medicine as directed and tell your doctor if your symptoms do not improve.

If you need surgery, inform the surgeon in advance that you are using Elavil. You may need to stop using the medicine for a short time.

Achieve not break exploitation Elavil all at once, or you ballplayer get disagreeable backdown evidence. Enquire your dr. how to safely break exploitation Elavil .

Store at room temperature away from moisture, heat and light.

Elavil Dosage Information
Usual Adult Dose of Elavil for Depression:


  • Usual dose: 75 mg orally per day in divided doses. It can be increased to 150 mg per day if necessary;
  • Alternative dose: 40-100 mg orally in a single dose at bedtime. This can be increased by 25 or 50 mg, if necessary, at bedtime to 150 mg per day;
  • Maximum dose: 150 mg orally per day


  • Initial dose: 100 mg orally per day;
  • Maintenance dose: 40-100 mg orally in a single dose at bedtime;
  • Maximum dose: 300 mg orally per day.

The dosage should be reduced to the minimum amount that will support symptom relief when satisfactory improvement is achieved.
The dose increase should preferably be done in the late afternoon or at bedtime due to the sedative effect.
The full therapeutic effect may take up to 30 days.
Support therapy should be continued for 3 months or longer to reduce the likelihood of relapse.


  • Relieving symptoms of depression
  • Usual geriatric dose of Elavil for depression:
    10 mg orally 3 times a day with 20 mg at bedtime

What happens if I miss a dose?
Capture the incomprehensible measure as presently as you mention. Bounce the forgone measure whether it is most age representing your following plotted measure. Achieve not capture additional prescription to create up representing the incomprehensible measure.

What happens if I overdose?
Seek emergency medical attention. An overdose of amitriptyline can be fatal.
Overdose symptoms may include irregular heartbeats, severe drowsiness, confusion, agitation, vomiting, hallucinations, a feeling of heat or cold, muscle stiffness, cramps (convulsions), or fainting.

What happens if I overdose?
Seek emergency medical attention. An overdose of amitriptyline can be fatal.
Overdose symptoms may include irregular heartbeats, severe drowsiness, confusion, agitation, vomiting, hallucinations, a feeling of heat or cold, muscle stiffness, cramps (convulsions), or fainting.

Side Effects of Elavil
Get emergency medical help if you have signs of an allergic reaction to Elavil:

  • cramps;
  • labored breathing;
    swelling of the face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as changes in mood or behavior, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, anxious, hyperactive (mentally or physically), more Depressed or thinking of suicide or self-harm.

Call your doctor right away if you have:

  • Unusual thoughts or behavior;
  • Frivolous feeling, how could you disappear;
  • Chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
  • Heart palpitations or chest pain;
  • Confusion, hallucinations;
  • Attack (convulsions);
  • Painful or difficulty urinating;
  • Severe constipation;
  • Light bruising, unusual bleeding;
  • Sudden weakness or poor feeling, fever, chills, sore throat, mouth ulcers, red or swollen gums, difficulty swallowing.

This is not a complete list of side effects, and others may occur. Ask your doctor about side effects.

What other drugs will affect Elavil?
Taking this medicine with other drugs that make you sleepy can make this effect worse. Ask your doctor before taking Elavil with sleeping pills, medicine for narcotic pain, muscle relaxation, or medicines for anxiety, depression, or seizures.

Tell your doctor if you have used the SSRI antidepressant in the last 5 weeks, such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone or Vilazodone.

Tell your doctor about all of your current medicines and what you start or stop using, especially:

  • Other antidepressants;
  • cimetidine;
  • Heart rhythm medicine, such as flecainide, propafenone, quinidine and others;
  • Medicine for the treatment of mental illness.

This list is not complete. Other drugs may interact with amitriptyline, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

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Active Ingredient: Methotrexate.

Active Ingredient: Methotrexate 2.5 mg

Release form, composition and packaging
Coated tablets 1 tab.

Methotrexate is used for treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients.

Pharmachologic effect
An antitumor agent from the group of antimetabolites – folic acid antagonists. Acts in the S-phase of mitosis. The mechanism of action is associated with the inhibition of the synthesis of purine nucleotides and thymidylate as a result of irreversible binding to dihydrofolate reductase, which prevents the restoration of dihydrofolate to active tetrahydrofolate. More active against rapidly growing cells. It has some immunosuppressive effect.

To a small extent penetrates the BBB (depending on the dose used). With intrathecal administration, a significant amount enters the systemic circulation. Binding to plasma proteins (mainly with albumin) of plasma is about 50%. Biotransformed in the liver. It is excreted by the kidneys (unchanged) and with bile (less than 10%). T1 / 2 depends on the dose used and has significant individual differences. With repeated administration, it accumulates in the tissues in the form of metabolites.

Acute lymphocytic leukemia, trophoblastic disease, skin cancer, cervical and vulvar cancer, esophageal cancer, squamous cell carcinoma of the head and neck, cancer of the renal pelvis and ureter, osteogenic and soft-cell sarcoma, Ewing’s sarcoma, lung cancer, breast cancer, germ cell tumors of the testis and testicles , liver cancer, kidney cancer, retinoblastoma, medulloblastoma, penile cancer, lymphogranulomatosis.

Severe forms of psoriasis (in case of failure of standard therapy).

Severe form of rheumatoid arthritis (in case of failure of standard therapy).

Dosage regimen
It is taken orally, administered iv, intramuscularly, intramuscularly. Installed individually, depending on the indications and stage of the disease, the state of the hematopoietic system, anti-tumor therapy regimen.
Side effect
From the digestive system: possible ulcerative stomatitis, anorexia, gingivitis, pharyngitis, nausea; rarely – diarrhea, melena, enteritis, pancreatitis; in some cases (with prolonged daily use) – liver necrosis, cirrhosis, fatty atrophy, periportal liver fibrosis.

From the hemopoietic system: leukopenia, anemia, thrombocytopenia.

From the side of the central nervous system: feeling tired, dizziness; rarely – headache, aphasia, drowsiness, cramps.

From the reproductive system: disorders of oogenesis and spermatogenesis, oligospermia, menstrual irregularities, decreased libido, impotence.

From the urinary system: hematuria, cystitis, severe renal dysfunction.

Allergic reactions: chills, decreased resistance to infection; rarely – urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome.

Dermatological reactions: skin rash, photosensitivity, pigmentation disorders, telangiectasia, acne, furunculosis.

Severe impaired liver and / or kidney function, leukopenia, thrombocytopenia, pregnancy. Methotrexate should not be used in immunodeficiency conditions.

Pregnancy and lactation
Methotrexate is contraindicated in pregnancy. If necessary, use during lactation should stop breastfeeding.

Women of childbearing age should use reliable methods of contraception while using methotrexate.

In experimental studies, the embryotoxic and teratogenic effects of methotrexate have been established.

Use for impaired liver function
Contraindicated in severely impaired liver function.
Use for impaired renal function
Contraindicated in severe renal impairment.
special instructions
Methotrexate should not be used for ascites, pleural effusion, gastric ulcer and duodenal ulcer, ulcerative colitis, gout or nephropathy (including a history).

It is not recommended for use in patients with chickenpox (including recently transferred or after contact with patients), herpes zoster, and other acute infectious diseases.

Before starting therapy and against the background of the treatment, the picture of peripheral blood, liver and kidney function, chest x-ray should be monitored.

In the treatment of rheumatoid arthritis or psoriasis, a comprehensive blood count should be done at least 1 time per month, and laboratory tests of liver or kidney function at least 1 time in 1-2 months.

When used for psoriasis, the local treatment of the disease should not be interrupted. In case of an overdose, the use of calcium folinate is recommended (but not later than 4 hours later).

When conducting combination antitumor therapy, special care should be taken while using methotrexate in high doses with drugs that have a nephrotoxic effect (for example, with cisplatin).

It is not recommended to vaccinate patients and their families.

Methotrexate (even at low doses) with acetylsalicylic acid should be combined with caution.

In experimental studies, the carcinogenic and mutagenic effects of methotrexate have been established.

Drug interaction
With simultaneous use with vitamin preparations containing folic acid or its derivatives, a decrease in the effectiveness of methotrexate is possible.

The simultaneous use of NSAIDs in high doses can lead to an increase in the concentration of methotrexate in plasma and to an increase in its T1 / 2, as well as to an increase in the concentration of methotrexate not associated with plasma albumin, which in turn enhances the toxic effects of methotrexate (primarily on the gastrointestinal tract and system hematopoiesis).

With the simultaneous use of methotrexate with penicillins (even at low doses), its toxic effects may increase.

With simultaneous use with sulfonamides, especially with co-trimoxazole, there is a risk of increased myelodepressive effect.

When nitrous oxide is used in patients receiving methotrexate, severe unpredictable myelodepression and stomatitis may develop.

With the simultaneous use of valproic acid with methotrexate, a decrease in its concentration in blood plasma is possible.

Colestyramine binds methotrexate, reduces its enterohepatic recirculation, which leads to a decrease in its concentration in blood plasma.

With simultaneous use with mercaptopurine, it is possible to increase its bioavailability due to metabolic disorders during the “first passage” through the liver.

Neomycin and paromomycin reduce the absorption of methotrexate from the gastrointestinal tract.

In patients receiving omeprazole, an increase in the concentration of methotrexate in blood plasma is possible.

With simultaneous use with probenecid, a 3-4-fold increase in the concentration of methotrexate in blood plasma is possible due to a decrease in its renal excretion.

With the simultaneous use of methotrexate with retinoids, an increased risk of hepatotoxic action is possible.

Salicylates potentiate the effect of methotrexate due to a decrease in its renal excretion.

After a course of treatment with tetracycline, methotrexate, used even in low doses, can have a toxic effect.

With the sequential administration of methotrexate and fluorouracil, a synergy of action is possible; fluorouracil introduced before methotrexate may reduce its toxicity.

Cisplatin has a nephrotoxic effect and therefore can reduce the renal excretion of methotrexate, which leads to an increase in its toxicity.

Possible increased toxicity with cyclosporine in patients receiving methotrexate.

A description of the active substances of the drug is provided. The scientific information provided is generalized and cannot be used to decide on the possibility of using a particular drug.

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Product Description

Just like most male enhancement pills found on the US market, ProSolutioN is a FDA approved male potency product which is recommended to men having erectile problems but also for men to improve their sexual performances. Most common among male users aged between 45- 60 years and very popular among younger users which administrate themselves with such product for a better sexual performance

Dosage and directions

The recommended dose is two tablets a day between a meal but in some cases your doctor might recommend a different daily dose with 1 tablet a day or in some cases, three tablets a day. If you have no erectile problems at all or any other type of male dysfunction, make sure to consult your doctor before taking ProSolution. Although a reliable male supplement with mainly natural ingredients like Ginseng, various fruits and types of roots, these pills might cause some forms of side effects if used improperly.


If you have a family history of health problems or in case you are already using other supplements based on herbs, make sure to consult your doctor for further instructions on how or if you should use ProSolution. Before use, carefully read the ingredients table to see if you suffer from any type of allergies regarding one or several ingredients displayed there.


Do not use if you suffer from sever heart problems, have a blood pressure condition or you have had any type of surgical interventions in last few months. Ask your doctor before you start using male enhancement pills and always read the instructions accordingly.

 Possible side effects

Due to it’s highly concentrated formula of herbal compounds, there are no reported side effects for ProSolution. Although it’s not known to cause important side effects, short head aches, light vomiting or nausea might occur if taken improperly or in higher that prescribed doses.

Missed dose

In case you miss a dose, simply skip it and proceed taking ProSolution with the next pill. Although these is no time period in which you should take the two recommended pills, it’s best to take them after your breakfast and after your lunch, that way reducing the risk of missing a dose.


Overdose with ProSolution is an unlikely event to happen because the product contains mainly natural herbal coumpounds which are know to cause no side effects of administrated in higher doses. However, taking more than the usual dosage might lead to unwanted nausea, vomiting and head aches. In case of an overdose, make sure to seek medical help in the fastest possible manner


Keep ProSolution pills in their original box, safe from the direct sun light, extreme heat or humidity. Make sure to store the box in a cool and safe environment, out of the reach of children or animals.

All products presented at this site are not intended to diagnose, treat, cure, or prevent any disease. Don’t hesitate to consult your health care practitioner before taking any herbal supplement.

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Among the best natural rejuvenators which helps re-balance the level of hormones released in out bodies restoring the level of your HGH. A herbal remedy to keep you young, healthy, full of energy and mentally balanced. We lose much of our energy and mental health as we get older but with Gen F20 Plus, we can trick the time and become younger again by keeping our levels of HGH to an optimum level so that we can enjoy healthy sexual life, plenty of energy and mental health.

Product Description

Gen F20 Plus is a natural product most commonly used by patients to re-balance their level of HGH and with that, to increase their libido, the muscle mass and tone, to enjoy a more youthful thinking and also to experience increased body energy. Most recommended to persons aged over 60, this commonly used health supplement will help them enjoy a much better and healthy life.

Dosage and directions

The normal dosage for Gen F20 is 4 tablets a day, 2 in advance of lunch and the other two ahead of the dinner. In some cases doctors can prescribe increased doses but that is only up to their decision and should not be taken by you on your own. An increased dosage might lead to unwanted side effects if unnecessary. The pills should be taken with water and not chewed or directly swallowed.


It’s very important to take Gen F20 ahead of a meal and not on an empty stomach. Like most supplements and pills, administrated on an empty stomach can lead to unwanted stomach aches. Hygiene is recommended ahead of every dose and both pills in a dose should be taken with a minimum amount of 100ml of water.


Gen F20 is not recommended to young patients or pregnant women. Also, patient suffering from heart problems or liver problems should consult their doctor before starting treatment with Gen F20. The anti-aging product contains a lot of vitamins, herbal plants and root extracts which might cause unwanted side effects to persons allergic to some of the ingredients or with intolerance to sugars.

Possible side effects

Although no records of serious side effects have been reported so far, GenF20 can cause limited aches on the level of your stomach if used improperly or if taken on an empty stomach.

Missed dose

A missed dose means that you should take it as soon as you remember or in case the next dose time is close, simply skip the missed one and proceed with taking Gen F20 as recommended. Missed doses for more than a day does not mean you should double the dose the next day. Simply proceed with the usual dose and skip the ones you missed.


Gen F20 presents no risk of an over dose but if taken an increased dose or double the usual dose might lead to unwanted health situations like vomiting or nausea. Consult your doctor if any of these problems appear or persist and stop taking Gen F20 until your doctor tells you otherwise. The risk of an over dose is very limited but you should always pay great care to your daily dose and recommendations.


Keep the Gen F20 pack in a cool and dry place at room temperature. Keep it safe from children or pets and never dispose in clean waters. Extreme heat, direct sun light or humidity might affect the product and damage its properties. DO not take Gen F20 if the product is expired or stored in improper places.


All products presented at this site are not intended to diagnose, treat, cure, or prevent any disease. Don’t hesitate to consult your health care practitioner before taking any herbal supplement.

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Product Description

Amalaki is commonly used by persons that are under stress or with a weak immune system. The pills help rejuvenate the body and mind but also helps building energy for the imune system to become stronger. Since it’s a vitamin C based natural product, it’s doesn’t require prescription from the doctor.It also provides positive effects over the cardiovascular system by balancing the blood pressure level to an optimum level. Especially useful for older patients.

Dosage and directions

Although Amalaki is a natural product which needs no prescription from the doctor, it’s always best to consult your physician in order to settle the optimal dose and the right period of time for you to take these herbal pills. The normal dosage should be 1-3 times a day depending on the age, medical condition or weight. However, only your personal physician can tell you the exact dosage you should take for the best results.


If you suffer from diabetes or you have an intolerance to sugar, it’s best to avoid using Amalaki as your rejuvenant remedy. Also, using Amalaki by younger persons is not recommended. Pregnant women should consult their doctor before taking Amalaki during and after pregnancy.


Amalaki is not to be used by small children, pregnant women in their last trimester or people suffering from diabetes. Although natural and based only on herb ingredients, it can provide forms of health problems if used improperly and by the wrong persons.

Possible side effects

Used in larger doses or on an empty stomach, Amalaki might cause some forms of side effects. Although no reports of serious side effects existing in the present, always make sure to follow instructions in order to avoid unwanted head aches, stomach aches or even vomiting.

Missed dose

A missed dose does not pose any type of threat to your daily usage of Amalaki. In case you miss to take a dose, proceed with taking it when you remember or skip to the next one if more than five hours have passed. Missed dosed that have passed more than 24 hours should be ignored and skipped for you to return to the daily administration.


Taking Amalaki in higher doses or without keeping in mind the instructions might lead to light forms of over dose which can be recognized when head aches, stomach aches or forms of nausea start to appear. In case of an over dose, stop taking Amalaki, drink lots of water and seek medical assistance as soon as possible. Forms of intoxication might follow an over dose which in turn might cause, itchiness, blisters or dry mouth.


AMalaki should be stored in cool and dry places, always in its original box. Not suitable for children or animals and forbidden from being disposed in clean waters. If expired, DO NOT take Amalaki.

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Active Ingredient: Naltrexone hydrochloride.

Indications for use:
👉Opioid addiction (as an auxiliary drug after the withdrawal of opioid analgesics);
👉Alcoholism (as part of a combination treatment).

Other names for this medication:
Nal trex own, Naltrexone oral.

Release form and composition

Dosage forms of Naltrexone:
Capsules: gelatinous with a white body and a dark green cap; contents – white or almost white powder (10 each in a blister pack; 2 or 5 packs in a carton; 100, 200 or 300 packs in a carton (for hospitals));
Tablets (10 pieces each in blister packs; 1, 2 or 5 packs in a cardboard box; 100, 200 or 300 packs in a cardboard box (for hospitals)). Active substance: naltrexone hydrochloride – 50 mg in 1 capsule / tablet.

Additional components:
Capsules: lactose monohydrate, magnesium stearate;
Tablets: potato starch, low molecular weight polyvinylpyrrolidone medical (povidone), milk sugar (lactose), aerosil (colloidal silicon dioxide), magnesium stearate, crospovidone; The composition of the capsule shell: titanium dioxide 1% and 2%, gelatin, dye indigo carmine, dye iron oxide yellow.

☞ Withdrawal syndrome;
☞ Taking opiates;
☞ Liver failure;
☞ Acute hepatitis;
☞ A positive test for the presence of opioids in the urine;
☞ Age to 18 years;
☞ Pregnancy;
☞ Period of breastfeeding;
☞ Hypersensitivity to the components of the product.

Mode of application

Dosage Inside.
Treatment for opioid addiction. The phase of introduction to the course of therapy with naltrexone.
Treatment with naltrexone is prescribed after the patient refrains from taking opioids for 7-10 days (in the absence of withdrawal symptoms).
Abstinence from the use of opioids is identified by indicators of laboratory tests of urine for the content of opioids. Treatment begins with a negative provocative test with 0.5 g of naltrexone . Description of the naltrexone test: the patient must be administered 0.2-0.4 mg of naltrexone intravenously for 5 minutes. or as an injection subcutaneously or intramuscularly. If there is no reaction to the administration of naloxone within 15-30 minutes, a second dose of 0.4 mg intravenously or 0.4-0.8 mg subcutaneously is administered and the reaction is monitored. The test is considered positive with severe mydriasis, a change in affect from complacently-drowsy to dysphoric, behavioral disorders, the appearance of signs of opium withdrawal. A naloxone test is not performed in patients with withdrawal symptoms and in the detection of opioids in the urine. The naloxone test can be repeated after 24 hours. Treatment with naltrexone is begun with caution, gradually increasing the dose. The contents of the capsule are dissolved in 50 ml of water. Initially, 25 mg of naltrexone is prescribed orally (contained in 25 ml of the stock solution). The doctor should monitor the act of swallowing the drug solution. Maintenance therapy with naltrexone. The next day after the initial dose is administered, 50 mg of naltrexone is started every 24 hours (the use of naltrexone at the indicated dose is sufficient to block the effects of parenteral opioids, for example, 25 mg of heroin injected intravenously). 100 mg of naltrexone is prescribed every 2 days or 150 mg every 3 days. Alcoholism treatment As part of combination therapy. Daily intake of 50 mg of naltrexone, the minimum course is 3 months. Treatment should be part of an appropriate alcohol dependence elimination program. Throughout the course of treatment, it is necessary to monitor adherence to all components of the treatment of alcoholism that affect a favorable outcome. Medication is recommended to be accompanied by a course of psychotherapy.
The criteria for selecting patients for the treatment of alcoholism are:
1) a positive attitude towards treatment;
2) the willingness to abandon the use of alcohol (psychoactive substances);
3) participation in rehabilitation programs;
4) the beginning of a healthy lifestyle after the end of the course of treatment.

Naltrexone is a moderately safe drug. According to studies, even large doses do not cause serious symptoms. There is evidence of a clinical study during which patients took 800 mg per day of naltrexone for a week without signs of intoxication.
If intoxication is suspected, symptomatic treatment should be prescribed.
At the preclinical study stage, with repeated administration of naltrexone at a dose of 100 mg / kg exceeding the maximum daily dose for treating a person by approximately 35 times, no significant changes were found in hematological and biochemical parameters of blood, as well as in the structure of internal organs. Naltrexone also has no local irritant effect.

Side effects
Digestive system: abdominal pain, dry mouth, nausea and / or vomiting, constipation, diarrhea, gastrointestinal upset, frequent bowel movements, flatulence, anorexia, taste change, decreased / increased appetite, erosive and ulcerative defects of the gastrointestinal tract, increased activity of liver enzymes, increased symptoms of hemorrhoids;
Respiratory system: hoarseness, cough, hyperemia of the vessels of the nasal cavity (nasal congestion), bronchial obstruction, sneezing, rhinorrhea, shortness of breath, nosebleeds, difficulty breathing, dry throat, increased sputum mucosa, pharyngitis (including streptococcal), sinusitis, nasopharyngitis;
Nervous system and sensory organs: nightmares, fatigue, nervousness, general weakness, restless sleep, dizziness, headache, blurred visual perception, hallucinations, confusion, drowsiness, irritability, fainting, depression of the central nervous system, disorientation, congestion and ringing ears, photophobia, burning sensation and pain in the eyes;
Cardiovascular system and hemopoietic system: chest pain, nonspecific changes in the electrocardiogram, increased blood pressure, tachycardia, palpitations, lymphocytosis, phlebitis;
Genitourinary system: increased urination, discomfort during urination, edema syndrome (swelling of the legs, feet, fingers, face), sexual disorders in men (decreased potency, delayed ejaculation);
Musculoskeletal system: arthritis, stiffness in joints, back pain, pain in joints / limbs, spasm and stiffness of muscles, muscle pain, muscle twitching;
Allergic reactions: skin rash, itching, flushing of the skin (including flushing of the face);
Other: decrease or increase in body weight, thirst, chills, fever, lymphadenopathy (including cervical adenitis), increased sweating.

Special instructions
Before starting the Naltrexone course, you need to make sure that there is no subclinical liver failure, during the period of treatment it is necessary to periodically monitor the level of transaminases. You can not use the drug with drugs that have a hepatotoxic effect.
In order to avoid the development of acute withdrawal symptoms, patients should stop using opioids and drugs containing them at least 7–10 days before the start of therapy, and be sure to conduct a provocative test with naltrexone . If these requirements are not observed, the development of withdrawal symptoms can occur 5 minutes after taking the drug and continue for 48 hours.
Before surgery, in which opioid analgesics will be used, the drug must be canceled at least 48 hours before the operation.
The use of Naltrexone is ineffective in the treatment of cocaine as well as non-opioid drug dependence.
When observing a persistent decrease in appetite and progressive weight loss, therapy should be discontinued. In case of emergency analgesia with narcotic drugs, it is necessary to prescribe opiates with extreme caution in an increased dosage (to overcome antagonism), since this will cause a deeper and longer respiratory depression.

Patients should know what is needed:

  • To inform, on a mandatory basis, medical personnel about treatment with naltrexone when seeking medical help;
  • Stop taking the medicine and consult a doctor if you observe yellowing of the sclera, darkening of urine and abdominal pain.
    It is required to take into account that there will be no effect from the independent use of heroin and other drugs in small doses, and a further increase in the doses of narcotic drugs will lead to death (respiratory arrest).

Drug interaction
Naltrexone reduces the effectiveness of drugs that include opioids (analgesics, antitussive drugs). In combination with hepatotoxic drugs, the threat of liver damage is aggravated (mutually). When combined with thioridazine, the risk of developing increased drowsiness or lethargy increases. Terms and conditions of storage Store in a place protected from moisture and light, out of the reach of children, at a temperature not exceeding 25 ° C.

Shelf life is 36 months.

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Active Ingredient: Cabergoline.

Analogs of Cabgolin:Dostinex.

Chemical name
1 – [(6-Allylergolin-8beta-yl) carbonyl] -1- [3- (dimethylamino) propyl] -3-ethylurea.

Chemical properties
This substance is a fairly common dopaminomimetic, a derivative of ergot alkaloids. The tool is synthesized in the form of a white fine powder, which is highly soluble in ethanol, N, N-dimethylformamide and chloroform. The chemical compound is slightly soluble in 0.1 n hydrochloric acid, n-hexane. The product does not dissolve in water.

In medicine, drugs based on Cabergoline are used to treat hyperprolactinemia, and the substance is also used by athletes.

Cabergoline in bodybuilding
The medicine is used to reduce prolactin levels and eliminate unwanted side effects from taking progestin anabolics – trenbolone and nandrolone. During the treatment, athletes monitor the level of prolactin and continue taking the medicine, depending on the results of the tests. It is believed that the substance eliminates fluid retention in the tissues and accelerates the growth of lean muscle mass.

Pharmachologic effect

Pharmacodynamics and pharmacokinetics
Cabergoline is a long acting dopamine receptor antagonist. The drug acts mainly on D2-dopamine receptors, to a lesser extent – on D1-dopamine, serotonin, alpha2- and alpha1-adrenergic receptors.

Laboratory data show that the drug has a direct effect on the synthesis of prolactin by lactotrophs in rats, lactotrophs are located in the pituitary gland. Plasma prolactin levels are significantly reduced, especially in reserpine individuals.

The hypoprolactinemic effect of the drug was carefully studied in two independent, randomized, double trials involving a placebo-controlled and comparative group. The effect of the substance was studied on women suffering from hyperprolactinemia. The test results improved, and the normal menstrual cycle was restored in about 77% of women who took the drug 2 times in 7 days at a dosage of 0.5 mg. In 73% of the subjects, galactorrhea disappeared.

Pharmacokinetic parameters are directly proportional to the dosage of the drug. Eating does not affect the processes of assimilation, metabolism and excretion. After penetration into the digestive tract, the maximum concentration of a substance in the blood plasma was observed after 2-3 hours. With systematic administration of the drug, its equilibrium concentration is several times higher than the concentration with a single dose.

It is not completely known what bioavailability Cabergoline has, but it is unambiguously exposed to the effect of “first passage” through the liver tissue. The degree of binding of the agent to plasma proteins ranges from 40 to 42%, depending on the dose taken. The medicine and its metabolites are quickly and well distributed in tissues and organs, the highest concentration was found in the pituitary gland.

The substance is metabolized by hydrolysis reactions involving urea residues or an acylurea bond in the liver tissues. Cytochrome P450 takes part to a small extent in the biotransformation of the drug. The half-life of the drug is about 65 hours. The substance and its metabolites are completely eliminated from the body within 20 days, mainly through the intestines and urine.

Mild to moderate renal failure and mild to moderate hepatic failure do not require dosage adjustment. With serious violations in the liver, an increase in the concentration of the drug in the blood plasma and AUC is observed. For elderly patients, the drug can be prescribed in the same dosages as for young ones, however, special care must be taken, taking into account all the concomitant diseases and the state of the body as a whole.

The effect of taking the drug is observed after 3 hours, after taking the tablets, reaching its maximum within 48 hours. The duration of the drug is 14 days. Cabergoline does not affect the secretion of other hormones of the anterior pituitary gland or cortisol level. The substance does not have mutagenic activity, slightly reduces fertility.

Indications for use
The tool is prescribed:

  • for the treatment of idiopathic hyperprolactinemia;
    – with macro- and microadenoma of the pituitary gland;
    – patients with amenorrhea, anovulation, oligomenorrhea and
  • – galactorrhea according to indications;
    – to suppress or prevent lactation after childbirth;
    -as part of complex therapy or as a monotherapy for Parkinson’s disease.

  • Contraindications
    The medicine should not be taken:
  • in the presence of hypersensitivity reactions to the active component or – – derivatives of ergoalkaloids;
    – during lactation;
    – patients with uncontrolled hypertension;
    – pregnant women
    – with fibrotic changes in the heart muscle or respiratory system, which – caused disturbances in the functioning of the organs.

  • Caution is recommended to observe:

– with low blood pressure;
– if parallel therapy with dopamine receptor antagonists, antihypertensive – drugs;
– with eclampsia or preeclampsia;
– persons suffering from liver disease;
– with psychosis, including a history of;
– to children.

Side effects
Adverse reactions due to treatment with this substance are quite rare, and in mild or moderate severity.

During clinical trials, the following adverse reactions have been identified.

Most often occur: constipation, headache and dizziness, nausea, pericarditis, peripheral edema, pericardial effusion.

Often develop:

hallucinations, confusion, depression;
indigestion, gastritis, angina pectoris, vomiting;
heart palpitations, flushing and redness of the face;
a decrease in the level of hemoglobin, red blood cells or hematocrit in the blood;
shortness of breath, increased sexual activity, asthenia, pain in the chest and lower back;
weakness, drowsiness (sudden falling asleep in people with Parkinson’s disease).

Less commonly observed:

hyperkinesia, psychotic disorders, fainting, delirium;
malfunctioning of the liver, dyskinesia of the gallbladder and biliary tract, spasm of the vessels of the fingers and toes;
respiratory failure, nosebleeds;
allergic rashes, alopecia, increased levels of creatine kinase in the blood, cramps of the fingers and muscles on the calves;
pulmonary fibrosis, hemionopsia, erythromelalgia, pleurisy, edema (rarely).

Cabergoline, instructions for use (Method and dosage)

In order to prevent lactation in the postpartum period, the medicine is taken once, on the first day after birth, at a dosage of 1 mg. To stop the existing lactation, 250 μg of the drug is used, every 12 hours, 4 times. The duration of treatment, therefore, is 2 days.

The treatment of hyperprolactinemia is carried out in accordance with the recommendations of the attending physician.

As a rule, the initial dosage is 500 mcg per week at a time or distributed over 2 applications. If necessary, the dosage can be increased by 0.5 mg per week, for a month. If the likelihood of developing unwanted adverse reactions is increased, then treatment can begin with 250 mg per week.

The standard therapeutic dose is 1 to 2 mg in 7 days. The maximum amount of a drug that can be prescribed per week is 4.5 mg.

Patients with Parkinson’s disease during monotherapy are prescribed from 500 μg to 3 mg of the substance, 1 time per day. The duration of treatment is determined by the doctor.

In case of an overdose, the victim has nasal congestion, hallucinations, increased side effects, and fainting. As a treatment, supportive and symptomatic therapy is used.

It is better to avoid co-administration of this substance and ergot alkaloids (their derivatives).

The drug is not recommended to be combined with macrolide antibiotics, they increase its bioavailability, more often and more side effects are manifested.

The drug cannot be combined with dopamine receptor antagonists (phenothiazines, thioxanthene, butyrophenone, metoclopramide), this leads to a decrease in the effectiveness of the drug.

Cabergoline is better not to use along with medicines that lower blood pressure.

Storage conditions
Tablets are stored in the original packaging in a cool place.

Shelf life
2 years.

Special instructions
Extra care must be taken in the treatment of patients with cardiovascular diseases, gastric and duodenal ulcers, Raynaud’s syndrome, gastrointestinal bleeding, severe liver diseases (dosage must be adjusted).

The first few days of drug therapy, it is recommended to control the patient’s blood pressure. The drug may cause it to decrease. Also, once a month you need to determine the level of prolactin in the blood. After discontinuation of the drug, prolactin levels can remain at a normal level from 2 weeks to several months.

Before starting treatment, the patient must undergo an examination to identify possible pathologies of the heart valves, liver or kidneys. It is also recommended to do an ECG about 1 time per six months or once a year, in accordance with the doctor’s recommendations. If valve regurgitation worsens, the valve wall thickens, and the lumen narrows, the drug must be replaced.

If during the course of therapy with the agent new clinical symptoms of the respiratory system have appeared, an X-ray of the lungs must be taken. If a patient develops pleural effusion or fibrosis (accompanied by shortness of breath, cough, chest pain and rapid breathing), blood ESR levels increase, additional studies are also needed.

Before starting treatment, it is necessary to accurately determine the cause of the development of hyperprolactinemia in order to exclude the presence of a pituitary tumor.

If you are taking drugs based on Cabergoline, then you can not drive a car and perform potentially dangerous activities, it should be remembered that drugs can lower blood pressure.

For children
This substance, as a rule, is not used in pediatric practice.
With antibiotics
The medicine cannot be combined with erythromycin and some macrolide antibiotics.

During pregnancy and lactation
During pregnancy, the drug is used with extreme caution. Pregnant women can start or continue treatment with the drug only after consulting a specialist.

The drug and its metabolites were found in the milk of experimental rats; it is not known whether the substance is excreted in milk in women. Since the drug can have a negative effect on the infant, it is recommended to stop breastfeeding or replace the medicine.

With antibiotics
The medicine cannot be combined with erythromycin and some macrolide antibiotics.

During pregnancy and lactation
During pregnancy, the drug is used with extreme caution. Pregnant women can start or continue treatment with the drug only after consulting a specialist.

The drug and its metabolites were found in the milk of experimental rats; it is not known whether the substance is excreted in milk in women. Since the drug can have a negative effect on the infant, it is recommended to stop breastfeeding or replace the medicine.

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