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Other names for this medication :
Baycip, Cifran, Ciloxan, Ciprofloksacin, Ciprofloxacina, Ciprofloxacinum,  Ciprofloxin, Ciproxin, Ciproxina, Ciriax, Floxelena, Kensoflex, Lucipro,  Novidat.

Cipro
Active Ingredient: Ciprofloxacin

Form of issue

Eye and ear drops 0,3%.
Concentrate for infusion therapy 2 mg / ml.
Pills coated with a film coat 250 mg, 500 mg, 1000mg and 750 mg.
Ointment ophthalmic 0,3%.

Composition

Ear and eye drops of Ciprofloxin contain Ciprofloxin hydrochloride at a concentration of 3 mg / ml (in terms of a pure substance), Trilon B, benzalkonium chloride, sodium chloride, purified water.

In the ophthalmic ointment, the active substance is also contained in a concentration of 3 mg / ml.

Pills Ciprofloxin: 250, 500,  and 750 mg 1000mg mg Ciprofloxin, MCC, potato starch, corn starch, hypromellose, croscarmellose sodium, talc, magnesium stearate, colloidal anhydrous silica, macrogol 6000, additive E171 (titanium dioxide), polysorbate 80.

The infusion solution contains the active substance at a concentration of 2 mg / ml. Excipients: sodium chloride, edetate disodium, lactic acid, dilute hydrochloric acid, water d / u.

 Pharmachologic effect

Bactericidal.

↘ Pharmacodynamics and pharmacokinetics ↙

Ciprofloxin is an anti-biotics or not?
Antibiotic Ciprofloxin is an early fluoroquinolone (1st generation drug) and is used primarily for hospital infections. The agent penetrates well into cells and tissues (including cells of bacteria and macroorganisms) and has good pharmacokinetic parameters.

➡ Pharmacodynamics

The mechanism of action of the drug is due to the ability to inhibit DNA-gyrase (enzyme of bacterial cells) with a violation of DNA synthesis, division and growth of microorganisms.

Wikipedia indicates that against the background of the use of the drug, resistance to other non-group inhibitors of gyrase, antibiotics is not developed. This makes Ciprofloxin highly effective against bacteria resistant to the action of penicillins, kaminoglikozidov, tetracyclines, cephalosporins and a number of other antibiotics.

The most active activity is with Gram (-) and Gram (+) aerobes: 

H. influenzae, N. gonorrhoeae, Salmonella spp., P. aeruginosa, N. meningitidis, E. coli, Shigella spp.

Effective in infections caused by: strains of staphylococci (including those producing penicillinase), individual strains of enterococci, legionella, campylobacteria, chlamydia, mycoplasmas, mycobacteria.

It is active against the producing beta-lactamase microflora.

Anaerobes are moderately sensitive or resistant to the drug. Therefore, in patients with mixed anaerobic and aerobic infections, Ciprofloxin treatment should be supplemented with the administration of lincosamides or metronidazole.

Resistant to the antibiotic are: Ureaplasma urealyticum, Streptococcus faecium, Treponema pallidum, Nocardia asteroides.

➡ Pharmacokinetics

After taking the pill, the drug is quickly and completely absorbed in the digestive tract.

Main pharmacokinetic parameters:

▶ bioavailability – 70%;
▶ TSmax in blood plasma – 1-2 hours after administration;
▶ T½ – 4 hours.

Plasma proteins bind from 20 to 40% of the substance. Ciprofloxin is well distributed in body fluids and tissues, and its concentration in tissues and liquids can significantly exceed the plasma one.

Through the placenta penetrates the cerebrospinal fluid, excreted into breast milk, high concentrations are fixed in the bile. Up to 40% of the dose taken is eliminated within 24 hours in unchanged form by the kidneys, part of the dose is excreted with bile.

➡Indications for use Ciprofloxin

Ciprofloxin – from what these pills / solution?

Ciprofloxin is prescribed for the treatment of infectious diseases of the ENT organs, pelvic organs, bones, skin, joints, abdominal cavity, respiratory tract, urogenital and postoperative infections caused by a flora sensitive to the drug.

The drug can be used in patients with immunodeficiency states (including in conditions that develop with neutropenia, or due to the use of immunosuppressors).

Ciprofloxin (like other early fluoroquinolones) is the preferred drug in the treatment of UTI, including, among others, hospital infections.

Due to the ability to penetrate well into tissues and, in particular, into prostate tissue, fluoroquinolones have practically no alternative in the treatment of bacterial prostatitis.

Being highly active against the most likely pathogens of hospital pneumonia (Staphylococcus aureus, enterobacteria and Pseudomonas aeruginosa), it is important for pneumonia associated with the need for artificial ventilation.

If the causative agent of the disease is P. aeruginosa, before prescribing the drug, its sensitivity to Ciprofloxin should be established. This is due to the fact that in intensive care units more than a third of the Pseudomonas aeruginosa strains are resistant to the drug.

Importance of the drug has with intra-abdominal surgical infections and infections of the hepatobiliary system. To prevent infection, he can be assigned to a patient with pancreatic necrosis.

Fluoroquinolones are not used for CNS infections. This is due to their low penetration (penetration) into the cerebrospinal fluid. In this case, they are effective in meningitis, the causative agents of which are resistant to cephalosplorins of the third generation of Gram (-) bacteria.

The presence of several dosage forms allows the use of the drug for the stepwise therapy. When switching from Ciprofloxin IV administration to oral intake in order to maintain therapeutic concentration, the dose for oral administration should be increased.

So, if the patient was prescribed the administration of 100 mg intravenously, then he should take 250 mg inside, and if 200 mg was administered to the vein, then 500 mg.

What is the medicine in the form of eye / ear drops?
In ophthalmology it is used for superficial bacterial infections of the eye (eye) and its appendages, as well as for ulcerative keratitis.

Indications for use Ciprofloxin in otology: acute bacterial otitis of the external ear and acute bacterial otitis of the middle ear in patients with a tympanostomy tube.

Contraindications
Contraindications in systemic application:

➲ hypersensitivity;
➲ pregnancy;
➲ lactation;
➲ severe renal / hepatic dysfunction;
➲ indications of a history of chronic tendonitis caused by the use of  quinolones.

Drops for eyes and ears are contraindicated in fungal and viral infections of the eyes / ears, with intolerance to Ciprofloxin (or other quinolones), during pregnancy and lactation.

For children, pills and a solution for intravenous administration can be prescribed from the age of 12, eye and ear drops from 15 years.

▶ Side effects
The drug is good tolerability.

The most common side effects with intravenous administration and ingestion:

➲ dizziness;
➲ fatigue;
➲ headache;
➲ tremor;
➲ excitation.

In Vidal’s handbook it is reported that in single cases the patients were recorded:

➲ sweating;
➲ violation of gait;
➲ peripheral sensory disorders;
➲ tides;
➲ intracranial hypertension;
➲ depression;
➲ feeling of fear;
➲ visual impairment;
➲ flatulence;
➲ stomach ache;
➲ indigestion;
➲ nausea, vomiting;
➲ diarrhea;
➲ hepatitis;
➲ necrosis of hepatocytes;
➲ tachycardia;
➲ arterial hypertension (rarely);
➲ itching;
➲ the appearance of rashes on the skin.

Exceptionally rare side effects: bronchospasm, anaphylactic shock, Quincke’s edema, arthralgia, petechiae, malignant erythema exudative, vasculitis, Lyell’s syndrome, leuko- and thrombocytopenia, eosinophilia, anemia, hemolytic anemia, thrombotic or leukocytosis, increased plasma LDH concentration, bilirubin, LF, transaminase of the liver, creatinine.

Application in ophthalmology is accompanied by:

⓵. often – a sense of discomfort and / or foreign body presence in the eye, the appearance of white plaque (usually in patients with ulcerative keratitis and with frequent use of drops), the formation of crystallites / scales, supergiosis and conjunctival hyperemia, tingling and burning;

⓶. in isolated cases – keratitis / keratopathy, eyelid edema, corneal staining, hypersensitivity reactions, lacrimation, decreased visual acuity, photophobia, corneal infiltration.

Side effects that are associated with or possibly related to the use of the drug are usually mild, do not pose a threat and go untreated.

In patients with ulcerative keratitis, the emerging white coating does not adversely affect the treatment of the disease and the parameters of vision and disappears on its own. As a rule, it appears in the period from 1-7 days after the beginning of the course of application of the drug and disappears immediately or within 13 days after its termination.

Neofthalmological disorders when using drops: the appearance of an unpleasant aftertaste in the mouth, in rare cases – nausea, dermatitis.

When used in otology, the following are possible:

  • often – a run-off in the ear;
  • in some cases – ringing in the ears, headache, dermatitis.

Pills Ciprofloxin: instructions for use

The daily dose for an adult varies from 500 mg to 1.5 g / day.  It should be divided into 2 receptions with an interval of 12 hours.
To prevent the crystallization of salts in the urine, the antibiotic should be taken with a large volume of liquid.

A single dose is selected depending on the diagnosis:

☞ urogenital infections – from 2 * 250 to 2 * 500 mg with uncomplicated acute, from 2 * 500 to 2 * 750 mg with complicated;
☞ cystitis in women before menopause – 500 mg (once);
☞ infection of the respiratory tract (depending on the pathogen and severity of the disease) – from 2 * 500 to 2 * 750 mg;
☞ gonorrhea – 500 mg once for acute uncomplicated and from 2 * 500 to 2 * 750 mg mg, if the patient is diagnosed with an extragenital form of the disease, and also in cases when the disease occurs with complications;
☞ joint and bone lesions, severe, life-threatening patients, infections, septicemia, peritonitis (in particular, in the presence of Pseudomonas,   Streptococcus or Staphylococcus) – 2 * 750 mg;
☞ gastrointestinal infections – from 2 * 250 to 2 * 500 mg;
Inhalation form of anthrax – 2 * 500 mg;
prevention of invasive infections caused by N. meningitidis – 1 * 500 mg.

The treatment continues until clinical symptoms stop, and a few more days after their disappearance and the normalization of body temperature. In most cases, the course lasts from 5 to 15 days, with lesions of joints and bone tissue it is prolonged to 4-6 weeks, with osteomyelitis – up to 2 months.

Patients with renal dysfunction require a dose adjustment and / or duration of the interval.

Application of ampoules
Ciprofloxin in ampoules is recommended to be administered intravenously in the form of a drop infusion. The dose for an adult is 200-800 mg / day. The duration of the course is on average from 1 week to 10 days.

With urogenital infections, joints and bones or ENT disorders, a patient is administered 200-400 mg twice a day during the day. With infections of the respiratory tract, intra-abdominal infections, septicemia, soft tissue and skin lesions, a single dose at the same multiplicity of applications is 400 mg.

With kidney dysfunction, the starting dose is 200 mg, and subsequently it is adjusted for Clcr.

In the case of the use of ampoules in a dose of 200 mg, the duration of the infusion is 30 minutes, with the administration of the drug at a dose of 400 mg – 1 hour.

Ciprofloxin injections are not prescribed.

Ear and Eye Drops Ciprofloxin: Instructions for Use
With ulcerative keratitis, the treatment is carried out according to the following scheme:

✹ ➊ day – during the first 6 hours of the conjunctival cavity is administered 2 drops of the solution every 15 minutes, then the interval between instillation increased to half (a single dose of the same – 2 drops);
✹ ➋ days – 2 drops with an interval between instillations of 60 minutes;
3-14 days – 2 drops with an interval between instillations of 4 hours.
Treatment for ulcerative keratitis can last longer than 14 days. The treatment plan is selected individually by the attending physician.

With superficial bacterial infections of the eye and its appendages, the standard dose is 1-2 drops with a multiplicity of applications of 4 r. / Day. In especially severe cases, in the first 48 hours the patient is instilled with 1-2 drops every 2 hours.

Treatment lasts from 7 to 14 days.

After instillation, a nasolacrimal occlusion is recommended to reduce systemic absorption of the drug administered into the eye.

In the case of concomitant treatment with other drugs for ophthalmic topical use should withstand 15-minute time intervals between their administration and administration of Ciprofloxin.

In otology, the standard dose of the drug is 4 drops in the previously cleared auditory canal of the affected ear 2 r. / Day.

Patients who use ear pads, the dose is increased only with the first use of the drug: children are administered 6, adults – 8 drops.

The course should not last more than 10 days. If it is necessary to extend it, determine the sensitivity of the local flora.

In case of using other agents for topical application between their administration and administration of Ciprofloxin, it is necessary to maintain an interval of 10-15 minutes.

Dosage for children from 15 years: 3 drops twice a day.

The effect of renal / hepatic dysfunction on the pharmacokinetic parameters of the drug in the form of ear and eye drops has not been studied.

To avoid vestibular stimulation, the solution is warmed to body temperature before insertion into the auditory canal.

The patient should lie on the opposite side of the affected ear. In this position, it is recommended to stay for 5-10 minutes after instillation of the solution.

It is also permissible after local cleaning to insert for 1-2 days in the ear canal a tampon moistened with a solution of hygroscopic cotton wool or gauze. To saturate the drug, it should be moistened twice a day.

To avoid contamination of the tip of the dropper bottle and the solution, do not touch the dropper to the eyelids, the pinna, the external auditory canal, outdoor areas and any other surfaces.

Additionally

Fundamental difference in how to take drugs from different manufacturers, no:    instructions for use Ciprofloxin-Akos similar to the instructions on the Ciprofloxin-FPO, Ciprofloxin, Promed, Vero Ciprofloxin or Ciprofloxin-Teva.

For children and adolescents under the age of 18, the drug should be prescribed only if the pathogen is resistant to other chemotherapeutic agents.

▶ Overdose
Specific symptoms with an overdose of Ciprofloxin not. The patient is shown gastric lavage, taking emetic drugs, creating an acidic urine reaction, introducing a large volume of fluid. All activities should be conducted against the backdrop of maintaining the function of vital systems and organs.

Peritoneal dialysis and hemodialysis contribute to the elimination of 10% of the dose.

There is no specific antidote for the drug.

▶  Interaction
The use in combination with Teofillinum promotes an increase in plasma concentration and an increase in T1 / 2 of the latter.

Al / Mg-containing antacids help to slow the absorption of Ciprofloxin and thereby reduce its concentration in urine and blood. Between the methods of these drugs should be maintained intervals of at least 4 hours.

Probenecid delayed excretion of the drug.

Ciprofloxin increases the effect of coumarin anticoagulants.

The interaction of Ciprofloxin for use in otology and ophthalmology with other drugs has not been studied.

▶ Storage conditions

Store the drug at room temperature, in a place inaccessible to children.

▶ Shelf life

For solution, ear and eye drops – 2 g (the contents of the opened vial should be used for 28 days), for pills – 3 g.

▶ Special instructions

Because of the possibility of occurrence of side effects from the side of the central nervous system in patients with a history of its pathology, the drug can be used exclusively for life indications.

Ciprofloxin is cautiously prescribed when lowering the threshold of convulsive readiness, epilepsy, brain damage, severe cerebrosclerosis (increased risk of blood flow and stroke), serious violations of the liver / kidney function, in old age.

During treatment it is recommended to avoid UV and solar irradiation and increased physical activity, to control urine acidity and drinking regimen.

In patients with an alkaline urine reaction, cases of crystalluria were recorded. To avoid its development, it is inadmissible to exceed the therapeutic dose of the drug. In addition, the patient requires a lot of drinking and maintaining an acid reaction of urine.

Pain in the tendons and the appearance of signs of tendovaginitis are a signal to stop treatment, as the possibility of inflammation / rupture of the tendon is not ruled out.

Ciprofloxin can inhibit the rate of psychomotor reactions (especially against the background of alcohol), which should be remembered for patients working with potentially dangerous devices.

With the development of severe diarrhea, pseudomembranous colitis should be ruled out. this disease is a contraindication to the use of the drug.

If necessary, simultaneous in / in the introduction of barbiturates should monitor the function of SSS: in particular, the parameters of ECG, heart rate, blood pressure.

The liquid ophthalmic form of the drug is not intended for intraocular injections.

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♀ Storage
The preparation should be stored in its packaging at room temperature.

It is necessary to protect it from heat, light and moisture, as well as from small children.

♀ Contraindications
Some patients may be endowed with hypersensitivity to sildenafil or other components of the drug. It is also not recommended to use together with other possible means for the treatment of erectile dysfunction in males or similar problems in women, since the possible results of such interactions and combinations are not fully understood.

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Lisinopril. Active Ingredient: Lisinopril

Other names for this medication:
Acecomb, Acelisino comp, Acemin, Acerbon, Acercomp, Acerdil, Acetan, Adicanil, Alapril, Amicor, Apo-lisinopril, Asrarn, Asteril, Axelvin, Bellisin, Belprel, Bpmed, Byzestra, Cardiostad, Cipril, Co lisinopril, Co-acetan, Co-linipril, Co-lisinopril eg, Co-trupril, Cotensil gmp, Dapril, Dironorm, Diroton, Doclinisopril, Doneka, Doneka plus, Dosteril, Doxapril, Ecardil, Eupril, Farpresse, Fibsol, Fisopril, Gamalizin, Genopril, Gnostoval, Hipril, Icoran, Inopril, Interpril, Iricil, Iricil plus, Irumed, Iruzid, Laaven, Landolaxin, Leruze, Lestace, Likenil, Linipril, Linopril, Linoril, Linoritic forte, Linoxal, Linvas, Liprace, Lipreren, Lipresan, Lipril, Lisdene, Lisi lich, Lisibeta, Lisidigal, Lisigamma, Lisilet, Lisilich comp, Lisinal, Lisinobell, Lisinocor, Lisinomerck, Lisinoplus, Lisinoprilum, Lisinoratio, Lisinoton, Lisipril, Lisiprol, Lisiren, Lisnop, Lisodura plus, Lisopress, Lisopril, Lisoril, Lispril, Listril, Liten, Lizinocor, Lizinopril, Lizopril, Lokopool, Longeril, Longes, Lopril, Loril, Mealis, Medapril, Nafordyl, Nalapres, Neopril, Noperten, Nopril, Noprisil, Novatec, Odace, Omace, Optimon, Perenal, Pesatril, Pms-lisinopril, Presiten, Presokin, Pressuril, Prinil, Prinivil plus, Ran-lisinopril, Ranolip, Ranopril, Rantex, Rilace, Rilace plus, Rowenopril, Safepril, Secubar diu, Sedotensil, Sinopren, Sinopril, Sinopryl, Sinoretik, Skopril, Skopryl, Stril, Tensikey, Tensinop, Tensiphar, Tensolisin, Tensyn, Terolinal, Tersif, Thriusedon, Tivirlon, Tonolysin, Tonoten, Tonotensil, Tytrix-10, Vercol, Veroxil, Vitopril, Vivatec, Zemax, Zesger, Zestan, Zestozide, Zinopril.

Composition
The main component of the drug is lisinopril dihydrate. But depending on the manufacturer of the drug, the composition of the additional substances can be different.
Ukrainian company Avant produces Lisinopril with subsidiary components such as corn starch, calcium phosphate, iron oxide, mannitol, magnesium stearate.
A Russian manufacturer ALSI Pharma produces a product with the following additional components: pregelatinized starch, silicon dioxide colloid, talc, lactose monohydrate, microcrystalline cellulose, magnesium stearate.
Furthermore, such known forms of release formulation as Lisinopril-Ratiopharm, Lisinopril-Astrafarm, Lisinopril Teva, Lisinopril STADA.

They have the following additional components:
☛ Lizinopril-Astropharm – corn starch, silicon dioxide colloid, mannitol, calcium hydrophosphate, magnesium stearate;
☛ Lizinopril-Ratiofarm – mannitol, calcium hydrophosphate, magnesium stearate, pregelatinized starch, croscarmellose sodium (20 mg tablets also contain PB-24824 dye, and the drug in 10 mg tablets is PB-24823 dye).

Lizinopril Stade has as an active ingredient lisinopril hydrate. In addition, the following additional substances:
☛  pregelatinized starch,
☛  silicon oxide,
☛  colloidal anhydrous,
☛  mannitol,
☛  magnesium stearate,
☛  corn starch,
☛  calcium phosphate disubstituted dihydrate.

Form of issue
Pills.

Pharmachologic effect
The drug has antihypertensive, cardioprotective, vasodilating and natriuretic effect on the human body.

Pharmacodynamics and pharmacokinetics
Lizinopril tablets block ACE, increase the content of endogenous vasodilating PG and prevent the transfer of angiotensin I to angiotensin II. They also reduce the conversion of arginine-vasopressin and endothelin-1, reduce the afterload on the myocardium, the total peripheral resistance of the vessels, the pressure in the pulmonary capillaries and systemic blood pressure. Patients with heart failure increase myocardial tolerance to exercise and cardiac output. Increase plasma renin activity.

The drug blocks the tissue renin-angiotensin system of the heart, prevents the appearance of myocardial hypertrophy and dilatation of the left ventricle, or helps in their disappearance.
The effect of the drug manifests itself after about 60 minutes, increases for 6-7 hours and lasts for a day. The maximum hypotensive effect is manifested when the course is a few weeks.
The active substance is absorbed by about 25%. The time of ingestion does not affect the absorption. The connection with plasma proteins is low. The active substance is not biotransformed and excreted by the kidneys in an unchanged form. Half-life is 12 hours.

Indications for use of lisinopril
This medicine can not be taken without the appointment of a specialist. Indications for use Lysinopropyl may be different. How to take and what pills will help in each case, only the doctor knows.

Typically, lisinopril tablets have the following indications for use:
☛  arterial hypertension;
☛  chronic heart failure;
☛  diabetic nephropathy in the case of insulin-dependent and type II diabetes mellitus;
☛  acute myocardial infarction without arterial hypotension.

Contraindications
The drug should not be taken with increased sensitivity to its components, lactation and pregnancy.

It is undesirable to prescribe this remedy when:
☛  hyperkalemia;
☛  anaphylactoid reactions;
☛  collagenoses;
☛  cerebrovascular insufficiency;
☛  disorders in the work of the kidneys and liver;
☛  bilateral stenosis of the renal arteries;
☛  transplanted kidney;
☛  gout;
☛  old age;
☛  Quincke’s edema in the anamnesis;
☛  bone marrow depression;
☛  hypotension;
☛  obstructive changes that prevent the outflow of blood from the heart;
☛  hyponatremia, as well as when eating with limited sodium intake;
☛  stenosis of the artery of a single kidney;
☛  hyperuricemia;
☛  childhood.

Side effects
Side effects may be different, they arise from different systems and bodies:
☛  nervous system – irritability, headache, ataxia, increased fatigue, transient impairment of cerebral circulation, tremor, drowsiness, impaired vision, confusion, nervousness, fainting, peripheral neuropathy, memory loss, dizziness, insomnia, paresthesia, convulsions, tinnitus;
☛  gastrointestinal tract – dry mouth, heartburn, vomiting, flatulence, abdominal pain, gastritis, indigestion, nausea, diarrhea, constipation, spasms, hepatotoxicity, pancreatitis;
☛  musculoskeletal system – arthralgia, myalgia, arthritis, neck and back pain;
☛  respiratory system – malignant lung tumors, embolism and lung infarction, dry cough, asthma, painful respiratory sensations, hemoptysis, laryngitis, pharyngitis, epistaxis, paroxysmal postural dyspnea, infiltration, pleural effusion, rhinitis, bronchitis, bronchospasm, sinusitis, runny nose;
☛  urogenital system – acute renal failure, problems with kidney function, pyelonephritis, oliguria, uremia, impotence, dysuria, anuria, edema, decreased libido;
☛  skin – hives, alopecia, pemphigus, Lyell’s syndrome, photosensitivity, rash, injuries and infections of the skin, Stevens-Johnson syndrome.

In addition, the following manifestations are possible: the development of infections, weight loss, sweating, diabetes mellitus, an increase in the titer of antinuclear antibodies and urea levels, gout, an increase in creatinine, hyperkalemia, hyperuricemia, fever, allergy, dehydration, hyponatremia.

If any side effects are found, you need to urgently consult a specialist.

Instructions for use of lisinopril (Method and dosage)
The medication is taken daily 1 time in the morning, regardless of food intake. Do this at the same time, while washing some liquid.
The exact dosage and the scheme of therapy is selected by a specialist individually. It depends on what Lysinopropyl is applied, what preparations are taken with it and what is the condition of the kidneys.
With arterial hypertension in the case of treatment without other antihypertensive drugs, the dosage is 2.5 mg once a day. For the most effective 2-4 weeks of therapy. Only then you can increase the daily dosage to a maximum of 20 mg. The daily dose should not be more than 40 mg.
If the desired antihypertensive effect is not achieved, you must additionally take another antihypertensive drug of another pharmacotherapeutic group.
In the case of acute myocardial infarction, if a medicine called lisinopril was prescribed, the instruction for use informs that it should be taken within 24 hours after the first symptoms of the disease manifest. The initial dosage is 5 mg once a day. It can be increased to 10 mg. People with arterial systolic pressure up to 120 mm Hg. Art. shows the use of 2.5 mg per day. And when arterial hypotension occurs, a single dose does not exceed 5 mg (if necessary, it can be reduced). If within 60 minutes after taking BP to 90 mm Hg, tablets are canceled. At a dosage of 10 mg, therapy for 6 weeks is recommended.
In the case of heart failure, the daily initial dosage is 2.5 mg. It can be gradually increased depending on the individual indications of the patient. Therapeutic daily dosage is 20 mg.
In the case of insulin-dependent diabetes mellitus and nephropathy, therapy is started with low doses and is under careful monitoring by a specialist. The initial daily dosage for type II diabetes is 10 mg. It is forbidden to exceed the daily dose of 20 mg.

With renal failure, dosage adjustment is required depending on the CK:
☛ 30-70 ml / min – take 5-10 mg / day;
☛ 10-30 ml / min – take 2.5-5 mg / day;
☛ up to 10 ml / min – you need to take 2.5 mg / day.

A daily dose of 20 mg can not be exceeded, and for people with CK up to 30 ml / min the maximum daily dosage is 10 mg.
In some cases, it is also possible to extend the interval between doses from one to two days.
There are also some changes in the scheme of taking the drug depending on the manufacturer.
So the instruction on the use of Lysinopril-Astropharm reports the following daily dosages depending on the diagnosis:
☛ Arterial hypertension – to start, the dosage should be 10 mg per day. In this case, after the first application, a significant decrease in blood pressure can occur. In this case, the initial dosage is 2.5-5 mg. Therapy should be under the supervision of a specialist. The maintenance daily dosage is 20 mg. If the proper effect is not achieved in 14-28 days, it can be increased. But you can not exceed the daily dosage of 80 mg;
☛ chronic heart failure – the drug can be used as a component of therapy with diuretics, beta-blockers and digitalis preparations. At the beginning of treatment, a daily dosage of 2.5 mg is prescribed. The medicine should be used under the supervision of a specialist. It is possible to increase the dose, but not more than 10 mg and not earlier than 14 days. The maximum daily dosage should not exceed 35 mg. The exact dose depends on the individual parameters of the patient;
☛ acute myocardial infarction – the drug is taken as a component of therapy with thrombolytic drugs, beta-blockers and acetylsalicylic acid. The dosage of Lisinopril-Astropharmum in the first two days is 5 mg. The course should start when the first symptoms occur and if the systolic blood pressure does not exceed 100 mm Hg. Art. Two days later, a daily dosage of 10 mg is prescribed. If the arterial pressure is up to 120 mm Hg. In the first 3 days you need to take 2.5 mg. If prolonged arterial hypotension occurs, therapy is immediately stopped. The course is designed for 6 weeks, after which the patient’s condition should be evaluated again for further treatment;
☛ Diabetic nephropathy – the initial dosage is 10 mg per day. If necessary, the dose rises to 20 mg.

For any diagnosis in the case of renal failure, the dosages are corrected in the KK dependence. So the initial dose can be:
☛ CK up to 10 ml / min – take 2.5 mg / day;
☛ KK 10-30 ml / min – take 2.5-5 mg / day;
☛ KK 31-80 ml / min – take 5-10 mg / day.

Instruction for use Lizinopril-Ratiofarm, Lizinopril Teva, Lizinopril Stida has no significant differences in the regimen of admission.

Overdose
When an overdose, as a rule, acute arterial hypotension appears. As a treatment, physiological saline is administered. Symptomatic therapy is performed.
In addition, shock, hyperventilation, acute renal failure, bradycardia, cough, electrolyte imbalance in the blood, tachycardia, palpitation, dizziness, a sense of anxiety are possible.
The drug must be canceled. If the patient is conscious, rinsing the stomach, lay the patient on his back with a low headrest, raised legs and a head sideways. In addition, enterosorbents are given.
When taking medication in especially high doses, the patient should be immediately hospitalized. In a hospital, treatment is conducted to maintain normal perfusion pressure, circulation, respiration, restore the volume of circulating blood and normal kidney function. Effective hemodialysis. It is mandatory to monitor the vital signs, as well as the level of creatinine and electrolytes in the blood serum.

Interaction
Taking the drug together with antihypertensive drugs can provoke an additive antihypertensive effect.
Potassium-sparing diuretics, substitutes for edible salt with potassium, and also drugs with potassium increase the possibility of developing hyperkalemia.

Combination with ACE blockers and NSAIDs increases the likelihood of kidney dysfunction. In rare cases, hyperkalemia is also possible.
And the application in conjunction with loop and thiazide diuretics is fraught with increased antihypertensive effect. At the same time, the risk of renal dysfunction significantly increases.
Indomethacin or agents with estrogen in combination with lisinopril lead to a decrease in the antihypertensive effect of the latter. And simultaneous intake of insulin and hypoglycemic drugs can cause hypoglycemia.
The combination with clozapine leads to an increase in its content in plasma. With the simultaneous intake of lithium carbonate, its serum level increases. This may be accompanied by symptoms of lithium intoxication.
The drug also increases the effect of ethanol. The symptoms of alcoholic intoxication are increasing. At the same time, it is possible to increase the hypotensive effect of lisinopril, so it is necessary to avoid alcoholic beverages during therapy with this drug or not to take it within a day after drinking alcohol.
Use of this medication together with narcosis drugs, narcotic analgesics, antidepressants, muscle relaxants with hypotensive effect, and also hypnotics leads to an increase in the hypotensive effect.
Thrombolytics increase the likelihood of arterial hypotension. This combination should be prescribed with caution and carefully monitor the patient’s condition.
Sympathomimetics to a significant extent weaken the hypotensive effect of the drug. A combination with drugs that have a myelosuppressive effect increases the risk of agranulocytosis and / or neutropenia.
The simultaneous use with Allopurinol, immunosuppressants, Procainamide, cytostatics, GCS can cause leukopenia.
With dialysis therapy, anaphylactoid reactions are possible in the case of high-flow polyacrylonitrile metal sulfonate membranes.

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Levothroid (Levothyroxine): instructiℴns fℴr use, reviews, descriptiℴn, analℴgues.

What is the purpℴse of the drug “Levothyroxine”? Instructiℴns fℴr use, dℴctℴr’s cℴmments abℴut this tℴℴl will be presented later. Alsℴ, we will tell yℴu abℴut the fℴrm in which this medicatiℴn is issued, whether it has cℴntraindicatiℴns and side effects, what it can replace, etc.

Cℴmpℴsitiℴn of the drug and its form of release
In what fℴrm can I buy a drug “Levothyroxine”? Instructiℴns fℴr use, reviews ℴf dℴctℴrs say that this medicatiℴn is available in tablets. Fℴr sale, they cℴme in the fℴllℴwing amℴunts: 50, 25, 100, 75, 150, 125, 200 ℴr 175 mcg. Their active substance is Levothyroxine sℴdium.

Pharmacological characteristics of the agent
What is the medical drug “Levothyroxine”? Instructiℴns fℴr use, reviews abℴut this tℴℴl cℴntain infℴrmatiℴn that it is a hℴrmℴne ℴf the thyrℴid gland, which has a synthetic ℴrigin.

In small dℴses, the drug is able tℴ have anabℴlic effect (that is, stimulate the prℴductiℴn ℴf prℴtein). The average vℴlumes ℴf medicament increase the activity ℴf the central nervℴus and cardiℴvascular system, the need fℴr ℴxygen in tissues, activate the metabℴlism ℴf prℴteins, as well as fats and carbℴhydrates.

As fℴr high dℴses, with them the drug helps tℴ lℴwer the prℴductiℴn ℴf hℴrmℴnes ℴf the pituitary and hypℴthalamus, which are prℴduced by glands ℴf internal secretiℴn (in the brain).

Pharmacokinetics of a medicinal preparation
Where and fℴr hℴw lℴng is the drug “Levothyroxine” absℴrbed? Instructiℴn means that after ℴral intake ℴf the drug cℴmes frℴm the digestive tract and is apprℴximately 49-78%.
Admissiℴn ℴf the drug ℴn an empty stℴmach significantly increases the absℴrptiℴn ℴf the active substance. The maximum cℴncentratiℴn ℴf the drug is reached in abℴut 5-6 hℴurs.
The cℴnnectiℴn with plasma prℴteins is mℴre than 98%.
The distributiℴn ℴf the drug ℴccurs mainly in the liver, as well as in muscles and the brain.
The eliminatiℴn half-life is 1 week. Apprℴximately 15% ℴf the drug is excreted tℴgether with bile and thrℴugh the kidneys – in the fℴrm ℴf cℴnjugates and unchanged, respectively.

Indications for the use of a medicinal product
What can be used fℴr the drug “Levothyroxine”? The instructiℴns attached tℴ this tℴℴl cℴntain the fℴllℴwing indicatiℴns:

➜mixed gℴiter;
➜secℴndary, as well as primary hypℴthyrℴidism;
➜cℴmplex therapy ℴf tℴxic gℴiter, autℴimmune thyrℴiditis and euthyrℴid hyperplasia ℴf the thyrℴid gland;
➜cretinism;
➜preventiℴn ℴf relapse after surgery ℴn the thyrℴid (after remℴval ℴf malignant and nℴdal neℴplasms).

Alsℴ, sℴdium Levothyroxine is used fℴr a differential diagnℴstic test ℴf thyrℴid suppressiℴn.

Contraindications to admission
At what deviatiℴns can nℴt take the medicine “Levothyroxine”? Tablets cℴnsidered by us, it is fℴrbidden tℴ use with thyrℴid hyperfunctiℴn, myℴcardial infarctiℴn (acute). It is alsℴ cℴntraindicated in cases ℴf hypersensitivity tℴ the main substance (ie, Levothyroxine sℴdium), nℴt cured insufficiency ℴf the adrenal cℴrtex.

Medicinal prℴduct “Levothyroxine“:  instructiℴns fℴr use
Reviews abℴut this drug cℴntain infℴrmatiℴn that its effect is manifested ℴnly 7-13 hℴurs after the start ℴf therapy. But this is ℴnly if the medicatiℴn was prescribed accℴrding tℴ the indicatiℴns and in the cℴrrect dℴsage.

The vℴlume ℴf the drug in questiℴn fℴr the treatment ℴf a deviatiℴn is determined individually, depending ℴn the available indicatiℴns. Usually at the beginning ℴf therapy this medicatiℴn is used in a dℴsage ℴf 12.5-25 mcg ℴnce a day (25-30 minutes befℴre a meal). Hℴwever, as a suppℴrtive treatment, this vℴlume can reach 200 mcg per day.

During the differential diagnℴstic test, the drug is administered ℴnce in a vℴlume ℴf 3 mg ℴr fℴr 14 days at 200 mcg ℴnce a day.

Fℴr the treatment ℴf hypℴthyrℴidism ℴf a cℴngenital nature, babies up tℴ 6 mℴnths receive 25-50 mcg ℴf medicatiℴn, up tℴ 1 year – 60 mcg, and at the age ℴf 1 tℴ 5 years – 100 mcg. Fℴr ℴlder children (6 tℴ 12 years), Levothyroxine sℴdium is prescribed in a dℴse ℴf 150 mcg. Teenagers after 12 years ℴf age are given 200 mcg per day.

Adult peℴple with a diagnℴsis such as hyperthyrℴidism, it is recℴmmended tℴ take 25-100 mcg ℴf drug per day. At the same time, the dℴsage is gradually increased (every twℴ ℴr three weeks at 25-50 mcg). As a result, the amℴunt ℴf the drug reaches the suppℴrtive and is abℴut 125-250 mcg per day.

After surgical interventiℴn tℴ remℴve the malignant tumℴr, the drug is taken in an amℴunt ℴf 300 mcg.

With euthyrℴid gℴiter, as well as tℴ prevent its re-educatiℴn, adults are prescribed medicatiℴn in the amℴunt ℴf 75-200 mcg, and children – 12.5-150 mcg per day.

Side effects after taking medication
Is it pℴssible tℴ take Levothyroxine and alcℴhℴl simultaneℴusly? Tℴ date, the interactiℴn ℴf this prℴduct with alcℴhℴl is nℴt established. Hℴwever, during treatment with hℴrmℴnal drugs, it is nℴt recℴmmended tℴ abuse strℴng alcℴhℴlic beverages.

With regard tℴ side effects, then after taking the drug in questiℴn, patients may experience symptℴms ℴf hyperthyrℴidism. Amℴng them, the fℴllℴwing cℴnditiℴns can be nℴted: palpitatiℴn, tachycardia, arrhythmia, headache, angina attacks, tremℴr, nervℴusness, inner anxiety, sleep disℴrders, seizures, weight lℴss, muscle weakness, diarrhea, vℴmiting, menstrual irregularities.

Overdose with medical device
When an ℴverdℴse ℴf this drug in the patient there are signs that are characteristic fℴr severe ℴr mℴderate hyperthyrℴidism. As a treatment fℴr such cℴnditiℴns, symptℴmatic therapy is used. At the same time, the drug is immediately withdrawn.

It is alsℴ pℴssible tℴ prescribe beta-blℴckers. When using extreme dℴsages, plasmapheresis is perfℴrmed. ℴne can nℴt help saying that hemℴdialysis is ineffective in this case.

Interaction with other drugs
Can I take the drug “Levothyroxine” and calcium at the same time? This element, as well as aluminum hydrℴxide and sucralfate, reduce the absℴrptiℴn ℴf the active substance ℴf the first drug frℴm the digestive tract.

It shℴuld alsℴ be nℴted that the main element ℴf the drug pℴtentiates the effect ℴf indirect anticℴagulants and reduces the effectiveness ℴf hypℴglycemic agents (ℴral).

In patients with diabetes mellitus and hypℴthyrℴidism at the beginning ℴf the substitutiℴn treatment with thyrℴid hℴrmℴne medicatiℴns, there is a pℴssibility ℴf increasing the need fℴr hypℴglycemic agents (ℴral) ℴr insulin.

Dicumarin, salicylates, clℴfibrate and furℴsemide can quite easily displace Levothyroxine sℴdium frℴm the bℴnd with plasma prℴteins.

Kℴlestyramin reduces the absℴrptiℴn ℴf the active substance frℴm the digestive tract.

When using “Ritℴnavir” there is a high prℴbability ℴf increasing the need fℴr “Levothyroxine”.

During the applicatiℴn ℴf “sertraline” in peℴple with hypℴthyrℴidism, the effect ℴf Levothyroxine sℴdium decreases.

With the simultaneℴus administratiℴn ℴf “Chlℴrℴquine” there is a pℴssibility ℴf increasing the metabℴlism ℴf Levothyroxine, as well as the cℴncentratiℴn ℴf TSH.

Breastfeeding and Pregnancy Time
During lactatiℴn and when carrying the fetus, the drug shℴuld be used ℴnly under the supervisiℴn ℴf a dℴctℴr. The use in cℴmbinatiℴn with thyreℴstatic drugs during pregnancy is cℴntraindicated. This is assℴciated with an increased risk ℴf hypℴthyrℴidism in the fetus in the wℴmb.

Special instructions for taking medication
Why is the drug “Levothyroxine” and hair lℴss related tℴ each ℴther? The fact is that when the thyrℴid gland is brℴken, patients can lℴse their hair quite viℴlently. Hℴwever, after taking medicatiℴn, this sign ℴf hℴrmℴnal imbalance is almℴst cℴmpletely eliminated.

The agent under cℴnsideratiℴn with special care is prescribed fℴr peℴple with cardiℴvascular diseases, including thℴse with arterial hypertensiℴn, ischemic heart disease and heart failure. In these cases, the medicatiℴn shℴuld be taken in a lℴw dℴsage, increasing it very slℴwly and with a large gap.

An elderly patient with a lℴng cℴurse ℴf a disease such as hypℴthyrℴidism, therapy shℴuld begin gradually.

With substitutiℴn thyrℴid treatment in peℴple with insufficient wℴrk ℴf the adrenal cℴrtex withℴut adequate therapy (suppℴrting) cℴrticℴsterℴids, there is a prℴbability ℴf develℴping an adrenal crisis (acute).

This drug with cautiℴn prescribed fℴr diabetes.

In sℴme cases, thyrℴid hℴrmℴnes cause ℴr exacerbate the myasthenic syndrℴme (preceding).

Preparatiℴns “Levothyroxine” and “Eutirℴx”: cℴntrast, reviews
Despite the fact that bℴth prℴducts have the same active element, each ℴf them has its ℴwn characteristics. This is due, abℴve all, tℴ the fact that the additiℴnal cℴmpℴnents that make up their cℴmpℴunds are cℴmpletely different.

There is alsℴ sℴme difference in the actiℴn ℴf medicatiℴns. Accℴrding tℴ the patients’ reviews, the therapeutic effect ℴf the drug “Levothyroxine” is ℴbserved after 7-13 days, and frℴm the means ℴf “Eutirℴks” – after twℴ weeks.

When used cℴrrectly, the last medicine dℴes nℴt have any side effects. As fℴr the fℴrmer, in rare cases it still leads tℴ undesirable cℴnsequences. Mℴreℴver, side effects can ℴccur even with small changes in dℴsage.

In children suffering frℴm epilepsy, ℴr with cℴnvulsive attacks, the use ℴf the drug “Levothyroxine” causes a wℴrsening ℴf the cℴnditiℴn. As fℴr the medicine “Eutirℴks”, after its use such deteriℴratiℴn is nℴt ℴbserved.

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Motilium☤ is an antiemetic, which also has the ability to reduce the severity of dyspeptic symptoms (heartburn, flatulence, belching, nausea, vomiting, sensation of fullness and stomach pain after eating, etc.) due to a violation of the evacuation of the food lump from the stomach into the intestine. Therefore, Motilium☤ is used to stop vomiting, as well as to alleviate dyspeptic symptoms in reflux esophagitis, gastroesophageal reflux, GERD, esophagitis, gastric hypotension, and also against cytostatic therapy or radiotherapy of tumors.👍

Forms of release, names and composition Motilium☤ Currently, Motilium☤ is available in the following three dosage forms:
1. Tablets for resorption in the oral cavity;
2. Tablets, coated with a coating, for oral administration;
3. Suspension for oral administration.

☘ Tablets in the shell and for resorption in the oral cavity are usually called simply “Motilium☤ tablets” without specifying which particular species are involved. And the suspension often in everyday speech is called Motilium☤ syrup. However, since MotiliuⓂ☤ does not exist as a syrup, this term denotes the liquid form of the preparation, without going into the subtleties of the differences between the suspension, solution, syrup, emulsion, etc. In addition, the suspension is often called children’s Motilium☤, since this particular dosage form is used in pediatric practice.
In the composition of all dosage forms of Motilium☤, Domperidone is included as the active substance in the following different dosages:

☞☞☞Tablets for resorption in the oral cavity – 10 mg;☞ Tablets for ingestion in the shell – 10 mg; Suspension – 1 mg per 1 ml.
The auxiliary components of all three dosage forms of Motilium☤ are reflected below

Lozenges:

☞Gelatin
☞Mannitol
☞Aspartame
☞Mint Essence
☞Poloxamer 188

Coated tablets:

☞Lactose
☞Corn starch
☞Potato starch
☞Polyvidone
☞Microcrystalline cellulose
☞Magnesium stearate
☞Hydrogenated vegetable oil
☞Lauryl sulfate
☞Hypromellose

Coated tablets:

☞Saccharin sodium
☞Sorbitol
☞Sodium hydroxide
☞Polysorbate
☞Microcrystalline cellulose
☞Purified water
☞Carboxymethylcellulose sodium
☞Methyl parahydroxybenzoate
☞Propyl parahydroxybenzoate

☘ Tablets for resorption have a round shape and are painted white or almost white. The tablets in the shell are round in shape, painted white or white-cream color and are labeled “Janssen” and “M / 10” on flat surfaces. If the tablet is broken in a shell, then at the break it will be uniformly white, without inclusions. Both types of tablets are available in packs of 10 or 30 pieces. The suspension is a white opaque liquid of a homogeneous structure and an acidic consistency. Produced in bottles of dark glass with a volume of 100 ml.

What helps Motilium☤ (therapeutic effects)

Motilium☤ has the following pharmacological effects: Suppression of vomiting center activity in the brain; Increase in intensity and duration of contractions of the stomach and duodenum; Increased pressure in the esophagus; Acceleration of the evacuation of the food lump from the stomach into the duodenum. These pharmacological effects provide the therapeutic effect of Motilium☤, which consists in stopping the symptoms of digestive disturbances (flatulence, eructation, a feeling of heaviness and pain in the stomach after eating, nausea, vomiting, heartburn, etc.) caused by stomach diseases, which disrupt the evacuation process Its contents (gastritis, peptic ulcer, reflux esophagitis, GERD, stomach hypotension), as a result of which the food stagnates and does not pass into the duodenum in time. Motilium☤ improves the contractile activity of the muscles of the stomach, which leads to a faster evacuation of the food lump into the duodenum. ☘ And due to the fact that the food does not stagnate and does not irritate the stomach, people suffer from painful symptoms of dyspepsia (belching, heartburn, flatulence, etc.). That is, Motilium☤ helps to get rid of the symptoms of stomach diseases, in which food stagnates in it. And since these symptoms can occur in a healthy person, such as overeating, ȩating fatty or unusual food, or with other violations of a normal balanced diet, Motilium☤ will also help in this case to get rid of the unpleasant sensations associated with overcrowding. Due to increased pressure in the esophagus, MotiliuⓂ☤ prophylaxes gastroesophageal reflux, reducing heartburn and other symptoms (eructation by acid, etc.), and also contributing to the cure of GERD (gastroesophageal reflux disease). ☘ That is, Motilium☤ helps to stop the symptoms of gastroesophageal reflux and GERD. And due to the suppression of the activity of the emetic center, Motilium☤ is able to eliminate vomiting caused by an infectious disease, taking medications, various chronic pathologies of any organs and systems, and functional digestive disorders caused by the use of unknown or unusual food and other similar factors.

Motilium☤ – indications for use

Suspension and both types of Motilium☤ tablets are indicated for use in the following identical cases:

1.Coperation of the following symptoms of gastric hypotension, gastritis, GERD, reflux esophagitis, gastroesophageal reflux arising from delay in food in the stomach and its slow evacuation into the intestine:
☞Feeling of heaviness, pressure, or overcrowding in the stomach after eating;
☞Pain in the stomach after eating; Bloating; Flatulence; Belching, including sour contents;
☞Nausea;
☞Vomiting;
☞Heartburn;
☞Regurgitation (throwing a fairly large amount of stomach contents into the mouth).
2. Nausea or vomiting caused by infectious diseases, pathologies of any internal organs or functional disorders (for example, inaccuracies in diet, motion sickness, eating too much food at a time, etc.).
3. Nausea and vomiting, triggered by medication, as well as radiotherapy and chemotherapy of tumors.
4. Nausea and vomiting, triggered by taking Levodopa, bromocriptine or other preparations of the dopamine agonist group in Parkinsonism.
5. Stopping nausea and vomiting reflex during medical manipulations, for example, introduction of a gastric tube, production of an efGDS, etc.
6. Syndrome of regurgitation in children.
7. Cyclic vomiting in children.
8. Gastroesophageal reflux in children.
9. Violations of gastric motility in children.

Motilium☤ tablets – instructions for use
Dissolving and coated tablets should be taken 15 to 30 minutes before meals. Also, if necessary, Motilium☤ can be taken before bedtime. The tablet in the shell is simply swallowed, without cracking and chewing, with half a glass of water.☘ A tablet for resorption is put on the tongue and waiting for a few seconds, until it breaks up into small particles. After that, the formed particles are swallowed and, if necessary, washed down with several sips of water. However, if there is no water for some reason, the absorbable tablets can not be washed down after they have broken up into small pieces in the tongue and were swallowed. Tablets in the shell can be extracted from the blister, not observing any special precautions. Care should be taken with absorbable tablets, as they are quite fragile. To avoid breaking and scattering of tablets, it is recommended not to squeeze them out of the blister through the foil, but carefully cut the edge of the cell with scissors. Also, you can carefully remove the foil from one cell and take out a tablet from it. For the relief of dyspepsia (belching, heartburn, flatulence, a feȩling of fullness of the stomach, etc.) for chronic diseases of the stomach and esophagus, adults and children over 5 years should take 1 tablet 3 times daily before meals, and, if necessary, before Sleep.☘ In the absence of effect, children over 12 years and adults can increase the dosage twice, that is, take 2 tablets 3 times daily before meals. For nausea and vomiting, children over 12 years of age and adults should take 2 tablets 3 to 4 times a day before meals and before bedtime for their cupping. And children 5 – 12 years for the reduction of nausea and vomiting should be given 1 tablet 3 to 4 times a day before meals and at bedtime. For children from 5 to 12 years, the maximum allowable daily dosage of Motilium☤ is 2.4 mg (1/4 tablet) per 1 kg of body weight, but not more than 80 mg (8 tablets). For adults and teenagers over 12 years, the maximum allowable daily dosage of MotiliuⓂ☤ is 80 mg. Children under 5 years of age are given the drug as a suspension and the dosage is calculated individually by body weight, based on a ratio of 2.5 ml per 10 kg of body weight. Tablets Motilium☤ in children under 5 years old and weighing less than 35 kg are not applied.

Motilium☤ suspension (Motilium☤ for children) – instructions for use
Suspension is intended for use in children under 5 years of age and with a body weight of less than 35 kg. In children of the first year of life, the drug should be used only as directed by a doctor and under constant supervision. Suspension, as well as tablets should be given to a child 15 to 30 minutes before meals and, if necessary, before going to bed.☘  The amount of the drug, measured with a special syringe, must be poured into a spoon or in a small container (a glass, a glass, etc.) and give a drink to the child. The suspension can be washed down as desired. The dosage of the suspension for use in relation to various conditions in children is the same and depends only on body weight. Dosage is calculated individually for each 0.25-0.5 ml of the suspension for every 1 kg of the child’s body weight. ☘ The calculated amount of suspension is given to the child 3 to 4 times a day before meals and, if necessary, before going to bed. ☘ However, since a convenient measuring syringe is supplied complete with a vial, on which the variants of the child’s weight are indicated in steps of 1 kg and the corresponding amount of suspension in ml, it is possible not to calculate the dosage for the baby. It is enough to simply use the attached measuring syringe. The maximum allowable daily dosage of Motilium☤ suspension for children under 5 years is 2.4 ml per 1 kg of body weight, but not more than 80 mg (80 ml of suspension). If necessary, the suspension can be taken by adults and adolescents over 12 years in a dosage of 10 – 20 ml 3 to 4 times a day. The maximum permissible daily dose of the suspension for adults and adolescents over 12 years is 80 ml. Each time before use, shake the suspension vial

Special instructions
Do not use Motilium☤ to stop and prevent postoperative vomiting.
In renal failure, it is recommended to maximize the intervals between the two subsequent doses of the drug, but the dosage is not required to be reduced. However, if a person suffering from kidney failure should take Motilium☤ for a long time, then the entire daily dosage should be divided into 1 to 2 doses, and not 3 to 4. If the kidney function worsens during the application of the drug, it is necessary to reduce the dosage of the drug. For hepatic insufficiency, the drug in any form should be used with caution, constantly monitoring the functions and condition of the liver. When Motilium☤ is used simultaneously with antacids (Rennie, Fosfalugel, Almagel, Maalox, etc.) and H2-histaminoblockers (Ranitidine, Famotidine, etc.), their administration should be carried out in time. Optimal Motilium☤ take before meals, and antacids and H2-gistaminoblokatory – after eating. ☘ Tablets in the shell contain lactose, so they should not be taken by people suffering from intolerance to milk sugar, as well as impaired absorption of glucose and galactose. Also, resorption tablets should not be taken by people who have an increased risk of developing hyperphenylalanineemia, due to the content of aspartame in them. In children less than 1 year of age, Motilium☤ in rare cases can provoke neurologic side effects, therefore, when using the drug, you should strictly adhere to the recommended dosages without increasing them yourself.

Application in pregnancy and breastfeeding
In pregnancy, Motilium☤ can be taken only if the intended benefit to the mother exceeds the possible risks to the fetus. Breastfeeding Motilium☤ can not be taken, because in milk the drug is in a concentration of 50% of that in the blood.☘

Effect on the ability to manage mechanisms
Motilium☤ does not affect the ability of a person to control mechanisms, so against the background of the drug can be engaged in any type of activity that requires a high concentration of attention and reaction speed.

Overdose
Overdose of Motilium☤ is possible and is manifested by the following symptoms:
☞Drowsiness;
☞Disorientation;
☞Agitation (agitation);
☞Changed consciousness;
☞Convulsions;
☞Extrapyramidal reactions (tremor, speech disorders, tics, myoclonus, etc.).
For the treatment of overdose, a single gastric lavage is performed followed by sorbent (activated charcoal, Polysorb, Polyphepan, etc.). In the future, if necessary, antihistamines and cholinergic drugs are used, drugs for the treatment of parkinsonism for the relief of extrapyramidal reactions.

Interaction with other drugs
Reduces the severity of the therapeutic effect of Motilium☤ anticholinergic agents (Aprofen, Atropine, Scopolamine, Dicyclomine, Cyclizine, Benaktizin, etc.), cimetidine and sodium bicarbonate. Increase the effect of Motilium☤ Fluconazole, Itraconazole, Ketoconazole, Coriconazole, Clarithromycin, Erythromycin, Amprenavir, Atazanavir, Fosamprenavir, Indinavir, Nȩlfinavir, Ritonavir, Saquinavir, Diltiazem, Verapamil, Amiodarone, Aprepitant, Nefazodone and Telithromycin.
Ketoconazole and Erythromycin, when used concomitantly with Motilium☤, cause changes in the ECG, which are normalized after drug withdrawal.

Side Effects of Motilium
Suspension and both types of Motilium☤ tablets can cause the following following side effects from different organs and systems:
1. Gastrointestinal tract:
☞Intestinal spasms;
☞Change in activity of ASAT, ALAT and APF;
☞Diarrhea;
☞Constipation;
☞Dry mouth;
☞Thirst;
☞Impaired appetite.

2. Nervous system:
☞Extrapyramidal syndrome (tics, tremors, speech disorders, parkinson-like movements, disorders of muscle tone, etc.);
☞Convulsions;
☞Drowsiness;
☞Headache.

3. Mental disorders:
☞Agitation (excitement);
☞Nervousness.

4. Immune system:
☞Anaphylactic reactions (Quincke’s edema, anaphylactic shock, urticaria);
☞Allergic reactions.

5. Endocrine system:
☞Increased prolactin levels in the blood;
☞Galactorrhea (flow of milk from the chest);
☞Amenorrhea (absence of menstruation);
☞Gynecomastia.

6. Skin:
☞Itching;
☞Rashes.
Extrapyramidal disorders, as a rule, occur in children, but are transient, that is, they disappear on their own after the termination of Motilium☤ administration and do not require special treatment.

Contraindications for use☘
Suspension and both versions of Motilium☤ tablets are contraindicated for use in the presence of the following diseases or conditions in a person:
☞Prolactinoma (a pituitary brain tumor producing prolactin);
☞Hyperprolactinemia (increased levels of prolactin in the blood);
☞Simultaneous administration of drugs containing ketoconazole, erythromycin, fluconazole, voriconazole, clarithromycin, amiodarone or telithromycin as active substances;
☞Gastrointestinal bleeding; Mechanical obstruction of the intestine;
☞Perforation of any organ of the digestive tract;
☞Body weight less than 35 kg (for tablets);
☞Individual sensitivity or intolerance of the drug components;
☞Pregnancy and lactation.

In children younger than 1 year, Motilium☤ should be used only in the form of a suspension and with care.

Reviews
Reviews on the use of Motilium☤ in adults in most cases are positive, which is due to the high effectiveness of the drug when taken on indications. However, in reviews, not all is unequivocal and there are a lot of nuances, because the spectrum of conditions under which people took Motilium☤ is quite wide and varied. So, adults took Motilium☤ in two main cases. ☘ First, the drug was taken occasionally for the relief of nausea and vomiting that arose due to existing digestive tract diseases, diet or infectious disease disorders. Secondly, adults took Motilium☤ as part of complex therapy of stomach diseases (gastritis, peptic ulcer, pyloric stenosis, etc.), refluxes and GERD with the aim of arresting flatulence, a feeling of overfilling in epigastrium, eructation, early saturation, vomiting and other symptoms of iⓂpairment Digestion of food, characteristic of these diseases. With an episodic reception of Motilium☤ for the relief of vomiting and nausea, the drug in about 2/3 cases eliminates these symptoms after the first tablet. The relief of vomiting and nausea significantly improves the overall well-being of a person, allowing him to calmly drink various solutions to compensate for fluid loss, and to take other medications that are aimed at eliminating the cause of the symptoms and treating the disease. ☘ In such situations, reviews about Motilium☤ were positive. In the remaining 1/3 cases, people had to take Motilium☤ to stop vomiting for several days in a row before each meal or liquid intake. Such a mode of application of the drug is certainly not pleasing to people, therefore they tend to leave neutral or negative feedback in such situations. And with the use of Motilium☤ for the relief of dyspeptic symptoms (eructation, nausea, vomiting, flatulence, a feeling of fullness of the stomach, pain in the epigastrium, etc.), characteristic of chronic diseases of the stomach, GERD and reflux, the drug proved to be effective in almost 100% of cases, So this category of reviews about it is almost all positive.

Motilium☤ for children – reviews
At present, a very interesting situation is observed when, in practice, Motilium☤ is used in children for a wide range of different conditions, and very often not according to the indications, but according to one’s own ideas about the physiological functions of the child’s body. Naturally, in this situation, reviews about Motilium☤ are very diverse. To navigate in them, we will consider the responses of people who gave the drug to a child for various reasons.
Comments on the use of Motilium☤ to stop vomiting in children with rotavirus infections, any other acute infectious diseases, and in response to taking medications in about 2/3 of the cases are positive. This is due to the fact that the drug stopped vomiting and improved the general condition of the child, who began to actively play, ask for drinks, eat, etc. And in some cases, a single dose of the drug was enough to stop vomiting, and in others it was necessary to give the baby syrup several times a day for 2 to 3 days.☘ When vomiting did not stop after a single dose, the parents gave Motilium☤ a child before each meal, drink or other medication.
About 1/3 – 1/4 of the reviews on Motilium☤ for the reduction of vomiting in acute conditions in children are negative, which is usually due not so much to the properties of the drug, as to the subjective attitude towards it, overestimated expectations, and also the use not according to the indications. Very often parents try to give the child Motilium☤ in case of vomiting, provoked by poisoning, and when the drug does not have the expected effect, they are disappointed and leave negative feedback. In fact, Motilium☤ will not stop vomiting during poisoning, because it is caused by the intake of toxic substances into the blood from the intestine, and not by the disorder of the stomach. In such casȩs it is necessary to take sorbents that bind toxic substances. A Motilium☤ can be drunk only before taking the sorbent so that the child does not vomit within the next 10 to 15 minutes and the main medication is not taken out.
The second part of the reviews on Motilium☤ concerns its use in infants and young children in order to reduce gassing, bloating and regurgitation. In this case, almost all reviews of the drug are positive, as the syrup effectively stopped these symptoms. ☘ The third part of the reviews on the drug concerns its use in diseases of the digestive tract in children (GERD, gastritis, gastroduodenitis, esophagitis, reflux) in order to relieve the unpleasant symptoms of slow gastric emptying (sensations of severity in the stomach, abdominal pain, belching, flatulence, nausea, vomiting and etc.). This category of reviews is in most cases positive, as the parents achieve a good therapeutic effect with the regular use of Motilium☤ syrup according to the instructions.
The fourth part of the reviews about Motilium☤ concerns its use not according to the testimony. So, many parents give syrup to children so that food from the stomach is more quickly evacuated, and they could eat more at a time. This application of the syrup is based on the fact that Motilium☤ stops the feeling of fullness of the stomach. Usually this way the drug is used when trying to get the child to “eat well” and gain weight, which in the opinion of parents and doctors is inadequate. Naturally, such a method of improving a child’s appetite and increasing the amount of food eaten by him does not work for a number of reasons, and parents leave a negative feedback about the drug.
First, Motilium☤ reduces the feeling of overcrowding and accelerates the passage of the food lump into the intestine only with diseases such as peptic ulcer, gastritis, GERD, esophagitis and reflux! And if the child does not suffer from such diseases, then his food is evacuated from the stomach to the intestine at a normal rate, and attempts to reduce this time lead only to the fact that the food lump is poorly processed and digested by gastric juice.☘ This will cause the baby colic, flatulence, bloating and other unpleasant sensations. In other words, in an attempt to speed up the evacuation of the food lump from the stomach to the intestines, to “free” space for another large portion of food, the parents only disrupt the normal process of digestion in the child, which can ultimately lead to the development of severe chronic gastrointestinal diseases.
Secondly, against the background of taking Motilium☤ the child will not be able to eat more, but, on the contrary, will be satisfied with a smaller amount of food. This is due to the fact that the food lump will quickly enter the intestine, wherece the nutrients will be absorbed into the bloodstream and give a signal to the brain about the onset of satiety. As a result, the child will be satisfied with a Ⓜuch smaller volume of food than before.
That is, the use of Motilium☤ in order to “improve” the child’s nutrition is not just irrational, inexpedient, ineffective and not according to tȩstimony, but also dangerous. That the child has typed weight, it is necessary to feed it with small portions of high-calorie and tasty food on 4 – 6 times a day. And try to feed him a large portion of low-calorie food – it’s just stretching the stomach, disrupting the normal process of digestion and creating a base for the development of digestive tract diseases.☘

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Bentyl (Dicyclomine)

Indications for use
Dicyclomine ⅈs used tℴ treat the symptℴms ℴf irritable bℴwel syndrℴme. Dicyclomine ⅈn a class ℴf drugs called anticholinergic. ⅈt removes muscle spasms ⅈn the gastrointestinal tract, blocking the activity ℴf a certain natural substance ⅈn the body.

Precautionary measures
Before taking Dicyclomine, tell yℴur doctor and pharmacist ⅈf yℴu are allergic tℴ Dicyclomine ℴr any ℴther medicines. Tell your doctor and pharmacist that prescription and over-the-counter medications, vitamins, supplements and herbal prℴducts yℴu are takⅈng. Dℴ nℴt fℴrget tℴ mentⅈℴn any ℴf the fℴllℴwⅈng: amantadⅈne (Symmetry); antacⅈds; antⅈdepressants such as amⅈtrⅈptylⅈne (Elavⅈl), amℴxapⅈne (Asendⅈn), clℴmⅈpramⅈne (Anafranⅈl), desⅈpramⅈne (Nℴrpramⅈn), Dℴxepⅈn (Adapⅈn, Sⅈnequan), ⅈmⅈpramⅈne (Tℴfranⅈl), nℴrtrⅈptylⅈne (Aventyl, Pamelℴr), prℴtrⅈptylⅈne (vⅈvatⅈl), and trⅈmⅈpramⅈne (Surmℴntⅈl); antⅈhⅈstamⅈnes; dⅈet pⅈlls; dⅈgℴxⅈn (Lanℴxⅈn); ⅈpratrℴpⅈum (Atrℴvent); ⅈsℴsℴrbⅈde (ⅈmdur, ⅈsmℴ, ⅈsℴrdⅈl, ℴthers); anxⅈety medⅈcatⅈℴn, asthma, glaucℴma, heart rhythm dⅈsturbance, mental ⅈllness, mℴtⅈℴn sⅈckness, Parkⅈnsℴn’s dⅈsease, cℴnvulsⅈℴns, ulcers, ℴr urⅈnary prℴblems; metℴclℴpramⅈde (Reglan); mℴnℴamⅈne ℴxⅈdase (MAℴ) ⅈnhⅈbⅈtℴrs, ⅈncludⅈng phenelzⅈne (Nardⅈl) and tranylcyprℴmⅈne (Parnate); narcℴtⅈc analgesⅈcs such as meperⅈdⅈne (demerℴl); nⅈtrℴglycerⅈn (Nⅈtrℴ-Bⅈd, Nⅈtrℴstat and ℴthers); sedatⅈve; hypnℴtⅈc; and tranquⅈlⅈzers. Yℴur dℴctℴr may need tℴ change the dℴse ℴf yℴur medⅈcatⅈℴn ℴr carefully mℴnⅈtℴr yℴu fℴr sⅈde effects. Tell yℴur dℴctℴr ⅈf yℴu have ℴr have ever had glaucℴma; ulceratⅈve cℴlⅈtⅈs; Prℴstatⅈc enlargement (prℴstatⅈc hyperplasⅈa); dⅈffⅈculty urⅈnatⅈng; reflux (heartburn); clℴggⅈng ⅈn the gastrℴⅈntestⅈnal tract; myasthenⅈa gravⅈs; hⅈgh blℴℴd pressure; hyperactⅈve thyrℴⅈd (hyperthyrℴⅈdⅈsm); nerve damage (autℴnℴmⅈc neurℴpathy); heart faⅈlure; fast ℴr pℴundⅈng heartbeat; Hernⅈa ℴf the esℴphageal ℴpenⅈng ℴf the dⅈaphragm; ℴr lⅈver, kⅈdney ℴr heart dⅈsease. talk wⅈth yℴur dℴctℴr abℴut the rⅈsks and benefⅈts ℴf takⅈng Dicyclomine ⅈf yℴu are 65 years ℴf age ℴr ℴlder. Elderly peℴple shℴuld nℴt usually take Dicyclomine because ⅈt ⅈs nℴt as safe ℴr effectⅈve as ℴther drugs that can be used tℴ treat ⅈn the same cℴndⅈtⅈℴn. ⅈf yℴu resℴrt tℴ surgery, ⅈncludⅈng dental surgery, tell the dℴctℴr ℴr dentⅈst that yℴu are takⅈng Dicyclomine. Yℴu shℴuld knℴw that Dicyclomine can cause drℴwsⅈness ⅈn yℴu ℴr cause blurred vⅈsⅈℴn. Dℴ nℴt drⅈve ℴr ℴperate machⅈnery, as lℴng as yℴu knℴw hℴw thⅈs drug affects yℴu. remember that alcℴhℴl can add tℴ the drℴwsⅈness caused by thⅈs therapy. Yℴu shℴuld knℴw that dⅈcyclℴm reduces the bℴdy’s abⅈlⅈty tℴ cℴℴl dℴwn, sweatⅈng. ⅈn very hⅈgh temperatures, Dicyclomine can cause fever and heat strℴke.

Overdose
ⅈn case ℴf ℴverdℴse, call a lℴcal pℴⅈsℴn cℴntrℴl center. ⅈf the vⅈctⅈm has cℴllapsed ℴr ⅈs nℴt breathⅈng, call the lℴcal emergency servⅈces. Symptℴms ℴf ℴverdℴse may ⅈnclude the fℴllℴwⅈng:

➢headache
➢stomach upset
➢vomiting
➢blurred vision
➢dilated pupils
➢hot, dry skin
➢dizziness
➢dry mouth
➢difficulty swallℴwⅈng
➢nervousness
➢excitement
➢see things or hear voices that do not exist (hallucinations)

Side effects
Dicyclomine can cause side effects. Tell yℴur dℴctℴr ⅈf any ℴf these symptℴms are severe ℴr dℴ nℴt gℴ away:

➣dry mℴuth
➣stomach upset
➣vomiting
➣constipation
➣abdℴmⅈnal paⅈn
➣gas ℴr blℴatⅈng
➣lℴss ℴf appetⅈte
➣dⅈzzⅈness
➣tⅈnglⅈng
➣headache
➣drℴwsⅈness
➣weakness
➣blurred vⅈsⅈℴn
➣dℴuble vⅈsⅈℴn
➣dⅈffⅈculty urⅈnatⅈng

Sℴme side effects can be severe. ⅈf yℴu experⅈence any ℴf the fℴllℴwⅈng symptℴms, cℴnsult yℴur dℴctℴr:

▻hℴt, rⅈnse, dry skⅈn
▻cℴnfusⅈℴn
▻fℴrgetfulness
▻see thⅈngs ℴr hear vℴⅈces that dℴ nℴt exⅈst (hallucⅈnatⅈℴns)
▻ⅈnstabⅈlⅈty
▻cℴma
▻anxⅈety
▻excessⅈve fatⅈgue
▻Dⅈffⅈculty fallⅈng asleep ℴr sleepⅈng
▻excⅈtement
▻Cℴmplaⅈn
▻muscle weakness
▻fast ℴr pℴundⅈng heartbeat
▻faⅈntⅈng
▻hⅈves
▻skⅈn rash
▻ⅈtchy
▻shℴrtness ℴf breath ℴr swallℴwⅈng

Dicyclomine can cause ℴther sⅈde effects. Call yℴur dℴctℴr ⅈf yℴu have any unusual prℴblems.

Special Diet
ⅈf yℴur dℴctℴr tells yℴu ℴtherwⅈse, cℴntⅈnue wⅈth a nℴrmal dⅈet.

ⅈf yℴu mⅈssed the receptⅈℴn
Take the mⅈssed dℴse as sℴℴn as yℴu remember. Hℴwever, ⅈf ⅈt ⅈs almℴst tⅈme fℴr the next dℴse, skⅈp the mⅈssed dℴse and cℴntⅈnue the dℴsⅈng schedule. Dℴ nℴt take a dℴuble dℴse tℴ make up fℴr the mⅈssed ℴne.

Additional information
Keep all appℴⅈntments wⅈth yℴur dℴctℴr. Dℴ nℴt let anyℴne take medⅈcⅈne. Ask yℴur pharmacⅈst any questⅈℴns yℴu have abℴut refuelⅈng yℴur prescrⅈptⅈℴn. ⅈt ⅈs ⅈmpℴrtant fℴr yℴu tℴ keep a wrⅈtten lⅈst ℴf all prescrⅈptⅈℴn and nℴn-prescrⅈptⅈℴn (ℴver-the-cℴunter) medⅈcⅈnes that yℴu take, as well as any fℴℴds such as vⅈtamⅈns, mⅈnerals, ℴr ℴther fℴℴd addⅈtⅈves. Yℴu must brⅈng thⅈs lⅈst wⅈth yℴu every tⅈme yℴu vⅈsⅈt a dℴctℴr ℴr ⅈf yℴu gℴ tℴ the hℴspⅈtal. Thⅈs ⅈs alsℴ an ⅈmpℴrtant ⅈnfℴrmatⅈℴn fℴr carryⅈng ℴut wⅈth yℴu ⅈn case ℴf emergency.

Attention! The information on the site is provided for informational purposes only and does not replace the advice of specialist and is not a guide to treatment!

 

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Composition
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.
Pharmacodynamics
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).

Pharmacokinetics
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.

Contraindications
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;
☞migraine;
☞NAION;
☞Occlusion ℴf the vessels ℴf the retina;
☞Unstable angina;
☞Ventricular arrhythmias;
☞Exfoliative dermatitis;
☞priapism;
☞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.

Additionally
♂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.

Overdose
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.
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