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Other names for this medication:
Adcirca, Snafi, Zydalis.

Apcalis SX 20 mg
Are available
The drug is manufactured in India by Ajanta Pharma Ltd. Effective for 36 hours; the effect occurs approximately 30 minutes after ingestion. The main active ingredient is Tadalafil 20 mg. Form release – tablets in a blister. Possible side effects; there are contraindications. Before use, read the instructions.

Ajanta Pharma Limited is an Indian pharmaceutical company that has released a new drug for the treatment of erectile dysfunction – Apcalis SX. At the moment, Apcalis is one of the most popular generics of Cialis. Sale of Apcalis is conducted in twenty-five countries of the world. The guarantor of the highest quality of the drug is that it is approved by US experts. In addition, the company itself Ajanta Pharma Ltd – a solid manufacturer with a worldwide reputation. It has a network of scientific laboratories, and all the funds released to it have undergone numerous studies and tests. Therefore, you can buy Apcalis with full confidence in the excellent result and safety.

Apcalis. Description of the preparation
So, Apcalis is a high-quality generic Cialis. It is produced by the same chemical formula as Cialis, has all the properties and effectiveness of the original and contains the same active substance – Tadalafil, belonging to the group of selective inhibitors. Its effect begins 30 minutes after oral administration and lasts about 36 hours.

Apcalis

The effect of the drug appears during a natural sexual stimulation, which causes the release of nitric oxide, a delay in the production of PDE-5. In the cavernous body of the penis, the level of cGMP increases. As a result, there is a relaxation of the smooth muscles of the vessels and the blood flow to the penis is activated, which causes an erection. Without sexual stimulation, these processes are not started. Admission of low-fat and not too abundant food does not affect the degree and level of absorption of Tadalafil.

When to take the Apcalis
The drug is taken in all forms and degrees of severity of erectile dysfunction. In addition, its safety and good tolerance make it possible to buy Apcalis and use it to prevent such disorders and to improve the quality of sexual intercourse.

Method of taking the drug
Tablets of Apcalis SX should be chewed well and washed down with a small amount of water or juice. Do not drink the product with grapefruit juice. Some of the substances that it contains are not combined with Tadalafil and can cause unpredictable consequences up to the symptoms of an overdose.

Fatty foods delay the process of absorption of the active substance into the blood. Alcohol dramatically reduces the sensitivity of the penis, so large doses of it should not be consumed with the drug. If you have a feast before sex, then you can afford a light dinner with a glass of wine.

The recommended initial dose of Apcalis is 10 mg. If it does not give the desired effect, then you can increase it to 20 mg. The interval between receptions of the remedy should not be less than 24 hours.

Contraindications to admission
Sale of Apcalis is carried out without prescriptions. But before taking the drug, you should consult your doctor to rule out possible contraindications.

The drug is contraindicated:

☞ with increased sensitivity to Tadalafil;
☞ multiple myeloma;
☞ sickle-cell anemia;
☞ leukemia;
☞ renal failure;
☞ any deformation of the penis;
☞ hepatic insufficiency;

Drug use is inadmissible by women and children under 18 years of age.

Use Tadalafil not together with the means containing nitrates, nitrogen oxides. The drug does not combine with ketoconazole, rifampicin, ritonavir, sancvinavir, erythromycin, intraconazole, and other means against erectile dysfunction.

In addition, care should be taken when taking the remedy for those who have suffered a stroke or myocardial infarction, who suffer from unstable blood pressure.

Side effects
Side effects with the use of Apcalis – a phenomenon, quite rare. But there may be: flushing to the face, dizziness or headache, myalgia, back pain, nasal congestion, nausea, indigestion, visual impairment (briefly), arrhythmia, painful erection, heart attack.

Overdose
Overdose can occur if the maximum allowable dose is exceeded – 20 mg or a reduction in the time between doses – less than 24 hours. In this case, there may be pronounced side effects. If you notice such symptoms, immediately call a doctor who will wash the stomach, cleanse the blood from toxins and prescribe the necessary treatment.

Buy Apcalis in a pharmacy online is more convenient and profitable.

It is much more convenient than in a typical city pharmacy, because:
no need to go anywhere. This saves time. It is enough to call the phone indicated on the site, or fill out the proposed order form and simply wait for the delivery of the purchase by mail or courier, doing your own business;
online purchase involves complete confidentiality, which can not be achieved with a purchase in a city pharmacy, where there are always other customers behind you. If you decide to order Apcalis online, then you will only deal with one manager by phone or by feedback form. If necessary, you will receive any advice from him.

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The desire to be in bed is always on top, peculiar to every man. After all, it is confidence in his sexual abilities that gives him special pride and guarantees stability in personal relationships. But various adverse factors – both psychogenic and physiological, can affect health and significantly shake it. Fortunately, modern pharmaceutical developments allow many men to regain full sexual relations – such drugs include tablets to increase the potency of the world-famous brand Fildena.

Fildena 100 – tablets to strengthen potency based on sildenafil

One of the most popular and modern means for correcting erectile dysfunction is the Fildena 100 preparation. This effective and safe remedy is prescribed for men of any age and with varying degrees of severity of erectile dysfunction. To buy tablets to improve the potency of Fildena 100 is also recommended in case a man can not only reach, but also keep an erection long enough for full sexual intercourse.

As an active ingredient, this drug comprises a Sildenafil substance in the amount of one hundred milligrams. Sildenafil belongs to the class of substances that inhibit phosphodiesterase. Elimination of erectile dysfunction and persistent erection is due to the fact that when the onset of stimulation the drug contributes to a powerful blood flow to the penis of a man. Tablets for the potency of Fildena 100, buy and which is recommended only after consultation with a doctor, can be used both once, and by the course, with individually set dosage. It is also important to take into account the general state of health and the existing diseases. Order Fildena 100 can safely and those who are planning a healthy offspring, because the drug does not affect the motility of sperm and male sex hormones.

From this popular brand, we also recommend to consider the drug Fildena Super Active, released in the form of capsules, which is much faster and better absorbed.

Main characteristics of the drug Fildena 100
Full name of the drug Fildena 100 Sildenafil Citrate Tablets 100 mg. The manufacturer is a well-known Indian enterprise specializing in the production of high-quality medicines, Fortune Health Care.

The dosage of 100 milligrams in which the drug is released is standard, intended for a one-day daily intake. Take the tablet inside whole, it is recommended to drink with plain water. The effect of taking Fildena 100 mg occurs on average 45-50 minutes. The duration of the drug is about 4-5 hours. In this interval, a man can perform sexual intercourse. Do not be afraid of manifestations of uncontrolled erection – it will appear only under the condition of sexual stimulation and stimulation.

It should be noted that Fildena 100 has certain contraindications and is not taken with alcoholic drinks and certain medicines, for example, organic nitrates, alpha and beta blockers, a number of antifungal and antiviral agents. Grapefruit juice can increase the level of active substance and contribute to the appearance of side effects.

Contraindicated remedy for those who have severe diseases of the cardiovascular system, serious diseases of the liver and kidneys, suffers from instability of blood pressure, allergic reactions, hereditary diseases of the eyes or diabetes.

In general, Fildena 100 is well tolerated, but sometimes headaches, nausea, manifestations of rhinitis, diarrhea, ringing in the ears, photosensitivity are possible.

Do not despair, if at some point you felt a decrease in their male abilities. Reliable and safe means Fildena 100 will return the joy of full-fledged sex into your life and fill it with new vivid sensations!
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NPHL in the capsules

NPHL consists of natural herbs, improves and restores blood flow to the genitals, gives the man a lot of strength and self-confidence and unforgettable insights from a healthy and prolonged erection, when your penis is 50% larger than before then and the level of self-esteem rises, which contributes to rapid restoration and strengthening of a sexual life.

Apply herbal NPHL one capsule in the morning and one capsule in the evening with milk.

The initial course of taking NPHL capsules is from forty to forty-five days, but one must understand that the longer NPHL capsules are taken, the more chances of complete penis enhancement, the enjoyment of a healthy erection during intercourse and a full, vigorous, sexual life!

Precautionary measures 

NPHL consists of natural ingredients, so the drug does not harm the body, but before use, you need to consult a specialist especially who uses other drugs.

NPHL begins to act about thirty minutes after admission

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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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➡ Symptoms of impotence in men ⚠

➡ Increase the potency of folk remedies ⚠

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