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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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♻Analog♻

Other names for this medication:
Aciban-dsr, Adzole-dm, Agilam, Apentral, Apuldon, Arcelenan, Atidon, Avizol-d, Avomit, Benzilum, Bipéridys, Bompy, Canozol-d, Cilroton, Cinet, Cobaperidon, Costi, Cosy, Coszol-d, Dalic, Dany, Deflux, Degut, Depam, Diocid-d, Docivin, Dolium, Dombaz, Domedon, Domepraz, Domerdon, Dometa, Dometic, Domezol, Domilin, Domilux, Domin, Dominal, Dominat, Dompan, Domped, Dompel, Dompenyl, Domper, Domperdone, Domperidona, Domperidoni maleas, Domperidonmaleat, Domperidonum.

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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♻Analog♻

Other names for this medication:
Algermin, Bentylol, Berclomine, Byclomine, Colchimax, Colicon, Colimix,  Cosaichill, Cyclominol, Cyclopam, Cyclopan, Cymine, Dibent, Diciclomina, Dicicloverina, Dicomin, Dicycloverin, Dicycloverine, Dicycloverinum,  Dicymine, Difemic, Formulex, Kolantyl, Loverin,   Magesan p, Mainnox, Merbentyl, Notensyl, Or-tyl, Relestal, Resporix, Trigan.

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.
☯Customers who bought this product also bought:    Motilium,  Levothroid, Bentyllisinopril,
Caps NPXL ,  Ciprolady era , Fildena, Neurotin, dutasteride.

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