MAXIGRA
a substitute for Viagra
Generic Viagra
Maxigra is a result of new methods of synthesis of sildenafil (Generic Viagra), developed by a team of researchers from the Institute of Pharmacy under the supervision of Professor Osman Achmatowicz.
In 1999, Polpharma, together with the Institute Farmaceutical reported to the invention of Polish Patent Office and 13 March this year received a patent for a process of synthesis.
Men are ashamed of doctors and pharmacists
The vast majority of men ashamed to be doctors and the willingness to (buy viagra) in pharmacies online.
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50 mg, 100 mg film-coated tablet1 tablet contains sildenafil respectively in quantity: 50 mg, 100 mg in the form of sildenafil citrate.
- Indications for use
- The dosage and method of administration
- Contraindications
- Special warnings and precautions for use
- Interactions with other drugs and other forms of interaction
- Side effects
- Overdose
- Pharmacological Properties
- The list of excipients
Indications for use
Treatment erekcji disorder, defined as the inability to obtain or utrzymania wzwodu penis enough to hold a sexual relationship. Preparation MAXIGRA helps achieve wzwód only subject to prior sexual arousal. Preparation MAXIGRA is not intended for use in women.The dosage and method of administration
Maxigra® - POLPHARMA S.A
Adults:
The recommended starting dose is 1 tablet 50 mg of sildenafil. The dose can be increased to 100 mg or reduced to 25 mg, depending on the effectiveness and tolerance of medicine. Do not use doses greater than 100 mg. Acceptance of preparation in doses greater than 100 mg of sildenafil does not increase its effectiveness, while increasing the incidence and severity of side effects. Do not use the preparation more often than once a day. Preparation MAXIGRA should take about 60 minutes before the start of sexual activity. Tablet should swallow whole, sufficient small amounts of water. Accepting the preparation of food may delay the start of operation of the medicine.
Elderly:
Elderly patients metabolism of sildenafil can be released, so it is advisable to reduce the dose of initial preparation to 25 mg of sildenafil. Another dose, depending on the effectiveness and tolerance of drug may be increased to 50 mg and 100 mg. Children: Preparation MAXIGRA is not indicated in patients aged below 18 years.
The use in patients with impaired renal function:
In patients with light to moderate impaired renal operations (creatinine clearance between 30-80 ml / min) change the dose of sildenafil is not necessary. In patients with severe renal insufficiency (creatinine clearance <30 ml / min) recommends a reduction in the first dose to 25 mg. Another dose can be increased to 50 mg and 100 mg, depending on the effectiveness and tolerance of medicine.
The use in patients with impaired liver function:
In patients with impaired liver disease (for example, in the marskości) metabolism of sildenafil is reduced. Therefore, in patients with mild to moderately impaired liver function, it is advisable to reduce the first dose to 25 mg. Another dose, depending on tolerance and efficacy may be increased to 50 mg and 100 mg. Due to the lack of properly controlled studies should not be used drug in patients with severe liver failure.
The use in patients taking other drugs:
In patients receiving both izoenzymu CYP3A4 inhibitors should be considered starting dose of 25 mg. The exception is ritonavir, which is not recommended for use concomitantly with sildenafil Syldenafilu (at a dose of> 25 mg) should not be used within 4 hours after the adoption of drug-α adrenolitycznego.
Contraindications
- Hypersensitivity to sildenafil or any of the ingredients
- Medications to help achieve wzwód, including sildenafil, should not be used in patients who are contraindicated sexual activity (for example in patients with severe disease cardiovascular diseases, such as unstable coronary artery disease, severe heart failure)
- Since sildenafil intensified action hypotensive medication release nitric oxide (such as nitrates, molsydominy, nitroprusydku sodium) preparation should not be used in patients treated with nitrates and other medicines uwalniającymi nitric oxide
- Due to the lack of properly controlled studies, the use of the preparation is contraindicated in patients with severe liver failure, arterial hypotension (blood pressure values of less than 90/50 mmHg), przebytym after recent myocardial infarction or stroke and brain in patients with inherited retinal degenerative diseases ( such as retinitis pigmentosa)
Special warnings and precautions for use
Before the start of sildenafil treatment of the patient should be subjected to medical examination to determine the cause disorder erection.- Since there is a risk of complications from cardiovascular diseases associated with sexual activity, before the start of sildenafil treatment should be assessed viability cardiovascular. Sildenafil has jurisdiction extending the blood vessels, which can cause mild, short-term reduction in blood pressure
- During clinical trials found no statistically significant differences in the occurrence of serious disruption to operations cardiovascular between groups of patients receiving sildenafil patients receiving a placebo (a rate of mortality was similar in both groups - 0.45 in the receiving sildenafil group and 0.57 in the placebo group). In any case, death did not identify the causal link between the adoption of sildenafil and the occurrence of death of the patient
- Following the introduction of sildenafil experience reports of the presence of heavy disruption operations cardiovascular (including myocardial infarction, unstable angina, sudden death, cabinets arrhythmias, intracranial bleeding, transient attacks niedokrwienne (TIA), hypertension and hypotension ) In a short period of time after the adoption of medicine. In most cases, identified the presence of pre-existing risk factors of diseases cardiovascular. A significant proportion of these disturbances occurred during intercourse or sex in a short period after its completion. In several cases, these disorders occurred shortly after the adoption of sildenafil before sexual activity took place. So far there are no data whether the severe impairment of cardiovascular diseases are associated with the imposition of existing risk factors, cardiovascular disease and increased sexual activity, or whether there are other reasons for their occurrence.
- Medications to help obtain wzwód, including sildenafil, should be used with caution in patients with co-anatomical irregularities penis (eg zwłóknienie bodies jamistych, Peyronie's disease) and patients with diseases predysponującymi to come priapizmu (sierpowatokrwinkowa such as anaemia, leukaemia, multiple myeloma)
- We do not recommend the use of sildenafil simultaneously with other methods of treatment erekcji disorder, due to a lack of studies proving the safety and effectiveness of such treatment.
- In vitro studies showed that sildenafil increasing antyagregacyjne action nitroprusydku sodium. There are no data on the safety of sildenafil in patients with impaired hemostasis and in patients with active owrzodzeniem within the digestive tract. Preparation MAXIGRA be used in these patients only when the benefits of the treatment of disorders erekcji prevail potential risk of bleeding.
- We do not recommend the use of sildenafil and ritonavir
Interactions with other drugs and other forms of interaction:
- Sildenafil increased hypotensive action medicines release nitric oxide (such as nitrates, molsydominy, nitroprusydku sodium) and therefore the preparation MAXIGRA in patients treated with nitrates or other drugs uwalniającymi nitric oxide is contraindicated.
- Sildenafil is metabolized in the liver by the cytochrome P450 (CYP), mainly by its izoenzym 3A4 and to a lesser extent by izoenzym 2C9. In clinical studies showed that the concomitant use of sildenafil with drugs inhibit CYP3A4 (eg, ketoconazole, erythromycin, cimetidine), the metabolism of sildenafil is reduced. Therefore, in the case of the simultaneous use of sildenafil and inhibitors of CYP3A4, it is advisable to reduce the initial dose of sildenafil to 25 mg.
- During concomitant use of sildenafil inhibitors CYP2C9 (tolbutamidem for example, warfarin, fenytoiną) has not shown the effects of these drugs on the pharmacokinetics of sildenafil
- During the simultaneous application of the HIV protease inhibitor ritonavir, which is a potent inhibitor of cytochrome P450 metabolism of sildenafil is significantly reduced. It is therefore not advisable to their concomitant use. In the case of the need for simultaneous use of sildenafil with ritonavir dose of sildenafil should not be greater than 25 mg per 48 hours.
- Concomitant use of sildenafil and HIV protease inhibitor sakwinawiru increases the concentration of sildenafil in blood plasma
- Sildenafil administered 100 mg did not affect the pharmacokinetics of ritonavir and sakwinawiru
- Grapefruit juice (weak inhibitor of CYP3A4) may cause a moderate increase in plasma concentrations of sildenafil
- It has not been demonstrated with a group of drugs CYP2D6 inhibitors (such as selective serotonin-back capture inhibitors, tricyclic antidepressants) on the pharmacokinetics of sildenafil
- There are no data indicating that tiazydowe diuretics, pętlowe diuretics and potassium sparing diuretics, angiotensin converting inhibitors, calcium channel antagonists, drugs β-adrenolityczne medicines and inducers of cytochrome P450 (eg barbiturany, rifampicin) affect the metabolism of sildenafil
- Sildenafil is a weak inhibitor izoenzymów cytochrome P450 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4. As the concentration of sildenafil in plasma, in which he has a deterrent effect on cytochrome P450 isoenzymes is several times greater than the maximum concentration of drug in plasma after the adoption of therapeutic doses, do not expect the impact of sildenafil on the metabolism of drugs that are substrates of these enzymes.
- There are no data indicating the existence of interaction between sildenafil and nieswoistymi phosphodiesterase inhibitors (eg, theophylline, dipirydamolem)
- During concomitant use of sildenafil, acetylsalicylic acid, sildenafil not nasilał action of acetylsalicylic acid, which result in increased bleeding time
- There have been observed increase in side effects, using sildenafil with drugs while dropping blood pressure of the following groups: diuretics, anticonvulsants β-adrenolityczne, angiotensin converting inhibitors, angiotensin II receptor antagonists, antihypertensive medication for immediate action expanding the dish, antihypertensive drugs with a central, drugs affecting pozazwojowe neurones adrenergic, calcium channel antagonists
- Sildenafil to be used with caution in patients using medications α-adrenolityczne. In patients receiving medication α-adrenolityczne while using sildenafil (especially at a dose of> 25 mg) within 4 hours after the adoption of sildenafil may be symptomatic hypotension
- Sildenafil administered 100 mg for patients with hypertension treated amlodipine increased hypotensive action of amlodipine (reduction skurczowego and diastolic pressure by 8 mmHg and 7 mmHg). Similar action hypotensive sildenafil were observed in healthy volunteers.
- A single dose of antacids (magnesium hydroxide or aluminium hydroxide) does not affect the bioavailability of sildenafil
- Sildenafil taken at a dose of 50 mg for healthy volunteers at the same time, alcohol is not nasilał action hipotensyjnego alcohol. However, since alcohol can temporarily impair the ability to achieve wzwodu, does not recommend the consumption of large quantities of alcohol while taking sildenafil.
Preparation MAXIGRA is not indicated for use in women. Syldenafil podawany doustnie szczurom i królikom nie wykazywał szkodliwego działania na reprodukcję. Sildenafil orally administered to rats and rabbits showed no harmful effects on reproduction
The impact on the ability to drive and use machines
Since sildenafil can cause dizziness and blurred vision, patients before carrying out the drive and handling machinery should know how to react to the medicine.
Side effects
These side effects were usually mild or moderate in nature bolstered, and their frequency and intensity increased with increasing doses. In clinical trials reported the following side effects: Very often (≥ 1 / 10):- headache
- hot flushes
- dizziness
- palpitations
- feeling nose
- indigestion
- visual disturbances, such as color vision, poświatą, hypersensitivity to light, blurred vision
Source: POLPHARMA S.A