Novagra tablets 100mg 4

Novagra tablets 100mg 4

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Composition active ingredient: sildenafil; 1 tablet contains sildenafil citrate, equivalent to sildenafil 25 mg or 50 mg, or 100 mg excipients: calcium hydrogen phosphate, cellulose microcrystalline, croscarmellose sodium, povidone, silica colloidal anhydrous, magnesium stearate, instachat IC-S-091 (pink). Dosage form Tablets, film-coated. The main physical and chemical properties: tablets 25 and 50 mg-round pink biconvex tablets covered with a film shell with a notch on the one hand and smooth on the other hand. Tablets 100 mg - round pink biconvex tablets, film-coated, plain on both sides. Pharmacological group Remedies used for erectile dysfunction. Sildenafil. ATC code G04B E03. Pharmacological properties Pharmacological. Sildenafil is an oral drug intended for the treatment of erectile dysfunction. When sexual excitation of the drug is reduced restores erectile function by increasing blood flow to the penis. Physiological mechanism that leads to erection, including the release of nitric oxide (NO) in cavernous bodies during sexual arousal. The released nitric oxide activates the enzyme guanylate cyclase, which stimulates an increase in the level of cyclic guanosine monophosphate (cGMP), which, in turn, causes relaxation of the smooth muscles of cavernous bodies, contributing to blood flow. Sildenafil is a potent and selective inhibitor of cGMP-specific phosphodiesterase 5 (PDE-5) in cavernous bodies, where PDE-5 is responsible for the breakdown of cGMP. The effects of sildenafil on erection are peripheral character. Sildenafil does not have a direct relaxing effect on isolated human cavernous bodies, but powerfully enhances the relaxing effect of NO on this tissue. When you activate a metabolic pathway NO/cGMP, what happens when sexual stimulation, inhibition of PDE5 sildenafilom leads to increased levels of cGMP in the cavernous bodies. Thus, in order for sildenafil to cause the necessary pharmacological effect, sexual arousal is necessary. In vitro studies have shown the selectivity of sildenafil exposure to PDE-5, which is actively involved in the erection process. The effect of sildenafil on PDE5 is more powerful than on other known phosphodiesterases. This effect is 10 times more powerful than the effect on PDE6, which is involved in the processes of photo-rotation in the retina. When using the maximum recommended doses of selectivity of sildenafil in PDE-5 to 80 times greater than its selectivity for ФДЕ1, 700 times higher than in ФДЕ2, PDAS, ФДЕ4, ФДЕ7, ФДЕ8, ФДЕ9, ФДЕ10 and ФДЕ11. In particular, the selectivity of sildenafil in PDE5 4000 times greater than its selectivity for FDEZ - cGMP-specific PDE isoforms involved in the regulation of cardiac contractility. In studies to estimate the time during which the use of sildenafil leads to erection in response to sexual stimulation, the median time before erection in patients who have achieved 60% rigidity erection (sufficient for sexual intercourse) was 25 minutes (in the range of 12-37 minutes). In another study, sildenafil was still able to cause an erection 4-5 hours after application. Sildenafil causes a slight and short-term decrease in blood pressure, in most cases, has no clinical manifestations. These decreases in blood pressure are in good agreement with the vasodilating effect of sildenafil, possibly as a result of increased levels of cGMP in the smooth muscle of the blood vessels. Single oral administration of sildenafil at doses up to 100 mg in healthy volunteers did not lead to any clinically significant changes in ECG. The study hemodynamic effects of single oral sildenafil in a dose of 100 mg in patients with severe coronary artery disease (stenosis at least one coronary artery more than 70%) average systolic and diastolic blood pressure at rest decreased by 7% and 6% respectively relative to the original level. The average pulmonary systolic blood pressure decreased by 9%. Sildenafil would not lead to a change in the parameters of cardiac output and did not reduce blood flow through stenosed coronary arteries. No clinically significant differences were demonstrated for the time before the occurrence of limiting angina in the use of sildenafil compared with placebo. Easy and temporary violation of the ability to distinguish colors (blue/green) was detected in some patients after use of sildenafil at a dose of 100 mg. These effects completely disappeared in 2:00 after the drug administration. Sildenafil does not affect visual acuity or contrast sensitivity. In patients with documented macular dystrophy (n = 9), the use of sildenafil (once at a dose of 100 mg) did not lead to significant changes in the results of the studies (visual acuity, Amsler grid, simulation of traffic light color recognition, Humphrey perimeter and photostress). Single oral administration of sildenafil to healthy volunteers did not affect sperm motility or morphology. Pharmacokinetics. Absorption. Sildenafil is rapidly absorbed. The maximum plasma concentration of the drug is achieved within 30-120 minutes (with a median of 60 minutes) after its oral administration on an empty stomach. The average bioavailability after oral administration is 41% (with a range of values from 25 to 63%). In the recommended dose range (25 to 100 mg), AUC and max sildenafil after oral administration are increased in proportion to the dose. In the application of sildenafil during meals extent of absorption is reduced, with an average lengthening of the T max of 60 minutes and an average reduction in C max of 29%. Distribution. The average equilibrium volume of distribution (V d ) is 105 liters, which indicates the distribution of the drug in the body tissues. After a single oral administration of sildenafil at a dose of 100 mg, the average maximum total plasma concentration of sildenafil is approximately 440 ng/ml (coefficient of variation is 40%). Since the binding of sildenafil and its main N-desmetil metabolite with plasma proteins 96%, the average maximum plasma concentration of free sildenafil reaches 18 ng/ml (38 nmol). The degree of binding to plasma proteins does not depend on the total concentrations of sildenafil. Metabolism. Sildenafil metabolism is carried out mainly with the participation of microsomal liver isoenzymes CYP3A4 (the main path) and CYP2C9 (minor route). The main circulating metabolite is formed by n-demethylation of sildenafil. The selectivity of the metabolite relative to PDE - 5 is comparable to the selectivity of sildenafil, and the activity of the metabolite relative to PDE-5 is approximately 50% of the activity of the starting substance. Plasma concentrations of this metabolite are approximately 40% of the concentrations of sildenafil in blood plasma. N-demethylated metabolite undergoes further metabolism, during its half-life is approximately 4:00. Breeding. The total clearance of sildenafil is 41 l/h, causing a half-life of 3-5 hours. Both after administration and after administration sildenafil excretion in the form of metabolites is carried out mainly with feces (about 80% of the oral dose) and to a lesser extent - with urine (about 13% of the oral dose). Patients of advanced age. At healthy volunteers of advanced age (over 65 years) showed reduced clearance of sildenafil, resulting in increased plasma concentrations of sildenafil and its active N-demethylated metabolite is approximately 90% compared to the corresponding concentrations in healthy volunteers of young age (18-45 years). Due to age differences in plasma protein binding, the corresponding increase in the plasma concentration of free sildenafil was approximately 40%. Renal failure. In volunteers with impaired renal function mild and moderate severity (creatinine clearance 30 to 80 ml/min) the pharmacokinetics of sildenafil was unchanged after a single oral dose of 50 mg. Average AUC and C max of the N-demethylated metabolite increased 126% and 73%, respectively, compared to such indicators in volunteers of similar age without renal dysfunction. However, due to the high individual variability, these differences were not statistically significant. In volunteers with severe renal impairment (creatinine clearance below 30 ml/min), sildenafil clearance was reduced, which resulted in average increases in AUC and C max of 100% and 88%, respectively, compared to volunteers of similar age without renal dysfunction. In addition, the AUC and C max of the N-demethylated metabolite significantly increased 79% and 200%, respectively. Liver failure. In volunteers with cirrhosis of the liver of mild and moderate severity (classes a and B according to the classification of child Pugh) clearance sildenafila decreased, which led to an increase in AUC (84%) and C max (47%) compared with volunteers of the same age without impaired liver function. Pharmacokinetics of sildenafil in patients with impaired hepatic function was not studied heavily. Indications Treatment of erection disorders, which are defined as inability to achieve and maintain the erection of the penis necessary for successful sexual intercourse. For the effective action of the drug NOVAGRO need sexual arousal. Contraindications Hypersensitivity to the active substance or to any of the auxiliary substances of the drug. Concurrent use of nitric oxide donors (such as amyl nitrite) or nitrates in any form is contraindicated because it is known that sildenafil affects the metabolic pathways of nitric oxide/cyclic guanosine monophosphate (cGMP) and potentiates hypotensive effect of nitrates. Medicines for the treatment of erectile dysfunction, including sildenafil, are contraindicated in men who sexual activity is not recommended (for example, patients with severe cardiovascular disorders such as unstable angina and severe heart failure). Patients with vision loss per eye due to nonarterial anterior ischemic optic neuropathy, regardless of whether this pathology is associated with previous use of PDE-5 inhibitors, or not. Patients with the following diseases: abnormal liver function, severe, hypotension (blood pressure below 90/50 mm), recently moved stroke or myocardial infarction and known hereditary degenerative retinal disorders such as retinitis pigmentosa (a small number of these patients have genetic disorders of retinal PDE), as the safety of sildenafil has not been investigated in these subgroups of patients. Interaction with other medicinal products and other forms of interaction. Effects of other medicinal products on sildenafil. Metabolism of sildenafil occurs mainly with the participation of the ZA4 isoforms (major route) and 2C9 isoforms (minor route) cytochrome P450 (CYP). Therefore, inhibitors of these isoenzymes able to reduce sildenafil clearance. Analysis of these studies has shown a decrease in clearance of sildenafil while the use of inhibitors CYP3A4 (such as ketoconazole, erythromycin, cimetidine). Although the simultaneous use of sildenafil and CYP3A4 inhibitors and increase in the frequency of side effects was not observed, the recommended initial dose of sildenafil is 25 mg. Simultaneous use of protease inhibitor HIV, a very powerful inhibitor R450, and sildenafil (single dose 100 mg) led to an increase in C max sildenafil 300% (4 times) and increase in plasma AUC sildenafil 1000% (11 times). After 24 hours, plasma levels of sildenafil were still approximately 200 ng/ml compared to about 5 ng/ml, typical of sildenafil alone, corresponding to the significant effect of ritonavir on a wide range of P450 substrates. Sildenafil does not affect the pharmacokinetics of ritonavir. Given these pharmacokinetic data, the simultaneous use of sildenafil and ritonavir is not recommended; in any case, the maximum dose of sildenafil under what circumstances should not exceed 25 mg for 48 hours. Coadministration of protease inhibitors HIV of saquinavir, a CYP3A4 inhibitor, at a dose that provides the equilibrium concentration (1200 mg three times daily) and sildenafil (100 mg dose) led to an increase in sildenafil C max 140% and an increase in systemic exposure (AUC) to sildenafil by 210%. No influence of sildenafil on the pharmacokinetics of saquinavir was revealed. It is assumed that more potent CYP3A4 inhibitors such as ketoconazole and Itraconazole will have a more pronounced effect. In the application of sildenafil (100 mg dose) and erythromycin, a specific CYP3A4 inhibitor, at steady state (500 mg 2 times a day for 5 days) was observed increase in systemic exposure to sildenafil 182% (AIS). Healthy male volunteers had no effect of azithromycin (500 mg/day for 3 days) on AUC, with max , t max , elimination rate constant and subsequent half-life of sildenafil or its main circulating metabolite. Cimetidine (cytochrome P450 inhibitor and non-specific CYP3A4 inhibitor) at a dose of 800 mg, while the use of sildenafil at a dose of 50 mg in healthy volunteers led to an increase in plasma concentrations of sildenafil by 56%. In the study simultaneous use of bosentan that is an antagonist of endothelin (CYP3A4 inducer (moderate), CYP2C9 and possibly of CYP2C19) at steady state (125 mg twice a day) and sildenafil at steady state (80 mg three times daily) resulted in a decrease in AUC and max sildenafil 62.6% and 55.4%, respectively. Therefore, the simultaneous use of strong CYP3A4 inductors, such as rifampicin, can lead to a more pronounced decrease in the concentration of sildenafil in blood plasma. The use of sildenafil in equilibrium (80 mg three times a day) led to an increase in AUC and max bosentan (125 mg twice a day) by 49.8% and 42%, respectively. Grapefruit juice is a weak inhibitor of CYP3A4 in the intestinal wall and can lead to a moderate increase in plasma levels of sildenafil. One-time use of antacid (magnesium hydroxide/aluminium hydroxide) did not affect the bioavailability of sildenafil. Although specific interaction studies with all drugs has not been conducted, according to the population pharmacokinetic analysis, the pharmacokinetics of sildenafil were not varied while the use of drugs belonging to the group of inhibitors of CYP2C9 (tolbutamide, warfarin, phenytoin) and inhibitors of CYP2D6 (such as selective inhibitors of serotonin reuptake, tricyclic antidepressants), thiazide group and tiazidopodobnye diuretics, loop and potassium-sparing diuretics, ACE inhibitors, calcium antagonists, antagonists of beta-adrenergic receptors, or inducers of CYP450 metabolism (such as rifampicin, barbiturates). Nicorandil is a hybrid of calcium channel activator and nitrate. Nitrate component determines the possibility of its serious interaction with sildenafil. The effects of sildenafil on other drugs. Sildenafil is a weak inhibitor of isoform 1A2, 2C9, 2C19, 2D6, 2E1 and ZA4 (IR 50 > 150 µmol) of cytochrome P450. Since the peak plasma concentrations of sildenafil are approximately 1 µmol, the effect of NOVAGRO on the clearance of substrates of these isozymes is unlikely. There is no data on the interaction of sildenafil and non-specific phosphodiesterase inhibitors such as theophylline and dipyridamole. Since it is known that sildenafil affects the metabolism of nitric oxide/cyclic guanosine monophosphate (cGMP), it was found that this drug potentiates the hypotensive effect of nitrates, so its simultaneous use with nitric oxide donors or nitrates in any form is contraindicated. The simultaneous use of sildenafil and alpha-adrenoreceptor blockers can lead to the development of symptomatic arterial hypotension in some predisposed patients. This reaction often occurred within 4: 00 after the use of sildenafil. With the simultaneous use of sildenafil and doxazosin, patients whose stabilization was achieved with doxazosin were sometimes reported to develop symptomatic orthostatic hypotension. In these, it has been reported cases of dizziness and faint as before, but without syncope. No significant interactions were observed with simultaneous use of sildenafil (50 mg) and tolbutamide (250 mg) and warfarin (40 mg), which were metabolized by CYP2C9. Sildenafil (50 mg) did not lead to an increase in bleeding time caused by acetylsalicylic acid (150 mg). Sildenafil (50 mg) potentiual hypotensive effect of alcohol healthy volunteers with an average maximum levels of ethanol in blood is 80 mg/DL. Patients receiving sildenafil, there was no difference in side effect profile compared to placebo while the use of such classes of antihypertensive drugs like diuretics, beta-adrenergic receptors, ACE inhibitors, angiotensin II antagonists, antihypertensive medicinal products (vasodilator and centrally acting), adrenergic neuron blockers, calcium channel blockers and blockers of alpha-adrenergic receptors. The study of interaction while the use of sildenafil and amlodipine in patients with arterial hypertension observed additional reduction in systolic blood pressure in the supine position is 8 mm Reduction in diastolic blood pressure was 7 mm, the magnitude of these additional blood pressure lowering was comparable with those observed with the use of sildenafil in healthy volunteers. Sildenafil did not affect the pharmacokinetic parameters of HIV protease inhibitors, saquinavir and ritonavir, which are substrates of CYP3A4. Application features Prior to therapy, it is necessary to collect the medical history of the patient and conduct a physical examination to diagnose erectile dysfunction and determine its possible causes. Risk factors from the cardiovascular system. Since sexual activity is accompanied by a certain risk from the heart, before any treatment of erectile dysfunction, the doctor should assess the state of the cardiovascular system of the patient. Sildenafil has a vasodilating effect, which is manifested by a slight and short-term decrease in blood pressure. Before the appointment of sildenafil, the doctor should carefully consider whether such an effect can have an adverse effect on patients with certain major diseases, especially in combination with sexual activity. To patients with hypersensitivity to vasodilators include patients with obstruction of the excretory tract of the left ventricle (eg aortic stenosis, hypertrophic obstructive cardiomyopathy), or patients with a rare syndrome, Multisystem atrophy, one manifestation of which is severe dysregulation of blood pressure the autonomic nervous system. Sildenafil potentiates the hypotensive effect of nitrates. In post-marketing period have reported serious adverse reactions from the cardiovascular system, including myocardial infarction, unstable angina, sudden cardiac arrest, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, arterial hypertension and arterial hypotension, which in time coincided with the drug of novagro . In most patients, but not all, there was the risk factors of cardiovascular diseases. Many such adverse reactions have been observed during or immediately after sexual act, and only a few happened shortly after use of the drug NOVAGRO without sexual activity. Therefore, it is impossible to determine whether the development of such adverse reactions is directly related to risk factors, or their development is due to other factors. Priapism. Funds for the treatment of erectile dysfunction, including sildenafil, should be administered with caution in patients with anatomical deformities of the penis (such as angulation, cavernous fibrosis or Peyronie's disease) or patients with conditions that contribute to the development of priapism (such as sickle cell anemia, multiple myeloma or leukemia). After entering the market, cases of prolonged erection and priapism were reported. In cases where the erection lasts more than 4:00, patients should immediately seek medical help. In the absence of immediate treatment, priapism can lead to damage to the tissues of the penis and to persistent loss of potency. The simultaneous use with other inhibitors of PDE5 or to other drugs for the treatment of erectile dysfunction. The safety and efficacy of the simultaneous application of sildenafil with other inhibitors of PDE5 or to other drugs used to treat hypertension of the pulmonary artery that contains sildenafil or other drugs for the treatment of erectile dysfunction were studied. Therefore, the use of such combinations is not recommended. Effect on vision. Spontaneous reports on the occurrence of visual defects have been associated with the use of sildenafil and other inhibitors PDE-5. Cases of non-arterial anterior ischemic optic neuropathy are rare, spontaneous reports have been reported and reported in a Supervisory study associated with the use of sildenafil and other PDE-5 inhibitors. Patients should be warned that in case of sudden visual impairment of the drug should be stopped and immediately consult a doctor. Concurrent use with ritonavir. Simultaneous use of sildenafil and ritonavir is not recommended. The simultaneous use of blockers of alpha adrenergic receptors. Patients taking alpha-adrenoreceptor blockers should use sildenafil with caution, since this combination can lead to symptomatic hypotension in some predisposed patients. Symptomatic hypotension usually occurs within 4: 00 after the use of sildenafil. In order to minimize the risk of orthostatic hypotension, sildenafil therapy can be started only in hemodynamically stable patients taking alpha-adrenoreceptor blockers. The recommended starting dose for such patients is 25 mg of sildenafil. In addition, patients should be informed how to act in case of symptoms of orthostatic hypotension. Impact on the blood. Studies of human platelets have shown that in vitro sildenafil potentiates the antiplatelet effects of sodium nitroprusside. There is no information about the safety of the use of sildenafil in patients with coagulation disorders or acute ulcer disease. Thus, the use of sildenafil in patients of this group is possible only after a thorough assessment of the ratio of benefit and risk. Women. The drug is not intended for use by women. Application of other methods of treatment of erectile dysfunction. Safety and efficacy of simultaneous use of sildenafil with other methods of treatment of erectile dysfunction have been studied, so the use of such combinations is not recommended. Use during pregnancy or breast-feeding. The drug is not intended for use by women. In the course of studies of reproductive toxicity in rats and rabbits with oral use of sildenafil, no corresponding side effects were observed. The ability to influence the reaction rate when driving motor transport or operating other mechanisms. Studies of the effect of the drug on the ability to drive vehicles or work with other mechanisms were not carried out. Since in clinical studies when using sildenafil reported cases of dizziness and visual impairment, before you get behind the wheel of a vehicle or work with mechanisms, it is necessary to find out the individual reaction to the use of the drug NOVAGRO. Method of application and doses The drug is administered orally. For the effective action of the drug NOVAGRO need sexual arousal. Adults. The recommended dose of novagro is 50 mg and is used when needed, around 1:00 to sexual intercourse. Depending on the efficacy and tolerance of the drug, the dose can be increased to 100 mg or reduced to 25 mg. the Maximum recommended dose is 100 mg. The maximum recommended frequency of the drug is 1 time per day. When using the drug NOVAGRO during meals, the effect of the drug may occur later than when it is applied on an empty stomach. Patients of advanced age. There is no need for dose correction in elderly patients. Patients with renal insufficiency. In patients with renal insufficiency of mild to moderate severity (creatinine clearance of 30 to 80 ml/min), the recommended dose is similar to the dose indicated above in the section "Adults". Since in patients with severe renal insufficiency (creatinine clearance below 30 ml/min) sildenafil clearance is reduced, the recommended dose is 25 mg. depending on the efficacy and tolerance of the drug, the dose can be increased to 50 mg and 100 mg. Patients with liver failure. Because patients with hepatic insufficiency (e.g. cirrhosis), sildenafil clearance is reduced, recommended dose is 25 mg depending on efficacy and tolerability the dose may be increased to 50 mg and 100 mg. Patients who use other drugs (e.g. ketoconazole, erythromycin, cimetidine, ritonavir). Detailed information is given in the section "Interaction with other medicinal products and other forms of interaction". The recommended initial dose of the drug to patients who use CYP3A4 inhibitors, with the exception of ritonavir, the use of which is not recommended with sildenafilom, is 25 mg. In order to minimize the risk of orthostatic hypotension, the condition of patients taking alpha-adrenoreceptor blockers should be stabilized by the beginning of sildenafil. The recommended initial dose of sildenafil is 25 mg. The drug of novagro is not intended to apply to women. Children. NOVAGRO the drug is not indicated for use in children under the age of 18 years. Overdose In studies using a single dose of sildenafil to 800 mg adverse reactions were similar to those observed in the application of sildenafil at lower doses, but were more common and heavier. Application of sildenafil at a dose of 200 mg led to an increase in efficiency, but causes an increase in the number of cases of adverse reactions (headache, flushes, dizziness, dyspepsia, nasal congestion, irregularities on the part of organs of vision). In case of overdose, if necessary, resort to the usual supportive measures. Acceleration of clearance of sildenafil in hemodialysis is unlikely due to the high degree of binding of the drug with plasma proteins and the lack of elimination of sildenafil with urine. Adverse reaction The safety profile of the drug NOVAGRO is based on data obtained from 8691 patients who received the drug in the recommended doses in the course of 67 placebo-controlled clinical trials. Most often reported adverse reactions such as headache, hot flashes, dyspepsia, visual impairment, nasal congestion, dizziness and impaired color perception. Information on adverse reactions in the framework of post-marketing surveillance has been gathered over a period of more than 9 years. Since not all adverse reactions have been reported but not all adverse reactions have been included in the safety database, the frequency of such reactions cannot be reliably determined. All clinically significant adverse reactions, which were observed in clinical studies more often than in placebo, are listed in the table in accordance with the classification "System-organ-class" and frequency: very often (? 1/10), often (? 100 and <1/10), infrequently (? 1000 and <1/100) and rarely (? 10000 and <1/1000). In addition, the frequency of clinically significant adverse reactions which were reported in post-marketing experience, defined as unknown. Within each frequency group, adverse reactions are listed in decreasing order of their degree of severity. Table 1. Clinically relevant adverse reactions that were reported with a frequency higher than for placebo in controlled clinical trials, clinically relevant adverse reactions reported in post-marketing surveillance framework. System-organ-class adverse reactions From the immune system rare hypersensitivity reactions From the nervous system very frequent pain frequency head infrequency, hypesthesia reconsult, fainting neizvestnaia ischemic attack, seizures, recurrent court By the organs of vision chlorastrolite vision, disturbances of color perception nechasto side of the conjunctiva, lacrimation disorders, other disorders of the organs of sight unknown anterial anterior ischemic optic neuropathy, retinal vascular occlusion, visual field defects. On the part of hearing and vestibular apparatus nachstgelegene, noise in the ears rare ear * From the vessels often blood flow to the face recoherence, hypotension From the heart unscented heartbeat, tachycardia recontact infarction, atrial fibrillation unknown ventricular arrhythmia, unstable angina pectoris, sudden cardiac death From the respiratory system, thorax and mediastinum palpability of the nose rare-state bleeding The gastro-intestinal tract customerbase rare nausea, vomiting, dry mouth The skin and subcutaneous tissue infrequent skin rash unknown syndrome of Stevens-Johnson, toxic epidermal necrolysis From the side of musculoskeletal system and connective tissue necessarially On the part of the reproductive system and mammary glands neizvestnaia, long-lasting erections, hematuria, hematospermia, bleeding from the penis General disorders and reactions at the injection site infrequent pain in the chest, fatigue survey excessive heart rate * - On the part of hearing and vestibular apparatus: sudden deafness. In clinical trials and post-marketing experience in the application of inhibitors of PDE5, including sildenafil, reported on a small number of cases of sudden decrease or loss of hearing. Attention! Report suspected adverse reactions after registration of the medicinal product is important. This allows continuous monitoring of the relationship between benefits and risks associated with the use of this drug. Doctors should report any suspected adverse reactions as required by law. Shelf life 2 years. Storage conditions Store in the original packaging at a temperature not exceeding 25 0 C. keep out of reach of children. Packaging 1, 2 or 4 tablets in a blister, 1 blister is put into a cardboard box. Category home away from home By prescription. Manufacturer Marksans Pharma Ltd. Manufacturer's location and address of the place of business Plot number L-82, L-83, Verna Industrial estate, Verna Goa, IN-403722, India. NOVAGRA 100MG №4 Novagra tablets 100 mg № 4 are intended for treatment of erection disorders in men. The drug, the main active ingredient of which is a powerful sildenafil inhibitor, restores impaired ability to erection in men of any age. Appointment The drug is intended for the stronger sex, experiencing problems with erection. Novagra restores impaired erectile function only in the presence of men sexual arousal. As a result of taking the drug: Slowing down the process of ejaculation. Increases the duration of intimacy. Dosage Make the tool needs orally, washed down a pill with water. The recommended dose of the drug is 50 mg. Take a pill need for 40-50 minutes before intimacy. If desired, the dosage can be increased up to 100 mg (whole tablet) or reduced to 25 mg (the fourth part of the tablet). The maximum dosage of the drug per day should not be more than 100 mg. Taking Novagra is better on an empty stomach, because if you drink a tablet while eating, then the action

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