Dynamico tabs 100mg #4

Dynamico user manual

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Composition

The tablet in a special protective film membrane of blue color contains 25/50/100 mg of sildenafil.
Additional components: Mg stearate, microcrystalline cellulose, silicon dioxide (anhydrous, colloidal form), giprolose, croscarmellose Na.
Components of the film membrane: white opadray-2 (citrate Na, macrogol, hypromellose, lactose monohydrate) and ingigokarmin.

Form of issue

Dynamico tablets for men 25/50 mg: biconvex, round shape; the color of the film shell is blue.
Dynamico tablets with a dosage of active substance 100 mg: biconvex, oval; there are risks on both sides. The color of the film shell is blue.
Blisters are made of oriented polyamide (possibly made of aluminum foil). Each blister contains 1 or 4 tablets. In the pack there is 1 blister.

pharmachologic effect

The drug is used dynamically to treat erectile dysfunction. The active substance inhibits PDE-5. Due to the increased blood flow to the penis, the active substance is able to restore impaired erectile function with provided sexual stimulation.
The erection at the physiological level is based on the release of NO-nitric oxide in the cavernous bodies as a result of excitation. NO is able to activate guanylate cyclase, which increases the level of the cyclic form of gunosine monophosphate (cGMP), relaxing the smooth muscle fibers in the blood vessels, which leads to increased blood flow to the cavernous bodies in the penis.
Sildenafil is an selective cGMP inhibitor (specific PDE-5), under the influence of which cGMP decays in the cavernous bodies in the penis. The active substance does not directly affect the relaxation of the smooth muscle in the cavernous bodies, but it can increase the blood flow to the penis and enhance the ability of NO to relax the smooth muscles. With sexual stimulation, the activation of the chain of NO-cGMP, which inhibits PDE-5, increases the level of cGMP in the cavernous bodies. The above described pharmacological effect is observed only with sexual stimulation.
Sildenophil is more active than all known isoenzymes of PDE: 10 times higher than that of PDE-6, 80 times PDE-1, 700 times PDE-2, 4, 7, 11. The active substance is selective in comparison with PDE-3 in 4 thousands of times, which is important, because PDE-3 - the main enzyme of regulation of cardiac contractility.
For sildenafil is characterized by a mildly pronounced hypotensive effect, which has a short-term effect and has practically no clinical significance in the treatment of medication at the manufacturer's recommended doses. The hypotensive effect is due to a vasodilating effect caused by an increased cGMP content in the smooth muscle fibers in the vascular wall.

Pharmacodynamics and pharmacokinetics

Suction process

Quickly absorbed after taking per os. When taken on an empty stomach, the maximum level is recorded after 0.5-2 hours. Biological availability depends on food intake: fasting - 41%, after meals - 20-40% (reached 1.5-3 hours).

Distribution

The VSS is 105 liters. With plasma proteins, active metabolites and Sildenafil itself bind to 90% of the dose. The indicator is not dose-dependent.

Metabolism

An additional pathway of metabolism is carried out with the participation of the microsomal isoenzyme CYP2C9, and the main one-CYP3A4. The most important active circulating metabolite is N-demethylmetabolite, which, with respect to PDE, exhibits activity equal to 50% of the activity of Sildenafil. Its concentration reaches 40% of the level of sildenafil. The half-life of N-demethylmetabolite is 4 hours.

Excretion

The clearance of the active substance is 41 l / h. The half-life is 3-5 hours. Inactive metabolites are excreted by 13% through the renal system and 80% by the intestine.

Special group of patients

In comparison with patients aged 18-45, Cmax is higher by 90% in people older than 65 years, which is explained by the reduced clearance of Sildenafil. The level of active substance not associated with plasma proteins is 40%. With a moderate pathology of the renal system, the pharmacokinetics does not change (when taking 50 mg of the drug). In cirrhotic lesions of the hepatic system, the Cmax and AUC values ​​increase by 47% and 84%, respectively.

Indications for use

The drug shows its activity only under the influence of sexual stimulation. The main direction of application Dynamic therapy of erectile dysfunction, which is characterized by the inability to achieve and maintain an erection of the penis, sufficient to commit sexual intercourse.

Contraindications

    reception of ritonavir;
    individual hypersensitivity;
    patients suffering from loss of vision in one eye due to optical ischemic anterior neuropathy of non-arterial origin (regardless of the effect of the PDE-5 inhibitor);
    restriction on age - before the 18th anniversary;
    female;
    reception of organic nitrates, donators NO;
    pronounced pathology of the hepatic system;
    degenerative changes in the retina of hereditary genesis (eg, retinitis pigmentosa).

The medication is not prescribed to persons to whom sexual activity is undesirable:

    life-threatening arrhythmias;
    heart failure;
    arterial hypertension;
    arterial hypotension;
    an unstable form of angina pectoris;
    myocardial infarction;
    disturbances of cerebral circulation.

Relative contraindications:

    obstructive lesion of the output tract of the left ventricle;
    syndrome of multiple systemic atrophy;
    obstructive hypertrophic cardiomyopathy;
    aortic stenosis;
    multiple myeloma;
    priapism;
    anatomical deformation of the penis;
    galactose-glucose malabsorption;
    lack of lactose;
    lactose intolerance;
    leukemia;
    reception of alpha-blockers.

Side effects

Organs of vision:

    infringement of a lacrimal drain;
    defeat of the conjunctiva;
    violation of color perception;
    impaired visual perception;
    transient form of chromatopsy;
    blurred vision;
    enhanced perception of light;
    reddening of the sclera;
    occlusion of vessels in the retina;
    ischemic form of anterior optic neuropathy;
    narrowing of visual fields;
    pain in the eyeballs.

Heart, vascular system:

    atrial fibrillation;
    a feeling of rapid heartbeat;
    sudden coronary death;
    an unstable form of angina pectoris;
    ventricular arrhythmias;
    myocardial infarction;
    instability of blood pressure.

Nervous system:

    transient ischemic attack;
    fainting;
    stroke;
    hypoesthesia;
    convulsions (including recurrent);
    increased drowsiness;
    dizziness;
    migraine headaches.

Other reactions:

    deafness;
    noise in ears;
    vertigo;
    nasal bleeding;
    nasal congestion;
    vomiting;
    dyspeptic disorders;
    dry mouth;
    fast fatiguability;
    pain in the chest;
    priapism;
    prolonged erection;
    skin rashes;
    nausea;
    Lyell's syndrome.

Dynamico tablets, instructions for use (Method and dosage)

The medication should be taken 1 hour before the alleged sexual activity.
Instructions for use Dynamico 50 mg: 1 tablet per day. Dosage can be reduced to 25 mg or increased to 100 mg, given the tolerability and efficacy of the drug.
With a mild / moderate renal system pathway, adjustment of the dosing regimen is not required. With severe pathology on the part of the kidneys, treatment begins with the admission of 25 mg of sildenafil with a gradual increase to 50 or 100 mg with good tolerability. The first dose for elderly men is 25 mg, with a gradual increase in need and good tolerability.
Treatment also begins with 25 mg for a mild / compensated pathology of the liver system, gradually increasing the dose to 50-100 mg as needed. A similar scheme should be followed and patients who take drugs from the group of alpha-adrenoblockers.

Overdose

Receiving 800 mg causes the following negative reactions:
    visual impairment;
    vertigo, dizziness;
    dyspeptic phenomena;
    tides;
    headaches like migraines;
    nasal congestion.
Hemodialysis does not work, it is recommended to hold a syndrome therapy.

Interaction

The concentration of sildenafil in the blood increases with treatment with inhibitors of isoenzymes CYP2C9 and CYP3A4:
    Erythromycin;
    Ketoconazole;
    Cimetidine.
Such patients are recommended to take 25 mg of sildenafil.
The maximum concentration of sildenafin increases by 300%, and the AUC - by 1000% with the simultaneous use of ritonavir. These indicators are also increasing with the treatment of saquinavir. Dynamics does not affect the pharmacokinetics of saquinavir and ritonavir. Sildenafil is able to enhance the antiaggregant effect of nitroprusside Na. Possible development of severe arterial hypotension with the reception of Nicorandil, which contains a nitrate component. There is a mutual enhancement of effects (a fatal outcome is possible) with the intake of nitrates and other donators NO. The drug Dynamico can enhance the antihypertensive effect of ACE inhibitors, beta-blockers and medications of the BCC group. There is an increase in the activity of hypoglycemic drugs. Perhaps the development of orthostatic hypotension and a marked drop in blood pressure when taking an alpha-adrenoblocker Doxazosin. The concentration of the active substance of sildenafil increases if you take the tablets with grapefruit juice.

Storage conditions

Tablets retain their effectiveness when stored at a temperature of up to 25 degrees while preserving the original packaging.
Shelf life - 36 months.

special instructions

A thorough examination is needed to determine the true causes of erectile dysfunction. Patients taking other medications, as well as suffering from serious diseases from the heart and the vascular system, are recommended to assess the risk of developing negative reactions associated with sexual activity. Sildenafil is able to smoothly lower blood pressure. In patients with a rare syndrome of multiple atrophy and with obstructive left ventricular lesion, the hypotensive effect is more pronounced. Most adverse reactions from the heart and vascular system develop right after the sexual act is committed or after a certain time after it. Very rarely, adverse reactions are observed before sexual intercourse. It is inadmissible to receive concurrently other medications prescribed for erectile dysfunction.
Medication with caution is used by people suffering from various diseases predisposing to the development of priapism:
    myeloma;
    sickle-cell anemia;
    leukemia (bone marrow disease).
With anatomical deformation of the penis (against cavernous fibrosis, angulation, Peyron's disease), Dynamic is prescribed with caution. With the development of visual impairment, immediate consultation of the treating doctor is required. The intake of more than 200 mg of active substance does not affect the efficacy, but increases the severity and frequency of manifestations of dose-dependent adverse reactions. It is recommended to refrain from driving a vehicle.

With alcohol

Sildenafil does not interact with Ethanol, but alcohol-containing beverages can dilate blood vessels, suppressing potency and causing the heart to work more often, with exercise. It is not recommended to drink alcohol to patients suffering from various diseases from the vascular system and heart.

Reviews of Dynamico

The drug has established itself as a good analogue of Viagra, used for erectile dysfunction.

Reviews about the drug Dynamico (100 mg, 4 tablets)

The medication does not provoke an erection on its own, the mechanism of action is aimed at enhancing excitation and blood flow. According to statistics, the potency normalized in 89% of patients. Patients note that if you take Dynamico before eating, then its effectiveness will manifest itself after 30-40 minutes, and if after eating, the effect can last for 3-4 hours.

Dynamico tablets, reviews from men

At thematic forums, the male person leaves mostly positive reviews about the drug, confirming its effectiveness in cases of potency disorders. Most patients write that due to the drug, the dyspnea decreases during sexual intercourse, which is caused by the action of enzymes on the vessels of the respiratory tract and the pulmonary artery (vasodilating effect). After the drug ceases, this effect is lost. The duration of the medication is individual and varies in the range of 5-9 hours.