Levitra 20mg #4

Levitra instruction for use

You can buy Levitra online

Composition

In film-coated tablets, the active ingredient vardenafil is contained, the amount of which varies depending on the dosage of the preparation and can be 5, 10 and 20 mg. Among the excipients - crospovidone, magnesium stearate, MCC; colloidal silicon dioxide.
The film membrane consists of macrogol 400, hypromellose, titanium dioxide and dyes - iron oxide, yellow and red.

Form of issue

Tablets are round, biconvex light orange color, can be a grayish shade, there are engravings from different sides - branded cross Bayer and designation of the dosage of the drug - "5", "10", "20" respectively. Levitra 20 mg and 10 mg are available in blisters for 1 or 4 tab, which are sealed in cardboard boxes or sliding packages such as "Burgopack". For dosage of 5 mg there are additional packages - 5 blisters for 4 tablets.

pharmachologic effect

The drug improves erectile function.

Pharmacodynamics and pharmacokinetics

The most known PDE is a specific PDE-5, participates in cleavage for the hydrolysis of cGMP, which is one of the sides of the regulation of cGMP levels during the erection of the penis. Vardenafil blocks PDE-5 and enhances the local action of nitric oxide (endogenous NO), which is released by nerve endings of cavernous bodies during sexual stimulation. NO is necessary for activation of the enzyme guanylate cyclase, which increases the content of cyclic guanosine monophosphate (abbr. CGMP) and leads to relaxation of smooth muscles in the cavernous bodies and, as a consequence, an increase in blood flow to the genital organ. Thus, Levitra is able to strengthen the natural reaction to sexual stimulation.
It was found that the average concentration required to inhibit PDE-5 is 0.7 nM, that is, vardenafil is a potent and highly selective inhibitor. 20 mg of vardenafil after 15 minutes in some men cause an erection level, sufficient for penetration. For a full answer it is necessary that 25 minutes pass.
Attention! There is a generic Levitra software which is characterized by the speed of the onset of the effect. Tablets can be chewed and rassasyvat under the tongue, thereby accelerating the onset of the effect (occurs usually after 10 minutes).
Pharmacokinetics research data

Suction

Suction at oral intake is fast, fasting maximum concentration may occur after 15 minutes, but more often (in 90%) - after 60 minutes. If taken with fatty foods, the rate of absorption decreases by an average of 20%. The level of absolute bioavailability is approximately 15%. The stationary volume of distribution is 208 liters. The level of binding of the main main (M1) to blood plasma proteins is not more than 95% (the process is reversible), 90 minutes to 0.00012% of the dose can be observed in the sperm of healthy men.

Metabolism and excretion

It occurs mainly with the participation of systems of cytochrome and hepatic enzymes. The average half-life is 4-5 hours, and the main metabolite, which is formed by the de-ethylation of the piperazine moiety in the molecule, is approximately 4 hours. Metabolites are excreted mainly through the gastrointestinal tract (approximately 91-95%), the rest by the kidneys.
Changes in AUC and other indicators in different patient groups
    in elderly individuals AUC usually increases by 52%;
    In severe renal insufficiency AUC increases by approximately 21%, and the maximum concentration decreases by 23%;
    when violations of liver function, clearance decreases in proportion to the level of disruption of liver function.

Indications for use

Like the usual Levitra, Levitra software and Levitra are potency regulators that should be taken with erectile dysfunction - the inability to achieve and maintain at the required level the erection required for a full sexual intercourse.

Contraindications

    patients with hypersensitivity to any component of the drug;
    persons taking nitrate-containing or nitric oxide donators, as well as inhibitors of CYP3A4 (eg: Ritonavir, Indinavir, Ketoconazole, Itraconazole, Erythromycin, Clarithromycin);
    drugs with erectile dysfunction;
    men who are not recommended for sexual activity, including the presence of such concomitant cardiovascular diseases as acute form of heart failure or unstable angina;
    severe liver disorders;
    hemodialysis at the initial stage of kidney disease;
    arterial hypotension (with BP at rest less than 90 mm Hg);
    recent stroke or myocardial infarction (up to 6 months);
    hereditary degenerative diseases of the retina, for example, retinitis pigmentosa;
    women, newborns and children.

With caution, it is necessary to apply, assessing the benefit-risk

    with an anatomically deformed genital organ, including various curvatures, cavernous fibrosis and Peyronie's disease;
    predisposition to priapism, for example, multiple myeloma, sickle-cell anemia, leukemia;
    tendency to bleeding;
    exacerbation of peptic ulcer.

Side effects

The undesirable reactions (HP) that occur when using Levitra are given below (in the listing, their manifestation strength is indicated in decreasing order):
    Infectious diseases: conjunctivitis.
    Disorders from the psyche and the central nervous system: sleep disorders, headache.
    Organs of vision: violation of visual acuity and color perception, congestion hyperemia, a feeling of discomfort and pain in the eyes, photophobia, an increase in IOP.
    Organs of hearing: vertigo, sudden deafness, ringing in the ears.
    Immune system: allergic or angioedema, allergic reactions.
    From the heart and blood vessels: palpitation, angina pectoris, tachycardia, myocardial infarction, ventricular tachyarrhythmia, vasodilation, hypotension.
    Gastrointestinal tract: dyspepsia, nausea, abdominal pain, diarrhea, dry mouth, gastritis, gastroesophageal reflux disease, vomiting.
    Respiratory system and organs of the chest, mediastinum: nasal congestion, shortness of breath, blocked paranasal sinuses.
    Liver and biliary tract: increased activity of transaminases.
    Skin and subcutaneous tissues: erythema, rash.
    Musculoskeletal and connective tissues: back pain, increased level of CK, increased muscle tone, myalgia.
    Sexual organs and mammary glands: strengthening of an erection, priapism.
    General: poor health, chest pain.

Instructions for use Levitra (method and dosage)

Tablets are usually taken orally, regardless of diet, 25-60 minutes before the onset of intercourse.

Standard reception scheme

The initial recommended dose is 10 mg (approximately 25-60 minutes before sexual contact). The maximum frequency of drug use is once every 24 hours. Considering the effectiveness and tolerability of treatment, it is possible to increase the daily dose of 20 mg or decrease to 5 mg.

Instructions for use Levitra in case of liver disorders

The initial recommended dose is 5 mg, which can be increased during therapy to 10 mg.

Overdose

If a dose of vardenafil is taken in the amount of 40 mg twice a day, the patient may have severe pain in the lumbar region with no signs of toxic effects on the nervous and muscular system.

Treatment of overdose

Standard maintenance therapy. Hemodialysis is ineffective.

Interaction

    With CYP inhibitors, a decrease in the clearance of vardenafil is possible.
    With Erythromycin in a day. a dose of 1500 mg there is a fourfold increase in AUC and a threefold increase in the maximum concentration of Levitra (5 mg).
    With ketoconazole at a dose of 200 mg, a tenfold increase in AUC occurs and a fourfold increase in the maximum concentration of Levitra (5 mg), which requires correction of their dosage.
    Simultaneous application of Levitra with HIV protease inhibitors of active substance - indinavir (daily dose of 2,400 mg) there is a sixteen-fold increase in PPC and a sevenfold increase in the maximum concentration of vardenafil.
    With Ritonavir (daily dose of 1200 mg): a 13-fold increase in the maximum concentration of Levitra in a dose of 5 mg and a 49-fold increase in the total daily AUC, as well as a significant extension (approximately 26 h) of T1 / 2 vardenafil.
    With Nitrates and donators of nitric oxide, the potency of their effects is observed, however - if the interval is maintained for 24 hours, drug interaction does not occur.
    Supertherapeutical doses of vardenafil with sodium nitroprusside cause a slight increase in antiaggregant effect.
    Between the reception of Levitra and alpha-adrenoblockers it is necessary to observe the time interval and apply only at stable indices of blood pressure. For example, Terazosin requires a 6-hour interval between doses.

Storage conditions

Dry place with temperature not higher than + 30 ° C.
The drug is contraindicated for children, therefore it should be stored in an inaccessible place.

Shelf life

Up to 36 months.

Levitra Analogues

Analogues of the drug, differ by active substance (used Sildenafil Sildenafil), but coinciding by the ATS code:
    Viagra;

Reviews about Levitra

The drug has established itself as an affordable tool for improving erectile function. Reviews on the forums are positive: men praise and recommend Levitra, note the possibility of taking a drug with alcohol, between the ages of 18 and 75, even with certain cardiovascular diseases.
Levitra, reviews of physicians: generic Levitra ODT and Levitra produced by the German company Bayer are modern potency regulators that increase the natural response to sexual stimulation to the level necessary for penetration and full sexual intercourse.