Principle of Action, Kamagra Efficiency, Indications for Uses, Mode of Application, Possible Side-Effects, Black-Box Warning, Pregnancy and Lactating and More
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- Kamagra’s Principle of Action
- Vision Impairment Due To Kamagra Intake
- What Do We Know of Kamagra Efficiency?
- Indications for Kamagra Use
- Mode of Kamagra Application
- Kamagra Possible Side-Effects
- Black-Box Warning
- Pregnancy and Lactating
- Kamagra Interaction with Other Drugs
- Effect of Sildenafil on Other Drugs
- Kamagra Overdose
- Storage Conditions
- ED Diagnostics and Kamagra Medical Analysis
- Customer Reviews
- Kamagra: FAQ
Kamagra’s Principle of Action
Kamagra is a citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate (cGMP), specific phosphodiesterase type 5 (PDE5). The physiological mechanism of erection lies in the release of nitrogen oxide in cavernous body during sexual stimulation. Nitrogen oxide activates the enzyme, guanylate cyclase, which causes increase in the level of cGMP, relaxation of smooth muscle cells of cavernous body and acceleration of blood flow to them.
Sildenafil does not have a direct relaxing effect on isolated cavernous bodies, but significantly increases the efficiency of nitrogen oxide by blocking PDE5 that is responsible for splitting of cGMP in a cavernous body. When sexual drive stimulates local release of nitrogen oxide, inhibition of PDE5 by sildenafil leads to the increase in the concentration of cGMP in cavernous bodies. This process results in the relaxation of smooth muscle cells and the increase in blood flow to cavernous bodies. Application of sildenafil (Kamagra’s active substance) in recommended doses will be ineffective without sexual stimulation.
Medical studies have shown that sildenafil has selectivity for PDE5. Its effect on PDE5 is more pronounced than on other known PDEs (10 times stronger than for PDE6, 80-fold stronger in comparison with PDE1, and 700-fold more efficient compared with PDE2, PDE3, PDE4, PDE7-11). In particular, sildenafil has a 400-fold better selectivity for PDE5 than for PDE3.
Vision Impairment Due To Kamagra Intake
When using Kamagra in a dose of 100 mg of sildenafil, some patients appeared to have a slight transient impairment of color perception within an hour (blue/green); after a couple of hours after taking the drug, these disorders disappear. A possible mechanism of color perception disorder is inhibition of PDE6 that occurs during the process of light transmission in eye retina. The results of multiple medical trials show that the effect of Kamagra on PDE6 is 10 times inferior to its activity relative to PDE5. Sildenafil does not affect visual acuity, in contrast to color perception, electroretinogram, intraocular pressure or pupilometry.
What Do We Know of Kamagra Efficiency?
The effectiveness of Kamagra was assessed with respect to the ability of the drug to ensure the onset and preservation of erection sufficient for sexual intercourse. Thus, it was demonstrated that the drug has a prolonged action.
The studies have shown that sildenafil in doses of 25, 50, 100 mg causes improvement in erection in 62; 74; 82% respectively. In addition to improvement of erectile function, the analysis of the international index of erectile function has shown that sildenafil treatment enhances orgasm sensitivity and a sense of satisfaction with sexual intercourse. During the treatment with Kamagra, improvement in 59% of patients with diabetes mellitus; in 43% of patients who underwent radical prostatectomy, in 83% of patients with spinal cord injury was noted.
Indications for Generic Kamagra Use
The drug Kamagra is intended for the treatment of erectile dysfunction which is defined as inability to achieve and maintain erection necessary for a successfully performed sexual intercourse. For the effective action of the Kamagra, sexual arousal is obligatory.
Mode of Generic Kamagra Application
Kamagra tablets are intended for peroral administration. To realize the effect of sildenafil, sexual arousal is mandatory.
Application by adults
The recommended adult dose is 50 mg of sildenafil taken at request approximately 1 hour before sexual activity. Taking into account the effectiveness and tolerability rate, the dose can be increased to 100 mg. The maximum recommended dose is 100 mg. The maximum recommended frequency of reception is 1 time per day. The time of Kamagra manifestation of activity can increase with combination with food in comparison with fasted application.
Usage by elderly patients
For elderly patients, dosage changes are not required.
Kamagra Possible Side-Effects
Side-effects caused by Kamagra tablets are transient, mildly or moderately expressed. During the studies, the frequency and severity of side-effects enhanced with increasing of doses. The nature of side-effects in studies with a variable dose that more closely reflects the recommended dosing regimen was similar to a fixed-dose study. The most common side-effects were headache and hot flashes.
- Nervous system: headache.
- Cardiovascular system: vasodilation.
- Nervous system: dizziness.
- Vision organs: abnormal vision (blurred vision, increased sensitivity to light), chromatopsy (moderate degree, transient, mainly color vision).
- Cardiovascular system: palpitation (heartbeats).
- Respiratory system: rhinitis (nasal congestion).
- Digestive tract: indigestion.
When using the drug in doses exceeding the recommended ones, side-effects are similar, but occur more frequently. The use of Kamagra does not affect the incidence of myocardial infarction and mortality from cardiovascular disease. In the post-registration period, atypical or low-prevalence reactions were detected against the background of drug administration.
- Immune system: hypersensitivity reactions (including skin rashes).
- Nervous system: epileptic attack, relapse of epileptic attack.
- Cardiovascular system: tachycardia, hypotension, syncope, nasal bleeding.
- Digestive tract: vomiting.
- Vision organs: pain in the eyes, redness of the eyes.
- Reproductive system: prolonged erection and/or priapism.
Generic Kamagra Black-Box Warning
The use of Kamagra is contraindicated to patients with increased sensitivity to the active substance or to any other components of the drug. Due to the effect on exchange of nitrogen oxide/cGMP, sildenafil enhances hypotensive effect of nitrates with their one-time or prolonged use, so its simultaneous use with nitrogen oxide donors, organic nitrates or other nitrites in any form is contraindicated either for continuous or for periodical application.
Drugs for the treatment of erectile dysfunction, including sildenafil, should not be used in patients for whom sexual activity is not recommended (for example, patients with severe forms of cardiovascular disease, such as unstable cardiac angina or severe heart failure).
Administration of Kamagra is contraindicated to patients with a loss of one-eye vision due to non-arterial anterior ischemic optic neuropathy, regardless of whether it was due to the intake of the PDE5 inhibitor or not.
The safety of Kamagra and its active component has not been studied in corresponding subgroups of patients; and therefore, its intake is contraindicated to patients with severe impairment of hepatic function, with arterial hypotension, with a recent heart or apoplectic attack or myocardial infarction and with known hereditary degenerative diseases of eye retina, such as retinitis pigmentosa (a small number of such patients have a genetic PDE of eye retina).
Pregnancy and Lactating
Kamagra is not intended for use by women.
Kamagra Interaction with Other Drugs
Sildenafil metabolism is mediated mainly by cytochrome P450 (CYP), in particular by its 3A4 isoforms (main way) and 2C9 (a secondary way). Thus, inhibitors of these isoenzymes can reduce elimination of sildenafil, whereas inducers of these enzymes can increase its clearance.
According to medical trials, population pharmacokinetic analysis of the results demonstrated a decrease in clearance of sildenafil while simultaneously applying it to CYP 3A4 inhibitors (such as ketoconazole, erythromycin, and cimetidine). Cimetidine (800 mg) is a cytochrome P450 inhibitor and a non-specific inhibitor of CYP 3A4 increased the serum sylenaphil concentration in blood plasma by 56% while co- administered to healthy volunteers with sildenafil dose of 50 mg. In case of using sildenafil in a dose of 100 mg simultaneously with erythromycin, a specific inhibitor of CYP 3A4 (500 mg twice a day for 5 days), an increase in the area under the concentration-time curve (AUC) of sildenafil by 182% was noted.
Simultaneous administration of saquinavir, HIV protease inhibitor (1200 mg 3 times a day), which is also an inhibitor of CYP 3A4, and sildenafil resulted in an increase of Cmax of sildenafil in serum by 140% and an increase in AUC by 210%. Sildenafil does not affect the pharmacokinetics of saquinavir. Strong inhibitors of CYP 3A4, such as ketoconazole and itraconazole, show a more pronounced effect.
Simultaneous intake of ritonavir, an HIV protease inhibitor, which is a highly specific inhibitor of P450, in an equilibrium state (500 mg twice daily) with sildenafil (100 mg once a day) leads to an increase in Cmax of sildenafil in blood plasma by 300% (by 4 times) and to increase by 1000% (by 11 times) AUC of sildenafil in blood plasma. After 24 hours, the concentration of sildenafil in blood plasma is about 200ng/ml, whereas in case of sildenafil alone, its concentration was 5ng /ml. This is due to the effect of ritonavir on P450 isoenzymes. Sildenafil does not affect the pharmacokinetics of ritonavir. When the dose of sildenafil for persons taking the CYP 3A4 inhibitor was applied according to the recommendations, the serum sildenafil concentration in lood plasma did not exceed 200 nM for any patient and the drug had good tolerance.
A single intake of antacid (magnesium hydroxide/ aluminum hydroxide) does not affect the bioaccessibility of sildenafil. CYP 2C9 inhibitors (such as tolbutamide, warfarin), CYP 2D6 inhibitors (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazide and thiazide-like diuretics, ACE inhibitors, calcium channel blockers, did not affect the pharmacokinetics of sildenafil.
Effect of Sildenafil on Other Drugs
According to medical studies, sildenafil is a weak inhibitor of cytochrome P450 isoforms, namely isoenzymes 1A2, 2C9, 2C19, 2D6, 2E1 and 3A4. In case Sildenafil enhances the hypotensive effect with short-term and prolonged use of nitrates, therefore, one-time or course use of nitrogen oxide donors or organic nitrates in any form along with sildenafil is contraindicated.
When sildenafil (25, 50 and 100 mg) was used by patients with benign prostatic hyperplasia concomitantly with the therapy of the β-adrenoceptor blocker with doxazosin (4 and 8 mg), which was maintained at a stable level, an additional decrease in blood pressure was observed. When sildenafil and doxazosin were administered simultaneously by patients resistant to doxazosin therapy, infrequent cases of symptomatic postural hypotension were noted. Its symptoms were dizziness and impaired coordination under the impact of light, but without losing consciousness. Co-administration of α-adrenergic blocking agents with sildenafil patients can lead to symptomatic hypotension in some patients.
- Signs of significant interaction of sildenafil (50 mg) with tolbutamide (250 mg) or warfarin (40 mg) each of which is metabolized by CYP 2C9 has not been identified.
- Sildenafil (100 mg) does not change the equilibrium state of pharmacokinetics of HIV protease, saquinavir and ritonavir that are inhibitors of CYP 3A4.
- Sildenafil (50 mg) does not increase the duration of bleeding caused by acetylsalicylic acid (150 mg).
- Sildenafil (50 mg) did not increase the hypotensive effect of alcohol in healthy volunteers. No interaction of sildenafil (100 mg) and amlodipine in patients with AH was noted. Additional decrease in systolic blood pressure is 8 mm Hg. The analysis of safety showed no difference in the profile of adverse reactions in patients taking sildenafil as monotherapy and combined with antihypertensive drugs.
The studies involving healthy volunteers have demonstrated that a single dose of Kamagra in doses up to 800 mg causes side-effects that are similar to those observed with sildenafil at lower doses, but their frequency of development and severity have increased. In case of an overdose, symptomatic therapy is performed. Dialysis does not accelerate clearance of the drug, since sildenafil binds firmly to plasma proteins and is not cleared with urine.
Kamagra tablets should be stored at a temperature of up to 25 ° C. Keep away from children and animals.
Kamagra Composition and Form
Kamagra is issued in a tableted form; each pill contains 100 mg of sildenafil. Each blister includes 4 tablets. 5 grams of Kamagra preparation contain: active substance - sildenafil citrate 100 mg, auxiliary substances: sucrose, sodium methylparahydroxybenzoate, sodium propyl parahydroxybenzoate, potassium acesulfame, sodium chloride, propylene glycol, sorbitol liquid (70%), carmellose sodium, citric anhydrous acid, citric acid monohydrate, yellow sunset FCF (E110), aromatizing orange 15215 or pineapple flavor RSV (IFF), quinoline yellow WS (E104), purified water.
ED Diagnostics and Kamagra Medical Analysis
To diagnose erectile dysfunction, determine possible causes of the disease and prescribe adequate treatment, it is necessary to carefully study the patient’s medical history and conduct a thorough medical examination. For the effectiveness of the action of Kamagra, sexual stimulation is necessary.
Sexual activity is associated with a certain degree of risk due to the possibility of a heart attack. Before starting any course of treatment for erectile dysfunction, the doctor should check the condition of the patient's cardiovascular system. Drugs intended for the treatment of erectile dysfunction should not be used in patients for whom sexual activity is undesirable.
After introduction of Kamagra in general medical practice, serious cardiovascular complications were reported that coincided with administration of sildenafil. These conditions included myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage and transient ischemic attack. Most of these patients have a history of cardiovascular risk factors. The prevalence of such cases was detected during or immediately after sexual activity, a smaller part - in a short period after taking sildenafil without sexual activity. Other cases are documented hours or days after the use of sildenafil and sexual activity. Thus, it is impossible to establish direct dependence of such cases on the use of sildenafil, sexual stress, concomitant cardiovascular diseases, a combination of these factors or other factors. In healthy volunteers, with a single admission of sildenafil in doses up to 100 mg, there were no clinically significant changes in electrocardiogram tracing. The maximum decrease in systolic blood pressure in supine position after oral administration of the drug at a dose of 100 mg was 8.34 mm Hg. The corresponding change in diastolic blood pressure in the supine position was 5.3 mm Hg. Lower than usual, but briefly, blood pressure decreased in patients who simultaneously took nitrates.
According to medical studies, sildenafil exhibited a systemic vasodilator effect which led to a transient decrease in blood pressure. This effect had little or no impact on most patients. Nevertheless, when prescribing Kamagra, a doctor must carefully consider the risk of adverse effects of Kamagra for patients with certain concomitant diseases, especially against the background of sexual activity. Increased sensitivity to vasodilators was noted in patients with left ventricular obstruction (aortic stenosis, obstructive hypertrophic cardiomyopathy), as well as with multiple manifestations of systemic atrophy, which are noted in individual cases and manifest severe abnormalities of autonomic control of blood pressure.
Kamagra containing a dose of 100 mg of sildenafil once a day for oral administration in patients with severe heart disease (stenosis> 70% of at least one coronary artery) reduces systolic blood pressure and diastolic blood pressure by 7 and 6%, respectively, in comparison with baseline. Pulmonary systolic pressure is reduced by 9%. Sildenafil has no effect on cardiac output and blood flow in stenotic coronary arteries due to an improvement (approximately 13%) in the adenosine-stimulated blood flow reserve (in the coronary arteries with and without stenosis).
Patients with erectile dysfunction and stable angina who regularly took anti-anginal drugs (with the exception of nitrates) and used sildenafil 100 mg one time per day experienced an increase in the duration of the treadmill test and the average exercise time before exacerbation of symptoms of angina, as opposed to compared with placebo.
Patients with concomitant hypertension who simultaneously took 2 or more antihypertensive drugs, sildenafil at a dose of 100 mg 1 time per day improved erection by 71% and increased the number of successful sexual attempts by 62%. The number of side-effects was the same in comparison with patients who took 3 or more antihypertensive drugs.
In all studies involving PDE5 inhibitors, including sildenafil, non-arterial anterior ischemic optic nerve neuropathy (NAION) has been reported, which causes a decrease or loss of vision. Most of these patients reported risk factors such as reduced depth/area ratio, age over 50 years, diabetes, AH, coronary artery disease, hyperlipidemia and smoking. There was no causal relationship between the use of PDE5 inhibitors and the onset of NAION. The doctor should warn patients who have already detected manifestations of NAION about the possible recurrence of NAION. Patients should be warned about the necessity to immediately seek medical attendance in the event of a sudden impairment of vision.
Patients suffering from age-related degeneration of eye retina, sildenafil (dose of 100 mg once a day) was well tolerated and did not cause a clinical effect in the study of visual functions in tests (visual acuity, Amsler's grid, color recognition, “artificial light stream”, perimeter Gamphrey and photostress).
Kamagra is recommended for use with caution by patients who simultaneously use alpha-adrenoceptor blockers, since in some cases such co-administration can lead to symptomatic hypotension. In order to minimize the risk of postural hypotension, it is necessary to achieve stabilization of blood pressure indicators with the help of α-adrenoreceptor blockers before using sildenafil. You should start using low doses of sildenafil. Moreover, doctors should inform patients about the way they must act in case of symptoms of postural hypotension.
Some patients with congenital pigment retinitis have genetic defects of the retina PDE. There is no information on safety of prescribing Kamagra to patients with retinitis pigmentosa, so this group of patients should be given caution with sildenafil.
The study of human platelets indicates that sildenafil enhances the anti-aggregation effect of sodium nitroprusside (nitrogen oxide donor). There is no safety information regarding the prescription of sildenafil to patients with a tendency to bleeding or with an acute gastric ulcer, so this group of patients is to be prescribed sildenafil with caution and under the supervision of a specialist.
Drugs intended for the treatment of erectile dysfunction should be used with caution by patients with anatomical deformities of the penis (such as angulations, cavernous fibrosis or Peyronie's disease) or patients with diseases that can lead to the development of priapism (such as sickle cell anemia, multiple myeloma or leukemia).
Safety and effectiveness of combinations of Kamagra with other types of treatment for erectile dysfunction have not been studied; therefore, it is not recommended using such combinations. After oral administration of a single dose of 100 mg of sildenafil, there was no effect on the motility and morphological properties of spermatozoa in healthy volunteers.
Just a few cases of sudden decrease and loss of hearing were reported in post-marketing studies after usage of PDE5 inhibitors, including sildenafil. Most of these patients reported risk factors for sudden reduction or loss of hearing. Causal connections of the use of PDE5 inhibitors and sudden decrease or loss of hearing in patients are not established. In case of sudden decrease and loss of hearing, patients should be advised to stop using sildenafil and immediately consult a doctor.
Kamagra dosage regimen by patients with impaired renal function of mild or moderate severity does not change. Since patients with severe renal insufficiency have reduced level of sildenafil clearance, the drug should be started with a dose of 25 mg. Patients with hepatic insufficiency have reduced clearance level of sildenafil, for example, in case of cirrhosis the drug should be started with a dose of 25 mg.
Given the degree of interaction in patients receiving concomitant therapy with ritonavir, it is recommended not to exceed the maximum single dose of 25 mg sildenafil within the period of 48 hours. The initial dose of 25 mg should be recommended to patients who receive concurrent treatments inhibitors of CYP 3A4 (e.g. erythromycin, saquinavir, ketoconazole, itraconazole). In order to reduce the risk of postural hypotension, it is necessary to achieve stabilization of patients with the therapy of α-adrenoceptor blockers before using sildenafil. In addition, you should start taking the drug with minimal doses.
Customer Reviews about Generic Kamagra
Problems with potency are a real tragedy for a young man in the prime of life. In my case, troubles were connected with a disease that I suffered as a child. It was necessary to urgently do something, and I was advised to us e Kamagra that is similar to Viagra. The effect occurred exactly in half an hour after the intake. Thanks to natural stimulation, a qualitative and stable erection was achieved. During sex, my girl did not complain about insufficient erection and I had no problems either! I was strong for about 4 hours, during this time I managed to commit 5 or 6 acts, I do not remember exactly. The result pleases. I took the pills on an empty stomach, I read in the instructions that it was more effective. I use the drug 3-4 times a week. There are no side effects. I'm happy, the girl is more than happy))))
Chronic prostatitis is not a sentence, I know from my own experience. Problems with erection have been torturing me for about 3 years, but I carefully concealed what was happening from my beloved wife. She did not want to upset me, and, what a sin to hide, I was afraid that she would find a lover. I used to take Viagra, but there were some side effects, my head was spinning. My physician consulted me and recommended paying attention to the modern analogue - Kamagra. I bought the package and realized I made a right choice! Erection is stable, penis is tight, and excitement begins after a brief caress, which is quite natural. My head was never sick, and I had no adverse effects. All is well, except for the fact that my wife has become overly active in bed. But after all, Kamagra administration more than once a day is not recommended.
I’ve always adored sexual experiments in bed, and my man jokingly called me a nymphomaniac. Alas, at 40 he can no longer afford to have sex all night long. I did not give up, but picked up the ED drug, Kamagra, after I had read good reviews on the Internet. I wanted to try a bright and unrestrained sex marathon. No sooner said than done. The effect, it seems to me, lasted more than 4 hours, and all this time my man did not feel tired. Penis was as strong, as I dreamed. The breaks between the acts were not longer than a couple of minutes. I will persuade a partner to take Kamagra at least several times a month. Still, there is no harm from the pills. My man says that he felt great after Kamagra use.
At about 47, I realized that my potency was bad, but it did not upset me that much. A couple of months ago I met a bright, extraordinary lady of 39 years old; I wanted to surprise her with something. But, ah, in my pants, I already had nothing. I wanted to buy Viagra, but for some reason I paid attention to Kamagra. I took a pill, went on a date and did not fall face to face in the mud. Sex normal, partner did not suspect that I was taking pills. No blushes, nausea or pain in heart, although my health condition is far from being perfect. Several sexual acts in a row – it’s still very cool for 57 years! Once, however, I bought from another pharmacy and it was a fake. Conclusion: trust only trusted suppliers, such as My Canadian Pharmacy.
I will not write much, I’ll only say that the effect is worth the money. Erection is as it should be lasting 3-5 hours, and this time is enough for satisfaction of the partner and me. I constantly wear Kamagra in the jacket pocket, just in case... I'm glad that the action begins really within 30 minutes, because sometimes I cannot wait too long!
Kamagra is a real salvation for a man who due to certain circumstances cannot boast of a tremendous erection. True, the first acquaintance with the tablets was not the best way, but it was my fault. On a festive day with his wife invited a lot of guests, of course, there was a sea of tasty and fatty food on the table. After the friends left, we went to the bedroom, I drank Kamagra, but even in an hour there was no result. Miracle occurred only in an hour and a half. But the instruction clearly indicates that you cannot combine Kamagra with fatty foods! I did not make more mistakes, and now everything is in order. I agree, in 30 minutes you can start sex. Erection is quite natural, comes only after a brief stimulation. The effect I personally experienced lasts 4 hours, but my wife and I do not always stand so much time in bed )))) Friends told that such drugs could lead to pimples, but I did not have them. Probably, it's important not to overdo it and not take the pill several times a day.
Generic Kamagra: FAQ
How does Kamagra work?
Viagra helps to minimize the symptoms of erectile dysfunction by increasing the flow of blood to penis. It performs this process by relaxing blood vessels so that more blood enters penis. For Kamagra, to function effectively and cause erection, there must be sexual stimulation.
How long does Kamagra work?
After taking Kamagra, the onset of erection should take about 30 minutes. Once the drug has begun to act, its effect can last up to 4 hours. Viagra will act faster if you have not eaten before taking Kamagra pills.
How often can I take Kamagra?
Kamagra can be taken once a day, if necessary, although it is important to remember that you should never take Kamagra pills more than recommended, even if you take the lowest dosage of the drug.
What is the best dose of Kamagra?
The dosage selection depends on your own individual characteristics and it is strongly recommended seeking the advice of a medical specialist to find out which dose of Kamagra will be optimal for you individually. If you take other medications or have serious health problems, often start with the lowest dose so that your health is not affected.
Can women take Kamagra?
Recent studies have shown that, yes, women can take Kamagra, although it is important to seek medical advice because there may be other non-medical procedures that could help women suffering from sexual disorders.
Can taking Kamagra be life-threatening?
If you saw your attending doctor, he studied your medical history and current health state and you stick to the dosages that were recommended, then you have a very low chance of suffering from any of the serious side-effects from Kamagra use. It is important to monitor yourself, and if you feel like Kamagra pills do not suit you, you must consult your doctor as soon as possible.