Average volume of distribution is around 63 liters suggesting that tadalafil is distributed in body tissues. At therapeutic concentrations, 94% of tadalafil in plasma is associated with proteins. Protein binding does not change with impaired renal function. In healthy persons less than 0.0005% of the administered dose was found in semen.
Metabolism Tadalafil is mainly metabolized with participation of cytochrome parabolan side effects izofermenta. The major circulating metabolite is metilkateholglyukuronnd. This metabolite is at least 13,000 times less active against PDE5 than tadalafil. Consequently, the concentration of this metabolite is not clinically significant.
Special Populations Elderly patients Healthy elderly patients (65 years or over) had a lower clearance of tadalafil when taken orally, which was reflected in an increase side effects of tren in the area under “concentration-time” curve by 25% compared with healthy limes in age from 19 to 45 years old . This difference is not clinically significant and does not require adjustment of the dosage.
Patients with renal insufficiency In patients with renal insufficiency, mild to moderate dose adjustment is required. Due to increased tadalafil exposure , in patients with severe renal impairment is not recommended parabolan side effects .
Patients with liver failure Farmakokinetnka of tadalafil in patients with mild to moderate hepatic impairment is comparable with that in healthy individuals. For patients with severe hepatic insufficiency (class C Child-Pugh classification) data are not available. In appointing parabolan side effects in patients with severe hepatic impairment must first conduct a risk assessment and the use of the drug.
Patients with diabetes, patients with diabetes during treatment with tadalafil area under the curve “concentration-time” was smaller about 19% than that of healthy individuals. This difference does not require dose adjustment.
- Hypersensitivity to tadalafil or to any substance that is part of the drug;
- In the case of taking the drugs containing any organic nitrates;
- The use of persons under 18 years of age;
- The presence of contraindications to the sexual activity in patients with diseases of the cardiovascular system: myocardial infarction within the past 90 days, unstable angina, occurrence of angina attack during intercourse, chronic heart failure II-IV class NYHA classification trenbolone effects, uncontrolled arrhythmias, hypotension ( BP less than 90/50 mmHg), uncontrolled hypertension, ischemic stroke within the last 6 months;
- Loss of vision due nearterialnoy anterior ischemic optic neuropathy (regardless of connection with taking PDE-5 inhibitors);
- Simultaneous treatment with doxazosin, as well as drugs for the treatment of erectile dysfunction;
- Frequent (more than 2 times per week) application in patients with chronic renal failure (creatinine clearance less than 30 mL / min);
- Deficiency of lactose, lactose intolerance, glucose-galactose malabsorption.
Precautions Since there is no data in patients with severe hepatic insufficiency, caution must be exercised what is trenbolone in the appointment of this group of patients. Caution must be exercised in the appointment of Cparabolan side effects patients. receiving alpha 1 adrenoblokatory as the simultaneous use can lead to symptomatic hypotension in some patients. In a clinical pharmacology study in 18 healthy volunteers who received a single dose of tadalafil, there was no symptomatic hypotension while the introduction of tamsulosin.
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