Viagra Strong (Generic) Sildenafil 200mg

Generic Viagra Cenforce-200 what is it?

Cenforce-200-enhanced formula of generic Viagra. The active substance-sildenafil, is contained in a dosage that exceeds the usual dose by 2 times (200 mg of sildenafil, instead of 100 mg for typical generic Viagra). Generic Viagra is used to restore a stable erection during sexual intercourse. Sildenafil is not intended for the treatment of the root cause of erectile dysfunction (age, high cholesterol, diabetes, etc.), its effect is to stimulate blood circulation in the penis, which lasts until the drug is active (4-8 hours). There is no habituation.

Indications for the use of Cenfors 200

Generic Cenforce-200 is indicated for a weak erection or complete absence of an erectile reaction during sexual acts that have occurred repeatedly. The drug is not intended for the treatment of the main causes of erectile dysfunction (diabetes mellitus, low levels of sex hormones, chronic fatigue, etc.) and is indicated exclusively as a temporary stimulant of potency.

Composition
The main active agent of Cenforce-200 is sildenafil citrate 200 mg. Related substances: GPMC, glycerol triacetate, lactose monohydrate (dehumidified by dispersion), croscarmellose sodium, hyprolose ultrafine grinding, microcellulose.

Pharmacological effect of sildenafil

Erection, as a mechanism, has a very complex chain of events in the physiology of men. Understanding the action of phosphodiesterase-5 (IPDE5) inhibitors should be considered within the framework of the complex mechanism of penile erection as a whole. Physiologically, an erection, as a mechanism, can be divided into certain conditional stages, which in turn are divided into many discrete ones. The very first such stage is the process of arousal-as a consequence of sexual stimulation, that is, arousal triggers the entire sequence of events leading to an erection.

Sexual stimulation can have a different nature: mechanical (tactile impact), imagination, visual impact, various combinations of the above and much more. The bottom line is that erotic signals that enter the brain are collected in its centers and transmitted by messengers (chemicals) to various organs and tissues. Androgens — male hormones of a steroid nature-play a huge role in the processes of arousal and the entire mechanism of stimulation of sexual desire.

The next stage is the transmission of a signal from the brain through neurons to the penis. Under the influence of signals from the cerebral cortex, the cells of the penis actively produce NO (nitric oxide), which activates another specific enzyme – guanylate cyclase. Under the influence of the latter, the formation of cyclic guanosine monophosphate (cGMP) begins.

In the normal, non-aroused state, there is an excess of Ca+ ions in the male cells, which maintain the tone of the smooth muscles of the male vessels, which prevents blood flow to it and as a result, the penis itself is in a relaxed state. Under the influence (cyclic forms guanosine monophosphate), CGMP and the subsequent decrease in the concentration of calcium ions, occurs relaxation of smooth of blood vessels, increasing the lumen of the cavernous arteries and sinusoids of the penis, which leads to an erection and increased blood flow in the penis and as a result to erection.

Method of application and effective dosages

Cenforce-200, including all other generics based on sildenafil, is undesirable to take simultaneously with heavy fatty foods. Fatty foods block the intake and absorption of sildenafil from the gastrointestinal tract into the blood. Do not use sildenafil dosages that exceed the standard 100 mg. Although the generic Cenforce 200 contains a dosage twice as high as the therapeutic one, taking a whole Cenforce-200 tablet is strongly discouraged. Experienced users buy this generic solely for financial gain, since in terms of sildenafil, the cost of a therapeutic dose will be much cheaper. Taking a whole tablet of Cenforce-200, you risk getting side effects, so before taking a generic pill, it is advisable to divide the tablet into several parts with a knife and take only half or a quarter of the tablet. Do not take the drug more than once a day and do not combine it with alcohol.

Older men
The age of the patients may not be a reason for dose adjustment. If there are no other contraindications, the dosage of sildenafil for patients in years should be selected in the same way as in other cases — up to 100 mg of sildenafil.

Contraindications of use
Some medications and chronic diseases can cause side effects and worsen the patient's health. Contact your doctor and let them know about current chronic diseases and medications that are being prescribed at this time.

The efficacy and safety of sildenafil Cenforce-200 has not been proven for patients with a predisposition to ulcerative diseases and gastrointestinal bleeding. People with open peptic ulcer disease should not take sildenafil, because in vitro studies sildenafil negatively affected platelet aggregation and rheological properties of blood. In human studies, this fact has not been confirmed, but you should take it into account and protect yourself as much as possible.

Co-administration with inhibitors of the CYP3A4 isoenzyme may extend the half-life of sildenafil. The initial recommended dosage of sildenafil should be reduced to 25 mg during use with CYP3A4 inhibitors. Avoid eating grapefruit juice or grapefruit products, because they similarly affect the main pathway of sildenafil metabolism (via CYP3A4).

Do not use other medications for the treatment of male impotence (alprostadil yohimbine, etc.) without first consulting your doctor.

• Patients with pulmonary veno-occlusive disease (LVOB) are not recommended to take sildenafil together with vasodilators, as pulmonary vasodilators can lead to complications of the patient's cardiovascular condition.
• Caution should be exercised when prescribing sildenafil to men with prolonged QT syndrome (including patients with congenital QT prolongation and those who use certain substances that prolong the QT interval), hypertrophic cardiomyopathy and aortic stenosis.
• Do not take Cenforce-200 if you have a history of diseases of the visual organs, including hereditary ones, for example, cases of ischemic anterior non-arteriitic optic neuropathy (NAION), retinitis pigmentosa, yellow body degeneration.
• Sildenafil is not indicated for use by persons whose active sexual life is prohibited due to health conditions, as well as women (including during pregnancy and breastfeeding) and children under 18 years of age.

Additional contraindications

• It is forbidden to use typical therapeutic dosages of sildenafil together with HIV protease inhibitors (indinavir, ritonavir), since such use significantly increases the plasma concentration and time of systemic action (AUC) of sildenafil (300% and 1000%, respectively). Co-administration of such drugs leads to a significant increase in the risk of undesirable side effects (hyperemia, vasodilation, dizziness, headache, nosebleeds, etc.).
  
  
• Sildenafil is contraindicated if the patient has previously had situations leading to priapism (a painful and prolonged state of erection) or when the patient has diseases that increase the risk of priapism: anatomical deformity of the IF (for example, cavernous fibrosis, angulation, Peyronie's disease), blood diseases (multiple myeloma, thrombocytopenia, acute leukemia, sickle cell anemia).
  
  
• Cenfors 200 is contraindicated in arterial hypertension (systolic more than 170 mm Hg, diastolic blood pressure more than 110 mm Hg), serious liver damage, severe renal failure (CC less than 30 ml / min) and significant hypotension (less than 90/50 mm Hg).
  
  
• Prohibited integrated use of sildenafil together with stimulants is called guanylate cyclase (riociguat), because of a significant reduction in arterial blood pressure. Do not take other PDE-5 inhibitors or any other medication that also contains sildenafil. It is forbidden to combine with drugs from the group of alpha-blockers and especially drugs based on nitrates for the treatment of anginal heart pain. Avoid sharing certain antiarrhythmic drugs-procainamide, amiodarone, quinidine, sotalol (see "Interactions").

Intolerance

Sildenafil is contraindicated in cases of heart attack, apoplexy that have occurred in the last 6 months, as well as in the presence of serious heart diseases: bradycardia (less than 50 beats per minute), coronary heart disease (CBS), cardiac tamponade, chest toad, heart failure.

Do not take sildenafil if you have an individual intolerance to drugs based on it (swelling of the throat, lips, face or tongue, difficulty breathing, including anaphylactic shock).

A small number of events have been recorded in which sildenafil citrate is likely to have caused vision loss. The cause of vision loss was caused by a lack of blood supply to the optic nerve due to non-arteriitic ischemic anterior neuropathy (NAION). Almost all patients had concomitant diseases and aggravating factors at the time of taking sildenafil: diabetes, edema of the optic disc, vascular complications, existing vision problems that occurred before, high cholesterol, high blood pressure, smoking and age over 50 years. There are discussions in the medical community about the provocation of sildenafil with such severe consequences, since the statistics of the occurrence of such complications in this group of patients are comparable to those if sildenafil was not taken.

Interaction with other drugs

Blockers of alpha adrenergic receptors. Combined treatment with alpha-adrenergic receptor blockers together with sildenafil leads to a significant increase in the likelihood of hypotension and associated undesirable side effects: fainting, confusion, dizziness and injuries (resulting from falls). Of all the alpha-adrenergic blockers, only alfuzosin and tamsulosin did not have undesirable effects on the subjects and can be considered relatively harmless when used together.

Guanylate cyclase stimulants. A significant number of patients with PAH who were prescribed combination therapy with sildenafil (20 mg of sildenafil three times a day) and riociguate (0.5 mg and 1 mg) stopped therapy, due to excessive hypotension and an increase in the likelihood of undesirable concomitant effects: headache, loss of consciousness, facial skin hyperemia, fainting, dizziness, etc.

Derivatives of morphine.
Combined use of opiates and sildenafil may induce priapism. This side effect has been reported specifically for dihydrocodeine, but is also possible with other opiates. Two individuals who used sildenafil as a treatment for erectile dysfunction reported prolonged erections lasting from 2 to 5 hours during the first 7 days after starting dihydrocodeine therapy. One subject stopped treatment with dihydrocodeine, after which his potency returned to normal. The second patient continued treatment for another two weeks, but without complaints.

Drugs that induce cytochrome CYP3A4 and CYP2C9 isoenzymes. The inducer of the cytochrome CYP3A4 isoenzyme rifampicin at a therapeutic dosage of 600 mg, which was prescribed daily with sildenafil, did not significantly increase the clearance of sildenafil. The decrease in AUC was 88%, and the maximum concentration was 46%, compared with sildenafil at the same dose, but without rifampicin. Other interactions with similar drugs have not been studied. There are suggestions that other inducers of the CYP3A4 isoenzyme, such as nevirapine, ciproterone, modafinil, can also increase the clearance of sildenafil. Adjustment of the dosage of sildenafil is not provided.

Barbituric acid derivatives
Co-administration of sildenafil with barbiturates may reduce the maximum concentration of the latter in the blood (Cmax) and/or reduce the area under the pharmacokinetic curve “concentration-time”. In turn, this interaction can lead to a decrease in the effectiveness of sildenafil. The recommended dose of sildenafil can be adjusted after the recommendations of the attending physician and under his personal supervision. To use both drugs safely, ask your healthcare provider to prescribe alternative treatment options.

Antacid medications. Substances such as calcium carbonate, aluminum hydroxide, magnesium oxide, magnesium hydroxide, almagel can affect the absorption of drugs, thereby delaying their physiological effects in time.

HIV protease inhibitors. Taking sildenafil in combination with such strong non-selective cytochrome inhibitors as ritonavir, saquinavir, indinavir and others can rapidly increase the content of sildenafil in the blood.

NO donators, organic nitrates and nitrites. It is strictly contraindicated to take sildenafil by persons who use organic medical nitrates, including nitric oxide donators. There are no well-defined time limits between the use of these drugs and sildenafil, at which the use of medical nitrates can be safe. Medical nitrates (as well as PDE-5 inhibitors) have their own exceptional time of pharmacological activity, which depends both directly on the active substance itself and on the form of its release (sublingual sprays, ointments, patches, capsules, drops or tablets). For example, people taking sildenafil need to wait at least a 12-hour interval after the last dose of sildenafil before taking sublingual nitroglycerin.

Inhibitors of the cytochrome P450 system
Powerful inhibitors of CYP450 3A4, are able to increase the Cmax and the area under the kinetic curve “concentration-time” (AUC) of sildenafil by an order of magnitude. A powerful selective inhibitor of CYP3A4 and CYP2C9-ketoconazole (400 mg per day), increased the maximum peak plasma concentration (Cmax) and the area under the pharmacological curve (AUC) of sildenafil by 3 and 10 times, respectively, compared with the use of sildenafil alone. Similar values of the mean maximum plasma concentration (Cmax) and AUC were found in itraconazole. This suggests that substances that inhibit cytochrome, such as amoxicillin, delavirdine, erythromycin, esomeprazole, rabeprazole, etc., may increase the time of pharmacological activity and the frequency of adverse side effects of sildenafil, however, laboratory tests have not been conducted in this regard. In erectile dysfunction, patients receiving combined treatment with strong cytochrome P450 inhibitors (isoform 3A4), such as voriconazole, itraconazole, telithromycin, pantoprazole, esomeprazole and HIV protease inhibitors, the recommended therapeutic dosage of sildenafil should not exceed 25 mg of sildenafil per day.

PDE5 inhibitors. Tell your doctor about all the medications, dietary supplements, and even herbal tinctures that you take with sildenafil. Do not take a combination of several medications for impotence, including the same type, especially if they contain sildenafil, tadalafil, udenafil, vardenafil, pentoxifylline, theophylline or avanafil. Combined use of these drugs may increase the risk of side effects.

Side effects
More than 20,000 volunteers participated in the clinical trials of sildenafil. The result of these studies proved that sildenafil has, although not the best among all PDE-5 inhibitors, but a fairly good safety profile. Adverse reactions in most cases recede within a few hours after the use of the drug and are transient in nature. The most pronounced manifestation of undesirable side reactions, as a rule, coincides with the maximum concentration (Cmax) of the active substance in the blood. In general, the drug is well tolerated by the body and only in extremely unlikely cases can cause complications (for more details, see Side effects based on drugs with sildenafil):

• From the gastrointestinal tract: inflammation of the esophageal mucosa, dyspepsia, numbness of the oral cavity, nausea, anal bleeding, inflammation of the stomach and small intestine, hemorrhoids.
• From the central nervous system: headache, restlessness, numbness of parts of the body, abnormal dreams, insomnia, drowsiness, tremor.
• From other systems and organs: priapism, abnormal liver tests, hematuria.
• From the respiratory system: inflammation of the larynx, runny nose, cough, pharyngitis, inflammation of sinusitis, asthma.
• From the skin and dermis: contact dermatitis, allergic rashes, herpes, exfoliative dermatitis, redness of the skin, itching.
• From the organs of hearing and vision: visual color distortions, eye and ear pain, retinal hemorrhage, corneal dryness, atherosclerotic retinopathy, glare in the eyes, hemorrhagic syndrome, eye edema, sclera discoloration, tinnitus, opacity of vitreous fibers.
• From the musculoskeletal system: tendon rupture, joint pain, tendon inflammation, muscle weakness, lower back pain, bone pain, myalgia.
• From the cardiovascular system: postural hypotension, ventricular arrhythmia, cerebrovascular and serious cardiovascular and vascular complications, AV block, atrial fibrillation, thrombosis, cardiomyopathy,heart failure and unstable angina.
• From the side of hematopoietic function: leukopenia, anemia.

Alcoholic beverages and Cenfors 200
Sildenafil in combination with alcohol can lower blood pressure. Significantly increases the tendency to symptoms such as tachycardia, dizziness, red eyes, fainting, headache and flushes of blood to the face. Alcohol does not affect the pharmacokinetic parameters of sildenafil in plasma — the area under the pharmacokinetic curve “concentration-time” (AUC) and the rate of excretion of the substance from the body. Either way, you should avoid or limit alcohol consumption during sildenafil therapy.

Overdose
Overdose of drugs based on sildenafil causes the same side effects as from the standard recommended doses. However, their probability of occurrence and the strength of their manifestation increase significantly. In case of overdoses with sildenafil, standard maintenance treatment is carried out, aimed at relieving and eliminating the main symptoms manifested. In severe cases, seek urgent medical attention.

Release form
Cenforce-200 tablets are available in 10 pieces in a foil blister. The batch number, expiration date and active substance content are printed on the package.

Recommendations for storage
Storage temperature range from 0 to 30 °C. The final date of storage of the drug Cenforce-200 is indicated on the convalute. Keep Cenfors 200 out of the reach of children.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

Known Trade Names

Sildenafil are usually being sold under following trade names: Viagra, Aurogra, Caverta, Extra Super Viagra, Female Viagra, Fildena, Kamagra, Kamagra Chewable, Kamagra Effervescent, Kamagra Gold, Kamagra Oral Jelly, Kamagra Polo, Kamagra Soft, Kamagra Super, Lady era, Malegra DXT, Malegra DXT Plus, Malegra FXT, Malegra FXT Plus, Nizagara, Penegra, Red Viagra, Silagra, Sildalis, Sildigra, Silvitra, Suhagra, Viagra Extra Dosage, Viagra Jelly, Viagra Plus, Viagra Professional, Viagra Soft, Viagra Sublingual, Viagra Super Active, Viagra Vigour, Zenegra, Sildenafila, Sildenafilo, Sildenafilum, Veega, Intagra, Vigra, Sildanil, Sildaccord, Silerec, Mecfil, Caveroz, Caverta, Fildena, Nizagara, Penegra, Silagra, Sildalis, Sildigra, Silvitra, Suhagra, Zenegra, Sildenafila, Sildenafilo, Sildenafilum, Veega, Intagra, Viprogra, Cenforce

FDA note

Following substances were examined by FDA and are known to contain sildenafil: "New" Extenze, Magic for Men, Triple MiracleZen, Sexy Monkey, XZone Gold, Boost Ultra, New XZen Platinum, Happy Passengers, STUD Capsules, Nite Rider Maximum, Super Power, Tiger King, SexRx, Various Distributors, Goldreallas XXX, Old Chinese, Shenjingpian, Ginseng for Reinforcing Kidney, Goldreallas Original, Golden Night, Mamba is Hero, Ginseng Power-X, Ninja-X, AMPD Gold Bee Pollen, Bull’s Genital, Weekend Prince, Bull, Zhong Hua Niu Bian, Man King, Hard Ten Days, Extenze Tablets, Germany Niubian, 72HP, Tibet Babao, Aspire36 and Aspire Lite, Libigrow XXX Treme, Black King Kong, Night Man, Vigour 300, Hard Wang, FX3000, MME MAXMAN, Super Hard, Plant Vigra, Sex Men, Santi Scalper, Diablos Eca Fire Caps, Natural Max Slimming, Herb Viagra, La Pepa Negra, Stiff Nights, Vim-25, Rhino Blitz Gold 3000, Baolong, Sextra, Black Mamba Premium, Bigger Longer More Time More Sperms, Black Ant King, African Superman

Known UPC numbers

Products with following UPC numbers are the same as Viagra: 4150089067633, 4150089067923, 4150089068005, 4150089068173, 4150089068234, 5017007013860, 5050650110043, 7891268102062, 7891268106503, 7891268106527, 7891268106541, 7891268106558, 7891268106596, 4150001424735, 4150001426227, 4150001427118, 4150001427286, 4150002345480, 4150002345541, 4150002348092, 4150002357087, 4150016207620, 4150016207910, 4150016208160, 4150016208221, 4150016208399, 4150017959931, 4150024648217, 4150028200848, 4150028206932, 4150043137822, 4150047103717, 4150047103885, 4150047127669, 4150047127720, 4150047127898, 4150047127959, 4150047134124, 4150048657486, 4150048680897, 4150048688534, 4150049327234, 4150050240928, 4150050241239, 4150066347116, 4150071160946, 4150071161318, 4150100678442, 4150101139003, 4150101428824, 5013457010800, 5013457010817, 5013457010824, 5013457010831, 5013457010848, 5013457010855, 5016695005188, 5016695005195, 5016695005218, 5017007013860, 5050650110043.