How to save on buying drugs online pharmacy?

Our customers continually ask why our drugs are many times cheaper than the known analogs. I’ll try to explain the matter is that buying drugs known manufacturers, you PEREPLAICHIETE FOR BRAND more money than the drug itself is, therefore, less well-known manufacturers that have a license to possess all permits, which had acquired the technology of manufacturing, selling their drugs much CHEAPER brands.

The quality is absolutely identical products manufactured by the same technology, the difference in price - the difference in the value of the brand!
So why pay more?
In recent times, the doctors themselves, who until recently wrote out after taking the expensive drugs, are advised to buy generics, ie, drugs that are sold in our Drugstore. I’ll try to quote a famous doctor, when he ordered medication patient: «Why should you buy a brand? Buy generics! »Indeed, once bought drugs in our pharmacy, people come back to us again and again, a stream of letters inexhaustible!
In our time, the time of the global financial crisis begins to take every dollar and buying the drugs in our online pharmacy you save HUNDREDS OF DOLLARS!

Synonims: Vitra, Vardenafil, Auvitra, Solvetra

buy cialis cheap

buy viagra cheap

viagra (sildenafil)
Health to you and good luck!

Offers an electronic tablet pharmacy

Offers an electronic tablet pharmacy, low prices, high quality, absolutely anonymously, DISCOUNTS:

buy viagra online, cheap tablet

buy viagra cheap

Synonims: Viagora, Sildenafil Citrate, Sildenafil Tablets, Ruagra, Kamagra, Caverta, Silagra

buy cialis online pharmacy

buy cialis cheap

Synonims: Cialis, Tadalafil Tablets,Tadanafil, Tadanafil SX, Sanafi, Tador

buy online levitra

Synonims: Vitra, Vardenafil, Auvitra, Solvetra

The big help, to the small friend

Let’s talk about weaknesses of the stronger sex, more precisely, about weakness. And though the conversation subject does not enter in any way into a category of gifts - viagra on a saucer from a blue kaemochkoj would look the insult even for the weakest man, - to talk about it costs. The quantity of the means promising the help in delicate questions, is so great, that in them can lose the way and analytical man’s mind. So, than can support the advantage of the man today?

Ancient Greek tragedy

Many consider, that as the first effective medicine helping men, there was a viagra. It not absolutely so. To it already was a kaverdzhekt, capable to help very many, and even in heavy cases. Speaking figuratively, the kaverdzhekt “lifted dead”. Why this medicine has not found such glory? The way of its application by much seemed too barbarous: the preparation was entered by means of a special syringe directly into “man’s advantage”.

Already therefore the kaverdzhekt could not become mass means, despite the fact that what the special needle did pricks almost painless. However, always were a marginaly, ready to go for the sake of sex and on big a victim. To urologists well-known cases when in the same way entered a papaverin, and it quite often came to an end with a priapizmom - “Ancient Greek tragedy”, named by name god Priapa possessing most impressive man’s “argument” on the Olympus. Only here at the person this “divine” gift got the form of the heavy illness quite often leading to loss of “man’s advantage”.

Shortly before occurrence of viagra of a kaverdzhekt modernised, having made its less ominous. A needle have cleaned, and a solution with active substance of a alprostadilom have transformed into a small candle which by means of a device shpritsepodobnogo inserted into an urethra. Efficiency of a preparation was approximately same, as well as at viagra, but is serious it and have not untwisted, and to Russia even have not taken. A preparation at us have registered, but viagra here has appeared in time, and it have decided not to import to Russia.

Spray with by-effects

Viagra has won the world, and at the same time and has cleared away a field to the future competitors thanks to two things - to convenience of application (easier than to accept inside a tablet, anything is not present) and the new mechanism of action. Before practically all means for strengthening of a potentiality in the form of pills were mythical. It is enough to recollect a johimbe. An extract from a bark of this tree traditionally used in Africa, but unequivocally to prove its efficiency and could not neither in Europe, nor in the USA. And it thus, that medicines from a johimbe in the form of tablets existed long before viagra. There are they and now: in Russia the johimbe preparation-shpigel is registered. And where it? Who uses it? And here BUDS from a johimbe widespread, very much love them credulous men, whose mentality is similar to the female logic.

Have not made a serious competition to viagra and the tablets of a juprima registered in 2000 in the USA. Their destiny is painfully improbable: the active substance of this medicine of a apomorfin was used very much for a long time as emetic means.

Being the student, I observed, how with its help developed an emetic reflex on vodka at alcoholics. The patient - to the classical intellectual, the worker and a gromile with the person of the serial murderer have entered a apomorfin. In half an hour when the preparation should start to operate, to it have suggested to drink “for three”. The intellectual has filled in a table in emetic weights, not having been in time and to touch vodka, the worker has broken on the third pile, and smashed has drunk up a bottle, not having hiccupped at all.

I think, not all lovers can far behave after a juprimy how smashed. Doctors assert, that among people with sexual problems it is a lot of intellectuals with the thin sincere organisation. And, probably, this preparation will not approach them. Though manufacturers assert, that a apomorfina dose in a preparation more low, than it is necessary for vomiting calling, this by-effect is present at the instruction.

Now in the USA the juprima in the form of a spray nazalnogo is tested. At such way of introduction the preparation should operate faster, despite the fact that what the nose is far from “man’s advantage”: simply so it is fast soaked up in blood. But besides, whether will cause this fast excitation of the emetic centre in a brain, the nose located much more close to a cavity? By the way, the way of introduction through a viagra nose is developed also. But the manufacturer of this preparation for some reason refuses to let out such spray.

Death in a saddle

Viagra has generated problems which were inherited also by its younger competitors - a cialis and a levitra. They possess the same mechanism of action, as well as viagra. When there was a viagra, physicians very attentively looked narrowly at it. It has appeared, that for some men sex with this medicine came to an end tragically. They had heart attack of a myocardium or other cardiovascular accidents. There were also deadly cases. Scientists argue till now, they are caused by the mechanism of action of a medicine or it is simple coincidence.

But this question in many respects the rhetorical. Even if similar medicines “to wash until white”, all of them it is equal in certain degree will be guilty both in heart attacks, and in these death. As the Swedish physicians from Karolingsky university have convincingly proved, sex and itself can cause a heart attack at people with ischemic illness hearts (IBS). The risk of it is insignificant, but it exists, and the the condition of the vessels supplying heart by blood, the it above is worse.

Far not all patients from a IBS can practise sex - loading during sexual intercourse is so high, that heart can not take out it. And having tried sex with tablets, they can erect themselves to a scaffold: cases “death in a saddle” (so name  destruction of men not on the battlefield, and on a love box) to physicians well-known. After such death manufacturers of medicines for an impotence began to bring in the instruction obligatory point that the preparation does not need to be accepted to those men at whom sexual activity is undesirable because of a condition of cardiovascular system. However precisely to define such condition it is uneasy.

- For this purpose it is better to test with physical activity on a veloergometre or a running path, - Raphael Oganov, the academician of the Russian Academy of Medical Science and the director of a GNII of the Center of preventive medicine considers. Is will help to look, as heart reacts to loading. It is possible to spend and a so-called holterovskoe monitoring - record of the electrocardiogram within days. It is quite good, if record is made and during sexual intercourse. It will show, how heart transfers this specific loading. If cardiogramme changes will not be, sex is not counter-indicative to the patient.

The basic compromising evidence is saved up on viagra, its competitors of a cialis and a levitra are still very young. But there are all bases to assume, that behind them business too does not become. As they call for more serious sexual feats, promising to deliver pleasure to the partner more than once. Certainly, it is healthy. But also the risk of warm accidents at double loading should be above. Besides the cialis promises you to hold in a condition of “the raised readiness” within 36 hours. It can increase risk for one reason. Such long “be ready” often unduly in home life, and here at extramarital affairs, spontaneous and unpredictable, will be just right. And as English scientists have established, probability “death in a saddle” at sex with the mistress four times above, than during love with the lawful spouse, - all business in stress and in emission of superfluous adrenaline.

Whether dangerously to you to have sex?

Experts of the British organisation on heart studying offer two simple tests which can help to define to cores, sex is safe for them or not.

The test the first: try to rise on 2-3 flights of stairs. If thus you did not have a pain in a breast or a short wind for you yet all is lost - moderate sex is not forbidden you.

The test of the second: instead of lifting on a ladder try to pass a distance in 300 metres. Speed should be moderated, but not slow. It is results of the test are interpreted in the same way, as well as in the previous case.

Keep in mind, that these tests are very primitive and can serve for most to the general and a rough estimate of your condition. They do not cancel medical consultation and the control and do not replace. Special tests for a veloergometre, a running path or a holterovskoe monitoring are more reliable, and to refuse them it is not necessary.

Viagra, Levitra, Cialis - win new segments of the market

“Viagra”, «Levitra» and «cialis» - three similar medicines for an impotence - win all new segments of the market. If earlier, in the first advertising campaign of “Viagra”, the elderly senator a Doul Bean now heroes of rollers of the man do not become more senior forty acted in film.

Experts in marketing any more do not suggest buyers to be treated for an impotence, and position the preparations as tablets for pleasure. «Levitra», for example, is painted in cheerful orange colour.
Who now buys “Viagra”

As newspaper The New York Times writes, the first people really sick of an impotence began to receive such medicines. Under the recipe of the doctor the sexual life managed to be adjusted suffering from a diabetes, neurologic infringements or by-effects of energizers.

However demand for “Viagra” has sharply increased in a consequence. First, doctors began to write out without superfluous questions recipes to all who asked. Secondly, there were numerous Internet drugstores which offered preparations from an impotence without the recipe and with delivery.

Accordingly, the circle of buyers has extended also. Healthy people who wished to make secure before disturbing appointment became “patients”.

The portrait of one of such consumers is described in New York Times. 41-year-old Chris London (Chris London) lives in New York and works as the lawyer. One of its business partners has declared once, that cannot normally work with the man if before it they did not have a sex. London has been at least discouraged by such statement, but has agreed to meet after work. According to the advice of the familiar doctor he has won the excitement by the “Viagra” silently swallowed in a bathroom.

Easier speaking, “Viagra”, «Levitra» and «cialis» all who wishes to be assured of the sexual possibilities irrespective of circumstances now buy. Manufacturers of medicines thus underline, that food intake or alcohol does not influence at all their efficiency.
What impotence?

The impotence (a erektilnaja dysfunction) is defined as repeated inability to support a erektsiju necessary for sexual intercourse.

This frustration young enough men suffer both elderly, and. In the first case the impotence reason are chronic diseases or traumas more often, and in the second the impotence is a psychological problem.

Contrary to opinion of many men, “Viagra” and its analogues operate exclusively on blood supply of a sexual member and have no psychotropic effects. That is, such preparations can improve a potentiality, but do not stimulate a libido. However, as doctors have found out, together with a normal erektsiej the desire of sex frequently comes.
Sex In The City

According to psychologists, the requirement for “Viagra” and its analogues first of all is at inhabitants of large cities. Sexual revolution has led to that even more often sexual contacts occur between unfamiliar people: the fellow workers who have got acquainted on a party or under the announcement on the Internet.

Thus in consciousness of the majority of people there is an image of the ideal man always ready to sex and the interested person this. Trying to correspond to such representation, men accept tablets secretly, as Chris London mentioned above. Entering into a bedroom with a flush on cheeks - a widespread by-effect of “Viagra” - they complain of a heat and closeness. And in the morning often hide as suffer from a headache.

As omechaet The New York Times, such tablets are drunk frequently also by men-gays. Both lovers do it secretly the friend-from to the friend, and then those by-effects together worry.

viagra, levitra, cialis - cheap!

Problems of erectile dysfunction how to treat problems with an erection

Development of modern medicine on a way of narrow specialisation has led to occurrence of experts in ischemic illness of heart, etc. At the same time it is obvious an arterial hypertensia that to survey these diseases separately from all organism it is impossible: they lead to a lesion of all organs and systems, including - to development of erectile dysfunction.

The reasons and mechanisms of erectile dysfunction

Erectile dysfunction define, how «disability to reach and (or) to support an erection, sufficient for satisfaction of sex activity» (Impotence. NIH Consensus Development Panel on Impotence. 1993) in the event that these disorders are observed at least within 3 months.

Actually the majority of men the main reason of disorder of an erection has a vascular disease. Almost in all epidemiological researches devoted by a ED, communication of its occurrence with an arterial hypertensia and an atherosclerosis is taped. Moreover, according to some authors, ED revealing can testify to presence at the patient of one of these diseases in the latent form (Nusbaum M.R. et al., 2002).

At an atherosclerosis of a wall of blood vessels lose elasticity and are narrowed at the expense of atherosclerotic plaques covering them that leads to development of infarcts and strokes. Owing to an atherosclerotic lesion of vessels of a sexual member arises not only mechanical disturbance of a blood flow, but nejromediatorov development is broken also, elasticity of vessels decreases. Quite often various implications of an atherosclerosis (for example, ischemic heart disease and a ED) develop in parallel, as risk factors of endothelial dysfunction and the atherosclerosis amazing with a penilnye blood vessels, the same, as ischemic heart disease risk factors - smoking, a dislipidemija, a diabetes (Kloner R.A., Speakman M., 2002). The risk of development of a coronary disease at patients aged is more senior 50 years is authentically raised in the presence of a ED (Speel T.G.W. et al., 2003). It is supposed, that the ED can serve as a marker of cardiovascular diseases, and on degree of its gravity it is possible to judge advance of ischemic illness of heart (Greenstein A. et al., 1997, Kirby M. et al., 2001, Solomon H. et al., 2003). At appreciable depression of a penilnogo of a blood flow according to an ultrasonic dopplerografii some authors even recommend to carry out loading electrocardiograms-assays before the beginning of treatment of a ED (Kawanishi Y. et al., 2001).

The arterial hypertensia also promotes ED occurrence, even in the absence of an atherosclerosis. According to Roth A. And co-workers. (2003), frequency of a ED among patients of a AG makes 46 %. The international experimental researches on studying of an arterial hypertensia and a ED have been generalised at the European conference on a AG in 2003 in Milan. According to the presented data, the arterial hypertensia promotes a proliferation of a muscular tissue in cavernous bodies and blood vessels, causes a fibrosis of a cavernous tissue and enlarges in it quantity of collagen III. Thus expression of these changes is directly proportional to degree of rising of systolic arterial pressure.

Besides, ED development quite often bind to inadequate hypotensive therapy. It is considered, that 25 % of cases of occurrence of a ED are anyhow bound to reception of medical products (Slag M. F. et al., 1983, O’Keefe M. et al., 1995). As clinical signs of a medicamental ED consider rather quick start, time communication with reception of the preparation negatively influencing various links of sexual intercourse, and reduction of expression of disorder or its full disappearance after preparation cancellation. ED occurrence is very frequent bind to reception of antihypertensives, especially - a tiazidnyh of diuretics and b-adrenoblokatorov (Fogari R, Zoppi A., 2002, Mickley H., 2002, Ralph D., McNicholas T., 2000). Some researches which in aggregate have occupied more of 30 years, have shown, that from 2,4 % to 58 % of men with an arterial hypertensia test one or more symptoms of disturbance of sexual function of this or that severity level throughout treatment by antihypertensive preparations. Occurrence of disorders of an erection certainly reduces adherence of patients to treatment and, finally, worsens the forecast of these patients. So, in the five years’ research Medical Research Council including 17354 patients with an arterial hypertensia, it is shown, that disturbances of sexual function are the frequent reason of non-observance by patients of a regimen of treatment or full refusal of patients of reception of antihypertensives. The premature termination of treatment in connection with a ED was observed authentically more often at the patients accepting a tiazidnyj a diuretic or b-adrenoblokator, in comparison with the patients receiving a platsebo (12,6 %, 6,3 % and 1,3 % on 1000, accordingly).

For today there is a mass of reports on occurrence of a ED against therapy by b-adrenoblockers. D.T. Ko and co-workers. (2002) have spent the meta-analysis and have estimated safety of application of b-adrenoblockers at an arterial hypertensia and an ischemic heart disease. It is shown, that application of preparations of this group is bound with small, but statistically significant risk of occurrence of sex dysfunction (1 additional case on each 199 patients receiving treatment by b-adrenoblockers within year). b-adrenoblokatory the first generations cause a ED, than modern preparations is more often, and their ability to cause a ED does not depend on lipofilnosti degree.

According to L.M. Prisant (2002), a sochetannoe bisoprolola application in a dose of 2,5-10 mg a day and Hydrochlorthiazidum in a dose of 6,25 mg a day does not provoke ED development. We carry out research by a comparative estimation of influence of monotherapy of a atenololom and a bisoprololom on erectile function at men with an arterial hypertensia. 144 patients of a male have been included in research with an arterial hypertensia at the age from 25 till 50 years (middle age of 39,2 years). The Bisoprolol in much smaller degree, rather than a atenolol, influenced an erectile component of a scale of a MKF, enlarged linear rate of a blood flow (according to a dopplerografii) and a krovenapolnenie of a sexual member (according to a radioisotope fallografii).

It is supposed, that the ED can arise owing to reduction of inflow of blood to a sexual member, however is obscure, whether this reduction by a consequence of depression of system arterial pressure is at effective hypotensive therapy, result of a vascular disease or implication of any other unknown effects of a medical product (Bansal S., 1988). If depression of arterial pressure in itself promoted ED development it would develop against any hypotensive therapy. It is proved, however, that many antihypertensives do not cause a ED. So, in a randomizirovannom double blind research with two-dimensional design R. Fogari et al. (1999) against reception of an inhibitor of a angiotenzinovyh of receptors of a valsartana the tendency to rising of sex activity of men is noted even. Similar data concerning a lozartana are received J.L. Llisterri and co-workers. (2001), estimated its efficiency and safety at 82 men with sexual dysfunction. Against therapy by this preparation in a dose of 50 mg a day throughout 12 weeks appreciable and statistically authentic augmentation of sexual satisfaction - from 7,3 % of patients initially to 58,5 % after treatment (p <0,001) is noted. Besides, application of this preparation has enlarged a share of patients with high frequency of the sexual intercourses (40,5 % in comparison with 62,3 %), quality of a life at 73 % of patients has improved and has lowered a share of the patients informing on a ED (75,3 % in comparison with 11,8 %).

Mnogotsentrovoe controllable research «LIFE», including about 10000 patients at the age of 50-80 years, also has not taped negative influence of a lozartana on sex function of men. As it has been noted at the European conference on an arterial hypertensia in 2003 in Milan, application of blockers of a angiotenzinovyh of receptors authentically reduces the changes of a cavernous tissue developing at an arterial hypertensia.

It is considered, that antagonists of calcium also do not worsen man’s sexual function. Anyway in research J.E. Marley (1989), studying shipping it is long operating nifedipine (20 mg 2 times a day), in 4 weeks after the beginning of therapy frequency of a ED has decreased as in group of the patients receiving earlier treatment by b-adrenoblockers and diuretics, and in group of the patients who earlier were not receiving treatments.

In many cases change of a regimen of reception of preparations can help to overcome to the patient negative changes in the sex sphere, treatments observed at some kinds. Besides, it is expedient to choose such hypotensive treatment which would be not only highly effective in respect of BP depression, but also would keep quality of a life of the patient. So, for example, at development of a ED at sick of an arterial hypertensia cancel a tiazidnye diuretics and not selective b-adrenoblokatory. In this situation preference give to antagonists of calcium, inhibitors of a angiotenzinprevrashchajushchego of enzyme and a-adrenoblockers which to a lesser degree influence sexual sphere (Khan M.A. et al., 2002, Ferrario C.M., Levy P., 2002) or to inhibitors of a angiotenzinovyh of receptors which can even raise a little sex activity of men (Fogari R, Zoppi A., 2002). In need of appointment of b-adrenoblockers (at sick of an arterial hypertensia, ischemic illness, with disturbances of a warm rhythm) preparations of a choice patients from a ED have modern vysokoselektivnye preparations, such as a bisoprolol.

So, the practical doctor should remember possibility of influence of hypotensive therapy on sexual sphere of men and discuss this problem with the patients (Ferrario C.M., Levy Р, 2001). It is considered, that on the collecting of the medical, sex anamnesis and the analysis of a psychological condition of the patient at the practical doctor on the average leaves only 4-6 mines (Kuritzky L., 2002). But how much it is necessary for the patient? In research Bedell S.T. et al. (2002) questions of the questionnaire of the cardiologist were answered with 188 men (middle age of 75 years), suffering with an arterial hypertensia in 54 %, with a myocardial infarction in the anamnesis in 41 % and a diabetes - in 11 % of cases. Results of questioning are presented in table 1.

It is necessary to notice, that on questions on existence of any obexes at discussion of sex problems with the cardiologist patients only in single instances mentioned discomfort tested during conversation (16 %), a disadvantage of experience of similar conversations (4 %), about what floor their doctor (3 %), about time disadvantage (7 %), confidentiality of data represented to the doctor (15 %). Thus, patients consider, that the doctor should discuss with them problems of a sex life and do not see in it any complexities.

Besides revealing of a ED at cardiologic patients and correction, in need of hypotensive therapy by a problem of the practical doctor the estimation of necessity and safety of treatment of the disorder of an erection is. Not only among patients, but also among doctors widespread the opinion on high risk of sudden mors sick of cardiovascular diseases during sexual intercourse, however, as shows a number of the spent researches, these pavors are considerably exaggerated.

First, the exercise stress during sex activity is not too great - on the average it is comparable to walk on 1 mile (1,6 km) for 20 mines or lifting on 2 flights of stairs (20 steps) for 10 with (Jackson G., 2000). According to Drory Y. And co-workers. (1995), the maximum frequency of warm reductions (CARDIAC CONTRACTIONS RATE) during a coitus statistically authentically does not differ from the CARDIAC CONTRACTIONS RATE at daily activity and much less, than the CARDIAC CONTRACTIONS RATE during carrying out of loading tests.

Secondly, results of epidemiological researches show, that in the absence of a myocardial infarction in the anamnesis the absolute risk of a myocardial infarction during sex activity it makes only 2 cases on 1 million men; the annual risk of development of a myocardial infarction during a coitus at the 50-year-old American makes 1 %, during sex activity - 1,01 %. As to men with a postinfarction cardiosclerosis, according to results of questioning of 1774 patients who have transferred a myocardial infarction (including sexly active 858), the absolute augmentation of risk of development of a myocardial infarction after or during sex is taped all at 0,9 % of patients (J.E. Muller et al., 1996). The relative risk of a myocardial infarction within 2 hours after sex contact was peer 2,5 % and was not enlarged after that time period. This risk was more low at patients with regular physical trainings in the anamnesis and did not depend on presence or absence of the previous anamnesis of an ischemic heart disease.

It is necessary to notice, that, as shown in a number of the researches spent to Germany and Japan, the risk of sudden mors during a coitus raises in case of illegitimate communication (Krauland W., 1976, Parzeller M. et al., 2000, Ueno M., 1963, table 2) and usually associates with the partner of younger age, and also with a previous plentiful meal and the alcohol use.

Thus, within the limits of the settled or family relations sex activity significantly does not enlarge risk of development of a myocardial infarction. On the contrary, depression or Absence of sex function can influence not only quality of a life of the man, but also, apparently, on its duration. So, in 25-year-old research including 270 men and women at the age of 60-94 years, it is shown, that frequency of sexual intercourses positively correlates with life expectancy of men (Duce First Longitudinal Study of Aging, Palmore E.B., 1982). In the Swedish research within 5 years 128 married men were observed; according to the received results, higher lethality associated with the early termination of a sex life (Persson G., 1981). In the research spent in the Wales including 918 men at the age of 45-59 years, the lethality for 10 years of observation was statistically above among men with low sex activity (less than 1 time a month) in comparison with the men who had an orgasm of 2 times a week and more often (Caerphilly Cohort Study, Davey Smith G. et al., 1997). Especially prognostically as the adverse consider a combination of a cardiovascular pathology, depression and a ED which some foreign authors suggest to designate as «Mutually reinforcing triad» («mutually potentsirujushchaja a triad»).

For standardization of the medical approach to a problem of sex activity and warm risk at the international conference spent at university Prinstauna (1999), references on treatment of sex dysfunction at patients with cardiovascular diseases (R have been developed. DeBusk et al., 2000). According to «the Princeton consensus» patients are parted on groups of low, average and high risk by) (tab. 3). In case of low risk renewal of sex activity or treatment of sex dysfunction consider safe; at average risk before renewal of sex activity additional inspection is necessary, at high - correction of cardiovascular disease.

Thus, it is possible to ascertain, that the sex life should be and is the important component of a qualitative life of patients with cardiovascular diseases. Pavors about its danger in advanced age are caused first of all by absence of the due information on real influence on health of patients.

Treatment

Wide involving of doctors of the general practice (including therapists and cardiologists) in the decision of questions of revealing and ED treatment in many respects speaks occurrence of inhibitors of a fosfodiesterazy 5 types (ФДЭ5) - effective and enough safe agents for ED treatment. Inhibitors ФДЭ5 do not render direct relaxing influence on cavernous bodies, but strengthen a relaksirujushchy effect of a oksida of nitrogen by inhibition ФДЭ-5 and risings of concentration of a cGMP at sex excitation, enlarging thus blood inflow to a cavernous body and promoting occurrence and maintenance of a physiological erection.

At sick of cardiovascular diseases it is necessary to consider two features of action of inhibitors ФДЭ5: they reduce arterial pressure and co-operate with Sodium nitritums. The first preparation from this group - a sildenafil Citras reduces systolic pressure approximately on 8 mm hg (Kloner R.A., 2000, Herrmann H.C., 2000), however against hypotensive therapy frequency of its undesirable actions bound to depression of a BP (depression, giddiness, syncopes), is not enlarged (Kloner R.A., 1999). At the same time reception of a sildenafil of Citras is contraindicative to the patients receiving Sodium nitritums in any form, regularly or periodically in connection with augmentation of risk of development of a serious arterial hypotension and a syncope. It is shown in a platsebo randomizirovannom-supervised research at sick of the stable ischemic heart disease, receiving sublingvalnyj Nitroglycerinum for 1 ch or Isosorbidum Monosodium nitritum within 5-7 days before reception of a sildenafil of Citras (Webb D.J. et al., 2000). Average maximum depression of a BP has made 52/29 mm hg at use Isosorbidum of Monosodium nitritum and a sildenafila of Citras and 25/15 mm hg in the group receiving only Sodium nitritum; 36/21 mm hg at a sublingvalnom reception of Nitroglycerinum and a sildenafila of Citras and 26/12 mm hg at use only Nitroglycerinum. According to references of the American association of heart of 1998 if patients with retrosternal pains accept a sildenafil Citras Sodium nitritums cannot be used within 24 hour.

Recently one more preparation became accessible to clinical practice in Russia from this group - a tadalafil (a Sialis, Lilly/ICOS), possessing a number of distinctive features in comparison with a sildenafilom. The clinical effect of a Sialisa develops at third of patients in 16 minutes and at the overwhelming majority of patients (79 %) remains during 36 ch after preparation reception (I. et al., 2002, Padma-Nathan H. et al., 2001). Besides, to advantages of a preparation carry absence of interaction with nutrition and alcohol. These features allow pair to choose more freely time of intimate affinity and relieve of necessity accurately to plan the sex life: for example, after reception of a preparation in the afternoon on Friday, sex relations are possible at any time till morning of Sunday… The Missed possibility does not mean in this case a failure.

In spite of the fact that the Sialis only became accessible recently in wide practice, it nevertheless is well studied preparation. Now it is spent more than 90 clinical researches (including long, in till 2 years) in which it has unequivocally proved the efficiency and safety. Brock B. And co-workers. (2002) have carried out a integrativnyj the analysis 5 randomizirovannyh of double-blind platsebo of-supervised researches with the parallel groups, including 1112 men. According to questioning, among the patients receiving a tadalafil in a dose of 20 mg a day, normal erectile function has been reached at 59 % of men in comparison with 11 % in control group; the absolute share of successfully complete attempts of sexual intercourse has made 75 % in comparison with 32 % in platsebo group. In the end of treatment of 81 % of the men receiving a Sialis in a dose of 20 mg a day, and only 35 % of men from platsebo group have informed on erection improvement. Efficiency of a preparation was comparable at young patients and at persons is more senior 65 years, and did not depend on a ED aetiology.

Cardiovascular effects of a Sialisa were studied at healthy volunteers and at sick of an angina of exertion and an arterial hypertensia. Sialisa reception in a dose of 10 and 20 mg did not cause statistically authentic depression of arterial pressure in healthy faces in position standing, and as a whole influence of a preparation on hemodynamic indicators did not differ from platsebo influence. The Sialis does not extend interval QT, does not cause disturbance of atrioventricular conductivity and a warm rhythm. Frequency of collateral cardiovascular effects of a Sialisa is comparable to corresponding indicators in group of a platsebo (tab. 4); its application is safe at the patients receiving hypotensive therapy. At more than 1200 patients frequency of development of a myocardial infarction against Sialisom therapy has made 0,39 for 100 cheloveko-years against 1,1 at the persons receiving a platsebo and was comparable to a corresponding indicator in the population of men standardised on age - 0,6 (Kloner R. et al., 2002).

Safety of a combination of a Sialisa from a amlodipinom in a dose of 5 mg/sut, a metoprololom in a dose of 25-200 mg/sut, by enalapril in a dose of 10-20 mg/sut, a indapamidom in a dose of 2,5 mg/sut, a lozartanom in a dose of 25-50 mg/days However is shown, as well as the sildenafil, a tadalafil cannot be combined with reception of Sodium nitritums as at certain group of patients the combined reception of these medical products leads to development of the expressed arterial hypotension (Kloner RA., Mitchell M.I. et al., 2002).

As contraindication to application of inhibitors ФДЭ5 simultaneous reception of Sodium nitritums (they can be applied not earlier than through 24 ch after use of a sildenafila and through 48 ch after Sialisa reception) serves. At development of an attack of a stenocardia against therapy by inhibitors ФДЭ5 Nitroglycerinum reception is categorically contraindicative. With care preparations of this group use at astable cardiovascular conditions at which in itself sex activity is a risk factor of development of complications, and also in the presence of anatomic deformations of a sexual member, the diseases promoting occurrence of a priapism (for example, a sickemia, a leukosis).

The conclusion

Thus, medicamental therapy by inhibitors ФДЭ5 - simple, effective and safe enough way of treatment of the ED, accessible not only to urologists and a andrologam, but also in the presence of certain preparation to doctors of a wide profile. It is possible to carry the prolonged action, high efficiency to advantages of a Sialisa at a ED irrespective of its aetiology, gravity and from age of the patient and good shipping of a preparation (absence of serious by-effects at sick of an arterial hypertensia and an angina of exertion), possibility of a combination to hypotensive and antianginal agents (except for Sodium nitritums).

how to treat problems with an erection????