Dapoxetine - instructions for use, reviews, analogs and forms of release (30 mg and 60 mg tablets) drugs for the treatment of premature ejaculation in men and potentiation. Composition and interaction with alcohol

In this article, you can read the instructions for using the drug Dapoxetine. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Dapoxetine in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues or generics of Dapoxetine in the presence of existing structural analogues. Use to treat premature ejaculation in men and enhance potency.Composition and interaction of the drug with alcohol.

Dapoxetine - the mechanism of action of the drug in premature ejaculation is associated with inhibition of the reuptake of serotonin by neurons, followed by an increase in the action of the neurotransmitter on pre- and postsynaptic receptors. The mechanism of ejaculation is regulated mainly by the sympathetic nervous system. Postganglionic sympathetic nerve fibers innervate the seminal vesicles, the vas deferens, the prostate, the urethra and the neck of the bladder, causing their coordinated contraction to achieve ejaculation. Dapoxetine influences the ejaculation reflex, increasing the latent period and decreasing the duration of reflex impulses of the motoneurons of the perineal ganglia. Stimulus, which starts ejaculation, is generated in the spinal reflex center, which is controlled through the brain stem by several nuclei of the brain, including the preoptic and paraventricular.

Composition

Dapoxetine + excipients.

Pharmacokinetics

Dapoxetine is rapidly absorbed, and the maximum concentration in the blood plasma (Cmax) is reached 1-2 hours after taking the drug.The intake of fatty food moderately reduces Cmax of dapoxetine (by 10%) and increases by 12% the AUC and the time to reach the maximum concentration in the blood plasma. However, the degree of absorption of dapoxetine remains unchanged. These changes are not clinically significant. The drug Dapoxetine can be taken regardless of food intake. More than 99% of dapoxetine binds to plasma proteins. The active metabolite, desmethyldapoxetine, binds to plasma proteins by 98.5%. Dapoxetine is rapidly distributed throughout the body with an average equilibrium volume of distribution of 162 liters.

Studies suggest that dapoxetine is metabolized by many liver and kidney enzymes, especially CYP2D6, CYP3A4 and flavin-containing monooxygenase (FM01) kidney. In a clinical study in which the metabolism of 14C-dapoxetine was studied, dapoxetine was actively metabolized after oral administration mainly by N-oxidation, N-demethylation, hydroxylation of the naphtho group, glucuronization and addition of the sulfo group. After oral administration, signs of a pre-systemic metabolism in the liver were found. The main components circulating in the blood plasma were intact dapoxetine and dapoxetine-N-oxide.In studies, it was found that dapoxetine-N-oxide is inactive. In addition, desmethyldapoxetine and didezmethyldapoxetine were detected in an amount of less than 3% of the total number of circulating metabolites of dapoxetine. The study found that desmethyldapoxetine is comparable in activity to dapoxetine, and didezmethyldapoxetine is about 2 times less active than dapoxetine. The exposure (AUC and Cmax) of unbound desmethyldapoxetine was 50% and 23% of unbound dapoxetine, respectively.

Metabolites of dapoxetine are excreted mainly with urine in the form of conjugates. An unchanged active substance in the urine is not detected. Dapoxetine is rapidly excreted, as evidenced by the low concentration of the substance in the blood plasma (less than 5% of the maximum) 24 hours after the dose. With daily intake of accumulation of matter in the body is minimal. When taken orally, the final elimination half-life is approximately 19 hours.

A single dose of dapoxetine in a dose of 60 mg did not reveal a significant difference in pharmacokinetics in healthy older men and men of a younger age.

Indications

• for the treatment of premature ejaculation in men aged 18 to 64 years (reflex enhancement of potency due to prolonged sexual intercourse and increase confidence).

Forms of release

Tablets coated with 30 mg and 60 mg.

Instructions for use and reception scheme

For oral administration. The tablet should be swallowed whole, washed down with at least one full glass of water. The drug Dapoxetine can be taken regardless of food intake.

The recommended initial dose for all men is 30 mg; this dose is taken 1-3 hours before the alleged sexual intercourse. With insufficient effect and good tolerability of 30 mg dose, it can be increased to 60 mg. The maximum recommended dose frequency is 1 time every 24 hours.

The doctor who prescribes the drug Dapoxetine for the treatment of premature ejaculation should assess the risk and benefit of using the drug after the first 4 weeks of treatment or after taking 6 doses and should determine the risk-benefit ratio for deciding whether to continue treatment with Dapoxetine.

Side effect

• insomnia;
• fatigue;
• anxiety;
• restlessness;
• unusual dreams;
• depression;
• a state of euphoria;
• mood changes;
• nervousness;
• indifference;
• apathy;
• sleep disorders;
• nightmares;
• decreased libido;
• loss of libido;
• anorgasmia;
• violation of concentration of attention;
• fainting, incl. vasovagal syncope;
• postural dizziness;
• perversion of taste;
• lethargy;
• oppression of consciousness;
• blurred vision;
• pain in the eye area;
• tinnitus;
• sinus bradycardia;
• tachycardia;
• a decrease in blood pressure;
• systolic hypertension;
• nasal congestion;
• yawn;
• nausea, vomiting;
• diarrhea, constipation;
• abdominal pain;
• dyspepsia;
• flatulence;
• bloating;
• dry mouth;
• itching;
• cold sweat;
• erectile disfunction;
• absence of ejaculation;
• violation of orgasm, incl. anorgasmia in men;
• paresthesia of male genital organs;
• irritability;
• feeling of heat;
• feeling of intoxication.

Contraindications

• hypersensitivity to dapoxetine or any auxiliary component of the drug;
• severe heart disease (eg, cardiac insufficiency 2-4 of NYHA class, cardiac conduction abnormalities (2-3 degree AV block or sinus syndrome (SSS)) in the absence of a permanent pacemaker, expressed by IHD or valve apparatus damage);
• simultaneous administration of MAO inhibitors and admission within 14 days after discontinuation of their use. Likewise, MAO inhibitors can not be taken within 7 days after discontinuation of Dapoxetine;
• simultaneous administration of thioridazine and within 14 days after discontinuation of its use. Similarly, thioridazine can not be taken within 7 days after discontinuation of Dapoxetine;
• simultaneous administration of serotonin reuptake inhibitors (selective serotonin reuptake inhibitors-SSRIs), serotonin and noradrenaline reuptake inhibitors and tricyclic antidepressants) and other drugs with serotonergic action (for example, L-tryptophan, triptans, tramadol, linezolid, lithium, preparations of St. John's wort (Hypericum perforatum) and within 14 days after discontinuation of these drugs, Similarly, these drugs can not be taken within 7 days after discontinuation of Dapoxetine;
• simultaneous administration with active inhibitors of CYP3A4, for example, ketoconazole, itraconazole, ritonavir, saquinavir, telithromycin, nefazodone, nelfinavir, atazanavir, etc .;
• moderately severe and severe liver function disorders;
• severe renal dysfunction;
• children and adolescents under the age of 18;
• lactose intolerance.

Carefully

• mild to moderate renal impairment;
• simultaneous application with potent CYP2D6 isoenzyme inhibitors and moderate inhibitors of CYP3A4 in patients with genotypically low activity of CYP2D6 isoenzyme and patients with high CYP2D6 isoenzyme activity (in combination with moderate CYP3A4 isoenzyme inhibitors);
• simultaneous use with drugs that affect platelet aggregation, and with anticoagulants due to the risk of bleeding.

Application in pregnancy and lactation

Dapoxetine is not suitable for use in women.

Pregnancy

Based on the limited amount of data obtained in clinical studies, there is no reason to assume that taking dapoxetine by a man can affect a partner's pregnancy. Well-controlled studies of dapoxetine in pregnant women have not been conducted.

Lactation period

It is not known whether dapoxetine and its metabolites are excreted in breast milk.

Use in children

Dapoxetine should not be taken by patients under the age of 18 years.

Application in elderly patients

A single dose of dapoxetine in a dose of 60 mg did not reveal a significant difference in pharmacokinetics in healthy elderly men (over 65 years of age) and men of younger age.

special instructions

Are common

The drug Dapoxetine is intended only for men with premature ejaculation. The safety of the drug in men without premature ejaculation is not established, there is no data on ejaculation delay.

A randomized, double-blind, placebo-controlled study confirmed the efficacy of Dapoxetine for the treatment of premature ejaculation (PE). Dapoxetine 60 mg significantly improves the average time of intravaginal ejaculation delay (IELT) compared with Dapoxetine 30 mg in men with lifelong PE, but there is no difference in men with acquired PE. Dapoxetine increases the sense of control and sexual satisfaction in men from 18 to 64 years of age with PE.

Admission with drugs

Patients should be advised not to take Dapoxetine together with narcotic drugs.Simultaneous administration of Dapoxetine with drugs that have serotonergic activity, for example, ketamine, methylenedioxymethamphetamine (MDMA) and lysergic acid diethylamide (LSD), can lead to potentially serious reactions, including but not limited to arrhythmia, hyperthermia and serotonin syndrome. Taking Dapoxetine together with sedatives, such as opiates or benzodiazepines, may increase drowsiness and dizziness.

Ethanol (alcohol)

The combination of Dapoxetine with alcohol can enhance the effect of the drug on the central nervous system and neuro-cardiogenic side effects of alcohol, for example, syncope, which increases the risk of accidental injury. Therefore, patients should be advised to refrain from drinking alcohol during the period of taking Dapoxetine.

Fainting

The frequency of syncope in clinical studies of the drug Dapoxetine depended on the patient category and ranged from 0.06% (for a dose of 30 mg) to 0.23% (for a dose of 60 mg) to 0.64% (for both doses together) in a study with the participation of healthy volunteers.

In patients who received the drug Dapoxetine, compared with patients receiving a placebo,more often there were prodromal symptoms, incl. nausea, dizziness / light-headedness and sweating. With a dose of Dapoxetine 30 mg, the incidence of nausea was 11.0%, the incidence of dizziness was 5.8%, and that of hyperhidrosis was 0.8%. With a dose of Dapoxetine 60 mg, these figures were 21.2%, 11.7% and 1.5%, respectively. The frequency of syncope and possible prodromal symptoms was dose-dependent, as indicated by higher rates in patients receiving higher doses than the maximum recommended daily dose of 60 mg. The cases of syncope observed in clinical trials were regarded as having a vaso-vagal nature. Most of these cases occurred within the first 3 hours after the first dose, or were associated with conducting research procedures in a clinical setting (for example, taking a blood sample, abruptly rising, measuring blood pressure). Possible prodromal symptoms, such as nausea, dizziness, lightheadedness, palpitations, asthenia, confusion and sweating, were also usually observed in the first 3 hours after taking the drug and often preceded fainting.Patients should be informed that during the treatment with Dapoxetine at any time, fainting with or without prodromal symptoms is possible. The physician should inform the patient of the importance of sufficient water stress and the recognition of prodromal signs and symptoms to reduce the risk of serious injury if dropped due to loss of consciousness. When there are possible prodromal symptoms, the patient should immediately lie down so that the head is below the trunk, or sit down, head down between the knees, and must remain in this position until the symptoms disappear. If fainting or other CNS effects occur, the patient should be warned to avoid potentially life-threatening situations, including driving and managing dangerous machinery.

The combination of Dapoxetine with alcohol may increase neurocardiogenic side effects, including syncope, which increases the risk of accidental trauma; so patients should be advised to refrain from drinking alcohol during treatment with Dapoxetine.

Patients with a risk of cardiovascular disease

In clinical studies of the drug did not participate patients with cardiovascular diseases. In patients with organic diseases of the heart and blood vessels (for example, obstruction of the discharge of blood from the heart, damage to the valve apparatus, stenosis of the carotid artery, coronary artery atherosclerosis), the risk of unwanted cardiovascular consequences of syncope of cardiac and other origin is increased. However, at present there is insufficient data to determine whether this risk extends to vaso-vagal syncope in patients with cardiovascular disease.

Orthostatic hypotension

In clinical trials, cases of orthostatic hypotension have been described. The doctor should inform the patient in advance that if there are possible prodromal symptoms, for example, a feeling of lightness in the head immediately after getting up, you should immediately lie down so that your head is below your torso, or sit down with your head between your knees, and stay in this position until disappearance of symptoms. In addition, you need to inform the patient about the need to avoid a sharp rise after prolonged lying or sitting.In addition, the drug Dapoxetine should be administered with caution to patients taking vasodilator drugs (eg, alpha-blockers, nitrates, PDE5 inhibitors), due to the possible reduced tolerance of such patients to the orthostatic effect of the drug.

Moderately active inhibitors of CYP3A4

When taking Dapoxetine together with moderately active inhibitors of CYP3A4 (erythromycin, clarithromycin, fluconazole, amprenavir, fosamprenavir, aprepitant, verapamil, diltiazem) the dose of the drug should be reduced to 30 mg, caution should be exercised.

Active inhibitors of CYP2D6

It is advisable to use caution when increasing the dose of Dapoxetine to 60 mg in patients receiving active inhibitors of CYP2D6 and in patients with low activity of CYP2D6, as this may increase the systemic exposure to the drug with a corresponding increase in the frequency and severity of dose-related adverse events.

Suicide / suicidal thoughts

In short-term studies, antidepressants, including SSRIs, increased the risk of suicide and suicidal ideation in children and adolescents with generalized depression and other psychiatric disorders compared with placebo. In adults over 24 years of this effect is not found.In clinical studies of the drug Dapoxetine for the treatment of premature ejaculation of clear data on the relationship of suicidal thoughts with treatment is not received.

Mania

The drug Dapoxetine can not be taken by patients with a history of mania / hypomania or bipolar disorder, when symptoms of these diseases appear, the drug should be discontinued.

Convulsions

Because of the ability of SSRIs to reduce the convulsive threshold, Dapoxetine should be avoided in patients with unstable epilepsy, and should the seizure occur, the drug should be discontinued. Patients with controlled epilepsy require careful monitoring.

Concomitant depression and mental disorders

If the patient has signs and symptoms of depression before starting Dapoxetine, a check should be performed to exclude the presence of undiagnosed depressive disorder. Dapoxetine should not be taken concomitantly with antidepressants, including SSRIs and serotonin and norepinephrine reuptake inhibitors. It is not recommended to stop treatment of depression or anxiety to start treatment with Dapoxetine.Dapoxetine is not intended for the treatment of mental disorders (eg, schizophrenia or depression), it should not be taken by men with these diseases, since it is not possible to exclude the increase in symptoms of depression. Immediately notify your doctor of any troublesome thoughts or feelings, and when signs and symptoms of depression appear during treatment, Dapoxetine should be discontinued.

Bleeding

When using SSRIs, cases of bleeding are described. It is advisable to take caution when taking Dapoxetine simultaneously with drugs that affect platelet function (for example, atypical antipsychotics, phenothiazines, acetylsalicylic acid, NSAIDs, anticoagulants), as well as in patients with bleeding or history of clotting.

Impaired renal function

Dapoxetine is not recommended for patients with severe renal dysfunction, patients with moderate to mild renal impairment should be cautious.

The withdrawal syndrome

There is evidence that the abrupt withdrawal of SSRIs,(for example, paresthesia in the form of an electric shock), anxiety, confusion, headache, lethargy, emotional instability, insomnia, dizziness, Hypomania.

In a clinical study to evaluate the effect of withdrawal of Dapoxetine after 62 days of admission at a dose of 60 mg (daily or on demand) in patients with premature ejaculation, no signs of withdrawal syndrome were found. After the transfer of patients to the placebo after daily administration of the drug Dapoxetine, only minor withdrawal symptoms were found in the form of mild or moderately expressed insomnia and dizziness. Similar results were obtained in another clinical trial with double-blind control with a weekly evaluation period of withdrawal effects after 24 weeks of drug use at a dose of 30 mg or 60 mg as needed.

Impact on the ability to drive and other mechanical means

When taking dapoxetine, cases of dizziness, attention disturbances, fainting, blurred vision, drowsiness are described. The patient should be warned to avoid situations in which injuries can occur, including driving and managing dangerous machinery.

Drug Interactions

Interaction with MAO inhibitors

In patients who received both SSRIs and MAO inhibitor, serious, sometimes fatal, reactions are described, incl. hyperthermia, stiffness, myoclonus, instability of the vegetative system with possible rapid fluctuations in the indices of vital functions, as well as changes in the mental state, including strong agitation, progressing to delirium and coma. These reactions were also observed in patients who recently stopped taking SSRIs and started treatment with MAO inhibitors. In some cases, the symptoms resembled a malignant neuroleptic syndrome. Data on the joint use of SSRIs and MAO inhibitors in animals suggest that these drugs can synergistically raise blood pressure and cause behavioral arousal.Therefore, the drug Dapoxetine can not be taken simultaneously with MAO inhibitors and within 14 days after discontinuation of their administration. Likewise, MAO inhibitors can not be taken within 7 days after discontinuation of Dapoxetine.

Interaction with thioridazine

Thioridazine prolongs the QTc interval, which is accompanied by ventricular arrhythmia. Drugs like Dapoxetine, which inhibit the enzyme CYP2D6, seem to inhibit the metabolism of thioridazine. It is expected that the resulting increase in the level of thioridazine will increase the elongation of the QTc interval. Dapoxetine should not be taken concomitantly with thioridazine and within 14 days after stopping it. Similarly, thioridazine can not be taken within 7 days after discontinuation of Dapoxetine.

Drugs that have a serotonergic effect

As with SSRIs, taking Dapoxetine simultaneously with serotonergic drugs (including MAO inhibitors, L-tryptophan, triptans, tramadol, linezolid, SSRIs, serotonin and norepinephrine seizure inhibitors, lithium, and Hypericum perforatum preparations may increase the incidence of serotonergic side effects .Dapoxetine should not be taken concurrently with other SSRIs, MAO inhibitors and other serotonergic drugs, and within 14 days after discontinuation of these drugs. Similarly, these drugs can not be taken within 7 days after discontinuation of Dapoxetine.

Drugs acting on CNC

The administration of the drug Dapoxetine concomitantly with drugs acting on the central nervous system, in patients with premature ejaculation has not been studied. It is recommended to be cautious when it is necessary to take these drugs at the same time.

The effect of other drugs on dapoxetine hydrochloride

Studies using microsomes of the liver, kidneys and intestines of humans have shown that dapoxetine is metabolized predominantly by CYP2D6, CYP3A4 and flavin-containing monooxygenase 1 (FMO1). Therefore, inhibitors of these enzymes can reduce the clearance of dapoxetine.

Inhibitors of CYP3A4

Active inhibitors of CYP3A4

Admission Ketoconazole 200 mg twice daily for 7 days increased Cmax dapoxetine (60 mg once) by 35% and 99%, respectively. Taking into account the fraction of unbound dapoxetine and desmethyldapoxetine, the Cmax of the active fraction (the amount of unbound dapoxetine and desmethyldapoxetine) in the presence of active inhibitors of CYP3A4 can increase by approximately 25%, and the AUC can double.This increase in Cmax and AUC of the active fraction may be significantly more pronounced in the subpopulation of patients having no functionally active enzyme CYP2D6, and while receiving active CYP2D6 inhibitors.

Dapoxetine drug should not be taken simultaneously with the active inhibitors of CYP3A4, such as ketoconazole, itraconazole, ritonavir, saquinavir, telithromycin, nefazodone, nelfinavir and atazanavir.

Moderately active inhibitors of CYP3A4

Simultaneous reception moderately active inhibitors of CYP3A4, such as erythromycin, clarithromycin, fluconazole, amprenavir, fosamprenavir, aprepitant, Verapamil or diltiazem, can significantly increase the level of systemic exposure of dapoxetine and dezmetildapoksetina, especially in patients with low activity of CYP2D6. The maximum dose of the drug Dapoxetine, taken concomitantly with these drugs, should be limited to 30 mg and taken with caution.

Active inhibitors of CYP2D6

Admission of Fluoxetine at a dose of 60 mg per day for 7 days increased Cmax of dapoxetine (60 mg once) by 50% and 88%, respectively. Taking into account the fraction of unbound dapoxetine and desmethyldapoxetine,The Cmax of the active fraction (the amount of unbound dapoxetine and desmethyldapoxetine) in the presence of active inhibitors of CYP2D6 can increase by approximately 50%, and the AUC can double. This increase in Cmax and AUC of the active fraction is close to that expected in patients with low CYP2D6 activity and may increase the frequency and severity of dose-dependent adverse reactions. Therefore, caution should be exercised with increasing the dose of Dapoxetine to 60 mg in patients receiving active inhibitors of CYP2D6, and in patients with low activity of CYP2D6.

Interaction with drugs metabolized by isoenzymes CYP1A and CYP 2B6

Based on the comparative data of Cmax dapoxetine when taking a dose of 60 mg and the concentration of dapoxetine at 50% inhibition (IC50) of the CYP1A2 isoenzyme, it was concluded that the effect of dapoxetine on the concentration of concurrently administered drugs metabolized by this isoenzyme is not expected. The effect of dapoxetine on the isoenzyme CYP2B6 has not been studied.

PDE-5 Inhibitors

The pharmacokinetics of dapoxetine, taken at a dose of 60 mg concomitantly with Tadalafil (20 mg) or Sildenafil (100 mg), was studied. Tadalafil did not affect the pharmacokinetics of dapoxetine.Sildenafil slightly increased the Cmax of dapoxetine (by 22% and 4%, respectively), which is considered clinically insignificant. Dapoxetine should be administered with caution to patients taking PDE5 inhibitors, because of the possibly reduced tolerance of these patients to orthostatic hypotension.

Effect of dapoxetine on concomitant medications

Tamsulosin

A single and multiple administration of Dapoxetine in doses of 30 mg and 60 mg of patients receiving Tamsulosin daily did not lead to a change in the pharmacokinetics of the drug. At the same time, the frequency of orthostatic hypotension did not change, which was the same with tamsulosin alone and in a combination of tamsulosin with Dapoxetine 30 mg or 60 mg. Dapoxetine should be administered with caution to patients taking alpha-blockers, because of the possibly reduced tolerance of these patients to orthostatic hypotension.

Drugs metabolized by CYP2D6

Multiple administration of Dapoxetine (60 mg / day for 6 days) increased Cmax of desipramine (50 mg once) by 11% and 19%, respectively, compared with taking only desipramine.Dapoxetine can similarly increase the concentration in the blood plasma and other drugs metabolized by CYP2D6. The clinical significance of this is likely to be small.

Drugs metabolized by CYP2C19

Multiple administration of Dapoxetine (60 mg / day for 6 days) did not affect the pharmacokinetics of Omeprazole (40 mg once). Dapoxetine hardly affects the pharmacokinetics of other CYP2C19 substrates.

Drugs metabolized by CYP2C9

Multiple administration of Dapoxetine (60 mg per day for 6 days) did not affect the pharmacokinetics and pharmacodynamics of glyburide (5 mg once). Dapoxetine hardly affects the pharmacokinetics of other CYP2C9 substrates.

PDE-5 Inhibitors

According to the results of the study, dapoxetine (60 mg) did not affect the pharmacokinetics of tadalafil (20 mg) and sildenafil (100 mg).

Warfarin

Data on the effects of long-term taking of Warfarin simultaneously with the drug Dapoxetine are not present. It is recommended to be cautious in prescribing Dapoxetine to patients taking long-acting warfarin. In a study of pharmacokinetics, repeated administration of dapoxetine (60 mg per day for 6 days) did not affect the pharmacokinetics and pharmacodynamics (PV and MHO) of warfarin (25 mg once).

Ethanol (alcohol)

A single dose of ethanol (0.5 g / kg, or approximately 2 doses) did not affect the pharmacokinetics of dapoxetine (60 mg once) and vice versa. Simultaneous administration of the drug Dapoxetine and ethanol (alcohol) increased drowsiness and significantly reduced the level of wakefulness when assessed by the patient. Admission of only ethanol and only the drug Dapoxetine did not significantly change the cognitive functions (reaction rate in the digestion test and in the symbol replacement test) compared with placebo, but the combination of ethanol with the drug Dapoxetine statistically significantly changed these values ​​compared with only ethanol. Simultaneous administration of ethanol and Dapoxetine increases the frequency and severity of such undesirable reactions as dizziness, drowsiness, slowing down of reflexes, changing judgments. The combination of alcohol with the drug Dapoxetine can also enhance neurocardiogenic side effects, in particular, the frequency of syncope, which increases the risk of accidental injury. Therefore, patients should be advised to refrain from drinking alcohol during treatment with Dapoxetine.

Analogues of the drug Dapoxetine

Structural analogs for the active substance:

• Dasutra (Dasutra);
• Extensil (Extensil);
• Lagose;
• Poxet-60 (Poxet-60);
• Precoce;
• Priligy (Priligi);
• Prolongal;
• Sustinex;
• Xydap.

Analogues on the pharmacological group (potency regulators):

• Vardenafil;
• Veromax;
• Verona;
• Viagra;
• Viassan LF;
• Vigrande;
• Vizarsin;
• Dynamics;
• Zidena;
• The Impaza;
• Yohimbine hydrochloride;
• Levitra;
• Maxigra;
• Muse;
• Olmax Strong;
• Priligi;
• Reilis;
• Cialis;
• Sildenafil;
• Sildenafil citrate;
• Spem;
• Spemann forte;
• Tadalafil;
• Taxiere;
• Tentex forte;
• Testalamine;
• Tornethis;
• Himkoline;
• Edex;
• Erexel.

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