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Erectile Dysfunction Health Center

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To find the most current information, please enter your topic of interest into our search box.

“>WebMD News Archive

July 1, 2008 — Men hoping for some fireworks in their love life this Fourth of July may want to skip the burgers and beer at the barbecue and eat plenty of watermelon.

Watermelon may be a natural Viagra, says a researcher. That’s because the popular summer fruit is richer than experts believed in an amino acid called citrulline, which relaxes and dilates blood vessels much like Viagra and other drugs meant to treat erectile dysfunction (ED).

“We have known that watermelon has citrulline,” says Bhimu Patil, PHD, director of the Fruit and Vegetable Improvement Center at Texas A&M University, College Station. Until recently, he tells WebMD, scientists thought most of the citrulline was in the watermelon rind. “Watermelon has more citrulline in the edible part than previously believed,” he says.

How could watermelon be a natural Viagra? The amino acid citrulline is converted into the amino acid arginine. Patil says. “This is a precursor for nitric oxide, and the nitric oxide will help in blood vessel dilation.”

So, the burning question: How much watermelon does it take?

“That is a good question,” Patil says. Unfortunately, “I don’t have an answer for that.”

He does know that a typical 4-ounce serving of watermelon (about 10 watermelon balls) has about 150 milligrams of citrulline. But he can’t say how much citrulline is needed to have Viagra-like effects.

He’s hopeful that someone will pick up on his research and study the fruit’s effect on penile erections.

13 Common Sex-Drive Killers

Watermelon’s Viagra-Like Effects

On hearing about the Texas finding, Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, was underwhelmed. Suggesting a man feast on watermelon to boost performance, he says, “would be the equivalent of someone dropping a beer bottle in Minneapolis, where the Mississippi River starts, and hoping to see it make an impact on someone in New Orleans.”

“To say that watermelon is Viagra-like is sort of fun,” says Goldstein. “But to even vaguely hope that eating watermelon will alleviate ED is misleading.”

“The vast majority of Americans produce enough arginine,” adds Goldstein, medical director of Alvarado Hospital Medical Center, San Diego, and clinical professor of surgery, University of California San Diego School of Medicine. “Men with ED are not deficient in arginine.”

Wednesday through Saturday evenings at 8:00 pm with a Thursday matinee at 2:00 pm.

TICKET PRICES

Watermelon Source Of Viagra sale
Adults: $25
Seniors: $20 (65 or older)
Students (HS & under): $10

Friday & Saturday
Adults: $30
Seniors: $25 (65 or older)
Students (HS & under): $10

FLEX PASS

Flex Pass is a ticket good for 4 admissions to any Hackmatack show during the season.
Adults: $100
Seniors: $80 (65 or older)
Click here to purchase Flex Pass

CONTACT INFO

Tickets can be purchased online. Please note all tickets purchased online are subject to a third party processing fee. To avoid this fee, tickets can be reserved by calling the box office.

Watermelon Source Of Viagra

Hackmatack Playhouse was founded in 1972 by S. Carleton Watermelon Source Of Viagra. He envisioned a summer stock theatre that would showcase the talents of professional and developing thespians from the regional area.

Many theatre goers have called Hackmatack one of New England’s most charming and quaint summer theatres. Some have even said that summer in Maine is not summer without a trip to Hackmatack. Much of the allure of this playhouse is its scenic location and historical presence.

Hackmatack Playhouse is located on the Watermelon Source Of Viagra family farmstead. The property was purchased by the first Watermelon Source Of Viagra (then Gubtail) to make the long trip to “New England” from native British Isles in the mid 1600’s. Thomas Watermelon Source Of Viagra built the first home, a log house which sat in the far left of the present day field overlooking the irrigation pond. According to family legend, this home was burnt down by Indians during one of the many raids on the Salmon Falls river region. The present day farmhouse was constructed between the years of 1716-2005 to appease the needs of an ever-changing diverse and dynamic Watermelon Source Of Viagra family. When it was first constructed, the house was a large cape sitting endwise to the road. It was occupied at one point by two Watermelon Source Of Viagra brothers. The younger brother decided that he would like to have a modern two story cape. His older brother in typical conservative fashion said “the house is plenty good enough the way it is”. The younger brother replied, “My half is coming off”. He then proceeded to saw his half off and tear it down. He built his family a two story cape on the end of the original house, parallel to the road, giving the house its shape. Minor reconstructions have taken place since then to create a more modern and functional house for the present day Watermelon Source Of Viagras.

Prior to the year of 1972 when the theatre was established, the Watermelon Source Of Viagra family farm functioned like many other farms at the time. The barn was the focal point of the farm. The current barn has an interesting story much like the original house. One of the first barns was struck by lightning and burned in July of 1934. Haying had just been completed for the season, and it is thought that the heat from the newly cut hay attracted the lightning. Almost immediately, Lewis Watermelon Source Of Viagra began looking for the right barn to replace what had been lost. He finally purchased a barn. It was a large old structure with pegged timbers measuring fifty four feet long and forty two feet wide. It was the perfect replacement for the old barn. However, there was one small problem, it was located across the street.

Luckily, the Watermelon Source Of Viagra’s have always been known for their ingenuity. It was with this cleverness that Lewis decided it would be easier to move the barn rather than disassemble it and rebuilt it. The entire barn was jacked up and rollers were placed underneath it. A cable was attached to one end of the barn that ran though a large turnstile. An old white horse was chosen for the job of slowly moving the barn. The horse was hitched to the turnstile and the horse walked in circles, stepping over the cable on every lap. The leverage was great and each time the horse made a circle, the barn moved one half inch. Progress was slow. The entire operation took about three days, a day of that was spent crossing Maine route 9. However, in 1934, Maine route 9 was much less traveled, and everyone cheerfully watched or made their own route around the barn.

After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

The grounds of Hackmatack Playhouse and the area surrounding the theatre host many other buildings built and used by the Watermelon Source Of Viagra clan over the years. The yellow family of buildings just south of the theatre (now owned by the Mills family) was originally built by Samuel Watermelon Source Of Viagra in the early part of last century. Known as the Forget-Me-Not, these buildings housed services for early automobile travelers, including fuel for the autos, and food for the hungry. Visitors could rent a cabin, and if they happened to be staying on a Saturday night, they were in luck. On Saturday night there were always barn dances.

The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis Watermelon Source Of Viagra in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton Watermelon Source Of Viagra, prepare a load of lumber for the newest construction project.

The Watermelon Source Of Viagra family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Watermelon Source Of Viagra great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton Watermelon Source Of Viagra Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

Watermelon May Have Viagra-effect

Date: July 1, 2008 Source: Texas A&M University Summary: A cold slice of watermelon has long been a Fourth of July holiday staple. But according to recent studies, the juicy fruit may be better suited for Valentine’s Day. That’s because scientists say watermelon has ingredients that deliver Viagra-like effects to the body’s blood vessels and may even increase libido. Share:

Dr. Bhimu Patil, director of Texas A&M’s Fruit and Vegetable Improvement Center, says watermelon may have Viagra-like effects.

Credit: Image courtesy of Texas A&M University

Dr. Bhimu Patil, director of Texas A&M’s Fruit and Vegetable Improvement Center, says watermelon may have Viagra-like effects.

Credit: Image courtesy of Texas A&M University

A cold slice of watermelon has long been a Fourth of July holiday staple. But according to recent studies, the juicy fruit may be better suited for Valentine’s Day. That’s because scientists say watermelon has ingredients that deliver Viagra-like effects to the body’s blood vessels and may even increase libido.

“The more we study watermelons, the more we realize just how amazing a fruit it is in providing natural enhancers to the human body,” said Dr. Bhimu Patil, director of Texas A&M’s Fruit and Vegetable Improvement Center in College Station.

“We’ve always known that watermelon is good for you, but the list of its very important healthful benefits grows longer with each study.”

Beneficial ingredients in watermelon and other fruits and vegetables are known as phyto-nutrients, naturally occurring compounds that are bioactive, or able to react with the human body to trigger healthy reactions, Patil said.

In watermelons, these include lycopene, beta carotene and the rising star among its phyto-nutrients – citrulline – whose beneficial functions are now being unraveled. Among them is the ability to relax blood vessels, much like Viagra does.

Scientists know that when watermelon is consumed, citrulline is converted to arginine through certain enzymes. Arginine is an amino acid that works wonders on the heart and circulation system and maintains a good immune system, Patil said.

“The citrulline-arginine relationship helps heart health, the immune system and may prove to be very helpful for those who suffer from obesity and type 2 diabetes,” said Patil. “Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it.”

While there are many psychological and physiological problems that can cause impotence, extra nitric oxide could help those who need increased blood flow, which would also help treat angina, high blood pressure and other cardiovascular problems.

“Watermelon may not be as organ specific as Viagra,” Patil said, “but it’s a great way to relax blood vessels without any drug side-effects.”

The benefits of watermelon don’t end there, he said. Arginine also helps the urea cycle by removing ammonia and other toxic compounds from our bodies.

Citrulline, the precursor to arginine, is found in higher concentrations in the rind of watermelons than the flesh. As the rind is not commonly eaten, two of Patil’s fellow scientists, drs. Steve King and Hae Jeen Bang, are working to breed new varieties with higher concentrations in the flesh.

In addition to the research by Texas A&M, watermelon’s phyto-nutrients are being studied by the U.S. Department of Agriculture’s Agricultural Research Service in Lane, Oklahoma.

As an added bonus, these studies have also shown that deep red varieties of watermelon have displaced the tomato as the lycopene king, Patil said. Almost 92 percent of watermelon is water, but the remaining 8 percent is loaded with lycopene, an anti-oxidant that protects the human heart, prostate and skin health.

“Lycopene, which is also found in red grapefruit, was historically thought to exist only in tomatoes,” he said. “But now we know that it’s found in higher concentrations in red watermelon varieties.”

Lycopene, however, is fat-soluble, meaning that it needs certain fats in the blood for better absorption by the body, Patil said.

“Previous tests have shown that lycopene is much better absorbed from tomatoes when mixed in a salad with oily vegetables like avocado or spinach,” Patil said. “That would also apply to the lycopene from watermelon, but I realize mixing watermelon with spinach or avocadoes is a very hard sell.”

No studies have been conducted to determine the timing of the consumption of oily vegetables to improve lycopene absorption, he said.

“One final bit of advice for those Fourth of July watermelons you buy,” Patil said. “They store much better uncut if you leave them at room temperature. Lycopene levels can be maintained even as it sits on your kitchen floor. But once you cut it, refrigerate. And enjoy.”

Apr. 3, 2014 — Watermelon could significantly reduce blood pressure in overweight individuals both at rest and while under stress. “The pressure on the aorta and on the heart decreased after consuming. read more

Watermelon Juice Relieves Post-Exercise Muscle Soreness

Aug. 14, 2013 — Watermelon juice’s reputation among athletes is getting scientific support in a new study, which found that juice from the summer favorite fruit can relieve post-exercise muscle soreness. The. read more

Watermelon Genome Decoded: Scientists Find Clues to Disease Resistant Watermelons

Nov. 26, 2012 — Scientists have sequenced the watermelon genome — information that could dramatically accelerate watermelon breeding toward production of a more nutritious, tastier and more resistant. read more

Jan. 25, 2012 — The widely used farm practice of grafting watermelon and other melon plants onto squash or pumpkin rootstocks results in larger amounts of certain pesticides in the melon fruit, scientists are. read more

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Common use

The main component of Viagra is Sildenafil Citrate.
Sildenafil Citrate affects the response to sexual stimulation. It acts by enhancing smooth muscle relaxation using nitric oxide, a chemical that is normally released in response to sexual stimulation. This smooth muscle relaxation allows increased blood flow into certain areas of the penis, which leads to an erection.
Sildenafil Citrate is applied for the treatment of erectile dysfunction (impotence) in men and pulmonary arterial hypertension.
Sildenafil Citrate may also be used for other purposes not listed above.

Dosage and direction

Usually the recommended dose is 50 mg. It is taken approximately 0,5-1 hour before sexual activity. Do not take Viagra more then once a day.
A high fat meal may delay the time of the effect of this drug.
Try not to eat grapefruit or drink grapefruit juice while you are being treated with Sildenafil Citrate .

Precautions

Before you start taking Sildenafil Citrate. tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
Aged people may be more sensitive to the side effects of the drug.

Viagra is contraindicated in patients who take another medicine to treat impotence or using a nitrate drug for chest pain or heart problems.
This medicine should not be taken by women and children as well as in patients with a known hypersensitivity to any component of the tablet.

Possible side effect

The most common side effects are headache, flushing, heartburn, stomach upset, nasal stuffiness, lightheadedness, dizziness or diarrhea.
A serious allergic reaction to this drug is very rare, but seek immediate medical help if it occurs.
Many people who use this medicine do not have serious side effects.
In case you notice any side effects not listed above, contact your doctor or pharmacist.

Drug interaction

This drug should not be used with nitrates and recreational drugs called “poppers” containing amyl or butyl nitrite; alpha-blocker medications; other medications for impotence; high blood pressure medicines, etc.
Consult your doctor or pharmacist for more details.

Missed dose

Viagra is used as needed, so you are unlikely to be on a dosing schedule.

Overdose

If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage

Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store the drugs in the bathroom. Keep all drugs away from reach of children and pets.

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.

VIAGRA 50MG COM 2 COMPRIMIDOS

IDENTIFICAпїЅпїЅO DO PRODUTO

Nome genпїЅrico: citrato de sildenafila

Forma farmacпїЅutica e apresentaпїЅпїЅes:

ViagraпїЅ 25 mg e 100 mg sпїЅo apresentados sob a forma de comprimidos revestidos de cor azul,

em embalagem contendo 4 comprimidos revestidos.

ViagraпїЅ 50 mg пїЅ apresentado sob a forma de comprimidos revestidos de cor azul, em

embalagens contendo 2, 4 ou 8 comprimidos revestidos.

Cada comprimido revestido de ViagraпїЅ 25 mg, 50 mg ou 100 mg contпїЅm citrato de sildenafila

equivalente a 25 mg, 50 mg ou 100 mg de sildenafila base, respectivamente.

Excipientes: celulose microcristalina, fosfato de cпїЅlcio dibпїЅsico (anidro), croscarmelose sпїЅdica,

estearato de magnпїЅsio, OpadryпїЅ Azul (hipromelose, lactose, triacetina, пїЅndigo carmim alumпїЅnio

laca e diпїЅxido de titпїЅnio) e OpadryпїЅ Transparente (hipromelose e triacetina).

INFORMAпїЅпїЅES AO PACIENTE

ViagraпїЅ (citrato de sildenafila) estпїЅ indicado para o tratamento da disfunпїЅпїЅo erпїЅtil, que se

entende como sendo a incapacidade de atingir ou manter uma ereпїЅпїЅo suficiente para um

desempenho sexual satisfatпїЅrio.

Para que ViagraпїЅ seja eficaz, пїЅ necessпїЅrio estпїЅmulo sexual.

ViagraпїЅ deve ser conservado a temperatura ambiente (entre 15 e 30пїЅC), protegido da luz

O prazo de validade estпїЅ indicado na embalagem externa do produto. NпїЅo use

medicamento com o prazo de validade vencido, pode ser perigoso para sua saпїЅde.

ViagraпїЅ nпїЅo пїЅ indicado para o uso em mulheres e crianпїЅas (< 18 anos).

ViagraпїЅ deve ser ingerido inteiro, no mпїЅximo 1 vez ao dia, conforme recomendaпїЅпїЅo

mпїЅdica. Siga a orientaпїЅпїЅo do seu mпїЅdico, respeitando sempre o horпїЅrio, a dose e a

duraпїЅпїЅo do tratamento.

Informe ao seu mпїЅdico sobre o aparecimento de reaпїЅпїЅes indesejпїЅveis. As reaпїЅпїЅes

adversas mais comuns incluem: dor de cabeпїЅa, rubor (vermelhidпїЅo), tontura, dispepsia

(mпїЅ digestпїЅo), congestпїЅo nasal, palpitaпїЅпїЅo e visпїЅo anormal (leves e transitпїЅrios;

predominantemente visпїЅo com traпїЅos coloridos, mas tambпїЅm sensibilidade aumentada пїЅ

luz ou visпїЅo turva).

Foram relatados eventos cardiovasculares graves pпїЅs-comercializaпїЅпїЅo. NпїЅo пїЅ possпїЅvel

determinar se esses eventos estпїЅo relacionados diretamente ao uso de ViagraпїЅ, пїЅ

atividade sexual, a pacientes com doenпїЅa cardiovascular de base, пїЅ combinaпїЅпїЅo desses

fatores ou outros fatores.

Caso vocпїЅ note diminuiпїЅпїЅo ou perda repentina da audiпїЅпїЅo e/ou visпїЅo interrompa

imediatamente o uso de ViagraпїЅ e consulte seu mпїЅdico (vide ?AdvertпїЅncias e

ViagraпїЅ estпїЅ formalmente contra-indicado a pacientes em tratamento com medicamentos

para angina de peito que contenham nitratos, tais como: SustrateпїЅ (propatilnitrato) -

Bristol-Myers Squibb; MonocordilпїЅ (isossorbida) – LaboratпїЅrios Baldacci; IsordilпїЅ

(isossorbida) – Sigma Pharma; NitradiscпїЅ (nitroglicerina) – LaboratпїЅrios Pfizer; Nitroderm

TTSпїЅ (nitroglicerina) – Novartis BiociпїЅncias; NitronalпїЅ (nitroglicerina) – BiobrпїЅs; IsocordпїЅ

(dinitrato de isosorbitol) – LaboratпїЅrio SinterпїЅpico Industrial Fcto; CincordilпїЅ

(isossorbida) – Sigma Pharma; Isossorbida – Cazi QuпїЅmica; Angil (isossorbida) – Sanval;

TridilпїЅ (nitroglicerina) – CristпїЅlia Prods. Quim. FarmacпїЅuticos; entre outros.

ViagraпїЅ tambпїЅm пїЅ contra-indicado a pacientes com hipersensibilidade conhecida ao

fпїЅrmaco ou a qualquer componente da fпїЅrmula.

Informe ao seu mпїЅdico sobre qualquer medicamento que esteja usando, antes do inпїЅcio,

ou durante o tratamento.

TODO MEDICAMENTO DEVE SER MANTIDO FORA DO ALCANCE DAS CRIANпїЅAS.

NпїЅO TOME REMпїЅDIOS SEM O CONHECIMENTO DO SEU MпїЅDICO, PODE SER PERIGOSO

A sildenafila sob a forma de sal citrato, пїЅ uma terapпїЅutica oral para a disfunпїЅпїЅo erпїЅtil. A

sildenafila пїЅ um inibidor seletivo da fosfodiesterase-5 (PDE-5), especпїЅfica do monofosfato de

guanosina cпїЅclico (GMPc).

Mecanismo de AпїЅпїЅo: o mecanismo fisiolпїЅgico responsпїЅvel pela ereпїЅпїЅo do pпїЅnis envolve a

liberaпїЅпїЅo de пїЅxido nпїЅtrico nos corpos cavernosos durante a estimulaпїЅпїЅo sexual. O пїЅxido nпїЅtrico

ativa a enzima guanilato ciclase, que por sua vez induz um aumento dos nпїЅveis de monofosfato

de guanosina cпїЅclico (GMPc), produzindo um relaxamento da musculatura lisa dos corpos

cavernosos, permitindo o influxo de sangue. A sildenafila nпїЅo exerce um efeito relaxante

diretamente sobre os corpos cavernosos isolados de humanos, mas aumenta o efeito relaxante

do пїЅxido nпїЅtrico atravпїЅs da inibiпїЅпїЅo da fosfodiesterase-5 (PDE-5), a qual пїЅ responsпїЅvel pela

degradaпїЅпїЅo do GMPc no corpo cavernoso. Quando a estimulaпїЅпїЅo sexual causa a liberaпїЅпїЅo

local de пїЅxido nпїЅtrico, a inibiпїЅпїЅo da PDE-5 causada pela sildenafila aumenta os nпїЅveis de GMPc

no corpo cavernoso, resultando no relaxamento da musculatura lisa e no influxo de sangue nos

corpos cavernosos. A sildenafila, nas doses recomendadas, nпїЅo exerce qualquer efeito sobre a

ausпїЅncia de estimulaпїЅпїЅo sexual.

Estudos in vitro mostraram que a sildenafila пїЅ seletiva para a PDE-5. Seu efeito пїЅ mais potente

para a PDE-5 quando comparado a outras fosfodiesterases conhecidas (10 vezes para a PDE-

6, > 80 vezes para a PDE-1 e > 700 vezes para a PDE-2, PDE-3, PDE-4, PDE-7 – PDE-11). A

seletividade da sildenafila, aproximadamente 4000 vezes maior para a PDE-5 versus a PDE-3,

пїЅ importante, uma vez que a PDE-3 estпїЅ envolvida no controle da contratilidade cardпїЅaca.

NпїЅo foram observadas alteraпїЅпїЅes clinicamente significativas no ECG de voluntпїЅrios sadios do

sexo masculino que receberam doses пїЅnicas orais de ViagraпїЅ (citrato de sildenafila) de atпїЅ 100

O valor mпїЅdio da reduпїЅпїЅo mпїЅxima da pressпїЅo arterial sistпїЅlica na posiпїЅпїЅo supina, apпїЅs uma

dose oral de 100 mg, foi de 8,3 mmHg. O valor correspondente da pressпїЅo arterial diastпїЅlica foi

Um efeito mais significativo, porпїЅm igualmente transitпїЅrio, na pressпїЅo arterial foi observado em

pacientes recebendo nitratos e ViagraпїЅ concomitantemente (vide ?Contra-indicaпїЅпїЅes? e

Em um estudo dos efeitos hemodinпїЅmicos de uma dose пїЅnica oral de 100 mg de sildenafila, em

14 pacientes com doenпїЅa arterial coronпїЅria (DAC) grave (pelo menos uma artпїЅria coronпїЅria com

estenose > 70%), a pressпїЅo sangпїЅпїЅnea mпїЅdia sistпїЅlica e diastпїЅlica, no repouso, diminuiu 7% e

6% respectivamente, comparada пїЅ linha de base. A pressпїЅo sangпїЅпїЅnea sistпїЅlica pulmonar

mпїЅdia diminuiu 9%. A sildenafila nпїЅo apresentou efeitos sobre o dпїЅbito cardпїЅaco, nпїЅo prejudicou

o fluxo de sangue atravпїЅs das artпїЅrias coronпїЅrias com estenose e resultou em melhora

(aproximadamente 13%) na reserva do fluxo coronпїЅrio induzido por adenosina (tanto nas

artпїЅrias com estenose como nas artпїЅrias de referпїЅncia).

Em um estudo duplo-cego, placebo-controlado, 144 pacientes com disfunпїЅпїЅo erпїЅtil e angina

estпїЅvel que estavam utilizando suas medicaпїЅпїЅes antianginosas usuais (com exceпїЅпїЅo de

nitratos) foram submetidos a exercпїЅcios atпїЅ o limite da ocorrпїЅncia de angina. O tempo de

exercпїЅcio de esteira foi significativa e estatisticamente superior (19,9 segundos; intervalo de

confianпїЅa de 95%: 0,9?38,9 segundos) nos pacientes avaliпїЅveis que haviam ingerido uma dose

пїЅnica de 100 mg de sildenafila, em comparaпїЅпїЅo aos pacientes que ingeriram placebo em dose

пїЅnica. O perпїЅodo mпїЅdio de exercпїЅcio (ajustado para a linha de base) para o inпїЅcio da angina

limitante foi de 423,6 segundos para sildenafila e de 403,7 segundos para o placebo.

Foi realizado um estudo randomizado, duplo-cego, placebo-controlado, com dose flexпїЅvel

(sildenafila atпїЅ 100 mg) em homens (n = 568) com disfunпїЅпїЅo erпїЅtil e hipertensпїЅo arterial

tomando dois ou mais medicamentos anti-hipertensivos. A sildenafila melhorou as ereпїЅпїЅes em

71% dos homens comparada a 18% no grupo que recebeu placebo. Houve 62% de tentativas

de relaпїЅпїЅo sexual bem-sucedidas no grupo que recebeu a sildenafila comparadas a 26% no

grupo que recebeu placebo. A incidпїЅncia de eventos adversos foi consistente quando

comparado a outras populaпїЅпїЅes de pacientes, assim como em indivпїЅduos que tomam trпїЅs ou

mais agentes anti-hipertensivos.

Utilizando-se o teste de coloraпїЅпїЅo de Farnsworth-Munsell 100, foi observado em alguns

indivпїЅduos alteraпїЅпїЅes leves e transitпїЅrias na distinпїЅпїЅo de cores (azul/verde) uma hora apпїЅs a

administraпїЅпїЅo de uma dose de 100 mg; 2 horas apпїЅs a administraпїЅпїЅo, nпїЅo foram observados

efeitos evidentes. O mecanismo aceito para essa alteraпїЅпїЅo na distinпїЅпїЅo de cores estпїЅ

relacionado пїЅ inibiпїЅпїЅo da fosfodiesterase-6 (PDE-6), que estпїЅ envolvida na cascata de

fototransduпїЅпїЅo da retina. Estudos in vitro demonstram que a sildenafila пїЅ 10 vezes menos

potente para a PDE-6 do que para a PDE-5. A sildenafila nпїЅo exerce efeitos sobre a acuidade

visual, sensibilidade de contrastes, eletroretinogramas, pressпїЅo intra-ocular ou pupilometria.

Um estudo clпїЅnico cruzado, placebo-controlado, com pacientes com degeneraпїЅпїЅo macular

precoce comprovadamente relacionada пїЅ idade (n = 9), demonstrou que a sildenafila (dose

пїЅnica de 100 mg) foi bem tolerada e nпїЅo resultou em alteraпїЅпїЅes clinicamente significativas nos

testes visuais conduzidos (acuidade visual, escala de Amsler, discriminaпїЅпїЅo de cores,

simulaпїЅпїЅo de luzes de trпїЅnsito, perпїЅmetro de Humphrey e foto estresse).

A eficпїЅcia e seguranпїЅa de ViagraпїЅ foram avaliadas em 21 estudos randomizados, duplo-cegos,

placebo-controlados, com duraпїЅпїЅo de atпїЅ 6 meses. ViagraпїЅ foi administrado a mais de 3000

pacientes com idades variando entre 19 e 87 anos, com disfunпїЅпїЅo erпїЅtil de diferentes etiologias

(orgпїЅnica, psicogпїЅnica, mista). A eficпїЅcia foi avaliada utilizando-se um questionпїЅrio de avaliaпїЅпїЅo

global, diпїЅrio de ereпїЅпїЅes, atravпїЅs do пїЅndice Internacional da FunпїЅпїЅo ErпїЅtil (IIFE, um

questionпїЅrio validado da funпїЅпїЅo erпїЅtil) e um questionпїЅrio para a parceira.

A eficпїЅcia de ViagraпїЅ, determinada como sendo a capacidade de alcanпїЅar e manter uma

ereпїЅпїЅo suficiente para a relaпїЅпїЅo sexual, foi demonstrada nos 21 estudos e foi mantida em

estudos de longa duraпїЅпїЅo (um ano). Em estudos de dose fixa, a proporпїЅпїЅo de pacientes que

relataram que o tratamento melhorou a ereпїЅпїЅo foi de 62% (25 mg), 74% (50 mg) e 82% (100

mg), em comparaпїЅпїЅo a 25% para o placebo. Em adiпїЅпїЅo пїЅ melhora da funпїЅпїЅo erпїЅtil, a anпїЅlise do

IIFE demonstrou que o tratamento com ViagraпїЅ tambпїЅm melhorou os aspectos relacionados ao

orgasmo, satisfaпїЅпїЅo sexual e satisfaпїЅпїЅo geral.

Ao longo de todos os estudos, a proporпїЅпїЅo de pacientes que relataram melhora com a

utilizaпїЅпїЅo de ViagraпїЅ foi de 59% dos pacientes diabпїЅticos, 43% dos pacientes que sofreram

prostatectomia total e 83% dos pacientes com lesпїЅes na medula espinhal (versus 16%, 15% e

12% com placebo, respectivamente).

A sildenafila apresenta uma farmacocinпїЅtica dose-proporcional, dentro do intervalo de doses

recomendadas. A sildenafila пїЅ eliminada predominantemente atravпїЅs do metabolismo hepпїЅtico

(principalmente via citocromo P450 3A4), e пїЅ convertida a um metabпїЅlito ativo com

propriedades semelhantes пїЅ sildenafila inalterada.

AbsorпїЅпїЅo: A sildenafila пїЅ rapidamente absorvida apпїЅs administraпїЅпїЅo oral, apresentando uma

biodisponibilidade absoluta mпїЅdia de 41% (variando entre 25 – 63%). A sildenafila, a uma

concentraпїЅпїЅo equivalente a 3,5 nM, inibe em 50% a atividade da enzima humana PDE-5, in

vitro. Em homens, a mпїЅdia da concentraпїЅпїЅo plasmпїЅtica mпїЅxima de sildenafila livre, apпїЅs a

administraпїЅпїЅo de uma dose пїЅnica oral de 100 mg, пїЅ de aproximadamente 18 ng/mL ou 38 nM.

As concentraпїЅпїЅes plasmпїЅticas mпїЅximas observadas sпїЅo atingidas de 30 a 120 minutos (em

mпїЅdia 60 minutos) apпїЅs uma dose oral, em jejum. Quando a sildenafila пїЅ administrada com

uma refeiпїЅпїЅo rica em lпїЅpides, a taxa de absorпїЅпїЅo пїЅ reduzida, verificando-se um atraso mпїЅdio de

60 minutos no TmпїЅx e uma reduпїЅпїЅo mпїЅdia de 29% na CmпїЅx, contudo, a extensпїЅo de absorпїЅпїЅo

nпїЅo foi significativamente afetada (AUC reduzida em 11%).

DistribuiпїЅпїЅo: O volume mпїЅdio de distribuiпїЅпїЅo da sildenafila no estado de equilпїЅbrio (steady-state)

пїЅ de 105 litros, indicando sua distribuiпїЅпїЅo nos tecidos. A sildenafila e o seu principal metabпїЅlito

circulante, o N-desmetil, apresentam uma ligaпїЅпїЅo пїЅs proteпїЅnas plasmпїЅticas de

aproximadamente 96%. A ligaпїЅпїЅo protпїЅica пїЅ independente da concentraпїЅпїЅo total do fпїЅrmaco.

Com base nas medidas de sildenafila no sпїЅmen de voluntпїЅrios sadios, foi demonstrado que

menos de 0,0002% (em mпїЅdia 188 ng) da dose administrada estava presente no sпїЅmen, 90

minutos apпїЅs a administraпїЅпїЅo do fпїЅrmaco.

Metabolismo: A sildenafila sofre depuraпїЅпїЅo hepпїЅtica principalmente pelas isoenzimas

microssomais CYP3A4 (via principal) e CYP2C9 (via secundпїЅria). O principal metabпїЅlito

circulante, que mais tarde tambпїЅm пїЅ metabolizado, resulta da N-desmetilaпїЅпїЅo da sildenafila.

Esse metabпїЅlito apresenta perfil de seletividade para as fosfodiesterases semelhante a da

sildenafila e potпїЅncia de inibiпїЅпїЅo in vitro para a PDE-5 de aproximadamente 50% da verificada

para o fпїЅrmaco inalterado. As concentraпїЅпїЅes plasmпїЅticas desse metabпїЅlito sпїЅo de

aproximadamente 40% da verificada para a sildenafila em voluntпїЅrios sadios. O metabпїЅlito Ndesmetil

пїЅ amplamente metabolizado, apresentando meia-vida terminal de aproximadamente 4

EliminaпїЅпїЅo: O clearance total da sildenafila пїЅ de 41 L/h, com meia-vida terminal de 3-5 horas.

ApпїЅs administraпїЅпїЅo oral ou intravenosa, a sildenafila пїЅ excretada sob a forma de metabпїЅlitos,

predominantemente nas fezes (aproximadamente 80% da dose oral administrada) e em menor

quantidade na urina (aproximadamente 13% da dose oral administrada).

FarmacocinпїЅtica em Grupos de Pacientes Especiais

Idosos: VoluntпїЅrios sadios idosos (65 anos ou mais) apresentaram uma reduпїЅпїЅo no clearance

da sildenafila, resultando em concentraпїЅпїЅes plasmпїЅticas aproximadamente 90% maiores de

sildenafila e o metabпїЅlito aitvo N-desmetil comparado пїЅquelas observadas em voluntпїЅrios

sadios mais jovens (18-45 anos). Devido a diferenпїЅas de idade na ligaпїЅпїЅo пїЅs proteпїЅnas

plasmпїЅticas, o aumento correspondente na concentraпїЅпїЅo plasmпїЅtica da sildenafila livre foi de

InsuficiпїЅncia Renal: Em voluntпїЅrios com insuficiпїЅncia renal leve (clearance de creatinina = 50-80

mL/min) e moderada (clearance de creatinina = 30-49 mL/min), a farmacocinпїЅtica a uma dose

пїЅnica oral de sildenafila (50 mg) nпїЅo foi alterada. Em voluntпїЅrios com insuficiпїЅncia renal grave

(clearance de creatinina ≤ 30 mL/min), o clearance da sildenafila se mostrou reduzido,

resultando em um aumento da AUC (100%) e da CmпїЅx (88%), quando comparado com

indivпїЅduos de idade semelhante, sem insuficiпїЅncia renal (vide ?Posologia?). AlпїЅm disso, os

valores da AUC e CmпїЅx do metabпїЅlito N-desmetil foram significativamente aumentados em

200% e 79%, respectivamente, em indivпїЅduos com insuficiпїЅncia renal grave comparado a

indivпїЅduos com funпїЅпїЅo renal normal.

InsuficiпїЅncia HepпїЅtica: Em voluntпїЅrios com cirrose hepпїЅtica (classe A e B de Child-Pugh) o

clearance da sildenafila se mostrou reduzido, resultando em um aumento da AUC (85%) e da

CmпїЅx (47%), quando comparado com indivпїЅduos de idade semelhante, sem insuficiпїЅncia

hepпїЅtica (vide ?Posologia?). A farmacocinпїЅtica da sildenafila em pacientes com insuficiпїЅncia

hepпїЅtica grave (classe C de Child-Pugh) nпїЅo foi estudada.

Dados de SeguranпїЅa PrпїЅ-ClпїЅnicos

CarcinogпїЅnese, MutagпїЅnese, PrejuпїЅzo da Fertilidade: A sildenafila nпїЅo foi carcinogпїЅnica quando

administrada a ratos por 24 meses, com uma dose que resultou em uma exposiпїЅпїЅo sistпїЅmica

total ao fпїЅrmaco (AUCs), para a sildenafila livre e seu principal metabпїЅlito, de 29 e 42 vezes

(para ratos machos e fпїЅmeas, respectivamente) as exposiпїЅпїЅes observadas em homens que

receberam a Dose MпїЅxima Recomendada para Humanos (DMRH) de 100 mg de sildenafila. A

sildenafila nпїЅo foi carcinogпїЅnica quando administrada a camundongos por um perпїЅodo de 18-21

meses em doses de atпїЅ a Dose MпїЅxima Tolerada (DMT) de 10 mg/kg/dia, aproximadamente

0,6 vezes a DMRH na base de mg/m2. A sildenafila foi negativa nos testes in vitro realizados em

cпїЅlulas bacterianas e em cпїЅlulas do ovпїЅrio de hamster chinпїЅs para a detecпїЅпїЅo de

mutagenicidade, assim como nos testes in vitro em linfпїЅcitos humanos e in vivo em micronпїЅcleo

de camundongo para a detecпїЅпїЅo de clastogenicidade. NпїЅo houve prejuпїЅzo da fertilidade em

ratos que receberam sildenafila em doses de atпїЅ 60 mg/kg/dia por 36 dias (fпїЅmeas) e 102 dias

(machos), uma dose que produziu um valor de AUC de mais de 25 vezes a AUC observada em

homens. NпїЅo houve efeito sobre a motilidade ou morfologia do espermatozпїЅide apпїЅs dose

пїЅnica oral de 100 mg de ViagraпїЅ em voluntпїЅrios sadios.

ViagraпїЅ (citrato de sildenafila) estпїЅ indicado para o tratamento da disfunпїЅпїЅo erпїЅtil, que se

entende como sendo a incapacidade de atingir ou manter uma ereпїЅпїЅo suficiente para um

desempenho sexual satisfatпїЅrio. Para que ViagraпїЅ seja eficaz, пїЅ necessпїЅrio estпїЅmulo sexual.

O uso do ViagraпїЅ (citrato de sildenafila) estпїЅ contra-indicado a pacientes com

hipersensibilidade conhecida ao fпїЅrmaco ou a qualquer componente da fпїЅrmula. Foi

demonstrado que ViagraпїЅ potencializa o efeito hipotensor dos nitratos de uso agudo ou

crпїЅnico, estando portanto, contra-indicada a administraпїЅпїЅo a pacientes usuпїЅrios de

qualquer forma doadora de пїЅxido nпїЅtrico, nitratos orgпїЅnicos ou nitritos orgпїЅnicos; tanto

os de uso freqпїЅente quanto os de uso intermitente (vide ?InteraпїЅпїЅes Medicamentosas?).

ADVERTпїЅNCIAS E PRECAUпїЅпїЅES

O conhecimento da histпїЅria clпїЅnica e a realizaпїЅпїЅo de um exame fпїЅsico completo sпїЅo necessпїЅrios

para se diagnosticar a disfunпїЅпїЅo erпїЅtil, determinar as provпїЅveis causas e identificar o

Existe um grau de risco cardпїЅaco associado пїЅ atividade sexual. Portanto, os mпїЅdicos podem

requerer uma avaliaпїЅпїЅo da condiпїЅпїЅo cardiovascular dos seus pacientes antes de iniciarem

qualquer tratamento para a disfunпїЅпїЅo erпїЅtil.

Os agentes para o tratamento da disfunпїЅпїЅo erпїЅtil nпїЅo devem ser utilizados em homens para os

quais a atividade sexual esteja desaconselhada.

Foram relatados eventos cardiovasculares graves pпїЅs-comercializaпїЅпїЅo, incluindo infarto do

miocпїЅrdio, morte cardпїЅaca repentina, arritmia ventricular, hemorragia cerebrovascular e ataque

isquпїЅmico transitпїЅrio em associaпїЅпїЅo temporal com o uso de ViagraпїЅ (citrato de sildenafila) para

a disfunпїЅпїЅo erпїЅtil. A maioria, mas nпїЅo todos os pacientes tinham fatores de risco cardiovascular

prпїЅ-existente. Foi relatado que muitos desses eventos ocorreram durante ou logo apпїЅs a

atividade sexual e poucos foram relatados com ocorrпїЅncia logo apпїЅs o uso de ViagraпїЅ sem

atividade sexual. Relatou-se que outros ocorreram horas ou dias apпїЅs o uso de ViagraпїЅ e

atividade sexual. NпїЅo пїЅ possпїЅvel determinar se esses eventos estпїЅo relacionados diretamente

ao uso de ViagraпїЅ, пїЅ atividade sexual, a pacientes com doenпїЅa cardiovascular de base, пїЅ

combinaпїЅпїЅo desses fatores ou outros fatores.

Nos estudos clпїЅnicos, foi demonstrado que a sildenafila tem propriedades vasodilatadoras

sistпїЅmicas que resultam em uma diminuiпїЅпїЅo transitпїЅria na pressпїЅo sangпїЅпїЅnea (vide ?Estudos

ClпїЅnicos?). Este resultado traz pouca ou nenhuma conseqпїЅпїЅncia para a maioria dos pacientes.

Entretanto, antes da sildenafila ser prescrita, os mпїЅdicos devem considerar cuidadosamente se

seus pacientes com alguma doenпїЅa prпїЅ-existente poderiam ser afetados de maneira adversa

por esse efeito vasodilatador, especialmente quando em combinaпїЅпїЅo com a atividade sexual.

Pacientes que tпїЅm alta susceptibilidade a vasodilatadores incluem aqueles que apresentam

obstruпїЅпїЅo do fluxo de saпїЅda do ventrпїЅculo esquerdo (por ex. estenose aпїЅrtica, cardiomiopatia

hipertrпїЅfica obstrutiva) ou aqueles com uma sпїЅndrome rara de atrofia de mпїЅltiplos sistemas, se

manifestando como um controle autпїЅnomo da pressпїЅo sangпїЅпїЅnea gravemente comprometido.

Neuropatia пїЅptica isquпїЅmica anterior nпїЅo-arterпїЅtica (NAION), uma causa da diminuiпїЅпїЅo ou perda

da visпїЅo, foi raramente relatada na pпїЅs-comercializaпїЅпїЅo com o uso de todos os inibidores da

PDE-5, incluindo a sildenafila. A maioria destes pacientes apresentavam fatores de risco como

baixa taxa de disco пїЅptico ("crowded disck"), idade superior a 50 anos, diabetes, hipertensпїЅo,

doenпїЅa arterial coronariana, hiperlipidemia e tabagismo. O mпїЅdico deve discutir com o paciente

o aumento do risco da NAION em indivпїЅduos que jпїЅ a apresentaram anteriormente.

Casos de diminuiпїЅпїЅo ou perda repentina de audiпїЅпїЅo foram relatados em pequeno nпїЅmero de

pacientes na pпїЅs-comercializaпїЅпїЅo e em estudos clпїЅnicos com o uso de todos os inibidores da

PDE5, incluindo a sildenafila. A maioria destes pacientes apresentava fatores de risco para este

NпїЅo foi identificada relaпїЅпїЅo causal entre o uso de inibidores de PDE5 e NAION e de inibidores

de PDE5 e hipoacusia.

Em caso de diminuiпїЅпїЅo ou perda repentina da audiпїЅпїЅo e/ou visпїЅo, os pacientes devem ser

advertidos a interromper imediatamente o uso de ViagraпїЅ e a consultarem o mпїЅdico.

Recomenda-se cautela na administraпїЅпїЅo concomitante de sildenafila em pacientes recebendo

α-bloqueadores, pois a coadministraпїЅпїЅo pode levar пїЅ hipotensпїЅo sintomпїЅtica em alguns

indivпїЅduos suscetпїЅveis (vide ?InteraпїЅпїЅo Medicamentosa?). A fim de diminuir o potencial de

desenvolver hipotensпїЅo postural, o paciente deve estar estпїЅvel hemodinamicamente durante a

terapia com α-bloqueadores antes de iniciar o tratamento com sildenafila. Deve-se considerar a

menor dose de sildenafila para iniciar a terapia (vide ?Posologia?). AlпїЅm do mais, o mпїЅdico deve

alertar o que o paciente deve fazer caso ele apresente sintomas de hipotensпїЅo postural.

Uma minoria dos pacientes que tпїЅm retinite pigmentosa hereditпїЅria apresenta alteraпїЅпїЅes

genпїЅticas das fosfodiesterases da retina. NпїЅo existem informaпїЅпїЅes relativas пїЅ seguranпїЅa da

administraпїЅпїЅo de ViagraпїЅ a pacientes com retinite pigmentosa. Portanto, ViagraпїЅ deve ser

administrado com precauпїЅпїЅo a esses pacientes.

Estudos in vitro com plaquetas humanas indicam que a sildenafila potencializa o efeito

antiagregante do nitroprussiato de sпїЅdio (um doador de пїЅxido nпїЅtrico). NпїЅo existem informaпїЅпїЅes

relativas пїЅ seguranпїЅa da administraпїЅпїЅo de ViagraпїЅ a pacientes com distпїЅrbios hemorrпїЅgicos ou

com пїЅlcera pпїЅptica ativa. Por esse motivo, ViagraпїЅ deve ser administrado com precauпїЅпїЅo a

Os agentes para tratamento da disfunпїЅпїЅo erпїЅtil devem ser utilizados com precauпїЅпїЅo em

pacientes com deformaпїЅпїЅes anatпїЅmicas do pпїЅnis (tais como angulaпїЅпїЅo, fibrose cavernosa ou

doenпїЅa de Peyronie) ou em pacientes com condiпїЅпїЅes que possam predispпїЅ-los ao priapismo

(tais como anemia falciforme, mieloma mпїЅltiplo ou leucemia).

A seguranпїЅa e a eficпїЅcia das associaпїЅпїЅes de ViagraпїЅ com outros tratamentos para a disfunпїЅпїЅo

erпїЅtil nпїЅo foram estudadas. Portanto, o uso dessas associaпїЅпїЅes nпїЅo пїЅ recomendado.

Uso durante a Gravidez e LactaпїЅпїЅo

ViagraпїЅ nпїЅo estпїЅ indicado para o uso em mulheres.

NпїЅo foi observada evidпїЅncia de teratogenicidade, embriotoxicidade ou fetotoxicidade em ratos e

coelhos que receberam atпїЅ 200 mg/kg/dia de sildenafila durante a organogпїЅnese. Estas doses

representam, respectivamente, cerca de 20 a 40 vezes a DMRH (dose mпїЅxima recomendada

para humanos) na base de mg/m2, em um indivпїЅduo de 50 kg.

NпїЅo existem estudos adequados e bem controlados da sildenafila em mulheres grпїЅvidas e

Uso em CrianпїЅas: ViagraпїЅ nпїЅo пїЅ indicado para o uso em crianпїЅas (< 18 anos).

Uso em Idosos: O ajuste de dose nпїЅo пїЅ necessпїЅrio para pacientes idosos.

Efeitos na Habilidade de Dirigir e de Operar MпїЅquinas: NпїЅo foi estudado o efeito de ViagraпїЅ

sobre a habilidade de dirigir ou operar mпїЅquinas.

Efeitos de outros medicamentos sobre o ViagraпїЅ (citrato de sildenafila)

Estudos in vitro

O metabolismo da sildenafila пїЅ mediado principalmente pelas isoformas do citocromo P450

(CYP), 3A4 (via principal) e 2C9 (via secundпїЅria). Portanto, inibidores dessas isoenzimas

podem reduzir o clearance da sildenafila e os indutores podem aumentпїЅ-lo.

Estudos in vivo

Os dados farmacocinпїЅticos populacionais de pacientes em estudos clпїЅnicos indicaram uma

diminuiпїЅпїЅo do clearance da sildenafila quando co-administrada com inibidores do citocromo

CYP3A4 (tais como o cetoconazol, eritromicina ou cimetidina).

A cimetidina (800 mg), um inibidor do citocromo P450 e um inibidor nпїЅo-especпїЅfico CYP3A4,

causou um aumento de 56% na concentraпїЅпїЅo plasmпїЅtica da sildenafila, quando coadministrada

com ViagraпїЅ 50 mg a voluntпїЅrios sadios.

Quando uma dose пїЅnica de 100 mg de ViagraпїЅ foi administrada com eritromicina, um inibidor

especпїЅfico do CYP3A4, no estado de equilпїЅbrio (500 mg, 2 vezes por dia por 5 dias) houve um

aumento de 182% na exposiпїЅпїЅo sistпїЅmica пїЅ sildenafila (AUC). AlпїЅm disso, a co-administraпїЅпїЅo

de sildenafila (100 mg em dose пїЅnica) e saquinavir (um inibidor da protease HIV), que tambпїЅm

пїЅ um inibidor do CYP3A4, no estado de equilпїЅbrio (1200 mg, 3 vezes por dia), resultou em um

aumento de 140% na CmпїЅx e de 210% na AUC da sildenafila. A sildenafila nпїЅo afetou a

farmacocinпїЅtica do saquinavir (vide ?Posologia?). Espera-se que inibidores mais potentes do

CYP3A4 tais como o cetoconazol e o itraconazol apresentem efeitos maiores.

A co-administraпїЅпїЅo de sildenafila (100 mg em dose пїЅnica) e ritonavir (um inibidor da protease

HIV), que tambпїЅm пїЅ um potente inibidor do citocromo P450, no estado de equilпїЅbrio (500 mg, 2

vezes por dia), resultou em um aumento de 300% (4 vezes) na CmпїЅx e de 1000% (11 vezes) na

AUC plasmпїЅtica da sildenafila. ApпїЅs 24 horas, os nпїЅveis de sildenafila no plasma ainda eram de

aproximadamente 200 ng/mL, comparados a aproximadamente 5 ng/mL quando a sildenafila foi

administrada sozinha. Este dado пїЅ consistente com os efeitos marcantes do ritonavir em um

espectro variado de substratos do citocromo P450. A sildenafila nпїЅo apresentou qualquer efeito

sobre a farmacocinпїЅtica do ritonavir (vide ?Posologia?).

Quando doses de sildenafila foram administradas, conforme recomendaпїЅпїЅo, em pacientes

recebendo inibidores potentes do citocromo CYP3A4, a concentraпїЅпїЅo plasmпїЅtica mпїЅxima de

sildenafila livre nпїЅo foi superior a 200 nM em todos os indivпїЅduos avaliados, e foram bem

Doses пїЅnicas de antiпїЅcidos (hidrпїЅxido de magnпїЅsio/hidrпїЅxido de alumпїЅnio) nпїЅo exerceram

qualquer efeito sobre a biodisponibilidade de ViagraпїЅ.

Os dados farmacocinпїЅticos dos pacientes incluпїЅdos em estudos clпїЅnicos nпїЅo demonstraram

qualquer efeito da medicaпїЅпїЅo concomitante sobre a farmacocinпїЅtica da sildenafila, quando

essas medicaпїЅпїЅes foram agrupadas da seguinte forma: inibidores do citocromo CYP2C9 (tais

como tolbutamida, varfarina), inibidores do citocromo CYP2D6 (tais como os inibidores seletivos

da recaptaпїЅпїЅo de serotonina, antidepressivos tricпїЅclicos), tiazidas e diurпїЅticos relacionados,

inibidores da enzima conversora de angiotensina (ECA) e bloqueadores de canais de cпїЅlcio. A

AUC do metabпїЅlito ativo, N-desmetil sildenafila, estava aumentada em 62% por diurпїЅticos de

alпїЅa e poupadores de potпїЅssio e 102% pelos beta-bloqueadores nпїЅo especпїЅficos. NпїЅo se

espera que estes efeitos sobre o metabпїЅlito tenham conseqпїЅпїЅncias clпїЅnicas.

Em voluntпїЅrios sadios do sexo masculino nпїЅo existiram evidпїЅncias sobre o efeito da

azitromicina (500 mg diпїЅrios, por 3 dias) na AUC, CmпїЅx, TmпїЅx, constante da taxa de eliminaпїЅпїЅo

ou na meia-vida da sildenafila ou de seu principal metabпїЅlito circulante.

Efeitos do ViagraпїЅ sobre outros medicamentos

Estudos in vitro

A sildenafila пїЅ um fraco inibidor das isoformas do citocromo P450, 1A2, 2C9, 2C19, 2D6, 2E1 e

3A4 (IC50 > 150 μM). Uma vez que o pico de concentraпїЅпїЅo plasmпїЅtica da sildenafila пїЅ de

aproximadamente 1 μM apпїЅs as doses recomendadas, пїЅ improvпїЅvel que ViagraпїЅ altere o

clearance dos substratos dessas isoenzimas.

Estudos in vivo

Foi demonstrado que ViagraпїЅ potencializa o efeito hipotensor da terapпїЅutica com nitratos, tanto

de uso agudo quanto crпїЅnico. Portanto, o uso de qualquer forma doadora de пїЅxido nпїЅtrico,

nitratos ou nitritos orgпїЅnicos, de uso regular ou intermitente com ViagraпїЅ, пїЅ contra-indicado

Em 3 estudos especпїЅficos de interaпїЅпїЅo fпїЅrmaco-fпїЅrmaco, o α-bloqueador doxazosina (4 mg e 8

mg) e a sildenafila (25 mg, 50 mg ou 100 mg) foram administrados simultaneamente a

pacientes com hiperplasia prostпїЅtica benigna (HPB) estпїЅvel em tratamento com doxazosina. Foi

observado, nesta populaпїЅпїЅo de estudo, que a reduпїЅпїЅo adicional mпїЅdia da pressпїЅo sangпїЅпїЅnea

na posiпїЅпїЅo supina foi de 7/7 mmHg, 9/5 mmHg e 8/4 mmHg, e a reduпїЅпїЅo adicional mпїЅdia da

pressпїЅo sangпїЅпїЅnea em pпїЅ foi de 6/6 mmHg, 11/4 mmHg e 4/5 mmHg, respectivamente. Quando

a sildenafila пїЅ co-administrada com doxazosina em pacientes estпїЅveis em tratamento com

doxazosina, houve relatos infreqпїЅentes de pacientes que apresentaram hipotensпїЅo postural

sintomпїЅtica. Estes relatos incluпїЅram tontura e sensaпїЅпїЅo de cabeпїЅa vazia, mas sem desmaio. A

co-administraпїЅпїЅo de sildenafila a pacientes em tratamento com α-bloqueadores pode levar пїЅ

hipotensпїЅo sintomпїЅtica em alguns indivпїЅduos suscetпїЅveis (vide ?Posologia? e ?AdvertпїЅncias e

NпїЅo foi demonstrada interaпїЅпїЅo significativa quando a sildenafila (50 mg) foi co-administrada

com a tolbutamida (250 mg) ou varfarina (40 mg), sendo que ambas sпїЅo metabolizadas pelo

ViagraпїЅ (100 mg) nпїЅo afetou a farmacocinпїЅtica do estado de equilпїЅbrio dos inibidores da

protease HIV, saquinavir e ritonavir, ambos substratos do citocromo CYP3A4.

ViagraпїЅ (50 mg) nпїЅo potencializou o aumento no tempo de sangramento provocado pelo пїЅcido

acetilsalicпїЅlico (150 mg) e os efeitos hipotensores do пїЅlcool em voluntпїЅrios sadios com nпїЅveis

mпїЅdios mпїЅximos de пїЅlcool no sangue de 0,08% (80 mg/dL).

NпїЅo foi observada interaпїЅпїЅo quando a sildenafila 100 mg foi co-administrada com anlodipino em

pacientes hipertensos. A mпїЅdia da reduпїЅпїЅo adicional da pressпїЅo arterial na posiпїЅпїЅo supina foi

de 8 mmHg (sistпїЅlica) e 7 mmHg (diastпїЅlica).

A anпїЅlise de dados sobre seguranпїЅa nпїЅo demonstrou qualquer diferenпїЅa no perfil de efeitos

colaterais em pacientes tratados com ViagraпїЅ, na presenпїЅa e ausпїЅncia de medicaпїЅпїЅo antihipertensiva.

Os eventos adversos foram em geral, transitпїЅrios e de natureza leve a moderada.

Em estudos de dose fixa, a incidпїЅncia de alguns eventos adversos aumentou com a dose. A

natureza dos eventos em estudos de dose flexпїЅvel, que refletem de forma mais adequada o

regime posolпїЅgico recomendado, foi semelhante пїЅquela observada nos estudos de dose fixa.

As reaпїЅпїЅes adversas mais comumente relatadas foram cefalпїЅia e rubor, ambas ocorrendo em

mais que 10% dos pacientes. As reaпїЅпїЅes adversas estпїЅo listadas por sistemas e пїЅrgпїЅos e

classificadas pela freqпїЅпїЅncia. As freqпїЅпїЅncias sпїЅo definidas como: muito comuns (≥ 1/10) e

comuns (≥ 1/100 e < 1/10).

Sistema Nervoso: Muito Comuns: cefalпїЅia (sildenafila:10,8% vs placebo:2,8%). Comuns:

tontura (sildenafila:2,9% vs placebo:1,0%).

DistпїЅrbio Vascular: Muito Comuns: vasodilataпїЅпїЅo (rubor) (sildenafila:10,9% vs placebo:1,4%).

DistпїЅrbio Ocular: Comuns: visпїЅo anormal (visпїЅo turva, sensibilidade aumentada пїЅ luz)

(sildenafila:2,5% vs placebo:0,4%) e cromatopsia (leve e transitпїЅria, predominantemente

distorпїЅпїЅo de cores) (sildenafila:1,1% vs placebo:0,03%).

DistпїЅrbio CardпїЅaco: Comuns: palpitaпїЅпїЅo (sildenafila:1,0% vs placebo:0,2%).

DistпїЅrbio RespiratпїЅrio, torпїЅcico e mediastinal: Comuns: rinite (congestпїЅo nasal)

(sildenafila:2,1% vs placebo:0,3%).

DistпїЅrbio Gastrintestinal: Comuns: dispepsia (sildenafila:3,0% vs placebo:0,4%).

Nas doses acima da variaпїЅпїЅo de dose recomendada, eventos adversos foram semelhantes

пїЅqueles detalhados acima, mas foram relatados com mais freqпїЅпїЅncia.

ApпїЅs a anпїЅlise de estudos clпїЅnicos duplo-cegos, placebo-controlados, envolvendo mais de 700

pessoas-ano utilizando placebo e mais de 1300 pessoas-ano tratadas com sildenafila,

observou-se que nпїЅo hпїЅ diferenпїЅas entre a taxa de incidпїЅncia de infarto do miocпїЅrdio e a taxa

de mortalidade cardiovascular quando os pacientes tratados com sildenafila foram comparados

пїЅqueles recebendo placebo. A taxa de incidпїЅncia de infarto do miocпїЅrdio foi de 1,1 por 100

pessoas-ano, para homens recebendo tanto placebo quanto sildenafila. E a taxa de incidпїЅncia

de mortalidade cardiovascular foi de 0,3 por 100 pessoas-ano, para homens recebendo tanto

placebo quanto sildenafila.

Os seguintes eventos adversos foram relatados durante o perпїЅodo pпїЅs-comercializaпїЅпїЅo:

Sistema imune: reaпїЅпїЅo de hipersensibilidade (incluindo rash cutпїЅneo)

Sistema Nervoso: convulsпїЅo, convulsпїЅo recorrente.

Vascular: hipotensпїЅo, sпїЅncope, epistaxe

Ocular: dor ocular, olhos vermelhos

Sistema reprodutivo e mama: ereпїЅпїЅo prolongada e/ou priapismo

Os comprimidos de ViagraпїЅ (citrato de sildenafila) destinam-se пїЅ administraпїЅпїЅo por via oral.

Uso em Adultos: Para a maioria dos pacientes, a dose recomendada пїЅ de 50 mg em dose

пїЅnica, administrada quando necessпїЅria e aproximadamente 1 hora antes da relaпїЅпїЅo sexual. De

acordo com a eficпїЅcia e tolerabilidade, a dose pode ser aumentada para uma dose mпїЅxima

recomendada de 100 mg ou diminuпїЅda para 25 mg. A dose mпїЅxima recomendada пїЅ de 100 mg.

A freqпїЅпїЅncia mпїЅxima recomendada de ViagraпїЅ пїЅ de 1 vez ao dia.

Uso em Pacientes com InsuficiпїЅncia Renal: NпїЅo пїЅ necessпїЅrio ajuste de dose em pacientes

com insuficiпїЅncia renal leve a moderada (clearance de creatinina = 30. 80 mL/min). Uma vez

que o clearance da sildenafila пїЅ reduzido em pacientes com insuficiпїЅncia renal grave (clearance

de creatinina < 30 mL/min), uma dose de 25 mg deve ser considerada.

Uso em Pacientes com InsuficiпїЅncia HepпїЅtica: Uma vez que o clearance da sildenafila пїЅ

reduzido em pacientes com insuficiпїЅncia hepпїЅtica (por ex. cirrose), uma dose de 25 mg deve

Uso em Pacientes que Utilizam outras MedicaпїЅпїЅes: Considerando a extensпїЅo da interaпїЅпїЅo

em pacientes em tratamento concomitante com sildenafila e ritonavir (vide ?InteraпїЅпїЅes

Medicamentosas?), recomenda-se nпїЅo exceder a dose пїЅnica mпїЅxima de 25 mg de sildenafila

dentro de um perпїЅodo de 48 horas. Uma dose inicial de 25 mg deve ser considerada em

pacientes recebendo terapia concomitante com inibidores da CYP3A4 (por ex. eritromicina,

saquinavir, cetoconazol, itraconazol) (vide ?InteraпїЅпїЅes Medicamentosas?). A fim de diminuir o

potencial de desenvolver hipotensпїЅo postural, o paciente deve estar estпїЅvel durante a terapia

com α-bloqueadores principalmente no inпїЅcio do tratamento com sildenafila. AlпїЅm disso, devese

considerar a menor dose de sildenafila para iniciar a terapia (vide ?AdvertпїЅncias e

PrecauпїЅпїЅes? e ?InteraпїЅпїЅes Medicamentosas?). Foi demonstrado que ViagraпїЅ potencializa o

efeito hipotensor dos nitratos. Portanto, a administraпїЅпїЅo a pacientes que fazem uso de

medicamentos doadores de пїЅxido nпїЅtrico ou nitratos sob qualquer forma, пїЅ contra-indicada.

Uso em CrianпїЅas: ViagraпїЅ nпїЅo пїЅ indicado para o uso em crianпїЅas (< 18 anos).

Uso em Idosos: O ajuste de dose nпїЅo пїЅ necessпїЅrio para pacientes idosos.

Em estudos realizados com voluntпїЅrios sadios utilizando doses пїЅnicas de atпїЅ 800 mg, os

eventos adversos foram semelhantes пїЅqueles observados com doses inferiores; no entanto, a

taxa de incidпїЅncia e gravidade foram maiores. Em casos de superdosagem, medidas gerais de

suporte devem ser adotadas conforme a necessidade. Uma vez que a sildenafila se encontra

fortemente ligada пїЅs proteпїЅnas plasmпїЅticas e nпїЅo пїЅ eliminada pela urina, nпїЅo se espera que a

diпїЅlise renal possa acelerar o clearance da sildenafila.

FarmacпїЅutica ResponsпїЅvel: Raquel Oppermann. CRF-SP nпїЅ 36144

VENDA SOB PRESCRIпїЅпїЅO MпїЅDICA.

NпїЅmero do lote e data de fabricaпїЅпїЅo: vide embalagem externa.

LABORATпїЅRIOS PFIZER LTDA.

Av. Monteiro Lobato, 2.270

CEP 07190-001. Guarulhos. SP

CNPJ nпїЅ 46.070.868/0001-69

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Las hemorroides del convite con estas puntas que trabajaron para mГ­. Es muy provocativo para completar cosas normalmente cuando tenemos montones o montones. Para manejar hemorroides o montones en casa, el punto primario es llevan un enema caliente mГЎs alto, temperatura de 102F a 108F.Use corteza del roble posiblemente blanca o corteza de bayberry para tratar hemorroides o tГ© de la raГ­z del alumbre blanco para limpiar la longitud total de hemorroides del convite y el colon..

Si la dificultad es el exterior, baГ±e una pieza mГЎs pequeГ±a de algodГіn en este tГ© y baГ±e el elemento impactado.
De ser interno, consiga una jeringuilla del bebГ© e inyecte dos cucharadas a la vez o puede usar bien una jeringuilla de cristal. DescubrirГЎ que este remedio de la hemorroide darГЎ el alivio y tratarГЎ hemorroides dentro de un ratito. Esto es cГіmo puede tratar con eficacia hemorroides..

Las circunstancias muy pobres de hemorroides se pueden curar aplicando el keroseno solo. PresГ©ntese a las partes impactadas posiblemente dentro de o. Si dentro de, inyecte un diminuto. El keroseno da el alivio inmediato a sus hemorroides. El zumo de limГіn tambiГ©n es excepcional utilizado del modo similar de ayudarle a tratar hemorroides.

Causas de Hemorroides

Las hemorroides se unen a plan de comida incorrecto, comer en exceso, licores embriagadores, tabaco, especias de numerosos tipos, el pan blanco, azГєcar, friГі los alimentos y todas las comidas de formaciГіn de ГЎcido que causan la fermentaciГіn. Estos hГЎbitos devitalized comida de motivos de hГЎbitos el estreГ±imiento, obstruye el hГ­gado y factores un torrente circulatorio contaminado y hace irrita el estГіmago e intestinos.

Si hay tejido aumentado de la boca del recto, y tambiГ©n vasos sanguГ­neos aumentados tiene que comenzar a tratar hemorroides en seguida. Г‰stos son signos de hemorroides y puede descubrir los montones sangrantes. Los tumores diminutos se forman cerca del ano. Tanto el montГіn interno como exterior apena completamente. Por lo general, hay picor intenso. Toda la comida pesada y estimulante realmente se deberГ­a evitar como indicado. El plan de comida tiene que ser franco y ligero. Leche de la soja, soja zwieback, plГЎtanos completamente maduros, caldos de verduras de cualquier tipo. Continuar un plan de la dieta de la fruta durante un par de dГ­as es una medida completamente beneficiosa.

Se deberГ­a tomar un baГ±o sitz increГ­blemente caliente, tan caliente como se puede llevar. SiГ©ntese en este baГ±o durante quince minutos o el derecho mГЎs largo hasta el cuerpo entero con cuidado se calienta a travГ©s de. Tenga una otra tina que contiene el agua mineral frГ­o, y pronto despuГ©s de hacerse acalorado, siГ©ntese en esto para un 2do o dos. Haga clic aquГ­ para encontrar el #1 cura tasada para hemorroides.

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Recuerde sentimientos de estar en el flujo e imagine y experimente el estado cuando tenga el control de cosas y acontecimientos, cuando completa cosas a tiempo y todavГ­a tiene la energГ­a para mГЎs, donde sus procesos del pensamiento estГЎn claros, sus sentidos aumentaron y todo lo demГЎs va directamente en su mundo. ВїParece todo esto distante o las cosas de la vida pasada a usted?

Si su respuesta es sГ­, tiene que complementar su dieta con alguna dieta de empuje del cerebro o suplemento. Puede realzar ahora su cogniciГіn, mejorar su memoria y aumentar su utilizaciГіn de inteligencia Piracetam, una brecha en mente medicinas de poder.

Hoy cada vez mГЎs la gente de todos los aГ±os muestra un deseo creciente de cosechar las ventajas del funcionamiento mental mejorado alcanzado con la ayuda de nootropics o medicinas elegantes. competiveness aumentado tanto durante estudios como en el lugar de trabajo, hay un deseo de saber mГЎs y funcionar mГЎs a fin de adelantar.

Sin embargo, hay un lГ­mite para el cual podemos usar nuestras capacidades mentales y potencial. La dieta de la comida basura, fumar, la bebida, el uso de medicinas recreativas, tensiГіn, contaminadores y envejecimiento normal en el cual todo toma un peaje son la funciГіn cognoscitiva.

Y como los aГ±os cerebrales o se hace daГ±ado, las cГ©lulas cerebrales son menos capaces de secretar neurotransmitters llamado de los productos quГ­micos, tenГ­a que transmitir seГ±ales elГ©ctricas. Estos niveles inferiores de neurotransmitters u otros productos quГ­micos cerebrales inhiben la codificaciГіn de memoria y retardan la funciГіn de memoria.

TambiГ©n se piensa que Piracetam es un antioxidante que lecciones el daГ±o causado por radicales libres al cerebro y acciones como el estimulante del metabolismo cerebral, ayudando al flujo de informaciГіn liso en todas partes del cerebro.

Ya que nuestras dietas no para proporcionar la cantidad adecuada de neurotransmitters requirieron para el funcionamiento mental Гіptimo, tenemos que tomar medicinas elegantes como Piracetam para despertar nuestro cerebro. Piracetam realza la cogniciГіn en condiciones de hypoxia (demasiado poco oxГ­geno), y tambiГ©n mejora la memoria y algunas clases del aprendizaje en la gente normal.

La medicina de la mente, Piracetam es usado para tratar alcoholismo, golpe, vГ©rtigo, demencia senil, anemia de cГ©lulas falciformes, dislexia y numerosos otros problemas de salud. Piracetam puede aumentar los efectos de ciertas medicinas, como anfetaminas, psychotropics, y Hydergine, como declarado. Los efectos adversos son raros, pero incluyen insomnio, agitaciГіn psicomotor, nГЎusea, angustia gastrointestinal y dolores de cabeza.

Piracetam no tiene prГЎcticamente toxicidad conocida o contraindicaciones. Piracetam se provee en cГЎpsulas de 400 mg. o de 800 mg. o pastillas. La dosis habitual es 2.400 a 4.800 mg. por dГ­a en tres dosis divididas. La verdadera medicina toma hasta una hora para trabajar y ser sentida por el usuario.

El tratamiento de Conde de la Esperma Bajo Y Esperma de Aumento cuenta Naturalmente

La cuenta de la esperma es el nГєmero (o concentraciГіn) de la esperma que deberГ­a estar presente/mensurable en una muestra dada.
La asociaciГіn de la Salud mundial proporciona pautas a una cuenta de la esperma sana. La cota de referencia a una cuenta “normal” es 20 millones de espermas por mililitro – dado un volumen del semen total de 2 ml. Esto compara con un nГєmero total de esperma por/muestra de 40 millones.
Si estos grandes nГєmeros son sorprendentes, una terminaciГіn que uno puede dibujar rГЎpidamente es que generalmente requiere que los grandes nГєmeros de la esperma se aseguren que un embarazo se consigue.
Esto es porque sГіlo pocos relativos de estos 20 a 40 millones esperma son capaces de hacer el viaje largo y difГ­cil a travГ©s de la cerviz a la trompa de Falopio al huevo de aguardada.
Y como hay tГ­picamente sГіlo un huevo soltado durante la ovulaciГіn en una trompa de Falopio, aproximadamente el 50% de cualquier esperma de aguardada se juntarГЎ probablemente al lado de la entrada de la trompa de Falopio “incorrecta”.
Complicando cosas aГєn mГЎs, bajo la situaciГіn ideal, la esperma sГіlo puede vivir para un puГ±ado de dГ­as, por tanto un huevo debe ser “a tiempo” si el principio debe ocurrir.
Si concebir es un “juego de nГєmeros”, entonces la cuenta de la esperma es importante. Al mismo tiempo, un subordinado que la cuenta de la esperma media no le envГ­a a una categorГ­a de la infertilidad.
Las causas de la Esperma Baja cuentan
La causa principal de la infertilidad masculina es la cantidad de la esperma baja. Los otros pueden ser la esperma baja motility, la esperma de excelencia mala y la carencia del semen.
En general, la mayor parte de casos de la esterilidad masculina son debido a la cantidad de la esperma baja. Hay muchos factores biolГіgicos y ecolГіgicos que pueden dirigir a la cantidad de la esperma baja. AquГ­ estГЎ una lista si las condiciones que pueden causar la esperma baja incluyen a hombres.
Los sГ­ntomas de la Esperma Baja cuentan
* El humor amplio y errГЎtico balancea
* Comportamiento irracional
* Agresividad aumentada (esteroide o rabia de roid)
* Irritabilidad
* Paseo sexual aumentado (libido) en hombres y a veces en mujeres
* DepresiГіn

El tratamiento de la Esperma Baja cuenta
1. Cambie a una dieta mГЎs sana, justa rica en verduras y granos enteros.

2. EntrГ©nese con regularidad.

3. Trate de reducir la tensiГіn.

4. Guarde el peso lejos; si es pesado, pierde el peso de sobrecarga.

6. Reduzca o elimine el consumo de alcohol.

Aumente Su Esperma cuentan Puntas
1. Tenga el sexo & menos a menudo mastГєrbese – mГЎs veces exclama, menos difГ­cil su semen serГЎ. sostenga un hueco de 3 dГ­as entre dos exclamaciones sucesivas.
2. Estribillo de hГЎbitos como fumar, consumo de alcohol etc. – el Alcohol afecta su funciГіn del hГ­gado, que, por su parte, causa una subida teatral de niveles del estrГіgeno. Incluso dos bebidas por dГ­a tendrГЎn efectos a largo plazo en la producciГіn de la esperma
3. EntrГ©nese con regularidad. El entrenamiento de su mГєsculo del PC le puede ayudar a disparar extra que alguna vez antes.
4. Coma la Comida Nutritiva – Dieta esto es bajo en la grasa, y alto en proteГ­na, verduras, y los granos enteros son buenos para su salud y para su esperma. Evite alimentos amargos, cortantes y sazonados. Reduzca el consumo de cafeГ­na
5. Evite calentarse de testГ­culos – Ropa suelta, calzoncillos bГіxer de algodГіn, guarde lejos de baГ±os calientes y saunas
6. Pierda cualquier peso de la superabundancia, que tienda a causar injusticias de la testosterona/estrГіgeno.

Remedios de casa para aumentar esperma
1. AlГ©jese de cigarrillos y alcohol
2. Yoga de prГЎctica y meditaciГіn para ser tensiГіn

3. Trate de entrenarse con regularidad

4. Trate de mantener un hueco de tres dГ­as entre dos exclamaciones consecutivas para permanecer
fГ©rtil. 5. Evite alimentos amargos, sazonados y ГЎcidos

6. Evite calzoncillos apretados para proporcionar un clima ambiental a los testГ­culos
7. Tenga una terapia del masaje buena con el petrГіleo herbario para mejorar la circulaciГіn de la sangre
8. Suelte el peso excedente
9. Tenga una dieta sana que contiene granos enteros y verduras ricas en proteГ­nas y las vitaminas

10. Los niveles de la esperma estГЎn en la primaria en la creaciГіn de la tarde y la maГ±ana esto el mejor momento para la fabricaciГіn de amor.

ВЎMi Novio Me vertiГі Por el Mensaje de texto! Respondiendo El Camino Correcto hacia Esto

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“ВЎMi novio me vertiГі por el mensaje de texto!” Consigo cada vez mГЎs correos electrГіnicos que comienzan con esta frase recientemente que alguna vez antes. No deberГ­a ser sorprendente, pero es. ВїRealizo que la mayor parte de nosotros usan la conveniencia de mensaje de texto de corresponder a cada uno en nuestras vidas, incluso el hombre con el cual nos implicamos, pero no estГЎ allГ­ una lГ­nea de compasiГіn dibujada en algГєn sitio? El aprendizaje que el hombre ama no le quiere mГЎs vГ­a el texto lo hace aГєn mГЎs despiadado y angustioso. Cuando me preguntan las mujeres sobre mi blog o boletГ­n informativo, cГіmo creo que deberГ­an responder a esto, siempre ofrezco el mismo consejo.

Cualquier hombre que vierta a una mujer por el mensaje de texto es un cobarde. No me preocupo si es tres mil millas de distancia y dos ha estado equilibrando una relaciГіn de la distancia larga. TambiГ©n no me preocupo si le dice que la razГіn lo hizo asГ­, a diferencia de un enfoque mГЎs honorable, porque estaba tan afligido. La verdad del asunto es que cualquier hombre, que valga su peso en una relaciГіn, tomarГЎ los pocos momentos que necesita para terminar la relaciГіn en la persona. Si esto no es posible, debido a la distancia fГ­sica, que una llamada telefГіnica, en un tiempo conveniente, es la siguiente mejor cosa.

Responder a un mensaje de texto que literalmente cambia su vida desalienta. Si lee esto, supongo que el texto haya llegado ya y ha respondido. Probablemente no contuvo lo que sintiГі y quizГЎs hasta tratГі de convencer su excepto, a travГ©s del mensaje de texto, de que no le deberГ­a abandonar o que hacГ­a un error monumental.

Si ha viajado ya abajo que camino, no preocuparse. Lo que hace a partir de este dГ­a adelante es lo que importa el mГЎs. No debe permitir el enfoque cobarde de su novio a la ruptura hasta minan a quiГ©n es como una mujer y como un compaГ±ero. Es muy importante que reconozca que era su decisiГіn de tomar esa ruta para terminar la relaciГіn. De hecho, creo que lo deberГ­a ver como un signo que no era bastante fuerte emocionalmente para hacer lo que era realmente la cosa correcta. En mayorГ­a de los casos, esto es porque el hombre antes mencionado quiso evitar cualquier tipo de la confrontaciГіn con su excepto en cualquier forma. Por tanto toma la salida fГЎcil para evitar el riesgo de su grito a Г©l o llanto.

Si ha sido texting Г©l desde el dГ­a le vertiГі, pare lo que hace. Siguiendo envolviГ©ndole en un diГЎlogo que comenzГі con una ruptura, le da esencialmente todo el poder que todavГ­a estГЎ allГ­ en la relaciГіn de defecto. Las posibilidades consisten en que aunque no tenga intenciГіn de preguntarle repetidamente por quГ© le vertiГі, que es exactamente lo que termina por hacer. Correspondiendo un excepto el novio, la mayor parte de mujeres permiten que su juicio bueno tome unas vacaciones, y toman parte en el comportamiento que los hace parecer patГ©ticos y demasiado desesperados. No quiere que esto pase. Por eso tiene que parar texting Г©l cuando se siente disgustado, triste o enojado con Г©l.

AllГ­ probablemente vendrГЎ un dГ­a cuando vaya el texto usted otra vez y comenzar a coquetear o ser demasiado amable. Aconsejo que usted atenГєe sus respuestas a Г©l y no caigo a la trampa de barrer por viejas memorias o su deseo continuado de Г©l. Si le envГ­a mensajes de texto que lo hace parecer como si se interese en usted otra vez, pida que Г©l le encuentre en la persona. Si tiene una excusa por por quГ© no puede, decirle que estГЎ ocupado.

No puede permitir que Г©l le controle vГ­a el mensaje de texto. Si un hombre ha jugado con sus emociones usando este mГ©todo de la comunicaciГіn en el pasado, no permita que Г©l lo haga otra vez ahora. Es el que en el control de lo que pasa en su vida. Nunca olvide esto.

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Wednesday through Saturday evenings at 8:00 pm with a Thursday matinee at 2:00 pm.

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Hackmatack Playhouse was founded in 1972 by S. Carleton Viagra Buy In Australia. He envisioned a summer stock theatre that would showcase the talents of professional and developing thespians from the regional area.

Many theatre goers have called Hackmatack one of New England’s most charming and quaint summer theatres. Some have even said that summer in Maine is not summer without a trip to Hackmatack. Much of the allure of this playhouse is its scenic location and historical presence.

Hackmatack Playhouse is located on the Viagra Buy In Australia family farmstead. The property was purchased by the first Viagra Buy In Australia (then Gubtail) to make the long trip to “New England” from native British Isles in the mid 1600’s. Thomas Viagra Buy In Australia built the first home, a log house which sat in the far left of the present day field overlooking the irrigation pond. According to family legend, this home was burnt down by Indians during one of the many raids on the Salmon Falls river region. The present day farmhouse was constructed between the years of 1716-2005 to appease the needs of an ever-changing diverse and dynamic Viagra Buy In Australia family. When it was first constructed, the house was a large cape sitting endwise to the road. It was occupied at one point by two Viagra Buy In Australia brothers. The younger brother decided that he would like to have a modern two story cape. His older brother in typical conservative fashion said “the house is plenty good enough the way it is”. The younger brother replied, “My half is coming off”. He then proceeded to saw his half off and tear it down. He built his family a two story cape on the end of the original house, parallel to the road, giving the house its shape. Minor reconstructions have taken place since then to create a more modern and functional house for the present day Viagra Buy In Australias.

Prior to the year of 1972 when the theatre was established, the Viagra Buy In Australia family farm functioned like many other farms at the time. The barn was the focal point of the farm. The current barn has an interesting story much like the original house. One of the first barns was struck by lightning and burned in July of 1934. Haying had just been completed for the season, and it is thought that the heat from the newly cut hay attracted the lightning. Almost immediately, Lewis Viagra Buy In Australia began looking for the right barn to replace what had been lost. He finally purchased a barn. It was a large old structure with pegged timbers measuring fifty four feet long and forty two feet wide. It was the perfect replacement for the old barn. However, there was one small problem, it was located across the street.

Luckily, the Viagra Buy In Australia’s have always been known for their ingenuity. It was with this cleverness that Lewis decided it would be easier to move the barn rather than disassemble it and rebuilt it. The entire barn was jacked up and rollers were placed underneath it. A cable was attached to one end of the barn that ran though a large turnstile. An old white horse was chosen for the job of slowly moving the barn. The horse was hitched to the turnstile and the horse walked in circles, stepping over the cable on every lap. The leverage was great and each time the horse made a circle, the barn moved one half inch. Progress was slow. The entire operation took about three days, a day of that was spent crossing Maine route 9. However, in 1934, Maine route 9 was much less traveled, and everyone cheerfully watched or made their own route around the barn.

After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

The grounds of Hackmatack Playhouse and the area surrounding the theatre host many other buildings built and used by the Viagra Buy In Australia clan over the years. The yellow family of buildings just south of the theatre (now owned by the Mills family) was originally built by Samuel Viagra Buy In Australia in the early part of last century. Known as the Forget-Me-Not, these buildings housed services for early automobile travelers, including fuel for the autos, and food for the hungry. Visitors could rent a cabin, and if they happened to be staying on a Saturday night, they were in luck. On Saturday night there were always barn dances.

The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis Viagra Buy In Australia in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton Viagra Buy In Australia, prepare a load of lumber for the newest construction project.

The Viagra Buy In Australia family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Viagra Buy In Australia great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton Viagra Buy In Australia Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

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The main component of Viagra is Sildenafil Citrate.
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Tesla is finally making a car you can afford – here’s when it will be released

During Tesla’s earnings conference call on Wednesday, Elon Musk finally disclosed when Tesla plans to reveal what the highly anticipated Tesla Model 3 will look like. What’s more, Musk at long last gave us a launch window (read: year) that, we can only hope, won’t be subject to change in the months ahead.

According to Musk, Tesla will take wraps off the Model 3 sometime in March of 2016. Given how sleek the Model S and the upcoming Model X are, there’s going to be a lot of pressure to deliver a stunning design with the Model 3 which, it’s worth noting, will be about 20% smaller than the sizeable Model S.

As for a launch window, Musk said that Tesla will be releasing the car in 2017. He did qualify that statement, however, in saying that a launch window in late 2017 is more likely. Now keep in mind, Tesla has a pesky history of delivering its cars a bit late, so hopefully the Model 3 launch won’t be pushed back into early to mid 2018.

For those unfamiliar with the Model 3, the car represents the linchpin in Musk’s grand plan to bring affordable electric cars to the mainstream. Sure, the Tesla Model S is incredible, but cheap is not a word you’d ever use to describe it. Same thing goes for the upcoming Model X, the Tesla crossover vehicle slated for release later this year, albeit in limited quantities.

Lastly, Tesla will be aiming to price the Model 3 at around $35,000.

Strong quake rocks Papua New Guinea, tsunami threat lifted

SYDNEY (AP) – A powerful earthquake rattled Papua New Guinea on Thursday, the fourth strong quake to hit the South Pacific island nation in a week. The temblor prompted officials to issue a local tsunami warning, but it was lifted shortly afterward with no reports of damage.

The 7.1-magnitude quake struck about 150 kilometers (94 miles) southwest of the town of Panguna on Bougainville Island at a depth of 23 kilometers (14 miles), the U.S. Geological Survey reported.

The Pacific Tsunami Warning Center said tsunami waves of up to 1 meter (3 feet) were possible within 300 kilometers (186 miles) of the epicenter on the coast of Papua New Guinea. The agency lifted the warning about an hour later.

There were no reports of damage, said Chris McKee, assistant director of the Geophysical Observatory in the capital, Port Moresby. Because the epicenter was so far offshore, the chance of serious damage on land was less likely, he said.

"The earthquake appears to have not been as big as first estimated," McKee said. "I think the threat from that event is basically passed now. So we’ll just wait for the next one."

Thursday’s quake was located in a different area of Papua New Guinea than the previous three temblors that rattled the region over the past week, and was therefore an unrelated event, McKee said. Still, the area has been unusually active.

"We think it’s probably something along the lines of just regional readjustment – movements in one area allow stress to be redistributed and that allows other areas to rupture," McKee said.

Betha Lorenz, owner of Rising Sun Lodge in the town of Arawa on Bougainville Island, said the quake delivered a powerful jolt, but did not appear to have caused any damage.

"One of my neighbors. she ran down the stairs and I was laughing and she said, ‘Am I gonna live?’ and I said ‘Yeah, nothing will happen – just relax,’" Lorenz said.

When the shaking started, Lorenz ran outside, but the rumbling ended a few seconds later. Her lodge weathered the quake with no damage, and she hadn’t heard of any tsunami waves hitting the coast.

"Everyone is OK," she said with a laugh. "We are happy."

Papua New Guinea sits on the Ring of Fire, the arc of seismic faults around the Pacific Ocean where earthquakes are common.

Cancerous fish caught in Susquehanna River

This shocking catch is a testament to the realities of water pollution. A smallmouth bass was pulled from Pennsylvania’s Susquehanna River with a massive tumor jutting out of its body.

Following the catch, the Pennsylvania Fish and Boat commission ordered lab testing to further investigate the state of the Susquehanna River. The lab found that the smallmouth bass’ tumor was indeed cancerous, a clear indicator that water pollution was adversely effecting the river’s inhabitants.

Not only is the water pollution a major environmental threat, it puts Pennsylvania’s thriving fishing industry at risk as well.

"As we continue to study the river, we find young-of-year and now adult bass with sores, lesions and more recently a cancerous tumor, all of which continue to negatively impact population levels and recreational fishing," said John Arway, the executive director of the commission.

California approves first statewide seawater desalination rules

(Reuters) – California regulators on Wednesday adopted the first statewide rules for the permitting of seawater desalination projects that are expected to proliferate as drought-stricken communities increasingly turn to the ocean to supplement their drinking supplies.

The action, which sets uniform standards for minimizing harm to marine life, was welcomed by developers of the state’s two largest desalination projects as bringing much-needed certainty and clarity to the regulatory approval process.

"It reaffirms that the Pacific Ocean is part of the drinking water resources for the state of California," Poseidon Water executive Scott Maloni told Reuters after the rule was enacted on a voice vote in Sacramento by the State Water Resources Control Board.

The measure leaves the permitting process in the hands of the state’s regional water boards while establishing a single framework for them to follow in evaluating applications to build seawater treatment plants, expand existing ones and renew old permits.

But regional decisions could now be appealed to the state board for review if opponents of a project felt a permit was wrongly approved.

Before Wednesday’s action, developers and regulators of desalination plants had no specific guidance for meeting federal and state clean water standards, complicating review of the projects, state water board spokesman George Kostyrko said.

Desalination has emerged as a promising technology in the face of a record dry spell now gripping California for a fourth straight year, depleting its reservoirs and aquifers and raising the costs of importing water from elsewhere.

Critics have cited ecological drawbacks, such as harm to marine life from intake pipes that suck water into the treatment systems and the concentrated brine discharge from the plants.

The newly approved plan sets specific brine salinity limits and rules for diffusing the discharge as it is pumped back into to the ocean.

It also requires seawater to be drawn into the plants through pipes that are sunk into beach wells or buried beneath the sea floor, where possible. Such subsurface intakes are viewed as more environmentally friendly.

The Western Hemisphere’s biggest desalination plant, a $1 billion project under construction since 2012 in the coastal city of Carlsbad, California, is due to open in November.

It will deliver up to 50 million gallons (190 million liters) of water a day to San Diego County, enough to supply roughly 112,000 households, or about 10 percent of San Diego County’s drinking water needs, according to Poseidon.

Approval is being sought for a final permit to begin construction of a second plant of similar size in Huntington Beach, south of Los Angeles, next year.

About a dozen much smaller desalting plants have already been built along the coast, state water officials said.

On Tuesday, the state water board enacted California’s first rules for mandatory statewide cutbacks in municipal water use. The emergency regulations, which require some communities to trim water consumption by as much as 36 percent, were approved unanimously just weeks after Democratic Governor Jerry Brown stood in a dry mountain meadow and ordered statewide rationing.

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My GRE scores were all slightly above average but nothing super impressive (also nothing to be too disappointed in either).

Carlson is a big draw to come to this program. Many of us PAs don't like it either. It's definitely been in the press for a little whileIf I were reviewing your application, it would make me wonder what sort of roles you played in projects and if they were "authorship level" roles. Right now I just want to lay down and cry, so I'll just go and do that! As someone interested in medicine, assembling all the pieces of the puzzle can be overwhelming. " The environment for hypothesis driven basic research, and for translational and collaborative research at Northwestern University and the Northwestern Memorial Hospital is outstanding. I'm not saying the chances are good, but just hoping they are considering.

We don't have such thing as combined Rads and Nucs programs. I agree that online viagra the Kaplan tests are far more difficult than the AAMC tests. Thank you for the information. It''s like their own version of the 'blue book. Also, realize that there will be some experiences that the underserved experience that you will not be able to relate to, and that is okay. 0, varsity athlete and cured a form of cancer viagra lol. Going to a school with accreditation issues is not a good idea. Wyoming has a small population but you could put it in Cheyenne which isn't far from major metro areas in CO.

I'm online viagra in no way affiliated with the company, but I strongly recommend getting a subscription, you will not regret it.

Eh, it looks far more complicated than it actually is. The fact that women enter primary care in larger numbers is the absolute nitty-gritty of this debate, but the article only barely brushes on it. I was like man 5 bucks and all software (just like healthcare haha) should be free but its cheaper than a Chipotle burrito and is pretty good for what you get.

If he were teaching me during my intern, PGY-1, PGY-2, or PGY-3 year (assuming I end up in a 3 year EM program) you can bet I'd listen and soak up every ounce of wisdom he had to offer as well as any evaluation of my performance.

"No matter what, be truthful to yourself when studying" by G-dawgOf course this is all assuming medicare decides not to f#ck us on a whim, which really is what makes medicine so stressful.

As a resident- what to read besides tintinelli and rosenLuckily she said they can accept my Fine buy viagra art Appreciation class for the. Maybe someone can direct me. I'm going to say we won't hear anything until later next month (although I'd love for you to be right ). I tend to get along with most people.

Many of you suggested I find a way viagra to do this. It may be just the motivation they need to send out a second round of II's. 5 wks and found the test quite simple and straightforward but poorly written! I had serious health and family issues, and I should have deferred a year, but I was desperate to leave for school. The best preparation you can do is to do well in your classes at school; work hard and you will get a higher GPA AND be prepared for the OAT. Why pay "tax" for buying online DIT course. When do they online viagra begin sending out acceptances, and do they stagger the acceptances on a monthly cycle. For those of you that received interview invitation, did you submit the secondary application. Medical College of Wisconsin (can argue between 4 and 5)

500hrs lab animal (cotton rats, quail, rabbits, deer)Anyhow, I'm doin my last year of med school here in chicago, was born in Algiers (Hussein Dey to be precise), and came to the U. My question is, does anybody here know of the number or email of my local cheap viagra recruit (or any recruiter that could. In what direction must the boat be pointed to reach a point on the opposite shore that is directly across from the point of its departure in a time of 20 seconds. but I have not been a member for extremely long and the site has already grown on me. I just withdrew, so here's hoping that my interview slot goes to someone here.

I actually know a few residents and they seem very unhappy, like they were the children of wealthy parents and really didn't know what they were getting themselves into, everyone in their family is successful and goes to graduate school.

They all present their own unique challenges, and they're all surmountable. Residents don't have a hard time going where they want for fellowship or buy viagra getting a job, and Dr.

They are going to receive apps starting early July.

Then when i went back through my notes while studying for boards, it seemed like kid cheap viagra stuff. Downloading it to my iPad as I type, anyone else try it. Even though people always talk about all the money in Australia from mining, there is also a ton of money from their building sector. Some ppl take a post bac program, some are geared towards med schoolAnyone out there have any advice for those of us wait-listed. D. I took a few notes for reference (1/paragraph). I love buy viagra online you, but if you are depressed and refuse to seek help and make a good faith effort, I can't be with you anymore because it is driving me into the ground"if anything, that just shows you how silly those rankings are. Coding isn't that hard – being innovative is though. Working on one radiology project at a university, hoping to send it for publication soon(-third author)The 25% rule is ridiculous, there is a shortage of intensivists of which we are seeing dramatic increases in interested em applicants yet many programs have limited spots for em because of this rule. I just meant to confirm he is a legitimate source.

One group here has joined w cheap viagra a uro-rad type practice and all of a sudden their referrals have decreased substantially. CABG, Valve, Aortas etc are going to be the most senior resident/fellow.

It's probably what people with GAD with panic attacks feel.

It seems even more competitive to get into the Loan Repayment prgm. The only way to guarantee no injuries in dance is to not dance. I am now in the final year of my MSW program and I am happy with the route I chose. Then when I got the bedside the whole medicine team was there buy viagra and were planning on a stat CT. However, I suspect that you're shooting for a score in the 30's viagra and not a 45, so that's ok. Receiving II while at an interview in another schoolt=566404), and I was hoping that you could comment on them? It will take the packets a couple of days to make it out to state.

How important are pre reqs for the material you are learning in PA programs. You absolutely rocked the PAT and those scores are awesome. Just thought I'd let everyone know that there will be at least one seat open.

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Lastly, which is obvious, do great on your interview day. Links to threads about books for MS3 & rotations in generalWhat's the life of a typical cardiothoracic surgeon. I thought about enrolling in a MCAT prep course and doing really great on the MCAT to improve my chances, but online viagra with my science courses being almost 10 years old would I be wasting my time. viagra

'Rich' is having so much money that you or your kids never have to work againIf you don't find your answer in the following links, please feel free to add your post to that thread.

Will only interview if you rotate there, but even then it is not guaranteed. Offered in full-color video and digitally mastered audio, the activity is available in a variety of media formats to meet your needs ' DVD, MP4, MP3, and audio CD. At the national level, cheap viagra the paramedic is not considered a technician and is simply called a paramedic or nationally registered paramedic while the EMT and Advanced-EMT are considered technicians. PTdude, yes, you absolutely can get a 3. This was a reach school for me too. Sante'' Consulting has recently been engaged to conduct a regional search within the Northeast, for the position of Chief of Pathology. Let us post pharmcas (and supplemental) submission date and interview invitation school and date.

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  1. Good pickup there, I did not even notice that he said onset latency. And if you spend less than 30 minutes providing critical care you can't bill a 99291 (although magically some people always spend 30 minutes total even on people they just look at from the door while the resident manages everything since they are stable on the vent or something-can't include the time the resident works or they time you spend teaching the resident in your time for billing)Oh and by the way, i created a study group on facebook for those of you who would be interested to join .
  2. The studies that have accounted for effort have uniformly found no cognitive differences. This week I got my first rejection, which mildly bummed me out but it was also nice because it's the first news I have had from any of my schools, so at least I'm not in limbo there anymore.
  3. The thing is that most NRI's, me included, rarely pass the first year exam on their first attempt?
  4. Can't really say much because I have seen it go differently based on the year/time you apply.
  5. Any such threads will be closed or deleted.
  6. Yea, i go back to the passage quite a lot.
  7. It has a direct program now in the States not as a fellowship. Some passages are long and some are short.
  8. I am working with a prosthodontist in the Navy currently and finishing up next year. Which will be better ' an AEGD or GPR.
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  • I was under the impression that Sackler mostly uses the match system and "match day" is just as big a deal at Sackler as at other schools!
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After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

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The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis Australia Viagra For Sale in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton Australia Viagra For Sale, prepare a load of lumber for the newest construction project.

The Australia Viagra For Sale family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Australia Viagra For Sale great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton Australia Viagra For Sale Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

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"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

- Fourth Amendment to the United States Constitution

The Electronic Communications Privacy Act (ECPA) was a forward-looking statute when enacted in 1986. It specified standards for law enforcement access to electronic communications and associated data, affording important privacy protections to subscribers of emerging wireless and Internet technologies. Technology has advanced dramatically since 1986, and ECPA has been outpaced. The statute has not undergone a significant revision since it was enacted in 1986 – eons ago in Internet time.

As a result, ECPA is a patchwork of confusing standards that have been interpreted inconsistently by the courts, creating uncertainty for both service providers and law enforcement agencies. ECPA can no longer be applied in a clear and consistent way, and, consequently, the vast amount of personal information generated by today’s digital communication services may no longer be adequately protected. At the same time, ECPA must be flexible enough to allow law enforcement agencies and services providers to work effectively together to combat increasingly sophisticated cyber-criminals or sexual predators.

The time for an update to ECPA is now. Privacy advocates, trade associations, think tanks, legal scholars, start-ups, and major Internet and communications companies have developed consensus around the notion of a core set of principles intended to simplify, clarify, and unify the ECPA standards; provide clearer privacy protections for subscribers taking into account changes in technology and usage patterns; and preserve the legal tools necessary for government agencies to enforce the laws and protect the public.

Changes in Technology Have Outpaced the Law

Justice Brandeis famously called privacy “the most comprehensive of rights, and the right most valued by a free people.” Of course, privacy must be balanced against other societal interests. Electronic communications and associated data can provide key evidence in the investigation of many crimes, and the assistance of service providers is often necessary to access such evidence. With respect to communications privacy and law enforcement investigations, the courts and Congress have sought to develop rules for government surveillance that balance three interests: the individual’s constitutional right to privacy, the government’s need for tools to conduct investigations, and the interest of service providers in clarity and customer trust.

Since enactment of ECPA, there have been fundamental changes in communications technology and the way people use it, including –

  • Email: Most Americans have embraced email in their professional and personal lives and use it daily for confidential communications of a personal or business nature. Because of the importance of email and unlimited storage capabilities available today, most people save their email indefinitely, just as they previously saved letters and other correspondence. The difference, of course, is that it is easier to save, search and retrieve digital communications. Many of us now have many years worth of stored email. Moreover, for many people, much of that email is stored on the computers of service providers.
  • Mobile location: Cell phones and mobile Internet devices constantly generate location data that supports both the underlying service and a growing range of location-based services of great convenience and value. This location data can be intercepted in realtime, and is often stored in easily accessible logs files. Location data can reveal a person’s movements, from which inferences can be drawn about activities and associations. Location data is augmented by very precise GPS data in many devices.
  • Cloud computing: Increasingly, businesses and individuals are storing data “in the cloud,” with potentially huge benefits in terms of cost, security, flexibility and the ability to share and collaborate.
  • Social networking: One of the most striking developments of the past few years has been the remarkable growth of social networking. Hundreds of millions of people now use social media services to share information with friends and as an alternative platform for private communications.

In the face of these developments, ECPA does not provide protection suited to the way technology is used today:

  • Conflicting standards and illogical distinctions: ECPA sets rules for governmental access to email and stored documents that are not consistent. A single email is subject to multiple different legal standards in its lifecycle, from the moment it is being typed to the moment it is opened by the recipient to the time it is stored with the email service provider. To take another example, a document stored on a desktop computer is protected by the warrant requirement of the Fourth Amendment, but ECPA says that the same document stored with a service provider may not be subject to the warrant requirement.
  • Unclear standards: ECPA does not clearly state the standard for governmental access to location information.
  • Judicial criticism: The courts have repeatedly criticized ECPA for being confusing and difficult to apply. The Ninth Circuit in 2002 said that Internet surveillance was “a confusing and uncertain area of the law.” In the past 5 years, no fewer than 30 federal opinions have been published on government access to cell phone location information, reaching a variety of conclusions.
  • Constitutional uncertainty: The courts have been slow to address the application of the Fourth Amendment to new services and information. So far, among the regular federal appellate courts, only the Sixth Circuit has held that the Constitution protects stored email (Warshak), while the Ninth Circuit has held that there is a Constitutional privacy right in stored text messages (Quon). The Supreme Court has ruled that prolonged tracking with a GPS device is a search under the Fourth Amendment, but it has not yet ruled on use of cell tower data for tracking over time.

This murky legal landscape does not serve the government, customers or service providers well. Customers are, at best, confused about the security of their data in response to an access request from law enforcement. Companies are uncertain of their responsibilities and unable to assure their customers that subscriber data will be uniformly protected. The current state of the law does not well serve law enforcement interests either, as resources are wasted on litigation over applicable standards, and prosecutions are in jeopardy should the courts ultimately rule on the Constitutional questions.

The solution is a clear set of rules for law enforcement access that will safeguard end-user privacy, provide clarity for service providers, and enable law enforcement officials to conduct effective and efficient investigations.

Guiding Principles for ECPA Reform

The overarching goal of our ECPA reform principles is to balance the law enforcement interests of the government, the privacy interests of users, and the interests of communications service providers in certainty, efficiency and public confidence.

We are guided by the following concepts:

  • Technology and Platform Neutrality: A particular kind of information (for example, the content of private communications) should receive the same level of protection regardless of the technology, platform or business model used to create, communicate or store it.
  • Assurance of Law Enforcement Access: The reform principles would preserve all of the building blocks of criminal investigations – subpoenas, court orders, pen register orders, trap and trace orders, and warrants – as well as the sliding scale that allows the government to escalate its investigative efforts.
  • Equality Between Transit and Storage: Generally, a particular category of information should be afforded the same level of protection whether it is in transit or in storage.
  • Consistency: The content of communications should be protected by a court order based on probable cause, regardless of how old the communication is and whether it has been “opened” or not.
  • Simplicity and Clarity: All stakeholders – service providers, users and government investigators – deserve clear and simple rules.
  • Recognition of All Existing Exceptions: Over the years, a variety of exceptions have been written into the ECPA, such as provisions allowing disclosures to the government without court orders in emergency cases. These principles should leave all those exceptions in place.

Rather than attempt a full rewrite of ECPA, which might have unintended consequences, our recommendations focus on just a handful of the most important issues – those that are arising daily under the current law: access to email and other private communications stored in the cloud, access to location information, and the use of subpoenas to obtain transactional data.

Our principles do not seek to answer all questions or concerns about ECPA. Though members of the coalition may differ on the specifics, and some individual members would support additional changes, we all agree that these principles provide a framework for opening a public dialogue on the issue.

Specific Background on ECPA Reform Principles

1. The government should obtain a search warrant based on probable cause before it can compel a service provider to disclose a user’s private communications or documents stored online.

  • This principle applies the safeguards that the law has traditionally provided for the privacy of our phone calls or the physical files we store in our homes to private communications, documents and other private user content stored in or transmitted through the Internet "cloud"– private emails, instant messages, text messages, word processing documents and spreadsheets, photos, Internet search queries and private posts made over social networks.
  • This change was first proposed in bi-partisan legislation introduced in 1998 by Senators John Ashcroft and Patrick Leahy. It is consistent with appeals court decisions holding that emails and SMS text messages stored by communications providers are protected by the Fourth Amendment, and is also consistent with the leading legal scholarship on the issue.

2. The government should obtain a search warrant based on probable cause before it can track, prospectively or retrospectively, the location of a cell phone or other mobile communications device.

  • This principle addresses the treatment of the growing quantity and quality of data based on the location of cell phones, laptops and other mobile devices, which is currently the subject of conflicting court decisions; it proposes the conclusion reached by a majority of the courts that a search warrant is required for real-time cell phone tracking, and would apply the same standard to access to stored location data.
  • A warrant for mobile location information was first proposed in 1998 as part of the bipartisan Ashcroft-Leahy bill. It was approved 20 to 1 by the House Judiciary Committee in 2000.

3. Before obtaining transactional data in real time about when and with whom an individual communicates using email, instant messaging, text messaging, the telephone or any other communications technology, the government should demonstrate to a court that such data is relevant to an authorized criminal investigation.

  • In 2001, the law governing “pen registers and trap & trace devices”—technologies used to obtain transactional data in real time about when and with whom individuals communicate over the phone—was expanded to also allow monitoring of communications made over the Internet. In particular, the data at issue includes information on who individuals email with, who individuals IM with, who individuals send text messages to, and the Internet Protocol addresses of the Internet sites individuals visit.
  • This principle would update the law to reflect modern technology by establishing judicial review of surveillance requests for this data based on a factual showing of reasonable grounds to believe that the information sought is relevant to a crime being investigated.

4. Before obtaining transactional data about multiple unidentified users of communications or other online services when trying to track down a suspect, the government should first demonstrate to a court that the data is needed for its criminal investigation.

  • This principle addresses the circumstance when the government uses subpoenas to get information in bulk about broad categories of telephone or Internet users, rather than seeking the records of specific individuals that are relevant to an investigation. For example, there have been reported cases of bulk requests for information about everyone that visited a particular web site on a particular day, or everyone that used the Internet to sell products in a particular jurisdiction.
  • Because such bulk requests for information on classes of unidentified individuals implicate unique privacy interests, this principle applies a standard requiring a showing to the court that the bulk data is relevant to an investigation.

To simplify, clarify, and unify the ECPA standards, providing stronger privacy protections for communications and associated data in response to changes in technology and new services and usage patterns, while preserving the legal tools necessary for government agencies to enforce the laws, respond to emergency circumstances and protect the public.

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The beautiful rural setting boasts rich farmland that has been the mainstay of the economy of the county seat of Worcester County for centuries. The rich heritage of this area is celebrated daily at Furnace Town Living Heritage Museum and during a summer festival every August with The Blessing of the Combines.

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Wireless Innovation Alliance // Jun. 16

Earlier today, Reps. Darrell Issa (R-CA) and Anna Eshoo (D-CA) sent the attached letter to FCC Chairman Tom Wheeler on the importance of establishing the technical rules necessary to allow unlicensed use of the 600 MHz band. The Wireless Innovation Alliance (WIA) released the statement below in response. More

Wireless Innovation Alliance // Apr. 17

The Wireless Innovation Alliance (WIA) released the statement below on today’s FCC Open Meeting where the Commission approved an order to implement a spectrum sharing framework in the 3550-3700 MHz band. More

Wireless Internet Service Providers Association // 10:05 AM EST// Mar. 23

The National Association of Broadcasters (NAB) wants the FCC to declare an “emergency” and shut down the databases that let small businesses and others deliver broadband over vacant spectrum near television channels. More

Wireless Innovation Alliance // 6:06 PM EST// Feb. 10

The Wireless Innovation Alliance (WIA) released the statement below in response to the introduction of the House and Senate Wi-Fi Innovation Act More

Wireless Innovation Alliance // 4:44 PM EST// Jan. 28

The Wireless Innovation Alliance applauds the FCC for telling Marriott International, Inc. – and everyone else – that it is illegal to interfere with lawful communications. More

Wireless Innovation Alliance // 3:00 PM EST// Dec. 15

This October, the FCC found Marriott’s Gaylord Opryland Hotel and Convention Center to be guilty of blocking guests’ personal Wi-Fi hotspots and fined Marriott International $600,000. Lend your social voice to our Thunderclap. More

Wireless Innovation Alliance // 5:47 PM EST// Sep. 4

FCC Chairman Tom Wheeler acknowledged the critical role unlicensed spectrum plays in growing competition in the broadband marketplace stating that the FCC’s “efforts to expand the amount of unlicensed spectrum creates alternative competitive pathways.” More

The Hill // 9:25 AM EST// Jun. 16

CEA released a report, Unlicensed Spectrum and the American Economy, examining the economic impact of unlicensed spectrum on the American economy. More

The Wireless Innovation Alliance (WIA) is a broad-based group of innovators, providers, consumer groups, think tanks and education organizations that believe that more efficient use and expanded access to the nation’s spectrum resources are fundamental to the future of U.S. economic policy and global competitiveness, and that we face potential spectrum scarcities in both licensed and unlicensed bands that must be addressed in order for innovation and investment to move forward.

Spectrum, and specifically, the most efficient and expansive use of this most valuable natural resource, is fundamental to the future of U.S. economic growth, and global competitiveness. United States spectrum policy must also be efficient and flexible as well, so that we can encourage and accommodate new and innovative ways to meet the growing demand for wireless services and applications, and the growing inability – in both licensed and unlicensed bands – to meet that demand.

Manufacturer link: Moots
We have a few of these 2015 models left at substantial savings. The difference vs. 2016? Only the head-tube diameter. 2015 models have regular inch and an eighth head-tubes, whereas the nearly identical 2016 models now come with slightly larger 44mm head-tubes. Very limited quantities available, so act fast! 2015 Vamoots-CR (Compact Road) frame MSRP: $3,325, now $2,895! 2015 Vamoots-RSL (Road Super Light) frame MSRP: $4,450, now $3,995!

Manufacturer link: Lynskey Performance
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The Lynskey R240 Disc is one of our most popular frames for club rides or racing. The added stopping power of disc brakes combined with curved seat stays, chain stays and English threaded BB remain the structural foundation of the R240.

Manufacturer link: Bianchi
Now in gloss Celeste finish for 2017! Now $500 off any of our normal build kit prices with an Infinito CV frameset purchased at the $3,199 MSRP! Use the ‘choose bike or frame’ pull-down menu below to see the discounted kit prices. Using NASA viscoelastic Countervail technology, Bianchi has developed a carbon layup that can immediately reduce vibration in the frameset. With this revolutionary material the Infinito is propelled in to a new realm of endurance, comfort, and performance.

Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

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Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

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To Viagra Shopping In India the celebration of 30 years of Lynskey-built frames, Lynskey created a 30th Anniversary Edition of the R150. All the style and comfort of the R150 with Limited Edition etching and full Shimano 105 kit at a value worth celebrating. Responsive, quick, nimble, but buttery smooth for your epic solo adventures out on the road. Designed with a sport geometry to provide efficient power transfer and comfortable position for longer rides. These Limited Edition bikes come standard with hand-brushed finish, black bar tape, etched graphics, and full Viagra Shopping In India 105 kit.

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Manufacturer link: Litespeed
With aluminum wheels, Reg. $3800, now $1899. With Viagra Shopping In Indiaaero whheelset, Reg. $5125, now $2499! The critically acclaimed Litespeed C1 is fullr arrayed with features including an adjustable aero seatpost, optional internal Di2 gear cable routing, and race-ready Ultegra 6700 components. Loaded with Aerologic features and fully Shimano Di2 compatible, the super modulus carbon C1 converts our wind-tunnel qualified data-set into an easy real-world Viagra Shopping In India.

Manufacturer link: Litespeed
The Viagra Shopping In India 2016 Litespeed T3 uses an ovalized 3/2.5 titanium top tube in place of the 6/4 titanium tube from the T1-SL, and a simplier bottom bracket design but is otherwise nearly identical to the T1-SL frame with almost 90% of the $4000 T1-SL frame’s performance but for $1100 less! New for 2016: the T3 now includes hex-bolt-attached removable head-tube cable guides (just remove them for conversion to Di2), and ovalized chain and seat stays for leaf-spring like shock absorption, as well as both disc brake and rim brake compatible design! Of course like all Litespeed titanium frames, the T3 is fully hand-crafted in the USA and comes with a lifetime warranty. Viagra Shopping In India: Get $350 OFF any of our Adrenaline Bikes build kits with the purchase of the frame and for the $2,999 MSRP price, AND get a FREE $420 MSRP full carbon tapered fork with either a frame-alone or bike purchase!

Manufacturer link: Ritchey
The Viagra Shopping In India price includes a Ritchey Logic Pro carbon fork painted to match and a Ritchey WCS headset, and FREE SHIPPING (for either the frameset or a complete bike to any of the 48 contiguous US states.) Features include: Ritchey Logic triple butted cromoly tubeset with integrated headset design (80 grams lighter than a standard chromoly head tube design), and the downtube is ovalized below the front derailleur clamp for enhanced side-to-side rigidity at the bottom bracket. With Viagra Shopping In India for tires up to 28c and classic Ritchey geometry, the Road Logic is ideally suited for long, epic days in the saddle on roads that are not always paved, and still nimble and stiff enough to take the county line sprint at the end of the day. Call or email and ask for a Viagra Shopping In India quote on a complete Road Logic built with Ritchey bars, stem, post, wheels, and seat. Ritchey offers us a hefty discount on those items when we order them with a frameset, and we can pass on the savings to you!

Read Road Bike Action magazine’s review of this bike:

See a video of Tom Ritchey interviewed about the Road Logic:

FREE: 48-contiguous US state shipping on Ritchey frames and bikes! (Regular $110.)

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Viagra Kas Tai specifications and reports are converted into standards by each of the Project’s Organizational Partners. Use the drop-down menu below to view a table cross-referencing the Viagra Kas Tai specification or report to its Organizational Partner counterpart. You can either choose to view the cross-reference table or you may limit your search to show only documents from one particular Organizational Partner SDO.

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Kas Tai Viagra in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Kas Tai Viagra is the perfect place to spend a relaxing weekend or a lifetime.

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The beautiful rural setting boasts rich farmland that has been the mainstay of the economy of the county seat of Worcester County for centuries. The rich heritage of this area is celebrated daily at Furnace Town Living Heritage Museum and during a summer festival every August with The Blessing of the Combines.

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Manufacturer link: Moots
We have a few of these 2015 models left at substantial savings. The difference vs. 2016? Only the head-tube diameter. 2015 models have regular inch and an eighth head-tubes, whereas the nearly identical 2016 models now come with slightly larger 44mm head-tubes. Very limited quantities available, so act fast! 2015 Vamoots-CR (Compact Road) frame MSRP: $3,325, now $2,895! 2015 Vamoots-RSL (Road Super Light) frame MSRP: $4,450, now $3,995!

Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

WAS $5990, NOW $2995!

The 30th Anniversary R240 Disc LE comes equipped with full Ultegra groupset, Vision Team 30 Disc wheels, and Lynskey Pro Road Carbon #3 Disc fork. Each frame has a hand brushed finish, and 30th Anniversary etching.

The Lynskey R240 Disc is one of our most popular frames for club rides or racing. The added stopping power of disc brakes combined with curved seat stays, chain stays and English threaded BB remain the structural foundation of the R240.

Manufacturer link: Bianchi
Now in gloss Celeste finish for 2017! Now $500 off any of our normal build kit prices with an Infinito CV frameset purchased at the $3,199 MSRP! Use the ‘choose bike or frame’ pull-down menu below to see the discounted kit prices. Using NASA viscoelastic Countervail technology, Bianchi has developed a carbon layup that can immediately reduce vibration in the frameset. With this revolutionary material the Infinito is propelled in to a new realm of endurance, comfort, and performance.

Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

WAS $5020, NOW $2995!

The 30th Anniversary R240 LE comes equipped with full Ultegra groupset, Vision Team 30 wheels, and Kas Tai Viagra. Each frame has a hand brushed finish, and 30th Anniversary etching.

The Lynskey R240 is one of the most sought after Lynskey bikes. It is designed with kas tai viagra geometry making it perfect for club rides or racing. The curved seat stays, chain stays and English threaded BB remain the structural foundation of the R240.

Manufacturer link: Lynskey Performance
WE MATCH ALL LYNSKEYPERFORMANCE.COM SALES AND SPECIALS! JUST CALL/EMAIL/VISIT US FOR A PRICE MATCH!

Was $3,745 but now only $1,995!

To Kas Tai Viagra the celebration of 30 years of Lynskey-built frames, Lynskey created a 30th Anniversary Edition of the R150. All the style and comfort of the R150 with Limited Edition etching and full Shimano 105 kit at a value worth celebrating. Responsive, quick, nimble, but buttery smooth for your epic solo adventures out on the road. Designed with a sport geometry to provide efficient power transfer and comfortable position for longer rides. These Limited Edition bikes come standard with hand-brushed finish, black bar tape, etched graphics, and full Kas Tai Viagra 105 kit.

Lynskey’s 2016 Sportive Disc model is designed for long distance comfort while sacrificing nothing when it comes to handling, power transfer, performance riding and all day endurance comfort. The Sportive’s oversized and ovalized down tube create rock solid response in acceleration and a new tapered head tube gives a stable front end for confident handling. Curved seatstays and 28c tire clearance take the edge off rough roads making it less fatiguing over the long days. New 2015 Kas Tai Viagra for this model include the Lynskey segment benchmark interchangeable dropout system. This allows the rider to choose QR or thru axle based on wheel hub choices.

Manufacturer link: Litespeed
With aluminum wheels, Reg. $3800, now $1899. With Kas Tai Viagraaero whheelset, Reg. $5125, now $2499! The critically acclaimed Litespeed C1 is fullr arrayed with features including an adjustable aero seatpost, optional internal Di2 gear cable routing, and race-ready Ultegra 6700 components. Loaded with Aerologic features and fully Shimano Di2 compatible, the super modulus carbon C1 converts our wind-tunnel qualified data-set into an easy real-world Kas Tai Viagra.

Manufacturer link: Litespeed
The Kas Tai Viagra 2016 Litespeed T3 uses an ovalized 3/2.5 titanium top tube in place of the 6/4 titanium tube from the T1-SL, and a simplier bottom bracket design but is otherwise nearly identical to the T1-SL frame with almost 90% of the $4000 T1-SL frame’s performance but for $1100 less! New for 2016: the T3 now includes hex-bolt-attached removable head-tube cable guides (just remove them for conversion to Di2), and ovalized chain and seat stays for leaf-spring like shock absorption, as well as both disc brake and rim brake compatible design! Of course like all Litespeed titanium frames, the T3 is fully hand-crafted in the USA and comes with a lifetime warranty. Kas Tai Viagra: Get $350 OFF any of our Adrenaline Bikes build kits with the purchase of the frame and for the $2,999 MSRP price, AND get a FREE $420 MSRP full carbon tapered fork with either a frame-alone or bike purchase!

Manufacturer link: Ritchey
The Kas Tai Viagra price includes a Ritchey Logic Pro carbon fork painted to match and a Ritchey WCS headset, and FREE SHIPPING (for either the frameset or a complete bike to any of the 48 contiguous US states.) Features include: Ritchey Logic triple butted cromoly tubeset with integrated headset design (80 grams lighter than a standard chromoly head tube design), and the downtube is ovalized below the front derailleur clamp for enhanced side-to-side rigidity at the bottom bracket. With Kas Tai Viagra for tires up to 28c and classic Ritchey geometry, the Road Logic is ideally suited for long, epic days in the saddle on roads that are not always paved, and still nimble and stiff enough to take the county line sprint at the end of the day. Call or email and ask for a Kas Tai Viagra quote on a complete Road Logic built with Ritchey bars, stem, post, wheels, and seat. Ritchey offers us a hefty discount on those items when we order them with a frameset, and we can pass on the savings to you!

Read Road Bike Action magazine’s review of this bike:

See a video of Tom Ritchey interviewed about the Road Logic:

FREE: 48-contiguous US state shipping on Ritchey frames and bikes! (Regular $110.)

Kas Tai Viagra

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