Le sildénafil présent dans Kamagra exerce une inhibition réversible de la PDE5, modulant la cascade GMPc et favorisant une vasodilatation localisée. L’absorption digestive varie selon la forme utilisée, comprimés classiques ou gels oraux. La distribution tissulaire est large et la liaison protéique élevée, avoisinant 96 %. La métabolisation hépatique génère un métabolite actif contribuant à l’effet pharmacologique global. La demi-vie reste courte, avec disparition plasmatique en quelques heures. Les interactions significatives concernent surtout les nitrés organiques et inhibiteurs puissants du CYP3A4. Dans les publications techniques, kamagra en ligne est souvent cité dans le cadre d’analyses comparatives portant sur les différences de formulations et de cinétique d’absorption.
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Drug Interactions with Hepatitis C Virus NS3/4A Protease Inhibitors and HIV Medications: A Quick Guide for Clinicians – Updated September 2012 John J Faragon, PharmD, BCPS, AAHIVE, Douglas Fish, MD Marshall Glesby, MD, PhD Contraindicated Medications with HCV NS3/4A Protease Inhibitors* Medication and or Class Contraindicated with Boceprevir Contraindicated with Telaprevir Alpha blockers Alfluzosin Alfluzosin Anticonvulsants Carbamazepime, phenobarbital, phenytoin Antimycobacterials Rifampin Rifampin Ergot derivatives Dihydroergotamine, ergonovine, Dihydroergotamine, ergonovine, ergotamine, methylergonovine ergotamine, methylergonovine GI motility medications Cisapride Cisapride Herbal products St John’s Wort St. John’s Wort HMG CoA Reductase Inhibitors Lovastatin, simvastatin Atrovastatin, lovastatin, simvastatin Oral contraceptives Drospirenone Neuroleptic Pimozide Pimozide Erectile Dysfunction Medications Sildenafil or tadalafil when used for Sildenafil or tadalafil when used for pulmonary hypertension pulmonary hypertension Sedative Hypnotics Triazolam and orally administered Orally administered midazolam midazolam *This table includes medications listed as contraindicated in the current Product Information for boceprevir and telaprevir. Other medications may also be contraindicated or should be co-administered with caution. Consult additional resources. Boceprevir (VictrelisTM) Drug Interactions with HIV Medications Concurrent Medication Recommendation Atazanavir/ritonavir (Reyataz®/Norvir®) Atazanavir AUC decreased 35%
Co-administration not
Atazanavir Cmin decreased 49% recommended
Ritonavir AUC decreased 36% Boceprevir AUC unchanged Darunavir/ritonavir (Prezista®/Norvir®) Darunavir AUC decreased 44%
Co-administration not
Darunavir Cmin decreased 59% recommended
Ritonavir AUC decreased 26% Boceprevir AUC decreased 29% Boceprevir Cmin decreased 35% Lopinavir/ritonavir (Kaletra®)
Lopinavir AUC decreased 34%
Co-administration not
Lopinavir Cmin decreased 43% recommended
Ritonavir AUC decreased 23% Boceprevir AUC decreased 44% Boceprevir Cmin decreased 35% Efavirenz (Sustiva®)
Efavirenz AUC increased 20%
Co-administration not
Boceprevir AUC decreased 19% recommended
Boceprevir Cmin decreased 44% Etravirine (Intelence®)
Etravirine AUC decreased 23%
Co-administration possible, clinical
Etravirine Cmin decreased 29% implications of reduced etravirine
Boceprevir AUC increased 10% levels unclear
Boceprevir Cmin decreased 12% Tenofovir (Viread®)
No significant changes reported
No dose adjustment necessary Raltegravir (Isentress®)
No significant changes reported
No dose adjustment necessary Telaprevir (IncivekTM) Drug Interactions with HIV Medications Concurrent Medication Recommendation Atazanavir/ritonavir (Reyataz®/Norvir®) Telaprevir AUC decreased 20%
No dose adjustment necessary
Atazanavir AUC increased 17%
Atazanavir Cmin increased 85% Darunavir/ritonavir (Prezista®/Norvir®)
Darunavir AUC decreased 40%
Co-administration not
Telaprevir AUC decreased 35% recommended Fosamprenavir/ritonavir
Amprenavir AUC decreased 47%
Co-administration not (Lexiva®/Norvir®)
Telaprevir AUC decreased 32% recommended Lopinavir/ritonavir (Kaletra®)
Lopinavir levels unchanged
Co-administration not
Telaprevir AUC decreased 54% recommended Efavirenz (Sustiva®)
Efavirenz AUC unchanged
Increase telaprevir dose to 1125mg
Telaprevir AUC decreased 26%
Telaprevir Cmin decreased 47% When used with tenofovir Efavirenz AUC decreased 15% to 18% Telaprevir AUC decreased 18% to 20% Etravirine (Intelence®)
Etravirine levels unchanged
No dosage adjustment necessary
Telaprevir AUC decreased 16% Telaprevir Cmin decreased 25% Rilpivirine (Edurant®)
Rilpivirine AUC increased 78%
No dosage adjustment necessary
Rilpivirine Cmin increased 93% Telaprevir AUC decreased 5% Telaprevir Cmin decreased 11% Tenofovir (Viread®)
Tenofovir AUC increased 30%
Monitor for tenofovir-associated
Tenofovir Cmin increased 6% to 41% toxicity Raltegravir (Isentress®)
Raltegravir AUC increased 31%
No dose adjustment necessary
Telaprevir levels unchanged Definitions: AUC – Area under the curve; used as a measure of overall drug exposure. Cmin – Minimum concentration; often referred to as the trough concentration References: Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. March 27,2012. Accessed on September 22, 2012. Product Information. Victrelis®, Merck and Co. Whitehouse Station NJ. May 2011. Product Information. Incivek®, Vertex. Cambridge, MA. May 2011. 13th International Workshop on Clinical Pharmacology of HIV Therapy, April 2012, Abstracts O-15 and O-18
A Comprehensive Team Approach to the Management of Introduction. The treatment of children with Prader-Willi syndrome Prader-Willi syndrome (PWS) is (PWS) represents a new challenge in the field of pediatric endocrinology. characterized by infantile hypotonia; The handicaps and problems of affected children are manifold, more so short stature; small hands and feet; increased th
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