How is tadalafil used for treating erectile dysfunction. What is the recommended dosage for benign prostatic hyperplasia. How should tadalafil be taken for optimal effectiveness. What are the key considerations when using tadalafil. How long do the effects of tadalafil last.

Understanding Tadalafil: A Comprehensive Overview

Tadalafil, commonly known by its brand name Cialis, is a medication primarily used to treat erectile dysfunction (ED) and symptoms of benign prostatic hyperplasia (BPH). As a phosphodiesterase type 5 (PDE5) inhibitor, it works by increasing blood flow to specific areas of the body, particularly the penis, facilitating and maintaining erections.

This versatile medication has gained popularity due to its long-lasting effects, often referred to as the “weekend pill” because of its ability to work for up to 36 hours after ingestion. However, proper usage and dosage are crucial for optimal results and minimizing potential side effects.

Tadalafil Dosage Guidelines: Finding the Right Amount

The appropriate dosage of tadalafil varies depending on the condition being treated, individual patient factors, and the frequency of use. Here are the general dosage guidelines:

For Erectile Dysfunction (ED):

• As-needed dosing: 10 mg taken 30 minutes before sexual activity, not more than once daily. The dose may be adjusted to 20 mg or reduced to 5 mg based on individual efficacy and tolerability.
• Daily dosing: 2.5 mg taken once daily, regardless of the timing of sexual activity. This dose may be increased to 5 mg if necessary.

For Benign Prostatic Hyperplasia (BPH):

• 5 mg taken once daily at approximately the same time.

For Both ED and BPH:

• 5 mg taken once daily at approximately the same time, irrespective of sexual activity timing.

For Pulmonary Arterial Hypertension (PAH):

• 40 mg (two 20 mg tablets) taken once daily. Both tablets should be taken together at the same time each day.

It’s crucial to note that these are general guidelines, and your healthcare provider may adjust the dosage based on your specific needs, medical history, and response to the medication.

Proper Administration of Tadalafil: Maximizing Effectiveness

To ensure the best results from tadalafil, follow these administration guidelines:

1. Take the tablet whole with a glass of water.
2. Do not split, break, chew, or crush the tablet.
3. Tadalafil can be taken with or without food.
4. For as-needed use in ED, take the medication at least 30 minutes before anticipated sexual activity.
5. For daily use, take the medication at approximately the same time each day.
6. Do not exceed the recommended dosage or frequency of use.

Remember, tadalafil does not provide immediate erections; sexual stimulation is still required for the medication to be effective in treating ED.

Duration of Effects: How Long Does Tadalafil Last?

One of the key advantages of tadalafil over other ED medications is its extended duration of action. When used for erectile dysfunction, the effects of tadalafil can last up to 36 hours after taking the tablet. This prolonged window of effectiveness has earned it the nickname “the weekend pill.”

However, it’s important to understand that this doesn’t mean you’ll have an erection for 36 hours straight. Instead, it means that during this period, you may be able to achieve and maintain an erection more easily when sexually aroused.

For daily use in treating BPH or as a daily ED treatment, the continuous presence of the medication in your system helps maintain a steady effect.

Potential Side Effects and Precautions

While tadalafil is generally well-tolerated, like all medications, it can cause side effects in some individuals. Common side effects may include:

• Headache
• Flushing
• Nasal congestion
• Back pain
• Muscle aches
• Indigestion
• Dizziness

More serious side effects, though rare, can occur. Seek immediate medical attention if you experience:

• Sudden vision loss
• Sudden hearing decrease or loss
• An erection lasting more than 4 hours (priapism)
• Chest pain or irregular heartbeat

It’s crucial to inform your healthcare provider about all medications you’re taking, as tadalafil can interact with certain drugs, particularly nitrates used for heart conditions. Additionally, alcohol consumption should be limited when using tadalafil, as it may increase the risk of side effects.

Special Considerations for Different Patient Groups

While tadalafil is effective for many individuals, certain patient groups may require special considerations:

Elderly Patients:

Older adults may be more sensitive to the effects of tadalafil. Typically, no dosage adjustment is necessary, but careful monitoring is advised.

Patients with Kidney or Liver Impairment:

Dosage adjustments may be necessary for patients with kidney or liver problems. Your doctor will determine the appropriate dose based on the severity of the impairment.

Patients with Cardiovascular Conditions:

Individuals with heart conditions should consult their healthcare provider before using tadalafil, as sexual activity can put additional strain on the heart.

Patients Taking Other Medications:

Tadalafil can interact with various medications, including alpha-blockers, antifungals, and HIV protease inhibitors. Always inform your doctor about all medications you’re taking to avoid potential interactions.

Missed Doses and Storage Guidelines

If you’re taking tadalafil daily and miss a dose, take it as soon as you remember. However, if it’s almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Never take a double dose to make up for a missed one.

Proper storage of tadalafil is essential to maintain its effectiveness:

• Store at room temperature, away from heat, moisture, and direct light.
• Keep the medication in its original container, tightly closed.
• Do not store in the bathroom.
• Keep out of reach of children and pets.
• Do not use expired medication.

Dispose of unused or expired medication properly. Consult your pharmacist or local waste disposal company for guidance on safe disposal methods.

Maximizing the Benefits of Tadalafil Treatment

To get the most out of your tadalafil treatment, consider the following tips:

1. Follow your doctor’s instructions carefully.
2. Be patient – it may take some time to find the optimal dosage for you.
3. Maintain a healthy lifestyle, including regular exercise and a balanced diet.
4. Communicate openly with your partner about your treatment.
5. Manage stress levels, as stress can impact sexual performance.
6. Avoid excessive alcohol consumption, which can interfere with the medication’s effectiveness.
7. Attend regular check-ups with your healthcare provider to monitor your progress and address any concerns.

Remember, tadalafil is a tool to help manage ED or BPH symptoms, but it works best when combined with a holistic approach to health and well-being.

Tadalafil has revolutionized the treatment of erectile dysfunction and benign prostatic hyperplasia, offering a long-lasting solution that fits various lifestyles. By understanding the proper usage, dosage, and precautions associated with this medication, patients can maximize its benefits while minimizing potential risks. Always consult with your healthcare provider for personalized advice and to address any specific concerns you may have about using tadalafil.

Tadalafil (Oral Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

Use tadalafil exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Also, do not stop taking this medicine without checking first with your doctor.

This medicine comes with a patient information leaflet. Read and follow these instructions carefully. Read it again each time you refill your prescription in case there is new information. Ask your doctor if you have any questions.

You may take this medicine with or without food.

Swallow the tablet whole. Do not split, break, chew, or crush it.

When using this medicine for erectile dysfunction, the ability to have sexual activity may be improved for up to 36 hours after taking the tablet.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• 
  For oral dosage form (tablets):
  • 
    For treatment of benign prostatic hyperplasia (daily use):
    • 
      Adults—5 milligrams (mg) as a single dose, no more than once a day, taken at the same time each day.
    • 
      Children—Use is not recommended.

  • 
    For treatment of erectile dysfunction (as needed):
    • 
      Adults—10 milligrams (mg) as a single dose, no more than once a day, taken 30 minutes before you think sexual activity may occur. Your doctor may adjust your dose as needed.
    • 
      Children—Use is not recommended.

  • 
    For treatment of erectile dysfunction (daily use):
    • 
      Adults—2.5 milligrams (mg) once a day, taken at the same time each day, without regard for the timing of sexual activity. Your doctor may adjust your dose as needed.
    • 
      Children—Use is not recommended.

  • 
    For treatment of erectile dysfunction and benign prostatic hyperplasia (daily use):
    • 
      Adults—5 milligrams (mg) once a day, taken at the same time each day, without regard for the timing of sexual activity.
    • 
      Children—Use is not recommended.

  • 
    For treatment of pulmonary arterial hypertension:
    • 
      Adults—40 milligrams (mg) (two 20 mg tablets) taken once a day. Take both tablets at the same time each day. Do not divide the 40 mg dose. Your doctor may adjust your dose as needed.
    • 
      Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Portions of this document last updated: Feb. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.

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Tadalafil: a medicine to treat erection problems and symptoms of an enlarged prostate

It’s important to take this medicine as advised by a doctor or pharmacist.

Tadalafil tablets come in different strengths.

Swallow your tablets whole, with a drink of water. The tablets can be taken with or without food.

How much will I take for erectile dysfunction?

You usually take tadalafil before having sex. Take 1 tablet at least 30 minutes before you want to have sex. Do not take more than 1 tablet a day.

The usual dose is 10mg. Your doctor may increase or decrease your dose, depending on how well it works and how often you take it.

The effects may last longer than 24 hours, so you’re not recommended to take the 10mg or 20mg tablets every day.

For the tablet to work properly, you’ll need to be sexually excited.

If you have a private prescription for tadalafil, read the information that comes with your medicine carefully. The strength and dosage instructions can vary.

How much will I take for benign prostate enlargement?

Tadalafil tablets for an enlarged prostate come as 2.5mg or 5mg. The usual dose is 5mg, taken once a day.

You can take your tablet in the morning or evening, but it’s best to take it at the same time each day.

Your doctor might give you a low dose of 2.5mg if you are having any problems, such as side effects.

If you are being treated for both benign prostatic enlargement and erectile dysfunction, the dose is 5mg.

How much will I take for pulmonary hypertension?

Tadalafil tablets for pulmonary hypertension come in 20mg strength.

The usual dose is 40mg – two 20mg tablets, taken once a day. These tablets are large, so take the tablets one after the other.

If you have kidney or liver problems your doctor might decrease the starting dose to 10mg or 20mg.

What if I forget to take it?

If you have:

• benign prostatic enlargement – take it as soon as you remember and then continue as usual
• pulmonary hypertension – take it within 8 hours if you can. If you remember after 8 hours, skip the missed dose and take the next dose as usual.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you.

You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too much tadalafil by accident can cause unpleasant side effects, including:

• headache
• dizziness
• indigestion
• stuffy nose
• problems with your vision (such as blurred vision)

Side effects will usually go away when you stop taking the tablets. Talk to a doctor if you have taken too much tadalafil and you’re worried about these side effects.

Cialis Can It Be Taken Daily

Viagra (sildenafil) and Levitra (vardenafil) are similar to Cialis, but the major difference is that Cialis can last up to 36 hours. 6/10 Cialis (Tadalafil) – Side Effects, Dosage, Interactions https://www. Courters, Thanks for your question. Once the endocannabinoid is supported in this way, it is able to function more efficiently, thus optimizing the body’s performance each day.. Mulhall says you should not take pills and injections at the same time. You need to talk to the. Depending on the effectiveness of the medication (and whether you experience any side effects), your healthcare provider may increase or decrease your tadalafil dosage. Sep 24, 2010 · it is safe to take them together. It lasts up to six hours When you start CIALIS for daily use, it may take approximately 4 to five days before it works. Avanafil (Stendra). It’s effective for up to 36 hours. The usual dosage for Viagra is 50mg once daily or 1 hour prior to sexual activity. For this use, the recommended dose is Cialis 2. This means you can have sex at any time, rather than needing to take a pill from time to time as needed like other ED brands. Don’t take on CIALIS for daily use many time every day. Answer. This medication is taken with or without food about one to two hours before sex. S. For Cialis Can It Be Taken Daily as-needed use: Typical starting dosage: 10 mg Brief Answer: Can take 4 tablets 5mg cialis in 36 hour dose. When therapy for BPH is initiated with CIALIS and finasteride, the recommended dose of CIALIS for once daily use is 5 mg, taken at approximately the same time every day for up to 26 weeks Men who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS Jan 11, 2008 · The FDA has approved once-daily use of Cialis in a dose of 5 milligrams or a new 2. It can be taken as a daily dose or ans a 36 hour dose as prescribed by …. In the U. As an experiment, I stopped the daily regime and now take it 3 times/week on … read more. In other cases, a smaller dose of the medicine is prescribed for daily use, regardless of whether you plan to have sexual activity Alternatively, Cialis can be taken on a daily basis (every single day, whether you plan sexual activity or not). You should try to find out the cause and treat it, then you would never need it. Staxyn is an orally disintegrating tablet that contains the same active ingredient as Levitra but is not. Com/answers/im-taking-cialis Nov 26, 2011 · CIALIS for Once Daily Use. In many cases, Cialis is taken as needed — typically an hour before sexual activity, although it can be taken anywhere from 1 to 36 hours before sexual activity. This provides erectile potency 24 hours per day, and can be used by men who anticipate engaging in intercourse two or more times per Avapro Irbesartan 150mg week The drug comes in low-dose versions that can be taken daily. 4/5 I’m taking Cialis daily 5 mg with mild result. User-friendly, the patient’s physician attire as in october taking cialis and viagra 2011, will regress Aug 23, 2008 · Can You Take Cialis If You Take Ramipril. Take one tablet daily at comparable time daily. 5 mg once daily, taken at the same time each day (it does not matter when you plan to have sexual activity if you take Cialis this way) Jan 28, 2013 · 1 Answer (question resolved) – Posted in: cialis, erection – Answer: No, the maximum dose if taken daily is 5 mg/day. The maximum tadalafil dosage is tadalafil 20 mg.. For something like Cialis it won`t harm you to take it, it just won`t be as effective. Doc told me I can take another dose of 10 mg if I consider needed but not more than that. 5 milligrams (mg). The risk of priapism is too high. However, in rare cases, you may have a slight drop in blood pressure from the tamsulosin, so if you feel dizzy or lightheaded, then you should take them about 1 hour apart However, you may take tadalafil anywhere from 1 hour to 36 hours before sexual activity. Meaning, say one is lucky enough to spend 8 hrs with a ladythen would taking the 2nd dose keep things ready for an extended session? It can be taken in a small dose daily or in a larger dose as needed. This medication is taken with or without food 30 minutes before sex, depending on the dose. 5mg daily Sublingual (holding under the tongue for thirty seconds) absorption takes place within 10‐15 minutes, while capsules can take anywhere from 1-2 hours to take effect. The recommended starting dose of CIALIS for once daily use is 2. CIALIS can be taken at any time daily or evening with or without food. Cialis works by increasing blood flow to the penis when it is stimulated. Can I boost https://www. Hope this helps Dosage of Tadalafil When using tadalafil for erectile dysfunction, the recommended starting dosage will often be 10 mg one hour prior to sexual activity. Nov 11, 2016 · First of all, these are prescription medications and practically no physician would write a prescription for both of these medications to be taken at the same time. Should you miss a dose, take it when you remember In many cases, Cialis is taken as needed — typically an hour before sexual activity, although it can be taken anywhere from 1 to 36 hours before sexual activity. For this use, the recommended dose is Cialis 2. 5 mg, taken at approximately the same time every day, without regard to timing of sexual activity. The usual dosage for Cialis is either 10mg 1 hour prior to sexual activity or 2. Everydayhealth. The starting dose for daily-use Cialis is 2. If you take Viagra for example, PDE5 is saturated with Viagra so adding Cialis into the blood stream …. Don’t take tadalafil more than once per day. When therapy for BPH is initiated with CIALIS and finasteride, the recommended dose of CIALIS for once daily use is 5 mg, taken at approximately the same time every day … 8. Cialis Daily doesn’t necessarily need to be taken before sex, but it needs to be taken at the same time every day. This can be minimized by not taking them together at the same time. Cialis is a popular medication used in the treatment of ED (erectile dysfunction) and works by dilating blood. His instructions are: Do not take Viagra or Levitra 18 hours before or after an injection and Cialis is not recommended at any time when using Trimix You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. The recommended dose of CIALIS for once daily use is 5 mg, taken at approximately the same time every day. Cialis is a medication that is prescribed for erectile dysfunction in men. Jan 04, 2011 · Dr. S. Second, Cialis, Viagra, and Levitra all inhibit the same enzyme in the penis – Phosphodiesterase 5 (PDE5). Drugs. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider May 06, 2015 · Since Levitra & viagra have a 4-5 hr working time, is it ok to take a 2nd dose say around hour 4? , it is the FDA that is responsible for creating any Recommended Daily Intake (RDI), defined as the daily levels of a nutrient sufficient enough to meet the requirements of 97-98% of healthy individuals Decadron Tablets Pills in the U. Com/drugs/cialis A: Cialis (tadalafil) is a prescription medication used to treat erectile dysfunction. There is a build up period but that is not significant, as the effect weans off after a few hours of its usage for the purpose of erectile dysfunction Colon cancer, swisher cialis how often can it be taken and 3. However, in rare cases, you may have a slight drop in blood pressure from the tamsulosin, so if you feel dizzy or lightheaded, then you should take them about 1 hour apart. When therapy for BPH is initiated with CIALIS and finasteride, the recommended dose of CIALIS for once daily use is 5 mg, taken at approximately the same time every day for up to 26 weeks Initially I was prescribed Cialis daily as they work in sequence, now scaled down to 10mg when needed to be taken tow or three hours before sex. If that doesn’t work, you can increase your daily dose up to 5 mg Jul 04, 2010 · Alternatively, Cialis can be taken on a daily basis (every single day, whether you plan sexual activity or not). Feb 01, 2014 · In any case, daily dose of Tadafil is not required. The best this to do would be to flush it down the toilet and buy new cialis Cialis starts working in about 30 to 60 minutes and lasts as long Cialis Can It Be Taken Daily as 36 hours. However, the FDA has not created an RDI for suggested daily servings of CBD. . This medication can also be taken in smaller amounts on a daily basis, depending on what your healthcare provider recommends If you take one of them, it may interact with your Xatral and cause some lower blood pressure. Mar 05, 2018 · The recommended dose of CIALIS for once daily use is 5 mg, taken at approximately the same time every day. Jun 11, 2019 · Tadalafil (Cialis). In other cases, a smaller dose of the medicine is prescribed for daily use, regardless of whether you plan to have sexual activity Tadalafil can be used either as needed or taken once a day. The maximum amount that should be taken on a daily basis is Cialis 20 mg; however, men with mild-to-moderate kidney or liver disease should only take 10 mg in a 48- …. Character taking cialis and viagra or someone who took over, with non stenosed, moderately symptomatic chagas parasite infections and acinetobacter. 5 mg once daily, taken at the same time each day (it does not matter when you plan to have sexual activity if you take Cialis this way) Nov 21, 2017 · Extreme caution should be taken with Cialis (tadalafil): the hiatus between the intake of Cialis and any other drug of PDE5 class, including Medrol Dose Pack For Sale Viagra, is 48 hours. Jan 13, 2012 · I have been taking Cialis (5mg) once daily primarily for BPH and secondarily for the boost it gives my sexual performance. Consult your doctor as for your minimal effective dose, and follow his or her instructions to the letter Sep 24, 2010 · it is safe to take them together. Detailed Answer: Hi, Thanks for writing in to us. The expiration date refers to the date that it will no longer be effective at what it is designed to do. The most common side effects with CIALIS are: headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose When used to treat the symptoms of an enlarged prostate, the recommended starting dose of Cialis is 5 mg daily. The medicine will usually remain effective for up to 36 hours. However, you can take it on as per need basis. The CIALIS dose for once daily use may be increased to 5 mg, based on individual efficacy and tolerability Mar 05, 2018 · The recommended dose of CIALIS for once daily use is 5 mg, taken at approximately the same time every day.

Cialis Daily Vs Cialis | LloydsPharmacy Online Doctor UK

Erectile dysfunction (ED) is an incredibly common condition, it is thought to affect half of all men between the ages of 40 and 70. In some cases, it can be mild or only occur infrequently; in other cases, it can be an indication of an underlying health condition like high blood pressure, diabetes or an overactive thyroid.

For many men, ED becomes more of a problem as they age. The good news is that tablets known as PDE-5 inhibitors can be prescribed; these tablets contain medicine that temporarily increases blood flow to the penis, allowing you to attain and maintain an erection sufficient for sex.

There are several PDE-5 inhibitors available but one of the most popular is Cialis, which comes in two varieties: Cialis prescribed for one-off use and Cialis Daily taken every day.

If you’re suffering from erectile dysfunction and considering treatment, read on to learn more about the differences between Cialis, Cialis Daily and the other ED tablets on the market.

What are the side effects?

Cialis Daily

Cialis Daily comes in tablet sizes of 2.5mg and 5mg, and can cause nausea, vomiting, diarrhoea, an allergic rash, facial flushing, headache and back pain. These side effects are uncommon and usually resolve within a few days. More known side effects are an erection that does not go away and can cause damage to the penis. Additionally, a sudden decrease in vision and hearing may occur although these side effects are very uncommon. A full list of side effects can be found in the information leaflet.

Cialis

Cialis is available in tablet sizes of 10mg and 20mg and is associated with the same side effects as Cialis Daily. However, because it is prescribed in higher dosages than Cialis Daily, these side effects can be stronger.

Considering ED treatment?

View our ED treatments

What does it do?

Cialis Daily

Cialis Daily enables an erection in men who suffer from ED, and is designed to allow for spontaneous sex. When you take it every day, you should be able to get erections and have sex whenever you want to.

Cialis

Cialis enables an erection in men with ED but it is designed for one-off use. To get an erection with regular Cialis you will have to take one tablet 30-60 minutes before you plan to have sex.

Who’s it for?

Cialis Daily

Cialis Daily is suited to men who have sex three or more times a week. It can be particularly helpful for men in long-term relationships who would like to have spontaneous sex with their partner.

Cialis

Cialis is suited to men who have sex on a less regular basis, or whose ED comes and goes.

When do I take it?

Cialis Daily

Cialis Daily must be taken once every 24 hours, with or without food. It’s best to get into a routine and take it at the same time each day, as you should never take more than one tablet in a 24-hour period.

Cialis

Cialis should be taken 30-60 minutes before you plan to have sex.

How quickly does it work, and how long does it last?

Cialis Daily

When taken correctly (see above), Cialis Daily should begin to work within 3-5 days. After this point, you should be able to achieve erections whenever you want them – bearing in mind that you will only get an erection if you are sexually aroused. Cialis Daily should continue to be effective for as long as you take it.

Cialis

When taken correctly, Cialis should begin to work within 30-60 minutes. The effects of one Cialis tablet can last up to 36 hours; however during this period you will only achieve an erection if you become sexually aroused.

What’s the pack size, and how expensive is it?

Cialis Daily

Cialis Daily ordered from LloydsPharmacy Online Doctor comes in packs of 28. Per tablet, Cialis Daily is cheaper than Cialis, however you may end up using more tablets.

Cialis

Cialis ordered from LloydsPharmacy Online Doctor comes in packs of 4, 8 or 16. Per tablet, Cialis is more expensive than Cialis Daily, however you may end up using fewer tablets.

Alternative ED tablets

If you don’t think Cialis Daily or regular Cialis are right for you, there are some alternative ED tablets to consider. Just remember that Cialis Daily is currently the only ‘every day’ option for men with ED.

Viagra is the most famous ED tablet and works in the same way as Cialis. It lasts 4-6 hours and should be taken 30-60 minutes before sex.

Sildenafil contains the same active ingredient as Viagra and works in exactly the same way. Sildenafil is the most affordable ED tablet.

Spedra is the fastest-acting ED tablet, as it only has to be taken 15-30 minutes before sex.

Levitra is recommended for diabetics, and works in a very similar way to Viagra and Sildenafil.

For more information on ED treatments and comparisons visit the LloydsPharmacy Online Doctor ED page.

References

www.medicines.org.uk/emc/product/8637/pil
www.nhs.uk/medicines/tadalafil/
www.medicines.org.uk/emc/product/7432/pil#gref

Tadalafil (Cialis) for Erectile Dysfunction – STEPS

JOHN A. NOVIASKY PHARM.D., ASIF MASOOD M.D., ASIF MASOOD M.D., and VINCENT LO M.D., St. Elizabeth Medical Center, Family Medicine Residency Program, Utica, Ny

Am Fam Physician. 2004 Jul 15;70(2):359-360.

Synopsis

Tadalafil is a reversible phosphodiesterase type 5 (PDE5) inhibitor approved for the treatment of erectile dysfunction (ED). As a class, PDE5 inhibitors (including sildenafil [Viagra] and vardenafil [Levitra]), enhance erectile response to sexual stimulation by increasing penile blood flow. The duration of action of tadalafil is longer than that of sildenafil or vardenafil.

View/Print Table

Safety

In general, few side effects occur with tadala-fil unless it is taken in conjunction with other drugs. When combined with α₁-adrenergic blockers such as doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin) but not tamsulosin (Flomax)—tadalafil can cause a significant drop in blood pressure. Similarly, concomitant use of nitrates (including recreational nitrates known as “poppers”) with tadalafil also is contraindicated. For life-threatening situations, nitrates may be considered if at least 48 hours have passed since the last dose of tadalafil and if close hemodynamic monitoring is available. Tadalafil will lower blood pressure an additional 4 to 10 mm Hg when used with antihypertensive drugs. Dosage should be limited to 10 mg within a 72-hour period when patients are also taking drugs such as erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), protease inhibitors, and other drugs that inhibit the CYP3A4 enzyme system.1

Patients with cardiovascular diseases have been excluded from studies of tadalafil because so little is known about its safety profile in this population.1 The current recommendation for patients who experience coital angina after taking a PDE5 inhibitor is to contact emergency services that provide transport to a hospital.2 Rare reports of priapism have been reported with all of the drugs in this class. 1 Long-term safety has not been established. Because of tadalafil’s long duration of action, patients are exposed to its effects for a longer period of time than with sildenafil or vardenafil.3,4

Tolerability

The most common dose-related side effects of tadalafil are headache (11 to 15 percent) and dyspepsia (8 to 10 percent). Back pain, beginning 12 to 24 hours after the dose and lasting for up to 48 hours, was reported in 5 to 6 percent of men, as compared with a rate of 3 percent in men receiving placebo. Changes in color vision, which has been reported with sildenafil, has been reported in less than 0.1 percent of patients in clinical trials of tadalafil.1 Tadalafil differs from sildenafil in its affinity for PDE6 and 11, which may account for fewer reported ocular effects and more reports of back pain with tadalafil than with sildenafil.3

Effectiveness

The main outcomes studied in the treatment of ED are achievement of an erection, successful intercourse, and overall satisfaction with sexual function. In five studies evaluating tadalafil in 5-, 10-, and 20-mg doses versus placebo, 321 men were assigned to a 10-mg regimen. In this group, 68 to 77 percent of men reported an erection suitable for insertion, compared with 42 to 55 percent receiving placebo (number needed to treat [NNT]=4 to 4.5). However, slightly fewer men reported successful intercourse (51 to 70 percent, NNT=4 to 5).1,5 The satisfaction with intercourse was 9.3 out of a maximum score of 15, compared with a score of 7.4 in patients taking placebo, and overall satisfaction was 6.7 out of a possible 10 with tadalafil compared with 5.2 in patients taking placebo.5 As with the other drugs in this class, overall effectiveness is diminished in patients with diabetes or ED. Tadalafil has not been studied in patients with antidepressant-induced ED. No studies have directly compared tadalafil with sildenafil or vardenafil, but overall success rates have been comparable among the three options.

Price

The cost per dose of tadalafil is comparable to sildenafil or vardenafil and, if sexual activity is desired weekly, the cost is about $39 per month. As a result of its long duration of action, fewer doses of tadalafil may be needed, resulting in a small savings over time.

Simplicity

The usual dose of tadalafil is 10 mg, no more than once per day, taken orally at least 30 to 60 minutes before sexual activity. Its effect may last up to 36 hours.1,6 The dose can be increased to 20 mg if necessary. Safe dosing of tadalafil includes downward dosage adjustment to 5 mg in patients with moderate to severe renal insufficiency. In patients with mild to moderate hepatic dysfunction, the tadalafil dose should not exceed 10 mg. Tadalafil is not recommended in patients with severe hepatic dysfunction.

Bottom line

Like other PDE5 inhibitors, tadalafil effectively improves the ability of men with erectile dysfunction to achieve an erection and successfully complete intercourse. It is less effective, although still useful, in some men with ED due to diabetes. Its longer duration may require less frequent dosing and may allow the user to take it earlier in the day of planned sexual activity. However, some authorities suggest that, because the sildenafil safety record is more established, it may be preferred over tadalafil.4

How Can I Make My ED Drug Work Better?

If you take a prescription drug for erectile dysfunction (ED), you’ll want to do everything you can to make sure it’s doing its job. Take a few minutes to learn how to get the most out of your medication. It will pay off later in the bedroom.

Watch what you eat when you take your pill.

Sometimes eating a big meal right after you take an ED drug may not always be the best idea. If you swallow sildenafil (Viagra) with a high-fat meal, such as a steak dinner, it may take longer for it to work.

You can take other ED drugs with or without food, such as:

Make sure you take the right drug for you.

While ED drugs work in similar ways, they’re each made up of different chemicals. This can affect how they work, how much time they take to kick in, and the different side effects that you may have.

Talk to your doctor about any health problems you have and other medications that you take. It will help your doctor find the ED drug that should work best for you.

Give it enough time to work.

For most ED drugs, you need to wait a while before you can expect them to start working. How long varies with the drug.

Viagra and Levitra take about 30 minutes to work, and the effects last for about 4 hours after you take the pill.

You should take Cialis at least 2 hours before you plan to have sex. The effects may last for up to 36 hours after you take it.

Check with your doctor to see if you need to increase your dose.

If the amount of medicine you use now doesn’t help you get an erection, you may need to take a bigger dose. But don’t do this on your own. Talk to your doctor to see if an increase in medication is right for you. 

Take it slow.

Time is on your side. You can’t take an ED drug and expect to get an erection right away. The medications boost the effects of a chemical your body makes called nitric oxide, which relaxes the muscles in your penis. That improves your blood flow and helps you get an erection.

But for the drugs to work, you need to be sexually aroused. So don’t rush things. Take some time to get into the mood. Use all of your senses to get turned on.

Never mix ED drugs with nitrates.

Do you have a heart condition? Pay attention to this: Don’t take ED drugs if you also take heart medicines called nitrates. The combination can cause a dangerous drop in your blood pressure.

To make sure you stay safe, talk to your doctor about all of the medications you take.

Cialis Drug / Medicine Information

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine,
speak to your doctor or pharmacist.

”>Why am I using CIALIS?

CIALIS contains the active ingredient tadalafil. CIALIS is used to treat erectile
dysfunction and urinary symptoms associated with benign prostatic hyperplasia in adult
men.

What should I know before I use CIALIS?

Do not use if you have ever had an allergic reaction to CIALIS or any of the ingredients
listed at the end of the CMI.

Do not take CIALIS if you are currently taking any nitrates or amyl nitrite.

Talk to your doctor if you have any other medical conditions such as heart problems
or take any other medicines.

”>What if I am taking other medicines?

Some medicines may interfere with CIALIS and affect how it works.

How do I use CIALIS?

Always take CIALIS exactly as your doctor has told you.

Follow all directions given to you by your doctor or pharmacist.

What should I know while using CIALIS?

Are there any side effects?

CIALIS may cause chest pain, headache or migraine, flushing, sweating, nausea or vomiting,
fatigue, back pain, muscle pain.

Active ingredient: tadalafil

Consumer Medicine Information (CMI)

This leaflet provides important information about using CIALIS. You should also speak to your doctor or pharmacist if you would like further information
or if you have any concerns or questions about using CIALIS.

Where to find information in this leaflet:

”>Why am I using CIALIS?

CIALIS contains the active ingredient tadalafil. CIALIS belongs to a group of medicines called phosphodiesterase type 5 inhibitors.

CIALIS is used to treat:

erectile dysfunction, also known as impotence, in men. This is when a man cannot get,
or maintain, a hard erect penis suitable for sexual activity. Following sexual stimulation,
CIALIS works by helping the blood vessels in your penis to relax, allowing the flow
of blood into your penis. The result of this is improved erectile function. CIALIS
will only treat erectile dysfunction if you are sexually aroused. You and your partner
will need to engage in foreplay, just as you would if you were not taking a medicine
for erectile dysfunction.

urinary symptoms associated with a common condition called benign prostatic hyperplasia.
This is when the prostate gland gets bigger with age. Symptoms include difficulty
in starting to pass urine, a feeling of not completely emptying the bladder and a
more frequent need to pass urine even at night. CIALIS improves blood flow to, and
relaxes the muscles of, the prostate and bladder which may reduce symptoms of benign
prostatic hyperplasia.

Your doctor may have prescribed you CIALIS to treat either, or both of these conditions.

What should I know before I use CIALIS?

Warnings

Do not use CIALIS if:

you are allergic to tadalafil, or any of the ingredients listed at the end of this
leaflet. Always check the ingredients to make sure you can use this medicine

you are currently taking any nitrates, medicines used for the treatment of angina
(“chest pain”) or other heart conditions. CIALIS has been shown to increase the effects
of these medicines.

if you use recreational drugs called “poppers” or “amyl” like amyl nitrite and butyl
nitrite that are normally taken through inhalation

if you use guanylate cyclase stimulators such as riociguat, used to treat pulmonary
arterial hypotension

if you have heart or blood vessel problems that make sexual intercourse inadvisable.
Sexual activity carries a possible risk to patients with a heart condition because
it puts extra strain on the heart

if you have heart problems such as angina, arrhythmias (change in rhythm or rate of
heart beat), heart failure

if you have suffered a heart attack in the last 3 months

if you have suffered a stroke in the last 6 months

if your blood pressure is unusually high or low or is not effectively treated

if you have vision loss in one eye because of non-arteritic interior ischaemic optic
neuropathy (NAION).

Check with your doctor if you have or have had:

liver or kidney problems

heart problems or if you have had a heart attack

blood vessel problems

sickle cell anaemia (an abnormality or red blood cells)

multiple myeloma (cancer of the bone marrow)

leukaemia (cancer of the blood cells)

any deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s
disease)

loss of vision in one or both eyes.

During treatment, you may be at risk of developing certain side effects. It is important
you understand these risks and how to monitor for them. See additional information
under Section 6. Are there any side effects?

Tell your doctor if you:

are aged 75 years and over.

You have a higher chance of experiencing side effects like dizziness and diarrhea.

Your doctor will assess if CIALIS is suitable for you.

Use in women

CIALIS is not intended for use by women.

Use in children

CIALIS is not intended for use by children under the age of 18 years.

What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any
medicines, vitamins or supplements that you buy without a prescription from your pharmacy,
supermarket or health food shop.

Some medicines may interfere with CIALIS or affect how it works.

These include:

some antibiotic medicines such as rifampicin, erythromycin and clarithromycin

some medicines used to treat seizures such as phenytoin, phenobarbitone and carbamazepine

some medicines used to treat fungal infections such as ketoconazole and itraconazole

protease inhibitors used to treat HIV such as ritonavir and saquinavir

medicines used to treat hypertension (high blood pressure) such as metoprolol, irbesartan
and enalapril

alpha-blockers (used to treat hypertension and some prostate problems) such as prazosin
and doxazosin

a 5-alpha reductase inhibitor, such as finasteride (used to treat prostate and hair
loss problems)

warfarin, a medicine used to prevent or treat blood clots

other PDE5 inhibitors such as sildenafil used to treat erectile dysfunction or pulmonary
arterial hypertension (high blood pressure in the blood vessels in the lungs)

grapefruit juice

large amounts of alcohol.

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins
or supplements you are taking and if these affect CIALIS.

How do I use CIALIS?

For Erectile Dysfunction:

CIALIS can be taken as either on-demand dosing or once-a-day dosing:

CIALIS on-demand (10 mg or 20 mg) is intended for use prior to anticipated sexual
activity and is not for continuous daily use

CIALIS once-a-day (5 mg) is for patients who anticipate frequent use of CIALIS (i.e.
at least twice weekly). Your doctor can advise on the appropriateness of once-a-day
treatment. When taken once a day, CIALIS allows you to obtain an erection, when sexually
stimulated, at any time point during the 24 hours of the day.

Do not take once-a-day dosing and on-demand dosing concurrently

When taking CIALIS once-a-day (5 mg), it may take up to 1 week for a full effect on
erectile dysfunction.

For urinary symptoms associated with benign prostate hyperplasia

CIALIS once-a-day (5 mg) is taken daily. It may take up to a week to notice an improvement
and 1 month for a full effect on urinary symptoms such as urinating too frequently
during the day or at night, the need to urinate being too urgent, or too soon after
relieving your bladder.

How much to take

You should not take CIALIS more than once a day.

On-demand dosing for Erectile Dysfunction:

the maximum recommended dose of CIALIS is one 20 mg tablet taken before sexual activity

if you have kidney disease, the recommended dose of CIALIS is one 10 mg tablet. This
dose may be increased up to 20 mg. For patients with severe renal impairment, 10 mg
is the maximum recommended dose

if you have liver disease, the recommended dose of CIALIS is one 10 mg tablet. Patients
with severe hepatic impairment should follow their doctor’s advice

no special dosing consideration is needed for the elderly or people with diabetes.

Once-a-day dosing for Erectile Dysfunction and/or urinary symptoms associated with
Benign Prostate hyperplasia:

the recommended dose of CIALIS is one 5 mg tablet taken once per day

dose adjustments are not required in patients with kidney disease unless you have
severe renal impairment. Once-a-day dosing of CIALIS is not recommended in patients
with severe renal impairment.

patients with liver disease should follow their doctor’s advice. Once-a-day dosing
is not recommended in patients with severe hepatic impairment.

no special dosing consideration is needed for the elderly or people with diabetes.

When to take CIALIS

CIALIS can be taken with or without food or alcohol. However, drinking alcohol may
affect your ability to get an erection, so avoid excessive drinking.

On-demand dosing for Erectile Dysfunction:

CIALIS (10 mg or 20 mg) should be taken at least 30-60 minutes prior to anticipated
sexual activity

The amount of time CIALIS takes to work varies from person to person. In some men
CIALIS can work as early as 16 minutes after taking the tablet but it is recommended
that you allow 1 hour the first time you take it

CIALIS has been proven to be effective for up to 36 hours. This means you can take
CIALIS and it will allow you to obtain an erection when sexually stimulated, at any
time during the 36 hours after taking it. Sometimes if you’re feeling anxious or nervous
you may not respond to the first tablet. Don’t give up, it may take a few doses before
you get the full benefit of CIALIS.

Once-a-day dosing for Erectile Dysfunction and/or urinary symptoms associated with
Benign Prostate hyperplasia:

CIALIS should be taken daily at approximately the same time of day

CIALIS must be taken daily to maintain effect.

How to take CIALIS

Swallow one tablet whole with a full glass of water.

If you take too much CIALIS

If you think that you have used too much CIALIS, you may need urgent medical attention.

You should immediately:

phone the Australian Poisons Information Centre
(by calling
13 11 26) or the New Zealand National Poisons Centre (by calling 0800 POISON or 0800 764 766), or

contact your doctor, or

go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

What should I know while using CIALIS?

Things you should do

If you have emergency treatment for any suspected heart condition, tell the emergency
medical or ambulance staff that you are taking CIALIS.

Remind any doctor, dentist or pharmacist you visit that you are using CIALIS.

Things you should not do

Do not take CIALIS for any other complaints unless your doctor tells you to.

Do not give you medicine to anyone else, even if they have the same condition as you.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how CIALIS
affects you.

Drinking alcohol

Tell your doctor if you drink alcohol.

Alcohol may affect your ability to get an erection. Avoid excessive drinking.

When taking CIALIS with large amounts of alcohol, some men may experience dizziness.

Looking after your medicine

Store below 25°C.

Keep your tablets in the original pack until it is time to take them.

Follow the instructions in the carton on how to take care of your medicine properly.

Store it in a cool dry place away from moisture, heat or sunlight; for example, do
not store it:

in the bathroom or near a sink, or

in the car or on window sills.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

If you no longer need to use this medicine or it is out of date, take it to any pharmacy
for safe disposal.

Do not use this medicine after the expiry date.

Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of
them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you
have any further questions about side effects.

Less serious side effects

Serious side effects

*Sudden loss or decrease in hearing which may be accompanied by ringing in the ears
and dizziness, loss of vision in one or both eyes and seizures have been reported
in people taking CIALIS. It is not possible to determine whether these events are
related directly to CIALIS, to other diseases or medications, to other factors, or
to a combination of factors. If you experience these symptoms, stop taking CIALIS
and contact a doctor immediately.

Tell your doctor or pharmacist if you notice anything else that may be making you
feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects that you experience, you
can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems . By reporting side effects, you can help provide more information on the safety of
this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop
taking any of your medicines.

Product details

This medicine is only available with a doctor’s prescription.

What CIALIS contains

This medicine does not contain sucrose, gluten, tartrazine or any other azo dyes.

Do not take this medicine if you are allergic to any of these ingredients.

What CIALIS looks like

CIALIS 5 mg tablets are yellow, film coated, almond shaped tablets, marked “C5” on
one side (Aust R 128496).

CIALIS 10 mg tablets are light yellow, film coated, almond shaped tablets, marked
“C10” on one side (Aust R 90590).

CIALIS 20 mg tablets are yellow, film coated, almond shaped tablets, marked “C20”
on one side (Aust R 81137).

Who distributes CIALIS

Eli Lilly Australia Pty Limited

112 Wharf Road

West Ryde NSW 2114

AUSTRALIA

Phone: 1800 454 559

Eli Lilly and Company (NZ) Limited

PO Box 109 197 Newmarket

Auckland 1149

NEW ZEALAND

Phone: 0800 500 909

® Registered Trademark

This leaflet was prepared in February 2021.

vA15

CIALIS instructions for use, price in pharmacies in Ukraine, analogues, composition, indications | CIALIS film-coated tablets from Eli Lilly Netherland

active ingredient of the drug Cialis – tadalafil – is a reversible selective inhibitor of specific PDE type 5 (PDE-5) cGMP. When sexual stimulation induces a local release of nitric oxide, inhibition of PDE5 by tadalafil results in an increase in cGMP levels in the corpus cavernosum of the penis. The consequence of this is the relaxation of the smooth muscles of the arteries and the flow of blood to the tissues of the penis, which causes an erection.Tadalafil has no effect in the absence of sexual stimulation.

In studies in vitro it was established that tadalafil is a selective PDE-5 inhibitor. PDE-5 is an enzyme found in the smooth muscles of the corpora cavernosa and vessels of internal organs, in skeletal muscles, platelets, kidneys, lungs and cerebellum. The effect of tadalafil on PDE-5 is 10,000 times higher than its effect on other types of PDE (PDE-1, PDE-2, PDE-4 and PDE-7). Tadalafil is 10,000 times more active in blocking PDE-5 than PDE-3, an enzyme found in the heart and blood vessels.This selectivity for PDE-5 over PDE-3 is important, since PDE-3 is an enzyme involved in cardiac muscle contraction. In addition, tadalafil is about 700 times more active against PDE-5 than against PDE-6, an enzyme found in the retina and responsible for phototransduction. Tadalafil also exhibits 9000 times more powerful effect on PDE-5 compared to its effect on PDE-8, PDE-9 and PDE-10, and also 14 times more than PDE-11.

Tissue distribution and physiological effects of PDE-8 and PDE-11 were not determined.

Tadalafil does not affect the perception of colors (blue / green), which is explained by its low affinity for PDE-6 compared to PDE-5. In addition, no effect of tadalafil on visual acuity, electroretinogram, intraocular pressure and pupil size was noted.

For 2.5 mg, 5 mg tablets: Rarely (<0.1%) reported changes in color perception in all studies.

Three clinical studies were conducted with the participation of 1504 patients in order to identify the period of the onset of the effect of Cialis, which demonstrated a statistically confirmed improvement in erectile function.Cialis acts for 36 hours. The effect appears within 16 minutes after taking a dose in the presence of sexual arousal.

Tadalafil in healthy individuals does not cause significant changes in systolic and diastolic blood pressure compared to placebo in the supine position (the average maximum decrease is 1.6 / 0.8 mm Hg) and in the standing position (the average maximum decrease is 0.2 / 4.6 mmHg). Tadalafil does not cause a significant change in heart rate. Significant changes were observed in patients who also took nitrates.

A placebo-controlled study of the effect on spermatogenesis of taking tadalafil for 6 months did not reveal a clinically significant effect of the drug on sperm characteristics (number, motility and structure of sperm). For tablets of 2.5 mg, 5 mg: taking tadalafil did not affect the level of testosterone, LH and FSH in the blood.

Tadalafil at doses of 2.5 mg and 5 mg at a dose of 1 time per day was evaluated in 3 clinical studies, including 853 patients of different ages (from 21 to 82 years) and ethnic group, with erectile dysfunction of varying severity (mild, moderate , severe) and of different etiology.Most patients used to take PDE5 inhibitors as needed. In 2 primary efficacy studies, the success rate was 57% and 67% for Cialis 5 mg, 50% for Cialis 2.5 mg compared to 31 and 37% for placebo. In studies in patients with secondary erectile dysfunction in relation to diabetes, the success rate was 41 and 46% for Cialis 5 mg and 2.5 mg, respectively, compared with 28% for placebo.

Pharmacokinetics. Suction .After oral administration, tadalafil is rapidly absorbed. Average C _max in blood plasma is achieved on average 2 hours after oral administration.

The speed and degree of absorption of tadalafil do not depend on food intake, so the drug can be taken regardless of food. The time of intake (morning or evening) does not significantly affect the rate and extent of absorption.

Distribution . The average volume of distribution is about 63 liters. At therapeutic concentrations, 94% of tadalafil binds to blood plasma proteins.

In healthy individuals, <0.0005% of the administered dose is detected in semen.

Metabolism . Tadalafil is mainly metabolized with the participation of the isoenzyme CYP 3A4 of cytochrome P450. The main circulating metabolite is methylcatechol glucuronide. This metabolite is 13,000 times less active against PDE-5 than tadalafil. Therefore, it can be assumed that this metabolite is not clinically significant at the determined concentrations.

Derivation .In healthy individuals, the average T _½ – 17.5 hours Tadalafil is excreted mainly in the form of inactive metabolites, mainly in the feces (about 61% of the dose) and to a lesser extent in the urine (about 36% of the dose).

Tablets of 2.5 mg and 5 mg

The clearance of oral tadalafil is 2.5 l / h.

The pharmacokinetics of tadalafil in healthy subjects are linearly proportional to time and dose. Increasing the dose from 2.5 mg to 20 mg, exposure (AUC) increases in proportion to the dose.A constant concentration in blood plasma is achieved within 5 days after a single dose.

Pharmacokinetics of the drug is the same both in patients with erectile dysfunction and without.

Selected patient groups . In healthy elderly people (≥65 years), there was a lower clearance of tadalafil when taking the drug orally, which was expressed in an increase in AUC by 25% compared to healthy individuals aged 19–45 years. This difference is not clinically significant and does not require dose adjustment.

Renal failure . For 2.5 mg and 5 mg tablets: In studies using a single dose of tadalafil (5-20 mg), the exposure of tadalafil AUC almost doubled in subjects with mild (creatinine clearance – 51 to 80 ml / min) or moderate (creatinine clearance – from 31 to 50 ml / min) renal failure, also in subjects with the last stage of renal disease on dialysis.

For 20 mg tablets: in subjects with renal insufficiency, including patients on hemodialysis, the exposure of tadalafil AUC was higher than in healthy subjects.

Liver failure . The exposure of tadalafil (according to the AUC value) in patients with mild to moderate hepatic impairment is comparable to that in healthy individuals. There are no data on the pharmacokinetics of tadalafil in severe hepatic impairment.

In patients with diabetes mellitus while using tadalafil, its exposure (AUC) was approximately 19% less than the AUC value in healthy individuals. This difference in exposure does not require dose adjustment.

erectile dysfunction treatment.The drug is effective in the presence of sexual stimulation.

should be taken internally by adults (men), regardless of food intake.

Tablets of 2.5 mg and 5 mg

The drug should be taken at least 30 minutes before anticipated sexual activity.

The effectiveness of tadalafil can persist for 36 hours after taking the drug.

Adult men: The usual recommended dose is 10 mg. In patients in whom tadalafil at a dose of 10 mg does not give an adequate effect, it is advisable to use 20 mg.The maximum recommended frequency of admission is 1 time per day.

Tadalafil at a dose of 10 mg and 20 mg is prescribed for use before the intended sexual activity and is not recommended for continuous daily use.

In patients planning frequent use of Cialis (at least 2 times a week), it may be advisable to take the drug daily in a low dose, based on the patient’s choice and the doctor’s decision.

For daily use, the recommended dose is 5 mg / day at approximately the same time.The dose may be reduced to 2.5 mg once a day, depending on individual tolerance.

The feasibility of long-term daily use should be periodically re-evaluated.

Elderly patients. No dosage correction required.

Patients with impaired renal function. No dosage adjustment is required in patients with mild or moderate renal impairment. For patients with severe renal impairment, the maximum recommended dose is 10 mg; daily use is not recommended.

Patients with impaired liver function. The recommended dose of Cialis is 10 mg, which should be used before the intended sexual activity, regardless of food intake. Clinical data on the safety of Cialis in patients with severe hepatic impairment (Child-Pugh class C) are limited, so the doctor must carefully and individually assess the benefits / risks of therapy. There are no data on the use of tadalafil at a dose above 10 mg in patients with liver damage.Taking a single dose once a day has not been evaluated in patients with impaired liver function, therefore, the physician must carefully and individually assess the benefits / risks of this therapy.

Patients with diabetes mellitus: no dosage adjustment required.

20 mg tablets

The recommended dose is 20 mg before anticipated sexual activity. The drug can be taken 16 minutes before sexual activity. The effectiveness of tadalafil can persist for up to 36 hours after taking a dose.

The maximum recommended frequency of admission is 1 time per day.

Elderly patients. No dosage correction required.

Patients with impaired renal function. No dosage adjustment is required in patients with mild or moderate renal impairment. For patients with severe renal impairment, the maximum recommended dose is 10 mg; daily use is not recommended.

Patients with impaired liver function. The recommended dose of Cialis is 10 mg, which should be used before the intended sexual activity, regardless of food intake. Clinical data on the safety of Cialis in patients with severe hepatic impairment (Child-Pugh class C) are limited, so the doctor must carefully and individually assess the benefits / risks of therapy. There are no data on the use of tadalafil in doses above 10 mg in patients with impaired liver function.

hypersensitivity to tadalafil or other components of the drug; simultaneous use of organic nitrates in any dosage form.

The drug is not used in men with heart disease, for whom sexual activity is contraindicated. Physicians should consider the potential cardiac risk of sexual activity for patients with cardiovascular disease.

The following groups of patients with cardiovascular diseases were not included in clinical trials, therefore the use of tadalafil is contraindicated in them:

• patients with myocardial infarction within the last 90 days;
• patients with unstable angina pectoris or angina pectoris occurring during intercourse;
• patients with heart failure, which corresponds to the II class or higher according to the NYHA classification, during the last 6 months;
• patients with uncontrolled arrhythmias, arterial hypotension (<90/50 mm Hg) or uncontrolled hypertension;
• patients after a stroke that occurred within the last 6 months.

The drug is contraindicated in patients with vision loss in one eye as a result of non-arterial anterior ischemic optic neuropathy (NAPION), regardless of whether it was associated with a previous effect of PDE-5 inhibitors.

Tablets 20 mg: Cialis should not be used in patients under the age of 18 years.

Tablets of 2.5 and 5 mg

The most frequently reported adverse events were headache and dyspepsia.Adverse reactions were short-term, mild to moderate.

Data on adverse reactions in patients over 75 years of age are limited.

The following are data on adverse reactions recorded during clinical studies among patients who used tadalafil as needed and daily, as well as data obtained as a result of post-marketing surveillance among patients who used Cialis as needed.

A slightly higher prevalence of ECG abnormalities, primarily sinus bradycardia, was recorded in patients who received tadalafil 1 time per day, compared with placebo.Most of these ECG abnormalities were not associated with adverse reactions.

20 mg tablets

The most frequently reported adverse events are headache and dyspepsia (≥10%).

Below is a table that contains data on adverse reactions that were obtained in placebo-controlled clinical trials and post-marketing observations.

¹ Most patients with these side effects previously had cardiovascular risk factors.

² Sudden hearing loss or loss has been reported in a small number of cases, all associated with the use of PDE5 inhibitors, including tadalafil.

³ Adverse reactions from post-marketing studies that were not detected in placebo-controlled clinical trials.

Description of selected adverse reactions. A slightly higher incidence of ECG abnormalities, primarily sinus bradycardia, was reported in patients who received tadalafil 1 time per day compared with placebo.Most of these ECG abnormalities were not associated with the manifestation of adverse reactions.

Tablets of 2.5 and 5 mg

Erectile dysfunction assessment should include identification of potential underlying causes and identification of an appropriate course of treatment after appropriate medical determination.

Before starting any treatment for erectile dysfunction, physicians should consider the cardiovascular system of patients, since there is a certain degree of cardiac risk associated with sexual activity.Tadalafil has an effect on vasodilation, which can lead to a mild and transient decrease in blood pressure and thus enhance the hypotensive effect of nitrates.

In patients concurrently using antihypertensive drugs, tadalafil can cause a decrease in blood pressure. In the case of starting the daily use of tadalafil, measures should be taken regarding the possible adjustment of the dose of antihypertensive therapy.

Serious cardiovascular events, including myocardial infarction, sudden cardiac death, unstable angina pectoris, ventricular arrhythmias, stroke, transient ischemic attacks, chest pain, irregular heartbeat, and tachycardia have been reported in post-marketing and / or clinical trials.The majority of patients with similar cases reported previously had cardiovascular risk factors. However, it is impossible to conclusively determine whether these cases are directly related to risk factors, the use of Cialis, sexual activity, or a combination of both.

Visual defects and cases of NAPION have been associated with the use of tadalafil and other PDE5 inhibitors. The doctor should warn the patient about the need to stop using tadalafil and seek medical attention in case of sudden loss of vision.

Due to the increased exposure to tadalafil (AUC), limited clinical experience and lack of ability to influence dialysis clearance, daily use of tadalafil is not recommended in patients with severe renal impairment.

Given the lack of data on the use of tadalafil in patients with severely impaired liver function (Child-Pugh class C), tadalafil is prescribed with caution to persons in this group. The use of the drug on a daily basis has not been thoroughly investigated in patients with hepatic impairment.Before prescribing Cialis, the doctor must carefully individually assess the benefits / risks of this therapy.

Patients who have erections lasting 4 hours or more should be advised to seek medical attention. If priapism is not treated immediately, it can lead to damage to the tissues of the penis and a prolonged loss of potency.

Care should be taken to prescribe tadalafil to patients with conditions that may cause a tendency to priapism (such as sickle cell anemia, myeloma or leukemia), or to patients with anatomical deformities of the penis (such as angular distortion, cavernous fibrosis or Peyronie’s disease).

Evaluation of erectile dysfunction should include identification of underlying potential causes and determination of appropriate therapy after appropriate medical evaluation. It is not known whether Cialis is effective in patients undergoing pelvic surgery or radical nerve-sparing prostatectomy.

In some patients, the simultaneous use of tadalafil and blockers of α ₁ -adrenergic receptors can lead to symptomatic arterial hypotension.The combination of tadalafil and doxazosin is not recommended.

Care should be taken to prescribe tadalafil to patients using CYP 3A4 inhibitors (ritonavir, saquinavir, ketoconazole, itraconazole, erythromycin), since an increase in the AUC of tadalafil was noted with the simultaneous use of these drugs.

The safety and efficacy of the combination of tadalafil and other drugs for the treatment of erectile dysfunction have not been studied. Therefore, this combination is not recommended.

The drug contains lactose monohydrate, therefore, patients with rare hereditary forms of galactose intolerance, lactase deficiency or glucose-galactase malabsorption syndrome should not use the drug.

20 mg tablets

Evaluation of erectile dysfunction includes determining its root cause and the appropriateness of the course of treatment. Before starting any treatment for erectile dysfunction, the doctor should assess the patient’s cardiovascular system, since there is a certain degree of risk associated with sexual activity.

It is not known whether Cialis is effective in patients undergoing pelvic surgery or radical prostatectomy without nerve preservation.

Cases of visual impairment and NAPION have been reported during the use of Cialis and other PDE-5 inhibitors. The doctor should warn the patient about the need to stop using tadalafil and seek medical attention in case of sudden loss of vision.

The patient should also be warned about a significant increase in the risk of developing NAPION, if in the anamnesis he had instructions about the transferred NAPION.

Patients who have erections lasting 4 hours or more should be advised to seek immediate medical attention.Late treatment of priapism leads to damage to the tissues of the penis with the onset of prolonged impotence.

Cialis should be used with caution in patients with a predisposition to priapism (for example, with sickle cell anemia, multiple myeloma or leukemia) or in people with deformity of the penis (for example, with angular curvature, cavernous fibrosis or Peyronie’s disease).

Data on the safety of a single dose of Cialis in patients with severe hepatic impairment (Child-Pugh class C) are limited.When prescribing Cialis, such patients require careful clinical evaluation.

It is necessary to prescribe Cialis with caution to patients taking α-adrenergic blockers ₁ -adrenergic receptors, since in some cases the simultaneous administration of these drugs can lead to symptomatic hypotension. Combination of use with doxazosin is not recommended.

Care should be taken to prescribe Cialis to patients receiving treatment with strong inhibitors of CYP 3A4 (ritonavir, saquinavir, ketoconazole, itraconazole, erythromycin), since there was an increase in the AUC concentration of tadalafil with the simultaneous use of these drugs.

The safety and efficacy of a combination of Cialis and other PDE-5 inhibitors or other drugs for the treatment of erectile dysfunction have not been studied. Therefore, it is necessary to inform patients that it is impossible to take Cialis in such combinations. Like other PDE-5 inhibitors, tadalafil is capable of exerting a systemic vasodilator effect, which can lead to a transient decrease in blood pressure. Therefore, before starting treatment, the doctor should assess the patient’s propensity to adverse vasodilatory effects.

The drug should not be prescribed to patients with rare hereditary forms of galactose intolerance, glucose-galactase malabsorption syndrome and Lapp lactase deficiency due to the content of lactose monohydrate.

Application in during pregnancy and breastfeeding

Cialis is not indicated for use in women. Research data on the use of tadalafil in pregnant women are limited.

Children. The use of the drug is not recommended for persons under the age of 18.

Ability to influence reaction speed when driving vehicles or working with other mechanisms

Tablets of 2.5 and 5 mg. No studies have been carried out on the ability of Cialis to influence the reaction rate when driving or working with other mechanisms.

Tablets of 20 mg. No studies have been conducted on the ability of Cialis to influence the reaction rate when driving or operating other mechanisms.Despite the fact that the incidence of dizziness in clinical trials with placebo and in clinical trials with tadalafil was similar, patients should know how tadalafil affects them before driving or operating other mechanisms.

it is not expected that tadalafil will have clinically significant inhibition or induction of the clearance of drugs, the metabolism of which occurs with the participation of the cytochrome P450 isoenzyme.The results of the study confirmed that tadalafil does not inhibit or induce isoenzymes CYP 3A4, CYP 1A2, CYP 2D6, CYP 2C19, CYP 2E1 and CYP 2C9.

Effect of other substances on tadalafil

Tadalafil is mainly metabolized with the participation of the CYP 3A4 enzyme. Selective inhibitor of CYP 3A4 ketoconazole, when taken at a dose of 400 mg / day, increases the AUC of tadalafil (20 mg) by 312%, increases C _max in blood plasma by 22%, and ketoconazole (200 mg daily) increases the AUC of one dose of tadalafil (10 mg) by 107% and C _max by 15% relative to the AUC and C _max values ​​of one tadalafil.

Ritonavir

For tablets of 2.5 and 5 mg: an inhibitor of CYP 3A4, 2C9, 2C19 and 2D6 at a dose of 200 mg 2 times a day increases the AUC of tadalafil after a single dose by 124%, without changing the C _max in the blood. Despite the fact that specific interactions have not been studied, it can be assumed that other HIV protease inhibitors, such as saquinavir and others, as well as CYP 3A4 inhibitors, such as erythromycin and itraconazole, increase plasma levels of tadalafil.

For tablets of 20 mg: an inhibitor of CYP 3A4, 2C9, 2C19 and 2D6 at a dose of 200 mg 2 times a day increases the AUC of tadalafil after a single dose by 124%, without changing the C _max in the blood.Although specific interactions have not been studied, it can be assumed that protease inhibitors such as saquinavir, as well as CYP 3A4 inhibitors such as erythromycin, clarithromycin, itraconazole and grapefruit juice, increase plasma levels of tadalafil.

For tablets of 2.5 and 5 mg: reduced exposure of tadalafil is expected when combined with rifampicin, which reduces the effectiveness of the daily dose of tadalafil, the magnitude of the reduction is unknown. It is possible that the combined use of tadalafil with other inducers of CYP 3A4 will also cause a decrease in the concentration of tadalafil in the blood plasma.

For tablets of 20 mg: the selective inducer of CYP 3A4 rifampicin (600 mg / day) reduces the AUC value with a single use of tadalafil by 88% and C _max – by 46% compared to the AUC and C _max values ​​only for one tadalafil (10 mg). It can be expected that such a decrease in concentration will lead to a decrease in the effectiveness of tadalafil.

It can be expected that the simultaneous use of other inducers of CYP 3A4, such as phenobarbital, phenytoin, carbamazepine, will also reduce the concentration of tadalafil in the blood plasma.

Effect of tadalafil on other medicinal products

Antihypertensive drugs

For tablets of 2.5 and 5 mg: tadalafil has a systemic vasodilating effect, which can potentiate the antihypertensive effect of antihypertensive drugs. In addition, in patients with poorly controlled hypertension, taking several antihypertensive drugs at the same time, a more significant decrease in blood pressure is possible. In most patients, a decrease in blood pressure is not accompanied by symptoms of hypotension.Individuals receiving treatment with antihypertensive drugs and taking tadalafil should be given appropriate clinical guidelines.

For 20 mg tablets: tadalafil has a systemic vasodilating effect, which can potentiate the hypotensive effect of antihypertensive drugs (calcium channel blockers, ACE inhibitors, β-adrenergic receptor blockers, thiazide diuretics and angiotensin II receptor blockers, alone and in combination with thiazide blockers calcium channels, blockers of β-adrenergic receptors and / or blockers of α-adrenergic receptors.In addition, in patients with poorly controlled hypertension, taking several antihypertensive drugs at the same time (up to 4), a more significant decrease in blood pressure is possible. In most patients, a decrease in blood pressure is not accompanied by symptoms of hypotension. Individuals receiving treatment with antihypertensive drugs and taking tadalafil should be given appropriate clinical guidelines.

Blockers of α-adrenergic receptors

For tablets of 2.5 and 5 mg: there was no significant decrease in blood pressure in patients taking simultaneously tadalafil and a selective α blocker ₁ -adrenergic receptors tamsulosin.

When using tadalafil in healthy volunteers who took the α ₁ α-adrenergic receptor blocker doxazosin at a dose of 4–8 mg / day, a significant increase in the hypotensive effect was noted. The effect lasts up to 12 hours and can be symptomatic, including loss of consciousness. This combination is not recommended.

The number of patients with potentially clinically significant reductions in blood pressure was higher with the combination of drugs. Dizziness was noted in some patients.

For tablets of 20 mg: there was no significant decrease in blood pressure in patients taking simultaneously tadalafil and a selective α-blocker ₁ -adrenergic receptors tamsulosin.

Alcohol. Tadalafil did not affect the concentration of ethanol, and ethanol did not affect the concentration of tadalafil. While taking ethanol in high doses (0.7 g / kg body weight), concomitant administration of tadalafil did not lead to a statistically significant decrease in blood pressure. In some patients, postural dizziness and orthostatic hypotension were noted.The use of tadalafil against the background of ethanol in lower doses (0.6 g / kg) did not cause the development of arterial hypotension, and dizziness was detected with the same frequency as with the use of alcohol alone.

N ₂ antagonists. An increase in gastric pH as a result of the use of a blocker H ₂ -receptors of nizatidine did not affect the pharmacokinetics of tadalafil.

Antacids (magnesium hydroxide / aluminum hydroxide). Simultaneous administration of antacids (magnesium hydroxide / aluminum hydroxide) with tadalafil reduces the rate of its absorption without changing the exposure of tadalafil AUC.

Acetylsalicylic acid. Tadalafil does not increase the duration of bleeding while taking acetylsalicylic acid.

Warfarin. Tadalafil has no clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin and does not affect the prothrombin time induced by warfarin.

Theophylline

For tablets of 2.5 and 5 mg: tadalafil has no clinically significant effect on the pharmacokinetics or pharmacodynamics of theophylline.

For tablets of 20 mg: when taking tadalafil (10 mg) with theophylline, no pharmacokinetic interaction was detected. The only insignificant pharmacodynamic effect was increased heart rate. It is necessary to take into account the occurrence of this effect with the simultaneous use of tadalafil with theophylline, despite the fact that this effect has no clinical significance.

For 20 mg tablets: ethinyl estradiol. Tadalafil increased the bioavailability of oral dosage forms with ethinyl estradiol.A similar increase in bioavailability can be expected when combined with terbutaline, although the clinical consequences of this combination are unknown.

For tablets of 20 mg: specific studies of the interaction of tadalafil with antidiabetic drugs have not been carried out.

Incompatibility. Tadalafil is contraindicated in patients using organic nitrates in any dosage form.

symptoms : with a single use of tadalafil in healthy individuals at a dose of up to 500 mg and patients with erectile dysfunction – repeatedly up to 100 mg / day – side effects were the same as when used at lower doses. Treatment : In case of overdose, standard symptomatic treatment is necessary. With hemodialysis, tadalafil is excreted slightly.

tablets of 2.5 and 5 mg: in their original packaging at a temperature not exceeding 30 ° C.

Tablets of 20 mg: in original packaging at temperatures below 30 ° C.

Cialis is a relatively new drug for the treatment of erectile dysfunction – the first publications concerning the experience of its clinical use appeared only in 2001.(Padma-Nathan H., 2001). In recent years, active research has been carried out on its effectiveness, side effects, advantages and disadvantages, as well as other possibilities of its use are being analyzed.

Mechanism of action

Cialis

The action of Cialis is based on the therapeutic effects of tadalafil, a specific reversible inhibitor of phosphodiesterase type 5 (PDE-5). Phosphodiesterases are a superfamily of enzymes that inactivate cAMP and cGFM.These two substances are secondary transmitters in reactions with prostacyclin or nitric oxide. The rationale for its clinical use is the property of PDE-5 inhibitors to express the oxide pathway through inhibition of cGMP hydrolysis. An increase in the concentration of the latter has vasodilating, antiproliferative and proapoptotic effects. The ability of the drug to directly improve the contractile function of the right ventricle has also been proven (Beltrán-Gámez M.E., 2015).

The mechanism of its main effect can be described as follows.Due to sexual stimulation, a large amount of nitric oxide is locally released in the tissues of the external genital organs (latent phase). In parallel with this, due to the inhibition of PDE-5 by tadalafil, the level of c-GMF in the cavernous body of the penis increases. This promotes relaxation of smooth muscle structures and blood flow to the tissues, due to which there is an erection (the phase of tumenescence) sufficient for sexual intercourse (instruction of the Ministry of Health of Ukraine).

Indications and method of application

Of course, the main and most widely known indication for the use of Cialis is erectile dysfunction.For one-off episodes of sexual activity, it is optimal to take the drug “on demand” (Bansal U.K., 2018). In this case, the patient is recommended a single dose of 10 mg, which is taken at least 30 minutes before sexual activity (although the initial therapeutic effect begins already 16 minutes after oral administration). If the effect of the indicated dose is insufficient, then a single dose can be doubled. The drug is taken 1 r / day, with repeated intercourse during the day, repeated administration of the drug is not required.

If a man is expected to frequently use Cialis (with an interval of no more than 2-3 days), then a systematic daily intake of the drug at a dose of 5 mg would be more rational (Peng Z., 2017). If the indicated dose contributes to the development of a pronounced therapeutic effect, then the daily dose can be individually reduced to 2.5 mg (Brock G., 2016).

First of all Cialis is relevant for the treatment of erectile dysfunction of vascular origin.However, it also has a positive therapeutic effect in psychogenic erectile dysfunction (Li G., 2017), as well as in neurogenic pathology – the consequences of spinal cord injury (García-Perdomo H.A., 2017).

PDE-5 inhibitors are effective for treating erectile dysfunction, even if it develops as a result of radical or extended prostatectomy. These operations are performed for prostate cancer and the technique usually requires transection of the pudendal nerve, which provides the somatic innervation of the penis.Quality of life studies show that erectile function is better restored with the systematic use of the drug, rather than when it is used on demand (Qui Sh., 2016). A similar effect is observed after radiotherapy – Cialis effectively helps with erectile dysfunction that has arisen as a result of one or more courses of brachytherapy (a method of treatment in which a radiation source in a capsule is inserted directly into the tissue of the affected organ) (Incrocci L., 2007).

When choosing a drug for the treatment of erectile dysfunction, it is necessary to clearly understand that taking Cialis cannot be equated with obtaining a stable erection without additional stimulation. It only improves a man’s response to sexual stimulation. The drug does not affect sexual desire, therefore it cannot be recommended for use in women (instructions of the Ministry of Health of Ukraine), however, today studies are underway on the possibility of using tadalafil to improve the quality of sexual life in women during the menopausal period (Borghi C., 2017). If the drug does not bring the expected effect to the man, it is necessary to carefully collect an anamnesis – he may have previously used stimulating dietary supplements to which tadalafil or other PDE-5 inhibitors are added uncontrollably (Park HN, 2017), sometimes even in doses significantly exceeding the content of the active substance in the original preparation.

Regular or one-time intake Cialis does not require correction of insulin dose in patients with diabetes mellitus, and also does not affect alcohol tolerance.

Other clinical applications

Cialis

The Canadian Drug Expert Committee in 2015 published a recommendation to use tadalafil for initial therapy in pulmonary arterial hypertension of II or III functional class. A post-marketing study in Japan (Yamazaki H., 2017) demonstrated the safety of long-term use of the drug (2 years or more) for the treatment of this pathology. The use of drugs of the PDE-5 inhibitor group has a relatively short history.The FDA recommendation for the use of the first representative of this group – sildenafil – for the treatment of pulmonary hypertension appeared relatively recently, only in 2005, while tadalafil was approved four years later – in 2009 (Beltrán-Gámez M.E., 2015).

There is also information about the possibility of using the drug to eliminate pulmonary edema in altitude sickness (Leshem E., 2012). This is a specific disease of climbers, which occurs due to a significant pressure drop and oxygen level in the air for a short period of time.Mountain sickness is an extremely severe acute pathological process and can even be fatal if a person is not evacuated to a lower altitude. Therefore, it is important to understand that Cialis is not a remedy for the treatment of pulmonary edema in this situation, and even more so does not allow you to continue climbing. But it can be successfully used as a first aid.

In our time, the possibilities of using tadalafil-containing drugs for the treatment of complications of hypertension are being studied.Tadalafil has a positive effect on the rigidity of the arterial bed in the absence of pronounced atherosclerotic changes, as well as on the diastolic function of the left ventricle (Özdabakoğlu O., 2016).

There is a large amount of information on the treatment of benign prostatic hyperplasia with drugs containing tadalafil. It is noted that the maximum therapeutic effect is achieved when PDE-5 inhibitors are combined with tamsulosin (Pattanaik S., 2019). The drug not only improves oxygenation of the glandular tissue, but also promotes relaxation of the smooth muscles of the bladder neck around the prostate gland, reduces the severity of inflammation, improves pelvic blood flow and afferent transmission of nerve impulses (Fukumoto K., 2016). Thus, tadalafil significantly alleviates the symptoms of chronic pelvic pain in men (Nishino Y., 2017).

It has also been proved (Tan P., 2017) that long-term use of PDE-5 inhibitors promotes a moderate increase in sperm motility and an improvement in their morphological characteristics in men with infertility. However, the official instructions indicate that Cialis helps to reduce the concentration of spermatozoa in the ejaculate (possibly by thinning the mucous fraction).

The use of tadalafil for the prevention of osteoporosis in women who, for one reason or another, underwent bilateral oophorectomy (Hamit H.A., 2017), that is, underwent surgical castration, can also be considered promising. In such a situation, hormonal changes do not occur smoothly, as with menopause, but at the same time, therefore, they are much more difficult to tolerate.

The literature describes the experience of using tadalafil for the treatment of intrauterine growth retardation (Kubo M., 2016). The drug reduces the severity of fetal distress syndrome and modulates the processes of intrauterine development. However, in the official instruction Cialis pregnancy is considered a contraindication to the use of this drug.

In an experiment on rats, the nephroprotective properties of tadalafil have been proven – it is able to protect the renal tissue and reduce the level of pro-inflammatory cytokines in case of short-term renal ischemia followed by its reperfusion (Medeiros V.F., 2017). The nephroprotective properties of tadalafil can be used to treat contrast-induced nephropathy – a kind of damage to the renal parenchyma with drugs for radiopaque or MR-contrast studies (Abassi Z., 2015).

In addition, a positive effect was recorded from the use of tadalafil in a simulated multiple organ failure syndrome (Oliveira G.G., 2017). It significantly reduces the severity of damage to internal organs both during ischemia and during reperfusion.However, to date, these properties have not found clinical use. This can be explained by the fact that tadalafil, both in the original and in generic preparations, is presented exclusively in tablet form, which cannot be used in intensive care – due to the peculiarities of the clinical situation, parenteral administration is preferred. From the experiments described, the only practical recommendation at the moment can be made – Cialis can be used in a complex of preoperative preparation for extensive interventions in which significant surgical trauma is expected.

Peculiarities of application and side effects

The available literature reports on the possibility of partial loss of vision after using Cialis (Bella A.J., 2006). This phenomenon has been associated with a specific condition called non-arterial ischemic optic neuropathy. To date, it has not been proven that the drug is the direct cause of a violation of the blood supply to the optic nerve, however, its uncontrolled use can become a trigger for the development of such pathological processes.

There are also separate reports of reversible hearing loss associated with the intake of Cialis (Wester J.L., 2018). The symptomatology of hearing loss (preceding tinnitus) indicates the neurological genesis of the pathology. In this case, the pathogenesis of the disease is presumably similar to the neuropathy of the optic nerve described above.

Regular use of tadalafil can lead to spontaneous migration of calculi from the distal urinary tract (Bai Y., 2017), which will be accompanied by unpleasant sensations of varying severity, similar to the symptoms of renal colic.

Patients who use high doses of PDE-5 inhibitors at one time often report a specific side effect – an urge to defecate. This phenomenon is not considered to be significant from a medical point of view, however, those who take the drug for the first time should take into account such phenomena.

Priapism is a rare side effect of taking Cialis , since an erection does not occur spontaneously, but only after sexual stimulation.However, if the patient has penile deformities (congenital or traumatic in origin) or Peyronie’s disease (fibrous degeneration of the tissue of the corpora cavernosa), then it is possible to develop a persistent painful erection even after sexual intercourse. In this case, you need to urgently seek medical help (instructions from the Ministry of Health of Ukraine).

The aforementioned side reactions cause some discomfort when using Cialis , so a comparative analysis of PDE-5 inhibitors has arisen.As a result of the meta-analysis (Gong B., 2017), it was found that tadalafil is similar to sildenafil in terms of the rate of onset of the therapeutic effect, its severity and duration. However, sildenafil is significantly inferior to tadalafil when considering the frequency of side effects.

Date added: 01.10.2021

Cialis instructions for use: indications, contraindications, side effects – description of Cialis tab., Cover. film coating, 5 mg: 14 or 28 pcs. (30057)

An agent for the treatment of erectile dysfunction, is a reversible selective inhibitor of specific PDE5 cGMP.When sexual arousal induces a local release of nitric oxide, inhibition of PDE5 by tadalafil leads to an increase in cGMP levels in the corpus cavernosum of the penis. The consequence of this is the relaxation of the smooth muscles of the arteries and the flow of blood to the tissues of the penis, which causes an erection. Tadalafil is ineffective in the absence of sexual stimulation.

In vitro studies have shown that tadalafil is a selective PDE5 inhibitor. PDE5 is an enzyme found in the smooth muscles of the corpora cavernosa, in the smooth muscles of the vessels of the internal organs, in skeletal muscles, platelets, kidneys, lungs, and cerebellum.

The effect of tadalafil on PDE5 is more active than on other phosphodiesterases. Tadalafil is 10,000 times more active against PDE5 than against PDE1, PDE2, PDE4, which are localized in the heart, brain, blood vessels, liver and other organs. Tadalafil is 10,000 times more active in blocking PDE5 than PDE3, an enzyme found in the heart and blood vessels. This selectivity for PDE5 over PDE3 is important because PDE3 is an enzyme involved in cardiac muscle contraction.In addition, tadalafil is approximately 700 times more active against PDE5 than against PDE6, which is found in the retina and is responsible for phototransmission. Tadalafil is also 10,000 times more active against PDE5 compared to its effect on PDE7-PDE10.

Acts within 36 hours. The effect appears within 16 minutes after ingestion in the presence of sexual arousal.

Tadalafil in healthy individuals does not cause significant changes in systolic and diastolic pressure, compared with placebo in the supine position (the average maximum decrease is 1.6 / 0.8 mm Hg respectively) and standing (the average maximum decrease is 0.2 / 4.6 mm Hg, respectively). Tadalafil does not cause a significant change in heart rate.

Tadalafil does not cause changes in color recognition (blue / green), which is explained by its low affinity for PDE6. In addition, no effect of tadalafil on visual acuity, electroretinogram, intraocular pressure and pupil size was noted.

There was no clinically significant effect on sperm characteristics in men who took tadalafil in daily doses for 6 months.

Cialis drug for impotence – an effective and economical way to solve the problem

Cialis drug against impotence – an effective and economical way to solve the problem

It is well known that impotence is now a widespread disease, and, therefore, the problem of its elimination is now very urgent … In this regard, a variety of methods for treating this disease and a variety of pharmaceuticals have been developed. One of the most effective ways to cure the mentioned disease is considered to be the use of Cialis.

Principle of drug action

Cialis is a powerful inhibitor designed to relax the smooth muscles of the penis that form the main bodies in it. This is done due to the fact that the drug in question expands the vessels and blood fills the corpora cavernosa, which leads to the appearance of blood pressure in it. At the end of intercourse due to the action of enzymes, the erection stops.

Features of action

Cialis is a drug designed to restore sexual relations in general, namely to treat erectile dysfunction.Moreover, by using the considered medical device, due to its reliability and high efficiency, it is possible to completely eliminate erectile dysfunction without professional medical intervention, which, of course, can be considered as one of the main positive qualities of this drug. In addition, Cialis is easy to use, which is just as important.

Another significant advantage in terms of the functioning of the drug in question is that the effect of its action occurs only with the manifestation of sexual desire.This determines the basic rule that must be taken into account in the process of using Cialis, which is that taking pills should be carried out only in a state of arousal, that is, if there is a desire to have sexual intercourse. In this case, the action of the drug will be most effective, and the effect of it will be observed throughout the entire continuation of sexual intercourse. If this condition is not observed, the drug may not work and the desired effect will not occur. In other words, Cialis functions only when necessary, and not constantly, as a result of which this drug cannot be considered as a normal stimulant.This is its significant advantage over other medicines of a similar purpose.

Method of taking Cialis

The tablets should be taken no more often than once a day and no less than 15 minutes before the expected proximity. The manufacturer considers such a frequency of taking his product to be quite sufficient for the full sexual functioning of the body. The action of the drug is 36 hours.

Contraindications

The drug in question is suitable for men who have problems with sexual activity, who need stimulation with drugs like Cialis to maintain full sexual activity.

However, it should be borne in mind that the use of this drug is recommended only for those of them who are healthy in general, and especially have a healthy heart, in order to avoid further disorders of the working capacity of both the heart and the whole body, which Cialis may cause.

General assessment of the preparation

At the end of the article, the main positive and negative qualities of Cialis should be cited.

The parameters of the drug belonging to the first category include the following:

– its effect is manifested only at the right time;

– an erection achieved with the use of this remedy continues stably throughout the duration of sexual intercourse;

– the effect produced by the drug gives its consumer confidence in their sexual capabilities;

– Cialis increases both the pleasure received from the corresponding process and the sensitivity during the orgasm achieved as a result of it;

– pleasant sensations from the action of the drug are experienced not only by its consumer, but also by the partner;

– the effect of the drug, and even more so its result, improves mood;

– Cialis may be useful even for people with severe impotence;

– the drug does not interfere and, on the contrary, promotes conception;

– Cialis is combined with other medicines.

Naturally, it is necessary to take into account the negative qualities of the drug:

– there are some contraindications for people with chronic heart disease;

– Cialis is incompatible with drugs for the treatment of the heart, namely with the nitrites they contain;

– these factors explain the dispensing of the drug by prescription, as well as the need for prior consultation;

– it is unacceptable to exceed the daily dose of 20 mg;

– it is undesirable to take this drug for a long time.

90,000 benefit or harm. Why do Kazakhstani athletes accept it?

Cialis is an effective modern drug for the treatment of manifestations of erectile dysfunction in men. When using it, you can achieve a long and stable erection, which allows for a full sexual intercourse and achieve the satisfaction of both partners.

Composition and properties of the preparation

The product is available in the form of coated tablets containing 20 mg of tadalafil and a certain amount of excipients.The tablets are packaged in blisters, packed in cardboard boxes. You can profitably buy Cialis in Almaty in our online pharmacy.

The main active ingredient of the drug is tadalafil. It is a reversible selective inhibitor of PDE5 or phosphodiesterase type 5. Under the influence of the drug, nitric oxide is released, which contributes to the expansion of the vessels of the pelvic organs. The congestion of blood to the genitals causes the penis to fill with blood and the appearance of a stable and long-lasting erection.

It is imperative to take into account that the drug itself is not an aphrodisiac, therefore, for the appearance of an erection, appropriate sexual arousal and desire are necessary.

Application of the agent

The drug is used approximately 40-60 minutes before the planned sexual intercourse. The action can occur in as little as a quarter of an hour and last up to 36 hours. During this period, a man can perform repeated full-fledged sexual acts with a minimum break for rest between them.

The maximum daily dosage is 20 mg, that is, 1 tablet every 24 hours. It should not be exceeded in order to avoid the manifestation of negative side effects.

Cialis contraindications

Contraindications for the use of this drug are the following diseases and conditions:

• Allergic reaction to tadalafil or any component of the drug.
• Age under 18 and over 65.
• Female
• History of heart attack and stroke in the last six months.
• Severe damage to the cardiovascular system.
• Severe forms of arterial hypertension.
• Consequences of diabetic retinopathy.
• Simultaneous intake of nitrogen or nitrate donors.

You can buy a medicine at a low price in the pharmacy of our company.

Possible side effects

The drug is generally well tolerated when used correctly. Side effects more often occur in case of an overdose and go away on their own after its reduction or drug withdrawal.It is best to start at 5 mg, increasing the dose as needed. The most common complaints are hot flashes, headache, aches in the back and lower back, dizziness, increased heart rate, and increased blood pressure.

By purchasing this drug in the SportFarm.kz online pharmacy in Kazakhstan, you get a high-quality proven remedy for getting rid of erectile dysfunction.

Source: http://inpushkino.ru/materialy/npr/sialis-polza-ili-vred-pochemu-kazahstanskie-sportsmeny-ego-prinimayut

90,000 Answers to popular questions about Cialis

Before buying the drug, we recommend that you read the detailed information about it.We have prepared answers to frequently asked questions about drug development, effects on the body and rules of use.

What is Generic Cialis?

Generic Cialis is a drug created according to the exact technology of the original, but its cost is several times lower. This is possible due to cost savings at the study stage, since all the necessary processes were carried out by the Cialis manufacturing company. And after the expiration of the patent, another organization can officially use the recipe and release a similar product.

Buy Cialis

What is Cialis Soft?

Cialis Soft is a generic drug, the main advantage of which is a faster onset of the desired effect, compared to regular Cialis. It also has medicinal properties – it improves the functioning of the reproductive system. The remedy is recommended for use even for men with advanced erectile dysfunction.

The advantage of tablets in comparison with analogues is the duration of action. Typically, it is between 24 and 36 hours.During this time, blood flow to the pelvic region increases, which affects the effect.

In the presence of sexual arousal, a man feels a surge of energy and sexual intercourse lasts longer. The drug does not excite, but enhances the natural attraction to the female sex.

Cialis Soft in our pharmacy

How is Cialis different from Viagra?

Viagra and Cialis differ in composition, rules of use, influence on the body and the duration of the effect. The active substance of Viagra is Sildenafil, Cialis is Tadalafil.This is manifested in the different effects of the funds on the body. The main advantages of Cialis:

• Allowed to be taken with food.
• Alcohol does not affect the quality of the effect.
• Time of exposure to the body – 24-36 hours.
• Rarely causes side effects.

Viagra loses in these indicators. The effectiveness of the drug drops sharply if the patient ate food shortly before taking it. Also, the agent is incompatible with alcohol, has a high probability of side effects, and the action time is reduced to 4-5 hours.

How to take Cialis?

It is recommended to consult a doctor before taking the drug. He will take into account the individual properties of the body and prescribe the optimal dosage for each specific case. It is advised to start treatment with 5 mg. The presence of diseases is a reason to reduce the volume or take the remedy less often than usual. Also, Cialis is contraindicated in combination with drugs containing nitrates.

You should not self-medicate and increase the dosage or take pills more often than the specialist has prescribed.After a certain period of admission and repeated consultation without the manifestation of adverse reactions, the doctor, if necessary, will change the appointment. In case of overdose, contact your doctor or call the emergency room.

Cialis tablets are used regardless of food intake. Also, one-time use is practiced immediately before intercourse or regular – every day for a certain period.

The effect is felt already after 15 minutes. However, the peak of exposure occurs after 2 hours.Therefore, it is recommended to take care of the appointment in advance.

The duration of the drug’s effect on the body is 36 hours. During this time, a man will experience an increased level of erection, subject to the presence of sexual arousal.

Which is more effective: Cialis or Levitra?

Cialis and Levitra differ in the level of impact on the body, the duration of the effect and the rules of use. The duration of Cialis is up to 36 hours, Levitra is from 8 to 12 hours.

Levitra is prescribed for men suffering from diabetes mellitus. Cialis is contraindicated in this diagnosis.

The advantage of Cialis is that it is compatible with a small amount of alcohol and fatty foods. Levitra does not possess such a feature – food and alcohol significantly reduce the effect of the remedy.

Which is safer: Cialis, Viagra or Levitra?

All three drugs are designed to increase potency. However, they affect the body in different ways.Cialis differ from Viagra and Levitra in the ability to use it on an ongoing basis. This avoids stressful situations and the occurrence of side processes. Levitra has a milder effect compared to analogues.

According to statistics, Cialis is the safest drug to combat erectile dysfunction. It is completely safe and keeps the result longer.

How does Cialis work?

Cialis is intended for men who suffer from erectile disorders.The effect of the drug on the body is explained by the presence of the tadalafil component in the composition. When sexual arousal occurs, nitric oxide is released. The substance relaxes the arteries of the penis and improves blood flow to the pelvic region. This provokes high-quality erections and increases the duration of intercourse.

However, the drug only works under conditions of sexual arousal.

How often can Cialis be taken?

The daily norm is a dosage of 2.5 mg to 5 mg. This is enough to have quality sex several times a week or be ready for spontaneous circumstances. I advise you to take the medicine in the amount of 10 and 20 mg for a quick onset of the effect and a single erection.

It is not recommended to use the drug more than once a day!

Is the drug compatible with alcohol?

Cialis is one of the few drugs in this category that is allowed when used together with alcohol. However, the amount of alcohol is advised to be reduced.In case of abuse, it is better to refuse to take the medication. However, it all depends on the individual characteristics of the organism, therefore it is recommended to clarify this detail with a doctor.

If a man rarely combines alcohol and Cialis, negative consequences can really be avoided. If combined regularly, there is a high likelihood of side effects. They manifest themselves in a deterioration in physical condition – pain in the muscles, head, dizziness and other negative symptoms.

Marina Epifantseva

Invited expert of the medko pharmacy. Graduated from the Bogomolets National Medical University in 2010. Specializes in the treatment of male infertility.

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects, and when you should contact your healthcare provider.

Trade names: USA

Adcirca; Alyq; Cialis

Trade names: Canada

ACT Tadalafil [DSC]; Adcirca; AG-Tadalafil; APO-Tadalafil; APO-Tadalafil PAH; Auro-Tadalafil; BIO-Tadalafil; Cialis; JAMP-Tadalafil; M-Tadalafil; Mar-Tadalafil; MINT-Tadalafil; MYLAN-Tadalafil; PMS-Tadalafil; Priva-Tadalafil; RAN-Tadalafil; RIVA-Tadalafil; TEVA-Tadalafil

What is this drug used for?

• The drug is indicated for the treatment of erectile dysfunction (ED).
• Used to treat symptoms of an enlarged prostate.
• Used to treat increased pulmonary pressure.
• This medicinal product may be used for other indications. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

For all uses of this product:

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• If you have any of the following health conditions: kidney disease or liver disease.
• If you have certain hereditary eye diseases such as retinal pigmentosa.
• If you have a condition known as veno-occlusive pulmonary disease (VOCD).
• If you have certain type of chest pain (unstable angina).
• If you have any of the following health problems: myocardial infarction in the past 90 days, chest pain during intercourse, heart failure, irregular heartbeats, high or low blood pressure, or a stroke in the past 6 months …
• When taking drugs (called “poppers”) such as amyl nitrite and butyl nitrite.
• If you are taking any of the following drugs: isosorbide dinitrate, isosorbide mononitrate, or nitroglycerin. Do not take these drugs with this drug. You may also need to refrain from taking these drugs for some time after your last dose of this drug.
• If you are taking any of the following drugs: alfuzosin, doxazosin, itraconazole, ketoconazole, prazosin, rifampin, riociguat, ritonavir, silodosin, tamsulosin, or terazosin.
• If you are taking another drug that contains the same drug.
• If you are taking another similar drug to treat erectile dysfunction or increased pressure in the lungs.
• If the patient is a child. This drug is not approved for use in children.

For erectile dysfunction:

• If you have been told that you are not healthy enough to have sex.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any medication or change the dosage without your doctor’s approval.

What do I need to know or do while I am taking this drug?

For all uses of this product:

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid driving or other activities that require increased attention until you can see how this drug affects you.
• To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position.Use caution when climbing and descending stairs.
• Consult a physician before drinking alcohol.
• Consult a healthcare professional if you frequently drink grapefruit juice or eat grapefruit.
• Very bad and sometimes deadly side effects, such as heart problems, heart attack, stroke, and high blood pressure, have happened with this drug. Consult your doctor.
• In rare cases, very bad eye problems have happened with this drug. This can lead to visual impairment, and sometimes to vision loss, which can be irreversible. Consult your doctor.
• If you have bleeding, consult your doctor.
• If you are 65 years of age or older, use this drug with caution. You may have more side effects.

Increased lung pressure:

• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.The benefits and risks for you and your child will need to be discussed.

For other reasons:

• This drug is not approved for use in women. Women using this drug should consult a doctor if they are pregnant, planning a pregnancy, or breastfeeding.

For erectile dysfunction:

• This drug does not prevent the spread of sexually transmitted diseases such as HIV or hepatitis.Do not have sexual intercourse without using a latex or polyurethane condom. If you have questions, consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Chest pain, angina pectoris, tachycardia, or irregular heart rhythm.
• Dizziness or fainting.
• Severe headache.
• Weakness on one side of the body, difficulty speaking or thinking, trouble maintaining balance, drooping one side of the face, or blurred vision.
• Change in vision.
• Loss of vision.
• Ringing in the ears, hearing loss, or any other change in hearing.
• Call your doctor right away if you have a painful erection or if an erection lasts more than 4 hours.This can happen even if you are not having sex at the time. If not addressed immediately, it can lead to long-term erection problems and you may not be able to have sex.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

For all uses of this product:

• Hyperemia (blush).
• Headache.
• Back pain.
• Muscle pain.
• Nausea.
• Irritation of nose or throat.
• Signs of a cold.

Increased lung pressure:

• Pain in the arms or legs.

This list of potential side effects is not comprehensive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

Increased pressure in the lungs:

• Take this drug with or without food.
• Take this drug at about the same time of the day.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

For other reasons:

• Take this medication with or without food.
• Do not break or crush the tablet.

What should I do if a dose of a drug is missed?

Increased pressure in the lungs:

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
• Do not take 2 doses at the same time or an additional dose.

For other reasons:

• For daily use: Take the missed dose as soon as you remember.If it’s time to take your next dose, do not take the missed dose and go back to your normal dose.
• Do not take 2 doses at the same time or an additional dose.
• In most cases, this drug is used as needed. Do not use this medicine more often than prescribed by your doctor.

How do I store and / or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone or take other people’s medicines.
• Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may come with other patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

Which medicine is better for potency

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Functional principle

PANT NUTS – a natural product based on natural substances. The product contains antlers of the Altai maral, ginseng, red root, lemongrass seeds, pine nuts. Pantomax restores an erection, normalizes hormonal levels, and eliminates inflammation of the prostate gland.The drug quickly enters the bloodstream and begins to act within 30 minutes

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Composition

Of the many drugs to increase potency, Viagra, Cialis and Levitra are especially famous. In addition to these funds, a medicine can be produced in various dosages to increase potency. It is better not to take Levitra more than 10 mg per day. “Cialis” Relatively new tablets that provide the fastest effect.7/22/2017 “Erection enhancers, pills for erectile dysfunction and potency increase, instructions for the use of drugs to stimulate and improve long-term erection.

Results of clinical trials

Medicine for impotence – an overview of the means to help restore “masculine strength”. What drugs are most effective? What are the consequences of using them? 8/2/2015 “The medicine is produced in various dosages. It is better not to take Levitra more than 10 mg per day.Cialis Relatively new … When the condition is not too severe, the presence of alcoholic beverages in the diet should be limited, it is not necessary to give up 100% of them, but smoking is still better to completely remove from …

Expert opinion

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This medicine is intended to increase potency, libido in men. It also produces more sperm, improves kidney function.What is the effect of Chinese medicines? This medicine is intended to increase potency, libido in men. It also produces more sperm, improves kidney function. What is the effect of Chinese medicines? Alice, not everything is as simple as it seems. All these funds are more suitable as prevention. But I agree with you on one thing, natural remedies for maintaining potency are better than chemistry.

Method of application

Take 1 nut 30 minutes before meals 3 times a day Chew and drink water Enjoy

Other drugs to increase potency, with the same active ingredients, are generics, that is, other pharmaceutical companies have bought out a patent for their production from developers.5/16/2014 “Cure for impotence – an overview of the means to help restore” masculine strength. ” What drugs are most effective? What are the consequences of using them? A newer drug for a quick increase in potency (since 2003 on the market), but quickly won the appreciation of men for its long-lasting effect. Why is Cialis better than Viagra?

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