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قرص cialis 20mg
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قرص های افزایش دهنده جنسی داروهای عمومی Cialis 20mg 4 قرص / جعبه
Generic Cialis دارو است که درمان اختلال نعوظ و هیپرپلازی خوش خیم پروستات (BPH) را درمان می کند.
قرص cialis 20mg
Generic Cialis برای درمان اختلال نعوظ نشان داده شده است. سیالیس سریعتر از سایر داروهای ED کار می کند و مدت زمان طولانی را ادامه می دهد.
Cialis که همچنین Tadalafil نامیده می شود برای درمان موفقیت آمیز اختلال نعوظ استفاده می شود.
قرص های سیالیس ارزان قیمت: Tadalafil
Generic Cialis یک داروی تجویزی جدید و فرموله شده شیمیایی است که به صورت خوراکی برای درمان اختلال نعوظ فقط در مردان مصرف می شود و فعالیت جنسی بسیار مردانه را افزایش می دهد که منجر به افزایش قدرت آلت تناسلی، ارگاسم چند برابر شده و افزایش اندازه آلت تناسلی می شود.
قرصهای اختلال نعوظ Cialis (Tadalafil) قرصی است که برای درمان علائم اختلال نعوظ ساخته شده است. Cialis (Tadalafil) 20 میلی گرم عضلات صاف آلت تناسلی را تحت تاثیر قرار می دهد. آن را مهارکننده نوع آنزیم فسفودی استراز 5 (PDE-5)، جلوگیری از تخریب گوانوزین مونوفسفره سیکل (cGMP) است که کمک می کند تا استراحت ماهیچه ها و افزایش جریان خون را افزایش دهد. به عنوان یک نتیجه، شما قدرتمند و پایدار نعوظ، حضور تحریک جنسی.
نحوه استفاده از داروهای اختلال نعوظ سیلان
یک قرص سیالیس عمومی (تادالافیل) 20 میلی گرم دریافت کنید و یک لیوان آب بنوشید.
مدت زمان عمل آن 36 ساعت پس از مصرف است. علاوه بر این، اکثریت مردم، بهبود نعوظ 30 دقیقه پس از مصرف سیالیال عمومی (تادالافیل) 20 میلیگرم اتفاق می افتد.
توجه داشته باشید:
در صورت مصرف CIALIS دیگر از داروهای ED و یا ED استفاده نکنید.
در هنگام مصرف CIALIS (به عنوان مثال، 5 عدد شراب یا 5 عکس از ویسکی)، الکل مصرف نکنید. نوشیدن بیش از حد الکل می تواند شانس خود را برای دریافت سردرد یا سرگیجه افزایش دهد، جایگزین آن با میزان ضربان قلب یا از دست دادن فشار خون بالا.
ذخیره سازی:
قرص های ارزان قیمت عمومی Cialis را در دمای اتاق بین 59 و 86 F (15 و 30 درجه سانتیگراد) ذخیره کنید. Cialis عمومی را در دسترس کودکان قرار ندهید
ارزان آنلاین cialis مشخصات: 4 قرص / جعبه؛ 30 قرص / بطری
ما عمده فروش حرفه ای چین ارزان cialis آنلاین، می تواند شما را با کیفیت بهترین محصولات، قیمت عمده فروشی ارزان تر، بیشتر به شما سفارش، ارزان تر، خوش آمدید به مشورت.
Which is better viagra or cialis?
Medically reviewed by Drugs.com Last updated on Apr 11, 2019.
Cialis and Viagra are both PDE5 inhibitors used for the treatment of erectile dysfunction (ED). Both only work when a man is sexually aroused. Cialis lasts for around 36 hours compared with only 4 to 5 hours for Viagra. Food does not affect the activity of Cialis, whereas food may decrease the effectiveness of Viagra. Cialis can be used once daily, at a smaller dosage, and is also effective at treating benign prostatic hyperplasia (BPH). Dosage of Cialis may need to be reduced in men with liver or kidney problems and risk of interactions may be higher than with Viagra.
See also: Drugs.com Compare Tool – Cialis vs Viagra
Cialis is the brand name for tadalafil and Viagra is the brand name for sildenafil.1,2 Both belong to a class of medicines known as phosphodiesterase type 5 (PDE5) inhibitors. PDE5 inhibitors work only in the presence of sexual stimulation, as they rely on the natural release of nitric oxide (NO), a chemical only released during sexual arousal. NO in turn activates other substances to relax the smooth muscle inside the penis to allow the inflow of blood and an erection to occur.1,2,3 PDE5 inhibitors enhance the effect of NO.1,2
قرص cialis 20mg
On March 27 th, 1998, Viagra became the first oral pill, and the first PDE5 inhibitor, to be approved by the FDA to treat ED.4 A generic for Viagra was approved in March 2016 5 and released in December 2017.
Cialis was first approved for ED on November 21st, 2003.6 It was the third PDE5 inhibitor to come onto the market (after Levitra [vardenafil]).7 Cialis has an advantage over Viagra and Levitra in that it lasts for a lot longer – 36 hours, compared with 4-5 hours for Viagra and Levitra.1,2,7 A generic for Cialis was approved in May 2018 11 and released in September 2018.
Cialis generally works within 16 to 45 minutes, and its activity is not affected by food. Viagra generally works within 30 minutes, and its effect may be diminished if taken soon after a high fat meal (which may also delay how fast it works). For this reason, Viagra is best taken on an empty stomach.1,2,7
Effectiveness of all PDE5 inhibitors is similar; although reported effectiveness of Viagra, at 84% is slightly higher than that of Cialis at 81%.7 However, more men prefer Cialis because of its longer duration of effect.7
Cialis can be taken on an as needed basis, or daily.1Generally, daily dosages are smaller than as needed doses.8 Typically, Cialis is taken as a 10mg starting dose, prior to sexual activity. The effects of Cialis will last around 36 hours. The dosage may be increased to 20mg if 10mg is ineffective or reduced to 5mg if side effects are intolerable.1
When Cialis is taken for daily use, the recommended initial dosage is 2.5mg once daily, or 5mg for people who also have BPH. Timing of the daily dosage does not matter in people using it solely for ED; however, those with BPH are advised to take it at the same time each day. Do not take more than one dose a day but your doctor may consider an increase in dosage from 2.5 to 5mg if ineffective. Side effects of Cialis include headache and indigestion.1
Viagra is taken on an as needed basis, at a dose of 50mg, approximately 1 hour before sexual activity (although can be taken from 30 minutes to 4 hours before). The dose may be increased to 100mg if 50mg is ineffective or decreased to 25mg if side effects are intolerable.2 Viagra should only be taken once a day even though the effects wear off after approximately 4-5 hours. The main side effects are headache, flushing and indigestion.2 Rarely, color perception may be altered with Viagra. This side effect does not happen with Cialis.7
Cost of Viagra varies depending on tablet strength but is approximately $24 per tablet for the 50mg strength and $35 for the 100mg strength.9 Cialis costs approximately $8.50 for the 5mg strength and $28 for the 20mg strength, per tablet.10
All PDE5 inhibitors are contraindicated with nitrates.1,2 The longer duration of action of Cialis means it is at higher risk for drug interactions,1 and dosages may need reducing in men with kidney or liver disease. Cialis is not recommended in men who have had a heart attack or stroke within the past 6 months, with either uncontrolled high blood pressure or severely low blood pressure, unstable angina, or other conditions that make sexual activity inadvisable.1,6
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Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 1 Aug 2019), Cerner Multum™ (updated 1 Aug 2019), Wolters Kluwer™ (updated 31 July 2019) and others.
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قرص cialis 20mg
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Brand name
Cialis Tablets
Active ingredient
Tadalafil
Schedule
S4
Please read this leaflet carefully before you start using Cialis [9310].
This leaflet answers some common questions about CIALIS. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking CIALIS against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, talk to your doctor or pharmacist.
Keep this leaflet with the medicine.
قرص cialis 20mg
You may need to read it again.
CIALIS is used to treat:
Your doctor may have prescribed you CIALIS to treat either, or both of these conditions.
Ask your doctor if you have any questions about why CIALIS has been prescribed for you.
Your doctor may have prescribed it for another reason. CIALIS is available only with a doctor’s prescription.
CIALIS is not intended for use by women, or by children under the age of 18 years.
The active ingredient in CIALIS tablets, tadalafil, belongs to a group of medicines called phosphodiesterase type 5 inhibitors.
Do not take CIALIS if you are currently taking any nitrates or amyl nitrite.
Nitrates are 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 are taking any form of nitrate or are unsure talk to your doctor.
Do not take CIALIS:
Do not take CIALIS if you have an allergy to:
Some of the symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body; rash, itching or hives on the skin.
Do not take this medicine after the expiry date printed on the pack.
If it has expired, return it to your pharmacist for disposal.
Do not take this medicine if the packaging is torn or if the seals over the carton ends are missing or broken. There are no seals over the carton ends of the 5mg physician sample pack.
If it is damaged, return it to your pharmacist for disposal.
If you are not sure whether you should start taking CIALIS, talk to your doctor.
Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.
CIALIS tablets contain a small amount of lactose.
Tell your doctor if you are aged 75 years and over.
You have a higher chance of experiencing side effects like dizziness and diarrhoea.
Your doctor will assess if CIALIS is suitable for you.
Tell your doctor if you have or have had any of the following medical conditions:
If you have not told your doctor or pharmacist about any of the above, tell them before you start taking CIALIS.
Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.
Some medicines may be affected by CIALIS or may affect how it works. These include:
These medicines may be affected by CIALIS or may affect how well it works. You may need different amounts of your medicines or you may need to take different medicines.
You should not take CIALIS together with any other treatments for erectile dysfunction.
Your doctor and pharmacist have more information on medicines to be careful with or avoid while taking this medicine.
Follow all directions given to you by your doctor or pharmacist carefully.
They may differ from the information contained in this leaflet.
For Erectile DysfunctionCIALIS can be taken as either on-demand dosing or once-a-day dosing.
CIALIS on-demand (10 mg and 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 (5mg), it may take up to 1 week for a full effect on Erectile Dysfunction.
For urinary symptoms associated with Benign Prostate HyperplasiaCIALIS once-a-day (5mg) is taken daily. For urinary symptoms associated with benign prostatic hyperplasia 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. CIALIS must be taken daily to maintain effect.
If you do not understand the instructions on the pack, ask your doctor or pharmacist for help.
You should not take CIALIS more than once a day.
Always take CIALIS exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.
ON-DEMAND DOSING FOR ERECTILE DYSFUNCTIONThe 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 10mg 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.
Dosage 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 of CIALIS is not recommended in patients with severe hepatic impairment.
No special dosing consideration is needed for the elderly or people with diabetes.
Swallow one tablet whole with a full glass of water.
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 DYSFUNCTIONCIALIS (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 5 mg should be taken daily at approximately the same time of day. CIALIS must be taken daily to maintain effect.
If you have any questions about taking CIALIS, ask your doctor or pharmacist.
Immediately telephone your doctor or the Australian Poisons Information Centre (telephone 13 11 26) or the New Zealand National Poisons Centre (0800 POISON or 0800 764 766), or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much CIALIS.
Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.
Symptoms of an overdose may include headache, dyspepsia (indigestion), back pain, muscular aches, nasal congestion and facial flushing.
If you have emergency treatment for any suspected heart condition tell the emergency medical or ambulance staff that you are taking CIALIS. If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking CIALIS. Tell any other doctors, dentists and pharmacists who treat you that you are taking CIALIS.
Do not take CIALIS to treat any other complaints unless your doctor tells you to.
Do not give your medicine to anyone else, even if they have the same condition as you.
Be careful driving or operating machinery until you know how CIALIS affects you.
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking CIALIS.
CIALIS helps most people with erectile dysfunction or urinary symptoms associated with benign prostatic hyperplasia but it may have unwanted side effects in a few people. All medicines can have side effects.
Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.
Do not be alarmed by the following list of possible side effects. You may not experience any of them.
Ask your doctor or pharmacist to answer any questions you may have.
The following side effects are usually mild and short-lived.
Tell your doctor or pharmacist if you notice any of the following and they worry you:
If you experience chest pain during or after sexual activity, stop what you are doing, sit up and sit forward.
Call an ambulance if the pain does not resolve. Do not use nitrates.
In rare instances it is possible that a prolonged and possibly painful erection may occur after taking CIALIS. Penile bleeding or presence of blood in semen may occur rarely.
If you have an erection which lasts longer than 4 hours you should contact a doctor immediately.
When taking CIALIS with large amounts of alcohol, some men may experience dizziness.
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.
This is not a complete list of all possible side effects. Others may occur in some people and there may be side effects not yet known.
Potential withdrawal effects from daily use have not been examined. It is recommended that patients continue to be monitored by their doctor after discontinuation of CIALIS.
If you notice any symptoms that worry you, check with your doctor.
Ask your doctor or pharmacist if you don’t understand anything on this list.
Keep your tablets in the original pack until it is time to take them.
If you take the tablets out of the pack they may not keep as well.
Keep your tablets in a cool dry place where the temperature stays below 25°C.
Do not store CIALIS or any other medicine in the bathroom or near a sink. Do not leave it on a window sill or in the car.
Heat and dampness can destroy some medicines.
Keep your medicine where children cannot reach.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.
If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.
CIALIS 5 mg tablets are yellow, film-coated, almond-shaped tablets, marked “C5” on one side.
CIALIS 10 mg tablets are light yellow, film-coated, almond-shaped tablets, marked “C10” on one side.
CIALIS 20 mg tablets are yellow, film-coated, almond-shaped tablets, marked “C20” on one side.
Active Ingredients
Other Ingredients
This medicine does not contain sucrose, gluten, tartrazine or any other azo dyes.
CIALIS is a product of:
Eli Lilly Australia Pty Limited112 Wharf RoadWest Ryde, NSW 2114AUSTRALIA
CIALIS is distributed in New Zealand by:
Eli Lilly and Company (NZ) LimitedLevel 1, 123 Ormiston RdBotany South, Auckland 2016NEW ZEALAND
®= Registered Trademark
CIALIS 5 mg tablet -AUST R 128496
CIALIS 10 mg tablet – AUST R 90590
CIALIS 20 mg tablet – AUST R 81137
If you have any questions about CIALIS, contact Eli Lilly at 800 454 559 (Australia) or 0800 500 909 (New Zealand) or your healthcare professional for assistance.
This leaflet was revised in November 2017.
vD13-1
Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise disclaims all liability (including for negligence) for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer. This website uses cookies. Read our privacy policy.
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Tadalafil, sold under the brand name Cialis among others, is a medication used to treat erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension.[2] It is a tablet taken by mouth.[2] Onset is typically within half an hour and the duration is up to 36 hours.[2]
Common side effects include headache, muscle pain, flushed skin, and nausea.[2] Caution is advised in those with cardiovascular disease.[2] Rare but serious side effects include a prolonged erection that can lead to damage to the penis, vision problems, and hearing loss.[2] Tadalafil is not recommended in people taking nitrovasodilators such as nitroglycerin, as this may result in a serious drop in blood pressure.[2] Tadalafil is a PDE5 inhibitor which increases blood flow to the penis with sexual arousal.[2] It also dilates blood vessels in the lungs, which lowers the pulmonary artery pressure.[2]
Tadalafil was approved for medical use in the United States in 2003.[2] It is available as a generic medication in the United States and United Kingdom.[3] In the UK it costs the NHS about 0.80 £ per dose as of 2019.[3] In the United States the wholesale cost of this amount is about 1.91 USD.[4] In 2016 it was the 280th most prescribed medication in the United States with nearly 1.5 million prescriptions.[5]
Tadalafil is used to treat erectile dysfunction (ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension.[2]
Tadalafil once-daily is FDA-approved for ED, for sale in 2.5, 5, 10, and 20 mg strengths. The price of the 5 mg and 2.5 mg are often similar, so some people score and split the pill.[6]
قرص cialis 20mg
Tadalafil 10 mg is FDA-approved for men as a once-daily therapy to treat and prevent symptoms of benign prostatic hypertrophy (BPH), such as urinary urgency, hesitancy, weak stream, dribbling, and incontinence.
Tadalafil 40 mg is approved in the United States, Canada, and Japan as a once-daily therapy to improve exercise ability in patients with pulmonary arterial hypertension (PAH).
The pulmonary vascular lumen is decreased in PAH as a result of vasoconstriction and vascular remodeling, resulting in increased pulmonary artery pressure and pulmonary vascular resistance. Tadalafil causes pulmonary artery vasodilation, and inhibits vascular remodeling, thus lowering pulmonary arterial pressure and resistance. Right heart failure is the principal consequence of severe pulmonary arterial hypertension.
The most common potential side effects when using tadalafil are headache, stomach discomfort or pain, indigestion, burping, acid reflux, back pain, muscle aches, flushing, and stuffy and runny nose. These side effects reflect the ability of PDE5 inhibition to cause vasodilation (cause blood vessels to widen), and usually resolve after a few hours. Back pain and muscle aches can occur 12 to 24 hours after taking the drug, and these symptoms usually resolve within 48 hours of onset.
In May 2005, the U.S. Food and Drug Administration found that tadalafil (along with other PDE5 inhibitors) was associated with vision impairment related to NAION (non-arteritic anterior ischemic optic neuropathy). Most, but not all, of these patients had underlying anatomic or vascular risk factors for development of NAION, unrelated to PDE5 use. The FDA concluded that they were not able to draw a cause and effect relationship, only an association; the label of all three PDE5 inhibitors was changed to alert clinicians to that fact.
In October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including tadalafil, requires a more prominent warning of the potential risk of sudden hearing loss as the result of postmarketing reports of temporary deafness associated with use of PDE5 inhibitors.[7]
Tadalafil is metabolized predominantly by the hepatic CYP3A4 enzyme system. The presence of other drugs which induce this system can shorten tadalafil half-life and reduce serum levels, and hence efficacy, of the drug.
Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic guanosine monophosphate (more commonly known as cyclic GMP or cGMP) in smooth muscle cells. cGMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.
The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil (and sildenafil and vardenafil) inhibits PDE5. However, because sexual stimulation is required to initiate the local penile release of nitric oxide, tadalafil’s inhibition of PDE5 will have no effect without direct sexual stimulation of the penis.
Although sildenafil, vardenafil, and tadalafil all work by inhibiting PDE5, tadalafil’s pharmacologic distinction is its longer half-life (17.5 hours)[8], compared to sildenafil and vardenafil, which are both 4–5 hours.[9] This translates to a longer duration of action, which is partly responsible for “The Weekend Pill” nickname. Furthermore, the longer half-life is the basis for tadalafil’s daily therapeutic use in treating pulmonary arterial hypertension.
Tadalafil, sildenafil, and vardenafil all act by inhibiting the PDE5 enzyme, but these drugs also inhibit PDE enzymes 6, 1, and 11 in varying degrees.
Sildenafil and vardenafil inhibit PDE6, an enzyme found in the eye, more than tadalafil.[10] Some sildenafil users see a bluish tinge and have a heightened sensitivity to light because of PDE6 inhibition.[11]
Sildenafil and vardenafil also inhibit PDE1 more than tadalafil.[10] PDE1 is found in the brain, heart, and vascular smooth muscle.[10] It is thought that the inhibition of PDE1 by sildenafil and vardenafil leads to vasodilation, flushing, and tachycardia.[10]
Tadalafil inhibits PDE11 more than sildenafil or vardenafil.[10] PDE11 is expressed in skeletal muscle, the prostate, the liver, the kidney, the pituitary gland, and the testes.[10] The effects on the body of inhibiting PDE11 are not known.[10]
Tadalafil is an annulated 2,5-diketopiperazine.[12] It is also a 1,2,3,4-tetrahydro-β-carboline.
Tadalafil can be synthesized starting from (D)-tryptophan methyl ester and piperonal via a Pictet–Spengler reaction. This is followed by condensations with chloroacetyl chloride and methylamine to complete the diketopiperazine ring:[13]
The FDA’s approval of sildenafil in 1998[14] was a ground-breaking commercial event for the treatment of ED, with sales exceeding US$1 billion. Subsequently, the FDA approved vardenafil in 2003,[15] and tadalafil in 2003.
It initially was developed by the biotechnology company ICOS, and then again developed and marketed worldwide by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company. Tadalafil was approved in 2009 in the United States for the treatment of pulmonary arterial hypertension[16] and is under regulatory review in other regions for this condition. In late November 2008, Eli Lilly sold the exclusive rights to commercialize tadalafil for pulmonary arterial hypertension in the United States to United Therapeutics for an upfront payment of $150 million.
Tadalafil was discovered by Glaxo Wellcome (now GlaxoSmithKline) under a partnership between Glaxo and ICOS to develop new drugs that began in August 1991.[17][18] In 1993, the Bothell, Washington biotechnology company ICOS Corporation began studying compound IC351, a phosphodiesterase type 5 (PDE5) enzyme inhibitor. In 1994, Pfizer scientists discovered that sildenafil, which also inhibits the PDE5 enzyme, caused penile erection in men participating in a clinical study of a heart medicine. Although ICOS scientists were not testing compound IC351 for treating ED, they recognized its potential usefulness for treating that disorder. Soon, in 1994, ICOS received a patent for compound IC351 (structurally unlike sildenafil and vardenafil), and Phase 1 clinical trials began in 1995. In 1997, the Phase 2 clinical studies were initiated for men experiencing ED, then progressed to the Phase 3 trials that supported the drug’s FDA approval. Although Glaxo had an agreement with ICOS to share profits 50/50 for drugs resulting from the partnership, Glaxo let the agreement lapse in 1996 as the drugs developed were not in the company’s core markets.[11]
In 1998, ICOS Corporation and Eli Lilly and Company formed the Lilly ICOS, LLC, joint venture company to further develop and commercialize tadalafil as a treatment for ED. Two years later, Lilly ICOS, LLC, filed a new drug application with the FDA for compound IC351 (under the tadalafil generic name, and the Cialis brand name). In May 2002, Lilly ICOS reported to the American Urological Association that clinical trial testing demonstrated that tadalafil was effective for up to 36 hours, and one year later, the FDA approved tadalafil. One advantage Cialis has over Viagra and Levitra is its 17.5-hour half-life (thus Cialis is advertised to work for up to 36 hours,[19] after which time there remains approximately 25% of the absorbed dose in the body) when compared to the four-hour half–life of sildenafil (Viagra).
In 2007, Eli Lilly and Company bought the ICOS Corporation for $2.3 billion. As a result, Eli Lilly owned Cialis and then closed the ICOS operations, ending the joint venture and firing most of ICOS’s approximately 500 employees, except for 127 employees of the ICOS biologics facility, which subsequently was bought by CMC Biopharmaceuticals A/S (CMC).
Persons surnamed “Cialis” objected to Eli Lilly and Company’s so naming the drug, but the company has maintained that the drug’s trade name is unrelated to the surname.[20]
On October 6, 2011, the U.S. FDA approved tadalafil[21] to treat the signs and symptoms of benign prostatic hyperplasia (BPH). BPH is a condition in males in which the prostate gland becomes enlarged, obstructing the free flow of urine. Symptoms may include sudden urges to urinate (urgency), difficulty in starting urination (hesitancy), a weak urine stream, and more frequent urination — especially at night. The FDA has also approved tadalafil for treatment of both BPH and erectile dysfunction (ED) where the two conditions co-exist.
In the United States, the FDA relaxed rules on prescription drug marketing in 1997, allowing advertisements targeted directly to consumers.[22] Lilly-ICOS hired the Grey Worldwide Agency in New York, part of the Grey Global Group, to run the Cialis advertising campaign.[23] Marketers for Cialis has taken advantage of its greater duration compared to its competitors in advertisements for the drug; Stuart Elliot of The New York Times opined: “The continuous presence of women in Cialis ads is a subtle signal that the drug makes it easier for them to set the pace with their men, in contrast to the primarily male-driven imagery for Levitra and Viagra.”[23] Iconic themes in Cialis ads include couples in bathtubs and the slogan “When the moment is right, will you be ready?”[23] Cialis ads were unique among the ED drugs in mentioning specifics of the drug.[24] As a result, Cialis ads were also the first to describe the side effects in an advertisement, as the FDA requires advertisements with specifics to mention side effects. One of the first Cialis ads aired at the 2004 Super Bowl.[24] Just weeks before the Super Bowl, the FDA required more possible side effects to be listed in the advertisement, including priapism.[24] Although many parents objected to the Cialis ad being aired during the Super Bowl, Janet Jackson’s halftime “wardrobe malfunction” overshadowed Cialis.[24] In January 2006, the Cialis ads were tweaked, adding a doctor on screen to describe side effects and only running ads where more than 90 percent of the audience are adults, effectively ending Super Bowl ads.[22] In 2004, Lilly-ICOS, Pfizer, and GlaxoSmithKline spent a combined $373.1 million to advertise Cialis, Viagra, and Levitra respectively.[24] Cialis has sponsored many sporting events, including the America’s Cup and the PGA Tour, once being title sponsor of the PGA Tour Western Open tournament.[25]
In the United States, the wholesale cost of tadalafil as of May 2019 is 1.91 USD for the 20 mg tabs and 7.65 USD for the 2.5 mg tabs.[4]
While some health insurance providers cover at least part of the cost (typically limiting the number of doses covered per month), many providers, including those operating under Medicare Part D, do not cover the cost of medications prescribed for erectile dysfunction.[26][27]
In the U.K., a generic version of tadalafil became available in November 2017, reducing its price per pill, and will be available on the NHS. Additionally, Tadacip, manufactured in India by Cipla, is considerably less expensive.
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