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Generic Name: tadalafil (ta DAL a fil)Brand Names: Adcirca, Cialis

Medically reviewed by Sanjai Sinha, MD Last updated on Jan 12, 2019.

Cialis (tadalafil) relaxes muscles of the blood vessels and increases blood flow to particular areas of the body.

Cialis is used to treat erectile dysfunction (impotence) and symptoms of benign prostatic hypertrophy (enlarged prostate).

Another brand of tadalafil is Adcirca, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. Do not take Cialis while also taking Adcirca, unless your doctor tells you to.cialis 20mg قرص

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as “poppers”. Taking tadalafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Some medicines can cause unwanted or dangerous effects when used with Cialis. Tell your doctor about all your current medicines, especially riociguat (Adempas).

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Get medical help at once if you have nausea, chest pain, or dizziness during sex.

Stop using Cialis and get emergency medical help if you have sudden vision loss.

You should not take Cialis if you are allergic to tadalafil.

Taking Cialis with certain other medicines can cause a sudden and serious decrease in blood pressure. Do not take this medicine if you also use:

riociguat (to treat pulmonary arterial hypertension); or

a nitrate drug (for chest pain or heart problems) such as nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, or recreational drugs such as amyl nitrate or nitrite “poppers”.

Some tadalafil can remain in your bloodstream for 2 or more days after each dose you take (longer if you have liver or kidney disease). Avoid nitrate use during this time.

To make sure this Cialis is safe for you, tell your doctor if you have ever had:

heart disease or heart rhythm problems;

a heart attack or stroke;

angina (chest pain), high or low blood pressure;

pulmonary hypertension (unless you are taking tadalafil for this);

a condition called pulmonary veno-occlusive disease (narrowing of the veins that carry blood from the lungs to the heart);

liver or kidney disease (or if you are on dialysis);

vision loss, or retinitis pigmentosa (an inherited condition of the eye);

a bleeding disorder;

a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;

a physical deformity of the penis (such as Peyronie’s disease), or an erection lasting longer than 4 hours;

a stomach ulcer; or

health problems that make sexual activity unsafe.

Sudden vision loss has occurred in a small number of people taking medicines like tadalafil (Viagra or others). Most of these people already had certain eye problems or had high cholesterol, diabetes, coronary artery disease, a history of smoking, or were over 50 years old). It is not clear whether the medicine was the actual cause of vision loss.

Cialis is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether tadalafil passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.

Cialis is not approved for use by anyone younger than 18 years old.

Cialis is usually taken only once per day. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Cialis can be taken with or without food.

Do not break or split a tablet. Swallow it whole.

For erectile dysfunction, take Cialis just before sexual activity but not more than once per day.

Cialis can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.

Do not take Cialis for erectile dysfunction if you are taking Adcirca for pulmonary arterial hypertension.

Store at room temperature away from moisture and heat.

Cialis dosage information (in more detail)

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As Cialis is used as needed, you are not likely to be on a dosing schedule.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Drinking alcohol with this medicine can cause side effects.

Grapefruit and grapefruit juice may interact with tadalafil and lead to unwanted side effects. Avoid the use of grapefruit products while taking this medicine.

Get emergency medical help if you have signs of an allergic reaction to Cialis: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop and get medical help at once if you have nausea, chest pain, or dizziness during sex. You could be having a life-threatening side effect.

Stop using this medicine and call your doctor at once if you have:

a light-headed feeling, like you might pass out;

an erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis);

vision changes or sudden vision loss;

ringing in your ears or sudden hearing loss; or

heart attack symptoms – chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Common Cialis side effects may include:

headache;

flushing (warmth, redness, or tingly feeling);

nausea, upset stomach;

stuffy nose; or

muscle pain, back pain, pain in your arms or legs.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Cialis side effects (in more detail)

Tell your doctor about all your current medicines and any you start or stop using, especially:

medicines to treat erectile dysfunction or pulmonary arterial hypertension;

an antibiotic or antifungal medicine;

antiviral medicine to treat hepatitis C or HIV/AIDS;

drugs to treat high blood pressure or a prostate disorder; or

seizure medicine.

This list is not complete. Other drugs may interact with tadalafil, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Cialis drug interactions (in more detail)

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Cialis only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2019 Cerner Multum, Inc. Version: 11.01.

Medical Disclaimer

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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]
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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.

Tadalafil is a medicine that is used to treat sexual ailments in men. It is used to treat symptoms like erectile dysfunction and sexual impotence. It does this by increasing the amount of blood that ultimately reaches the penis. This medicine works by relaxing the muscles around the genital area of men. It does this by preventing Phosphodiesterase-5 from working on the body. This further increases the amount of cyclic guanosine monophosphate (cGMP) present in the body, which ends up relaxing smooth muscles inside blood vessels.

This medicine can also be used to treat problems of the prostrate gland and of passing urine. However, it will not help you in protection against and treatment of sexually transmitted diseases like syphilis. This medicine does not require a doctor’s prescription, but you should talk to a urologist about the dosage you specifically require, as any kind of overdose may be extremely dangerous. It may even cause death. Before you obtain the dosage, make sure to inform your doctor of your medical history and of any drugs you are currently taking. After the prescription, you may take this medicine with or without food and resume sexual activity after about 60 minutes of consumption.

Information given here is based on the salt and content of the medicine. Effect and uses of medicine may vary from person to person. It is advicable to consult a Urologist before using this medicine.

This medicine is prescribed for the following conditions:

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erectile dysfunction

benign prostatic hyperplasia

Allergy

This medicine should not be used by you if you have had allergy or increased sensitivity to it or its active components in the past.

Organic nitrates

Riociguat

This medicine causes side effects such as:

Nausea

Decrease/loss of vision

Change in color vision

Dizziness

Peeling and blistering of skin

Uterine bleeding

heartburn

How long is the duration of effect?

This medicine should be consumed 2 hours before any sexual activity at the least. The effects of this medicine may persist in your body for about 3 days.

What is the onset of action?

The onset period of this medicine varies according to the mental health and state of the user. The average onset of action is about 2 hours after oral administering of the medicine.

Is it habit forming?

This medicine does not exhibit habit forming tendencies.

Is It safe with alcohol?

Alcohol is not recommended when you are using this medicine. The combination of it with alcohol may cause symptoms like dizziness, exhaustion, lack of focus or understanding, and pains in your head. These, if caused, should be immediately reported to your physician.

Are there any pregnancy warnings?

This medicine is not advisable to be used when you are pregnant. You must seek medical attention to help you in determining the dosage if you absolutely cannot do without it.

Are there any breast-feeding warnings?

This medicine can absolutely not be used by mothers who are lactating. You should use some other medicine as replacement when you are breastfeeding.

Is it safe to drive while on this medicine?

Sufficient information is not available on whether you can drive while on this medicine. Lack of focus caused by this medicine varies from person to person, so you should not drive or operate heavy machinery if you feel drowsy yourself after consuming this drug.

Does this affect kidney function?

This medicine is not recommended for patients of kidney disease. If you have a less intense degree of kidney disease, you may still take a very muted dose of this medicine, but if your kidneys don’t function at all, you may be prohibited from taking this medicine. Speak to your doctor before you go ahead, in any case.

Does this affect liver function?

If you have intense liver disease, you are asked to not take this medicine. You can have lesser doses if your liver ailment is less serious. Consult your doctor before taking any action.

Are there any missed dose instructions?

If you have forgotten the timing of a dose, and hence happen to have skipped it, take it as soon as you remember. However, if you are due for your next dose at the time, skip the missed dose altogether.

Are there any overdose instructions?

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If you notice symptoms of an overdose, you should seek your doctor’s help immediately.

India

United States

Japan

Cialis 20Mg Tablet relaxes the smooth muscles by inhibiting Phosphodiesterase type-5. This results in the increase of cyclic guanosine monophosphate (cGMP) which relaxes the smooth muscles and increases the flow of blood.

Whenever you take more than one medicine, or mix it with certain foods or beverages, you”re at risk of a drug interaction.

This medicine interacts with diseases like heart disease, increased blood pressure, ailments of the liver and kidney, seizure disorder and abnormal erections.

This medicine if taken in combination with alcohol may cause abnormally less blood pressure, and fainting, sweating and dizziness along with it. Hence, alcohol use is recommended to be limited when a person is consuming this medicine.

This medicine interacts with other medicines like Amlodipine, Carbamazepine, Ketoconazole, Phenytoin, Nitroglycerin and Cimetidine. This interaction may harm efficiencies of both medicines.

This medication is typically used for erectile problems in men. Its effects can be felt in about 30 minutes.

Certain heart medication (nitrates) must be avoided while taking this product. If in doubt, consult your doctor or pharmacist.

Generally, this medication is used only as needed. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed.

This medication does not produce erections by itself. It simply facilitates erections with sexual arousal. This medication may be taken with or without food. Avoid grapefruit and grapefruit juice during your treatment. Grapefruit can seriously affect how this medication works.

In addition to its desired action, this medication may cause some side effects, notably:
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Each person may react differently to a treatment. If you think this medication may be causing side effects (including those described here, or others), talk to your doctor or pharmacist. He or she can help you to determine whether or not the medication is the source of the problem.

As with most medications, this product should be stored at room temperature. Store it in a secure location where it will not be exposed to excessive heat, moisture or direct sunlight. Keep it out of reach of young children. Make sure that any leftover portion is disposed of safely.

If you have an erection which lasts continuously for 4 hours or more, you should contact a doctor immediately.

This medication may interact with other medications or supplements, sometimes significantly. Many interactions, however, may be dealt with by a dosage adjustment or a change in medication schedule. Check with your pharmacist before using this medication in combination with any other medications (including non-prescription products), vitamins or natural products.

It is important to tell the health professionals you consult:

The active ingredient of this medicine is Tadalafil. The pharmacological action is based on the inhibition of cGMP. Nitric oxide is released during the sexual stimulation that leads to the inhibition of PDE5 and the increase of the concentration of cGMP in corpus cavernosum of the penis. Due to this the main pharmacological effect is occurred, i.e. the stable erection due to relaxation of smooth muscle of the penis and the improvement of blood supply. Pay attention that the indicated effect cannot be reached without a man’s sexual stimulation.

The active ingredient of Cialis does not inhibit other types of phosphodiesterase so does not influence the functions of organism. It does not impact cardiovascular system, the work of liver and cross-striated muscles. Also the research has shown that this medicine does not influence the quality of sperm, structure and mobility of spermatozoa. In addition Tadalafil does not change the level of sexual and other types of hormones. The effect comes after 20 minutes after administration, and the effect lasts more than 30 hours.

Cialis enters the bloodstream through the mucous membranes of the stomach. Its concentration in the blood reaches maximum within 2 hours after oral administration. Food or liquid intake does not influence this indicator. Cialis is actively excreted via the kidneys and intestines in the form of related substances.

Male erectile dysfunction.

This drug is taken orally and is produce in tablet form. The tablet should be swallowed whole, without chewing and without dissolution. The attending physician prescribes the course and dosage of the drug. It is desirable to schedule the sexual intercourse and take 1 tablet 20 minutes before it. Daily and the maximum dose is 1 tablet.cialis 20mg قرص

The patients’ reaction to Cialis is good, but in some cases the side effects were registered:

In some cases, the patients had prolonged erection (over 4 hours). Such conditions require medical care, because they lead to malnutrition of the cavernous bodies of the penis and death of its cells.

Cialis is contraindicated to woman and children under 18 years old. It is not prescribed to patients with hypersensitivity to the active ingredient of Cialis (Tadalafil). It is prohibited to patients, who administrate the nitrate containing medicines for cardiac insufficiency treatment.

A person, who suffer heart disease and the doctor forbids sexual contact, should refrain from taking the drug. Also the patients, who have suffered a heart attack, should also avoid Cialis use. The direct contraindication for Cialis use is heart failure II stage, angina, complex forms of arrhythmias, resistant hypertension, and states associated with a drop in blood pressure.

The physician should prescribe Cialis with caution if there is leukemia and anemia in the patient’s history. It is prohibited to administrate this medicine if the patient has any form of curvature of penis and fibrous processes in the corpora cavernosa. Cialis can be prescribed for patients with chronic renal insufficiency after additional research. Also it is prohibited to coadministrate Cialis and anti-arrhythmic drugs on the basis of α and β – blockers.

Cialis cannot be combined with nitrates containing medicines. The concentration of Tadalafil in the blood may increase at coadministration of inhibitors of CYP3 A4 and Tadalafil. The special caution should be given at combination of hormones and erythromycin group of antibiotics. It was recorded a decrease in the level of Cialis in blood at simultaneous administration with rifampicine group of antibiotics. The level of Cialis absorption is greatly reduced at the treatment of peptic ulcer of the stomach by the drugs reducing acidity. It is undesirable to combine the use of this drug and the medicines lowering blood pressure.

It is possible the development of adverse reactions and negative effects at increasing dose over the therapeutic one. The direct antagonist to Tadalafil does not exist. The symptomatic treatment should be prescribed at the side effects or an overdose. There will be no result for blood purification by means of dialysis, because the active substance is well associated with the blood proteins.

For example: at a sharp decrease in blood pressure, the patient should be laid on the bed and raise his legs up. The patient should be released from pressure clothes and to provide fresh air. At first signs of an allergic reaction the patient should immediately cease the administration of the drug, try to induce vomiting and cleanse the stomach with activated coal. The patient should pay special attention to blood pressure and respiratory function. In case of respiratory arrest, it is necessary to apply cardiopulmonary resuscitation, making mouth-to-mouth ventilation. Before the doctor’s arrival it is necessary to take history and to find out what drugs in addition to Tadalafil the patient took. This information will expedite the provision of medical assistance and its quality.

It is necessary to call an ambulance and wait for arrival of doctors before starting the abovementioned activities.

The drug should be kept at a dry place, at the temperature from 15C to 30C.

Cialis (tadalafil) increase increases blood flow to a certain area of the body and is used …

VIAGRA (sildenafil citrate), an oral therapy for erectile dysfunction, is the citrate salt of …

Levitra (vardenafil) relaxes muscles found in the walls of blood vessels and increases blood …

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