12 CLINICAL PHARMACOLOGY

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 Generic name: tadalafil [ ta-DAL-a-fil ] Other brand names of tadalafil include: Adcirca, Cialis Drug class: Impotence medications Cialis 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.

Parameter	Value	Notes
Absorption Half-life	~2 hours	Peak plasma concentration occurs in ~2 hours
Duration of Action	Up to 36 hours	Long-lasting effect
Metabolism	Liver (CYP3A4 enzyme)	Primarily processed in the liver
Excretion	Feces and urine	Mainly via feces

Do not take Cialis while also taking Adcirca, unless your doctor tells you to.

14.1 CIALIS for Use as Needed

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. 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. 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".

Product	Dosage	Quantity + Bonus	Price
Cialis Generic	20mg	30 + 4 Pills	68.05€ 64.81€	Buy
Cialis Generic	5mg	20 Pills	41.99€ 39.99€	Buy
Cialis Original	20mg	64 + 4 Pills	274.18€ 261.12€	Buy
Cialis Generic	20mg	270 + 10 Pills	335.21€ 319.25€	Buy
Cialis Professional	40mg	10 Pills	65.09€ 61.99€	Buy
Cialis Generic	2.5mg	90 + 6 Pills	112.43€ 107.08€	Buy
Cialis Generic	5mg	10 Pills	29.39€ 27.99€	Buy
Cialis Professional	40mg	90 + 2 Pills	348.59€ 331.99€	Buy
Cialis Professional	20mg	10 Pills	48.29€ 45.99€	Buy
Cialis Generic	2.5mg	360 + 10 Pills	260.03€ 247.65€	Buy
Cialis Soft Tabs	20mg	20 + 2 Pills	66.98€ 63.79€	Buy
Cialis Original	20mg	92 + 4 Pills	377.99€ 359.99€	Buy
Cialis Generic	40mg	180 + 10 Pills	277.29€ 264.09€	Buy
Cialis Generic	60mg	90 + 6 Pills	196.67€ 187.30€	Buy
Cialis Generic	2.5mg	270 + 10 Pills	199.64€ 190.13€	Buy
Cialis Generic	40mg	10 Pills	37.79€ 35.99€	Buy
Cialis Super Active	20mg	30 + 6 Pills	128.09€ 121.99€	Buy

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.

13.2 Animal Toxicology and/or Pharmacology

If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS, and call a healthcare provider right away. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS. If you experience these symptoms, stop taking CIALIS and contact a healthcare provider right away. These are not all the possible side effects of CIALIS. For more information, ask your healthcare provider or pharmacist.

Why it’s used

Store CIALIS at room temperature between 59° and 86°F (15° and 30°C). Keep CIALIS and all medicines out of the reach of children. Medicines are sometimes prescribed for conditions other than those described in patient information leaflets. This is a summary of the most important information about CIALIS. For more information you can also visit or call 1-877-CIALIS1 (1-877-242-5471).

Is a 40-mg dose of Cialis safe to take?

CIALIS® (tadalafil) is a registered trademark of Eli Lilly and Company. The makers of these brands are not affiliated with and do not endorse Eli Lilly and Company or its products. If your selected quantity is intended to last longer than one month, please recheck the price using the 3-months supply option. In some cases, the estimated drug price may vary depending on the supply duration. You may find alternative ways to save with this medication. Tell your doctor about all your current medicines, especially riociguat (Adempas).

Risk or Precaution	Explanation	Mitigation Measures
Priapism	Prolonged erection (>4 hours)	Seek immediate medical treatment if occurs
Heart Conditions	Possible risk if patient has underlying heart issues	Consult doctor before use
Allergic Reactions	Rash, swelling, difficulty breathing	Discontinue use, seek medical help
Drug Interactions	With nitrates, alpha-blockers, etc.	Medical consultation before use

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.

8.1 Pregnancy

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 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.

How does Cialis work?

No studies have directly compared tadalafil with sildenafil or free samples of cialis in canada vardenafil, but overall success rates have been comparable among the three options. 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. 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. Get medical help at once if you have nausea, chest pain, or dizziness during sex.

• Do not consume alcohol excessively with Cialis 20mg.
• Alcohol can increase side effects like dizziness.
• Always follow your healthcare provider’s instructions.

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.

Ingredient	Quantity per Pill	Function	Notes
Tadalafil	20 mg	Active pharmaceutical ingredient	Main compound
Microcrystalline Cellulose	50 mg	Filler	Binds ingredients
Magnesium Stearate	2 mg	Lubricant	Improves manufacturing
Lactose Monohydrate	10 mg	Diluents	Contains lactose

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 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".

• Do not take if you have a history of non-arteritic anterior ischemic optic neuropathy (NAION)
• NAION can cause sudden vision loss
• Risk increases with age and certain health conditions
• Stop use if sudden vision loss occurs
• Avoid if you have retinitis pigmentosa
• Genetic eye disorders may increase risk
• Regular eye exams recommended for users
• Report any vision changes to doctor immediately
• 20mg dose may have higher risk than lower doses
• Balance benefits against potential risks
• Discuss personal risk factors with your doctor
• Use lowest effective dose when possible

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".

What to avoid

Talk to your pharmacist about the potential option(s) noted below. View images of TADALAFIL (Generic for CIALIS) and identify pills by imprint, color or shape. If you need to save money on your TADALAFIL (Generic for CIALIS), compare our prices. Our prescription savings may even be lower than your insurance copay! Note: Multiple images may be displayed for medicines available in different strengths, sold under different brand names, or manufactured by different pharmaceutical companies.

Oral antifungal drugs

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. 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.

Before taking tadalafil,

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 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. 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). To make sure this Cialis is safe for you, tell your doctor if you have ever had: angina (chest pain), high or low blood pressure; angina (chest pain), high or low blood pressure; pulmonary hypertension (unless you are taking tadalafil for this); 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); 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); liver or kidney disease (or if you are on dialysis); vision loss, or retinitis pigmentosa (an inherited condition of the eye); vision loss, or retinitis pigmentosa (an inherited condition of the eye); a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia; 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 physical deformity of the penis (such as Peyronie's disease), or an erection lasting longer than 4 hours; health problems that make sexual activity unsafe.