5.1 Cardiovascular

Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)]. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered. CIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.

Dosage for benign prostatic hyperplasia (BPH)

For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours. For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. PATIENT PACKAGE INSERT Patient InformationCIALIS®(See-AL-iss)(tadalafil) tabletsRead this important information before you start taking CIALIS and each time you get a refill. You may also find cialis order mastercard it helpful to share this information with your partner. In most patients, the ability to have sexual intercourse is improved for up to 36 hours.For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity.

Product	Dosage	Quantity + Bonus	Price
Cialis Generic	2.5mg	180 + 10 Pills	154.86€ 147.49€
Cialis Generic	40mg	60 + 6 Pills	130.98€ 124.74€
Cialis Generic	20mg	270 + 10 Pills	335.21€ 319.25€
Cialis Generic	10mg	10 Pills	31.41€ 29.91€
Cialis Professional	40mg	60 + 2 Pills	262.32€ 249.83€
Cialis Generic	5mg	20 Pills	41.99€ 39.99€
Cialis Generic	10mg	60 + 6 Pills	105.81€ 100.77€
Cialis Generic	60mg	120 + 8 Pills	240.18€ 228.74€
Cialis Professional	20mg	360 + 6 Pills	807.03€ 768.60€
Cialis Generic	60mg	180 + 10 Pills	313.11€ 298.20€
Cialis Generic	20mg	360 + 10 Pills	427.34€ 406.99€
Cialis Professional	20mg	60 + 2 Pills	183.83€ 175.08€
Cialis Black	80mg	20 Pills	71.83€ 68.41€
Cialis Professional	20mg	270 + 6 Pills	623.07€ 593.40€
Cialis Super Active	20mg	20 + 4 Pills	92.35€ 87.95€
Cialis Generic	10mg	20 Pills	48.23€ 45.93€
Cialis Super Active	20mg	30 + 6 Pills	128.09€ 121.99€

Cialis is effective at improving erectile function over the course of therapy. Physicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates.

5. Tips

This information does not take the place of talking with your healthcare provider. You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups. If you do not understand the information, or have questions, talk with your healthcare provider or pharmacist.What Is The Most Important Information I Should Know About CIALIS?CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.Do not take CIALIS if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches.

Comparison with actions of other PDE5 inhibitors

Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates. (See “Who should not take CIALIS?”)Tell all of your healthcare providers that you take CIALIS. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took CIALIS.After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications (see “Can Other Medicines Affect CIALIS?”).Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke.

Mechanism of action: Inhibits phosphodiesterase type 5 (PDE5) in smooth muscle.
PDE5 breaks down cyclic guanosine monophosphate (cGMP).
Sexual stimulation releases nitric oxide (NO), which increases cGMP.
cGMP causes smooth muscle relaxation in the corpus cavernosum of the penis.
This relaxation allows increased blood flow and an erection.
By inhibiting PDE5, tadalafil increases cGMP levels, enhancing the erectile response.
In BPH/urinary tract, relaxation of prostate and bladder smooth muscle improves symptoms.
In PAH, vasodilation occurs in the pulmonary vascular bed.
It has minimal effect on PDE6 (retina) compared to sildenafil, possibly fewer visual effects.
It has weak inhibition of PDE11 (function unknown); clinical significance unclear.
The effect is dependent on sexual stimulation and intact neural pathways.

Parameter	Value	Description	Notes
Absorption Time	30-60 minutes	Time to reach peak plasma concentration	After oral intake
Half-life	17.5 hours	Duration of action	Prolonged effects possible
Peak Plasma Levels	Achieved in 2 hours	Time to maximum concentration	Variable per individual
Bioavailability	~84%	Proportion absorbed into bloodstream	When taken with food

Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)]. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].

Patient counseling points: Take exactly as prescribed by your doctor.
For on-demand (20mg), take at least 30 minutes before sexual activity.
For daily use, take at approximately the same time each day, with or without food.
Do not take more than one dose per day.
Seek immediate medical help for an erection lasting more than 4 hours.
Stop taking Cialis and seek medical help if you experience sudden vision or hearing loss.
Be cautious when rising from a sitting/lying position to avoid dizziness.
Report any new medications (prescription, OTC, herbal) to your doctor before taking Cialis.
It does not protect against sexually transmitted infections (STIs) or pregnancy.
Keep all appointments with your doctor for monitoring.
Do not share your medication with others.

Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)]. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.

Side Effect	Incidence Rate	Severity	Recommendations
Headache	Common	Mild	Hydrate, over-the-counter pain relief
Flushing	Common	Mild	Avoid hot environments
Nasal Congestion	Less common	Mild	Use decongestants cautiously
Back Pain	Less common	Mild	Seek medical advice if persists

CIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.

Comparison with other PDE5 inhibitors: Sildenafil (Viagra) and Vardenafil (Levitra).
Key difference: Tadalafil's duration of action is much longer (up to 36 hours).
Sildenafil and vardenafil typically last 4-5 hours.
Tadalafil is less affected by food, especially high-fat meals.
Sildenafil absorption is significantly delayed by a high-fat meal.
Onset of action is similar for all (30-60 minutes), though sildenafil can be faster.
Side effect profiles are similar, but tadalafil is more associated with back pain.
Tadalafil is the only PDE5 inhibitor approved for daily use and for BPH.
Choice depends on individual response, lifestyle, frequency, and cost.
Do not take tadalafil within 24-48 hours of taking another PDE5 inhibitor.
Consult a doctor to determine the most suitable medication.

For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours. For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. PATIENT PACKAGE INSERT Patient InformationCIALIS®(See-AL-iss)(tadalafil) tabletsRead this important information before you start taking CIALIS and each time you get a refill. You may also find cialis order mastercard it helpful to share this information with your partner. This information does not take the place of talking with your healthcare provider.

Further information

You should not take CIALIS if your healthcare provider has told you not to have sexual activity because of your health problems.have low blood pressure or have high blood pressure that is not controlledhave had a strokehave liver problemshave kidney problems or require dialysishave retinitis pigmentosa, a rare genetic (runs in families) eye diseasehave ever had severe vision loss, including a condition called NAIONhave stomach ulcershave a bleeding problemhave a deformed penis shape or Peyronie's diseasehave had an erection that lasted more than 4 hourshave blood cell problems such as sickle cell anemia, multiple myeloma, or leukemiaCan Other Medicines Affect CIALIS?Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. CIALIS and other medicines may affect each other. Always check with your healthcare provider before starting or stopping any medicines. Especially tell your healthcare provider if you take any of the following:*medicines called nitrates (see “What Is The Most Important Information I Should Know About CIALIS?”)medicines called alpha blockers. Alpha blockers are sometimes prescribed for prostate problems or high blood pressure.

1. They Look Different

If CIALIS is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.other medicines to treat high blood pressure (hypertension)medicines called HIV protease inhibitors, such as ritonavir (Norvir®, Kaletra®)ketoconazole (Nizoral®)itraconazole (Sporanox®)erythromycinother medicines or treatments for ED.CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension. Do not take Revatio® with CIALIS.How Should I Take CIALIS?Take CIALIS exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you.Some men can only take a low dose of CIALIS or may have to take it less often, because of medical conditions or medicines they take.Do not change your dose or the way you take CIALIS without talking to your healthcare provider. You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups.

7.1 Potential for Pharmacodynamic Interactions with CIALIS

Dose proportionality

If you do not understand the information, or have questions, talk with your healthcare provider or pharmacist.What Is The Most Important Information I Should Know About CIALIS?CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.Do not take CIALIS if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates. (See “Who should not take CIALIS?”)Tell all of your healthcare providers that you take CIALIS. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took CIALIS.After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications (see “Can Other Medicines Affect CIALIS?”).Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.See also “What Are The Possible Side Effects Of CIALIS?”What Is CIALIS?CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him. CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away.Some form of sexual stimulation is needed for an erection to happen with CIALIS.CIALIS does not:cure EDincrease a man's sexual desireprotect a man or his partner from sexually transmitted diseases, including HIV.

Tips to Get the Best Results from Cialis

Integrated statistical analysis

Speak to your healthcare provider about ways to guard against sexually transmitted diseases.serve as a male form of birth controlCIALIS is only for men over the age of 18 who have ED, including men with diabetes or who have undergone prostatectomyCIALIS is not for women or children.CIALIS must be used only under a healthcare provider's care.Who Should Not Take CIALIS?Do not take CIALIS if you:take any medicines called “nitrates”.use recreational drugs called “poppers” like amyl nitrite and butyl nitrite. (See “What Is The Most Important Information I Should Know About CIALIS?”)What Should I Tell My Healthcare Provider Before Taking CIALIS?CIALIS is not right for everyone. Only your healthcare provider and you can decide if CIALIS is right for you. Before taking CIALIS, tell your healthcare provider about all your medical problems, including if buy cialis daily uk you:are allergic to CIALIS or ADCIRCA any of its ingredients. See the end of this leaflet for a complete list of ingredients in CIALIS.have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity.

Cialis 20mg is sometimes used off-label for other medical conditions.
The medication is designed to improve quality of life for men with ED.
Tadalafil acts by increasing blood flow during sexual arousal.
Cialis can be used with certain lifestyle adjustments for better results.
Patients should monitor their response and side effects.
Cialis 20mg might interact with certain antifungal medications.
It is sometimes prescribed alongside other ED treatment options.
The safety profile of Cialis is well established.
Cialis 20mg helps improve confidence in intimate moments.
The medication should not be shared with others.
It is crucial to follow the prescribed dosage.
Always report any adverse effects to your healthcare provider.

Tadalafil or Cialis: Are They Basically The Same?

Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.See also “What Are The Possible Side Effects Of CIALIS?”What Is CIALIS?CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him. CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away.Some form of sexual stimulation is needed for an erection to happen with CIALIS.CIALIS does not:cure EDincrease a man's sexual desireprotect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases.serve as a male form of birth controlCIALIS is only for men over the age of 18 who have ED, including men with diabetes or who have undergone prostatectomyCIALIS is not for women or children.CIALIS must be used only under a healthcare provider's care.Who Should Not Take CIALIS?Do not take CIALIS if you:take any medicines called “nitrates”.use recreational drugs called “poppers” like amyl nitrite and butyl nitrite.

Cialis and herbs and supplements

(See “What Is The Most Important Information I Should Know About CIALIS?”)What Should I Tell My Healthcare Provider Before Taking CIALIS?CIALIS is not right for everyone. Only your healthcare provider and you can decide if CIALIS is right for you. Before taking CIALIS, tell your healthcare provider about all your medical problems, including if buy cialis daily uk you:are allergic to CIALIS or ADCIRCA any of its ingredients. See the end of this leaflet for a complete list of ingredients in CIALIS.have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. CIALIS and other medicines may affect each other. Always check with your healthcare provider before starting or stopping any medicines.

Cialis vs. Tadalafil: Frequently Asked Questions

Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.17.10 Recommended AdministrationCIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours.For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. Cialis is effective at improving erectile function over the course of therapy. Physicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke.

Does tadalafil interact with foods or drinks?

Therefore, patients who experience anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)]. Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)]. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol. Especially tell your healthcare provider if you take any of the following:*medicines called nitrates (see “What Is The Most Important Information I Should Know About CIALIS?”)medicines called alpha blockers. Alpha blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.other medicines to treat high blood pressure (hypertension)medicines called HIV protease inhibitors, such as ritonavir (Norvir®, Kaletra®)ketoconazole (Nizoral®)itraconazole (Sporanox®)erythromycinother medicines or treatments for ED.CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension. Do not take Revatio® with CIALIS.How Should I Take CIALIS?Take CIALIS exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you.Some men can only take a low dose of CIALIS or may have to take it less often, because of medical conditions or medicines they take.Do not change your dose or the way you take CIALIS without talking to your healthcare provider.

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