Cialis 20mg #4

Cialis user manual

You can buy Cialis on this page

Composition

Cialis tablets contain 5 mg of tadalafil, lactose (in the form of monohydrate) and spray dried lactose monohydrate, giprolose and extra thin giprolose, sodium lauryl sulfate, MCC, croscarmellose Na, plant stearate Mg.
Composition p / o: Opadry yellow (hypromellose, triacetin, Ti dioxide, lactose monohydrate, dye E172 (yellow)).

Form of issue

Tablets in p / o.5 mg. Packing No. 14 and No. 28.
The tablets are almond-shaped, covered with a light yellow film membrane. On one side is engraved "C 5".

pharmachologic effect

Improves erectile function.

Pharmacodynamics and pharmacokinetics

What is Cialis?

Cialis (tadalafil) is a drug that reversibly and selectively suppresses specific PDE-5 cGMP (cyclic guanosine monophosphate).
Wikipedia says that the drug is designed to treat disorders in which a man is not able to achieve and maintain the necessary erection for sexual intercourse.

Pharmacodynamics

When sexual excitement occurs, local release of nitric oxide, and due to the suppression of PDE-5 increases the concentration of cyclic guanosine monophosphate in the cavernous body of the penis.
As a result of this - smooth muscles of the arteries relax, blood flow to the tissues of the penis increases and an erection occurs. In the absence of sexual arousal, there is no such effect.
Elevated concentrations of cGMP are also observed in the smooth muscles of the bladder, the prostate and supplying them with blood vessels.
Relaxation of the musculature of the vessels promotes an increase in perfusion (passage) of blood in these organs and a decrease in the manifestation of BPH symptoms, and relaxation of the smooth muscles of the bladder and prostate further enhances vascular effects.
Improving the erection, tadalafil thus increases the possibility of carrying out PA (sexual intercourse).
In healthy men, compared with placebo, there is no significant change in the change in DAD, SAD, and heart rate, does not affect the electroretinogram, visual acuity, IOP and pupil size, does not violate the ability to recognize colors (green / blue).

Pharmacokinetics

After taking the pill tadalafil well absorbed in the body. The concentration of the substance in the blood plasma reaches peak values ​​2 hours after ingestion. Food and time of taking the drug have no clinically significant effect on the rate of absorption of tadalafil and its bioavailability.
About 94% of the substance is in the state associated with plasma proteins. It is metabolized in the liver with the participation of the CYP3A4 isoenzyme. The main circulating metabolite in comparison with tadalafil displays at least 13,000 times less activity with respect to PDE-5.
The average half-elimination period in healthy men is 17.5 hours. The drug is excreted mainly in the form of pharmacologically inactive metabolites. About 61% of the accepted dose is excreted with feces, about 36% - with urine.

Indications for use

The drug is used for ED (erectile dysfunction); with MRSA (symptoms of the lower urinary tract) in patients with BPH; with ED in patients with LUTS with BPH.

Contraindications

Cialis is not prescribed for:
    hypersensitivity to tadalafil or auxiliary components of tablets;
    simultaneous use of any organic nitrate-containing preparation;
    simultaneous use of doxazosin or preparations for the treatment of ED;
    the presence of contraindications to sexual activity in men with cardiac and vascular pathologies (unstable angina, suffered during the last three months of myocardial infarction, angina attacks occurring during PA, CHF II-IV classes according to the NYHA classification, AH, uncontrolled arrhythmias, transferred during the last six months ischemic stroke);
    whether or not associated with the use of PDION-5 inhibitors NAION (anterior ischemic optic neuropathy);
    intolerance to lactose, lactase deficiency, malabsorption of glucose / galactose.
In addition, the drug is contraindicated to persons under the age of eighteen, and can not be used more than 2 rubles a week. in men with renal damage, in which Clcr is below 30 ml / min.

Relative contraindications

Due to the lack of data on patients with hepatic insufficiency, which is classified in the Child-Pugh C-Class classification, caution should be exercised when using tadalafil in this group of patients.
With caution, Cialis is prescribed to persons who are on treatment with α1-adrenoreceptor blockers. This is due to the fact that with the simultaneous use of tadalafil with these drugs has a risk of symptomatic arterial hypotension (SAG).
Clinical studies of the pharmacological properties of tadalafil in a group of healthy men showed that a single dose of a standard dose of Cialis does not lead to SAG with simultaneous application of α1A-adrenoblocker tamsulosin. The study involved 18 people.
Other restrictions apply:
    predisposition to priapism;
    anatomical deformation of the penis;
    simultaneous administration of antihypertensive drugs, as well as drugs that suppress the isoenzyme CYP3A4 (Erythromycin, Saquinavir, Itraconazole, Ritonavir, Ketoconazole).
Diagnosis of ED should include identifying the main cause of impotence, conducting an appropriate examination and determining adequate therapy.

Side effects

With erectile dysfunction, the use of Cialis is most often accompanied by pain in the muscles or back, headache, flushing of the face, dyspepsia, nasal congestion.
In patients with ED / BPH, pain in the extremities and / or muscles, headache, gastroesophageal reflux (GER), dyspepsia were most often recorded.
Other possible adverse reactions:
    often - dizziness;
    infrequently, hypersensitivity reactions, blurred perception of visual images, pain in the eyeball, tachycardia, palpitations, increased or decreased blood pressure (the latter is possible in people who have already taken antihypertensive drugs), shortness of breath, nasal congestion, GER, abdominal pain, hyperhidrosis, rash ;
    rarely - a stroke (including acute disruption of the blood circulation of the brain with a rupture of the vessel and hemorrhage (ONMK hemorrhagic type)), transient amnesia, epileptic seizure, eyelid swelling, visual field disturbance, injection of the vessels of the sclera of the eyeball, myocardial infarction, urticaria, a prolonged erection.
In patients with previously existing risk factors for CVD, there were:
    infrequently - chest pain;
    in rare cases - fainting, migraines, transient ischemic attacks, sudden cardiac death.
However, to be precise, these phenomena are associated with the use of tadalafil, risk factors for CVD, sexual arousal, other factors or a combination of factors, or not, can not.
There are also reports of isolated cases of sudden hearing loss when using PDE-5 inhibitors (including tadalafil) during clinical and post-marketing studies.
Side effects that occurred during postmarketing studies, but were not found in clinical placebo-controlled studies:
    swelling of the face;
    migraine;
    NAION;
    occlusion of the vessels of the retina;
    unstable angina;
    ventricular arrhythmias;
    exfoliative dermatitis;
    priapism;
    Stevens-Johnson syndrome;
    sudden cardiac death.
Instructions for use Cialis

How to take Cialis with ED?

Patients with frequent sexual activity, when PA occurs more than 2 rub / week, 5 mg tablets are recommended to be taken daily, one at a time, at the same time. Depending on the individual tolerability, it is possible to reduce the dosage of tadalafil up to 2.5 mg.
If PA occurs less often than 2 r. / Wk., It is recommended to take tablets immediately before coition at a dose of 20 mg.
The permissible upper limit of the daily dose of Cialis is 20 mg.

Instructions for the use of Cialis according to ED / BPH or BPH

With these pathologies, the patient is prescribed a drug of 1 r./day for one tablet at the same time (any, regardless of the time of ingestion and the time of sexual activity).
The duration of the course of treatment Cialis 5 mg is determined individually.

Additionally

In renal lesions, when the Clcr score is 31-80 ml / min, there is no need for dose correction. Patients with severe renal damage, in which Clcr does not exceed 30 ml / min, daily use of the drug is contraindicated.

Overdose

A single dose of up to 0.5 g of tadalafil by a healthy person and repeated application up to 100 mg / day. Tadalafil in patients with erectile dysfunction is accompanied by side effects similar to those that occur with the use of a lower drug.
In case of an overdose, standard symptomatic therapy is performed. Cialis is practically not excreted in hemodialysis.

Interaction

The effect of other drugs on tadalafil
Biotransformation of Cialis is carried out with the participation of the isoenzyme CYP3A, and therefore drugs inhibiting this isoenzyme increase the value of Cmax and AUC of tadalafil.
Despite the fact that specific studies were conducted only with respect to the interaction of tadalafil with ketoconazole and ritonavir, it can be assumed that such drugs as Itraconazole and Erythromycin are also capable of increasing the activity of tadalafil.
Rifampicin, which is an inducer of CYP3A, reduces the exposure of a single dose of the drug and the value of Cmax. Most likely, the simultaneous use of other drugs from the group of CYP3A inducers should help reduce the plasma concentration of tadalafil.
The use of Cialis in combination with antacids (hydroxide Al / Mg hydroxide) helps to reduce the rate of absorption of the active substance of the drug without changing the AUC for tadalafil.
Drugs that increase the acidity of the stomach (pH), and, in particular, the H2-blocker nizatidine, do not affect the pharmacokinetic parameters of tadalafil.
A study of the safety and efficacy of the use of Cialis in combination with other methods of treating erectile dysfunction (including in combination with other PDE5 inhibitors) has not been carried out, and it is therefore recommended that such combinations be avoided.
Tadalafil does not contribute to an increase in bleeding time caused by ASA.

Effect of tadalafil on other drugs

Tadalafil is able to enhance the hypotensive effect of nitrates, because of what these drugs are not prescribed in combination.
The substance has no significant effect on the clearance of drugs that are metabolized with the participation of the cytochrome P450 system. In the course of the studies it was found that tadalafil:
    Does not suppress or induce isoenzymes CYP3A4, CYP1A2, CYP2C19, CYP2C9, CYP2T1 and CYP2D6;
    does not have a significant effect on the pharmacokinetics of S- or R-warfarin, as well as on the effect of warfarin on PTV (prothrombin time);
    does not increase the duration of bleeding caused by ASA;
    causing a systemic vasodilator effect, is able to intensify the hypotensive effect of the funds intended for lowering blood pressure (in patients taking several antihypertensive drugs in poorly controlled hypertension, the blood pressure decreased more pronounced, and in most patients this phenomenon was not associated with hypotensive symptoms);
    does not have a significant effect on the pharmacodynamics and pharmacokinetic profile of Teofillin.
The results of two studies show that the use of the drug in healthy men in combination with Tamsulosin (α1A-adrenoblocker) does not cause a significant reduction in blood pressure.
The use of a drug with α 1 -adrenoblocker Doxazosin (provided that the latter is taken at a dose of 4 to 8 mg / day) was accompanied by augmentation of the hypotensive effect of doxazosin. Individual patients experienced pressure-related symptoms including fainting.

Storage conditions

Tablets should be stored at a temperature below 30 ° C.

Shelf life

Three years.

special instructions

Sexual activity can be dangerous in a number of pathologies of the heart and blood vessels. In this regard, men with diseases that require restriction of sexual activity, treatment of erectile dysfunction, including tadalafil, is contraindicated.
There are reports of cases of priapism (long, unrelated to sexual arousal, involuntary erection) against treatment with PDE-5 inhibitors.
Patients should be informed of the urgent need to see a doctor if the erection persists for four (or more) hours. In the absence of timely assistance, such conditions lead to irreversible impotence.
Like other inhibitors of PDE-5, the drug causes systemic vasodilation, which can provoke a transient decrease in blood pressure. Before appointing tadalafil, the physician should make sure that the patient with cardiac / vascular pathology does not undergo undesirable effects due to this effect.
Non-arterial AION is one of the causes of visual impairment (in some cases, before its complete loss). Post-marketing observations recorded reports of rare cases of development of this pathology (cases were time-related with the use of PDE-5 inhibitors).
Determine exactly whether there is a direct link between tadalafil and NAION treatment, to date it is impossible.
In case of sudden loss of vision, tadalafil should be discontinued and seek medical attention.
The patient should also be warned that the people who have undergone NAION have a high risk of re-development of optical neuropathy.
If a patient is suspected of having BPH, he should undergo an additional examination to rule out prostate cancer.
Despite the fact that dizziness with the admission of tadalafil occurred with the same frequency as when taking placebo, during the treatment should be careful when driving and machinery.

Analogues of Cialis

Analogues with a similar mechanism of action:  Viagra, Yohimbin hydrochloride, Verona, Impaza.

What is better - Cialis, Levitra or Viagra?

Levitra and Viagra today are the main analogues of Cialis tablets.
The active substance of Levitra is vardenafil. The effect after application of this drug develops on average after 15 minutes and lasts up to 12 hours.
The active substance of Viagra is sildenafil. The substance begins to act in half an hour-hour after taking the pill, the effect persists for 4 hours.
A distinctive feature and advantage of Cialis over analogues is its duration of action: the effect of conventional tablets persists to 36 hours, the effect of tablets with an extra dosage of tadalafil - up to 72 hours.
Cialis can be taken immediately before sexual activity, Levitra - for 20 minutes, Viagra - for 30-60 minutes.
Another important point is that the pharmacokinetics of Cialis and Levitra intake of food (as well as the amount eaten) and the use of alcohol does not affect, it is recommended to take Viagra on an empty stomach.
Thus, trying to find an answer to the questions "Viagra or Cialis, Cialis or Levitra - what is better?", One should focus on how quickly it is necessary to get an effect, how long the effect should be preserved, whether alcohol consumption is planned before sexual activity.

Cialis and alcohol

The drug does not affect the concentration of alcohol, and alcohol does not affect the concentration of tadalafil.
The use of alcohol in a dose exceeding 0.7 g / kg, against the background of the use of tadalafil does not lead to a statistically significant decrease in the average BP values. Individual men had orthostatic hypotension and postural dizziness.
Taking a drug with alcohol at a dose less than 0.6 g / kg was not accompanied by a decrease in blood pressure, and dizziness occurred with a frequency similar to that of dizziness only with alcohol.

In pregnancy

The drug is not intended for women.

Reviews of Cialis

Reviews of Cialis tablets on the forums are mostly good. And they are confirmed by the results of a number of clinical studies, according to which, when taking 20 mg of the drug, improvement in potency was noted in 81% of men who participated in the experiment with varying degrees of erectile dysfunction (from minor to severe).
Reviews of Cialis Soft and Cialis Forte (Cialis generics) are also good. The main advantages of the drugs of men are called a faster onset of the effect in comparison with the usual 5 mg tablets and a substantially lower price.
Reviews of Cialis and reviews of Cialis generics suggest that, despite the good tolerability of tadalafil, some patients may have side effects in the form of heartburn, muscle pain, low back pain, headache, dizziness.
Individual patients say that in the morning after taking the pill there was a feeling similar to that arising from a hangover.
In this regard, before using the drug, it is very important to read the doctors' reviews of contraindications to Cialis.
It should also be remembered that tadalafil only provides blood to the genital area of ​​a man, but in the absence of sexual stimulation "does not work." That is, if a man is not physically ready for sexual intimacy and not excited, there will be no effect.
Cialis is not intended for women. Instead, you can use the generic Female Cialis, whose action is aimed at increasing the flow of blood to the genitals and increasing excitement.