Cialis: Say “No” to Erectile Dysfunction

Cialis: Say “No” to Erectile Dysfunction

Cialis is a medicament that contains an active substance called Tadalafil. It is used for the treatment of erectile dysfunction (ED) in adult men. ED is defined as an inability to achieve and maintain an erection sufficient for sexual intercourse. In 2014, as many as 150 million men worldwide have suffered from erectile dysfunction. It is expected that 300 million men will have ED by 2028.

There are many possible causes of erectile dysfunction, but most common are hormonal, psychological, neurological and vascular. Many men often avoid seeing their doctors for diagnosis of ED, because they perceive this problem as embarrassing. Most of them simply buy drugs that can help them solve this problem.

Mechanism of action

It is well known that sexual stimulation stimulates the release of neurotransmitters that initiate erection. The most important neurotransmitter that initiates erection is nitrogen-II-oxide (NO). NO increases the synthesis of cyclic guanosine monophosphate (cGMP) – a substance that causes dilation of blood vessels in penile tissue, thus leading to erection.

PDE5 is an enzyme that 60 years ago that blocks the release of NO and causes decomposition of cGMP. Cialis inhibits PDE5, increases the concentration of NO and cGMP in the blood, and directly potentiates and facilitates erection.

Tadalafil has proven to be very effective in the treatment of all forms of erectile dysfunction, including severe forms. Its efficacy and safety has been confirmed in numerous clinical studies worldwide. It belongs to one of the most frequently used drugs in the treatment of ED.

Contraindications

Clinical studies have proven that Cialis increases the effects of organic nitrates – drugs used to treat angina pectoris. In a clinical study that examined interaction between Tadalafil and nitrates, it was found that this interaction lasted more than 24 hours. For this reason, you should wait at least 48 hours after the last dose of Cialis before you start taking nitrates. Simultaneous administration of Cialis with organic nitrates leads to a clinically significant hypotensive effect that can endanger your life.

Cialis should not be used in patients with cardiac diseases in whom sexual activity is not recommended. Physicians should consider the potential risk of sexual activity in patients with any cardiovascular disease.

The use of Cialis is contraindicated in patients who:

  • Had myocardial infarction in the past three months.
  • Had a stroke in the past six months.
  • Have an unstable angina pectoris.
  • Have severe heart failure.
  • Have arrhythmias.
  • Have hypotension.
  • Have severe forms of hypertension.

Cialis is contraindicated in patients who have visual impairment, because cases of ischemic optic neuropathy have been reported in patients taking this medicine.

Precautions

Prior to taking Tadalafil, a detailed examination of the patient is recommended in order to determine the possible cause of erectile dysfunction. Do not use Cialis on your own without prior consultation with the doctor.

Cialis may increase the antihypertensive effect of numerous drugs, and should not be used or should be used only with extra precaution in all patients using antihypertensive drugs.

Clinical studies have shown that this drug excretion has been reduced in patients with impaired renal function, causing the accumulation of Tadalafil in the body. Use of Cialis should be avoided in patients with severe kidney damage.

Cases of priapism (prolonged and painful erection lasting longer than four hours) have been reported in patients taking Cialis. Men who have anatomic malformations of the penis (e.g. Peyronie’s disease) or who suffer from anemia or leukemia, have a higher risk of developing priapism. If the erection lasts more than four hours, you should contact your doctor immediately.

Cases of sudden hearing loss have been reported in patients taking this medicament. If you notice a hearing impairment, stop taking Cialis immediately and contact your doctor.

Due to lack of data, Cialis should not be used in patients with severe hepatic impairment.

Dosage

The recommended initial dose is Generic Cialis 20mg, half an hour before the expected sexual intercourse, regardless of the meal. The dose may be increased up to 20mg in patients who do not respond to 10mg daily,

Cialis can be taken only once a day. Patients who are planning to use Tadalafil more than twice a week, consideration should be given to the use of 2.5mg or 5mg once daily.

The use of Cialis in patients with severe hepatic impairment should be avoided because there is insufficient data to confirm the safety of its use in this population.

Dose adjustment is not required in elderly and in patients with impaired renal function.

Interactions with other drugs

The following drugs may lead to major (clinically significant) interactions with Cialis:

  • Organic nitrates, such as Nitroglycerine, Isosorbide Mononitrate, Isosorbide Dinitrate, Amyl Nitrite and Nitroprusside. These drugs are used in the treatment of angina pectoris and heart failure. Simultaneous administration with Cialis can lead to a sudden fall in blood pressure, which can cause cardiovascular collapse.
  • Telaprevir and Boceprevir – medicines used to treat hepatitis C. Concomitant use with these drugs increases the risk of side effects, such as headache, ringing in the ears, fainting, vision loss, hearing loss, arrhythmias, prolonged and painful erections, loss of breath and chest pain.
  • Riociguat – a medicine used to treat chronic thromboembolic pulmonary hypertension. Simultaneous administration with this medicine may lead to severe hypotension.

Moderate interactions may occur if Cialis is co-administrated with the following drugs:

  • Alpha antagonists, such as Doxazosin, Prazosin and Terazosin. These drugs are used to treat hypertension and benign prostate enlargement. Simultaneous administration increases the risk of hypotension. It is therefore necessary to reduce the dose of Cialis (no more than 5mg once a day).
  • Antibiotics, such as Ciprofloxacin, Norfloxacin, Grepafloxacin, Erythromycin, and Clarithromycin. These drugs increase plasma concentrations of Cialis, thereby increasing the risk of side effects.
  • Antifungal medicines, such as Clotrimazole, Fluconazole and Ketoconazole. These drugs increase plasma concentrations of Tadalafil, thereby increasing the risk of side effects.

Concomitant use with alcoholic beverages must be avoided because alcohol enhances the effects of Cialis and may lead to a significant drop in blood pressure.

Side Effects

Common side effects (occurring in 1-10% of patients) associated with Cialis use include:

  • Headache
  • Hot flashes
  • Nasal congestion
  • Gastro-esophageal reflux
  • Dyspepsia
  • Back pain
  • Myalgia
  • Pain in the extremities

Uncommon side effects (occurring in 0.1-1% of patients) include:

  • Dizziness
  • Hypersensitivity reactions
  • Blurred vision
  • Tinnitus (ringing in the ears)
  • Tachycardia
  • Low blood pressure
  • Difficulty breathing
  • Abdominal pain
  • Penile hemorrhage
  • Chest pain

Rare side effects (occurring in 0.01-0.1% of patients) include:

  • Heart attack
  • Stroke
  • Ischemic optic neuropathy
  • Sudden loss of hearing
  • Stevens-Johnson syndrome
  • Priapism

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