Description

Cialis 20mg film-coated tablets containing the active ingredient tadalafil are used to treat erectile dysfunction (ED) in men. They are available in various strengths, including 20mg tablets.To treat ED, Cialis can be taken as needed, usually at least 30 minutes before sexual activity. The effect on sexual ability may last up to 36 hours. Alternatively, it can be taken regularly, once a day every day, in which case sexual activity can be attempted at any time between doses.                                               

Active Ingredient

Cialis contains the active ingredient tadalafil, which belongs to a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. It works by helping to relax the blood vessels in the penis, allowing increased blood flow, which helps achieve and maintain an erection during sexual stimulation.

Dosage

The recommended dose of Cialis 20mg is one tablet taken with water, as needed, usually at least 30 minutes before sexual activity. The effect on sexual ability may last up to 36 hours. Alternatively, it can be taken regularly, once a day every day, in which case sexual activity can be attempted at any time between doses.

Availability in Pakistan

Cialis 20mg film-coated tablets are available in Pakistan, including cities like Lahore, Sialkot, Peshawar, and Karachi. A pack of 4 tablets made in Turkey can be purchased for Rs. 3,900.

Precautions

Do not exceed the recommended dosage, as overdoses of any health supplements may cause health concerns. Always consult with a healthcare professional before starting any new medication or treatment for erectile dysfunction.                                                                                                                               

Major Interactions

• Cialis can cause a serious drop in blood pressure when used with nitrates (e.g. nitroglycerin, isosorbide) or recreational drugs called “poppers” containing nitrites. This can lead to dizziness, fainting, and in rare cases, heart attack or stroke. Cialis should not be used with these medications.

Moderate Interactions

• Cialis may interact with alpha blocker medications used to treat an enlarged prostate or high blood pressure (e.g. doxazosin, tamsulosin). This can lead to low blood pressure and dizziness/fainting. The dosage of Cialis or the alpha blocker may need to be adjusted.

Other Interactions

• Cialis may interact with other medications that can affect how it is metabolized and removed from the body, such as certain antifungals, antibiotics, and HIV medications. This can impact the effectiveness of Cialis.
• Cialis should not be taken with any other PDE5 inhibitors used to treat erectile dysfunction or pulmonary hypertension, as this could lead to an overdose.

Key Benefits of Daily Cialis

1. Easier spontaneous sex: Cialis has a long half-life, so when taken daily, it remains active in the body, allowing for increased spontaneity and the ability to be ready for sex at any time.
2. Improved lower urinary tract symptoms: Daily low-dose Cialis is FDA-approved to treat benign prostatic hyperplasia (BPH) by relaxing the bladder and prostate muscles, making it easier to urinate.
3. Potential cardiovascular health benefits: While not FDA-approved for this purpose, there is evidence that daily Cialis may improve cardiovascular health and reduce the risk of major adverse cardiac events.
4. Increased sexual confidence: Knowing Cialis is always working can provide a confidence boost and reduce anxiety before sexual intercourse.
5. Reduced risk of side effects: Daily Cialis is taken at a lower dosage than as-needed, potentially leading to a lower risk of side effects like headache.

Key Ingredient

The active ingredient in Cialis is tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor that helps relax blood vessels and increase blood flow to the penis, enabling an erection. Tadalafil is also the active ingredient in Adcirca, which is FDA-approved to treat pulmonary arterial hypertension.                           

Tadalafil

Medication used to treat erectile dysfunction, benign prostatic hyperplasia, and pulmonary arterial hypertension

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Trade Names

Cialis, Adcirca, others

Uses

Treatment of erectile dysfunction, benign prostatic hyperplasia, pulmonary arterial hypertension

Onset of Action

30 minutes

Mechanism of Action of Cialis (Tadalafil)

Cialis, with the active ingredient tadalafil, belongs to a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. It works by inhibiting the PDE5 enzyme, which is primarily found in the corpus cavernosum of the penis.When a man is sexually stimulated, nitric oxide is released in the corpus cavernosum. This leads to the production of cyclic guanosine monophosphate (cGMP). cGMP causes the smooth muscles of the corpus cavernosum to relax, enabling blood to rush into the penis, resulting in an erection.PDE5 is the enzyme that breaks down cGMP, causing the smooth muscles to contract and reducing blood flow to the penis. By inhibiting PDE5, Cialis increases the levels of cGMP in the corpus cavernosum, leading to increased blood flow and a stronger erection in response to sexual stimulation.It’s important to note that Cialis does not directly cause an erection. It enhances the biochemical response to sexual stimulation by increasing the effects of nitric oxide

Major Interactions

• Nitrates: Taking Cialis with nitrates (e.g., nitroglycerin, isosorbide) can cause a serious drop in blood pressure, leading to dizziness, fainting, and in rare cases, heart attack or stroke. This combination is contraindicated.
• Alpha Blockers: Combining Cialis with alpha blockers (e.g., doxazosin, tamsulosin) can lead to low blood pressure and dizziness/fainting. The dosage of Cialis or the alpha blocker may need to be adjusted.

Moderate Interactions

• PDE5 Inhibitors: Cialis should not be taken with other PDE5 inhibitors used to treat erectile dysfunction or pulmonary hypertension, as this could lead to an overdose.
• Antifungals, Antibiotics, and HIV Medications: These medications can affect how Cialis is metabolized and removed from the body, potentially impacting its effectiveness.

Minor Interactions

• Other Medications: Cialis may interact with various other medications, including blood pressure medications, antihistamines, and antidepressants. These interactions can affect blood pressure, heart rate, or the effectiveness of Cialis.

Alcohol and Food Interactions

• Alcohol: Consuming alcohol while taking Cialis can lower blood pressure, so moderation is advised.
• Grapefruit: Grapefruit can interact with Cialis, potentially increasing its levels in the blood and leading to side effects.

Disease Interactions

• Cardiovascular Disease: Cialis may interact with cardiovascular conditions, such as heart problems, and should be used with caution in these cases.
• Renal Dysfunction, Pulmonary Disease, and Other Conditions: These conditions can also interact with Cialis, and patients should consult their healthcare provider before starting treatment.

Contraindications and Interactions

• Nitrates: Cialis should not be taken with any nitrate medications, such as nitroglycerin, as this can cause a dangerous drop in blood pressure. 
• Alpha Blockers: Cialis should be used with caution when taken with alpha blocker medications, as this combination can also lead to low blood pressure and dizziness. 
• PDE5 Inhibitors: Cialis should not be taken with other PDE5 inhibitor medications used to treat erectile dysfunction or pulmonary hypertension, as this could lead to an overdose. 
• Alcohol: Drinking alcohol while taking Cialis can further lower blood pressure and decrease sexual performance. Moderation is advised. 

Cardiovascular Precautions

• Cialis should not be used if sexual activity is inadvisable due to cardiovascular status, as the physical exertion can put extra strain on the heart. 
• Patients should seek emergency medical attention if experiencing symptoms like chest pain, dizziness, or nausea during sexual activity. 

Vision and Hearing Precautions

• Patients should stop taking Cialis and seek immediate medical care if they experience sudden vision loss in one or both eyes, as this could be a sign of a serious eye condition. 
• Sudden hearing loss has also been reported with Cialis, so patients should stop the medication and see a doctor if this occurs. 

Other Precautions

• Cialis is not recommended for use in children or adolescents under 18 years old. 
• Patients with a history of priapism (prolonged erections) should use Cialis with caution. 
• Patients should inform their healthcare provider of all medications they are taking, including prescriptions, over-the-counter drugs, and supplements, to avoid potential interactions. 

 key points about dietary restrictions with Cialis (tadalafil):

Alcohol Interactions

• Consuming alcohol while taking Cialis can further lower blood pressure, so moderation is advised. Excessive alcohol intake during Cialis treatment may further decrease blood pressure levels.

Grapefruit Interactions

• Grapefruit can interact with Cialis, potentially increasing its levels in the blood and leading to side effects. Patients should avoid or limit grapefruit consumption when taking Cialis.

Food Intake

• Food intake does not appear to significantly affect the absorption or effectiveness of Cialis. The medication can be taken with or without food.

Marijuana/Cannabis Interactions

• Patients should talk to their doctor if they are using marijuana or cannabis products, as these may interact with Cialis.

In summary, the main dietary restrictions with Cialis are:

• Limit alcohol consumption to no more than 4 drinks at a time
• Avoid or limit grapefruit and grapefruit juice
• Cialis can be taken with or without food