Brand Cialis is a drug for the treatment of erectile dysfunction. The drug belongs to a reversible selective inhibitor of specific phosphodiesterase type 5 (PDE5) cGMP. When sexual exited, this drug causes local release of nitric oxide. The inhibition of PDE5 by tadalafil contributes to an increase in cGMP levels in the corpus cavernosum of the penis. The effect of Cialis use lies in the relaxation of the smooth muscles of the arteries and the flow of blood to the tissues of the penis—é Thus, it causes an erection. Cialis has no effect in the absence of sexual stimulation.

Indications

Brand Cialis is used for erectile dysfunction.

Dosage

Middle-aged men are advised to take Brand Cialis at a dose of 20 mg. Cialis is taken at least 16 minutes before the planned sexual activity, regardless of food intake. Patients can hold sexual intercourse at any time within 36 hours after taking the drug in order to establish the optimal response time to taking the drug. The maximum recommended frequency of admission is 1 time/day.

Mode of application

Brand Cialis is taken orally, washed down with water, 30 minutes before the moment when sexual contact occurs. The effect of the drug lasts for about 36 hours. The maximum daily dose of Cialis is 20 mg (1 table). The medicine can be taken with food.

Contraindications

  • Hypersensitivity to tadalafil or other components of the drug;
  • Simultaneous use of organic nitrates in any dosage form.

The drug is not used in men with heart disease, for whom sexual activity is contraindicated. Physicians should consider the potential cardiac risk of sexual activity for patients with cardiovascular disease.

The following groups of patients with cardiovascular diseases were not included in clinical trials, therefore, the use of tadalafil is contraindicated in them:

  • myocardial infarction in the past 90 days;
  • unstable angina pectoris or angina pectoris that occurs during intercourse;
  • heart failure, which corresponds to class II or higher according to the NYHA classification, during the last 6 months;
  • uncontrolled arrhythmias, arterial hypotension (<90/50 mm Hg) or uncontrolled hypertension;
  • patients after a stroke that occurred within the last 6 months.

The drug is contraindicated in patients with vision loss in one eye as a result of non-arterial anterior ischemic optic neuropathy (NAPION), regardless of whether it was associated with a previous effect of PDE-5 inhibitors.

Side effects

Like most other medications for ED treatment, Cialis has a number of adverse reactions that are mild or moderate, provided that the recommended doses are observed. Possible, most common reactions include:

  • swelling of the face;
  • general weakness, drowsiness;
  • painful heart palpitations, angina pectoris;
  • blood pressure surges;
  • upset stomach, gastritis;
  • nausea, vomiting, loose stools;
  • feeling of dry mouth;
  • pain in the neck, lower back;
  • dizziness;
  • muscle pain;
  • feeling of numbness in various parts of the body or skin;
  • shortness of breath, nasal congestion;
  • increased sweating;
  • visual disturbances, changes in color perception;
  • lacrimation, pain in the eyes.

Drug interactions

Tadalafil is mainly metabolized with the participation of the CYP3A4 enzyme. The selective inhibitor of CYP3A4 ketoconazole increases AUC by 107%, and rifampicin reduces it by 88%.

Despite the fact that specific interactions have not been studied, it can be assumed that protease inhibitors such as ritonavir and saquinavir, as well as CYP3A4 inhibitors such as erythromycin and itraconazole, increase the activity of tadalafil.

With the simultaneous administration of an antacid (magnesium hydroxide/aluminum hydroxide) and tadalafil, the rate of absorption of the latter decreases without changing its AUC.

Tadalafil enhances the hypotensive effect of nitrates. This is due to the additive effect of nitrates and tadalafil on the metabolism of nitric oxide and cGMP. Therefore, the use of tadalafil in patients receiving nitrates is contraindicated.