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Cialis Super Active is a new generation drug for increasing potency. The main active ingredient is tadalafil, which helps to increase blood circulation in the pelvic area. This drug is available in gelatin capsules and contains a daily dose of the active substance. This dosage will effectively support the full sexual activity of a man. Tadalafil affects the penile vessels by expanding them. In this case, the substance acts only on this area, without exerting a vasodilating effect on the vessels of other organs. The capsule drug form acts more efficiently than the tableted form. The effect of the drug remains longer with the maximum absorption rate.
Mode of application and dosage
Cialis Super Active capsules are packed in blisters. Each pill contains the maximum allowable amount of Tadalafil 20 mg that can be taken during the day. Obviously, the daily dose should not exceed 1 capsule. From the moment of taking the pill to the erection, it usually takes about 45 minutes, that is, 15 minutes less compared to the tablet form. The effect lasts up to 36 hours.
Side effects
Side effects are usually minor or moderate in severity, transient and decrease with continued administration of the drug.
- Most often: headache (11%), dyspepsia (7%).
- Possible side effects caused by Cialis Super Active: back pain, myalgia, dizziness, nasal congestion, flushing.
- Rare side effects: eyelid edema, eye pain, conjunctival hyperemia.
- Very rare: hypersensitivity reactions (including rashes, hives and facial edema, Stevens-Johnson syndrome and exfoliative dermatitis); arterial hypotension (in patients who have already taken antihypertensive drugs), hypertension and syncope; abdominal pain and gastroesophageal reflux; hyperhidrosis (excessive sweating); priapism and delayed erection; blurred vision, non-arterial anterior ischemic neuropathy of the optic nerve, retinal vein occlusion, visual field disturbance, migraine, epistaxis.
In patients with cardiovascular risk factors: myocardial infarction, sudden cardiogenic death, stroke, chest pain, palpitations, tachycardia.
However, it is impossible to accurately determine whether these events are directly related to these risk factors of tadalafil, sexual arousal, or a combination of these or other factors.
Contraindications
- Combined administration of drugs containing any organic nitrates;
- Use in persons under the age of 18;
- Hypersensitivity to drug components.
Overdose
A single appointment to healthy volunteers at a dose of 500 mg/day and to patients with erectile dysfunction – repeatedly up to 100 mg/day, causes the same side effects as when using the drug at lower doses.
Treatment: carrying out standard symptomatic therapy. With hemodialysis, tadalafil is practically not excreted.
Drug interactions
Effect of other drugs on tadalafil
Tadalafil is mainly metabolized with the participation of the CYP3A4 enzyme. The selective CYP3A4 inhibitor ketoconazole at a dose of 400 mg/day increases the AUC of tadalafil in a single dose by 312%, and Cmax by 22%. Ketoconazole at a dose of 200 mg/day increases the effect of tadalafil taken in a single dose by 107% and Cmax by 25 %, relative to AUC and Cmax values for tadalafil alone.
Ritonavir (200 mg 2 times/day) increases the AUC of tadalfil in a single dose by 524% without changing the Cmax. Despite the fact that specific interactions have not been studied, it can be assumed that other inhibitors of HIV protease, for example, saquinavir, as well as CYP3A4 inhibitors, such as erythromycin and itraconazole, increase the activity of tadalafil.
The selective inducer of CYP3A4 rifampin (rifampicin, 600/mg/day), reduces the AUC of tadalafil in a single dose by 88% and Cmax by 46%, relative to AUC and Cmax values for tadalafil alone. It is assumed that the simultaneous administration of other inducers of CYP3A4 should also reduce plasma concentrations 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.
An increase in the pH of gastric juice as a result of taking the histamine H2-receptor blocker nizatidine does not affect the pharmacokinetics of tadalafil.
The effect of tadalafil on other drugs
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 appointment of Cialis on the background of the use of nitrates is contraindicated.
Tadalafil does not have a clinically significant effect on the clearance of drugs, the metabolism of which occurs with the participation of cytochrome P450 isoenzymes. Studies have confirmed that tadalafil does not inhibit or induce isoenzymes CYP3A4, CYP1A2, CYP2D6, CYP2E1, CYP2C9, CYP2C19.
Tadalafil has no clinically significant effect on the pharmacokinetics of S- and R-warfarin. Tadalafil does not affect the prothrombin time effect of warfarin.
Cialis Super Active does not increase the duration of bleeding in the presence of acetylsalicylic acid.
Tadalafil has systemic vasodilating properties and can enhance the effect of antihypertensive drugs aimed at lowering blood pressure. Additionally, in patients on multiple antihypertensive drugs in whom hypertension was poorly controlled, slightly larger reductions in blood pressure were observed. In the vast majority of patients, these reductions were not associated with hypotensive symptoms. Patients receiving treatment with antihypertensive drugs and taking tadalafil should be given appropriate clinical guidelines.