1 INDICATIONS AND USAGE

It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol.

5.13 Counseling Patients About Sexually Transmitted Diseases

In cases of overdose, standard supportive measures should be adopted as required. Single doses up to 500 mg have been given to healthy subjects, and multiple daily doses up to 100 mg have been given to patients. Tadalafil has the empirical formula C22H19N3O4 representing a molecular weight of 389.41. It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol.CIALIS is available as film-coated, almond-shaped tablets for oral administration. CIALIS (tadalafil), an oral treatment for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). CIALIS is available as film-coated, almond-shaped tablets for oral administration.

Product	Dosage	Quantity + Bonus	Price
Cialis Professional	20mg	180 + 4 Pills	423.11€ 402.96€	Buy
Cialis Generic	5mg	20 Pills	41.99€ 39.99€	Buy
Cialis Generic	40mg	20 Pills	59.47€ 56.64€	Buy
Cialis Generic	2.5mg	360 + 10 Pills	260.03€ 247.65€	Buy
Cialis Super Active	20mg	90 + 10 Pills	314.14€ 299.18€	Buy
Cialis Soft Tabs	20mg	20 + 2 Pills	66.98€ 63.79€	Buy
Cialis Super Active	20mg	10 Pills	55.64€ 52.99€	Buy
Cialis Soft Tabs	20mg	270 + 10 Pills	471.40€ 448.95€	Buy
Cialis Generic	60mg	360 + 10 Pills	570.52€ 543.35€	Buy
Cialis Generic	40mg	10 Pills	37.79€ 35.99€	Buy
Cialis Generic	10mg	60 + 6 Pills	105.81€ 100.77€	Buy
Cialis Professional	20mg	30 Pills	104.57€ 99.59€	Buy
Cialis Soft Tabs	20mg	90 + 6 Pills	216.71€ 206.39€	Buy
Cialis Original	20mg	48 + 4 Pills	224.69€ 213.99€	Buy
Cialis Black	80mg	60 + 4 Pills	150.98€ 143.79€	Buy
Cialis Generic	2.5mg	30 + 4 Pills	51.95€ 49.48€	Buy

12 CLINICAL PHARMACOLOGY 12.1 Mechanism of ActionPenile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle.

• Cialis 10 mg dosage may be adjusted by doctors.
• It is effective in males with reduced libido.
• Cialis begins working within 30 minutes in most cases.
• It boosts confidence during intimate moments.
• The medication isn’t suitable for women.
• Keep track of your response to the medication.
• Cialis can be part of ED management strategies.
• Avoid taking multiple doses in a 24-hour period.
• The medication is approved by multiple health agencies.
• Consult a doctor if you experience dizziness.
• Cialis should be used responsibly with medical guidance.

This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum.

2.2 Use with Food

In patients on hemodialysis taking 10- or 20-mg tadalafil, there were no reported cases of back pain. [See Dosage and Administration (2.3) and Warnings and Precautions (5.7)]. Pregnancy Category B — CIALIS (tadalafil) is not indicated for use in women. Animal reproduction studies in rats generic cialis softtabs and mice revealed no evidence of fetal harm. Non-teratogenic effects — Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis.

Side effects and risks

(See Animal Toxicology and/or Pharmacology Section 13.2) CIALIS is not indicated for use in women. While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk. CIALIS is not indicated for use in pediatric patients. Safety and efficacy in patients below the age of 18 years has not been established. Of the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately 3 percent were 75 and over.

What should I tell my healthcare provider before using tadalafil?

In clinical pharmacology studies, tadalafil exposure (AUC) in subjects with mild or moderate hepatic impairment (Child-Pugh Class A or B) was comparable to exposure in healthy subjects when a dose of 10 mg was administered. [See Dosage and Administration (2.3) and Warnings and Precautions (5.8)]. In clinical pharmacology studies using single-dose tadalafil (5 to 10 mg), tadalafil exposure (AUC) doubled in subjects with mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency. 10 OVERDOSAGE Single doses up to 500 mg have been given to healthy subjects, and multiple daily doses up to 100 mg have been given to patients. Adverse events were similar to those seen at lower doses. The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP.

1 Introduction

(See Animal Toxicology and/or Pharmacology Section 13.2)8.3 Nursing MothersCIALIS is not indicated for use in women. It is not known whether tadalafil is excreted into human milk. While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk.8.4 Pediatric UseCIALIS is not indicated for use in pediatric patients. Safety and efficacy in patients below the age of 18 years has not been established.8.5 Geriatric UseOf the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately 3 percent were 75 and over. No overall differences in efficacy or safety were observed between subjects over 65 years of age compared to younger subjects, therefore no dose adjustment is warranted based on age alone.

Dosage adjustments

However, a greater sensitivity to medications in some older individuals should be considered. [See Clinical Pharmacology (12.3)].8.6 Hepatic ImpairmentIn clinical pharmacology studies, tadalafil exposure (AUC) in subjects with mild or moderate hepatic impairment (Child-Pugh Class A or B) was comparable to exposure in healthy subjects when a dose of 10 mg was administered. There are no available data for doses higher than 10 mg of tadalafil in patients with hepatic impairment. Insufficient data are available for subjects with severe hepatic impairment (Child-Pugh Class C). [See Dosage and Administration (2.3) and Warnings and Precautions (5.8)].8.7 Renal InsufficiencyIn clinical pharmacology studies using single-dose tadalafil (5 to 10 mg), tadalafil exposure (AUC) doubled in subjects with mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency.

Product Details

In subjects with end-stage renal disease on hemodialysis, there was a two-fold increase in Cmax and 2.7- to 4.1-fold increase in AUC following single-dose administration of 10 or 20 mg tadalafil. Exposure to total methylcatechol (unconjugated plus glucuronide) was 2- to 4-fold higher in subjects with renal impairment, compared to those with normal renal function. Hemodialysis (performed between 24 and 30 hours post-dose) contributed negligibly to tadalafil or metabolite elimination. In a clinical pharmacology study (N=28) at a dose of 10 mg, back pain was reported as a limiting adverse event in male patients with moderate renal impairment. At a dose of 5 mg, the incidence and severity of back pain was not significantly different than in the general population. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation.Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5.

The drug Cialis is popular because you can take it every day. But should you?

Although specific interactions have not been studied, other CYP3A4 inhibitors, such as erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure. HIV Protease inhibitor — Ritonavir (500 mg or 600 mg twice daily at steady state), an inhibitor of CYP3A4, CYP2C9, CYP2C19, and CYP2D6, increased tadalafil 20-mg single-dose exposure (AUC) by 32% with a 30% reduction in Cmax, relative to the values for tadalafil 20 mg alone. Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure [see Dosage and Administration (2.4)]. Cytochrome P450 Inducers — Studies have shown that drugs that induce CYP3A4 can decrease tadalafil exposure. CYP3A4 (e.g., Rifampin) — Rifampin (600 mg daily), a CYP3A4 inducer, reduced tadalafil 10-mg single-dose exposure (AUC) by 88% and Cmax by 46%, relative to the values for tadalafil 10 mg alone.

Dosage Forms & Strengths

The reduced exposure of tadalafil with the coadministration of rifampin or other CYP3A4 inducers can be anticipated to decrease the efficacy of CIALIS for once daily use; the magnitude of decreased efficacy is unknown. Cytochrome P450 Substrates — CIALIS is not expected to cause clinically significant inhibition or induction of the clearance of drugs metabolized by cytochrome P450 (CYP) isoforms. Studies have shown that tadalafil does not inhibit or induce P450 isoforms CYP1A2, CYP3A4, CYP2C9, CYP2C19, CYP2D6, and CYP2E1. When tadalafil was administered to subjects taking theophylline, a small augmentation (3 beats per minute) of the increase in heart rate associated with theophylline was observed. 8 USE IN SPECIFIC POPULATIONS 8.1 PregnancyPregnancy Category B — CIALIS (tadalafil) is not indicated for use in women.

More common

There are no adequate and well controlled studies of CIALIS use in pregnant women. Animal reproduction studies in rats and mice revealed no evidence of fetal harm.Non-teratogenic effects — Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis. In one of two perinatal/postnatal developmental studies in rats, postnatal pup survival decreased following maternal exposure to tadalafil doses greater than 10 times the MRHD based on AUC. Signs of maternal toxicity occurred at doses greater than 16 times the MRHD based on AUC. Surviving offspring had normal development and reproductive performance. PDE5 is found in corpus cavernosum smooth muscle, vascular and visceral smooth muscle, skeletal muscle, platelets, kidney, lung, cerebellum, and pancreas.In vitro studies have shown that the effect of tadalafil is more potent on PDE5 than on other phosphodiesterases. These studies have shown that tadalafil is >10,000-fold more potent for PDE5 than for PDE1, PDE2, PDE4, and PDE7 enzymes, which are found in the heart, brain, blood vessels, liver, leukocytes, skeletal muscle, and other organs.

• 10 mg Cialis is a prescribed medication for erectile dysfunction.
• It is the lowest available dose of Cialis.
• Cialis contains the active ingredient tadalafil.
• It typically works within 30 minutes to 2 hours.
• The effects can last up to 36 hours.
• Cialis 10 mg should be taken with water.
• It is usually taken about 30 minutes before sex.
• Do not exceed one dose per day.
• Consult a healthcare provider before use.
• Cialis can cause side effects like headache and flushing.
• Do not take with nitrates or certain medications.

Tadalafil is >10,000-fold more potent for PDE5 than for PDE3, an enzyme found in the heart and blood vessels. Additionally, tadalafil is 700-fold more potent for PDE5 than for PDE6, which is found in the retina and is responsible for phototransduction. Tadalafil is 14-fold more potent for PDE5 than for PDE11A1 and 40-fold more potent for PDE5 than for PDE11A4, two of the four known forms of PDE11.

• The drug's development involved clinical trials with thousands of participants.
• It was first approved by the FDA for ED in 2003 and for BPH in 2011.
• The "Cialis" name is a portmanteau of "continuous" and "quality of life."
• Its long duration of action was a significant advancement over earlier drugs.
• It is on the World Health Organization's List of Essential Medicines.
• This signifies it is one of the most effective and safe medicines needed in a health system.
• In some countries, it is available at a much lower cost than in the United States.
• Traveling with prescription medication requires keeping it in original packaging.
• Having a copy of the prescription or a doctor's note is also recommended.
• It is a widely studied and generally very safe medication when used correctly.

PDE11 is an enzyme found in human prostate, testes, skeletal muscle and in other tissues. In vitro, tadalafil inhibits human recombinant PDE11A1 and, to a lesser degree, PDE11A4 activities at concentrations within the therapeutic range.

Parameter	Description	Notes
Effect on erectile function	Improves ability to achieve and sustain erection	Most effective within 30-60 mins
Response rate	About 80% of users find it effective	Varies by individual
Onset time	Usually within 30 minutes	Depends on food intake
Duration	Up to 36 hours	Long-lasting, effective window
Onset variation	Faster on empty stomach	Slower if taken after heavy meals

The physiological role and clinical consequence of PDE11 inhibition in humans have not been defined.12.2 PharmacodynamicsEffects on Blood PressureTadalafil 20 mg administered to healthy male subjects produced no significant difference compared to placebo in supine systolic and diastolic blood pressure (difference in the mean maximal decrease of 1.6/0.8 mm Hg, respectively) and in standing systolic and diastolic blood pressure (difference in the mean maximal decrease of 0.2/4.6 mm Hg, respectively).

• Cialis 10 mg is not suitable for everyone.
• Men with heart disease should discuss risk with a doctor.
• It’s essential to stay hydrated while taking Cialis.
• Avoid high-fat meals close to dosing time.
• Cialis may improve self-esteem and relationships.
• Overdose can cause significant health issues.
• Always adhere to the prescribed dosage.
• Cialis may be used in combination with psychotherapy.
• Effectiveness may improve with healthy lifestyle changes.
• Keep a medication diary to track effects.
• Report any persistent side effects immediately.