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Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of CIALIS.

In such a patient, who has taken CIALIS, where nitrate administration is deemed medically necessary for a life-threatening situation, at least 48 hours should have elapsed after the last dose of CIALIS before nitrate administration is considered. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring. Patients with left ventricular outflow obstruction, e.

The following groups of patients with cardiovascular disease were not included in clinical safety and efficacy trials for CIALIS, and therefore until further information is available, CIALIS is not recommended for the following groups of patients: As with other PDE5 inhibitors, tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressure. In a clinical pharmacology study, tadalafil 20 mg resulted in a mean maximal decrease in supine blood pressure, relative to placebo, of 1.

While this effect should not be of consequence in most patients, prior to prescribing CIALIS, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects.

Patients with severely impaired autonomic control of blood pressure may be particularly sensitive to the actions of vasodilators, including PDE5 inhibitors. Prolonged Erection There have been rare reports of prolonged erections greater than 4 hours and priapism painful erections greater than 6 hours in duration for this class of compounds. Priapism, if not treated promptly, can result in irreversible damage to the erectile tissue.

Patients who have an erection lasting greater than 4 hours, whether painful or not, should seek emergency medical attention. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy NAION , a rare condition and a cause of decreased vision, including permanent loss of vision, that has been reported rarely postmarketing in temporal association with the use of all PDE5 inhibitors. A similar study reported a consistent result, with a risk estimate of 2.

Patients with known hereditary degenerative retinal disorders, including retinitis pigmentosa , were not included in the clinical trials, and use in these patients is not recommended.

Caution is advised when PDE5 inhibitors are coadministered with alpha-blockers. Consideration should be given to the following: Patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of PDE5 inhibitors. In those patients who are stable on alpha-blocker therapy, PDE5 inhibitors should be initiated at the lowest recommended dose.

In those patients already taking an optimized dose of PDE5 inhibitor, alpha-blocker therapy should be initiated at the lowest dose. Stepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a PDE5 inhibitor. Safety of combined use of PDE5 inhibitors and alpha-blockers may be affected by other variables, including intravascular volume depletion and other antihypertensive drugs.

Therefore, physicians should inform patients that substantial consumption of alcohol e. PDE5 is found in platelets. When administered in combination with aspirin, tadalafil 20 mg did not prolong bleeding time, relative to aspirin alone. CIALIS has not been administered to patients with bleeding disorders or significant active peptic ulceration. Although CIALIS has not been shown to increase bleeding times in healthy subjects, use in patients with bleeding disorders or significant active peptic ulceration should be based upon a careful risk-benefit assessment and caution.

Counseling patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus HIV should be considered. In addition, prostate cancer and BPH may coexist. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope , or even heart attack or stroke.

Cardiovascular Considerations Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Priapism There have been rare reports of prolonged erections greater than 4 hours and priapism painful erections greater than 6 hours in duration for this class of compounds. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy NAION , a cause of decreased vision, including possible permanent loss of vision, that has been reported rarely postmarketing in temporal association with the use of all PDE5 inhibitors.

Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus HIV should be considered. In most patients, the ability to have sexual intercourse is improved for up to 36 hours. Cialis is effective at improving erectile function over the course of therapy. Systemic drug exposures, as measured by AUC of unbound tadalafil, were approximately fold for mice, and and fold for male and female rats, respectively, the exposures in human males given Maximum Recommended Human Dose MRHD of 20 mg.

Uses Uses Tadalafil is used to treat male sexual function problems impotence or erectile dysfunction -ED. In combination with sexual stimulation, tadalafil works by increasing blood flow to the penis to help a man get and keep an erection.

Tadalafil is also used to treat the symptoms of an enlarged prostate benign prostatic hyperplasia - BPH. It helps to relieve symptoms of BPH such as difficulty in beginning the flow of urine, weak stream, and the need to urinate frequently or urgently including during the middle of the night.

Tadalafil is thought to work by relaxing the smooth muscle in the prostate and bladder. This drug does not protect against sexually transmitted diseases such as HIV , hepatitis B , gonorrhea , syphilis.

Practice " safe sex " such as using latex condoms. Consult your doctor or pharmacist for more details. How to use Cialis Read the Patient Information Leaflet provided by your pharmacist before you start taking tadalafil and each time you get a refill.

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