What are the risks and warnings for Cialis (tadalafil)?

Cialis (tadalafil) can cause some serious health issues. This risk may be even higher for certain groups.

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If this worries you, talk to your doctor or pharmacist about other options

Risk of heart attack or stroke

  • Risk factors: Existing heart condition | Recent heart attack or stroke in past 6 months | High or low blood pressure

It’s not recommended for men to take Cialis (tadalafil) if they’ve had a heart attack, stroke, or symptoms of heart failure in the past 6 months, abnormal blood pressure, or if they have chest pain. The safety of Cialis (tadalafil) has not been studied in these situations. Talk to your doctor if you have any of these health conditions.

Low blood pressure

  • Risk factors: Taking alpha blockers | Taking medications for high blood pressure or chest pain (angina) | Drinking alcohol

If you’re taking alpha blockers or medications for high blood pressure with Cialis (tadalafil), your blood pressure may drop too low. Make sure to check your blood pressure regularly if you’re taking these other medications. Be very careful getting up from a sitting or lying down position since this can make you feel dizzy and more likely to fall. Drinking alcohol can also cause low blood pressure. Avoid or lower your alcohol consumption when taking Cialis (tadalafil). You should never take Cialis (tadalafil) when taking nitrate medication for chest pain (angina) because it can cause your blood pressure to suddenly drop to unsafe levels.

Prolonged erection

  • Risk factors: Peyronie’s disease | Cavernosal fibrosis | Sickle cell anemia

There have been reports of men having an erection lasting more than 4 hours while on Cialis (tadalafil). This is rare but if it’s not treated in time, it can cause permanent damage to your penis, including permanent impotence. Get medical help immediately if this happens.

Vision changes

If you suddenly notice changes in your vision in one or both eyes, go to the emergency room or call your doctor immediately. Although this is rare, Cialis (tadalafil) can cause permanent eye damage.

Hearing loss

There have been reports of men having permanent hearing loss while taking Cialis (tadalafil). This may happen along with ringing in the ears (tinnitus) and dizziness. Go to the emergency room or call your doctor immediately if you notice changes in your hearing in one or both ears.

Interactions with other medications

  • Risk factors: Age 65 years or older | Liver disease | Kidney disease | Taking medications such as nitrates, anti-hypertensives, alpha blockers, ketoconazole, or ritonavir

You may experience more side effects while taking Cialis (tadalafil) if you are also taking medications called nitrates for chest pain, blood pressure medications, certain medications for HIV, are elderly, or have liver or kidney disease. Talk to your doctor before starting Cialis (tadalafil) if any of these apply to you.

What is the distanges of taking Cialis ?

Cialis (tadalafil) is the only medication in its class that treats both erectile dysfunction and enlarged prostate symptoms. You can also take it on a regular basis, which can allow for more spontaneity.

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, dyspepsia, back pain, nasal congestion, and flushing are the most commonly reported side effects.
  • Other side effects include a drop in blood pressure, muscle or limb pain, or conjunctivitis.
  • Rarely, may decrease blood flow to the optic nerve causing sudden vision loss. The risk is greater in people aged older than 50, with diabetes, heart disease, high blood pressure, high cholesterol, who smoke, or with certain pre-existing eye problems.
  • The dosage of Cialis may need reducing in men with kidney disease. For men with CLCR of 30 to 50 mL/min, a starting dose of 5mg not more than once per day is recommended. The maximum dose is 10mg not more than once every 48 hours.
  • For men with CLCR of < 30 mL/min or on hemodialysis, the maximum dose is 5mg not more than once every 72 hours. Once daily use may not be recommended in men with CLCR < 30 mL/min.
  • For men with mild-to-moderate liver disease (Child-Pugh Class A or B), the dose should not exceed 10mg once per day. Cialis is not recommended in severe liver disease (Child-Pugh Class C).
  • Rarely, may cause other side effects including hearing loss or lead to painful erections lasting longer than four to six hours. See your doctor immediately if this happens.
  • May not be suitable for some people including those with angina, chest pain, or other heart conditions, liver or kidney problems, blood or bleeding disorders, stomach ulcers, certain eye conditions, a physical deformity of the penis (such as Peyronie’s disease), or serious prior hypersensitivity reactions to tadalafil.
  • May interact with some medications including nitrates – use of Cialis and nitrates is contraindicated because of the severe hypotension that can develop. May also interact with other medications including ketoconazole or ritonavir; dosage adjustment is recommended.
  • A lower dosage of Cialis is recommended in men with mild-to-moderate liver disease. Cialis should be avoided with severe liver disease.
  • Not for use in females.

 

What is the advantages of taking Cialis ?

Tadalafil (Cialis) is used to treat erectile dysfunction (ED, impotence; inability to get or keep an erection), and the symptoms of benign prostatic hyperplasia (BPH; an enlarged prostate) which include difficulty urinating (hesitation, dribbling, weak stream, and incomplete bladder emptying), painful urination, and urinary frequency and urgency in adult men.

Tadalafil (Adcirca) is used to improve the ability to exercise in people with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness).

Tadalafil is in a class of medications called phosphodiesterase (PDE) inhibitors. It works to treat erectile dysfunction by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection. Tadalafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow more easily.

If you are taking tadalafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. Tadalafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV).

  • Cialis is used for the treatment of erectile dysfunction (ED). It increases blood flow to the penis following sexual stimulation and allows men to keep an erection hard enough for sex.
  • Cialis is also used to treat the signs and symptoms of benign prostatic hyperplasia (BPH).
  • Cialis is available as a lower-strength tablet that can be taken on a daily basis, eliminating the need to ‘plan’ for sex.
  • Cialis is also available as an ‘as needed’ tablet. The effect of one tablet lasts for up to 36 hours.
  • The recommended ‘as needed’ dose for Cialis is 10mg, taken prior to anticipated sexual activity. The dose may be increased to 20mg or decreased to 5mg. It should not be taken more than once a day.
  • The recommended starting dose for Cialis intended for once daily use is 2.5mg, take at the same time each day, without regard to timing of sexual activity. This may be increased to 5mg/day based on need and tolerability.
  • May be taken with or without food.
  • Cialis is available as a generic, under the name tadalafil.

How does Cialis work?

Cialis works by enhancing the effects of one of the chemicals the body normally releases into the penis during sexual arousal.

This allows an increase of blood flow into the penis. An erection is the result of an increase in blood flow into certain internal areas of the penis.

  • Cialis is a brand (trade) name for tadalafil which may be used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH).
  • Cialis (tadalafil) works by blocking the action of an enzyme known as cGMP-specific phosphodiesterase type-5 (PDE-5). This enzyme breaks down cGMP, a substance that induces smooth muscles to relax. Blocking PDE-5 means increased levels of cGMP within the smooth muscles which promotes muscle relaxation and vasodilation (a widening of blood vessels).
  • High levels of PDE-5 are found in the penis, lungs, and retina. PDE-5 is also found throughout the body within the smooth muscle cells of blood vessels and muscles.
  • Cialis (tadalafil) belongs to the class of medicines known as PDE-5 inhibitors.

What important information should you know about Cialis?

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as “poppers”. Taking tadalafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Some medicines can cause unwanted or dangerous effects when used with Cialis. Tell your doctor about all your current medicines, especially riociguat (Adempas).

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Get medical help at once if you have nausea, chest pain, or dizziness during sex. Stop using Cialis and get emergency medical help if you have sudden vision loss.

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What important information should you know about Cialis?

  • CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with any nitrate medication. You could get dizzy, faint or have a heart attack or stroke.
  • Tell your healthcare provider that you take Cialis. If you need emergency medical care for a heart problem, it will be important for your health care provider to know when you last took Cialis.
  • After taking a single tablet, some of the active ingredient of Cialis remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications.
  • Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha-blockers and antihypertensive medications.

What special precautions should I follow?

Before taking tadalafil,

  • tell your doctor and pharmacist if you are allergic to tadalafil, any other medications, or any of the ingredients in tadalafil tablets. Ask your pharmacist for a list of the ingredients.
  • tell your doctor if you are taking or have recently taken riociguat (Adempas) or nitrates such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Minitran, Nitro-Dur, Nitromist, Nitrostat, others). Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your doctor if you are not sure whether any of your medications contain nitrates. Your doctor will probably tell you not to take tadalafil if you are taking nitrates.
  • tell your doctor if you are taking street drugs containing nitrates (‘poppers’) such as amyl nitrate, butyl nitrate, or nitrite while taking tadalafil. Your doctor will probably tell you not to take tadalafil if you are taking street drugs containing nitrates.
  • you should know that tadalafil is available under the brand names Adcirca and Cialis. You should only be treated with one of these products at a time.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), dutasteride (Avodart, in Jalyn), prazosin (Minipress), silodosin (Rapaflo), tamsulosin (Flomax, in Jalyn), and terazosin; amiodarone (Cordarone, Pacerone); certain antifungals such as fluconazole (Diflucan), griseofulvin (Grifulvin, Gris-PEG), itraconazole (Onmel, Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegel), and voriconazole (Vfend); aprepitant (Emend); bosentan (Tracleer); carbamazepine (Carbatrol, Epitol, Tegretol, Teril, others); clarithromycin (Biaxin, in Prevpac); diltiazem (Cardizem, Cartia,Tiazac, others); efavirenz (Sustiva, in Atripla); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors including indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra), lovastatin (Altocor, in Advicor); medications for high blood pressure; nefazodone; nevirapine (Viramune); other medications or treatments for erectile dysfunction; other medications or treatments for PAH; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); sertraline (Zoloft); telithromycin (Ketek); and verapamil (Calan, Covera,Verelan, in Tarka). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor what herbal products you are taking, especially St. John’s wort.
  • tell your doctor if you smoke; if you have ever had an erection that lasted more than 4 hours; and if you have recently had diarrhea, vomiting, not been drinking enough fluids, or sweating a lot which may have caused dehydration (loss of a large amount of body fluids. Also tell your doctor if you have or have ever had pulmonary veno-occlusive disease (PVOD; blockage of veins in the lungs); any condition that affects the shape of the penis; diabetes; high cholesterol; high or low blood pressure; irregular heartbeat; a heart attack or heart failure; angina (chest pain); a stroke; ulcers in the stomach; a bleeding disorder; blood circulation problems; blood cell problems such as sickle cell anemia (a disease of the red blood cells), multiple myeloma (cancer of the plasma cells), or leukemia (cancer of the white blood cells); or heart, kidney, or liver disease. Also tell your doctor if you or any of your family members have or have ever had an eye disease such as retinitis pigmentosa (an inherited eye condition that causes loss of vision) or if you have ever had sudden severe vision loss, especially if you were told that the vision loss was caused by a blockage of blood flow to the nerves that help you see.
  • if you are a woman and you are taking tadalafil to treat PAH, tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking tadalafil, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking tadalafil.
  • talk to your doctor about the safe use of alcoholic beverages during your treatment with tadalafil. If you drink a large amount of alcohol (more than five glasses of wine or five shots of whiskey) while you are taking tadalafil you are more likely to experience certain side effects of tadalafil such as dizziness, headache, fast heartbeat, and low blood pressure.
  • if you are taking tadalafil to treat erectile dysfunction, tell your doctor if you have ever been advised by a health care professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity. Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain, dizziness, or nausea during sexual activity, call your doctor immediately or get emergency medical treatment, and avoid sexual activity until your doctor tells you otherwise.
  • tell all your health care providers that you are taking tadalafil. If you ever need emergency medical treatment for a heart problem, the health care providers who treat you will need to know when you last took tadalafil.