Every tenth men at the mature age suffers from sexual disorders. In many countries, Cialis has come a long way before entering the global pharmaceutical market and outstripped the sales of the legendary Viagra.

The giant pharmaceutical companies struggle for the chance to produce its magic formula. It is not weird. There are drugs that can provide similar effect, but an absolute analogue (except generics) does not exist.

Cialis drew the serious attention of the medical society. It appears that the power of the drug is not limited to erectile problems only, as the new research showed unexpected health benefits. What is its secret; who and how it can really help?

What Is Tadalafil?

Tadalafil is the active chemical component of the brand drug Cialis (Adcirca). Tadalafil belongs to the phosphodiesterase type 5 inhibitors (PDE5) drug class.

The uses of tadalafil are the following:

1. Treatment of erectile dysfunction (ED). In particular, it treats the incapacity to achieve and maintain erection, including total, inconsistent inability or a tendency to sustain only brief erections. It does not increase sexual desire, and it does not prevent pregnancy or sexually transmitted illnesses such as human immunodeficiency virus (HIV), Hepatitis B, syphilis, and gonorrhea.
2. Expectant treatment of benign prostatic hyperplasia (BPH), noncancerous enlargement of the prostate gland. Tadalafil helps to enfeeble painful and frequent urination.
3. For improving the physical abilities in patients suffering from pulmonary arterial hypertension (PAH), a serious blood pressure condition that affects the arteries in the lungs and heart causing shortness of breath and fatigue.

It is a prescription medicine for daily usage or taking on demand. It may be used not only for main purposes listed above.

Researchers from the Cedars-Sinai Medical Center in Los Angeles discovered that tadalafil (Cialis), as well as sildenafil (Viagra), may be used in patients who suffer from Duchenne muscular dystrophy (DMD). This is a widespread ruinous illness among young males that has no specific cure. The mentioned PDE5 inhibitors helped boys to perform handgrip exercises. According to the information of the senior author, Dr. Ronald Victor, both drugs provided similar effects, though the effects of Cialis lasted longer (24 hours) as compared to Viagra (1 hour).

Also, Cialis was thoroughly checked for its benefits in sport performance. The clinical tests showed that it significantly improves testosterone levels. This feature is used by sportsmen who need to reach maximum power output in a moment. Increasing the «stress» response to the body, tadalafil helps to reduce the time of pick power reaching. But the chemical does not impact the total effect of exercise performance.

Short History

Cialis is an outcome of cooperative work between Glaxo Wellcome and the biotechnology company ICOS in Washington which started in 1991. Initially ICOS worked at the IC351 (PDE5) inhibitor. Concurrently in 1994, Pfizer scientific researches ascertained new feature of their product sildenafil (Viagra in the future).

Although ICOS workers did not intend to tailor an ED drug, Pfizer claimed it caught their attention, and they started working towards that end. ICOS certified the chemical IC351 in 1994 and started research studies on it in 1995. The tests in 1997 showed significant effect of tadalafil on males with ED problems. After successful ending phase 3, Cialis was given approval by the Food and Drug Administration (FDA).

Firstly, the partnership of ICOS and Glaxo was based on half of the profits from Cialis distribution. Later, Glaxo disproved the contract due to a mismatch of Cialis to the key products of the market outlet.

The amalgamation of companies ICOS and Eli Lilly happened in 1998. The new-formed biological corporation Lilly ICOS continued developing and commercializing tadalafil as an ED drug. They applied to the FDA again in 2000 for approval IC351 under the generic name of tadalafil and brand name of Cialis.

In May of 2002, during scientific research the main feature of tadalafil which distinguishes it from similar PDE5 inhibitors was discovered (Viagra, Levitra): it effectiveness lasts up to 36 hours.

In 2007, Eli Lilly & Co acquired ICOS for US $2.3 billion and become a fully legitimate owner of Cialis.

Is Tadalafil Approved by FDA?

On May 28, 2009, the FDA approved tadalafil for PAH therapy. It was the first once-daily PDE5 inhibitor for PAH medical maintenance.

On October 6, 2011, Cialis was endorsed for BPH treatment, becoming the first drug for this purpose. Scott Monroe, director of FDA’s Division of Reproductive and Urologic Products, stated that BPH and ED are often concomitant disorders, and Cialis becomes a convenient option. Daily usage was allowed by FDA as well for treating urinary symptoms in males who suffer from BPH.

Cialis was approved for the curing of erectile problems on November 21, 2003. It was the third prescription medicine for ED on the pharmaceutical market of the USA after Viagra (sildenafil) and Levitra (vardenafil).

Is tadalafil a controlled substance? Yes, of course. This drug is strongly protected by the FDA. In 2015, US officials confiscated a shipment of forgery Cialis versions. The batch was chemically analyzed. The incoming drugs included tadalafil and sildenafil together, which is absolutely inadmissible and rife with negative health consequences. «Cialis» was misspelled on one side of the bottle. The country of the manufacturer was Australia, where Eli Lilly has not been manufacturing human drugs for 30 years. Other signs specific for counterfeit production were found, too.

The FDA strongly prohibits the importation of prescription medicines from overseas. The incoming packages are held back by Customs and Border Protection in the United States. The suspected products undergo close examination. The FDA appeals for team play with clinicians and users and asks them to inform them about suspicious medical products anonymously. It highly cooperates with Interpol and other law machinery to find sellers of fake medications.

How Tadalafil Works

For better understanding the drug effect, it is useful to know how tadalafil works. Cialis acts similarly to other PDE5 inhibitors. Its function consists of averting the quick action of the PDE5 ferment. It naturally acts in the phallus. The main feature which differs Cialis from other equal medications is its prolonged working time (up to 36 hours).

To achieve an erection, the phallus should be filled with blood. Massive blood circulation in the genital area enlarges it and provides rigidity. The male’s body in an aroused state releases nitric oxide in the phallus, proceeding cyclic guanosine monophosphate (cGMP), a ferment which is responsible for the regulation of blood vessels in size. While PDE5 destroys cGMP, causing a weak blood circulation and a flaccid phallus state respectively, Cialis helps to achieve and maintain erection, inhibiting the damaging activity of PDE5. Presence of cGMP is necessary for a stable and rock hard erection.

The mechanism of action for BPH is unclarified. Possibly the existence of a PDE5 inhibitor in the prostate gland and the bladder helps easy urination through reducing pressure on the muscles and regulation the urine flowing.

It is very important to know not only the effect of tadalafil but also how long does it last, as this is its main feature among other similar preparations. The elimination half-life of tadalafil is long — 17.5 hours. The longer the half-life period is, the longer the activity of the preparation is. That is why the drug has received the name the «weekend pill».

The prolonged period of action lends itself well to daily regimen. As far as it implies intake of lower doses, the steady-state plasma concentrations are attained within 5 days of daily intake. Even more, the index is greater when tadalafil is taken on a daily basis rather than intermittently.

Within 5 days of Cialis intake in dosages 2.5 mg and 5 mg, the plasma concentration indexes are 4 mg and 8 mg, respectively. Taking the drug daily was allowed by the FDA in January 2008 on the base of clinical conclusions. Daily dosing is also suggested to reduce the risk of possible side effects which are more likely to occur after intake of larger doses intermittently.

Tolerance to the therapeutic effect of tadalafil, which may cause the decreasing of drug effectiveness and possible failures in treatment course, does not happen during 6 months of treatment for males with ED.

Tadalafil is eliminated out of the body primarily as metabolites in excrement and urine.

Tadalafil Dosages

Cialis tablets come in dosages 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, 60 mg, 80 mg, and 100 mg, 200 mg.

The suggested dose for different regimens:

1. On demand schedule. 10 mg of tadalafil should be taken half an hour before sexual intercourse. The dose may be corrected depending on the user’s response: decreased to 5 mg or 2.5 mg in case of good effectiveness but unwanted side effects manifestations, or increased in case of well acceptance but weak effect.
2. Daily schedule. 2.5 mg once a day, preferably at the same time, regardless of sexual intercourse. It may be increased up to 5 mg depending on the patient’s individual response.

For treatment of BPH symptoms, 5 mg of tadalafil should be taken once a day at the same time. It is important to remember that tadalafil is an additional symptomatic treatment which should be applied along with other specific medications for a BPH cure. The same dosage is suggested if BPH and ED diseases are concomitant.

As practice shows, the classic and most frequently prescribed dose of Cialis is 20 mg. Both drugs, 20 mg and 100 mg, provide the same result. High dosage does not mean 5 times higher efficiency, it is just another way of consumption.

According to clinical trials, Cialis 100 mg showed gradual results as compared to 20 mg. A high concentration of the active ingredient is useful for those who want to change basic drugs from short time pill’s action for a longer time.

Since the first ED pills appeared on the counters as 100 mg, other manufacturers keep on the same line. During consumption of one active ingredient, the user’s body is acquiring a kind of habit to it which should be replaced when another substance comes. To avoid negative health changes, it’s suggested to wait shortly before the previous ingredient goes out of the organism.

Forms of Drug

Cialis is manufactured in multiple medical forms for maximal convenience for the consumer. Other than the habitual rigid form, drugs provide the same efficiency as classic tabs as long as they contain the same active ingredient tadalafil.

The main difference between them all is the method of consumption and the start of the working period. Some forms promote better assimilation and digestion due to quick absorption, quickening the onset of action to start eventually. Choosing a different form, consumers should pay attention to the measure of the active ingredient.

The known forms of Cialis introduced into the pharmacy market are below:

1. Rigid tablets. The classic film-coated form which should be used without damaging, splitting, or chewing along with a glass of water.
2. Liquid. Tasteless and clear syrup with no delays in action. The clinical trials showed minor or mild side effects, such as runny nose, mild sore head, and vertigo with diminishing risks for health. The appropriate dose of citrate liquid is 5 ml.
3. Soft tabs (e20, sublingual). A new, upgraded, and better chewable form of Cialis with a pleasant taste which drives a user more to have sex. Its main benefit is its absorption directly into the bloodstream and faster action consequently. The pills should be chewed or dissolved under the tongue. The medicine can be consumed right after a square dinner regardless of the meals calorific value.
4. Soft gel capsules. One of the quickest ways to achieve results. Quick solubility provides faster results: the medication starts acting within 10-15 minutes after consumption. It is suggested for senior males who find it difficult to gulp standard pills.
5. Oral jelly. It is a convenient form for those who have difficulties swallowing rigid pills. The content of the sachet should be placed right into the mouth. Once the remedy is dissolved, wash it down with water. The preparation is available in a various range of flavors.

Thusly, thanks to resourceful generic manufacturers, users do not have problems with tadalafil consumption. Among various forms, every man will find the best medicine for himself.

Tadalafil Brands

Cialis patent expiration extends at the earliest on September 27, 2018. According to a reached settlement with generic producers, the patent is set to expire in 2020. The branded product is available only in 20 mg classic rigid form.

Being one of the most popular medicines, Cialis is widely available at the pharmaceutical market under other brand names. It would not be too much trouble for users to find another form and dosage.

Generic Cialis has no significant differences from the brand mark because the manufacturers comply with the demand and apply already invented composition. It means that generic interpretations offer the same efficiency and high quality. Auxiliary chemicals can be replaced, but that does not impact its medical activity.

Unlike original Cialis, which is produced in the USA, generic products are mainly manufactured in India and third-world countries. The costs for generics are in many times lower, because the compositions are ready. It does not require a lot of time, investments, and other necessary-for-approval procedures. Marketing issues do not require major expense either, because the product is already known. These notable factors define generics’ cheap prices. Eventually, users have a great chance to save and get the needed drug at affordable prices.

A few examples of generic names:

• Tadalis (Ajanta Pharma Ltd.);
• Tadalista Super Active (Fortune Health Care);
• Vidalista (Centurion Laboratories);
• Tadora (German Remedies Pvt. Ltd.);
• Tadacip (Cipla Ltd.);
• Apcalis (Ajanta Pharma Ltd.);
• Super Tadarise (Sunrise Remedies Pvt. Ltd.);
• Forzest (Ranbaxy Laboratories Ltd.);
• Cialis Professional (Sunrise/Aurochem/Dharam).

Tadalafil is also used as a compound in combination with other chemical agents. Tadapox is a generic version of Cialis which is used in combination with dapoxetine. The renovation formula treats not only ED problems but also premature ejaculation (PE).

Sildalis is a combination of tadalafil and sildenafil (the compound of Viagra). It is double effectiveness for the treatment of sexual problems in males which works up to 48 hours.

All tadalafil variations are the Rx medicines and require a preliminary medical consultation.

Difference Between Cialis and Tadalafil

After the brand Cialis entered the pharmaceutical market, many users estimated its excellent and prolonged effect. Giant pharmaceutical companies were eager to earn on this drug, too. The producer holds the exclusive rights for Cialis, but the patent was helpful. When the patents are near the expiration date, other producers requested permission to manufacture the same pill under their own trademarks and add it specific features if they wish. In this way, omnifarious jellies, capsules, and other types of tadalafil appeared in the global pharmacy market.

Original and generic versions both are manufactured according to standards of quality. Generics also have to receive the law endorsement and pass through numerous relevant procedures. Only this order guarantees equal effectiveness to the brand production. All the main chemical qualities remain the same.

So, what is the difference between Cialis and tadalafil?

1. Price. Tadalafil costs half as much as original Cialis. Producing a copy of original product, the best way for the manufacturers to attract consumers is setting a low cost. Besides, the manufacturing process does not cost much for them, as was mentioned above.
2. Multiformity. A successful marketing hook which provides more convenience to the users. Containing the same active substance, jellies, capsules, and other medicines meet the needs of the most demanding customer. The original Cialis is available only in the form of classic rigid tabs.

Thusly, users can be sure and calm: buying tadalafil instead of brand Cialis, they will receive the desired effect.

Who Can Use Tadalafil?

Tadalafil is a prescription drug which is intended for males, although in some cases it can be used in women and cautiously in children. Cialis is certified for the treatment of ED treatment and PAH therapy, but it may be adapted to cure particular rare diseases, too, if a healthcare provider finds tadalafil usage appropriate. Let’s examine, what tadalafil is used for:

1. ED treatment. Tadalafil cannot be used by sexually active people who are under the age of 18. It has been widely tested and proved for male usage. Tadalafil can be used by females, too, for solving sexual arousal problems. Cialis for women exists in the pharmaceutical market, although the clinical studies on this matter are limited.
2. PAH therapy. Tadalafil can be used by males and females with PAH. No difference in negative health reactions have been reported. Tadalafil was tolerated well in children with PAH and showed more efficient and safer results than sildenafil in the same purpose.
3. Symptomatic treatment of BPH in males. Improving bloodflow to the genital area, tadalafil helps to relax muscles of the prostate and bladder, reducing symptoms of trouble with urination.
4. Raynaud’s phenomenon (deficient blood circulation to the hand and fingers caused by freeze burn or heavy stress). Tadalafil reduces the duration and frequency of secondary episodes in male and female patients with scleroderma and mixed connective-tissue disease.
5. Duchenne muscular dystrophy (muscle degenerative disease, mostly diagnosed in boys between 2-7 y.o.). Tadalafil increases lipid metabolism and protein synthesis efficiency, as well as promotes a better action network management at Z-disk.

The efficiency of PDE5 inhibitors in clinical cases, among ED problems, has been under the scrutiny of medics. Possibly a list of ailments that are treated by tadalafil will be added shortly.

Is It Used for Pulmonary Hypertension?

Tadalafil is officially approved for the treatment of PAH. The progressive illness is defined by the chronicle rising of the pulmonary arterial pressure that often leads to failure of the right side of the heart and early death. The mechanisms of disease development is poorly understood and no specific cure is known today, except approved treatment options including PDE5 inhibitors.

PAH is connected with the impaired release of nitric oxide at least partially because of the reduced expression of its synthase in the vascular endothelial tissues of pulmonary arteries. Tadalafil makes a relaxing and dilating action on the muscle cells in the walls of blood vessels to lungs, reducing the pressure in blood pathways and making blood circulation easier. Good blood circulation improves physical health and the ability to exercise.

Long-term treatment with tadalafil was well-tolerated. Tadalafil in doses 10 mg, 20 mg, and 40 mg (but not 2.5 mg) significantly improved the walked distance at the 16th week. Tadalafil 40 mg showed the best statistical significance. After all mentioned doses, mild or moderate adverse events were displayed. The dose 40 mg significantly decreased the incidences of clinical worsening.

The studying has demonstrated the safety and effectiveness of tadalafil for the treatment of patients with symptomatic PAH. The 40 mg dose offers clinically meaningful additions to the main approved treatment.

Safety

Those who are interested in Cialis but concerned whether is it safe should be sure: Cialis is a safe drug. Multiple clinical trials have proven that tadalafil can be used on an on-demand or daily basis with no harm to health. Taking it daily is more efficient and reduces side effects manifestations.

However, it is very important to take it according to rules stated by the FDA. Cialis must be used only after a preliminary medical consultation. The clinician should inform a patient what is Cialis, how much drug will provide the best effect, when to take the drug, and how to use it.

Cialis should be excluded if a patient:

• is prohibited to have sex due to weak state of cardiovascular system;
• suffers from heart illnesses (chest pain, irregular heartbeat, heart failure);
• has had a heart seizure recently (in the last 90 days);
• has sustained a stroke (in the last half of year);
• experiences blood pressure drops;
• has one eye vision due to non-arteritic interior ischaemic optic neuropathy;
• practices recreational use, especially amyl nitrite, butyl nitrite that were breathed in;
• has allergy to ingredients of the drug.

During a medical examination, a patient should necessarily inform healthcare if these impairments take place:

• chronic liver or kidney illnesses;
• heart and blood vessels ailments;
• sickle cell disease;
• cancer formed by malignant plasma cells (multiple myeloma);
• cancer of the blood (leukemia);
• phallus deformation (penile fibromatosis);
• blindness.

The drug and its correct doses must be prescribed individually according to their state of health. Never share the drug with anyone, even if the symptoms look similar.

Cialis shelf life is 2 years from the date of producing. Never use an expired product and instead discard it.

How and When to Take Tadalafil Pills?

It is highly suggested to stick to the rules that are created for a safe treatment course. These simple steps will help to avoid negative reactions and have the maximum effect for a patient:

1. Before taking tadalafil, read the annotation carefully. It provides information about the tabs and full list of possible side effects a patient might experience.
2. Take the drugs strictly according to the scheme prescribed by a personal clinician.
3. One dose should be taken only once a day. Do your best to take it at the same time of the day.
4. The medicine should be taken along with a glass of water regardless of meal time.
5. One forgotten dose should be taken as soon as a patient remembers. Two or more forgotten ones should be left out. A patient must continue following the ordinary regime further. Never use a double dose to compensate the missed tab, as it will cause an overdosing effect.
6. Regular appointments with a private healthcare provider will help to monitor the progress or correct the treatment scheme if needed.
7. Before a surgery, inform a medical specialist about using tadalafil.
8. Before starting the next pack of the drug, make sure that it is the same as the previous one.
9. Be cautious about using tadalafil together with other medicines. Consult with a doctor regarding every particular over the counter (OTC) and Rx drug.
10. After first consumption, avoid driving or operating machinery until you know how tadalafil affects your body.

Remembering and keeping to these easy rules will help to avoid many possible problems in future and reach progress shortly.

Overdose

Taking too much of the drug may cause numerous unwanted reactions; that is why following the treatment scheme is very important. In case of sudden overdose a patient should contact a personal clinician or contact a local medical center right away. There is no specific cure for overdose. A patient will be provided supportive care.

Tadalafil overdose symptoms include:

• chest pain;
• abnormal heart rhythm;
• vertigo;
• lightheadedness or fainting;
• queasiness.

Overdosing may rise up the risk of adverse events, for example:

• sore head;
• stomach upsets;
• blushing;
• backache, muscle aches;
• upper and lower extremities pain;
• stuffy nose.

It is always better to prevent overdose. Remembering the simple rules of usage will help to exclude these problems:

1. The active ingredient stays in the body up to 72 hours. The patients on an on-demand base of treatment are suggested to mark the days when they consume tadalafil in the calendar.
2. Do not increase the dose independently if the prescribed dosage showed a weak effect. Highly likely, a patient abused the rules of taking the prescribed once and, as a result, has not received the desired effect again.
3. Do not mix tadalafil with drugs that highly interact with it.

New patients might be worried in the beginning of the course, but soon they will get used to the regime and just enjoy the drug’s effect.

Side Effects of Tadalafil

Cialis was taken by over 9000 men in the world. Its clinical trials for daily regime lasted 6 months, 1 year, and 2 years. The studies for use on an on-demand basis lasted 6 months and 1 year.

Diagram 1 represents the frequency of reported side effect manifestations in patients with regular daily treatment for 12 weeks. The middle age of patients was 58 y.o.(from 21 to 82).

Diagram 2 shows the frequency of reported adverse events in patients who used Cialis on demand. The data was taken for the same period of 12 weeks. The middle age was 59 y.o. (from 22 to 88).

The test results were estimated after tadalafil had been approved. The monitoring was done through volunteering from an unlimited number of people. Therefore, it is barely conceivable to provide more accurate statistics of the side effects frequency. The symptoms based upon the above studies have been marked due to their seriousness, regularity of reports, deficiency of other manifestation reasons, or all these factors together.

The character of side effects is individual. Many people do not experience any negative health changes at all. Remember that Cialis is prescribed by a healthcare provider only when the advantages outweigh disadvantages.

Patients are suggested to appeal for medical advice in case of any unusual reactions or rapid negative health changes immediately. It is not always necessary to reject the drug completely. A clinician may suggest a few useful tips that help to overcome side effects easily or correct the dose of intake.

Common

The vast majority of side effects after tadalafil consumption do not require medical assistance and go away by themselves as soon as a patient’s body gets used to the new preparation.

Nevertheless, if the character of symptoms is annoying and prevents the person from remaining in the normal living environment, a patient should appeal for medical consultation. The specialist will suggest simple methods or remedies which should help to overcome the symptoms. Long-term side effects are a sign for monitoring the drug’s effect and practicability of its further usage.

The most frequently reported reactions are represented in the table.

More Common	Less Common	Rare
Dyspepsia	Nose bleeding	Color vision defects
	Overall body ache
	Crawling
	Itch
	Numbness
	Dry, burning or itching feeling in the eye
	Chest burning
Burping	Stuffy nose
	Motion difficulty
	Swallowing difficulty
	Thirst
	Throat inflammation
	Swollen lymph nodes
	Pain in the eyes
	Excess fluid in the eye
Acid reflux	Constant sensation of motion
	Blushing
	Warmth and redness of arms and upper chest
	Ague
	Husk
	Voice mutation
	Erection enhancement
	Weakness
Stomach upsets	Diarrhea
	Muscles aches or spasms
	Muscle rigidity
	Neck, arm, leg pain
	Hypoesthesia (sensitivity loss)
	Rheum
	Dizziness
	Somnolence
Abdominal pain	Poor sleep
	Insomnia
	Sudden erection
	Indigestion
	Puffy eyes, face
	Joint effusion
	Blear-eyedness
	Abdominal tenderness

Remember that side effects do not necessarily appear in every single case. Many users do not feel any health changes at all and successfully continue the treatment course.

More Serious

Serious side effects are not widespread but possible. If a patient experiences acute symptoms, it is necessary to examine them at a medical center. The table below represent the states which demand medical attention.

Less Common	Rare	Isolated incidents
Jaw, arm pain, backache	Priapism (painful erection for hours)	Abdominal ache
Foggy vision		Blindness
Chest pain troubles		Skin blisters, peeling, abrasion
Heavy or tight feeling in the chest		Cracked skin
		Scaly skin
Dither		Cough
Cold sweats		Vision decreasing or defects
Mental fog		Loose stools
Fatigue		Trouble speaking, slow speech, muteness
Syncope		Diplopia (double vision)
Vertigo from standing up		Arrhythmia
Abnormal heart rhythms		Migraine
Sore head		Rash, wheals
Deafness		Numbness of facial muscles or extremities
Nervosity		Myalgia
Pulse beat in the ear		Tingling in extremities
Short breath		Inflamed eyes
Feeling exhausted		Cutaneous lesions purple in the middle
Emesis		Skin redness and swelling
		Ulcers, white spots on the lips or in the mouth
Sickness		Lower extremities swelling
		Sudden cardiac arrest

Sudden blindness is obviously one of the most scarring symptoms for patients. It happens in a very small number of people as a result of decreased blood circulation to the optic nerve. The most vulnerable are individuals over the age 50 with:

• hypertension;
• high cholesterol levels;
• heart ailments;
• diabetes;
• eye problems.

It is unsure if tadalafil initiates sudden blindness in the cases listed above. Nevertheless, if a patient feels any vision defects during the course of Cialis, he should appeal for medical help immediately.

Interactions

Regardless of consumption schedule, two or more medicines may interact with one another. This process increases or decreases the efficiency of the medicines or causes unwanted reactions. Patients who use more than one medicine during the same period should be cautious.

The interwork appears between drug substances or a mixture of medicine with food. The interaction leads to changes in absorption, metabolizing, or elimination. Quite often it happens when two drugs have a similar assignment or provide canceling reactions. As a result, a patient may not receive the desired effect from the preparations or his health condition may drastically worsen.

When two drugs enhance a benefit without side effects, they can be parts of one treatment course. For instance, drugs that lower blood pressure through different working mechanisms may be used together because they enhance the effect and work better than one particular drug alone.

Drug leaflets always contain information about potential drug interwork. The mentioned reactions are chiefly unpredictable and occur individually in every person. The factors which impact on drug interactions are:

• genetic predisposition;
• physiological characteristics;
• age;
• life mode (diet, sport);
• primary diseases;
• drug dosages;
• continuance of combined cure;
• schedule of intake (some interactions may be excluded by taking the medicines at different time of a day).

Here are a few tips how to avoid drug interactions during Cialis treatment:

1. Inform a clinician about the complete list of Rx and OTC drugs you have been using regularly or seldom, including herbal supplements, vitamins and nutraceuticals.
2. Impart the period when preparations were added or rejected.
3. Let a healthcare provider know about your lifestyle, sport involvement, special dietary regime or alcohol dependency.
4. Receive the complete information about Cialis interactions, in particular the most frequent and serious ones.
5. Discuss with a personal physician the elimination of unnecessary preparations or switching the most potential for interaction drugs.

The drug interaction provides only general data based on clinical research, but it can barely predict every possible situation. Derive maximum benefits from it by minimizing the risks of negative interworks and improving success of the cure.

Can I Take Tadalafil While Drinking Alcohol?

Excessive alcohol consumption may cause serious adverse events. This fact is explained by the similar action of spirituous beverages and the chemical substances: they are vasodilators, which means they widen blood vessels and reduce blood pressure.

Orthostatic hypotension is the most frequent result of Cialis and alcohol combination.

The signs of orthostatic hypotension are:

• headache;
• fast heart rate;
• vertigo;
• swoon;
• different physical traumas caused by the states listed above.

Alcohol in small amounts does not cause any serious problems and can be used with tadalafil. Moderate drinking (less that three spirituous beverages per day) is allowed. Tolerated doses per day are represented in the table.

Drink	Allowed dose (oz)
Beer	12
Wine	5
80-proof liquor (vodka, gin, rum, whiskey, tequila)	1.5

Those who drink alcohol regularly and consume more than 3 drinks daily should visit a counseling psychologist. Cialis is not suggested to people who suffer from chronic alcoholism due to increased risks of heart ailments, adiposity, and brain diseases.

Give your healthcare provider truthful information about your alcohol habits during the first medical examination. It will help to avoid potentially dangerous pathologies.

With Food

Unlike other ED drugs, tadalafil shows good effectiveness regardless of the types of food and time of meal, though users have marked that its effect is still better when tadalafil was taken on an empty stomach or after food.

The warning about grapefruit juice remains unchanged for all drugs and tadalafil is not an exception. Being a good source of vitamin C, grapefruit reduces the pharmacologic effect of the drug, causes the accumulation of the chemical substance in the organism, and provokes multiple side effects, such as:

• vertigo;
• lassitude;
• sore head;
• sickness;
• indigestion.

By and large, preventing the breakdown of tadalafil, grapefruit and grapefruit juice actually causes overdosing which is extremely dangerous.

Patients who use Cialis on a demand basis should be especially cautious. The components of this product stay in the stomach up to 72 hours. Remember that after consuming at least one glass of grapefruit juice, you should wait at least 3 days before taking Cialis. The best way out is to exclude this product you’re your diet during a Cialis treatment course.

What Other Drugs Will Affect Tadalafil?

There are a few groups of drugs which Cialis highly interacts with. The medications that are not suggested for parallel intake with Cialis or the ones which require an individual scheme of cure are represented in the table.

Drug class	Examples	Interaction result	Recommendation
CYP3A4 Inhibitors.	Erythromycin (E-mycin); Itraconazole (Sporanox); Indinavir (Crixivan); Isoniazid; Ketoconazole (Nizoral); Nefazodone (Serzone); Nelfinavir (Viracept); Nicardipine (Cardene); Posaconazole (Noxafil); Ritonavir (Norvir).	Decreasing the breakdown and elimination of tadalafil out of the organism.	The doses must be adjusted.
Hypertension medicines.	Lisinopril (Qbrelis); Atenolol (Tenormin); Bystolic (Nebivolol); Diovan (Valsartan); Amlodipine (Norvasc); Benicar (Olmesartan); Losartan (Cozaar); Carvedilol (Coreg); Avapro (Irbesartan); Tekturna (Aliskiren).	Tadalafil decreases blood pressure. Mixing preparation leads to hypotension.	Combining is not suggested.
Alpha-adrenergic antagonists.	Alfuzosin (Uroxatral); Doxazosin (Cardura); Terazosin (Hytrin); Tamsulosin (Flomax); Prazosin (Minipress); Phentolamine (Regitine); Phenoxybenzamine (Dibenzyline); Silodosin (Rapaflo).	Combining causes hypotension.	Individual consultation is required.
Nitrate-containing medicines.	Isosorbide dinitrate (Isordil); Nitroglycerin; Isosorbide mononitrate (Imdur); Amyl nitrite “poppers”.	Parallel intake causes life-threatening blood pressure drops.	Never take these drugs together.
Other phosphodiesterase type 5 inhibitors	Sildenafil (Viagra); Vardenafil (Levitra).	Priapism, multiple side effects.	Do not use different ED drugs together.
Bronchodilator.	Theophylline (Aerolate, Slo-bid, Theo-Dur).	Concomitant use increases heart rate.	The dose corrections are necessary.

The drug interaction list is represented for review and does not cover all drugs with which Cialis interacts. Contact a medical center to receive detailed information regarding every particular medicine.

Tadalafil Reviews and Ratings

Tadalafil has many fans all over the world. Men love Cialis because it is a really effective medicine. All chemical characteristics are correct and the «weekend pill» works in the claimed time.

Many users were happy to find an absolute absence of side effects, which helped them to enjoy the sexual performance. Only a few customers did not feel the effect in the beginning of the course starting from a low dosage.

Consumers whose insurance does not cover Cialis cost complain about the high price of the original product. Those who have been using generics feel no inconveniences with high prices. No prescription is also a reason why users chose generic interpretations.

According to the online reviews, Cialis has got 8.7 voices of 10, where 57% of users have given the highest rates to the medication.

Comparison

To choose an alternative preparation, it is important to understand how tadalafil works, what is its effect, and how long does it last. In fact, Cialis is a single medicinal product which provides a guaranteed effect up to 36 hours. Its unique formula distinguishes it from other similar ED drugs which do not possess such long periods of action.

Due to Cialis side effects, users might seek a herbal substitute first. Natural ingredients are usually well-tolerated without adverse reactions, plus prescribing information is not needed. But can their power compare to the strength of a modern medical product?

Many famous remedies for ED treatment that are made from plants were clinically tested and really showed some effect in ED treatment. They support physical and mental energy and stamina. Unfortunately, most of them are unproven and associated with possible risks. The lack of safety information still requires preliminary medical consultation.

It should be noted that mechanism of action of the natural drugs is not instantaneous. The results of their efficacy are shown within a period of regular intake which sometimes takes up to 2 months. Therefore, it’s not the best option for those who need an immediate result in a matter of hours. Possibly, natural drugs could be good preventive measures for escaping ED and PE problems in the future, but medics can not guarantee the results in the curing of current impairments.

Despite positive promised effects and simple usage conditions, receiving the consultation of a homeopathist and a naturopath before starting the herbal treatment course is highly suggested.

Tadalafil Vs Sildenafil

Cialis and Viagra (sildenafil) are designed for ED treatment. Belonging to one drug class, they have significant differences. A patient should choose only one preparation according to chemical characteristics. Taking drugs with identical purpose may lead to abnormal erections and various side effects.

Criterion	Tadalafil	Sildenafil
Brand name	Cialis	Viagra
Price for original product (10 tablets)*	$339-$401 ($37 per pill)	$218-$320 ($25 per pill)
Without prescription	No	No
Generics	Tadalafil	Sildenafil citrate
Dosages	2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, 60 mg	20 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg
Working start after consumption	Within 15-20 minutes	Within 30 minutes
Duration	Up to 36 hours	4-6 hours
Intake	Regardless of meal time. Grapefruit products are not allowed.	Taking on empty stomach or after a light meal. No grapefruit products can be used during the treatment course.
Sales claim	«Weekend pill» with action up to 36 hours	The first ED drug, safe and successful
Adverse reactions	Both drugs may cause mild, moderate or serious side effects

*Prices may vary depending on the seller

Both drugs are effective and widely used in ED treatment all over the world. Viagra was the first drug in the pharmaceutical market, Cialis appeared later and is considered to be a modern drug. Those who want to achieve a quick and long-lasting effect should doubtlessly choose tadalafil as a superior drug for ED.

Versus Vardenafil

Vardenafil is an active ingredient in the famous and effective ED drug, Levitra.

It belongs to the PDE5 inhibitors drug class which means it works similarly to Cialis and Viagra. But differences still exist. Let’s check them out in the table below.

Criterion	Tadalafil	Vardenafil
Brand name	Cialis	Levitra
Assignment	For ED
Dosages	2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, 60 mg
Price for generics (per pill)	$0.79-0.99 per pill
Price for brand product (10 tablets)	$339-$401 ($37 per pill)	$341-$450 ($40 per pill)
Effectiveness	Works in 85% cases	Works in 92% cases
Sales claim	«Weekend pill» with action up to 36 hours	Helps in cases when Viagra was ineffective
When to take	15-20 minutes before sexual activity	1 hour before sexual activity
Consumption recommendations	Regardless of meal time. No grapefruit products in ration.
Duration	Up to 36 hours	5-7 hours
Half life	18 hours	4-5 hours

As we can see, tadalafil does not have competitors in its duration of action, taking the stable leading positions among other PDE5 inhibitors, although Levitra should not be underestimated, as well. It was the third approved drug for ED treatment in the US, and it also possesses good therapeutic qualities.

Tadacip Vs Tadalafil

Tadacip is a name of generic Cialis with the active ingredient tadalafil manufactured by Indian company Cipla. It is a relatively new preparation which is available and identical to the brand drug. The distinguishing factors are examined in the table.

Criterion	Cialis	Tadacip
Active ingredient	Tadalafil
Assignment	For ED
Activity period	32-36 hours
Working start after consumption	Within 15-20 minutes	Within 40 minutes
Dosages	2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg, 60 mg	20 mg

In view of the fact that both drugs contain the same active ingredient, they have more similarities than differences. Its price varies from $1.10 to $3.59 per tablet, which is significantly less than the price of the brand Cialis. This factor appears to be the main advantage of Tadacip.

Buy Tadalafil at Online Pharmacy

Those who are thinking about where to buy Cialis and how to save money should not seek further. Buying tadalafil in an online pharmacy is the best option for those who do not want to pay extra money for the expensive original product. Purchase it in our drugstore CialisBit and have many advantages.

We sell the Indian generics of pure quality and offer the most famous and highly effective drugs for ED and PE (Viagra, Priligy, and many more) at the cheapest prices without a prescription. Discount for Bitcoin payments (-35%) is a bonus for our customers. Quick shipping will not keep you waiting, as the packages are sent through all the US states within 7-18 days. Professional customer service members will gladly answer all your questions regarding the choice of the preparation, payment, or delivery issues.

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