Cialis (tablets of 2.5 mg, 5 mg and 20 mg) - instructions for use, feedback, analog, side effects of drugs and indications for the treatment of erectile dysfunction and restore potency in men. The composition and the interaction with alcohol On this page, published detailed instructions on the use of Cialis. The available dosage forms of the drug (2.5 mg tablets, 5 mg and 20 mg) and its analogs. The information about the side effects that can cause Cialis, about the interaction with other drugs. In addition to information on diseases, treatment and prevention of which is prescribed drug (erectile dysfunction and restore the potency), painted in detail algorithms reception possible dosage for men. Abstract Cialis supplemented by reviews of patients and physicians. The composition and interaction of the drug with alcohol. Instructions for use and dosage regimen The drug is taken orally, regardless of the meal. The recommended maximum dose of Cialis is 20 mg. The maximum recommended frequency of administration - one time per day. Cialis take at least 16 minutes before anticipated sexual activity. Patients can perform attempt intercourse at any time within 36 hours after dosing in order to determine the optimal response time to the drug.

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Method of production Tablets, film-coated 2.5 mg, 5 mg and 20 mg. Cialis - a drug for the treatment of erectile dysfunction. It is a reversible selective inhibitor of specific phosphodiesterase type 5 (PDE5) cGMP. When sexual stimulation causes local release of nitric oxide, inhibition of PDE5 tadalafil leads to increased levels of cGMP in the cavernous body of penis. The result is relaxation of smooth muscles of arteries and blood flow to the tissues of the penis that causes erections. Tadalafil (the active ingredient of Cialis) has no effect in the absence of sexual stimulation. Studies in vitro have shown that tadalafil is a selective inhibitor of PDE5. PDE5 - an enzyme found in corpus cavernosum smooth muscle, vascular smooth muscle in internal organs, skeletal muscle, platelets, kidney, lung, cerebellum. Cialis improves erection and the possibility of successful sexual intercourse. The drug acts during 36 hours. The effect is already apparent 16 minutes after taking the drug in the presence of sexual arousal. Tadalafil in healthy individuals does not cause significant changes in systolic and diastolic blood pressure compared with placebo in the prone position (mean maximum decrease in blood pressure of 1.6 / 0.8 mm Hg, respectively) and standing (mean maximum decrease in blood pressure of 0.2 / 4.6 mm Hg .st. respectively). Tadalafil does not cause significant changes in heart rate. Tadalafil does not cause changes in the recognition of color (blue / green), due to its low affinity to the PDE6. In addition, no marked effect on visual acuity tadalafil, electroretinogram, intraocular pressure and pupil size. In order to evaluate the effect of a daily intake of at tadalfila spermatogenesis have been several studies. None of the studies was not observed undesired effects on sperm morphology and motility. In one study showed a reduction in the average sperm concentration relative to placebo. Reduced sperm concentration was associated with a higher frequency of ejaculation. Furthermore, tadalafil does not cause undesirable changes of testosterone, LH and FSH in the blood plasma, as compared to placebo.

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Pharmacokinetics Once inside Cialis is rapidly absorbed. The rate and extent of absorption is unaffected by food. Time dosing (morning or evening) had no clinically significant effect on the rate and extent of absorption. At therapeutic concentrations, 94% tadalafil bound to plasma proteins. In healthy persons less than 0.0005% of the administered dose was found in semen. Tadalafil is excreted mainly in the form of inactive metabolites, mainly in the feces (about 61%) and to a lesser extent in the urine (about 36%).

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Indications erectile dysfunction. Contraindications concomitant use of drugs containing any organic nitrates; use in patients under the age of 18 years; hypersensitivity to the drug. Composition Tadalafil + auxiliaries. special instructions Precautions should be prescribed to patients with severe hepatic insufficiency (Class C of Child-Pugh), since the data of controlled clinical trials on the safety and efficacy of Cialis in this group of patients are not available. Care should be taken in the appointment of Cialis to patients taking α1-blockers such as doxazosin, as the simultaneous use, in some cases may lead to symptomatic hypotension. In clinical pharmacology studies in 18 healthy volunteers who received a single dose of tadalafil showed no symptomatic hypotension while the introduction of alpha-1-blocker tamsulosin.

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Sexual activity is a potential risk for patients with cardiovascular diseases. Therefore, treatment of erectile dysfunction, including using Cialis, you should not hold for men with heart disease, in which sexual activity is not recommended. It should be taken into account the potential risk of complications during sexual activity in patients with diseases of the cardiovascular system: myocardial infarction within the last 90 days; unstable angina or angina occurring during sexual intercourse; Chronic heart failure (functional class 2 or higher on the classification of NYHA), which developed during the last 6 months; uncontrolled heart rhythm disorder; hypotension (blood pressure less than 90/50 mm Hg), or uncontrolled hypertension; stroke, myocardial in the last 6 months. Caution should be used Cialis for patients with severe renal insufficiency (creatinine clearance less than 30 ml / min), renal failure, moderate (creatinine clearance 31 to 50 mL / min) and in patients with a predisposition to priapism (eg, sickle at cell anemia, multiple myeloma or leukemia), or in patients with anatomical deformation of the penis (for example, angulation, cavernous fibrosis or Peyronie's disease). There are reports of occurrence of priapism PDE5 inhibitors, including Cialis. The patient should be informed of the need for immediate treatment to the doctor in the event of an erection, continued for 4 hours or more. Delays in treatment of priapism leads to tissue damage of the penis, as a result of this loss may occur long-term potency. The safety and efficacy of a combination of Cialis with other treatments for erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended. As with other PDE5 inhibitors, tadalafil has systemic vasodilator properties, which may lead to a transient decrease in blood pressure. Before the appointment of Cialis, physicians should carefully consider the question - not whether the patients with their existing cardiovascular disease subjected adversely affected by such vasodilatory effects. Nearterialnaya anterior ischemic optic neuropathy (NAPION) is the cause of visual impairment, including total loss of vision. There are rare post-marketing reports of cases of NAPION, the time associated with taking PDE5 inhibitors. At the present time it is impossible to determine whether there is a direct link between the development and NAPION taking PDE5 inhibitors or to other factors. Physicians should advise patients in the event of a sudden loss of vision stop taking tadalafil and seek medical advice. Patients should be warned that in people who have had NAPION increased risk of recurrence of the condition.

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Effects on ability to drive vehicles and management mechanisms Despite the fact that the incidence of dizziness in placebo and Cialis is the same in the period of treatment, patients should be careful when driving and occupation of other potentially hazardous activities that require high concentration and speed of psychomotor reactions. Pregnancy and breast-feeding The preparation is not intended for use in women. Side effect headache; backache; myalgia; dizziness; nasal congestion; flushing; dyspepsia; swelling of the eyelids; Pain in the eyes; conjunctival hyperemia; hypersensitivity reactions (which include rashes, hives, and swelling of the face, Stevens-Johnson syndrome, and exfoliative dermatitis); hypotension (in patients who are already taking antihypertensive agents); hypertension; hyperhidrosis (excessive sweating); priapism and delayed erection; blurred vision; nearterialnaya anterior ischemic optic neuropathy; retinal vein occlusion; violation of the visual fields; nose bleed; myocardial infarction; sudden cardiac death; stroke; chest pain; tachycardia. Drug Interactions The influence of other drugs on tadalafil At the same time taking an antacid (magnesium hydroxide / aluminum hydroxide) and tadalafil reduced the rate of absorption of the latter without changing its AUC. Increased gastric pH as a result of receiving blocker histamine H2-receptors nizatidine has no effect on the pharmacokinetics of tadalafil. Effect of tadalafil on other drugs Cialis 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 during treatment with nitrates is contraindicated. Tadalafil has no clinically significant effect on clearance of drug metabolism that occurs with the participation of cytochrome P450 isoenzymes. Studies have confirmed that tadalafil does not inhibit or induce isozymes CYP3A4, CYP1A2, CYP2D6, CYP2E1, CYP2C9, CYP2C19. Tadalafil has no clinically significant effect on the pharmacokinetics of S-and R-warfarin. Tadalafil has no effect on the action of warfarin on prothrombin time. Cialis does not increase the duration of bleeding against the background of aspirin. Cialis has a systemic vasodilating properties and may exacerbate the effects of antihypertensive drugs aimed at reducing blood pressure. Additionally, patients taking multiple antihypertensive agents that have hypertension, poorly controlled, observed several large blood pressure reduction. The vast majority of these patients reduction was not associated with hypotensive symptoms. Patients receiving treatment with antihypertensive drugs and receiving tadalafil should be given appropriate clinical guidelines. There was no significant reduction in blood pressure when used in conjunction with selective tadalafil alfa1A-blocker tamsulosin. When using tadalafil in healthy volunteers who took alpha 1-blocker doxazosin (8 mg daily), were increased hypotensive action of doxazosin. Some patients experienced dizziness. Cases of syncope were observed. Lower doses of doxazosin have not studied. Cialis does not affect the concentration of ethanol (alcohol), as well as ethanol (alcohol) does not affect the concentration of tadalafil. At high doses of ethanol (0.7 g / kg) dose of tadalafil did not cause a statistically significant decrease in the average value of blood pressure. Some patients showed postural dizziness and orthostatic hypotension. When administered tadalafil in conjunction with lower doses of ethanol (0.6 g / kg), hypotension was not observed, and dizziness occurred with the same frequency as the reception of only one alcohol. Tadalafil has no clinically significant effect on the pharmacokinetics and pharmacodynamics of theophylline. Analogs of the drug Cialis Structural analogs of the active substance does not have a drug Cialis. Analogs of a therapeutic effect (potency regulators): Afrodor 2000; Veromaks; Verona; Viagra; Viasan LF; Vigrande; Vizarsin; In speaker; Zidena; Impaza; Yohimbine "Spiegel"; Yohimbine hydrochloride; Levitra; Maksigra; Muse; Raylis; Sildenafil citrate; Speman; Speman forte; Super Yohimbe Plus; Tentex Forte; Testalamin; Himcolin; Edeks. It treats the following diseases: erection, impotence