17 PATIENT COUNSELING INFORMATION

(See Animal Toxicology and/or

Proper Use

Warfarin) — Tadalafil had no significant effect on exposure (AUC) to S-warfarin or R-warfarin, nor did tadalafil affect changes in prothrombin time induced by warfarin. Nitrates — Administration of CIALIS to patients who are using any form of organic nitrate, is contraindicated. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)]. Alpha Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha blockers. Clinical pharmacology studies have been conducted with coadministration of tadalafil with doxazosin or tamsulosin [see Warnings and Precautions (5.6), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].

Drug details

Antihypertensives — PDE5 inhibitors, including tadalafil, are mild systemic vasodilators. [See Warnings female cialis uk and Precautions (5.6) and Clinical Pharmacology (12.2)]. Alcohol — Both alcohol and tadalafil, a PDE5 inhibitor, act as mild vasodilators. [See Warnings and Precautions (5.9) and Clinical Pharmacology (12.2)]. [See Dosage and Administration (2.4) and Warnings and Precautions (5.10)]. Pharmacology Section 13.2)8.3 Nursing

• Cialis 20mg does not increase sexual desire (libido).
• It only facilitates an erection when sexual stimulation occurs.
• Relationship issues can affect sexual function despite effective medication.
• Couples therapy may be a helpful adjunct to medical treatment.
• The medication can be used by men in same-sex relationships.
• Efficacy is not dependent on the gender of one's partner.
• It is important for all sexually active individuals to practice safe sex.
• Cialis does not replace the need for condoms to prevent STIs or pregnancy.
• Open dialogue with healthcare providers about sexual health is crucial.

MothersCIALIS is not indicated for use in women.

Product	Dosage	Quantity + Bonus	Price
Cialis Generic	60mg	120 + 8 Pills	240.18€ 228.74€	Buy
Cialis Generic	60mg	30 + 2 Pills	85.33€ 81.27€	Buy
Cialis Generic	10mg	90 + 6 Pills	146.17€ 139.21€	Buy
Cialis Generic	40mg	10 Pills	37.79€ 35.99€	Buy
Cialis Generic	10mg	10 Pills	31.41€ 29.91€	Buy
Cialis Black	80mg	120 + 8 Pills	264.77€ 252.16€	Buy
Cialis Professional	40mg	20 Pills	110.24€ 104.99€	Buy
Cialis Generic	5mg	10 Pills	29.39€ 27.99€	Buy
Cialis Generic	2.5mg	30 + 4 Pills	51.95€ 49.48€	Buy
Cialis Soft Tabs	20mg	60 + 4 Pills	159.37€ 151.78€	Buy
Cialis Super Active	20mg	270 + 30 Pills	661.49€ 629.99€	Buy
Cialis Original	20mg	8 Pills	61.70€ 58.76€	Buy
Cialis Generic	2.5mg	10 Pills	28.51€ 27.15€	Buy
Cialis Black	80mg	20 Pills	71.83€ 68.41€	Buy
Cialis Generic	20mg	120 + 8 Pills	188.15€ 179.19€	Buy

It is not known whether tadalafil is excreted into human milk.

Ingredient	Quantity per Tablet	Function
Tadalafil	20 mg	Active ingredient
Microcrystalline cellulose	50 mg	Fillers
Croscarmellose sodium	10 mg	Disintegrant
Magnesium stearate	5 mg	Lubricant

While tadalafil or some metabolite of tadalafil was excreted

17.5 Priapism

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. into rat milk, drug levels in animal breast milk may

• Some men may experience flushing (redness of face and neck).
• Nasal congestion or a runny nose is a possible side effect.
• These side effects are usually mild and diminish over time.
• Back pain and muscle aches are more common with higher doses like 20mg.
• These pains typically occur 12-24 hours after taking the pill.
• They usually resolve within 48 hours and respond to over-the-counter pain relievers.
• Staying hydrated may help reduce the incidence of muscle-related side effects.
• If side effects are severe or persistent, contact your healthcare provider.
• Do not stop taking other prescribed medications without consulting your doctor.

not accurately predict levels of drug in human breast milk.8.4

• Cialis 20mg may cause side effects like back pain and jaw pain.
• Always review your health history with your doctor before starting Cialis.
• Do not suddenly stop taking Cialis 20mg without consulting your doctor.
• Cialis 20mg is sometimes used in the treatment of pulmonary hypertension.
• Do not take Cialis 20mg if you have a history of allergic reactions.
• The medication can interact with certain antifungal and antibiotic drugs.
• Follow prescribed dosages to minimize the risk of adverse effects.
• Cialis 20mg is generally well-tolerated when used properly.
• Avoid combining Cialis 20mg with other vasodilators.
• Proper hydration can help reduce some side effects of Cialis 20mg.

Pediatric UseCIALIS is not indicated

Use Area	Description	Recommended Dosage	Onset of Action
Erectile Dysfunction	Improves blood flow to penile tissue	20 mg	30-60 minutes
Benign Prostatic Hyperplasia	Relieves urinary symptoms	As prescribed	1-2 hours
Pulmonary Hypertension	Reduces blood pressure in lungs	40 mg daily	2 hours

for use in pediatric patients.

Cialis 20 Tablet Ingredients

Nizatidine) — An increase in gastric pH resulting from administration of nizatidine had no significant effect on pharmacokinetics. Cytochrome P450 Inhibitors — CIALIS is a substrate of and predominantly metabolized by CYP3A4. Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure. CYP3A4 (e.g., Ketoconazole) — Ketoconazole (400 mg daily), a selective and potent inhibitor of CYP3A4, increased tadalafil 20 mg single-dose exposure (AUC) by 312% and Cmax by 22%, relative to the values for tadalafil 20 mg alone. Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone [see Dosage and Administration (2.4)].

Discover more about Cialis

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 — canadian online pharmacy generic cialis 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. Safety and efficacy in patients below the age of 18

Condition	Details	Why Important
Temperature	Store at room temperature (20-25°C)	Prevents degradation
Protect from moisture	Keep in dry place	Maintains tablet stability
Keep out of reach of children	Secure storage	Prevent accidental ingestion

years has not been established.8.5

• Absorption is not significantly affected by food, unlike some other ED drugs.
• A high-fat meal may delay the time to reach maximum concentration.
• For predictable timing, take on an empty stomach or with a light meal.
• Maximum plasma concentration is reached approximately 2 hours after dosing.
• The medication is highly protein-bound in the bloodstream.
• It is not removed by dialysis, so dose adjustment is critical in renal failure.
• In mild to moderate renal impairment, a maximum dose of 10mg is often advised.
• In severe renal impairment, the maximum recommended dose is 5mg.
• For patients on dialysis, use is not recommended.

Geriatric UseOf the total number of

Warnings and Precautions

Nizatidine) — An increase in gastric pH resulting from administration of nizatidine had no significant effect on pharmacokinetics.Cytochrome P450 Inhibitors — CIALIS is a substrate of and predominantly metabolized by CYP3A4. Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure.CYP3A4 (e.g., Ketoconazole) — Ketoconazole (400 mg daily), a selective and potent inhibitor of CYP3A4, increased tadalafil 20 mg single-dose exposure (AUC) by 312% and Cmax by 22%, relative to the values for tadalafil 20 mg alone. Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone [see Dosage and Administration (2.4)].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. Ritonavir (200 mg twice daily), increased tadalafil 20-mg single-dose exposure (AUC) by 124% with no change 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.

Does tadalafil interact with foods or drinks?

Although specific interactions have not been studied, other CYP3A4 inducers, such as carbamazepine, phenytoin, and phenobarbital, would likely decrease tadalafil exposure. 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 cost cialis everyday magnitude of decreased efficacy is unknown.7.3 Potential for CIALIS to Affect Other DrugsCytochrome 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.CYP1A2 (e.g. Theophylline) — Tadalafil had no significant effect on the pharmacokinetics of theophylline. 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.CYP2C9 (e.g. subjects in clinical studies of tadalafil, approximately 25 percent were

Triple Zero 0.0.0% Installments

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. 65 and over, while approximately 3 percent were 75 and over.

Benefits and Uses

Urogenital — priapism [see Warnings and Precautions (5.3)]. 7 DRUG INTERACTIONS 7.1 Potential for Pharmacodynamic Interactions with CIALISNitrates — Administration of CIALIS to patients who are using any form of organic nitrate, is contraindicated. In a patient who has taken CIALIS, where nitrate administration is deemed medically necessary in a life-threatening situation, at least 48 hours should elapse 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 [see Contraindications (4.1), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].Alpha Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha blockers. Clinical pharmacology studies have been conducted with coadministration of tadalafil with doxazosin or tamsulosin [see Warnings and Precautions (5.6), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].Antihypertensives — PDE5 inhibitors, including tadalafil, are mild systemic vasodilators.

Cialis and foods

Small reductions in blood pressure occurred following coadministration of tadalafil with these agents compared with placebo. [See Warnings and Precautions (5.6) and Clinical Pharmacology (12.2)].Alcohol — Both alcohol and tadalafil, a PDE5 inhibitor, act as mild vasodilators. Substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache. Tadalafil did not affect alcohol plasma concentrations and alcohol did not affect tadalafil plasma concentrations. [See Warnings and Precautions (5.9) and Clinical Pharmacology (12.2)].7.2 Potential for Other Drugs to Affect CIALIS[See Dosage and Administration (2.4) and Warnings and Precautions (5.10)].Antacids — Simultaneous administration of an antacid (magnesium hydroxide/aluminum hydroxide) and tadalafil reduced the apparent rate of absorption of tadalafil without altering exposure (AUC) to tadalafil.H2Antagonists (e.g.