Cialis

Cialis (tadalafil) relaxes muscles found in the walls of blood vessels and increases blood flow to particular areas of the body.

Cialis is used to treat erectile dysfunction (impotence) and symptoms of benign prostatic hypertrophy (enlarged prostate).

Another brand of tadalafil is Adcirca, which is used to treat pulmonary arterial hypertension. Do not take Cialis while also taking Adcirca, unless your doctor tells you to.

Important information

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

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 Cialis with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

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.

Stop using Cialis and get emergency medical help if you have sudden vision loss.

Before taking this medicine

You should not take Cialis if you are allergic to tadalafil, or:

if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas).

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking Cialis with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

To make sure Cialis is safe for you, tell your doctor if you have any of these other conditions:

heart disease or heart rhythm problems, coronary artery disease;

a recent heart attack (within the past 90 days);

a recent history (in the past 6 months) of a stroke, or congestive heart failure;

angina (chest pain), high or low blood pressure;

liver or kidney disease (or if you are on dialysis);

a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;

a bleeding disorder such as hemophilia;

a stomach ulcer;

retinitis pigmentosa (an inherited condition of the eye);

a physical deformity of the penis (such as Peyronie's disease); or

if you have been told you should not have sexual intercourse for health reasons.

Cialis can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Viagra or other drugs similar to tadalafil. Most of these people also had certain pre-existing eye problems or risk factors for blood vessel disorders (such as heart disease, diabetes, high blood pressure, high cholesterol, coronary artery disease, smoking, or being over 50 years old). It is not clear whether Cialis is the actual cause of vision loss.

tadalafil is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether tadalafil passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take Cialis?

Cialis is usually taken only once per day. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Cialis can be taken with or without food.

Do not break or split a tablet. Swallow it whole.

For erectile dysfunction, take this medicine just before sexual activity but not more than once per day.

Cialis can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor's instructions.

During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Cialis.

Do not take Cialis for erectile dysfunction if you are taking Adcirca for pulmonary arterial hypertension.

Store at room temperature away from moisture and heat.

Cialis dosing information

Usual Adult Dose for Erectile Dysfunction:

Use as needed for ED:
-Initial dose: 10 mg orally once a day, as needed, prior to sexual activity
-Maintenance dose: 5 to 20 mg orally once a day, as needed, prior to sexual activity based on individual efficacy and tolerability

Comment: Consider that this drug has shown to improve erectile dysfunction up to 36 hours following dosing, when used as needed.

Once a day use for ED:
-Initial dose: 2.5 mg orally once a day at approximately the same time, without regard to timing of sexual activity
-Maintenance dose: 2.5 to 5 mg orally once a day based on individual efficacy and tolerability.

Once daily use for ED and Benign Prostatic Hyperplasia (BPH):
-5 mg orally once a day at approximately the same time, without regard to timing of sexual activity

Use: Treatment of erectile dysfunction (ED)

Usual Adult Dose for Benign Prostatic Hyperplasia:

Once daily use for BPH:
-5 mg orally once a day at approximately the same time

Concomitant administration with finasteride:
-5 mg orally once a day at approximately the same time, for up to 26 weeks

Comments: The incremental benefit of this drug decreases from 4 weeks until 26 weeks. The incremental benefit of this drug beyond 26 weeks is unknown.

Once daily use for ED and BPH:
-5 mg orally once a day at approximately the same time, without regard to timing of sexual activity

Use: Treatment of the signs and symptoms of benign prostatic hyperplasia (BPH)

What happens if I miss a dose?

If Cialis is used as needed, you are not likely to be on a dosing schedule.

If you take Cialis every day and you miss a dose, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Cialis?

Drinking alcohol with this medicine can cause side effects.

Grapefruit and grapefruit juice may interact with tadalafil and lead to unwanted side effects. Avoid the use of grapefruit products while taking this medicine.

Avoid using any other medicines to treat impotence, such as alprostadil or yohimbine, without first talking to your doctor.

Cialis side effects

Get emergency medical help if you have any signs of an allergic reaction to Cialis: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using Cialis and get emergency medical help if you have:

erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis);

vision changes or sudden vision loss; or

heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Also call your doctor right away if you have:

ringing in your ears, or sudden hearing loss;

swelling in your hands, ankles, or feet;

shortness of breath;

Researcher Dr. Michael Adams answers some important questions.

Dr. Michael Adams: “This is a normal part of health and should be discussed freely.”

Did you know that hypertension (high blood pressure) can cause tension in the bedroom?

Men who have uncontrolled high blood pressure are likely to lose their erectile function at least twice as fast as men with normal levels, says Dr. Michael Adams, a pharmacologist and a cardiovascular and sexual medicine researcher at Queen’s University in Kingston, Ont.

A Heart and Stroke Foundation-supported researcher, Dr. Adams is a member of both the International Society of Sexual Medicine and Hypertension Canada. He’s been researching the connection between cardiovascular health and sexual function for 25 years.

Dr. Adams answered our questions (and we’re mostly talking to men – but women, you’ll want to listen in).

What is the connection between blood pressure and sex?
An increase in blood pressure can occur with any kind of activity, depending on intensity – jogging, playing hockey and sex.

If your blood pressure is normal, that’s fine. But if you have uncontrolled hypertension you need to be careful, especially if you have been physically inactive for some time then suddenly regain sexual function from medications like Viagra or Cialis. In that case, the increase in blood pressure could put you at higher risk for progression of cardiovascular disease. Talk to your doctor before using these drugs to ensure you’re fit enough to engage in sexual activity.

Your sexual function can be an indicator of your cardiovascular health. Just throwing a Band-Aid on it and saying, “I’ve got drugs, I can do it,” is not a safe approach.

How can high blood pressure affect my sex life?
Hypertension is a known risk factor for inducing erectile dysfunction. High blood pressure that is not properly controlled is going to weaken your body’s ability to increase blood flow when needed, making it more difficult for you to generate an erection.

If I control my high blood pressure with medication, will that help my sexual function?
Following your medication plan is crucial for combating high blood pressure. However, certain hypertension drugs – including some beta blockers and diuretics – increase the possibility of erectile dysfunction.

Don’t despair if your blood pressure medication is affecting you this way. There are solutions and they start with talking to your doctor. It might be as simple as adjusting your medication schedule.

Does high blood pressure affect women’s sexual function?
The evidence isn’t as strong as it is for men. Women’s sexual dysfunction is more complicated than erectile dysfunction.

If I take medication to control my blood pressure, can I also take erectile dysfunction drugs (Viagra or Cialis)?
When these drugs were approved, they were tested on patients taking blood pressure medications. But blood pressure medication taken incorrectly, combined with sexual enhancement drugs, could possibly result in a dangerous drop in blood pressure. That’s why talking to your doctor is key; as your main healthcare provider, he or she needs to know about all medications you are taking, including prescriptions from specialists as well as any herbal remedies or supplements.

Your doctor should be able provide you with a safe and effective medication strategy to address both issues.

Should I talk to my doctor about sexual function and blood pressure?
Absolutely. This is a normal part of health and should be discussed freely.

And if you think this is difficult to bring up, so does your doctor. One of the hardest questions for doctors to ask is, “How is your sex life? What is the quality of your erections?”

Break the silence. After all, says Dr. Adams, consider how we now talk about depression or prostate issues – these topics have become locker room conversation. Erectile dysfunction should be discussed as openly – and managed just like any other outcome of vascular disease.

Plus, think of it as incentive. If you know that healthier blood pressure means better sexual function, that’s a great reason to follow your treatment and change your lifestyle.

Need help to control your blood pressure? Sign up for the free Heart&Stroke Blood Pressure Action Plan TM .

High Blood Pressure and Erectile Dysfunction Treatments

Even if your high blood pressure (or hypertension ) has caused erectile dysfunction (ED), you have every reason to be optimistic about the future and a healthy sex life. ED is a common problem associated with high blood pressure. but there are many proven treatments you can try.

A doctor's first choice for treating erection problems is usually one of the pills called PDE5 inhibitors. First there was Viagra. Now there's also Cialis. Levitra. and Staxyn. All of these drugs work in similar ways. They don't increase sexual desire. They make it physically possible to get an erection when you are aroused.

No one of them has been proven to work better than the others. But the time they take to start working and the duration of their effects vary. That's something you may want to consider based on your sexual habits. For example, does spontaneity matter to you, or do you usually plan sex ahead of time?

Viagra starts working in about 15 to 30 minutes and its effects last about two to four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours. Cialis starts working in about 30 to 60 minutes and lasts as long as 36 hours.

Staxyn is an orally disintegrating tablet that contains the same active ingredient as Levitra but is not interchangeable with Levitra tablets.

Men whose blood pressure isn't under control and those who take alpha-blockers (for high blood pressure or prostate problems ) shouldn't take Cialis, Levitra, Staxyn, or Viagra.

Also, you may not be able to take these drugs if you:

When Erectile Dysfunction Pills Aren't an Option

If erectile dysfunction pills are out of the question, or if pills haven't worked for you, don't worry. There are other options.

Alprostadil is another drug for erectile dysfunction. However, it's not a pill. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. It widens blood vessels and relaxes smooth muscle tissue in the penis. allowing blood to fill the spongy tissue that makes the penis erect.

Continued

Injections directly into the penis are another way to deliver alprostadil. Phentolamine and papaverine are additional drugs that are injected into the penis to treat erectile dysfunction. When injecting these drugs there is some risk that your erection may last too long, a condition that can require medical treatment.

Next, you may want to try a vacuum device, or "penis pump." This is typically a clear plastic cylinder with a bulb or plunger and a constriction band.

You put your penis in the cylinder and start pumping. The suction creates a vacuum, so blood rushes in to fill the spaces in the spongy tissue of the penis, creating an erection. The erection lasts only as long as the blood stays in, so you slide the band down around the base of your penis, trapping the blood. It's safe to keep the band on for up to 30 minutes.

These devices are available without a prescription, but it's important to buy one from a reputable manufacturer. The device must include a safety control so you can't harm your penis with too much suction.

Surgery for Erectile Dysfunction

Most men would prefer to avoid surgery, but for some men with erection problems, penis implants are another option for regaining sexual function.

There are two kinds of penis implants. One kind is a rigid but flexible rod implanted in the penis. You bend it up for sex or down for daily living. The other kind is an inflatable implant. The device stores fluid in a reservoir under the skin of your abdomen or scrotum. You press on the reservoir to pump fluid into cylinders in the penis. That creates an erection. A valve drains the fluid out of the penis when you're done.

There are drawbacks to implants. An erection you get with an implant may be slightly shorter than a natural erection. The device itself may malfunction, in which case it would require another surgery to remove or replace it.

Getting a penis implant is a big decision. Once you have it, you may not be able to try other treatments. That's because the implant replaces the chambers in the penis that fill with blood for a natural erection.

Continued

Alternative Treatments for Erectile Dysfunction

Before Viagra hit the market in 1998, there was no proven treatment for erectile dysfunction that men could take in pill form. Doctors were interested in yohimbe. an herb that increases heart rate and blood pressure. Some doctors prescribed it to their patients in combination with other treatments for erectile dysfunction. Even then it was not a recommended treatment and is still not today. Studies have not proven that it works.

Men with high blood pressure especially shouldn't take either the prescription drug or the herb. It can dangerously raise blood pressure.

Currently, no herb or supplements have been proven to help with erectile dysfunction. Herbs and supplements that some believe are helpful for erection problems include:

Before trying any alternative treatment, be sure to ask your doctor about it. Herbs and supplements. whether they help with erections or not, have real effects on the body. They could cause dangerous reactions with other medicines you might be taking.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on April 12, 2015

Sources

American Urological Association: "Erectile Dysfunction Clinical Guidelines Panel. The Treatment of Organic Erectile Dysfunction: A Patient's Guide," 1996; and "AUA Guideline on the Management of Erectile Dysfunction: Diagnosis and Treatment Recommendations," 2005.

Gaines, K. Urologic Nursing. February 2004.

Lamm, S. The Hardness Factor. HarperCollins, 2005.

Medscape Drug Reference from First DataBank: "Alprostadil Urethral" and "Sildenafil Oral."

Vivus, Inc. "Administering MUSE," 2004.

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