Cialis - June 17, 2019

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Cialis 20 Mg Price: Cialis pills 20mg 8 book

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Cialis is a drug for the treatment of erectile dysfunction (erectile dysfunction). It causes relaxation of the arteries of the penis and increases blood flow to the tissues of the penis, which results in an erection.

Latin name:

Cialis / Cialis.

Composition and release form:

Cialis coated tablets, 1, 2, 4 or 8 pcs. packaged.

1 tablet Cialis contains 20 mg of tadalafil.

Active-active substance:

Tadalafil / Tadalafil.

Properties / Action:

Cialis (tadalafil) is an effective, reversible selective inhibitor of specific phosphodiesterase type 5 (PDE5) cyclic guanosine monophosphate (cGMP). When sexual arousal causes local release of nitric oxide, inhibition of PDE5 by tadalafil leads to an increase in cGMP levels in the cavernous body of the penis. The result is a relaxation of smooth muscles of the arteries and blood flow to the tissues of the penis, which causes an erection. Tadalafil has no effect in the absence of sexual stimulation.

In vitro studies have shown that tadalafil is a selective PDE5 inhibitor. PDE5 is an enzyme found in the smooth muscles of the cavernous body, in the smooth muscles of the vessels of the internal organs, in skeletal muscles, platelets, kidneys, lungs and cerebellum. The effect of tadalafil on PDE5 is more active than on other phosphodiesterase. Tadalafil is 10,000 times more potent with PDE5 than with PDE1, PDE2, and PDE4, which are located in the heart, brain, blood vessels, liver, and other organs. Tadalafil is 10,000 times more active in blocking PDE5 than PDE3, an enzyme that is found in the heart and blood vessels. This selectivity with respect to PDE5 over PDEZ is important because PDEZ is an enzyme involved in the contraction of the heart muscle. In addition, tadalafil is approximately 700 times more active in relation to PDE5 than in relation to PDE6, which is found in the retina and is responsible for photo transmission. Tadalafil also exhibits an effect 10,000 times more potent with respect to PDE5 compared to its effect on PDE7 – PDE10.

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Tadalafil improves erection and the possibility of successful sexual intercourse. The drug is valid for 36 hours. The effect appears already after 16 minutes after taking the drug in the presence of sexual arousal.

In healthy individuals, tadalafil does not cause a significant change in systolic and diastolic pressure compared with placebo in the prone position (the average maximum decrease is 1, 6/0, 8 mm Hg, respectively) and in the standing position (the average maximum decrease is 0, 2/4, 6 mm Hg. Art., Respectively). Tadalafil does not cause significant changes in heart rate.

Tadalafil does not cause changes in color recognition (blue / green), which is explained by its low affinity for PDEb. In addition, no effect of tadalafil on visual acuity, electroretinogram, intraocular pressure and pupil size is observed.

In the study of tadalafil in men in a daily dose of 10 mg, no clinically significant effect of the drug on the amount and concentration of sperm, mobility and morphology of spermatozoa was detected.

Pharmacokinetics:

After taking Cialis inside tadalafil quickly absorbed. The average maximum concentration (Cmax) in plasma is achieved on average 2 hours after ingestion.

The speed and extent of absorption of tadalafil do not depend on food intake, therefore, CIALIS can be taken regardless of the food intake. The time of administration (in the morning or in the evening) did not have a clinically significant effect on the rate and extent of absorption.

The pharmacokinetics of tadalafil in healthy individuals is linear with respect to time and dose. In the dose range from 2, 5 to 20 mg, the area under the concentration-time curve (AUC) increases in proportion to the dose. Equilibrium plasma concentrations are achieved within 5 days while taking the drug once a day.

The pharmacokinetics of tadalafil in patients with dysfunction of erection is similar to the pharmacokinetics of the drug in individuals without dysfunction of erection.

The average volume of distribution is about 63 liters, which indicates that Tadalafil is distributed in the tissues of the body. At therapeutic concentrations, 94% tadalafil in plasma binds to protein-mi. Protein binding does not change with impaired renal function.

In healthy individuals, less than 0, 0005% of the injected dose is found in semen.

Tadalafil is mainly metabolized with the participation of the cytochrome P450 isoenzyme (CYP) 3A4. The major circulating metabolite is methylcatechol glucuronide. This metabolite is at least 13,000 times less active in relation to PDE5 than tadalafil. Therefore, it can hardly be assumed that this metabolite is clinically significant at the observed concentrations.

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In healthy individuals, the average clearance of tadalafil when taken orally is 2.5 l / h, and the average half-life is 17, 5 hours. Tadalafil is excreted mainly in the form of inactive metabolites, mainly with feces (about 61% of the dose) and, to a lesser extent, with urine (about 36% of the dose).

Healthy elderly people (65 years and more) had a lower clearance of tadalafil when taken orally, which resulted in an increase in the area under the concentration-time curve by 25% compared with healthy individuals aged 19 to 45 years. This difference is not clinically significant and does not require dose selection.

In individuals with mild (creatinine clearance 51–80 ml / min) or moderate (creatinine clearance 31–50 ml / min) renal failure, the area under the concentration-time curve was greater than in healthy individuals. In individuals with severe renal insufficiency (creatinine clearance 30 ml / min) Tadalafil has not been studied (see the section “Special warnings and precautions for use”).

The pharmacokinetics of tadalafil in patients with weak and moderate hepatic insufficiency is comparable to that in healthy individuals. In such patients, dose selection is not required.

In patients with diabetes mellitus with tadalafil, the area under the concentration-time curve was less by about 19% than in healthy individuals. This difference does not require dose selection.

Indications:

Cialis is indicated for erectile dysfunction.

Dosage and administration:

Cialis is taken orally.

The use of Cialis in middle-aged men

The recommended dose of Cialis is 20 mg. Cialis is taken before the intended sexual activity, regardless of the meal. Cialis should be taken at least 16 minutes before the intended sexual activity.

Patients can attempt sexual intercourse at any time within 36 hours after taking Cialis in order to establish the optimal response time for taking the drug.

The maximum recommended frequency of admission – once a day.

The use of Cialis in older men

For elderly patients, a special dose selection is not required. Recommendations for admission listed in the section “Use in middle-aged men” are applicable to elderly patients.

The use of Cialis in men with impaired renal function and liver

For patients with impaired renal function (creatinine clearance 30 ml / min) and liver special dose selection is not required (see section “Special warnings and special precautions for use”).

The use of Cialis in children

Cialis does not apply to persons under 18 years of age.

Overdose:

With a single appointment to healthy individuals tadalafil at a dose of up to 500 mg and in patients with erectile dysfunction – many times up to 100 mg / day., Undesirable effects were the same as when using lower doses. In case of overdose, standard symptomatic treatment is necessary.

Contraindications:

established hypersensitivity to tadalafil or to any substance constituting Cialis;

in the case of taking drugs containing any organic nitrates;

use in persons under 18 years.

Use during pregnancy and lactation:

Cialis is not intended for use in women.

Side effect:

The most frequently observed adverse events are headache and dyspepsia (11 and 7% of cases, respectively). Unwanted events associated with taking tadalafil were usually insignificant or moderate in severity, transient and decreased with continued use of the drug.

Other common undesirable effects were back pain, myalgia, nasal congestion, and blood flushing to the face.

Rarely – swelling of the eyelids, eye pain, conjunctival hyperemia and dizziness.

Precautions and special instructions:

Since there are no data from controlled clinical studies on the safety and efficacy of Cialis in the following groups of patients:

patients with severe renal insufficiency (creatinine clearance 30 ml / min)

patients with severe hepatic impairment, such patients should be prescribed the drug with caution.

Sexual activity has a potential risk for patients with cardiovascular disease. Therefore, treatment of erectile dysfunction, including using Cialis, should not be carried out in men with heart diseases for which sexual activity is not recommended.

The potential risk of complications from sexual activity in patients with cardiovascular diseases should be considered:

myocardial infarction in the last 90 days;

unstable angina or angina arising during intercourse;

heart failure class 2 and above in NYHA, which has developed in the last 6 months;

uncontrolled cardiac arrhythmias, hypotension (with AD <90/50 мм рт. ст. ) или неконтролируемая артериальная гипертензия;

stroke suffered in the last 6 months.

Cialis should be used with caution in patients with a predisposition to priapism (for example, in sickle cell anemia, multiple myeloma or leukemia), or in patients with anatomical deformation of the penis (for example, in angular curvature, cavernous fibrosis, or Peyronie’s disease).

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There are reports of the occurrence of priapism when using another PDE5 inhibitor, sildenafil, although cases of priapism have not been reported while taking Cialis. Patients should be informed of the need to immediately seek medical help in the event of an erection that lasts 4 hours or more. Late treatment of priapism leads to damage to the tissues of the penis, which can result in long-term loss of potency.

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The safety and effectiveness of Cialis combination with other types of treatment for erectile dysfunction has not been studied. Therefore, the use of such combinations is not recommended.

With Cialis treatment in patients with moderately severe renal insufficiency (creatinine clearance 31–50 ml / min), such an undesirable phenomenon as back pain was more common in comparison with patients with mild renal insufficiency (creatinine clearance 51-80 ml / min) or healthy faces. In patients with severe impaired renal function (creatinine clearance 30 ml / min) Tadalafil has not been studied. Cialis should be administered with caution to patients with creatinine clearance of 50 ml / min.

Drug Interactions:

Effect of other drugs on Cialis (tadalafil):

Tadalafil is mainly metabolized by the enzyme CYP3A4. A selective CYP3A4 inhibitor, ketoconazole, increases the area under the concentration-time curve by 107%, and rifampicin reduces it by 88%.

Although specific interactions have not been studied, it can be assumed that protease inhibitors such as ritonavir and saquinavir, as well as CYP3A4 inhibitors such as erythromycin and itraconazole, increase tadalafil activity.

The simultaneous administration of antacid (magnesium and aluminum hydroxide) and tadalafil reduces the rate of absorption of tadalafil without changing the area under the pharmacokinetic curve for tadalafil.

An increase in the pH of the stomach as a result of taking a H2-antagonist of nizatidine did not affect the pharmacokinetics of tadalafil.

Effect of Cialis (tadalafil) on other drugs:

It is known that Tadalafil enhances the hypotensive effect of nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate). This occurs as a result of the additive effect of nitrates and tadalafil on the metabolism of nitric oxide and cGMP. Therefore, the use of Cialis against the use of nitrates is contraindicated.

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Cialis has no clinically significant effect on the clearance of drugs, the metabolism of which proceeds with the participation of the cytochrome P450 isoenzyme. Studies have confirmed that Tadalafil does not inhibit or induce CYP3A4, CYP1A2, CYP2D6, CYP2E1 and CYP2C9 isoenzymes.

Tadalafil has no clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin. Tadalafil does not affect the effect of warfarin on prothrombin time.

Tadalafil does not increase the duration of bleeding caused by acetylsalicylic acid.

Tadalafil does not show a clinically significant interaction with the main classes of antihypertensive agents, including calcium channel blockers (amlodipine), angiotensin-converting enzyme inhibitors (enalapril), beta-adrenergic receptor blockers (metoprolol), alpha blockers, thiazide diuretics (bendy), and beavers, thiazide diuretics (bendpuns), beavers, thiazide diuretics (alpha-blockers, metoprolol), alpha-blockers, thiazide diuretics (inhibitors); which were used in various doses as monotherapy or in combinations. There were no differences in adverse events in patients taking tadalafil with or without antihypertensive drugs.

The effect of a single dose of tadalafil on blood alcohol concentration, effect of alcohol on cognitive function and blood pressure was not detected. In addition, there were no changes in the level of tadalafil in the blood 3 hours after it was taken in combination with alcohol.

Tadalafil has no clinically significant effect on the pharmacokinetics or pharmacodynamics of theophylline.

Influence on ability to drive and work with mechanisms:

There are no special regulations.

Storage conditions:

Store at temperatures below 30 ° C in the original packaging.

Keep out of reach of children.

Shelf life 2 years. Do not use later than the date indicated on the package.

Pharmacy sales conditions – by prescription.

Cialis – information for patients:

What is Cialis?

Cialis is a drug for treating erectile dysfunction. Cialis belongs to the class of inhibitors of the enzyme phosphodiesterase-5. Its action is based on selective and effective blockade of phosphodiesterase-5, which contributes to the relaxation of smooth muscle cells and an increase in blood flow in the penis. Cialis treats erectile dysfunction by increasing blood flow to the penis with appropriate sexual arousal.

Cialis is intended for the treatment of erectile dysfunction of any severity. It is recommended to use orally in a dose of 20 mg before the intended sexual activity, regardless of the concomitant food or alcohol intake.

Currently, Cialis is the only phosphodiesterase-5 inhibitor whose effect lasts for more than a day – up to 36 hours. It is important to note that an erection occurs only with sexual arousal. This will allow couples not to plan their sexual relationships and not to abandon the usual rhythm of life. Having taken the drug in the morning, you can take advantage of its effect in the evening.

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Cialis is already well established in Europe, Australia and New Zealand. The first countries where this drug appeared were the United Kingdom, Denmark, Finland, Sweden and Germany.

To date, over 4,000 men have participated in more than 60 clinical studies that have proven the efficacy and safety of the drug. Cialis improved erectile function in 81% of men and showed good tolerability.

Cialis has a positive effect on the following manifestations and consequences of erectile dysfunction:

An erection as a whole;

The ability to achieve an erection sufficient for sexual intercourse;

The ability to maintain an erection during intercourse;

Getting satisfaction from intercourse;

Positive emotions;

Satisfaction from a good erection;

Confidence in the ability to achieve and maintain an erection;

Satisfaction of the partner from sexual intercourse;

Since Cialis has a prolonged effect, men can no longer think constantly about taking the drug.

What are the advantages of Cialis?

Cialis has high efficiency, which not only improves erection but also helps the patient to restore the naturalness of sexual relations. Cialis is reliable, effective, easy to use and safe, it restores normal sex life for patients suffering from erectile dysfunction, freeing them from constant thoughts about treatment.

For a certain number of patients, the clinical effect begins within 16 minutes. after taking Cialis and lasts 36 hours.

Cialis, which is taken as needed, up to once a day, improves erectile function in most men suffering from erectile dysfunction of any degree.

What treatments for erectile dysfunction are most common?

There are various methods. Oral medications, penile injections, vacuum erectors and implants can help with erectile dysfunction. Psychological or sexological counseling can be useful in violation of the psychogenic erection type.

If a patient has severe erectile dysfunction, can Cialis help?

Yes. In clinical trials, 81% of patients taking Cialis tablets 20 mg each showed an improvement in potency. The study included patients with varying degrees of erectile dysfunction, from mild to severe.

Can Cialis help diabetic patients?

Yes. In clinical trials, 68% of diabetic men who took Cialis in 20 mg tablets showed an improvement in erection.

When is Cialis taken?

Patients should take Cialis as prescribed by a physician or consultant. The drug begins to act within 30 minutes and remains effective for up to 36 hours. Cialis can be taken regardless of the meal. For a successful result requires sexual arousal.

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What side effects can you expect from Cialis?

Patients taking any form of organic nitrates should not take Cialis or any other PDE5 inhibitor. This combination can cause a dangerous drop in blood pressure. If a patient complains of chest pain or other cardiac-related symptoms during sex, he should immediately see a doctor. In clinical trials, the most frequent side effect was headache, dyspepsia, back pain, muscle pain and flushing of the face. Usually, the side effects are mild or moderate, pass quickly and their frequency decreases with constant use of the drug. In clinical studies, most men did not experience serious side effects that would cause them to stop taking Cialis.

Can Cialis be taken if nitrates are taken?

No, patients taking any form of nitrates should not take Cialis. If a patient takes Cialis while taking any nitrate-based drug, blood pressure can drop to a dangerous level. Many medications prescribed for the treatment of chest pain caused by heart disease contain nitrates. These drugs include nitroglycerin (sprays, ointments, patches or pastes, and lozenges under the tongue) or isosorbide mononitrate and dinitrate (tablets that swallow, chew, or hold under the tongue). Certain soft drugs such as amyl nitrate also contain nitrates. The listed list is far from complete, so it is important to know whether you are taking nitrates or preparations containing them.

If any restrictions in eating during treatment with cialis?

Not. Cialis can be taken with or without food.

How best to take Cialis?

In some men, Cialis begins to act after 16 minutes. For most patients, this time is 30 minutes. But remember, without sexual arousal, the effect does not come. Most patients take Cialis in order to be ready for intimacy with a partner at any time convenient for them for 36 hours. It is recommended to limit one 20 mg tablet per day.

Can Cialis be used daily for a long time?

Daily use of the drug is strongly discouraged.

Will patients experience an erection if they don’t want it?

No, sexual arousal is required for the effectiveness of Cialis.

Will Cialis act if you take only half a pill?

Cialis is designed for use in the dosage of 20 mg, the tablet can not be divided into smaller doses.

Can women take Cialis?

Not. Cialis is for men only.

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