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Over The Counter Cialis: Cialis instructions for use, analogues, composition, indications

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Over The Counter Cialis: Cialis instructions for use, analogues, composition, indications

Cialis: instructions for use, analogues, composition, indications

Cialis – instructions, indications for use, indications and contraindications. Availability in pharmacies, prices and analogues of Cialis on the website 103.by

The effect of other drugs on tadalafil

Tadalafil is mainly metabolized with the participation of the isoenzyme CYP3A4. The selective CYP3A4 isoenzyme inhibitor ketoconazole (400 mg / day) increases the AUC of tadalafil in a single dose by 312% and Cmax by 22%, and ketoconazole (200 mg / day) increases the AUC of tadalafil in a single dose of 107% and Cmax by 15% relative to AUC and Cmax values ​​only for one tadalafil. Ritonavir (200 mg 2 times a day), an inhibitor of isoenzymes CYP3A4, 2C9, 2C19 and 2D6, increases the AUC of tadalafil in a single dose by 124% without changing Cmax. Although specific interactions have not been studied, it can be assumed that other HIV protease inhibitors, such as saquinavir, as well as CYP3A4 isoenzyme inhibitors, such as erythromycin and itraconazole, increase the activity of tadalafil.

Selective inducer of CYP3A4 isoenzyme, rifampicin (600 mg / day), reduces the exposure of a single dose of tadalafil (AUC) by 88% and Cmax by 46% relative to AUC and Cmax values ​​only for tadalafil alone. It can be assumed that the simultaneous use of other inducers of the CYP3A4 isoenzyme should also reduce plasma tadalafil concentrations.

The simultaneous use of an antacid (magnesium hydroxide / 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 the blocker H2-histamine receptor nizatidine did not affect the pharmacokinetics of tadalafil.

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The safety and efficacy of tadalafil combination with other types of treatment of erectile dysfunction have not been studied, so the use of such combinations is not recommended.

Tadalafil does not potentiate the increase in bleeding time caused by taking acetylsalicylic acid.

The effect of tadalafil on other drugs

Over The Counter Cialis: Cialis instructions for use, analogues, composition, indications

It is known that tadalafil enhances the hypotensive effect of nitrates. This occurs as a result of the additive effect of nitrates and tadalafil on the metabolism of nitric oxide (NO) and cGMP. Therefore, the use of tadalafil on the background of taking nitrates is contraindicated.

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Tadalafil does not have a clinically significant effect on the clearance of drugs, the metabolism of which proceeds with the participation of cytochrome P450. Studies have confirmed that tadalafil does not inhibit and does not induce CYP1A2, CYP3A4, CYP2C9, CYP2C19, CYP2D6, CYP2E1 isoenzymes.

Tadalafil does not have a clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin. Tadalafil does not affect the effect of warfarin on PV.

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

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Tadalafil has systemic vasodilating properties and may enhance the effect of antihypertensive drugs aimed at reducing blood pressure.

Additionally, in patients taking several antihypertensive drugs in which hypertension was poorly controlled, there was a slightly greater decrease in blood pressure. In the vast majority of patients, this reduction was not associated with hypotensive symptoms. Patients receiving antihypertensive drugs and receiving tadalafil should be given appropriate clinical guidelines.

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No significant reduction in blood pressure was observed when tadalafil was used by healthy individuals who took a selective tamsulosin alpha1A-blocker according to the results of two clinical studies.

The simultaneous use of tadalafil with doxazosin is contraindicated. When tadalafil was used by healthy volunteers who took doxazosin (4–8 mg / day), alpha1-blocker, there was an increase in the doxazosin hypotensive effect. Some patients experienced symptoms associated with a decrease in blood pressure, including syncope.

Tadalafil did not affect the concentration of alcohol, nor did alcohol affect the concentration of tadalafil. With high doses of alcohol (0.7 g / kg), tadalafil intake did not cause a statistically significant decrease in the mean BP. Some patients had postural dizziness and orthostatic hypotension. When taking tadalafil in combination with lower doses of alcohol (0.6 g / kg), a decrease in blood pressure was not observed, and dizziness occurred with the same frequency as when taking one alcohol.

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

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