DRUG INTERACTIONS
St John's WortSt John's Wort will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. St John's Wort will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
- Cialis can be taken daily or as needed, depending on the prescription.
- It may improve the quality of erections but does not increase sexual desire.
- Avoid alcohol while taking Cialis, as it can cause dizziness and lower blood pressure.
- Inform your doctor about any heart conditions before starting Cialis.
- Store Cialis in a cool, dry place away from children and pets.
Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. tecovirimattecovirimat will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. tecovirimat will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. telmisartantadalafil increases effects of telmisartan by pharmacodynamic synergism. tadalafil increases effects of telmisartan by pharmacodynamic synergism. terazosintadalafil increases effects of terazosin by pharmacodynamic synergism. tadalafil increases effects of terazosin by pharmacodynamic synergism. tetracyclinetetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
14.2 CIALIS for Once Daily Use
St John's WortSt John's Wort will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. St John's Wort will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. tecovirimattecovirimat will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
Does Cialis work and is it safe?
tecovirimat will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. telmisartantadalafil increases effects of telmisartan by pharmacodynamic synergism. tadalafil increases effects of telmisartan by pharmacodynamic synergism. terazosintadalafil increases effects of terazosin by pharmacodynamic synergism. tadalafil increases effects of terazosin by pharmacodynamic synergism.
Cialis form
tetracyclinetetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. timololtadalafil increases effects of timolol by pharmacodynamic synergism. tadalafil increases effects of timolol by pharmacodynamic synergism. tipranavirtipranavir will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. timololtadalafil increases effects of timolol by pharmacodynamic synergism. tadalafil increases effects of timolol by pharmacodynamic synergism. tipranavirtipranavir will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tipranavir will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tobramycin inhaledtobramycin inhaled and tadalafil both increase nephrotoxicity and/or ototoxicity. Avoid concurrent or sequential use to decrease risk for ototoxicity tobramycin inhaled and tadalafil both increase nephrotoxicity and/or ototoxicity. Avoid concurrent or sequential use to decrease risk for ototoxicity topiramatetopiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Cialis Generic | 5mg | 60 + 4 Pills | 86.02€ 81.92€ | |
| Cialis Generic | 40mg | 180 + 10 Pills | 277.29€ 264.09€ | |
| Cialis Black | 80mg | 10 Pills | 43.27€ 41.21€ | |
| Cialis Generic | 60mg | 10 Pills | 41.22€ 39.26€ | |
| Cialis Original | 20mg | 48 + 4 Pills | 224.69€ 213.99€ | |
| Cialis Generic | 2.5mg | 90 + 6 Pills | 112.43€ 107.08€ | |
| Cialis Generic | 20mg | 30 + 4 Pills | 68.05€ 64.81€ | |
| Cialis Professional | 40mg | 20 Pills | 110.24€ 104.99€ | |
| Cialis Generic | 2.5mg | 120 + 6 Pills | 128.93€ 122.79€ | |
| Cialis Generic | 5mg | 360 + 10 Pills | 268.08€ 255.31€ | |
| Cialis Soft Tabs | 20mg | 20 + 2 Pills | 66.98€ 63.79€ | |
| Cialis Generic | 2.5mg | 10 Pills | 28.51€ 27.15€ | |
| Cialis Generic | 2.5mg | 60 + 4 Pills | 83.43€ 79.46€ | |
| Cialis Professional | 20mg | 270 + 6 Pills | 623.07€ 593.40€ |
topiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
17.2 Cardiovascular Considerations
verapamil will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. voriconazolevoriconazole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. voriconazole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. zafirlukastzafirlukast will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. zafirlukast will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
The Bottom Line
acetazolamideacetazolamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. acetazolamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozoleanastrozole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. cyclophosphamidecyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
How long does it take for Cialis to work?
cyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. danazoldanazol will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. danazol will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. drospirenonedrospirenone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. drospirenone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. torsemidetadalafil increases effects of torsemide by pharmacodynamic synergism. tadalafil increases effects of torsemide by pharmacodynamic synergism. trandolapriltadalafil increases effects of trandolapril by pharmacodynamic synergism. tadalafil increases effects of trandolapril by pharmacodynamic synergism. triamterenetadalafil increases effects of triamterene by pharmacodynamic synergism. tadalafil increases effects of triamterene by pharmacodynamic synergism. valsartantadalafil increases effects of valsartan daily cialis price by pharmacodynamic synergism. tadalafil increases effects of valsartan by pharmacodynamic synergism. Comment: Avoid combination; duplicate therapy is not recommended. verapamilverapamil will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. verapamil will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. voriconazolevoriconazole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. voriconazole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. zafirlukastzafirlukast will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. zafirlukast will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. acetazolamideacetazolamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
- Cialis is available by prescription and should be used under medical supervision.
- It works by inhibiting PDE5 enzymes that restrict blood flow in the penis.
- Cialis's effect can be affected by other medications, especially nitrates.
- The medication is not intended for use as an emergency drug before sexual activity.
- Always follow your doctor's dosage instructions to avoid adverse effects.
acetazolamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozoleanastrozole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
| Feature | Description | Notes |
|---|---|---|
| Active Ingredient | Tadalafil | Used for erectile dysfunction |
| Dosage Strength | 20 mg | Higher strength option |
| Typical Onset of Action | 30-60 minutes | Varies with individual |
| Duration of Effect | Up to 36 hours | Long-lasting effect |
| Common Side Effects | Headache, flushing, indigestion | Usually mild |
cyclophosphamidecyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
5.7 Renal Insufficiency
tipranavir will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tobramycin inhaledtobramycin inhaled and tadalafil both increase nephrotoxicity and/or ototoxicity. Avoid concurrent or sequential use to decrease risk for ototoxicity tobramycin inhaled and tadalafil both increase nephrotoxicity and/or ototoxicity. Avoid concurrent or sequential use to decrease risk for ototoxicity topiramatetopiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. topiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
Taking Cialis with food
torsemidetadalafil increases effects of torsemide by pharmacodynamic synergism. tadalafil increases effects of torsemide by pharmacodynamic synergism. trandolapriltadalafil increases effects of trandolapril by pharmacodynamic synergism. tadalafil increases effects of trandolapril by pharmacodynamic synergism. triamterenetadalafil increases effects of triamterene by pharmacodynamic synergism.
Drug forms and strengths: 2.5 mg, 5 mg, 10 mg, 20 mg
tadalafil increases effects of triamterene by pharmacodynamic synergism. valsartantadalafil increases effects of valsartan daily cialis price by pharmacodynamic synergism. tadalafil increases effects of valsartan by pharmacodynamic synergism. Comment: Avoid combination; duplicate therapy is not recommended. verapamilverapamil will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. cyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
12.1 Mechanism of Action
larotrectiniblarotrectinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. larotrectinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ranolazineranolazine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Ranolazine may theoretically increase plasma concentrations of CYP3A4 substrates, such as tadalafil. ranolazine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
Off-label use for Cialis
Visual field defect, retinal vein occlusion, retinal artery occlusion, and non–arteritic anterior ischemic optic neuropathy (NAION) Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis Guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Do not use nitrates within 48 hr of the last dose of macitentan/tadalafil This potentiation is thought to result from the combined effects of nitrates and tadalafil on the nitric oxide/cGMP pathway The potentiation is consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway Use caution in patients with anatomic deformation of penis, cardiovascular disease, left ventricular outflow obstruction, myocardial infarction in preceding 90 days, unstable angina, angina occurring during sexual intercourse, NYHA class 2 or greater heart failure in preceding 6 months, uncontrolled arrhythmias, hypotension, uncontrolled hypertension, cerebrovascular accident in preceding 6 months, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, conditions predisposing to priapism, concomitant use of CYP3A4 inhibitors May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Do not use nitrates within 48 hours of last dose of tadalafil Drug has vasodilatory properties that may result in transient decreases in blood pressure; prior to prescribing, carefully consider whether patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects; patients with preexisting hypotension, with autonomic dysfunction, with left ventricular outflow obstruction, may be particularly sensitive to actions of vasodilators When used to treat erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, reported postmarketing; if vision problems arise, discontinue, and contact physician CYP3A4 inhibitors (eg, erythromycin, ketoconazole, itraconazole, indinavir, ritonavir) may significantly increase tadalafil serum levels CYP3A4 inducers (eg, rifampin, St John’s wort) may decrease tadalafil serum levels Potentiates hypotensive effect of nitrates (see Contraindications) Concomitant use with alpha blockers (other than tamsulosin 0.4 mg/day) should be stabilized before initiation of phosphodiesterase (PDE)-5 inhibitors; patients with instability on alpha-blocker therapy alone are at increased risk for symptomatic hypotension with concurrent PDE-5 inhibitor therapy Not to be taken with other PDE-5 inhibitors (eg, sildenafil, vardenafil) Not recommended in patients with pulmonary veno-occlusive disease Advise patients to seek emergency treatment if an erection lasts >4 hr Limited data from case series with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death In animal reproduction studies, no adverse developmental effects were observed with oral administration to pregnant rats or mice during organogenesis at exposures 7 times the exposure at maximum recommended human dose (MRHD) of 40 mg/day based on AUC There are no data on presence of drug and/or its metabolites in human milk, effects on breastfed child, or on milk production; drug and/or its metabolites are present in milk of lactating rats at concentrations approximately 2.4-times that found in the plasma; when a drug is present in animal milk, it is likely that the drug will be present in human milk Controlled studies in pregnant women show no evidence of fetal risk. Erectile dysfunction: Inhibits PDE-5, increasing cyclic guanosine monophosphate (cGMP) to allow smooth-muscle relaxation and inflow of blood into corpus cavernosum Pulmonary arterial hypertension (PAH): Inhibits PDE-5, increasing cGMP to allow relaxation of pulmonary vascular smooth-muscle cells and vasodilation of pulmonary vasculature Peak plasma time: Erectile dysfunction, 0.5-6 hr; PAH, 2-8 hr Vd: Erectile dysfunction, 63 L; PAH, 77 L Half-life: Erectile dysfunction, 15-17.5 hr; PAH (not on bosentan), 35 hr Total body clearance: Erectile dysfunction, 2.5 L/hr; PAH (not on bosentan), 1.6 L/hr Erectile dysfunction (PRN use): Take before anticipated sexual activity Erectile dysfunction (once-daily use): Take at approximately same time each day without regard to timing of sexual activity Shake well for 30 seconds before measuring dose Take with or without food or water Do not split or break a chewable tablet because this may result in a dose below the minimum therapeutic dose or greater than the maximum recommended dose, which may increase risk of adverse effects Tablets, chewable tablet, oral suspension: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) Adding plans allows you to compare formulary status to other drugs in the same class.
ED dosage for occasional use
danazoldanazol will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. danazol will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. drospirenonedrospirenone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. drospirenone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
| Use Case | Patient Profile | Additional Info |
|---|---|---|
| Erectile Dysfunction (ED) | Men aged 40-70 | Approved by FDA |
| Pulmonary Hypertension | Adults with PAH | Off-label use |
| BPH (Benign Prostatic Hyperplasia) | Men with urinary symptoms | Sometimes combined with other drugs |
| Exercise Performance Enhancement | No approved use | Not recommended |
larotrectiniblarotrectinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. larotrectinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ranolazineranolazine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Ranolazine may theoretically increase plasma concentrations of CYP3A4 substrates, such as tadalafil. ranolazine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Visual field defect, retinal vein occlusion, retinal artery occlusion, and non–arteritic anterior ischemic optic neuropathy (NAION) Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis Guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Do not use nitrates within 48 hr of the last dose of macitentan/tadalafil This potentiation is thought to result from the combined effects of nitrates and tadalafil on the nitric oxide/cGMP pathway The potentiation is consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway Use caution in patients with anatomic deformation of penis, cardiovascular disease, left ventricular outflow obstruction, myocardial infarction in preceding 90 days, unstable angina, angina occurring during sexual intercourse, NYHA class 2 or greater heart failure in preceding 6 months, uncontrolled arrhythmias, hypotension, uncontrolled hypertension, cerebrovascular accident in preceding 6 months, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, conditions predisposing to priapism, concomitant use of CYP3A4 inhibitors May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Do not use nitrates within 48 hours of last dose of tadalafil Drug has vasodilatory properties that may result in transient decreases in blood pressure; prior to prescribing, carefully consider whether patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects; patients with preexisting hypotension, with autonomic dysfunction, with left ventricular outflow obstruction, may be particularly sensitive to actions of vasodilators When used to treat erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, reported postmarketing; if vision problems arise, discontinue, and contact physician CYP3A4 inhibitors (eg, erythromycin, ketoconazole, itraconazole, indinavir, ritonavir) may significantly increase tadalafil serum levels CYP3A4 inducers (eg, rifampin, St John’s wort) may decrease tadalafil serum levels Potentiates hypotensive effect of nitrates (see Contraindications) Concomitant use with alpha blockers (other than tamsulosin 0.4 mg/day) should be stabilized before initiation of phosphodiesterase (PDE)-5 inhibitors; patients with instability on alpha-blocker therapy alone are at increased risk for symptomatic hypotension with concurrent PDE-5 inhibitor therapy Not to be taken with other PDE-5 inhibitors (eg, sildenafil, vardenafil) Not recommended in patients with pulmonary veno-occlusive disease Advise patients to seek emergency treatment if an erection lasts >4 hr Limited data from case series with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death In animal reproduction studies, no adverse developmental effects were observed with oral administration to pregnant rats or mice during organogenesis at exposures 7 times the exposure at maximum recommended human dose (MRHD) of 40 mg/day based on AUC There are no data on presence of drug and/or its metabolites in human milk, effects on breastfed child, or on milk production; drug and/or its metabolites are present in milk of lactating rats at concentrations approximately 2.4-times that found in the plasma; when a drug is present in animal milk, it is likely that the drug will be present in human milk Controlled studies in pregnant women show no evidence of fetal risk.
| Side Effect | Severity | Recommended Action |
|---|---|---|
| Headache | Mild to moderate | Take analgesics if necessary |
| Flushing | Mild | Usually temporary |
| Dizziness | Mild to moderate | Avoid driving if dizzy |
| Priapism | Severe, rare | Seek immediate medical help |
| Vision changes | Rare | Discontinue & consult doctor |
Erectile dysfunction: Inhibits PDE-5, increasing cyclic guanosine monophosphate (cGMP) to allow smooth-muscle relaxation and inflow of blood into corpus cavernosum Pulmonary arterial hypertension (PAH): Inhibits PDE-5, increasing cGMP to allow relaxation of pulmonary vascular smooth-muscle cells and vasodilation of pulmonary vasculature Peak plasma time: Erectile dysfunction, 0.5-6 hr; PAH, 2-8 hr Vd: Erectile dysfunction, 63 L; PAH, 77 L Half-life: Erectile dysfunction, 15-17.5 hr; PAH (not on bosentan), 35 hr Total body clearance: Erectile dysfunction, 2.5 L/hr; PAH (not on bosentan), 1.6 L/hr Erectile dysfunction (PRN use): Take before anticipated sexual activity Erectile dysfunction (once-daily use): Take at approximately same time each day without regard to timing of sexual activity Shake well for 30 seconds before measuring dose Take with or without food or water Do not split or break a chewable tablet because this may result in a dose below the minimum therapeutic dose or greater than the maximum recommended dose, which may increase risk of adverse effects Tablets, chewable tablet, oral suspension: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) Adding plans allows you to compare formulary status to other drugs in the same class.
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