Cialis (Tadalafil)

When you are aroused your tissues release a chemical called nitric oxide (NO), this, in turn, causes the release of a second chemical called cyclic guanosine monophosphate (cGMP). cGMP causes the muscles at the sides of your penis to relax, allowing blood to rush in. The veins that drain the blood from your penis also get compressed, trapping the increased blood in your penis, resulting in an erection.

An enzyme called phosphodiesterase-5 (PDE5) breaks down the cGMP and your penis returns to its original state. Cialis/Tadalafil is a PDE5 inhibitor, meaning it blocks the action of PDE5. As your levels of cGMP remain high, the muscles at the side of your penis relax, more blood rushes in and you can achieve a firmer and longer lasting erection. It is important to remember that Cialis/Tadalafil only exerts its action when you are sexually aroused. It does not increase your sexual desire, and it will not resolve any underlying physical causes of your ED.

Cialis/Tadalafil can take between 30 to 60 minutes to take effect, although some people find it works best taken 2 hours before. It can remain effective for up to 36 hours. The time it takes to work will be different for each man. It is unaffected by taking it with food or on an empty stomach. Cialis/Tadalafil will only work when you are sexually stimulated.

If your doctor has prescribed you Cialis/Tadalafil to be taken daily, 30 to 60 minutes after the very first dose there will already be a level of the medication in your system, so you would not have to ‘wait’ for it to take an effect.

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You must not take more than 1 tablet a day or exceed the dose recommended for you. If you feel that your dose is not appropriate, that the effects of the medication are too much, or not enough, your doctor can alter your dose.

If you do take more than the recommended dose, your risk of side effects, including serious ones, like low blood pressure or an erection that won’t go away even after 4 hours, dramatically increases. If you do experience any side effects, particularly serious side effects, you should seek medical attention immediately.

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Cialis/Tadalafil cannot be used if you:

• do not have erectile dysfunction
• are a woman
• are under the age of 18
• are allergic to Tadalafil or any of the other ingredients in this medicine
• are taking any form of organic nitrate or nitric oxide donors such as amyl nitrite. This is agroup of medicines (“nitrates”) used in the treatment of angina pectoris (“chest pain”).
  Cialis/Tadalafil has been shown to increase the effects of these medicines. If you are taking any form of nitrate or are unsure tell your doctor
• have serious heart disease or recently had a heart attack within the last 90 days
• recently had a stroke within the last 6 months
• have low blood pressure or uncontrolled high blood pressure
• ever had loss of vision because of non-arteritic anterior ischemic optic neuropathy (NAION), a condition described as “stroke of the eye”
• are taking riociguat. This drug is used to treat pulmonary arterial hypertension (i.e. highblood pressure in the lungs) and chronic thromboembolic pulmonary hypertension (i.e. high blood pressure in the lungs secondary to blood clots). PDE5 inhibitors, such as Cialis/Tadalafil, have been shown to increase the hypotensive effects of this medicine. If you are taking riociguat or are unsure tell your doctor.

Be aware that sexual activity carries a possible risk if you have heart disease because it puts an extra strain on your heart. If you have a heart problem, you should tell your doctor.

Before taking the tablets, tell your doctor if you have:

• sickle cell anaemia (an abnormality of red blood cells)
• multiple myeloma (cancer of the bone marrow)
• leukaemia (cancer of the blood cells)
• any deformation of your penis
• a serious liver problem
• a severe kidney problem

It is not known if Cialis/Tadalafil is effective in patients who have had:

• pelvic surgery
• removal of all, or part, of the prostate gland in which nerves of the prostate are cut (radical non-nerve-sparing prostatectomy)

If you experience a sudden decrease or loss of vision, stop taking Cialis/Tadalafil and contact your doctor immediately.

Decreased or sudden hearing loss has been noted in some patients taking Cialis/Tadalafil. Although it is not known if the event is directly related to Cialis/Tadalafil. If you experience decreased or sudden hearing loss, stop taking Cialis/Tadalafil and contact your doctor immediately.

Do not take Cialis/Tadalafil if you are already taking nitrates.

Tell your doctor if you are taking, have recently taken, or might take any other medicines. Some medicines may be affected by Cialis/Tadalafil, or they may affect how well Cialis/Tadalafil will work. Tell your doctor or pharmacist if you are already taking:

• an alpha blocker (used to treat high blood pressure or urinary symptoms associated with benign prostatic hyperplasia)
• other medicines to treat high blood pressure
• riociguat
• a 5-alpha-reductase inhibitor (used to treat benign prostatic hyperplasia)
• medicines such as ketoconazole tablets (to treat fungal infections) and protease inhibitors (for treatment of AIDS or HIV infection)
• phenobarbital, phenytoin and carbamazepine (anticonvulsant medicines)
• rifampicin, erythromycin, clarithromycin or itraconazole
• other treatments for erectile dysfunction

Grapefruit juice may affect how well Cialis/Tadalafil will work and should be taken with caution. Talk to your doctor for further information.

Some men taking Cialis/Tadalafil, in clinical studies, have reported dizziness. Check carefully how you react to the tablets before driving or using machines.

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Common (may effect up to 1 in 10 users)

• Headache
• Back pain
• Muscle aches
• Pain in arms and legs
• Facial flushing
• Nasal congestion
• Indigestion

Uncommon side effects (may affect 1 in 100 users)

• Dizziness
• Stomach-ache
• Feeling sick
• Being sick (vomiting)
• Reflux
• Blurred vision
• Eye pain
• Difficulty in breathing
• Presence of blood in urine
• Prolonged erection
• Pounding heartbeat sensation
• Fast heart rate
• High blood pressure
• Low blood pressure
• Nose bleeds
• Ringing in the ears
• Swelling of the hands, feet or ankles
• Feeling tired

Rare side effects (may affect 1 in 1,000 users)

• Fainting
• Seizures and passing memory loss
• Swelling of the eyelids
• Red eyes
• Sudden decrease or loss of hearing
• Hives (itchy red welts on the surface of the skin)
• Penile bleeding
• Presence of blood in semen
• Increased sweating
• Heart attack and stroke have also been reported rarely in men taking Cialis/Tadalafil. Most of these men had known heart problems before taking this medicine
• Partial, temporary, or permanent decrease or loss of vision in one or both eyes has been rarely reported

There are further very rare side effects that occasionally people can experience when taking Cialis/Tadalafil, for complete details about all side effects always read the Patient Information Leaflet.

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