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Cialis

Specifications

The action of the generic Cialis 20 mg is completely similar to the patented drug. Taking the drug increases blood flow to the cavernous bodies of the penis. This ensures a stable erection. This drug, like the generic dapoxetine, is recommended to be taken for erectile dysfunctions of various origins, in addition, for male impotence.

It should be noted that Tadalafil does not eliminate the cause of impotence. Its direct purpose is to increase the intensity of blood circulation, as well as to increase blood flow for a certain time.

Contraindications to taking Cialis

should not be taken in case of intolerance or individual sensitivity of Tadalafil;
cannot be combined with drugs that contain nitric oxide donors or nitrates in any amount;
additionally, it is necessary to consult with cardiovascular diseases, hypertension, sickle-cell anemia, various leukemias, with curvature of the penis.

The tablets should be taken in the amount of 20 mg at a time, approximately half an hour before sexual intercourse. Tadalafil 20 mg is effective for 36 hours. You can take the drug regardless of food intake.

About Generic Cialis

The popularity and frequency of use of Cialis is slightly inferior to the main generic Viagra - sildenafil. Why urologists like to prescribe this medicine and are actively used by ordinary men, we will figure it out below.

For the treatment of erectile dysfunction, experts recommend Generic Cialis 20mg. Its formula and chemical composition completely repeat the original, since the main active ingredient in both cases is the same - Tadalafil. And the generic price is more attractive. The drug is available not only to managers of large companies, but also to men with average incomes.

Interesting facts about the drug

The first doses of the drug enter the bloodstream within 16 minutes after swallowing the pill, but a man is considered fully ready for intercourse only after 4 hours. In this case, he is guaranteed a persistent erection, prolonged intercourse and the transition of the penis to an unexcited state after reaching orgasm.
The medicine is in the blood for one and a half days, that is, 36 hours. At this time, you can have sex again without swallowing additional doses of the drug.
Due to the long duration of the action of the drug, many men develop spontaneous erections, which allow them to move away from the exact schedule "pill - intercourse" and get unplanned pleasure.
Even with regular use of the drug, addiction does not develop to it. Clinical trials have shown that with frequent use of Cialis for two years, a man also achieves an erection and maintains it, as after the first or second dose of the pill.
The drug relaxes not only the smooth muscles of the cavernous bodies of the penis, so that blood flows into them and provides an erection. At the same time, the smooth muscles of the urinary tract relax. Men with benign prostatic hyperplasia (prostate adenoma) find it easier to urinate, especially with frequent use of the drug.
The absorption of the tablet does not depend on the presence of food in the stomach and on the nature of the food - fatty, carbohydrate or protein. Combination with small doses of alcohol is acceptable.

Side effects

Side effects of the drug are more often observed in men after the first intake of pills, they gradually decrease or disappear. If you have purchased Cialis tablets, in which Tadalafil is the main substance, do not be afraid of headaches or pain in the muscles of the back, in the abdomen, dizziness or nausea. These side effects do not require special medical attention, they go away on their own.

The drug promotes an erection, regardless of the cause of the violation of potency (erectile dysfunction). That is, it "works" both with psychogenic erectile dysfunction, which is a reaction to stress or the unattractiveness of a partner, and with organic erectile dysfunction, which has arisen due to heart disease, nervous or endocrine system.

Not all men can improve their erection using the described drug. The instruction does not allow the following categories of men to take Cialis:

those who take nitrates
persons with anatomical curvature of the penis
persons who have experienced an allergic reaction to drugs containing Tadalafil
under 18 years old
with diseases of the heart and blood vessels - with unstable angina, during the first three months after myocardial infarction, with attacks of angina pectoris during intercourse, within six months after an ischemic stroke (cerebral infarction), with low blood pressure - less than 90/50 mm Hg

Special instructions

Sexual activity has a potential risk for patients with cardiovascular disease. Therefore, the treatment of erectile dysfunction, including with the use of the drug Cialis, should not be carried out in men with heart diseases, in which sexual activity is not recommended. Consideration should be given to the potential risk of complications from sexual activity in patients with cardiovascular disease:

myocardial infarction within the past 90 days;
unstable angina or angina that occurs during intercourse;
NYHA grade 2 or higher heart failure that developed within the past 6 months;
uncontrolled heart rhythm disturbances, hypotension (with blood pressure <90/50 mm Hg), or uncontrolled arterial hypertension;
a stroke in the past 6 months.

Cialis should be used with caution in patients with a predisposition to priapism (for example, with sickle cell anemia, multiple myeloma or leukemia), or in patients with anatomical deformity of the penis (for example, with angular curvature, cavernous fibrosis or Peyronie's disease). Untimely treatment of priapism leads to damage to the tissues of the penis, resulting in a long-term loss of potency. The safety and effectiveness of the combination of the drug Cialis with other treatments for erectile dysfunction has not been studied. Therefore, the use of such combinations is not recommended. Against the background of Cialis treatment, patients with moderate renal failure (creatinine clearance 31-50 ml / min) more often encountered such an undesirable phenomenon as back pain, in comparison with patients with mild renal insufficiency (creatinine clearance 51-80 ml / min). min) or healthy persons. In patients with severe renal impairment (creatinine clearance 30 ml / min), Tadalafil has not been studied. Cialis should be used with caution in patients with creatinine clearance of 50 ml / min.

Impact on the ability to drive a car and use equipment: There are no special regulations.

Interaction

The effect of other drugs on Tadalafil

Tadalafil is mainly metabolized with the participation of the CYP3A4 enzyme. A selective inhibitor of CYP3A4, ketoconazole, increases the area under the concentration-time curve by 107%, while rifampicin decreases 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 intraconazole, increase the activity of tadalafil. The simultaneous intake 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 gastric pH as a result of taking the H2-antagonist nizatidine did not affect the pharmacokinetics of tadalafil.

The effect of Tadalafil on other drugs

It is known that Tadalafil enhances the hypotensive effect of nitrates. This is due to the additive action of nitrates and tadalafil on the metabolism of nitric oxide and cGMP. Therefore, the use of the drug Cialis against the background of the use of nitrates is contraindicated. Cialis does not have a clinically significant effect on the clearance of drugs, the metabolism of which occurs with the participation of the cytochrome P450 isoenzyme. Studies have confirmed that Tadalafil does not inhibit or induce isoenzymes CYP3A4, CYP1A2, CYP2D6, CYP2E1 and CYP2C9. Tadalafil has no clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin. Tadalafil does not affect the effect of warfarin in relation to prothrombin time. Tadalafil does not increase the duration of bleeding caused by acetylsalicylic acid. Tadalafil does not show clinically significant interactions with the main classes of antihypertensive drugs, including calcium channel blockers (amlodipine), angiotensin-converting enzyme inhibitors (enalapril), beta-adrenergic receptor blockers (metoprolol), alpha-blockers, thiazide diuretics (bendopenzines) II which have been used in various doses as monotherapy or in combinations. There were no differences in adverse events in patients taking Tadalafil in combination with antihypertensive drugs or without them. The effect of a single dose of tadalafil on blood alcohol concentration, the effect of alcohol on cognitive function and blood pressure was not revealed. In addition, there were no changes in the level of concentrations of tadalafil in the blood 3 hours after taking it in combination with alcohol. Tadalafil has no clinically significant effect on the pharmacokinetics or pharmacodynamics of theophylline.

Pharmacological properties

Tadalafil is an effective, reversible selective inhibitor of the specific phosphodiesterase type 5 (PDE5) cyclic guanosine monophosphate (cGMP). When sexual arousal induces a local release of nitric oxide, inhibition of PDE5 by tadalafil leads to an increase in cGMP levels in the corpus cavernosum of the penis. The consequence is relaxation of the 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 corpora cavernosa, 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 phosphodiesterases. Tadalafil is 10,000 times more potent for PDE5 than for PDE1, PDE2 and PDE4, which are localized in the heart, brain, blood vessels, liver and other organs. Tadalafil is 10,000 times more active in blocking PDE5 than PDE3, an enzyme found in the heart and blood vessels. This selectivity for PDE5 compared to PDEZ is important, since PDEZ is an enzyme involved in the contraction of the heart muscle. In addition, tadalafil is approximately 700 times more active against PDE5 than against PDE6, which is found in the retina and is responsible for phototransmission. Tadalafil also has an effect 10,000 times more potent against PDE5 in comparison with its effect on PDE7 - PDE10. Tadalafil improves erection and the possibility of successful intercourse. Cialis works for 36 hours. The effect appears within 16 minutes after taking the drug in the presence of sexual arousal. Tadalafil in healthy individuals does not cause significant changes in systolic and diastolic pressure compared to placebo in the supine 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, respectively).

Tadalafil does not cause a significant change in heart rate. Tadalafil does not cause changes in color recognition (blue / green), which is explained by its low affinity for PDEb. In addition, there is no effect of tadalafil on visual acuity, electroretinogram, intraocular pressure and pupil size. In the study of tadalafil in men in a daily dose of 10 mg, no clinically significant effect of the drug on the number and concentration of sperm, motility and morphology of sperm was revealed. Pharmacokinetic properties

Suction

After oral administration, tadalafil is rapidly absorbed. The average maximum concentration (Cmax) in plasma is reached on average 2 hours after ingestion. The speed and degree of absorption of tadalafil do not depend on food intake, therefore the drug CIALIS can be taken regardless of food intake. Dosing time (morning or 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 of 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 when the drug is taken once a day. The pharmacokinetics of tadalafil in patients with erectile dysfunction is similar to the pharmacokinetics of the drug in persons without erectile dysfunction.