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Cialis increases blood flow to the penis, and this enables a man to achieve an erection. It does not lead to sexual arousal. It should be used with caution, and only under medical supervision.

Tadalafil was approved by the United States (U.S.) Food and Drug Administration (FDA) in 2003 for the treatment of erectile dysfunction (ED).  It is also used to treat pulmonary arterial hypertension and benign prostatic hyperplasia, a condition in which the prostate gland becomes enlarged, causing problems with urination.

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Fast facts on Cialis:

Here are some key points about Cialis. More detail is in the main article.

• • • Under the name Cialis, tadalafil is used to treat erectile dysfunction.
    • As Adcirca, the same drug treats pulmonary arterial hypertension and benign prostatic hyperplasia.
    • Cialis increases blood flow to the penis, enabling an erection to occur when a man is sexually stimulated.
    • Anyone with a heart condition should seek medical advice before using Cialis.
    • Cialis is a medication, with potentially serious adverse effects. It should only be obtained from a reputable source and used under medical supervision.

How it works

Penile erection occurs when the penis fills with blood. This happens because the blood vessels that bring blood flow to the penis dilate, increasing the blood supply. At the same time, the blood vessels that remove blood from the penis contract. The blood accumulates in the penis, causing an erection.

When a man is sexually stimulated, nitric oxide is released into the penis. Nitric oxide enables the production of cGMP, which controls the dilation and contraction of the blood vessels that carry blood to and from the penis.

Another substance, PDE5, destroys cGMP. When this occurs, the blood vessels return to their normal size, and the erection ends. Tadalafil stops PDE5 from destroying cGMP. This causes the erection to last for longer.

The muscles of the arteries in the walls of the lungs also contain PDE5, which is why the same drug can also help with pulmonary hypertension treatment.

Cialis Side Effects

Which is the best ? Cialis or Viagra ?

• • Cialis (tadalafil) and Viagra (sildenafil) are phosphodiesterase-5 (PDE5) inhibitors used for treating impotence (erectile dysfunction, or ED).
  • Adcirca is another brand name of tadalafil.
  • Common side effects of Cialis and Viagra that are similar include flushing (redness or warmth of the face, neck, or chest), headaches, stomach pain or upset, flu-like symptoms (such as stuffy nose, sneezing, or sore throat), memory problems, muscle or back pain, blurred vision and changes in color vision (such as an inability to differentiate between the colors green and blue), dizziness, diarrhea, nausea, low blood pressure, abnormal ejaculation, and prolonged erections (priapism), loss of hearing, and ringing in the ears.
  • One difference between the drugs is how long they stay in your system. Cialis provides penile hardness (the ability to obtain an erection) over a longer period than Viagra because it lasts up to 18 hours, while Viagra only lasts for about  4 to 6.

Here are the basic features of each of these drugs:

The drugs are available in a variety of doses, ranging from 2.5 milligrams (mg) to 200 mg. All can be taken with or without food. However, taking these drugs after eating a high-fat meal does slow the rate of absorption.

ED Drug interactions – Cialis

Each drug comes with the risk of drug interactions. Since PDE5 inhibitors work on the body in similar ways, Viagra, Cialis, Levitra, and Stendra lead to similar interactions.

All four of these drugs interact with:

• • • nitrates, such as isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat)
    • certain blood pressure drugs, such as calcium channel blockers
    • alpha blockers, which can treat high blood pressure or an enlarged prostate
    • certain pulmonary hypertension drugs, such as riociguat (Adempas)
    • protease inhibitors, a class of HIV drugs
    • antifungal drugs, such as ketoconazole and itraconazole (Onmel, Sporanox)
    • antibacterial drugs, such as clarithromycin (Biaxin)

Drinking excessive amounts of alcohol while on any PDE5 inhibitor should be avoided, and you shouldn’t combine different ED drugs.

Cialis may also be less effective if used alongside antiseizure medications such as carbamazepine (Tegretol) and phenobarbital.

For specifics on which medications are safe for you to use, it’s best to consult your doctor or pharmacist.

In some cases, using these medications may mean you need to completely avoid PDE5 inhibitors. In other cases, adjusting your dosage of the medication can reduce the possibility of drug interactions while using PDE5 inhibitors.

For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity (tadalafil for use as needed).

Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). For once daily use without regard to sexual activity the recommended dose is 2.5 to 5 mg daily. Tadalafil should not be taken more than once daily.

The recommended dose for BPH, or BPH and ED is 5 mg daily taken about the same time each day. Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.

The dose of tadalafil may require adjustment for patients with reduced kidney or liver function.

• • The usual recommended dose is 25 to 100 mg 1 hour before sexual activity.
  • The maximum dose is 100 mg daily.
  • The elderly (over 65 years of age) should start at 25 mg before sexual activity.
  • Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour.

Cialis

Tadalafil is not approved for women and has not been evaluated in women who are breastfeeding.

Viagra

Although extensive testing in animals has demonstrated no negative effects on the fetus, Viagra has not been studied in pregnant women. There is no effect on sperm count or motility of sperm in men.

It is not known whether sildenafil is excreted into breast milk.

What is Cialis?

Cialis (tadalafil) relaxes muscles of the blood vessels and increases blood flow to particular areas of the body. Cialis is used to treat erectile dysfunction (impotence) and symptoms of benign prostatic hypertrophy (enlarged prostate).

Another brand of tadalafil is Adcirca, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. Do not take Cialis while also taking Adcirca, unless your doctor tells you to.

Important information

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as “poppers”. Taking tadalafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Some medicines can cause unwanted or dangerous effects when used with Cialis. Tell your doctor about all your current medicines, especially riociguat (Adempas).

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Get medical help at once if you have nausea, chest pain, or dizziness during sex.

Stop using Cialis and get emergency medical help if you have sudden vision loss.

Before taking this medicine

You should not take Cialis if you are allergic to tadalafil.

Taking Cialis with certain other medicines can cause a sudden and serious decrease in blood pressure. Do not take this medicine if you also use:

• riociguat (to treat pulmonary arterial hypertension); or
• a nitrate drug (for chest pain or heart problems) such as nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, or recreational drugs such as amyl nitrate or nitrite “poppers”.

Some tadalafil can remain in your bloodstream for 2 or more days after each dose you take (longer if you have liver or kidney disease). Avoid nitrate use during this time.

To make sure this Cialis is safe for you, tell your doctor if you have ever had:

• • heart disease or heart rhythm problems;
  • a heart attack or stroke;
  • angina (chest pain), high or low blood pressure;
  • pulmonary hypertension (unless you are taking tadalafil for this);
  • a condition called pulmonary veno-occlusive disease (narrowing of the veins that carry blood from the lungs to the heart);
  • liver or kidney disease (or if you are on dialysis);
  • vision loss, or retinitis pigmentosa (an inherited condition of the eye);
  • a bleeding disorder;
  • a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
  • a physical deformity of the penis (such as Peyronie’s disease), or an erection lasting longer than 4 hours;
  • a stomach ulcer; or
  • health problems that make sexual activity unsafe.

Sudden vision loss has occurred in a small number of people taking medicines like tadalafil (Viagra or others). Most of these people already had certain eye problems or had high cholesterol, diabetes, coronary artery disease, a history of smoking, or were over 50 years old). It is not clear whether the medicine was the actual cause of vision loss.

Cialis is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether tadalafil passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.

Cialis is not approved for use by anyone younger than 18 years old.

How should I take Cialis?

Cialis is usually taken only once per day. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Cialis can be taken with or without food.

Do not break or split a tablet. Swallow it whole.

For erectile dysfunction, take Cialis just before sexual activity but not more than once per day.

Cialis can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.

Do not take Cialis for erectile dysfunction if you are taking Adcirca for pulmonary arterial hypertension.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

As Cialis is used as needed, you are not likely to be on a dosing schedule.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Cialis?

Drinking alcohol with this medicine can cause side effects.

Grapefruit and grapefruit juice may interact with tadalafil and lead to unwanted side effects. Avoid the use of grapefruit products while taking this medicine.

Cialis side effects

Get emergency medical help if you have signs of an allergic reaction to Cialis: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop and get medical help at once if you have nausea, chest pain, or dizziness during sex. You could be having a life-threatening side effect.

Stop using this medicine and call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• an erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis);
• vision changes or sudden vision loss;
• ringing in your ears or sudden hearing loss; or
• heart attack symptoms – chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Common Cialis side effects may include:

• headache;
• flushing (warmth, redness, or tingly feeling);
• nausea, upset stomach;
• stuffy nose; or
• muscle pain, back pain, pain in your arms or legs.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cialis?

Tell your doctor about all your current medicines and any you start or stop using, especially:

• medicines to treat erectile dysfunction or pulmonary arterial hypertension;
• an antibiotic or antifungal medicine;
• antiviral medicine to treat hepatitis C or HIV/AIDS;
• drugs to treat high blood pressure or a prostate disorder; or
• seizure medicine.

This list is not complete. Other drugs may interact with tadalafil, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Cialis only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Questions and Answers for Cialis (tadalafil)

1.  What is Cialis used to treat?

Cialis is approved for the treatment of men who experience difficulty having and maintaining an erection (impotence).

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2.  How does Cialis work?

Cialis works by enhancing the effects of one of the chemicals the body normally releases into the penis during sexual arousal. This allows an increase of blood flow into the penis. An erection is the result of an increase in blood flow into certain internal areas of the penis.

3.  How is Cialis different from the currently approved products for erectile dysfunction (ED)?

Cialis is different from other currently approved products for ED in that it stays in the body longer. However, there were no studies that directly compared the clinical efficacy and safety of Cialis to other products.

4.  How do I take Cialis?

Cialis is taken orally before sexual activity, not more than once daily. Cialis may be taken with or without food. In some patients, the dose strength and maximum frequency of use may be adjusted. For more detailed information consult with your health care provider.

5.  Are there any side effects with Cialis?

As with any drug product, there may be side effects. The most commonly reported side effects in patients treated with Cialis during the testing of the product were:

• • headache
  • indigestion
  • back pain
  • muscle pain
  • flushing
  • stuffy nose

Patients who get back pain and muscle aches usually get them 12 to 24 hours after taking Cialis and these usually go away by themselves within 48 hours. A small number of patients taking Cialis also reported abnormal vision.

6.  What important information should you know about Cialis?

• • CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with any nitrate medication. You could get dizzy, faint or have a heart attack or stroke.
  • Tell your healthcare provider that you take Cialis. If you need emergency medical care for a heart problem, it will be important for your health care provider to know when you last took Cialis.
  • After taking a single tablet, some of the active ingredient of Cialis remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications.
  • Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha-blockers and antihypertensive medications.

7.  What should I talk to my doctor about when considering if Cialis is right for me?

Because sexual activity can increase the work of the heart, your doctors should talk to you about your heart’s general condition and if Cialis is right for you. Patients who have a condition called “left ventricular outlet obstruction” from valvular problems or heart muscle enlargement may get side effects such as fainting or light-headedness. Because patients with recent heart attacks or stroke, heart pains (angina), heart failure, uncontrolled blood pressure or uncontrolled irregular heart beats, severe liver disease, and retinal eye problems were not studied with Cialis, Cialis is not recommended for these patients. There may be rare occurrences of priapism or painful, prolonged erections. This is a serious condition that requires immediate medical attention. Patients should seek prompt medical attention if their erection lasts longer than four hours.

8.  Who should not take Cialis?

Cialis should not be used by patients taking nitrates (such as nitroglycerin tablets or patches) because the combination of these with Cialis could significantly lower blood pressure and lead to fainting or even death in some men.

9.  Can Cialis be used with other treatments for impotence?

The safety and effectiveness of Cialis when used with other treatments for impotence has not been studied. Combined use could lead to additional lowering of blood pressure, possibly to unsafe levels. Therefore the use of such treatments in combination with Cialis is not recommended.

10. What if I am taking other drugs?

Always discuss with your health care practitioner ALL of the medications you are taking (prescription and over-the-counter) that way, you can receive the best advice for your own situation. Cialis is not recommended for people taking any form of nitroglycerin because the combination may lower blood pressure to an unsafe level.

11.  How will Cialis be supplied?

Cialis will be available as oral tablets in 5mg, 10mg and 20mg strengths.

12. Will Cialis be prescription or OTC (over-the-counter)?

Cialis will be available by prescription only.

13.  When will Cialis be available to pharmacies?

FDA has no control over when products are available in pharmacies after FDA approval for marketing. The decision of availability is completely up to the company marketing the product. For further information contact your pharmacist or Eli Lilly and Company directly.

14.  How can I report a serious side effect with Cialis to FDA?

FDA encourages anyone aware of a serious side effect, including consumers or patients, to make a MedWatch report.

You can report an adverse event either online, by regular mail or by fax, using the contact information at the bottom of this page.