16 HOW SUPPLIED/STORAGE AND HANDLING

Medical uses
How Cost Factors into the Decision?
Cialis Warnings/Precautions
6.1 Clinical Studies Experience
5.10 Concomitant Use of Potent Inhibitors of Cytochrome P450 3A4 (CYP3A4)
Cialis contraindications & warnings

Medical uses

Physicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke. Therefore, patients who experience anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)]. Physicians should consider the ordering cialis from canada potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)].

Higher dosages of Cialis

Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)]. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)].17.3 Concomitant Use with Drugs Which Lower Blood PressurePhysicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.4 Potential for Drug Interactions When Taking CIALIS for Once Daily UsePhysicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol.17.5 PriapismThere have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) for this class of compounds. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention.17.6 VisionPhysicians should advise patients to stop use of all PDE5 inhibitors, including CIALIS, and seek medical attention in the event of a sudden loss of vision in one or both eyes. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)].17.7 Sudden Hearing LossPhysicians should advise patients to stop taking PDE5 inhibitors, including CIALIS, and seek prompt medical attention in the event of sudden decrease or loss of hearing. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6.1) and (6.2)].17.8 AlcoholPatients should be made aware that both alcohol and CIALIS, a PDE5 inhibitor, act as mild vasodilators. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.9 Sexually Transmitted DiseaseThe use of CIALIS offers no protection against sexually transmitted diseases.

Interaction With	Effect on Cialis	Potential Risks
Blood pressure medications	Enhanced effect	Risk of hypotension
Antifungal drugs (e.g., ketoconazole)	Increased levels	Side effects amplification
Protease inhibitors for HIV	Increased tadalafil levels	Potential toxicity

Product	Dosage	Quantity + Bonus	Price
Cialis Generic	5mg	60 + 4 Pills	86.02€ 81.92€
Cialis Generic	2.5mg	180 + 10 Pills	154.86€ 147.49€
Cialis Professional	40mg	10 Pills	65.09€ 61.99€
Cialis Generic	5mg	180 + 10 Pills	159.65€ 152.05€
Cialis Generic	5mg	10 Pills	29.39€ 27.99€
Cialis Generic	10mg	120 + 6 Pills	178.49€ 169.99€
Cialis Black	80mg	10 Pills	43.27€ 41.21€
Cialis Generic	2.5mg	90 + 6 Pills	112.43€ 107.08€
Cialis Super Active	20mg	10 Pills	55.64€ 52.99€
Cialis Professional	20mg	10 Pills	48.29€ 45.99€
Cialis Generic	5mg	120 + 6 Pills	132.92€ 126.59€
Cialis Generic	5mg	30 + 4 Pills	53.56€ 51.01€

In most patients, the ability to have sexual intercourse is improved for up to 36 hours.For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. Cialis is effective at improving erectile function over the course of therapy. Physicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke. Therefore, patients who experience anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)]. Physicians should consider the ordering cialis from canada potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease.

How Cost Factors into the Decision?

Legal Class

Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)]. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].

Clinical trials demonstrated significant improvement in International Index of Erectile Function scores.
For BPH, trials showed improvement in International Prostate Symptom Score (IPSS).
The 5 mg dose balances efficacy with a generally favorable side effect profile.
Long-term cardiovascular safety data is reassuring for most patients.
It is one of the most extensively studied medications in its class.

Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol.

Cialis 5 mg can be effective for many men with ED.
Proper timing enhances its benefits.
Men should avoid heavy meals when possible.
Combining with psychological therapy can be beneficial.
It is not an aphrodisiac and requires arousal.
Using it responsibly avoids complications.
Always consult your healthcare provider for personalized advice.

Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention.

Cialis Warnings/Precautions

You could get dizzy, faint, or have a heart attack or stroke.Do not take CIALIS if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates. (See “Who should not take CIALIS?”)Tell all of your healthcare providers that you take CIALIS.

3. Follow safe, recommended Cialis doses

If you need emergency medical care for a heart problem, it will be important for your healthcare 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 (see “Can Other Medicines Affect CIALIS?”).Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.See also “What Are The Possible Side Effects Of CIALIS?”What Is CIALIS?CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him. CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)]. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered. CIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.

Cialis 5 mg may be used in men with comorbid conditions.
It is not recommended for men with severe kidney or liver issues.
The pill can be taken with or without food.
Consistent use may provide better results for some users.
Sexual activity should only occur when ready.
Some users experience nasal congestion as a side effect.
Keep out of reach of children.

For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity.

6.1 Clinical Studies Experience

Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke.Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of CIALIS. Therefore, patients who experience anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)].17.2 Cardiovascular ConsiderationsPhysicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)].17.3 Concomitant Use with Drugs Which Lower Blood PressurePhysicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.4 Potential for Drug Interactions When Taking CIALIS for Once Daily UsePhysicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol.17.5 PriapismThere have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) for this class of compounds. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention.17.6 VisionPhysicians should advise patients to stop use of all PDE5 inhibitors, including CIALIS, and seek medical attention in the event of a sudden loss of vision in one or both eyes. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)].17.7 Sudden Hearing LossPhysicians should advise patients to stop taking PDE5 inhibitors, including CIALIS, and seek prompt medical attention in the event of sudden decrease or loss of hearing.

Looking after your medicine

It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6.1) and (6.2)].17.8 AlcoholPatients should be made aware that both alcohol and CIALIS, a PDE5 inhibitor, act as mild vasodilators. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.9 Sexually Transmitted DiseaseThe use of CIALIS offers no protection against sexually transmitted diseases. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.17.10 Recommended AdministrationCIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours.For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. Cialis is effective at improving erectile function over the course of therapy. In most patients, the ability to have sexual intercourse is improved for up to 36 hours. For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. PATIENT PACKAGE INSERT Patient InformationCIALIS®(See-AL-iss)(tadalafil) tabletsRead this important information the best generic cialis before you start taking CIALIS and each time you get a refill. You may also find it helpful to share this information with your partner. This information does not take the place of talking with your healthcare provider. You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups.

Cialis 5 mg is often recommended for moderate ED.
It can improve confidence and sexual performance.
The tablet should be swallowed whole.
Do not break or chew the Cialis 5 mg tablet.
Taking it on an empty stomach may be more effective.
Cialis's effects can last up to 36 hours.
Regular use requires doctor approval.

If you do not understand the information, or have questions, talk with your healthcare provider or pharmacist.What Is The Most Important Information I Should Know About CIALIS?CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.Do not take CIALIS if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate.

5.10 Concomitant Use of Potent Inhibitors of Cytochrome P450 3A4 (CYP3A4)

Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered. CIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use. For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours. For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity.

Use in children

PATIENT PACKAGE INSERT Patient InformationCIALIS®(See-AL-iss)(tadalafil) tabletsRead this important information the best generic cialis before you start taking CIALIS and each time you get a refill. You may also find it helpful to share this information with your partner. This information does not take the place of talking with your healthcare provider. You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups. If you do not understand the information, or have questions, talk with your healthcare provider or pharmacist.What Is The Most Important Information I Should Know About CIALIS?CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates. (See “Who should not take CIALIS?”)Tell all of your healthcare providers that you take CIALIS. If you need emergency medical care for a heart problem, it will be important for your healthcare 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 (see “Can Other Medicines Affect CIALIS?”).Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex.

Side Effect	Frequency	Severity	Notes
Headache	Common	Mild to Moderate	Usually resolves in hours
Flushing	Common	Mild	Redness of face
Upset Stomach	Less Common	Mild	Nausea or indigestion
Muscle Pain	Rare	Mild	Usually disappears after a few days

Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.See also “What Are The Possible Side Effects Of CIALIS?”What Is CIALIS?CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him. CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity.