Photos are for illustrative purposes only.
All around the world, men with erectile dysfunction (ED) have taken 36-hour CIALIS as needed.
Talk to your doctor to see if a CIALIS option is right for you.
CIALIS is indicated for the treatment of erectile dysfunction.
What Should I Tell My Healthcare Provider Before Taking CIALIS?
CIALIS is not right for everyone.
Only your healthcare provider and you can decide if CIALIS is right for you.
Ask your healthcare provider if it is safe for you to have sexual activity.
You should not take CIALIS if your healthcare provider has told you not to have sexual activity because of your health problems.
Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex.
Can Other Medicines Affect CIALIS?
After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days.
CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension.
Do not take both CIALIS and ADCIRCA.
What Should I Avoid While Taking CIALIS?
Do not use other ED medicines or ED treatments while taking CIALIS.
Do not drink too much alcohol when taking CIALIS (for example, 5 glasses of wine or 5 shots of whiskey).
Drinking too much alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.
What Are The Possible Side Effects Of CIALIS?
The most common side effects with CIALIS are: headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
These side effects usually go away after a few hours.
Men who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS.
Back pain and muscle aches usually go away within 2 days.
Call your healthcare provider if you get any side effect that bothers you or one that does not go away.
An erection that won't go away: As with any ED tablet, in the rare event of an erection lasting more than 4 hours, seek immediate medical help to avoid long-term injury.
In rare instances, men taking prescription ED tablets (including CIALIS) reported a sudden decrease or loss of vision or hearing (sometimes with ringing in the ears and dizziness).
It's not possible to determine if these events are related directly to the ED tablets or to other factors.
If you have a sudden decrease or loss of vision or hearing, stop taking any ED tablet, including CIALIS and call your doctor right away.
CIALIS is available by prescription only.
For additional safety information, talk to your doctor about this medicine and see the full Patient Information.
This site is intended for use by United States residents age 18 and over.
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.
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.
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.
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.
What Are The Possible Side Effects Of CIALIS?
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.
Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away.
Some form of sexual stimulation is needed for an erection to happen with CIALIS.
Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
CIALIS is not for women or children.
CIALIS must be used only under a healthcare provider's care.
What Is The Most Important Information I Should Know About CIALIS?
What Should I Tell My Healthcare Provider Before Taking CIALIS?
CIALIS is not right for everyone.
Only your healthcare provider and you can decide if CIALIS is right for you.
CIALIS or ADCIRCATM (tadalafil) or any of its ingredients.
Ask your healthcare provider if it is safe for you to have sexual activity.
Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
CIALIS and other medicines may affect each other.
Always check with your healthcare provider before starting or stopping any medicines.
What Is The Most Important Information I Should Know About CIALIS?
Alpha blockers are sometimes prescribed for prostate problems or high blood pressure.
If CIALIS is taken with certain alpha blockers, your blood pressure could suddenly drop.
Take CIALIS exactly as your healthcare provider prescribes it.
Your healthcare provider will prescribe the dose that is right for you.
Some men can only take a low dose of CIALIS or may have to take it less often, because of medical conditions or medicines they take.
Do not change your dose or the way you take CIALIS without talking to your healthcare provider.
Your healthcare provider may lower or raise your dose, depending on how your body reacts to CIALIS and your health condition.
CIALIS may be taken with or without meals.
If you take too much CIALIS, call your healthcare provider or emergency room right away.
Do not take CIALIS more than one time each day.
CIALIS tablet before you expect to have sexual activity.
You may be able to have sexual activity at 30 minutes after taking CIALIS and up to 36 hours after taking it.
You and your healthcare provider should consider this in deciding when you should take CIALIS before sexual activity.
Some form of sexual stimulation is needed for an erection to happen with CIALIS.
Your healthcare provider may change your dose of CIALIS depending on how you respond to the medicine, and on your health condition.
Take one CIALIS tablet every day at about the same time of day.
You may attempt sexual activity at any time between doses.
If you miss a dose, you may take it when you remember but do not take more than one dose per day.
Some form of sexual stimulation is needed for an erection to happen with CIALIS.
Your healthcare provider may change your dose of CIALIS depending on how you respond to the medicine, and on your health condition.
Do not use other ED medicines or ED treatments while taking CIALIS.
Drinking too much alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.
What Are The Possible Side Effects Of CIALIS?
The most common side effects with CIALIS are: headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
These side effects usually go away after a few hours.
Back pain and muscle aches usually go away within 2 days.
An erection that won't go away (priapism).
Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
It is not possible to determine whether these events are related directly to these medicines, to other factors such as high blood pressure or diabetes, or to a combination of these.
If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS, and call a healthcare provider right away.
Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS.
It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors.
If you experience these symptoms, stop taking CIALIS and contact a healthcare provider right away.
These are not all the possible side effects of CIALIS.
For more information, ask your healthcare provider or pharmacist.
Keep CIALIS and all medicines out of the reach of children.
Medicines are sometimes prescribed for conditions other than those described in patient information leaflets.
Do not use CIALIS for a condition for which it was not prescribed.
Do not give CIALIS to other people, even if they have the same symptoms that you have.
This is a summary of the most important information about CIALIS.
If you would like more information, talk with your healthcare provider.
You can ask your healthcare provider or pharmacist for information about CIALIS that is written for health providers.
For more information you can also visit www.
The brands listed are trademarks of their respective owners and are not trademarks of Eli Lilly and Company.
The makers of these brands are not affiliated with and do not endorse Eli Lilly and Company or its products.
Cialis (tadalafil) Information from Drugs.
Cialis relaxes muscles and increases blood flow to particular areas of the body.
It is a phosphodiesterase inhibitor.
Cialis is used to treat erectile dysfunction (impotence).
It works by helping to increase blood flow into the penis during sexual stimulation.
This helps you to achieve and maintain an erection.
Cialis may also be used for purposes other than those listed in this medication guide.
Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems.
This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket).
Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers").
Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.
If you become dizzy or nauseated during sexual activity, or if you have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away.
You could be having a serious side effect of Cialis.
Do not take this medication more than once a day.
Allow 24 hours to pass between doses.
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.
Cialis can decrease blood flow to the optic nerve of the eye, causing sudden vision loss.
This has occurred in a small number of people taking Cialis, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old.
It is not clear whether this medication is the actual cause of vision loss.
Stop using Cialis and get emergency medical help if you have sudden vision loss.
Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers") Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.
If you have certain conditions, you may need a dose adjustment or special tests to safely take Cialis.
This medication can decrease blood flow to the optic nerve of the eye, causing sudden vision loss.
It is not clear whether Cialis is the actual cause of vision loss.
FDA pregnancy category B: Although Cialis is not for use in women, this medication is not expected to be harmful to an unborn baby.
Do not use Cialis without telling your doctor if you are pregnant or plan to become pregnant during treatment.
Although this medication is not for use in women, it is not known if tadalafil passes into breast milk or if it could harm a nursing baby.
Do not use this medication without telling your doctor if you are breast-feeding a baby.
Take Cialis exactly as it was prescribed for you.
Do not take it in larger doses or for longer than recommended by your doctor.
Taking this medication in larger doses will not make it more effective, and could cause dangerous side effects.
Cialis can be taken with or without food.
This medication is usually taken only when needed, just before sexual activity.
However, Cialis may also be taken daily (at a lower dose), regardless of when sexual activity is planned.
Follow your doctor's instructions.
Cialis can help achieve an erection when sexual stimulation occurs.
An erection will not occur just by taking a pill.
Do not take Cialis more than once a day.
If you take the medication daily, take it at the same time each day.
Store this medication at room temperature away from moisture and heat.
Since Cialis is used as needed, you are not likely to be on a dosing schedule.
If you take Cialis every day and you miss a dose, take the missed dose as soon as you remember.
If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose.
Do nottake extra medicine to make up the missed dose.
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.
What should I avoid while taking Cialis?
Avoid drinking alcohol, which can increase some of the side effects of Cialis.
Grapefruit and grapefruit juice may interact with Cialis.
Discuss the use of grapefruit products with your doctor.
Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.
During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away.
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.
See also: Cialis side effects in more detailWhat other drugs will affect Cialis?
Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers").
Tegretol), phenobarbital (Luminal), or phenytoin (Dilantin).
This list is not complete and there may be other drugs that can interact with Cialis.
Tell your doctor about all the prescription and over-the-counter medications you use.
This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors.
Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about Cialis.
What does my medication look like?
Tadalafil is available with a prescription under the brand name Cialis.
Other brand or generic formulations may also be available.
Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc.
Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect.
Drug information contained herein may be time sensitive.
Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.
Multum's drug information does not endorse drugs, diagnose patients or recommend therapy.
The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient.
Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.
The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
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Cialis (tadalafil), a drug used to treat erectile dysfunction, appears effective in treating pulmonary hypertension, researchers report.
A daily dose of the erectile dysfunction drug tadalafil (Cialis) helped relieve lower urinary tract symptoms in men with signs of enlarged prostates, ...
FDA informed healthcare professionals of reports of sudden decreases or loss of hearing following the use of PDE5 inhibitors Viagra, Levitra, Cialis for the ...
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Cialis Official FDA information, side effects and uses.
Cialis is indicated for the treatment of erectile dysfunction.
The maximum recommended dosing frequency is once per day in most patients.
Cialis for use as needed was shown to improve erectile function compared to placebo up to 36 hours following dosing.
Therefore, when advising patients on optimal use of Cialis, this should be taken into consideration.
The recommended starting dose of Cialis for once daily use is 2.
Cialis may be taken without regard to food.
No dose adjustment is required.
Use In Specific Populations (8.
The use of Cialis once per day has not been extensively evaluated in patients with hepatic insufficiency and therefore, caution is advised.
Use in Specific Populations (8.
Mild or moderate (Child Pugh Class A or B): Cialis for once daily use has not been extensively evaluated in patients with hepatic insufficiency.
Therefore, caution is advised if Cialis for once daily use is prescribed to these patients.
For patients taking concomitant potent inhibitors of CYP3A4, such as ketoconazole or ritonavir, the dose should not exceed 2.
In clinical pharmacology studies, Cialis was shown to potentiate the hypotensive effect of nitrates.
Evaluation of erectile dysfunction should include an appropriate medical assessment to identify potential underlying causes, as well as treatment options.
Physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity.
Therefore, treatments for erectile dysfunction, including Cialis, should not be used in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status.
Patients who experience symptoms upon initiation of sexual activity should be advised to refrain from further sexual activity and seek immediate medical attention.
Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of Cialis.
Cialis before nitrate administration is considered.
In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring.
Therefore, patients who experience anginal chest pain after taking Cialis should seek immediate medical attention.
Patient Counseling Information (17.
Patients with left ventricular outflow obstruction, (e.
As with other PDE5 inhibitors, tadalafil has mild systemic vasodilatory properties that may result in transient decreases in blood pressure.
While this effect should not be of consequence in most patients, prior to prescribing Cialis, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects.
Patients with severely impaired autonomic control of blood pressure may be particularly sensitive to the actions of vasodilators, including PDE5 inhibitors.
Physicians should be aware that Cialis for once daily use provides continuous plasma tadalafil levels and should consider this when evaluating the potential for interactions with medications (e.
There 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.
Priapism, if not treated promptly, can result in irreversible damage to the erectile tissue.
Patients who have an erection lasting greater than 4 hours, whether painful or not, should seek emergency medical attention.
Cialis should be used with caution in patients who have conditions that might predispose them to priapism (such as sickle cell anemia, multiple myeloma, or leukemia), or in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie's disease).
Physicians 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.
Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision, including permanent loss of vision that has been reported rarely postmarketing in temporal association with the use of all PDE5 inhibitors.
It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or other factors.
Patients with known hereditary degenerative retinal disorders, including retinitis pigmentosa, were not included in the clinical trials, and use in these patients is not recommended.
Physicians 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.
These events, which may be accompanied by tinnitus and dizziness, have been reported in temporal association to the intake of PDE5 inhibitors, including Cialis.
Caution is advised when PDE5 inhibitors are coadministered with alpha blockers.
PDE5 inhibitors, including Cialis, and alpha-adrenergic blocking agents are both vasodilators with blood-pressure-lowering effects.
When vasodilators are used in combination, an additive effect on blood pressure may be anticipated.
Patients should be stable on alpha-blocker therapy prior to initiating a PDE5 inhibitor.
Patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of PDE5 inhibitors.
In those patients who are stable on alpha-blocker therapy, PDE5 inhibitors should be initiated at the lowest recommended dose.
In those patients already taking an optimized dose of PDE5 inhibitor, alpha-blocker therapy should be initiated at the lowest dose.
Stepwise increase in alpha-blocker dose may be associated with further lowering of blood pressure when taking a PDE5 inhibitor.
Safety of combined use of PDE5 inhibitors and alpha blockers may be affected by other variables, including intravascular volume depletion and other antihypertensive drugs.
See Dosage and Administration (2.
Due to increased tadalafil exposure (AUC), limited clinical experience, and the lack of ability to influence clearance by dialysis, Cialis for once daily use is not recommended in patients with severe renal insufficiency.
Cialis for once daily use has not been extensively evaluated in patients with mild or moderate hepatic insufficiency.
Patients should be made aware that both alcohol and Cialis, a PDE5 inhibitor, act as mild vasodilators.
When mild vasodilators are taken in combination, blood-pressure-lowering effects of each individual compound may be increased.
Therefore, physicians should inform patients that substantial consumption of alcohol (e.
Cialis is metabolized predominantly by CYP3A4 in the liver.
In patients taking potent inhibitors of CYP3A4 and Cialis for once daily use, the dose of Cialis should not exceed 2.
The safety and efficacy of combinations of Cialis and other PDE5 inhibitors or treatments for erectile dysfunction have not been studied.
Therefore, the use of such combinations is not recommended.
Cialis has not been administered to patients with bleeding disorders or significant active peptic ulceration.
Although Cialis has not been shown to increase bleeding times in healthy subjects, use in patients with bleeding disorders or significant active peptic ulceration should be based upon a careful risk-benefit assessment and caution.
The use of Cialis offers no protection against sexually transmitted diseases.
Counseling patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Tadalafil was administered to over 6550 men during clinical trials worldwide.
In trials of Cialis for once daily use, a total of 716, 389, and 115 were treated for at least 6 months, 1 year, and 2 years, respectively.
For Cialis for use as needed, over 1300 and 1000 subjects were treated for at least 6 months and 1 year, respectively.
Patients Treated with Cialis for Once Daily Use (2.
Back pain or myalgia was reported at incidence rates described in Tables 1 and 2.
In tadalafil clinical pharmacology trials, back pain or myalgia generally occurred 12 to 24 hours after dosing and typically resolved within 48 hours.
In the 1-year open label extension study, back pain and myalgia were reported in 5.
Diagnostic testing, including measures for inflammation, muscle injury, or renal damage revealed no evidence of medically significant underlying pathology.
Incidence rates for Cialis for once daily use are described in Table 2.
In studies of Cialis for once daily use, events of back pain and myalgia were generally mild or moderate with a discontinuation rate of 0.
Cialis for once daily use or use as needed.
A causal relationship of these events to Cialis is uncertain.
The following adverse reactions have been identified during post approval use of Cialis.
These events have been chosen for inclusion either due to their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
The list does not include adverse events that are reported from clinical trials and that are listed elsewhere in this section.
Serious cardiovascular events, including myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported postmarketing in temporal association with the use of tadalafil.
Most, but not all, of these patients had preexisting cardiovascular risk factors.
Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of Cialis without sexual activity.
Others were reported to have occurred hours to days after the use of Cialis and sexual activity.
Non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported rarely postmarketing in temporal association with the use of phosphodiesterase type 5 (PDE5) inhibitors, including Cialis.
Cases of sudden decrease or loss of hearing have been reported postmarketing in temporal association with the use of PDE5 inhibitors, including Cialis.
In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events.
In many cases, medical follow-up information was limited.
Administration of Cialis to patients who are using any form of organic nitrate, is contraindicated.
In a patient who has taken Cialis, where nitrate administration is deemed medically necessary in a life-threatening situation, at least 48 hours should elapse after the last dose of Cialis before nitrate administration is considered.
Clinical pharmacology studies were conducted to assess the effect of tadalafil on the potentiation of the blood-pressure-lowering effects of selected antihypertensive medications (amlodipine, angiotensin II receptor blockers, bendrofluazide, enalapril, and metoprolol).
Small reductions in blood pressure occurred following coadministration of tadalafil with these agents compared with placebo.
See Warnings and Precautions (5.
Both alcohol and tadalafil, a PDE5 inhibitor, act as mild vasodilators.
Substantial consumption of alcohol (e.
Cialis can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache.
Tadalafil did not affect alcohol plasma concentrations and alcohol did not affect tadalafil plasma concentrations.
An increase in gastric pH resulting from administration of nizatidine had no significant effect on pharmacokinetics.
Cialis is a substrate of and predominantly metabolized by CYP3A4.
Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure.
Although specific interactions have not been studied, other CYP3A4 inhibitors, such as erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure.
Studies have shown that drugs that induce CYP3A4 can decrease tadalafil exposure.
Although specific interactions have not been studied, other CYP3A4 inducers, such as carbamazepine, phenytoin, and phenobarbital, would likely decrease tadalafil exposure.
No dose adjustment is warranted.
Tadalafil did not potentiate the increase in bleeding time caused by aspirin.
Cialis is not expected to cause clinically significant inhibition or induction of the clearance of drugs metabolized by cytochrome P450 (CYP) isoforms.
Studies have shown that tadalafil does not inhibit or induce P450 isoforms CYP1A2, CYP3A4, CYP2C9, CYP2C19, CYP2D6, and CYP2E1.
Tadalafil had no significant effect on the pharmacokinetics of theophylline.
When tadalafil was administered to subjects taking theophylline, a small augmentation (3 beats per minute) of the increase in heart rate associated with theophylline was observed.
Tadalafil had no significant effect on exposure (AUC) to S-warfarin or R-warfarin, nor did tadalafil affect changes in prothrombin time induced by warfarin.
Tadalafil had no significant effect on exposure (AUC) to midazolam or lovastatin.
Coadministration of tadalafil (40 mg once per day) for 10 days did not have a significant effect on the steady-state pharmacokinetics of digoxin (0.
Cialis (tadalafil) is not indicated for use in women.
There are no adequate and well controlled studies of Cialis use in pregnant women.
Animal reproduction studies in rats and mice revealed no evidence of fetal harm.
Signs of maternal toxicity occurred at doses greater than 16 times the MRHD based on AUC.
Surviving offspring had normal development and reproductive performance.
Cialis is not indicated for use in women.
It is not known whether tadalafil is excreted into human milk.
While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk.
Cialis is not indicated for use in pediatric patients.
Safety and efficacy in patients below the age of 18 years has not been established.
Of the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately 3 percent were 75 and over.
No overall differences in efficacy or safety were observed between subjects over 65 years of age compared to younger subjects, therefore no dose adjustment is warranted based on age alone.
However, a greater sensitivity to medications in some older individuals should be considered.
In subjects with end-stage renal disease on hemodialysis, there was a two-fold increase in Cmax and 2.
Exposure to total methylcatechol (unconjugated plus glucuronide) was 2- to 4-fold higher in subjects with renal impairment, compared to those with normal renal function.
In patients on hemodialysis taking 10- or 20-mg tadalafil, there were no reported cases of back pain.
Adverse events were similar to those seen at lower doses.
In cases of overdose, standard supportive measures should be adopted as required.
Hemodialysis contributes negligibly to tadalafil elimination.
Cialis (tadalafil), an oral treatment for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).
Tadalafil has the empirical formula C22H19N3O4 representing a molecular weight of 389.
It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol.
Cialis is available as film-coated, almond-shaped tablets for oral administration.
Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle.
This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells.
Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum.
The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP.
Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation.
PDE5 is found in corpus cavernosum smooth muscle, vascular and visceral smooth muscle, skeletal muscle, platelets, kidney, lung, cerebellum, and pancreas.
PDE5 than on other phosphodiesterases.
PDE5 than for PDE1, PDE2, PDE4, and PDE7 enzymes, which are found in the heart, brain, blood vessels, liver, leukocytes, skeletal muscle, and other organs.
PDE5 than for PDE3, an enzyme found in the heart and blood vessels.
Additionally, tadalafil is 700-fold more potent for PDE5 than for PDE6, which is found in the retina and is responsible for phototransduction.
PDE5 than for PDE8, PDE9, and PDE10.
Tadalafil is 14-fold more potent for PDE5 than for PDE11A1 and 40-fold more potent for PDE5 than for PDE11A4, two of the four known forms of PDE11.
PDE11 is an enzyme found in human prostate, testes, skeletal muscle and in other tissues.
PDE11A1 and, to a lesser degree, PDE11A4 activities at concentrations within the therapeutic range.
The physiological role and clinical consequence of PDE11 inhibition in humans have not been defined.
Hg, respectively) and in standing systolic and diastolic blood pressure (difference in the mean maximal decrease of 0.
In addition, there was no significant effect on heart rate.
A study was conducted to assess the degree of interaction between nitroglycerin and tadalafil, should nitroglycerin be required in an emergency situation after tadalafil was taken.
Subjects were administered a single dose of 0.
NTG) at pre-specified timepoints, following their last dose of tadalafil (2, 4, 8, 24, 48, 72, and 96 hours after tadalafil).
The objective of the study was to determine when, after tadalafil dosing, no apparent blood pressure interaction was observed.
In this study, a significant interaction between tadalafil and NTG was observed at each timepoint up to and including 24 hours.
At 48 hours, by most hemodynamic measures, the interaction between tadalafil and NTG was not observed, although a few more tadalafil subjects compared to placebo experienced greater blood-pressure lowering at this timepoint.
After 48 hours, the interaction was not detectable (see Figure 1).
Therefore, Cialis administration with nitrates is contraindicated.
In two studies, daily oral alpha blocker (at least 7 days duration) was administered to healthy male subjects taking repeated daily doses of tadalafil.
Blood pressure was measured manually at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours after tadalafil or placebo administration.
Hg following tadalafil and placebo, respectively.
Severe adverse events potentially related to blood-pressure effects were assessed.
No such events were reported following placebo.
Two such events were reported following administration of tadalafil.
Vertigo was reported in one subject that began 7 hours after dosing and lasted about 5 days.
This subject previously experienced a mild episode of vertigo on doxazosin and placebo.
The placebo-subtracted mean maximal decreases in systolic blood pressure over a 12-hour period after dosing in the placebo-controlled portion of the study (part C) are shown in Table 5 and Figure 3.
Blood pressure was measured by ABPM every 15 to 30 minutes for up to 36 hours after tadalafil or placebo.
Hg from a time-matched baseline occurred during the analysis interval.
Hg, following tadalafil and placebo, respectively.
Some additional subjects in both the tadalafil and placebo groups were categorized as outliers in the period beyond 24 hours.
In the period prior to tadalafil dosing, one severe event (dizziness) was reported in a subject during the doxazosin run-in phase.
The results are shown in Table 6.
All adverse events potentially related to blood pressure effects were rated as mild or moderate.
Tadalafil or placebo was administered 2 hours after tamsulosin following a minimum of seven days of tamsulosin dosing.
Blood pressure was measured manually at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours after tadalafil or placebo dosing.
No severe adverse events potentially related to blood-pressure effects were reported.
Blood pressure was measured manually pre-dose at two time points (-30 and -15 minutes) and then at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours post dose on the first, sixth and seventh days of tamsulosin administration.
Hg at one or more time points).
No severe adverse events potentially related to blood pressure were reported.
Tadalafil or placebo was administered 4 hours after alfuzosin following a minimum of seven days of alfuzosin dosing.
Blood pressure was measured manually at 1, 2, 3, 4, 6, 8, 10, 20, and 24 hours after tadalafil or placebo dosing.
No severe adverse events potentially related to blood pressure effects were reported.
There was no effect of tadalafil on amlodipine blood levels and no effect of amlodipine on tadalafil blood levels.
Subjects in the study were taking any marketed angiotensin II receptor blocker, either alone, as a component of a combination product, or as part of a multiple antihypertensive regimen.
A study was conducted to assess the interaction of bendrofluazide (2.
Alcohol and PDE5 inhibitors, including tadalafil, are mild systemic vasodilators.
The interaction of tadalafil with alcohol was evaluated in 3 clinical pharmacology studies.
In 2 of these, alcohol was administered at a dose of 0.
In one of these two studies, blood alcohol levels of 0.
In these two studies, more patients had clinically significant decreases in blood pressure on the combination of tadalafil and alcohol as compared to alcohol alone.
Some subjects reported postural dizziness, and orthostatic hypotension was observed in some subjects.
The effects of tadalafil on cardiac function, hemodynamics, and exercise tolerance were investigated in a single clinical pharmacology study.
In this blinded crossover trial, 23 subjects with stable coronary artery disease and evidence of exercise-induced cardiac ischemia were enrolled.
The primary endpoint was time to cardiac ischemia.
Further statistical analysis demonstrated that tadalafil was non-inferior to placebo with respect to time to ischemia.
Of note, in this study, in some subjects who received tadalafil followed by sublingual nitroglycerin in the post-exercise period, clinically significant reductions in blood pressure were observed, consistent with the augmentation by tadalafil of the blood-pressure-lowering effects of nitrates.
Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels.
This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina.
There were no adverse effects on sperm morphology or sperm motility in any of the three studies.
The effect of a single 100-mg dose of tadalafil on the QT interval was evaluated at the time of peak tadalafil concentration in a randomized, double-blinded, placebo, and active (intravenous ibutilide) -controlled crossover study in 90 healthy males aged 18 to 53 years.
The mean change in QTc (Fridericia QT correction) for tadalafil, relative to placebo, was 3.
The mean change in QTc (Individual QT correction) for tadalafil, relative to placebo, was 2.
A 100-mg dose of tadalafil (5 times the highest recommended dose) was chosen because this dose yields exposures covering those observed upon coadministration of tadalafil with potent CYP3A4 inhibitors or those observed in renal impairment.
In this study, the mean increase in heart rate associated with a 100-mg dose of tadalafil compared to placebo was 3.
AUC) increases proportionally with dose in healthy subjects.
Steady-state plasma concentrations are attained within 5 days of once per day dosing and exposure is approximately 1.
Figure 4) to healthy male subjects are depicted in Figure 4.
After single oral-dose administration, the maximum observed plasma concentration (Cmax) of tadalafil is achieved between 30 minutes and 6 hours (median time of 2 hours).
Absolute bioavailability of tadalafil following oral dosing has not been determined.
Cialis may be taken with or without food.
L, indicating that tadalafil is distributed into tissues.
At therapeutic concentrations, 94% of tadalafil in plasma is bound to proteins.
Tadalafil is predominantly metabolized by CYP3A4 to a catechol metabolite.
The catechol metabolite undergoes extensive methylation and glucuronidation to form the methylcatechol and methylcatechol glucuronide conjugate, respectively.
The major circulating metabolite is the methylcatechol glucuronide.
Methylcatechol concentrations are less than 10% of glucuronide concentrations.
The mean oral clearance for tadalafil is 2.
Tadalafil is excreted predominantly as metabolites, mainly in the feces (approximately 61% of the dose) and to a lesser extent in the urine (approximately 36% of the dose).
AUC) with no effect on Cmax relative to that observed in healthy subjects 19 to 45 years of age.
No dose adjustment is warranted based on age alone.
AUC) was reduced approximately 19% and Cmax was 5% lower than that observed in healthy subjects.
Ames assays or the forward mutation test in mouse lymphoma cells.
Animal studies showed vascular inflammation in tadalafil-treated mice, rats, and dogs.
The abnormal blood-cell findings were reversible within 2 weeks upon removal of the drug.
Reproduction studies have been performed in rats and mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg and have revealed no evidence of impaired fertility or harm to the fetus due to tadalafil.
In addition, there was no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the MRHD during the period of major organ development.
This gives approximately 16 and 10 fold exposure multiples, respectively, of the human AUC for the MRHD of 20 mg.
The efficacy and safety of tadalafil in the treatment of erectile dysfunction has been evaluated in 22 clinical trials of up to 24-weeks duration, involving over 4000 patients.
Cialis, when taken as needed up to once per day, was shown to be effective in improving erectile function in men with erectile dysfunction (ED).
Cialis was studied in the general ED population in 7 randomized, multicenter, double-blinded, placebo-controlled, parallel-arm design, primary efficacy and safety studies of 12-weeks duration.
Two of these studies were conducted in the United States and 5 were conducted in centers outside the US.
Additional efficacy and safety studies were performed in ED patients with diabetes mellitus and in patients who developed ED status post bilateral nerve-sparing radical prostatectomy.
In these 7 trials, Cialis was taken as needed, at doses ranging from 2.
Patients were free to choose the time interval between dose administration and the time of sexual attempts.
Food and alcohol intake were not restricted.
Several assessment tools were used to evaluate the effect of Cialis on erectile function.
Sexual Encounter Profile (SEP).
The IIEF is a 4-week recall questionnaire that was administered at the end of a treatment-free baseline period and subsequently at follow-up visits after randomization.
The IIEF EF domain has a 30-point total score, where higher scores reflect better erectile function.
SEP is a diary in which patients recorded each sexual attempt made throughout the study.
Were you able to insert your penis into the partner's vagina?
Did your erection last long enough for you to have successful intercourse?
The overall percentage of successful attempts to insert the penis into the vagina (SEP2) and to maintain the erection for successful intercourse (SEP3) is derived for each patient.
The 2 primary US efficacy and safety trials included a total of 402 men with erectile dysfunction, with a mean age of 59 years (range 27 to 87 years).
ED of various severities, etiologies (organic, psychogenic, mixed), and with multiple co-morbid conditions, including diabetes mellitus, hypertension, and other cardiovascular disease.
ED of at least 1-year duration.
A was conducted primarily in academic centers.
B was conducted primarily in community-based urology practices.
The treatment effect of Cialis did not diminish over time.
The 5 primary efficacy and safety studies conducted in the general ED population outside the US included 1112 patients, with a mean age of 59 years (range 21 to 82 years).
The population was 76% White, 1% Black, 3% Hispanic, and 20% of other ethnicities, and included patients with ED of various severities, etiologies (organic, psychogenic, mixed), and with multiple co-morbid conditions, including diabetes mellitus, hypertension, and other cardiovascular disease.
Most (90%) patients reported ED of at least 1-year duration.
ED of all degrees of disease severity while taking Cialis, compared to patients on placebo.
Therefore, in all 7 primary efficacy and safety studies, Cialis showed statistically significant improvement in patients' ability to achieve an erection sufficient for vaginal penetration and to maintain the erection long enough for successful intercourse, as measured by the IIEF questionnaire and by SEP diaries.
Cialis was shown to be effective in treating ED in patients with diabetes mellitus.
Cialis was shown to be effective in treating patients who developed ED following bilateral nerve-sparing radical prostatectomy.
Several studies were conducted with the objective of determining the optimal use of Cialis in the treatment of ED.
In one of these studies, the percentage of patients reporting successful erections within 30 minutes of dosing was determined.
Using a stopwatch, patients recorded the time following dosing at which a successful erection was obtained.
A successful erection was defined as at least 1 erection in 4 attempts that led to successful intercourse.
Two studies were conducted to assess the efficacy of Cialis at a given timepoint after dosing, specifically at 24 hours and at 36 hours after dosing.
The results demonstrated a difference between the placebo group and the Cialis group at each of the pre-specified timepoints.
In the second of these studies, a total of 483 patients were evenly randomized to 1 of 6 groups: 3 different dosing groups (placebo, Cialis 10, or 20 mg) that were instructed to attempt intercourse at 2 different times (24 and 36 hours post-dosing).
Patients were encouraged to make 4 separate attempts at their assigned dose and assigned timepoint.
In this study, the results demonstrated a statistically significant difference between the placebo group and the Cialis groups at each of the pre-specified timepoints.
At the 24-hour timepoint, the mean, per patient percentage of attempts resulting in successful intercourse were 42, 56, and 67% for the placebo, Cialis 10-, and 20-mg groups, respectively.
At the 36-hour timepoint, the mean, per-patient percentage of attempts resulting in successful intercourse were 33, 56, and 62% for placebo, Cialis 10-, and 20-mg groups, respectively.
The efficacy and safety of Cialis for once daily use in the treatment of erectile dysfunction has been evaluated in 2 clinical trials of 12-weeks duration and 1 clinical trial of 24-weeks duration, involving a total of 853 patients.
Cialis, when taken once daily, was shown to be effective in improving erectile function in men with erectile dysfunction (ED).
Cialis was studied in the general ED population in 2 randomized, multicenter, double-blinded, placebo-controlled, parallel-arm design, primary efficacy and safety studies of 12- and 24-weeks duration, respectively.
One of these studies was conducted in the United States and one was conducted in centers outside the US.
An additional efficacy and safety study was performed in ED patients with diabetes mellitus.
Cialis was taken once daily at doses ranging from 2.
Timing of sexual activity was not restricted relative to when patients took Cialis.
The primary US efficacy and safety trial included a total of 287 patients, with a mean age of 59 years (range 25 to 82 years).
The population was 86% White, 6% Black, 6% Hispanic, and 2% of other ethnicities, and included patients with ED of various severities, etiologies (organic, psychogenic, mixed), and with multiple co-morbid conditions, including diabetes mellitus, hypertension, and other cardiovascular disease.
The primary efficacy and safety study conducted outside the US included 268 patients, with a mean age of 56 years (range 21 to 78 years).
The population was 86% White, 3% Black, 0.
Hispanic, and 10% of other ethnicities, and included patients with ED of various severities, etiologies (organic, psychogenic, mixed), and with multiple co-morbid conditions, including diabetes mellitus, hypertension, and other cardiovascular disease.
Ninety-three percent of patients reported ED of at least 1-year duration.
In each of these trials, conducted without regard to the timing of dose and sexual intercourse, Cialis demonstrated clinically meaningful and statistically significant improvement in erectile function, as measured by the EF domain of the IIEF questionnaire and Questions 2 and 3 of the SEP diary (see Table 16).
When taken as directed, Cialis was effective at improving erectile function.
In the 6 month double blind study, the treatment effect of Cialis did not diminish over time.
Twenty-four-week study conducted in the US.
Twelve-week study conducted outside the US.
Cialis for once daily use was shown to be effective in treating ED in patients with diabetes mellitus.
In this third trial, Cialis demonstrated clinically meaningful and statistically significant improvement in erectile function, as measured by the EF domain of the IIEF questionnaire and Questions 2 and 3 of the SEP diary (see Table 17).
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.
In such a patient, who has taken Cialis, where nitrate administration is deemed medically necessary for a life-threatening situation, at least 48 hours should have elapsed after the last dose of Cialis before nitrate administration is considered.
Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease.
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.
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.
Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.
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.
Read this important information 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.
You could get dizzy, faint, or have a heart attack or stroke.
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.
Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates.
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.
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.
What Are The Possible Side Effects Of Cialis?
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.
Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away.
Some form of sexual stimulation is needed for an erection to happen with Cialis.
Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
Cialis is not for women or children.
Cialis must be used only under a healthcare provider's care.
What Should I Tell My Healthcare Provider Before Taking Cialis?
Cialis is not right for everyone.
Only your healthcare provider and you can decide if Cialis is right for you.
Cialis or ADCIRCA any of its ingredients.
See the end of this leaflet for a complete list of ingredients in Cialis.
Ask your healthcare provider if it is safe for you to have sexual activity.
You should not take Cialis if your healthcare provider has told you not to have sexual activity because of your health problems.
Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Cialis and other medicines may affect each other.
Always check with your healthcare provider before starting or stopping any medicines.
Alpha blockers are sometimes prescribed for prostate problems or high blood pressure.
If Cialis is taken with certain alpha blockers, your blood pressure could suddenly drop.
Cialis is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension.
Do not take both Cialis and ADCIRCA.
Take Cialis exactly as your healthcare provider prescribes it.
Your healthcare provider will prescribe the dose that is right for you.
Some men can only take a low dose of Cialis or may have to take it less often, because of medical conditions or medicines they take.
Do not change your dose or the way you take Cialis without talking to your healthcare provider.
Your healthcare provider may lower or raise your dose, depending on how your body reacts to Cialis and your health condition.
Cialis may be taken with or without meals.
If you take too much Cialis, call your healthcare provider or emergency room right away.
Cialis tablet before you expect to have sexual activity.
You may be able to have sexual activity at 30 minutes after taking Cialis and up to 36 hours after taking it.
You and your healthcare provider should consider this in deciding when you should take Cialis before sexual activity.
Your healthcare provider may change your dose of Cialis depending on how you respond to the medicine, and on your health condition.
Do not take Cialis more than one time each day.
Take one Cialis tablet every day at about the same time of day.
You may attempt sexual activity at any time between doses.
If you miss a dose, you may take it when you remember but do not take more than one dose per day.
What Should I Avoid While Taking Cialis?
Do not use other ED medicines or ED treatments while taking Cialis.
Drinking too much alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.
The most common side effects with Cialis are: headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
It is not possible to determine whether these events are related directly to these medicines, to other factors such as high blood pressure or diabetes, or to a combination of these.
Cialis, and call a healthcare provider right away.
Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including Cialis.
It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors.
If you experience these symptoms, stop taking Cialis and contact a healthcare provider right away.
These are not all the possible side effects of Cialis.
For more information, ask your healthcare provider or pharmacist.
Keep Cialis and all medicines out of the reach of children.
Medicines are sometimes prescribed for conditions other than those described in patient information leaflets.
Do not use Cialis for a condition for which it was not prescribed.
Do not give Cialis to other people, even if they have the same symptoms that you have.
This is a summary of the most important information about Cialis.
If you would like more information, talk with your healthcare provider.
You can ask your healthcare provider or pharmacist for information about Cialis that is written for health providers.
What Are The Ingredients In Cialis?
The brands listed are trademarks of their respective owners and are not trademarks of Eli Lilly and Company.
The makers of these brands are not affiliated with and do not endorse Eli Lilly and Company or its products.
Each tablet contains 5 mg of tadalafil.
Viagra, Levitra, sildenafil, tadalafil, vardenafil, alprostadilErectile DysfunctionViagraLevitrasildenafiltadalafilvardenafilalprostadilCaverjectMuseEdexYohimbeYoconCaverject ImpulseErexAphrodyneTestomarYohimarYohimexMore...
Erectile dysfunction: Viagra and other oral medications - MayoClinic.
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Erectile dysfunction and diabetes: Take control today Erectile dysfunction: Viagra and other oral medications Erectile dysfunction herbs: A natural treatment for ED?
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Wondering about drugs to treat erectile dysfunction?
Find out how Viagra, Levitra and Cialis compare with each other.
For most men with erectile problems, they work well and have few side effects.
All three medications improve erectile function in the same basic way, but the effects of tadalafil (Cialis) last longer.
This and a few other minor differences among these medications may make one a better choice over another for some men.
Viagra, Levitra and Cialis increase levels of nitric oxide, a chemical produced by your body during sexual stimulation that causes blood vessels in the penis to relax and open.
This allows you to achieve and maintain an erection.
Viagra, Levitra and Cialis each have a slightly different chemical make up.
Your doctor will consider these factors when deciding if one of these medications is a good choice for you.
Your doctor will also consider any other health problems you have and whether any of your current medications could cause problems when taken with Viagra, Levitra or Cialis.
Although these erectile dysfunction medications can help many people, not all men can safely take them.
Tell your doctor about all medications you take, including herbal remedies.
A number of other drugs, including certain antibiotics, anti-seizure medications, blood thinners and anti-arrhythmic heart medications can affect how well Viagra, Levitra or Cialis work and cause other side effects.
Never take Viagra, Levitra or Cialis if you take nitrate drugs to treat chest pain due to heart problems (angina).
Like Viagra, Levitra and Cialis, nitrates dilate blood vessels.
Their combined effects can cause dangerous low blood pressure and loss of consciousness.
Talk to your doctor if you take alpha blockers, medications often used to treat an enlarged prostate.
Alpha blockers can cause dangerously low blood pressure when combined with drugs for erectile dysfunction.
Examples of alpha blockers include: tamsulosin (Flomax), terazosin (Hytrin) and doxazosin (Cardura).
Don't use Viagra, Levitra or Cialis within four hours of taking an alpha blocker.
If you do use an alpha blocker, never take sildenafil (Viagra) in doses above 25 milligrams.
There's one exception to the rule about not taking alpha blockers with medications for erectile dysfunction: Tadalafil (Cialis) has been approved for use with the alpha blocker tamulosin (Flomax).
Viagra, Levitra and Cialis all belong to a type of medications called phosphodiesterase-5 (PDE-5) inhibitors, which improve erectile function by affecting blood pressure.
Experts are investigating whether these drugs may be useful to treat certain heart or blood flow problems.
Revatio, the same medication as sildenafil (Viagra) was recently approved by the Food and Drug Administration as a treatment for pulmonary hypertension, a rare condition affecting blood flow to the lungs.
Buying prescription drugs online: The do's and don'ts 'Herbal Viagra': Is it safe?
Erectile dysfunction and diabetes: Take control today Erectile dysfunction herbs: A natural treatment for ED?
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CIALIS is available as film-coated, almond-shaped tablets for oral administration.
CIALIS is indicated for the treatment of erectile dysfunction.
CIALIS, this should be taken into consideration.
The recommended starting dose of CIALIS for once daily use is 2.
CIALIS may be taken without regard to food.
CIALIS for once daily use is prescribed to these patients.
Eli Lilly and Company, Indianapolis, IN 46285, USA.
In trials of CIALIS for once daily use, a total of 716, 389, and 115 were treated for at least 6 months, 1 year, and 2 years, respectively.
For CIALIS for use as needed, over 1300 and 1000 subjects were treated for at least 6 months and 1 year, respectively.
In eight primary placebo-controlled Phase 3 studies of 12 weeks duration, mean age was 59 years (range 22 to 88) and the discontinuation rate due to adverse events in patients treated with tadalafil 10 or 20 mg was 3.
In three placebo-controlled Phase 3 clinical trials of 12 or 24 weeks duration, mean age was 58 years (range 21 to 82) and the discontinuation rate due to adverse events in patients treated with tadalafil was 4.
Patients Treated with CIALIS for Once Daily Use (2.
Incidence rates for CIALIS for once daily use are described in Table 2.
In studies of CIALIS for once daily use, events of back pain and myalgia were generally mild or moderate with a discontinuation rate of 0.
CIALIS for once daily use or use as needed.
A causal relationship of these events to CIALIS is uncertain.
The following adverse reactions have been identified during post approval use of CIALIS.
CIALIS without sexual activity.
CIALIS before nitrate administration is considered.
AUC) by 312% and Cmax by 22%, relative to the values for tadalafil 20 mg alone.
Cmax, relative to the values for tadalafil 20 mg alone.
CYP3A4 can decrease tadalafil exposure.
P450 isoforms CYP1A2, CYP3A4, CYP2C9, CYP2C19, CYP2D6, and CYP2E1.
AUC) to midazolam or lovastatin.
Included as part of the PRECAUTIONS section.
Therefore, treatments for erectile dysfunction, including CIALIS, should not be used in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status.
CIALIS should be used with caution in patients who have conditions that might predispose them to priapism (such as sickle cell anemia, multiple myeloma, or leukemia), or in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis, or Peyronie's disease).
PDE5 inhibitors or other factors.
CIALIS is metabolized predominantly by CYP3A4 in the liver.
The safety and efficacy of combinations of CIALIS and other treatments for erectile dysfunction have not been studied.
The use of CIALIS offers no protection against sexually transmitted diseases.
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 clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.
For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity.
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.
Systemic drug exposures, as measured by AUC of unbound tadalafil, were approximately 10-fold for mice, and 14- and 26-fold for male and female rats, respectively, the exposures in human males given Maximum Recommended Human Dose (MRHD) of 20 mg.
AUCs for unbound tadalafil of 14-fold for males or 26-fold for females the exposures observed in human males given the MRHD of 20 mg.
CIALIS is not indicated for use in women.
CIALIS is not indicated for use in pediatric patients.
CIALIS was shown to potentiate the hypotensive effect of nitrates.
PDE11 inhibition in humans have not been defined.
Tadalafil 20 mg administered to healthy male subjects produced no significant difference compared to placebo in supine systolic and diastolic blood pressure (difference in the mean maximal decrease of 1.
Therefore, CIALIS administration with nitrates is contraindicated.
Doxazosin was administered at the same time as tadalafil or placebo after a minimum of seven days of doxazosin dosing (see Table 4 and Figure 2).
There were nine and three outliers following administration of tadalafil 20 mg and placebo, respectively.
Dizziness was reported in another subject that began 25 minutes after dosing and lasted 1 day.
In the second doxazosin study, a single oral dose of tadalafil 20 mg was administered to healthy subjects taking oral doxazosin, either 4 or 8 mg daily.
Tadalafil was administered at either 8 a.
In this part, tadalafil or placebo were administered at either 8 a.
Of the 24 subjects in part C, 16 subjects were categorized as outliers following administration of tadalafil and 6 subjects were categorized as outliers following placebo during the 24-hour period after 8 a.
During the 24-hour period after 8 p.
Blood pressure was measured manually pre-dose at two time points (-30 and -15 minutes) and then at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12 and 24 hours post dose on the first day of each doxazosin dose, (1 mg, 2 mg, 4 mg), as well as on the seventh day of 4 mg doxazosin administration.
Hg at one or more time points) following administration of tadalafil 10 mg, 20 mg, and placebo, respectively.
Hg) following administration of tadalafil 20 mg.
In both these studies, all patients imbibed the entire alcohol dose within 10 minutes of starting.
When tadalafil 20 mg was administered with a lower dose of alcohol (0.
The mean difference in total exercise time was 3 seconds (tadalafil 10 mg minus placebo), which represented no clinically meaningful difference.
Three studies were conducted in men to assess the potential effect on sperm characteristics of tadalafil 10 mg (one 6 month study) and 20 mg (one 6 month and one 9 month study) administered daily.
In the study of 10 mg tadalafil for 6 months and the study of 20 mg tadalafil for 9 months, results showed a decrease in mean sperm concentrations relative to placebo, although these differences were not clinically meaningful.
This effect was not seen in the study of 20 mg tadalafil taken for 6 months.
In addition there was no adverse effect on mean concentrations of reproductive hormones, testosterone, luteinizing hormone or follicle stimulating hormone with either 10 or 20 mg of tadalafil compared to placebo.
CIALIS may be taken with or without food.
Elimination - The mean oral clearance for tadalafil is 2.
Cmax was 5% lower than that observed in healthy subjects.
In mice and rats, lymphoid necrosis and hemorrhage were seen in the spleen, thymus, and mesenteric lymph nodes at unbound tadalafil exposure of 2- to 33-fold above the human exposure (AUCs) at the MRHD of 20 mg.
In dogs, an increased incidence of disseminated arteritis was observed in 1- and 6-month studies at unbound tadalafil exposure of 1- to 54-fold above the human exposure (AUC) at the MRHD of 20 mg.
In a 12-month dog study, no disseminated arteritis was observed, but 2 dogs exhibited marked decreases in white blood cells (neutrophils) and moderate decreases in platelets with inflammatory signs at unbound tadalafil exposures of approximately 14- to 18-fold the human exposure at the MRHD of 20 mg.
CIALIS, when taken as needed up to once per day, was shown to be effective in improving erectile function in men with erectile dysfunction (ED).
CIALIS was studied in the general ED population in 7 randomized, multicenter, double-blinded, placebo-controlled, parallel-arm design, primary efficacy and safety studies of 12-weeks duration.
In these 7 trials, CIALIS was taken as needed, at doses ranging from 2.
Several assessment tools were used to evaluate the effect of CIALIS on erectile function.
The 3 primary outcome measures were the Erectile Function (EF) domain of the International Index of Erectile Function (IIEF) and Questions 2 and 3 from Sexual Encounter Profile (SEP).
SEP Question 2 asks, "Were you able to insert your penis into the partner's vagina?
SEP Question 3 asks, "Did your erection last long enough for you to have successful intercourse?
Study B was conducted primarily in community-based urology practices.
The treatment effect of CIALIS did not diminish over time.
US included 1112 patients, with a mean age of 59 years (range 21 to 82 years).
CIALIS did not diminish over time.
In addition, there were improvements in EF domain scores, success rates based upon SEP Questions 2 and 3, and patient-reported improvement in erections across patients with ED of all degrees of disease severity while taking CIALIS, compared to patients on placebo.
Therefore, in all 7 primary efficacy and safety studies, CIALIS showed statistically significant improvement in patients' ability to achieve an erection sufficient for vaginal penetration and to maintain the erection long enough for successful intercourse, as measured by the IIEF questionnaire and by SEP diaries.
ED in patients with diabetes mellitus.
Two studies were conducted to assess the efficacy of CIALIS at a given timepoint after dosing, specifically at 24 hours and at 36 hours after dosing.
In the first of these studies, 348 patients with ED were randomized to placebo or CIALIS 20 mg.
The results demonstrated a difference between the placebo group and the CIALIS group at each of the pre-specified timepoints.
In the second of these studies, a total of 483 patients were evenly randomized to 1 of 6 groups: 3 different dosing groups (placebo, CIALIS 10, or 20 mg) that were instructed to attempt intercourse at 2 different times (24 and 36 hours post-dosing).
In this study, the results demonstrated a statistically significant difference between the placebo group and the CIALIS groups at each of the pre-specified timepoints.
At the 24-hour timepoint, the mean, per patient percentage of attempts resulting in successful intercourse were 42, 56, and 67% for the placebo, CIALIS 10-, and 20-mg groups, respectively.
At the 36-hour timepoint, the mean, per-patient percentage of attempts resulting in successful intercourse were 33, 56, and 62% for placebo, CIALIS 10-, and 20-mg groups, respectively.
The efficacy and safety of CIALIS for once daily use in the treatment of erectile dysfunction has been evaluated in 2 clinical trials of 12-weeks duration and 1 clinical trial of 24-weeks duration, involving a total of 853 patients.
CIALIS, when taken once daily, was shown to be effective in improving erectile function in men with erectile dysfunction (ED).
CIALIS was studied in the general ED population in 2 randomized, multicenter, double-blinded, placebo-controlled, parallel-arm design, primary efficacy and safety studies of 12- and 24-weeks duration, respectively.
CIALIS was taken once daily at doses ranging from 2.
Read this important information before you start taking CIALIS and each time you get a refill.
You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups.
What Is The Most Important Information I Should Know About CIALIS?
Do not take CIALIS if you take any medicines called "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.
See "Can Other Medicines Affect CIALIS?
See also "What Are The Possible Side Effects Of CIALIS?
CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.
CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity.
Some form of sexual stimulation is needed for an erection to happen with CIALIS.
CIALIS is not for women or children.
CIALIS must be used only under a healthcare provider's care.
See "What Is The Most Important Information I Should Know About CIALIS?
What Should I Tell My Healthcare Provider Before Taking CIALIS?
CIALIS is not right for everyone.
CIALIS or any of its ingredients.
CIALIS and other medicines may affect each other.
Take CIALIS exactly as your healthcare provider prescribes it.
CIALIS and your health condition.
Do not take CIALIS more than one time each day.
Take one CIALIS tablet before you expect to have sexual activity.
Take one CIALIS tablet every day at about the same time of day.
What Should I Avoid While Taking CIALIS?
Call your healthcare provider if you get any side effect that bothers you or one that will does not go away.
An erection that won't go away (priapism).
If you get an erection that lasts more than 4 hours, get medical help right away.
In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS) reported a sudden decrease or loss of vision in one or both eyes.
If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS, and call a healthcare provider right away.
CIALIS and contact a healthcare provider right away.
These are not all the possible side effects of CIALIS.
Keep CIALIS and all medicines out of the reach of children.
Do not use CIALIS for a condition for which it was not prescribed.
Do not give CIALIS to other people, even if they have the same symptoms that you have.
This is a summary of the most important information about CIALIS.
You can ask your healthcare provider or pharmacist for information about CIALIS that is written for health providers.
What are The Ingredients in CIALIS?
IMPORTANT NOTE: This is a summary and does not contain all possible information about this product.
For complete information about this product or your specific health needs, ask your health care professional.
Always seek the advice of your health care professional if you have any questions about this product or your medical condition.
This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional.
This information does not contain any assurances that this product is safe, effective, or appropriate for you.
TADALAFIL - ORAL (tah-DA-la-fil) COMMON BRAND NAME(S): Cialis USES: Tadalafil is used to treat male sexual function problems (impotence or erectile dysfunction) by blocking a certain enzyme (phosphodiesterase-PDE5) in the body.
In combination with sexual stimulation, tadalafil helps blood flow into the penis to achieve and maintain an erection.
This drug is not indicated for use in women.
Use of this drug does not protect against sexually transmitted diseases (e.
HIV, hepatitis B, gonorrhea, syphilis).
Consult your doctor or pharmacist for more details.
HOW TO USE: Read the patient information leaflet provided by your pharmacist and ask questions if any of the information is unclear.
Take this medication by mouth with or without food as directed by your doctor.
There are two ways that this drug may be prescribed and taken.
It may be taken as needed, or it may be taken once a day every day.
Your doctor will determine which is the best way for you to take this drug.
If used regularly every day, your doctor will prescribe a low dose (usually 2.
When this drug is taken only as needed, the dosing may need to be higher.
Never take more of this drug than prescribed because you may experience serious side effects.
Your doctor will adjust your dosage based on your response and other medications you may be taking (see also Drug Interactions section).
Therefore, do not take more than once daily as needed.
When taken regularly every day, you may attempt sexual activity at any time between your doses.
Do not take more than one dose each day.
Avoid eating grapefruit or drinking grapefruit juice while being treated with this medication unless your doctor instructs you otherwise.
Grapefruit juice can increase the amount of certain medications in your bloodstream.
SIDE EFFECTS: Headache, stomach upset, back pain, muscle pain, nasal stuffiness, flushing, pain in arms or legs, dizziness, or vision changes may occur.
If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.
Many people using this medication do not have serious side effects.
Rarely, a sudden loss of eyesight in one or both eyes (NAION) may occur.
This may or may not be due to tadalafil.
If this serious problem occurs, seek immediate medical attention.
Sexual activity may put extra strain on your heart, especially if you have heart problems.
If you have heart problems or experience any of the following serious side effects during sex, stop and seek immediate medical attention: severe dizziness, fainting, chest pain.
For males, in the very unlikely event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and seek immediate medical attention, or permanent problems could occur.
Rarely, tadalafil may cause sudden hearing problems, or ringing in the ears.
Stop taking this medication and tell your doctor immediately if these effects occur.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs.
Symptoms of a serious allergic reaction include: rash, itching, unusual swelling, severe dizziness, trouble breathing.
This is not a complete list of possible side effects.
If you notice other effects not listed above, contact your doctor or pharmacist.
Contact your doctor for medical advice about side effects.
The following numbers do not provide medical advice, but in the US you may report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088.
In Canada, you may call Health Canada at 1-866-234-2345.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: penis conditions (e.
To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.
This drug is not indicated for use in women or children.
DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.
Do not start, stop, or change the dosage of any medicine before checking with them first.
See also How To Use section for drug-food interactions.
This drug should not be used with the following medications because very serious (possibly fatal) interactions may occur: nitrates (e.
If you are currently using any of these medications, tell your doctor or pharmacist before starting tadalafil.
CYP 3A4 substrates, inhibitors and inducers such as cimetidine, rifamycins, St.
If you are also taking certain drugs (potent inhibitors of CYP3A4 such as fosamprenavir, amprenavir, ritonavir, nelfinavir, erythromycin, ketoconazole, itraconazole), you must place special limits on your use of tadalafil to reduce the risk of severe dizziness.
If you are taking tadalafil as needed, do not take more than one 10-milligram dose of tadalafil in a 72-hour period.
If you are taking tadalafil once a day, do not take more than 2.
Contact your doctor or pharmacist for more details.
This document does not contain all possible interactions.
Therefore, before using this product, tell your doctor or pharmacist of all the products you use.
Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately.
US residents can call the US national poison hotline at 1-800-222-1222.
Canadian residents should call their local poison control center directly.
NOTES: Do not share this medication with others, since they may have a problem that is not effectively treated by this drug, or they may have a condition that is complicated by this drug.
MISSED DOSE: If you are taking this medication on a regular schedule and you miss a dose, take it as soon as you remember.
If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule.
Do not double the dose to catch up.
STORAGE: Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture.
Brief storage between 59 and 86 degrees F (15-30 degrees C) is permitted.
Keep all medicines away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so.
Properly discard this product when it is expired or no longer needed.
Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Now you can gain knowledge and insight about a drug treatment with Patient Discussions.
Here is a collection of user reviews for the medication Cialis sorted by most helpful.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit the FDA MedWatch website or call 1-800-FDA-1088.
Urgency, Strain, Lack of Control...
Quiz: How Severe Are Your BPH Symptoms?
HCl 10 mg extended-release tablets) is an alpha1-blocker for the treatment of the signs and symptoms of BPH.
Do not take UROXATRAL if you have liver problems or if you are taking antifungal drugs like ketoconazole or itraconazole, or HIV drugs like ritonavir.
UROXATRAL can cause a sudden drop in blood pressure, especially when starting treatment.
This may lead to fainting, dizziness, and lightheadedness.
Do not drive, operate machinery, or do any dangerous activity until you know how UROXATRAL will affect you.
This is especially important if you already have a problem with low blood pressure or take medicines to treat high blood pressure.
There may be an increased risk of low blood pressure and fainting when taking UROXATRAL in combination with blood pressure medication or nitrates, or erectile dysfunction medication.
If considering cataract surgery (clouding of the eyes), tell your eye surgeon that you are currently taking UROXATRAL or have previously been treated with an alpha-blocker.
Before taking UROXATRAL, tell your doctor if you have kidney problems.
Also, tell your doctor if you or any family member(s) have or take medications for a rare heart condition known as congenital prolongation of the QT interval.
BPH and prostate cancer can cause the same symptoms.
However, UROXATRAL is not a treatment for prostate cancer.
The most common side effects with UROXATRAL are dizziness, upper respiratory tract infection, headache, and tiredness.
Please see UROXATRAL full prescribing information.
Get tips to boost your love life.
Healthy Home: To Buy or Not to Buy Organic?
RxList does not provide medical advice, diagnosis or treatment.
For a Central Asian kingdom, see Karasahr.
It initially was developed by the biotechnology company ICOS, and then again developed and marketed world-wide by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company.
Cialis tablets, in 5 mg, 10 mg, and 20 mg doses, are yellow, film-coated, and almond-shaped.
The approved dose for pulmonary arterial hypertension is 40 mg, and is marketed under the brand name Adcirca.
In December 2003, the Food and Drug Administration approved tadalafil (as Cialis) for sale in the United States as the third ED prescription drug pill (after sildenafil citrate (Viagra) and vardenafil (Levitra)).
Cialis is the only one of the three that is also offered as a once-daily medication.
Moreover, tadalafil was approved in May 2009 in the United States for the treatment of pulmonary arterial hypertension and is currently under regulatory review in other regions for this condition.
The FDA's approval of Viagra on 27 March 1998 was a ground-breaking commercial event for the treatment of ED, with sales exceeding one billion dollars.
Subsequently, the FDA approved Levitra (vardenafil) on 19 August 2003, and Cialis (tadalafil) on 21 November 2003.
In 1993, the Bothell, Washington, biotechnology company ICOS Corporation began studying compound IC351, a phosphodiesterase type 5 (PDE5) enzyme inhibitor.
In 1994, Pfizer scientists discovered that sildenafil, which also inhibits the PDE5 enzyme, caused penile erection in men participating in a clinical study of a heart medicine.
Although ICOS scientists were not testing compound IC351 for treating ED, they recognized its potential usefulness for treating that disorder.
Soon, in 1994, ICOS received a patent for compound IC351 (structurally unlike sildenafil and vardenafil), and Phase 1 clinical trials began in 1995.
In 1997, the Phase 2 clinical studies were initiated for men experiencing ED, then progressed to the Phase 3 trials that supported the drug's FDA approval.
Glaxo let the agreement lapse in 1996 as the drugs developed were not in the company's core markets.
In 1998, ICOS Corporation and Eli Lilly and Company formed the Lilly ICOS, LLC, joint venture company to further develop and commercialize tadalafil as a treatment for ED.
Two years later, Lilly ICOS, LLC, filed a New Drug Application with the FDA for compound IC351 (under the tadalafil generic name, and the Cialis brand name).
In May 2002, Lilly ICOS reported to the American Urological Association that clinical trial testing demonstrated that tadalafil was effective for up to 36 hours, and one year later, the FDA approved tadalafil.
One advantage Cialis has over Viagra and Levitra is its 17.
In 2007, Eli Lilly and Company bought the ICOS Corporation for 2.
Persons surnamed "Cialis" objected to Eli Lilly and Company's so naming the drug, but the company has maintained that the drug's trade name is unrelated to the surname.
Although sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) all work by inhibiting PDE5, tadalafil's pharmacologic distinction is its longer half-life (17.
Furthermore, the longer half-life is the basis for current investigation of tadalafil's daily therapeutic use in relieving pulmonary arterial hypertension.
Currently, sildenafil (trade name Revatio) is approved in several world regions as a thrice-daily therapy for pulmonary arterial hypertension.
Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum.
Cyclic GMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.
Tadalafil (and sildenafil and vardenafil) inhibits PDE5, however, because sexual stimulation is required to initiate the local penile release of nitric oxide, tadalafil's inhibition of PDE5 will have no effect without direct sexual stimulation of the penis.
The recommended Cialis starting dose for most men is 10 mg, taken as needed before sexual activity (but not more than once daily).
The dose may be increased to 20 mg or decreased to 5mg, per its efficacy and the man's personal tolerance of the drug.
To avoid the inconvenience of a man having to program and plan using Cialis around the time of his anticipated sexual activity, Lilly ICOS began a clinical development program to evaluate the risks and benefits of chronic, once-daily use of the drug.
In June 2007, the European Commission approved low-dose (2.
Cialis to be used as single-daily ED therapy.
Moreover, tadalafil at a dose of 40 mg once daily has been approved in the United States in May 2009 for treating pulmonary arterial hypertension, and marketing approval in Canada, Mexico, Japan, and the European Union is pending.
NO system in the pulmonary vasculature that favours selective vasoconstriction of the pulmonary arteries.
Investigation of tadalafil in this disease presumes that inhibiting PDE5 will effect pulmonary artery vasodilation, thus lowering pulmonary arterial pressure and pulmonary vascular resistance.
These physiologic changes may then reduce the workload of the heart's right ventricle.
Right heart failure and pulmonary oedema are the principal consequences of pulmonary arterial hypertension.
The most common side effects when using tadalafil are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
These side effects reflect the ability of PDE5 inhibition to vasodilate (cause blood vessels to widen) and usually go away after a few hours.
Back pain and muscle aches can occur 12 to 24 hours after taking the drug, and the symptom usually disappears after 48 hours.
Food and Drug Administration found that tadalafil (along with other PDE5 inhibitors) was associated with vision impairment related to NAION (non-arteritic anterior ischemic optic neuropathy) in certain patients taking these drugs in the post-marketing (outside of clinical trials) setting.
Given the small number of NAION events with PDE5 use (less than 1 in 1 million), the large number of users of PDE5 inhibitors (millions) and the fact that this event occurs in a similar population to those who do not take these medicines, the FDA concluded that they were not able to draw a cause and effect relationship, given these patients underlying vascular risk factors or anatomical defects.
However, the label of all three PDE5 inhibitors was changed to alert clinicians to a possible association.
In October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including tadalafil, requires a more prominent warning of the potential risk of sudden hearing loss as the result of postmarketing reports of deafness associated with use of PDE5 inhibitors.
Since PDE5 inhibitors such as tadalafil may cause transiently low blood pressure (hypotension), organic nitrates should not be taken for at least 48 hours after taking the last dose of tadalafil.
Using organic nitrites (such as the sex drug amyl nitrite) within this timeframe may increase the risk of life-threatening hypotension.
Since people who have taken tadalafil within the past 48 hours cannot take organic nitrates to relieve angina (such as glyceryl trinitrate spray), these patients should seek immediate medical attention if they experience anginal chest pain.
In the event of a medical emergency, paramedics and medical personnel should be notified of any recent doses of tadalafil.
Tadalafil, sildenafil, and vardenafil all act by inhibiting the PDE5 enzyme.
These drugs also inhibit other PDE enzymes.
Sildenafil and vardenafil inhibit PDE6, an enzyme found in the eye, more than tadalafil.
Some sildenafil users see a bluish tinge and have a heightened sensitivity to light because of PDE6 inhibition.
Sildenafil and vardenafil also inhibit PDE1 more than tadalafil.
PDE1 is found in the brain, heart, and vascular smooth muscle.
It is thought that the inhibition of PDE1 by sildenafil and vardenafil leads to vasodilation, flushing, and tachycardia.
Tadalafil inhibits PDE11 more than sildenafil or vardenafil.
PDE11 is expressed in skeletal muscle, the prostate, the liver, the kidney, the pituitary gland, and the testes.
The effects on the body of inhibiting PDE11 are not known.
The FDA relaxed rules on prescription drug marketing in 1997, allowing advertisements targeted directly to consumers.
Lilly-ICOS hired the Grey Worldwide Agency in New York, part of the Grey Global Group, to run the Cialis advertising campaign.
Cialis ads have been gentler and warmer than its rivals' ads to reflect the longer duration of the drug, allowing a more relaxed approach.
Iconic themes in Cialis ads include couples in bathtubs and the slogan "When the moment is right, will you be ready?
Cialis ads were unique among the ED drugs in mentioning specifics of the drug.
As a result, Cialis ads were also the first to describe the side effects in an advertisement, as the FDA requires advertisements with specifics to mention side effects.
One of the first Cialis ads aired at the 2004 Super Bowl.
Just weeks before the Super Bowl, the FDA required more possible side effects to be listed in the advertisement, including priapism.
Although many parents objected to the Cialis ad being aired during the Super Bowl, Janet Jackson's halftime "wardrobe malfunction" overshadowed Cialis.
Cialis, Viagra, and Levitra respectively.
Cialis has sponsored many golf events, including the America's Cup and the PGA Tour, once being title sponsor of the PGA Tour Western Open tournament.
The discovery of tadalafil: a novel and highly selective PDE5 inhibitor.
Richards, Rhonda (September 17, 1991).
ICOS At A Crest On Roller Coaster".
The Formula -- Bothell Biotech Icos Keeps The Pipeline Full Of Promise".
Drugs giant says its new pill will pack more punch than rival Viagra".
FDA Announces Revisions to Labels for Cialis, Levitra and Viagra".
Cialis: Warnings, Precautions, Pregnancy, Nursing, Abuse".
Potency, selectivity, and consequences of nonselectivity of PDE inhibition".
International Journal of Impotence Research 16: S11-4.
Elliott, Stuart (January 10, 2006).
For Impotence Drugs, Less Wink-Wink".
Elliott, Stuart (April 25, 2004).
Viagra and the Battle of the Awkward Ads".
D0CE2DB123AF936A15757C0A9629C8B63.
McCarthy, Shawn (March 5, 2005).
Ads for erectile dysfunction drug Cialis bared all - including a scary potential side effect.
It was risky but it has paid off".
Levitra Expects Approval Next Month, Cialis Later This Year".
This page was last modified on 27 December 2009 at 14:04.
ED tablet of your choice as prescribed by your doctor.
That's the CIALIS Promise Program.
Not all men with ED have the same needs.
That's why CIALIS offers two dosing options.
Talk with your doctor to decide whether CIALIS for daily use or 36-hour CIALIS is right for you.
CIALIS Free Trial Voucher and the CIALIS Promise Program Card.
CIALIS is only approved for the treatment of ED (erectile disfunction) in men.
While CIALIS is not approved for use in females, this voucher can be downloaded for partner use.
Which of the following best describes you or your partner?
Eli Lilly and Company will not sell or rent your personally identifiable information from the CIALIS Promise Program to third parties for their marketing use.
I have read and accept the terms listed above.
Only your healthcare provider and you can decide if CIALIS is right for you.
After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days.
CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension.
Do not take both CIALIS and ADCIRCA.
Do not use other ED medicines or ED treatments while taking CIALIS.
Do not drink too much alcohol when taking CIALIS (for example, 5 glasses of wine or 5 shots of whiskey).
The most common side effects with CIALIS are: headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
Men who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS.
Call your healthcare provider if you get any side effect that bothers you or one that does not go away.
If you have a sudden decrease or loss of vision or hearing, stop taking any ED tablet, including CIALIS and call your doctor right away.
In addition, the green brushstroke resembles a "C".
Note the characteristic imprint markings and almond shaped tablet.
Note the atypical round tablet shape and lack of imprint markings.
Please Note: We do not accept ads for generic Cialis on this page.
We only sell genuine Cialis made in the USA not that generic crap from India or China.
Our Customer Service Reps Speak Perfect English!!!
Leading Online Pharmacy Since 2002, and only promotes FDA-approved Cialis.
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Where Are The Best Places to Buy Cialis Online?
Where is the best place to buy Cialis online?
Before writing this page, we investigated the top websites that sell Cialis online.
We keep this information up-to-date, so all shoppers should find the prices current.
After doing research we found out that convenience, privacy, and Authentic Medications are the reason shoppers chose some websites over others.
If you are looking for genuine, brand-name Cialis Online manufactured by Eli Lilly, I recommend AccessRx.
They have been in business since 1998.
They are located in the USA in Tempe Arizona.
Bernstein takes his business seriously and takes pride in his company's track record and reputation.
They have a 24 hour telephone number for customer service.
They even have licensed physicians and pharmacists on staff to answer your medical questions.
Their prices are higher than the generics but you are assured of getting brand-name, American, FDA-Approved Cialis (and other medications) delivered to your door in a couple of days without having to go to a doctor.
More and more people are buying Cialis online.
In 2008 daily Cialis was launched, which should boost Cialis sales even further towards reaching Viagra.
There is no such thing as an FDA approved generic Cialis.
Eli Lilly 2007 annual report, p 41).
This means that Lilly has a legal monopoly on all versions of Cialis.
Q: What if I tried generic Cialis and it worked?
CSI expert this is not a realistic option.
Q: If it's not legitimate, why do they sell it?
The government considers generic Cialis to be an illegal substance.
The sellers are usually charged with mail fraud and or conspiracy to introduce misbranded drugs into interstate commerce in violation of the Federal Food, Drug, and Cosmetic Act.
Q: Where is the best place to buy Cialis Online?
Google the operation that is selling the Cialis.
You would be surprised to see what turns up.
Mexico and the Caribbean Basin.
The online pharmacy should have a physical address (not a just P.
Unites Stated or Canada and a working telephone number.
Speak with a customer service representative.
Ask a few questions such as, "what is your shipping policy?
What is the name of your supervising pharmacist?
If they sound fishy on the phone stay away.
A prescription should be required.
B) Mail or fax them a prescription.
C) Have them call your doctor to get a telephone prescription.
No Prescription Needed", that's a bad sign.
If you are looking for the authentic Brand Name Cialis, I recommend AccessRx.
They do not sell generic Cialis, which is good considering that it is illegal and dangerous to your health.
Their customer service representatives are available 6-days a week and they have licensed physicians and pharmacists on staff to answer your medical questions.
American, FDA-Approved Cialis delivered to your door conveniently in a couple of days without having to visit your own doctor.
Q: What is the correct dose and dosing regimen?
Q: How often can I take Cialis safely?
Beginning in January of 2008, Lilly began marketing Cialis in a different manner.
Cialis for every-day-administration is given in a lower dose - 2.
It can be taken from 30 minutes to 12 hours prior to sexual activity.
When an erection goes limp, you have PDE5 to thank.
The more cGMP available, the more Durable the erection.
Cialis inhibits the PDE5 enzyme, preserving cGMP levels, therefore aiding erection viability and durability.
Cialis is a member of a family of drugs known as PDE5 enzyme inhibitors.
Cialis has a long duration of action.
Cialis blocks an enzyme that causes an erection to go flaccid.
Cialis is a member of a family of drugs called PDE5 Inhibitors.
Eventually, Lilly bought out Icos.
The more cGMP, the more robust and durable the erection.
How Does Cialis Compare To Viagra and Levitra?
One huge difference is that Cialis is used to tread erectile dysfunction as though it is a chronic condition.
As stated above, only Cialis is approved by the FDA to be taken once-per-day whether or not you are going to engage in sex.
Viagra, on the other hand, is only taken just before sex.
Here is a complete table that shows the difference between Viagra, Cialis, and Levitra.
Cialis and Viagra in slide show format.
Viagra focuses on depicting happy men in their ads.
Levitra uses a woman's testimonial and sports star Mike Ditka.
Cialis, which is more subtle and longer-lasting, focuses on the relationship ...
Editor's Note: Above report offers comparison between Cialis, Viagra and Levitra in terms of advertising.
Cialis is readily absorbed from the bloodstream.
Tadalafil is about 94% bound to plasma protein.
Tadalafil was achieved 2 hours post dose.
Efficacy of tadalafil may persist up to 24 hours post-dose.
Recent information published in scientific journals indicate that Cialis may be useful for treating lower urinary tract symptoms associated with benign enlargement of the prostate.
Of the doses studied, the 5 mg Cialis dose seemed to be the most appropriate dose.
CONCLUSIONS: Once daily tadalafil demonstrated clinically meaningful and statistically significant efficacy and it was well tolerated in men with benign prostatic hyperplasia lower urinary tract symptoms ...
See Also: Impotence Drug Eases Prostate Problems ...
Eli Lilly, the company that owns the rights to the drug tadalafil, shows a daily dose of the drug may help ease some of the urinary symptoms related to an enlarged prostate ...
Because of Cialis' effect on the cardiovascular system, researchers are looking into if it is beneficial to administer Cialis it to people who are susceptible to high altitude sickness.
See Also: Am J Physiol Heart Circ Physiol.
Evidence supportive of impaired myocardial blood flow reserve at high altitude in subjects developing high-altitude pulmonary edema ...
Cialis Prescribing Information ...
There has never been a Cialis recall so this page should be blank.
Questions and answers for Cialis, Cialis consumer drug information sheet.
Cialis News (from Google) recently published news regarding Cialis.
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Hypersensitivity reactions have been reported, including Stevens-Johnson syndrome and exfoliative dermatitis.
Cardiovascular: Physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity.
Treatments for erectile dysfunction, including CIALIS, should not be used in men for whom sexual activity is inadvisable as a result of their underlying cardiovascular status.
PDE5 inhibitors, including CIALIS, are mild systemic vasodilators.
While this effect should not be of consequence in most patients, physicians should consider this potential when prescribing CIALIS.
Patients with left ventricular outflow obstruction (e.
Class 2 in last 6 months), unstable angina or angina occurring during sexual activity.
CIALIS for once daily use provides continuous plasma tadalafil levels.
Physicians should consider this when evaluating the potential for interactions.
Combination with other PDE5 inhibitors: CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension.
Do not take both CIALIS and ADCIRCA or other PDE5 inhibitors.
CIALIS for once daily use: dose not to exceed 2.
Special Populations: For patients with severe hepatic impairment use of CIALIS is not recommended.
For patient with severe renal impairment CIALIS for daily use is not recommended.
Additional dose adjustments may be required for mild and moderate renal and hepatic impairment or with other concomitant medications.
See Dosing Guidelines and full Prescribing Information for complete dosing instructions.
Prolonged Erection: There have been rare reports of priapism with this class of compounds.
Patients should be advised to seek immediate medical attention should this occur.
Use CIALIS with caution in patients who have conditions that might predispose them to priapism.
It is not possible to determine whether these events are related directly to the medicines, other health conditions, or to a combination of these.
If a patient experiences a sudden decrease or loss in vision or hearing he should stop taking CIALIS, and call a healthcare provider right away.
This site is intended for use by healthcare professionals in the United States only.
View Important Safety Information.
View Full Prescribing Information.
CIALIS is available in 20-mg, 10-mg, 5-mg, and 2.
The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability.
CIALIS for use as needed was shown to improve erectile function compared to placebo up to 36 hours following dosing.
CIALIS is the only PDE5 inhibitor with absorption not affected by high-fat foods.
Concomitant use of potent inhibitors of CYP3A4 (e.
For additional details on dosing and administration of CIALIS, see the full Prescribing Information.
Based on data regarding rate and extent of absorption taken from studies of healthy subjects described in product labels and not based on head-to-head clinical studies.
The clinical significance of these effects has not been studied.
All PDE5 inhibitors can be taken with or without food.
We provide helpful information ragarding medications you need: dosage, side effects, prescriptions, prices on the web, and more customer information.
Tadalafil (brand name Cialis) is prescribed for oral use in case of certain sexual problems in men, most often impotence, and in other cases of erectile dysfunction, as prescribed by a doctor.
Tadalafil is used for treating certain sexual problems in men, most often impotence, and for treating other cases of erectile dysfunction, as prescribed by a doctor.
Tadalafil has gained its high popularity among clients for its 36-hours lasting effect and high safety notes.
Before using Tadalafil you are strongly recommended to consult your doctor about the preferable dose and possible side effects and drug interactions.
Carefully read the label on the drug before use!
Take Tadalafil from 30 minutes up to 12 hours before the contact, in case if you take it by necessity.
If you take Cialis each day, just follow your own schedule of the drug use.
Cialis works for 36 hours - do not take 2 or more doses a day (or at once), as it may cause serious side effects.
The drug dose taken by necessity is usually 10 mg, the drug dose for daily use is usually 5 mg.
Cialis is a phosphodiesterase inhibitor.
It increases the flow of blood into the penis thus maintaining and strengthening an erection in case of sexual stimulation.
Check the prices, and if you are satisfied, click on any of the buttons to proceed to the original shop.
Tadalafil: Information from Answers.
Tadalafil Oral tabletWhat is this medicine?
TADALAFIL (tah DA la fil) is used to treat erection problems in men.
What should I tell my health care provider before I take this medicine?
How should I use this medicine?
Take this medicine by mouth with a glass of water.
Follow the directions on the prescription label.
You may take this medicine with or without meals.
The dose is usually taken 30 to 60 minutes before sexual activity.
You should not take this dose more than once per day.
Do not take your medicine more often than directed.
Talk to your pediatrician regarding the use of this medicine in children.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you.
Do not share this medicine with others.
What may interact with this medicine?
This list may not describe all possible interactions.
Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use.
Also tell them if you smoke, drink alcohol, or use illegal drugs.
Some items may interact with your medicine.
What should I watch for while using this medicine?
If you notice any changes in your vision while taking this drug, call your doctor or health care professional as soon as possible.
Stop using this medicine and call your health care provider right away if you have a loss of sight in one or both eyes.
Contact you doctor or health care professional right away if the erection lasts longer than 4 hours or if it becomes painful.
This may be a sign of serious problem and must be treated right away to prevent permanent damage.
If you experience symptoms of nausea, dizziness, chest pain or arm pain upon initiation of sexual activity after taking this medicine, you should refrain from further activity and call your doctor or health care professional as soon as possible.
Do not drink alcohol to excess (examples, 5 glasses of wine or 5 shots of whiskey) when taking this medicine.
When taken in excess, alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate or lowering your blood pressure.
Using this medicine does not protect you or your partner against HIV infection (the virus that causes AIDS) or other sexually transmitted diseases.
What side effects may I notice from receiving this medicine?
This list may not describe all possible side effects.
Where should I keep my medicine?
Keep out of the reach of children.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F).
Throw away any unused medicine after the expiration date.
Important Disclaimer: The drug information provided here is for educational purposes only.
It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional.
This drug information does not cover all possible uses, precautions, side effects and interactions.
It should not be construed to indicate that this or any drug is safe for you.
Consult your medical professional for guidance before using any prescription or over the counter drugs.
This entry is from Wikipedia, the leading user-contributed encyclopedia.
How long do the effects of tadalafil last?
Can you eat tadalafil tablets while you plan for baby?
Cure for allergic reaction to tadalafil?
Can you take tadalafil tablets while you plan for baby?
How would tadalafil show up on a drug screening?
It uses material from the Wikipedia article "Tadalafil".
Is there a generic form of tadalafil?
What does a tadalafil tablet look like?
Where to get Tadalafil Tablets in mumbai?
Several years ago the impotence drugs Viagra and Cialis and Levitra have been associated with a form of eye damage.
It even could cause suddent blindness.
Concerns about the side effects associated with Cialis, emerged four years ago.
FDA received some data on the number of men suffering from a rare vision disorder aftr taking anti impotence drugs.
In July 2005 the FDA required that information about the risk of eye disease to be added to the labels for Viagra, Cialis and Levitra.
People who take these drugs were warned to stop taking them and to contact their doctors if they experienced sudden vision loss or decreased vision in one or both eyes.
Latest research made by Eli Lilly, maker of the well known ED drug Cialis (Tadalafil), shows that all attempts to link eye disease and ED drugs are unreasonable.
The latest study led on men under 65 years old did not revealed vision side effects.
Researchers observed 244 men between 30 and 65.
Equal parts of them used Cialis, Viagra and a placebo during 6 months.
USA that are unable to achieve an erection and for 16.
The researchers have realized that the results may be not the same in men with diabetes or other serious health conditions.
Cialis Eases Erectile Dysfunction After Spinal Cor...
An adult signature is required upon delivery.
Accurate information is required before any physician can write a prescription for any illness or condition.
If you are declined there will be no charge to you.
If you miss a dose, do not double the next dose.
C) away from light and moisture.
KwikMed is a trademark of Phoenix Capital Management.
Cialis may rival Viagra as a treatment for erectile dysfunction.
The launch of Viagra, the world's first treatment for impotency, was an instant success.
Now, Eli Lilly and ICOS Corporation (Lilly Icos) have tapped into the vast demand for Viagra with a new drug called Cialis, Viagra's first direct competitor.
The market for Cialis is huge - following the runaway success of Viagra.
An estimated 30 million men in the US and 175 million worldwide suffer from erectile dysfunction, and only a fraction are currently using Viagra.
Viagra, Cialis, Levitra and other second-generation treatments.
As with Viagra, Cialis is likely to be used as a performance enhancer, rather than just as treatment for an ailment.
All these impotence drugs block an enzyme called phosphodiesterase 5 (PDE-5), which relaxes smooth some kinds of muscle cells and allows increased blood flow into the penis.
Cialis has key advantages over Viagra and could develop blockbuster status.
Cialis is available on prescription in the UK, Germany, Denmark, Finland, Sweden and Australia.
Cialis has yet to be approved in the US.
Cialis can last for two daysCialis starts working faster than Viagra, sometimes in 16 minutes, and lasts 24 hours or more.
In contrast, Viagra usually works for only four hours after an hour's delay.
As with Viagra, 80% of men with erectile function are able to achieve an erection with Cialis use and three out of four are able to achieve sexual intercourse.
But in one Cialis study, 59% of previously impotent men were still able to have sex 36 hours after taking it.
The reason is that the body takes four times as long to get rid of Cialis than to eliminate Viagra.
The half-life of Viagra (time for blood levels to fall 50%) is 4 hours compared to 17 hours for Cialis.
That means 25% of a Cialis dose is still present in the body after 35 hours, and 12.
It also means that Cialis will accumulate in the body if taken regularly.
Cialis can build up in the bodySomeone using one Cialis tablet every two days will find Cialis levels go on rising to reach a steady state after about a week.
On day 2, when taking a second tablet around 20% of the original tablet is still in the blood stream.
On day 4, 22% of a single dose will still remain.
So someone who finds a single dose still has an effect after 36 hours could in theory find that a tablet every other day enables them to have sex whenever they wish without fear of failure - assuming reasonable intervals before doing so.
Of course, other factors are important such as the possibility of more continuous or more serious side effects - after a single dose 14% experience headaches and 9% heartburn.
Taking Cialis in such a way should not be considered by anywone under any circumstances without close medical supervision and advice.
In France, it has been dubbed 'Le Weekend' pill.
Unlike Viagra, Cialis does not interact with with food or alcohol - Viagra is best taken on an empty stomach.
Bayer's Levitra is expected to launch in 2003.
Pfizer is trying to block US launches of Cialis and Levitra, but similar legal action in Europe failed on the grounds that the information to be patented was already in the public domain.
As with Viagra, many will be watching to see if Cialis has a roled to play in enhancing sexual function in women.
In the majority of cases they are likely to be disppointed since the female sexual response is complex: there is far more to a fulfilling, satisfying and exciting sex life than mere pharmacology, and this is also important in the majority of men.
Drugs - what is substance abuse?
Javacript is required for help and viewing images.
Keith, yes it was approved for taking it every day.
I take every other day and Cialis has been working great for me.
I recently saw an ad on TV claiming that Cialis can be taken everyday or something to that effect.
You need to consult your own physician about suitable dose for you, risks, side effects, frequency and so on.
You could also look at guidance on the manufacturer's website.
Do you have special like cialis and viagra offers?
Thanks - The only product sold on this site is my books - see www.
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Cialis gives you the freedom to choose the ED treatment that suits you best.
Talk to your doctor to see if a Cialis option is right for you.
PDE5 inhibitor (oral prescription treatment for ED).
PRESCRIPTION MEDICINE for the treatment of erection problems in men.
A charge applies, you will need to pay for this medicine.
Consult your doctor if Cialis is right for you.
Sexual stimulation is required for Cialis to work.
Do not use when taking nitrates for angina or where there is known heart disease like heart failure or heart rhythm disturbances, low or uncontrolled blood pressure.
Use with caution when taking alpha 1 blockers such as doxazosin.
Caution in kidney or liver disease or conditions which predispose to persistent erection of the penis like certain blood disorders.
Always read the label, use strictly as directed and if symptoms persist or you have side effects see your doctor.
Maximum daily dose 5mg for continuous daily use.
Maximum daily dose 20mg for on-demand use.
For further product information check www.
On this site, we give you everything you need to know about this medication.
In addition, we give you a wide range of different articles about Cialis itself, and about the situation in which you and your partner may find yourselves.
You should make the time to read the articles.
There is no substitute for getting the best information available both about erectile dysfunction itself, and the treatment for it.
On this site, we also offer you the reliable online pharmacies (OP) where you can order Cialis or generic Cialis under the name Tadalafil without having to worry about being cheated.
We have thoroughly investigated all these OPs and have chosen them as the most reliable pharmacies on the web.
You no longer have to fear the embarrassment of having to go to your neighbourhood pharmacy to collect this medication.
Choose the online pharmacy that fits your needs and order Cialis online.
All these OPs are NROPs which means that they do not have to see your medical records.
They are allowed to prescribe medications based on the answers you give to an online medical questionnaire.
Cialis is the only erectile dysfunction prescription medicine that has been clinically proven not only to work fast, but also to last for up to thirty-six hours.
That is the longest time being offered by any erectile dysfunction drug on the market today.
Cialis is your one and only reliable partner to bring romance and relaxation back into your life.
Take this drug and it starts to work in as little as fifteen minutes and remains active for up to thirty-six hours.
In clinical studies, men with ED took CIALIS .
Why you should talk over certain problems with your doctor.
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It is a crystalline solid that is practically insoluble in water and the solubility in ethanol.
CIALIS is very slightly available like the film-had tablets, almond-shaped for administration.
CIALIS of the DOSAGE and the ADMINISTRATION for the use as it needed the dose that begins recommended of CIALIS for the use as needed in the majority of the patients is magnesium 10, taken before anticipated sexual activity.
The dose can be increased to magnesium 20 or be fallen to magnesium 5, based on individual effectiveness and tolerabilidad.
The frequency of recommended dosage maximum is once per day in the majority of patients.
Therefore, when advising to patients in the optimal use of CIALIS, this one is due to consider.
CIALIS for the once daily use the dose that begins recommended of CIALIS for the once daily use is magnesium 2,5, taken in approximately equal daily time, without consideration some towards the synchronization of the sexual activity.
The dose of CIALIS for the once daily use can be increased to magnesium 5, based on individual effectiveness and tolerabilidad.
The use with FoodCIALIS can be taken without consideration some towards the food.
A dose that begins of magnesium 5 per day recommends not more in one go, and the maximum permissible dose is due to limit magnesium 10 not more in one go on every 48 hours.
Hepatic weakening CIALIS for the smooth or moderate use like necessary (class To de Pugh of boy or B): The dose of CIALIS does not have to exceed magnesium 10 per day once.
The use of CIALIS per day has once not been evaluated extensively in patients with the hepatic shortage and therefore, the precaution is advised.
CIALIS for the smooth or once moderate daily use (class To de Pugh of boy or B): CIALIS for the once daily use has not been evaluated extensively in patients with the hepatic shortage.
Therefore, the precaution is advised if CIALIS for the once daily use prescribes these patients.
The molds alpha when CIALIS coadministered with a mold alpha, patients must be stable in therapy of the alpha-mold before initiating the treatment with CIALIS, and CIALIS is due to initiate in lower recommended inhibitors .
Eli Lilly and Company, Indianapolis, IN 46285, date of the Rev of USA.
INDIRECT EFFECT ExperienceBecause of the clinical studies are conducted extensively under diverse conditions, observed the adverse tariffs of the reaction in the clinical tests of a drug cannot be compared directly to the tariffs in the clinical tests of another drug and can not reflect the observed tariffs actually.
Tadalafil was administered envelope to 6550 men during clinical tests by everybody.
In tests of CIALIS for the once daily use, a total of 716, 389, and 115 was treated at least 6 months, 1 year, and 2 years, respectively.
For CIALIS for the use according to the needed thing, on 1300 and 1000 subjects were treated at least 6 months and 1 year, respectively.
CIALIS for the use according to the needed thing in eight placebo-controlled studies primary of phase 3 the duration of 12 weeks, age average era 59 years (range 22 to 88) and the tariff of discontinuation due to the adverse events in the patients dealt with 10 tadalafil or magnesium 20 was 3.
CIALIS for the daily use (magnesium 2,5 or 5) and once more frequent in the drug that placebo in a Placebo-Control study of phase 3 of 24 durations of the treatment of the weeks for CIALIS stops of the use the pain or mialgia once daily back was disclosed to the tariffs of described incidence in pictures 1 and the tests of the pharmacology of the tadalafil happened of 2.
In, clinical backache or mialgia generally 12 to 24 hours after dosing typically and resolute within 48 hours.
Description of Cialis which is Cialis?
ED is a condition where the penis does not harden and it is not extended when a man sexual is moved, or when he cannot keep an erection.
Cialis can help to a man with the ED to secure and to keep an erection when it sexual is moved.
Cialis is only for the men, it does not stop the women and the children, and it is due to only use underneath doctor' taken care of of s.
Cialis does not do: Increase of the ED of the treatment man' the sexual desire of s protects an O-Man to its sexual partner against - the transmitted diseases (STDs), including service of HIV as it forms masculine of birth control.
Cialis is done by Eli Lilly and Company, and was approved by the U.
Food and the administration of the drug (FDA) in 2003.
Although is other drugs in the market to deal to men there with ED, Cialis is different because it can work up to 36 hours after dosing.
The alarm of Cialis FDA in 2005, the FDA published an alarm for the men who used Cialis, Viagra, or Levitra.
This type of loss of the vision is called sudden loss of the previous ischaemic optical causes non-arteritic of neuropathy (NAION) .
NAION of view because the blood flow is blocked to the optical nerve.
The FDA still does not know if these drugs cause NAION, since this condition also happens in the men who do not take these medicines.
People who cause that one more a higher occasion of NAION includes to which: it has cardiac disease are during 50 years have diabetes to have high arterial tension to have rich cholesterol smoke to have certain problems of the eye that the FDA has approved the new labels for Cialis, Viagra, and Levitra to include the information on the possible loss of the view (NAION).
If you experience a loss in seen his, she stops using of these medicines, and secures the medical aid immediately.
Who does not have to take Cialis?
It uses recreational drugs called " poppers" , like amylic nitrate and butyl nitrate they have been said by its professional of the medical care not to have sexual activity due to the risks for the health of Cialis of the health problems that Cialis can cause the arterial pressure to fall suddenly at an uncertain level if it is taken with certain other medicines such as nitrates and alpha-molds, and the recreational drugs that contain the nitrates called " poppers.
The sudden drops in the arterial pressure can cause vertigos, on the point of passing out, the attack of the heart, or the movement.
The infrequent indirect effect of the use of Cialis include: An erection that will not go the absent changes of the vision (of priapism), such as to consider a blue dye to the objects or to have difficulty saying of the difference between the blue colors and the green common indirect effect of the use of Cialis it includes: The muscle of the backache of the indigestión of the headache hurts cleaning the nose with a congested water spurt or that moquea what must I say professional of the medical care?
You must say to all professionals who you take Cialis.
If that you need emergencia medical aid for a problem the heart, he from the medical care will be important so that their professionals of the medical care know when you took finally Cialis.
Cialis and certain other medicines can build reciprocally with one a.
It says to his professional of the medical care on all the medicines that you take - including medicines of the prescription and non-prescription, the herbal vitamins, and supplements.
Cialis - to secure legal aid whereas all the medications have certain advance indirect effect, a manufacturer of the drug must have to make its products so reasonably safe as it is possible, and to inform to the medical community and the public the risks known associated to his drugs.
If a manufacturer cannot do therefore, can be maintained legally responsible if they damage to the patients as a result of the inadequate warnings or of the dangerous desrazonable nature of the drug, under legal theory called " responsibility by the manufacture of a product.
If loved you or have undergone any dangerous symptoms or unusual ailments whereas she takes Cialis, you must first make contact with enemy with his doctor or to the other professional of the medical care.
You can also wish to find with a an experienced lawyer to discuss his options and to protect his right to a legal remedy for any injury caused by the use of Cialis.
He is going here to learn more on attorney' paper of s in a pharmaceutical case of the responsibility.
In order to find an experienced lawyer, it uses " It finds a Lawyer" the tool in the left side of this page, or chasca here.
It also sees: Because the drugs secure distances of the responsibility by the manufacture of a pharmaceutical product of the market the majority of the content arrives of the U.
Buy Cialis (Tadalafil) online at very competitive prices from 121doc.
Cialis is an oral treatment for erectile dysfunction, which has now been approved for sale within the E.
Cialis contains Tadalafil which is a PDE5 inhibitor.
Cialis Tadalafil is manufactured by Lilly ICOS LLC.
Cialis Tadalafil is the only erectile dysfunction treatment that has been clinically proven to work up to 36 hours.
Cialis (Tadalafil) is a safe prescription medication for impotence treatment but you can not buy Cialis without proper consultation and prescription from a registered medical practitioner.
Cialis (Tadalafil)works for long duration in quick time as it stays in your system for up to 36 hours.
Tadalafil in Cialis works by enabling blood regulation in penis resulting in firm erection.
When a man is sexually excited, his body normally reacts by increasing the blood flow to his penis.
ED occurs when the blood flow to the penis is diminished or lessened.
After Cialis Tadalafil is taken, your body starts responding within 30 minutes to an hour making it easier to achieve an erection.
Cialis will remain active within your body for following 36 hours, so achieving and maintaining an erection within this period will be easy.
Cialis Tadalafil has proven to improve erectile function in most men, even when men suffer with mild, moderate or severe erectile dysfunction.
Cialis has shown great promise with satisfactory results under clinical trials.
Cialis helps to boost your confidence by improving your ability with power to maintain hard and strong erection, which will give you the ultimate satisfaction during sexual intercourse.
Cialis (Tadalafil) allows you to respond to your partner at the right moment.
How does Cialis compare to Viagra?
What are the possible side effects of Cialis?
Cialis works faster than Viagra.
It starts its act in just 30 minutes time, where as Viagra take about an hour.
As Cialis stays in your body for 36hrs, it allows you to choose the right moment.
Cialis is available in 10mg and 20mg.
Cialis is taken usually 30 minutes to an hour prior to sexual intercourse and Cialis remain active in the body in the following 24-36 hours.
This means that Cialis allows you to achieve and maintain an erection easier than normal within this period.
Medicines and their possible side effects can affect individual people in different ways.
The following are some of the side effects that are known to be associated with Cialis.
Because a side effect is stated here, it does not mean that all people using Cialis will experience that or any side effect.
Though Cialis is a safe treatment, there are certain precautions to be taken.
Cialis (tadalafil) must not be taken with any form of nitrate medication, as this combination can produce a severe drop in blood pressure that can cause dizziness, fainting, or even a heart attack.
If Cialis is taken by people who are taking medicines for high blood pressure (antihypertensives), the combination may potentially cause an extra drop in blood pressure.
This is unlikely to be significant, but you should be aware that if it does occur it may make you feel dizzy.
The use of Cialis with other treatments for erectile dysfunction is not recommended, as the safety of such combinations has not yet been established.
The antifungal medicines ketoconazole and itraconazole.
The antibiotic medicines clarithromycin and erythromycin.
The HIV protease inhibitors ritonavir and saquinavir.
Tell your doctor if you are taking any of these as you may need a lower Cialis tadalafil dose.
Grapefruit juice taken with Tadalafil may also cause an increase in the blood level of tadalafil.
All trademarks and registered marks are the properties of their respective companies.
The medicine, Cialis is produced from Lilly ICOS LLC.
GPs and Pharmacists to assess you, the patient.
There is no hard sell or sensational claims made at ukmedix.
We hope you enjoy ukmedix and the amount of features we offer on Cialis.
Cialis please click here to contact our doctors directly.
They will be able to help you with any queries you may have.
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Bottom Line on how Cialis Works:When an erection goes limp, you have PDE5 to thank.
Specialized penis tissue produces a substance called cyclic guanosine monophosphate (cGMP) in response to sexual stimulation.
The more cGMP available, the more durable the erection.
Cialis inhibits the PDE5 enzyme, preserving cGMP levels, therefore aiding erection viability and durability.
Cialis received approval for use in the United States November 21, 2003.
Although Cialis is similar to Levitra and Viagra, its dose, onset of action, and duration of action is unique.
Cialis is now marketed in approximately 40 countries and is available by prescription in pharmacies on five continents.
Cialis was developed by Icos, a relatively small biotech company located in Washington State, in the United states.
The partnership is called Lilly Icos .
Where is the best place to buy Generic Cialis?
They have all the qualifications of a reputable online pharmacy:- They have been in business since 1998.
They have 24-hour online chat customer service and a 24-hour toll free telephone number for during normal business hours.
They get their generic Cialis from Cipla (the largest pharmaceutical company in India).
Cipla does business in more than 170 countries and their manufacturing facilities have been approved by the Food and Drug Administration (FDA).
Their prices are reasonable, and they have no membership fees.
Best of all, they have a money-back guarantee if you are not satisfied.
Few other sites have this policy.
They even have a guarantee whereby if your stuff gets confiscated by postal authorities, they will reship you a replacement for free.
I have purchased generic Cialis 20mg and other products from 4RX.
The BIG Discovery: cyclic guanosine monophosphate (cGMP) Some very smart scientists discovered that cyclic guanosine monophosphate (cGMP) was the key to sustaining an erection.
As long as there are sufficient levels of cGMP, the penis can remain erect.
If you inhibit the degradation of cGMP it stays around in the penis longer, producing a more durable erection.
Another way you can think of Cialis (and all other similar medicines) is that it preserves the elevated levels of cGMP that are created when a man is sexually stimulated for a stronger, more lasting erection.
That's how Cialis works - Cialis blocks the enzyme phosphodiesterase-5 (PDE5) which is responsible for the neutralization of cGMP.
Cialis (tadalafil) is a highly selective inhibitor of PDE5.
PDE5 is not the only phosphodiesterase involved in the erectile physiology but it appears to be the most important one).
The nice thing about PDE5 blockers is that they shouldn't cause erections at inappropriate times because they only block degradation of cGMP produced in reaction to sexual stimulation, such as thinking about something sexy.
If you are not being sexually stimulated, there is no cGMP to protect, so the drug remains in the background.
Maximum plasma concentration of Tadalafil was achieved 2 hours post dose.
The Cialis label states that It can be taken from 30 minutes to 12 hours prior to sexual activity.
Metabolism, Half Life, ExcretionCialis is mostly metabolized in the liver by an enzyme known as CYP3A4 and to a lesser extent CYPC2.
If you are going to take any of the PDE5 inhibitors such as Cialis, it is very important that your doctor be aware if you have a liver condition (such as cirrhosis) or kidney condition ( such as if you are on dialysis) because you may need a special dosage adjustment.
Likewise, if you try to obtain Cialis on the internet, please make sure that the person authorizing your prescription knows the true status of your liver function and your kidney function.
Dose:Cialis is available 10mg and 20mg tablets.
The recommended dose is 10mg taken prior to anticipated sexual activity and without regard to food.
In those patients in whom tadalafil 10mg does not produce an adequate effect, 20mg might be tried.
The efficacy of tadalafil may persist up to 24 hours post-dose.
The maximum recommended dose is one pill per day.
Cialis Information On The Internet:Cialis Price Check ...
Cialis Recall Information - up to date information regarding possible Cialis recalls if appropriate.
There has never been a Cialis recall.
Cialis talk paper, Cialis label, Cialia approval letter, Questions and answers for Cialis, Cialis consumer drug information sheet.
Cialis is different from other erectile dysfunction drugs, starting dose, metabolism, possible drug interactions, contraindications.
Cialis used for, how does it work, how is it different from similar drugs, how do you take cialis, common doses, etc.
Similar to the drugtore flyer you get when you pick up a prescription at the drugstore.
Cialis price comparison shoppingThere is a lot of competition between sites that sell Cialis.
This competition drives down the prices.
Here are the top internet websites that sell Cialis and similar products.
You can get a good price on Cialis if you comparison shop.
Warning: Make sure they have a customer service telephone number or customer service chat and test it out before you give them any credit card information.
That's the fastest way to spot a rip-off site.
CIALIS is the only prescription erectile dysfunction (ED) tablet clinically proven to both go to work fast, in as little as 30 minutes for some men, and work up to 36 hours.
With CIALIS, you can be ready when the moment is right.
This site is intended for use by United States residents only.
Updated safety information for oral ED medications, including CIALIS Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been reported in rare instances in men taking prescription ED tablets, including CIALIS.
If you experience these symptoms, stop taking CIALIS and contact a doctor right away.
Tell your doctor about your medical conditions and all medications, and ask if you're healthy enough for sexual activity.
Don't take CIALIS if you take nitrates, often prescribed for chest pain, as this may cause a sudden, unsafe drop in blood pressure.
Don't drink alcohol in excess (to a level of intoxication) with CIALIS, as this may increase your chances of getting dizzy or lowering your blood pressure.
CIALIS does not protect against sexually transmitted diseases, including HIV.
The most common side effects with CIALIS were headache and upset stomach.
Backache and muscle ache were also reported, sometimes with delayed onset.
As with any ED tablet, in the rare event of priapism (an erection lasting more than 4 hours), seek immediate medical help to avoid long-term injury.
In rare instances, men taking prescription ED tablets (including CIALIS) reported a sudden decrease or loss of vision.
It's not possible to determine if these events are related directly to the ED tablets or to other factors.
If you have a sudden decrease or loss of vision, stop taking any ED tablet and call your doctor right away.
Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been reported in rare instances in men taking prescription ED tablets, including CIALIS.
In clinical trials, CIALIS was shown to improve, up to 36 hours after dosing, the ability of men with ED to have a single successful intercourse attempt.
CIALIS has not been studied for multiple sexual attempts per dose.
For additional safety information, talk to your doctor about this medicine and see the full Patient Information.
Therapeutic considerations Pregnancy cat.
Tadalafil is an orally administered drug used to treat male erectile dysfunction (impotence).
It was initially developed by the biotechnology firm ICOS and subsequently developed and marketed worldwide by a joint venture of ICOS Corporation and Eli Lilly and Company (Lilly ICOS LLC) under the brand name Cialis.
In the United States, tadalafil has Food and Drug Administration approval and became available in December, 2003 as the third impotence pill after sildenafil (Viagra) and vardenafil (Levitra).
Due to its 36-hour effect it is also known as the weekend pill.
As with sildenafil and vardenafil, it is recommended that tadalafil be used no more than once daily.
Tadalafil is also currently undergoing Phase 3 clinical trials for the treatment of pulmonary arterial hypertension.
History The history of Cialis cannot be discussed without mentioning Pfizer's drug, Viagra (sildenafil).
The FDA's approval of Viagra on March 27, 1998, was a groundbreaking event for the treatment of erectile dysfunction and sales eventually reached over a billion dollars.
The FDA subsequently approved Levitra (vardenafil) on August 19, 2003, and Cialis (tadalafil) on November 21, 2003.
In 1993, the Bothell, Washington-based biotechnology company ICOS began studying IC351, which is a phosphodiesterase type 5 (PDE5) enzyme inhibitor.
In 1994, Pfizer scientists discovered that sildenafil citrate, which also inhibits the PDE5 enzyme, caused patients that were participating in a clinical study of a heart medicine to have erections.
Although the ICOS scientists were not testing the chemical compound IC351 for erectile dysfunction, it was recognized that the compound could have potential usefulness for the treatment of this disorder.
Soon ICOS received a patent in 1994 for IC351, which is structurally different from sildenafil (and vardenafil), and Phase 1 clinical trials began in 1995.
In 1997, Phase 2 clinical studies were initiated in patients with erectile dysfunction and led to pivotal Phase 3 trials that supported approval.
In 1998, ICOS Corporation and Eli Lilly and Company formed a joint venture (Lilly ICOS LLC) to further develop and commercialize the drug for erectile dysfunction, and two years later they filed a New Drug Application with the U.
Food and Drug Administration for IC351 (under the generic name tadalafil and the brand name Cialis).
In May of 2002, Lilly ICOS reported to the American Urological Association that clinical trial testing in men with erectile dysfunction showed that tadalafil works for up to 36 hours, and one year later tadalafil was approved.
One advantage that Cialis has over Viagra and Levitra is that tadalafil has a half-life of 17.
Cialis is advertised to work for up to 36 hours, after which time there is still about one quarter of the absorbed dose in the body) as compared to 4 hours half-life for sildenafil (Viagra).
Mechanism of action Although Viagra, Levitra, and Cialis all work by inhibition of PDE5, tadalafil's distinguishing pharmacologic feature is its longer half-life (17.
Viagra and Levitra (4-5 hours).
This longer half-life also is the basis of current investigation for tadalafil's use in pulmonary arterial hypertension as a once-daily therapy.
At present, sildenafil (trade name Revatio) is approved in various regions worldwide as a 3-times daily therapy for pulmonary arterial hypertension.
Tadalafil (as well as sildenafil and vardenafil) inhibits PDE5.
The recommended starting dose of Cialis in most patients is 10 mg, taken as needed before anticipated sexual activity (but no more than once daily).
To avoid the inconvience of men with erectile dysfunction needing to plan use of Cialis around anticipated sexual activity, Lilly ICOS embarked upon a clinical development program to evaluate the benefits and risks of chronic (once-a-day) use.
Cialis to be used as a once-a-day therapy for men with erectile dysfunction.
Tadalafil is currently undergoing clinical trials for the treatment of pulmonary arterial hypertension.
NO system in the pulmonary vasculature that favors selective vasoconstriction of the pulmonary artery.
Investigation of tadalafil in this disease assumes that PDE5 inhibition will result in pulmonary artery vasodilation, thus lowering pulmonary artery pressure and pulmonary vascular resistance.
These physiologic changes may then reduce the workload of the right ventricle of the heart.
Right heart failure is the main consequence of pulmonary arterial hypertension.
However, the label of all three PDE5 inhibitors was changed to highlight clinicians to a possible association.
Drug interactions Since PDE5 inhibitors such as tadalafil may cause transiently low blood pressure (hypotension), organic nitrates should not be taken for at least 48 hours after taking the last dose of tadalafil.
Marketing In the United States, Eli Lilly has a multiyear agreement to promote tadalafil (Cialis) with professional golf's PGA Tour.
Cialis is one of the most frequent offerings of E-mail spam.
Lilly's naming of the drug, but the company insists that the drug's trade name has nothing to do with the surname.
Epocrates Rx software, produced by Epocrates, Inc..
Information also available online.
FDA Announces Revisions to Labels for Cialis, Levitra and Viagra.
Food and Drug Administration (2007-10-18).
Cialis: Warnings, Precautions, Pregnancy, Nursing, Abuse.
The Observer, February 2, 2003.
This page was last modified 13:00, 23 January 2008.
All text is available under the terms of the GNU Free Documentation License.
Tadalafil is part of WikiProject Pharmacology, a project to improve all Pharmacology-related articles.
If you would like to help improve this and other pharmacology articles, please join the project.
All interested editors are welcome.
Start This article has been rated as start-Class on the quality scale.
Mid This article has been rated as mid-importance for this Project's importance scale.
This article states that Lilly bought Icos in 2006.
Icos still has not been purchased and maybe never will.
As with Levitra, I just had to put that bit in about what to do if a certain body part remains hard for more than four hours.
Levitra and cialis difference2 Comparison with other drugs3 Cialis Drug History cleanup 3.
Niagara means 'waterfall' in latin??
Levitra and cialis difference Levitra and cialis both are PDE5 inhibitors and in which way do they differ in performance, price, customer satisfaction, Any clarifications please?
Comparison with other drugs I've made a request for more information about how this drug compares to similar ones.
I think other people would like to know more about this too.
Eje211 16:57, 9 May 2006 (UTC) A great in-depth article can be found here, in which the three drugs are compared.
Tadalafil has a different binding-mode than Sildenafil or Vardenafil, which are structurally very similar.
Pfizer as if it were a drug, whereas Pfizer is the company that owns Viagra.
The statement that Cialis works for up to 36 hours occurs twice in the last two sentences.
And the whole thing needs to sourced.
Corrected the confusion between company (Pfizer) and drug (Viagra).
The statement about the effect duration depends on the half-life of the substance.
Both the mesured halfe-life and the advertised effect duration can be found in any drug data base.
The few public I know are in french.
I don't know which source to mention here.
DrYak 13:36, 24 November 2006 (UTC) If you don't know of any publicly accessible source in English, cite a French one.
If someone finds a source in English, it can always be added then.
Another reading of that sentence is that the name Viagra is derived from the Latin vita and from the name of the waterfall, which does not imply that 'Niagara' is from Latin.
However, the whole thing is unsourced.
December 2006 (UTC) As opposed to all the other drugs that are not offered through e-mail spam?
Donald Albury 02:20, 17 December 2006 (UTC) Mostly this and Viagra are in spam, I would say it's significant and notable 84.
Surely this is wrong or incorrectly phrased?
Dpbsmith (talk) 13:10, 30 December 2006 (UTC) Slightly incorrectly phrased.
As part of the clinical development procedure, all drugs go through a First in Man clinical trial.
As it's the first time the drug has been tested in humans, all partipants are healthy young males.
As any young male can testify, you don't really need much stimulation to obtain an erection, let alone with chemical assistance.
If you're still skeptical, bear in mind that FIM trials are usually closely monitored by medical staff, which include nurses.
Oni no Akuma 07:11, 12 September 2007 (UTC)Ooops, forgot to mention, this was how sildenafil was discovered.
The line you've highlighted is discussing the history of viagra and how that drug has affected the development of cialis.
The article, presumably sponsored by Eli Lilly omits to mention that other brands of Tadalafil are available e.
Forzest from Ranbaxy Pharmaceuticals.
This page was last modified 11:11, 13 September 2007.
FDA has received reports of cases of sudden decreases or loss of hearing following the use of PDE5 inhibitors, Viagra, Levitra, and Cialis for the treatment of erectile dysfunction and Revatio for the treatment of pulmonary arterial hypertension.
In some cases, the sudden hearing loss was accompanied by tinnitus and dizziness.
Medical follow-up information was often limited for the cases reported postmarketing, which makes it difficult to determine whether these reports are directly related to the use of one of these drugs, an underlying medical condition, or other risk factors for hearing loss, a combination of these factors, or other factors.
Sudden hearing loss was also reported in a few patients in clinical trials of these drugs.
In response to a request from FDA, the manufacturers of Viagra, Levitra and Cialis have revised the labeling for these products to address the potential risk of sudden hearing loss and to guide patients on what to do if they experience sudden problems with their hearing.
FDA is currently working with the sponsor to revise the labeling for Revatio.
The approved revised labeling for Viagra, Levitra and Cialis includes a new Precaution and updated Adverse Reactions sections.
FDA intends to update this sheet when additional information or analyses become available.
Drug Uses Cialis is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men.
How Taken Take Cialis exactly as your doctor prescribes.
Cialis comes in different doses (5 mg, 10 mg, and 20 mg).
For most men, the recommended starting Cialis dose is 10 mg.
For all other orders: 4 Viagra pills FREE.
Cialis should be taken no more than once a day.
Some men can only take a low dose of Cialis because of medical conditions or medicines they take.
Your doctor will prescribe the dose that is right for you.
A sudden drop in your blood pressure could cause you to become dizzy, faint, or have a heart attack or stroke.
Until you are certain how you are affected by Cialis, use caution when driving or operating heavy machinery.
Cialis contains some lactose and should not be taken by patients who are lactose intolerant.
Also, during treatment you should avoid grapefruit juice.
Taking Cialis with grapefruit juice can increase your chances of experiencing undesirable side effects.
If you are taking medications with nitrates or nitric oxide, have uncontrolled blood pressure (high or low), or if you have a history of stroke or heart attack DO NOT take Cialis.
Missed Dose Take the missed dose as soon as you remember it.
However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.
Do not take a double dose to make up for a missed one.
Possible Side Effects The most common side effects with Cialis are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
Patients who get back pain and muscle aches usually get it 12 to 24 hours after taking Cialis.
Back pain and muscle aches usually go away by themselves within 48 hours.
Call your doctor if you get a side effect that bothers you or one that will not go away.
Storage Store Cialis at room temperature between 59 and 86 F (15 and 30 C).
OverdoseIn cases of overdose, standard supportive measures should be adopted as required.
Hemodialysis contributes negligibly to Cialis elimination.
More InformationDo not change your dose of Cialis without talking to your doctor.
Your doctor may lower your dose or raise your dose, depending on how your body reacts to Cialis.
Do not drink alcohol to excess when taking Cialis (for example, 5 glasses of wine or 5 shots of whiskey).
When taken in excess, alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.
Disclaimer This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication.
This is only general information, and should not be relied on for any purpose.
It should not be construed as containing specific instructions for any particular patient.
No warranty, either expressed or implied, is made in regards to this information.
I say my supplier of medical assistance before taking CIALIS?
CIALIS is not to the right for each.
Only his supplier of medical assistance and you can decide if correct CIALIS for you.
You do not have to take CIALIS if its supplier of medical assistance has said to him not to have sexual activity due to its problems of health.
He stops the sexual activity and he secures the medical aid immediately if you secure to symptoms such as pain chest, vertigos, or nausea during sex.
Can other medicines affect CIALIS?
After taking a single tablet, something of the active ingredient of CIALIS remains in its body by more than 2 days.
HIV or the eritromicina antifungi of medications other medicines or treatments for ED CIALIS also are put like ADCIRCA for the treatment of the pulmonary arterial hypertension.
It does not take CIALIS and ADCIRCA.
What I must avoid whereas it takes CIALIS?
It does not use other medicines of the ED or the treatments of the ED whereas it takes to drink from CIALIS.
Do not too much alcohol when taking CIALIS (for example, 5 wine glasses or 5 whiskey shots).
The consumption of too much alcohol can increase its occasions to secure a headache or to obtain been annoying, increasing its heart rate, or the loss of its arterial pressure.
Which are the possible indirect effect of CIALIS?
The indirect effect but common with CIALIS are: headache, indigestión, backache, pains the muscle, cleaning with a spurt of water, and moquea congested nose or that.
These indirect effect go generally far after some hours.
The men who secure to back pains the pain and the muscle generally obtain 12 to him to 24 hours after taking pain CIALIS.
Back and the pains the muscle go generally far within 2 days.
The infrequent indirect effect include: An erection that won' t leaves: Like with cualquie tablet of the ED, in the rare event of an erection that lasts more than 4 hours, immediate medical aid of the search to avoid injury of long term.
In rare cases, the men who took the tablets from the ED of the prescription (CIALIS including) disclosed a diminution or a sudden loss of vision or hearing (sometimes with the sound in the ears and the vertigos).
It' s possible not to determine if these events are related directly to the tablets of the ED or other factors.
If you have a diminution or a sudden loss of vision or hearing, the shutdown that takes any tablet from the ED, including CIALIS and calls immediately to its doctor.
CIALIS does not do: increase of the ED of the treatment man' the sexual desire of s protects an O-Man to its sexual partner against - the transmitted diseases, including service of HIV as it forms masculine of the birth control CIALIS are in favor available of the prescription only.
For the information of additional security, it speaks with his doctor on this medicine and sees the complete patient information.
This site thinks above for use of age 18 of the residents of the United States and.
Which is the most important information that I must know on Cialis?
The return to finish off Cialis can cause its arterial pressure to fall suddenly at an uncertain level if it is taken with some other medicines.
You could obtain been annoying, weak, or has an attack or a movement of the heart.
Cialis does not cure the ED, increases man' the sexual desire of s, service as it forms masculine of birth control, or protects an O-Man to its sexual partner against - transmitted diseases, including the impulsion of HIV.
Do or possibly does not carry out other uncertain tasks until you know you you react to this medication.
Cialis can cause vertigos, drowsiness, desmayando itself, or the blurred vision.
These effects can be worse if you take with alcohol or certain medicines.
It does not drink you seed amounts of alcohol (5 drinks or more) whereas you take this medicine.
Doing so can increase its risk of vertigos, of headache, beat of the fast heart, and arterial tension loss.
Cialis can cause rarely to have prolonged, painful erection.
This could even happen when you are not having sex.
If this does not treat immediately, could take to the permanent sexual problems such as impotence.
Their doctor makes contact with enemy with a if the changes of the vision persist or are severe.
The sexual activity can put an additional tension in its heart, especially if its heart is or weak of an attack of the heart or a cardiac disease.
Cialis is not for the women or the children.
Cialis is due to only use under medical care provider' taken care of of s.
The arterial pressure was measured manually in 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours after dosing of the tadalafil or placebo.
No millimeters potentially related for the purposes of the blood-pressure were disclosed.
Menscare cannot and do not make any claims for the product.
All information set out below, is provided by the manufacturers.
How does Cialis (tadalafil) work?
How well does Cialis (tadalafil) work?
What's the normal Cialis (tadalafil) dose?
Cialis or 20 mg Cialis tablet per day.
Are there any side effects with Cialis (tadalafil)?
What are the benefits of Cialis One a Day?
What Cialis is and what it it used for.
Cialis comes as yellow film coated tablets.
If you have a serious liver or kidney problem.
Cialis if you are taking these medicines.
Cialis tablets are for oral use.
Daily use of Cialis is strongly discouraged.
Like all medicines, Cialis can have side effects.
The most common undesirable effects are headache and indigestion.
Allergic reactions (including skin rashes)could occur.
Keep out of reach and sight of children.
You probably know by now, that Cialis has at a lot of points, taken over Viagra sales.
Cialis can be effective for up to 36 hours.
American men and their partners.
Are you searching for Cialis information online?
You will find complete information on Cialis pills here.
Olympics to compete with Viagra.
Cialis works incredibly well, when stimulated properly.
Take only as directed, usually once daily as needed.
If these effects persist or worsen, notify your doctor promptly.
Pharmacy while placing an order with the pharmacy.
Nothing on this site is intended as medical advice.
The information provided here is for informational purposes only.
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Scientists claim to be close to anti-impotence creamPosted on 2009-09-21 15:07:44Scientists are perfecting a new cream that promises instant anti-impotence with no side effects, according to London's Daily Mail.
It could one day mean the end of Viagra pill-popping for the estimated 15 million American men suffering from erectile dysfunction.
ED-ified about ViagraPosted on 2009-05-12 01:26:06Even though prime-time television often plays like a nonstop round of sex jokes and hookups these days, our next argument over TV's sexual content may center on ads suggesting many real-life people need help having sex.
Quality of life' enhancement: Free ViagraPosted on 2008-11-14 15:37:21It's never too late for love, especially in Mexico City.
Clinics there will be giving out free Viagra and other impotence drugs to men 70 and older.
E-Addiction: Your teen and the World Wide Web of drugsPosted on 2008-07-11 03:49:27A reader named Stephan just sent me a news story that's got him worried.
It's about a brand new report from Columbia University's National Center on Addiction, trumpeting that "the Internet is a pharmaceutical candy store.
Stocks mixed after Bank of America profit falls short Posted on 2008-04-21 00:00:00Wall Street started the week with a mixed performance Monday, as investors regained a cautious stance in response to a weaker-than-expected profit report from Bank of America Corp.
Neighborhood: Manhattan, West Side Occupation: Comedian, author, radio-show host, "employer ...
PMThe Government Accounting Office's report into drug pricing - which found that 416 drug brands had "extraordinary price increases" between 2000 and ...
AMTo the list of reasons Congress may find it difficult to rein in health-care costs, add "diagnostic creep.
Step One: Society medicalizes ...
AMBiotech firm Vivus unveiled a would-be player Monday in the 3.
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Tadalafil), is a treatment for male erectile dysfunction.
Cialis is the first oral medication proven to work up to 36 hours and is effective within 30 minutes, allowing you to choose the moment that is both right for you and your partner.
Clinical trials have found that Cialis can be effective for over 88% of men in gaining and sustaining an erection sufficient for penetrative sexual intercourse.
Although Cialis is present and active within the body for up to 36 hours, erections can only occur with sexual stimulation and will only last for as long as required, up to 4 hours each time.
The active ingredient of Cialis, Tadalafil, is a type of medication called a Phosphodiesterase Type 5 Inhibitor that works to induce an erection in men who suffer from Impotence by improving blood flow to the penis.
Before an erection can happen a complex series of events must take place, with or without the use of Cialis.
This chemical works to relax muscle tissue, within the blood vessels of the penis allowing them to widen.
This causes blood to enter into the penis, filling the spongy cylindrical tubes located in the penis known as the corpora spongiosum and corpora cavernosa, which in turn results in an erection.
Once a patient who is using Cialis has finished sexual intercourse and sexual stimulation has ceased, the enzyme phosphodiesterase (PDE5) is released which starts to break down the chemical Cyclic GMP, resulting in the loss of an erection.
It is the early release of this enzyme which is responsible for the majority of erectile dysfunction cases and can occur for a number of different reasons.
Cialis is effective at inhibiting this enzyme which allows for the blood vessels within the penis to be dilated for a period of time, which helps to maintain and prolong an erection.
This means that by taking Cialis, you will experience longer lasting and harder erections than you would have naturally, which in turn makes sexual intercourse far more satisfying for both you and your partner.
What's the difference between Viagra and Cialis?
Cialis comes in smaller doses and produces fewer side effects.
This treatment also works much faster than Viagra.
In clinical trials, the majority of men who took the drug were able to engage in sexual intercourse within 30 minutes or less.
The studies also indicated that Cialis stays in the system for up to 36 hours.
That's 32 hours difference than the traditional Viagra treatment.
Test results have also shown that Cialis has no adverse side effects on vision or the heart.
It's believed that Tadalafil is a more selective active ingredient than Sildenafil, the active ingredient of Viagra at targeting PDE-5 receptor sites.
Besides controlling blood flow to the penis, PDE-5 enzymes play an essential role in the action of cells in the brain, heart, kidney, and eyes.
How do I know that I will receive genuine Cialis?
Cialis 20 mg tablets are yellow, film coated, almond shaped tablets, marked "C20" on one side.
Cialis 10 mg tablets are light yellow, film coated, almond shaped tablets, marked "C10" on one side.
Both doses of this treatment are packaged in a green and white box containing the logos and markings of lilly icos, the manufacturer of Tadalafil.
What are the side effects of Cialis?
Like all medications, Cialis can cause some side effects.
The most common side effects reported in the study were headache, myalgia (muscle pain), dyspepsia (upset stomach following meals) and back pain.
The severities of these side effects were minimized with lower doses.
Most patients will not experience any side effects at all.
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Genuine Cialis, also known as Tadalafil can only be sort after a consultation with a registered doctor who will make an initial diagnosis.
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The effects of buy Cialis UK can last up to 36 hours after a single dose, allow patients who have opted to buy Cialis online an increased freedom when engaging in sexual relations with their partner.
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Medical and Pharmacy Editor: Jay Marks, M.
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Erection of the penis is caused by the filling of the penis with blood.
Tadalafil was approved by the FDA in November, 2003.
PREPARATIONS: Tablets: 5, 10, and 20 mg.
PRESCRIBED FOR: Tadalafil is used for the treatment of impotence.
The effect of tadalafil may last up to 36 hours.
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A few patients after taking Cialis have experienced loss of eyesight in one eye.
This vision loss is referred to NAION, or non-arteritic anterior ischemic optic neuropathy.
This occurs as a result of blocked blood flow to the optic nerve.
So far, it is not known if Cialis causes NAION, since it also happens with patients who are not on Cialis.
If you lose eyesight in any way, it is strongly advised to stop using Cialis and get medical attention.
Flomax (tamsulosin) in a dosage of .
Examples are Hylorel (guanadrel), Minipress (prazosin), Hytrin (terazosin) and others.
If you aren't sure about the drugs you're currently taking, and the interaction with Cialis, it is strongly advised to speak to your doctor and divulge all the drugs you're currently on, recreational or not, to make sure Cialis is right for you.
Using Cialis in conjunction with any of the above-listed medications may cause a drop in blood pressure, which can result in dizziness, fainting, stroke or a heart attack in extreme cases.
If you have an erection that lasts longer than 4 hours, you should call your doctor or seek emergency medical attention, since having a prolonged erection for that long can cause damage to the penis.
Do not engage in sexual activity and contact your doctor if you experience dizziness, nausea, vomiting, or angina (experiencing pain, tightness, discomfort, numbness or tingling in the arms, neck, chest or jaw) during sexual activity.
Cialis is normally taken as needed before you engage in sexual activity.
The effects of the pill can last up to 36 hours or more.
This is why it's important to have your doctor determine how often you can take Cialis, and why it's important to not take Cialis more often than is directed.
Cialis is a drug that was formulated to aid in the blood flow to the penis to help relieve the stress of erectile dysfunction.
When Cialis is taken, it relaxes muscles within the penis, allowing increased blood flow into the penis, which is necessary for the promotion, and maintaining, of an erection.
Cialis is mainly prescribed to treat ED (erectile dysfunction), also known as impotence.
Cialis may also be utilized for other purposes not listed in this Cialis medication guide.
What do I need to discuss with my health care provider before taking Cialis?
If you suffer from any of these ailments, you either may not be able to take Cialis, or you may be required to receive an adjustment in dosage or special monitoring during the period you are on Cialis.
Cialis is specially formulated for men, and should not be taken by women.
Even though it is not a medication for women, it has been classified as FDA pregnancy category B, which means that Cialis is not expected to do harm to an unborn baby.
Currently, it is not known whether or not Cialis can be passed into breast milk.
For men who are over the age of 65, the risk of experiencing the side effects of Cialis are increased.
For this reason, your doctor may prescribe a lower dosage for you if you qualify.
Cialis should be taken exactly as told by your doctor.
If you find yourself not understanding the dosage directions, make sure to ask your doctor, a pharmacist, or a nurse to explain them to you until you understand.
Each dose should be taken with a full glass of water.
Cialis is taken normally as needed before having sexual activity.
It can help you maintain an erection as sexual stimulation occurs, but will not just occur by taking a pill, meaning it doesn't just happen just because you took the pill.
The effects of Cialis can last up to and over 36 hours.
This is why it's important to speak to your doctor about the required dosage, and how often you can take Cialis.
Cialis can be taken with or without food, but it should not be taken while imbibing excessive amounts of alcohol.
This may increase the risk of such events as headaches, dizziness, low blood pressure or an increased heart rate when Cialis is taken.
Contact your doctor if you experience dizziness, nausea, vomiting, or angina (experiencing pain, tightness, discomfort, numbness or tingling in the arms, neck, chest or jaw) during sexual activity, or after sexual activity.
If you have an erection that lasts longer than 4 hours, seek emergency medical attention, since a prolonged erection can damage the penis.
If you eat grapefruit, or drink grapefruit juice, you should discuss this part of your diet with your doctor, as the interaction with Cialis could cause potential adverse effects.
Don't decrease or increase the amount of grapefruit you currently use without discussing it with your doctor.
Be sure to store Cialis at room temperature, away from moisture and heat.
Cialis is used as needed, so you are not likely to miss a dose.
What should I do if I overdose on Cialis?
Emergency medical attention should be sought immediately if an overdose occurs, since currently, the symptoms of an overdose on Cialis is unknown.
What should be avoided while I taking Cialis?
You should not be on any other erectile dysfunction or impotence drugs, such as Viagra (sildenafil), alprostradil (common names Muse, Caverject or Edex), Levitra (vardenafil), or yohimbine (common names Yocon, Yodoxin or others) without first discussing it with your doctor.
Excessive alcohol drinking (5 or more drinks) should be avoided while taking Cialis, since it may increase the risk of headaches, dizziness, low blood pressure or an increased heart rate when Cialis is taken.
Grapefruit and grapefruit juice, as well as other products that contain grapefruit may interact with Cialis, leading to potential adverse effects, which is why you should discuss it with your doctor if grapefruit products are part of your diet before making any kinds of changes.
What side effects are possible while taking Cialis?
There are also less severe side effects which are more likely to occur than the above stated side effects.
Another uncommon side effect is that you may experience a temporary blue tint in your vision, or have difficulty distinguishing the differences between blue and green colors.
Even though this is extremely uncommon, it is advised to talk to your doctor if you are experiencing these systems.
Other side effects besides the ones listed here may occur, and you should talk to your doctor about any side effects that you experience while you are on Cialis that may be unusual or bothersome.
What kind of drugs should I avoid while on Cialis?
If you're currently taking any HIV medications, such as ritonavir (Norvir), indinavir (Crixivan) or any others.
If you are on any of these medications, you may not be able to take Cialis, or you may have your dosage adjusted or special monitoring.
This is why it is important to divulge all drugs you are currently taking to your doctor to make sure that Cialis is right for you.
Ask your doctor, pharmacist or nurse about any further information about Cialis.
Site Last Updated: 15-January-2010.
All trademarks used on this site and brand names "Viagra", "Cialis", "Levitra" are the property of the respective trademark holders.
We are not associated with these trademark holder companies in any sense and have never been affiliated with Pfizer, Bayer or Lilly ICOS, except in the fact that we make it possible for consumers to order certain Generic Drugs by internet.
Cialis (Tadalifil citrate) is the second-generation Viagra, more or less.
While the little blue pill may work to give you an erection for 6-8 hours, Cialis is good for 36-48 hours.
This obviously makes it much more practical.
Well I doubt anyone using endogenous testosterone would need to consider the use of such a compound, this drug can still have some uses during post-cycle therapy.
A lot of men find that once they go off steroids and begin post cycle therapy (PCT), they suffer reduced libido as well as erectile dysfunction.
Well, Cialis may be useful for helping this, at least during PCT.
The efficacy and safety of Tadalafil for the treatment of erectile dysfunction was assessed in a 6-month study.
Tadalafil significantly improved erectile function compared with placebo (which only succeeded in embarrassing the men who took it and tried to get laid).
At the end of the study, sexual intercourse attempts success rate for those using Cialis was 73.
Of particular interest to those considering the use of Cialis is that Lack of sexual activity due to erectile dysfunction actually decreases testosterone (T) levels through a central effect on the hypothalamic-pituitary axis.
Cialis was given to men for a month, and at the end, they had considerably higher testosterone levels, because they got laid more(2), as it is unlikely that the drug has a different direct effect on the pituitary-testis axis.
This stuff is actually very safe, and was even given 3x a week to men (1) for an extended length of time, and was well tolerated, had very few sides, and was very effective (1).
Thus, it could be another potential compound for inclusion in PCT.
Tadalafil (20 mg) significantly improves erectile function, could increase testosterone, and is well tolerated (3), certainly something to think about after your next cycle.
A 6-month study of the efficacy and safety of tadalafil in the treatment of erectile dysfunction: a randomised, double-blind, parallel-group, placebo-controlled study in Australian men.
Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels.
Efficacy and treatment satisfaction with on-demand tadalafil (Cialis) in men with erectile dysfunction.
What makes Cialis an effective treatment for impotence?
Lilly's introduction of Cialis has helped many impotence sufferers around the world.
Cialis comes in two different strengths.
Cialis pill which is popular with less severe sufferers.
The strongest available Cialis dose is the twenty-milligram pill.
Cialis is manufactured by Lilly ICOS LLC.
If you require any further information about Cialis please click here to contact our doctors directly.
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ED patients with diabetes mellitus.
ED status post bilateral nerve-sparing radical prostatectomy.
Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by CIALIS has no effect in the absence of sexual stimulation.
Studies in vitro have demonstrated that CIALIS is a selective inhibitor of PDE5.
In vitro studies have shown that the effect of CIALIS is more potent on PDE5 than on other phosphodiesterases.
Additionally, CIALIS is 700-fold more potent for PDE5 than for PDE6, which is found in the retina and is responsible for phototransduction.
PDE11A4, two of the four known forms of PDE11.
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Cialis is by far the most effective and safe Erectile Dysfunction drug available for male Erectile Dysfunction problems.
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Viagra, which is mentioned below.
Stays longer in the system -- up to 24 hours.
Acts fast within 30 minutes or less.
Cialis is Available in smaller doses.
Cialis has No adverse effects on vision or heart.
More selective than Viagra at targeting PDE5 receptor sites.
Before you purchase your pack of Cialis inform your doctor about the prescription and non prescription medicines you are taking or have been taking.
Extra caution should be considered especially in the case of drugs containing nitrates as its active ingredient.
Start with a normal life with a satisfying night life with Cialis.
Viagra- Pfizer's wonder drug Viagra needs no introduction.
Sildenafil Citrate is the active ingredient of Viagra which is the most trusted drug for the treatment of male impotence problems.
With Viagra in your hand, you are no longer an alien in solitude and Erectile Dysfunction signifying the dusk of unsung glory.
Levitra- Levitra is the latest entrant in the erectile dysfunction drug market primarily dominated by Viagra and Cialis.
It is the third most popular drug for the treatment of erectile dysfunction after Viagra and Cialis.
Levitra has captured a number of new prescriptions written for impotency also known as Erectile Dysfunction since its launch.
Vardenafil HCl is most active ingredient in Levitra.
Food and Drug Administration (FDA) to cure erectile dysfunction (impotence) and has gained immense popularity in European countries.
Men who experience back pain and lower spine problems could also experience problems with erections.
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Senator Akaka's Senate Hearings, Removal of Lahaina Sailboat, Molokai Green Goddess, Vete...
This week on The Maui Daily, Maui Gold's Here to Stay, Hale Kau Kau Christmas Dinner, Barr...
This week on The Maui Daily, a look back at the events of 2009.
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Adds A New Course To Its Education Curriculum.
Maui Community Television is now offering a 3 day course in the use of Photoshop Elements software.
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Evelyn has over 25 years of experience in information technologies, she is currently a local high school teacher, she teaches the Adobe line of software, including Photoshop, Flash and Premiere Pro.
The class will cover all the tools and filters used to customize your photographs and help you manage all your photographs.
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Friday, January 8th, 2010 from 9 a.
Staff In-Service Training in preparation for the upcoming Strategic Planning Retreat and will re-open at 5 p.
Monday, January 18th, 2010 in observance of the Martin Luther King Holiday and will re-open on Tuesday, January 19th, 2010 at 9:00 a.
Maui Community Television at The Akaku Center, 333 Dairy Road, Suite 104, Kahului.
Maui Community Television will be hosting on Friday, Jan.
Maui-born Destin Daniel Cretton.
Please call 871-5554 to confirm your attendance.
Empowering The Community's Voice.
Akaku: Maui Community Television (Akaku) empowers the community's voice through access to media.
Akaku is a 501(c)3 nonprofit corporation that airs content created by the community for the community.
Community members on Maui, Moloka'i, and Lana'i are encouraged to submit programming to the station, create their own television shows and have their voices heard by fellow community members.
All content is copyright of Akaku unless otherwise stated.
TADALAFIL - ORAL (Cialis) side effects, medical uses, and drug interactions.
USES: Tadalafil is used to treat male sexual function problems (impotence or erectile dysfunction) by blocking a certain enzyme (phosphodiesterase-PDE5) in the body.
Practice "safe sex" such as using latex condoms.
This medication's effect on sexual ability may last up to 36 hours.
The dosage is based on your medical condition, response to therapy, and other medications you may be taking (see also Drug Interactions section).
Read the patient information leaflet provided by your pharmacist and ask questions if any of the information is unclear.
If you have heart problems or experience any of the following serious side effects during sex, stop and tell your doctor immediately of: severe dizziness, fainting, chest pain.
In the unlikely event you have a painful or prolonged erection (lasting more than 4 hours), stop using this drug and seek immediate medical attention or permanent problems could occur.
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Emmick JT, Stuewe SR, Mitchell M.
The FDA drug information shown here is licensed from Thomson CenterWatch.
The information provided here is for general educational purposes only and does not constitute medical or pharmaceutical advice which should be sought from qualified medical and pharmaceutical advisers.
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Today I noticed there are a lot of nice romantic songs I have to turn off when I hear them in the radio.
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Cialis is an orally adminstered drug used to treat male erectile dysfunction (impotence).
It is marketed worldwide under the brand name Cialis.
It is a phosphodiesterase 5 (PDE5) inhibitor.
Cialis's distinguishing pharmacologic feature is its longer half-life (17.
This longer half-life results in a longer duration of action and is, in part, responsible for the Cialis nickname of the "weekend pill.
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 harden and expand when a man is sexually excited, or when he cannot keep an erection.
Cialis may help a man with ED get and keep an erection when he is sexually excited.
Cialis (Tadalafil), dubbed 'Le Weekend Drug' in Europe, is a new treatment for Erectile Dysfunction (ED) from Lilly ICOS LLC.
Clinical studies show that Cialis works faster, lasts up to 36 hours and has less side effects than Viagra.
Pharmacology: Cialis is used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH).
Part of the physiological process of erection involves the release of nitric oxide (NO) in the corpus cavernosum.
This then activates the enzyme guanylate cyclase which results in increased levels of cyclic guanosine monophosphate (cGMP), leading to smooth muscle relaxation in the corpus cavernosum, resulting in increased inflow of blood and an erection.
Cialis is a potent and selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum.
This means that, with tadalafil on board, normal sexual stimulation leads to increased levels of cGMP in the corpus cavernosum which leads to better erections.
GMP system, tadalafil should not cause an erection.
What important information should you know about CIALIS?
Tell all your healthcare providers that you take CIALIS.
CIALIS may help a man with ED get and keep an erection when he is sexually excited.
CIALIS is only for men with ED.
Talk to your doctor to decide if CIALIS is right for you.
Do not use CIALIS if you are using these drugs.
See the end of this leaflet for a complete list of ingredients.
What should you discuss with your doctor before taking CIALIS?
Ask your doctor if it is safe for you to have sexual activity.
Can other medications affect CIALIS?
Take CIALIS exactly as your doctor prescribes.
For most men, the recommended starting dose is 10 mg.
CIALIS should be taken no more than once a day.
Some men can only take a low dose of CIALIS because of medical conditions or medicines they take.
If you have kidney problems, your doctor may start you on a lower dose of CIALIS.
Take one CIALIS tablet before sexual activity.
CIALIS when compared to a sugar pill.
CIALIS prior to sexual activity.
Do not change your dose of CIALIS without talking to your doctor.
If you take too much CIALIS, call your doctor or emergency room right away.
What are the possible side effects of CIALIS?
These are not all the side effects of CIALIS.
Store CIALIS at room temperature between 59 and 86 F (15 and 30 C).
This leaflet summarizes the most important information about CIALIS.
What are the ingredients of CIALIS?
Boehringer Ingelheim Pharmaceuticals, Inc.
Tadalafil is a substrate of and predominantly metabolized by CYP3A4.
Ketoconazole (400 mg daily), a selective and potent inhibitor of CYP3A4, increased tadalafil 20-mg single-dose exposure (AUC) by 312% and Cmax by 22%, relative to the values for tadalafil 20 mg alone.
Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone.
HIV Protease inhibitor: Ritonavir (200 mg twice daily), an inhibitor of CYP3A4, CYP2C9, CYP2C19, and CYP2D6, increased tadalafil 20-mg single-dose exposure (AUC) by 124% with no change in Cmax, relative to the values for tadalafil 20 mg alone.
Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure.
Based upon these results, in patients taking concomitant potent CYP3A4 inhibitors, the dose of Tadalafil should not exceed 10 mg, and Tadalafil should not be taken more frequently than once in every 72 hours.
Other cytochrome P450 inhibitors: Although specific interactions have not been studied, other CYP3A4 inhibitors, such as erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure.
Rifampin: Rifampin (600 mg daily), a CYP3A4 inducer, reduced tadalafil 10-mg single-dose exposure (AUC) by 88% and Cmax by 46%, relative to the values for tadalafil 10 mg alone.
Although specific interactions have not been studied, other CYP3A4 inducers, such as carbamazepine, phenytoin, and phenobarbitol, would likely decrease tadalafil exposure.
H2 antagonists: An increase in gastric pH resulting from administration of nizatidine had no significant effect on tadalafil pharmacokinetics.
Tadalafil is not expected to cause clinically significant inhibition or induction of the clearance of drugs metabolized by cytochrome P450 (CYP) isoforms.
CYP1A2 substrate: Tadalafil had no clinically significant effect on the pharmacokinetics of theophylline.
CYP3A4 substrates: Tadalafil had no clinically significant effect on exposure (AUC) to midazolam or lovastatin.
CYP2C9 substrate: Tadalafil had no clinically significant effect on exposure (AUC) to S-warfarin or R-warfarin, nor did tadalafil affect changes in prothrombin time induced by warfarin.
Both alcohol and Tadalafil, a PDE5 inhibitor, act as mild vasodilators.
Tadalafil can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache.
PDE5 inhibitors, including tadalafil, are mild systemic vasodilators.
Clinical pharmacology studies were conducted to assess the effect of tadalafil on the potentiation of the blood-pressure-lowering effects of selected anti-hypertensive medications.
Tamsulosin: In a clinical pharmacology study, when a single dose of tadalafil 20 mg was administered to healthy subjects taking 0.
Tadalafil to patients taking any alpha-adrenergic blocker other than 0.
Amlodipine: A study was conducted to assess the interaction of amlodipine (5 mg daily) and tadalafil 10 mg.
In a similar study using tadalafil 20 mg, there were no clinically significant differences between tadalafil and placebo in subjects taking amlodipine.
Metoprolol: A study was conducted to assess the interaction of sustained-release metoprolol (25 to 200 mg daily) and tadalafil 10 mg.
Bendrofluazide: A study was conducted to assess the interaction of bendrofluazide (2.
Enalapril: A study was conducted to assess the interaction of enalapril (10 to 20 mg daily) and tadalafil 10 mg.
Angiotensin II receptor blocker (and other anti-hypertensives): A study was conducted to assess the interaction of angiotensin II receptor blockers and tadalafil 20 mg.
Subjects in the study were taking any marketed angiotensin II receptor blocker, either alone, as a component of a combination product, or as part of a multiple anti-hypertensive regimen.
In clinical pharmacology studies, tadalafil was shown to potentiate the hypotensive effect of nitrates.
Alpha Blockers - Administration of Tadalafil to patients taking any alpha-adrenergic antagonist other than 0.
In a drug-drug interaction study, when tadalafil 20 mg was administered to healthy subjects taking doxazosin (8 mg daily), there was a significant augmentation of the blood-pressure-lowering effect of doxazosin.
Hypersensitivity - Tadalafil is contraindicated for patients with a known hypersensitivity to tadalafil or any component of the tablet.
Mechanism Of Action: Cialis inhibits the cGMP specific phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum located around the penis.
The inhibition of phosphodiesterase type 5 (PDE5) by tadalafil enhances erectile function by increasing the amount of cGMP.
Absorption: After single oral-dose administration, the maximum observed plasma concentration (Cmax) of tadalafil is achieved between 30 minutes and 6 hours (median time of 2 hours).
Biotransformation: Tadalafil is predominantly metabolized by CYP3A4 to a catechol metabolite.
In vitro data suggests the metabolites are not expected to be pharmacologically active at observed metabolite concentrations.
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Cialis (Tadalafil) is an oral treatment to help men suffering from erectile dysfunction.
Cialis tablets are manufactured by the pharmaceutical company Lilly ICOS and have been available by prescription since 2003.
Since its approval by the FDA, Cialis has quickly gained a reputation as one of the leading impotence treatment drugs on the market today.
It is the only drug that is proven to last for 36 hours, giving couples more freedom to engage in sexual activity, without having to worry about time constrictions of the drug.
Cialis has a proven efficiency record, with clinical trials showing it to be effective for 88% of men in achieveing an erection sufficient for sex.
What is the recommended dosage of Cialis?
Cialis tablets are available in doses of 10mg and 20mg.
Usually a patient will be prescribed the lower of the two unless their condition is more serious by a physician.
If the results experienced are found to be less than hoped for with no adverse effects, then the strength can be raised.
Alternatively the dosage can also be dropped if the intended effects occurred but other adverse side-effects were experienced.
A 20mg dose of tadalafil is comparable to a 100mg dose of sildenafil (Viagra).
Tadalafil, the key ingredient in Cialis, works by inhibiting an enzyme called PDE5 found primarily in the smooth muscle tissue of the penis' arterial walls and the lungs.
By inhibiting PDE5, tadalafil helps relax blood vessels in the penis and facilitates increased blood flow, enabling an erection.
After sexual activity has finished, your erection dissipates and the penis normally returns to a flaccid state again.
When will I see results with Cialis?
Cialis pills works faster and longer compared to other erectile dysfunction treatments.
Cialis starts working in as little as 30 minutes and lasts as long as 36 hours.
This is the reason the French fondly refer to Cialis as the 'La weekend pill'.
With these two attributes you don't need to schedule your love making sessions.
You can spontaneously react when the mood is just right for both of you, making Cialis a popular choice for those looking for an erectile dysfunction treatment.
Cialis is not affected by food.
Thus, when you buy Cialis it is not necessary to avoid high fat-content meals as you would with other impotence treatments.
Alcohol can also be consumed prior to taking Cialis however it should taken only in moderation.
When you order Cialis (tadalafil), the most common effects you might experience are headaches, an upset stomach, back pains, and muscle aches.
These side effects usually go away after a few hours and should not be the cause of any concern.
Back pain and muscle aches usually happen in 12 to 24 hours after taking Cialis and disappear within 48 hours.
In the rare case of Priapism, a condition where your erection does not go away even after four hours, inform your doctor immediately.
Very rarely, Cialis has been found to cause sudden decrease or loss of vision.
Whether, Cialis is responsible for this is not yet proven.
It should be noted that most men use Cialis and experience no side effects at all, however as with all prescription medication, any possible side effects will vary from person to person.
If you feel a effect of Cialis is becoming particularly bothersome, you should speak to your doctor immediately.
Cialis pills have been proven to be the most effective treatment available online, however it is not for everyone.
If you want to order Cialis pills and have concerns whether it is the correct medication for impotence treatment, you should firstly speak to your doctor to see if you are suitable.
Men who take nitrates, alpha-blockers or who have been advised not to have sexual activity because of health problems should not order Cialis.
Genuine Cialis contains the active ingredient Tadalafil and is available through our online service in 10mg and 20mg dosages, or 2.
It is possible to buy Cialis online by completing the order form and the medical consultation with one of our registered physicians, who will evaluate your submitted details to ensure you are safe to buy Cialis-Daily or Cialis treatment.
If an individual is suffering from erectile dysfunction or impotence then Cialis is clinically proven to be one of the most effective methods of treating this condition, which an unprecedented success rate among male patients.
Order Cialis online to receive branded medication, manufactured by the pharmaceutical company Lilly ICOS.
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Cialis - What professionals say.
Attitudes that encourage to Cialix this evidence using a evidence uptake and access and uptake efforts by physicians influence their decision.
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McPherson College Milwaukee Center.
From 1998, Viagra enjoyed a monopoly in the market until, in 2003, Cialis and Levitra were also approved by the FDA for the sale of drugs to treat erectile dysfunction.
In the early 1990s, ICOS was undertaking research into a range of drugs thought to have potential in the treatment of heart disorders.
In one of the trials, researchers noted that the male patients participating were experiencing an unusual number of erections.
This was sufficiently unusual that further studies were put in hand.
When the results were replicated, ICOS identified the active ingredients in their prototype as being the chemical compound known as IC351.
Later in 1994, the company was granted a patent for IC351 as a therapy for male impotence.
Some four years later, ICOS entered into a joint venture with Eli Lilly and Company and, as a result of their further research and testing, they were granted full FDA approval for Cialis.
Co bought out ICOS, thereby terminating the venture and acquiring sole ownership of Cialis.
Welcome For those men who have taken that first tough step - seen their doctor - and have been prescribed Cialis, please follow the log-in details to enter the Cialis website.
Only men who have been prescribed Cialis are able to enter this site.
This is because the site contains information about Cialis, a prescription medication from Eli Lilly Australia.
Access to the site is restricted because Lilly respects and adheres strictly to the Medicines Australia Code of Conduct, which protects consumers' rights in relation to the marketing of prescription products to the general public.
If you would like to find out more about Cialis please refer to our CMI.
Patient LoginPlease complete the following information to login.
Declaration "I am a patient who has been prescribed an ED medication supplied by Eli Lilly and am over the age of 18".
This site is intended for use by Australian residents only.
For more information about ED contact your doctor or other healthcare professional.
The active substance is tadalafil.
Tablet Core: lactose monohydrate, croscarmellose sodium, hydroxyproplycellulose, microcrystalline cellulose, sodium laurilsulfate, magnesium stearate.
Film-Coat: lactose monohydrate, hypromellose, triacetin, titanium dioxide (E171), iron oxide yellow (E172), talc.
These tablets are available in blister packs containing 2, 4 or 8 tablets.
This is when a man cannot get, or keep a hard, erect penis suitable for sexual activity.
The result of this is improved erectile function.
You and your partner will need to engage in foreplay, just as you would if you were not taking a medicine for erectile dysfunction.
If you are taking any form of nitrate or are unsure tell you doctor.
If you have serious heart disease or have had a recent heart attack.
If you have had a recent stroke.
If you have low blood pressure or uncontrolled high blood pressure.
Sexual activity carries a possible risk to patients with heart disease because it puts an extra strain on your heart.
If you have a heart problem you should tell your doctor.
You have a serious liver or kidney problem.
As a general rule, always tell your doctor if you are taking or have recently taken any other medicine, even those not prescribed, because occasionally they might interact.
Lapp lactase deficiency or glucose-galactose malabsorption.
You should check with your doctor or pharmacist if you are unsure.
The recommended starting dose is one 10mg tablet before sexual activity.
If the effect of this dose is too weak your doctor may increase the dose to 20mg.
Swallow the tablet whole with some water.
These effects are normally mild to moderate in nature.
Less commonly reported side effects are back pain, muscle aches, nasal congestion, facial flushing and dizziness.
Uncommon effects are swelling of the eyelids, eye pain and red eyes.
If you have any of these side effects and they are troublesome, sever, or do not go away, tell your doctor.
Allergic reactions (including skin rashes) could occur.
If you have such an erection, which lasts continuously for more than 4 hours, you should contact a doctor immediately.
In case of chest pain occurring during or after sexual activity you should NOT use nitrates but you should seek immediate medical assistance.
If you notice any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.
Most, but not all of these men had known heart problems before taking this medicine.
Effects were seen in one animal species that might indicate impairment of fertility.
Subsequent studies in man suggest that this effect is unlikely in humans.
Do not use after the expiry date stated on the carton and blister.
The above information is the translation of the manufacturer's insert.
It is provided under the supplying company's terms and conditions and should not replace the advice of your personal physician.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 2.
When you order Cialis it comes as a prescription medicine to be taken by mouth for the treatment of erectile dysfunction (ED) in men.
Order Cialis exactly as your doctor prescribes.
When you order Cialis it comes in different doses (5 mg, 10 mg, and 20 mg).
If you order Cialis you should take it no more than once a day.
Order Cialis, but be aware that it can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines such as nitrates and alpha-blockers, and recreational drugs that contain nitrates called "poppers".
Until you are certain how you are affected when you order Cialis, use caution when driving or operating heavy machinery.
Be aware that if you order Cialis it contains some lactose and should not be taken by patients who are lactose intolerant.
Order Cialis but avoice drinking grapefruit juice as it can increase your chances of experiencing undesirable side effects.
If you are taking medications with nitrates or nitric oxide, have uncontrolled blood pressure (high or low), or if you have a history of stroke or heart attack DO NOT order Cialis.
Take the missed dose as soon as you remember it.
The most common side effects when people order Cialis are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
Patients who order cialis and get back pain and muscle aches usually get it 12 to 24 hours after taking Cialis.
When you order Cialis store it at room temperature between 59 and 86 F (15 and 30 C).
Do not change your dose when you order Cialis without talking to your doctor.
Do not drink alcohol to excess when you order Cialis (for example, 5 glasses of wine or 5 shots of whiskey).
This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication.
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All other trademarks are the property of their respective owners.
Orders are typically reviewed within 4 hours.
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All prescription medications must be kept out of reach of children.
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Generic means using a different name for the same ingredients.
The contents of the pills are absolutely the same in our generic version and the branded analogue.
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We do not spend anything on marketing, there are no taxes to be paid as the product comes into the country unregistered, the manufacturer is located in an offshore zone and the production costs are way lower.
Cialis (Tadalafil) is an oral drug, used for treating male impotence, also known as erectile men's erectile dysfunction.
Cialis' effect starts working in 30 minutes and lasts for about 48 hours, while Viagra effect lasts fot about 4 hours.
Drug NameCialis (Tadalafil) Drug UsesCialis is to treate male impotence (eg, men's erectile dysfunction).
It is supposed to be used for other purposes.
Viagra and Levitra, Cialis' effect lasts much longer - up to 48 hours.
Cialis is to be used for daily use, so you can be ready anytime.
How to useCialis should be taken as directed by your doctor.
Please check the label to detemine an exact dosing instructions.
Cialis is to be taken oral, with or without food.
For using as needed: Cialis is to be taken at least 30 minutes before sexual activity, as directed by your doctor.
Cialis' effects can last for up to 48 hours after taking.
For daily use: Take Cialis regularly at about the same time each day.
Talk to your doctor, if you have questions about the way of taking Cialis.
Consult your physician before eating grapefruit or drinking grapefruit juice while using Cialis.
Drug Class and MechanismCialis is a phosphodiesterase inhibitor type 5.
It works by helping the blood flow into a penis to achieve and maintain an erection.
Missed DoseFor use as needed: If you miss a dose of Cialis and you still intend to engage in sexual activity, take it as soon as you remember.
Continue to take it as directed by your doctor.
For daily use: If you miss a dose of Cialis , take it as soon as possible.
If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
StorageKeep Cialis at room temperature away from moisture, heat and light (between 59 and 86 degrees F (15-30 degrees C)).
Store this medication out of the reach of children.
Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite ("poppers").
Possible Side EffectsThe most common side effects with Cialis are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
More InformationSexual stimulation is required for Cialis effect.
Without sexual stimulation you can't get erection just by taking Cialis.
PDE5 inhibitors or to other factors.
PDE5 inhibitors are coadministered with alpha-blockers.
CIALIS in this group is not recommended.
CYP3A4 such as ritonavir, ketoconazole, and itraconazole.
CIALIS offers no protection against sexually transmitted diseases.
Immunodeficiency Virus (HIV) should be considered.
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Recent data have indicated a potential association between epidemiological, physiologic, pathophysiologic, and treatment aspects of ED and lower urinary tract symptoms (LUTS) secondary to BPH.
PDE5 inhibitor for once-daily dosing in a trial of LUTS secondary to BPH.
McVary and associates reported a multicentered, randomized, double-blind, placebo controlled study of 281 men with LUTS secondary to BPH who were randomly assigned to once-daily tadalafil 5 mg for 6 weeks, followed by dose escalation to 20 mg for 6 weeks, or 12 weeks of placebo.
The latest innovation in the treatment of ED has arrived in the form of a simpler, once-daily dosing schedule for tadalafil, unlinking the temporal association of the medication and the sexual encounter.
The unnatural process of taking a medication just prior to sex is a negative aspect of ED treatment for many patients.
Additionally, at steady-state concentration, the daily exposure is 1.
Therefore, after 5 days of once-daily dosing, the plasma concentration of tadalafil (Cialis) achieved with a 2.
The FDA announced approval for once-daily dosing of tadalafil in January 2008 after a thorough review of the studies outlined below.
All of the available prostate cancer treatments, including radical prostatectomy, external beam radiation therapy, brachytherapy, cryotherapy, androgen-deprivation therapy, and even active surveillance alone, can result in ED.
ED after prostate cancer treatment includes both organic and psychogenic causes, as significant anxiety and depression may result from a diagnosis of prostate cancer, leading to psychogenic ED.
The most important risk for organic ED after prostate cancer treatment of any type is damage to the cavernosal nerves.
Walsh first described the technique for sparing the bilateral neurovascular bundles to better preserve erectile function, and a bilateral nerve sparing radical prostatectomy (BNSRP) is the surgical standard for prostate cancer today.
Approximately 155,000 prostatectomies were performed in the United States in 2005 according to hospital discharge data.
Potency in men after open BNSRP has a wide reported range of 10% to 97% in the literature.
Of 1288 men who underwent radical prostatectomy as part of the Prostate Cancer Outcomes Study, only 28% had erections sufficient for intercourse at 5 years.
ED is a common problem afflicting over a third of all men with diabetes mellitus type 2, and diabetes is independently responsible for a 3- to 4-fold increase in the risk of ED according to a survey of 1460 diabetic men.
ED is strongly related to the severity of diabetes, with a higher incidence in patients with a long history of diabetes, patients using insulin, and patients with microvascular complications of diabetes.
Diabetic men with ED also have significantly worse disease-specific health-related quality of life.
As with every PDE5 inhibitor, tadalafil is absolutely contraindicated with nitrate medications for angina pectoris secondary to the potentiated hypotensive effect the drugs can have together.
Because of the longer half-life, treatment with nitrate medications must be deferred for at least 48 hours after ingestion of tadalafil, compared with 24 hours for sildenafil (Viagra) and vardenafil (Levitra).
The cardiac effects of PDE5 inhibitors have received considerable attention because the drugs were originally studied as a treatment for angina pectoris secondary to their action of smooth muscle relaxation.
A large study of 2102 men from 11 different multicentered, randomized, double-blind, placebo controlled trials of tadalafil reported the drug is well tolerated overall.
Fifty-one percent of men using tadalafil 20 mg had at least one adverse event (AE), but only 3.
The most common AEs reported with the 20 mg dose were headache (15%), dyspepsia (8%), and back pain (5%) (Table 1).
Most AEs are a result of vasodilation of vascular beds other than in the penis.
In the two trials mentioned in the previous section, the patient population was largely a primary care population of relatively healthy men with ED of varying severities and etiologies.
To the contrary, a multicentered, randomized, double-blind, placebo controlled trial evaluated how tadalafil 20 mg improved ED in men presenting to tertiary care centers with more severe, organic ED and with more comorbid medical conditions than previous studies.
Tadalafil is an orally administered drug for treating impotence (erectile dysfunction), that initially was developed by the biotechnology company ICOS, and then developed and marketed world-wide as Cialis, by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company.
Cialis tablets, in 5mg, 10mg, and 20mg doses, are yellow, film-coated, and almond-shaped.
This is an independent website that provides information about Cialis.
It is not affiliated with Eli Lilly and Company, the manufacturers of Cialis, and does not represent Eli Lilly and Company in any way whatsoever.
Lilly was the first company to isolate and purify insulin as a treatment for diabetes, back in 1922.
The generic name for Cialis is taladafil.
Cialis is the third pill to be developed as an oral treatment for ED (Viagra and Levitra are its predecessors), and has it now been prescribed to men all over the world for more than 5 years.
Cialis is safe for the majority of men and can be taken in conjunction with many other prescription medications (but you must always inform your doctor of any other medications you are taking before getting a prescription).
However, you should not take Cialis if you take any medicines that contain nitrates, including organic nitrate or nitric oxide.
Nitrates are often prescribed to treat chest pain caused by angina pectoris and include drugs such as amyl nitrate.
Welcome to the Cialis information web site.
Cialis, generic name taladafil, is a prescription pill that is a treatment for erectile erectile dysfunction.
It is now available in two formats - 36 hour Cialis, or Cialis for daily use.
It works by relaxing the muscles and increasing the blood flow to certain parts of the body.
For example, when Cialis is used to treat erectile dysfunction, it helps to increase the blood flow into the penis to enable you to achieve and maintain an erection when sexually stimulated.
Which type of Cialis is right for you?
The advantage of taking the daily use Cialis table is that it allows you to be ready to have sex at anytime.
This is a great option for men who expect to have sex regularly, for example, twice a week or more.
In this case, go for Cialis once a day.
The advantage of the 36 hour Cialis (the traditional Cialis tablet) is that it is only taken when needed and it can work in as little as half an hour in some men.
Also, once dose can work for up to 36 hours - nearly a weekend.
So if you expect to have sex from time to time but not regularly - go for the 36 hour cialis.
With both of the above options, the Cialis is still an effective treatment for erectile dysfunction that is mild, moderate or severe.
You do not need to plan when you will take your tablet around your meals, and you are still able to choose the right moment for you and your partner.
Typically, a 30 day supply of once a day Cialis (Cialis for daily use) should cost about the same as 8 tablets of 36 hour Cialis.
However, individual internet pharmacies are free to set their own pricing.
THE FDA (Food and Drug Administration) approved Cialis (taladafil) as a treatment for ED on November 21st, 2003.
See FDA approves third drug to treat erectile dysfunction for further details.
Cialis has also been approved by the EMEA (the European Medicines Evaluation Agency) - the date of this approval was November 12th, 2002.
Cialis is only available on the NHS (the National Health Service in the UK) for the treatment of ED when it is caused by a limited number of physical conditions, including multiple sclerosis, spina bifida, Parkinson's disease, spinal injury, prostate cancer, polio and some genetic neurological conditions.
If you are not sure whether you would qualify to receive Cialis on the NHS, you should discuss the matter with your doctor.
Cialis is prescribed for the treatment of erectile dysfunction in men.
It should not be taken by women.
Please enable cookies in your browser to continue shopping at Pharmacy2U.
What erection problems (erectile dysfunction) can Cialis (tadalafil) help?
Cialis (tadalafil) can help men who suffer with erection problems (erectile dysfunction), also called impotence.
This is an ongoing problem with getting or keeping a hard enough erection to have sex to their satisfaction.
The erection problem results in the man being unable to penetrate their partner or keep their erection to allow enjoyable sex.
Cialis (tadalafil) can be prescribed to alleviate this problem.
How many men suffer with erection problems (erectile dysfunction)?
Most men, at some point in their lives, suffer with the occasional erection problem often associated with stress, tiredness or drinking too much alcohol.
However it is estimated that at least one in ten men suffer with frequent and long-standing erection problems (erectile dysfunction) and it is these men who may be able to benefit from Cialis (sildenafil).
That means there are well over 2 million men in the UK who suffer with erection problems.
The problem becomes more frequent in older men.
It is probable that around 20 % of men between 50 and 54 years and 50 % of men between 70 and 74 years have erection problems.
It is estimated that only 10% of men who suffer with frequent and long-standing erection problems (erectile dysfunction) actually seek medical assistance.
This is remarkable since effective treatments like Cialis are available for many men that can really help.
If you have a prescription for Cialis please CLICK HERE for information on Pharmacy2U's private prescription dispensing services.
All prescriptions issued here will be dispensed at Pharmacy2U.
What are the causes of erection problems (erectile dysfunction)?
Erection problems or erectile dysfunction is caused by both psychological and physical factors.
It is thought that in 75% of cases there is a physical factor involved.
Most men who take Cialis are able to achieve an erection again, enabling sexual activity.
Men with erection problems often suffer from the fear of failure.
Men who have suffered from erection problems in the past worry about their performance, and this removes the pleasure of feeling sexually excited.
This in itself contributes to their erection problems.
Sexual therapy can be of great help for men with erection problems with a predominantly psychological cause.
Often medicines are used in association with such therapy.
If a physical cause is the main problem, such as a hormonal imbalance addressing this can remove the erection problems.
In some cases surgery can ensure normal blood flow is restored.
Treatment of depression can remove erection problems caused by this.
In many cases medicines will be prescribed by a patient?
These medicines can either be injected into the penis (e.
Caverject (alprostadil), inserted into the eye of the penis (e.
MUSE (alprostadil)) or taken as a tablet by mouth (E.
Cialis (tadalafil), Levitra (vardenafil) and Viagra (sildenafil).
Vacuum pumps are another option to help men with erection problems get a good erection.
Cialis (tadalafil) belongs to a group of medicines called ?
Cialis comes as an almond shaped yellow tablet with strengths of 10mg or 20mg to be taken as needed before sex and strengths of 2.
It is an oral tablet, which is swallowed.
For Cialis to be effective sexual stimulation is required and so Cialis will not create an erection unless a man engages in sexually exciting activity.
Cialis (tadalafil) works by helping the blood vessels to the penis to let more blood flow.
This helps to create and keep an erection.
This increased blood flow is achieved by relaxing the blood vessels that supply blood to the penis.
Cialis (tadalafil) can work for up to 36 hours, so allowing the man suffering with erection problems to take the tablet plenty of time before he wishes to have sex.
Cialis should be taken at least 30 minutes before the man wishes to have sex.
Cialis 10mg or 20mg tablets should be taken at least 30 minutes before anticipated sexual activity.
The effects last up to 36 hours after taking the tablet.
Your treatment can be taken with or without food.
Two doses are available: 10mg or 20mg.
In some people 10mg is enough to be effective but in others 20mg may be necessary.
If you are on 10mg and find that this is not effective after several attempts, you should talk to your doctor or pharmacist to consider increasing your dose to 20mg.
Cialis 10mg or Cialis 20mg tablets should NOT be taken more than once a day and it is not recommended that you take it every day.
Such once a day use of Cialis is suitable for patients who anticipate frequent use of Cialis, Levitra or Viagra (at least twice a week) who have had a good response to Cialis, Levitra or Viagra when used "as required".
It is normal to start once a day treatment with Cialis with the 5mg dose.
Take one tablet a day at approximately the same time of day.
You may find it helpful to make taking your tablet a part of your daily routine, for example when you brush your teeth.
It may take up to 5 days before the full effect of the treatment is experienced, as the levels in your body build up over time.
After 5 days the levels have built up to a point where you can respond naturally whenever you are sexually stimulated.
Does Cialis (tadalafil) always work?
Cialis has been shown to work in many clinical trials, however individual results may vary.
Cialis has been shown to improve the ability for most men with erection problems to have successful sex.
When taken at the recommended dose, the possible side effects of Cialis (tadalafil) are mild and normally pass with time.
The most common side effects are a headache and upset stomach.
Less common effects include flushing, stuffy nose, muscle pain, dizziness and back ache.
Most men aren't bothered by the side effects enough to stop taking Cialis.
Is Cialis (tadalafil) for everyone?
Cialis (tadalafil) is only for men.
Cialis (tadalafil) should only be taken if your doctor has prescribed it for you.
This is because Cialis can be dangerous if you take it at the same time as certain other medicines including some that are used to treat chest pain (angina), high blood pressure or prostate problems.
In addition, some men may not be well enough to have sex because of the extra strain it puts on the heart and so Cialis is unsuitable.
For these reasons you should always see your doctor if you think you could benefit from Cialis (tadalafil).
How do I get Cialis (tadalafil)?
You need a prescription from your doctor to legally obtain Cialis (tadalafil).
Companies offering Cialis without a valid prescription is breaking the law and you may be putting your health at risk.
For many men who are prescribed treatments for erectile dysfunction, taking their prescription to the pharmacy represents an embarrassing hurdle which some may not overcome.
Pharmacy2U offers one option to avoid this hurdle.
Pharmacy2U is an NHS contracted, fully registered pharmacy that specialises in national home delivery of medicines, including the common treatments for erection problems (erectile dysfunction).
Pharmacy2U offers patients a professionally controlled and discreet service.
All medicines are conveniently delivered in plain packaging to your chosen delivery address, so there is no need to go into a pharmacy.
Medicines are dispatched by recorded delivery on the same day the prescription is received at Pharmacy2U.
Please click here for further details of how to use this service.
Unless you have an underlying medical condition such as diabetes or multiple sclerosis, the NHS does not pay for Cialis.
In this case your doctor will give you a private prescription that means you have to pay for the full cost of the medicine and also any dispensing fee the pharmacist chooses to charge.
Big differences can exist depending on where you take your prescription to be dispensed.
This means that it is important for you to find the best price available to you.
Highly competitive prices are available at Pharmacy2U Ltd.
Prompt delivery is what matters to me and I received the delivery the day after I ordered it.
ED drug info : by Ray Sahelian, M.
Cialis research is listed below.
A rare Cialis side effect is transient global amnesia.
Eli Lilly has changed its labels on Cialis due to side effects.
Serotonin increasing drugs can cause sexual dysfunction in women.
Cialis before anticipated sexual activity.
Journal of Sexual and Marital Therapy.
Cialis for the treatment of ED.
Cialis for ED therapy during an 8-week extension.
Cialis side effect of priapism.
International Journal of Impotence Research.
Cialis side effects were headache, back pain, dyspepsia, and nasopharyngitis.
These Cialis side effects were mostly mild to moderate.
British Journal of Urology International.
Archives of Neurology, November 2007.
I took a dose of Cialis that my doctor gave me.
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Interestingly, I noticed differences in how I feel even with a condom.
I reordered a second bottle and taking it now.
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ICOS Corporation (Nasdaq: ICOS) today sent their financial results for the three and nine months finished the 30 of September of 2004, and summarized recent events.
Clark, group of the operator CHE of the hotels of the president of ICOS and CEO.
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Cialis for the sale that could augur a quota of market of the major of 50 percent for Levitra against Viagra in comparable sales because the new accounts of the prescription do not reflect repuesios in those financial results of Full-Year prescriptions.
Lilly ICOS to the five percent of their net sales of the product.
INDIANAPOLIS--(BW HealthWire)--30 of April of 2002 Eli Lilly and Company (NYSE: LLY) provided an update in financial expectations today, including cialis of the revisions for the sale in full-year 2002 and 2003 guidance.
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Drug DescriptionDESCRIPTION CIALIS (tadalafil), an oral treatment for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5).
Text Continues BelowEach tablet contains 5, 10, or 20 mg of tadalafil and the following inactive ingredients: croscarmellose sodium, hydroxypropyl cellulose, hypromellose, iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, and triacetin.
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Cialis' effect starts working in 30 minutes and lasts for about 48 hours, while Viagra effect lasts for about 4 hours.
Cialis is to be taken with or without food.
Drug NameCialis (Tadalafil) Drug UsesCialis is to treate male impotence (eg, men's erectile dysfunction).
Missed DoseIf you miss a dose of Cialis and you still intend to engage in sexual activity, take it as soon as you remember.
Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke or heart attack.
Call your doctor, if you get a side effect that bothers you or one that will not go away.
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What are tadalafil soft tablets?
Tadalafil does not cure ED or increase a man's sexual desire.
Tadalafil is only for men with ED and is not for women or TEENren.
Tadalafil should only be used under a healthcare provider's care.
Viagra dose What should I tell my health care provider before I take this medicine?
How should this medicine be used?
Take tadalafil tablets by mouth.
The dose is usually taken 30 minutes to 1 hour before sexual activity.
The pill needs to be put under the tongue till it dissolves.
If you have TEENney or liver problems or are taking certain medications, your prescriber may limit your dose of tadalafil.
At this time, this medicine is not for use in TEENren.
What drug(s) may interact with Tadalafil?
Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products.
Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs.
These may affect the way your medicine works.
Check with your health care professional before stopping or starting any of your medicines.
What side effects may I notice from receiving Tadalafil?
What should I watch for while taking Tadalafil?
If you notice any changes in your vision while taking this drug, notify your prescriber or health care professional as soon as possible.
Stop using tadalafil right away if you have a loss of sight in one or both eyes.
Contact your healthcare provider immediately.
Contact your physician immediately if the erection lasts longer than 4 hours or if it becomes painful.
This may be a sign of priapism and must be treated immediately to prevent permanent damage.
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Please call your prescriber or health care professional to determine if your dose needs to be reevaluated.
Using tadalafil does not protect you or your partner against HIV infection (the virus that causes AIDS) or other sexually transmitted diseases.
Keep out of the reach of TEENren in a container that small TEENren cannot open.
What is the shelf life of the pills?
The expiry date is mentioned on each blister.
It is different for different batches.
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The American Medical Association spent several million dollars in the early '90s to discredit the Canadian system and create doubts in the mind of the American public about a government-managed system for universal coverage.
These advertisements contribute to rising costs by inducing consumer demand for newer, higher-priced drugs, when the older ones may work just as well.
A study in Spain declares that between 20 and 25% of total surgical practice represents unnecessary operations.
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They approved the drugs, so there can't possibly be anything wrong with it.
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In fact, they are summaries of after-hours conferences sponsored by pharmaceutical companies.
Simmons, MD, had himself been a homoeopathic practitioner in Lincoln, Nebraska, "and one of a rather partisan hue.!
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Wouldn't it seem that consumers have no influence whatsoever on the success of a prescription drug, so advertising should be directed entirely toward doctors.
They resisted the idea that there were equally good and perhaps even better ways to relieve their allergy symptoms than a new (and therefore less well tested) drug.!
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As we know from The Story of Stuff with Annie Leonard, when we purchase and give objects, they often add to the amount of non-biodegradable material on our planet.
They make their way to our landfills, where they slowly leach more toxic elements into the environment.
What can we give, if not objects?
We can give, through the giftee, clean water to families in developing nations.
World Wide Opportunities on Organic Farms.
Skimpy underwear with a picture of the planet.
A solar-powered golf cart (for the very rich).
Reusables from shopping bags to sporks (spoon-forks).
Safe green toys, charitable gifts, solar-powered watches, gifts from recycled materials, artisanal food gifts.
Donations go to preserving habitats and keeping shelters open, for example.
See this Humane Society website.
Give a donation to Conservation International for a specific purpose.
The specifics will depend on your giftee.
With this gift you receive a cookie cutter or a stuffed animal for the person gifted.
LED (light-emitting diode) holiday lights use 90% less energy than ordinary (incandescent) holiday lights.
LEDs as well as hundreds of classy green-living tips.
This year, holiday LED lights are offered at the best price ever by three online companies.
My impression is that LEDs shine even more brightly than traditional lights, and they come in more colors.
You can get LED holiday lights at a good discount by mailing your old traditional lights to these companies.
Your old lights will be responsibly recycled into components like glass and copper.
Their cost will probably drop before too long.
LED desk lamps are already becoming fairly reasonable to buy.
Environmental Lights has a recycling program.
Click on the link for their recycling address, to get 15% off their new holiday lights.
They will blink, chase, sparkle, fade, or whatever you set them to do.
Christmas Lights has a recycling program also, and a 10% discount on their LED lights.
Holiday LEDs will give you a 15% discount for recycling your old light sets.
These companies welcome big recycle shipments, and they lower their prices if you buy in bulk.
All this environmental information is hard to process.
Is there any way to learn about the big picture without years of study?
Al Gore is leading the way again.
His sequel to An Inconvenient Truth has just come out.
Bill McKibben, head of the worldwide 350 organization to influence the Copenhagen talks in December (referenced in the last few green tips!
Our Choice gathers in one place all of the most effective solutions that are available now and that, together, will solve this crisis.
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The Daily Green says that profits from Our Choice go to the Allance for Climate Protection, founded by Gore, which works to influence global warming legislation in Congress.
CD, audiobook, and hard copy versions.
Cynthia Nixon, John Slattery, and Al Gore.
The book form of Our Choice has great pictures and graphs.
This will save 950 metric tons of CO2e from reaching the atmosphere for vehicles sold in 2012-2016.
They just want our names, email, zip, and so forth.
Every signature makes a difference.
Task Two: We can go to the 350 action site itself and petition the Obama administration to stop the blasting at Coal River Mountain, West Virginia, in Appalachia, where they practice mountaintop removal coal mining.
Worthy of 5 minutes of our time?
I should really do something about this.
Internet petitions create national support and do good.
The more petitions we sign, the more we are emailed to sign.
For the small price of a signature, we become part of the solution.
What else can I do, just by myself, to bring worldwide carbon emissions down to that 350 parts per million number?
Spend 10 additional minutes after washing your clothes.
Remember last week, we discovered each kilowatt of electric energy puts 1.
CO2e (carbond dioxide equivalents) into the atmosphere?
Well, each time we run a clothes dryer, we send 5.
Those emissions are the environmental cost of electric energy for dryers.
Why did we think up clothes dryers in the first place?
People outsmarted themselves, looking for convenience.
Clothes dryers use the second most electric energy of any appliance.
Rethinking Laundry in the 21st century.
Check it out for fascinating bits.
Italian households own a dryer).
Like how good your clothes smell when you dry them outside.
Colleges are starting to catch on.
She also persuaded the college to loan racks to students each semester.
They rigged up an outdoor clothesline, in the snow, and hung out 350 pieces of their underwear for Action Day, October 24th.
Since they assumed spectators would walk up and inspect the underwear, they taped informational notes about carbon emissions to the bras and thongs and shorts and socks.
They say rack-drying puts good moisture in the air.
Reluctant Environmentalist and I will find a clothesline contraption for the porch.
Anyone have ideas for student residence halls at Fairfield?
This seems like a harder subject than it really is.
Remember how the 350 movement is trying to reduce the current 390 parts per million of CO2 in our atmosphere down to 350?
Well, Fairfield University helped put that 390 up there.
If we helped raise it, we can help bring it down.
Fairfield University just had its carbon footprint measured.
That means a Consultant helped us calculate how many tons of CO2e we put into the atmosphere each year.
His report came out in May, 2009.
University Presidents Climate Commitment (ACUPCC).
Dana August, President of the Student Environmental Association, is one of those studying the numbers.
Simply, here are our CO2e emissions for 2008.
According to Dana, this amounts to 6.
When we are using greener cars, in the near future, our CO2e will decrease.
We can get by with less electricity.
But how will using less electricity make a dent in all those tons?
And one good website called Green Living Tips spells out how to save many pounds.
Laptop computers save about half a ton of CO2e per year over desktops.
Apparently a single person can save tons of CO2e emissions each year.
When first I read this website, it was late at night.
I walked over and unplugged my laptop charger.
Then I unplugged my cell phone charger.
Typically I charge my laptop and cell phone overnight, but why?
I go to bed, so what am I doing?
Why is the number 350 all over Fairfield campus?
The safe upper limit for CO2 in our atmosphere is 350 ppm (parts per million).
Today CO2 (carbon dioxide) in our atmosphere is around 390 ppm and rising.
We need to return quickly to below 350ppm, or the planet will melt.
The 350 Movement Supposed to Do?
Heighten global awareness, big-time.
Put worldwide pressure on the crucial United Nations Climate Negotiations in Copenhagen this December, 2009.
In Copenhagen, these world leaders will decide on a global treaty to cut carbon emissions, but their current draft treaty is too weak to reduce our CO2 to 350 ppm.
The 350 Movement plans to push world leaders to act.
The International Day of Climate Action is October 24th.
Rallies and community events will spread across nearly every country on the planet.
Every event will emphasize the number 350.
This four-minute video shows some typical participants in this world movement.
We can donate our old bed sheets, rugs, blankets, and tarps in the next few days at the InfoDesk of the BCC.
Students and others on campus will be using them (and recycled materials) to build a network of art projects by October 21st, on top of the School of Business roof.
This art-project network will create the number 350, big enough for an aerial photograph.
October 21st and delivered to the 350 team organizers on October 24th.
That means Fairfield will be part of the giant visual international petition on the Day of Action.
What else is being done on campus?
The Student Environmental Association (SEA) and the Green Campus Initiative (CGI) are sponsoring this project here.
Dana August, President of the SEA, is now working on the impressive job of cataloguing those emissions.
More news about that in the next post.
A box of Ivory Snow (flakes, not liquid).
A box of quart-sized plastic bags with zip seals.
A ring of teaspoon-tablespoon measures.
Pour into it 2 cups of the Ivory Snow flakes.
Seal the bag and shake to mix, then put the teaspoon-tablespoon measures into the bag and re-seal.
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To make more detergent, just return to your original boxes of Ivory Snow, Borax, and Washing Soda.
Voices for the Earth has been pressuring these companies to list their ingredients, and the companies now offer fragrance-free and dye-free detergents.
But there are still other harmful chemicals that remain unlisted.
In the meantime, many people are hosting WVE green-cleaning parties to learn how to make their own safe household cleaners.
Party instructions are on the website.
Hammer Essentials are definitely an improvement over regular brands.
Their surfactants are usually biodegradable.
Add a quarter cup of white vinegar.
Do you see a recycle triangle with a 5 inside it?
We are the first university to have this Gimme 5 program, in partnership with Preserve Products.
We are pioneers in going-green territory.
The Gimme 5 bins have a bright green top, with two container-sized holes.
They have blue silhouettes on them of yogurt cups, medicine bottles, and the rest.
Just inside the front door of the BCC extension.
Just inside the back door of the BCC extension.
Inside the Stag Diner (by sometime next week).
Recycling Coordinator for the campus.
Dana August of the Student Environmental Association tells me that SEA members go through the bins each week, check for contamination, and then package the containers and ship them off to the Preserve company in Cortland, New York.
Then they take even their own products back and upcycle them into plastic wood for park benches and decks.
Do you use a Brita pitcher to filter tap water?
Brita and Preserve have now teamed up.
Brita manufacturers to team up with Preserve, get their filters recycled, and regenerate (or convert to energy) the filter ingredients.
Want to see what a successful grassroots campaign looks like?
One person at a time, one container at a time, and pretty soon we have real numbers.
This is a big campus to walk around.
With no shuttle, and no cars for first or second-year students (half the student body), what will students do in the bleak midwinter?
Think of walking from Julie Hall to Donnarumma, or from Jogues to the School of Business.
Once inside the buildings, you meet cold and flu viruses.
An electric bike gets you from Julie Hall to the School of Business before your feet get cold.
On the way back, its 750W electric motor takes the hills.
Electric bikes have racks and baskets for your books.
True, an electric bike does cost money.
But you can get an electric bike for less, or for more.
You can get an electric bike that folds up.
You can get a power kit to put on your old bike.
Compare electric bike costs with car costs.
Will e-bikes finally take off in America?
Want to break out of your car-addicted lifestyle without having to break out in a sweat?
Clean Republic has an electric bike conversion kit that takes 3 minutes to install on your old bike, they say.
Save gas money, save the world.
They look slick and smooth, and they go for 40 miles per charge.
How about checking out electric bike sites on the Internet?
It would beat walking from Jogues to the Library in 15 degrees.
The views expressed in this blog are those of the page authors, and don't necessarily represent those of Fairfield University.
Fairfield University is not responsible for errors or omissions.
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Blogging on the overlap between principle and power.
Sad to have this relevant update to the pharmaceuticals and war post, but the terrorists behind the recent Mumbai attacks were found to be using cocaine, LSD, steroids and possibly other stimulants during the fighting.
This explains why they managed to battle the commandos for over 50 hours with no food or sleep.
Full story from the Telegraph is here.
Thanks to Chris Albon from warandhealth.
PTSD and keep needed soldiers on the front lines.
There is a long history of the use of drugs during warfare, from antidepressants in current wars, to amphetamines in Somalia (Khat), Vietnam and WWII, to alcohol from time immemorial.
I heard chilling first-hand stories of Serb soldiers drunk on schlivovitz from Bosnian refugees after the war.
Air Force pilot performance during long missions.
An old issue that might deserve a well-researched and reasoned debate in a news magazine?
The Washington Post had a pretty good review of PEPFAR last week.
SAIS International Health Policy student Ilaria Regondi sets the record straight in this letter to the Washington Post, reprinted below.
Is State Failure an Antidote to AIDS?
Death, then, acts as a powerful incentive for behavioral change, but it can hardly be prescribed as the ideal antidote to AIDS.
While the health benefits of embracing monogamy are obvious, the cause of this shift (poverty) should also be a cause for widespread concern.
Skyrocketing unemployment and social disruption have also played a part, at once reducing mobility and increasing migration.
HIV rates while letting Zimbabwe benefit.
When a country with 150,000 percent inflation and a despotic ruler flaunts achievements that no one else can claim, perhaps a little more caution is in order.
Forum on Microbial Threats convened an expert meeting to explore the links between climate change and infectious disease.
The event brought together a diverse group of experts from fields such as medicine, public health, ecology, plant science, remote sensing, agriculture, entomology, demography, and public policy to grapple with an important, but somewhat controversial, question within the overall climate change debate: will a changing climate lead to more infectious disease?
In seeking an answer to the general question, presenters tackled multiple perplexing sub-questions, such as: What are the mechanisms by which climate change leads to shifts in disease?
How do human social factors interact with the ecological processes leading to shifts in disease?
Which countries will be most affected and which will be spared?
How potent are the tools that we currently have at predicting, identifying and ameliorating future changes in disease incidence?
After two full days of rigorous discussion, it seems fair to say that participants found that clear, convincing answers to these questions were often hard to come by.
There is solid scientific evidence that increasing temperatures can lead to increased transmission of disease, through direct action on infectious agents (e.
Rainfall and humidity also have proven biological effects.
While these biological effects can be proven, what is increasingly clear is that such changes will be dwarfed by the interacting variables of future human behavior in reaction to climate changes (urbanization, migration, and agricultural practices), and the pre-existing and future capacity of public health systems.
A poor country with a weak health system and a large infectious disease burden will likely have a hard time adapting (or even identifying) relevant changes in disease incidence in the future, leaving it vulnerable to the effects of climate change.
In contrast, a rich country with an effective, existing public health system is likely to respond well.
Whatever the temperature is in Atlanta in the future, we are unlikely to ever again see endemic malaria there.
Putting yet another layer of perspective on it, one can note that the additional cases of disease likely attributable to climate change as predicted by our best forecasting models represent only a small fraction of the current global infectious disease burden.
Why are we worked up about possible climate change-induced disease when we have totally unacceptable levels of disease right now?
This viewpoint was captured beautifully by Dr.
Burke responded that countries could reduce and even eliminate vector-borne diseases with existing tools and knowledge, all it would take is adequate financial resources and political will.
Thailand could end its dengue problem now, he said, and never have to worry about whether or not climate change will increase dengue in the future.
Concerns about climate change could raise awareness about weaknesses in these areas and could lead to corrective actions (which would be a welcome development), but a changing climate is will not be a principal determinant of the future global distribution infectious diseases in general.
Poverty, lack of adaptive capacity, and human social factors (including trade and travel practices) will play a much bigger role and should be placed at the center of all these discussions of the health effects associated with climate.
What does health mean to the Department of Defense?
For militaries, health has always meant the preservation of the health of armed forces.
They more often mop up after the barrage of epidemics.
DoD) interest in health is in maintaining the health of its forces and their dependents during peacetime, predicting and preventing illness during deployment, and in combat care during war.
The rational is of course to minimize or even eliminate the impact of disease on U.
DoD is also interested in the health of foreign militaries.
AIDS from causing instability in foreign militaries that could lead to state instability and calls for U.
AIDS that enables greater cooperation with the U.
The rationale for this is competitive.
The example I hear repeatedly is the case of Hezbollah running hospitals, and providing public health and social services, then going on to win significant representation in Lebanese elections.
The Cuban training and exporting of medical personnel across Latin America since 1960 is another often cited example.
Another example is the use of medical civil-assistance programs (MEDCAPs) in Iraq, which are essentially temporary health clinics set up to treat as many patients as possible in a few hours before closing down.
Supporters argue that a few hours of world class medical care can help win support of local populations, gather intelligence, and reward communities for cooperation with the U.
Major Jay Baker argues that MEDCAPs actually undermine local health systems while failing to build Iraqi health capacity.
In the end he argues, they weaken the ability of the Iraqi government to provide health services and therefore undermine U.
It seems that DoD still has a lot to learn about basic global health principles such as sustainability, building capacity, and low-tech interventions that save the most lives including clean water and maternal healthcare.
A final uncomfortable note for those in global health is provided by David Kilcullen, currently advising General Petraeus in Iraq, in his fascinating Twenty-Eight Articles of conducting counterinsurgency.
There is no such thing as impartial humanitarian assistance or civil affairs in counterinsurgency.
Every time you help someone, you hurt someone else - not least the insurgents.
Bill and Melinda Gates (their foundation, I should declare, funds our Global Health and Foreign Policy Initiative) are not lacking in ambition for global health.
On October 17th, they called for malaria to be eradicated.
The answer is no, given current technology.
The drive to eradicate polio, which began in 1988 and which was to have finished by 2000 but is still ongoing, demonstrates the importance of technology.
Should we succeed in eradicating the wild polioviruses (more on this below), we will only face a new challenge.
The vaccine being used to eradicate the wild viruses contains live viruses that can mutate and evolve to resemble the wild viruses.
Stopping use of this vaccine thus creates risks.
In short, the vaccines we have today are ideal for controlling polio but not for eradicating polio.
D for new tools before embarking on the quest to eradicate polio.
A program to eradicate guinea worm has been underway since 1981.
The technology for doing so is very simple.
Education and water filters alone can do the job.
However, civil war in Sudan has blocked progress.
For eradication, the weakest link is often a failed state.
Polio suffers the same problem.
It is still endemic in the border region between Pakistan and Afghanistan.
Even with the right tools, it may not be possible to interrupt transmission in these areas.
This is because, once a disease has been eradicated, control of the disease can be stopped.
Eradication is thus the ultimate form of sustainable development.
Indeed, as I explain in my new book, Why Cooperate?
However, smallpox may yet prove the exception.
Other eradication efforts, including an earlier effort to eradicate malaria, all failed.
IEDs (improvised explosive devices) in Iraq.
IEDs have proven to be a low-tech and deadly way to attack U.
How does, say, 1st Platoon manage their bees?
Just as interesting is what the articles say about the nature of this war and why high-tech solutions to the IED problem may only be half-measures.
Three 152mm rounds underneath a tank, which will blow a hole in it, are artillery rounds.
They came through a social trajectory and a social network in the community.
In other words the artillery shells are not being fired at vehicles by a traditional army, but are coming at U.
Dealing with this social network is low-tech, requiring deep understanding of language, culture and insurgent social networks.
IEDs have had some success, but low-tech, on the ground intelligence may be the only way to stop IEDs before they explode under our troops, ie.
Two photos from a friend witnessing the Saffron Revolution in Burma.
Good information has been difficult to come by as the junta attempts to enforce a media blackout.
Official (and by that I mean the military junta) data reports 9 deaths, while a recent high-level defector reports thousands of deaths.
On Thursday we were praying at the Kyethune Phaya.
Then we heard the sound of the soldiers coming.
Banging their sticks on their shields.
Without warning they entered the pagoda and started to beat us with their sticks.
Some had swords on the end of their guns.
They beat a young monk, only 15 years old.
He fell down, bleeding on the head.
The young monk ran and escaped.
They (the Government) are afraid.
They (the soldiers) are going to the monasteries at night.
Entering the monastery, beating and taking away the monks.
They raided Waizayandar on Thursday.
On Friday they cleaned the monastery and replaced the monks.
With men who are not real monks or with monks who side with the government.
They do not put them in prison.
They take them to the many military camps around the country.
The monks are refusing the small bowl of rice being offered to them by the soldiers.
The soldiers offer it to them after 1pm to make them break their vows.
We see the situation in the country.
We go around and we beg for our food.
We see that a very few people are very rich.
They are all the families and relations of the Generals.
We see that the people are getting poorer.
They cannot even feed themselves.
But too many of us have died already.
Burma has long been a terrible example of how violation of human rights contributes to worsening public health (warning, large pdf file).
AIDS, along with rising drug-resistance due to counterfeit drugs.
Saffron Revolution succeeds for the health and political freedom of the Burmese.
An outside observer might get the idea that the US Congress is ignoring the international disease threat.
Senator Joe Biden (democrat from Delaware, and current aspirant for the democratic presidential nomination) along with co-sponsors Sen.
CDC and DoD programs in other nations.
House of Representatives after being approved by the Senate Committee on Foreign Relations.
See the original press release on the bill from Sen.
CBO) cost estimate for implementing the bill here.
Senate in March of this year by Joe Lieberman, Sen.
Currently the bill is sitting with the House Subcommittee on Horticulture and Organic Agriculture and the Senate Committee on Health, Education, Labor, and Pensions without having been voted on.
House vote during the previous congressional session.
The CBO cost estimate for Wildlife GAINS can be seen here.
Making law is cumbersome and time-consuming, and many factors can determine success and failure.
Still, the main culprit behind the inability to turn these bills into law can be probably attributed to a lack of popular understanding of their importance to protect US public health.
Probably it will take a serious health emergency to shock the public out of complacency, but hopefully these bills (or something like them) will be move beyond the subcommittee rooms of the capital and into become law before that occurs.
A delay in detecting and reacting to an outbreak of human-to-human transmission caused by self-interested hoarding of samples or information could lead to thousands, if not millions, of otherwise avoidable deaths.
That is why the pressure is on for the World Health Organization (WHO) to help countries iron out a possible impasse on bird flu sample sharing.
The tension originally arose from a group of countries, led by Indonesia, claiming intellectual property rights over flu virus samples originating inside their borders.
Health Protection Agency) to isolate and study them.
Indonesia, which has recorded the highest death toll due H5N1 (avian) influenza, stopped sharing samples earlier this year saying that it required assurances that it would have access to any products developed using its samples.
Other countries quickly joined the call for access to life-saving interventions generated using samples coming from their territory.
In response to the growing stalemate, the WHO convened a special working group meeting of 24 countries on July 31, 2007, whose goal is to generate recommendations flu virus sample sharing.
While the task at hand is limited to flu samples, the repercussions of any guidelines could include other infectious diseases of international concern.
Governments, pharmaceutical companies, intellectual property rights supporters, and public health representatives all have large, and somewhat opposing, stakes in the outcome of these discussions.
It would not be hard to imagine, especially in the face of an actual pandemic, that vaccines generated from Indonesian virus samples might be hoarded by rich countries where the manufacturing capabilities lie, or perhaps priced too high for poor countries to purchase enough to adequately protect their populations.
On the other hand, any restrictions on virus sharing could hinder tracking the virus and developing necessary vaccines.
If countries are allowed to share only on a limited basis, gaps in knowledge will result and the march of scientific progress will be slowed.
The WHO can be commended for taking rapid action on this complicated issue.
The solution should fall heavily on the side of maintaining a robust scientific exchange on disease, because the cost (in lives and dollars) of a slow pandemic response far outweighs the potential loss of economic returns on a product.
Nitze School of Advanced International Studies of The Johns Hopkins University.
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But common sense has not prevailed: the industry pressured the FDA to legalize direct-to-consumer advertising in 1998, and since that time drug ads have polluted the airways and the world of print publications, and prescriptions for those advertised drugs have risen considerably as a direct result of the advertising.
So, according to Strand, there's a 70 percent chance the doctor will prescribe Zoloft, the exact prescription the consumer requested.
Among the wealthy nations that support the global pharmaceutical industry, the United States is by far the most permissive in its regulatory scheme.
Its duty, by law, is to set standards for drug advertisements.
The following interview with Dr.
Gary Null's Prescription For Disaster video documentary, which is available at the Gary Null website and is a must-see video for anyone who wants to know the truth about the pharmaceutical industry and the FDA.
I'm currently the Associate Director for Science and Medicine in the Office of Drug Safety.
Car and pharmaceutical commercials use the same hooks -- popular music, good acting and lofty promises -- to hook consumers and reel them in.
The voiceover answers our question as we think it: The woman has social anxiety disorder, a condition that can be treated with the prescription drug Paxil.
So, let's say that a consumer who has been feeling a little sad lately sees a commercial for the antidepressant drug Zoloft.
The reason drugs cost more in America than in any other country boils down to one simple factor: the pursuit of maximum profit.
Could it be this is a strategy being deployed against the dietary supplement industry.
Wilkes' group speculated "that the FDA is unable or unwilling to enforce adequately its rules relating to drug advertising.
On The Take by Jerome P Kassirer M.
They estimate a figure of 5 billion dollars was spent in 1991 for this type of advertising and add, "Though doctors insist their scientific training, high intelligence, and sophistication enable them to resist manipulation, the truth is that skillful marketers can influence M.
In addition, there is strong and irrational Internet resistance from physicians, who control about 80 percent of healthcare resources.!
The scattered nutritional or biochemical articles are rarely read.!
It's safer for you than anything you've ever seen before, and it'll take away your pain," you should likewise be skeptical and not believe that either.
It's more than a coincidence that many of the most expensive medications happen to be those medications that are most heavily advertised.
The Kaiser Family Foundation reports that with thousands of drugs on the market, 60 percent of DTC spending in 2000 went to plug just twenty products.!
When you combine this with some of the other actions that Merck has engaged in (which have been discussed in detail on this site) and some of which has been revealed in e-mails published by the Wall Street Journal, it paints a bigger picture.
The study attributed the spending increase to a boost in the number of prescriptions for the fifty drugs, and not from a rise in their price.!
What may be even more important to note in all of this is the Vioxx cover-up further confirms the character of the drug companies in our modern day environment of drug promotion and suppression of negative side effects.
Notice their promotional hooks and be grateful that you, unlike most consumers, are no longer susceptible to their influence.
Drug reps fill doctors' cabinets with "free" samples, knowing that if patients do well on them, they won't want to switch.
The study was published in the June 1,1992 issue of the Annals of Internal Medicine.!
The PDR, free meetings and gifts, and direct contact by drug-company representatives constitute three major ways that drug companies influence physicians' choices of medications.
Wilkes and a group of colleagues had earlier conducted a study of prescription drug advertisements which showed "many claims prove to be inaccurate or misleading.
We can be pretty certain that the FDA would not agree with most of what I have to say.!
Russia couldn't even find the wherewithal to buy television advertising time on national television to promote AIDS education.
The doctors themselves are also a part of the problem.
Richard Smith, editor of the British Medical Journal, has raised the concern that lucrative advertising and reprint sales can be a corrupting influence.!
These publications masquerade as educational materials, but many are largely marketing efforts that deserve as much scrutiny as drug advertisements.
And despite the huge increase, drug companies spend even far more dollars in advertising their products to physicians, not consumers.!
Vodra put it, to "fight fire with fire in the marketplace.
More than half recognized Paxil, 45 percent knew the cholesterol-lowering Zocor, and nearly 80 percent were aware of the pharmaceutical phenomenon Viagra.!
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Although this symbol has been a patriotic representation for over 150 years, Uncle Sam cannot stand as a fair symbol of our nation any longer.
If this long time representative of our nation could speak to us today perhaps he would remind us that our constitution gives us unalienable rights from the creator to the individual and can not under any circumstance be surrendered or taken.
Contrary to the common misconception, the United States is a constitutional republic and not a democracy.
In a republic, the sovereignty resides with the people themselves and one may act on his own or through his representatives when he chooses to confront a problem.
Since September 11, 2001 we have been witnessing the destruction of our republic.
Congress is gradually dismantling the Bill of Rights and the Constitution with the strong influence of the two most recent presidents.
In this way national sovereignty and the freedom of individuals is being destroyed.
Also permitted by the bill is the indefinite imprisonment of any citizen without due process, access to the courts, or the counsel of a lawyer.
The Federal Bureau of Investigation is now able to obtain records from businesses, hospitals, bookstores, and libraries for any reason and can search phone, email, and financial records without a court order.
The Military Commissions Act of October 17, 2006 assigns dictatorial powers to the president while stripping citizens of the right to habeas corpus.
The John Warner National Defense Act empowers military troops to police within US cities during emergency situations to suppress public disorder and dissent, a violation of the Posse Comitatus Act of 1878.
The US has also engaged in torture, initiated undeclared wars, built FEMA camps that closely resemble concentration camps, encouraged the public to spy on each other, and committed several other acts that allow the government to have increased control over the lives of its citizens.
Our government servants are constantly changing laws to favor and protect global banks.
While the Constitution is being destroyed, these global bankers are committing financial terrorism.
The private banking cartel of the Federal Reserve has been all but openly permitted to bankrupt our country and destroy our wealth, setting up the need for a global currency.
The multinational corporations as well as the technocrats of large foundations and other non-governmental organizations lobby congress with a large degree of influence as well.
Seldom is it the voice of ordinary citizens the shapes the actions and opinions of our representatives in congress.
From the influence of the global powers and ruling establishment a new world order is emerging.
Once only recognized by the media as mere conspiracy, it is now considered a reality as hundreds of articles across the world address this issue on a weekly basis.
The standardization of one system of government throughout the world is steadily being introduced as we come into the Age of World Managers.
If you look at the charter and mandate of the Council on Foreign Relations and the Royal Institute of International Affairs, you will see that the future they envision is a world of service.
We are living through a cultural revolution right now that is transitioning us into a world system.
The major media plays a significant role in forming social opinion as it relates to global and national events.
These individuals have been trained not to look at the obvious but only at what is presented to them.
This country has fallen victim to a form of psychic tyranny, where we have become mind slaves of major media mainly through the use of television.
If you study Stalin you will see how those in power know that the masses can be strongly influenced by repetition.
The media bombards the public with repetition of certain thoughts or opinions and individuals slowly start to adopt these thoughts and opinions as their own.
We shall conquer the world by the use of slogans.
Our culture, created mainly by the mass media, has trained the public to be docile and apathetic.
Rather than trust themselves, many people will only shape their opinions from those who are presented as experts or authority figures in the mass media.
In this way the US resembles the beginnings of a scientific dictatorship- a managed society ruled by the intellectual elite.
The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element in democratic society.
Our nation is becoming something that we have long fought against.
Their objective to rule rests in the annihilation of our consciousness as they create a state of learned helplessness among the masses.
Terrorists hate us for our freedom.
Now it is clear that the true terrorists are the ruling establishment working through those who are elected to represent and serve the people.
The series of recent articles on mammography which report the harm done by overscreening, written by New York Times columnist Gina Kolata, as well as in other newspapers, have made no reference to the critical role of the American Cancer Society, warns Samuel S.
Five radiologists have served as presidents of the American Cancer Society (ACS).
In its every move, the ACS promotes the interests of the major manufacturers of mammogram machines and films, including Siemens, DuPont, General Electric, Eastman Kodak, and Piker.
I recently attended an Al Gore event here in Toronto Canada to cover the latest information regarding climate change.
We were there no longer than one hour when security guards kicked us off the grounds.
We left their private property and proceeded to the public sidewalk outside their property line.
PFT member Mark and almost broke my camera.
I could see the red and white in his hands as he squeezed my camera in an effort to break it.
This goes to show the unprecedented lengths authorities will go to in order to silence alternative media.
We are clearly having an effect in this information war and the time to stand up against the new world order is upon us now more than ever.
There have been 24 confirmed cases of a type of severe allergic reaction called anaphylaxis in Canadians who have received an H1N1 flu shot, including one person who died after getting vaccinated, the head of the Public Health Agency of Canada said Wednesday.
Al Gores LIES on how he think Global Warming is caused by a LIFE GIVING GAS called C02 are exposed by Rep.
Al Gore OWNS the Carbon Trading Companies and OCCIDENTAL Petrol.
He does not care about the environment, he only cares about money and ENSLAVING YOU!
For a while now there has clearly been a more relaxed approach from officialdom to former insiders revealing their knowledge of extraterrestrial activity.
He said that life on Mars cannot be ruled out, either.
Those in the know are fully aware that the mainstream media is nothing more than the propaganda arm of the State.
It is so easy to fall into the mental trap that, if you know something, then how can it not be common knowledge?
They are completely and utterly clueless.
For the rest of us, the fight is joined.
The globalists have thrown their best punches while we played rope-a-dope.
Even before this scandal broke, they were running out of gas.
The media will not be our ally in this.
The globalists, the eugenicists, are in this for the long haul.
All of their eggs are in the climate hoax basket.
We all know this was never about climate change in the first place.
No, what this is and always was about is an excuse for global government.
This they certainly do not deny.
New York Times last month in which he called for a global government funded by carbon taxes.
We know that this scheme is completely unknown to the vast majority of people.
Unfortunately, because Beck and Fox actively promote the left-right paradigm, the establishment will still try to paint the issue as an attack by right wing hacks and special interests.
This story does not belong to the media.
Why not report on the story, if only to downplay it and attack climate change skeptics, like every other news outlet has?
Objective readers are capable of making their own judgments, but this is an obviously damning admission.
English that any 6 year old can comprehend, but again journalistic integrity takes a back seat to demagoguery.
Well I have my own article on where the heck is global warming?
We are asking that here in Boulder where we have broken records the past two days for the coldest days on record.
The high the last 2 days was below 30F and the normal is 69F, and it smashed the previous records for these days by 10F.
The low was about 18F and also a record low, well below the previous record low.
The CERES data published in the August BAMS 09 supplement on 2008 shows there should be even more warming: but the data are surely wrong.
Our observing system is inadequate.
Can you delete any emails you may have had with Keith re AR4?
Can you also email Gene and get him to do the same?
We will be getting Caspar to do likewise.
Our chapter and figs (including 6.
But, that said, I do feel your are right that our team would not have said what the TAR said about 1998, and thus, we should delete that second sentence.
Send them a subset removing station data from some of the countries who made us pay in the normals papers of Hulme et al.
This should also omit some other countries like (Australia, NZ, Canada, Antarctica).
Also should remove many of the early stations that we coded up in the 1980s.
Send them the raw data as is, by reconstructing it from GHCN.
Replace all stations where the WMO ID agrees with what is in GHCN.
This would be the raw data, but it would annoy them.
RC in any way you think would be helpful.
On the other hand, you might want to visit the thread and post replies yourself.
RC as a resource that is at your disposal to combat any disinformation put forward by the McIntyres of the world.
Just sent loads of station data to Scott.
Make sure he documents everything better this time !
The two MMs have been after the CRU station data for years.
Does your similar act in the US force you to respond to enquiries within 20 days?
The UK works on precedents, so the first request will test it.
We also have a data protection act, which I will hide behind.
Office, IPCC is an international organization, so is above any national FOI.
UK has a Freedom of Information Act !
The Climate Audit web site has a new thread on the Jones et al.
So they may not be going to submit something to Albany.
Just agreed to review a paper by Ren et al.
This refers to a paper on urbanization effects in China, which may be in press in J.
Have requested JGR get a copy a copy of this in order to do the review.
In the meantime attaching this paper by Ren et al.
Had an email from David Jones of BMRC, Melbourne.
He said they are ignoring anybody who has dealings with CA, as there are threads on it about Australian sites.
They are most interested here re Ch 6 on paleo.
When the FOI requests began here, the FOI person said we had to abide by the requests.
The VC is also aware of what is going on.
Here are some speculations on correcting SSTs to partly explain the 1940s warming blip.
This still leaves an ocean blip, and i think one needs to have some form of ocean blip to explain the land blip (via either some common forcing, or ocean forcing land, or vice versa, or all of these).
When you look at other blips, the land blips are 1.
Removing ENSO does not affect this.
The other interesting thing is (as Foukal et al.
MAGICC) that the 1910-40 warming cannot be solar.
The Sun can get at most 10% of this with Wang et al solar, less with Foukal solar.
So this may well be NADW, as Sarah and I noted in 1987 (and also Schlesinger later).
You can draw your own conclusions from these emails, and decide for yourself whether they are cherry-picked and taken out of context, and whether it is the proponents being vilified by the skeptics or vice-versa.
As usual, you must do your own research, and it is up to you to push this into the public eye.
They must be made aware, and they must have a fire lit under the backsides, to understand that they cannot sit around unaware and uncaring of current events.
Push for an aggressive congressional investigation.
Motivate others to do the same.
The media will not drive this story.
In fact they will do everything in their power to suppress it.
Government targets, initiatives and new laws, the chief of inspector of police has said.
Laugh, cry, but whatever you do, read on.
Every little bit helps us continue.
Thanks in advance and KEEP UP THE FIGHT!!!
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However, if you were to read the labeling for these drugs it doesn't point that fact out so patients think one SSRI is as good as another.
Everybody knows the game is up -- the FDA is merely protecting the industry it's supposed to be regulating.
GRAHAM: The drug companies pay a substantial amount of money to the FDA at the time that they bring a drug application for approval in order for the FDA to review the drug.
GRAHAM: It's a myth that is promulgated not only by industry but also by the FDA itself.
He who pays the piper calls the tune, and we now have a captured agency.
The nation as a whole is not healthier, even though we are taking far more prescription drugs than we ever have.
First, there are some 200 to 300 different influenza virus strains, but the vaccine usually contains antigens of only a few.
Tell us a little bit about that.
The adaptive immune system creates taylor-made antibodies to pathogens by trial and error.
So it's a captured agency and America is not well served when industry is calling all the shots.
On one side, you have the highly corrupt FDA and the scheming pharmaceutical companies who seem to be willing to say anything and do anything to maximize profits.
What happens is the drug gets marketed.
Doubters, on the other hand, simply see this attitude as a triumph of marketing over science.
The times when I've done the benefit analysis, I've been chastised, criticized and suppressed by the FDA.
But the governor of Wisconsin is more interested in helping the citizens of that state actually afford prescription drugs.
I wouldn't take prescription drugs if you paid me to.
In his book, Death by Prescription, Ray D.
There has to be an overwhelming reason for you not to approve.
Somebody is selling something to somebody else.
When they look at safety it's entirely the opposite.
They're really proud of the fact that I've said it and they're not afraid to be seen with me.
I think at the same time there are other people who don't think it's such a bad problem, and many of those people honestly believe that.
A vaccine presents the patient.
Early counsel: the strategy on brand identity, for one of the best motion picture brand developers in the world.
A number of years, back, I had the opportunity to work with James Cameron and his marketing team on the conception of the Abyss.
Bear in mind, that any process in identity development for films is about collaboration, the studio, the ad agency, the director, the stars: the team, in the submission of literally dozens (maybe hundreds, sometimes) to the tuning and treatment of the final title.
We go there, work there, create ideas.
Girvin has a particular reputation as designers to the theatrical marketing place of advertising communications.
That call came in a strange string of connections.
Herb Lubalin, who I met in NYC, during my early years there.
Coppola had seen these expositions and called for me to offer ideas about the logo of his film.
That heritage continues in the partnering with dozens of studios, celebrities and directors to act as a kind of specialized design agency focusing on creating highly customized logo treatments.
Girvin has been involved, over time, in working on literally hundreds of films.
All of these treatments are made by hand, individually analyzing the nature of the story, history, context, production design and how it might be presented as a keystone marketing element in theatrical advertising.
Later, our team worked with Cameron and Paramount Studios on the identity design programming for Titanic, a film that, during its development, was a production of almost unheard of proportions, not only in scale but in the majesty of its explication and finally the worldwide sales, representing a global audience of truly spectacular scale.
A venture into Alien territory, as well as his advancement of the Terminator saga that began as an earlier foray into the spacious technological renderings of a world gone amok in the takeover of humankind by a generation of machines, webbed by the monstrous Skynet and its murderous inclinations for domination.
Avatar and seen some of the opening treatments of the concept of its visual identity.
Early renderings and pre-marketing show reels expressed this in a font that to my thinking failed to appropriately reach to the innovation potential of his visioning.
And like my connections with J.
Abrams, or Clint Eastwood, and Ridley Scott, sometimes these ideas will reach a fertile audience and lend themselves to involvement.
However, I was never able to get through, to finalize a potential deal in supporting the marketing of the film.
My pitch related to the concepts of reaching into the archetypal otherworldly dreams of this story by reaching back into time, finding primordial renderings of the concept of the alphabet being seminal symbols in the consciousness of the ancient roots of alphabetic history.
It might be suggested that the alphabet, occurring many millennia back, could be traced into the mists of time and even be drawn with the tools of the era, to suggest another parallel world.
No answer, but the following represents a play to that imaginative visualization.
And the inspirational route of experience development in design ranges nearly four thousand years back, to the middle eastern levant, in examining the primitive strikes of the form of content.
This grouping could relate to the essential beginnings of the alphabet in the so-called Proto-Sinaitic forms of the letter.
And aside from edicts and other promulgations of governing entities, many of these documentations are literal shipping lists or exchange orders.
Greeks, in their systems of writing.
Part of this transmission, though essentially untranslated, relates to the markings found in a group of excavated scapula and bronze plates, from Byblos, roughly dated between the 18th and 15th centuries BCE.
The later treatment of the evolution of both Greek and Latin calligraphy found their way to the geometrically rhythmic Uncial form, like this 4th century papyrus manuscript.
There are, of course, hundreds of scripted variations, influenced by the movement of ancient hands in places of antiquity.
Avatar font, in a manner that uses the tools of thousands of years back.
I did the same with Ridley Scott, on Gladiator.
David Fincher, Tom Cruise, Jerry Bruckheimer, Zemeckis, Leone, Zwick, others.
One inspiration, plays to another.
And the story is continuously told.
That last image is simply stunning.
I am sorely disappointed that they did not use it for the branding of the movie.
From seeing the first teaser trailers, Avatar has always felt cheap and campy to me, I think largely due to the use of Papyrus.
I definitely think they made a mistake with the branding.
Having seen the movie, I questioned whether Tim had any involvement in the logo design and branding of the film.
However, I also believe that whoever did develop the design could have made the logo even more primitive, even aboriginal, as the clan was referred to in the movie.
The idea of infusing some sort of hieroglyphic into the design would have also brought some mystique to the brand.
Having now seen the movie, and after re-reading this post, I have to say again how disappointed I am that your work was not used.
It appears that you put a lot more thought and passion into this than the designers of the final Avatar logo did.
When I saw the final stretched, 3D-beveled logo come up at the end I cringed.
The version you have created here really would have been the icing on the cake for an otherwise quality movie.
A very educational and inspiring post.
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Girvin Strategic Branding Design Blog.
And check my channel for a lot more rare Jeff Buckley stuff!
I have that performance on my channel!
I would give anything to have that voice.
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Not long ago, men were considered to be old horses (no pun intended) as far as sex was concerned once they crossed 50 years.
Not any more, today modern medicine has progressed to such a level that men are not only expected to be physically active, but are also expected to be sexually active, well past their prime.
Most men probably are not aware of the strong relationship between remaining fit and good male sexual health.
Good male sexual health is defined as the ability to perform satisfactory sexual intercourse which is satisfying to both the man and his partner and enhances their overall psychological feeling of well being.
Most men overlook the importance of keeping themselves fit, in order to enjoy good sexual health.
They have an unhealthy lifestyle which includes fatty food, lack of aerobic exercise and plenty of stress, all of which contribute to fat clogging those very arteries responsible for ensuring plentiful supply of blood to the penis.
These clogged arteries lose their elasticity and become rigid, leading to an increase in the blood pressure, which further affects blood flow to the penis.
Only when there is good blood flow can there be good penile health.
A good erection requires three very important predisposing factors.
This is the second factor and lastly the third factor, these love signals cause the blood vessels of the penis to dilate and further increase the blood flow to the penis, leading to the penis becoming engorged and hard.
If there is any factor which interferes at any of the three stages.
Two are called the corpus cavernosa and the third which surrounds the urethra (which carries urine) is called the corpus spongiosum.
These cylindrical spongy chambers are surrounded by special strong fibrous tissue.
What is tadalafil?
Tadalafil relaxes muscles and increases blood flow to particular areas of the body.
Tadalafil is used to treat erectile dysfunction (impotence).
Tadalafil may also be used for purposes other than those listed in this medication guide.
What should I discuss with my doctor before taking tadalafil?
Do not take tadalafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking tadalafil with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.
A small number of patients have had a sudden loss of eyesight after taking tadalafil. This type of vision loss is caused by decreased blood flow to the optic nerve of the eye. It is not clear whether tadalafil is the actual cause of such vision loss. Sudden vision loss with tadalafil use has occurred most often in people with heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old.
Before taking tadalafil, tell your doctor if you have:
heart disease or heart rhythm problems;
a recent history a heart attack (within the past 90 days);
a recent history of stroke or congestive heart failure (within the past 6 months);
angina (chest pain);
high or low blood pressure;
liver disease;
kidney disease (or if you are on dialysis);
a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
a bleeding disorder such as hemophilia;
a stomach ulcer;
retinitis pigmentosa (an inherited condition of the eye);
a physical deformity of the penis (such as Peyronie's disease); or
if you have been told you should not have sexual intercourse for health reasons.
If you have any of these conditions, you may not be able to use tadalafil or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category B: Although tadalafil is not for use in women, this medication is not expected to be harmful to an unborn baby. Do not use tadalafil without telling your doctor if you are pregnant or plan to become pregnant during treatment.
Although tadalafil is not for use in women, it is not known if tadalafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
You may need a lower dose of this medication if you are older than 65. Follow your doctor's instructions.
How should I take tadalafil?
Take each dose with a full glass of water.
Avoid taking High-fat food before taking Viagra as it may cause the medicine to take more time to start working.
Tadalafil is usually taken only when needed, 30 - 60 minutes before sexual activity. The medication can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill.
Do not take tadalafil more than once a day. Allow 24 hours to pass between doses.
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Since tadalafil is used as needed, you are not likely to be on a dosing schedule.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Symptoms of a tadalafil overdose may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.
What should I avoid while taking tadalafil?
Avoid drinking alcohol, which can increase some of the side effects of tadalafil.
Grapefruit and grapefruit juice may interact with tadalafil. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Do not use any other drug to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), unless your doctor tells you to.
What are the possible side effects of tadalafil?
If you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw during sexual activity, stop and call your doctor right away. You could be having a serious side effect of tadalafil.
Stop using tadalafil and get emergency medical help if you have sudden vision loss.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using tadalafil and call your doctor at once if you have any of these serious side effects:
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
irregular heartbeat;
swelling in your hands, ankles, or feet;
shortness of breath;
vision changes;
feeling light-headed, fainting; or
penis erection that is painful or lasts 4 hours or longer.
Continue taking tadalafil and talk with your doctor if you have any of these less serious side effects:
warmth or redness in your face, neck, or chest;
stuffy nose;
headache;
upset stomach; or
back pain.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What drug(s) may interact with tadalafil?
Do not take tadalafil if you are taking the following medications:
nitroglycerin-type drugs for the heart or chest pain such as amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin, even if these are only taken occasionally
Tadalafil may also interact with the following medications:
alpha blockers, such as alfuzosin (UroXatral®), doxazosin (Cardura®), prazosin (Minipress®), or terazosin (Hytrin®), used to treat high blood pressure or an enlarged prostate.
bosentan
certain antibiotics such as clarithromycin, erythromycin, troleandomycin
certain drugs used for seizures such as carbamazepine, phenytoin, and phenobarbital
cimetidine
cisapride
diltiazem
grapefruit juice
medicines for fungal infections (fluconazole, itraconazole, ketoconazole, voriconazole)
mibefradil
nicardipine
certain medicines for the treatment of HIV infection or AIDS
quinidine
rifabutin, rifampin or rifapentine
some drugs for treating depression, anxiety or other mood problems (examples: fluoxetine, fluvoxamine, nefazodone)
verapamil
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