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Lilly Cialis


What is Cialis?

Cialis is quite similar to Viagra. This medication also expands the walls of arterial vessels, enhancing the blood flow to the penis. Please note that Cialis must never be taken together with Adcirca (used to treat pulmonary arterial hypertension).

When is Cialis used?

Cialis is a very good alternative to Viagra in Erectile Dysfunction treatment. Moreover, Cialis is often used to treat symptoms of benign prostatic hypertrophy. Erectile Dysfunction is when you cannot achieve or maintain an erection because the flow of blood to your penis is not enough. Unfortunately, this can lead to relationship problems and even depression if not addressed properly. Cialis will act by stimulating the arterial vessels in the penis, allowing more blood to flow. It is important to state that the medication alone does nothing as it is always required sexual stimulation in order to achieve and maintain an erection. With Cialis you can expect to revert the normal process of the body where blood vessel stimulants created by the body are broken down; Cialis blocks this, resulting in a longer erection.

How to use Cialis?

The 10mg and 20mg tablets are effective for 36 hours. You can take this with or without food and you should swallow the tablet whole. You may take Cialis just before sexual activity. As always, sexual stimulation is required in order to achieve an erection. Cialis will not act on its own. If you feel any kind of nausea or pain in your arms/chest after taking Cialis, please contact your doctor as soon as possible.

Dosage

Cialis comes in doses of 10mg and 20mg. The usual dosage is 10mg but in some cases 20mg reveals itself as more effective; it all depends on the person and on what doctor recommended. Please notice that the 10mg and 20mg tablets are good for 36 hours.

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*Prices are subject to change due to fluctuations and may differ from the price shown for the item on the product detail page. Items in your shopping cart will always reflect the recent and final price.

Buy Cialis With an Online Prescription

An online doctor consultation means filling out a medical questionnaire. A registered EU doctor assesses your medical questionnaire and analize whether Cialis is suitable and safe for you to buy. After approval, a prescription is issued and send to the registered EU pharmacy. You will receive your discretely shipped Lilly Cialis pills within 3 business days.


The clinical trial results related to Cialis show that the administration of Cialis 10 mg resulted in a solid erection more than enough for penetration in 78% of men and completed sexual intercourse in 59%. In regards to the 20 mg version the percentages were 78% and 71%.


How does Cialis work?

Contraindications

There are several contraindications which must be taken care to avoid any unwanted situation or severe side effect. Some of these contraindications are below--

  • In case of taking preparations containing any organic nitrates.
  • Hypersensitivity to tadalafil or to any substance that is part of the drug. 
  • Diseases of the cardiovascular system: unstable angina pectoris, myocardial infarction over the past 90 days, chronic heart failure II-IV classes according to NYHA classification, the occurrence of an attack of angina pectoris during intercourse, arterial hypotension (blood pressure less than 90/50 mm Hg) , uncontrolled arrhythmias, ischemic stroke in the last 6 months, uncontrolled arterial hypertension. 
  • Loss of vision due to non-arterial anterior ischemic optic neuropathy (regardless of association with PDE-5 inhibitors). 
  • Age to 18 years. 
  • Glucose-galactose malabsorption, lactose intolerance, lactase deficiency. 
  • Frequent (more than 2 times a week) use in patients with chronic renal failure (creatinine clearance less than 30 ml/min). 
  • Simultaneous administration of doxazosin, as well as drugs for the treatment of erectile dysfunction.
  • Simultaneous administration with potent inhibitors of the CYP3A4 isoenzyme (erythromycin, saquinavir, ritonavir, itraconazole, ketoconazole), antihypertensive drugs.
  • Accepting alpha 1 blockers in patients. 
  • Severe hepatic impairment (Child-Pugh class C). 
  • Anatomical deformation of the penis (Peyronie's disease or cavernous fibrosis, angular curvature). 
  • A predisposition to priapism (with leukemia, multiple myeloma, or sickle cell anemia).

Dosage and Administration

The recommended frequency of administration for patients with frequent (more than two times a week) sexual activity is daily, regardless of food intake, at the same time, once a day, 5 mg. Depending on individual sensitivity, the daily dose may be reduced to 2.5 mg. For oral administration.  

The purpose of the drug in a dose of 20 mg is recommended according to the instructions for medical use of the drug immediately before sexual activity for patients with infrequent (less than twice a week) sexual activity is recommended. 20 mg is the maximum daily dose.

Side effects

The list of reported side effects is big as there are several side effects are possible. Some of the popular reported side effects are-

  • Most often : dyspepsia, headache, nasal congestion, myalgia, flushing of the face, back pain.
  • Disorders from the nervous system: headache (very often), dizziness (often), rarely - migraine, fainting, stroke, transient ischemic attacks. 
  • Disorders from the cardiovascular system: infrequently - tachycardia *, palpitations *, increased blood pressure, decreased blood pressure (in patients already taking antihypertensive drugs), myocardial infarction * (rare), unknown - unstable angina *. 
  • Disorders of the respiratory system: epistaxis (infrequently).
  • Disorders from the organs of vision: blurred visual perception (infrequently), violation of the visual fields (rarely), unknown - occlusion of the retinal veins, non-arterial anterior ischemic optic neuropathy. 
  • Reproductive system disorders: prolonged erection (rare), unknown - priapism. 
  • Disorders from the subcutaneous tissue and skin: infrequently - hyperhidrosis (excessive sweating), urticaria, rash, unknown - exfoliative dermatitis and Stevens-Johnson syndrome. 
  • Digestive disorders: abdominal pain (often), gastroesophageal reflux (infrequently). 
  • Immune system disorders: hypersensitivity reactions (infrequently). 
  • General disorders: chest pain * (infrequently), swelling of the face (rarely), sudden cardiac death *. 

* Observed in patients previously having cardiovascular risk factors. However, it is impossible to determine exactly whether these phenomena are directly related to tadalafil, to these risk factors, to a combination of these or other factors, or to sexual arousal.

Special instructions

Since in some patients the simultaneous use can lead to symptomatic arterial hypotension, caution should be exercised when prescribing Cialis to patients receiving alpha1-blockers. Symptomatic arterial hypotension with the simultaneous administration of alpha-1-blocker, tamsulosin in 18 healthy volunteers taking a single dose of tadalafil was not observed in a clinical pharmacology study. An appropriate medical examination, determination of treatment tactics and identification of a potential underlying cause should be included in the diagnosis of erectile dysfunction. For patients with cardiovascular disease, sexual activity has a potential risk. It should not be performed in men with heart diseases in which sexual activity is not recommended,

When using PDE-5 inhibitors, including tadalafil, there are reports of the occurrence of priapism. Patients should be informed about the need to immediately seek medical help in case of a lasting 4 hours or more erection. Irreversible impotence may occur since the untimely treatment of priapism leads to damage to the tissues of the penis. With other treatments for disorders, the efficacy and safety of the combination of Cialis have not been studied. Therefore, the use of such combinations is not recommended. The use of tadalafil can lead to a transient decrease in blood pressure, since tadalafil has systemic vasodilating properties, like other PDE-5 inhibitors. Whether patients with cardiovascular disease will be exposed to undesirable effects due to such vasodilating effects - doctors should carefully consider this issue before prescribing Cialis. The cause of visual impairment is non-arterial anterior ischemic optic neuropathy (NAPION), including complete loss of vision. There are rare postmarketing reports of cases of the development of NAPION in time associated with the intake of PDE-5 inhibitors. is there a direct relationship between taking PDE-5 inhibitors and the development of NAPION or other factors is currently impossible to determine. In the event of a sudden loss of vision, doctors should recommend that patients seek medical help and stop taking tadalafil. Doctors should also inform patients that there is an increased risk of re-developing NAPION in people who have undergone NAPION. 

Use in case of impaired liver function: care must be taken when prescribing the drug to patients with severe hepatic insufficiency (according to the Child-Pugh classification class C) since there is no data on this group of patients. 

Impact on the ability to control mechanisms and drive vehicles: during treatment, care must be taken when driving vehicles and other activities that require an increased concentration of attention and speed of psychomotor reactions to potentially dangerous activities, despite the fact that the incidence of dizziness against the background of placebo and tadalafil is the same.

Drug interaction

Tadalafil is metabolized mainly with the participation of the CYP3A4 isoenzyme. The selective inhibitor of the isoenzyme CYP3A4 ketoconazole (400 mg per day) increases the exposure of a single dose of tadalafil (AUC) by 312% and the maximum concentration in the blood plasma by 22%, and ketoconazole (200 mg per day) increases the exposure of a single dose of tadalafil (AUC by 107%) ) and 15% maximum concentration relative to AUC and maximum concentration values ​​for only one tadalafil. 

Ritonavir (200 mg twice daily), an inhibitor of isoenzymes 2C9, CYP3A4, 2D6 and 2C19, increases the exposure of a single dose of tadalafil (AUC) by 124% without changing the maximum concentration. It can be assumed that other HIV protease inhibitors, such as saquinavir, as well as CYP3A4 isoenzyme inhibitors, such as itraconazole and erythromycin, increase tadalafil activity, despite the fact that specific interactions have not been studied. 

Rifampicin (600 mg per day), a selective inducer of the CYP3A4 isoenzyme, reduces the exposure of a single dose of tadalafil by 88% and the maximum concentration by 46%, for only one tadalafil relative to AUC and maximum concentration values. The simultaneous use of other inducers of the CYP3A4 isoenzyme should also reduce plasma tadalafil concentrations. 

It reduces the absorption rate of tadalafil without changing the area under the pharmacokinetic curve for tadalafil while taking tadalafil and antacid (aluminum hydroxide/magnesium hydroxide). 

An effect on the pharmacokinetics of tadalafil as a result of taking blockers of the H2-histamine receptors of nizatidine did not increase the pH of the stomach. 

The use of a combination of tadalafil with other types of treatment for erectile dysfunction is not recommended since the effectiveness and safety of such combinations have not been studied. Tadalafil does not potentiate an increase in the time caused by the intake of acetylsalicylic acid bleeding.

The antihypertensive effect of tadalafil nitrates enhances. This occurs as a result of the additive effect of tadalafil and nitrates on the metabolism of cGMP and nitric oxide II (NO). Therefore, the use of tadalafil is contraindicated in patients receiving nitrates.

Tadalafil does not have a clinically significant effect on the clearance of drugs whose metabolism occurs with the participation of cytochrome P450. Studies have confirmed that tadalafil does not induce or inhibit the isoenzymes CYP3A4, CYP1A2, CYP2C19, CYP2C9, CYP2E1, CYP2D6. 

Tadalafil has no clinically significant effect on the pharmacokinetics of R-warfarin or S-warfarin. In relation to prothrombin time, tadalafil does not affect the effect of warfarin. The duration of tadalafil bleeding caused by acetylsalicylic acid does not increase. 

Tadalafil can enhance the action of antihypertensives aimed at lowering the blood pressure of drugs and has systemic vasodilating properties. A slightly greater decrease in blood pressure was observed in patients taking several antihypertensive drugs, in whom arterial hypertension was poorly controlled. In the vast majority of patients, this decrease was not associated with hypotensive symptoms. Appropriate clinical recommendations should be given to patients taking tadalafil and receiving treatment with antihypertensive drugs. 

When tadalafil was used by individuals taking selective alpha 1A-blocker tamsulosin, there was no significant decrease in blood pressure. 

The simultaneous use of doxazosin with tadalafil is contraindicated. An increase in the hypotensive effect of doxazosin was observed with the use of tadalafil by healthy doxazosin users (4-8 mg per day), alpha1-blocker volunteers. Some patients experienced dizziness. There were no cases of fainting. The use of doxazosin in lower doses has not been studied. 

Like alcohol did not affect the concentration of tadalafil, so tadalafil did not affect the concentration of alcohol. The administration of tadalafil did not cause a statistically significant decrease in the average blood pressure at high doses of alcohol (0.7 g / kg). Orthostatic hypotension and postural dizziness were observed in some patients. A decrease in blood pressure was not observed when taking tadalafil in combination with lower doses of alcohol (0.6 g / kg), and dizziness occurred with the same frequency as when taking only alcohol. 

Tadalafil has no clinically significant effect on the pharmacodynamics or pharmacokinetics of theophylline.

Overdose

Symptoms: in patients with erectile dysfunction and a single administration to healthy volunteers at a dose of up to 500 mg - repeatedly up to 100 mg/day, as with the use of the drug at lower doses, the undesirable effects were the same. 

Treatment: standard symptomatic therapy. Tadalafil is practically not excreted during hemodialysis.