Cialis Tadalafil review

Background

Cialis (generic name Tadalafil) is the most modern of the three PDE5 drugs, with the medication receiving FDA approval in November 2003.

Manufacturer Lilly launched Cialis into the pop culture vocabulary with a nickname of “The Weekender”, due to its unique property of having an effect that lasts up to 36 hours. More conservative advertising used the slogan, “When the moment is right, will you be ready?”

Cialis is shown to be effective, both in the short term and in the long term, with the original clinical trials still showing results at 24 weeks when the study was completed [Ref]. Among five randomized control trials with 1,112 erectile dysfunction patients, intercourse was successful with 10mg (61% success rate) and 20mg (75% success rate) of Cialis, compared to only a 32% success rate with placebo.

Cialis Dosage and usage

Cialis is packaged as yellow, almond-shaped coated tablets in 5mg, 10mg or 20mg strengths.

Men should be advised that a starting dose allows them to evaluate the drug for both side-effects and efficacy. The starting dose varies by clinical indication and other comorbid conditions. Normally, the starting dose of Cialis is 10mg, though for certain cases, a starting dose of 5mg is recommended. If the starting dose is well-tolerated, but insufficient to achieve results, a subsequent dose increase can be considered. A patient should try the drug at least four times before considering a higher dose.

Ingestion of food neither impacts the absorption rate nor impacts the absorption extent of Cialis. In contrast to the other PDE5 inhibitor medications, fatty-meals are not an issue in planning when to take the drug [Ref]. There is no difference whether the pill is taken in the morning or in the evening.

Cialis is taken as needed prior to anticipated sexual activity. It is effective as soon as 30 minutes within taking the tablet. The medication’s effect lasts as long as 36 hours after ingestion.

A male with erectile dysfunction requires sexual stimulation in order to produce an erection after taking Cialis. Taking Cialis without the accompanying sensual and/or physical arousal will not achieve the expected results.

The maximum recommended frequency of Cialis is one dose per 24 hour period.

Cialis Side-effects

The side-effects of Cialis are usually mild. The commonest ones reported are: headache (11%), dyspepsia (7%), back pain (4%), myalgia (4%), nasal congestion (4%) and flushing (4%) [Ref]. Most of these side-effects are similar to other PDE5 inhibitor medications.

All side-effects are PDE5 class-related, except for the back pain [Ref]. This back pain is only rarely severe enough to cause discontinuation.

There are other rare side-effects including priapism, due to the length of time that the drug stays in the body. Rare possible side-effects in which causality is unclear include: dizziness (1.7%), swollen eyelids (0.3%) and ocular discomfort (0.3%).

Cialis has good selectivity for PDE5 versus other PDE enzymes around the body. The drug is 700-fold more selective for PDE5 in the penis than the PDE6 in the retina, which likely accounts for its very low numbers of visual side-effects. Among all clinical trials of Cialis at doses of 10-20mg, reports of colour vision abnormalities were under 0.1%.

Cialis Contraindications, drug interactions and cautions

Contraindications and cautions are mostly similar to other PDE5 inhibitor agents.

Men who use nitrates should not take Cialis. This includes nitrates in any form: inhaled, oral, sublingual or transdermal. Coadministration of the two medications can lead to a dangerous hypotension.

Patients taking many alpha-blocker medications (such as prazosin) should also be aware that Cialis can cause an additive hypotension [Ref]. However, the manufacturer reports that Cialis can be safely used with some selective alpha-1 blocker medications including tamsulosin.

Cialis is not recommended to be combined with other oral erectile dysfunction medications, since the risk of priapism increases.

Since it is metabolized in the liver, caution should be used when using other drugs which slow down the metabolism, such as some antivirals, some antibiotics or some antifungals. Specific drugs include ketoconazole and ritonavir. This slowed metabolism can result in higher levels of Cialis in the bloodstream. Conversely, some drugs such as rifampicin speed up the liver metabolism, dropping the plasma levels of Cialis to an ineffective dose.

The clinical trials for Cialis did not include some groups of patients, and thus caution is required if using the drug in those patients. These include men with unstable angina, severe renal insufficiency, severe hepatic insufficiency, hypotension below 90/50 mmHg, hypertension greater than 170/100, uncontrolled arrhythmias, a myocardial infarction within the last 3 months, a stroke in the last 6 months, or heart failure worse than New York Heart Association Class 2 in the last 6 months

Cialis has neither an impact on cardiac exercise tolerance nor on reproductive abilities [Ref]. Cialis can be used safely in stable cardiac patients without other contraindications. For some cardiac patients, sexual activity–with or without Cialis–may be inappropriate [Ref]. Patients with renal impairment should not use Cialis on a daily basis.

Finally, caution should be used in patients with conditions which predispose to priapism, or with an anatomical deformity of the penis.

Strengths and weaknesses

One of the most prominent strengths of Cialis is the relatively long half-life. A 36 hours, Cialis lasts significantly longer, as compared to the 4 hour half-life or either Viagra or Levitra. This extended half-life can allow the patient to have increased spontaneity of intercourse, especially those less likely to predict when they will have intercourse. There is some evidence in comparison studies that Cialis may be preferred to Viagra, perhaps because of this extended length of action.

With regards to flexibility with meals, Cialis does hold the advantage versus the other PDE5 inhibitor medications. Viagra and Levitra can’t be taken effectively following a high fat meal, but Cialis still has the expected effect regardless of whether or not a fatty meal was recently consumed.

Among the PDE5 inhibitor medications, Cialis has the least effect on PDE6 in the eye. Whereas Viagra has only a 10-fold specificity for PDE5 in the penis versus PDE6 in the retina, Cialis has a 700-fold specificity. Current case reports of retinal problems from Viagra are very uncommon, though the long-term effects are unknown.

The long-term effects of the extended 36 hours of systemic exposure to Cialis are unknown, though there is no evidence to show that it more harmful versus other agents.

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