Medication

Cialis

Structure

Cialis tablets contain 5 mg tadalafil, lactose (in the form of a monohydrate) and spray-dried lactose monohydrate, hyprolose and extra-thin hyprolysis, Na lauryl sulfate, MCC, croscarmellose Na, plant stearate Mg.

Composition p / o: Opadry yellow (hypromellose, triacetin, Ti dioxide, lactose monohydrate, dye E172 (yellow)).

Release form

Tablets in n / a. 5 mg. Packing No. 14 and No. 28.

Almond-shaped tablets, covered with a light yellow film shell. On one side is engraved “C 5”.

Pharmachologic effect

Improves erectile function.

Pharmacodynamics and pharmacokinetics

What is Cialis?

Cialis (tadalafil) is a drug that reversibly and selectively suppresses specific PDE-5 cGMP (cyclic guanosine monophosphate).

Wikipedia says that the drug is intended to treat disorders in which a man is unable to achieve and maintain an erection necessary for sexual intercourse.

Pharmacodynamics

With sexual arousal, local release of nitric oxide occurs, and due to the suppression of PDE-5, the concentration of cyclic guanosine monophosphate in the cavernous body of the penis increases.

As a result of this, the smooth muscles of the arteries relax, the flow increases blood to the tissues of the penis and an erection occurs. In the absence of sexual arousal, there is no such effect.

Elevated concentrations of cGMP are also observed in the smooth muscles of the bladder, prostate and blood vessels supplying them.

Relaxation of the muscles of blood vessels increases blood perfusion (passage) in these organs and reduces the severity of symptoms of BPH, and relaxation of the smooth muscles of the bladder and prostate further enhances vascular effects.

Improving erection, tadalafil thus increases the possibility of PA (sexual intercourse).

Moreover, in healthy men, it, in comparison with placebo, does not cause a significant change in the change in DBP, CAD and HR, does not affect the electroretinogram, visual acuity, IOP and pupil size, does not violate the ability to recognize colors (green / blue).

Pharmacokinetics

After taking the pill, tadalafil is well absorbed in the body. Substance concentration in blood plasma reaches peak values ​​2 hours after administration. Food and the time of taking the drug do not have a clinically significant effect on the rate of absorption of tadalafil and its bioavailability.

About 94% of the substance is in a state bound to plasma proteins. It is metabolized in the liver with the participation of the CYP3A4 isoenzyme. Primary circulating metabolite in comparison with tadalafil exhibits at least 13 thousand times less activity against PDE-5.

The average half-elimination period in healthy men is 17.5 hours. The drug is excreted mainly in the form of pharmacologically inactive metabolites. About 61% of the dose taken is excreted in feces, about 36% in urine.

Indications for use

The drug is used for ED (erectile dysfunction); with CMS (symptoms of lower urinary tract) in patients with BPH; with ED in patients with LUTS with BPH.

Contraindications

Cialis is not prescribed for:

  • hypersensitivity to tadalafil or auxiliary components of tablets;
  • the simultaneous use of any drug containing organic nitrates;
  • simultaneous use Doxazosin or drugs to treat ED;
  • the presence of contraindications to sexual activity in men with pathologies of the heart and blood vessels (unstable anginatransferred during the past three months, MI arising during PA angina attacks, CHF II-IV classes according to the classification of NYHA, AH, uncontrolled arrhythmiascarried over the past six months ischemic stroke);
  • associated or not related to the use of PDE-5 NAION inhibitors (anterior ischemic optic neuropathy);
  • lactose intolerance, lactase deficiency, glucose / galactose malabsorption.

In addition, the drug is contraindicated for persons under the age of eighteen years of age, and cannot be used more than 2 p. / Week. in men with kidney damagein which Clcr is below 30 ml / min.

Relative contraindications

Due to lack of data regarding persons with liver failureaccording to the Child-Pugh classification of the S-class, caution should be exercised when applying tadalafil in this group of patients.

With caution, Cialis is prescribed to individuals who are undergoing treatment with α1-adrenergic blockers. This is due to the fact that with simultaneous use tadalafil with these drugs has a risk of developing symptomatic arterial hypotension(SAG).

Clinical studies of pharmacological properties tadalafilin a group of healthy men, showed that a single dose of a standard dose of Cialis does not lead to SAG with the simultaneous use of α1A-blocker tamsulosin. The study involved 18 people.

Other restrictions for use:

  • predisposition to priapism;
  • anatomical deformation of the penis;
  • simultaneous reception antihypertensive drugsas well as drugs that potently inhibit the CYP3A4 isoenzyme (Erythromycin, Saquinavir, Itraconazole, Ritonavir, Ketoconazole).

Diagnosis of ED should include identifying the root cause impotenceconducting an appropriate examination and determining adequate therapy.

Side effects

With erection dysfunction, the use of Cialis is most often accompanied by pain in the muscles or back, headacherushing blood to the face, dyspepsianasal congestion.

In patients with ED / BPH, pain in the limbs and / or muscles, headache, gastroesophageal reflux (GER), and dyspepsia were most often recorded.

Other possible adverse reactions:

  • often - dizziness;
  • infrequently - hypersensitivity reactions, blurred perception of visual images, pain in the eyeball, tachycardiapalpitations, increase or decrease HELL (the latter is possible with people who have already taken antihypertensives), dyspneanasal congestion, GER, abdominal pain, hyperhidrosis, rash;
  • seldom - stroke (including acute cerebrovascular accident with rupture of the vessel and hemorrhage (ONMK hemorrhagic type)), transient amnesia, epileptic seizureswelling of the eyelids, violation of the visual fields, injection (expansion) of the vessels of the sclera of the eyeball, MI, nosebleed, hivesprolonged erection.

In patients with previously available risk factors for CVD, the following occurred:

  • infrequently - chest pain;
  • in rare cases - fainting, migrainetransient ischemic attackssudden heart death.

However, to be sure, these phenomena are associated with the use of tadalafil, risk factors for CVD, sexual arousal, other factors or a combination of factors, or not, is not possible.

There are also reports of individual cases of sudden hearing loss with the use of PDE-5 inhibitors (including tadalafil) during clinical and post-marketing research.

Side effects that occurred during post-marketing studies, but were not detected during clinical placebo-controlled studies:

  • edema persons;
  • migraine;
  • NAION;
  • retinal vascular occlusion;
  • unstable angina;
  • ventricular arrhythmias;
  • exfoliative dermatitis;
  • priapism;
  • Stevens-Johnson syndrome;
  • sudden cardiac death.

Instructions for use Cialis

How to take Cialis for ED?

Patients with frequent sexual activity, when PA occurs more than 2 r / week., 5 mg tablets are recommended to be taken daily, one at a time, at the same time. Depending on individual tolerance, dosage may be reduced. tadalafil up to 2.5 mg.

If PA occurs less frequently than 2 r / week, it is recommended to take tablets immediately before coition in a dose of 20 mg.

The permissible upper limit of the daily dose of Cialis is 20 mg.

Instructions for use of Cialis according to the indications of ED / BPH or BPH

With these pathologies, the patient is prescribed to take the drug 1 r / day, one tablet at the same time (any, regardless of the time of eating and the time of sexual activity).

The duration of treatment for Cialis 5 mg is set individually.

Additionally

At kidney damagewhen the Clcr is 31-80 ml / min, there is no need for dose adjustment. Patients with severe kidney damagein which Clcr does not exceed 30 ml / min., daily use of the drug is contraindicated.

Overdose

Single dose up to 0.5 g tadalafila healthy person and repeated use up to 100 mg / day. Tadalafil in patients with erection dysfunction is accompanied by side effects similar to those that occur when using a lower drug.

In case of an overdose, standard symptomatic therapy is performed. Cialis practically does not appear when hemodialysis.

Interaction

The effect of other drugs on tadalafil

Cialis biotransformation is carried out with the participation of the CYP3A isoenzyme, and therefore drugs that inhibit this isoenzyme increase the value of Cmax and AUC tadalafil.

Despite the fact that specific studies were conducted only regarding the interaction tadalafil from Ketoconazole and Ritonavir, we can assume that drugs such as Itraconazoleand Erythromycinalso able to increase activity tadalafil.

Rifampicin, which is an inducer of CYP3A, reduces the exposure of a single dose of the drug and the value of Cmax. Most likely, the simultaneous use of other drugs from the CYP3A inducer group should contribute to a decrease in plasma concentration tadalafil.

The use of Cialis in combination with antacids(Al hydroxide / Mg hydroxide) helps to reduce the absorption rate of the active substance of the drug without changing the AUC for tadalafil.

Drugs that increase the acidity of the stomach (pH), and, in particular, H2-blocker nizatidinedo not affect pharmacokinetic parameters tadalafil.

A study of the safety and effectiveness of Cialis in combination with other methods of treatment of erection dysfunction (including in combination with other PDE-5 inhibitors) was not conducted, and therefore it is recommended to avoid such combinations.

Tadalafil It does not increase the bleeding time caused by taking ASA.

The effect of tadalafil on other drugs

Tadalafil able to enhance hypotensive effect of nitrates, which is why these drugs are not prescribed in combination.

The substance does not significantly affect the clearance of drugs that are metabolized with the participation of the cytochrome P450 system. In the course of studies, it was found that tadalafil:

  • does not inhibit or induce isoenzymes of CYP3A4, CYP1A2, CYP2C19, CYP2C9, CYP2T1 and CYP2D6;
  • does not significantly affect the pharmacokinetics of S- or R-warfarin, as well as the effect of warfarin on PTV (prothrombin time);
  • does not increase the duration of bleeding caused by taking ASA;
  • causing a systemic vasodilating effect, it can enhance the hypotensive effect of drugs designed to lower blood pressure (in patients taking several antihypertensive drugs with poorly controlled hypertension, blood pressure was more pronounced; in most patients, this phenomenon was not associated with hypotensive symptoms);
  • does not significantly affect pharmacodynamics and pharmacokinetic profile Theophylline.

The results of two studies show that the use of the drug in healthy men in combination with Tamsulosin (α1А-blocker) does not cause a significant decrease in blood pressure.

Use by healthy volunteers of the drug with α1-blocker Doxazosin (provided that the latter is taken in a dose of 4 to 8 mg / day.) was accompanied by an increase hypotensive effect of doxazosin. Some patients experienced symptoms associated with decreased pressure, including fainting.

Terms of sale

On prescription.

Storage conditions

Three years.

Shelf life

Tablets should be stored at temperatures below 30 ° C.

Special instructions

Sexual activity can be dangerous in a number of pathologies of the heart and blood vessels. In this regard, men with diseases requiring restriction of sexual activity, treatment of erection dysfunction, including tadalafilcontraindicated.

There are reports of cases of occurrence of priapism (prolonged, not associated with sexual arousal, involuntary erection) during treatment with PDE-5 inhibitors.

Patients should be informed of the need to urgently consult a doctor if an erection persists for four (or more) hours. In the absence of timely assistance, such conditions lead to irreversible impotence.

Like other PDE-5 inhibitors, the drug causes systemic vasodilation, which can provoke a transient decrease in blood pressure. Before appointment tadalafil the doctor must make sure that the patient with pathology of the heart / blood vessels will not be undesirable due to this effect.

Non-arterial AION is one of the causes of visual impairment (in some cases, until it is completely lost). In the course of post-marketing observations, there were reports of rare cases of the development of this pathology (cases were time-related with the use of PDE-5 inhibitors).

Determine exactly whether there is between treatment tadalafil and NAION direct communication is not possible today.

In case of sudden loss of vision tadalafil should stop and seek medical help.

The patient should also be warned that people who have had NAION are at high risk for re-development. optic neuropathy.

If a patient is diagnosed with BPH, he should undergo an additional examination to rule out prostate cancer.

Although dizziness upon admission tadalafil arose with the same frequency as when taking a placebo, during the treatment period you should be careful when driving a car and mechanisms.

Analogs of Cialis

Matches for ATX Level 4 code:TornetisOlmax StrongTaxiereDynamicallyRevazioCoverjectLevitraTentex ForteRailisViagraSildenafilYohimbine HydrochlorideZidenaRange

Analogs with a close mechanism of action: AFALAZA, Viasan-LF, Viagra, Yohimbine hydrochloride, Verona, Dynamically, Vizarsin, Tornetis, Zidena, Railis, Maksigra, Silafil, Impaza, Sirbida, Sildenafil, Olmax Strong.

Cialis generics - what is it and how do they differ from the original drug?

The most popular generic Cialis - Cialis Soft, Cialis Forte, Cialis Capsules.

Generic Feature Cialis Forte is that he, with the same duration of action with Cialis, acts faster and provides a more stable erection.

Generic Cialis Soft also acts faster than regular Cialis tablets. The effect is achieved due to the fact that the drug is taken sublingually, and due to this, contained in it tadalafil more likely to enter the systemic circulation.

In the preparation Cialis Capsules the active substance is contained in the form of a concentrated gel placed in a rapidly dissolving gelatin shell. This dosage form provides a higher rate of exposure tadalafil. An important feature of capsules is that tadalafil they contain 4 times more than tablets.

The duration of the effect when using capsules is approximately the same as when using the tablet form of the drug.

For people who for some reason are unable or unwilling to take pills, it is available Cialis Gel.

Another analogue of the drug is Female Cialis - Female Cialis. Generic helps increase blood flow to the genitals of a woman and thus enhances their sensitivity to stimulation.

Along with pills Cialis Orange and tablets of high power and duration of action are available Cialis Black 800 mg.

There are also generics with an extra dosage of the active substance:
Cialis Extra Dosage (40, 50, 60, 200, 100 mg; 30 tablet, 40 tablet, 60 tablet, 90 tablet, 120 tablet, 180 tablet, 10 or 20 tablet);
Cialis Professional (20 mg and 40 mg; 10, 20, 30, 40, 60, 90, 120, 180 tablet).

On many foreign sites and online pharmacies (pharmacy / apotheke / eczane) it is possible to purchase the drug online without a prescription (eng - without a prescription; es - sin receta; de - ohne rezept bestellen).

Before ordering a tool, it is very convenient to make price comparisons (price / preise / precio; price comparison / preiswert im internet bestellen) in different stores. You can search by querying “discount cialis send thread”, “buy cialis 5mg”, “kaufen ohne rezept 20mg”, “cialis rezeptfrei kaufen deutschland”, “daily cialis forum”.

You can also compare the prices of generics (generics in uk / generika in deutschland / generico en espana) and study their effect, contraindications (contraindications / gegenanzeigen / contraindicaciones / contactrendikasyonlar) and side effects (side effects / nebenwirkungen / efectos secundariosos / )

Information on Cialis can also be obtained at www.cialis.com.

Cialis or Sealex?

Due to the consonance of the names, Cialis is often confused with the drug Sealex. However, these tools have a lot of differences.

Cialis contributes to the appearance of a natural erection, without creating sexual arousal artificially. If necessary, it can be taken once, immediately before sexual activity.

Effects Sealexa due to the properties of the components of plant origin contained in it, which are obtained by special extraction.

Mongnier Root, the active substance of which is ostol, has a prophylactic effect on erectile dysfunction, yohimbine stimulates the synthesis of endogenous testosterone, ginseng helps to relax the smooth muscles of the blood vessels of the penis.

Indole-3-carbinol is a powerful natural antioxidant that prevents the growth of prostate tissue, facilitates urination in case of problems with the prostate gland and ejaculation.

QuercetinIt regulates the permeability of the walls of blood vessels, has a vasodilating and hemorrhaging effect.

Vitamins B6 and AT 12 actively involved in metabolism amino acidsexhibit antioxidant properties and protect vascular walls.

Essential amino acid L-arginine necessary for the synthesis of nitrous oxide (NO) with the participation of NO synthase. The synthesis of nitrous oxide, in turn, is one of the key points, without which the implementation of erectile function is impossible.

Folic acid provides protection of the cavernous bodies of the penis when associated with diabetes erection dysfunction, reduces the concentration of homocysteine ​​and the risk of damage atherosclerosis significant for erection of blood vessels.

Zinc is involved in the formation of dihydrocorticosterone and inhibition of the enzyme PDE-5, which affects the blood supply to the cavernous bodies of the penis.

The advantages of Sealex are ease of use (capsules are taken one per day, once or, if necessary, general recovery of the body - course), a comprehensive healing effect, safety, accessibility, a pronounced effect after the first use.

Sealex has a natural composition, due to which adverse reactions during treatment with this drug are extremely rare.

Which is better - Cialis, Levitra or Viagra?

Levitra and Viagra today are the main analogues of Cialis tablets.

Active substance Levitra is an vardenafil. The effect after the use of this drug develops on average after 15 minutes and lasts up to 12 hours.

Active substance Viagra - sildenafil. The substance begins to act half an hour or an hour after taking the pill, the effect persists for 4 hours.

A distinctive feature and advantage of Cialis over its analogues is its duration of action: the effect of conventional tablets lasts up to 36 hours, the effect of tablets with an extra dosage of tadalafil - up to 72 hours.

Cialis can be taken immediately before sexual activity, Levitra - in 20 minutes Viagra - in 30-60 minutes.

Another important point is that on the pharmacokinetics of Cialis and Levitra eating (as well as the amount eaten) and drinking do not affect, Viagrait is recommended to take on an empty stomach.

Thus, trying to find the answer to the questions “Viagra or Cialis, Cialis or Levitra - which is better? ”, one should be guided by how quickly it is necessary to get the effect, how long the effect should be maintained, whether alcohol consumption is planned before sexual activity.

Cialis or Ziden - which is better?

Zidena - these are coated p / o tablets, which include, as an active substance, udenafil (100 mg / tab.).

Like tadalafil, udenafilselectively and reversibly suppresses PDE-5 - enzymecontributing to the metabolism of cGMP.

The substance begins to act half an hour after taking the pill, the effect lasts up to 24 hours, but the severity of the action udenafila slightly less than tadalafil.

Wherein Zidena It acts very gently, stabilizing the most important processes in a man’s body, increasing the duration of an erection and helping to prolong the time of sexual intercourse.

The positive aspects of the drug are the lack of effect on blood pressure and vision, sperm concentration and quantity, sperm morphology and motility.

Cialis and alcohol

The drug does not affect the concentration of alcohol, and alcohol does not affect the concentration tadalafil.

Alcohol consumption in a dose exceeding 0.7 g / kg during administration tadalafil does not lead to a statistically significant decrease in average blood pressure. Some men have been reported orthostatic hypotension and postural dizziness.

Taking the drug with alcohol in a dose less than 0.6 g / kg was not accompanied by a decrease in blood pressure, and dizziness occurred with a frequency similar to the frequency of dizziness only when drinking alcohol.

During pregnancy

The drug is not intended for women.

Reviews about Cialis

Reviews about Cialis tablets on forums are mostly good. And they are confirmed by the results of a number of clinical studies, according to which, when taking 20 mg of the drug, an improvement in potency was observed in 81% of men participating in the experiment with varying degrees of erection dysfunction (from mild to severe).

Reviews about Cialis Softand Cialis Forte (generic Cialis) are also good. The main advantages of drugs are men called a faster onset of effect in comparison with conventional 5 mg tablets and a significantly lower price.

Reviews about Cialis and reviews about generic Cialis suggest that, despite good tolerance tadalafil, some patients may have side effects in the form of heartburnmuscle pain, lower back pain, headache, dizziness.

Some patients say that in the morning after taking the pill, there was a sensation similar to that of a hangover.

In this regard, before using the drug, it is very important to read the reviews of doctors about contraindications for Cialis.

It should also be remembered that tadalafil only provides blood flow to the genitals of men, but in the absence of sexual stimulation “does not work”. That is, if a man is not physically ready for sexual intimacy and is not aroused, there will be no effect.

Cialis is not intended for women. Instead, you can use a generic Female Cialiswhose action is aimed at increasing blood flow to the genitals and enhancing arousal.

Cialis Price

The price of Cialis in pharmacies in Moscow and St. Petersburg is from 980 rubles. per pack No. 1, 20 mg. Price Cialis 5 mg No. 14 - from 3000 rubles. Most online pharmacies sell the drug throughout Russia: to Yekaterinburg, Krasnodar, Novosibirsk, Ufa, etc.

You can buy Cialis in Ukraine from 390 UAH. In Kiev, Odessa, Dnepropetrovsk, Kharkov and other large cities, the average price of Cialis 20 mg tablets No. 1 is UAH 470, 20 mg tablets No. 2 is 740 UAH.

In Minsk, the cost of tablets 20 mg No. 1 - from 151.5 thousand rubles, in Kazakhstan - from 2950 tg.

The price of generics is slightly lower. So, for example, the price of Cialis Soft tablets (pack No. 5) in Ukraine is from 200 UAH. You can buy Cialis generic in Russia (unitary enterprise No. 5) for 450 rubles.

  • Online Pharmacies in Russia
  • Online pharmacies in UkraineUkraine
  • Online pharmacies in Kazakhstan

ZdravCity

  • Cialis Tab. 5mg n14 Lilly del Caribe Inc. 3401 rub. Order
  • Cialis Tab. 5mg n28 Lilly del Caribe Inc. 6209 rub.order
  • Cialis Tab. 20mg n4Lilly del Caribe Inc. 366 rub.order
  • Cialis Tab. 20mg n1Lilly del Caribe Inc. 1286 rub.order
  • Cialis Tab. 20mg n8 Lilly del Caribe Inc. 7992 rub.order

Pharmacy Dialog

  • Cialis (tab. N / a 5mg No. 28) 6175 rub.order
  • Cialis (tab. N / a 5mg No. 14) 3448 rub.order
  • Cialis (tab. 20mg No. 8) 6637 rub.order
  • Cialis (tab. 20mg No. 4) 3670 rub.order
  • Cialis (tab. 20mg No. 1) 1119 rub.order

Eurofarm * 4% discount on the promotional code medside11

  • Cialis 20 mg No. 1 tabletEli Lilly Vostok S.A. / Lilly Del 1390 rub.order
  • Cialis 5 mg No. 14 tabletEli Lilly Vostok S.A. / Lilly Del3999 rub.order
  • Cialis 20 mg No. 2 tablilly del Caribe Inc. / Lilly S.A. 2590 rub.order
  • Cialis 20 mg No. 4 tabletEli Lilly Vostok S.A. / Lilly Del4190 rub.order
  • Cialis 5 mg n28 tabletEli Lilly Vostok S.A. / Lilly Del 6990 rub.
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Pani Pharmacy

  • Cialis tablets Cialis tablets 20mg No. 8 Spain, Lilly S.A. 3845 UAH to order
  • Cialis tablets Cialis tablets 5mg No. 28 Spain, Lilly S.A. 3787 UAH to order
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BIOSPHERE

  • Cialis 20 mg No. 1 tablet by Lilly del Caribe Inc. (Puerto Rico) 6 tg.order
  • Cialis 20 mg No. 2 tablets by Lilly del Caribe Inc. (Puerto Rico) 12 tg.order
  • Cialis 5 mg No. 14 tablets p.p. Lilly del Caribe Inc. (Puerto Rico) 25 tg.order
  • Cialis 20 mg No. 4 tablets by Lilly del Caribe Inc. (Puerto Rico) 27 tg.order
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Watch the video: 10 Cialis Secrets and Answers (March 2020).

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