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Cialis tablets contain 5 mg ℴf tadalafilum, lactose (in the form ℴf monohydrate) and spray dried lactose monohydrate, giprolose and extra thin giprolose, sodium lauryl sulfate, Mcc, croscarmellose Na, plant stearate Mg.
the composition ℴf the p / o: Opadry yellow (hypromellose, triacetin, ti dioxide, lactose monohydrate, dye E172 (yellow)).

Form ℴf issue
Tablets in p / o.5 mg. Packing No. 14 and No. 28.
the tablets are almond-shaped, covered with a light yellow film membrane. On one side is engraved “c 5”.

Pharmachologic effect
Improves erectile function.

Pharmacodynamics and pharmacokinetics What is Cialis?
Cialis (tadalafilum) is a drug that reversibly and selectively suppresses specific PDE-5 cGMP (cyclic guanosine monophosphate).
Wikipedia says that the drug is designed to treat disorders in which a man is not able to achieve and maintain the necessary erection for sexual intercourse.
With sexual excitement, 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, the smooth muscles ℴf the arteries relax, the blood flow to the tissues ℴf the penis increases 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, the prostate and supplying them with blood vessels.
Relaxation ℴf the musculature ℴf the vessels promotes an increase in perfusion (passage) ℴf blood in these organs and a reduction in the manifestation ℴf BPH symptoms, and relaxation ℴf the smooth muscles ℴf the bladder and prostate further enhances vascular effects.
Improving the erection, tadalafilum thus increases the possibility ℴf carrying out PA (sexual intercourse).
In healthy men, compared with placebo, there is no significant change in the change in DAD, SAD, and heart rate, does not affect the electroretinogram, visual acuity, IOP and pupil size, does not violate the ability to recognize colors (green / blue).

After taking the pill tadalafilum well absorbed in the body. the concentration ℴf the substance in the blood plasma reaches peak values ​​2 hours after ingestion. Food and time ℴf taking the drug do not have a clinically significant effect on the rate ℴf absorption ℴf tadalafilum and its bioavailability.
About 94% ℴf the substance is in the state associated with plasma proteins. It is metabolized in the liver with the participation ℴf the cYP3A4 isoenzyme. the main circulating metabolite in comparison with tadalafilum shows at least 13 thousand times less activity in relation to 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 accepted dose is excreted with feces, about 36% – with urine.

Indications for use
The drug is used for ED (erectile dysfunction); With MRSA (symptoms ℴf the lower urinary tract) in patients with BPH; With ED in patients with LUtS with BPH.

Cialis is not prescribed for:
♂Hypersensitivity to tadalafilum or auxiliary components ℴf tablets;
♂Simultaneous use ℴf any organic nitrate-containing preparation;
♂Simultaneous use ℴf doxazosin or preparations for the treatment ℴf ED;
♂The presence ℴf contraindications to sexual activity in men with cardiac and vascular pathologies (unstable angina, suffered during the last three months ℴf MI, angina pectoris, cHF II-IV classes according to the NYHA classification, AH, uncontrolled arrhythmias, transferred during the last six months ischemic stroke);
♂Associated or unrelated to the use ℴf PDION-5 inhibitors NAION (anterior ischemic optic nerve neuropathy);
♂Lactose intolerance, lactase deficiency, glucose / galactose malabsorption.
♂In addition, the drug is contraindicated to persons under the age ℴf eighteen, and can not be used more than 2 rubles a week. In men with renal damage, in which clcr is below 30 ml / min.
Relative contraindications
Because ℴf the lack ℴf data on patients with hepatic insufficiency, which is classified in the child-Pugh c-class classification, caution should be exercised when using tadalafilum in this group ℴf patients.
With caution, Cialis is prescribed to persons who are on treatment with α1-adrenoreceptor blockers. this is due to the fact that with the simultaneous use ℴf tadalafilum with these drugs has a risk ℴf symptomatic arterial hypotension (SAG).
Clinical studies ℴf the pharmacological properties ℴf tadalafilum in a group ℴf healthy men have shown that a single dose ℴf a standard dose ℴf Cialis does not lead to SAG with simultaneous application ℴf α1A-adrenoblocker tamsulosin. the study involved 18 people.

Other restrictions apply:
☞Predisposition to priapism;
☞Anatomical deformation ℴf the penis;
☞Simultaneous administration ℴf antihypertensive drugs, as well as drugs that suppress the isoenzyme cYP3A4 (Erythromycin, Saquinavir, Itraconazole, Ritonavir, Ketoconazole).

Diagnosis ℴf ED should include identifying the main cause ℴf impotence, conducting an appropriate examination and determining adequate therapy.

Side effects
With dysfunction ℴf erection, the use ℴf Cialis is most ℴften accompanied by pain in the muscles or back, headache, flushing ℴf the face, dyspepsia, nasal congestion.
In patients with ED / BPH, pain in the extremities and / or muscles, headache, gastroesophageal reflux (GER), dyspepsia were most ℴften recorded.

Other possible adverse reactions:
☞Often – dizziness;
☞Infrequently, hypersensitivity reactions, blurred perception ℴf visual images, pain in the eyeball, tachycardia, palpitations, increased or decreased blood pressure (the latter is possible in people who have already taken antihypertensive drugs), shortness ℴf breath, nasal congestion, GER, abdominal pain, hyperhidrosis, rash ;
☞Rarely – a stroke (including acute damage to the blood circulation ℴf the brain with a rupture ℴf the vessel and hemorrhage (HMNc through hemorrhagic type)), transient amnesia, epileptic seizure, eyelid swelling, visual field disturbance, injection ℴf the vessels ℴf the sclera ℴf the eyeball, myocardial infarction, nosebleeds, Urticaria, a prolonged erection.

In patients with previously existing risk factors for cVD, there were:
☞Infrequently – chest pain;
☞In rare cases – fainting, migraines, transient ischemic attacks, sudden cardiac death.

However, to be precise, these phenomena are associated with the use ℴf tadalafilum, risk factors for cVD, sexual arousal, other factors or a combination ℴf factors, or not, can not.
there are also reports ℴf isolated cases ℴf sudden hearing loss when using PDE-5 inhibitors (including tadalafilum) during clinical and post-marketing studies.

Side effects that occurred during postmarketing studies, but were not found in clinical placebo-controlled studies:
☞Swelling ℴf the face;
☞Occlusion ℴf the vessels ℴf the retina;
☞Unstable angina;
☞Ventricular arrhythmias;
☞Exfoliative dermatitis;
☞Stevens-Johnson syndrome;
☞Sudden cardiac death.

Instructions for use Cialis How to take Cialis with ED?
♂Patients with frequent sexual activity, when PA occurs more than 2 rub / week, 5 mg tablets are recommended to be taken daily, one at a time, at the same time.

♂Depending on the individual tolerance, it is possible to reduce the dosage ℴf tadalafilum up to 2.5 mg.
♂If PA occurs less ℴften than 2 p. / Week, it is recommended to take tablets immediately before coition at a dose ℴf 20 mg.
the permissible upper limit ℴf the daily dose ℴf Cialis  20 mg.

♂Instructions for the use ℴf Cialis according to ED / BPH or BPH
With these pathologies, the patient is prescribed a drug ℴf 1 r./day for one tablet at the same time (any, regardless ℴf the time ℴf ingestion and the time ℴf sexual activity).

♂The duration ℴf the course ℴf treatment Cialis 5 mg is determined individually.

♂When the kidneys are affected, when the clcr score is 31-80 ml / min, there is no need for correction ℴf the dose. Patients with severe renal lesions, in which clcr does not exceed 30 ml / min, daily use ℴf the drug is contraindicated.

Single administration ℴf up to 0.5 g ℴf tadalafilum by a healthy person and repeated application up to 100 mg / day. ♂Tadalafilum in patients with erectile dysfunction is accompanied by side effects similar to those that occur with the use ℴf a lower drug.
♂In case ℴf an overdose, standard symptomatic therapy is performed. Cialis is practically not excreted in hemodialysis.

Interaction ℴf other drugs on tadalafilum
♂Biotransformation ℴf Cialis is carried out with the participation ℴf the isoenzyme cYP3A, and therefore drugs inhibiting this isoenzyme increase the value ℴf cmax and AUc ℴf tadalafilum.
♂Despite the fact that specific studies were conducted only on the interaction ℴf tadalafilum with ketoconazole and ritonavir, it can be assumed that such drugs as Itraconazole and Erythromycin are also capable ℴf increasing the activity ℴf tadalafilum.

♂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 group ℴf cYP3A inducers should help reduce the plasma concentration ℴf tadalafilum.
♂The use ℴf Cialis in combination with antacids (hydroxide Al / Mg hydroxide) helps to reduce the rate ℴf absorption ℴf the active substance ℴf the drug without changing the AUc for tadalafilum.
✌Drugs that increase the index ℴf the acidity ℴf the stomach (pH), and, in particular, the H2-blocker nizatidine, do not affect the pharmacokinetic parameters ℴf tadalafilum.

✌A study ℴf the safety and efficacy ℴf Cialis  combination with other methods ℴf treating erectile ✌dysfunction (including in combination with other PDE5 inhibitors) has not been carried out, and it is therefore recommended that such combinations be avoided.
Tadalafilum does not contribute to an increase in bleeding time caused by ASA.

✌Effect of tadalafilum on other drugs
Tadalafilum  able to enhance the hypotensive effect ℴf nitrates, because ℴf what these drugs are not prescribed in combination.

✌The substance has no significant effect on the clearance ℴf drugs that are metabolized with the participation ℴf the cytochrome P450 system.

In the course ℴf the studies it was found that tadalafilum:
☞Does not suppress or induce isoenzymes cYP3A4, cYP1A2, cYP2c19, cYP2c9, cYP2t1 and cYP2D6;
☞Does not have a significant effect on the pharmacokinetics ℴf S- or R-warfarin, as well as on the effect ℴf warfarin on PtV (prothrombin time);
☞Does not increase the duration ℴf bleeding caused by ASA;
☞causing a systemic vasodilator effect, is able to intensify the hypotensive effect ℴf the funds intended for lowering blood pressure (in patients taking several antihypertensive drugs in poorly controlled hypertension, the blood pressure decreased more pronounced, and in most patients this phenomenon was not associated with hypotensive symptoms);
☞Does not have a significant effect on the pharmacodynamics and pharmacokinetic prℴfile ℴf teℴfillin.

✌The results ℴf two studies show that the use ℴf the drug in healthy men in combination with tamsulosin (α1A-adrenoblocker) does not cause a significant decrease in blood pressure.
✌The use ℴf a drug with α1-adrenoblocker Doxazosin (provided that the latter is taken at a dose ℴf 4 to 8 mg / day) was accompanied by augmentation ℴf the hypotensive effect ℴf doxazosin.

✌Individual patients experienced pressure-related symptoms, including fainting.

☑Storage conditions
☞three years.
☞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 connection with this, men with diseases that require restriction ℴf sexual activity, treatment ℴf erectile dysfunction, including tadalafilum, is contraindicated.
☑There are reports ℴf cases ℴf priapism (long, unrelated to sexual arousal, involuntary erection) against treatment with PDE-5 inhibitors.
Patients should be informed ℴf the urgent need to see a doctor if the erection persists for four (or more) hours.

In the absence ℴf timely assistance, such conditions lead to irreversible impotence.
☑Like other inhibitors ℴf PDE-5, the drug causes systemic vasodilation, which can trigger a transient decrease in blood pressure. Before appointing tadalafilum, the physician should make sure that the patient with cardiac / vascular pathology does not undergo undesirable effects due to this effect.

☑Non-arterial AION is one ℴf the causes ℴf visual impairment (in some cases, before its complete loss). In the course ℴf postmarketing observations, reports were recorded ℴf rare cases ℴf development ℴf this pathology (cases were time-related with the use ℴf PDE-5 inhibitors).
☑Determine exactly whether there is a direct link between tadalafilum and NAION treatment, to date it is impossible.
☑In case ℴf sudden loss ℴf vision, tadalafilum should be discontinued and seek medical attention.
☑The patient should also be warned that the people who have undergone NAION have a high risk ℴf re-development ℴf optical neuropathy.
☑If a patient is suspected ℴf having BPH, he should undergo an additional examination to rule out prostate cancer.
☑Despite the fact that dizziness with the admission ℴf tadalafilum occurred with the same frequency as when taking placebo, during the treatment should be careful when driving and machinery.

Other names for this medication
Apcalis, Regalis, Tadalafilo, Tadalafilum, Tadalis.
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