Cialis Lilly medicine for erectile dysfunction (1 blister x 2 tablets)

Cialis is contraindicated for patients with visual losses one eye due to ischemic neurological anemia non -inflammatory artery (Naion), regardless of whether or not it is related to PDE5 inhibitor exposure.

Precautions when using

need to ask the history and physical examination to diagnose erectile dysfunction as well as identify the hidden causes, before prescribing the use of pharmaceuticals.

Before starting any treatment for erectile dysfunction, physicians should pay attention to the patient's cardiovascular condition because there is a degree of cardiovascular risk associated with sexual activity. Tadalafil has vascular stretch properties, resulting in a decrease in blood pressure but at a mild and transient level. This will increase the potential of hypotension of nitrate.

Erectile dysfunction assessment needs to consider the hidden causes attached to determine the appropriate treatment after evaluating the patient's pathology. Currently, whether the Cialis is effective or not in patients with spinal cord lesions and patients with pelvic surgery or prostate surgery thoroughly without nervous preservation.Heart

Meet when bringing the drug to the market and/or in clinical trials, serious cardiovascular phenomena, including myocardial infarction, sudden death from heart disease, unstable angina, ventricular arrhythmia, stroke, transient ischemic attack, chest pain, drum pain and tachycardia. Most patients who have the above phenomena have previous cardiovascular risk factors. However, it is difficult to determine definitely to see if the above phenomena are directly related to these risk factors, to use Cialis, to sexual activity or due to the coordination of these factors or other factors.

Patients who are taking alpha 1 blockers, monkeys simultaneously with Cialis may have symptomatic hypotension in some patients. Therefore, it is not recommended to simultaneously use Tadalafil and Doxazosin.

vision

Blinds and cases of non -inflammatory anemic anemic anemia (Naion) have been reported when using Cialis simultaneously with other PDE5 inhibitors. In the case of sudden blind appearance, patients should stop the drug and consult a doctor immediately.

kidney failure

Due to the increase in the concentration of the Curve (AUC) of Tadalafil, the clinical experience is limited, and is not able to eliminate the impact by the separation; If prescribing the Cialis, the doctor should consider carefully assess the benefits and risks for each patient, in patients with severe renal impairment, the maximum recommended dose is 10 mg. 20 mg tadalafil tablets are not for patients with severe renal failure.

Hepatic failure

Clinical data on the safety of single-dose Cialis use in patients with severe liver failure (C Child-Pugh group) is limited; If the prescription is indicated for this patient, the physician needs to consider carefully between the benefits and the risk of each case. There is no data on doses higher than 10 mg Tadalafil in patients with liver failure.

Penis and anatomical deformation

Patients with penis that lasts 4 hours or longer, need to recommend medical assistance immediately. If the penis is not treated immediately, the penis tissue damage can be damaged and permanently lost its ability.

Medicines to treat erectile dysfunction, including Cialis, need to be cautious when prescribing patients with penis anatomy (such as an angle folding penis, cave fibroids or Peyronie disease) or in patients with diseases that can cause penis pain (such as sickle cell anemia, multiple marrow, leukemia).

Use with CYP3A4 inhibitors

Be cautious when prescribing Cialis for patients who are using strong CYP3A4 inhibitors (such as ritonavir, saquinavir, ketoconazole, iTraconazole, and erythromycin) for receiving the area under the curve (AUC) of Tadalafil when used in combination with these drugs.

Cialis and other erectile dysfunctions

Safety and effectiveness when coordinating Cialis with PDE5 inhibitors or other drugs to treat erectile dysfunction has not been studied. Therefore recommendations should not be used in combination with cialis with these drugs.

lactose

Cialis contains lactose monohydrate. Do not use Cialis for patients with genetic problems related to galactose intolerance, lapp lactase or glucose - galactose absorption disorder.

The ability to drive and operate machines

Cialis has negligible effects on the ability to drive or operate machinery.

Despite the clinical trials, the rate of dizziness reports in groups of placebo and Tadalafil is similar, patients should still be aware of the reaction of Cialis drugs for them before driving or operating machinery.

Pregnancy

There is no Cialis appointment for women.

There is not much data on the use of Tadalafil in pregnant women. Animal studies show that the drug is not directly or indirectly harmful to pregnancy, the development of embryos or fetuses, the birth or postpartum process. The most cautious is to avoid using Cialis during pregnancy.

Breastfeeding period

Data on toxic, pharmacological energy in animals shows that Tadalafi is excreted in milk, the risk for breastfed babies is not excluded. Do not use Cialis during breastfeeding.

Drug interaction

Many studies on drug interaction with Tadalafil 10mg and/or 20mg have been done and described below. In these buildings, Tadalafil dose is only 10mg, so clinical symptoms related to higher doses to assess drug interactions cannot be completely listed.

The impact of other drugs on Tadalafil

Cytochrome p450 inhibitors

Tadalafil is metabolized mainly by CYP3A4. A selective inhibitor CYP3A4, Ketoconazole (200mg per day) when used in combination with Tadalafil increases the area under the curve (AUC) of Tadalafil (10mg) double and 15% CMAX when compared to the AUC and CMAX value of Tadalafil (10mg) only used alone. Ketoconazole (400mg per day) increases the area under the curve (AUC) of Tadalafil (20mg) 4 times and 22%CMAX. Ritonavir, a protease inhibitor (200mg used twice daily), is CYP3A4, CYP2C9, CYP2C9, and CYP2D6 inhibitors, increasing the area under the curve (AUC) of Tadalafil (20mg) twice without changing CMAX. Although specialized interactions have not been studied, some protease inhibitors, such as Saquinavir, and other CYP3A4 inhibitors, such as Erythromycin, Clarithromycin, iTraconazole and grapefruit juice when used simultaneously with Tadalafil should be cautious because they can increase Tadalafil concentration in plasma. Thus, the rate of unwanted effects can also increase.

Transport substances

The role of transport substances (such as P - Glycoprotein) with Tadalafil is not known. Therefore there is a potential drug interaction if these substances are inhibited.

Cytochrome P450 induction substances

A CYP3A4, Rifampidn induction, reducing the area under the curve (AUC) Tadalafil to 88% when compared to the AUC value of Tadalafil (10mg) only used alone. Reducing the area under the curve may reduce the effect of Tadalafi, but the reduction level is not known. Other CYP3A4 induction substances such as phenobarbital, phenytoin and carbamazepine can also reduce the concentration of Tadalafil in plasma.

Tadalafil's influence on other drugs

nitrates

The results of clinical research tests show that Tadalafil (5 mg, 10 mg and 20 mg) shows signs of increasing the lowering effects of nitrates. Therefore, contraindicated use of Cialis for patients is taking any form of organic nitrate. Based on the results of a clinical trial, of which 150 subjects are assigned daily doses of Tadalafil 20mg for 7 days and 0.4mg nitroglycerin under the tongue at different times, the drug interaction lasts more than 24 hours and no more interaction 48 hours after taking Tadalafil the last dose. Therefore, in the case of patients who have used Cialis (2.5 mg - 20 mg), and nitrate indications are thought to be an essential solution in life -threatening situations, note that the use of nitrate needs at least 48 hours after the last dose of Cialis use. In such cases, nitrate is only used with strict supervision by appropriate machines for hemodynamic monitoring.

Anti -blood pressure medications (including calcium channel blockers)

Concomitance the use of doxazosin (4 and 8 mg daily) with Tadalafil (single dose 5 mg and 20 mg daily) increases the hypotension effect of this alpha blocker significantly. This impact lasts at least 12 hours and may have symptoms of fainting. Therefore, recommendations must not be combined with tadalafil and Alpha inhibitors. In drug interactive studies conducted on a limited number of healthy volunteers, these effects have not been reported to alfuzosin or tamsulosin. However, be careful when using Tadalafil for patients who are taking any alpha blockers, especially for the elderly. Should start treatment with the lowest dose and increase gradually.

In Tadalafil clinical experimental studies, the characteristics that increase the hypotension of hypotension drugs have also been surveyed.

CYP1A2 substrates (such as theophylline)

In clinical pharmacological research, when using Tadalafil 10 mg with theophylline (an unstable phosphodiesterase inhibitor), there is no pharmacokinetic interaction. There is only one effect of pharmacological force is a slight increase of heart rate (3.5 beats/minute). Although this impact is insignificant and does not cause a clear clinical effect in this test, it should also be noted when used with the above drugs.

ethinylestradiol and terbutaline

Tadalafil has been shown to increase the bioavailability of EthinyleLestradiol oral use; The results are the same for oral terbutaline, although it is not sure to have a clinical impact.

alcohol

Alcohol concentration (the average concentration of the blood in the blood is 0.08%) is not affected when used simultaneously with Tadalafil (10 mg and 20 mg). In addition, there is no change in the concentration of Tadalafil observed 3 hours after taking the drug simultaneously with alcohol. Alcohol has been used in experiments with a way to maximize the speed of alcohol absorption (drinking at night and eating 2 hours later). Tadalafil (20mg) does not increase the average level of hypoglycemia due to alcohol (drink for 0.7 g/kg or about 180 ml or 40% wine [vodka] in men weighing 80 kg) but in some research subjects, observing dizziness and lower posture hypotension. When using Tadalafil with a small amount of alcohol (0.6 g/kg), observing no hypotension and the rate of dizziness occurs at the same frequency as when the object only drinks alcohol. The impact of alcohol on cognitive function does not change when using Tadalafil (10 mg).

Metabolic drugs by Cytochrome P450

Tadalafil does not cause inhibition or reduction of clinical significance of metabolic drugs by CYP450 similarities. Studies have confirmed that the Tadalafil does not inhibit or the CYP450 homogeneous touch includes CYP3A4, CYP1A2, CYP2D6, CYP2E1, CYP2C9, and CYP2C19.

CYP2C9 (such as R-Warfarin)

Tadalafil (10 mg and 20 mg) has no clinical significance related to the area under the curve (AUC) when used with S - Warfarin or R - Warfarin (CYP2C9) as well as Tadalafil does not change the prothrombin time when used with Warfarin.

aspirin

Tadalafil (10 mg and 20 mg) does not add bleeding time when used with acetyl salicylic acid.

Diabetes treatments

Specific studies on interaction with diabetes drugs have not been conducted.