Cialis Tadalafil 20mg Strengths and Indications

Visual field defect, retinal vein occlusion, retinal artery occlusion, and non–arteritic anterior ischemic optic neuropathy (NAION) Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis Guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Do not use nitrates within 48 hr of the last dose of macitentan/tadalafil This potentiation is thought to result from the combined effects of nitrates and tadalafil on the nitric oxide/cGMP pathway The potentiation is consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway Use caution in patients with anatomic deformation of penis, cardiovascular disease, left ventricular outflow obstruction, myocardial infarction in preceding 90 days, unstable angina, angina occurring during sexual intercourse, NYHA class 2 or greater heart failure in preceding 6 months, uncontrolled arrhythmias, hypotension, uncontrolled hypertension, cerebrovascular accident in preceding 6 months, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, conditions predisposing to priapism, concomitant use of CYP3A4 inhibitors May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Do not use nitrates within 48 hours of last dose of tadalafil Drug has vasodilatory properties that may result in transient decreases in blood pressure; prior to prescribing, carefully consider whether patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects; patients with preexisting hypotension, with autonomic dysfunction, with left ventricular outflow obstruction, may be particularly sensitive to actions of vasodilators When used to treat erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, reported postmarketing; if vision problems arise, discontinue, and contact physician CYP3A4 inhibitors (eg, erythromycin, ketoconazole, itraconazole, indinavir, ritonavir) may significantly increase tadalafil serum levels CYP3A4 inducers (eg, rifampin, St John’s wort) may decrease tadalafil serum levels Potentiates hypotensive effect of nitrates (see Contraindications) Concomitant use with alpha blockers (other than tamsulosin 0.4 mg/day) should be stabilized before initiation of phosphodiesterase (PDE)-5 inhibitors; patients with instability on alpha-blocker therapy alone are at increased risk for symptomatic hypotension with concurrent PDE-5 inhibitor therapy Not to be taken with other PDE-5 inhibitors (eg, sildenafil, vardenafil) Not recommended in patients with pulmonary veno-occlusive disease Advise patients to seek emergency treatment if an erection lasts >4 hr Limited data from case series with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death In animal reproduction studies, no adverse developmental effects were observed with oral administration to pregnant rats or mice during organogenesis at exposures 7 times the exposure at maximum recommended human dose (MRHD) of 40 mg/day based on AUC There are no data on presence of drug and/or its metabolites in human milk, effects on breastfed child, or on milk production; drug and/or its metabolites are present in milk of lactating rats at concentrations approximately 2.4-times that found in the plasma; when a drug is present in animal milk, it is likely that the drug will be present in human milk Controlled studies in pregnant women show no evidence of fetal risk. Erectile dysfunction: Inhibits PDE-5, increasing cyclic guanosine monophosphate (cGMP) to allow smooth-muscle relaxation and inflow of blood into corpus cavernosum Pulmonary arterial hypertension (PAH): Inhibits PDE-5, increasing cGMP to allow relaxation of pulmonary vascular smooth-muscle cells and vasodilation of pulmonary vasculature Peak plasma time: Erectile dysfunction, 0.5-6 hr; PAH, 2-8 hr Vd: Erectile dysfunction, 63 L; PAH, 77 L Half-life: Erectile dysfunction, 15-17.5 hr; PAH (not on bosentan), 35 hr Total body clearance: Erectile dysfunction, 2.5 L/hr; PAH (not on bosentan), 1.6 L/hr Erectile dysfunction (PRN use): Take before anticipated sexual activity Erectile dysfunction (once-daily use): Take at approximately same time each day without regard to timing of sexual activity Shake well for 30 seconds before measuring dose Take with or without food or water Do not split or break a chewable tablet because this may result in a dose below the minimum therapeutic dose or greater than the maximum recommended dose, which may increase risk of adverse effects Tablets, chewable tablet, oral suspension: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) Adding plans allows you to compare formulary status to other drugs in the same class. To view formulary information first create a list of plans. Your list will be saved and can be edited at any time. View the formulary and any restrictions for each plan. Manage and view all your plans together – even plans in different states. Compare formulary status to other drugs in the same class. Access your plan list on any device – mobile or desktop. If you can't find what you were looking for, please contact us using one of the methods below so we can better serve you. Due to the Coronavirus (COVID-19) outbreak worldwide, the global demand for some Personal Protective Equipment (PPE) is exceeding current supply availability.

• Cialis is considered effective for most common causes of erectile dysfunction.
• This includes ED caused by diabetes, hypertension, and prostate surgery.
• Response rates may be lower in men with severe neurological damage.
• It can be effective even in cases where other ED medications have failed.
• Do not switch medications or adjust dosages without consulting your doctor.
• A urologist is a specialist who can provide advanced ED management.
• Treatment options include oral medications, injections, implants, and pumps.
• Cialis is often the first-line oral therapy tried.

In addition, the manufacturing of the PPE and many other wound care/infection prevention products have been impacted by the global response to the Coronavirus. While you may see product availability reduction in the near-term, please cost cialis everyday be assured that we at McGuff Medical are continuing to work diligently to ensure an uninterrupted supply of products and alternative products to you. Additionally, in order to ensure healthcare providers have access to the PPEs they need, the McGuff Company is temporarily limiting PPEs to healthcare providers.

• Cialis is classified as a Schedule 4 (IV) controlled substance in some countries.
• This is due to potential for abuse, though the risk is generally considered low.
• It is not typically associated with producing a "high" or euphoria.
• Abuse can occur in attempts to enhance athletic performance or stamina.
• There is no evidence that it actually improves athletic performance.
• Misuse can lead to an increased risk of serious cardiovascular events.
• It is sometimes used recreationally in combination with other drugs.
• This polydrug use significantly increases the potential for adverse effects.

As always, please feel free to reach out to our McGuff Customer Service team with any questions that you may have.

• For patients with renal impairment, dose adjustments are necessary.
• A maximum dose of 10 mg is recommended for severe renal impairment.
• Cialis is not recommended for patients with severe hepatic impairment.
• For moderate hepatic impairment, a maximum dose of 10 mg is advised.
• Age alone does not require a dose adjustment for healthy elderly patients.
• However, renal function often declines with age, which may require a change.
• Other age-related cardiac issues may also affect suitability.
• A lower starting dose is often prudent for older patients.

All content on this page has been medically reviewed by: Hassan Thwaini, Clinical Pharmacist and Copywriter, Master of Pharmacy (MPharm) on 30 March, 2026. Tadalafil is a clinically-proven erectile dysfunction treatment that gives you the freedom to enjoy sex when you want it.

What About Other ED Medications?

Tadalafil is a clinically-proven erectile dysfunction treatment that gives you the freedom to enjoy sex when you want it. It lasts for 36 hours - so there’s less need for planning before sex. Find the clinically proven ED treatment that suits you best. No names, no logos, no delivery fee. 4.6* from over 33,000 people like you.

Alternatives for benign prostatic hyperplasia (BPH)

BSc (Hons) MBBS MRCGP AFHEA MA (Hons) AFMCP Answer a few simple questions to get the treatment you need. Receive our latest updates about our products & promotions. Skip to content Cialis 20mg - 4 Tablets ImportedFree ReturnsShipped Within 2 - 5 Bussiness DaysUses of the Cialis 20 mg Tablets1. Benign Prostatic Hyperplasia (BPH)How Does Cialis 20 mg Tablet Work?Sexual Stimulation Triggers Nitric OxideNitric Oxide Creates cGMPTadalafil Blocks PDE5How Should You Take Cialis 20 mg Tablet?Recommended Dosage of Cialis 20 mg TabletWarnings and PrecautionsHave severe medical conditions, including:Additional Precautions:Possible Side Effects of Cialis 20 mg TabletsLower Dosage Cialis 5mg available in Pakistan Information and PurposeFood SupplementsUse of InformationResponsibility and LiabilitySafety and StorageLegal and Regional ConsiderationsExcellent Result Satisfied with it GOOD Good Goood Related Products Recently Viewed Products Sign Up for Discount's Offers & Health Tips! Erectile Dysfunction (ED) Erectile dysfunction means you struggle to get or keep an erection hard enough for..

Can Cialis be crushed, split, or chewed?

For a seamless shopping experience, Vitamins House allows you to return most new, unopened items within 14 days for a full refund. If the return is due to buy cialis over the counter our error (like receiving an incorrect or defective item), we will cover the return shipping costs. You can expect your refund within four weeks of sending your item back, though it often arrives sooner. To start a return, log into your account, go to "Complete Orders" under My Account, and click "Return Item(s)." We'll email you once we've processed your returned item. Or you can contact us directly on our official number 0322-2223149. It lasts for 36 hours - so there’s less need for planning before sex. Find the clinically proven ED treatment that suits you best. No names, no logos, no delivery fee.

Product	Dosage	Quantity + Bonus	Price
Cialis Generic	10mg	60 + 6 Pills	105.81€ 100.77€	Buy
Cialis Generic	20mg	270 + 10 Pills	335.21€ 319.25€	Buy
Cialis Original	20mg	4 Pills	41.99€ 39.99€	Buy
Cialis Super Active	20mg	10 Pills	55.64€ 52.99€	Buy
Cialis Black	80mg	30 + 2 Pills	89.11€ 84.87€	Buy
Cialis Black	80mg	180 + 10 Pills	356.64€ 339.66€	Buy
Cialis Professional	20mg	120 + 4 Pills	291.68€ 277.79€	Buy
Cialis Black	80mg	120 + 8 Pills	264.77€ 252.16€	Buy
Cialis Generic	10mg	180 + 8 Pills	236.88€ 225.60€	Buy
Cialis Generic	40mg	60 + 6 Pills	130.98€ 124.74€	Buy
Cialis Black	80mg	10 Pills	43.27€ 41.21€	Buy
Cialis Black	80mg	60 + 4 Pills	150.98€ 143.79€	Buy
Cialis Generic	2.5mg	180 + 10 Pills	154.86€ 147.49€	Buy
Cialis Generic	2.5mg	30 + 4 Pills	51.95€ 49.48€	Buy
Cialis Professional	20mg	60 + 2 Pills	183.83€ 175.08€	Buy
Cialis Generic	10mg	10 Pills	31.41€ 29.91€	Buy
Cialis Black	80mg	90 + 6 Pills	207.88€ 197.98€	Buy

4.6* from over 33,000 people like you. BSc (Hons) MBBS MRCGP AFHEA MA (Hons) AFMCP Answer a few simple questions to get the treatment you need.

How it works

Visual field defect, retinal vein occlusion, retinal artery occlusion, and non–arteritic anterior ischemic optic neuropathy (NAION) Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis Guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Do not use nitrates within 48 hr of the last dose of macitentan/tadalafil This potentiation is thought to result from the combined effects of nitrates and tadalafil on the nitric oxide/cGMP pathway The potentiation is consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway Use caution in patients with anatomic deformation of penis, cardiovascular disease, left ventricular outflow obstruction, myocardial infarction in preceding 90 days, unstable angina, angina occurring during sexual intercourse, NYHA class 2 or greater heart failure in preceding 6 months, uncontrolled arrhythmias, hypotension, uncontrolled hypertension, cerebrovascular accident in preceding 6 months, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, conditions predisposing to priapism, concomitant use of CYP3A4 inhibitors May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Do not use nitrates within 48 hours of last dose of tadalafil Drug has vasodilatory properties that may result in transient decreases in blood pressure; prior to prescribing, carefully consider whether patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects; patients with preexisting hypotension, with autonomic dysfunction, with left ventricular outflow obstruction, may be particularly sensitive to actions of vasodilators When used to treat erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, reported postmarketing; if vision problems arise, discontinue, and contact physician CYP3A4 inhibitors (eg, erythromycin, ketoconazole, itraconazole, indinavir, ritonavir) may significantly increase tadalafil serum levels CYP3A4 inducers (eg, rifampin, St John’s wort) may decrease tadalafil serum levels Potentiates hypotensive effect of nitrates (see Contraindications) Concomitant use with alpha blockers (other than tamsulosin 0.4 mg/day) should be stabilized before initiation of phosphodiesterase (PDE)-5 inhibitors; patients with instability on alpha-blocker therapy alone are at increased risk for symptomatic hypotension with concurrent PDE-5 inhibitor therapy Not to be taken with other PDE-5 inhibitors (eg, sildenafil, vardenafil) Not recommended in patients with pulmonary veno-occlusive disease Advise patients to seek emergency treatment if an erection lasts >4 hr Limited data from case series with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death In animal reproduction studies, no adverse developmental effects were observed with oral administration to pregnant rats or mice during organogenesis at exposures 7 times the exposure at maximum recommended human dose (MRHD) of 40 mg/day based on AUC There are no data on presence of drug and/or its metabolites in human milk, effects on breastfed child, or on milk production; drug and/or its metabolites are present in milk of lactating rats at concentrations approximately 2.4-times that found in the plasma; when a drug is present in animal milk, it is likely that the drug will be present in human milk Controlled studies in pregnant women show no evidence of fetal risk. Erectile dysfunction: Inhibits PDE-5, increasing cyclic guanosine monophosphate (cGMP) to allow smooth-muscle relaxation and inflow of blood into corpus cavernosum Pulmonary arterial hypertension (PAH): Inhibits PDE-5, increasing cGMP to allow relaxation of pulmonary vascular smooth-muscle cells and vasodilation of pulmonary vasculature Peak plasma time: Erectile dysfunction, 0.5-6 hr; PAH, 2-8 hr Vd: Erectile dysfunction, 63 L; PAH, 77 L Half-life: Erectile dysfunction, 15-17.5 hr; PAH (not on bosentan), 35 hr Total body clearance: Erectile dysfunction, 2.5 L/hr; PAH (not on bosentan), 1.6 L/hr Erectile dysfunction (PRN use): Take before anticipated sexual activity Erectile dysfunction (once-daily use): Take at approximately same time each day without regard to timing of sexual activity Shake well for 30 seconds before measuring dose Take with or without food or water Do not split or break a chewable tablet because this may result in a dose below the minimum therapeutic dose or greater than the maximum recommended dose, which may increase risk of adverse effects Tablets, chewable tablet, oral suspension: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) Adding plans allows you to compare formulary status to other drugs in the same class. To view formulary information first create a list of plans. Your list will be saved and can be edited at any time. View the formulary and any restrictions for each plan.

Financial and insurance assistance

Manage and view all your plans together – even plans in different states. Compare formulary status to other drugs in the same class. Access your plan list on any device – mobile or desktop. If you can't find what you were looking for, please contact us using one of the methods below so we can better serve you. Due to the Coronavirus (COVID-19) outbreak worldwide, the global demand for some Personal Protective Equipment (PPE) is exceeding current supply availability.

Warnings and Precautions

In addition, the manufacturing of the PPE and many other wound care/infection prevention products have been impacted by the global response to the Coronavirus. While you may see product availability reduction in the near-term, please cost cialis everyday be assured that we at McGuff Medical are continuing to work diligently to ensure an uninterrupted supply of products and alternative products to you. Additionally, in order to ensure healthcare providers have access to the PPEs they need, the McGuff Company is temporarily limiting PPEs to healthcare providers. As always, please feel free to reach out to our McGuff Customer Service team with any questions that you may have. All content on this page has been medically reviewed by: Hassan Thwaini, Clinical Pharmacist and Copywriter, Master of Pharmacy (MPharm) on 30 March, 2026. Receive our latest updates about our products & promotions. Skip to content Cialis 20mg - 4 Tablets ImportedFree ReturnsShipped Within 2 - 5 Bussiness DaysUses of the Cialis 20 mg Tablets1.

Side Effect	Frequency	Severity	Recommendations
Headache	Common	Mild	Use over-the-counter pain relief
Flushing	Common	Mild	Hydrate and avoid extreme temperatures
Indigestion	Less common	Mild	Avoid heavy or greasy meals
Muscle aches	Occasional	Mild	Rest and hydration
Vision changes	Rare	Moderate	Seek medical attention if severe

Benign Prostatic Hyperplasia (BPH)How Does Cialis 20 mg Tablet Work?Sexual Stimulation Triggers Nitric OxideNitric Oxide Creates cGMPTadalafil Blocks PDE5How Should You Take Cialis 20 mg Tablet?Recommended Dosage of Cialis 20 mg TabletWarnings and PrecautionsHave severe medical conditions, including:Additional Precautions:Possible Side Effects of Cialis 20 mg TabletsLower Dosage Cialis 5mg available in Pakistan Information and PurposeFood SupplementsUse of InformationResponsibility and LiabilitySafety and StorageLegal and Regional ConsiderationsExcellent Result Satisfied with it GOOD Good Goood Related Products Recently Viewed Products Sign Up for Discount's Offers & Health Tips! Erectile Dysfunction (ED) Erectile dysfunction means you struggle to get or keep an erection hard enough for.. For a seamless shopping experience, Vitamins House allows you to return most new, unopened items within 14 days for a full refund. If the return is due to buy cialis over the counter our error (like receiving an incorrect or defective item), we will cover the return shipping costs. You can expect your refund within four weeks of sending your item back, though it often arrives sooner. To start a return, log into your account, go to "Complete Orders" under My Account, and click "Return Item(s)." We'll email you once we've processed your returned item.

STRONGER ERECTIONS, BETTER SEX

If you need to return an item, simply login to your account, view the order using the "Complete Orders" link under the My Account menu and click the Return Item(s) button. We'll notify you via e-mail of your refund once we've received and processed the returned item. Vitamins House offers Cash on Delivery (COD) services exclusively within Pakistan, simplifying the process for our local customers. Please note, we do not provide international shipping. Shipping costs and delivery times are calculated based on your location within Pakistan.

Lower Dosage Cialis 5mg available in Pakistan

Erectile dysfunction means you struggle to get or keep an erection hard enough for satisfying intercourse. It can stem from stress, diabetes, hypertension, surgery, hormonal shifts or simply age-related circulation changes. A single Cialis 20 mg pill increases blood flow to penile tissue for up to 36 hours, letting sexual stimulation translate into a firm, dependable erection. An enlarged prostate can squeeze the urethra and trigger frequent nighttime urination, weak flow or a feeling that the bladder never empties. Tadalafil 20 mg relaxes smooth muscle inside the prostate and bladder neck, improving stream strength and cutting bathroom trips.

How long does Cialis stay in your system?

Men who search “Cialis Pakistan” or “tadalafil in Pakistan” for urinary relief often find the 20 mg tablet doubly convenient—one medicine, two problems solved. Or you can contact us directly on our official number 0322-2223149. If you need to return an item, simply login to your account, view the order using the "Complete Orders" link under the My Account menu and click the Return Item(s) button.

Parameter	Value	Notes
Absorption Time	30-60 minutes	Peak plasma levels in about 2 hours
Half-life	17.5 hours	Long duration of action
Bioavailability	Approximately 80%	Percentage absorbed into bloodstream
Metabolism	Liver (via CYP3A4 enzyme)	Main pathway in the body
Excretion	Feces and urine	Mainly metabolized forms

We'll notify you via e-mail of your refund once we've received and processed the returned item. Vitamins House offers Cash on Delivery (COD) services exclusively within Pakistan, simplifying the process for our local customers. Please note, we do not provide international shipping. Shipping costs and delivery times are calculated based on your location within Pakistan. Erectile dysfunction means you struggle to get or keep an erection hard enough for satisfying intercourse. It can stem from stress, diabetes, hypertension, surgery, hormonal shifts or simply age-related circulation changes.

Mechanism of action

Key takeaways

A single Cialis 20 mg pill increases blood flow to penile tissue for up to 36 hours, letting sexual stimulation translate into a firm, dependable erection. An enlarged prostate can squeeze the urethra and trigger frequent nighttime urination, weak flow or a feeling that the bladder never empties. Tadalafil 20 mg relaxes smooth muscle inside the prostate and bladder neck, improving stream strength and cutting bathroom trips.

Brand Name	Manufacturer	Price Range (per pill)	Notes
Cialis	Lilly	$20 - $50	Original brand
Tadalista	Strides Pharma	$15 - $30	Generic option
Tadalis SX	Ajanta Pharma	$10 - $25	Generic available
Apcalis Oral Jelly	Eisai	$25 - $45	Liquid form for ease of intake

Men who search “Cialis Pakistan” or “tadalafil in Pakistan” for urinary relief often find the 20 mg tablet doubly convenient—one medicine, two problems solved.