3 DOSAGE FORMS AND STRENGTHS

17.4 Potential for Drug Interactions When Taking CIALIS for Once Daily Use
Cialis 20 Tablet Ingredients
5.6 Alpha blockers and Antihypertensives
1.1 Erectile Dysfunction

16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 How SuppliedCialis 10mg tablets are available in bottles of 10 (NDC 21695-028-10)Cialis 20mg tablets are available in bottles of 10 (NDC 21695-029-10)Cialis 20mg tablets are available in bottles of 16 (NDC 21695-029-16)Cialis 20mg tablets are available in bottles of 30 (NDC 21695-029-30)REPACKAGED BY:REBEL DISTRIBUTORS CORP.THOUSAND OAKS, CA 91320 Cialis 10mg tablets are available in bottles of 10 (NDC 21695-028-10) Cialis 20mg tablets are available in bottles of 10 (NDC 21695-029-10) 17 PATIENT COUNSELING INFORMATION See FDA approved Patient Labeling17.1 NitratesPhysicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke.Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of CIALIS. Therefore, patients who experience anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)].17.2 Cardiovascular ConsiderationsPhysicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)].17.3 Concomitant Use with Drugs Which Lower Blood PressurePhysicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.4 Potential for Drug Interactions When Taking CIALIS for Once Daily UsePhysicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol.17.5 PriapismThere have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) for this class of compounds.

17.4 Potential for Drug Interactions When Taking CIALIS for Once Daily Use

Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)]. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)].

Are you currently using Tadalafil (Cialis, Adcirca, and others)?

Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered. CIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use. For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours.

Benign prostatic hyperplasia explained

For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. PATIENT PACKAGE INSERT Patient InformationCIALIS®(See-AL-iss)(tadalafil) tabletsRead this important information before you start taking CIALIS and each time you get a refill. You may also find it helpful to cialis 5 mg lilly share this information with your partner. This information does not take the place of talking with your healthcare provider. You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention.17.6 VisionPhysicians should advise patients to stop use of all PDE5 inhibitors, including CIALIS, and seek medical attention in the event of a sudden loss of vision in one or both eyes.

Product	Dosage	Quantity + Bonus	Price
Cialis Soft Tabs	20mg	120 + 6 Pills	248.64€ 236.80€
Cialis Generic	10mg	360 + 10 Pills	388.49€ 369.99€
Cialis Black	80mg	360 + 20 Pills	639.78€ 609.31€
Cialis Generic	60mg	30 + 2 Pills	85.33€ 81.27€
Cialis Professional	20mg	360 + 6 Pills	807.03€ 768.60€
Cialis Professional	20mg	30 Pills	104.57€ 99.59€
Cialis Professional	40mg	120 + 4 Pills	436.68€ 415.89€
Cialis Generic	10mg	10 Pills	31.41€ 29.91€
Cialis Generic	60mg	180 + 10 Pills	313.11€ 298.20€
Cialis Super Active	20mg	10 Pills	55.64€ 52.99€

Ingredient	Quantity per Tablet	Function
Tadalafil	20 mg	Active ingredient
Microcrystalline cellulose	50 mg	Fillers
Croscarmellose sodium	10 mg	Disintegrant
Magnesium stearate	5 mg	Lubricant

It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6.1) and (6.2)].17.8 AlcoholPatients should be made aware that both alcohol and CIALIS, a PDE5 inhibitor, act as mild vasodilators. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.9 Sexually Transmitted DiseaseThe use of CIALIS offers no protection against sexually transmitted diseases. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.17.10 Recommended AdministrationCIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours.For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. Cialis is effective at improving erectile function over the course of therapy. Physicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke. Therefore, patients who experience pharmacy cialis uk anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)]. Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)]. Physicians should discuss with patients the potential for CIALIS to augment the blood-pressure-lowering effect of alpha blockers and antihypertensive medications [see Warnings and Precautions (5.6), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing CIALIS for once daily use, especially the potential for interactions with medications (e.g., nitrates, alpha blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4) and with substantial consumption of alcohol. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention. Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)]. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)]. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.

Cialis 20 Tablet Ingredients

If you do not understand the information, or have questions, talk with your healthcare provider or pharmacist.What Is The Most Important Information I Should Know About CIALIS?CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.Do not take CIALIS if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates.

Erectile dysfunction explained

(See “Who should not take CIALIS?”)Tell all of your healthcare providers that you take CIALIS. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took CIALIS.After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications (see “Can Other Medicines Affect CIALIS?”).Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex.

Dosage Forms & Strengths

CIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.

Symptom	Management Approach	When to Seek Help
Headache	Over-the-counter pain relievers	Severe or persistent headache
Muscle pain	Rest, hydrate, consult doctor if severe	Severe muscle cramps
Flushing	Cooling measures, avoid hot drinks	If accompanied by dizziness
Indigestion	Antacids or dietary adjustments	Severe or prolonged indigestion

For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity.

5.6 Alpha blockers and Antihypertensives

Can Cialis be crushed, split, or chewed?

How does tadalafil work (mechanism of action)?

In most patients, the ability to have sexual intercourse is improved for up to 36 hours. For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity. PATIENT PACKAGE INSERT Patient InformationCIALIS®(See-AL-iss)(tadalafil) tabletsRead this important information before you start taking CIALIS and each time you get a refill.

There is no evidence that Cialis causes infertility.
It does not affect sperm count, motility, or morphology.
Men trying to conceive can generally use it safely.
However, always inform your fertility specialist of all medications.
Some studies suggest PDE5 inhibitors may improve sperm function.
This is an off-label and not a guaranteed effect.
For men with BPH, improved urinary symptoms can significantly improve sleep.
Better sleep can have positive effects on overall health and libido.
Treating BPH may reduce the need for invasive surgical procedures.

You may also find it helpful to cialis 5 mg lilly share this information with your partner.

Question	Answer
Can I take Cialis daily?	Usually not; consult your doctor for daily use plans
Is Cialis 20mg safe for everyone?	No, contraindicated in some conditions; see doctor
How long does the effect last?	Up to 36 hours depending on individual factors
Can I drink alcohol with Cialis?	Moderate alcohol is generally safe; excessive alcohol can increase side effects

This information does not take the place of talking with your healthcare provider.

1.1 Erectile Dysfunction

Does tadalafil interact with foods or drinks?

Physicians should also discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE5 inhibitors [see Clinical Studies (6.2)].17.7 Sudden Hearing LossPhysicians should advise patients to stop taking PDE5 inhibitors, including CIALIS, and seek prompt medical attention in the event of sudden decrease or loss of hearing. It is not possible to determine whether these events are related directly to the use of PDE5 inhibitors or to other factors [see Adverse Reactions (6.1) and (6.2)].17.8 AlcoholPatients should be made aware that both alcohol and CIALIS, a PDE5 inhibitor, act as mild vasodilators. Therefore, physicians should inform patients that substantial consumption of alcohol (e.g., 5 units or greater) in combination with CIALIS can increase the potential for orthostatic signs and symptoms, including increase in heart rate, decrease in standing blood pressure, dizziness, and headache [see Warnings and Precautions (5.9), Drug Interactions (7.1), and Clinical Pharmacology (12.2)].17.9 Sexually Transmitted DiseaseThe use of CIALIS offers no protection against sexually transmitted diseases. Counseling of patients about the protective measures necessary to guard against sexually transmitted diseases, including Human Immunodeficiency Virus (HIV) should be considered.17.10 Recommended AdministrationCIALIS is available in two dosing regimens; therefore, physicians should instruct patients on the appropriate administration to allow optimal use.For CIALIS for use as needed, patients should be instructed to take one tablet at least 30 minutes before anticipated sexual activity. In most patients, the ability to have sexual intercourse is improved for up to 36 hours.For CIALIS for once daily use, patients should be instructed to take one tablet at approximately the same time every day without regard for the timing of sexual activity.

Side effect details

Cialis is effective at improving erectile function over the course of therapy. Physicians should discuss with patients the contraindication of CIALIS with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of CIALIS with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke. Therefore, patients who experience pharmacy cialis uk anginal chest pain after taking CIALIS should seek immediate medical attention [see Contraindications (4.1) and Warnings and Precautions (5.1)]. Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. You and your healthcare provider should talk about CIALIS when you start taking it and at regular checkups. If you do not understand the information, or have questions, talk with your healthcare provider or pharmacist.What Is The Most Important Information I Should Know About CIALIS?CIALIS can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. You could get dizzy, faint, or have a heart attack or stroke.Do not take CIALIS if you take any medicines called “nitrates.” Nitrates are commonly used to treat angina. Angina is a symptom of heart disease and can cause pain in your chest, jaw, or down your arm.Medicines called nitrates include nitroglycerin that is found in tablets, sprays, ointments, pastes, or patches. Nitrates can also be found in other medicines such as isosorbide dinitrate or isosorbide mononitrate. Some recreational drugs called “poppers” also contain nitrates, such as amyl nitrite and butyl nitrite.Ask your healthcare provider or pharmacist if you are not sure if any of your medicines are nitrates. (See “Who should not take CIALIS?”)Tell all of your healthcare providers that you take CIALIS. If you need emergency medical care for a heart problem, it will be important for your healthcare provider to know when you last took CIALIS.After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days.

Cialis 20mg is available by prescription and should be used responsibly.
It helps improve blood flow to the penis for a firmer erection.
Dosage can be adjusted based on medical history and response.
Cialis 20mg may cause dizziness; avoid driving if affected.
Alcohol consumption can reduce the effectiveness of Cialis 20mg.
Patients with kidney or liver issues should discuss usage with their doctor.
The medication is not a hormone and does not affect libido directly.
Cialis 20mg should not be used recreationally or past prescribed dosage.
Immediate medical attention is needed if an erection lasts over 4 hours.
Combining Cialis 20mg with other ED medications is not recommended.

The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications (see “Can Other Medicines Affect CIALIS?”).Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex.