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he history of Cialis cannot be discussed without mentioning Pfizer's drug, Viagra. The FDA's approval on March 27, 1998, led this prescription drug, Viagra, to a ground breaking success in just the first year of introduction as Pfizer sold drugs worth over a billion dollars. However, things changed considerably for the giant of erectile dysfunction drugs when the FDA also approved Levitra in August 19, 2003, and Cialis in November 21, 2003. In 1993 the drug company Icos began studying IC351, which is a PDE5 enzyme inhibitor, and this is basically the process through which the erectile dysfunction drugs work. In 1994, Pfizer scientists discovered that Sildenafil Citrate, which is a white crystalline powder that temporarily normalizes erectile function of the penis by blocking an enzyme known to inhibit the production of a chemical that causes erections, caused the heart patients that were participating in a clinical study of a heart medicine to have erections. Although the scientists were not testing the chemical compound IC351 for erectile dysfunction, the compound seemed to have a side effect which could potentially be worth millions, if not billions of dollars. Soon Icos received its very first patent in 1994 on IC351, and the clinical trials of phase I took place in 1995. In 1997, phase II clinical studies began and Icos performed its first study on patients with erectile dysfunction. Phase II lasted about two years, and after that phase III began. n 1998, ICOS Corporation, and Eli Lilly and Company, commercialized the drug for erectile dysfunction, and two years later they filed a new drug application with the U.S. Food and Drug Administration for IC351; the only difference was that this time they decided to call the drug, Cialis. In May of 2002, Icos and Eli Lilly and Company reported to the American Urological Association that the phase III tests show that Cialis works for up to 36 hours, and one year later Icos and Eli Lilly and Company received the U.S. FDA's approval for Cialis. One advantage that Cialis has over Viagra is that tadalafil has an half-life of 17.5 hours (and thus Cialis is advertised to work for up to 36 hours) as compared to 4 hours half-life for sildenafil (Viagra). Tadalafil is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Tadalafil is in a class of medications called phosphodiesterase (PDE) inhibitors. It works by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection. Tadalafil does not cure erectile dysfunction or increase sexual desire. Tadalafil does not prevent pregnancy or the spread of sexually transmitted diseases such as human immunodeficiency virus (HIV). Tadalafil comes as a tablet to take by mouth. It is usually taken with or without food before sexual activity. Your doctor will help you decide the best time for you to take tadalafil before sexual activity. Tadalafil should not be taken more often than once every 24 hours. If you have certain health conditions or are taking certain medications, your doctor may tell you to take tadalafil less often. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take tadalafil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. * tell your doctor and pharmacist if you are allergic to tadalafil or any other medications. * do not take tadalafil if you are taking or have recently taken nitrates such as isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, ISMO), and nitroglycerin (Nitro-BID, Nitro-Dur, Nitroquick, Nitrostat, others). Nitrates come as tablets, sublingual (under the tongue) tablets, sprays, patches, pastes, and ointments. Ask your doctor if you are not sure whether any of your medications contain nitrates. * do not take street drugs containing nitrates such as amyl nitrate and butyl nitrate ('poppers') while taking sildenafil. * tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), tamsulosin (Flomax), and terazosin (Hytrin); amiodarone (Cordarone, Pacerone); certain antifungals such as fluconazole (Diflucan), griseofulvin (Fulvicin, Grifulvin, Gris-PEG), itraconazole (Sporanox), ketoconazole (Nizoral), voriconazole (Vfend); aprepitant (Emend);carbamazepine (Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); delavirdine (Rescriptor); dexamethasone (Decadron); diltiazem (Cardizem, Dilacor, Tiazac); efavirenz (Sustiva);erythromycin (E.E.S., E-Mycin, Erythrocin); ethosuximide (Zarontin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); HIV protease inhibitors including atazanavir (Reyataz), indinavir (Crixivan), lopinavir (in Kaletra),nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); isoniazid (INH, Nydrazid); lovastatin (Altocor, Mevacor); medications for high blood pressure; metronidazole (Flagyl); nefazodone (Serzone); nevirapine (Viramune); other medications or treatments for erectile dysfunction; phenobarbital; phenytoin (Dilantin); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. * tell your doctor what herbal products you are taking, especially St. John's wort.. * tell your doctor if you smoke and if you have ever had an erection that lasted more than 4 hours. Also tell your doctor if you have or have ever had a condition that affects the shape of the penis, such as angulation, cavernosal fibrosis, or Peyronie's disease; diabetes; high cholesterol; high or low blood pressure; irregular heartbeat; a heart attack; angina (chest pain); a stroke; ulcers in the stomach or intestine; a bleeding disorder; blood cell problems such as sickle cell anemia (a disease of the red blood cells), multiple myeloma (cancer of the plasma cells), or leukemia (cancer of the white blood cells); and liver, kidney, or heart disease. Also tell your doctor if you or any of your family members have or have ever had an eye disease such as retinitis pigmentosa or if you have ever had severe vision loss, especially if you were told that the vision loss was caused by a blockage of blood flow to the nerves that help you see. Tell your doctor if you have ever been advised by a health care professional to avoid sexual activity for medical reasons or if you have ever experienced chest pain during sexual activity. * you should know that tadalafil is only for use in males. Women should not take tadalafil, especially if they are or could become pregnant or are breast-feeding. If a pregnant woman takes tadalafil, she should call her doctor. * if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking tadalafil. * ask your doctor about the safe use of alcoholic beverages while you are taking tadalafil. Alcohol can make the side effects from tadalafil worse. Your doctor will tell you how much alcohol you may drink while you are taking this medication. * you should know that sexual activity may be a strain on your heart, especially if you have heart disease. If you have chest pain during sexual activity, call your doctor immediately and avoid sexual activity until your doctor tells you otherwise. * tell all your health care providers that you are taking tadalafil. If you ever need emergency medical treatment for a heart problem, the health care providers who treat you will need to know when you last took tadalafil. ell your doctor about your medical conditions and all medications, and ask if you're healthy enough for sexual activity. Don't take CIALIS if you take nitrates, often prescribed for chest pain, as this may cause a sudden, unsafe drop in blood pressure. Don't drink alcohol in excess (to a level of intoxication) with CIALIS, as this may increase your chances of getting dizzy or lowering your blood pressure. CIALIS does not protect against sexually transmitted diseases, including HIV. The most common side effects with CIALIS were headache and upset stomach. Backache and muscle ache were also reported, sometimes with delayed onset. Most men weren't bothered by the side effects enough to stop taking CIALIS. As with any ED tablet, in the rare event of priapism (an erection lasting more than four hours), seek immediate medical help to avoid long-term injury. In rare instances, men taking prescription ED tablets (including CIALIS) reported a sudden decrease or loss of vision. It's not possible to determine if these events are related directly to the ED tablets or to other factors. If you have a sudden decrease or loss of vision, stop taking any ED tablet and call your doctor right away. Viagra's famous little blue pill is getting some serious competition in Europe from a newcomer called Cialis. Nicknamed "Le Weekender" in France, Cialis helps men with erectile dysfunction have sex up to 36 hours after swallowing it. Viagra, on the other hand, lasts only about four hours. Other advantages: men can take Cialis even on a full stomach, then start getting that loving feeling in just half an hour—vs. up to an hour with Viagra. All we need now is a little pill that keeps women in the mood for days as well. And because CIALIS has an extended period of effectiveness, you don’t have the pressure to perform within a few hours. You and your partner can relax and take your time to choose the moment that is right for both of you. With CIALIS, you don’t need to plan around meals or avoid high-fat foods because the absorption of CIALIS is not affected by food. You can eat and drink like you normally do, but do not drink alcohol in excess when taking CIALIS (for example, 5 glasses of wine or 5 shots of whiskey). This combination may increase your chances of getting dizzy or lowering your blood pressure. Like all medications, CIALIS may have some side effects. The most common side effects with CIALIS are headache, upset stomach, back pain, and muscle aches. These side effects usually go away after a few hours. Patients who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS. Back pain and muscle aches usually go away by themselves within 48 hours. Call your doctor or other healthcare professional if side effects continue to bother you. 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 medications affect CIALIS?"). What is CIALIS? CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. ED is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his doctor for help if the condition bothers him. CIALIS may help a man with ED get and keep an erection when he is sexually excited. * 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 isosorbidedinitrate or isosorbide mononitrate. Some recreational drugs called "poppers" also contain nitrates, such as amyl nitrite and butyl nitrite. Do not use CIALIS if you are using these drugs. Ask your doctor or pharmacist if you are not sure if any of your medicines are nitrates. * you have been told by your healthcare provider to not have sexual activity because of health problems. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease. * are allergic to CIALIS or any of its ingredients. The active ingredient in CIALIS is called tadalafil. See the end of this leaflet for a complete list of ingredients. Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. CIALIS and other medicines may affect each other. Always check with your doctor before starting or stopping any medicines. Especially tell your doctor if you take any of the following:* Take CIALIS exactly as your doctor prescribes. CIALIS comes in different doses (5 mg, 10 mg, and 20 mg). For most men, the recommended starting dose is 10 mg. CIALIS should be taken no more than once a day. Some men can only take a low dose of CIALIS because of medical conditions or medicines they take. Your doctor will prescribe the dose that is right for you. Take one CIALIS tablet before sexual activity. In some patients, the ability to have sexual activity was improved at 30 minutes after taking CIALIS when compared to a sugar pill. The ability to have sexual activity was improved up to 36 hours after taking CIALIS when compared to a sugar pill. You and your doctor should consider this in deciding when you should take CIALIS prior to sexual activity. Some form of sexual stimulation is needed for an erection to happen with CIALIS. CIALIS may be taken with or without meals. Do not change your dose of CIALIS without talking to your doctor. Your doctor may lower your dose or raise your dose, depending on how your body reacts to CIALIS. Do not drink alcohol to excess when taking CIALIS (for example, 5 glasses of wine or 5 shots of whiskey). When taken in excess, alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure. If you take too much CIALIS, call your doctor or emergency room right away. The most common side effects with CIALIS are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose. These side effects usually go away after a few hours. Patients who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS. Back pain and muscle aches usually go away by themselves within 48 hours. Call your doctor if you get a side effect that bothers you or one that will not go away. If your doctor prescribes CIALIS for you, your local pharmacy should be able to fill your prescription for CIALIS. You may also have a prescription drug benefit that allows you to obtain your prescription through a mail-order pharmacy. You may also choose to fill your prescription through an online pharmacy. There are several reputable online pharmacies including those associated with retail pharmacies. If you choose to use an online pharmacy, we recommend consulting the National Association of Boards of Pharmacy (NABP), a professional association that represents the state boards of pharmacies in all 50 United States. This website provides a list of online pharmacies certified by this organization. While this is not a complete list of reputable online pharmacies, the NABP certification tells you that those pharmacies listed follow established standards. There are also many online pharmacies that are not legitimate. Beware of sites that offer to diagnose you. They may ask you only to fill out a brief online survey to get your prescription from a doctor that you’ve never met. Don’t use a foreign site to purchase CIALIS. The best way to ensure that your purchase is authentic CIALIS is to buy the product from a licensed pharmacy that you know to be reputable with a prescription from your doctor. Always get a diagnosis from a healthcare professional you trust. ED is a common condition that affects more than 30 million men in the United States. ED occurs when blood flow to the penis is diminished or lessened and can be caused by a number of medical conditions as well as some medications. CIALIS treats ED by allowing more blood to flow into the penis when you are sexually stimulated. This may result in an erection. What is CIALIS? CIALIS is a prescription tablet to treat ED in men. CIALIS is the only ED tablet clinically proven to both work up to 36 hours and work in some men as fast as 30 minutes. This allows you to respond to sexual stimulation when the moment is right for you and your partner. How do I take CIALIS?Take CIALIS exactly as prescribed. Your doctor or other healthcare professional will prescribe the dose that is right for you. CIALIS may be taken up to once per day by most patients. CIALIS goes to work fast and can work up to 36 hours. And because sexual stimulation is required for CIALIS to work, you respond to your partner only when the moment is right. With CIALIS, you don’t need to plan around meals or avoid high-fat foods because the absorption of CIALIS is not affected by food. You can eat and drink like you normally do, but do not drink alcohol in excess when taking CIALIS (for example, 5 glasses of wine or 5 shots of whiskey). This combination may increase your chances of getting dizzy or lowering your blood pressure. Has CIALIS proven to be effective? CIALIS has been shown to improve erectile function in most men with ED, including those with mild, moderate or severe ED. In clinical trials, CIALIS improved: * Confidence in ability to achieve and maintain an erection * Satisfaction with the hardness of erections * Ability to maintain erections for successful sexual intercourse * Satisfaction with sexual intercourse I’ve tried other oral prescription treatments for ED. What can I expect from CIALIS? CIALIS gives you and your partner up to 36 hours to choose the moment that's right to be intimate, so a relaxing moment can turn into the right moment. And with CIALIS, you don’t need to plan around meals or avoid high-fat foods because the absorption of CIALIS is not affected by food. The safety and efficacy of combinations of CIALIS and other treatments for ED have not been studied. Therefore, the use of such combinations is not recommended. Even if I have severe ED, can CIALIS work for me? CIALIS has been shown to improve erectile function in most men with ED, including those with mild, moderate or severe ED. Individual results may vary. Is CIALIS right for me? Only your doctor or other healthcare professional can determine if CIALIS is right for you. CIALIS is not for everyone. Men who take nitrates, men who take alpha-blockers (other than Flomax® 0.4 mg once-daily) or men who have been told by their physician not to have sexual activity because of health problems should not take CIALIS. For additional safety information, click here. What side effects might I experience with CIALIS? In clinical trials, the most common side effects with CIALIS were headache and upset stomach. Backache and muscle ache were also reported, sometimes with delayed onset. Most men weren’t bothered by the side effects enough to stop taking CIALIS. Will I get an erection that won't go away? Priapism, a prolonged erection, is a rare potential side effect of all prescription ED medications. If by chance you have a prolonged erection, lasting more than 4 hours, seek immediate medical attention as this condition can cause damage to your penis potentially leading to the inability to have an erection. If I have diabetes and ED can CIALIS work for me? Clinical studies were conducted among men with ED and type 1 or type 2 diabetes. For most men in these studies, CIALIS improved overall erectile function and the ability to maintain erections for successful sexual intercourse. Individual results may vary. Will I get erections when I don’t want them? Sexual stimulation is required for CIALIS to work. You will not get an erection just by taking CIALIS without sexual stimulation. Will CIALIS work if I take half the tablet? CIALIS is designed to be taken in a single 20 mg, 10 mg, or 5 mg dose as prescribed by your doctor or other healthcare professional. Can a woman take CIALIS too? No. CIALIS is for men only. Does CIALIS offer protection from sexually transmitted diseases or HIV? No. CIALIS does not protect a man or his partner from sexually transmitted diseases, including HIV. With correct guidance and treatment, and a positive approach, a good sexual life can be experienced during your 60s, 70s and even 80s. Cialis is the best medicine developed to treat erectile dysfunction (ED), known as impotence. We have designed this site to help you learn more about Cialis, how that works and what should you expect while taking it. Cialis (Tadafil) is a new erection enchnacer, received FDA and European Union approval in November 2003 and is currently available in 45 countries. Discovered by biotech firm ICOS (ICOS), and being co-developed by Eli Lilly (LLY), it is supposedly easier to use than Viagra. On top of that it goes to work faster, within 16 minutes, it lasts about six or seven times longer than Viagra and Levitra, according to the company, up to 36 hours. Dubbed the weekend drug, around the world it is called "Le Weekender", because users can take it on Friday night and have a fun-filled 48 hours. Cialis is all about romance. More than 30 millions of men in the U.S. suffer from erectile disfunction. If you think you might be one of them, do not be embarrassed, talk to your doctor about this problem as soon as possible. You should remember that ED is a progressive health problem abd also might be an indicator of high blood pressure or diabetes mellitus. Only your physician can determine if you have ED in fact and only physician can prescribe you right medicine treatment and dosage. Sooner you talk to your doctor and determine your helath problem - sooner you get appropriate help. See Self-assessment quiz here. Which is better: Cialis or Viagra? Cialis and Viagra both are in the same class of drugs (these are both PDE-5 inhibitors) and allow relaxation of the smooth muscle of the penis. They both need sexual stimulation to start working. But their chemical structures are different. And the main difference is the duration of action of Cialis. Cialis offers flexible and responsiveness period lasting 24-36 hours. For those men, who find it very difficult to estimate exact time when they might have sex, this feature of Cialis is very important. Some men also comlained that having to take a pill right before sex makes the situation very "medical". There is no interaction between Cialis and food, whereas onset of Viagra's activity may be delayed by food. Cialis (Tadalafil) aiming for the 25-30% non-responders to Viagra, namely a new trial for the "failures". Cialis is also effective in treating ED in patients suffering from diabetes mellitus. While clinical trials Cialis showed clinically meaningful and statistically significant improvement in erectile function of patients with diabetes mellitus. Cialis must not be taken with any nitrates. Before taking Cialis always consult with your physician, especially if you take alpha blockers, ritonavir (Norvir®) or indinavir (Crixivan®); ketoconazole or itraconazole (such as Nizoral® or Sporanox®); erythromycin; other medicines or treatments for erectile disfunction. You should always inform all your healthcare providers that you take Cialis - in case when you need emergency medical care for a heart problems, for your healthcare provider will be important when you last took Cialis. There is no harm to you if you drink alcohol while taking Cialis. But you should know that both of them are mild vasodilators and in combination they might lower blood pressure. Important: The health information provided on this site does not intend to replace discussions with your health care practitioner. Be sure to consult your doctor on the safe and appropriate uses of any drugs. According to a recent data, one in 10 men in the world have erectile dysfunction. 30 million men in the United States have erectile dysfunction. 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis. The likelihood of erectile dysfunction increases with age: 39% at age 40, 65% over the age of 65. Smokers have a higher likelihood of erectile dysfunction. Men who smoke more than 1 pack per day have a 50% higher chance of impotency than nonsmokers the same age. Isn't it alarming? You need not worry. In an attempt to help persons having erectile dysfunction (ED) problem or searching for ED related information and terms, we have compiled a glossary page serving that purpose on this site. It lists the majority of terms to help you understand when searching for general terms, descriptions, and specifications related to impotency and ED. The Glossary content is only for information purpose. We encourage you to seek medical advice before reaching any treatment option or conclusion based on your findings here. We hope Glossary section may be beneficial to you in understanding ED related terms and making better decisions. You can engage in sexual activity within half an hour of taking the tablet and up to 36 hours later. It may be possible for you to engage in sexual activity more than once - for example, in the evening and again in the morning. The amount of time CIALIS takes to work varies from person to person. After you have taken CIALIS, you may wish to attempt sexual intercourse at different times to decide the best time range for you and your partner. Your dose may be lowered to 10mg based on your individual response to CIALIS. If you are not sure when to take CIALIS, ask your doctor or health care professional. Why confine Love within a time frame? Let love happen when the moment is right. Cialis helps you consummate passion play when a real moment turns into the right moment. Cialis enables you to enjoy a spontaneous love reaction while you have 36 hours to relax and take your time. Cialis is the only erectile dysfunction (ED) prescription tablet that has been clinically proven to not only work fast, but also up to 36 hours. For romance to come back into your life, Cialis is the right partner for you. A single pill can work as soon as after 16 minutes and remains effective for up to 36 hours. Cialis was launched by Lilly Icos in the major markets of Europe on February 5, 2003. Cialis is already available in 50 countries, including France, where its long-lasting effects have won it the nickname "Le weekend" pill. Countries that have approved Cialis (tadalafil) for sale: Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Netherlands, Spain, Sweden, United Kingdom, New Zealand, Australia, Singapore, Saudi Arabia, Korea, and South Africa. 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Clinicalstudies show that Cialis works faster, lasts up to 36 hours and hasless side effects than Viagra Uses The following Information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using any of our products. This medication is used to treat male sexual function problems (erection problems). Regalis (Tadalafil) is known as Super Viagra because it acts quicker and lasts much longer! Cialis is a brand new treatment for impotence that works just like Viagra, only it gives you faster results, has a higher success rate, lasts up to 32 hours longer, and causes fewer unpleasant side effects! Tadalafil is also known to: - Increase Sex Drive - Boost Sexual Performance - Cause Fuller & Harder Erections - Increase Stamina & Endurance - Help with Quicker Recharges. How to take This drug is taken by mouth as needed 20 minutes before sexual activity. Take only as directed, usually once each 3 days as needed. Cialis works along with sexual stimulation to help achieve an erection. The usual dose for most people is 10mg (half a pill). Side Effects Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness might occur. If these effects persist or worsen, notify your doctor promptly. Precaution Before using this drug, tell your doctor your medical history, including any allergies (especially drug allergies), any penis conditions such as fibrosis/scarring, history of painful/prolonged erection (priapism), sickle cell anemia, blood system cancers (such as leukemia or myeloma), or Peyronie's disease, eye problems (retina diseases). kidney or liver disease, bleeding disorders or active stomach ulcers, heart diseases, stroke or severe high or low blood pressure. Limit alcohol intake, as it may aggravate side effects of this drug. To avoid dizziness and lightheadedness when rising from a seated or lying position, get up slowly. The elderly may be more sensitive to the side effects of this drug, therefore caution is advised in this group. Drug Interactions Tell your doctor of all nonprescription and prescription medication you may use, especially any nitrate medications (e.g., nitroglycerin, isosorbide dinitrate), nitroprusside (any "nitric oxide donor" medicines), cimetidine, erythromycin, azole antifungals (e.g., itraconazole, ketoconazole), mibefradil, rifamycins (e.g., rifampin) or high blood pressure medicines. Storage Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from light and moisture. Keep this and all medications out of the reach of children. DESCRIPTION CIALIS® (tadalafil), an oral treatment for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). Tadalafil has the empirical formula C 22 H 19 N 3 O 4 representing a molecular weight of 389.41. The structural formula is: The chemical designation is pyrazino[1',2':1,6]pyrido[3,4-b]indole-1,4-dione, 6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydro-2-methyl-, (6R,12aR)-. It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol. CIALIS is available as film-coated, almond-shaped tablets for oral administration. Each tablet contains 5, 10, or 20 mg of tadalafil and the following inactive ingredients: croscarmellose sodium, hydroxypropyl cellulose, hypromellose, iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, and triacetin. CLINICAL PHARMACOLOGY Mechanism of Action Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum. The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil inhibits PDE5. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 by tadalafil has no effect in the absence of sexual stimulation. Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5. PDE5 is found in corpus cavernosum smooth muscle, vascular and visceral smooth muscle, skeletal muscle, platelets, kidney, lung, cerebellum, and pancreas. In vitro studies have shown that the effect of tadalafil is more potent on PDE5 than on other phosphodiesterases. These studies have shown that tadalafil is >10,000-fold more potent for PDE5 than for PDE1, PDE2, PDE4, and PDE7 enzymes, which are found in the heart, brain, blood vessels, liver, leukocytes, skeletal muscle, and other organs. Tadalafil is >10,000-fold more potent for PDE5 than for PDE3, an enzyme found in the heart and blood vessels. Additionally, tadalafil is 700-fold more potent for PDE5 than for PDE6, which is found in the retina and is responsible for phototransduction. Tadalafil is >9,000-fold more potent for PDE5 than for PDE8, PDE9, and PDE10 and 14-fold more potent for PDE5 than for PDE11A1, an enzyme found in human skeletal muscle. Tadalafil inhibits human recombinant PDE11A1 activity at concentrations within the therapeutic range. The physiological role and clinical consequence of PDE11 inhibition in humans have not been defined. Pharmacokinetics Over a dose range of 2.5 to 20 mg, tadalafil exposure (AUC) increases proportionally with dose in healthy subjects. Steady-state plasma concentrations are attained within 5 days of once-daily dosing, and exposure is approximately 1.6-fold greater than after a single dose. Tadalafil is eliminated predominantly by hepatic metabolism, mainly by cytochrome P450 3A4 (CYP3A4). The concomitant use of potent CYP3A4 inhibitors such as ritonavir or ketoconazole resulted in significant increases in tadalafil AUC values ( see PRECAUTIONS and DOSAGE AND ADMINISTRATION ). Mean tadalafil concentrations measured after the administration of a single oral dose of 20 mg to healthy male subjects are depicted in Figure 1. Therefore, CIALIS administration with nitrates is contraindicated. In a patient who has taken CIALIS, where nitrate administration is deemed medically necessary in a life-threatening situation, at least 48 hours should elapse after the last dose of CIALIS before nitrate administration is considered. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring ( see CONTRAINDICATIONS ). Effects on Exercise Stress Testing --The effects of tadalafil on cardiac function, hemodynamics, and exercise tolerance were investigated in a single clinical pharmacology study. In this blinded crossover trial, 23 subjects with stable coronary artery disease and evidence of exercise-induced cardiac ischemia were enrolled. The primary endpoint was time to cardiac ischemia. The mean difference in total exercise time was 3 seconds (tadalafil 10 mg minus placebo), which represented no clinically meaningful difference. Further statistical analysis demonstrated that tadalafil was non-inferior to placebo with respect to time to ischemia. Of note, in this study, in some subjects who received tadalafil followed by sublingual nitroglycerin in the post-exercise period, clinically significant reductions in blood pressure were observed, consistent with the augmentation by tadalafil of the blood-pressure-lowering effects of nitrates. Effects on Vision --Single oral doses of phosphodiesterase inhibitors have demonstrated transient dose-related impairment of color discrimination (blue/green), using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. In a study to assess the effects of a single dose of tadalafil 40 mg on vision (N=59), no effects were observed on visual acuity, intraocular pressure, or pupillometry. Across all clinical studies with CIALIS, reports of changes in color vision were rare (<0.1% of patients). Effects on Sperm Characteristics --There were no clinically relevant effects on sperm concentration, sperm count, motility, or morphology in humans in placebo-controlled studies of daily doses of tadalafil 10 mg (N=204) or 20 mg (N=217) for 6 months. In addition, tadalafil had no effect on serum levels of testosterone, luteinizing hormone, or follicle stimulating hormone. Effects on Cardiac Electrophysiology --The effect of a single 100-mg dose of tadalafil on the QT interval was evaluated at the time of peak tadalafil concentration in a randomized, double-blinded, placebo, and active (intravenous ibutilide)-controlled crossover study in 90 healthy males aged 18 to 53 years. The mean change in QT c (Fridericia QT correction) for tadalafil, relative to placebo, was 3.5 milliseconds (two-sided 90% CI=1.9, 5.1). The mean change in QT c (Individual QT correction) for tadalafil, relative to placebo, was 2.8 milliseconds (two-sided 90% CI=1.2, 4.4). A 100-mg dose of tadalafil (5 times the highest recommended dose) was chosen because this dose yields exposures covering those observed upon coadministration of tadalafil with potent CYP3A4 inhibitors or those observed in renal impairment. In this study, the mean increase in heart rate associated with a 100-mg dose of tadalafil compared to placebo was 3.1 beats per minute. Online Buy Cialis, no prior prescription needed. Free online diagnosis. All orders are reviewed by licensed physicians and shipped from US licensed pharmacies. Get overnight delivery. www.kwikmed.com (sponsored listing) Cialis Alternatives Compared Compare Cialis with popular non-prescription impotence treatments and save today. www.impotenceguide.info (sponsored listing) Order Cialis Low As $52.95 10mg x10 pills $99.95 Free FedEx Shipping on All orders. US Pharmacy. US orders only. 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All orders are filled FDA ALERT [07/2005]: A small number of men have lost eyesight in one eye some time after taking Cialis, Viagra, or Levitra. This type of vision loss is called non-arteritic anterior ischemic optic neuropathy (NAION). NAION causes a sudden loss of eyesight because blood flow is blocked to the optic nerve. We do not know at this time if Cialis, Viagra or Levitra causes NAION. NAION also happens in men who do not take these medicines. People who have a higher chance for NAION include those who: have heart disease are over 50 years old have diabetes have high blood pressure have high cholesterol smoke have certain eye problems FDA has approved new labels for Cialis, Viagra, and Levitra to include information on possible eyesight loss (NAION). Stop using Cialis, Viagra, or Levitra if you have a loss in your eyesight. Get medical help right away. Current Information CIALIS IS NOT FOR EVERYONE. Tell your doctor about your medical conditions and all medications, and ask if you're healthy enough for sexual activity. Don't take CIALIS if you take nitrates, often prescribed for chest pain, as this may cause a sudden, unsafe drop in blood pressure. Don't drink alcohol in excess (to a level of intoxication) with CIALIS, as this may increase your chances of getting dizzy or lowering your blood pressure. CIALIS does not protect against sexually transmitted diseases, including HIV. The most common side effects with CIALIS were headache and upset stomach. Backache and muscle ache were also reported, sometimes with delayed onset. Most men weren't bothered by the side effects enough to stop taking CIALIS. As with any ED tablet, in the rare event of priapism (an erection lasting more than four hours), seek immediate medical help to avoid long-term injury. In rare instances, men taking prescription ED tablets (including CIALIS) reported a sudden decrease or loss of vision. It's not possible to determine if these events are related directly to the ED tablets or to other factors. If you have a sudden decrease or loss of vision, stop taking any ED tablet and call your doctor right away. Individual results may vary. In clinical trials, CIALIS was shown to improve, up to 36 hours after dosing, the ability of men with ED to have a single successful intercourse attempt. CIALIS has not been studied for multiple sexual attempts per dose. CIALIS is available by prescription only. For additional safety information, talk to your doctor about this medicine and see the full Patient Information. CIALIS is a prescription medicine taken by mouth for the treatment of erectile dysfunction (ED) in men. CIALIS helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity If a relaxing moment turns into the right moment, will you be ready? You can be with CIALIS. CIALIS is the only ED tablet clinically proven to both work up to 36 hours and work in some men as fast as 30 minutes*. With CIALIS you don’t have to hurry if you don’t want to. You don’t have to schedule your lovemaking if you don’t want to. You and your partner can relax and take your time to choose the moment that’s right for both of you. Discuss your health status with your doctor, and if you want to be ready when the moment is right, be sure to ask about 36-hour CIALIS. *Individual results may vary. Not studied for multiple attempts per dose. With Cialis (from 1Tadalafil) You can improve Your erectile function today! Recent thought and media hype on Cialis and (tadalafil) Generic Cialis has been a real eye-opener for society, with men from young to old. If doctors today have a favourite pill for erectile dysfunction, it is surely cialis. The 1tadalafil site aims to shed new light on Cialis, whilst allowing You to buy cialis at the LOWEST prices, improve erectile function and understand the drugs 36 hour momentum. One quote comes instantly to mind when examining Cialis. We mean of course the words of popular U.S. medical journalist Mike Dickinson 'I demand Cialis, I demand sexual freedom, nothing more nothing less.' One must argue that his insight into cialis provided the inspiration for these great words. Perhaps the word which best sums up the importance today of cialis to our male society is '36 hours of Freedom'. Today millions of men like Mike buy Cialis simply because it quickly helps them to improve erectile function as well as confront and master the inevitable crises of sexual impotence. Why is Cialis so popular? Unlike other a few other oral treatments for impotence, Cialis is never affected by the intake of alcohol or food. In studies Cialis and Generic Cialis were found to improve erections in 82% of U.S. men who had previously experienced some or other degree of impotence, with 76% of intercourse attempts proving successful. A Huge matter of frustration for men who experience impotence is that their sexual activity has to be planned around the medication they take. Cialis (Tadalafil, Generic Cialis, Brand Apcalis) has very limited side effects if any and most men that buy it have experienced none at all. Why is Cialis so popular? Why do so many men buy Cialis?.. you may enquire, Simply because there are other erectile dysfunction pills on the world market but the experts all believe that Cialis is a step above the rest of the erectile dysfunction treatments. Cialis is similar to Viagra in the results achieved but works differently. Taken orally as an erectile dysfunction medication, Viagra is digested and typically begins to work in 25 to 60 minutes. When the active ingredients (sildenafil citrate) travel in the bloodstream to a male's genitalia, blood vessels of a male who is sexually stimulated are induced to fill the erectile chambers of his penis. Cialis differs with Sildenafil (Brand Viagra) in that the drug was developed & intended by medical researchers to work much faster than Viagra, perhaps in 18 to 30 minutes. It is also taken orally, and its active chemical (tadalafil) influences the the flow of blood to the penis. In a comparison study of Cialis vs Viagra, the new anti-impotence pill appeared to have the edge over competitor drug Viagra. Research shows that effective impotence treatments like Tadalafil - Generic Cialis can help members of all racial, ethnic, and cultural groups. Before making a decision on whether or not to authorize Cialis (Generic Cialis) for public use, officials of the U.S. FDA (Food and Drug Administration) had to conduct a complete review of the Cialis researchers suggestions and the study data compiled during the testing phase. What is the difference between Cialis and Viagra? Cialis comes in smaller doses and produces fewer side effects. It also works much faster than Viagra. In clinical trials, the majority of men who took the drug were able to engage in sexual intercourse within 30 minutes or less. These studies also indicated that Cialis stays effective in the system for up to 24 hours. This compares to a 4-hour norm for Viagra. However, Pfizer's Viagra has been in use since 1998 and is still the most popular treatment for male impotence. Start Using Cialis Pill Today And Your Loved One Will Thank You The market for Cialis is huge - following the runaway success of Viagra. As estimated by different surveys 30 million men in the US and 175 million worldwide suffer from erectile dysfunction, and only a fraction are currently using Viagra. The current Viagra market of around $1.5bn a year could rise to the sales of total impotence drugs of around $6bn over the next eight years, split between Viagra, Cialis, Levitra and other second-generation treatments. Cialis is likely to be used as a performance enhancer, rather than just as a treatment for an ailment. All these impotence drugs block an enzyme called phosphodiesterase 5 (PDE-5), which relaxes smooth some kinds of muscle cells and allows increased blood flow into the penis. CIALIS DRUG: CIALIS 20MG TABLETS GENERIC NAME: TADALAFIL (tah-DA-la-fil) COMMON USES: This medicine is a phoshodiesterase inhibitor used to treat function problems such as impotence or erectile dysfunction. In combination with sexual stimulation this medicine by helping the blood flow into the penis to achieve and maintain and erection. This medicine is not intended for use in women or children. This medicine will not protect against sexually transmitted diseases including HIV infection. Use ? safe sex? practices such as latex condoms. Contact your doctor or pharmacist for more details. HOW TO USE THIS MEDICINE: Follow the directions for using this medicine provided by your doctor. This medicine comes with a patient information leaflet. Read it carefully. Ask your doctor, nurse, or pharmacist any questions that you may have about this medicine. TAKE THIS MEDICINE by mouth as needed before sexual activity as directed by your doctor. DO NOT TAKE THIS MEDICINE more often than once daily. If you are taking certain other medicines you may only be able to take this medicine one time every two of three days. Contact your doctor or pharmacist for more information. This medicine may be taken on an empty stomach or with food. STORE THIS MEDICINE at room temperature 77 degrees F (25 degrees C) in a tightly ?closed container, away from heat and light. Brief storage between 59 and 86 degrees F (15 and 30 degrees C) is permitted. CAUTIONS: DO NOT TAKE THIS MEDICINE if you have had allergic reaction to it or are allergic to any ingredients in this product. THIS MEDICINE MAY RARLEY CAUSE DIZZINESS OR VISION CHANGES. DO NOT DRIVE, OPERATE MACHINERY, OR DO ANYTHING ELSE THAT COULD BE DANGEROUS until you know how you react to this medicine. Using this medicine alone with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. TO MINIMZE DIZZINESS OR LIGHTHEADEDNESS, sit up or stand slowly when rising from a seated or lying down position. Your dose is based on medical condition, response to therapy and the other medicines that can change the heart rhythm. This change in the heart rhythm can result in serious, rarely fatal, irregular heartbeats. Ask doctor for more information and I if you should stop taking any of your other medicines to reduce the risk of this side effect. BEFORE YOU BEGIN TAKING ANY NEW MEDICINE, either prescription or over- the counter, check with your doctor or pharmacist. CAUTION IS ADVISED WHEN USING THIS MEDICINE IN THE ELDERLY because they may be more sensitive to the side effects of this medicine. THIS MEDICINE SHOULD NOT BE USED IN WOMEN OR CHILDREN. POSSIBLE SIDE EFFECTS: SIDE EFFECTS that may occur while taking this medicine include headache, flushing, stomach upset or nausea, heartburn, stuffy or runny nose, back pain muscle pain, muscle pain or vision changes such as trouble telling the difference between blue and green or seeing a blue tinge to objects. If these continue or are bothersome, check with your doctor. In the unlikely event that you have a painful or prolonged erection (lasting more problems than 4 hours), stop using this medicine and seek immediate medical attention or permanent problems may occur. AN ALLERGIC REACTION to this medicine is unlikely but seek immediate medical attention if it occurs. AN ALLERGIC REACTION to this medicine is unlikely but seek immediate usual swelling, severe dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse or pharmacist. BEFORE USING THIS MEDICINE: Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHAMACIST of all prescription and over-the ?counter medicine that you are taking. DO NOT TAKE THIS MEDICINE if your are also talking or using any form of nitroglycerin, other nitrates such as isosorbide, nitroprusside or any ?nitric oxide donor? medicine, or recreational drugs called ?poppers? containing amly or butyl nitrate because very serious interactions may occur. If you are not sure whether a certain medicine is a nitrate, contact your doctor or pharmacist before taking this medicine. DO NOT TAKE THIS MEDICINE if you are taking any of these medicines, contact your doctor or pharmacist before taking this medicine. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking other medicines for erectile dysfunction; certain antifungal medicines such as itraconzole or ketoconazole; marolide antibiotics such as clarithromycin or erythromycin, medicine for high blood pressure; or HIV PROTEASE inhibitors such ritonavir or indinvir. DO NOT HAVE TO STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including penis, problems; history of painful or prolonged erection, any heart problems, kidney problem, stomach ulcers, bleeding problems; bleed cell problems such as sickle cell anemia, leukemia or myeloma, eye diseases, especially retina diseases such as retinitis pigmentose, uncontrolled high blood pressure, or allergies. USE OF THIS MEDICINE IS RECOMMENED, if you have a history of angina or chest pain, heart attack, stoke, low blood pressure, severe liver problems, or if you have been told by tour healthcare provider to not have sexual activity because of certain health problem. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include back pain, muscle pain and abnormal vision. ADDITIONAL INFORMATION: If your symptoms do not improve or if they become worse, check with your doctor. DO NOT SHARE THIS MEDICINE with others from whom it was not prescribed, since they may have a problem that is not effectively treated with this medicine, or they may have condition that is complicated by this medicine, DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS MEDICINE out of the reach of children and pets. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before supply runs out. The in formation in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse. Cialis Soft Tabs is the new impotence treatment drug that everyone is talking about. It has benefits over Viagra and other ED treatment solutions. Here goes some reasons to choose Cialis Soft Tabs: 1. You can mix alcohol drinks with Cialis Soft Tabs without any undesired effects. 2. Cialis Soft Tabs does not make you feel dizzy or make vision blurred, so you can easily drive a car or operate heavy machinery. 3. Cialis soft tabs works much faster than any known ED treatment solution. Cialis Soft Tabs enters the bloodstream directly instead of going through the stomach, thus you need only 15 minutes till you feel the effect. Just look at the graph below, yellow line represents Cialis Soft Tab efficacy (in percent) during first 75 minutes, and green line represents Pfizer Viagra. You can see that Cialis Soft Tabs begins to act much faster. 4. And at last, but not least, Cialis Soft Tabs acts up to 36 hours, compare this to only two or three hours of Viagra action! Here's what usually happens when a man is sexually excited: The arteries in the penis relax and widen (this allows more blood to flow into the penis). The increased blood flow causes the penis to become hard and erect. The veins that normally carry blood away from the penis get compressed (this restricts the blood flow out of the penis). More blood begins flowing in and less flows out, making the penis larger; this causes an erection. What is Cialis Soft Tabs? These pills are just like regular Cialis but they are specially formulated to be soft and dissolvable under the tongue. The pill is absorbed at the mouth and enters the bloodstream directly instead of going through the stomach. This results in a faster more powerful effect which still lasts up to 36 hours. Cialis Soft Tabs also have less sidebacks (you can drive or mix alcohol drinks with Cialis). Cialis Soft Tabs Information A mint flavored oral Lozenge containing quick dissolving 100% Tadalafil Citrate 20mg melt in your mouth. Soft Tabs are a faster acting Cialis solution. A Soft Tab is an oral lozenge, mint in flavor, containing pure Tadalafil Citrate that is placed under your tongue and dissolved. This method allows for the medicine to enter your blood stream much faster than digesting a pill. For men who need to wait 60 or 90 minutes when taking Cialis in a pill form, you can now experience results in 15 minutes or less when using a Soft Tab. This is enough time to keep your partner in the mood while the medicine is absorbed into your body. No more planning for sex hours in advance. With Soft Tabs you can be ready when your partner is ready. Some men can get results from a usual Cialsis pill (not Soft Tab) in about 40 minutes. For others it can take as long as 60 to 90 minutes as results vary per individual. When using a pill reaction time can also vary depending on what type of meal you have recently eaten. A meal high in saturated fat will increase the period of time a tadalafil citrate pill can be absorbed into the blood stream to begin its effect. However with Cialis Soft Tabs it doesnt matter what type of meal you have recently eaten because the medicine does not pass through your digestive system. For men who need to wait an hour or more for Cialis to work after ingesting a pill, this can cause difficulties when it comes time to use the medication. If your partner surprises you with spontaneous sexual interest, having to wait an hour for a pill to work can kill the mood. Working with such a long timeframe requires too much planning for sex. In this case Soft Tabs are a perfect match for you and your partner. Ingredients lactose monohydrate, croscarmellose sodium, hydroxypropylcellulose, microcrystalline cellulose, sodium laurylsulphate, magnesium stearate, actose monohydrate, hypromellose, triacetin, titanium dioxide (E171), iron oxide (E172), talc The chemical designation is pyrazino[ 1 ,2 :1,6] pyrido[ 3,4-b] indole-1,4-dione, 6-( 1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydro-2-methyl-, (6R, 12aR)-. It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol. CIALIS is available as film-coated, almond-shaped tablets for oral administration CIALIS is available as film-coated, almond-shaped tablets for oral administration. Each tablet contains 5, 10, or 20 mg of tadalafil and the following inactive ingredients: croscarmellose sodium, hydroxypropyl cellulose, hypromellose, iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, and triacetin. Cialis® is a PRESCRIPTION MEDICINE for the treatment of erection problems in men. A charge applies, you will need to pay for this medicine. Consult your doctor if Cialis is right for you. Normal doctor’s fees will apply. Sexual stimulation is required for Cialis to work. Do not use when taking nitrates for angina or where there is known heart disease like heart failure or heart rhythm disturbances, low or uncontrolled blood pressure. Use with caution when taking alpha 1 blockers such as doxazosin. Caution in kidney or liver disease or conditions which predispose to persistent erection of the penis like certain blood disorders. Not to be used by women. Possible side effects are headache, indigestion, back & muscle pain, blocked nose, flushing and dizziness. Use strictly as directed and if symptoms persist or you have side effects see your doctor. Contains tadalafil 10 & 20mg. Maximum daily dose 20mg. For further product information check www.medsafe.govt.nz or call 0800 36HOURS. IIntroducing Cialis, the only oral treatment for erectile dysfunction (ED) that lasts for up to 36 hours. Cialis gives men the confidence they can enjoy a natural sexual relationship with their partner. The Cialis.co.nz web site is intended to help you learn more about the research and development of new medicines, understanding ED and determining if Cialis® can help. Of course, your doctor is always the best source of medical information and can determine if a free trial of Cialis® is right for you. Prescription Cialis® is for the treatment of erectile dysfunction in men. Remember that no medicine is for everyone. If you take any form of nitrates, often prescribed to control chest pains, do not take Cialis®. This combination could cause an unsafe drop in blood pressure. Discuss your health status with your doctor to ensure that you are healthy enough to engage in sexual activity. If you have chest pain, or other heart related symptoms during sex, seek immediate medical help. The most common side effects with Cialis® were headache, upset stomach, backache, muscle ache and flushing. CIALIS IS NOT FOR EVERYONE. Tell your doctor about your medical conditions and all medications, and ask if you're healthy enough for sexual activity. Don't take CIALIS if you take nitrates, often prescribed for chest pain, as this may cause a sudden, unsafe drop in blood pressure. Don't drink alcohol in excess (to a level of intoxication) with CIALIS, as this may increase your chances of getting dizzy or lowering your blood pressure. CIALIS does not protect against sexually transmitted diseases, including HIV. The most common side effects with CIALIS were headache and upset stomach. Backache and muscle ache were also reported, sometimes with delayed onset. Most men weren't bothered by the side effects enough to stop taking CIALIS. As with any ED tablet, in the rare event of priapism (an erection lasting more than four hours), seek immediate medical help to avoid long-term injury. In rare instances, men taking prescription ED tablets (including CIALIS) reported a sudden decrease or loss of vision. It's not possible to determine if these events are related directly to the ED tablets or to other factors. If you have a sudden decrease or loss of vision, stop taking any ED tablet and call your doctor right away. Individual results may vary. In clinical trials, CIALIS was shown to improve, up to 36 hours after dosing, the ability of men with ED to have a single successful intercourse attempt. CIALIS has not been studied for multiple sexual attempts per dose. CIALIS is available by prescription only. For additional safety information, talk to your doctor about this medicine and see the full Patient Information. CIALIS is the only ED tablet clinically proven to both work up to 36 hours* and work in some men as fast as 30 minutes. And because CIALIS has an extended period of effectiveness, you don’t have the pressure to perform within a few hours. You and your partner can relax and take your time to choose the moment that is right for both of you. CIALIS IS NOT FOR EVERYONE. Tell your doctor about your medical conditions and all medications, and ask if you're healthy enough for sexual activity. Don't take CIALIS if you take nitrates, often prescribed for chest pain, as this may cause a sudden, unsafe drop in blood pressure. Don't drink alcohol in excess (to a level of intoxication) with CIALIS, as this may increase your chances of getting dizzy or lowering your blood pressure. CIALIS does not protect against sexually transmitted diseases, including HIV. The most common side effects with CIALIS were headache and upset stomach. Backache and muscle ache were also reported, sometimes with delayed onset. Most men weren't bothered by the side effects enough to stop taking CIALIS. As with any ED tablet, in the rare event of priapism (an erection lasting more than four hours), seek immediate medical help to avoid long-term injury. In rare instances, men taking prescription ED tablets (including CIALIS) reported a sudden decrease or loss of vision. It's not possible to determine if these events are related directly to the ED tablets or to other factors. If you have a sudden decrease or loss of vision, stop taking any ED tablet and call your doctor right away. Individual results may vary. In clinical trials, CIALIS was shown to improve, up to 36 hours after dosing, the ability of men with ED to have a single successful intercourse attempt. CIALIS has not been studied for multiple sexual attempts per dose. CIALIS is available by prescription only. For additional safety information, talk to your doctor about this medicine and see the full Patient Information. We would like to ask you a few questions about your experience on the Cialis.com website. Before proceeding, please review the Lilly/ICOS Privacy Policy [Privacy Policy]. This survey is being conducted on the Cialis.com website by CRM Metrix, a market research agency. If you choose to participate, all information collected by CRM Metrix will be used in a manner consistent with the Lilly/ICOS Privacy Policy. Your responses will not be disclosed with any information that can personally identify you (e.g., email address, name, address, etc.) and will only be looked at in anonymous form with answers from other participants. Information that may identify you will be kept strictly confidential. Participation is limited to one survey per household. Over 30 million men that have impotence Prescription drug costs are sky-high The Increased health concerns regarding the use of prescription drugs Greater understanding of the importance of overall health Worldwide evidence supporting the effectiveness of herbal treatments for many medical conditions is greater than ever. Even medical doctors, typically resistant to herbal and naturopathic healing, now endorse natural formulas for male impotence and sexual enhancement. Herbal supplements are used by 150 million Americans to treat medical conditions and promote health Let's take a look at how these products do the job, compare with Cialis and what makes them effective for hundreds of thousands of men. Quality impotence/enhancement pills contain a number of natural ingredients that come from around the world, with proven anecdotal records of success in increasing libido, empowering sexual drive and function, and creating greater stamina and erection hardness. However, in researching this article we focused on ingredients that produce male impotence results backed by scientific research. In our quest to find the answer, we scoured medical research to find any side by side human studies comparing Cialis to other commonly used herbs or herbal supplement products. Unfortunately, we were unable to find any side by side studies. Next we reviewed impotence research studies for; The overall effect various herbal ingredients had on male impotence If an herb has a demonstrated effect as a PDE-5 inhibitor (Viagra, Cialis & Levitra are PDE-5 Inhibitors). If an herb facilitated the effect of nitric oxide which is necessary for an erection (PDE-5 inhibitors facilitate the effect of Nitric Oxide). The effect various herbs had on specific body functions that are required to produce a strong, firm erection and a strong sex drive. (i.e. circulatory, vascular, nervous, endocrine system, muscular system) We found research studies reported by well respected Institutes: Sloan-Kettering Cancer Institute; Institute of Pharmacology, Toxicology and Pharmacy, Munich, Germany; University of Peking; National University of Mexico; and others that demonstrate the positive effect that the proper herbal ingredients provide treating impotence. How Cialis Works During sexual excitation the erection is mediated by nitric oxide released from nerve endings close to the blood vessels of the penis. Relaxation of these vessels causes blood to pool producing an erection. Cialis works by inhibiting the breakdown of nitric oxide and thus enhances its effect. Summary of Cialis Compared to Herbal Treatments (Read Findings For Details) Criteria Cialis Herbal Formula's How often is it taken? 1 tablet 30 minutes prior to sex. 1 or 2 times daily like vitamins depending on ingredient or formulation. Enhances the body's use of nitric oxide Very effective and specifically design to do only this. Effective but depends on the actual herb in each formulation. Immediate Effect Effect typically happens in 30 - 45 minutes. Men will have an increased ability to have an erection when aroused. Cialis immediate effect tends to be more potent in the short term. Reported as 45 minutes to 1 1/2 hour depending on herb. Men will have an increased ability to have an erection when aroused. Typically full impotence benefits are achieved over time. Long term Effect Lasts 36 hours no long term positive effect reported. The effects are typically cumulative and the greatest benefit happen over extended daily use in most instances 4 weeks Other Benefits That Help Treat Impotence No other physical benefits Depending on the herb benefits helping impotence can vary and include increased cardiovascular health, increased testosterone, Side Effects Headache, flushing, stomach upset, nasal stuffiness, diarrhea and dizziness, painful or other urination problems, vision problems, skin rash. Should not be used if you are using and M.A.O. inhibitors. Depending on the ingredient No side effects or very few minor side effects. Typical 4 Month Cost $480 $120 - $226 Summary of Popular Herbal Products Containing Impotence Effective Herbs Described in Findings Herb Enzyte(3) Orexis(2) Vipra(2) Zenerx(4) Shilajit (1) Horny Goat Weed (1) Allium Sativum (1) Mucuna Pruriens Tribulus Terrestris Tongkat Ali Ashwagandha (1) Herb has demonstrated Nitric Oxide enhancement effect as Viagra, Cialis, Levitra. (2) Even though Orexis and Vipra ingredients provide positive benefits for impotence they also contain Yohimbe which is potentially dangerous thus we do not recommend either product. (3) Enzyte contains only safe ingredients, however in our research we have found a high number of complaints with the BBB and a class action lawsuit because they do not honor their product guarantee. (4) Out of the 4 herbal supplements Zenerx is our recommended choice. Click Here For Product Information Findings Ingredients That Enhance Nitric Oxide Effects Like Cialis If you are looking for herbal alternatives to Cialis here are three herbs that you should look for that have a demonstrated effect on the body's Nitric Oxide usage like Cialis. Horny Goat Weed Horny goat weed contains a prominent flavonoid called icariin. Icariin is a cGMP-specific PDE5 inhibitor like Viagra, Cialis and Levitra. This was demonstrated in a 1984 University of Peking study which concluded: "Icariin is a cGMP-specific PDE5 inhibitor that can be developed into an oral effective agent for the treatment of ED." Horny goat weed has been used for for over 2000 years as an sexual and reproductive tonic. It's acts in multiple ways to increase erection ability, size, and fullness. Besides it's PDE-5 inhibitor characteristics it also has positive effects on the endocrine system functioning as an adaptogen by increasing levels of epinephrine, norepinephrine, serotonin, and dopamine when they are low - promoting energy, but reduces cortisol levels when they are elevated (an anti-stress effect). High stress conditions, increase cortisol levels causing fatigue and depressing sex drive. It also helps restore low levels of both testosterone and thyroid hormone back to normal - improving sex drive. Allium Sativum (Garlic) Yes, Good old garlic. In two different 1998 studies from the National University of Mexico and one from the Institute of Pharmacology, Toxicology and Pharmacy, Munich, Germany to Garlic was show "activate nitric oxide synthase" or enhances the nervous systems ability to react to nitric oxide. Also there are multiple studies compiled at the Sloan-Kettering Cancer Institute which demonstrate Garlic’s assistance in both preventing and assisting in curing several medical conditions which are often the cause of ED. These include high blood pressure, heart disease, hypertension and artherosclerosis. Shilajit Studies in India showed that Shilajit provided protection to methacrylate against hydroxyl radical induced polymerization and acted as a reversible nitric oxide-captodative agent. These findings are consistent with the therapeutic uses of Shilajit against oxidative stress and geriatric complaints of erectile dysfunction. Herbal Nutrients That Promote All Aspects of Male Health & Naturally Treat Many of The Conditions That Cause ED There are multiple causes of sexual dysfunction and low sex drive which may range from mild (low sex drive, weak erections, lack of energy, slow and weak ejaculation) to severe (total inability to achieve erection and complete lack of sexual desire). These include: Cardiovascular Renal or urological Nutritional (malnutrition, vitamin deficiency) Endocrine (hormonal, i.e. low testosterone or high prolactin are causes Impotence) Neurological Psychological (stress, anxiety, etc.) Pharmacological (alcohol, smoking, recreational and prescription drugs) Environmental toxins (lead, herbicides) General systemic health problems By increasing your health in the above areas you are often able resolve sexual dysfunction issues. This is perhaps where the greatest benefit that natural herbal supplements provide to a mans total sexual performance. Four Herbs Shown to Be Highly Effective Increasing Libido & Treating Conditions That Cause Impotence Mucuna Pruriens Mucuna Pruriens increases testosterone, stimulates the production of human growth hormone and acts as a prolactin inhibitor. Increased levels of prolactin are considered responsible for up to 70% of erection failure in males. In 2002 a U.S. patent was filed on the use of mucuna pruriens to stimulate the release of growth hormone in humans. Studies in this patent showed that the high levels of L-dopa in the mucuna seed are converted to dopamine which stimulates the release of growth hormone by the pituitary gland. L-dopa and dopamine are also effective prolactin inhibitors. In one another study, Mucuna Pruriens was taken by 56 human males and resulted in improved erection, duration of coitus, and post-coital satisfaction after only four weeks of treatment. It also showed fertility promoting and spermatogenic effects in men, improving sperm count and motility. Tribulus Terrestris Tribulus is a natural testosterone enhancer and also said to be an excellent circulatory system tonic and can help build muscle and strength. Clinical studies on the sexual activity-enhancing effect of tribulus have shown the herb to contain protodioscin, a saponin constituent, improving libido in men with impotence due to various causes; libido in women with menopausal symptoms; and sperm motility in infertile and subfertile men. In another study involving 59 men, ages 22-67, suffering from a range of sexual dysfunctions. An increase of sexual desire and fantasies, as well as sexual self-confidence, were reported in almost all of the patients. The subjective experience of pleasure, joy and satisfaction was reported in 80% of the men; erection improved in over 75% of the men; and the duration of intercourse before ejaculation was prolonged in 25% of the men. Tongkat Ali (Eurycoma longfolia) Eurycoma longifolia tree root (long jack root) is a traditional remedy for fatigue, loss of sexual desire, and impotence used for centuries in Malaysia. This amazing plant has only recently been recognized in the west for it's potency helping sexual performance issues. The bioactive Glygopeptide compounds in Tongkat ali are shown to increase free testosterone and decrease SHBG levels in human clinical trials. Both effects assist a mans erection ability, performance and sex drive. In the study by Ismail Tamby, MD, head of the Human Reproductive Specialist Center in Kuala Lumpur, 90% of the men given Tongkat ali extract (100 to 1) reported a boost in their libido and 73.3% reported improved sexual function. In human studies results occur after taking Tongkat Ali for more than one week. As an added benefit Tongkat Ali contains superoxide dimutase, a powerful anti-oxidant enzyme that inhibits the chain reaction of free radicals harmful to the body. Ashwagandha Here is what the Sloan-Kettering Cancer Center had to say in their Ashwagandha Clinical Summary. "It (Ashwagandha) is also used as a general tonic, to increase energy and improve health and longevity... Ashwagandha has been shown to exhibit antioxidant effects in the brain and to have a tranquilizing effect on the central nervous system in animals... Human study's suggest Ashwagandha may promote growth in children and improve hemoglobin concentration, red blood cell count and sexual performance in adults." What To Look For With A Herbal Impotence Supplement With so many herbal "Male Enhancement/Enlargement/Sexual Performance/ Impotence" products that are advertised, it can get difficult to choose products that can actually help and are safe. Also some supplements contain herbs that can be dangerous. Look for ingredients that help your overall health and conditions as well as the ingredients targeted strictly for ED and enhanced performance. This may help treat an health issue which may be causing your impotence or erection quality. Make sure it is manufactured in and shipped from the US Review the ingredients looking for herbs where research substantiates claims such as the herbs we have listed above. Watch out for potentially dangerous ingredients that are listed on the FDA's "Ingredients of Concern" such as Yohimbe Look for chemical additives All products should be guaranteed The above herbs listed represent ones that have positive demonstrated effects helping treat ED, increasing libido and energy. As so many men have discovered herbal supplements may be the perfect Cialis alternative for you. Summary Cialis has proven to be an excellent prescription drug for men with impotence. Positives: Fast acting and tends to have stronger 24 hour effect than herbs specifically at enabling an erection. Negatives: Costs, side effects, short term (24 hours) and it only treats the symptom of impotence but does nothing help causes of impotence, low sex drive or improved body functions. Specific herbal ingredients contained Herbal Impotence & Enhancement Products have a demonstrated positive effect on male impotence. Some herbs act similar to Cialis at enhancing the body's use of Nitric Oxide. Positives: Cost, minimal or no side effects, the positive effects tend to accumulate and become more produced over time. Dosages can be skipped and benefits are retained. Herbal formulations have positive benefits on multiple body functions (cardiovascular, endocrine, muscular and nervous system) that are essential to a strong erection and sex drive. Negatives: Immediate short term effect is not as pronounced as Cialis. Are Herbal Treatments right for you? Based on the evidence, there are a number ingredients that have proven effective for men. However, as with any prescription drug, medical treatment or supplement individual results vary. Reputable nutraceutical companies recognize this by providing a money back guarantee and honoring it. So in many case you can try a supplement to see if it works for your condition. Zenerx (See Product Information) a herbal product that contains multiple herbs that have proven to be beneficial to men with Impotence and enhance the body's use of Nitric Oxide like Cialis. They also have no reported consumer complaints. What is the most important information I should know about tadalafil? • A small number of patients have lost eyesight in one eye after taking tadalafil. This type of vision loss is called non-arteritic anterior ischemic optic neuropathy (NAION). NAION causes a sudden loss of eyesight because blood flow is blocked to the optic nerve. It is not clear at this time if tadalafil causes NAION. NAION also happens in patients who do not take this medicine. People who have a higher chance for NAION include those who: · have heart disease; · are over 50 years old; · have diabetes; · have high blood pressure; · have high cholesterol; · smoke; or · have certain eye problems. • Stop using tadalafil if you have any loss in your eyesight and seek medical help right away. • Do not take tadalafil if you are taking any of the following medicines: · a nitrate such as nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro, others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), isosorbide mononitrate (Imdur, ISMO, Monoket), and others; · nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"); or · an alpha blocker (other than tamsulosin (Flomax) 0.4 mg once a day) such as doxazosin (Cardura), guanadrel (Hylorel), prazosin (Minipress), terazosin (Hytrin), alfuzosin (Uroxatral), and others. • Taking tadalafil with any of these medications may cause very low blood pressure, possibly resulting in dizziness, fainting, stroke, or heart attack. • Contact your doctor or seek emergency medical attention for any erection that lasts longer than 4 hours. A sustained erection can damage the penis. • Refrain from further sexual activity and notify your doctor it you develop dizziness, nausea, or angina (pain, tightness, discomfort, numbness, or tingling in the chest, arms, neck, or jaw) during sexual activity. • Tadalafil is usually taken when needed before sexual activity. The effects of tadalafil may last for up to 36 hours or more. Your doctor will determine how often you can take tadalafil. Do not take tadalafil more often than is directed by your doctor. What is tadalafil? • Tadalafil relaxes muscles within the penis. This allows increased blood flow into the penis, necessary to achieve and maintain an erection. • Tadalafil is used to treat erectile dysfunction (impotence). • Tadalafil may also be used for purposes other than those listed in this medication guide.

Nov. 25, 2003 -- Cialis, a drug for male impotence, was approved by the US Food and Drug Administration last week. Cialis joins sildenafil (Viagra), approved by the FDA in 1998, and vardenafil (Levitra), approved earlier this year, as drugs for erectile dysfunction. The effect of Cialis can last 24 to 36 hours, several times longer than Viagra or Levitra. "In France, it's called 'le weekend' drug," according to the drugmaker. Our Thoughts: The FDA announcement of Cialis follows. Whenever possible, we prefer to provide you with the FDA announcement of a new drug rather than a rewrite of it which is often selective and biased. Note that, if the effects of a drug are longer lasting, so usually are the dangers and side effects longer lasting. For additional information, please see the following MedicineNet.com areas Before using Cialis Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking. Do not take this medicine if you are taking any form of nitroglycerin, other nitrates such as isosorbide, nitroprusside or any "nitric oxide donor" medicine, or recreational drugs called "poppers" containing amyl or butyl nitrate because very serious interactions may occur. Order Cialis now. Cialis Common uses Cialis is a phosphodiesterase inhibitor used to treat sexual function problems such as impotence or erectile dysfunction. In combination with sexual s