What Should I Know Before I use CIALIS?

Warnings

Do not use CIALIS if:

you are allergic to tadalafil, or any of the ingredients listed at the end of this leaflet. Always check the ingredients to make sure you can use this medicine
you are currently taking any nitrates, medicines used for the treatment of angina (“chest pain”) or other heart conditions. CIALIS has been shown to increase the effects of these medicines.
if you use recreational drugs called “poppers” or “amyl” like amyl nitrite and butyl nitrite that are normally taken through inhalation
if you use guanylate cyclase stimulators such as riociguat, used to treat pulmonary arterial hypotension
if you have heart or blood vessel problems that make sexual intercourse inadvisable. Sexual activity carries a possible risk to patients with a heart condition because it puts extra strain on the heart
if you have heart problems such as angina, arrhythmias (change in rhythm or rate of heart beat), heart failure
if you have suffered a heart attack in the last 3 months
if you have suffered a stroke in the last 6 months
if your blood pressure is unusually high or low or is not effectively treated
if you have vision loss in one eye because of non-arteritic interior ischaemic optic neuropathy (NAION).

Check with your doctor if you have or have had:

liver or kidney problems
heart problems or if you have had a heart attack
blood vessel problems
sickle cell anaemia (an abnormality or red blood cells)
multiple myeloma (cancer of the bone marrow)
leukaemia (cancer of the blood cells)
any deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease)
loss of vision in one or both eyes.
During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section

Tell your doctor if you:

are aged 75 years and over.
You have a higher chance of experiencing side effects like dizziness and diarrhea.
Your doctor will assess if CIALIS is suitable for you.

Use in women

CIALIS is not intended for use by women.

Use in children

CIALIS is not intended for use by children under the age of 18 years.

What are the risks and warnings for Cialis (tadalafil)?

Cialis (tadalafil) can cause some serious health issues. This risk may be even higher for certain groups.

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If this worries you, talk to your doctor or pharmacist about other options

Risk of heart attack or stroke

  • Risk factors: Existing heart condition | Recent heart attack or stroke in past 6 months | High or low blood pressure

It’s not recommended for men to take Cialis (tadalafil) if they’ve had a heart attack, stroke, or symptoms of heart failure in the past 6 months, abnormal blood pressure, or if they have chest pain. The safety of Cialis (tadalafil) has not been studied in these situations. Talk to your doctor if you have any of these health conditions.

Low blood pressure

  • Risk factors: Taking alpha blockers | Taking medications for high blood pressure or chest pain (angina) | Drinking alcohol

If you’re taking alpha blockers or medications for high blood pressure with Cialis (tadalafil), your blood pressure may drop too low. Make sure to check your blood pressure regularly if you’re taking these other medications. Be very careful getting up from a sitting or lying down position since this can make you feel dizzy and more likely to fall. Drinking alcohol can also cause low blood pressure. Avoid or lower your alcohol consumption when taking Cialis (tadalafil). You should never take Cialis (tadalafil) when taking nitrate medication for chest pain (angina) because it can cause your blood pressure to suddenly drop to unsafe levels.

Prolonged erection

  • Risk factors: Peyronie’s disease | Cavernosal fibrosis | Sickle cell anemia

There have been reports of men having an erection lasting more than 4 hours while on Cialis (tadalafil). This is rare but if it’s not treated in time, it can cause permanent damage to your penis, including permanent impotence. Get medical help immediately if this happens.

Vision changes

If you suddenly notice changes in your vision in one or both eyes, go to the emergency room or call your doctor immediately. Although this is rare, Cialis (tadalafil) can cause permanent eye damage.

Hearing loss

There have been reports of men having permanent hearing loss while taking Cialis (tadalafil). This may happen along with ringing in the ears (tinnitus) and dizziness. Go to the emergency room or call your doctor immediately if you notice changes in your hearing in one or both ears.

Interactions with other medications

  • Risk factors: Age 65 years or older | Liver disease | Kidney disease | Taking medications such as nitrates, anti-hypertensives, alpha blockers, ketoconazole, or ritonavir

You may experience more side effects while taking Cialis (tadalafil) if you are also taking medications called nitrates for chest pain, blood pressure medications, certain medications for HIV, are elderly, or have liver or kidney disease. Talk to your doctor before starting Cialis (tadalafil) if any of these apply to you.

What is the distanges of taking Cialis ?

Cialis (tadalafil) is the only medication in its class that treats both erectile dysfunction and enlarged prostate symptoms. You can also take it on a regular basis, which can allow for more spontaneity.

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, dyspepsia, back pain, nasal congestion, and flushing are the most commonly reported side effects.
  • Other side effects include a drop in blood pressure, muscle or limb pain, or conjunctivitis.
  • Rarely, may decrease blood flow to the optic nerve causing sudden vision loss. The risk is greater in people aged older than 50, with diabetes, heart disease, high blood pressure, high cholesterol, who smoke, or with certain pre-existing eye problems.
  • The dosage of Cialis may need reducing in men with kidney disease. For men with CLCR of 30 to 50 mL/min, a starting dose of 5mg not more than once per day is recommended. The maximum dose is 10mg not more than once every 48 hours.
  • For men with CLCR of < 30 mL/min or on hemodialysis, the maximum dose is 5mg not more than once every 72 hours. Once daily use may not be recommended in men with CLCR < 30 mL/min.
  • For men with mild-to-moderate liver disease (Child-Pugh Class A or B), the dose should not exceed 10mg once per day. Cialis is not recommended in severe liver disease (Child-Pugh Class C).
  • Rarely, may cause other side effects including hearing loss or lead to painful erections lasting longer than four to six hours. See your doctor immediately if this happens.
  • May not be suitable for some people including those with angina, chest pain, or other heart conditions, liver or kidney problems, blood or bleeding disorders, stomach ulcers, certain eye conditions, a physical deformity of the penis (such as Peyronie’s disease), or serious prior hypersensitivity reactions to tadalafil.
  • May interact with some medications including nitrates – use of Cialis and nitrates is contraindicated because of the severe hypotension that can develop. May also interact with other medications including ketoconazole or ritonavir; dosage adjustment is recommended.
  • A lower dosage of Cialis is recommended in men with mild-to-moderate liver disease. Cialis should be avoided with severe liver disease.
  • Not for use in females.