Cialis (tadalafil) is the third prescription drug approved by the US FDA for treating erectile dysfunction (ED) or impotence in men. Clinically, the term impotence is no longer being used and the inability of a man to get and keep an erection firm enough for sexual intercourse is simply referred to as male erectile disorder or erectile dysfunction. In lay usage, impotence has a derogatory connotation and its true meaning often confused many. Impotence is a reproductive system disease in which one is unable to engage in a sexual act due to various reasons, which may include sexual arousal problems, premature ejaculation, inability to gain an erection, or having a weak erection. In this sense, the term can also be applied to women sexual disorders.
Cialis, just like Viagra (sildenafil) and Levitra (vardenafil), is a reversible phosphodiesterase 5 inhibitor (PDE5) that enhances erectile response to sexual stimulation by increasing blood flow to the penis. Compared to sildenafil and vardenafil, tadalafil has the longest duration of action. Cialis stays in your system for up to 36 hours or more, though there are other factors that can affect how long the drug stays in your body. The half-life of Cialis is 17.5 hours, while Viagra has a half-life of 3–5 hours. That is why the effects of Cialis can last for up to 2 days or more. As with all medications, Cialis can affect each person differently.
Treatment approaches for Cialis
The major selling point of the branded tadalafil is its long-lasting action. The drug should be taken 30 minutes prior to sexual activity, and its average onset of action is 16–45 minutes. You can take Cialis with or without food, but many individuals reported early onset of action when it’s taken on an empty stomach. While other PDE5 inhibitors are taken on an as-needed basis, Cialis can also be taken on a daily basis, but in a lower dose. The usually prescribed dosage is 10mg as needed, and 2.5–5mg for daily usage. As a daily regimen, you should take Cialis around the same time each day for best results.
Safety and tolerability
Concomitant use of nitrates, including recreational inhalation drug known as poppers, with PDE5 inhibitors is contraindicated. When coadminstered with antihypertensive drugs, tadalafil lowers blood pressure at 4 to 10mm Hg. If you are taking antibiotics or antifungal drugs, limit dosage to 10mg within a 72-hour period. In contrast with Viagra, changes in color vision is reported less in Cialis (less than 0.1 percent). Tadalafil does not inhibit PDE6, which may account for fewer reported visual disturbances. Tadalafil also inhibits PDE11, which is expressed in the prostate, liver, kidney, and skeletal muscles, more than sildenafil but its effects are unknown. The most common side effects associated with tadalafil are:
- Headache;
- Indigestion;
- Stomach aches;
- Back pain;
- Muscle pains;
- Flushing;
- Runny nose.
There are rare reports of priapism (persistent and painful erection of the penis lasting for several hours) in all medications in this drug class. Priapism is a medical emergency that can cause permanent damage to your penis if not treated immediately. You can employ some strategies to reduce erection as long as they do not delay timely medical attention:
- You may exercise by climbing stairs or going for a walk;
- Take pain relievers such as paracetamol if needed;
- Hydrate by drinking lots of water;
- Have a warm bath or take a shower;
- Try to pee;
- Ice pack may relieve symptoms for ischemic priapism;
- Do not masturbate;
- Do not smoke or drink alcohol.
In a multicenter, open-label trial spanning 12 months and involving 1,173 patients, tadalafil was safe and well tolerated. 74.8% of patients, with mean age of 57, were taking concomitant medications for controlling comorbid conditions, such as diabetes mellitus and high blood pressure. There were four non tadalafil-related deaths that occurred during the trial. The study demonstrated that tadalafil at doses of 5, 10, and 20mg taken as need for 18–24 months was safe and well tolerated, supporting the long-term use of the drug for the clinical management of ED.
Potency
In five clinical trials comparing tadalafil with placebo, 68 to 77% out of 321 men reported an erection suitable for insertion, compared with 42 to 55% in the placebo group. However, only 50 to 70% reported successful intercourse. Participants’ satisfaction with intercourse was reported at 9.3 and 7.4 in the placebo group out of a maximum score of 15. Overall satisfaction was 6.7 over 10.