Tadalafil

About Tadalafil

Tadalafil blocks the enzyme PDE5, relaxing smooth muscle in blood vessels; PDE5 is also found in the prostate and bladder, but the label says the mechanism for easing BPH symptoms has not been established. Cialis is labeled for erectile dysfunction, the signs and symptoms of BPH, or both together, and not for women or children. Taken as needed, it starts at 10 mg before sexual activity, adjusted to 5 or 20 mg, at most once a day; the label reports better erections up to 36 hours after a dose. Once-daily use for erectile dysfunction starts at 2.5 mg and may rise to 5 mg; BPH, with or without erectile dysfunction, is treated with 5 mg a day. When Cialis is started together with finasteride for BPH, the label recommends that combination for up to 26 weeks. Adcirca, Alyq and Tadliq are labeled for PAH (WHO Group 1) to improve exercise ability: 40 mg once a day, as two 20 mg tablets taken together (the tablet labels advise against dividing the dose through the day) or 10 mL of suspension; their safety and effectiveness in children have not been established.

There is no boxed warning. Tadalafil must not be taken with nitrates in any form, used regularly or now and then, with riociguat or another guanylate cyclase stimulator, or after a serious allergic reaction to it, including Stevens-Johnson syndrome. If a nitrate is needed in a life-threatening emergency, the Cialis label says at least 48 hours should pass after the last dose, under close medical supervision. It should not be used for erectile dysfunction by men for whom sexual activity is inadvisable because of their heart. An erection lasting more than 4 hours, sudden vision loss (a possible sign of NAION) or sudden hearing loss needs medical help right away. It adds to the blood pressure lowering of alpha-blockers, other blood pressure drugs and heavy drinking, and Cialis is not recommended with an alpha-blocker for BPH. Cialis and the PAH products are not taken together or with another PDE5 inhibitor. Common side effects include headache, indigestion, back pain, muscle aches, nasal congestion and flushing.

Kidney or liver disease and strong CYP3A4 inhibitors such as ketoconazole or ritonavir lower or limit the dose: with those inhibitors, the Cialis label caps as-needed use at 10 mg once every 72 hours and daily use at 2.5 mg, and daily use for erectile dysfunction or BPH is not recommended with severely reduced kidney function. Cialis 2.5 mg tablets are discontinued, though generic 2.5 mg tablets are sold; the other Cialis strengths, Adcirca, Alyq and Tadliq are still sold. Entadfi, which combined tadalafil with finasteride for BPH, is discontinued.

Taking Tadalafil

How to take it

With or without food. As needed for erectile dysfunction, take one dose before sexual activity, no more than once a day; take daily doses at about the same time each day. For PAH, take the whole daily dose at once rather than dividing it. Do not split Cialis tablets; take the whole dose. Shake Tadliq well for 30 seconds before measuring a dose.

If you miss a dose

As-needed use has no schedule. For daily use, take a missed dose as soon as you remember, unless it is almost time for the next one; then skip it and carry on as usual. Do not take a double dose or more than one dose in a day.

Storage

At room temperature, away from excess heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Nitrates and riociguat are never combined with it, and alpha-blockers, other blood pressure drugs and large amounts of alcohol add to its blood pressure lowering. Ketoconazole, ritonavir and other strong CYP3A4 inhibitors raise its levels and limit the dose; rifampin lowers them.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Tadalafil differs from pharmacy to pharmacy

Generic tadalafil tablets come from many makers, so quotes for the same strength and quantity differ by each pharmacy’s fee and markup and by whether tadalafil is on its flat-price generic list. In the Orange Book, generic 20 mg tablets are coded AB1 (equivalent to Cialis) or AB2 (equivalent to Adcirca, as Alyq is), and products with different codes are not equivalent to each other, so a pharmacist substitutes only a generic rated to the product written.

Daily use for erectile dysfunction or BPH means a tablet every day, as-needed use at most one a day, and PAH two 20 mg tablets a day, which shapes each quote. Tadliq is a brand-only suspension.

Ways to pay less for Tadalafil without insurance

• Ask for a generic rated to the product prescribed, and check that the prescription does not block substitution.
• Ask whether tadalafil is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• For daily use, once the dose is settled, ask the prescriber about a ninety-day supply.
• If Tadliq is prescribed, ask the prescriber whether tablets would suit you, or ask the maker whether any savings program applies when paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Tadalafil

1. 1.Do any of my heart, blood pressure or prostate medicines interact with tadalafil?
2. 2.Is my prescription for the erectile dysfunction and BPH tablets or the PAH tablets?
3. 3.How much alcohol is safe for me while I take it?
4. 4.Which vision, hearing or erection problems mean I should get help right away?

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