DOSAGE FORMS AND STRENGTHS

It is not possible to determine whether these reported events are related directly to the use of CIALIS, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors [see Warnings and Precautions (5.5) and Patient Counseling Information (17.7)]. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].Alpha Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha blockers. Clinical pharmacology studies have been conducted with coadministration of tadalafil with doxazosin or tamsulosin [see Warnings and Precautions (5.6), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].Antihypertensives — PDE5 inhibitors, including tadalafil, are mild systemic vasodilators. [See Warnings and Precautions (5.9) and Clinical Pharmacology (12.2)].7.2 Potential for Other Drugs to Affect CIALIS[See Dosage and Administration (2.4) and Warnings and Precautions (5.10)].Antacids — Simultaneous administration of an antacid (magnesium hydroxide/aluminum hydroxide) and tadalafil reduced the apparent rate of absorption of tadalafil without altering exposure (AUC) to tadalafil.H2Antagonists (e.g.

Side Effects

In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1)].Effect on Blood Pressure When Administered With Alpha BlockersSix randomized, double-blinded, crossover clinical pharmacology studies were conducted to investigate the potential interaction of tadalafil with alpha-blocker agents in healthy male subjects [see Dosage and Administration (2.4) and Warnings and Precautions (5.6)]. In four studies, a single oral dose of tadalafil was administered to healthy male subjects taking daily (at least 7 days duration) oral alpha blocker. In two studies, daily oral alpha blocker (at least 7 days duration) was administered to healthy male subjects taking repeated daily doses of tadalafil.Doxazosin — Three clinical pharmacology studies were conducted with tadalafil and doxazosin, an alpha[1]-adrenergic blocker.In the first doxazosin study, a single oral dose of tadalafil 20 mg or placebo was administered in a 2-period, crossover design to healthy subjects taking oral doxazosin 8 mg daily (N=18 subjects). Doxazosin was administered at the same time as tadalafil or placebo after a minimum of seven days of doxazosin dosing (see Table 4 and Figure 2).Blood pressure was measured manually at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours after tadalafil or placebo administration. In this part, tadalafil or placebo were administered at either 8 a.m.

In Treatment of Pulmonary arterial hypertension (PAH)

or 8 p.m.The placebo-subtracted mean maximal decreases in systolic blood pressure over a 12-hour period after dosing in the placebo-controlled portion of the study (part C) are shown in Table 5 and Figure 3.Figure 3: Doxazosin Study 2 (Part C): Mean Change from Time-Matched Baseline in Systolic Blood PressureBlood pressure was measured by ABPM every 15 to 30 minutes for up to 36 hours after tadalafil or placebo. Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone [see Dosage and Administration (2.4)].Although specific interactions have not been studied, other CYP3A4 inhibitors, such as erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure.HIV Protease inhibitor — Ritonavir (500 mg or 600 mg twice daily at steady state), an inhibitor of CYP3A4, CYP2C9, CYP2C19, and CYP2D6, increased tadalafil 20-mg single-dose exposure (AUC) by 32% with a 30% reduction in Cmax, relative to the values for tadalafil 20 mg alone. Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure [see Dosage and Administration (2.4)].Cytochrome P450 Inducers — Studies have shown that drugs that induce CYP3A4 can decrease tadalafil exposure.CYP3A4 (e.g., Rifampin) — Rifampin (600 mg daily), a CYP3A4 inducer, reduced tadalafil 10-mg single-dose exposure (AUC) by 88% and Cmax by 46%, relative to the values for tadalafil 10 mg alone. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)]. Alpha Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha blockers. Clinical pharmacology studies have been conducted with coadministration without prescription cialis soft of tadalafil with doxazosin or tamsulosin [see Warnings and Precautions (5.6), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)]. [See Dosage and Administration (2.4) and Warnings and Precautions (5.10)]. Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone [see Dosage and Administration (2.4)]. Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure [see Dosage and Administration (2.4)]. 8 USE IN SPECIFIC POPULATIONS 8.1 PregnancyPregnancy Category B — CIALIS (tadalafil) is not indicated for use in women.

Product	Dosage	Quantity + Bonus	Price
Cialis Professional	20mg	270 + 6 Pills	623.07€ 593.40€	Buy
Cialis Generic	2.5mg	20 Pills	40.73€ 38.79€	Buy
Cialis Generic	10mg	270 + 10 Pills	308.71€ 294.01€	Buy
Cialis Generic	60mg	90 + 6 Pills	196.67€ 187.30€	Buy
Cialis Black	80mg	10 Pills	43.27€ 41.21€	Buy
Cialis Professional	20mg	180 + 4 Pills	423.11€ 402.96€	Buy
Cialis Generic	10mg	120 + 6 Pills	178.49€ 169.99€	Buy
Cialis Original	20mg	48 + 4 Pills	224.69€ 213.99€	Buy
Cialis Generic	40mg	90 + 6 Pills	171.35€ 163.19€	Buy
Cialis Original	20mg	120 + 8 Pills	497.29€ 473.61€	Buy
Cialis Generic	60mg	30 + 2 Pills	85.33€ 81.27€	Buy
Cialis Generic	20mg	30 + 4 Pills	68.05€ 64.81€	Buy
Cialis Generic	40mg	360 + 10 Pills	477.87€ 455.11€	Buy
Cialis Generic	20mg	270 + 10 Pills	335.21€ 319.25€	Buy
Cialis Soft Tabs	20mg	20 + 2 Pills	66.98€ 63.79€	Buy

There are no adequate and well controlled studies of CIALIS use in pregnant women. Animal reproduction studies in rats and mice revealed no evidence of fetal harm.Non-teratogenic effects — Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis. In one of two perinatal/postnatal developmental studies in rats, postnatal pup survival decreased following maternal exposure to tadalafil doses greater than 10 times the MRHD based on AUC. (See Animal Toxicology and/or Pharmacology Section 13.2)8.3 Nursing MothersCIALIS is not indicated for use in women. It is not known whether tadalafil is excreted into human milk. While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk.8.4 Pediatric UseCIALIS is not indicated for use in pediatric patients.

How Cialis Tablet works

Safety and efficacy in patients below the age of 18 years has not been established. Of the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately 3 percent were 75 and over. [See Dosage and Administration (2.3) and Warnings and Precautions (5.8)]. In clinical pharmacology studies using single-dose tadalafil (5 to 10 mg), tadalafil exposure (AUC) doubled in subjects with mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency. 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.

17 Patient Counseling Information

CIALIS (tadalafil), an oral treatment for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). CIALIS is available as film-coated, almond-shaped tablets for oral administration. 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. PDE11 is an enzyme found in human cialis alternative prostate, testes, skeletal muscle and in other tissues. Safety and efficacy in patients below the age of 18 years has not been established.8.5 Geriatric UseOf the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately generic cialis 5 mg 3 percent were 75 and over. No overall differences in efficacy or safety were observed between subjects over 65 years of age compared to younger subjects, therefore no dose adjustment is warranted based on age alone. [See Dosage and Administration (2.3) and Warnings and Precautions (5.8)].8.7 Renal InsufficiencyIn clinical pharmacology studies using single-dose tadalafil (5 to 10 mg), tadalafil exposure (AUC) doubled in subjects with mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency.

• The social and cultural perceptions of ED treatment have evolved.
• It is now more widely accepted as a common medical treatment.
• Celebrities and public figures have helped normalize its use.
• However, privacy remains a top concern for most users.
• Reputable pharmacies have strict privacy policies for online orders.
• Packaging is often discreet, without revealing the contents.
• Consulting a doctor is the first and most important step.
• Self-diagnosis and self-medication can be dangerous.
• A doctor can determine if ED is a symptom of a more serious condition.
• Conditions like heart disease can sometimes first present as ED.
• Treating ED can therefore be an important part of preventative health.
• The 10mg tablet is a powerful tool in modern men's health.

In subjects with end-stage renal disease on hemodialysis, there was a two-fold increase in Cmax and 2.7- to 4.1-fold increase in AUC following single-dose administration of 10 or 20 mg tadalafil.

• Cialis 10mg is a convenient treatment for erectile dysfunction.
• It is proven effective in clinical studies.
• Do not use Cialis if you are on certain medications.
• It is important to report any side effects immediately.
• Cialis does not protect against pregnancy or STIs.
• Discuss potential interactions with your healthcare provider.
• It is advisable to inform of any recent surgeries.
• Cialis should be used as part of a trusted medical regimen.

In a clinical pharmacology study (N=28) at a dose of 10 mg, back pain was reported as a limiting adverse event in male patients with moderate renal impairment.

• Cialis 10mg contains tadalafil as its active ingredient.
• Common side effects include headache and flushing.
• Consult your doctor before using Cialis if on other medications.
• Cialis should be stored at room temperature away from moisture.
• Avoid grapefruit juice while taking Cialis.
• Cialis may cause a drop in blood pressure.
• Do not use Cialis if allergic to tadalafil.
• Notify your doctor if you experience vision changes.

[See Dosage and Administration (2.3) and Warnings and Precautions (5.7)].

In case of emergency/overdose

Pregnancy Category B — CIALIS (tadalafil) is not indicated for use in women. Animal reproduction studies in rats and mice revealed no evidence of fetal harm.

Region	Average Price per 10mg Tablet	Brand Options	Generic Availability
United States	$10 - $20	Cialis, Tadalis	Widely available
European Countries	€8 - €18	Cialis, Tadalafil	Readily accessible
India	₹50 - ₹150	Tadaflo, Tadagra	Affordable options
Australia	AUD 15 - AUD 25	Cialis, Tadalafil	Easily purchased
Online Vendors	Varies	Multiple brands	Verify authenticity

Non-teratogenic effects — Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis. (See Animal Toxicology and/or Pharmacology Section 13.2) CIALIS is not indicated for use in women. While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk. Safety and efficacy in patients below the age of 18 years has not been established. Of the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately 3 percent were 75 and over. [See Dosage and Administration (2.3) and Warnings and Precautions (5.8)].

How Cialis 10 Mg Tablet Works

It is not possible to determine whether these reported events are related directly to the use of CIALIS, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors [see Warnings and Precautions (5.5) and Patient Counseling Information (17.7)]. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].Alpha Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha blockers. Clinical pharmacology studies have been conducted with coadministration of tadalafil with doxazosin or tamsulosin [see Warnings and Precautions (5.6), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)].Antihypertensives — PDE5 inhibitors, including tadalafil, are mild systemic vasodilators. [See Warnings and Precautions (5.9) and Clinical Pharmacology (12.2)].7.2 Potential for Other Drugs to Affect CIALIS[See Dosage and Administration (2.4) and Warnings and Precautions (5.10)].Antacids — Simultaneous administration of an antacid (magnesium hydroxide/aluminum hydroxide) and tadalafil reduced the apparent rate of absorption of tadalafil without altering exposure (AUC) to tadalafil.H2Antagonists (e.g. Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone [see Dosage and Administration (2.4)].Although specific interactions have not been studied, other CYP3A4 inhibitors, such as erythromycin, itraconazole, and grapefruit juice, would likely increase tadalafil exposure.HIV Protease inhibitor — Ritonavir (500 mg or 600 mg twice daily at steady state), an inhibitor of CYP3A4, CYP2C9, CYP2C19, and CYP2D6, increased tadalafil 20-mg single-dose exposure (AUC) by 32% with a 30% reduction in Cmax, relative to the values for tadalafil 20 mg alone.

How do the dosages for Cialis and Viagra compare?

Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure [see Dosage and Administration (2.4)].Cytochrome P450 Inducers — Studies have shown that drugs that induce CYP3A4 can decrease tadalafil exposure.CYP3A4 (e.g., Rifampin) — Rifampin (600 mg daily), a CYP3A4 inducer, reduced tadalafil 10-mg single-dose exposure (AUC) by 88% and Cmax by 46%, relative to the values for tadalafil 10 mg alone. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)]. Alpha Blockers — Caution is advised when PDE5 inhibitors are coadministered with alpha blockers. Clinical pharmacology studies have been conducted with coadministration without prescription cialis soft of tadalafil with doxazosin or tamsulosin [see Warnings and Precautions (5.6), Dosage and Administration (2.4) and Clinical Pharmacology (12.2)]. [See Dosage and Administration (2.4) and Warnings and Precautions (5.10)]. In clinical pharmacology studies using single-dose tadalafil (5 to 10 mg), tadalafil exposure (AUC) doubled in subjects with mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency. 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.

17.3 Concomitant Use with Drugs Which Lower Blood Pressure

No overall differences in efficacy or safety were observed between subjects over 65 years of age compared to younger subjects, therefore no dose adjustment is warranted based on age alone. [See Dosage and Administration (2.3) and Warnings and Precautions (5.8)].8.7 Renal InsufficiencyIn clinical pharmacology studies using single-dose tadalafil (5 to 10 mg), tadalafil exposure (AUC) doubled in subjects with mild (creatinine clearance 51 to 80 mL/min) or moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency. In subjects with end-stage renal disease on hemodialysis, there was a two-fold increase in Cmax and 2.7- to 4.1-fold increase in AUC following single-dose administration of 10 or 20 mg tadalafil. In a clinical pharmacology study (N=28) at a dose of 10 mg, back pain was reported as a limiting adverse event in male patients with moderate renal impairment. [See Dosage and Administration (2.3) and Warnings and Precautions (5.7)].

Patient resources

Pregnancy Category B — CIALIS (tadalafil) is not indicated for use in women. Animal reproduction studies in rats and mice revealed no evidence of fetal harm. Non-teratogenic effects — Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis. (See Animal Toxicology and/or Pharmacology Section 13.2) CIALIS is not indicated for use in women. While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk. CIALIS (tadalafil), an oral treatment for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). CIALIS is available as film-coated, almond-shaped tablets for oral administration.

Condition	Caution	Alternative Advice
Use with Nitrates	Contraindicated due to risk of severe hypotension	Consult healthcare provider before use
Severe Cardiovascular Disease	Use with caution or avoid	Prior medical consultation required
Liver or Kidney Impairment	Adjust dosage or avoid	Regular monitoring essential
Allergies to Tadalafil	Discontinue use if allergic	Seek medical advice
Eye Conditions (e.g., Retinitis Pigmentosa)	Use cautiously	Regular eye check-ups recommended

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.

5.14 Consideration of Other Urological Conditions Prior to Initiating Treatment for BPH

Ketoconazole (200 mg daily) increased tadalafil 10-mg single-dose exposure (AUC) by 107% and Cmax by 15%, relative to the values for tadalafil 10 mg alone [see Dosage and Administration (2.4)]. Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure [see Dosage and Administration (2.4)]. 8 USE IN SPECIFIC POPULATIONS 8.1 PregnancyPregnancy Category B — CIALIS (tadalafil) is not indicated for use in women. There are no adequate and well controlled studies of CIALIS use in pregnant women. Animal reproduction studies in rats and mice revealed no evidence of fetal harm.Non-teratogenic effects — Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose (MRHD) of 20 mg/day during organogenesis.

Safety Advice

In one of two perinatal/postnatal developmental studies in rats, postnatal pup survival decreased following maternal exposure to tadalafil doses greater than 10 times the MRHD based on AUC. (See Animal Toxicology and/or Pharmacology Section 13.2)8.3 Nursing MothersCIALIS is not indicated for use in women. It is not known whether tadalafil is excreted into human milk. While tadalafil or some metabolite of tadalafil was excreted into rat milk, drug levels in animal breast milk may not accurately predict levels of drug in human breast milk.8.4 Pediatric UseCIALIS is not indicated for use in pediatric patients. Safety and efficacy in patients below the age of 18 years has not been established.8.5 Geriatric UseOf the total number of subjects in clinical studies of tadalafil, approximately 25 percent were 65 and over, while approximately generic cialis 5 mg 3 percent were 75 and over. 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. PDE11 is an enzyme found in human cialis alternative prostate, testes, skeletal muscle and in other tissues. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring [see Contraindications (4.1)].Effect on Blood Pressure When Administered With Alpha BlockersSix randomized, double-blinded, crossover clinical pharmacology studies were conducted to investigate the potential interaction of tadalafil with alpha-blocker agents in healthy male subjects [see Dosage and Administration (2.4) and Warnings and Precautions (5.6)]. In four studies, a single oral dose of tadalafil was administered to healthy male subjects taking daily (at least 7 days duration) oral alpha blocker. In two studies, daily oral alpha blocker (at least 7 days duration) was administered to healthy male subjects taking repeated daily doses of tadalafil.Doxazosin — Three clinical pharmacology studies were conducted with tadalafil and doxazosin, an alpha[1]-adrenergic blocker.In the first doxazosin study, a single oral dose of tadalafil 20 mg or placebo was administered in a 2-period, crossover design to healthy subjects taking oral doxazosin 8 mg daily (N=18 subjects). Doxazosin was administered at the same time as tadalafil or placebo after a minimum of seven days of doxazosin dosing (see Table 4 and Figure 2).Blood pressure was measured manually at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours after tadalafil or placebo administration. In this part, tadalafil or placebo were administered at either 8 a.m. or 8 p.m.The placebo-subtracted mean maximal decreases in systolic blood pressure over a 12-hour period after dosing in the placebo-controlled portion of the study (part C) are shown in Table 5 and Figure 3.Figure 3: Doxazosin Study 2 (Part C): Mean Change from Time-Matched Baseline in Systolic Blood PressureBlood pressure was measured by ABPM every 15 to 30 minutes for up to 36 hours after tadalafil or placebo.