Generic Cialis Soft

Indications for application:

Cialis is applied for the treatment of erectile dysfunction.  

Counter indications:

• Identified hyper sensibility to tadalaphyl, or to any other substance as a component of the preparation;

• In case of intake of the preparation containing any organic nitrates;

• Use in persons under 18 years old.  

Use in pregnancy and lactation:

Cialis is not indicated for use in women.  

Dosage regimen and mode of use:

Tablets of Cialis are to be taken by mouth. 

Use in men of middle age

Recommended dose of Cialis is 20 mg. Cialis is taken before a supposed sexual activity regardless of meals intake. The preparation should be taken at least 15 minutes before a supposed sexual activity.

Patients may have a try at a sexual act any time during 36 hours after intake of the medication in order to fix an optimum time of the response for the medication intake.

The most recommended frequency of intake – once in 24 hours.  

Use in senior people and patients with impaired function of the kidney and liver

There is no need of a special dosage for senior patients. The use recommendations of the section “Use in men of middle age” are also applicable in senior patients. For patients with impaired function of the kidney (clearance of creatinine 30 ml/min) and the liver there is no need of a special dosage (look the section “Special warnings and special precautions in use”) .  
 
 

Side effects:

The most frequently occurring undesired events are headache and dyspepsia (11 и 7% of case respectively). The undesired events connected with the use of tadalaphyl usually were insignificant or moderate in terms of expressiveness, were transitory and were decreasing when the medication continued to be used.

Other usual undesired effects there have been backache, myalgia, stuffed nose and “flashes” of blood to the face.

Very seldom there happen hydrops of the eyelids, ache in the eyes, hyperemia of the conjunctiva and faintness.  

Overdosing:

With a single administration of tadalaphyl in the dose up to 500 mg. in 24 hours to healthy patients, and with a multiple administration of the same in the dose up to 100 mg. in 24 hours to patients with erectile dysfunction - undesired effects were the same as with the use of lower doses. In case of overdosing it is necessary to administer a standard symptomatic therapy.  

Special notices:

Sexual activity has a potential risk for patients with cardiovascular diseases. That is why the treatment of erectile dysfunction, also with the use of Cialis, is not advised for men with the heart diseases with which sexual activity is not recommended.

It is advised to bear in mind a potential risk of aggravations in patients with cardiovascular diseases:

• myocardial infarction endured during the last 90 days;

• unstable stenocardia or the stenocardia emerged during sexual intercourse;

• cardiac insufficiency of class 2 and higher in terms of NYHA, having developed during the last 6 months;

• uncontrollable impairments of cordial rhythm, hypotension (with AP

• insult endured during the last 6 months. 

Cialis should be taken with care in patients predisposing for priapism (for instance with crescent-cell anemia, multiple myeloma or leukemia), or in patients with anatomic deformation of the penis (for instance, with angulation, cavernous fibrosis or Peironi disease). Untimely treatment of priapism leads to liaisons of the tissues of the penis, which may result in a long-standing loss of potency.  

There have not been studied safety and efficiency of the combination Cialis with other kinds of impairment of the erection function. That is why it is not recommended the use of such combinations.  

Influence of ability to guide automobile or use machinery:

There are no special prescriptions.  

Pharmacologic properties:

Tadalaphyl is an efficient, inversible selective inhibitor of a specific phosphodiesterasa of the 5th type (PDE5) cyclic guanosine monophosphate (cGMP). When sexual excitement provokes local liberation of oxide of nitrogen, inhibition of PDE5 by tadalaphyl results in the increase of the levels of cGMP in the cavernous body of the penis. In consequence of it there is relaxation of the smooth muscles of the arteries and reflux of blood to the tissues of the penis, which favors erection. Tadalaphyl does not give effect without sexual stimulation.  
 

Tadaklaphyl improves erection and the possibility of a successful sexual act. Cialis is effective during 36 hours. The effect appears already in 15 minutes after the intake of the medication if there is sexual excitement.  

Tadalaphyl does not induce an accurate change of the frequency of heartbeats.  

Tadalaphyl does not induce changes in color discrimination (blue/green). Moreover, the effect of tadalaphyl on vision, electroretinogram, intraocular pressure and dimension of the pupil is not observed.  

During investigations of tadalaphyl in men there have not been shown up clinically important influence of the medication on the quantity and concentration of the sperm, mobility and morphology of spermatozoids.  

Pharmacokinetic properties

After intake by mouth tadalaphyl is soaked quickly. Mean maximum concentration in the plasma is reached at average in 2 hours after the intake by mouth.

Speed and rate of soaking of tadalaphyl do not depend on food acceptance, that is why CIALIS may be taken regardless of food acceptance. The time of intake (morning or evening) does not give clinically important effect on speed and rate of soaking.

Metabolism

Tadalaphyl generally is metabolized with participation of isoferment (CYP)3A4 cytochrome Р450. The main circulating metabolite is methylcatecholglucuronid. This metabolite is at least 13000 times less active than tadalaphyl in respect of PDE5. Thus, it is unlikely that this metabolite in the observed concentrations is clinically significant.  

Elder people

Healthy people of advanced age (65 years old and more) have a lesser clearance with intake of tadalaphyl by mouth, which is expressed in the increase of the area under the curve “concentration-time” by 25% in comparison with healthy people of 19 through 45 years old. This difference is not clinically significant and not requires a special dosage.  
 

Impairment of the liver function

Pharmacokinetics of tadalophyl in people with weak and intermediate liver impairment is comparable with that in healthy persons. No need of special dosage for such patients.  

Patients with diabetes

In patients with diabetes against the use of tadalapnyl the area under the curve “concentration-time” is lesser by about 19% than the one in healthy persons. This difference does not require a special dosage.  

Expiry time: 2 years. Do not use it after the date indicated on the package.  

Storage conditions:

Store in the temperature under 10°С in the original package, out of reach of children.

IMPOTENCE AND AGING

It is normal to slow down sexually in later life but still be able to have intercourse. However, some older men suffer from impotence, chronic erection problems that make intercourse impossible. Impotence most often happens when the normal age-related slowing described earlier is compounded by medical conditions that prevent a man from having an erection full enough for intercourse. Among men over sixty, it is estimated that more than 70 percent of the time impotence has a primarily organic cause.
An erection occurs when the intricate web of blood vessels and blood-containing chambers in the penis becomes engorged. The blood flow into and out of the penis is regulated by hormones, nerves, and tiny valves. Any problem that affects the delicate erection mechanism has the potential to cause impotence: disorders affecting the blood vessels (arteriosclerosis, high blood pressure, diabetes); operations done in the pelvic area (bladder, prostate, or rectal surgery); injuries to the pelvic region and spine; diseases such as kidney ailments or multiple sclerosis.
Medications taken for high blood pressure, heart conditions, arteriosclerosis, depression, and anxiety may impair sexual performance. Alcohol is another drug that erodes sexuality. Drinking blocks the erection reflex. Chronic excessive drinking also has a long-term permanent inhibiting effect on sexual capacities because it damages the liver, suppresses the level of the male hormone testosterone, and affects circulation.
The answer to whether a given case of impotence is physical or psychological lies in sleep. Normally men have an erection every ninety minutes during the dreaming stage of sleep, called the REM (rapid eye movement) period. A device attached to the penis and worn for several nights can monitor whether erections do occur during this stage. If they do not occur or occur only partially, a man's impotence has a physical cause.
Great medical advances have recently been made in treating impotence. There are now erection-improving medications. (One muscle relaxant, Papaverine, when injected into the penis, can cause an erection lasting one to two hours). If the problem has to do with the blood vessels regulating blood flow into and out of the penis, surgery on the penile arteries may help keep the penis engorged. And there are devices that artificially support the penis, called penile implants.
Penile implants fit in the penis, producing an erection. There are three types. With the inflatable implant, a man pumps fluid from a reservoir in the abdomen to tubes in the penis when he wants an erection. The semi-rigid implant produces a permanent erection, one that is less firm than normal but usable for intercourse. Its advantage is that it is more economical and simpler to install than the pump. A third type of implant has been developed that combines the simplicity of the semi-rigid implant with the realism of the inflatable variety.
None of these treatments is a panacea. They vary in effectiveness, and they may produce complications. Still, depending on the cause of the problem, they may help tremendously.
If sexual difficulties concern you, have your problem diagnosed by a competent specialist – an urologist, an internist, or a psychiatrist who specializes in treating sexual problems. The physician you visit should give you a complete physical; take a careful sexual history; measure testosterone or other hormone levels; test your cholesterol and blood sugar; test for erections during sleep; and analyze whether penile circulation problems are to blame.
If your difficulty is found to have a psychological cause, you may be referred to a non-medical professional - a psychologist or social worker with special training in treating sexual disorders. The basic principle underlying the psychological treatment of impotence is to reduce the performance anxiety in sexual situations that inhibits an erection. To achieve this goal, couples are often told to take the following steps.
Make love with fingers and tongue but do not have intercourse. If lovemaking does not involve intercourse, then there are no expectations to perform.
When an erection occurs, do not have intercourse. The idea is to practice getting erections easily but keep down the anxiety involved in maintaining an erection for intercourse.
Concentrate on your own pleasure without considering your partner's needs. Because worrying excessively about the other person's feelings tends to inhibit arousal, these instructions help the person's natural responses to emerge.
In addition, a therapist may train a couple in relaxation techniques; teach them to utilize sexual fantasies; give them specific pleasure-enhancing tips. The approach used is tailored to what is likely to be most effective for the particular problem and people involved.

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