Principle of Action

Tadalafil is the main active ingredient of Cialis, one of the most popular drugs for erectile dysfunction (ED) today. This substance is responsible for the effect of Cialis on the male body. How is the effect of the drug achieved, which allows to improve potency and get rid of ED symptoms?
Tadalafil is one of the inhibitors of the PDE-5 enzyme. Medicines in this category inhibit (prevent) the production of the PDE-5 enzyme in a man’s body. This enzyme is responsible for stopping an erection.

The action of Tadalafil begins approximately 15-20 minutes after the drug enters the man’s body (that is, after taking the pill or another release form like oral gel or soft pills). It is important to note that Cialis itself, or rather, its active ingredient, doesn’t cause an erection. A more pronounced and prolonged erection than usual is observed only under the condition of sexual desire or sexual stimulation. This is due to the fact that Tadalafil does not affect the nerve centers in the brain, is not a drug or aphrodisiac. It only provides a significant decrease in the production of PDE-5 by stimulating an increase in the production of nitric oxide, which, in turn, leads to vasodilation in the penis and increased blood flow to the genital area, especially to the cavernous bodies of the penis. It is the cavernous bodies tissue which is targeted by PDE-5 inhibitors. This enzyme is also produced in a certain amount in the lungs, in skeletal muscles and large arteries, but the clinical effect of Tadalafil is mainly on the arteries in the penis.

Cialis positively differs from other drugs against erectile dysfunction in that the duration of its action is more than great: after a single dose, Tadalafil remains in the system for up to 36 hours. This property of Cialis has earned it the nickname “pill for the weekends”. In addition, another remarkable property of Cialis is that it can be taken on a regular basis, right up to the daily dosage regimen. In the dose range from 2.5 to 20 mg, the area under the concentration-time curve (AUC) increases in proportion to the dose. Equilibrium plasma concentrations are achieved within 5 days when the drug is taken once a day. The pharmacokinetics of Tadalafil in patients with erectile dysfunction is similar to the pharmacokinetics of the drug in patients without any problems with potency.

Indications for Use

Tadalafil is indicated primarily for erectile dysfunction. However, in addition, this medicine is also used in the treatment of benign prostatic hyperplasia (BPH). This disease very often goes hand in hand with erectile dysfunction, while all other PDE-5 inhibitors, except for Tadalafil, are not recommended for BPH. Thus, to date, Cialis is the only option available to patients suffering from both erectile dysfunction and prostate adenoma. With prostate adenoma, Tadalafil is usually prescribed to be taken every day in a small dosage (most commonly, 5 mg, less often 10 mg). Tadalafil received FDA approval as a drug that can be officially used in the treatment of benign prostatic hyperplasia in 2012, that is, almost ten years after approval as an anti-erectile dysfunction drug.

A more detailed study of the instructions for Tadalafil shows that this medicine is also prescribed in case of symptoms of the lower urinary tract in patients with benign prostatic hyperplasia (BHP) and in the presence of erectile dysfunction in patients with symptoms of the lower urinary tract against the background of benign prostatic hyperplasia.

Contraindications for Use

The main contraindication to taking Tadalafil is the simultaneous administration of drugs containing any organic nitrates, and the presence of contraindications to sexual activity. The latter is usually observed in patients with diseases of the cardiovascular system, including myocardial infarction or stroke in the past six months, unstable angina pectoris, the occurrence of an attack of angina pectoris during intercourse, chronic heart failure class II or higher according to the NYHA classification, uncontrolled arrhythmias, severe arterial hypotension, uncontrolled arterial hypertension. It is prohibited to combine Tadalafil with nitrates because of the additive effect of nitrates and tadalafil on the metabolism of nitric oxide and cGMP, which causes an enhanced hypotensive effect.

It is not recommended to take Tadalafil for patients who have a history of vision loss because of non-arterial anterior ischemic neuropathy of the optic nerve.
Taking Tadalafil should not be combined with the therapy using other PDE-5 inhibitors, as well as other options for the treatment of erectile dysfunction, including drugs for intracavernous injections.

Among the contraindications for Tadalafil, which are mentioned less often, one can note severe chronic renal failure, age up to 18 years, lactase deficiency, lactose intolerance, glucose-galactose malabsorption, as well as hypersensitivity to tadalafil or to any auxiliary substance that is part of Cialis composition. Despite the fact that Tadalafil is not recommended for patients with severe chronic renal failure (with creatinine clearance less than 30 ml/min), dose adjustment is not required in patients with mild to moderate renal failure.

In addition to absolute contraindications, there are also relative ones. Care must be taken when prescribing Tadalafil to patients with severe hepatic impairment. The simultaneous use of alpha1-blockers and Tadalafil can lead to symptomatic arterial hypotension, therefore, such patients need medical supervision. Of the selective alpha1-blockers, the drug tamsulosin shows the best compatibility with Tadalafil.

Tadalafil should be used with caution in patients with a predisposition to priapism, which can occur with sickle cell anemia, multiple myeloma or leukemia, as well as in patients with anatomical deformities of the penis. These include angular curvature, cavernous fibrosis, and Peyronie’s disease. Despite the fact that such cases are very rare, the use of PDE-5 inhibitors, including Tadalafil, can cause an attack of priapism, mainly if there is a predisposition to this condition. It is important to remember that if, after taking Cialis, an erection occurs that lasts four hours or more without interruption, it is necessary to urgently seek medical help in order to avoid the development of necrosis of the tissues of the penis and irreversible erectile dysfunction.

As for the compatibility of Tadalafil with other drugs, medical supervision is necessary while taking this medication with inhibitors of the isoenzyme CYP3A4 (these include ritonavir, saquinavirum, ketoconazole, itraconazole, clarithromycin, erythromycin, and, oddly enough, grapefruit juice), antihypertensive drugs and 5-alpha-reductase inhibitors.
By itself, the elderly age of patients does not require any dose adjustment. An individual approach is required by patients of any age who have concomitant diseases that impose certain restrictions on the intake of Tadalafil and other PDE-5 inhibitors.

Discounted Branded Cialis Cost

The prices for branded Cialis do not please men suffering from potency disorders. The onset of2021 and the change of government in the United States were marked by another rise in the price of drugs, including drugs to combat erectile dysfunction. One 20 mg pill of Cialis can cost up to $70 or more. If you imagine that it is advisable to take Cialis at least three times a week for men with severed ED, more than an impressive amount runs up. Other dosage options for branded Cialis – 5 and 10 mg – cost a little cheaper, about $15 and $40, respectively, but still hit the pocket a lot.

Nevertheless, there are quite real ways to buy branded Cialis at more affordable prices. The most basic of these is the use of discount coupons that are offered by specialized aggregator sites. In this way, you can save up to 50% of the cost of the original Cialis, although significantly more often, of course, there are much more modest discounts. The disadvantage of this method is that at the moment when you need the medicine, you may not find an active coupon, all the more one offering a solid discount.
Discounts can be offered not only by third-party services, but also by the pharmacies themselves where you buy Cialis. This is especially true for online pharmacies, but ordinary local pharmacies quite often hold various promotions and reduce prices for PDE-5 inhibitors. Traditionally, the best prices for remedies to increase potency are observed around Valentine’s Day.

Promo codes are another option for getting a discount on Cialis, but usually it does not exceed 20% of the initial amount and cannot be combined with coupons or own discounts of a particular pharmacy.

Generic Cialis Cost

Buying generic Cialis is the best option to save money for those men who are not tied to loud labels and names. The cost of generics is several times less than the cost of branded Cialis, while modern generics are almost never inferior to their prototype in quality, and sometimes even surpass it.

Not all Cialis generics are very cheap, but all of them are somehow much cheaper than the branded medicine. A large selection of countries and manufacturing companies allows a man to choose the best option for himself in terms of dosage, cost, form of drug release, its quality and reputation.

Traditionally, the most affordable generics are produced in India. The country is leading the way in generics, and ED drugs are no exception. Generics of Cialis produced by Indian companies such as Centurion Laboratories, Dr. Reddy’s, Rakshit Pharmaceuticals Limited and many others enjoy impeccable reputations and are available at ridiculous prices compared to the original drug. One 20 mg pill of Tadalafil can cost the buyer about $1, especially if you buy a lot of pills at the same time. In addition to traditional pills, Indian manufacturers offer Tadalafil release options such as soft tablets, oral gel and even capsules. Dosages also vary, and consumers can choose 2.5 mg, 15 mg or 40 mg besides ordinary dosages. All Indian generic PDE-5 inhibitors are available without a doctor’s prescription.

Not the cheapest, but impeccably quality generics are made in Canada. One 20 mg Tadalafil pill will cost you about $2-4, and Canadian pharmacies rarely require a prescription.
Medium-priced, but beneficial in quality and reliable generics of Cialis are produced in many other countries, including Hungary, Slovakia, Austria, Poland, Malaysia, Australia. The most expensive versions of Tadalafil are made in the United States and Israel. They are only 40-50% cheaper than the original drug, which makes purchasing them not the most attractive option. In addition, in most cases, you need to have a prescription from a doctor to buy them.