Notes

Dosage: how does Cialis work and how is it used?

Erectile dysfunction
Image representing blue padsTadalafil belongs to the class of phosphodiesterase type 5 (PDE5) inhibitors, which also includes Sildenafil (the active ingredient in Viagra). Type 5 phosphodiesterase is an enzyme that can hydrolyze a substance called cyclic GMP (cyclic guanosine mono phosphate or cGMP). It is present in the smooth muscle of the corpus cavernosum of the penis, visceral and vascular smooth muscle, skeletal muscle , platelets , kidneys , lungs and cerebellum .

The cells of the corpus cavernosum of the penis produce nitric oxide (NO) which, during sexual arousal, stimulates the formation of cyclic GMP . An increase in cyclic GMP in smooth muscle causes relaxation of the muscle fibers resulting in vasodilation. Treatment with a type 5 phosphodiesterase inhibitor increases the quantity and permanence of NO in situ and thus prolongs and accentuates this relaxation. The effect of tadalafil is more powerful

on PDE5 than on other phosphodiesterases. Tadalafil is 10,000 times more potent for PDE5 than for PDE1, PDE2 and PDE4, enzymes that are present in the heart, brain, blood vessels, liver and other organs. Tadalafil is 10,000 times more potent for PDE5 than for PDE3, an enzyme found in the heart and blood vessels. This selectivity for PDE5 over PDE3 is important because PDE3 is an enzyme involved in cardiac contractility.
Tadalafil has a longer duration of action than sildenafil and this allows for a single daily administration.

ATTENTION: Always take Cialis following your doctor 's instructions carefully . If in doubt, consult your doctor or pharmacist. The tablets are to be taken orally , regardless of food intake. If you forget to take the dose of cialis, take the dose as soon as you remember , but do not take a double dose to make up for the forgotten tablet. Do not take Cialis more than once a day.


Adult men
In general, the recommended dose is 10 mg taken before anticipated sexual activity and regardless of meals.
In those patients in whom a 10 mg dose of tadalafil does not produce an adequate effect, a 20 mg dose may be tried.
The medicine can be taken at least 30 minutes before sexual activity .
Do not exceed once daily dosing.
Cialis 10 mg and 20 mg should only be used firstof anticipated sexual activity and are not recommended for continuous daily use.

In patients who anticipate frequent use of Cialis (e.g., at least twice a week) it may be advisable to dosing once a day with the lowest dosages ( e.g. 5 mg taken once a day at approximately the same time of the day), based on the patient's choice and the doctor's judgment. The dose can be decreasedto 2.5 mg once daily based on individual tolerability. The appropriateness of continued use of the daily dosing schedule should be reassessed periodically .

시알리스 구입 is not required in the elderly , diabetics and patients with mild to moderate renal impairment .
In patients with severe renal impairment, the maximum recommended dose is 10 mg as needed, although administration is not generally recommended.
In patients with hepatic impairment, the recommended dose is 10 mg taken before anticipated sexual activity.
In patients with severe hepatic impairment, a careful risk-benefit assessment should be performed by the prescribing physician on a case-by-case basis.


BPH
The dose is one 5 mg tablet to be taken once a day at approximately the same time of day. In the case of benign prostatic hyperplasia and erectile dysfunction, the dose remains one 5 mg tablet to be taken once daily .

Pulmonary arterial hypertension
Pulmonary arterial hypertension is associated with an insufficient release of nitric oxide from the vascular endothelium and consequent reduction of cGMP concentrations within the pulmonary vascular smooth muscle. PDE5 is the predominant phosphodiesterase in the pulmonary vessels . Inhibition of PDE5 by tadalafil increases cGMP concentrations resulting in relaxation of the smooth muscle of the pulmonary vessels and vasodilation of the pulmonary vascular bed. In pulmonary arterial hypertension the recommended dose is 40 mg (2x20 g) taken once daily, with or
without food .

Overdose : Single doses up to 500 mg have been administered to healthy subjects, and multiple daily doses up to 100 mg have been administered to patients. Adverse events were similar to those seen at lower doses . In the event of an overdose, necessary standard supportive measures should be employed. Hemodialysis contributes negligibly to the elimination of tadalafil .
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