8 USE IN SPECIFIC POPULATIONS

drospirenone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Cialis generic name: Tadalafil

topiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. torsemidetadalafil increases effects of torsemide by pharmacodynamic synergism. tadalafil increases effects of torsemide by pharmacodynamic synergism. trandolapriltadalafil increases effects of trandolapril by pharmacodynamic synergism. tadalafil increases indian cialis generic effects of trandolapril by pharmacodynamic synergism.

Food, drink and alcohol with tadalafil

triamterenetadalafil increases effects of triamterene by pharmacodynamic synergism. tadalafil increases effects of triamterene by pharmacodynamic synergism. valsartantadalafil increases effects of valsartan by pharmacodynamic synergism. tadalafil increases effects of valsartan by pharmacodynamic synergism. Comment: Avoid combination; duplicate therapy is not recommended. larotrectiniblarotrectinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

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larotrectinib will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

14.1 CIALIS for Use as Needed

verapamilverapamil will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. verapamil will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. voriconazolevoriconazole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. voriconazole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. zafirlukastzafirlukast will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Oral Administration

zafirlukast will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. acetazolamideacetazolamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. acetazolamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozoleanastrozole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozole will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ranolazineranolazine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

Medication Class	Interaction Type	Effect	Notes
Nitrates	Dangerous	Severe blood pressure drop	Avoid combining with Cialis
Alpha-blockers	Caution	Potential for hypotension	Use at lowest effective dose
Antifungals (e.g., Ketoconazole)	Increased Tadalafil levels	Possible side effects	Adjust dosage if needed
Blood Pressure Medications	Additive effects	Lowered blood pressure	Monitoring recommended
CYP3A4 inhibitors	Prolonged Tadalafil action	Increased risk of side effects	Dose adjustment required

Ranolazine may theoretically increase plasma concentrations of CYP3A4 substrates, such as tadalafil.

• The font used for the "C" and "10" imprint is specific to the manufacturer.
• Generic versions must have a different imprint to avoid trademark infringement.
• This helps pharmacists and patients identify the product and its strength.
• Pill identification tools are available online using these imprints.
• The tablet's dimensions are approximately 9.0 mm x 7.5 mm.
• The film coating ensures easy swallowing and masks any bitter taste.
• The excipients (inactive ingredients) are necessary for tablet formation.
• These include fillers, binders, disintegrants, and lubricants.
• Lactose is a common filler; those with lactose intolerance should be aware.
• The manufacturing process involves blending, granulation, compression, and coating.
• Each step is rigorously controlled to ensure product quality and safety.
• Final products are tested for dissolution rate to ensure proper absorption.

ranolazine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

• 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.

Visual field defect, retinal vein occlusion, retinal artery occlusion, and non–arteritic anterior ischemic optic neuropathy (NAION) Hypersensitivity, including Stevens-Johnson syndrome and exfoliative dermatitis Guanylate cyclase (sGC) stimulators (eg, riociguat); concomitant use can cause hypotension Coadministration with nitrates (either regularly and/or intermittently) and nitric oxide donors Do not use nitrates within 48 hr of the last dose of macitentan/tadalafil This potentiation is thought to result from the combined effects of nitrates and tadalafil on the nitric oxide/cGMP pathway The potentiation is consistent with the effects of PDE5 inhibition on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway Use caution in patients with anatomic deformation of penis, cardiovascular disease, left ventricular outflow obstruction, myocardial infarction in preceding 90 days, unstable angina, angina occurring during sexual intercourse, NYHA class 2 or greater heart failure in preceding 6 months, uncontrolled arrhythmias,

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

hypotension, uncontrolled hypertension, cerebrovascular accident in preceding 6 months, bleeding disorders, active peptic ulcer disease, liver disease, renal impairment, conditions predisposing to priapism, concomitant use of CYP3A4 inhibitors May cause dose-related impairment of color discrimination; use caution in patients with retinitis pigmentosa Evaluate underlying causes of erectile dysfunction or BPH before initiating therapy Do not use nitrates within 48 hours of last dose of tadalafil Drug has vasodilatory

Brand Name

tadalafil increases effects of terazosin by pharmacodynamic synergism. tetracyclinetetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. timololtadalafil increases effects of timolol by pharmacodynamic synergism. tadalafil increases effects of timolol by pharmacodynamic synergism.

Stomach acid drugs

tipranavirtipranavir will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tipranavir will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tobramycin inhaledtobramycin inhaled and tadalafil both increase nephrotoxicity and/or ototoxicity. Avoid concurrent or sequential use to decrease risk for ototoxicity tobramycin inhaled and tadalafil both increase nephrotoxicity and/or ototoxicity. Avoid concurrent or sequential use to decrease risk for ototoxicity topiramatetopiramate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. properties that may result in transient decreases in blood pressure; prior to prescribing, carefully consider whether patients with underlying cardiovascular disease could be affected adversely by such vasodilatory effects; patients with preexisting hypotension, with autonomic dysfunction, with left ventricular outflow obstruction, may be particularly sensitive to actions of vasodilators When used to treat erectile dysfunction, non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss

Aspect	Description	Common Uses	Key Benefits
Active Ingredient	Tadalafil	Erectile Dysfunction	Longer-lasting effects
Dosage	10 mg per tablet	BPH (Benign Prostatic Hyperplasia)	Once daily or as needed
Onset of Action	Typically within 30-60 minutes		Fast relief
Duration of Effect	Up to 36 hours		Extended window of efficacy
Approval Year	2003		FDA approved

of vision, reported postmarketing; if vision problems arise, discontinue, and contact physician CYP3A4 inhibitors (eg, erythromycin, ketoconazole, itraconazole, indinavir, ritonavir) may significantly increase tadalafil serum levels CYP3A4 inducers (eg, rifampin, St John’s wort) may decrease tadalafil serum levels Potentiates hypotensive effect of nitrates (see Contraindications) Concomitant use with alpha blockers (other than tamsulosin 0.4 mg/day) should be stabilized before initiation of phosphodiesterase (PDE)-5 inhibitors; patients with instability on alpha-blocker therapy alone are at increased risk for symptomatic hypotension with concurrent PDE-5 inhibitor therapy Not to be taken with other PDE-5 inhibitors (eg, sildenafil, vardenafil) Not recommended in patients with pulmonary veno-occlusive disease Advise patients to seek emergency treatment if an erection lasts >4 hr Limited data from case series with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or

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tadalafil increases effects of spironolactone by pharmacodynamic synergism. St John's WortSt John's Wort will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. St John's Wort will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. tecovirimattecovirimat will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

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Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. tecovirimat will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. telmisartantadalafil increases effects of telmisartan by pharmacodynamic synergism. tadalafil increases cheap cialis soft tabs effects of telmisartan by pharmacodynamic synergism. terazosintadalafil increases effects of terazosin by pharmacodynamic synergism. adverse maternal or fetal outcomes Pregnant women with untreated pulmonary arterial hypertension are at risk for heart failure, stroke, preterm delivery, and maternal and fetal death In animal reproduction studies, no adverse developmental effects were observed with oral administration to pregnant rats or mice during organogenesis at exposures 7 times the exposure at maximum recommended human dose (MRHD) of 40 mg/day based on AUC There are no data on presence of drug and/or its metabolites in human milk, effects on breastfed child, or on milk production; drug and/or its metabolites are present in milk of lactating rats at concentrations approximately 2.4-times that found in the plasma; when a drug is present in animal milk, it is likely that the drug will be present in human milk Controlled studies in pregnant women show no evidence of fetal risk. Erectile dysfunction: Inhibits PDE-5, increasing cyclic guanosine monophosphate (cGMP) to allow smooth-muscle relaxation and inflow of blood into corpus cavernosum Pulmonary arterial hypertension (PAH): Inhibits PDE-5, increasing cGMP to allow relaxation of pulmonary vascular smooth-muscle cells and vasodilation of pulmonary vasculature Peak plasma time: Erectile dysfunction, 0.5-6 hr; PAH, 2-8 hr Vd: Erectile dysfunction, 63 L; PAH, 77 L Half-life: Erectile dysfunction, 15-17.5 hr; PAH (not on bosentan), 35 hr Total body clearance: Erectile dysfunction, 2.5 L/hr; PAH (not on bosentan), 1.6 L/hr Erectile dysfunction (PRN use): Take before anticipated sexual activity Erectile dysfunction

• The environmental impact of pharmaceutical excretion is a concern.
• Trace amounts of Tadalafil can be found in wastewater.
• Its effects on aquatic life are not fully understood.
• Advanced water treatment plants can remove a significant portion.
• Proper disposal of unused medication helps minimize environmental contamination.
• The synthesis of Tadalafil is a multi-step chemical process.
• The starting material is often D-tryptophan methyl ester.
• The manufacturing process is subject to strict Good Manufacturing Practice (GMP).
• Quality control ensures each tablet contains the precise 10mg dose.
• Stability testing determines the shelf life of the product.
• Packaging is designed to protect the tablets from moisture and light.
• Batch numbers and expiration dates are printed on every package.

(once-daily use): Take at approximately same time each day without regard to timing of sexual activity Shake well for 30 seconds before measuring dose Take with or without food or water Do not split or break a chewable tablet because this may result in a dose below the minimum therapeutic dose or greater than the maximum recommended dose, which may increase risk of adverse effects Tablets, chewable tablet, oral suspension: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) Adding plans allows you to compare formulary status to other drugs in the same class.

7. Interactions

cyclophosphamidecyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. cyclophosphamide will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. danazoldanazol will increase buy cialis uk cheap the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. danazol will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. drospirenonedrospirenone will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism.