Tadalafil went through 3 phases of clinical trials during 1994 - 2003. After that, it was approved by the FDA and EMA for the treatment of ED in men and within a few years won over about 40% of the market from its main competitor, Viagra.

The main advantages of Cialis turned out to be:

• longer duration of action (up to 36 hours)
• more selective action in relation to PDE5, which reduced the frequency of side effects
• a wide range of dosages for men of different ages with varying degrees of ED severity
• the possibility to use it even when you consume alcohol
• maintenance of 100% effectiveness even when taken after meals

Penis erection. How it works?

To get a better understanding of the pharmacological properties of how much Cialis costs, first you need to understand how erection appears.

Penis erection is a biochemical process that stimulates a reflex in the muscle fibers of the penis.

Sexual stimulation (visual, tactile, etc.) activates the parasympathetic nervous system. This results in the release of nitric oxide, which stimulates the endothelium (inner wall) of the vessels of the corpora cavernosa and relaxes the smooth muscle fibers of the walls of the arteries and cavernous bodies.

This makes the arteries dilate and increases blood flow to the corpora cavernosa. Their extension provokes compression of the veins and blockage of the blood outflow from the penis. Maintaining high pressure in the blood vessels gives the penis hardness, increase in volume and stiffness - in simple words, an erection process occurs.

If one of the erection processes is impaired, man has erectile dysfunction. As a rule, impairment is caused by the enzyme PDE5, which blocks the action of nitric oxide and prevents the expansion of arterial vessels. Insufficient blood flow to the penis does not allow for a normal erection to manifest.

For this reason, the PDE5 inhibitors have been created, such as Cialis, which are able to block this enzyme and restore the natural erection process.

It should be noted that there is a big difference between Erectile Dysfunction and Impotence.

• Erectile dysfunction is a partial loss of erection or inability to maintain a strong erection during an intercourse
• Impotence is an irreversible pathological condition with total loss of erection.

That is why, with the appearance of the first ED symptoms and disturbances in the processes in the blood vessels, you need to begin a comprehensive treatment of pathology.

Pharmacological action of Tadalafil

Thesis description of the pharmacological properties of Tadalafil:

• within 30 minutes from the pill intake, the active substances are completely absorbed from the gastrointestinal tract into the blood and stimulate the increased activity of nitric oxide,
• under the action of the drug, a more pronounced relaxation of the walls of arterial vessels occurs and increases blood flow to the corpora cavernosa,
• the principle of action of all PDE5 inhibitors is not only to stimulate an erection, but also to maintain it until ejaculation,
• the half-life of Tadalafil is about 17-18 hours.

The activity of the active ingredients lasts up to 36 hours. This does not mean that you will have an erection during this entire period. This means that within 36 hours, you will have a natural erectile response, when sexually stimulated. There will be no difficulties in achieving and maintaining an erection. Naturally, there will be no erection in the absence of arousal.

Should I expect increased sexual arousal?

Tadalafil drug enhances exclusively the mechanical processes in the pelvic organs and does not affect libido and the level of male sex hormones. As you know, sexual arousal is a psychological and hormonal process.

Despite a common misconception, Tadalafil cannot increase arousal in men. It is solely intended to neutralize the symptoms of ED.

Dosage and dosing regimen. Official instruction and personal experience of men

Cialis is available in diamond-shaped yellow tablets.

But since the patent protection of Tadalafil expired, there are over 30 manufacturers of Cialis (Adcirca) in the world, and some of them are located in India. Thus, drugs can have different dosage forms, and this should not mislead potential buyers. Cialis pills come in doses of 2.5 mg, 5 mg, 10 mg, 20 mg and 40 mg.

• Low doses of Cialis 2.5 mg and 5 mg are intended for everyday use.
• Higher doses of Cialis 10 mg, 20 mg and 40 mg are prescribed for the spontaneous treatment of ED in men with psychogenic or organic ED types. Simply put, they should be taken just before intercourse to enhance erection.
• The tablets should be taken at least 20 minutes before intercourse with a full glass of water.
• Food does not affect the rate of Cialis dissolution in the gastrointestinal tract, so you can take it after meals.

For more detailed dosage information, see the table below:

	Cialis 2,5 mg and 5 mg	Cialis 10 mg	Cialis 20 mg	Cialis 40 mg
How long does 1 tablet last	Up to 26 hours	36 hours	36 hours	36-40 hours
Dosing interval	Every 20-24 hours	No more than once in 24 hours	No more than once in 24 hours	No more than once in 36 hours
Can I take it with alcohol?	Yes	Yes	Only with small amount of light alcohol	Not recommended

After reviewing the feedbacks of men on popular social platforms, we can provide some important recommendations that they share based on their experience:

• The dosage of 2.5 mg and 5 mg takes effect after 2 hours. Therefore, take the drug in advance, and preferably daily if you have chronic ED.
• It is better to take the medication on an empty stomach, since the action onsets faster, and moreover, the risk of flatulence and indigestion reduces.
• It is better not to take doses higher than 10 mg if you take alcohol. Otherwise, headache and dizziness are possible.

PDE5 inhibitors: comparison of characteristics

Cialis is not the only drug that can be taken to treat ED. In addition to Tadalafil, the FDA approved 2 more PDE5 inhibitors that have similar pharmacological characteristics:

• Vardenafil (brand name Levitra)
• Sildenafil (brand name Viagra)

Each of these drugs went through clinical trials, during which different options for the use of these drugs in different groups of men were proposed.

• Sildenafil is suitable for men under 60, who suffer from severe ED.
• Vardenafil is ideal for men under 70, as it does not cause stress on the cardiovascular system.
• Tadalafil is ideal for continuous use thanks to the availability of tablets for “daily use” with a small dosage, as well as a long period of action.

You can learn more details in the following table:

	Tadalafil (Cialis)	Sildenafil (Viagra)	Vardenafil (Levitra)
Available dosages	2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg	25 mg, 50 mg, 100 mg	5 mg, 10 mg, 20 mg
Time of the action onset	40 minutes	60 minutes	25 minutes
Duration of action	36 hours	4-5 hours	Up to 6 hours
Can it be used with alcohol?	Yes	No	No
Does food intake affect the rate of the action onset?	No	Yes	No
Maximum patients’ age	70 years	60 years	70 years
Does it increase blood pressure?	No	Yes	No

Regardless of men's choice, each of these drugs has its own positive characteristics. Therefore, the choice of a drug for the treatment of ED depends solely on the disease pattern.

Side effects

We have prepared a special table, which helps learn more about the most common side effects of Cialis.

Mild side effects: no doctor's help needed	Moderate side effects: consult with your doctor	Severe side effects: require treatment discontinuation and prompt medical attention
Headache	Back pain	Pain in the region of the heart
Dizziness	Migraine	Severe dizziness and loss of coordination
Nasal congestion	Redness of the face	Allergic reaction
Cough	Tachycardia	Loss of vision or hearing
	Nose bleeding	Sudden weakness and numbness in the limbs
	Muscle pain

• Keep in mind! Manifestation of side effects indicates that this regimen of Cialis use is not suitable for you. You need to either reduce the dose of the drug or ask your doctor why these symptoms appeared and how to avoid them.

Precautions. What to watch out for?

Tadalafil does not cause drug dependence or tolerance and is absolutely safe if precautions are taken. As a rule, side effects are the result of an overdose or non-compliance with contraindications. They are all divided into degrees of importance.

Absolute contraindications (in which you should never use this drug):

• allergic reaction to Tadalafil
• age less than 18 and more than 70 years
• heart failure
• ischemic heart attack or stroke within the past 6 months
• angle-closure glaucoma

Below is the list of other contraindications, in which you can take Cialis subject to certain precautions under a doctor’s supervision:

• arterial hypertension,
• tachycardia, arrhythmia,
• liver/kidney disease,
• stomach ulcer.

With these diseases, it is necessary to adjust Tadalafil dosage in order to exclude side effects. As a rule, patients are prescribed low doses of 2.5 mg, 5 mg, or 10 mg. Their effectiveness is high enough to boost erection, and they do not cause an increase in blood pressure and other side effects.

Drug interactions. What you should avoid when using Tadalafil:

• Tadalafil should not be taken with other PDE5 inhibitors: Sildenafil (Viagra), Vardenafil (Levitra), as this can provoke an overdose.
• It is strictly forbidden to use Tadalafil with organic nitrates: nitroglycerin.
• It is not recommended to use isosorbide mononitrate and isosorbide dinitrate in conjunction with Tadalafil, as this can cause a decrease in blood pressure and hypotension.

Which PDE5 inhibitors are officially allowed for use with alcohol

Patients who take PDE5 inhibitors on an ongoing basis are forced to limit their alcohol intake. There is a number of explanations for this:

• alcohol slows down the natural reaction of the nervous system,
• ethanol dulls sensations and, despite the degree of arousal, it is more difficult to achieve an erection,
• alcohol consumption increases blood pressure and makes blood thicker.

Therefore, if you plan on taking erectile dysfunction medications after a party or event where you plan to consume alcohol, choose Cialis.

Tadalafil is officially allowed to be taken with alcohol or in a state of mild alcoholic intoxication. It does not increase blood pressure, does not increase the load on the heart muscle. Therefore, the risk of side effects is significantly lower than that of other PDE5 inhibitors.

However, some precautions still do exist, such as:

• do not take Tadalafil in the state of severe alcohol intoxication
• take the minimum dose if you consumed alcohol

Treatment of prostatic hyperplasia. What role does Tadalafil play?

Benign prostatic hyperplasia is an inflammatory chronic disease of the prostate gland, manifested by specific clinical symptoms: pain, urinary disorders, changes in the sexual sphere, psychological abnormalities. Specialized treatment of this disease includes the use of anti-inflammatory drugs.

However, PDE5 inhibitors also play an important role in the treatment of this pathology. By improving blood circulation in the vessels of the pelvic organs, Tadalafil helps to reduce the inflammatory response and eliminate a number of symptoms.

As a rule, when taking Tadalafil, the following is traced: improvement of erectile function, reduction of the inflammatory process, reduction of pain when urinating, reduction of urinary frequency.

Diabetic patients taking Tadalafil notice a significant improvement in the disease symptoms 2 times faster than when taking only anti-inflammatory drugs.

Use of Tadalafil for the treatment of BPH does not require a special regimen. In the treatment of prostatic hyperplasia, the most convenient dosage form of the drug is 1 tablet of 2.5 mg or 5 mg per day, for 2-3 months. Symptoms of the disease disappear gradually, within 3-4 weeks.