LEVITRA is a prescription medicine that is used to treat erectile dysfunction (ED). Men taking nitrate drugs, often used to control chest pain (also known as angina), should not take LEVITRA. Such combinations could cause blood pressure to drop to an unsafe level.

As with all ED drugs, there is a rare risk of an erection lasting longer than four hours. To avoid long-term injury, seek immediate medical attention. LEVITRA does not protect against sexually transmitted diseases. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicine, including LEVITRA) reported a sudden decrease or loss of vision in one or both eyes, or a sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience any of these symptoms, stop taking PDE5 inhibitors, including LEVITRA, and call a doctor right away.

Discuss your medical conditions, including heart problems, and medications, including alpha blockers prescribed for prostate problems or high blood pressure, with your doctor to ensure LEVITRA is right for you and that you are healthy enough for sexual activity. LEVITRA is not recommended for men with uncontrolled high blood pressure.

The starting dose of LEVITRA is 10 mg taken no more than once per day. Your doctor will decide the dose that is right for you. In patients taking alpha blockers, your doctor may start you on a lower dose of LEVITRA. In patients taking certain medications such as ritonavir, indinavir, saquinavir, atazanavir, ketoconazole, itraconazole, erythromycin and clarithromycin, lower doses of LEVITRA are recommended, and time between doses of LEVITRA may need to be extended.

In clinical trials, the most commonly reported side effects were headache, flushing, and stuffy or runny nose. LEVITRA is available in 2.5-mg, 5-mg, 10-mg, and 20-mg tablets.

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Generic Name: tadalafil (tah DAL a fil)
Brand Names: Cialis

What is Cialis?
Cialis relaxes muscles and increases blood flow to particular areas of the body. Cialis is used to treat erectile dysfunction (impotence). Cialis may also be used for purposes other than those listed in this medication guide.

Before taking Cialis
Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (”poppers”). Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

Before taking Cialis, tell your doctor if you are allergic to any drugs, or if you have:

•       heart disease or heart rhythm problems;
•       a recent history a heart attack (within the past 90 days);
•       a recent history of stroke or congestive heart failure (within the past 6 months);
•       angina (chest pain);
•       high or low blood pressure;
•       liver disease;
•       kidney disease (or if you are on dialysis);
•       a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
•       a bleeding disorder such as hemophilia;
•       a stomach ulcer;
•       retinitis pigmentosa (an inherited condition of the eye);
•       a physical deformity of the penis (such as Peyronie’s disease); or
•       if you have been told you should not have sexual intercourse for health reasons.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Cialis.

This medication can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Cialis, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Cialis is the actual cause of vision loss. Stop using Cialis and get emergency medical help if you have sudden vision loss.

FDA pregnancy category B: Although Cialis is not for use in women, this medication is not expected to be harmful to an unborn baby. Do not use Cialis without telling your doctor if you are pregnant or plan to become pregnant during treatment. Although Cialis is not for use in women, it is not known if Cialis passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. You may need a lower dose of this medication if you are older than 65. Follow your doctor’s instructions.

What happens if I miss a dose?
Since Cialis is used as needed, you are not likely to be on a dosing schedule.

What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.
What should I avoid while taking Cialis?
Avoid drinking alcohol, which can increase some of the side effects of Cialis.

Grapefruit and grapefruit juice may interact with Cialis. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.

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How Cialis works:
When an erection goes limp, you have PDE5 to thank. Specialized penis tissue produces a substance called cyclic guanosine monophosphate (cGMP) in response to sexual stimulation. The more cGMP available, the more durable the erection. Cialis inhibits the PDE5 enzyme, preserving cGMP levels, therefore aiding erection viability and durability.

• Cialis was developed by Icos, a relatively small biotech company located in Washington State, in the United states. Icos has formed a 50/50 joint venture with American Pharmaceutical Giant, Eli Lilly & company. The partnership is called Lilly Icos.
• Cialis is known as the ” 36 hour pill” or the “weekend pill” because unlike other similar drugs, Cialis has a long duration of action.
• Cialis received approval for use in the United States November 21, 2003.
• Cialis is a member of a family of drugs known as PDE5 enzyme inhibitors.
• Cialis is a member of a family of drugs called PDE5 Inhibitors. Cialis is now marketed in approximately 40 countries and is available by prescription in pharmacies on five continents.
• Cialis blocks an enzyme that causes an erection to go flaccid. Although Cialis is similar to Levitra and Viagra, its dose, onset of action, and duration of action is unique.

Some very smart scientists discovered that cyclic guanosine monophosphate (cGMP) was the key to sustaining an erection. They discovered that when a man gets sexually stimulated, a chain reaction occurs in the tissue of the penis that results in elevated levels of a substance called cyclic guanosine monophosphate (cGMP). As long as there are sufficient levels of cGMP, the penis can remain erect. The more cGMP, the more robust and durable the erection. If you inhibit the degradation of cGMP it stays around in the penis longer, producing a more durable erection. Another way you can think of Cialis (and all other similar medicines) is that it preserves the elevated levels of cGMP that are created when a man is sexually stimulated for a stronger, more lasting erection.

That’s how Cialis works - Cialis blocks the enzyme phosphodiesterase-5 (PDE5) which is responsible for the neutralization of cGMP. Cialis (tadalafil) is a highly selective inhibitor of PDE5. (PDE5 is not the only phosphodiesterase involved in the erectile physiology but it appears to be the most important one). The nice thing about PDE5 blockers is that they shouldn’t cause erections at inappropriate times because they only block degradation of cGMP produced in reaction to sexual stimulation, such as thinking about something sexy. If you are not being sexually stimulated, there is no cGMP to protect, so the drug remains in the background.

Dose:
Cialis is available 10mg and 20mg tablets. The recommended dose is 10mg taken prior to anticipated sexual activity and without regard to food. In those patients in whom tadalafil 10mg does not produce an adequate effect, 20mg might be tried. It can be taken from 30 minutes to 12 hours prior to sexual activity. The efficacy of tadalafil may persist up to 24 hours post-dose.
The maximum recommended dose is one pill per day.

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