Contraindications Cialis tablets 20mg

 

Hypersensitivity to tadalafil or to any substance that is part of the drug: -in the case of taking drugs containing any organic nitrates; use in persons under 18 years of age; the presence of contraindications to sexual activity in patients with diseases of the cardiovascular system: myocardial infarction within the last 90 days, unstable angina pectoris or the occurrence of an attack of angina pectoris during intercourse, chronic heart failure class II and higher according to the NYHA classification during the last 6 months, uncontrolled arrhythmias, arterial hypotension (blood pressure less than 90/50 mm Hg). uncontrolled arterial hypertension, ischemic stroke within the last 6 months;loss of vision due to non-arterial anterior ischemic optic neuropathy (regardless of the connection with the previous intake of PDE-5 inhibitors); simultaneous use with doxazosin, with other PDE-5 inhibitors, with other treatment options for erectile dysfunction, with guanylag cyclase stimulants such as riociguat; use in patients with chronic renal failure (creatinine clearance less than 30 ml / min); lactase deficiency, lactose intolerance, glucose-galactose malabsorption. Carefully. Since there is insufficient data on patients with severe hepatic impairment (class C according to the Child-Pugh classification), caution must be exercised when prescribing Cialis to this group of patients. Care must be taken when prescribing Cialis to patients taking alpha adrenergic blockers,since the simultaneous use of these drugs can lead to symptomatic arterial hypotension. In two clinical pharmacology studies in 18 healthy volunteers taking tadalafil, symptomatic arterial hypotension was not observed when used simultaneously with tamsulosin, a selective alpha blocker. Cialis should be used with caution in patients with a predisposition to priapism (with sickle cell anemia, multiple myeloma or leukemia) or in patients with anatomical deformity of the penis (angular curvature, cavernous fibrosis or Peyronie's disease). You should also be careful while taking with inhibitors of the isoenzyme CYP3A4 (ritonavir, saquinavir, ketoconazole, itraconazole, clarithromycin, erythromycin, grapefruit juice), antihypertensive drugs,5-alpha reductase inhibitors. Application during pregnancy and lactation. Cialis is not intended for use in women. So its preferable to 시알리스 구매

pharmachologic effect

Pharmacodynamics. Tadalafil is an effective, reversible selective inhibitor of the specific phosphodiesterase type 5 (PDE-5) cyclic guanosine monophosphate (cGMP). When sexual arousal causes a local release of nitric oxide, inhibition of PDE5 by tadalafil leads to an increase in the concentration of cGMP in the corpus cavernosum of the penis. The consequence of this is relaxation of the smooth muscles of the arteries and blood flow to the tissues of the penis, which causes an erection. Tadalafil has no effect in the absence of sexual arousal. In vitro studies have shown that tadalafil is a selective PDE-5 inhibitor. PDE-5 is an enzyme found in the smooth muscles of the corpus cavernosum, in the smooth muscles of the vessels of the internal organs, in skeletal muscles, platelets, kidneys, lungs and cerebellum.The effect of tadalafil on PDE-5 is more active than on other phosphodiesterases. Tadalafil is 10,000 times more active against PDE-5 than against PDE-1. PDE-2, PDE-4 and PDE-7, which are localized in the heart, brain, blood vessels, liver, leukocytes, skeletal muscles and other organs. Tadalafil is 10,000 times more active in blocking PDE-5 than PDE-3, an enzyme found in the heart and blood vessels. This selectivity for PDE-5 over PDE-3 is important because PDE-3 is an enzyme involved in cardiac muscle contraction. In addition, tadalafil is about 700 times more active against PDE-5. than with respect to PDE-6, found in the retina and is responsible for phototransmission.Tadalafil is also 9000 times more potent against PDE-5 compared to its effect on PDE-8. 9 and 10 and 14 times more active against PDE-5 compared to PDE-11. Tadalafil improves erection and the possibility of successful intercourse. Tadalafil in healthy volunteers does not cause significant changes in systolic and diastolic pressure in comparison with placebo in the supine position (the average maximum decrease is 1.6 / 0.8 mm Hg, respectively) and in the standing position (the average maximum decrease is 0.2 / 4.6 mm Hg. Art .. respectively). Tadalafil does not cause significant changes in heart rate. Tadalafil does not cause changes in color recognition (blue / green), which is explained by its low affinity for PDE-6. In addition, there is no observed effect of tadalafil on visual acuity,electroretinogram, intraocular pressure and pupil size. Pharmacokinetics. Suction. After oral administration, tadalafil is rapidly absorbed. The average maximum concentration (Stmax) in plasma is reached on average 2 hours after ingestion. The speed and degree of absorption of tadalafil do not depend on food intake, so the drug Cialisk can be taken regardless of food intake. Dosing time (morning or evening) had no clinically significant effect on the rate and extent of absorption. The pharmacokinetics of tadalafil in healthy volunteers is linear with respect to time and dose. In the dose range of 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 erectile dysfunction. Distribution. The average volume of distribution is about 63 liters, which indicates that tadalafil is distributed in body tissues. At therapeutic concentrations, 94% of tadalafil in plasma binds to proteins. Protein binding does not change with impaired renal function. In healthy volunteers, less than 0.0005% of the administered dose was found in semen. Metabolism. Tadalafil is mainly metabolized with the participation of the isoenzyme CYP3A4 of cytochrome P450. The main circulating metabolite is methylcatechol glucuronide. This metabolite is at least 13,000 times less active against PDE-5. than tadalafil. Therefore, the concentration of this metabolite is not clinically relevant. Excretion.In healthy volunteers, the average clearance of tadalafil when taken orally is 2.5 l / h. and the average elimination half-life is 17.5 hours. Tadalafil is excreted mainly in the form of inactive metabolites, mainly through the intestines (about 61% of the dose) and. to a lesser extent, by the kidneys (about 36% of the dose). Age over 65. Healthy volunteers aged 65 and over had a lower oral clearance of tadalafil, which was expressed in an increase in the area under the concentration-time curve by 25% compared with healthy volunteers aged 19 to 45 years. This difference is not clinically significant and does not require dose adjustment. Renal failure In patients with renal insufficiency of mild severity (creatinine clearance from 51 to 80 ml / min) and moderate severity (creatinine clearance from 31 to 50 ml / min),as well as in patients with end-stage renal failure on hemodialysis, the exposure of tadalafil (AUC) approximately doubled. In patients on hemodialysis, the Cmax was 41% higher than in healthy volunteers. The elimination of tadalafil by hemodialysis is negligible. Liver failure. The pharmacokinetics of tadalafil in patients with mild to moderate hepatic impairment (class A and B according to the Child-Pugh classification) is comparable to that in healthy volunteers. Insufficient data are available for patients with severe hepatic impairment (Child-Pugh class C). When prescribing Cialis to patients with severe hepatic impairment, it is necessary to first assess the risks and benefits of using the drug. Patients with diabetes mellitus.In patients with diabetes mellitus while using tadalafil, the area under the concentration-time curve was less, by about 19%, compared with healthy volunteers. This difference does not require dose adjustment.

Side effect of Cialis 

tablets 20mgThe most common adverse events in patients with erectile dysfunction are headache and dyspepsia, as well as back pain and myalgia. Reported side effects were usually mild to moderate and transient. In accordance with the WHO classification, all reactions are distributed according to organ systems and frequency of development: very often (> 1/10); often (> 1/100, <1/10); infrequently (> 1/1000. <1/100); rarely (> 1/10000. <1/1000); very rare (<1/10000); frequency unknown (cannot be determined from available data). Immune system disorders: infrequently - hypersensitivity reactions; rarely - angioedema. Nervous system disorders: often - headache; infrequently - dizziness;rarely - stroke (including stroke of hemorrhagic type), fainting, transient ischemic attacks, migraine, epileptic seizure, transient amnesia. Disturbances from the organs of vision: infrequently - blurred vision, pain in the eyeball; rarely - disturbance of visual fields, swelling of the eyelids, injection of the vessels of the sclera of the eyeball, non-arterial anterior ischemic optic neuropathy, occlusion of the vessels of the retina. Hearing disorders and labyrinthine disorders: infrequently - ringing in the ears; rarely - sudden hearing loss. Violations of the cardiovascular system: often: "hot flushes" of blood to the face; infrequently - a feeling of palpitations, tachycardia, a decrease in blood pressure (in patients who have already taken antihypertensive drugs), an increase in blood pressure; rarely - myocardial infarction,ventricular arrhythmias, unstable angina pectoris. Respiratory system disorders chest and mediastinal organ: often - nasal congestion; infrequently - shortness of breath, nosebleeds. Disturbances from the gastrointestinal tract: often - dyspepsia; infrequently - abdominal pain, gastroesophageal reflux, diarrhea in patients over 65, vomiting, nausea. Skin and subcutaneous tissue disorders: infrequently - rash; rarely - hyperhidrosis (excessive sweating), urticaria, Stevens-Johnson syndrome, exfoliative dermatitis. Musculoskeletal and connective tissue disorders: often - back pain, myalgia, pain in the extremities. Violations of the genitals and mammary gland: infrequently - prolonged erection; rarely - priapism, hematospermia, bleeding from the penis. General disorders: infrequently - chest pain;rarely - facial edema, sudden cardiac death.

Overdose

With a single appointment of tadalafil to healthy individuals at a dose of up to 500 mg and to patients with erectile dysfunction - repeatedly up to 100 mg / day, the undesirable effects were the same as when using lower doses. In case of overdose, it is necessary to carry out standard symptomatic treatment. With hemodialysis, tadalafil is practically not excreted.