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Common uses.

• Tadalafil is to relax unstriped muscles of arteries for enhancement of the blood flow to special parts of the body.
• Tadalafil is used for erectile dysfunction treatment.
• Tadalafil can be used for other purposes then ones written about in this medicine guide.

What have I ask my doctor before starting treatment with tadalafil?

• Do not take tadalafil if you are getting treatment with nitrate containing drugs for heart problems, unless your doctor checked the possibility of such combination and specified dosage. Mentioned above group of drugs consists of nitroglycerin (Nitrolingual, Minitran, Nitrostat, Deponit, Nitro – Bid, Nitrol, Nitro – Dur, Transderm – Nitro), isosorbide mononitrate (Oral, Monoket, Ismo, Imdur), isosorbide dinitrate (Sorbitrate, Isordil, Dilatrate-SR), and amylnitrite. Associated use of the tadalafil and nitrate containing drugs can produce an abrupt decrease of the arterial pressure which makes the danger of stroke, sheer heart attack or fainting. So called poppers – recreational drugs, used to prolong, to enlarge and to enhance sexual activity related sensations – also include amyl combined nitrite or nitrate.
• Sometimes after taking tadalafil a small number of patients may have temporal vision changes such as increased sensitivity to light, blurred vision. Impaired blue/green color discrimination may also occur. These kinds of vision distortions are caused with changes in the blood supply of the optic nerves in the eye. It is impossible to call tadalafil the actual cause of mentioned above vision problems. These distortions usually occur in patients with diabetes, high cholesterol levels, heart diseases, high blood pressure, existing eye diseases, and in the elderly persons. If these problems continue or are bothersome, check with your doctor.
• Before start treatment with tadalafil, inform your doctor about listed below diseases and conditions:
• heart beat problems or other heart diseases
• the history of the heart attack (within the past three months)
• the history of the heart failure with congestion within the past half of the year
• stroke within the past half of the year
• coronary disease (angina)
• unstable blood pressure (arterial hypertension or hypotension)
• terminal stage of kidney disease. Slight kidney dysfunctions are not the cause to reduce the dose of tadalafil.
• kidney diseases, including dialysis demanding conditions
• heavy liver dysfunctions. Most of the slight liver dysfunctions are not the reasons to deny the treatment with tadalafil. In such cases tadalafil’s starting dose shall be reduced up to 5 mg, further treatment have to be performed with adjusted dose of tadalafil.
• stomach or duodenal ulcers
• high sensibility to any ingredient of tadalafil tablet
• aorta stenosis
• inherited diseases of retina, such as retinitis pigmentosa
• inclinations to hemorrhage
• penis anatomic deformities (such as Peyronie’s disease)
• diseases, which may cause priapism (sickle cells anemia, myelomathosis, leukemia).
• if you are told to withhold from sexual intercourse to prevent health problems
• In case if you have any of listed above diseases or conditions your dose may need an adjustment. Sometimes, during the treatment with tadalafil, there may appear a need for special tests.
• FDA pregnancy category B: Though tadalafil is not designed to be used in women, this drug is not supposed to be dangerous for fetus. If you are or going to be pregnant and intend to take tadalafil, tell your doctor about it beforehand.
• Though tadalafil is not designed to be used in women, there are no data about its penetration into breast milk or its harmful influence on a nursing baby. Anyhow, before take tadalafil, tell your doctor you feed baby with your breast milk.
• You tadalafil dose possibly needs to be reduced if you are over 65. Ask your doctor about it.

How tadalafil is to be taken?

• Each dose has to be followed with a full glass of water.
• High fat food may delay absorption of the tadalafil from the stomach and cause delay of the drug activity.
• Usually tadalafil is taken as needed, 60 – 30 minutes before having sexual activity. Drug’s erection enhancing activity develops in sexual stimulation. Medication itself does not produce an erection.
• Take tadalafil once a day only. Next dose may be taken after 24 hours.
• This drug has to be stored at the room temperature in a dry place away from heat sources.

What to do if dose is missed?

• As far as tadalafil is to be used as needed, there may not be any case of the dose missed.

What to do in case of the overdose?

• If you suppose you took too much tadalafil you have to get urgent medical attention.
• Tadalafil overdose symptoms are fainting, nausea, chest pain, irregular heart rhythm, light – headed feeling, severe dizziness, and long lasting erection.

What should I withhold during the treatment with tadalafil?

• Alcohol consumption should be restricted because it can provoke or strengthen some side effects of the tadalafil.
• Tadalafil may interact with grapefruit juice or grapefruits. If you are going to take these products talk it over with you doctor. Do not change the amount of grapefruit or grapefruit juice in your diet without your doctor’s permission.
• Do not combine tadalafil with any other medication for erectile dysfunctions treatment, such as yohimbine (Yodoxin, Youcon, etc.), or alprostadil (Muse, Caverject, Edex), if your doctor did not prescribed such combination.

What possible side effects tadalafil may induce?

• Side effects of tadalafil occur not often and are mild as a rule. But sometimes it may be so serious that treatment with tadalafil has to be stopped and immediate medical help is needed. Such cases are:
• acute dizziness
• numbness
• continuous tingling in the ears
• pain in the chest, neck and left shoulder
• heart rhythm disorder
• swelling of the feet
• sudden loss of the vision
• allergic reaction such as difficult breathing, swelling of the face or tongue, hives
• painful and long lasting erection
• fainting and light – headedness
• In case of listed above conditions appearance stop having sex and call for medical help.
• If side effect is mild treatment with tadalafil may be continued with doctor permission. Such conditions are listed below:
• redness or feeling of the heat in the face, neck, and upper chest
• vision changes
• stuffy nose
• nausea
• upset stomach
• headache
• back pain
• There may appear side effects other than listed above. Inform your doctor about anything that seems unusual.
• Some medication may interact with tadalafil, reducing, amplifyining, or distorting its action. Do not take tadalafil if you are treated with any of listed below medications:
• any nitrate or nitrite containing drug used for treatment of angina, such as nitroglycerin, isosorbid monoor dinitrate, amyl nitrite or amyl nitrate.
• Tadalafil also interacts with following drugs:
• antibiotics such as troleandomycin, erythromycin, clarithromycin
• alpha blockers, such as terazosin (Hytrin®), alfuzosin (UroXatral®), doxazosin (Cardura®), or prazosin (Minipress®) used for high blood pressure treatment and prostate enlargement
• cimetidine
• bosentan
• diltiazem
• cizapride
• carbamazepine
• phenobarbital
• phenitoin
• fluconazole
• itraconazole
• ketoconazole
• voriconazole
• mibefradil
• nicardipine
• verapamil
• rifapentine
• rifampin
• rifabutin
• fluvoxamine
• fluoxetine
• nefazodone
• quinidine
• some drugs for HIV treatment, such as delavirdine or ritonavir and saquinavir.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.