Indications:
Erectile dysfunction.

Contraindications:
Hypersensitivity, simultaneous reception of nitrates (in all forms), the age of 18 let.C caution. Diseases of the CAS (myocardial infarction within the last 90 days, unstable angina or angina occurring during sexual intercourse; heart failure (NYHA II class and above) evolved in the past 6 months, uncontrolled cardiac arrhythmia, hypotension (BP less than 90 / 50 mm Hg) or uncontrolled hypertension, stroke, or transferred within the last 6 months, severe renal insufficiency (CC <30 mL / min), CRF (CC less than 50 ml / min), severe hepatic insufficiency (class C by Child-scale Pyuga), predisposition to priapism (with sickle cell anemia, multiple myeloma, or leukemia), anatomical deformity of the penis (the angular distortion, cavernous fibrosis or Peyronie's disease).

Side effects:
Headache (11%), dyspepsia (7%) - transient, slightly pronounced, declining with continued use of the drug. Back pain, myalgia, nasal congestion and "tides" of blood to the face. Seldom - swelling of the eyelids, eye pain, conjunctival hyperemia, golovokruzhenie.Peredozirovka. Symptoms: increased severity of side effects. Treatment: standard supportive measures may be needed.

Dosage and administration:
Inside, 20 mg, regardless of the meal, at least 16 minutes prior to the alleged sexual activity. Patients may attempt to carry out a sexual act at any time within 36 hours after dosing in order to establish the optimal response time to receive the drug. The maximum recommended frequency of admission - 1 times per day. In renal / hepatic failure, as well as in elderly patients dose adjustment is required.

Cautions:
Sexual activity is potentially dangerous for patients with diseases of cardiovascular system, and therefore the treatment of erectile dysfunction, including with tadalafil, there should be men with heart disease, in which sexual activity is not recommended. During the clinical trials have been reported cases of priapism. However, there are reports of occurrence of priapism using other PDE5 inhibitors - Sildenafil. Patients should be informed of the need for immediate access to medical care in the event of an erection that lasted 4 hours or more. Delays in treatment of priapism leads to tissue damage of the penis, resulting in a loss may occur long-term potency. Against the background of therapy in patients with renal insufficiency moderately (CC 31-50 ml / min) is more common order cialis online drug administration food and hit bg side effects such as back pain (compared with patients with mild renal insufficiency or normal individuals). In patients with severe renal impairment (CC less than 30 ml / min), tadalafil has not been studied. Although the incidence of dizziness in placebo and tadalafil background is the same, during treatment you should use caution when driving vehicles and occupation of other potentially hazardous activities requiring a high concentration of attention and quickness of psychomotor reactions.

Interaction:
Enhances hypotensive effects of nitrates (an additive effect of nitrates and tadalafil on the metabolism of nitric oxide and cGMP). Safety and efficacy of a combination of tadalafil with other treatments violations of erectile function was not studied, so the use of such combinations is not recommended. Tadalafil is metabolized primarily involving the enzyme CYP3A4. Selective inhibitor of CYP3A4, ketoconazole, increases the AUC by 107%, and rifampicin reduces by 88%. Although specific interactions have not been studied, we can assume that such protease inhibitors (ritonavir and saquinavir), as well as inhibitors of CYP3A4 (erythromycin and itraconazole) increase the activity of tadalafil. Antacids (magnesium hydroxide and aluminum hydroxide) reduce the rate of absorption without changing the AUC. Increase in pH of the stomach as a result of receiving nizatidina not affect the pharmacokinetics of tadalafil. No clinically significant effect on clearance of BOS, the metabolism of which proceeds with the participation of isoenzymes P450 Order cialis online drug administration food and hit bg (tadalafil has no effect on CYP3A4, CYP1A2, CYP2D6, CYP2E1, and CYP2C9). No clinically significant effect on the pharmacokinetics and pharmacodynamics of warfarin. Not affect the validity of ASC on bleeding time. Not detected clinically significant interaction with the major classes of antihypertensive LAN (as in monotherapy and in combination). There is no evidence the influence of single dose of tadalafil on the concentration of ethanol in the blood and its effect on cognitive function and blood pressure. No observed changes in tadalafil concentrations in the blood after 3 h after his admission, in combination with ethanol. No clinically significant effect on the pharmacokinetics or pharmacodynamics of theophylline.