Doctor’s advice is needed if a person has the conditions seriously influencing his general health, including: kidney or liver impairment, heart disease and others.

Here is information for those patients who have kidney or liver insufficiency and need special dose adjustments for ED and BPH.

Patients with renal (kidney) impairment:

Cialis dose for use as needed for the treatment of erectile dysfunction in patients with kidney problems depend on the creatinine clearance of a patient:

• Patients with creatinine clearance 30 to 50 mL/min should take an initial dose of 5 mg not more than once in 24 hours. The maximum allowed dose is 10 mg not more than once in every 48 hours.
• Patients with creatinine clearance ≤ 30 mL/min should not exceed the maximum dose of Cialis 5 mg not more than once in every 72 hours. Patients on hemodialysis are not recommended to use Cialis.

Cialis for daily use for the treatment of ED in patients with renal impairment:

• Patients with creatinine clearance less than 30 mL/min or on hemodialysis are not recommended to use Cialis.

Dose of Cialis for patients with kidney impairment for Benign Prostatic Hyperplasia and Erectile Dysfunction/Benign Prostatic Hyperplasia:

• Men with creatinine clearance 30 to 50 mL/min are allowed to use the dose of 2.5 mg. The max possible dose is 5 mg if a patient tolerates Cialis well.
• Men with creatinine clearance less than 30 mL/min or on hemodialysis are not recommended to use Cialis.

Patients with hepatic (liver) impairment:

Cialis dose for use as needed for the treatment of erectile dysfunction in patients with hepatic insufficiency depends on the severity of the condition:

• Men with mild or moderate hepatic impairment should not get more than 10 mg once per day.
• Men with severe hepatic impairment are not recommended to use this drug.

Cialis for daily use in men with mild or moderate hepatic problems should be the lowest recommended dose. Great caution is advised by the manufacturer when Cialis is administered to such patients.

Cialis’ benefit is its prolonged action allowing taking the drug every two days. Besides, the medication is produced in low doses and can be used by those who are not recommended to take large dose of the drug. Cialis for the treatment of benign prostatic hyperplasia is used once a day in a dose of 5 mg. The dose should be taken the same time each day.

If a person suffers from both ED and BPH conditions he will benefit from Cialis treatment by taking it regularly everyday in the dose of 5 mg. The dose can be taken without regard to sexual activity.

Other dose recommendations may be needed for patients older 65 years of age and those patients with kidney or liver impairment.

Cialis was approved by FDA in 2011 to treat enlarged prostate, the very common condition in men.  The prostate is a part of the male reproductive system. It gives the special liquid that with sperm makes semen.

The prostate grows as a man ages. When a man is in his 40s, the prostate starts to grow more intensively. About 50% of all males have an enlarged prostate by the time they are 60 years of old and by age 80-85, 90% of men have an enlarged prostate. The symptoms of enlarged prostate are very unpleasant, they include:

• feeling hard when  starting to urinate;
• dribbling after urination;
• a feeling of complete bladder and thus the desire to urinate more often.

Enlarged prostate condition has a medical term – benign prostatic hyperplasia or BPH, its symptoms may appear or not in men. But if they appear they cause many problems to a person, so they should be treated properly.

Cialis has undergone several clinical trials and was approved as a medication to treat erectile dysfunction in men. The other medical purpose of Cialis is to relieve the symptoms of benign prostatic hyperplasia. Cialis was estimated in 3 clinical trials in men with BPH symptoms, the last trial involved men with BPH and ED conditions. The medication demonstrated high efficacy in the treatment of both conditions and is recommended by the doctors as a combined therapy for men who have been diagnosed with BPH and ED.

During clinical studies Tadalafil (administered to healthy men) had no clinically meaningful difference in systolic and diastolic blood pressure and heart rate.

When Tadalafil (in the doses ranging from 5-20mg) was administered with nitrates (nitroglycerin) it was observed that Tadalafil may enlarge hypotensive effect of nitrates. Thereby, the use of Tadalafil in men taking a nitrate medication is contraindicated.

A special study was devoted to evaluation of interaction between nitroglycerin and Tadalafil. It was stated that nitroglycerin should be administered in an emergency situation only after 48 hours of Ttadalafil intake has passed. The main goal of the study was to identify the time after Tadalafil administration where no blood pressure effect was noted.

Clinical studies have shown that the main component of Cialis – Tadalafil is an inhibitor selectively of PDE5. PDE5 is located in the tissues and muscles such as in corpus cavernosum smooth muscle, vascular and visceral smooth muscle, skeletal muscle, platelets, kidney, lung, cerebellum, and pancreas.

Penile erection happens with sexual stimulation when increased penile blood flow fills the penis. The extra blood flow is arranged by the loosening of penile arteries and corpus cavernosal smooth muscle. Natural erection process includes the release of nitric oxide (NO) and activation of the cGMP production in smooth muscle cells. Cyclic GMP results in muscle loosening and enhanced blood flow into the corpus cavernosum. It is proved that the restriction of phosphodiesterase type 5 (PDE5) improves erectile function by producing more cGMP. Cialis restricts PDE5 and with sexual stimulation the natural erection occurs.

Cialis can interact with different medications; the concomitant usage of Cialis with nitrates, alpha-blockers and medications lowering blood pressure is prohibited. The administration of Cialis with the following medications should be made with much caution:

• rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, Rifater, Rifamate), or rifapentine (Priftin);
• an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), or telithromycin (Ketek);
• antifungal medication such as itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);
• an antidepressant such as nefazodone;
• a barbiturate such as phenobarbital (Solfoton);
• drugs to treat high blood pressure or a prostate disorder, such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin), tamsulosin (Flomax);
• heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quin-G), or verapamil (Calan, Covera, Isoptin, Verelan);
• HIV or AIDS medications such as darunavir (Prezista), efavirenz (Sustiva), etravirine (Intelence), nevirapine (Viramune), fosamprenavir (Lexiva), indinavir (Crixivan), ritonavir;
• seizure medications such as carbamazepine (Tegretol), phenytoin (Dilantin).

If you take some medications not listed above, inform your doctor about them. Don’t forget to mention all prescription, over-the-counter, vitamin, and herbal medications.

Cialis usual dose for patients with erectile problems is10 mg tablets. The medication is used prior to sexual activity. The maximum recommended dose taken once a day is 20 mg of Tadalafil. Most patients have normal clinical response to the therapy with Cialis so the dose for such patients can be enlarged to 20 mg.
If patients have certain diseases or take other medications (nitrates, alpha blockers, antihypertesives) the dose should be carefully considered by a doctor. Usually such patients are administered the lowest starting dose of 2.5 mg taken once a day. In case the medication is well tolerated the dose of Cialis may be increased to 5 mg per day.

Cialis may be taken on a daily basis or as needed, this depends on the preferences of a patient, his general health and drugs he takes. Discuss your Cialis intake with your doctor. Cialis 2.5 mg tablets are taken daily, without regard to timing of sexual activity. The dose may be increased to 5 mg orally once daily based on efficacy and tolerability.

Cialis should be administered with caution in the following groups of patients:

• Geriatrics;
• Males suffering from renal insufficiency;
• Males suffering from hepatic impairment.

The dose in each case is adjusted by the doctor. The dose depends on the severity of the mentioned above disorders and the age of a patient; nevertheless the dose of Cialis should be the lowest from the initiation of the treatment.

Ciallis (Tadalafil) adverse reactions were reported and investigated during post marketing experience. Among the rarest but most dangerous side effects of Cialis are sudden vision and hearing loss.

Cialis can cause sudden vision loss mostly in patients suffering from heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems. Smokers are also in a risk group for having this side effect. Vision changes were also reported in association with Cialis intake.

It is not justified that Cialis may cause vision loss or vision changes, still be careful while taking Cialis if you have other preexisting problems. Stop using this medication and get emergency medical help if you have sudden vision loss. FDA alarms the doctors and users about this serious adverse reaction and appeals to the doctors to warn the patients about sudden vision loss.

The other serious side effect of Cialis happening rarely but demanding medical assistance is sudden hearing loss. This adverse reaction was reported related to the Cialis intake, but there is no evidence that Cialis was the actual cause of hearing problems. However if you experience hearing loss after Cialis usage, stop and get emergency medical help.

Cialis is a safe medication approved for treatment of ED problems in men of different ages. However the drug can cause side effects especially in men who are predisposed to adverse reactions due to other existing conditions.

Cialis is well tolerated in most cases and cause no or minor side effects. Read this information about adverse events of Cialis and ask your doctor for more if necessary.

Cialis side effects, not serious but necessary to report them may include:

• redness or warmth in your face, neck, or chest;
• cold symptoms such as stuffy nose, sneezing, or sore throat;
• headache;
• memory problems;
• diarrhea, upset stomach;
• muscle pain, back pain.

Cialis may cause severe allergic reactions in rare cases. It is necessary to tell your doctor if you are allergic to tadalafil or other components of the drug. If you experience hives, difficulty breathing, swelling of the face, lips, tongue, or throat stop using this drug and call your doctor at once. Severe allergic reactions may be dangerous for your health.

You should also stop using Cialis and call your doctor at once if you have any of these serious side effects:

• changes in vision or sudden vision loss;
• ringing in your ears, or sudden hearing loss;
• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
• irregular heartbeat;
• shortness of breath, swelling in your hands, ankles, or feet;
• seizure (convulsions);
• feeling light-headed, fainting; or

• penis erection that is painful or lasts 4 hours or longer.

Your response to this drug may differ, report your doctor if you have unusual conditions or other serious adverse reactions.

Once your doctor has prescribed Cialis tablets to you he will certainly instruct you on how to take this drug. Follow your doctor’s directions and the directions on your prescription label.

To avoid possible side effects and get the most benefit from the treatment with Cialis take this medications exactly as ordered by your doctor.

Take the exact dose prescribed for you; never take the medication in larger amounts or more than once a day. Taking Cialis improperly may cause unpleasant health conditions and increase the chances of developing side effects.

Take Cialis with full glass of water, do not drink grapefruit juice, it may increase side effects of Cialis. The medication can be taken with or without food.

Cialis is taken when needed, before sexual activity and daily. Remember that daily usage of Cialis involves taking the drug at a lower dose, regardless of sexual activity. Sexual stimulation will help the drug to start acting. Without it you will not have an erection.

Avoid using other medicines to treat erectile dysfunction, such as sildenafil (Viagra) or vardenafil (Levitra) while you are taking tadalafil. Alcohol using is also restricted while being treated with Cialis.

If overdose is suspected you need to seek emergency medical help.

Store at room temperature away from moisture and heat.