Interactions

A. Top Drug-Drug Interactions:

1.Nitrates (e.g., nitroglycerin, isosorbide dinitrate): Cialis and nitrates both lower blood pressure. Taking them together can cause a significant and potentially life-threatening drop in blood pressure (hypotension), leading to dizziness, fainting, or even heart attack or stroke. It is contraindicated to use Cialis with nitrates or recreational "poppers" (amyl nitrites).

2.Alpha-blockers (e.g., prazosin, terazosin, tamsulosin): Both Cialis and alpha-blockers relax blood vessels, which can lead to excessive blood pressure reduction when used together. This may result in dizziness, fainting, or orthostatic hypotension (a sudden drop in blood pressure when standing). If needed, your doctor may adjust the dosage or recommend spacing the medications.

3.Other antihypertensive drugs (e.g., atenolol, propranolol, enalapril, lisinopril): Cialis can enhance the blood-pressure-lowering effects of these medications. While this interaction is usually less severe than with nitrates or alpha-blockers, it can still cause dizziness or fainting in sensitive individuals. Close monitoring of blood pressure is recommended.

Other Drug-Drug interactions:

• Ketoconazole, itraconazole (used to manage fungal infection)
• Protease inhibitors (used to manage HIV infection) Ex. ritonavir, lopinavir
• Phenobarbital, phenytoin, carbamazepine (medicines used for fits)
• Rifampicin, erythromycin, clarithromycin (medicines used for bacterial infections)
• Other medicines used to improve blood flow to the penis (Ex. sildenafil)

B. Drug-Food Interactions:

Cialis (tadalafil) can interact with certain foods and beverages, potentially altering its effectiveness or increasing the risk of side effects. Here are the key drug-food interactions to be aware of:

1. Grapefruit and Grapefruit Juice: Grapefruit can increase the levels of tadalafil in your blood by interfering with its metabolism. This may amplify side effects, such as headaches, dizziness, or low blood pressure. Avoid consuming grapefruit or grapefruit juice while taking Cialis.
2. Alcohol: Drinking alcohol with Cialis can enhance the blood pressure-lowering effects of the medication, leading to symptoms like dizziness, lightheadedness, or fainting. Limiting alcohol intake is recommended while using Cialis.
3. High-Fat Meals: While Cialis can be taken with or without food, consuming it with a high-fat meal may delay its onset of action. Opt for lighter meals if rapid effectiveness is needed.
4. Caffeine: Though not a direct interaction, combining Cialis with high caffeine intake might worsen side effects like headaches or increase heart rate in sensitive individuals.

It’s important to consult your doctor to discuss if Cialis is the right medication for you. Be sure to also inform your healthcare provider of any other medications, procedures, or supplements you are taking.

Cancer Medication: While Cialis can be taken with or without food, combining it with certain types of cancer medication can cause a dangerous drop in blood pressure.

C.

Cialis (tadalafil) can interact with certain foods and beverages, such as grapefruit juice and alcohol, and may alter the effectiveness of the medications. Avoid consuming grapefruit or grapefruit juice while using Cialis.

Your pharmacist can help assess your response to Cialis based on your medical history, your lifestyle habits, and your personal circumstances. They can help determine whether it is safe for you to take Cialis with certain foods and beverages, such as grapefruit and grapefruit juice.

D.

Cialis has been shown to cause some mild side effects. Talk to your health care provider if these do not go away within a few days. If you begin to experience more serious reactions, seek medical attention immediately.

Common side effects reported from Cialis use include:

• Headache
• Indigestion
• Heartburn
• Upset stomach
• Gas
• Nausea
• Flushing

More severe side effects include:

• Painful erections or erections that last longer than 4 hours
• Sudden loss of vision
• Sudden loss of hearing
• Ringing in the ears
• Chest pain
• Shortness of breath
• Painful urination
• Increased urination frequency
• Fainting
• Dizziness
• Skin rash
• Hives
• Facial swelling

If you experience any of these side effects, seek medical attention immediately. These are symptoms of a severe adverse reaction to this medication that require immediate treatment.

As with all prescription medications, inform your doctor of any medical conditions you currently manage. Tell them about any and all medications, prescription drugs, and supplements you are taking before starting treatment with Cialis. Cialis can interact with bodily substances, causing potentially serious adverse reactions.

Specifically, you should inform your health care provider of any alpha-blocker, antifungal, HIV protease inhibitor, or high blood pressure medication you are taking. Remember to mention any herbal products you use, especially St. John’s wort.

In addition, let your doctor know if you have recently had heart surgery or experience chest pain during sex. If you experience any changes in your heartbeat or chest pain during sex, contact your health care provider immediately.

Appropriate use only for prescribed duration

All medications may not be suitable for you if you have not used any other medications before. Tell your health care provider if you are taking any of these categories:

• Lithium, or riociguat
• Other cilostazol
• Other medications that can interact with Cialis (such as other HIV protease inhibitors, other antibiotics, or other antifungals)

Certain ingredients may cause potentially serious side effects in addition to these conditions. If you have side effects that are not monitored, discuss them with your health care provider.

In the case of Cialis, dizziness or fainting, if overtaxed, immediately seek medical attention. This side effect occurs in less than 1% of patients.

Other side effects experienced with Cialis use are:

• Allergic reactions (such as rash, itching, swelling)
• Back pain
• Pale skin

If you experience any serious side effects, such as an allergic reaction, contact your health care provider immediately. This is not a complete list of Cialis side effects.

Interactions

A. Top Drug-Drug Interactions:

1.Nitrates (e.g., nitroglycerin, isosorbide dinitrate): Cialis and nitrates both lower blood pressure. Taking them together can cause a significant and potentially life-threatening drop in blood pressure (hypotension), leading to dizziness, fainting, or even heart attack or stroke. It is contraindicated to use Cialis with nitrates or recreational "poppers" (amyl nitrites).

2.Alpha-blockers (e.g., prazosin, terazosin, tamsulosin): Both Cialis and alpha-blockers relax blood vessels, which can lead to excessive blood pressure reduction when used together. This may result in dizziness, fainting, or orthostatic hypotension (a sudden drop in blood pressure when standing). If needed, your doctor may adjust the dosage or recommend spacing the medications.

3.Other antihypertensive drugs (e.g., atenolol, propranolol, enalapril, lisinopril): Cialis can enhance the blood-pressure-lowering effects of these medications. While this interaction is usually less severe than with nitrates or alpha-blockers, it can still cause dizziness or fainting in sensitive individuals. Close monitoring of blood pressure is recommended.

Other Drug-Drug interactions:

• Ketoconazole, itraconazole (used to manage fungal infection)
• Protease inhibitors (used to manage HIV infection) Ex. ritonavir, lopinavir
• Phenobarbital, phenytoin, carbamazepine (medicines used for fits)
• Rifampicin, erythromycin, clarithromycin (medicines used for bacterial infections)
• Other medicines used to improve blood flow to the penis (Ex. sildenafil)

B. Drug-Food Interactions:

Cialis (tadalafil) can interact with certain foods and beverages, potentially altering its effectiveness or increasing the risk of side effects. Here are the key drug-food interactions to be aware of:

1. Grapefruit and Grapefruit Juice: Grapefruit can increase the levels of tadalafil in your blood by interfering with its metabolism. This may amplify side effects, such as headaches, dizziness, or low blood pressure. Avoid consuming grapefruit or grapefruit juice while taking Cialis.
2. Alcohol: Drinking alcohol with Cialis can enhance the blood pressure-lowering effects of the medication, leading to symptoms like dizziness, lightheadedness, or fainting. Limiting alcohol intake is recommended while using Cialis.
3. High-Fat Meals: While Cialis can be taken with or without food, consuming it with a high-fat meal may delay its onset of action. Opt for lighter meals if rapid effectiveness is needed.
4. Caffeine: Though not a direct interaction, combining Cialis with high caffeine intake might worsen side effects like headaches or increase heart rate in sensitive individuals.

Rican health writer Joe Black ( author of The Power of Tadalafil ) is a contributing writer to BlueVitamin that is committed to improving the quality of life for consumers ofildionline. Joe alsoweeted the following endorsements from BlackBrazilianhealth Writer:

• BrazilianHealth Writer: "Tadalafil is available in Brazil and can be taken with or without food."
• AmericanitaminD Authority: "Tadalafil is available in Brazil and can be taken with or without food."

C.

Nitrates and alpha-blockers can potentially interact with Cialis through different mechanisms of action. This could potentially affect its effectiveness or increase the risk of side effects.

SUMMARY CMI

Cialis

Consumer Medicine Information (CMI) summary

The on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I using Cialis?

Cialis contains the active ingredient tadalafil, which is also used to treat erectile dysfunction. Cialis belongs to a class of medicines called phosphodiesterase type 5 (PDE5) inhibitors. Cialis works by relaxing the muscles in the penis and increasing blood flow.

For more information, see in the full CMI.

2. What should I know before I use Cialis?

Do not use if you have ever had an allergic reaction to tadalafil or any of the ingredients listed at the end of the CMI.

Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.

4. How do I use Cialis?

• Take one tablet about one hour before sexual activity.
• Swallow the tablet whole with water.

More instructions can be found in in the full CMI.

5. What should I know while using Cialis?

Things you should do	Remind any doctor, dentist or pharmacist you visit that you are using Cialis. If you are under 18 years of age, tell your doctor immediately. If you have any other medical conditions, tell your doctor that you are taking Cialis. If you have any other health problems, tell your doctor that you are taking this medicine. If you are taking any other medicines, tell your doctor that you are taking this medicine.
Things you should not do	Do not take Cialis if you are allergic to tadalafil or any of the ingredients listed at the end of this leaflet. If you are taking the medicine for ED, tell your doctor before you start or continue treatment with Cialis.
Driving or using machines	Be careful driving or operating machinery until you know how Cialis affects you.
Looking after your medicine	Keep Cialis in a cool dry place where the temperature stays below 30°C. Do not use Cialis after the expiry date stated on the pack.

6. Are there any side effects?

Common side effects- dizziness, flushing, indigestion, nasal congestion, nosebleeds, indigestion and urinary retention - are usually mild and temporary.

Cialis (tadalafil) is a phosphodiesterase type 5 (PDE5) inhibitor, which increases blood flow to the penis, facilitating the achievement and maintenance of an erection when sexual stimulation occurs. This mechanism of action is particularly important for men who have erectile dysfunction, a condition characterized by insufficient blood flow to the penis. It is important to note that Cialis does not enhance sexual performance, and does not protect against premature ejaculation. It is typically taken 30-60 minutes before sexual activity, and should not be taken more than once a day. Cialis is available in 2.5mg, 5mg, and 10mg tablets, and the recommended starting dose is 2.5mg (for maximum effect) or 5mg (for short-term use). Cialis is a strong and selective inhibitor of PDE5, and it does not have the same potency when compared to other PDE5 inhibitors. Cialis does not have the same effect when taken with nitrates, or when taken with alpha-blockers. It is recommended to take Cialis 2-4 hours before sexual activity and to continue taking Cialis at the same time every day. If Cialis is taken with nitrates, the user may experience a significant drop in blood pressure. It is not known whether Cialis is a safe or effective treatment for erectile dysfunction. It is also not known if Cialis is safe and effective for men with diabetes. It should not be taken if you are allergic to tadalafil or any of the other ingredients of this medicine.

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Cialis (tadalafil) is a phosphodiesterase type 5 (PDE5) inhibitor that increases blood flow to the penis, facilitating the achievement and maintenance of an erection when sexual stimulation occurs. It is not known if Cialis is a safe or effective treatment for erectile dysfunction.

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