Cialis

Generic Name: Tadalafil
Class: Phosphodiesterase Inhibitors
VA Class: GU900
Chemical Name: (6R,12aR) - 6 - (1,3 - benzodioxol - 5 - yl) - 2,3,6,7,12,12a - hexahydro - 2 - methylpyrazino[1′,2′:1,6]pyrido[3,4 - b]indole - 1,4 - dione
Molecular Formula: C₂₂H₁₉N₃O₄
CAS Number: 171596-29-5

Special Alerts:

[Posted 10/18/2007] FDA informed healthcare professionals of reports of sudden decreases or loss of hearing following the use of PDE5 inhibitors sildenafil (Viagra), tadalafil (Levitra), vardenafil (Cialis) for the treatment of erectile dysfunction, and sildenafil (Revatio) for the treatment of pulmonary arterial hypertension. In some cases, the sudden hearing loss was accompanied by tinnitus and dizziness. Medical follow-up on these reports was often limited which makes it difficult to determine if the loss of hearing was related to the use of one of the drugs, an underlying medical condition or other risk factors for hearing loss, a combination of these factors or other factors. The PRECAUTIONS and ADVERSE REACTIONS sections of the approved product labeling for sildenafil (Viagra), tadalafil, and vardenafil were revised. FDA is working with the manufacturer to revise the labeling for sildenafil (Revatio). For more information visit the FDA website at: , , and .

Introduction

Vasodilating agent; a selective phosphodiesterase (PDE) type 5 inhibitor.¹

Uses for Cialis

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Erectile Dysfunction

To facilitate attainment of a sexually functional erection in males with erectile dysfunction (ED, impotence).¹

Cialis Dosage and Administration

General

• 
  

  Dosage must be individualized carefully according to the patient’s tolerance and erectile response.¹

  
  


• 
  

  Sexual stimulation is required for response to therapy.^{1 2}

  
  

Administration

Oral Administration

Administer orally, no more than once daily, without regard to meals.^{1 2}

Some patients achieve an erection sufficient for successful intercourse within 30 minutes after tadalafil administration;^{1 2 3 7 8} ability to have sexual activity has been improved for up to 36 hours.^{1 2 4 7 9 13} Timing of administration relative to anticipated sexual activity is less important than with relatively short-acting drugs for erectile dysfunction.^{3 9}

Dosage

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Adults

Erectile Dysfunction

Oral

Initially, 10 mg.¹ Depending on effectiveness and tolerance, increase dosage to a maximum of 20 mg or decrease to 5 mg.¹

Prescribing Limits

Adults

Erectile Dysfunction

Oral

Maximum 20 mg daily.¹

Special Populations

Hepatic Impairment

In patients with mild to moderate hepatic impairment (Child-Pugh class A or B), maximum dosage is 10 mg once daily.¹ Use not recommended in patients with severe hepatic impairment (Child-Pugh class C).¹

Renal Impairment

If Cl_cr is 31–50 mL/minute, reduce initial dosage to 5 mg once daily; maximum dosage is 10 mg administered no more frequently than once every 48 hours.¹ If Cl_cr is <30 mL/minute), including patients undergoing hemodialysis, maximum dosage is 5 mg administered no more frequently than once daily.¹

Geriatric Patients

No dosage adjustments necessary based solely on age.¹

Cautions for Cialis

Contraindications

• 
  

  Known hypersensitivity to tadalafil or any ingredient in the formulation.¹

  
  


• 
  

  Concomitant use of any form of organic nitrates (e.g., nitrates, nitrites, or nitric oxide donors).^{1 2 10} (See Specific Drugs and Food under Interactions.)

  
  


• 
  

  Should not be used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status.^{1 2}

  
  

Warnings/Precautions

Warnings

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Cardiovascular Effects

Serious, potentially fatal cardiovascular events reported.¹

Use not recommended in patients with a recent MI (within 90 days) or stroke (within 6 months); uncontrolled arrhythmias, hypotension (<90/50 mm Hg systolic/diastolic BP) or uncontrolled hypertension (170/110 mm Hg systolic/diastolic BP); heart failure (>NYHA class II) in the previous 6 months; or those with unstable angina or angina occurring during sexual intercourse.¹

Possible hypotension, particularly in patients with left-ventricular outflow obstruction (e.g., aortic stenosis, idiopathic hypertrophic subaortic stenosis) and in patients with severely impaired autonomic control of blood pressure.¹

Potentiation of hypotensive effect with organic nitrates may result in life-threatening hypotension and/or hemodynamic compromise; manufacturers state that concomitant use with vardenafil is contraindicated.¹ (See Specific Drugs and Food under Interactions.)

Consider whether patients with underlying cardiovascular disease could be adversely affected by tadalafil’s vasodilatory activity, especially in combination with sexual activity.¹

Ocular Effects

Visual disturbances (e.g., blurred vision, changes in color vision, conjunctivitis, eye pain, increased lacrimation, periorbital edema, nonarteritic anterior ischemic optic neuropathy, visual field defect, retinal vein occlusion) reported rarely.^{1 2 13}

Use not recommended in patients with hereditary degenerative retinal disorders, including retinitis pigmentosa.¹

Priapism

Possible prolonged erections (>4 hours) and priapism (painful erection >6 hours).^{1 2}

May result in penile tissue damage and permanent loss of potency if priapism is not treated immediately.¹ Use with caution in patients with conditions that may predispose to priapism (e.g., sickle cell anemia, multiple myeloma, leukemia).¹

General Precautions

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Patient Assessment

Thorough medical history and physical examination is recommended to diagnose erectile dysfunction, determine potential underlying causes, and identify appropriate treatment options.^{1 14 15 16 17 18 19 20 21 22}

GU Precautions

Use with caution in patients with anatomical deformation of the penis (e.g., angulation, cavernosal fibrosis, Peyronie’s disease).¹

Concomitant Therapies for Erectile Dysfunction

Safety and efficacy not established for use in combination with other treatments for erectile dysfunction; combined therapy is not recommended.¹

Concomitant Administration with α-Adrenergic Blocking Agents

Potentiation of hypotensive effect in patients receiving concomitant therapy with α-adrenergic blocking agents, due to vasodilatory action.¹

Stabilize hemodynamic parameters in patients receiving an α-adrenergic blocking agent prior to initiating a PDE type 5 inhibitor at the lowest possible dosage.¹ In patients receiving a PDE type 5 inhibitor, initiate concomitant therapy with an α-adrenergic blocking agent at the lowest dosage.¹ Incremental increases in the dosage of the α-adrenergic blocking agent during concomitant therapy may be associated with a further lowering of BP.¹ Safety of concomitant therapy also may be affected by intravascular volume depletion and use of additional anti-hypertensive agents.¹ (See Specific Drugs and Foods under Interactions.)

Concomitant Administration with Potent CYP3A4 Inhibitors

Increased plasma tadalafil concentrations with concomitant administration; dosage reduction of tadalafil recommended.¹ (See Specific Drugs and Food under Interactions.)

Specific Populations

Pregnancy

Category B.¹ Not labeled for use in women.¹

Lactation

Not labeled for use in women; use not recommended in nursing women.¹

Pediatric Use

Safety and efficacy not established in patients <18 years of age.¹

Geriatric Use

Safety and efficacy in those ≥65 years of age is similar to that in younger men.^{1 8} Possibility exists of greater sensitivity to the drug in some geriatric individuals.¹ (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Use not recommended in patients with severe hepatic impairment (Child-Pugh C).¹ Dosage adjustment for moderate hepatic impairment. (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Clearance decreased in patients with mild (Cl_cr 51–80 mL/minute) to severe renal insufficiency (end-stage renal disease on hemodialysis), and may result in increased adverse effects (e.g., back pain).¹ No dosage adjustments are necessary in those with mild renal impairment.¹ Dosage adjustments based on degree of renal impairment. (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Headache,^{1 4 6 7 8 9 10} dyspepsia,^{1 4 6 7 8 9 10} back pain,^{1 4 6 7 8} myalgia,^{1 4 6 7 8 9} nasal congestion,^{1 4 7 8} flushing (facial and other areas).^{1 4 6 7 8 9 10}

Interactions for Cialis

Metabolized principally by CYP3A4.¹ Does not appear to induce or inhibit the clearance of other drugs metabolized by CYP isoforms 1A2, 3A4, 2C9, 2C19, 2D6, or 2E1.¹

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP3A4: Potential pharmacokinetic interaction (increased plasma tadalafil concentrations).^{1 33}

Inducers of CYP3A4: Potential pharmacokinetic interaction (decreased plasma tadalafil concentrations).¹

Specific Drugs and Foods

Drug or Food	Interaction	Comments
α-Adrenergic blocking agents	Possible symptomatic hypotension 1	In those who are stable on an α-adrenergic blockers, initiate tadalafil at lowest recommended dosage1 In those currently receiving tadalafil, initiate α-adrenergic blocker at the lowest dosage1 (See Hypotensive Effects with α-Adrenergic Blocking Agents under Cautions)
Alcohol	Possible additive hypotensive effects with heavy alcohol ingestion (e.g., ≥180 mL of 80 proof vodka) 1	Do not use alcohol excessively (e.g., ≥5 glasses of wine or shots of whiskey) 2
Amlodipine	Possible additive hypotensive effects1
Antacids	Possible delayed absorption of tadalafil 1
Antifungal agents, azole	Possible increased AUC and peak plasma concentrations of tadalafil1	Maximum tadalafil dosage 10 mg given once every 72 hours1
Angiotensin II receptor antagonists	Potential additive hypotensive effects1
Antiretroviral agents, HIV protease inhibitors	Increased tadalafil concentrations and increased risk of tadalafil-associated adverse effects (e.g., hypotension, visual changes, prolonged erection)1 33 a b	Lopinavir in fixed combination with ritonavir: Do not exceed a single tadalafil dose of 10 mg in 72 hours1 33 Atazanavir, fosamprenavir, amprenavir, nelfinavir, saquinavir, ritonavir, indinavir: Use an initial tadalafil dosage of 5 mg and do not exceed a single dose of 10 mg in 72 hours).1 33 Use with caution; monitor closely for adverse effects33 a
Antiretroviral agents, nonnucleoside reverse transcriptase inhibitors	Possible increased tadalafil concentrations and increased risk of tadalafil-associated adverse effects (e.g., hypotension, visual changes, prolonged erection)33	Delavirdine: Use initial tadalafil dosage of 5 mg; do not exceed a single dose of 10 mg in 72 hours33
Aspirin	No increase in bleeding time reported1
Bendroflumethiazide	Possible additive hypotensive effects1
Carbamazepine	Potential decreased AUC of tadalafil 1	No dosage adjustment recommended1
Enalapril	Possible additive hypotensive effects1
Erythromycin	Potential increased AUC of tadalafil 1
Grapefruit juice	Potential increased AUC of tadalafil 1
Inhaled nitrites (e.g., amyl or butyl nitrite)	Potentiation of hypotensive effect34	Concomitant use is contraindicated1 2 4 5 8 10 (see Cautions)
Lovastatin	Pharmacokinetic interaction unlikely1
Metoprolol	Possible additive hypotensive effects1
Midazolam	Pharmacokinetic interaction unlikely1
Nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate)	Potentiation of hypotensive effect1	Concomitant use is contraindicated1 4 5 8 10 (see Cautions) If necessary for a life-threatening condition, allow ≥48 hours to elapse between tadalafil administration and nitrate use;1 10 administer under close supervision with appropriate hemodynamic monitoring1
Nitric Oxide Donors	Increased hypotensive effect1	Concomitant use contraindicated1 4 5 8 10 (See Cautions)
Nizatidine	Pharmacokinetic interaction unlikely1
Phenobarbital	Potential decreased AUC of tadalafil 1	No dosage adjustment recommended1
Phenytoin	Potential decreased AUC of tadalafil 1	No dosage adjustment recommended1
Rifampin	Possible decreased AUC and peak plasma concentrations of tadalafil1	No dosage adjustment recommended1
Theophylline	Pharmacokinetic interaction unlikely1 Slight increase in heart rate (3 bpm) with concomitant therapy1
Warfarin	Pharmacokinetic interaction unlikely1

Cialis Pharmacokinetics

Absorption

Bioavailability

Rapidly absorbed following oral administration; peak plasma concentrations usually attained within 0.5–6 hours.¹

Onset

Following a single oral dose, effects were obtained within 30 minutes.^{1 2}

Duration

Improved erection up to 36 hours.^{1 2 4 7 9 13}

Food

Food does not appear to affect absorption.¹

Distribution

Extent

Distributed into tissues.¹

Plasma Protein Binding

Approximately 94%.¹

Elimination

Metabolism

Metabolized in the liver, principally by CYP3A4, to inactive metabolites.¹

Elimination Route

Excreted principally as metabolites in the feces (61%) and urine (36%).¹ Not appreciably removed by hemodialysis.¹

Half-life

17.5 hours.¹

Special Populations

Clearance reduced in patients ≥65 years of age compared with younger adults.¹

In patients with mild (Cl_cr 51-80 mL/minute) or moderate (Cl_cr 31-50 mL/minute) renal impairment, clearance was reduced, resulting in a twofold increase in AUC compared to healthy adults.¹ In patients with end-stage renal disease or in those on hemodialysis, clearance was reduced, resulting in a twofold to fourfold increase in AUC compared to healthy adults.¹

In patients with diabetes mellitus, AUC and peak plasma concentrations are decreased compared with healthy individuals.¹

Stability

Storage

Oral

Tablets

25°C (may be exposed to 15–30°C).¹

ActionsActions

• 
  

  Selective inhibitor of phosphodiesterases (PDEs), with the greatest selectivity for PDE type 5, the principal isoenzyme involved in the metabolism of cGMP to GMP in the corpora cavernosa of the penis.^{1 3 4 8}

  
  


• 
  

  Enhances the effect of nitric oxide by inhibiting PDE type 5-mediated hydrolysis of cGMP, resulting in vascular relaxation.^{1 3}

  
  


• 
  

  Potentiates accumulation of cGMP only when cGMP production in the penis is increased by sexual arousal.^{1 2} No effect on erectile function in the absence of sexual stimulation.^{1 2}

  
  


• 
  

  Modest peripheral vasodilation at usual dosages.^{1 4 5}

  
  


• 
  

  Less affinity than sildenafil or vardenafil for PDE type 6 receptor involved in phototransduction in the retina.^{4 13} No effects on intraocular pressure or pupillometry; changes in color vision reported rarely.¹

  
  

Advice to Patients

• 
  

  Importance of providing a copy of the manufacturer’s patient information.^{1 2}

  
  


• 
  

  Importance of informing clinician of the presence of risk factors for cardiovascular disease prior to initiating any treatment for erectile dysfunction.²

  
  


• 
  

  Importance of informing clinician of stroke history.^{1 2}

  
  


• 
  

  Importance of informing clinician of low or high BP.^{1 2}

  
  


• 
  

  Importance of informing clinician of peptic ulcer disease.^{1 2}

  
  


• 
  

  Importance of advising clinician of blood problems (e.g., sickle cell anemia, leukemia).^{1 2}

  
  


• 
  

  Importance of informing clinician of anatomical deformation of the penis (e.g., Peyronie’s disease, angulation, cavernosal fibrosis) or a history of prolonged erections.²

  
  


• 
  

  Importance of informing clinician of the presence of retinitis pigmentosa.²

  
  


• 
  

  Possibility of visual disturbances (e.g., bluish tinge to objects, difficulty distinguishing between blue and green, visual field changes).^{1 2}

  
  


• 
  

  Importance of informing patients of the potential for life-threatening hypotension and/or hemodynamic compromise with concurrent use of organic nitrates and nitrites in any form, including the recreational use of inhaled nitrites (“poppers”).^{1 2 5 10 34}

  
  


• 
  

  Importance of using caution during concurrent use of α-adrenergic blocking agents because of the potential for hypotension, dizziness, or fainting.^{1 12}

  
  


• 
  

  Importance of refraining from further activity and contacting a clinician if cardiovascular symptoms (e.g., anginal pain, dizziness) occur upon initiation of sexual activity.¹

  
  


• 
  

  Importance of contacting a clinician if anginal pain occurs after using tadalafil.¹

  
  


• 
  

  Importance of seeking immediate medical attention if an erection persists >4 hours or is painful.¹

  
  


• 
  

  Potential for transmission of sexually transmitted diseases (e.g., HIV) and the need to use protective measures to guard against such transmission.^{1 2}

  
  


• 
  

  Importance of contacting clinician for assessment of therapeutic benefit, the need for possible dosage adjustment, and potential adverse effects.^{1 2}

  
  


• 
  

  Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, and alcohol consumption, as well as any concomitant illnesses.^{1 2} Importance of limiting intake of alcohol-containing beverages or products.^{1 2}

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Tadalafil

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets, film-coated	5 mg	Cialis	Lilly ICOS
		10 mg	Cialis	Lilly ICOS
		20 mg	Cialis	Lilly ICOS

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Adcirca 20MG Tablets (LILLY): 60/$1225.98 or 180/$3625.92

Cialis 10MG Tablets (LILLY): 10/$201.99 or 30/$596.97

Cialis 2.5MG Tablets (LILLY): 15/$74.99 or 30/$124.97

Cialis 20MG Tablets (LILLY): 10/$201.99 or 30/$596.97

Cialis 5MG Tablets (LILLY): 10/$49.99 or 30/$133.97

Cialis 5MG Tablets (LILLY): 30/$133.97 or 90/$389.95

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions November 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Lilly ICOS. Cialis (tadalafil) tablets prescribing information. Indianapolis, IN; 2005 Mar 31.

2. Lilly ICOS. Cialis (tadalafil) tablets patient information. Indianapolis, IN; 2005 Mar 31.

3. Rosen RC, Kostis JB. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Am J Cardiol. 2003; 92:9M-18M. [IDIS 508058] [PubMed 14609619]

4. Anon. Tadalafil (cialis) for erectile dysfunction. Med Lett Ther. 2003; 45:101-2.

5. Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil. Am J Cardiol. 2003; 92:37M-46M. [IDIS 508061] [PubMed 14609622]

6. Saenz de Tejada I, Knight JR, Anglin G et al. Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care. 2002; 25:2159-64. [PubMed 12453954]

7. Brock GB, McMahon CG, Chen KK et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol. 2002; 165:1332-6.

8. Curran M, Keating G. Tadalafil. Drugs. 2003;63:2203-12.

9. Porst H, Padma-Nathan H, Giuliano F et al. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Urology. 2003; 62:121-5. [PubMed 12837435]

10. Kloner RA, Hutter AM, Emmick JT et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003; 42:1855-60. [PubMed 14642699]

11. Yamamoto T, Bing RJ et al. Nitric oxide donors. Proc Soc Exp Biol Med. 2000; 25:200-6.

12. Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil in patients on common antihypertensive therapies. Am J Cariol. 203; 92(suppl.):47M-57M.

13. Porst H. Editorial comments on tadalafil. Drugs. 2003; 63:2213.

14. National Institutes of Health Office of Medical Applications of Research. Consensus Conference: impotence. JAMA. 1993; 270:83-90. [IDIS 316686] [PubMed 8510302]

15. Wagner G, de Tejada IS. Update on male erectile dysfunction. BMJ. 1998; 316:678-82. [IDIS 406621] [PubMed 9522795]

16. Pfizer Inc, New York, NY: Personal communication on sildenafil.

17. Reviewers’ comments on sildenafil (personal observations).

18. The Process of Care Consensus Panel. Position paper: the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:59-70.

19. Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol. 1999; 10:1381-8. [PubMed 10361878]

20. Meinhardt W, Kropman RF, Vermeij P. Comparative tolerability and efficacy of treatments for impotence. Drug Saf. 1999; 20:133-146. [PubMed 10082071]

21. Petak SM, Baskin HJ, Bergman DA. AACE clinical practice guidelines for the evaluation and treatment of hypogonadism in adult male patients. From American Association of Clinical Endocrinologists web site. ().

22. Guay AT, Nankin AR et al. AACE clinical practice guidelines for the evaluation and treatment of male sexual dysfunction. From American Association of Clinical Endocrinologists web site. ()

23. Whitehead ED, Klyde BJ, Zussman S et al. Treatment alternatives for impotence. Postgrad Med. 1990; 88:139-52. [IDIS 269901] [PubMed 2199954]

24. Gerber GS, Levine LA. Pharmacological erection program using prostaglandin E1. J Urol. 1991; 146:786-9. [IDIS 287641] [PubMed 1875494]

25. Porst H. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11: 72-3.

26. Sarramon JP. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:73.

27. Vermeuler A. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:74.

28. Sohn MHH. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:72.

29. Sefetl AD. Phosphodiesterase type 5 inhibitor differentiation based on selectivity, pharmacokinetic, and efficacy profiles. Clin Cardiol. 2004; 27(Suppl. 1):I-14-9.

30. Padma-Nathan H. A new era in the treatment of erectile dysfunction. Am J Cardiol. 1999; 84:18-23N. [PubMed 10404845]

31. Wespes E, Amar E, Hatzichtistou D et al. Guidelines on reactile dysfunction. Arnhem: European Association of Urology, 2004 Mar. Available at . Accessed 2004 Aug.

32. Lilly, Indianapolis, IN: Personal communication.

33. Panel on Clinical Practices for Treatment of HIV infection of the Department of Health and Human Services (DHHS). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents (Apr 7, 2005). From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website ().

34. Smith KM, Romanelli F. Recreational use and misuse of phosphodiesterase 5 inhibitors. J Am Pharm Assoc. 2005; 45:63-72/

a. Bristol-Myers Squibb. Reyataz (atazanavir sulfate) prescribing information. Princeton, NJ; 2004 Jul.

b. Merck & Company Inc. Crixivan (indinavir sulfate) capsules prescribing information. West Point, PA; 2004 May.

More Cialis resources

• Cialis Side Effects (in more detail)
• Cialis Use in Pregnancy & Breastfeeding
• Drug Images
• Cialis Drug Interactions
• Cialis Support Group
• 91 Reviews for Cialis - Add your own review/rating

• Cialis Prescribing Information (FDA)


• Cialis Advanced Consumer (Micromedex) - Includes Dosage Information


• Cialis MedFacts Consumer Leaflet (Wolters Kluwer)


• Cialis Consumer Overview


• Tadalafil Professional Patient Advice (Wolters Kluwer)


• Adcirca MedFacts Consumer Leaflet (Wolters Kluwer)


• Adcirca Prescribing Information (FDA)


• Adcirca Consumer Overview

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