New England Journal of Medicine 1998;
24
Approved Drugs of the United States (Apotex, Eli Lilly, Schering-Plough Corp., Indianapolis, Indiana, USA) Sustained-release and sustained-release drugs are indicated for the relief of symptomatic and/or aphactic episodes. Sustained-release drugs should be used with caution in patients who experience adverse drug reactions (ADRs) or who are taking other medicines that may prolong the half-life of sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), vardenafil and/or avanafil (Spedra) and/or cyclosporine (Neoral, Sandoz, Sandoz Corporation).
The use of these agents is based on their ability to prolong the half-life of sildenafil. Sildenafil is the active metabolite of the drug and is also known to be active for oral administration. Because of the greater bioavailability of sildenafil compared to other tadalafil derivatives, sildenafil is considered an acceptable alternative to the drug for treatment of erectile dysfunction. The drug is also indicated in patients who are not responding to oral medications. The drug is generally well-tolerated. Sildenafil is not expected to have the same pharmacologic effect as other tadalafil derivatives. It is not known whether the drug is excreted in human milk or by the human milk. Sildenafil may be found in milk and should be considered in milk-based products when milk is considered to be a therapeutic item.
The most common adverse effects of Sildenafil in the United States are headache, flushing, dyspepsia, back pain, and upset stomach. These are generally mild and resolve on their own without being caused by the adverse reactions listed below.
Although the drug has the potential to cause adverse effects, patients should be warned about the potential for them to become symptomatic or have an increased risk of developing drug-induced erections and/or premature ejaculation. If you notice any of these symptoms, stop taking Sildenafil and seek immediate medical attention. You may be at greater risk for the following: decreased sexual desire; decreased libido; decreased ejaculatory volume; loss of muscle control; and/or ejaculation disorder (such as delayed ejaculation). If you have any questions or concerns about the risk of these adverse reactions, talk with your doctor or pharmacist.
If you experience any of the following symptoms while taking Sildenafil, you should stop the drug and seek immediate medical attention: headache, flushing, dyspepsia, back pain, muscle aches, nausea and vomiting; flushing and dyspepsia have been reported rarely (2% to 4%), but have occurred rarely in other studies. If you have any questions or concerns about the risk of these symptoms, talk with your doctor or pharmacist.
Although the drug has the potential to cause side effects, you should be aware that such symptoms occur in less than 1% of patients taking Sildenafil. If you notice any of the following symptoms while taking Sildenafil, you should stop the drug and seek immediate medical attention: headache, flushing, dyspepsia, back pain, muscle aches, nausea and vomiting; flushing and dyspepsia have been reported rarely (2% to 4%), but have occurred rarely in other studies.
You should not be treated with Sildenafil, except for in cases of overdose, or if the patient is a CYP2D6/P-450-dependent drug user. If you are taking any of the following medications, you should stop the drug: nitrate drugs for heart problems (such as amyl nitrite, nitroglycerin), blood thinners (such as warfarin); theophylline, a muscle relaxant; theophylline, a calcium channel blocker; or theophylline, an inhibitor of CYP3A4; any of these medications may cause liver toxicity (see comment below).
In patients who are not receiving adequate therapy or receiving treatment in the first 48 hours of therapy, the drug should be used with caution.
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.
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:
Discuss any pregnant or breast-feeding individuals with your doctor before taking Cialis with meals containing grapefruit or grapefruit juice. The increased blood pressure in these individuals may be explained by the medication's inhibition of the enzyme PDE5, which regulates the levels of a chemical in the penis. If the PDE5 inhibitor prolongs the blood pressure-lowering effects of Cialis, dizziness, lightheadedness, or fainting could occur.
Ex. Zofia, used with or without food: isosorbide dinitrate, isradipine, sildenafil, tadalafil, and vardenafil. Distinct from Cialis, these medications may prolong the blood pressure-lowering effects of Cialis. Avoid consuming grapefruit or grapefruit juice while taking these medications.
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.
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:
poses like
Here are the key drug-food interactions:
Here are the key drug-food 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.
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:
Stade de France Pharmacy