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What is Cialis?

Cialis is a molecule belonging to the category of 5-phosphodiesterase inhibitors, an enzyme involved in the process of erection in men. It is commercially available in the United States, Britain, Canada, Australia and other countries in known industrial preparations, such as Cialis (generic) pills. This category includes other known molecules, such as sildenafil and verdenafil (Levitra®). In fact, tadalafil is also used to treat pulmonary arterial hypertension: for this therapeutic indication, the patent for use does not expire until other years.

To Cialis on this site - you do not need a prescription!

What happens when the Tadalafil expires? Just a pharmacist can produce a galenic drug based on tadalafil with all the characteristics of the galenic drug:

  • the possibility of carrying out any doses (for example, 7 mg, 11 mg, 26 mg, etc.) to satisfy every medical request of the Doctor.
  • making any number of capsules or pills: 10/100/1000 in accordance with what is indicated in the recipe.
  • the ability to make the drug without certain excipients, to which the patient may be allergic or intolerant.
  • the possibility of creating alternative pharmaceutical forms for capsules / pills in case of special needs or difficulties in swallowing (for example, pills of tadalafil syrup or talalafil sublingual)

Of course, an expired patent, there will be a fall in prices for industrial drugs (usually at least 50% or even more), and the same will happen for the Galician tadalafil made by a pharmacist. With the update of the Tariff of Medicines, how much is tadalafil?

Here you can (order) without a prescription!

I must say that the price depends in part on the purchase price of the Pharmacist, but the price is dictated (rightfully) because of the costs of producing the drug. As an example (they are absolutely indicative and not necessarily exact prices), you can have the following:

10/20/30 Tadalafil 10 mg capsules $ 37-43
10/20/30 Tadalafil 20 mg capsules $ 40-45
50 Tadalafil 5 mg capsules $ 40-45
100 Tadalafil 10 mg capsules $ 50-55

The cost of the calculation using the new Pharmaceuticals Tariff.

The drug can be ordering on-the-spot right now! Information about the side effects and problems of tadalafil? As a reference, you can read here, even when it comes to medicinal specialties, but the chemical molecule is always the same: warnings, side effects and interactions are reported. On the other hand, nothing will change with regard to the dispensation regime: just as a repeated medical prescription (valid for 6 months for 10 packets) is necessary for industrial medications based on the use of tadalafil, to obtain talalafil manufactured by the pharmacist, a repeatable medical recipe. After oral administration, tadalafil rapidly absorbs. The mean concentration (Plasma) in the plasma is approximately 2 hours after inhalation. The rate and degree of tingalphile absorption is not dependent on the intake of food, so the medicine can be taken regardless of nutrition. There was no clinically significant effect on the rate and degree of absorption of the reception time (morning or evening).

Spread
The average spread is approximately 63, indicating that the desalafil is spread to the tissues of the body. In therapeutic concentrations, 94% of desaliline is associated with proteins in plasma. When the renal function breaks down, protein binding does not change. Less than 0.0005% of the dose is found in healthy individuals.

Metabolism
Tadalafil is mainly metabolized in the presence of CYP3A4 isoferment of Cytokrom P450. The main metabolite in metabolism is methylcarone glycuronic acid, which is less than 13,000 times less than that of taalapile compared to FD5. Consequently, this metabolite concentration is not clinically significant.

Release
When taking Cialis mail order, the average body weight in the healthy people is 2.5 lbs per hour, and the average half-life is 17.5 hours. Tadalafil is mainly produced in the form of inactivated metabolites, mainly with the feces (about 61% of the dose) and, with less urination (about 36% of the dose). Tadalafil's pharmacokinetics depend on time and dose in healthy subjects. Within the range of 2.5 to 20 mg, the area under the "concentration-time" curve (AUC) increases proportionately with the dose. The equilibrium concentrations in the plasma reach the drug once every 5 days. Thalalphyl Pharmacokinetics In patients with erectile function, the drug is similar to pharmacokinetics in patients with erectile function.

Special groups of population:

Elderly patients
It was found that desalafil clearance decreased when entering the drug in elderly people (65 years of age and older), which leads to a 25% increase in the AUC concentration (AUC) compared to healthy subjects aged 19 to 45 years. This difference is not clinically significant and does not require dose correction.

Patients with renal insufficiency
In patients with terminal renal insufficiency in liver failure (creatinine clearance from 51 to 80 ml / min) or moderate (creatinine clearance from 31 to 50 ml / min), as well as in patients with terminal stage renal insufficiency dialalphyll doses of 5 to 20 mg the area under the "concentration-time" curve (AUC) doubled. In hemodialysis patients, Cmax was 41% higher than in healthy subjects. Hemodialysis affects slightly elimination of tadalafil.

Patients with hepatic impairment
People with light and middle hepatic insufficiency have a similarity to pharmacokinetics of titdalafil in healthy subjects. Patients with severe liver failure (C-class P class) have limited clinical data on the use of the drug. In patients with hepatic impairment, there is no data on once daily use of calalafil. In the case of prescribing the drug once a day, the physician should start with a careful assessment of the benefits and risks for the patient.

Patients with diabetes mellitus
In patients with diabetes mellitus, the area under the "concentration-time" curve (AUC) was approximately 19% lower than in healthy subjects. This difference does not require dose correction.

Pharmacodynamics
order cialisCialis improves erection and proper sexuality. The drug is exposed within 36 hours. The effect is known after 16 minutes of taking the drug when it has sexual excitement. Cialis is an effective, reversible selective brake of 5 type special phosphodiesterase (FD5) of cyclic guanozine monophosphate (sGMF). When sexual excitement causes local release of nitrogen oxidation, the Cialis FDP5 inhibitory activity results in an increase in the GMMF levels in the cervical body of the genital organ. The result is the relaxation of the smooth muscles of the arteries and the flow of blood to the genital tissue, which causes anesthesia. Cialis generic does not have any sexual stimulation if it does not.

FDA-5 ilealaphile inhibition in the cervical body of the cervical body is also observed in the smooth muscle of the prostate cavity, in the bladder and in the blood vessels that provide them with blood. The resulting condition results in an increase in blood perfusion as a result of relaxation of smooth muscle vessels in these organisms and, as a consequence, leads to a decrease in clarity of benign hyperplasia of the pancreatic gall bladder in lower urinary tract. The indicated root effects may be accompanied by abrasion of the afferent nerve of the bladder and the smooth muscle relaxation of the prostate cavity and bladder.

In vitro studies have shown that Cialis is a selective brake of FDE5. FD5 is an enzyme found in smooth muscles of the cavernous body, smooth muscles of the internal organs, skeletal muscles, platelets, kidneys, pulmonary and muscle. The effect of Cialis on FDE5 is more effective than other phosphodiesteraseases. Cialis® is 10000 times stronger compared to FDE5, relative to FTE1, FDe2, FDe4 and FDE7, located in the heart, the liver, the blood vessels, the liver, the leukocytes, the skeletal muscle and other organisms. Cialis® suppresses FDE5 more than 10,000 times more than the enzyme found in the heart and blood vessels - FDA3. This selectivity is significant compared to FDE3 compared to FDE5 because FDE3 is an enzyme that participates in the heart muscle contraction. In addition, Cialis® is about 700 times faster than the FDA6, which is responsible for photorealysis, compared to the FDE6. Cialis® also has a 9,000-fold effect compared to its FDA-5, FDe8, FDe9 and FDE10, and 14 times stronger compared to FDE11 compared to FDE11. The physiological effects of diffusion of tissues and the containment of FDA8 - FDE11 have not been determined yet.

Cialis® is found to be in healthy individuals (the highest average decline is 1.6 / 0.8 mm, respectively) and is moderate (mean maximum diminished to 0.2 / 4.6 mm), compared with placebo, and systolic and diastolic pressure does not make any real change. Cialis does not cause a real change in heart rate.

Cialis does not have the ability to distinguish colors (blue / green), which is explained by a low HDF6 ratio compared to the FDA. In addition, Cialis does not have an impact on eye vision, electroencepinoma, intraocular pressure, and pupil size. Three studies were carried out for male patients in order to assess the potential effects of daily intake of Tadalafil on spermatogenesis, 10 mg (one 6-month study) and 20 mg (one six month and one 9-month study). None of the studies have an adverse effect on sperm morphology and their mobility. In both studies, spermatozoa concentration has decreased compared to placebo. In the 9-month study, a decrease in spermatozoa concentrations was associated with higher ejaculation frequency. During the 6-month study, the frequency of ejaculation was not evaluated. In addition, when taking 10 mg or 20 mg of Generic Cialis, the adverse effect on the mean concentrations of the hormone stimulating hormones, testosterone, luteinizing hormone and follicular was not observed compared with placebo.

Application:

  • in erectile dysfunction
  • Symptoms and symptoms of benign hyperplasia of the gallbladder
  • Erectile dysfunction in patients with severe hyperplasia of the gallbladder.
  • Sexual stimulation is needed to make the taalalais appear.
  • Cialis is not intended for use in females.

Dosage and method of administration:

  • Intolerance.
  • Erectile Dysfunction (ED)

The recommended dose for predictable sexual activity is 10 mg regardless of food intake. If you take 10 mg of the necessary reactions, the dose may be increased to up to 20 mg of tadalafil. Maximum dose frequency - 1 times a day. Cialis is intended for 10 to 20 mg of recommended sexual activity and is not recommended for daily use. The drug should be taken at least 30 minutes before supposed sexual activity. Frequent sexual activity (up to 2 times a week) is recommended for patients with Tadalafil at 5 mg once daily, regardless of food intake. Patients may attempt sexual intercourse at any time within 36 hours after taking the drug to determine the optimal time for response to the preparation. Regular daily assessment of the duration of the daily administration should be carried out.

Severe hyperplasia of the gut (CLG)

  • The recommended dose of Tadalafil is 5 mg once daily. The drug should be administered at approximately the same time, regardless of the time of sexual activity. The duration of treatment is determined by the physician individually.
  • In patients with severe hyperplasia accompanying erectile dysfunction, the recommended dose is about 5 mg once per day.
  • In patients with severe hyperplasia of the prostate gland, it is important to consider alternatives to treatment if they can not cure Tadalafil at 5 mg.

Erectile Dysfunction and Sickle Hyperplasia of the Acne (ED / GHG)
The recommended frequency of administration of Cialis® is about 5 mg 1 times per day.

Special groups of population
For patients with advanced age (65 years and older) patients with moderate and severe renal failure, dose adjustment is not required in patients with diabetes mellitus. The recommended dose of Cialis 10 mg, regardless of intake of anticipated sexual activity, as it is needed for the treatment of erectile dysfunction in patients with hepatic impairment. Patients with severe hepatic impairment (Class C on Child-Plagiate scale) have limited clinical data on Cialis generic safety. In the case of prescribing this medication, the physician should take into account the risk of personal injury and personal risk. In patients with hepatic insufficiency, there is no data on the use of taalpaphil, which is greater than 10 mg. In the event that the drug is administered to the given group, it is necessary to begin with a careful assessment of the relationship between the patient and the patient for the patient. One-time admission of Cialis for treatment of erectile dysfunction or severe hyperplasia of the pancreas was not studied in patients with hepatic impairment. For treatment of acute dysfunction or severe hyperplasia of the pancreas, the administration of Cialis1 in a single dose of 5 mg per day is not recommended for patients with severe renal insufficiency.

Cialis is not used for treatment of erectile dysfunction in children and teens under 18.

Side effects:
The most common (10%) negative reactions are the following: often (1%, 0.01% 0.1%); very rarely (1%); rarely (0.01%, chewing gum (0.1%,%), frequency uncertainty (the frequency of occurrence of reactions by available data can not be estimated).

Frequently:

  • headache
  • nasal congestion
  • dyspepsia, gastroesophageal reflux
  • backbone pain, myalgia, pain in the arms and legs
  • blood pressure / blood transfusions
  • Sometimes
  • High sensitivity reactions
  • dizziness
  • Not seeing clearly, the feeling of pain in the eye
  • Noise in the ear
  • tachycardia, increased heart rate, hypotension, hypertension
  • Dizziness, bleeding from the nose
  • pain in the abdomen
  • rash, hyperhidrosis (severe sweating)
  • hematuria, genital herpes, hemospermia
  • chest pain

Rare:

  • ngiorezmiral swelling
  • stroke (including hemorrhagic type CNS), nausea, transient ischemic attacks (TIS) 1, head ring3, stroke / cramps, transient amnesia
  • Visual disruption, swelling of the eyelids, conjunctiva hyperemia
  • non-arterial ischemic optical neuropathy3 (Aeiion), occlusion of gastrointestinal tract.
  • sudden hearing
  • myocardial infarction, unstable angina3, ventricular arrhythmias.
  • hives, Stevens Johnson syndrome, exfoliative dermatitis.
  • prolonged erection, priapism.
  • swelling of the face, sudden death from heart.
  1. Previously observed in patients with cardiovascular risk factors.
  2. In most cases, it was observed in patients taking hypotensive medications.
  3. Negative reactions recorded in clinical placebo-controlled trials and recorded during postmarketing research

In patients receiving Cialis one-time per day, there was a significant increase in ECG recorded changes compared to placebo, primarily for susceptible bradycardia. The ECG's abnormalities were not associated with negative reactions. There are limited data on reactions of patients over the age of 65 who took tadalafil for the treatment of erectile dysfunction or severe hyperplasia of the pancreas during clinical trials. In clinical trials, treatment for proximal hyperplasia of the prostate gland was administered at 5 mg once a day, with dizziness and diarrhea in patients over 75 years of age.

Unusable cases

  • Sensalafil or any substance that is part of the drug
  • Preparation of any preparation containing any organic nitrates
  • Presence of anti-sexual activity in patients with cardiovascular system: presence of myocardial infarction in the last 90 days, unstable angina, stenocardia occurrence during sexual intercourse, classification of New York Cardiac Association (NYHA) in the last 6 months class II-IV, uncontrolled arrhythmia, arterial hypotension (less than 90/50 mm critical), uncontrolled arterial hypertension, ischemic stroke during the last 6 months
  • One eye blindness due to non-arterial ischemic ischemic optic neuropathy (AEAIION) (regardless of FDP5 inhibitors)
  • Simultaneous administration of the guanilatcyclosase stimulants such as doxazosine, ricocciate, as well as medicines for the treatment of erectile dysfunction
  • frequent (more than twice a week) patients with chronic renal insufficiency (less than 30 ml per minute)
    • Lack of hereditary galactose, Lapp-lactase deficiency and glucose-galactose malabsorption
  • severe renal failure
  • Children and teens under the age of 18

The effect of other drugs on tadalafil

Cialis is basically metabolized in the presence of CYP3A4 enzyme. Acceptance of CYP3A4 selective brake ketoconazole 200 mg per day increases the effect of the drug (AUC) (10 mg) by 2 times and Cmax by 15% compared to those in monotherapy with Cialis. Ketokonazole administration increases the effect of tadalafil (AUC) (20 mg) by 4 times and Cmax - 22% at 400 mg / day. Ritonavir doubles the effect of Cialis (20 mg), which is a brake of 200 mg twice a day, a Protea brake, CYP3A4, CYP2C9, CYP2C19 and CYP2D6, without changing Cmax. Although specific interactions are not investigated, it should be used with caution with other proteins such as protozoa, such as sacveurus, as well as CYP3A4 inhibitors, such as erythromycin, clarithromycin, intraconazole, and giant Cialis, as the concentration of the drug in the plasma is predicted.

Cialis and carrier proteins (eg, p-glycoprotein) have the potential to interact with the carrier by blocking the carriers. Selective CYP3A4 inducer, rifampicin (rifampicin, 600 mg / day), decreases the effect of Cialis (AUC) (10 mg) by 88% and Caxax - 46% for AUC and Caxax in monotherapy with Cialis. This decrease in drug effect can reduce the effectiveness of Tadalafil; The value of decline in efficiency is unknown. When administered with rifampicin, once a day, the medication can be expected to reduce the effectiveness of Cialis. Simultaneous use of CYP3A4 inductors such as phenobarbital, phenytoin and carbamazepine may also reduce the concentration of Tadalafil in plasma.

Simultaneous administration of antacids (magnesium hydroxide / aluminum hydroxide) and Cialis drug reduces the absorption rate of the drug without altering the area under the pharmacological curve (AUC) of the drug Cialis. Increased pH of gastric acids by administration of a non-histidine H2 receptor blocker did not affect the pharmacokinetics of Cialis. The safety and efficacy of the use of Cialis® in combination with other FDE inhibitors or alternative methods of treatment of erectile dysfunction has not been studied, so it is not recommended to use such compounds.

Influence of Tadalafil on other drugs:

Tadalafil WikiIt is known that Tadalafil enhances the hypotensive effect of nitrates. Cialis should not be administered to patients receiving any type of organic nitrates. In the event of life-threatening conditions when the appointment of nitrates is clinically reasonable, it is important to maintain a 48-hour interval after taking the final dose of Cialis®. In such cases, nitrates should only be used strictly under medical supervision in accordance with hemodynamic monitoring.
Cialis metabolism does not have a clinically significant effect on the clearance of P450 cytokrom by the presence of isoferment. Studies have shown that Cialis does not inhibit or inhibit cytochrome isomers P450, including CYP3A4, CYP1A2, CYP2D6, CYP2E1, CYP2C9 and CYP2C19.
Cialis does not have a clinically significant effect on the pharmacokinetics of varapharin or R-varpharine. Cialis prothrombin time does not affect varpharin's effect.
Cialis does not increase the duration of bleeding caused by acetylsalicylic acid.

Tadalafil may enhance the effect of hypertension, which has a systemic vasodilator and is aimed at reducing blood pressure. There was a marked decline in blood pressure in patients with multiple hypertension, poorly monitored patients with arterial pressure. In most patients, these reductions did not coincide with the development of hypotensive symptoms. Patients receiving treatment with hypertension and receiving Cialis® should be given the appropriate clinical guidelines. Patients receiving hypertension medications should be warned of the potential risk of arterial pressure.
Significantly increased the hypoxanemic effect of doxazinine when using Cialis drug for the healthy people receiving doxazosine alpha-adrenoblocker (4-8 mg / day). This effect lasts for at least twelve hours and can be accompanied by various symptoms, including unconsciousness. Cialis and doxosazine should not be used simultaneously.

According to two clinical studies, selective alpha1-adrenoblocators were administered arsenic and alphusosin, while healthy individuals did not significantly reduce blood pressure when using Cialis. Cialis should be cautious when administering any alpha-adrenoblocker, especially in elderly patients. Treatment should begin with minimal doses and gradually correct. In clinical trials, it was investigated the ability of titalafil to increase the antihypertensive effect of antihypertensive drugs. Blockers of calcium rods (amlodipine), angiotensin-changing enzyme (AFF) inhibitors (enalapril), beta-adrenergic receptor blockers (metoprolol), thiazide diuretics (bentroplazide) and angiotensin II receptor blockators (isolated or blocked by blockers, calcium channel blockers, beta- and / or different types and dosages used in combination with alpha-blockers) and basic classes of antihypertensive drugs. There was no clinically significant relationship between any of these classes of teagalaphile (10 mg, except for the study of interaction with angiotensin II receptor blockers and amlodipine in 20 mg dose).

Clinical pharmacological studies have investigated the interaction of Cialis (20 mg) cost, combined with several (up to 4) class antihypertensive drugs. Changes in arterial pressure measured in outpatient patients in patients receiving multiple hypotensive drugs were consistent with the regulation of pressure. In patients with arterial pressure, medication was thoroughly adjusted, and its rate was less than that of healthy subjects. In patients who did not have arterial pressure, this decrease was dominated by a decrease in the majority of observed patients, although it did not cause hypotensive symptoms. Takdalaffil taken when patients are prescribed with antihypertensive medicines may cause lower pressure (usually, for example, alpha-blockers), which is the smallest of 20 mg and may cause an acute lowering of clinically significant symptoms. The analysis of the third phase of the clinical trials did not show any difference in the occurrence of adverse effects in patients with taindhalhal, combined with antibiotics or with individual intake. However, patients receiving hypertension should be warned about a possible reduction in blood pressure. Cialis (10 mg or 20 mg) did not affect the alcohol concentration, nor did alcohol affect the concentration of Cialis. The use of Cialis® did not substantially reduce the mean value of the arterial pressure caused by the administration of alcohol at a dose of 0.7 g / kg, but postural and moderate hypotension was observed in some patients. When Cialis® was combined with very low doses of alcohol (0.6 g / kg), no arterial hypotension was detected, and dizziness appeared only at the same time as alcohol. The use of Cialis® (10 mg) did not increase the effect of alcohol on cognitive functions.

In the symptomatic treatment of adenoma of the adrenal gland no new adverse reactions have been reported in the clinical trial comparing Tadalafil with 5 mg and 5 mg of Finasseride placemoma and 5 mg of Finasseride simultaneously. Pre-clinical studies have demonstrated an additional reducing effect of the arterial pressure system when combined with FDA-5 in combination with ryocytosis. During the clinical trials, riyocigat showed increased hypotensive effect of FDE-5 inhibitors. There is no evidence of clinical positive effects in the coordination of such drugs from the study groups of patients. The use of rhinoccus in combination with the FDE-5 inhibitors, including taalanphylys, is contraindicated.

Combination of guanilatcicase stimulants such as titdalafil and riyocigate is not recommended because it can lead to symptomatic hypotension.

However, since formal studies of the effects of Cialis and 5-alpha-reductase inhibitors have not been carried out, it is important to be cautious when assigning them together. Cialis theophylline (CYP1A2 substrate), pharmacokinetics and pharmacodynamics of selective non-selective phosphodiesterase inhibitors, and a slight increase in heart rate (3.5 times per minute) did not have clinically significant effects. It should be borne in mind that although Cialis® and theophylline can be administered simultaneously, it is possible to increase the frequency of AIDS. When using Cialis ordering, increased bioavailability of ethinylestradiol was found. Although the clinical implications are not clearly defined, it may be expected that such an effect can occur when oral administration of terbutalin is present. Thalangiline (10 mg and 20 mg) does not increase the duration of bleeding caused by acetylsalicylic acid. No clinical studies were conducted to investigate the interaction of Professional Cialis with diabetes mellitus.

Specific instructions:

  • Cialis is not recommended for women!
  • It is important to examine the history of the disease prior to the medication and conduct a physical examination of the patient for diagnosis of erectile dysfunction or severe hyperplasia of the pancreas and the potential causes of this condition.
  • Sexual activity is potentially a threat to patients with cardiovascular disease. Before treatment of erectile dysfunction, doctors should consider the condition of the cardiovascular system of the patient due to a certain degree of risk of cardiovascular disease associated with sexual activity. Treatment of erectile dysfunction, including the use of Cialis®, can not be performed with men who have the same heart condition as if they were not sexually active.
  • As with other FDE5 inhibitors, Cialis has a vasoconstriction, which can lead to a transient reduction in blood pressure, thereby enhancing the hypotensive effect of nitrates.
  • In order to treat Cialis for treating severe hyperplasia of the gut, it is necessary to carefully examine the patient for the presence of cardio-vascular pathology and lack of carcinoma of the pancreas.
  • Evaluation of erectile dysfunction should include the identification of appropriate treatment modalities and potential causes after medical examination. The efficacy of Cialis Super Active for patients who underwent radical prostatectomy or operated on pelvic organs was preserved.
  • Within the framework of post-marketing and clinical studies of tachycardia post-marketing and / or clinical studies, it was observed in many patients with cardiovascular risk factors, such as myocardial infarction, sudden cardiac death, unstable angina, ventricular arrhythmia, stroke, transient ischemic attacks, chest pain, heart failure. However, it is impossible to determine whether this phenomenon is directly or indirectly associated with these hazardous factors, drug administration, sexual excitement, or combination with these or other factors.
  • The use of tadalafil in patients receiving simultaneous antiplatelet therapy may lead to lower blood pressure. In the case of appointment of a daily intake of taallafil, the medical practitioner should consider the clinical situation to evaluate the possibility of correcting the dose of antihypertensive drugs.
  • When administering Cialis® to patients receiving alpha1-adrenoblocker, care should be taken as simultaneous use of these drugs may lead to some patients developing symptomatic hypotension. Doxazosine and Cialis should not be taken simultaneously. According to the results of two clinical trials a significant reduction in blood pressure was not observed when healthy people were taken using Cialis selective alpha1-adrenoblocator dosage.
  • There were cases of visual impairment and occurrence of non-arterial ischemic optical neuropathy (Aeion) when using Cialis and other FD5 inhibitors. Aei'ion also causes visual impairment, including incomplete visual impairment. It is currently impossible to determine whether there is a direct link between the occurrence of Aaion and FDE5 inhibitors or other factors. When the patient suddenly sees the eyes, the patient should stop receiving Tadalafil and be sure to consult a doctor immediately. Physicians should also be aware that the risk of re-emergence in people who suffer from AeAI can be higher.
  • It was reported that sudden deterioration of hearing or hearing loss accompanied by noise in the ear caused by the use of Cialis 20 mg. In this case, the doctor should be called immediately.
  • Taking into account the limited effectiveness of the drug (AUC), clinical practice is limited and can not be affected by dialysis, Tadalafil is recommended for patients with severe renal failure 1 time per day.
  • Patients with severe hepatic impairment (C-class P class) have limited clinical data on the safety of Cialis Soft intake. One-daily use of Cialis® for the treatment of erectile dysfunction and severe hyperplasia of the pancreas was not studied in patients with hepatic impairment. In the case of Cialis, the caregiver should start with a careful assessment of the relationship between the patient and the risk for the patient.
  • There are reports of the emergence of priapism. Patients should be aware of the need for immediate medical attention if an erection lasting for 4 hours or more. The immediate prophylaxis of the prostate can lead to the development of genital tissue damage, which can potentially be lost for a long time. Cialis® should be used with caution in patients with prickly-prone patients (eg, cellular anemia, multiple myeloma or leukemia) or an abnormal genital anomaly (eg, angular dislocation, covernous fibrosis, or peony ulcer).
  • When using Cialis for patients taking severe CYP3A4 inhibitors (ritonavir, sakvinavir, ketokonazol, ithranonazole and erythromycin), it is important to be aware that the effect of Cialis (AUC) increases when combined with these medicines.
  • The safety and efficacy of the combination of tadalafil with other FD5 inhibitors and other methods of treatment of erectile dysfunction has not been studied. Patients should be aware that such an association can not be used to treat Cialis.
  • Cialis contains lactose. Patients with rare hereditary problems, such as galactose failure, Lapp-lactase deficiency or glucose-galactose malabsorption, should not take Cialis.
  • In patients over the age of 65 who are taking Cialis, data on the use of the drug for the treatment of erectile dysfunction or severe hyperplasia of the pancreas is limited in clinical trials.
  • Pregnancy There is limited data on the use of tortillery in pregnant women. As a precaution, it is best to avoid taking Cialis Professional in pharmacy.
  • Lactation Cialis® should not be used during breastfeeding.
  • It has been found that spermatozoids concentration has decreased in some men. Peculiarities of the action of the medicinal product to control the vehicle or the hazardous mechanisms.
  • Cialis is negligible in its ability to control the vehicle or the hazardous mechanisms. While taking Cialis medication, the frequency of dizziness is the same as in placebo, but it is important to be cautious when driving during driving and when dealing with other hazardous activities requiring high concentration and rapid response to psychomotor reactions.

Overdosage:

Symptoms: Adverse effects on healthy subjects when Cialis Super Active (tadalafil) was administered once in a dose of up to 500 mg and more than 100 mg per day to patients, was as if the use of very low doses of the drug.
Treatment: In case of overdosage it is necessary to perform standard symptomatic treatment. Hemodialysis plays an important role in the production of Cialis.
Form of extraction and packaging: The tablet is made of 14 pills of polyvinylchloride fibers and aluminum foil. Packaged in a cardboard box together with instructions in the state and Russian languages on medical use of 1 or 2 shell packages.
Storage conditions: Store at room temperature not exceeding 25 C.
WARNING: Keep out of the reach of children!

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