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The weekend pill

Cialis from Lilly pharmaceutical company is sometimes known as The Weekend Pill due to its 36-hour duration of action.

It has been licensed in the UK since 2003. It was the second erectile dysfunction (ED) prescription medication of its type to receive a UK license, after Viagra (sildenafil). Its prolonged effectiveness and the option to take a low dose daily tablet have led to Cialis becoming increasingly popular and being more widely prescribed.

Generic Cialis

The patent for Cialis expired in the UK on 14 November 2017, allowing other drug manufacturers to legally make and sell generic versions (marketed as tadalafil). Generic medicines are medically identical to branded originals and are usually much lower cost.

Daily versus Cialis '36 hours'

Most men take Cialis as and when they need it, usually 10mg or 20mg, which is effective for up to 36 hours.

Men who need erectile dysfunction treatment two or more times a week should consider taking a regular low dose tablet daily. 2.5mg or 5mg strength tablets taken every day will provide continuous erectile dysfunction treatment, without peaks and troughs.

What does it do?

Cialis contains tadalafil which is known medically as a PDE5 inhibitor. Tadalafil inhibits the PDE5 enzyme which is involved in regulating blood flow in the penis during erections. Sexual stimulation is required before the medication will work - without stimulation it will have no effect. Cialis augments and supports sexual performance and relationships.

Tadalafil can also be used to treat benign prostatic hyperplasia (enlarged prostate) symptoms.

Why do men get erectile dysfunction?

A range of factors contribute to erectile dysfunction, including lifestyle choices, mental state, chronic disease, injuries, and operations. Emotional problems, such as stress and performance anxiety, can have an impact on both erectile performance and sexual desire. Occasional treatment with a PDE5 inhibitor such as Cialis can be effective in breaking a cycle of anxiety and failure. Lifestyle factors, such as smoking, non-prescription drug use, excessive drinking, and even obesity can have an effect. Erectile dysfunction is sometimes a symptom of underlying health problems such as diabetes, atherosclerosis, and heart disease, amongst others.

Men suffering from erectile dysfunction should inform their GP who will undertake an assessment, possibly perform tests, and provide advice.

Why choose Cialis?

Cialis (tadalafil) benefits from having a long duration of action. Viagra (sildenafil) remains active for about 4 hours, Levitra (vardenafil) for 4-5 hours, and Cialis for 36 hours – hence its familiar name 'The Weekend Pill'. Erections will not be continuous during 36 hours after taking Cialis, occurring only at times of arousal during those 36 hours.

For further details see How long does tadalafil last?

Alternative treatment

Viagra (sildenafil), Levitra (vardenafil), and Spedra (avanafil) are alternative tablet treatments for erectile dysfunction and are also available to buy in various strengths and pack sizes after completing the same medical consultation.

Compare erectile dysfunction tablets

Taking Cialis for the first time

There are four strengths: 2.5mg, 5mg, 10mg, and 20mg. The lower doses of 2.5mg and 5mg are primarily for regular daily use, although the 5mg strength can be taken on an as required basis by men who respond well to one-off lower doses.

The usual starting dose is 10mg taken at least 30 minutes before sexual activity. If this dose is highly effective, subsequent doses could be reduced to 5mg on a trial basis. If repeated trials of a 10mg dose prove ineffective, the dose can be increased to 20mg.

There is no benefit in taking a higher dose than is needed. Repeated trials of treatment at one dose are recommended before changing to higher or lower strength tablets.

For further information read NHS - How and when to take tadalafil

Dosage

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Does it work every time?

Response to treatment is usually predictable and consistent. On most occasions, if Cialis has worked before, it will work again.

Some causes of erectile dysfunction, such as physical injuries or nerve damage, are more resistant to tablet treatments and may require other therapies, such as injections or penile implants.

Erectile dysfunction may require specialist treatment apart from tablets. Some men, whose erectile dysfunction has psychological causes, may benefit from counselling.

All men who are troubled by erectile dysfunction, which can be a distressing problem, should consult a doctor for a full assessment and advice.

Side effects of Cialis

Most men do not experience significant side effects. A full list of the most frequent side effects can be found in the manufacturer's patient information leaflet supplied with tablets (links below).

Some men experience a bluish or yellowish tinge to their vision after taking Cialis. This is not dangerous and fades after a few hours. This is a possible side effect of all ED drugs (PDE5 inhibitors).

Other common side effects (affecting 1%-10%) include headache, back pain, muscle aches, pain in the arms or legs, nasal congestion, facial flushing, and indigestion.

On very rare occasions ED treatment produces prolonged and painful erections, in a condition known as priapism. Priapism is a medical emergency with the potential on rare occasions for irreversible injury to the penis. If an erection lasts for more than 2 hours, medical attention should be sought immediately.

When not to take Cialis

During an assessment on the Dr Fox website, men are required to complete an erectile dysfunction questionnaire. This determines if treatment is suitable. Men should not take Cialis without further assessment from their GP if any of the following apply:

• They are taking other erectile dysfunction drugs such as Viagra/sildenafil, Levitra/vardenafil, or Spedra/avanafil
• They are currently taking nitrates for angina, including isosorbide mononitrate, isosorbide dinitrate, nicorandil, and glyceryl trinitrate - serious reactions possible
• They are taking medications to treat HIV, including Indinavir and Ritonavir
• They are using anti-fungal treatments like itraconazole or ketoconazole.
• They are using recreational drugs such as amyl nitrate ('poppers').
• They are taking alpha-blockers often used in the treatment of prostate enlargement and high blood pressure such as doxazosin, prazosin, alfuzosin, terazosin, indoramin, and tamsulosin.
• They are taking antibiotics such as erythromycin, clarithromycin, or rifampicin.
• They are on anticonvulsants such as phenobarbital, phenytoin, or carbamazepine.

Dr Fox cannot supply treatment to men where the above are present.

Cialis should not be taken at the same time or within 24 hours of taking Viagra/sildenafil, Levitra/vardenafil, or Spedra/avanafil.

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