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Cialis

Aka: Cialis, Tadalafil
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  1. Indications
    1. Psychogenic Impotence
    2. Neurogenic Impotence
    3. Vasculogenic Impotence
  2. Contraindications
    1. Absolute Contraindications (risk of Hypotension)
      1. Men using nitrates (i.e. Nitroglycerin)
      2. Men using alpha blockers (e.g. Hytrin for BPH)
    2. Relative Contraindications
      1. Active coronary ischemia in men not on nitrates
      2. Congestive Heart Failure
        1. Borderline low Blood Pressure
        2. Bordrline low volume status
      3. Multidrug antihypertensive regimen
      4. Taking Cytochrome P450-3A4 (CYP3A4) inhibitor
  3. Mechanism
    1. Phosphodiesterase Type 5 causes Erection to subside
    2. Cialis blocks Phosphodiesterase Type 5
      1. Results in enhanced Erection if man is aroused
      2. Unlike Alprostadil, will not cause Erection
    3. Cialis enhances vasodilating effect of Nitrous Oxide
      1. Normally released during sexual stimulation
  4. Pharmacokinetics
    1. Onset within 30 to 60 minutes
    2. Duration as long as 36 hours
      1. Contrast with 4 hours with Viagra
      2. Prolonged effect also leads to prolonged side effects
  5. Dosing
    1. Start 20 mg PO 1 hour before intercourse
      1. Do not take more than once per 2 days
      2. Most insurance limits to 6 per month
    2. Indications to start with half dosing (10 mg)
      1. Age over 65 years
      2. Hepatic Impairment
      3. Renal Impairment
      4. Concurrent use of Cytochrome P3A4 inhibitor below
  6. Drug Interactions
    1. Inhibit breakdown of Viagra via Cytochrome P3A4
      1. Cimetidine (Tagamet)
      2. Erythromycin
      3. Ketoconazole (Nizoral)
      4. Itraconazole (Sporonox)
      5. Mibefradil (Posicor)
    2. Profound Vasodilitation and Hypotension (Avoid)
      1. Nitrates
      2. Alpha-blockers (use Tamsulosin instead)
        1. Uroxatral
        2. Doxazosin
        3. Terazosin
        4. Prazosin
  7. Adverse Effects
    1. Hypotensive effect for men on Nitrates (Avoid)
    2. Temporary color vision disturbance
      1. Blue colors may appear to be green
    3. Mild Headache
    4. Facial Flushing
    5. Myalgias
    6. Indigestion or Dyspepsia
    7. Does not cause Priapism
    8. Sensorineural Hearing Loss
      1. Sudden onset and permanent Hearing Loss
      2. McGwin (2010) Arch Otolaryngol Head Neck Surg 136(5):488-49
  8. References
    1. 2003 Med Lett Drug Ther 45:101-2
Medication Costs
Cialis (on 2/9/2012 at DrugStore.com)
Cialis 5mg Tablets #10 for $49.99 ($5.00/unit)
Cialis 30 5mg Tablets Box #1 for $133.97 ($133.97/unit)
Cialis 10mg Tablets #10 for $220.99 ($22.10/unit)
Cialis 20mg Tablets #10 for $219.99 ($22.00/unit)
Cialis 15 2.5mg Tablets Box #1 for $74.99 ($74.99/unit)
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Cialis (C0967376)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C429886
SnomedCT 407112003
Spanish Cialis (producto), Cialis
English cialies, cialis, Cialis, Lilly brand of tadalafil, Cialis (product)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


tadalafil (C1176316)

Definition (NCI) A carboline-based compound with vasodilatory activity. Tadalafil selectively inhibits the cyclic guanosine monophosphate (cGMP)-specific type 5 phosphodiesterase- (PDE-5)-mediated degradation of cGMP, which is found in the smooth muscle of the corpus cavernosa and corpus spongiosum of the penis. Inhibition of cGMP degradation by tadalafil results in prolonged muscle relaxation, vasodilation, and blood engorgement of the corpus cavernosa, and, so, prolonged penile erection.
Definition (NCI) A drug used to treat erectile dysfunction. It is also being studied in the treatment of sexual problems in patients treated with radiation or surgery for prostate cancer. Cialis blocks the action of a certain enzyme, which can result in increased blood flow to the penis, causing an erection. It is a type of cGMP phosphodiesterase type 5 (PDE5) inhibitor.
Definition (PDQ) A carboline-based compound with vasodilatory properties. Tadalfil selectively inhibits the cyclic guanosine monophosphate (cGMP)-specific type 5 phosphodiesterase- (PDE-5)-mediated degradation of cGMP, which is found in the smooth muscle of the corpus cavernosa and corpus spongiosum of the penis. Inhibition of cGMP degradation by tadalfil results in prolonged muscle relaxation, vasodilation, and blood engorgement of the corpus cavernosa, and, so, prolonged penile erection. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=462366&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=462366&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C47743" NCI Thesaurus)
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C429886
SnomedCT 407734006, 407111005
English TADALAFIL @ @ UNIDENTIFIED, TADALAFIL UNIDENTIFIED, (6R,12aR)-2,3,6,7,12,12a-Hexahydro-2-methyl-6-(3,4-methylenedioxyphenyl)pyrazino(1',2':1,6)pyrido(3,4-b)indole-1,4-dione, tadalafil (medication), tadalafil [Chemical/Ingredient], TADALAFIL, tadalafil, Tadalafil (product), Tadalafil (substance), Tadalafil, Pyrazino(1',2':1,6)pyrido(3,4-b)indole-1,4-dione, 6-(1,3- benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydro-2-methyl-, (6R,12aR)-
Spanish tadalafil (producto), tadalafil (sustancia), tadalafil
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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