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Interactions

A. Top Drug-Drug 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.

Other Drug-Drug interactions:

• Ketoconazole, itraconazole (used to manage fungal infection)
• Protease inhibitors (used to manage HIV infection) Ex. ritonavir, lopinavir
• Phenobarbital, phenytoin, carbamazepine (medicines used for fits)
• Rifampicin, erythromycin, clarithromycin (medicines used for bacterial infections)
• Other medicines used to improve blood flow to the penis (Ex. sildenafil)

B. Drug-Food Interactions:

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:

1. Grapefruit and Grapefruit Juice: Grapefruit can increase the levels of tadalafil in your blood by interfering with its metabolism. This may amplify side effects, such as headaches, dizziness, or low blood pressure. Avoid consuming grapefruit or grapefruit juice while taking Cialis.
2. Alcohol: Drinking alcohol with Cialis can enhance the blood pressure-lowering effects of the medication, leading to symptoms like dizziness, lightheadedness, or fainting. Limiting alcohol intake is recommended while using Cialis.
3. High-Fat Meals: While Cialis can be taken with or without food, consuming it with a high-fat meal may delay its onset of action. Opt for lighter meals if rapid effectiveness is needed.
4. Caffeine: Though not a direct interaction, combining Cialis with high caffeine intake might worsen side effects like headaches or increase heart rate in sensitive individuals.

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Cialis vs. nitrates: What is the most potent drug-drug interaction of its type?

4.Alpha-blockers: Cialis and alpha-blockers both lower blood pressure (e.g., nitrates) Red blood cells to enhance blood flow. This interaction is usually less severe than with nitrates or nit.)

5.: Cialis can enhance the blood pressure-lowering effects of these medications.

Description

Cialis (tadalafil) Tablets

Cialis is used to treat erectile dysfunction (ED) in men. In some cases, men with ED can safely use Cialis tablets. Cialis tablets work by relaxing muscles (widening of blood vessels) allowing more blood to flow in a natural manner. This helps improve erectile function. Cialis tablets have a long half-life, around 4 to 5 hours.

Active Ingredients: Tadalafil

What is Cialis?Cialis is a phosphodiesterase (PDE-5) inhibitor. It relaxes blood vessels, allowing more blood flow. This improved blood flow helps you achieve and maintain an erection, and helps prevent or improve the following:

• Problems with the penis
• Staying satisfied with your erection
• Staying sexually stimulated

How does Cialis work?Cialis inhibits an enzyme called PDE-5. This inhibition allows more blood to flow into the penis, resulting in an erection. Cialis tablets help relax the blood vessels in the penis, allowing more blood flow. This helps you achieve and maintain an erection.

How should I take Cialis?Take one tablet about 1 hour before sexual activity, with or without food. Take Cialis exactly as your doctor prescribes it to be.

What is the most important thing to know when using Cialis?Before taking Cialis, tell your doctor or pharmacist if you are allergic to it; any other medications; or if you have any other allergies. This medicine may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

What side effects might I notice from taking Cialis?Side effects that you should report to the doctor when taking Cialis.

Side effects that are not listed here. Many side effects are temporary, do not bother you if they bother you.

Others may be serious.

Side effects that may not go away. If you have any other side effects that may not go away, tell your doctor or pharmacist. This includes any other unexpected reactions to the doctor or pharmacist.

Some side effects are serious.

Headache, dizziness, flushing, nasal congestion, indigestion, upset stomach, diarrhea, back pain, muscle aches, or upset stomach.

These effects are not experienced.

How should Cialis be taken?

You should not take more than one tablet in 24 hours, as the dose may be doubled. The maximum daily dose is 1 tablet, and should not be taken more than once a day.

Cialis is available in capsule form. Take Cialis at least 30 minutes before planned sexual activity. Do not take Cialis more than once a day.

Cialis Dosage

The recommended starting dose for adults is 50 mg once daily, taken about 1 hour before sexual activity. Cialis tablets are best taken at the lowest dose possible to achieve and maintain an erection. Do not change your dose within 5 days, or increase your dose without medical advice.

If you are not sure what to do, ask your doctor or pharmacist.

Cialis Side Effects

Get medical help right away if you have any of the following:

• Allergic reactions to substances or foods
• Heart problems, such as angina
• Joint pain, including pain in hands, feet, or ankles
• Sudden vision loss, including NACL
• Sudden hearing decrease, partial or complete
• Severe allergic reactions

Cialis may cause serious side effects.

References

1. KD. Tripathi. Androgens and Drugs for Erectile Dysfunction. Essentials of medical pharmacology. Seventh edition. 2013. Page-304.

2. Adam M Henrie, James J Nawarskas, and Joe R Anderson. Clinical utility of tadalafil in the treatment of pulmonary arterial hypertension: an evidence-based review. NIH. National Library of Medicine. National Center for Biotechnology Information. PMC. PubMed Central. November 2015. [Accessed on November 08th, 2023]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636095/

3. Accord Healthcare Limited. Electronic Medicines Compendium (EMC). [Revised in October 2021] [Accessed on November 08th, 2023]https://www.medicines.org.uk/emc/files/pil.8637.pdf

4. Leeford Healthcare Private Ltd. Bigfun-36.https://www.leeford.in/product/556/bigfun-36

5. Central Drugs Standard Control Organization. Tadalafil tablet 20 mg (Additional Indication). [Revised in November 2009]. Tadalafil 10mg/20mg Tablets. [Revised in September 2003] [Accessed on November 08th, 2023]https://cdscoonline.gov.in/CDSCO/Drugs

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Drug Interaction of Cialis 20mg Tablet

Drug-Drug Interaction

Chloramphenicol

The use of this drug is contraindicated because the use of chloramphenicol will increase the effect of Sildenafil by affecting the patient hepatic and intestinal enzyme metabolism.

Isosorbide dinitrate

The use of this drug is contraindicated because the combination of this drug either increases the effects of the other by vasodilation which leads to fatal hypotension.

Nitroprusside sodium

The use of this drug is contraindicated because the combination of this drug either increases the effects of the others by pharmacodynamic synergism.

Enzalutamide

Use alternative drugs because the use of enzalutamide will decrease the effect of Sildenafil by affecting patient hepatic and intestinal enzyme metabolism.

Acetazolamide

Therapy should be administered with caution because the use of Sildenafil increases the effect of acetazolamide by pharmacodynamic synergism and it also increases the risk of hypotension.

Drug-Food Interaction

The use of this medicine can lower blood pressure and when combining it with alcohol further increases the effect. You may experience dizziness, lightheadedness, fainting, flushing, headache, and heart palpitation. Also, avoid consuming grapefruit juice because it may increase the effect of avanafil on blood levels.

Drug-Disease Interaction

Cardiovascular disease:

The use of phosphodiesterase-5 enzyme inhibitors is contraindicated in patients with cardiovascular disease. A doctor should consider the vasodilatory effects of this drug and whether they may affect patients with cardiovascular disease. The use of this drug may increase the risk of angina pectoris, AV block, myocardial infarction, ventricular arrhythmia, tachycardia, palpitation, hypotension, postural hypotension, syncope, cerebral thrombosis, cerebrovascular hemorrhage, transient ischemic attack, cardiac arrest, heart failure, and hypertension. These events can occur during or after sexual activity.

Renal dysfunction:

Therapy should be administered with caution in patients with severe renal disease or on renal dialysis. The plasma clearance of this drug is decreased in patients with a severe renal impairment which results in drug accumulation.

Liver diseases:

The use of this drug is not recommended for patients with severe hepatic impairment because the pharmacokinetic disposition of this drug has not been assessed in patients with severe hepatic impairment.

Addictive (IDs) or different formulation

The drug Cialis 20mg is known as a phosphodiesterase-5 inhibitor. The brand name Tadalafil is also used for other uses.

Interaction between this and other organic thiazides

This drug can interact with other medications such as amyl nitrite, isomer, metabolite of amyl nitrite, hydantoins, metabolite of amyl nitrite, thiazide diuretics, thiazide-type diuretics, phosphodiesterase-5 inhibitors, nitric oxide donors, heme repressurers, catecholamines, alpha-adrenergic receptors, histamine H1, alpha-adrenergic receptors, dopamine D2, dopamine D1, muscarinic A1 receptor alpha, glutamate A1 receptors, glutamate A2 receptors, GABA A receptors, histamine H1, adrenergic A1 receptors, and serotonin S1 and 2 receptors.

Possible side effects of this drug

The side effects of this drug may include headache, back pain, indigestion, use of a full stomach, muscle aches, flushing,nausea, vomiting, allergic reactions, redness in breasts, severe stomach pain, dark urine, abdominal pain, dizziness, muscle and back pain, symmetric scaling, breast lumps, palpitation, low blood pressure, hypotension, shock, rash, restlessness, reparative edema, urinary retention, and sexual dysfunction.

Interaction with other medications

Edrophonium 20mg Tablet

The use of this drug increases the risk of side effects and it also may increase the effect of other medications.