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.

ased in

C. Long-term Use of Prazosin, tamsulosin, or other Drug-Food Interactions

Using Cialis with the following medications may:

• With or without a doctor's prescription
• May delay your use of dangerous anti-fungal medications.
• May cause side effects like nausea or dizziness.
• Other Drug-Food interactions

Drug-Medications:

Tadalafil, including the above drugs, can amplify the blood pressure-lowering effects of tamsulosin or other nitrates (nitrates containing generic form of the medication tadalafil). This can affect how it works and increase the risk of angina, heart attack, or stroke. If you have any questions or concerns about Tadalafil, consult your doctor.

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Cialis has been shown to cause some mild side effects. Talk to your health care provider if these do not go away within a few days. If you begin to experience more serious reactions, seek medical attention immediately.

Common side effects reported from Cialis use include:

• Headache
• Indigestion
• Heartburn
• Upset stomach
• Gas
• Nausea
• Flushing

More severe side effects include:

• Painful erections or erections that last longer than 4 hours
• Sudden loss of vision
• Sudden loss of hearing
• Ringing in the ears
• Chest pain
• Shortness of breath
• Painful urination
• Increased urination frequency
• Fainting
• Dizziness
• Skin rash
• Hives
• Facial swelling

If you experience any of these side effects, seek medical attention immediately. These are symptoms of a severe adverse reaction to this medication that require immediate treatment.

As with all prescription medications, inform your doctor of any medical conditions you currently manage. Tell them about any and all medications, prescription drugs, and supplements you are taking before starting treatment with Cialis. Cialis can interact with bodily substances, causing potentially serious adverse reactions.

Specifically, you should inform your health care provider of any alpha-blocker, antifungal, HIV protease inhibitor, or high blood pressure medication you are taking. Remember to mention any herbal products you use, especially St. John’s wort.

In addition, let your doctor know if you have recently had heart surgery or experience chest pain during sex. If you experience any changes in your heartbeat or chest pain during sex, contact your health care provider immediately.

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Talk to your health care provider if your symptoms persist or become severe.

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

Central for clinical research analysis quality control committee. [Revised in November 2009] [Accessed on November 08th, 2023]https://www.ncbi.nlm.nra. View/ Aff Servolutelyoud. 2013Rates of side effects in patients with pulmonary arterial hypertension: is Cialis responsible for your headache worth it? public health Organization of European Community.https://www. Rbmg.org.uk/Content/ grandma.html

6. American College of Card Health. Is Cialis my face all? [Revised in September 2013] [Accessed on November 08th, 2023]https://www.ach.org.hr/publications/my-face/

Pfizer’s cardiovascularsidaviour in patients with heart failure: a cohort meta-analysis.Unedible.

7. European Society of Cardiology.https://cdscoonline.org.in/View/Aff Servingly

Cialis prescribing information: [Accessed on November 08th, 2023] [Accessed on November 08th, 2023]

8. US National Library of Medicine.

9. Protonreal.

Protonreal prescribing information: [Accessed on November 08th, 2023]

10. Total NHS: [Accessed on November 08th, 2023]

Public health information: [Accessed on November 08th, 2023]Public health data: [Accessed on November 08th, 2023]

A brief view of Cialis from the NNPhC

What is Cialis?

Cialis is a prescription drug used to treat erectile dysfunction (impotence) in men. It works by helping to restore blood flow to the penis by relaxing muscles in the walls of blood vessels so that it becomes erect. Cialis comes in a few different formulations:

• 1:Oral tablet: 10mg, 20mg, 40mg, 60mg, 80mg, 100mg
• 2:Extended-release (XR): 20mg, 40mg, 60mg, 80mg, 100mg

Cialis is usually taken one to three hours before sexual activity.

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PlatinumRx is dedicated to delivering dependable and trustworthy information to empower our customers. However, the information presented here is solely for general informational purposes and should not be utilized for diagnosing, preventing, or treating health issues. It is not intended to establish a doctor-patient relationship or serve as a substitute for professional medical advice.

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