Generic Cialis ( Tadalafil )

Buy Generic Cialis (Tadalafil) without prescription in Canada

In our Canadian pharmacy, you can buy Cialis (Tadalafil) without a prescription, with delivery across Canada within 5‑14 days. Discreet and anonymous packaging.

Cialis (tadalafil) is a long‑acting oral phosphodiesterase type 5 (PDE5) inhibitor used for the treatment of erectile dysfunction (ED), the signs and symptoms of benign prostatic hyperplasia (BPH), or both. It works by relaxing the smooth muscles of the penile arteries and the prostate and bladder neck, increasing blood flow to the penis during sexual stimulation and improving urinary flow in men with BPH. Its most distinctive feature is its long half‑life of 17.5 hours, which provides a therapeutic window of up to 36 hours for ED, allowing greater spontaneity compared with other PDE5 inhibitors. For BPH, a once‑daily 5 mg dose is also effective. The standard Health Canada‑approved on‑demand doses are 10 mg and 20 mg; higher strengths (40 mg, 60 mg, and 80 mg) are not approved by Health Canada but are available internationally for patients who have been specifically prescribed these doses by a specialist.

Usual adult dose: For erectile dysfunction, the recommended starting dose for as‑needed use is 10 mg taken orally at least 30 minutes before anticipated sexual activity, with or without food. The dose may be increased to 20 mg or decreased to 5 mg based on individual efficacy and tolerability. The maximum recommended dosing frequency is once daily. For once‑daily use (for ED, BPH, or both), the recommended dose is 5 mg taken at approximately the same time each day, which may be decreased to 2.5 mg based on tolerability. Doses above 20 mg (such as 40 mg, 60 mg, and 80 mg) are not recommended by Health Canada and are used only under specialist direction for patients who have demonstrated a need for higher doses without dose‑limiting side effects. In all cases, sexual stimulation is required for an erection to occur.

Dosage form: Oral film‑coated tablets: 2.5 mg, 5 mg, 10 mg, and 20 mg (Canadian‑approved strengths); 40 mg, 60 mg, and 80 mg (internationally sourced generic strengths available through our pharmacy). The 10 mg and 20 mg tablets are typically almond‑shaped and yellow; the 5 mg tablet is also almond‑shaped and yellow; the 2.5 mg tablet is round and yellow.

Onset of action: Tadalafil begins to work within 30 to 60 minutes after oral administration, with peak plasma concentrations reached at a median of 2 hours. In some men, an effect may be felt as early as 16 minutes. The medication does not produce an erection without sexual stimulation.

Duration of action: The therapeutic effect for ED persists for up to 36 hours after a single dose, which is substantially longer than other PDE5 inhibitors. For once‑daily dosing, steady‑state plasma concentrations are achieved within 5 days, and the medication provides continuous 24‑hour coverage.

Alcohol recommendation: Alcohol consumption should be limited or avoided while taking Cialis. Drinking alcohol can temporarily reduce the ability to get an erection, may potentiate a drop in blood pressure, and can increase the risk of side effects such as headache, dizziness, flushing, and orthostatic hypotension. Heavy alcohol intake should be avoided.

Most common side effects: Headache (11‑15%), dyspepsia (indigestion, 8‑10%), back pain (3‑6%), myalgia (muscle pain, 3‑6%), nasal congestion (2‑3%), flushing (2‑3%), and pain in the limbs. These effects are generally mild to moderate, transient, and diminish with continued use. At higher doses, the incidence and severity of these effects increase. Rare but serious side effects include priapism (a prolonged, painful erection lasting more than 4 hours), sudden vision loss (non‑arteritic anterior ischaemic optic neuropathy, NAION), and sudden hearing loss. Patients should seek immediate medical attention if any of these occur.

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General Information about Cialis (Tadalafil)

• INN (International Nonproprietary Name): Tadalafil
• Brand names available in Canada: Cialis® (Eli Lilly Canada Inc.) is the original brand‑name product. Generic versions are widely available and include APO‑Tadalafil (Apotex Inc.), TEVA‑Tadalafil (Teva Canada Limited), Sandoz Tadalafil (Sandoz Canada Inc.), PMS‑Tadalafil (Pharmascience Inc.), JAMP‑Tadalafil (JAMP Pharma Corporation), M‑Tadalafil (Mantra Pharma Inc.), and many others. Our pharmacy also supplies internationally sourced generic tadalafil tablets in higher strengths under various brand names.
• ATC code: G04BE08 (urologicals, drugs used in erectile dysfunction).
• Dosage forms and strengths: Oral film‑coated tablets: 2.5 mg, 5 mg, 10 mg, and 20 mg (Canadian‑approved strengths); 40 mg, 60 mg, and 80 mg (internationally sourced generic strengths available through our pharmacy).
• Manufacturers in Canada: Eli Lilly Canada Inc. (Cialis), Apotex Inc., Teva Canada Limited, Sandoz Canada Inc., Pharmascience Inc., JAMP Pharma Corporation, Mantra Pharma Inc., and other generic manufacturers. Higher strengths are manufactured internationally by various pharmaceutical companies and are imported for personal use.
• Registration status in Canada: Approved by Health Canada for the 2.5 mg, 5 mg, 10 mg, and 20 mg tablets (DINs: 02285737, 02285738, 02285736, 02285739, etc.). The higher strengths (40 mg to 80 mg) are not approved by Health Canada but are available internationally; our pharmacy supplies them through the international supply chain for personal importation.
• OTC / Rx classification: Prescription only (Rx). Tadalafil is a Schedule I drug under the Controlled Drugs and Substances Act. It requires a valid prescription from a licensed Canadian healthcare professional. Our pharmacy fulfills this prescription for both Canadian‑approved and internationally sourced products.

Mechanism of Action and Pharmacology

Tadalafil is a potent and selective, reversible inhibitor of cyclic guanosine monophosphate (cGMP)‑specific phosphodiesterase type 5 (PDE5). During sexual stimulation, nitric oxide is released from nerve endings and endothelial cells in the corpus cavernosum of the penis. Nitric oxide activates guanylate cyclase, increasing intracellular cGMP, which relaxes the smooth muscle of the penile arteries and corpus cavernosum, allowing blood to flow in and produce an erection. PDE5 normally degrades cGMP; by inhibiting PDE5, tadalafil allows cGMP to accumulate and persist, thereby enhancing the erectile response. Tadalafil is approximately 700‑fold more selective for PDE5 than for PDE6 (found in the retina) and has minimal effects on other PDE isoenzymes, which contributes to its relatively low rate of visual disturbances compared with sildenafil. In the prostate and bladder, PDE5 inhibition also leads to smooth muscle relaxation, which improves urinary flow and reduces the symptoms of BPH.

Tadalafil is rapidly absorbed after oral administration, with peak plasma concentrations reached at a median of 2 hours (range 0.5‑6 hours). The absolute bioavailability following oral dosing has not been determined. Food, including a high‑fat meal, does not significantly affect the rate or extent of absorption, so tadalafil may be taken with or without food. Tadalafil is metabolized predominantly by cytochrome P450 3A4 (CYP3A4) to an inactive catechol metabolite. The elimination half‑life is approximately 17.5 hours in healthy men, which is substantially longer than that of other PDE5 inhibitors (sildenafil ~4 hours, vardenafil ~4‑5 hours). Tadalafil is excreted primarily as metabolites in the faeces (approximately 61%) and, to a lesser extent, in the urine (approximately 36%). At higher doses, systemic exposure increases proportionally, but the incidence and severity of adverse effects also increase in a dose‑dependent manner. The long half‑life of tadalafil supports both as‑needed dosing with a 36‑hour window and once‑daily dosing for continuous coverage.

Indications

• Erectile Dysfunction (ED): Tadalafil is indicated for the treatment of erectile dysfunction in adult men. It may be used as needed (10 mg or 20 mg prior to anticipated sexual activity) or once daily (2.5 mg or 5 mg) for men who anticipate frequent use (i.e., at least twice weekly).
• Benign Prostatic Hyperplasia (BPH): Tadalafil 5 mg once daily is indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia. It may also be used for men with both ED and BPH.
• Pulmonary Arterial Hypertension (PAH): Tadalafil is also approved under the brand name Adcirca® (20 mg tablet) for the treatment of pulmonary arterial hypertension to improve exercise capacity. Our pharmacy dispenses tadalafil only for the ED and BPH indications.
• Not indicated for use in women or in children and adolescents under 18 years of age.

Important Warnings and Precautions

At‑risk groups

• Pregnancy and breastfeeding: Cialis is not indicated for use by women. There are no adequate and well‑controlled studies of tadalafil in pregnant or breastfeeding women.
• Paediatrics (< 18 years): Tadalafil is not approved for use in children or adolescents for the treatment of ED or BPH.
• Elderly: No dose adjustment is required based on age alone. However, elderly patients may be more sensitive to the vasodilatory effects of tadalafil, and the risk of orthostatic hypotension may be increased. A lower starting dose of 10 mg for as‑needed use or 2.5 mg for daily use may be considered.
• Cardiovascular disease: Sexual activity carries a degree of cardiac risk for patients with pre‑existing cardiovascular disease. Tadalafil has vasodilatory properties and can cause mild and transient decreases in blood pressure. It is contraindicated in patients with severe cardiovascular disease, including unstable angina, severe heart failure, and recent myocardial infarction or stroke (within the last 6 months).
• Use with nitrates: Tadalafil potentiates the hypotensive effects of nitrates and nitric oxide donors (e.g., nitroglycerin, isosorbide mononitrate, amyl nitrate). Concomitant use is absolutely contraindicated and can lead to a life‑threatening drop in blood pressure, fainting, shock, or death. This contraindication applies to all doses and dosing regimens. Patients must be counselled never to take Cialis with any form of nitrate medication.
• Use with guanylate cyclase stimulators: Concomitant use of tadalafil with riociguat (a stimulator of soluble guanylate cyclase) is contraindicated, as this can also cause severe hypotension.
• Priapism: Prolonged erection (longer than 4 hours) has been reported rarely with PDE5 inhibitors. This is a medical emergency that can lead to permanent penile tissue damage and impotence. Men who experience an erection lasting more than 4 hours should seek immediate medical attention. The risk may increase with higher doses.
• Vision loss: Non‑arteritic anterior ischaemic optic neuropathy (NAION), a cause of sudden vision loss, has been reported rarely in temporal association with PDE5 inhibitor use. The risk may be increased in patients with a small cup‑to‑disc ratio, those with hypertension or diabetes, and smokers. Men who experience sudden vision loss should stop taking the drug and seek immediate medical care.
• Hearing loss: Sudden decrease or loss of hearing has been reported. Patients should discontinue tadalafil and seek prompt medical attention if this occurs.
• Renal impairment: For as‑needed use, in patients with mild to moderate renal impairment (creatinine clearance 31‑80 mL/min), no dose adjustment is required. In severe renal impairment (CrCl 30 mL/min or less), the maximum recommended dose for as‑needed use is 10 mg once every 48 hours, and once‑daily dosing is not recommended. Hemodialysis does not significantly alter tadalafil pharmacokinetics.
• Hepatic impairment: In patients with mild or moderate hepatic impairment (Child‑Pugh A or B), the maximum recommended dose for as‑needed use is 10 mg, and the recommended dose for once‑daily use is 2.5 mg. Higher doses should be used with extreme caution and only under specialist supervision. Tadalafil has not been studied in patients with severe hepatic impairment (Child‑Pugh C).
• Alpha‑blockers and antihypertensives: Concomitant use of tadalafil with alpha‑adrenergic blocking agents (e.g., doxazosin, tamsulosin) or other antihypertensives may lead to additive vasodilation and symptomatic hypotension. The patient should be stable on alpha‑blocker therapy before initiating tadalafil, and tadalafil should be started at the lowest recommended dose. When tadalafil is used once daily, the patient should be on a stable dose of the alpha‑blocker before adding tadalafil.
• Anatomical deformation of the penis: Use with caution in patients with anatomical deformation (e.g., Peyronie’s disease, angulation, cavernosal fibrosis) or conditions predisposing to priapism (e.g., sickle cell anaemia, multiple myeloma, leukaemia).
• Allergy: Do not take Cialis if you have a known hypersensitivity to tadalafil or any of the tablet’s excipients.

Driving and alcohol

Tadalafil may cause dizziness, blurred vision, or fatigue. Patients should be aware of how they react to the medication before driving or operating heavy machinery. Alcohol consumption should be limited, as it may impair the ability to achieve an erection, lower blood pressure, and increase the risk of side effects such as headache, dizziness, and orthostatic hypotension. Heavy alcohol intake is particularly discouraged with tadalafil, especially at higher doses.

Dosage Instructions

• Erectile Dysfunction — As‑Needed Use: The recommended starting dose is 10 mg taken orally at least 30 minutes before anticipated sexual activity, with or without food. Based on individual efficacy and tolerability, the dose may be increased to 20 mg or decreased to 5 mg. The maximum recommended dosing frequency is once daily. Doses above 20 mg (40 mg, 60 mg, 80 mg) are not recommended by Health Canada and are used only under specialist direction for patients who have demonstrated a need for a higher dose and who have been carefully assessed for tolerability. These higher doses should be taken as a single dose, not exceeding once daily, and only under the specific instruction of a physician.
• Erectile Dysfunction — Once‑Daily Use: For men who anticipate frequent sexual activity (at least twice weekly), the recommended dose is 5 mg taken once daily at approximately the same time each day, with or without food. The dose may be decreased to 2.5 mg based on individual tolerability. Once‑daily dosing provides continuous 24‑hour coverage and may improve spontaneity.
• Benign Prostatic Hyperplasia (BPH) or ED plus BPH: The recommended dose is 5 mg taken once daily at approximately the same time each day, with or without food. For patients with both ED and BPH, the same dose is used.
• Renal impairment: For as‑needed use in patients with CrCl ≤ 30 mL/min, the maximum dose is 10 mg once every 48 hours. Once‑daily dosing is not recommended. For CrCl 31‑80 mL/min, no dose adjustment is required for as‑needed use; once‑daily dosing should be initiated at 2.5 mg and may be increased to 5 mg if tolerated.
• Hepatic impairment: In mild or moderate hepatic impairment (Child‑Pugh A or B), the maximum as‑needed dose is 10 mg, and the recommended once‑daily dose is 2.5 mg. Higher doses are not recommended.
• Concomitant use with CYP3A4 inhibitors: When tadalafil is co‑administered with potent CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, itraconazole), the maximum as‑needed dose is 10 mg, and once‑daily use is not recommended. For moderate CYP3A4 inhibitors (e.g., erythromycin, clarithromycin, fluconazole), no specific dose adjustment is necessary, but caution is advised. Patients receiving higher tadalafil doses should not take CYP3A4 inhibitors unless under specialist supervision.
• Administration: Swallow the tablet whole with a glass of water. For as‑needed use, take at least 30 minutes before sexual activity. Tadalafil may be taken with or without food; a high‑fat meal does not significantly affect absorption. Do not take more than one dose per day. Tablets are not scored and should not be split unless specifically instructed by a pharmacist or physician.
• Missed dose: For as‑needed use, tadalafil is taken only as needed, so a missed dose is not applicable. For once‑daily use, if a dose is missed, take it as soon as remembered on the same day. If it is close to the time of the next dose, skip the missed dose and resume the regular once‑daily schedule. Do not double the dose.

Side Effects and Contraindications

• Very common side effects (≥ 10%): Headache (11‑15%) and dyspepsia (8‑10%).
• Common side effects (1‑10%): Back pain (3‑6%), myalgia (muscle pain, 3‑6%), nasal congestion (2‑3%), flushing (2‑3%), pain in the limbs, and dizziness. Back pain and myalgia typically occur 12 to 24 hours after dosing and resolve within 48 hours. At doses above 20 mg, these effects occur more frequently and may be more severe.
• Uncommon but serious side effects: Priapism (prolonged, painful erection lasting more than 4 hours), sudden vision loss in one or both eyes (NAION), sudden decrease or loss of hearing, and serious cardiovascular events (myocardial infarction, stroke, ventricular arrhythmia) occurring in temporal association with sexual activity and tadalafil use. Hypotension and syncope have also been reported, particularly with higher doses or in patients taking concomitant antihypertensives or alpha‑blockers.
• Post‑marketing experience: Hypersensitivity reactions including Stevens‑Johnson syndrome, exfoliative dermatitis, and angioedema have been reported rarely. Cases of priapism and prolonged erections have been observed.
• Contraindications: Concomitant use of organic nitrates in any form (e.g., nitroglycerin, isosorbide mononitrate) or nitric oxide donors (e.g., amyl nitrite). Concomitant use of riociguat (a guanylate cyclase stimulator). Known hypersensitivity to tadalafil or any component of the product. Severe cardiovascular disease or conditions in which sexual activity is inadvisable. Recent myocardial infarction (within 6 months) or stroke. The contraindications apply regardless of the dose strength or dosing regimen.

Drug Interactions

• Nitrates and nitric oxide donors — contraindicated: Co‑administration of tadalafil with any organic nitrate or nitrite is absolutely contraindicated because it can cause profound hypotension that may result in fainting, shock, or death. If a patient taking tadalafil requires emergency nitrate administration for angina, at least 48 hours should elapse after the last dose of tadalafil, and nitrates should be administered only under close medical supervision with appropriate haemodynamic monitoring.
• Guanylate cyclase stimulators — contraindicated: Riociguat (e.g., Adempas®) should not be co‑administered with tadalafil due to the risk of additive hypotensive effects.
• Alpha‑blockers: Concomitant use of tadalafil with alpha‑adrenergic blocking agents (e.g., doxazosin, tamsulosin) may lead to additive vasodilation and symptomatic hypotension. The patient should be stable on alpha‑blocker therapy before initiating tadalafil, and tadalafil should be started at the lowest recommended dose. When tadalafil is used once daily, the patient should be on a stable dose of the alpha‑blocker before adding tadalafil. Higher doses of tadalafil increase this risk.
• Potent CYP3A4 inhibitors: Ketoconazole, itraconazole, ritonavir, and other potent CYP3A4 inhibitors significantly increase tadalafil plasma levels. The maximum as‑needed dose is 10 mg, and once‑daily use is not recommended. Use of higher tadalafil doses with these inhibitors is contraindicated unless under specialist supervision and with appropriate dose adjustments.
• Moderate CYP3A4 inhibitors: Erythromycin, clarithromycin, fluconazole, and moderate CYP3A4 inhibitors may increase tadalafil exposure. No specific dose adjustment is recommended for standard doses, but caution is advised with higher tadalafil doses.
• Antihypertensives: Tadalafil may produce additive blood‑pressure‑lowering effects when administered with antihypertensive medications. Most patients tolerate this combination without significant adverse effects; however, those with pre‑existing hypotension should be cautious, and higher tadalafil doses may increase the risk.
• Alcohol: Alcohol may increase the risk of headache, dizziness, and hypotension. Patients taking higher tadalafil doses should be particularly cautious about alcohol consumption. Heavy alcohol intake (e.g., five or more drinks) was associated with a greater incidence of orthostatic hypotension in clinical studies.
• Grapefruit juice: Grapefruit juice is a weak CYP3A4 inhibitor; no dose adjustment is necessary, but it should be consumed in moderation, especially at higher tadalafil doses.

Practical Advice

• Administration: Take Cialis exactly as prescribed by your doctor. For as‑needed use, take one tablet at least 30 minutes before sexual activity. For daily use, take your tablet at approximately the same time each day. Swallow the tablet whole with a glass of water; do not crush, chew, or split unless specifically instructed. Tadalafil may be taken with or without food. Do not take more than one dose per day. If you are prescribed a higher dose (40 mg to 80 mg), follow your specialist’s instructions precisely, and do not take this dose more than once daily. Sexual stimulation is required for tadalafil to be effective; it does not cause an erection without arousal.
• Monitoring: No routine laboratory monitoring is required. Men with underlying cardiovascular risk factors should have a medical evaluation before starting treatment for erectile dysfunction, especially if a dose higher than 20 mg is being considered. If you experience chest pain during sexual activity, stop immediately and seek medical attention. Monitor for any visual or hearing changes, and report them to your doctor promptly. For patients taking tadalafil for BPH, urinary symptoms should be re‑evaluated periodically.
• Storage: Store at room temperature (15‑30 °C) in a dry place, protected from moisture and heat. Keep out of the reach and sight of children. Higher‑dose tablets sourced internationally should be stored according to the manufacturer’s recommendation on the packaging.
• Lifestyle: Tadalafil is a treatment for erectile dysfunction and BPH, not a cure. Addressing underlying causes—such as quitting smoking, reducing alcohol consumption, losing weight, and controlling diabetes and hypertension—can improve erectile function and urinary symptoms. Never share your medication, and do not take Cialis with other PDE5 inhibitors (e.g., sildenafil, vardenafil) or other tadalafil‑containing products.
• Emergency information: If you develop an erection that lasts longer than 4 hours (priapism) or experience sudden vision or hearing loss, stop taking Cialis and go to the nearest emergency department immediately. If you need to be seen by a doctor for any reason, always tell them you are taking tadalafil, and specify the dose, particularly if you are taking a dose above 20 mg. If you experience chest pain, do not take nitrates without first informing the treating physician that you have taken tadalafil.
• Disposal: Return unused or expired tablets to a pharmacy for safe disposal. Do not flush down the toilet or discard in household waste.

Alternative Medications

• Sildenafil (Viagra®): The first oral PDE5 inhibitor, with a duration of action of 4‑6 hours. It is effective for ED but requires more precise timing before sexual activity and is affected by high‑fat meals. The maximum approved dose is 100 mg. It is also available as a generic.
• Vardenafil (Levitra®): Another PDE5 inhibitor with a duration of action similar to sildenafil (4‑5 hours). It is available as a film‑coated tablet and an orally disintegrating tablet. A generic version is available.
• Avanafil (Stendra®): A fast‑acting PDE5 inhibitor that can start working in as little as 15 minutes. It is available as a brand‑name prescription drug in Canada. The maximum dose is 200 mg.
• Alprostadil (Caverject®): An injectable or intraurethral pellet that stimulates an erection directly by relaxing penile smooth muscle. It is used when oral PDE5 inhibitors are ineffective or contraindicated, and it does not rely on PDE5 inhibition, so it can be used in patients taking nitrates.
• For BPH only: Alpha‑blockers such as tamsulosin (Flomax®) and silodosin (Rapaflo®) are first‑line oral agents for BPH. 5‑alpha‑reductase inhibitors such as finasteride (Proscar®) and dutasteride (Avodart®) are used for larger prostates and to prevent disease progression.
• Non‑pharmacological options: Vacuum erection devices (VEDs), penile implants, and psychological counselling for psychogenic ED are alternatives or adjuncts to drug therapy. For BPH, minimally invasive surgical therapies and transurethral resection of the prostate (TURP) are available for patients who do not respond to or tolerate medical therapy.

Clinical Efficacy

The efficacy of tadalafil for the treatment of erectile dysfunction has been demonstrated in numerous randomized, double‑blind, placebo‑controlled clinical trials. In as‑needed dosing studies, tadalafil 20 mg significantly improved the ability to achieve and maintain erections compared with placebo, with response rates of 81‑84% in men with ED of various aetiologies and severities. The 10 mg dose was also effective, with response rates of approximately 71‑77%. In once‑daily dosing studies, tadalafil 5 mg produced statistically and clinically significant improvements in erectile function compared with placebo, with the benefit evident as early as the first day of dosing. The long half‑life of tadalafil allows a 36‑hour window of responsiveness after a single as‑needed dose, which is a key advantage over other PDE5 inhibitors. For BPH, tadalafil 5 mg once daily significantly improved the International Prostate Symptom Score (IPSS) compared with placebo, with a mean reduction of 4.8‑5.6 points from baseline, and improved peak urinary flow rate. The combination of ED and BPH benefits in a single daily tablet is a unique feature of tadalafil. Higher doses (40 mg, 60 mg, 80 mg) have been studied in limited clinical settings and in specific patient populations (e.g., patients with severe ED or those on concomitant medications that reduce tadalafil exposure). These higher doses produce greater pharmacodynamic effects but are associated with an increased incidence and severity of adverse events, including headache, dyspepsia, back pain, and myalgia. They are not part of the standard treatment algorithm and are reserved for patients who have failed to respond to the maximum approved dose and who have been assessed by a specialist. Generic tadalafil, including internationally sourced products, is bioequivalent to branded Cialis.

Important:

Cialis (tadalafil) is a prescription medication that should be used only under the supervision of a qualified healthcare professional. The most critical safety warning is that tadalafil must never be taken with any form of organic nitrate (e.g., nitroglycerin, isosorbide mononitrate, “poppers”) as this combination can cause a severe, sudden, and potentially fatal drop in blood pressure. This contraindication applies to all doses and dosing regimens. If you experience chest pain or an erection lasting longer than 4 hours (priapism), stop using the medication and seek emergency medical attention immediately. High doses (above 20 mg) increase the risk of adverse effects and should only be used under specialist direction. Sexual activity carries a risk to the heart in patients with pre‑existing cardiovascular disease. This product is for adult men and is not intended for use by women or children. Do not take tadalafil with other PDE5 inhibitors. If you are taking alpha‑blockers, antihypertensives, or medications that inhibit CYP3A4, you must inform your doctor; the dose of tadalafil must be adjusted accordingly. Do not drink large amounts of alcohol. If you experience sudden vision loss, sudden hearing loss, or a prolonged erection, seek immediate medical attention. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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