Tadatron-5 Generic Cialis (Tadalafil 5mg)

Additional Information

Dosages of Tadalafil

Tadalafil is available under the brand names Adcirca and Cialis, both of which are employed for different medical conditions but share the same active ingredient.

Tablet Forms and Strengths

Below are the dosage considerations for different conditions:

Erectile Dysfunction (ED)

• As Needed Use:
  • Start with 10 mg orally before sexual activity, with or without food.
  • The dose can be increased to 20 mg or reduced to 5 mg based on efficacy and tolerability.
  • The maximum dosing frequency is typically once daily.
• Once-Daily Use:
  • 2.5 mg/day orally in a single daily dose, regardless of sexual activity timing, with or without food.
  • It can be increased to 5 mg/day based on efficacy and tolerability.
• Dosing Considerations:
  • As Needed Use: Decrease dose with concomitant use of potent CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, itraconazole); do not exceed 10 mg/72 hours.
  • Once-Daily Use: Decrease dose with concomitant use of potent CYP3A4 inhibitors; do not exceed 2.5 mg/day.

Benign Prostatic Hyperplasia (BPH)

• Cialis:
  • 5 mg orally once daily for treatment of BPH.
  • For patients with both BPH and ED, take 5 mg orally once daily, approximately at the same time each day, regardless of the timing of sexual activity.
  • With finasteride for BPH: tadalafil 5 mg plus finasteride 5 mg orally once daily for up to 26 weeks.

Pulmonary Arterial Hypertension (PAH)

• Adcirca:
  • 40 mg orally once daily; dividing the dose is not recommended.
  • For patients also taking ritonavir: 20 mg orally once daily initially for 1 week or more; may be increased to 40 mg/day based on tolerability.
• Dosing Considerations:
  • If possible, avoid coadministration with CYP3A4 inhibitors. If essential, modify or hold the dose.
  • Patients already taking a strong CYP3A4 inhibitor who require tadalafil: Start with 20 mg orally once daily; may increase to 40 mg/day based on tolerability.
  • Patients already taking tadalafil who require a strong CYP3A4 inhibitor: Avoid tadalafil, stop 24 hours before starting the inhibitor, and resume after a week at 20 mg orally once daily; may increase to 40 mg/day based on tolerability.

Geriatric Dosing

• Erectile Dysfunction (ED): No dosage adjustment is warranted solely based on age; however, greater sensitivity to medications in some older individuals should be considered.
• Pulmonary Arterial Hypertension (PAH): A lower dose or reduced dosing frequency may be required in the elderly due to decreased renal or hepatic clearance.

Renal Impairment (ED)

• Cialis (As Needed Use):
  • Mild (CrCl ≥51 mL/min): No dosage adjustment is needed.
  • Moderate (CrCl 30-50 mL/min): Maximum dosage, 10 mg orally every 48 hours.
  • Severe (CrCl <30 mL/min and on hemodialysis): Maximum dosage, 5 mg orally every 72 hours.
• Cialis (Once Daily Use):
  • CrCl ≥30 mL/min: No dosage adjustment is needed.
  • CrCl <30 mL/min: Not recommended.
• Renal Impairment (PAH):
  • Adcirca:
    • Mild-to-moderate (CrCl 31-80 mL/min): 20 mg orally once daily initially; may be increased to 40 mg once daily based on tolerability.
    • Severe (CrCl <30 mL/min and on hemodialysis): Avoid use.

Hepatic Impairment (ED)

• Cialis (As Needed Use):
  • Mild-to-moderate (Child-Pugh class A or B): Max 10 mg orally once daily.
  • Severe (Child-Pugh class C): Not recommended.
• Cialis (Once Daily Use):
  • Mild-to-moderate (Child-Pugh class A or B): Data limited; caution advised.
  • Severe (Child-Pugh class C): Not recommended.
• Hepatic Impairment (PAH):
  • Adcirca:
    • Mild-to-moderate (Child-Pugh class A or B): Consider starting a dosage of 20 mg orally once daily.
    • Severe (Child-Pugh class C): Avoid use.

Drug Interactions with Tadalafil

Before starting or stopping any medication, consult with your doctor, healthcare provider, or pharmacist. Tadalafil has various drug interactions which can result in severe consequences if not monitored properly.

Severe Interactions

• Boceprevir
• Isosorbide dinitrate
• Isosorbide mononitrate
• Nitroglycerin (IV, PO, rectal, sublingual, topical, transdermal, translingual)
• Riociguat
• Telaprevir

Moderate Interactions

Tadalafil has moderate interactions with at least 152 different drugs. Some notable mentions include:

• Alpha-blockers (must be stabilized before initiation of PDE-5 inhibitors)
• Antifungals (e.g., ketoconazole, itraconazole)
• Antibiotics (e.g., erythromycin)

Mild Interactions

• Ranolazine

This list is not exhaustive. Always keep a list of all your medications and share it with your healthcare provider to ensure there are no harmful interactions. For a full list of drug interactions, consult your doctor or pharmacist.

Special Populations and Considerations

Pregnancy and Lactation

Tadalafil may be acceptable for use during pregnancy. Although human studies are not comprehensive, animal studies typically show no significant risk. However, the usage of tadalafil is not recommended in nursing women due to the potential risks to the infant.

Patients with Underlying Conditions

• Cardiovascular Disease: Use caution in patients with cardiovascular conditions or those with a history of heart-related issues, such as myocardial infarction or angina.
• Renal Impairment: Dosage adjustments are necessary based on the severity of renal function impairment.
• Hepatic Impairment: Careful monitoring and dosage adjustments are required for patients with liver issues.
• Priapism: Patients with conditions predisposing to priapism (prolonged erections) should use tadalafil with caution.
• Retinitis Pigmentosa: Use caution due to potential color discrimination impairment.
• Underlying Causes of ED or BPH: Always evaluate the underlying causes before initiating therapy.

Due to the extensive list of potential interactions and special considerations, it’s crucial to consult healthcare providers for personalized medical advice, especially when other conditions or medications are involved.

Sources:

• WebMD. “Tadalafil oral: Uses, Side Effects, Interactions.” WebMD. Accessed on [insert date].
• FDA. “Tadalafil – FDA prescribing information, side effects and uses.” Accessed on [insert date].