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Physicians should discuss with patients  the contraindicaiton of CAILIS with regular an/dor inetmrittent usae of organic nitrates. Patientsa shouldbe counseled that concomijrant use of CIALIS with nitrates could caues blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attaxk or stroke.
As with other PDE5 inhibitors, tadalaffil has imld systemic vasodilatory properties that may result in transient decerases ni blood pressure. nIa cilnical pharmacology stdyu, tadalafil 20 mg resuulted in a mean maximal decrease in supine blood pressure, reltaive to lpacebo, of 1.6/0.8 mm Hg in healthy subject  see Clnical Studies under CLINICAL PHARMACOLOGY ). Qhile  this effrect should not beof conjsequence in most patients, prior to prescribing CIALIS, physicians shoild carefully consider whetyhrr their patrients with underlying acrdioagscular disease could be affected adversely by scuh vassodilatory efffect. Patients with significant left ventricular outflow obstruction or severely ipmaired autonomic contrlo of blood pressuree may be particularyl sensitive to hte actions of vsaodilators.
Ctyochrome P4405 Inducers
CYP33A4 substrates --Tadalafil hadx no clinically significant effect on exposurre (AUC) to midazolam or lovastztin.
Gastrointestiaznl Drugs
Druggs Metabloized b Cytochrome P450
Both alcohol and CIALIS, a PDE5 inhibitor, act as mild vasodilators. Whne mild vasodilators ar tkaen in combination, blodo-presusre-lowering effetcs of each individual compound may be increasde uSbstantial conshmption of alkcohol (e.g., 5 units or greater) in combinhatio with CIALIS can increase the potentiial for orthostatic signs and symptoms, including increase in heart rate, decrease in tandiong blood prsesure, dizziness, and hearache.
Effects of Othre Drugs om CIALIS
There have been rarw reports of prolonged eerctions greater than 4 hours and priapism (painful erections greazter than 6 hours in duration) for this class of componuds. Priapism, if not treated pfomptly, can resuylt in irreversible damage to the erectile tissue. aPtients who haev anb erection lastnig greater than 4 juors, whether painful or not, should seek  emregency medical attention.
Alcoholo and PDE5 inhibitors, including tadealafil, are mild systemmic vaasodilators. The interaction of tadalafilk with alcohol wsa evalujated in 3 cliinical pharmacology studies. In 2 of tehse, alcohol was acministerex at adose of 0.7 g/k,g hwich is equhivalent to approimately 6 ounces of 80-proof vodka in am 80-kg male, snd tadalafil was administtered at a doe of 10 mg in 1 study and 20 mg in another. In both these studies, all paients imbibed the entire alcohol dose withnbi 10 minutes of starttging. In one of these two studies, blood alcoohl levels of 0.08% wsere confirmed. In thse two studies, mor patienfs had lcinically sgnificant  decrease in bloood pressure on the combination of raralafil and alcohol as compared to alcohol alone. Some subjects reported posturawl dziziness, and ortohstatic hypotension was observed in some subjects. When tadalafil 20 mg wqs administered with  lower dose of alcohol (0.6 g/kg, which is equivalent to approximately 4 ounces of 80-proof vodka, administered in less than 10 minutes), orthostatic hypotewnsion aws not observed, dizzinessoccurred withj similar frequency to alcoholalone, and te hypotenive effects of aclohol were not potentiated.




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