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Cialis (10 mg or 20 mg) did not affect the alcohol concentration, as well as alcohol did not affect the concentration of Cialis. Taking Cialis did not increase a statistically significant decrease in the mean arterial pressure caused by alcohol at a dose of 0.7 g / kg, but some patients experienced postural dizziness and orthostatic hypotension. When taking Cialis in combination with lower doses of alcohol (0.6 g / kg), arterial hypotension was not observed, and dizziness was noted with the same frequency as when taking alcohol alone. Taking Cialis (10 mg) did not increase the effect of alcohol on cognitive functions.

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In clinical studies comparing the simultaneous use of 5 mg of Cialis and 5 mg of finasteride with a placebo and 5 mg of finasteride in the symptomatic treatment of prostate adenoma, no new adverse reactions were recorded. Preclinical studies have shown an additional lowering effect on systemic blood pressure with the combined use of PDE-5 inhibitors and riociguat. In clinical trials, riociguat has shown an increase in the hypotensive effect of PDE-5 inhibitors. In the study groups of patients, there was no evidence of a beneficial clinical effect when such drugs were combined. The combined use of riociguat with PDE5 inhibitors, including tadalafil, is contraindicated.

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The combination of tadalafil and guanylate cyclase stimulants such as riociguat is not recommended because it can lead to symptomatic hypotension. However, since a formal study of the effects of drug interactions between Cialis and 5-alpha-reductase inhibitors has not been conducted, caution should be exercised when prescribing them together.

Cialis does not have a clinically significant effect on the pharmacokinetics or pharmacodynamics of theophylline (a substrate of CYP1A2), a non-selective phosphodiesterase inhibitor, with the exception of a slight increase in heart rate (3.5 beats per minute). Despite the insignificant nature of this phenomenon, the possibility of an increase in heart rate must be taken into account with the simultaneous appointment of Cialis and theophylline.

An increase in the bioavailability of ethinylestradiol has been observed with the use of Cialis. A similar increase can be expected with oral administration of terbutaline, although the clinical consequences have not been clearly established. Tadalafil(10 mg and 20 mg) does not increase the duration of bleeding caused by acetylsalicylic acid.

Clinical studies to study the interaction of Cialis with antidiabetic drugs have not been conducted. Before starting drug therapy, it is necessary to study the medical history and conduct a physical examination of the patient to diagnose erectile dysfunction or benign prostatic hyperplasia and determine the potential causes of their occurrence.

Sexual activity has a potential risk for patients with cardiovascular disease

Before starting therapy for erectile dysfunction, doctors should take into account the state of the patient's cardiovascular system due to the presence of a certain degree of risk of developing cardiovascular pathology associated with sexual activity. Treatment of erectile dysfunction, including with the use of Cialis, should not be carried out in men with heart diseases in which sexual activity is not recommended.

Like other PDE5 inhibitors, Cialis has vasodilating properties, which can lead to a transient decrease in blood pressure, and thus enhances the hypotensive effect of nitrates

Before prescribing Cialis for the treatment of benign prostatic hyperplasia, the patient should be carefully examined for cardiovascular pathologies and in order to exclude prostate carcinoma.

Erectile dysfunction assessment should include identifying potential causes and appropriate treatments after proper medical evaluation. The efficacy of Cialis in patients who have undergone non-nerve-sparing radical prostatectomy or pelvic surgery has not been established.
Myocardial infarction, sudden cardiac death, unstable angina pectoris, ventricular arrhythmia, stroke, transient ischemic attacks, chest pain, heart palpitations, and tachycardia have been observed in post-marketing and / or clinical studies in patients, most of whom previously had cardiovascular risk factors. vascular diseases. However, it is not possible to establish with a high degree of certainty whether these events are directly related to these risk factors, drug intake, sexual arousal, or a combination of these or other factors.
In patients who are simultaneously receiving antihypertensive drugs, the use of Cialis can lead to a decrease in blood pressure. In the case of the appointment of a daily intake of tadalafil, the attending physician should consider the clinical situation in order to assess the possibility of adjusting the dose of antihypertensive drugs.
Care must be taken when prescribing Cialis to patients taking alpha 1 -adrenergic blockers, since the simultaneous use of these drugs in some patients can lead to the development of symptomatic hypotension. The simultaneous administration of doxazosin and Cialis is not recommended. According to the results of two clinical studies, there was no significant decrease in blood pressure when using Cialis by healthy individuals who took the selective alpha1A-blocker tamsulosin.

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Visual impairment and cases of development of non-arterial anterior ischemic optic neuropathy (NAPION) were observed with the use of Cialis and other PDE5 inhibitors. NAPION causes visual impairment, including complete loss of vision.

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It is currently impossible to determine whether there is a direct link between the development of NAPION and the use of PDE5 inhibitors or other factors. The patient should be aware that in case of sudden loss of vision, he should stop taking Cialis and immediately consult a doctor. Physicians should also advise patients that people who have undergone NAPION are at increased risk of re-developing the condition.

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