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.
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.
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.
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.
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.
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.