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Active Ingredient: Tadalafil

The drug Cialis is used to treat erectile dysfunction in men. At the same time, the drug does not affect the level of libido. The main active component of Cialis is tadalafil. It is thanks to him that the erection does not just come, but also the necessary amount of time remains until the natural process of ejaculation. In pharmacology, Cialis belongs to the list of drugs inhibitors of type 5 photodiesterase (PDE 5). This group of drugs eliminates the symptoms of impotence in men. The effectiveness of the tool is observed only in the case of normal sexual desire, the desire of the man. Only with sexual stimulation, psychological mood, will a full-fledged long-lasting erection after taking Cialis pill.

Cialis - Tadalafil: Overcoming Erectile Dysfunction

Cialis, whose base compound is Tadalafil, a drug used in one of the most frequent pathologies in the world: erectile dysfunction. This disorder affects more than 30 million people worldwide, and according to the NAMCS, at least 8 men out of 1000 consult for erection problems.

Depending on the definition given, because there are several ways to define erectile dysfunction, the number of cases may be higher. Many studies claim that the incidence tripled by the early 2000s, and has gradually increased since then.

The severity of this pathology, and how important sexual well-being is to a person's development and growth, led to the creation of special compounds to promote erection. One of the most used, after sildenafil citrate, is Cialis (Tadalafil).

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In fact, the approval of Viagra in 1998 by the FDA gave the green light for the rest of the drugs, such as Cialis, to also have the approval of the most important organization in the U.S. when it comes to drugs. Tadalafil received its permits in 2003, and since then is considered a safe drug.

Mechanism of Action - How It Works

It acts on smooth cells in a similar way to Viagra, inhibiting Phosphodiesterase 5 (PDE5), an important enzyme at the cellular level that regulates other secondary messengers called cGMP, which are related to nitric oxide.

Remember that during erection, what is really happening is that the penis is gaining volume thanks to dilation or relaxation of the arteries and vessels of the penis, and the smooth muscle of the cavernous body. Not only this, but there is also an increase of flow towards this sector that makes possible the growth of the penis. This is due to the release of Nitric Oxide from the nerve cells and endothelial cells of that sector. Nitric Oxide is one of the most powerful vasodilators in the body, which can be produced in various sectors, but mostly at the endothelial level.

The release of nitric oxide is due to the increase of cGMP in smooth muscle cells. Therefore, with the inhibition of PDE5 (responsible for the destruction of this second messenger) we would have a significant increase in cGMP, and therefore, an increase in nitric oxide, leading to vasodilatation and erection of the penis.

One fact that must be mentioned is that Tadalafil has a long half-life of around 18 hours. It is also known as "the weekend pill". In fact, thanks to this characteristic, its use in other important pathologies such as pulmonary hypertension is being studied.

It is also important to note that, as with all drugs for erectile dysfunction, there needs to be an initial stimulus to give rise to the release of nitric oxide from nerve endings and endothelium. If there is no direct sexual stimulation, there will be no response on the penis. Therefore, certain patients with mental disorders involving decreased libido cannot use this medication because it simply will have no effect.

Normally, doctors indicate about 10mg of Cialis when the patient deserves it, but no more than once a day. As already mentioned, it has a long half-life. Therefore, if you take another pill in less than 24 hours you will probably experience important secondary symptoms. If that dose is not useful, it may be increased to 20mg, or decreased to 5mg if it is too much.

Other types of patients, such as those who use Cialis for pulmonary hypertension, can use up to 40mg once a day. However, approval is still pending in some countries.

Not everyone reacts the same way to this drug. Some may be more sensitive than others, which is why it is necessary to start with a dose of 5mg and then increase. There are special cases of patients who have alterations in the PDE5/NO system, which may react strongly to small amounts of Cialis.

Side Effects

Although it is one of the safest drugs when it comes to erectile dysfunction, like all drugs, it is not without adverse effects. In large studies, with more than 15,000 participants, Cialis has been tested with great results.

Most of the side effects are headache, indigestion, back pain, muscle aches, redness and nasal congestion or discharge. All are due to the same effect on PDE5 inhibition, which has the same effects throughout the body. Most of these appear quickly, but disappear within a few hours. Generally, most long-lived are back and muscle pain, which can occur up to a day after taking the drug, disappearing within 48 hours.

It is important to point out that the FDA indicated in 2005 that all the drugs used for erectile dysfunction (whose main component inhibits PDE5) were related to important ocular disorders that arose from ischemic optic neuropathies. However, the side effect was not directly associated with Cialis. It turns out that most of these patients had anatomical or vascular disorders that predisposed the development of this pathology. Therefore, the use of PDE5 inhibitors simply increased the probability of the development of this lesion. In addition, many of them had other associated secondary diseases such as hypertension, diabetes, lung disorders, etc.

Despite all this, the FDA kept the drug on the market because there was no probable direct relationship between the disorder and the drug.

Another important side effect is hearing loss. Many of the drugs with the same mechanism of action, after they came onto the market, were found to be associated with sudden hearing loss. In 2007 the FDA carried out the relevant studies and confirmed this link. What they proposed was to warn the consumer of the possible -but very rare - side effect.

Hypertension and Cialis

A big myth is the "risk" of taking drugs like Tadalafil when you have hypertension. This is not entirely true.

Erectile dysfunction drugs are approved for use in people who are hypertensive. In fact, as mentioned above, it can be used in a type of pulmonary arterial hypertension.

However, the real problem - and the reason why you should consult with your doctor - lies in the medications you use to treat hypertension.

Remember that tadalafil, through important cellular processes, can increase the amount of nitric oxide in the smooth muscle cells of the penis, causing vasodilation and increased blood flow. However, there are many patients with hypertension who use nitric derivatives to control their blood pressure. This group includes some of the "calcium channel blockers" such as Nifedipine, nitroglycerin, etc.

The combination of both drugs can result in a potentially serious adverse effect: severe hypotension. Both drugs can vasodilate your arteries, thus generating a powerful synergistic effect, causing hypotension.

That's not all. Tadalafil is also able to inhibit the mechanisms by which nitrates are degraded, allowing your blood pressure medication to remain in the system longer, causing dangerous side effects.

Many people report that they feel palpitations when taking Cialis. This is a regulatory response of your heart to counteract the hypotension generated. However, when both drugs are used together your heart is not able to regulate this response, so it can be deadly.

Always consult your doctor before using two drugs together.

There are certain signs that you should watch for and see your doctor if you have them. These are:

  • An erection that lasts more than four hours: erections usually give way between the first and second hour. However, if it spreads, it is necessary to consult your doctor. You should find out what the underlying mechanism is or why the drug is lasting longer in your system or why you react more strongly to it. In addition, prolonged erections can cause collateral damage to your limb, so it should be calmed down as soon as possible.
  • Pain in the chest, arms, neck or nausea during sexual activity: by decreasing the tension your body generates endless compensatory responses, as explained above. These can be signs that your blood pressure is well below what it should be, which is very dangerous. Consult your doctor as soon as possible.
  • Sudden loss of sight or hearing: the adverse effects mentioned above include visual and hearing impairments. However, these can be controlled to limit the alterations and complications following the onset of such effects.
  • Allergic reactions: another reason why it is important to start with small doses, especially if you have never used this medicine, are allergies. Everyone can be allergic to any medicine, you should always be aware of possible rashes, hives, swelling of the tongue, throat, lips or face, and trouble breathing.

Important Facts About Cialis

Use: You can use only one pill a day, at least one hour before any sexual activity. It is indistinct if taken with or without food, will not affect its absorption or functioning. Remember that this medicine will be between 18 and 24 hours in your system, so it is important to avoid and regulate the use of other medications with nitrates during that time.

Dosage: You should always talk to your doctor so that he or she can recommend a personalized treatment. It is normal to start with low doses to avoid possible allergies and to evaluate how you respond to this medicine. If higher doses are needed, please consult your doctor again for a readjustment.

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Sexual stimulation is necessary: although the medication is in your bloodstream, it will have no effect if you do not have any sexual stimulation. This medicine is not related to libido or desire. It is not an aphrodisiac. It will not help you feel desire for your partner. So if there's no initial stimulation, as in some mental disorders, you won't be able to get an erection even if you take this medicine.

Don't drink alcohol: alcohol is also an important vasodilator, so you will be enhancing its effect. But the most important thing is that it can interrupt your metabolism at the liver level, prolonging the half-life of the drug, causing more side effects and unwanted, within which hypotension can occur.

If you are hypertensive, please consult your doctor. It is important that you evaluate the type of medication you are using to find out whether it is compatible with Cialis. You may be able to use medications such as nitrates but adjust the dosages very well and be aware of the effects. You may be told to stop using nitrate many hours before using tadalafil, however, it is best not to use this medication under these circumstances or to change your antihypertensive.

Those who take medications such as Cardura or Hytrin for urinary symptoms cannot use Cialis. You need to consult your doctor to see what options are available to you and how you can resolve your problem.

Drug interactions: This medicine may alter the half-life and effectiveness of others. Your doctor should be aware of the drugs you take, even sporadically. Not only can they cause you harmful adverse effects, but you may simply not see any effect, due to the mechanism of action of Cialis. This also includes those you take as a supplement, and even common or over-the-counter medications.

Storage: This is a delicate medicine that should always be stored and kept under supervision. Try to keep the medication in its original container and name it. Keep at room temperature and in a dry place. Do not mix it with other tablets or put it somewhere with other medicines. The effect on children is much more potent and low blood pressure can cause death. In case you notice any alteration on the tablet, which is damaged or something similar, do not consume it. Do not dispose of the medicine by traditional means, keep it and consult with your pharmacist or doctor on how to dispose of it.

Erectile Dysfunction: A Disorder for Men

Erectile dysfunction is perhaps the most important sexual disorder of the male gender. It is defined as the inability to achieve an ideal erection, rigid enough and firm enough to have satisfactory sexual relations.

Many doctors suggest that erectile dysfunction does not have to be an age-related disorder, which is not a disease that men simply must wait for at some point. Experts say it's a totally preventable disease, rooted in lack of care in general, but also in other external problems, such as traumatic accidents.

Because of the definition given to this disorder, and its slightly subjective character, it is difficult to estimate the incidence and prevalence of this disease worldwide. However, the best studies suggest that at least 30 million men worldwide suffer from this problem and that about 35% of the male population will suffer from this disorder at some point in their lives.

As the disease became better known, and devices were developed to act on it, the numbers gradually increased. Men felt more confident to go out and talk about their problem because they knew there was a solution. Therefore, numbers have been in constant evolution, and today a large population of people with erectile dysfunction is known.

How does everything work normally?

Under normal conditions, the penis has diminished or normal blood flow, which keeps the penis flaccid but with the necessary irrigation to perform the rest of its functions. In principle, when sexual stimulation is received (which can come from many different pathways, in which the senses or the mind are involved) many signals are released that conclude in the increase of a fundamental molecule called Nitrous Oxide (NO), which will mediate the whole process.

The secret of the whole erection is in one word, "Vasodilatation". With nitric oxide, one of the most powerful vasodilators in the entire body, the multiple arteries of the penis widen and allow more blood to flow through it, greatly increasing the volume. The secretion and constant local formation of this mediator are what gives way to a sustained erection.

As the penis enlarges, the veins, which do not have firm vascular walls, compress. This way the blood gets "stuck" in the penis. In theory, what we would have is an increase in blood flow from the inlet, with the outlet closed. So, the penis only increases in volume and becomes stiffer.

So... Where is the problem?

Erection is a phenomenon, as we mentioned, of purely neurovascular origin, but like everything else, it is subject to hormonal control. There are many factors involved, where the most important is Nitrous Oxide.

There can be many causes that give way to the appearance of erectile dysfunction. They can be problems based on the body, traumatic events or the mind. Let's explain each of them step by step.

1. Organic:

These are related to anatomical problems, neurological, endocrine, etc.. Any problem that originates in the organism, either by external mechanisms (drugs or alcohol) or internal ones (vascular, nervous, infectious disorders). In this classification, endocrine and vascular disorders stand out.

Cardiovascular complications are usually the most frequent cause of erectile dysfunction. This is where patients with high-fat arteriosclerosis and obese patients come in. In this case, the disorder is in the production of nitric oxide by the destruction of the endothelium and vascular damage caused by that basal vascular damage.

As for diabetes, high concentrations of glucose in the blood can greatly decrease the amount of nitric oxide released from our arteries. Under both conditions, blood flow may be preserved, but endothelial damage will not allow an erection to develop.

2. Traumatic:

There is a separate classification for traumatic causes in the classification. Here come some problems such as pelvic fractures, where there are also several anatomical problems that do not allow the erection to develop.

3. Psychological:

As mentioned above, sexual stimulation plays a fundamental role in erection. It is necessary to emphasize it because even to have erections using drugs such as Sildenafil, it is necessary to have an initial sexual stimulus. Even if you use the medication, if there is no stimulus, there will be no erection.

In order to talk about psychological causes, the penis (and the patient's body) must be in good condition. Most of the time it is due to some effective or interpersonal disorders, such as depression or anxiety. However, it can oscillate and involve other problems such as infidelity or feelings of guilt.

Even low self-esteem can be a major cause of erectile dysfunction.

Frequently it is not due to the presence of a single mechanism, but there are several involved. For example, the patient may have physiological disorders (such as diabetes, problems with the release of certain hormones, etc.) with alterations typical of a pelvic fracture or major psychological problems.

In any patient with erectile dysfunction, the doctor is obliged to look for relevant causes of vascular damage such as diabetes and cholesterol. Heart disease is a good start, especially high blood pressure where blood flow is hindered. Many medications, which can be the treatment of these diseases, can also cause erectile dysfunction. Many times, drugs are not the best remedy.

Risk Factors

Many of the risk factors, as expected, are related to the pathology itself. In this case, it may resemble other common cardiovascular diseases (such as hypertension and heart attack) where lack of exercise, hypercholesterolemia and metabolic syndrome would be highlighted. Some of them, of course, could be modified, although there are also factors related to sex and age, which cannot be modified.

There are many studies that support these data. Some of the larger studies evaluated middle-aged men who started exercising. The experts found that they reduced the risk of developing erectile dysfunction by 70% with respect to the control population over an 8-year follow-up period, during which they maintained their exercise.

Direct changes in BMI are important. Those who are overweight or obese are at increased risk of developing ED, not only because they may develop major cardiovascular complications but may also suffer from diabetes or similar pathologies involving the general condition.

On the other hand, the consumption of legal or illegal additives is also known as an important risk factor.

Let us remember that, since there are causes of psychic origin, maintaining a good state of mental health must be a priority. It is necessary to manage stressful events with specialists and go to higher instances if the dysfunction remains more than 3 months after these events.

Erectile Dysfunction vs. Aging

There are great myths that associate age directly with the inability to achieve a satisfactory erection. It cannot be further from the truth.

As we age, we lose many important characteristics. One of them is our ability to achieve erections after a previous orgasm, it is possible that the time between one orgasm and another is now much longer. In the same way, perhaps it happens with the time necessary for erection, excitement, and ejaculation.

However, this is not directly related to the erection itself. A satisfactory erection can still be achieved, even if the times are slightly increased. Despite being older, sexual stimulation is almost completely mental. Sexuality does not watch over physical changes, it has a personal and intrinsic origin. As we age, we are more likely to develop other secondary diseases that limit erection, including the medications we use to treat them, rather than age itself. A healthy 70-year-old can perfectly achieve a satisfactory erection.

Treatments - Beating Dysfunction

There are many therapeutic measures that can be used to treat erectile dysfunction. There are some that are invasive, others pharmacological and other measures. Let's explain a little of each of these.

Treatment - Noninvasive Measures

Initially, we can address some general measures where lifestyle changes, which may directly affect the cardiovascular system, would enter such as quitting smoking, moderating sedentary lifestyle, exercising, improving diet, and learning stress management techniques that allow long-term benefits. In addition, as mentioned above, there are some medications that may be involved in the development of erectile dysfunction. These drugs should be changed, or at least your doctor should decrease the doses of these drugs so that you can achieve a satisfactory erection and ideal intercourse. Explain the situation to your treating doctor, he is obliged to respond to your demands and change the doses, or the drug, that you are currently using.

Let's go into some more direct therapies:

Psychological Therapy

In many men, especially those under the age of 40, erectile dysfunction often originates in thought. It is necessary to consult a specialist to help you analyze if there is a possible disorder, and to treat it. Most doctors first test Sildenafil. If you can take a pill, you will be asked to try using it to see if you get sexual stimulation and a satisfactory erection. If not, it will confirm that the problem is psychological - most of the time.

There are several techniques and therapies aimed at treating stress, the main psychological aggressor that prevents erection. Depending on your personality and your job, your specialist will tell you which ones are the most appropriate for you.

On the other hand, it may also merit a visit to a psychiatrist. As we mentioned, depression and anxiety, diseases treated by the psychiatrist, can also be the cause of this disorder. Pharmacological treatment of these pathologies may be the solution for you.

Hormonal Treatment

There are several types of dysfunction. Some of them, for example, may be caused by disorders of testosterone, one of the most important hormones in male sexual function. Depending on the cause of this dysfunction, your doctor may tell you to use special patches, pills, or injections to help you cope. In addition, other hormones may be involved (increased or absent). One of them is insulin, which decreases in type 1 diabetics, so it may also be a treatment for the dysfunction.

Pharmacological Treatment

There are three very important drugs that are the most used worldwide for erectile dysfunction Sildenafil, Tadalafil, and Vardenafil. Each of them can be indicated in different patients or can be found more easily in different countries.

  1. Sildenafil (Viagra)

    Without a doubt, Viagra was the revolution in erectile dysfunction. Countless studies were conducted before its release and approval for use in Europe and the United States. This drug improved erections in more than 80% of people. Sildenafil acts through cyclic GMP, an important cellular intermediary that seeks the elevation of a single product: nitric oxide. All this will lead to vasodilation of the arteries of the penis and compression of the veins, which translates into an erection.

    However, it is important to emphasize that Sildenafil cannot act if there is no sexual stimulus. Viagra is by no means an aphrodisiac, it is designed for a physical response, but this cannot take place without sexual stimulation. The mind cannot be disconnected from the body, so that in some patients, especially those with mental problems, will not be able to achieve an erection even though they are consuming the medication.

  2. Tadalafil (Cialis) and Vardenafil (Levitra)

    Both drugs fall under the same Viagra classification, however, have different characteristics. Vardenafil, on the one hand, is also approved in many countries, is administered orally and has a similar effect. Even so, the most important difference in Vardenafil has to do with the times it is in the body. On the other hand, Tadalafil has an important feature, that its action is much faster and longer, it is even possible that its effect extends to more than 36 hours in the body.

    All these drugs cannot be used lightly. You should consult your doctor first before buying it. An important example is hypertensive patients who consume nitrates (nitroglycerin, nifedipine, etc.). Remember that what we do with Viagra is to provide a mediator that activates the production of intrinsic nitric oxide, to vasodilate, the same as do these drugs, because the reaction can lower blood pressure and create a state of hypotension.

Invasive Treatments

Finally, we have the surgical measures, those that merit an intervention and a device to be implanted. This only occurs in less than 1% of cases and the truth is that it is not very effective.

It consists of placing penile implants, whether plastic, hydraulic or prosthetic, that can achieve an erection. At this moment they are almost in disuse, however, some doctors place them in young patients who have suffered strong traumatisms or in some other complications when the rest of the treatments fail.

Men's Health: A quick look at the most common problems

All humans are different, not only because of our race and/or age, but also because of our sex. The biological differences between men and women go far beyond the sexual organ they possess. Men are characterized by having more hormones such as testosterone, androgens, cortisol, etc. in their blood, in addition to having less estrogen.

The latter, for example, is a great example of the differentiation between the two sexes. Estrogen provides protection against many diseases in women, especially cardiovascular problems, so we can imagine the great benefits it provides. However, men, usually subjected to more stress during their life without the protection of estrogen, tend to carry a greater basal cardiovascular risk.

In America, men's health presents great challenges. Men are known to have several unhealthy habits, involving smoking, excessive alcohol consumption, sedentary lifestyles, mental alterations, violence, and so on. Mostly due to lack of information and lack of interest in correcting them. Men are highly likely to develop major chronic diseases, such as diabetes and cancer, making them a major challenge for any health service in any country.

Gender-focused programs are increasing, unfortunately the vast majority are being diverted to women, downplaying the importance of men's status. Even so, health problems persist in countries, and this is due to the large base risks that men go through.

Most Relevant Risk Factors

1. Cigarette

The most concise and accurate estimates from the best studies state that the male population smokes up to 2-3 times more than the female sex. It may sound like a small number, but that means there is a double or triple chance that a male will develop lung cancer or serious lung lesions that directly compromise his health. In addition, the cigarette has many vascular problems, direct endothelial damage, which can alter the circulatory system itself, increasing the risk of heart attacks, and erectile dysfunction, one of the most common problems in those over 60.

2. Alcohol

Alcohol consumption is one of the most talked about problems in male health. Large studies affirm that this population is the one that commits more excess or have weekly episodes of excessive consumption, up to four times more than women. This is why they have high mortality rates associated with alcohol, especially those between 15 and 49 years of age. This is a problem that affects both socially, due to the family and interpersonal dysfunction it creates, and economically, since it is a negative habit that carries -usually- a great impact on the pocket of all consumers. Large international organizations link male alcohol consumption with behavior problems for women. These affirm that the disinhibition caused by alcohol consumption can encourage the liberation of impulsive behaviors that end up injuring women.

3. Cardiovascular

As mentioned above, cardiovascular disorders are much more frequent in men than in women, due to the great protection provided by estrogens. In men, for example, the risk of suffering a heart attack is significantly higher when patients are over 45 years old. In women, however, it is only after total menopause, which is approximately after age 55.

Men may be at greater risk of suffering from essential diseases such as hypertension, where various genetic, environmental, etc. factors lead to the development of this complex disorder. It is frequent to see that this sex has complications at a younger age, even before the age of 30. It is not only related to the different internal biological factors they possess, but also by the behaviors they take, which are based on the different cultural patterns that exist in our current society.

For this reason, measures should be taken at an early age:

  • Exercise for at least 30 minutes a day, five times a week. Let it be a workout that increases the heart rate at least twice as fast, so that it is effective.
  • Reduce the consumption of fats and increase the consumption of essential elements such as omega 3 and omega 6, which reduce free radicals in the blood, dangerous molecules that directly attack your heart.
  • Reduce salt intake to just 3-4g a day. Perhaps less if you already suffer from hypertension and what you want is to prevent major complications.
  • Avoid sedentary life, look for jobs where activity is greater. If this is not possible, try not to spend more than 1 hour sitting in the same place, do stress relief exercises when getting up and propose a more active life. Sometimes, small changes such as "walking one more block home" can have big effects on overall health.

4. Erectile Dysfunction

It's no secret that erectile dysfunction is one of the most important problems when it comes to men. Without a doubt, having an unsatisfactory sexual relationship because you didn't get the erection you were looking for is not at all pleasant. Although many people attribute this factor to age, it is nothing more than a myth.

The central problem lies in personal care. Most people only think it's a matter of aging, but the truth is that endothelial damage to the arteries of the penis is the real cause of this problem. This is due to various activities and basal diseases that you may have, such as hypertension and diabetes, even the various medications that are used to treat many of the frequent pathologies of the older adult.

Because of this and many other things, men are at special risk for multiple pathologies. It is important to raise awareness and promote the dissemination of information to reduce this major health problem. Learn how to take care of yourself and avoid major problems, Change now!


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