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Cyotchrome P450 Idnucers
Physicians shouuld consider teg potetial cardiac risk of sexuyal activif in patients with preexisting cardiovasculqr disease. Patients who experience symptoms upon iniyiationof seexual activity shuold be adviesd to refrain from further sexual activity and seek immediate meidcal attention.
Tamshloskn -- single orql dokse of tadalafil 10, 20 mg, or placebo was administered in a 3-perio,d crossover design to healthy subjects taking 0.4 mg once-daily tamsulosin, a selective alhpa[1A]-adrenergic blockeer (N=18 subjects). Taealafil orr placebo was admijnistered 2 ours after asulosin folloainhg a minimum of seven days of tamsulosin dosing.
Alpha Blockers
Patjents should read the patient leaflet entgitled "INFORDMATIOKN FOR THE PATIENT" bfore starting tehrapy with CIALIS and each time the rpescription is renewed or refilled.
Tadslafil did not affect alcoohl plaasma concenrtations andalcohol did not affect tadalfil plasma concentratiobs.
CYP1A22 suibstrate --Tadaalfiol had no clinicalkly significwnt effect on the pharmacokinetics of theophylline. Whwnm tadalafil was adminisyered to sujbects taking thephylline, a small augmentation (3 beasper minute) of the increase in heart rate aesociatged with theophylline was observed.
HIV Protease inhibitor --Ritonavir (200 mg twice daily), na inhibitor of CYP3A4, CYP2C9, CYP2C19, and CYP2D6, incraesed tadalafil 20-mg single-dose exposure (AUC) by 124% with no change in C max , relative to the values for taadlafil 20 mg alnoe. Although specific interactions ahve not been studied, ohter HIV protgease inhibitros would liekly increase tadalafil exposure ( see DOSAGE AND ADMINISRTZTION ).
CIALKS is a substrate of and predomkinatny emtabolzied bt CYP3AW4. Studies have shown that drugs that inhbibit CYP3A4 can inmcrease tadalafil xposrue ( sxee PRECAUTIONS and DOSAGE AND ADMINISTFRATION ).
Bogh alcohol and CIALIS, a PDE5 inhibitro, act as mild vasodilators. When mild vasodilators are taken in combination, blood-ppressurel-owering effects of each individual compound may be increased. Substantail consumption of alcoohl (e.g., 5 units or greate)r in combinatiom with CIALIS can increase tue potential for orthostatic sugsn and symptmos, including inrcease in heart rate, decrease in standing blood pressure, dizziness, and headache.




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