Cialis Together – Who can use it?
Cialis Together – Who can use it?
Cialis together is indicated for men aged 18 and over with erectile dysfunction, and must not be used by patients who do not have ED.22 It is not indicated for use by women.
For first time users, confirm that the patient has ED and that Cialis Together is indicated for the patient. Then follow steps 1-3 below to determine whether it is suitable.
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- Myocardial infarction in the last 3 months
- Unstable angina or angina during sex
- Heart failure in the last 6 months (where ordinary physical activity results in fatigue, palpitation, shortness of breath, dyspnoea )
- Arrhythmia, hypotension (<90/50 mmHg; symptoms of which include dizziness and blurred vision) or uncontrolled hypertension
- Stroke in the last 6 months
- Non-arteritic anterior ischaemic optic neuropathy (NAION - loss of blood flow to the optic nerve)
- Anatomical deformations of the penis:
- Bent or curved penis (angulation)
- Scar tissue on or below the surface of the penis (cavernosal fibrosis)
- Peyronie’s disease
- Allergy to the active ingredient, tadalafil, or any of the excipients
If the patient has any of the contraindicated health conditions, Cialis Together is not suitable.
- Severe renal or hepatic impairment
- Priapism or conditions that predispose to priapism such as sickle cell anaemia, multiple myeloma, leukaemia
- Pelvic surgery or radical non-nerve sparing prostatectomy (the effectiveness of tadalafil is unknown in this group of patients)
- Hereditary degenerative retinal disorders (e.g. retinitis pigmentosa)
- Increased susceptibility to vasodilators
- Successful vascularisation, asymptomatic controlled hypertension or mild valvular disease
- Uncontrolled hypertension, moderate to severe valvular disease, left ventricular dysfunction, hypertrophic obstructive and other cardiomyopathies, or significant arrythmias
- Breathlessness or chest pain from light to moderate physical activity
If the patient has any of these health conditions, Cialis Together may not be suitable.
The patient should be referred to a doctor for assessment of suitability.
- Nitric oxide donors or nitrates used for angina (e.g. molsidamine, nicorandil, glyceryl trinitrate, isosorbide dinitrate) or as the recreational drug ‘poppers’ (amyl nitrite)
- Guanylate cyclase stimulators used for pulmonary hypertension (e.g. riociguat)
- Alpha blockers used for benign prostatic hypertrophy or hypertension (e.g. doxazosin)
- CYP1A2 substrates used for asthma or COPD (e.g. theophylline)
- CYP3A4 inhibitors used for:
- HIV infections (e.g. ritonavir, saquinavir)
- Fungal infections (e.g. ketoconazole, itraconazole)
- Bacterial infections (e.g. clarithromycin, erythromycin)
- Stomach ulcers or oesophageal reflux disease (e.g. cimetidine)
- CYP3A4 inducers used for epilepsy, used for bacterial infection (e.g. rifampicin) or for epilepsy (e.g. phenobarbital, phenytoin and carbamazepine)
- 5-alpha reductase inhibitors used for benign prostatic hyperplasia or male pattern hair loss (e.g. finasteride)
- Cialis Together should not be taken with recreational drugs as this may lead to unpredictable and dangerous drug-drug interactions.
This could result in dizziness, decrease in blood pressure, coma, stroke or heart attack, seizures and priapism.
If the patient is taking an interacting medication, refer the patient to their doctor for advice.
If the patient is taking a PDE5 inhibitor or other ED treatment, provide advice on how to take Cialis Together safely.