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Before the treatment of ED and BPH a person should be examined by a doctor who can professionally assess the condition, its potential underlying causes and define treatment methods.

Patients with cardiovascular disease should be especially careful while taking this medication. Sexual activity increases the burden on the heart and may be dangerous for health in such patients. Therefore patients with cardiovascular disease need a doctor’s consultation before using Cialis.

Males, who experience symptoms after the beginning of sexual activity are advised to avoid further sexual activity, stop and seek immediate medical help.

The patients who experience anginal chest pain taking nitroglycerin should not take Cialis. Therefore, patients who experience anginal chest pain after taking Cialis should not take nitrate-based medications and seek immediate medical attention.

Males with left ventricular outflow obstruction including aortic stenosis and idiopathic hypertrophic subaortic stenosis can be sensitive to PDE5 inhibitors vasodilating actions.

Clinical studies did not include the following groups of patients and the efficacy and safety of Cialis were not estimated. So Cialis for such patients is not recommended:

• myocardial infarction within the last 3 months;
• unstable angina or angina after or during sexual intercourse;
• heart failure or stroke in the last 6 months;
• uncontrolled arrhythmias, hypotension (<90/50 mm Hg), or uncontrolled hypertension.

Cialis has mild systemic vasodilatory effects that may result in mild decreases in blood pressure. Cialis 20 mg effects on blood pressure show a mean max decrease in supine blood pressure, in comparison to placebo, of 1.6/0.8 mm Hg in healthy subjects.

Still in patients with underlying cardiovascular disease the blood pressure may be affected by Cialis vasodilatory effects.

Cialis was approved by FDA in October 2011 to manage enlarged prostate gland symptoms. After three main clinical studies the medication received additional medical indication- the treatment for benign prostatic hyperplasia, BPH or enlarged prostate. The studies have shown positive results such as the reduction of the symptoms of BPH – the urge to urinate was decreased, the difficulty to urinate, weak stream, and other symptoms significantly improved. Besides, the trials included men with ED and BPH. The results of the trials have demonstrated meaningful improvements in both disorders.

Doctors are convinced that Cialis can help men with both conditions, especially to those men whose ED was caused by BPH.

If you have other problems with health and take medications regularly to manage your problems, it is urgent to tell your doctor about these medications to avoid possible drug interactions with Cialis.

Remember that other medication to treat erectile problems should not be taken in combination with Cialis.  Besides, be careful if you take any medication from this list:

• rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, Rifater, Rifamate), or rifapentine (Priftin);
• antibiotics;
• antifungal medications such as itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);
• antidepressants such as nefazodone;
• barbiturates such as phenobarbital (Solfoton);
• drugs to treat high blood pressure or a prostate disorder, such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin), tamsulosin (Flomax);
• blood pressure lowering medication;
• HIV or AIDS medications;
• seizure medications.

If you experience any side effects after taking Cialis, you should tell your doctor. Side effects may be provoked by concomitant use of different drugs with Cialis.

During clinical studies of Tadalafil, several cases of serious side effects were observed. These side effects rarely occurred, in no more than 2 % of the participants of the studies. The serious adverse reactions of Cialis which should be reported to the doctor and demand medical assistance include:

• Severe allergic reactions;
• General ill feeling during sexual activity (dizziness, nausea, pain in the chest, arms, neck or jaw);
• Changes in vision or sudden vision loss;
• Ringing in the ears, or sudden hearing loss;
• Irregular heartbeat;
• Convulsions;
• Priapism condition – penis erection that is painful or lasts 4 hours or longer.

In case you experience any side effect from the mentioned above, you should get immediate medical help.

There were reports of other side effects, happening very rarely. There is no evidence if Cialis is directly related to the occurrence of other conditions. Still if you have other strange effects and you suspect they were caused by Cialis, call your doctor right away.

Cialis may cause side effects which commonly are minor or not serious. These common side effects of Cialis may include:

• redness or warmth in face, neck, or chest;
• stuffy nose, sneezing, sore throat;
• headaches;
• diarrhea, upset stomach;
• muscle pain, back pain.

In case a patient experiences any side effects which bother him, a doctor may adjust the lower dose of Cialis in a period of more than 24 hours between doses.

If a patient has serious side effects which can be dangerous for his health the therapy with this medication may be stopped.

After several clinical trials and post-marketing reports of Cialis, FDA has made an announcement including recommendations for medical practitioners prescribing Cialis for their patients. These recommendations contain special warnings for the patients taking Cialis. The most important warning are:

Tadalafil is not allowed to be administered for patient having allergic reactions or for those who can possibly have allergy to any ingredients of Cialis.

Tadalafil is contraindicated with nitrate medicines and antihypertensive drugs due to the possibility of these combinations to cause a sudden and serious drop in blood pressure.

Tadalafil should not be administered to the patients with high risk of priapism condition side effect.

Tadalafil can vision changes and even vision loss. Patients should be specially warned about this side effect if they have preexisting problems of the eyes.

Tadalafil medication should be taken as your doctor ordered to you. Take the exact prescribed dose for you; it is based on your individual health status and medications you may be taking. Never enlarge your dose without first consulting with your doctor. Cialis is to be used orally with water, regardless from food.

A patient should be sexually stimulated to get Cialis start working. Cialis may be taken as needed or daily, this depends on your preferences, dose adjustment and other factors.

Do not take the other dose of Cialis until 24hours pass.

Store Cialis at room temperature away from moisture and heat. Keep your medication away from children and pets. Never share your medication with other people even if they have the same symptoms as you.

There are lots of treatment methods available now: surgery implants, oral medications, vacuum devices, injections and others.

The treatment depends on the underlying cause of sexual dysfunction. If the problem is caused by a hormonal imbalance, hormones to treat endocrine disorder are prescribed, in case the cause of your ED is diabetes, your doctor will recommend changing your lifestyle, keeping a diet, taking certain medications and controlling your blood sugar level.

Still in many cases the same treatment may be used for many males. First of all consult your doctor before starting any treatment on your own.

The treatment options include most popular oral ED medicines, ED injections into the penis, medicines inserted into the urethra, and others. Each therapy may have side effects and contradictions, be ready to face them when you choose the treatment option.

Most doctors advise to start the treatment with oral ED medications, which are handy, most comfortable for using and safe. In addition these oral drugs have shown positive results in fighting even severe cases of ED in men. Cialis is one of the most effective ED medications available now; it is of high quality and safe for usage by most patients.

Cialis is well tolerated and usually have no or minor side effects, which makes it the most popular drug among ED sufferers.

At your first visit to your medical practitioner you should discuss your problem and determine its cause. A doctor is professionally trained to perform a physical examination, so you should not be afraid if your doctor would check your blood pressure, exam your penis and make a rectal exam. This is necessary to do to find out the underlying affliction of your ED condition.

You may assist to your doctor by answering all his questions frankly. It will help to put a correct diagnosis of the cause of the problem. To be sure that you can give answers to all your doctor’s questions you may try to do it beforehand. This list includes usual questions:

• Is it difficult to get an erection or keep it?
• Do you have erections at night?
• How long have you suffer from ED?
• What medications are you taking?
• What other conditions do you have?
• Do you smoke? Do you drink alcohol?
• Have you ever undergone prostate surgery?
• Do you have any mental disorders?
• Do you have problems with sleep?
• Have you ever experienced any physical or psychological traumas?
• Do you urinate with difficulty?

Your doctor may also check how sensitive your penis is. It is usually done to the patients with diabetes, damaged arteries or nerve damages.

After physical examination and questions your doctor will adjust you special tests and procedures to evaluate your ED condition.

These tests and analysis may include:

• Blood tests (complete blood count, blood sugar level, metabolic panel and others);
• Neurological evaluation;
• Nocturnal penile tumescence (NPT);
• Urine analysis;
• Blood test on hormone imbalances.

Men are reluctant to discuss their potency problems with their partners, or medical professionals and this makes the problem more difficult to solve and the disorder to treat. If you have a persistent problem with your erections, do not hesitate, call your doctor.

The disorder will not go away with self-care procedures; modern medicine offers effective treatment methods.

Visit your doctor if your problem begins after an injury or prostate surgery.

Consult your doctor if you experience other symptoms like low back pain, abdominal pain, or change in urination.

If you think that your ED may be caused by a medication you are taking for an unrelated condition, discuss it with your doctor. You may get rid of your problem by making changes in the dose of the drug or changing to another drug that has the same result but not the same side effects. Talk to your doctor before you stop taking any medications.

If you have heart problems and think that your erection problems are related to fear of recurring heart problems, consult your doctor. Sexual activity is usually safe, but it depends on your individual conditions.