Everything You Need To Know Before You Buy Cialis

Cialis is a popular erectile dysfunction medication second only to Viagra.

Unlike Viagra, Cialis has long-lasting effects (up to 36 hours) — leading to its common name, “the weekend pill.”

In this article, we’ll cover everything you need to know before using Cialis. We’ll discuss how it works, where to buy it, how to take it safely, and what you can expect after taking it.

Let’s jump straight in.

What is Cialis?

Cialis is the brand name for the prescription erectile dysfunction and benign prostatic hyperplasia drug called tadalafil. It’s owned by Eli Lilly — a large pharmaceutical company headquartered in Indiana, USA.

You can find Cialis in the form of a small egg-shaped orange tablet — often sold in packs of 10.

Like most other erectile dysfunction medications, Cialis works by inhibiting an enzyme known as PDE5 (phosphodiesterase type 5). Blocking this enzyme improves the entry of blood into the penis to form an erection.

Unlike Viagra, Cialis has a very long duration. It remains active for up to 36 hours. This is the main selling point for Cialis over its competitors.

There’s another reason many doctors prefer to prescribe Cialis over Viagra or other ED meds like Levitra.

Cialis is highly specific for the PDE5 enzyme. This is important because there are several other PDE enzymes that may be targeted to varying degrees by ED medications — such as PDE6, PDE1, and PDE11. Each of these enzymes is found in different concentrations around the body. Interference with these related enzymes is one of the main reasons for the side effects of these medications.

For example, both Viagra and Levitra inhibit both PDE5 and PDE6 enzymes much more than Cialis. PDE6 is abundant in the eye, which can lead to adverse side effects like vision disturbances or blindness.

Viagra and Levitra also have a higher affinity for inhibiting PDE1 — which is abundant in the heart, brain, and vascular tissue. This is thought to be the cause of symptoms like flushing of the skin and rapid heart rate after taking the medication.

What’s the Dose of Cialis?

Cialis is sold in four different doses:

2.5 mg
5 mg
10 mg
20 mg

For erectile dysfunction (ED), Cialis is used as an “as-needed” medication — meaning you don’t need to take it every day. It’s designed to be used to improve erection for sexual intercourse when required. If you’re not planning on having sex, there’s no reason to take the drug.

The standard starting dose of Cialis for ED is 10 mg. Depending on how you respond to the drug, your doctor may prescribe a stronger pill (20 mg) or a weaker pill (5 mg).

The maximum dose of Cialis is 1 pill per day.

For benign prostatic hyperplasia (BPH), the dosing is a little different. This treatment is used daily, around the same time every day. The initial dose of Cialis for treating BPH is usually 5 mg per day.

How Long Does Cialis Last?

Cialis is the longest-lasting prescription ED medication available.

The effects of the drug last up to 36 hours after use. Cialis owes its long duration to the slow half-life of the active ingredient. It takes roughly 17.5 hours for exactly half the drug to be metabolized. Compare this to 4 hours with Viagra, and 6 hours with Levitra.

This means that 36 hours after taking a 10 mg pill, roughly 2.5 mg of active Cialis is still running through the bloodstream — which is enough to have a mild to moderate impact on supporting an erection.

How Much Does Cialis Cost?

Upon its launch in 2011, Cialis was sold for roughly $2000 for a pack of 30 (5 mg) tablets. This works out to around $66.70 for each tablet.

Today, Cialis can cost anywhere from $12.70 to $103.01 per tablet.

There is a huge variance in the actual cost of Cialis due to coupons, rebates, and price reductions by Cialis resellers around the world. In the USA, you can expect to pay between $12.70 and $18.00 for each tablet of Cialis.

The patents protecting the active ingredient of Cialis — tadalafil — from being made by third-party companies as generic drugs expired in 2017. Other companies can now produce generic (non-name brand) forms of the drug at a reduced cost.

You can order tadalafil generics for roughly half the cost of Cialis — at around $6.00 per tablet.

The History of Cialis

Cialis was developed as a competitor to Pfizer’s Viagra — which was launched earlier in 1998.

Viagra was the first publicly available ED medication to enter the market. Researchers looking for a treatment for angina discovered the ability for the drug to promote erection.

In 1993, a joint venture between the biotech company ICOS and GlaxoSmithKline discovered a new compound that showed promise as a PDE5 inhibitor. The team referred to the new research chemical as IC351. This compound was discovered a year before Pfizer researchers first discovered the compound that went on to become Viagra several years later.

Glaxo and ICOS weren’t initially looking at the benefits of IC351 until after it came to light that Pfizer’s similar PDE5 inhibitor, Viagra, had a lot of potential as a treatment for ED.

ICOS earned a patent on the drug in 1994 and began phase I clinical trials the following year. By the end of 1997, a year before Viagra was approved by the FDA, IC351 was nearing the completion of phase III clinical trials.

Glaxo backed out of the agreement with ICOS, who then joined up with American pharmaceutical giant Eli Lilly. The joint partnership further developed the drug over the next 4 years. During this time, there were multiple lawsuits between Pfizer and the Lilly-ICOS partnership over their new medications.

In 2003, ICOS was bought by Eli Lilly for $2.3 billion — giving Eli Lilly full ownership over their new blockbuster ED medication.

It wasn’t until 2011 that Cialis was approved by the FDA — a full 13 years after approval was granted for Pfizer’s Viagra.

Who Should Take Cialis?

Cialis is only available by prescription from a registered doctor. While the drug has been proven to have a high degree of safety, there are some inherent risks with using the drug that make it important for a medical professional to vet each potential user and ensure all parties are familiar with the level of risk.

Doctors may prescribe Cialis to patients experiencing erectile dysfunction (defined as the inability to achieve or maintain an erection long enough for sexual intercourse), and benign prostatic hyperplasia (BPH).

Your doctor will first assess whether Cialis is likely to interact with your current medications or whether any underlying health conditions could lead to a higher risk of severe side effects.

The risk of using Cialis needs to be weighed with the potential benefits before a prescription is written.

Is Cialis Safe?

Cialis has been shown to be well-tolerated and was approved as a safe and effective medication by the FDA in 2011.

However, like most medications, there are some potential risks to using Cialis. In rare cases, severe or life-threatening side effects may occur.

During clinical trials on Cialis involving 179 patients with erectile dysfunction, only two dropped out because of negative side effects. The most common side effects reported were headaches and dyspepsia (indigestion) [1].

The same study found that 80% of study participants with severe ED and 90% of participants with moderate ED showed marked improvements in their condition.

Throughout the years, tadalafil has been administered to over 9000 men. The dropout rate for adverse reactions is reported by Eli Lilly to be just 3.1%, along with 1.4% dropout for the same reason in the placebo control groups.

Side Effects of Cialis May Include:

Headache (6% of users)
Dyspepsia (5% of users)
Back Pain (3% of users)
Upper Respiratory Tract Infection (3% of users)
Flushing (3% of users)
Myalgia (muscle pain) (2% of users)
Cough (2% of users)
Diarrhea (2% of users)
Nasal Congestion (2% of users)
Pain in the Extremities (2% of users)
Gastroesophageal Reflux Disease (1% of users)
Abdominal Pain (1% of users)
Priapism (<1% of users)
Angina or Chest Pain (<1% of users)
Vision Disturbances (<1% of users)

* Prevalence of side effects based on the 5 mg dose of Cialis used in phase III clinical trials.

Cialis & Negative Drug Interactions

There are a few known interactions of Cialis with other prescription medications. Many of these interactions are the same as other PDE5 inhibitory medications like Levitra or Viagra. This means that if you’re using a drug that’s contraindicated for use with Cialis, there are little other options to choose from in this family of ED medications.

Some common drugs that may interact with Cialis include:

Nitrates

Cialis may increase the hypotensive effects of nitrate medications, causing users to faint or feel lightheaded. Nitrates are used to treat high blood pressure, coronary artery disease, and angina.

Alpha-Blockers

Cialis and alpha-blockers are both vasodilators that can cause blood pressure to drop below healthy limits. Taking both drugs in combination must be done carefully under the supervision of a trained medical professional.

Antihypertensives

Due to overlapping effects, Cialis and high blood pressure medications can cause blood pressure to drop too low, causing dizziness and fainting.

Alcohol

The effects of Cialis and alcohol overlap in a few areas — causing excessive effects of both drugs. Low blood pressure, dizziness, headaches, and increased heart rate are all common side effects of mixing Cialis with alcohol.

Antacids

Common antacids such as magnesium hydroxide can dramatically reduce the absorption of Cialis — reducing its effectiveness.

CYP3A4 Inhibitors

Cialis is primarily metabolized in the liver by the CYP3A4 enzymes. Taking other drugs that are metabolized by this enzyme can affect the rate of decay for Cialis. This can lead to a prolonged half-life of the drug and elevated concentrations in the bloodstream.

Some common CYP3A4 inhibitory medications include:

Ketoconazole
Erythromycin
Itraconazole
Grapefruit juice

CYP3A4 Inducers

Opposite to CYP3A4 inhibitors, some medications increase the activity of this enzyme — leading to faster metabolism of Cialis and shorter or less pronounced effects.

Common CYP3A4 Inducers Include:

Rifampin
Carbamazepine
Phenytoin
Phenobarbital

Who Should Avoid Taking Cialis?

Cialis isn’t suitable for everybody.

The manufacturer of the drug, Eli Lilly, provides a detailed breakdown of patients who should not be prescribed Cialis:

Anybody using nitrate medications
Anybody using amyl nitrite and butyl nitrite — commonly referred to as “poppers”
Anybody taking guanylate cyclase stimulators (such as riociguat)
Patients with known allergies to Cialis or other forms of tadalafil
Patients with pulmonary hypertension
Patients told to avoid sexual activity due to a health condition
Patients with uncontrolled high or low blood pressure
Patients with chronic liver or kidney disease
Patients with retinitis pigmentosa
Patients with a history of NAION
Patients with current stomach ulcers
Patients with Peyronie’s disease

How Does Cialis Work?

Cialis works by improving the penis’ ability to pump blood into a region called the corpora cavernosa.

A series of arteries are responsible for feeding the flow of blood into the corpora cavernosa to induce erection. They act as a gate for the blood. When the arteries dilate and relax, blood rushes through the gates to fill the cavity — leading to an erection.

In many cases of ED, these arteries are no longer able to dilate enough to pump blood into the penis — which results in the symptoms we associate with erectile dysfunction.

Cialis works indirectly by blocking a specific enzyme known as phosphodiesterase type 5 (PDE5).

PDE5 is especially abundant in the penis but is also found in other areas, such as the eyes and ears. This enzyme is responsible for breaking down cGMP, which is one of the primary chemicals used to relax the blood vessels controlling blood flow to the penis.

By preventing this enzyme from breaking down cGMP, erections form much more easily.

Cialis itself doesn’t directly induce an erection. Arousal is still needed to send the signal to the penis to trigger the erection in the first place.

For this reason, it’s important to take other measures to improve your erection as well — such as practicing foreplay and managing other aspects of health and well-being.

Can Women Use Cialis Too?

Cialis is not approved for use in women because the only accepted conditions for prescribing the drug are benign prostatic hyperplasia and erectile dysfunction — both of which are male-specific health conditions.

While women aren’t going to be able to get a prescription for Cialis, some reports suggest the drug may improve sexual function and orgasm in women.

One study was conducted on the related drug — Viagra — and postmenopausal women to explore its potential for improving sexual enjoyment in women.

This study found that only 18% of women experienced notable improvement in sexual performance — much of which can be ruled out by the placebo effect [2].

In summary, Cialis is unlikely to offer many benefits to women — though a small percentage of women may find improvement in sexual function and arousal after using the drug.

Cialis Alternatives

Cialis is just one of several brand-name PDE5 inhibitors used for treating erectile dysfunction.

The main competitors for Cialis include:

Avanafil (Stendra)
Mirodenafil (Mvix)
Sildenafil (Viagra)
Udenafil (Zydena)
Vardenafil (Levitra, Staxyn, and Vivanza)

Tadalafil is also no longer protected under patent law, which means there are generic versions of the drug available at a much lower cost to the official brand name version of the drug.

Manufacturers making generic tadalafil include:

Ajanta Pharma
Apotex
Camber Pharmaceuticals
Dr. Reddy’s Laboratories
Teva Pharmaceuticals
Torrent Pharma

Are There any Natural Cialis Alternatives?

While there are natural PDE5 inhibitors and other forms of erectile dysfunction supplements, nothing in the natural world is as reliable as Cialis or other prescription medications.

Many of these natural substances lack the clinical testing and proof necessary to recommend these products for erectile dysfunction ethically.

However, there are a few promising candidates worth mentioning:

Horny Goat Weed (Epimedium spp.) — this plant contains a compound called icariin, which is a relatively strong PDE5 inhibitor similar to Cialis [4].
L-Arginine — this amino acid is one of the required precursors for nitric oxide production, which in turn promotes the activity of cGMP to promote erection [5].
Korean Red Ginseng (Panax quinquefolium) — KRG extracts have been shown to improve nitric oxide production to promote dilation of the arteries in the penis to promote erection [6].

Where to Buy Cialis in 2020

Cialis is a prescription-only medication in most countries, including the United States.

If you would like to try Cialis to improve erectile function or to support prostate health, you should visit your doctor. They’ll review any medications and underlying health conditions to assess whether Cialis is right for you.

Once you have a prescription, you can order Cialis online from online pharmacies or by stopping in at your local pharmacy in person.

Most places will offer both the brand-name Cialis, and generic forms of tadalafil. Both will work just as well, but the generic forms tend to be about 50% cheaper.

It’s worth shopping around before you buy to find the best price. There’s a significant difference in the cost of Cialis depending on the pharmacy.

References

Padma-Nathan, H., McMurray, J. G., Pullman, W. E., Whitaker, J. S., Saoud, J. B., Ferguson, K. M., & Rosen, R. C. (2001). On-demand IC351 (Cialis™) enhances erectile function in patients with erectile dysfunction. International journal of impotence research, 13(1), 2-9.
Kaplan, S. A., Reis, R. B., Kohn, I. J., Ikeguchi, E. F., Laor, E., Te, A. E., & Martins, A. C. (1999). Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction. Urology, 53(3), 481-486.
Porst, H. (2002). IC351 (tadalafil, Cialis): update on clinical experience. International Journal of Impotence Research, 14(1).
Liu, W. J., Xin, Z. C., Xin, H., Yuan, Y. M., Tian, L., & Guo, Y. L. (2005). Effects of icariin on erectile function and expression of nitric oxide synthase isoforms in castrated rats. Asian journal of andrology, 7(4), 381-388.
Melman, A. (1997). L-Arginine and penile erection. The Journal of urology, 158(3), 686-686.
Leung, K. W., & Wong, A. S. (2013). Ginseng and male reproductive function. Spermatogenesis, 3(3), e26391.