01Does age or a meal change the written milligram?
Healthy men 65 or over had a 25 percent higher AUC and no Cmax change versus men 19 to 45. The US label does not cut the dose on age alone. About 25 percent of men in the ED trials were 65 and over; about 3 percent were 75 and over.
A meal does not change the milligram either. Tadalafil may be taken without regard to food. Once per day is the cap on either ladder. See Cialis and food.
02How do kidneys rewrite the number?
Creatinine clearance 30 to 50 mL/min: as-needed starts at 5 mg, not more often than every 48 hours; daily starts at 2.5 mg. Creatinine clearance under 30 mL/min or on hemodialysis: as-needed 5 mg not more often than every 72 hours; once-daily tadalafil is not recommended.
03What if an alpha-blocker is already written?
For erectile dysfunction, the person should already be stable on the alpha-blocker, and CIALIS starts at the lowest recommended dose. CIALIS is not recommended with an alpha-blocker when the indication is BPH. That start is a written line, not a home split of a 20 mg tablet.
04What dose is written for BPH?
Benign prostatic hyperplasia is 5 mg once daily. ED plus BPH is also 5 mg once daily. Those indications do not use the as-needed 10-to-20 ladder. The pharmacy fills the indication that arrived on the order.
05Who writes the milligram?
A licensed US clinician writes the strength. A pharmacy fills that line. Brand Cialis and generic tadalafil use the same four tablet strengths: 2.5, 5, 10, and 20 mg. How that order is obtained sits on how to get tadalafil.
06How does the liver rewrite the number?
Mild or moderate hepatic impairment: as-needed 10 mg is the ceiling. Once-daily use is not recommended in that group. Severe hepatic impairment: tadalafil is not recommended on either route.
07What are the two ED ladders?
As-needed: 10 mg before sexual activity, then 20 mg or 5 mg. Once daily: 2.5 mg at about the same time each day, then 5 mg. This site locks 5 mg daily on the tadalafil shelf. Which route is written is a separate ask: daily or as needed.
Both ladders still need stimulation. Food does not hold the swallow. A second tablet the same day is not a labelled step.
08What do ketoconazole and ritonavir do to the dose?
With a strong CYP3A4 inhibitor such as ketoconazole or ritonavir, as-needed tadalafil is 10 mg at most, not more often than every 72 hours. Once-daily tadalafil is 2.5 mg. Those caps belong on the written line.
09What is the once-a-day cap on either ladder?
Most patients take one tadalafil tablet in 24 hours. As-needed 20 mg does not add a second swallow the same day. Daily 5 mg does not add an as-needed 10 mg on Saturday. Riociguat stays off the chart with tadalafil, the same contraindication family as nitrates. That stop is not a milligram, and a milligram is not a workaround for that stop.