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Ask · tadalafil

How soon can Cialis work?

4 min read · Reviewed

Medically reviewed by Dr. Priya Natarajan, MD - Clinical pharmacology, Dublin

At or before 30 minutes, 39 of 75 men on CIALIS 20 mg (52%) and 26 of 74 men on placebo (35%) had at least one erection in four attempts that led to intercourse. On 10 mg the same read was 28 of 74 (38%). One stopwatch program enrolled 223 men.

01What if creatinine clearance is under 30 on a 30-minute swallow?

A 30-minute swallow with clearance under 30 mL/min, or hemodialysis, stays at 5 mg every 72 hours. Once-daily CIALIS is not recommended in that group. Between 30 and 50 mL/min, as-needed CIALIS starts at 5 mg not more than once per day, and the maximum is 10 mg not more than once every 48 hours.

02Does age 65 move the 30-minute swallow?

Age 65 and over lowered oral clearance in a pharmacology read, so AUC sat 25 percent higher than in healthy men 19 to 45, with no effect on Cmax. The US label does not cut the dose on age alone. About 25 percent of men in the ED trials were 65 and over.

03Does the tablet work if there is no stimulation?

No stimulation, no nitric oxide from the nerve ending. Tadalafil's PDE5 block has no effect in the absence of that stimulation. The 30-minute read counted erections that led to intercourse.

04What if an erection lasts more than 4 hours after the swallow?

After the 30-minute swallow, an erection past 4 hours still needs emergency care, as does priapism past 6 hours. Caution sits on sickle cell anemia, multiple myeloma, leukemia, and anatomical deformation of the penis.

05What if the liver is impaired?

For as-needed CIALIS in mild or moderate hepatic impairment, Child-Pugh A or B, the dose should not exceed 10 mg once per day. Severe hepatic impairment, Child-Pugh C, is not recommended. Once-daily use has not been extensively evaluated in hepatic impairment.

06What dose does the label start as-needed?

The labelled as-needed start for erectile dysfunction is 10 mg before sexual activity. The dose may increase to 20 mg or decrease to 5 mg. The stopwatch program randomized 223 men to placebo, 10 mg, or 20 mg and used a stopwatch for the first successful erection in four attempts.

07Can a second tablet go down the same day?

Most patients get one CIALIS swallow per day. A quiet first attempt is still one swallow for that day. As-needed CIALIS with ketoconazole or ritonavir has a tighter line: 10 mg not more than once every 72 hours.

08What does 5 units of alcohol do after that swallow?

Alcohol and CIALIS are both mild vasodilators. Five units or more can raise the chance of a faster pulse, a drop in standing blood pressure, dizziness, and headache. Two pharmacology studies used 0.7 g/kg of alcohol, about 6 ounces of 80-proof vodka in an 80-kg man, with tadalafil 10 mg or 20 mg. More men had a clinically important blood-pressure drop on the combination than on alcohol alone. A lower alcohol dose, 0.6 g/kg, about 4 ounces of 80-proof vodka, did not show that same blood-pressure signal.

09What if an alpha-blocker is already on the chart?

When CIALIS is added 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 for the treatment of BPH. Patients who are already hemodynamically unstable on the alpha-blocker alone have a higher risk of symptomatic hypotension when a PDE5 inhibitor is added.

10Does once-daily 5 mg use that 30-minute stopwatch?

Once-daily CIALIS for erectile dysfunction starts at 2.5 mg at about the same time every day, without regard to timing of sexual activity, and may go to 5 mg. BPH, and ED with BPH, sit at 5 mg once daily. Steady-state plasma concentrations are attained within 5 days of once-daily dosing.

11Does a meal move that 30-minute clock?

A meal does not move the 30-minute stopwatch. The rate and extent of absorption of tadalafil are not influenced by food. The stopwatch program did not ask men to hold a meal to hit that 30-minute read. Cmax still arrives between 30 minutes and 6 hours, median 2 hours, after a single oral dose. The meal sentence alone sits on Cialis and food.

12Where does tadalafil go after that 30-minute swallow?

Mean oral clearance is 2.5 L/hr. Mean terminal half-life is 17.5 hours in healthy men. Apparent volume of distribution after an oral dose is about 63 L. At therapeutic concentrations, 94 percent of tadalafil in plasma is bound to proteins. Less than 0.0005 percent of the administered dose appeared in the semen of healthy subjects.

Before you start, stop, or change any medicine, speak with your prescriber or pharmacist. They hold your chart. This bin card does not. Open the bin disclaimer.

Sources

  1. FDA / Lilly Cialis prescribing information, DailyMed set bcd8f8ab-81a2-4891-83db-24a0b0e25895, section 14 stopwatch program and sections 2.1, 2.5, 2.6, 8.5, 8.6, 12.2, 12.3

Checked against the current label and reviewed by Dr. Priya Natarajan. See Pick → Check → Tag → Bin.

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Answers follow the U.S. Cialis label.

Nate asks

If 20 mg was 52 percent at 30 minutes, should I skip 10 mg?

That stopwatch program randomized men to 10 mg, 20 mg, or placebo. The labelled as-needed start is 10 mg. The 20 mg arm was 39 of 75. The 10 mg arm was 28 of 74.

Igor asks

If Cmax can sit as late as 6 hours, why talk about 30 minutes?

The 223-man program asked for a successful intercourse erection at or before 30 minutes. Median Cmax is 2 hours. Those are two reads on the same swallow.

Walt asks

If I am 68, do I take 20 mg later because AUC is higher?

AUC sat 25 percent higher in healthy men 65 and over, with no Cmax change. The US label does not cut the dose on age alone. The stopwatch program still used 10 mg and 20 mg.

Omar asks

If I had two beers, is that the 5-unit line?

The labelled example is 5 units or more: 5 glasses of wine or 5 shots of whiskey. Two beers sit under that example. Alcohol and CIALIS can still add as vasodilators.