01The bin card locks 5 daily, 25, and 10
Dublin's PDE5 bin card holds three labelled locks and refuses to rank them by slogan. Cialis 5 mg once daily. Viagra 25 mg swallowed when sex is planned. Levitra 10 mg as the film-coated usual start. Same enzyme. Different calendars.
A borrowed neighbour card that stamps tadalafil 2.5, sildenafil 100, and vardenafil 2.5 answers a different question. So does a 20 / 50 / 5 strip. This slip is for the man already on, or about to start, those three strengths.
Each tablet still needs sexual stimulation. PDE5 blockade only keeps cyclic GMP around after nitric oxide arrives. Swallowing 5, 25, or 10 on a quiet afternoon does not manufacture want.
Priya Natarajan files the card under clocks and contraindications. Headache rates do not pick the lock. Neither does a forum thread about which brand hits hardest. Hardest is the wrong verb for a threshold drug.
If a till later asks about generic cash, send the person to a live pharmacy quote. This bin does not invent dollar figures. Labelled milligrams and washouts come first.
| Lock on this card | INN / brand | How the label uses it |
|---|---|---|
| 5 mg once daily | tadalafil / Cialis | Same time each day; ED daily may start 2.5 then rise to 5; BPH and ED+BPH use 5 |
| 25 mg as needed | sildenafil / Viagra | Labelled decrease from 50, and the start when age, liver, kidney, or CYP3A4 raise exposure |
| 10 mg as needed | vardenafil / Levitra | Usual start about 60 minutes before sex; may rise to 20 or fall to 5 |
02Myalgia on 5 daily, chromatopsia on 25
Headache, flushing, nasal congestion, and dyspepsia are class noise. They do not pick a winner among 5 daily, 25, and 10. They do decide whether a man will stay on a daily tablet through ordinary weekdays.
Tadalafil's extra fingerprint is delayed myalgia. In pharmacology trials, back or thigh ache often started 12 to 24 hours after a dose and settled within 48 hours. Daily 5 mg can put that ache on a Tuesday that was never a date night. Acetaminophen or an NSAID usually covers it; a few men stop.
Sildenafil reaches PDE6 in the retina more than the other two. Blue-tinge or brightness stories attach to the 25 mg lock more often in counselling. They are usually transient. Sudden vision loss is a stop-and-seek rule on the whole class, not a curiosity.
Levitra 10 mg is the most PDE5-selective of the three on paper. That does not erase headache or hypotension. It does mean colour-shift talk is usually shorter than with Viagra 25.
Priapism past four hours is urgent on every lock. So is sudden hearing change. Bring the blister. Staff need the INN, not the colour of the tablet.
| Fingerprint | Cialis 5 mg daily | Viagra 25 mg | Levitra 10 mg |
|---|---|---|---|
| Headache / flush | Class-common, can be daily | Class-common, evening-tied | Class-common, dose-related |
| Back / myalgia | More often counselled | Less often the story | Back pain ~2% in trials |
| Colour / brightness | Uncommon emphasis | PDE6-linked; more reported | Less PDE6 talk |
| Priapism >4 h | Emergency - class | Emergency - class | Emergency - class |
03High-fat supper only moves the 25 mg peak
A rib-eye after 8 p.m. is the classic reason Viagra 25 mg looks like a failed class. High-fat meals delay sildenafil Tmax by about 60 minutes and cut Cmax by about 29 percent. Couples then wait the usual hour, get nothing, and blame the blister.
Daily Cialis 5 mg does not ask anyone to rebuild supper. The label says without regard to food. That is the practical reason men who live on late dinners migrate to the daily lock after one wasted month on 25 mg.
Levitra 10 mg sits between those stories. The film-coated label allows food. A greasy breakfast can still shove the peak later. If the pattern is steak plus a 60-minute stopwatch, counsel the delay instead of jumping to 20 mg the same night.
Alcohol is a separate subtractor on all three locks. It adds hypotension and it dulls stimulation. A failed 25 mg after two pints is not proof the enzyme is wrong. Read 25 mg after dinner before anyone orders a second INN from a cart.
| Evening pattern | Which lock moves |
|---|---|
| Heavy fat, then sex in 45 minutes | Viagra 25 mg peak slips; daily 5 does not care |
| Moderate restaurant meal, Levitra 10 already swallowed | Usually little change; still wait the hour |
| Daily 5 taken at 8 a.m. for weeks | Supper is not the variable |
| No stimulation, any lock | Nothing happens - food is irrelevant |
04Class IA or III lists push Levitra 10 aside
Vardenafil is the only lock on this card with an explicit congenital-QT and class IA / class III warning. Quinidine, procainamide, amiodarone, and sotalol belong in that pile. Those patients should avoid Levitra 10 mg.
In the thorough QT study, therapeutic 10 mg and a supratherapeutic 80 mg dose moved QTc in the same direction as the moxifloxacin control. Heart rate rose about 5 beats per minute after 10 mg versus placebo. A later combination study showed an additive QT effect with another QT-active drug.
Sildenafil 25 mg and tadalafil 5 mg daily still need a medicine list. They do not carry that same vardenafil-specific avoid line. When the list is crowded with antiarrhythmics, walk the QT pass clip and lean toward another lock if the clinician agrees.
A new macrolide or an azole on a borderline tracing is a common outpatient stumble. Flag it before the 10 mg box leaves the counter.
05Plasma tails: 17.5 hours versus about four
Mean terminal half-life for tadalafil is 17.5 hours in healthy subjects. Sildenafil and its active metabolite sit near 4 hours. Vardenafil's mean elimination half-life is about 4 to 5 hours. Those three numbers decide whether Tuesday's tablet is still in play on Wednesday.
Daily Cialis 5 mg is a continuous-exposure plan once steady state arrives. It is not the 36-hour as-needed window measured after 10 mg or 20 mg PRN doses. Mixing those two stories is how men redose daily 5 on Friday night and wonder why the flush lasts all weekend.
Viagra 25 mg and Levitra 10 mg share a short tail. Plan one evening. Do not promise Saturday from Thursday's 25 mg. Do not promise a second attempt at 2 a.m. from a 10 mg taken at 7 p.m. without checking the clock and the once-daily rule.
Tmax differs enough to counsel. Tadalafil daily is not chasing a peak for tonight; it is already on board. Sildenafil 25 mg, fasted, often peaks near an hour. Vardenafil 10 mg, fasted, often peaks in 30 to 60 minutes.
| Parameter | Cialis 5 mg daily | Viagra 25 mg | Levitra 10 mg |
|---|---|---|---|
| Role on this card | Same-time daily lock | Cautious / step-down PRN | Usual-start PRN |
| Approx. terminal t½ | 17.5 h | ~4 h | ~4-5 h |
| Typical Tmax | Not the counselling target | 30-120 min (median 60, fasted) | ~0.5-1 h fasted |
| Food instruction | Without regard to food | High-fat delays Tmax ~60 min, cuts Cmax ~29% | Label: with or without food |
| Max frequency | Once daily | Once per 24 h | Once per 24 h |
| Primary clearance | CYP3A4 | CYP3A4 | CYP3A4 (some 2C) |
06BPH and ED can share the 5 mg morning lock
Cialis 5 mg once daily is the lock that also carries a labelled BPH indication. Viagra 25 mg and Levitra 10 mg do not substitute as prostate therapy. A man who wants both streams on one tablet is a tadalafil-daily conversation.
That is also how duplicate PDE5 scripts appear. Urology starts 5 mg for lower-urinary symptoms. A second clinic later adds sildenafil 25 mg for weekends. The bin treats that as two hypotensive plans, not clever coverage.
Alpha-blockers for BPH or blood pressure still drop standing pressure when any PDE5 is added. Labels want the alpha-blocker stable first, then a PDE5 start at the low end, not a same-day stack of doxazosin and Levitra 10.
If the prostate plan is already an alpha-blocker plus 5 mg tadalafil, do not add 25 mg or 10 mg for special nights. Adjust the one daily lock, or redesign the whole chart with the prescriber. See daily 5 mg stock.
07Ritonavir and azoles rewrite each milligram cap
All three locks clear through CYP3A4. Boosted HIV regimens, ketoconazole, itraconazole, and some macrolides raise exposure. Grapefruit is a nudge in the same direction, not a free pass to ignore the table.
Daily Cialis plus a potent CYP3A4 inhibitor: do not exceed 2.5 mg. That footnote alone can knock the 5 mg daily lock off the card. As-needed tadalafil has a different cap (10 mg no more than once every 72 hours with those inhibitors) - do not paste it onto the daily row.
Sildenafil 25 mg is already the labelled start when those inhibitors are present. Ritonavir goes further: 25 mg in 48 hours, not a nightly 25.
Vardenafil plus ritonavir 600 mg twice daily (studied with 5 mg vardenafil) raised AUC about 49-fold and Cmax about 13-fold, and stretched half-life to about 26 hours. The labelled cap is a single 2.5 mg in 72 hours. Indinavir with 10 mg vardenafil raised AUC about 16-fold; cap is 2.5 mg in 24 hours. Levitra 10 mg is the wrong strength in those combinations.
Rifampin and other inducers can starve tadalafil exposure. Daily 5 mg may look weak for a pharmacokinetic reason, not a relationship one.
| Situation | Cialis 5 mg daily | Viagra 25 mg | Levitra 10 mg |
|---|---|---|---|
| Potent CYP3A4 inhibitor | Daily max 2.5 mg | 25 mg is the labelled start; ritonavir: 25 mg / 48 h | Often 2.5 mg with long spacing - 10 mg is too high |
| Moderate hepatic impairment | Caution; severe hepatic: avoid | Consider 25 mg start | Start 5 mg; max 10 mg (Child-Pugh B) |
| Age over 65 | Watch accumulation on daily use | 25 mg is the labelled consideration (AUC +~40%) | Lower start often used; 10 mg is not automatic |
| Class IA / III antiarrhythmic | Standard class caution | Standard class caution | Avoid vardenafil |
08Organic nitrates shut all three locks
GTN spray, isosorbide, nicorandil, and recreational alkyl nitrites stay contraindicated with tadalafil 5 mg daily, sildenafil 25 mg, and vardenafil 10 mg. Hours of spacing is not a home workaround. The shared nitric oxide / cGMP path can drop blood pressure into a collapse.
Riociguat for pulmonary hypertension follows the same ban. A man on that path needs a specialist ED plan, not a Dublin bin experiment.
If emergency nitrate is judged medically necessary after tadalafil, the Cialis label wants at least 48 hours from the last dose, then close haemodynamic monitoring. Daily 5 mg makes that conversation more urgent, not less, because the drug is meant to be on board every day.
After sildenafil, the Viagra label still says it is unknown when nitrates can be given safely. Plasma levels at 24 hours are much lower than peak in healthy men, yet in older, hepatic, or renal impairment those 24-hour levels can run several times higher. Levitra 10 mg does not create a safe DIY gap either.
Ambulance crews need the INN and the last swallow time. Daily Cialis, Viagra 25, and Levitra 10 are useful words. Weekend pill is not.
09Daily Cialis 5 mg is a same-time tablet
Once-daily tadalafil at five milligrams sits on a calendar, not a kitchen timer. The US Cialis label tells people to take it at about the same time every day. Food does not rewrite that instruction.
For erectile dysfunction used every day, the labelled start is 2.5 mg. The prescriber may raise it to 5 mg if the lower lock is weak and side effects are tolerable. This card still bins 5 mg because that is the strength men bring to Fitzwilliam Place after the first review, and because 5 mg is the BPH and combined ED-plus-BPH daily dose.
Steady-state plasma levels arrive within about five days of once-daily dosing. Exposure is about 1.6 times a single dose. That is why a missed Monday and a double Tuesday is not a home fix. The bin wants a regular swallow.
Do not treat daily 5 mg as a shy version of a 20 mg Friday tablet. The weekend 20 clip is a different lane. Daily 5 keeps tadalafil in the blood on ordinary Tuesdays. Weekend 20 is as-needed. Stacking them stacks the enzyme.
Potent CYP3A4 inhibitors cap once-daily Cialis at 2.5 mg. Severe renal impairment is a reason to keep daily tadalafil off the chart. Those footnotes belong on the 5 mg lock before anyone praises the long half-life.
What the 5 mg daily lock actually says
- Same clock time each day, without regard to meals or to when sex might happen
- ED daily: 2.5 mg start, 5 mg if needed; BPH or ED+BPH: 5 mg
- Steady state in about 5 days; about 1.6-fold accumulation versus a single swallow
- Daily plus a strong CYP3A4 inhibitor: do not exceed 2.5 mg
- Daily tadalafil is not recommended in severe renal insufficiency
10Levitra 10 mg is the film-coated usual start
Levitra's labelled usual start is 10 mg, taken about 60 minutes before sex. That is why 10 mg - not 2.5 mg - sits on this card. The prescriber may raise to 20 mg or drop to 5 mg. Once per day remains the ceiling.
Film-coated vardenafil may be taken with or without food. That sentence is on the US tablet label. A high-fat breakfast can still postpone Tmax by about an hour and trim Cmax; a moderate-fat evening meal has little clinical pull in the published food study. Do not copy Viagra's steak rule onto 10 mg without reading the format.
Moderate hepatic impairment (Child-Pugh B) starts at 5 mg and must not exceed 10 mg. After a 10 mg dose in that group, Cmax rose about 130 percent and AUC about 160 percent versus healthy controls. Mild impairment needs no routine cut.
Lead time still matters. Open Levitra 10 onset notes when someone swallows 10 mg at the bedroom door and calls the class a dud twenty minutes later.
11Viagra 25 mg is the labelled step-down swallow
Twenty-five milligrams of sildenafil is the lowest film-coated Viagra tablet, not the usual start for a healthy middle-aged man. The label still opens most people at 50 mg about an hour before sex, then lets the prescriber drop to 25 or climb to 100.
This bin keeps 25 mg because that is the cautious first swallow Kaelis is asked about: age over 65 (about 40 percent higher AUC), hepatic impairment (about 80 percent), creatinine clearance under 30 mL/min (about a doubling), or a strong CYP3A4 inhibitor already on the list.
Ritonavir has its own cap: a single 25 mg sildenafil in a 48-hour period. If someone arrives waving a 100 mg blister and a boosted antiviral, the 25 mg lock is the labelled conversation, not a stingy downgrade.
The tablet may be taken from 30 minutes to 4 hours before sex. Maximum frequency is once per day. Fasted Tmax sits between 30 and 120 minutes, median 60. Terminal half-life of parent and N-desmethyl metabolite is about 4 hours. That is an evening drug, not a weekend cover.
When 25 mg is too quiet after a fair meal and honest stimulation, the next labelled move is a structured step, not a second brand the same night. See 25 to 100 ladder.
12Mail the bin, not a stacked blister
Bring three facts to any review: last swallow time, the exact milligram on the blister, and every nitrate, riociguat, alpha-blocker, and CYP3A4 drug in the house. Priya would rather see that list than a screenshot of three brands in one suitcase.
If the 25 mg evenings keep dying after late fat, fix the meal or move to daily 5. If daily 5 aches through the working week, a short-tail 10 mg or 25 mg plan may be kinder. If amiodarone is on the chart, leave Levitra 10 in the bin.
Do not add a second PDE5 for a special night. Do not invent a dollar race between generics on this page. Ask a live pharmacy. Change starting locks only with the prescriber or pharmacist who can see the rest of the chart.
Corrections and label clashes go to [email protected]. Urgent erections past four hours, chest pain, or sudden vision or hearing loss go to emergency care with the blister in the pocket. Read the full disclaimer before treating this card as a personal plan.