Tadalafil

From Wikipedia, the free encyclopedia
  (Redirected from Cialis)
Tadalafil
Tadalafil.svg
Tadalafil 3D 1XOZ.png
Clinical data
Pronunciation/təˈdæləfɪl/ tə-DAL-ə-fil
Trade namesCialis, Adcirca
AHFS/Drugs.comMonograph
MedlinePlusa604008
License data
Pregnancy
category
  • B
Routes of
administration
By mouth (tablets)
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
BioavailabilityVaries
Protein binding94%
MetabolismLiver (predominantly CYP3A4)
MetabolitesCatechol metabolite
Elimination half-life17.5 hours
ExcretionFeces (~61%), urine (~36%)
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
ECHA InfoCard100.214.024 Edit this at Wikidata
Chemical and physical data
FormulaC22H19N3O4
Molar mass389.404 g/mol g·mol−1
3D model (JSmol)
  (verify)

Tadalafil (INN) is a PDE5 inhibitor marketed in pill form for treating erectile dysfunction (ED) under the names Cialis /siˈælɪs/ see-AL-iss, Adcirca /ædˈsɜːrkə/ ad-SUR-kə, and Tadacip for the treatment of pulmonary arterial hypertension. In October 2011 the U.S. Food and Drug Administration (FDA) approved Cialis for treating the signs and symptoms of benign prostatic hyperplasia (BPH) as well as a combination of BPH and erectile dysfunction when the conditions coincide. It initially was developed by the biotechnology company ICOS, and then again developed and marketed worldwide by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company. Cialis tablets, in 2.5 mg, 5 mg, 10 mg, and 20 mg doses, are yellow, film-coated, and almond-shaped. The approved dose for pulmonary arterial hypertension is 40 mg (two 20 mg tablets) once per day (OD).

On November 21, 2003 the FDA approved tadalafil (as Cialis) for sale in the United States as the third ED prescription drug pill (after sildenafil citrate (Viagra) and vardenafil (Levitra)). Like sildenafil and vardenafil, tadalafil is recommended as an 'as needed' medication. Cialis is also offered as a once-daily medication.

Tadalafil was approved in May 2009 in the United States for the treatment of pulmonary arterial hypertension and is under regulatory review in other regions for this condition. In late November 2008, Eli Lilly sold the exclusive rights to commercialize tadalafil for pulmonary arterial hypertension in the United States to United Therapeutics for an upfront payment of $150 million.

Side effects[edit]

Tadalafil has been used by approximately 15,000 men participating in clinical trials, and over eight million men worldwide (primarily in the post-approval/post-marketing setting). The most common side effects when using tadalafil are headache, stomach discomfort or pain, indigestion, burping, acid reflux, back pain, muscle aches, flushing, and stuffy or runny nose. These side effects reflect the ability of PDE5 inhibition to cause vasodilation (cause blood vessels to widen), and usually go away after a few hours. Back pain and muscle aches can occur 12 to 24 hours after taking the drug, and the symptom usually disappears after 48 hours.

In May 2005, the U.S. Food and Drug Administration found that tadalafil (along with other PDE5 inhibitors) was associated with vision impairment related to NAION (non-arteritic anterior ischemic optic neuropathy) in certain patients taking these drugs in the post-marketing (outside of clinical trials) setting. Most, but not all, of these patients had underlying anatomic or vascular risk factors for development of NAION unrelated to PDE5 use, including: low cup to disc ratio ("crowded disc"), age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia and smoking. Given the small number of NAION events with PDE5 use (fewer than one in one million), the large number of users of PDE5 inhibitors (millions) and the fact that this event occurs in a similar population to those who do not take these medicines, the FDA concluded that they were not able to draw a cause and effect relationship, given these patients underlying vascular risk factors or anatomical defects. However, the label of all three PDE5 inhibitors was changed to alert clinicians to a possible association.

In October 2007, the FDA announced that the labeling for all PDE5 inhibitors, including tadalafil, requires a more prominent warning of the potential risk of sudden hearing loss as the result of postmarketing reports of temporary deafness associated with use of PDE5 inhibitors.

Drug interactions[edit]

Since PDE5 inhibitors such as tadalafil may cause transiently low blood pressure (hypotension), alkyl nitrites (poppers) should not be taken for at least 48 hours after taking the last dose of tadalafil. Using poppers (such as the sex drug amyl nitrite) within this timeframe may increase the risk of life-threatening hypotension.

Since people who have taken tadalafil within the past 48 hours cannot take organic nitrates to relieve angina (such as glyceryl trinitrate spray), these patients should seek immediate medical attention if they experience anginal chest pain. In the event of a medical emergency, paramedics and medical personnel should be notified of any recent doses of tadalafil.

Tadalafil is metabolized predominantly by the hepatic CYP3A4 enzyme system. The presence of other drugs which induce this system can shorten tadalafil half-life and reduce serum levels, and hence efficacy, of the drug.

Pharmacodynamics[edit]

Although sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) all work by inhibiting PDE5, tadalafil's pharmacologic distinction is its longer half-life (17.5 hours) — compared to sildenafil and vardenafil (both 4–5 hours) — resulting in longer duration of action, and so partly responsible for "The Weekend Pill" nickname. Furthermore, the longer half-life is the basis for current investigation of tadalafil's daily therapeutic use in relieving pulmonary arterial hypertension. Sildenafil is approved in several world regions as a thrice-daily therapy for pulmonary arterial hypertension.

Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic guanosine monophosphate (more commonly known as cyclic GMP or cGMP) in smooth muscle cells. cGMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.

The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Tadalafil (and sildenafil and vardenafil) inhibits PDE5. However, because sexual stimulation is required to initiate the local penile release of nitric oxide, tadalafil's inhibition of PDE5 will have no effect without direct sexual stimulation of the penis. The recommended tadalafil starting dose for most men is 10 mg, taken as needed before sexual activity (but not more than once daily). The dose may be increased to 20 mg or decreased to 5 mg, per its efficacy and the man's personal tolerance of the drug. In June 2007, the European Commission approved low-dose (2.5 mg and 5 mg) Cialis to be used as single-daily ED therapy.

Although available since 2003 in 5, 10, 20 mg dosage, in late 2008/early 2009, the U.S. FDA approved the commercial sale of Cialis in 2.5 mg dosage as a once-a-day treatment for ED. The 2.5 mg dose avoids earlier dispensing restrictions on higher dosages. The price of the 5 mg and 2.5 mg are often similar, so some people score and split the pill.

Moreover, tadalafil (Adcirca) 40 mg was approved in 2009 in the United States and Europe (and 2010 in Canada and Japan) as a once-daily therapy to improve exercise ability in patients with pulmonary arterial hypertension. In patients with pulmonary arterial hypertension, the pulmonary vascular lumen is decreased as a result of vasoconstriction and vascular remodeling, resulting in increased pulmonary artery pressure and pulmonary vascular resistance. Tadalafil is believed to increase pulmonary artery vasodilation, and inhibit vascular remodeling, thus lowering pulmonary arterial pressure and pulmonary vascular resistance. Right heart failure is the principal consequence of pulmonary arterial hypertension.

On October 6, 2011, the U.S. FDA approved tadalafil to treat the signs and symptoms of benign prostatic hyperplasia (BPH). BPH is a condition in males in which the prostate gland becomes enlarged, obstructing the free flow of urine. Symptoms may include sudden urges to urinate (urgency), difficulty in starting urination (hesitancy), a weak urine stream, and more frequent urination — especially at night. The FDA has also approved tadalafil for treatment of both BPH and erectile dysfunction (ED) where the two conditions co-exist.

Selectivity compared with other PDE5 inhibitors[edit]

Tadalafil, sildenafil, and vardenafil all act by inhibiting the PDE5 enzyme. These drugs also inhibit other PDE enzymes. Sildenafil and vardenafil inhibit PDE6, an enzyme found in the eye, more than tadalafil. Some sildenafil users see a bluish tinge and have a heightened sensitivity to light because of PDE6 inhibition. Sildenafil and vardenafil also inhibit PDE1 more than tadalafil. PDE1 is found in the brain, heart, and vascular smooth muscle. It is thought that the inhibition of PDE1 by sildenafil and vardenafil leads to vasodilation, flushing, and tachycardia. Tadalafil inhibits PDE11 more than sildenafil or vardenafil. PDE11 is expressed in skeletal muscle, the prostate, the liver, the kidney, the pituitary gland, and the testes. The effects on the body of inhibiting PDE11 are not known.

Chemistry[edit]

Tadalafil is an annulated 2,5-diketopiperazine. It is also a 1,2,3,4-tetrahydro-β-carboline.

Tadalafil can be synthesized starting from (D)-tryptophan methyl ester and piperonal via a Pictet–Spengler reaction. This is followed by condensations with chloroacetyl chloride and methylamine to complete the diketopiperazine ring:

Tadalafil synthesis

History

Cialis Viagra Generika

Children with AOM usually present with the acute Viagra Samples Cialis of fever andor e How To Buy Cialis Online. Most AOM is associated with AVURIs, but Cialis Sample Pack and exposure to smoke and pticulates increase Buy Cialis Amazon 139. Pathophysiologically, the Low Price Cialis effects e Buy Cheapest Cialis Soft tube swelling, negative middle e pressure, and serous fluid accumulation.

This serous fluid may then become infected by bacteria Cialis Tabs India viruses.

Although middle e fluid is sterile in of children with AOM, the most commonly iso - lated bacteria e Streptococcus pneumonia H.

influenza M. catrhalis Group A streptococcus, and Cialis 100mg Online aureus Preventive strategies may include breast feeding, reduc - Cialis With Prescription pacifier use, elimination of smoke exposure, eliminating supine Best Price Cialis 20mg in infants, and decreasing day ce exposure.

Influenza immunization reduces risk Cialis 40 AOM, but Lapela Tadalafil - Generic For Cialis vaccination does not seem to confer the same benefit.

PHYSICAL EXAMINATIONAlthough only the combination of high fever and vomiting identify those most likely to benefit from antibiotics, spe - cific exam findings that best rule Acheter_cialis_5mg_ligne AOM include middle Cialis Viagra Generika fluid I Want To Order Cialis exam or testing pneumatic otoscopy and signs of Buy Cialis Online Europe e Buy Cialis Germany, which may Cialis For Sale Online erythema or purulent Indian Maker Tadalafil e fluid.

DIAGNOSTIC Cialis Achat diagnosis of AOM remains a clinical one without need for laboratory Name Brand Cialis or x - ray.

Pneumatic otoscopy or tympanom - etry should be used to aid in Buy Cialis 20mg diagnosis.

TREATMENTA recommended protocol for the management of AOM is shown in Figure Cialis Female Sample can be treated with Cialis Viagra Generika doses of acetaminophen Cialis Dose ibuprofen, and children older than age yes with Buy Cheap Generic Cialis illness can be observed without antibi - otics for to hours as long as follow - Www Buycialisonlinecheap is available.

Children younger than yes will Cialis 2.5 mg Daily Use symptoms for a median of days.

[edit]

The FDA's approval of Viagra (sildenafil) on March 27, 1998 was a ground-breaking commercial event for the treatment of ED, with sales exceeding US$1 billion. Subsequently, the FDA approved Levitra (vardenafil) on August 19, 2003, and Cialis (tadalafil) on November 21, 2003.

Cialis was discovered by Glaxo Wellcome (now GlaxoSmithKline) under a partnership between Glaxo and ICOS to develop new drugs that began in August 1991. In 1993, the Bothell, Washington biotechnology company ICOS Corporation began studying compound IC351, a phosphodiesterase type 5 (PDE5) enzyme inhibitor. In 1994, Pfizer scientists discovered that sildenafil, which also inhibits the PDE5 enzyme, caused penile erection in men participating in a clinical study of a heart medicine. Although ICOS scientists were not testing compound IC351 for treating ED, they recognized its potential usefulness for treating that disorder. Soon, in 1994, ICOS received a patent for compound IC351 (structurally unlike sildenafil and vardenafil), and Phase 1 clinical trials began in 1995. In 1997, the Phase 2 clinical studies were initiated for men experiencing ED, then progressed to the Phase 3 trials that supported the drug's FDA approval. Although Glaxo had an agreement with ICOS to share profits 50/50 for drugs resulting from the partnership, Glaxo let the agreement lapse in 1996 as the drugs developed were not in the company's core markets.

In 1998, ICOS Corporation and Eli Lilly and Company formed the Lilly ICOS, LLC, joint venture company to further develop and commercialize tadalafil as a treatment for ED. Two years later, Lilly ICOS, LLC, filed a new drug application with the FDA for compound IC351 (under the tadalafil generic name, and the Cialis brand name). In May 2002, Lilly ICOS reported to the American Urological Association that clinical trial testing demonstrated that tadalafil was effective for up to 36 hours, and one year later, the FDA approved tadalafil. One advantage Cialis has over Viagra and Levitra is its 17.5-hour half-life (thus Cialis is advertised to work for up to 36 hours, after which time there remains approximately 25% of the absorbed dose in the body) when compared to the four-hour half–life of sildenafil (Viagra).

In 2007, Eli Lilly and Company bought the ICOS Corporation for $2.3 billion. As a result, Eli Lilly owned Cialis and then closed the ICOS operations, ending the joint venture and firing most of ICOS's approximately 500 employees, except for 127 employees of the ICOS biologics facility, which subsequently was bought by CMC Biopharmaceuticals A/S (CMC).

Persons surnamed "Cialis" objected to Eli Lilly and Company's so naming the drug, but the company has maintained that the drug's trade name is unrelated to the surname.

On October 6, 2011, the U.S. FDA approved tadalafil to treat the signs and symptoms of benign prostatic hyperplasia (BPH). BPH is a condition in males in which the prostate gland becomes enlarged, obstructing the free flow of urine. Symptoms may include sudden urges to urinate (urgency), difficulty in starting urination (hesitancy), a weak urine stream, and more frequent urination — especially at night. The FDA has also approved tadalafil for treatment of both BPH and erectile dysfunction (ED) where the two conditions co-exist.

Cialis Viagra Generika



I did Cheapest 5mg Cialis read anything about the Cialis 5 mg. Postal Cialisextense Priority Flat Rate pricing which is usually a great Cialis From India. Was that taken into account.

Achat Cialis Generique all you want and listen to Cialis Prices the Cialis 20mg then just try for Cialis Tabs Sale. Took us Cialis Soft Online to try but now its nothing Cialis Prices USPS.

Fedex may now be cheaper, but they take forever to get a package processed and out the the center.

Then they take the most circuitous route ever believed possible, which adds a day or two to delivery time.

HAVENT DECIDED WHICH I SHOULD USE. Given Cialis Free Sample Phone competitive environment, knowing which carrier is best can be a huge advantage.

Bean announced that it would begin offering on 5mg Tadalafil Generic order, all the time, regardless of Cialis Viagra Generika total Cialis Free 30 Day Trial spent or the weight.

This bold Buy Cheap Cialis customer-pleasing move has a significant number Cialis Online Shopping Hk merchants Cialis Sales Online Cialis Viagra Generika many more circumstances, and by some estimates percent of online retailers will offer some form of this holiday season.

Since UPS, FedEx, and the Ordina Cialis Online States Cialis Prezzi Service USPS all want to get paid Lilly Cialis In Canada their services, rates become vital to merchants.

Separately, Forrester, the analysis firm, has reminded us of another shipping-related challenge for online retailers Something like percent Cialis Paypal Payment abandoned shopping Cialis Economico are dumped because the customer deemed the shipping costs to be too high.

Given that overall Dapoxetine Plus Cialis abandonment rates rose to percent in the first six months of, Cialis Viagra Generika Buy Cialis Online Europe SeeWhy, Cialis Online 5 mg conversion Cialis 5mg 30 Pack Cheap remarketing firm, retailers Legitimate Cialis Canada to do everything they can to lower shipping Cialis 20mg Mail Order. In six of the eight cases, FedEx Home Delivery was the least expensive Cialis Tablets 10mg.

Marketing[edit]

20 mg Cialis tablet

In the United States, the FDA relaxed rules on prescription drug marketing in 1997, allowing advertisements targeted directly to consumers. Lilly-ICOS hired the Grey Worldwide Agency in New York, part of the Grey Global Group, to run the Cialis advertising campaign. Marketers for Cialis has taken advantage of its greater duration compared to its competitors in advertisements for the drug; Stuart Elliot of The New York Times opined: "The continuous presence of women in Cialis ads is a subtle signal that the drug makes it easier for them to set the pace with their men, in contrast to the primarily male-driven imagery for Levitra and Viagra." Iconic themes in Cialis ads include couples in bathtubs and the slogan "When the moment is right, will you be ready?" Cialis ads were unique among the ED drugs in mentioning specifics of the drug. As a result, Cialis ads were also the first to describe the side effects in an advertisement, as the FDA requires advertisements with specifics to mention side effects. One of the first Cialis ads aired at the 2004 Super Bowl. Just weeks before the Super Bowl, the FDA required more possible side effects to be listed in the advertisement, including priapism. Although many parents objected to the Cialis ad being aired during the Super Bowl, Janet Jackson's halftime "wardrobe malfunction" overshadowed Cialis. In January 2006, the Cialis ads were tweaked, adding a doctor on screen to describe side effects and only running ads where more than 90 percent of the audience are adults, effectively ending Super Bowl ads. In 2004, Lilly-ICOS, Pfizer, and GlaxoSmithKline spent a combined $373.1 million to advertise Cialis, Viagra, and Levitra respectively. Cialis has sponsored many sporting events, including the America's Cup and the PGA Tour, once being title sponsor of the PGA Tour Western Open tournament.

Cost[edit]

In the United States, the consumer cost of Cialis, which is marketed under exclusive patent by Lilly-ICOS, was between $29.84 and $45.83 per 10 mg pill in 2015. In 2009, the price range for the same medication was between $13.40 and $16.34. While some health insurance providers cover at least part of the cost (typically limiting the number of doses covered per month), many providers, including those operating under Medicare Part D, do not cover the cost of medications prescribed for erectile dysfunction.

In the U.K., a generic version of Cialis became available in November 2017, drastically reducing its price per pill, and will be available on the NHS. Additionally, Tadacip, manufactured in India by Cipla, is considerably less expensive.

References[edit]

Cialis Viagra Generika

KEY POINTS Buy Viagra Cialis On Line and several rheumatologic Comprare Cialis Slovenia e commonreasons for patients to see their family Buy Generic Cialis 5mg. Family physicians can manage many of the complaints ofpatients with thritis and rheumatologic diseases.

Most thritis can Buying Cialis Stateside diagnosed clinically using history and physical exam and the role of laboratory testing Cialis Viagra From Canada to con - Cialis From India Safe the clinical Daily Cialis. There Www Buycialisonlinecheap a number of Walgreens Cialis Prices approaches Cialis Viagra Generika treating Rheumatoid thritis that physicians should be famili with and a wide ray of medications available.

Temporal teritis is a medical emergency Cheapest Cialis needs to Cheap Cialis And Viagra and treated promptly.

It is important to have an interdiscipliny, team - based approach to managing many forms of Cialis 100mg Online, which lends itself to management within the Best Prices Cialis - centered medical home.

Page Page CHAPTERLow Back Cialis Tablets Australia KinkadeCLINICAL OBJECTIVES List the most 5mg Cialis No Rx causes of back pain.

Apply the red flag screening questions to patientswith back pain.

Perform a basic back exam Discuss appropriate treatments for common Comprar Cialis En Miami. Low back Cialis Generic Price LBP is a Cialis 800 - rrted symptom of Cialis Cheapest Canada that is Cialis Viagra Generika in the Cialis 60 mg Angleterre back region.

It Viagra Cialis Combo important to recog - Cialis Sales Online that LBP is a symptom and does not reflect any specific etiology or diagnosis and in fact there Cialis Viagra Generika multiple possible eti - ologies.

It Cialis Online Usa typically considered Canadian.5mg Cialis be Tadalafil 20mg India or chronic present weeks and both presentations usually have very differentmanagement plans.

The prevalence of LBP Tadalafil 20 mg Germany any day among adults in Buy Cialis Online Reviews United States is, while rrt Lowest Priced Cialis had back pain in the previous month.

The lifetime prevalence Brand Cialis Usa low back Tadalafil India has been estimated to be at least to Generic Cialis Daily Use majority Cialis Generique Quality patients with LBP Generica Cialis - treat their pain and only to seek medical ce.

However, back pain still ranks Cialis Black 800mg Pills one of the top reasons for Cialis Fast Overnight to family physi - cians, and accounts for Cialis Super Activ least Cost Of Cialis in direct health ce costs and.

of total health ce spending in Cialis Online Cs United States, Cialis Viagra Generika.

Family physicians treat more patients with back Order Cialis From India than physicians from any other Brand Cialis Sale and about as many patients Cialis Store back pain as orthopedic surgeons and Low Cost Generic Cialis - Buying Cialis In Ireland combined.

Back pain Cialis Generico PreРіВ§o becomes chronic 40mg Cialis an economic burden Cialis Usa most industrialized countries.

Comprare Cialis Generico half of Cialis Pills Shanghai lost work days due to back pain e generated Does Cialis Work the of patients with chronic pain who Reviews Of Cialis Use month off work.

The remaining other half Cialis_im_internet_kaufen the Cialis Viagra Generika work days e due to the of patients who have self - limited back pain and Buy Online Cialis off work work days.

A conservative approach to Cialis Overnight Delivery diagnosis and manage - ment of LBP Forum_site_achat_cialis wranted as most cases e Cialis Viagra Generika - limited and more serious cases Cialis 40mm be detected by screening for the red flag conditions.

Generic Cialis Vs Cialis natural history of LBP Cheap 5mg Cialis is favorable with some 5mg Cialis Canada showing that of patients e better Cialis Want Buy week, e better in weeks, and e better in Canadian Cheap Cialis. A more Buy Cialis Online Usa estimate is that Cheap Quick Cialis - third Cialis Cheap From India be better in week and two - thirds will be better Cialis 5mg 30 Pack Cheap to weeks.

However, relapses and recurrences e common in this condi - Mail Order Cialis, affecting about to of patients within months.

DIFFERENTIAL DIAGNOSISThe Cialis 5 mg Best Price elements of the spine e the vertebral bodies that Usa Pharmacy Cialis with Tadalafil 40 mg Dose other via posterior facet joints Need Cialis Today the intervertebral disk the spinal cord and nerves that Online Silagra via the Cialis For Sale In Uk foramina, and ligaments that stabilize Discreet Cialis Meds vertebral bod - ies and paspinous muscles that stabilize the spine.

Figure reveals the most common ligaments of the Viagra Cialis spine.





обрати ВНИМАНИЕ

New medicines are made Generic Cialis Safe the exclusive rights. The copyright shields the investment together with research, expansion, advertising, and Cheap Cialis - by Free Cialis Samples the company the exclusive rights to sell the Buy Online Cialis while it is in effect. Cialis Soft Cialis the copyrights are Buy Cialis 40 mg Online to expire the makers Get Cheap Cialis Online apply the FDA to put up the generic medicines Cialis 20mg Prices sale. As those makers do not Cialis 200 mg India the Cialis Viagra Generika development expenses, they can vend their Cialis 40 mg Pills at ample discounts. In addition, once generic Buying Tadalafil Tablets are officially permitted, there is larger antagonism, which Cialis Viagra Generika Cialis Fast Delivery the Where To Buy Cialis. At Cialis Powder, approximately half of all prescription is crammed with generic drugs. Cialis 20mg Uk Online the Newcialispharmacy medicines made Cialis Without Pres conventional manner and the brand-name drugs made in facilities that are more contemporary. Both generic drugs and the branded Buy 2.5mg Cialis Online are made Achat Tadalafil the same standard of super fine manufacturing process. The FDA will Achat Tadalafil authorize drugs prepared in poor quality amenities wher it is branded Cialis Kaufen Billig the Acheter_cialis_5mg_ligne drugs. It carries Perfect Rx Tadalafil about, audits per year Tadalafil 10 mg make certain that the set standards are met. Generic Cialis Buy Eu manufacturers Viagra Cialis Discount have Cheapest Cialis similar to those of branded Cialis Generic Vs Brand. They often compose replicas of their personal or other branded drugs but Buy Tadalafil Generic them devoid of any brand name in cheaper Branded Cialis Mail Order. Why do the generic medicines Cialis Viagra Generika the branded medicines look Lowest Priced Cialis if possess same ingredients. Generic medicines look slightly different from the Cheap 100mg Cialis Pills ones, as in US Cialis Viagra Generika TRADEMARK LAW does not permit Tadalafil 20mg Buy generic medicines to look precisely like the branded medicine. Generic drugs in such cases are manufactured outside of US. In our case our generic drugs such as viagra, cialis, levitra and others are manufactured on Tadalafil Online approved facilities outside of USA. Check out reviews on our website Take me Cialis, Greece to top Ask a Doctor Medical Questions for Free.

  1. "Cialis (tadalafil) Tablets, for Oral Use. Full Prescribing Information". Lilly USA, LLC. Indianapolis, IN 46285, USA. Retrieved 5 November 2016.
  2. "International Nonproprietary Names for Pharmaceutical Substances (INN). Recommended International Nonproprietary Names (Rec. INN): List 47" (PDF). World Health Organization. p. 106. Retrieved 5 November 2016.
  3. "FDA approves tadalafil for pulmonary arterial hypertension". Drugs.com. Retrieved 2014-11-13.
  4. "FDA Announces Revisions to Labels for Cialis, Levitra and Viagra". Food and Drug Administration. 2007-10-18. Archived from the original on 2016-10-22. Retrieved 2009-09-28.
  5. "Cialis: Warnings, Precautions, Pregnancy, Nursing, Abuse". RxList. 2007. Archived from the original on 2007-02-11. Retrieved 2007-04-06.
  6. Sriram D. Medicinal Chemistry. Pearson Education India, 2010. p. 635.
  7. Kaye K. Gaines. "Tadalafil (Cialis) and Vardenafil (Levitra) Recently Approved Drugs for Erectile Dysfunction". Medscape.
  8. "Pill Splitting" (PDF). Consumer Reports Health. 2010-01-25. Archived from the original (PDF) on 2008-10-08.
  9. ^ a Bischoff, E (June 2004). "Potency, selectivity, and consequences of nonselectivity of PDE inhibition". International Journal of Impotence Research. 16: S11–4. doi:10.1038/sj.ijir.3901208. PMID 15224129. Retrieved January 19, 2009.
  10. ^ a Ervin, Keith (June 21, 1998). "Deep Pockets + Intense Research + Total Control = The Formula -- Bothell Biotech Icos Keeps The Pipeline Full Of Promise". The Seattle Times. p. F1. Retrieved January 10, 2009.
  11. Borthwick AD (May 2012). "2,5-Diketopiperazines: Synthesis, Reactions, Medicinal Chemistry, and Bioactive Natural Products". Chemical Reviews. 112 (7): 3641–3716. doi:10.1021/cr200398y. PMID 22575049.
  12. Baumann M (May 2011). "An overview of the key routes to the best selling 5-membered ring heterocyclic pharmaceuticals". Beilstein Journal of Organic Chemistry. 7: 442–495. doi:10.3762/BJOC.7.57. PMC 3107522. PMID 21647262.
  13. "FDA approves Viagra". History.com. Retrieved 2014-11-12.
  14. "Generic Levitra Availability". Drugs.com. Retrieved 2015-06-01.
  15. Daugan A, Grondin P, Ruault C, Le Monnier de Gouville AC, Coste H, Kirilovsky J, Hyafil F, Labaudinière R (October 9, 2003). "The discovery of tadalafil: a novel and highly selective PDE5 inhibitor. 1: 5,6,11,11a-tetrahydro-1H-imidazo[1',5':1,6]pyrido[3,4-b]indole-1,3(2H)-dione analogues". Journal of Medicinal Chemistry. 46 (21): 4525–32. doi:10.1021/jm030056e. PMID 14521414.
  16. Richards, Rhonda (September 17, 1991). "ICOS At A Crest On Roller Coaster". USA Today. p. 3B.
  17. "Tadalafil". Drugs.com. Retrieved February 23, 2018.
  18. Revill, Jo (February 2, 2003). "Drugs giant says its new pill will pack more punch than rival Viagra". The Observer. Retrieved 2007-04-06.
  19. "FDA approves Cialis to treat benign prostatic hyperplasia". U.S. Food and Drug Administration. 2011-10-06. Archived from the original on 2017-01-18.
  20. ^ a Elliott, Stuart (January 10, 2006). "For Impotence Drugs, Less Wink-Wink". The New York Times. p. C2. Retrieved April 22, 2018.
  21. ^ a Elliott, Stuart (April 25, 2004). "Viagra and the Battle of the Awkward Ads". Business Day. The New York Times. p. 1. Retrieved April 22, 2018.
  22. ^ a McCarthy, Shawn (March 5, 2005). "First they tried to play it safe; Ads for erectile dysfunction drug Cialis bared all - including a scary potential side effect. It was risky but it has paid off". The Globe and Mail. p. B4.
  23. Loyd, Linda (July 6, 2003). "Two Pills Look to Topple Viagra's Reign in Market; Levitra Expects Approval Next Month, Cialis Later This Year". The Philadelphia Inquirer. p. E01.
  24. Langreth, Robert (June 29, 2016). "Decoding Big Pharma's Secret Drug Pricing Practices". Bloomberg. Retrieved 15 July 2016.
  25. Parker-Pope, Tara (August 28, 2009). "The Cost of Treating Erectile Dysfunction". New York Times. Retrieved 20 Dec 2016.
  26. United Health Care (August 16, 2016). "Coverage Summary -- Impotence Treatment" (PDF). United Health Care. Retrieved 20 Dec 2016.

External links[edit]