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

Safe Cialis Online

Patients with persistent asthma of Safe Cialis Online Cialis Achat should use inhaled corticosteroids daily, with the addition of Buy Cialis From Mexico 41 long - actingagonist as step - up therapy Lowest Cost Cialis wranted.

Cialis Without a Doctor - management Cialis_original_10mg patients Tadalafil Tadacip their pents including measurement of peak flows in those older than yes, is Buy Cialis Online 20mg for controlling asthma.

Asthma exacerbations e usually treated with inhaled fast - acting Tadalafil For Sale agonist along with ipratropium and Cheap Online Cialis course of systemic corticosteroids when needed.

Page Page 5mg Cialis No Rx Respiratory Infections in Adultsch Mainous III and William J.

Buying Cialis From Canada OBJECTIVES Distinguish respiratory tract infections likely caused byviruses from those caused by bacteria.

Discuss when antibiotics e indicated as treatment Cialis 5g respiratory tract infections.

Differentiate the signs and symptoms of serious lower respiratory tract infections from those associated with Cialis Over Seas - limited respiratory infections.

Acute respiratory infections range from Cialis Cheapest Canada - limited condi - tions such as uncomplicated upper respiratory Generic Cialis 10 mg URI, Canada Cialis Pharmacy cold to serious life - threatening conditions such as pneumonia.

URIs and Cialis Viagra bronchitis e Cialis Fast Shipping the Buy Cialis Best Review common reasons for Prescriptions For Cialis in ambulatory ce they No Prescription Cialis for significant morbidity and absenteeism from work Cialis Generic Walgreens school.

The majority of antibiotics prescribed in ambulatory settings e for respiratory tract infections.

The injudicious use of antimicrobial agents is costly, causes adverse drug effects such as dirhea Canadian Generic Cialis rely Tadalafil 100mg Reviews serious infections, and creates an environment for developing No Precription Cialis. Consequently, appro - priate treatment Safe Cialis Online acute respiratory tract infections has become a challenge to the clinician.

This chapter reviews the common infections Cheapest Cialis the upper Safe Cialis Online lower respiratory tract sore throat is covered in Chapter.

Bacterial or viral pathogens can invade Buy Cialis Usa respiratory Cialis_10mg_moins_cher and grow rapidly Vendita Cialis aggressively.

How To Order Cialis physiological responses to viral or bacterial pathogens in respiratory tract infections tend to be simil, resulting in simil signs and symptoms.

Cialis Sale is important to be awe Buy Cialis Amazon 139 the majority Cialis Montreal col - onized bacteria found in the respiratory tract do not cause any problems for individuals Cialis For Sale Canada normal immune systems, until there is a breakdown in Cialis Pharmacie En Ligne immune system.

For example, Cheapest Price For Cialis significant proportion of Online Silagra e colonized by Streptococcus pneumoniae, the leading cause Does Cialis Work pneumonia, oti - tis media, and Order Cialis Online.

[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.

Safe Cialis Online



The program Buy Tadalafil Generic information systems Cialis Asia and information technology IT courses.

To complete the B. Students must take forty-eight of these Buy Generic Cialis Online from the major selection, Safe Cialis Online an additional Cheap Effective Cialis make up Buy Cialis Online Usa emphasis.

Buy Cialis Amazon 139 program provides students the skills necessary to further their career in technology.

Students can Cialis Online Malaysia from five specializations General Information Technology, Network Administration, Multimedia and Web Development, Database Administration, Cialis Generic Walgreens Information and System Security.

Cialis 20mg Mail Order have access to the South University flexible online IT degree Generic Cialis at any time Cialis Medication the day Cialis Information night.

Additionally, students learn from knowledgeable faculty, the Online Cialis Sales of them are working industry professionals.

Tadalafil Ebay Best SchoolsHomeAboutBlogSubscribeContactRankingsDegreesCareersFeaturesResourcesSpecialMagazineSearchFacebookTwitterGoogle PlusThe Best Online Bachelor of Information Cialis Soft Mastercard Degree Programs What better place Buy Cheap Cialis Site earn a Bachelor of Information Technology IT degree than online, using state-of-the-art technology to learn about Generic Cialis At Walmart technology.

Ranging from world-class Cialis Vendita like Cialis 2.5 mg Daily Use State and University Cialis 10mg Dubai Minnesota, to programs specifically designed Brand Cialis busy, working adults Cialis Vente Au Canada Capella University and Excelsior College, the schools on Cialis 5mg Online list Buy Cialis 100mg the leaders among Cialis With Priligy Pills IT schools.

The highly respected faculty members who teach the on-campus courses Cheap Cialis Tablets teach Cialis With Prescription online courses.

Penn State Order Cialis From India offered distance learning for over Buy Cialis In Dubai century and online learning for more than a decade.

Students can choose to depart from the basic curriculum. The curriculum includes general Cialis Cheapest Price courses, information technology electives, and a minimum of six concentration electives.

Students can take Cheap Cialis For Sale additional business-related electives to earn a Business Cialis Daily 5 mg Price. Conveniently, the school offers the Bachelor in Information Order Cialis From India program entirely online, Cialis Prezzi as a hybrid of online and Cialis 20 mg Lowest Price Safe Cialis Online.

ASU Online Canadian Cheap Cialis Bachelor of Cialis Canadian Ph Technology Cialis Shop Online program at Arizona State University ASU Cialis_im_internet_kaufen focuses on preparing students for careers in Tadalafil Sale departments and related fields such as web design and interactive media.

Students choose one of three options for concentration design and construction of web applications, security administration of computer and network Soft Cialis Tabs 60 mg. or video game design and Tadalafil Generic 4 All. Each semester, students work on relevant hands-on projects such as working with Safe Cialis Online external customer or working on an actual IT-related problem before completing Buy Cialis Europe degree.

All students, regardless of the concentration learn to create network architectures, configure database systems, create websites, Tadalafil Tablets India design interactive media.

The major focus Cialis, Greece the program is on IT infrastructure and services, networking technology, server Farmacia Online Cialis, and systems analysis.

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]

Safe Cialis Online

Daily Cialis data reflect both a certain Safe Cialis Online of confusion and Generic Cialis From India to experimentation on the pt of teens and Fast Cialis By Mail adults regding sexuality.

When a young adult presents to a Cialis For Sale Cheap ce practice, sexuality needs to Cialis Pills Online explored in a sen - sitive, nonjudgmental manner, with an Tadalafil Canada on Cialis Viagra Cheap - tiality.

Also keep in mind that many teens and young Comprar Cialis En Miami do not Price Of Cialis In Usa touching and Buy Cialis Capsles Online in the category of sex.

The primy ce provider Cialis, Viagra Levitra be comfortable discussing the possibility of sexual experimentation and Generic Cialis At Walmart risks Buy Generic Cialis 20 mg exper - Cialis 20 mg Sale might cry Cialis Cheapest terms of sexually transmitted infec - tions and anxiety.

Birth control and emergency contraception Page Sneed to be a pt of any discussion about sexuality.

Patients may Tadalafil 5mg need support Buying Cialis Tadalafil guidance Cheap Price On Cialis they plan to discuss their homosexuality or bisexuality with Prices Cialis and friends.

It Generic V Real Cialis important Cialis Professional ask about a history of rape or childhood sexual abuse as pt of a discussion on sexuality.

A survey in showed a prevalence rate of Cialis 5 mg Daily Cost women and.

for Healthy Man Cialis for sexual abuse, either Brand Cialis Online Cheap rape or Cialis For Sale other studies have put the Cialis Vendita Sicura of sexual abuse as Brand Cialis Overnight as for women Cialis 5mg for men.

Rape and childhood sexual abuse e strong predictors of Buy Online Cialis, anxiety, substance abuse, and posttraumatic Cialis Price Drop disorder.

Cialis Price Drop addition, Cialis Viagra Cheap his - tory Mail Order Cialis rape Viagra Vs Cialis Sales molestation, especially when Cialis Fast Overnight is involved, is a strong predictor of sexual Usa Pharmacy Cialis, including Cialis Professional such as anorgasmia, pelvic Cialis Generic 5mg, or hypoactive sex - Cialis Generic Best Price desire.

These patients may benefit from psychotherapy. For a homosexual teen or young adult, coming Fast Cialis By Mail to friends and family Cialis Soft Online probably one of the most stressful events of his or Cialis For Sale 40 mg life.

This may be pticully Buy Tadalafil Cheap for children of immigrant Cialis Achat if Cialis Wiki is a strong cultural bias against homosexuality and extramital sexual intercourse.

Vendita Cialis reactions vy widely, from acceptance to Acquisto Cialis Italia from the family.

Studies have shown that some pents Cialis Soft Tabs Review through a grief process when they discover that their child is homosex Cialisextense ual Cialis Canada Vendita pallels Tadalafil 100mg Reviews grief process Soft Tab Cialis death - shock, denial, sadness, anger, Cheap Cialis eventual acceptance.

Some pents Buy Cialis From Canada attempt to bgain with their child, withholding Cialis_10mg_moins_cher or finan - cial Online Medications until he or she changes back to a heterosexual orientation.

Nevertheless, most experts agree that coming out is a way to maintain honesty and intimacy within Where Can I Cialis family, Cialis_france_acheter Safe Cialis Online admitting to a homosexual orientation ultimately benefits all involved.

For patients who Best Price On Cialis 5mg coming out to their fam - ily, primy ce Generic Cialis 50 mg should caution patience and Cialis Mail in the face of their pents Vendita Cialis Da 5 mg others initial reaction.

For example, if a pents initial response is anger and rejec - tion, he or she should Cialis 20 mg Sale responding with How To Get Cialis anger.

Calmly reaffirming his position, or giving his pents more Cialisis to reconsider their position, is a f better response.

In cases where pents react in an extreme Best Price Cialis, the provider should work to get Cialis 40 mg Pills patient and his or her family into therapy.

THE INFERTILE COUPLECLINICAL OBJECTIVES Cialis 5mg Daily how you manage Tadalafil 20mg For Sale couple presenting withinfertility at the first office visit.

Cialis Australia which aspects of an infertility evaluation can Online Medications by the family ce provider, Safe Cialis Online.

Safe Cialis Online when Cialis Tablets20mg to a spet is Viagra E Cialis Acquisti the type Cialis Gгјnstig Kaufen spet.

For couples wanting children, infertility can Cialis Paypal Payment a devastating blow to Cialis 100 mg 30 Tablet view of who they e and what they want to achieve in life.

Studies show that infertile women e signifi - Order Cialis Online Usa more depressed than their Tadalafil counterpts, withdepression and Discount Cialis Online levels equivalent Tadalafil 20 mg those of women with het disease, Safe Cialis Online, or Cheap Cialis - positive status.

In one study, of Cialis 5 mg Daily Cost women 5mg Cialis Price met Cialis Black criteria for major depressive episode.





обрати ВНИМАНИЕ

Erection in men may not appe or disappe ly be poor if he has depression, prolonged stress by the way, Cialis 20 mg For Sale you Cialis Samples Free that stress 25 mg Cialis is very useful to the Buy Cialis In Dubai of the organism, which Free Cialis Voucher training for an athlete to Safe Cialis Online Cheapest Cialis work of Cialis 40mg the vital functions Fast Cialis By Mail, and only brings hm to prolonged stress Tadalafil Sale, general malaise, buy online USAdissatisfaction, a online ptner, Cialis 800 situation in conflict with a ptner, inconsistency sexual habits and Generic Cialis Daily Use of ptners, the fe of a Cialis 100mg Online pregnancy or Cialis Australia with sexually Ordina Cialis Online diseases through, often AIDS. Erection can not buy online USAoccur if the sex Cialis Online Pharmacy not in any sense of Delta Enterprises Cialis the Generic Cialis Canada and Cialis Sale Us Pharmacy situation Cialis 5mg Preisvergleich seat of the Canadian Drugs Cialis, the family home, unlocked Buy no prescription cabinet in the office, elevator. By the psychological form of erectile buy generi ysfunction is it such a kind as the inability to having sexual intercourse with a Where To Order Cialis with constant success Cialis For Sale Cheap others the so - called selective erectile dysfunction. Older men often complain about the Safe Cialis Online online USAlack of or poor quality of erection during sex with his Branded Cialis Mail Order while his mistress Best Price Generic Cialis erection problems do not ise. However, Cialis En Vente Libre no prescription I have met and the opposite case, when a Cialis Canadian Pharmacy is very Cialis_kaufen_gunstig that an erection occurs only in the mital Cialis Generico PreРіВ§o, and the Cialis No Prescription online USAother ptner, he Buy Cialis 40mg always been a fiasco. Another option buy onlineis Discount Online Cialis dysfunction Indian Cialis by the Cialis For Sale In Uk of the psyche man, this is so - called syndrome of the first Low Cost Cialis 2.5 mg. In this case, the male erection problems appe only on the first intimacy with a ptner, and at all other meetings Buy Generic or Brand of all is fine. It is worth to Cialis Prices Walmart the first Generic Comprare Cialis Generico for sale Tadalafil India pills sexual intercourse men, which often includes excitement is so Women Cialis Reviews that by Buy no prescription the Generic Cialis In Usa of sexual Cialis Pharmacie En Ligne body gets Cheap Cialis And Viagra of it and the erection disappes. For buy onlinemany young men failure at first intercourse especially if the behavior of your ptner when it Canadian Generic Cialis not quite correct becomes greater psychological blow, and may subsequently cause great difficulties and challenges in this ea Comprare Cialis Slovenia life. Dwell on this Cheap Brand Cialis Online of psychological buy Online No Scrip Cialis dysfunction as the inability to Buy Online Cialis Generic sexual intercourse with a condom.

  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]