Cialis, 2 pcs., 20 mg, film-coated tablets

Composition and principle of action of the drug

Cialis is a drug that belongs to the PDE-5 inhibitors. It comes in the form of tablets for oral use. The main active ingredient in the composition of the pharmacological agent is tadalafil.

The active component tadalafil is one of the powerful phosphodiesterase-5 (PDE-5) inhibitors. Increased activity of this enzyme reduces the production of nitric oxide by the vascular endothelium, which leads to deterioration of the blood vessels of the penis, lungs and prostate gland.

Cialis is a long-acting drug - the stimulation effect lasts up to 24-36 hours.

Tadalafil inhibits the production of PDE-5, promoting the relaxation of blood vessels and the expansion of their lumen, accelerating blood flow to the penis and prostate. The medicine stimulates the relaxation of the smooth muscles of the pelvic organs, ensuring the natural occurrence of an erection, making sexual intercourse possible. The outflow of blood from the pelvic organs occurs only after ejaculation.

What is erectile dysfunction, what causes it and how common is it?

Erectile dysfunction (ED) can be defined as the inability of a man to achieve or maintain an erection sufficient to insert the penis into the vagina and perform satisfactory sexual intercourse.
The incidence of ED varies depending on age. If in the age group from 20 to 40 years it averages 3%, then in the age group from 40 to 60 years it occurs in 15 - 20% of men. Over the age of 70, erectile dysfunction can affect up to 30% of men. At any age, ED is not the norm, because... the ability to have a regular and satisfactory sex life is one of the essential functions of a man of any age. Erection disorders can be caused by two groups of reasons: psychological (psychogenic) and somatic (organic). Research over the past 20 years has shown that ED is quite rarely caused by purely psychological reasons (stress, depression, behavioral characteristics, etc.). At the same time, it became known that about 80% of all cases of erectile dysfunction are caused by some physical (somatic, organic) conditions. These include: diabetes mellitus, high blood pressure, high blood cholesterol and vascular atherosclerosis, renal and liver failure, thyroid diseases, hormonal disorders, consequences of operations on the prostate gland and rectum, trauma and diseases of the spinal cord and brain (stroke , Alzheimer's disease, etc.), consequences of pelvic injuries, Peyronie's disease. Erection disorders can also be caused by taking certain medications. Persistent erectile dysfunction can develop due to bad habits such as drinking alcohol, smoking and taking drugs.

Indications for use

Cialis is a drug intended for both situational (one-time) and course use. Main indications for use of the drug:

• complete or partial loss of erection;
• premature ejaculation;
• deterioration in strength and decreased duration of erection;
• decreased libido;
• short duration of sexual contact;
• prostatitis;
• pathological fear or nervous tension before sex.

Maximum results in case of deterioration of potency are shown by a course of use of the drug - it has a systematic, cumulative effect on the penis and other pelvic organs and contributes to the long-term preservation of the effect obtained.

The use of the medication does not affect the quality, quantity and composition of sperm, and does not impair a man’s ability to bear children.

The drug has a selective effect. Tadalafil directly affects the smooth muscles of the pelvis, blood capillaries and veins of the cavernous and cavernous bodies of the penis, without affecting the cardiovascular system as a whole.

When there is no drug effect

If the patient takes the drug, but does not receive the expected stimulating effect, there is a possibility:

• purchasing counterfeit medicine
• expiration date or improper storage of the medication (pills with tadalafil are placed in dark places where room temperature and low humidity levels are maintained)
• use of tablets in the presence of absolute contraindications (individual intolerance, cavernous fibrosis, Peyronie's disease, penile curvature)

Single use of Cialis

A single use of Cialis is recommended in cases where a man’s sexual performance has decreased due to severe mental or physical fatigue, nervous stress, after conflicts in the family or at work, during psycho-emotional experiences and fear of sex. Even one tablet of tadalafil helps to get rid of temporary deterioration in erectile function and stabilize potency.

The initial dosage of tadalafil for a single use is 10 mg, but if the desired therapeutic effect is not achieved, the next time the dose is increased to 20 mg (the maximum permissible dose for a single dose).

If the medication has a dosage of 20 mg, the tablet should be divided into two parts. It is recommended to take the drug at least 60 minutes before sexual intercourse. This time is quite enough for the breakdown and active action of tadalafil.

Cialis is intended for oral use. The tablet is swallowed whole, without chewing, and washed down with a sufficient amount of water - at least 100 ml.

Characteristics

• Composition: Tadalafil 20 mg
• Action time: Up to 36 hours
• Onset of action: After 25-45 minutes
• Active ingredient: Tadalafil (Tadalafil)
• Daily dosage: 20 mg
• Application: Suitable for daily use
• Alcohol compatibility: Compatible

Cialis means a highly effective pharmacological agent necessary for stabilizing male sexual abilities and obtaining complete satisfaction from sexual contacts. The characteristics of the drug's medicinal effect depend on compliance with the instructions for use and the doctor's recommendations.

Course intake of Cialis

For severe sexual disorders, persistent and prolonged erectile dysfunction, Cialis is prescribed as a course of treatment. Also, long-term use of the drug is allowed with frequent sexual intercourse (more than 3 times a week).

The standard dosage for course use is 5 mg, tablets should be taken no more than once a day.

The dose of the medication can be adjusted by the doctor depending on the form, cause and severity of erectile dysfunction. The average duration of treatment is 3-4 weeks. Basic rules for the course use of pharmaceuticals:

• It is advisable to take the tablet at the same time of day;
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• taking pills during a course does not depend on food intake and sexual activity of a man;
• if a man misses a dose of medication, the dosage should not be increased the next time he takes it to compensate;
• if necessary, the doctor can extend the course of treatment with Cialis up to 8 weeks;
• Even with prolonged use, the drug is not addictive.

It is not recommended to take Cialis with citrus juice, as it increases the concentration of tadalafil in the blood plasma. This may lead to the development of side effects of the medicine.

Cialis drug interactions

Cialis does not have a clinically significant effect on the clearance of drugs whose metabolism occurs with the participation of the cytochrome P450 isoenzyme. The results of the study confirmed that tadalafil does not inhibit or induce the isoenzymes CYP 3A4, CYP 1A2, CYP 2D6, CYP 2C19, CYP 2E1 and CYP 2C9. Tadalafil is mainly metabolized by the CYP3A4 enzyme. The selective CYP3A4 inhibitor ketoconazole, when taken at a dose of 400 mg/day, increases the AUC of tadalafil after a single dose by 312%, increases the maximum concentration in blood plasma by 22%, and at a dose of 200 mg/day - by 107 and 15%, respectively. Ritonavir (inhibitor of CYP 3A4, 2C9, 2C19 and 2D6) at a dose of 200 mg 2 times a day increases the AUC of tadalafil after a single dose by 124%, without changing the maximum concentration in the blood. Although specific interactions have not been studied, it can be assumed that protease inhibitors such as saquinavir, as well as CYP3A4 inhibitors such as erythromycin and intraconazole, increase the plasma levels of tadalafil. The selective inducer of CYP 3A4 rifampicin at a dose of 600 mg/day reduces the AUC of tadalafil after a single dose by 88%, and increases its maximum plasma concentration by 46%. It can be expected that the simultaneous use of other CYP3A4 inducers will also reduce the concentration of tadalafil in the blood plasma. Antihypertensive drugs . Tadalafil has a systemic vasodilating effect, which may potentiate the hypotensive effect of antihypertensive drugs. In addition, patients with poorly controlled hypertension taking multiple antihypertensive drugs simultaneously may experience greater reductions in blood pressure. In the vast majority of patients, a decrease in blood pressure is not accompanied by symptoms of hypotension. Patients treated with antihypertensive drugs and taking tadalafil should be given appropriate clinical advice. α-adrenergic receptor blockers . There was no significant reduction in blood pressure in patients taking tadalafil and the selective α1-adrenergic receptor blocker tamsulosin simultaneously. When tadalafil was prescribed to healthy volunteers taking the α1-adrenergic receptor blocker doxazosin at a dose of 4–8 mg/day, an increase in the hypotensive effect was noted. Some patients experienced dizziness. Alcohol . Tadalafil had no effect on ethanol concentrations, and ethanol had no effect on tadalafil concentrations. When taking ethanol in high doses (0.7 g/kg), simultaneous administration of tadalafil did not lead to a statistically significant decrease in blood pressure. Some patients experienced postural dizziness and orthostatic hypotension. Taking tadalafil with lower doses of ethanol (0.6 g/kg) did not cause the development of arterial hypotension, and dizziness was detected with the same frequency as when taking alcohol alone. H2 antagonists . An increase in gastric pH as a result of taking the H2 receptor blocker nizatidine did not affect the pharmacokinetics of tadalafil. Antacids (magnesium hydroxide/aluminum hydroxide) . Concomitant use of antacids (magnesium hydroxide/aluminum hydroxide) with tadalafil reduces the rate of its absorption without changing the AUC exposure of tadalafil. Acetylsalicylic acid . Tadalafil does not increase the duration of bleeding while taking acetylsalicylic acid. Warfarin . Tadalafil has no clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin and does not affect the prothrombin time induced by warfarin. Theophylline . Tadalafil does not have a clinically significant effect on the pharmacokinetics or pharmacodynamics of theophylline.

Contraindications and side effects

Cialis has a wide list of contraindications that must be taken into account before taking the pills. These include:

• old age over 85 years;
• adolescence up to 18 years of age;
• renal and liver failure;
• 90 days after acute myocardial infarction;
• 6 months after stroke;

• Diseases of the cardiovascular system - unstable angina, second degree heart failure, uncontrolled arrhythmia;
• arterial hypotension;
• anterior optical ischemic neuropathy of the optic nerve;
• predisposition to priapism;
• multiple myeloma;
• cavernous fibrosis;
• leukemia;
• anatomical deformation of the penis;
• hypersensitivity to tadalafil.

Cialis cannot be taken simultaneously with certain medications, which include Ketoconazole, Itraconazole, Ritonavir, Saquinavir, Erythromycin. These medications increase the plasma concentration of tadalafil, which may lead to the development of unwanted side effects.

Tablets can be combined with alcoholic drinks.

But it must be taken into account that alcohol reduces and slows down the effect of the drug, so the resulting therapeutic effect is significantly reduced.

Side effects of Cialis

The most common symptom is headache (≥10% of cases). Other common side effects (with an incidence of ≥1% but ≤10%) are back pain, dyspepsia, dizziness, flushing, myalgia, nasal congestion. In isolated cases (with a frequency of ≥0.1%, but ≤1%), swelling of the eyelids, painful sensations in the eyes, and conjunctival hyperemia were noted. In post-marketing studies, the following side effects were very rarely identified: General reactions: hypersensitivity reactions - skin rash, urticaria and facial swelling, Stevens-Johnson syndrome, exfoliative dermatitis; from the cardiovascular system: cases of such severe reactions from the cardiovascular system as myocardial infarction, sudden cardiac death, stroke, angina pectoris, tachycardia have been described, however, most patients had a history of risk factors from the cardiovascular system . However, it is impossible to establish a reliable connection between the development of the above reactions and cardiac risk factors, taking tadalafil, sexual activity, or a combination of all of these factors. The development of arterial hypotension (usually in the case of simultaneous use of tadalafil with antihypertensive drugs), hypertension (arterial hypertension), fainting has also been reported; from the gastrointestinal tract : abdominal pain, gastroesophageal reflux; from the skin : hyperhidrosis; from the organ of vision: blurred vision, non-arterial anterior optical ischemic neuropathy, retinal vein occlusion, visual field impairment; from the genitourinary system: prolonged erection, priapism. from the central nervous system : migraine from the respiratory system : nosebleeds. Side effects reported that were not encountered during clinical trials and therefore their frequency is unknown: seizures, temporary memory loss, some disorders affecting ocular circulation, arrhythmia, skin rash, and sudden decrease or loss of hearing. Sometimes men experienced a decrease in sperm concentration.

Side effects and overdose

Taking Cialis can cause a number of side effects from the central nervous, cardiovascular systems and other internal organs. The most common side effects include:

• attacks of headache, dizziness;
• swelling of the face;
• dyspepsia;
• runny nose;

• inflammation of the upper respiratory tract;
• frequent flushes of blood to the face;
• painful spasms in muscles, limbs and back;
• temporary visual impairment;
• pain in the eyeballs;
• tachycardia;
• cardiopalmus;
• dyspnea;
• stomach ache;
• stool disorder;
• sharp fluctuations in blood pressure;
• increased sweating;
• allergic skin rashes.

When taking an increased dosage of the drug, overdose symptoms similar to side effects develop. In such cases, symptomatic treatment is carried out.

Symptoms of overdose appear when taking more than 100 mg of tadalafil when taking Cialis daily or more than 500 mg of the drug when taking it once.

How and when are erection pills used and what is the difference between Viagra, Cialis and Levitra?

Erection pills from the group of PDE inhibitors (Viagra, Cialis, Levitra) are the first choice for any form of organic ED. They are prescribed immediately before sexual intercourse in a period of time from 30 minutes to 1 hour before planned sex. In some cases, drugs are prescribed regularly before each sexual intercourse, sometimes they are recommended to be taken only in cases where, in the opinion of the patient, there is the greatest chance of failure. These drugs have differences that are useful to know. Viagra has the greatest clinical experience, because. has been in use since 1998. This drug has already helped more than 16 million people worldwide and is the most well-studied of all erection pills. Viagra should be taken 1 hour before sexual intercourse, it works for up to 4 hours and is more likely to cause side effects after taking it compared to newer PDE inhibitors. Before taking Viagra, it is not recommended to eat rich fatty foods, because... it reduces the effectiveness of the drug. Levitra can be taken 15㪶 minutes before planned sex, its duration of action is slightly longer than that of Viagra, and the frequency of side effects is less. Cialis is taken 30 minutes before intended sexual intercourse; fatty foods do not affect its activity, and it lasts up to 36 hours and sometimes more. For this reason, Cialis is called a weekend pill, because... one tablet allows you to stay “in good shape” the whole weekend. To compare the side effect profile of all 3 drugs, you can refer again to Table 1.

What is the effectiveness of erection pills and is it possible to completely get rid of ED with their help?

The effectiveness of PDE inhibitors for various forms of ED ranges from 60 to 85%, according to various clinical studies. The tablets are designed to be taken before each sexual intercourse, i.e. when you take the pill, the erection improves; without the pill, the erection will be the same as it was recently before the start of treatment. In recent years, there have been reports that regular daily use of relatively small doses of erection pills for at least 12 weeks has a certain healing effect, i.e. improves the quality of your own natural erections. To enhance the effect of PDE inhibitors, they are used in conjunction with male sex hormones, injections of vasodilators into the penis, and operations to limit venous outflow from the penis.

What to do if erection pills don't work?

In such cases, under the supervision of a doctor, it makes sense to try second-line therapy or injections of vasodilators into the penis. If this does not help, you should resort to one of the surgical treatment options. It should be remembered that penile prosthesis has the highest effectiveness among all methods of treating ED.

The Andros clinic presents all modern methods of diagnosing and treating ED without exception. The most accurate diagnosis helps to individualize treatment and make it more effective. Mastery of the technique of implanting all types of penile prostheses allows us to achieve restoration of sexual activity even in the most seemingly hopeless cases. Contact only professionals armed with the entire arsenal of remedies and methods for treating erectile dysfunction available in the world!

The result of using Cialis

The effectiveness and duration of action of Cialis depends on the duration and method of taking it, as well as the dosage. Short-term or one-time use of the drug is recommended for men with mild, minor erectile dysfunction.

A single dose of a pharmacological agent is recommended if the decrease in potency is associated with temporary factors - problems at work, stress, psychological or physical stress.

For serious disorders that develop against the background of inflammatory disease of the prostate gland or psychosomatic diseases, the drug is included in the complex treatment of impotence. A course of therapy with a pharmacological drug eliminates congestion in the pelvis, improves the flow of blood, oxygen and nutrients to the penis and other reproductive organs.

When taken for a long time in dosages prescribed by the doctor, the drug does not have any effect on the state of the cardiovascular system, the quality and quantity of seminal fluid. The medicine helps reduce the symptoms of impotence, restore normal erection and the ability to have sexual intercourse.

What place do erection pills occupy among ED treatment methods?

Currently, there are 5 groups of methods for treating erectile dysfunction:

1. Psychotherapy and sex therapy, which is used only for so-called psychologically caused or psychogenic ED, less often as an auxiliary method for somatic or organic ED.
2. Taking tablets or Viagra tablets for an erection: Cialis, Levitra. It is used as a first choice (first line of therapy) for all forms of organic ED, regardless of its cause.
3. Injection pharmacotherapy or “erection on demand”. It is used as a second-line treatment for all forms of ED in cases where erection pills do not provide the desired effect or their use is contraindicated. Erection pills and injections of vasodilators into the penis can be used together as a combination treatment option for ED.
4. Vacuum erection therapy or the use of vacuum erectors of various models and modifications to obtain or maintain an erection. It is a type of second-line treatment for organic and, less commonly, psychogenic forms of ED. — 90% efficiency; — There is no need to use medications that have side effects; — Non-aggressive method of treatment; - Helps create an erection while maintaining all precautions.
5. Surgical methods of treatment: operations on the vessels of the penis and penile prosthesis. The first group of interventions is divided into operations on the veins (limiting venous outflow) and arteries (increasing arterial inflow) of the penis. Vein surgery can be used effectively in selected cases of ED, especially in combination with erection pills. Surgeries on arteries are ineffective and are used less and less. Penile prosthesis is the most effective and radical of all types of treatment for ED, the only method that provides a complete cure for organic ED. Surgical methods, as a rule, are used only in cases of organic ED when conservative therapy has failed.

So, erection pills are the first-line therapy, which most often begins in the treatment of any form of ED. Viagra, Cialis and Levitra are today the only tablet drugs available in the world that are truly effective in treating ED. The effectiveness of all other advertised tablets, as a rule, is invented (and absolutely not proven) by their manufacturers and is no different from a pacifier. All these domestic “impazs”, “golden skates”, foreign “veromaxes”, “superyochimbe extracts” and many others. other drugs are nothing more than means of making money based on people who trust primitive advertising.

How do erection pills work? How harmful are they? Is it possible to become addicted to erection pills? What are the side effects and contraindications? What are the known drug interactions?

Viagra, Cialis and Levitra have exactly the same mechanism of action and are selective (selective) inhibitors of the activity of the enzyme - phosphodiesterase type 5 (PDEס). This enzyme, in turn, inhibits the production of cyclic guanosine monophosphate (CGMP) in smooth muscle tissue, which is formed from guanosine monophosphate (GMP) under the influence of nitric oxide (NO). The main function of CGMP is to relax the smooth muscles of the cavernous (cavernous) bodies of the penis. When the action of PDE is inhibited, a significantly larger amount of CGMP accumulates in the corpora cavernosa, their smooth muscles relax much better and a significantly larger amount of blood rushes to the penis, which causes an erection.

Drugs in this group act selectively in the vascular tissue of the penis and are practically harmless. They do not cause lasting negative consequences with long-term and regular use. No addiction to erection pills develops. With the exception of purely psychological dependence. Having once tried an erection pill and felt its significantly better quality, feeling the lost voluptuousness, a man sometimes does not want to give up Viagra pills. This is similar to how a driver who has once driven a high-quality foreign car tends to never drive a Zhiguli again.

Analogues of the drug

If Cialis is contraindicated for use or if its use causes an allergic reaction and other side effects, it can be replaced with an analogue drug.

Only a doctor should select a pharmacological drug for the treatment of erectile dysfunction, since such medications differ in composition, mechanism of action, method of administration and contraindications.

Cialis and Levitra - which is better?

In order to answer whether Cialis or Levitra is better, you need to take into account the pharmacological features of both drugs. Levitra contains the active substance vardenafil, which is one of the least selective PDE-5 inhibitors. Thanks to this, Levitra is considered more powerful compared to its analogue.

The effect of Levitra begins within 10-15 minutes after taking the tablet, but lasts no more than 10-12 hours.

The effectiveness of Levitra, like its analogue, is not affected by food intake or alcoholic beverages. The drug Levitra has fewer contraindications.

The drug can be used to treat erectile dysfunction in men with diabetes, as well as after surgical removal of the prostate gland. When choosing between pharmaceuticals, you need to be guided primarily by how quickly and how long-lasting the result you want to get.

Cialis and Viagra - similarities and differences

Cialis and Viagra are medications designed to treat various sexual disorders in men. These medications have both similarities and significant differences.

Features of drugs to stimulate erection:

1. After taking Viagra, an erection occurs very quickly and is stronger. But after using the analogue, side effects occur much less frequently.
2. The erection after Viagra is so powerful that it can cause severe pain in the penis. The analogue has a softer and more gentle effect on the male body.
3. Sildenafil, contained in Viagra, affects the condition of the heart and blood vessels.
4. The effect of Viagra lasts no more than 4-6 hours, while tadalafil lasts up to 24-36 hours.
5. Tadalafil begins to act within 20-30 minutes after administration; Viagra takes at least 1-2 hours to act.

Taking into account the specific pharmacological effects of Viagra, Viagra is most often recommended for men for one-time use - if a man has a panicky fear of intimacy or is afraid of disappointing his partner.

Cialis is more suitable for long-term, course use and regular sexual intercourse. It helps to gently and effectively increase potency, make sex more measured and sensual.

The drug Cialis 5 mg in modern urological practice. Satellite Symposium

Topic of the debate: “Cialis 5 mg in modern urological practice” The debate was opened by Associate Professor of the Department of Urology at Moscow State Medical University, Ph.D. P.I. Rasner. P.I. Rasner spoke about the epidemiology of erectile dysfunction (ED), based on data from various studies. One of them, conducted in 2011 in the United States, was a large-scale 45-minute survey of 123,163 adult respondents, of whom 75,000 completed it. This survey showed that ED was present in 24.6% of men surveyed (average age: 60 years), and ED with lower urinary tract symptoms (LUTS) was identified in 4.9% of respondents (average age: 68 years). Interestingly, 66% of respondents told doctors about their problems, which, according to P.I. Rasner, is still an unattainable figure for Russia, and 23% received drugs for the treatment of ED. As a result of the European study MSAM-7, which involved more than 14,000 men aged 50–80 years in 7 countries (Russia was not included in this study), it was revealed that men of this age also need effective treatment for ED. Thus, the average number of sexual intercourses among men 70–80 years old is 3 times a month. The speaker pointed out that these figures are of great interest: “Sexual intercourse almost once a week for an 80-year-old man is somewhat unexpected data.” At the same time, sexual activity was absolutely clearly associated with the severity of LUTS: the more severe the symptoms were, the lower the activity. Even more intriguing data came from a large Asian study that was divided by country. It turned out that on average, people in Asia are slightly less sexually active than in Europe, but not all countries have the same sexual activity in their respective age categories. In Japan, for example, 44% of men are sexually active and over the age of 80, which cannot be said about other countries. Another interesting fact for urology specialists was mentioned: many studies have shown that men who initially involved their sexual partners in treatment were much more motivated. And they were absolutely satisfied that they shared this problem with their partner. Chief urologist of the Ministry of Health of the Russian Federation, professor, head. Department of Urology, Moscow State Medical University, Doctor of Medical Sciences D.Yu. Pushkar summarized and summarized the data presented in the studies. He said that, despite the lack of Russian research in this area, by and large, all patients - in France, Japan, Italy and Russia - are no different. And, in principle, all this research can be transferred to our country. The professor asked his colleagues to pay attention to how quickly a urologist’s patient is changing in the modern world: “What is called erectile dysfunction today was not considered such 10–20 years ago. Today the evolution of patients is happening very quickly. Yesterday this patient would have undergone transurethral resection, the day before yesterday he would have undergone extensive surgery, today he is being observed and is ready to be observed. Moreover, he chooses observation, and I do not have the right to offer him surgery for indications for which it would have been done yesterday. And today the indications are different, and patients are more literate - they listen to their urination in a completely different way. But therapy is also changing: not so long ago there was no magic pill that we are talking about today. Also, there was no this unique dosage – 5 mg, which is the only one for daily use among phosphodiesterase type 5 inhibitors (PDE-5 inhibitors), but at the same time shows high efficiency compared to the use of PDE-5 inhibitors on demand.” In his speech prof. D.Yu. Pushkar raised another important point that no one has ever studied the quality of urination in men who take enough fluids. It is known that to prevent urolithiasis, osteoarticular disorders, and cardiovascular pathology, it is necessary to drink 11 glasses of water daily. Most men, incl. participants in the studies do not receive as much fluid. What data can be obtained from studies conducted taking this factor into account? After all, many urinary disorders may not be detected until there are conditions for their detection. Next, the issue of risk factors for early termination of sexual life in Russian men was raised. Data from a domestic study were presented, which showed that the age of cessation of sexual activity among men in Russia is on average 45–60 years. 37% of men surveyed stopped having sex before the age of 60, and this was done on the initiative of the men themselves in 70% of cases. The risk factors are obvious: 63% drink alcohol, 50% smoke, the majority have an increased body mass index. D.Yu. Pushkar pointed out that today's symposium is discussing a rare case where doctors can meet the expectations of patients. A small dosage of Cialis 5 mg with the possibility of daily use - as the speaker said - has revolutionized the ideas of urologists about the formula for treating ED.

Professor of the Department of Urology of the First Moscow State Medical University named after I.M. Sechenova Doctor of Medical Sciences A.Z. Vinarov provided data on various representatives of the PDE-5 inhibitor group: in addition to tadalafil, there are other, and more studied, drugs. The most studied drug used in the treatment of ED is sildenafil; It is followed by tadalafil in terms of the number of studies. According to the European Association of Urology (EAU) guidelines, there is currently no evidence to suggest that patients prefer sildenafil, tadalafil or vardenafil. Today, the choice of drug depends on the frequency of sexual intercourse and the patient’s own experience. Therefore, the patient should be aware that there are short- and long-acting drugs and should know their disadvantages and advantages.

Associate Professor, Department of Urology, First Moscow State Medical University named after I.M. Sechenova Doctor of Medical Sciences N.D. Akhvlediani contrasted the data of Prof. A.Z. Vinarov the following facts: “If we compare Cialis 5 mg and Cialis 20 mg,” he began, “then we can definitely say that these are different drugs with different philosophies of use. If we try to use Cialis 20 mg in a sexually active patient, then, based on the instructions, we can prescribe it only every other day. It is known to be effective for 36 hours. Thus, there is an 8-hour window when the patient will not have the effect of the PDE5 inhibitor, and he may get into the unpleasant situation of forgetting about it, hoping for the effect of the drug. This is excluded when using Cialis 5 mg, because the concentration of this drug does not constantly change due to daily use, and the effectiveness does not decrease. We must admit that there is objective research data: by using inhibitors more often, for example, daily, like Cialis 5 mg, we have better results in terms of the frequency of spontaneous night or morning erections. We are talking about a comparison with Cialis 20 mg and sildenafil. The pattern is this: the more often the patient takes the inhibitor, the better the effect. In addition, we must admit, based on data from long-term serious studies, that with daily use, almost 60% of men experienced complete normalization of erectile function, i.e. they show no signs of illness and feel healthy. Interestingly, after 2 years of use this figure remains virtually unchanged. This suggests that there is no tachyphylaxis. The psychological status of patients taking tadalafil 5 mg, Cialis 20 mg and sildenafil is different. Data from a large-scale study are such that patients who take a PDE-5 inhibitor - Cialis 5 mg - daily are less concerned about the duration of action of the drug, the speed of onset of the effect, and the spontaneity of sexual activity. The patient does not think about whether the pill he takes will work. This cannot be said about the action of the on-demand PDE-5 inhibitor sildenafil. Why is tadalafil 5 mg daily more effective than on-demand PDE5 inhibitors? Firstly, in these patients morning erections are restored and they occur more often. And the man feels healthy again. Secondly, this drug is easier to use. After all, many patients take PDE-5 inhibitors incorrectly. Because you may forget how long before sexual intercourse you should take the medicine, because some of these medicines are titrated, i.e. it is necessary to select a dosage. Thirdly, there is no concern about the duration of action of the drug and the speed of onset of the effect. And the most convincing data (this work has not yet been published) is a comparison of the effectiveness of tadalafil 5 mg, tadalafil 20 mg and placebo in the most severe patients with radical prostatectomy, naturally nerve-sparing. Over a long follow-up period of 13.5 months, the most effective results were shown by long-acting PDE-5 inhibitors compared to placebo, but the best result was with Cialis 5 mg: the only reliable indicator of the relative probability of restoration of erection.”

Professor A.Z. Vinarov: “You know that PDE-5 inhibitors are now included in the EAU recommendations as drugs that can be used in patients with urinary disorders. Moreover, it has long been known that sildenafil improves symptoms of impaired urination. In 2013, recommendations appeared in the journal "European Urology", which indicated that PDE-5 inhibitors reduce the severity of moderate and severe storage and excretory symptoms of impaired urination in men with or without ED disorders. But only tadalafil 5 mg is registered for the treatment of men with urinary symptoms in Europe.”

Associate Professor N.D. Akhvlediani: “We understand that the treatment of urinary disorders requires continuous exposure, long-term inhibition of phosphodiesterase-5. In Europe and other countries, PDE-5 inhibitors are registered for both the treatment of ED and urinary symptoms. Tadalafil is a leader in this sense. 111 publications mentioning tadalafil used in the treatment of symptoms of impaired urination. Second place, oddly enough, was taken by the short-acting drug sildenafil. But this is the first drug from the PDE-5 inhibitor group, and these studies began with it. But should it be used in the treatment of patients?

Professor A. Z. Vinarov summed up: “PDE-5 inhibitors and, in particular, tadalafil, can be equally effective in patients with ED and urinary disorders, and in patients with urinary disorders, but without erectile dysfunction.”

Associate Professor, Department of Urology, Moscow State Medical University, Ph.D. A.V. Govorov raised another important topic - the daily use of PDE-5 inhibitors for the treatment of benign prostatic hyperplasia (BPH). “What do we know about standard treatment for BPH? We know that α-blockers are the standard of care for BPH because they act quickly, they are effective, and they have low incidence and severity of side effects. We know that they reduce patients' I-PSS on treatment by about 30 to 40% and increase peak urinary flow rate by about 25%. They can be prescribed to a patient with BPH at any age. Lately we have been saying that the selectivity of these drugs is important to us. On the one hand, we understand that the higher the selectivity, the better it would seem. At the same time, more selective drugs are characterized by the presence of such a criterion as retrograde ejaculation. When we talk about this with patients, we explain to them upfront that modern selective drugs can cause this condition. Patients seem to agree to such conditions. But quite often, using this therapy, they return to us with complaints about exactly what they were warned about. Now let's talk about the group of drugs that we know well: PDE-5 inhibitors. They are the only group of medications that prevent BPH symptoms while also effectively reducing I-PSS, effectively reducing prostate volume by approximately 18-25% when used for 2-4 years. We remember that the larger the patient's prostate volume, the more pronounced the effect of PDE-5 inhibitor treatment. These drugs are needed and important in modern combinations. Now there are drugs that combine α-blockers with PDE-5 inhibitors. We are talking about the fact that today other patients come to see us and, thanks to the Internet, have an idea of ​​what kind of treatment they want to receive. There are more and more such patients. These are the patients with whom we can discuss new treatment options for BPH.”

Professor of the Department of Urology and Surgical Andrology of the Russian Medical Academy of Postgraduate Education, Doctor of Medical Sciences. E.I. Veliyev spoke about a study that compared the effectiveness of tadalafil 5 mg with placebo: “Half of the patients had successful sexual intercourse from the 2nd day of therapy. Then the number of such attempts increased. Tadalafil 5 mg was studied with long-term use - over 12 months. The conclusions are: the dose is small, it acts quickly and it works well.” Further E.I. Veliyev briefly discussed the effect of tadalafil on LUTS: “When we talk about the effects of Cialis 5 mg with constant use, we mean the effects associated with both LUTS and the severity of ED. Data from a study in which patients were divided into 3 groups - with mild ED, with moderate and severe ED - show that tadalafil 5 mg with chronic use showed an improvement in I-PSS scale scores. Today we know several methods for treating BPH and LUTS. We are accustomed to dividing our patients into several groups: these are patients who can use monotherapy and those who are indicated for combination therapy. We say, as a rule, that those patients for whom combination therapy is recommended have progressive BPH. Regardless of the progression of BPH, Cialis 5 mg is effective. Where ED is associated with LUTS, tadalafil 5 mg demonstrates effectiveness everywhere, regardless of the severity of its manifestation. Tadalafil 5 mg improves LUTS, with any degree of ED in the patient.” Prof. E.I. Veliyev, summing up the debate, said that two problems can really have one solution in the group of patients discussed today: ED and urinary disorders with BPH. And this number of patients can be more than 70%.