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Brand Name: Adcirca, Cialis Generic Name: tadalafil Drug Class: PAH, PDE-5 Inhibitors; Phosphodiesterase-5 Enzyme Inhibitors WHAT IS TADALAFIL AND HOW DOES IT WORK? Tadalafil is a phosphodiesterase inhibitor used for treating impotence (erectile dysfunction, or ED), benign prostatic hyperplasia (BPH), and pulmonary arterial hypertension (PAH). Tadalafil is available under the following different brand names: Adcirca, and Cialis. DOSAGES OF TADALAFIL Dosage Forms and Strengths Tablet (Adcirca) 20 mg Tablet (Cialis) 2.5 mg 5 mg 10 mg 20 mg Dosage Considerations – Should be Given as Follows: Erectile Dysfunction (ED) Cialis As needed use: 10 mg orally initially before sexual activity, with or without food; may be increased to 20 mg or reduced to 5 mg on basis of efficacy and tolerability; in most patients, maximum dosing frequency is once daily Once-daily use: 2.5 mg/day orally in single daily dose, without regard to timing of sexual activity, with or without food; may be increased to 5 mg/day on basis of efficacy and tolerability Dosing considerations As needed use: Decrease dose with concomitant use of potent CYP3A4 inhibitor (e.g., ritonavir, ketoconazole, itraconazole); not to exceed 10 mg/72 hours Once-daily use: Decrease dose with concomitant use of potent CYP3A4 inhibitor (e.g., ritonavir, ketoconazole, itraconazole); not to exceed 2.5 mg/day Benign Prostatic Hyperplasia Treatment of signs and symptoms of benign prostatic hyperplasia (BPH); daily use also indicated for treatment of patients with both BPH and erectile dysfunction Cialis BPH: 5 mg orally once daily BPH with erectile dysfunction: 5 mg orally once daily, taken at approximately same time each day without regard to timing of sexual activity With finasteride for BPH: tadalafil 5 mg plus finasteride 5 mg orally once daily for up to 26 weeks Pulmonary Arterial Hypertension (PAH) Adcirca 40 mg orally once daily; dividing dose for more frequent dosing is not recommended Patients also taking ritonavir: 20 mg orally once daily initially for 1 week or more; may be increased to 40 mg/day on basis of tolerability Dosing considerations If possible, avoid coadministration with CYP3A4 inhibitors; if coadministration is essential, long-term therapy is indicated, or strong CYP3A4 inhibitors are required, modify or hold dose Patients already taking strong CYP3A4 inhibitor who require tadalafil: 20 mg orally once daily; may be increased to 40 mg/day on basis of tolerability Patients already taking tadalafil who require strong CYP3A4 inhibitor: Avoid using tadalafil while starting strong CYP3A4 inhibitor; stop tadalafil 24 hours or more before starting strong CYP3A4 inhibitor; after 1 week, resume tadalafil at 20 mg orally once daily; may be increased to 40 mg/day on basis of tolerability Geriatric Dosing Erectile Dysfunction (ED) Cialis: No dosage adjustment is warranted solely on basis of age; however, greater sensitivity to medications in some older individuals should be considered Pulmonary Arterial Hypertension (PAH) Adcirca: Lower dose or reduced dosing frequency may be required in elderly because of decreased renal or hepatic clearance Dosing Modifications Pediatric: Safety and efficacy not established Renal impairment (ED) Cialis (as needed use) Mild (CrCl 51 mL/min or more): No dosage adjustment needed Moderate (CrCl 30-50 mL/min): Not to exceed 5 mg orally once daily initially; maximum dosage, 10 mg orally every 48 hours Severe (CrCl less than 30 mL/min and on hemodialysis): Not to exceed 5 mg orally every 72 hours Cialis (once daily use) CrCl 30 mL/min or more: No dosage adjustment needed CrCl less than 30 mL/min: Not recommended Renal impairment (PAH) Adcirca Mild-to-moderate (CrCl 31-80 mL/min): 20 mg orally once daily initially; may be increased to 40 mg once daily on basis of tolerability Severe (CrCl less than 30 mL/min and on hemodialysis): Avoid use Hepatic impairment (ED) Cialis (as needed use) Mild-to-moderate (Child-Pugh class A or B): Not to exceed 10 mg orally once daily Severe (Child-Pugh class C): Not recommended Cialis (once daily use) Mild-to-moderate (Child-Pugh class A or B): Data limited; caution advised Severe (Child-Pugh class C): Not recommended Hepatic impairment (PAH) Adcirca Mild-to-moderate (Child-Pugh class A or B): Consider starting dosage of 20 mg orally once daily Severe (Child-Pugh class C): Avoid use

Other studies find that some women report a higher sex drive on the Pill or no change at all. In order to experience the best results of sildenafil, it is recommended that you limit the amount of alcohol you drink. Many hormonal conditions can be treated using injections of synthetic man made hormones to restore normal hormone levels. The physician can identify reversible risk factors that contribute to the patient s erectile dysfunction, such as medications, poor diet, low exercise, endocrinopathies and anxiety.