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special instructions With extreme caution and only in case of emergency it is possible to use tadalafil in patients with severe renal failure (CC ≤ 30 ml / min) and severe liver failure. During treatment with tadalafil, patients with moderate renal insufficiency (CC from 31 to 50 ml / min) were more likely to have back pain compared with patients with mild renal insufficiency (CC from 51 to 80 ml / min) or healthy volunteers . In patients with CC ≤ 50 ml / min, tadalafil should be used with caution. Therefore, the treatment of erectile dysfunction, including with tadalafil should not be used in men with heart diseases in which sexual activity is not recommended. The potential risk of complications due to sexual activity in patients with diseases of the cardiovascular system should be considered: myocardial infarction in the last 90 days; unstable angina or angina that occurs during intercourse; chronic heart failure (NYHA functional class II and above), which has developed over the past 6 months; uncontrolled heart rhythm disturbances; arterial hypotension (blood pressure less than 90/50 mm Hg) or uncontrolled arterial hypertension; stroke suffered in the last 6 months. With caution, tadalafil should be used in patients with a predisposition to priapism (for example, with sickle cell anemia, multiple myeloma or leukemia) or in patients with anatomical deformation of the penis (for example, during angulation, cavernous fibrosis or Peyronie's disease). The patient should be informed of the need to immediately consult a doctor in case of an erection lasting 4 hours or more. Untimely treatment of priapism leads to damage to the tissues of the penis, as a result of this, a long-term loss of potency may occur. With the use of tadalafil, no cases of priapism have been reported. It is not recommended to use tadalafil in combination with other types of treatment for erectile dysfunction.

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Both Viagra® (sildenafil citrate) and Cialis® (tadalafil) are used to treat erectile dysfunction (also known as ED). Erectile dysfunction is a condition in which a man is unable to consistently maintain an erection that is firm enough for sexual intercourse. There are many similarities between these two drugs, but also some important points to keep in mind when comparing Cialis vs. Viagra.
 
Cialis comes in tablet form and can be taken just when you need it (before anticipated sexual activity) or on a daily basis. A single dose of Cialis starts working in about 30 minutes and lasts for up to 36 hours. Viagra also comes in tablet form, but is only taken prior to sexual activity. A single dose of Viagra starts working in about 30 minutes and lasts for about 4 hours (perhaps longer in some men).
 
A very important difference between Cialis and Levitra is that Cialis is approved to treat enlarged prostate symptoms as well as ED. Levitra is not approved for this use.
 
Both medications have a similar effect on the body and work by inhibiting the chemical reaction that causes blood to flow out of the penis.
 
Viagra and Cialis also have similar safety concerns men should be aware of before beginning treatment. For example, both drugs may not be appropriate for men with certain medical conditions, such as heart disease, angina, or liver disease. And both medications can cause potentially serious side effects, such as priapism; sudden blindness; and an increased risk of a heart attack, stroke, or sudden death.
 
So which medicine is right for you? This will depend on a variety of factors and is a matter that should be discussed with your healthcare provider, who understands your situation best. Depending on your current health status, as well as what you expect from an erectile dysfunction medication, the two of you can come to a decision that is right for you.
 
(Click Cialis and Viagra to learn more about the similarities and differences between these two medications. These articles discuss such topics as possible side effects, dosing guidelines, when and how to take these drugs, and more.)
 
eMedTV's free HealthSavvy service can help you stay up-to-date on this topic. Sign up for HealthSavvy now.
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