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A causal relationship of these events to Cialis is uncertain. Postmarketing experience has included seizure and seizure recurrence and transient global amnesia.
Ocular
Ocular side effects have included blurred vision, changes in color vision, conjunctivitis (including cialis drug impotence hyperemia), eye pain, increased lacrimation, and swelling of the eyelids.
Non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision including permanent loss of vision, has been reported rarely postmarketing in temporal association with the use of phosphodiesterase type 5 (PDE5) inhibitors, including tadalafil.
Other
Other side cialis drug impotence have included cases of sudden decrease or cialis drug impotence of hearing reported postmarketing in temporal association with the use of PDE5 inhibitors, including tadalafil. In studies of Cialis for once daily use, events of back pain and myalgia were generally mild or moderate with a discontinuation rate of 0.3%.
Across all studies with any Cialis dose, reports of changes in color vision were rare (<0.1% of patients).
The following section identifies additional, less frequent events (<2%) reported in controlled clinical trials of Cialis for once daily use or use as needed. Diagnostic testing, including measures for inflammation, muscle injury, or renal damage revealed no evidence of medically significant underlying pathology. Excluded from this list are those events that were minor, those with no plausible relation to drug use, and reports too imprecise to be meaningful:
Body as a whole — asthenia, face edema, fatigue, pain
Cardiovascular — angina pectoris, chest pain, hypotension, myocardial infarction, postural hypotension, palpitations, syncope, tachycardia
Digestive — abnormal liver function tests, dry mouth, dysphagia, esophagitis, gastritis, GGTP increased, loose stools, nausea, upper abdominal pain, vomiting
Musculoskeletal — arthralgia, neck pain
Nervous — dizziness, hypesthesia, insomnia, paresthesia, somnolence, vertigo
Respiratory — dyspnea, epistaxis, pharyngitis
Skin and Appendages — pruritus, rash, sweating
Ophthalmologic — blurred vision, changes in color vision, conjunctivitis (including conjunctival hyperemia), eye pain, lacrimation increase, swelling of eyelids
Otologic — sudden decrease or loss of hearing, tinnitus
Urogenital — erection increased, spontaneous penile erection
Postmarketing Experience
The following adverse reactions have been identified during post approval use of Cialis. The list does not include adverse events that are reported from clinical trials and that cialis drug impotence listed elsewhere in this section.
Cardiovascular and cerebrovascular — Serious cardiovascular events, including myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported postmarketing in temporal association with the use of tadalafil. The back pain/myalgia associated with tadalafil treatment was characterized by diffuse bilateral lower lumbar, gluteal, thigh, or thoracolumbar muscular discomfort and was exacerbated by recumbancy. reported for Cialis for use as needed:
Table 1: Treatment-Emergent Adverse Events Reported by ≥2% of Patients Treated with Cialis (10 or 20 mg) and More Frequent on Drug than Placebo in the Eight Primary Placebo-Controlled Phase 3 Studies (Including a Study in Patients with Diabetes) for Cialis for Use as Needed
a The term flushing includes: facial flushing and flushing
Adverse Event
Placebo
(N=476)
Tadalafil 5 mg
(N=151)
Tadalafil 10 mg
(N=394)
Tadalafil 20 mg
(N=635)
Headache
5%
11%
11%
15%
Dyspepsia
1%
4%
8%
10%
Back pain
3%
3%
5%
6%
Myalgia
1%
1%
4%
3%
Nasal congestion
1%
2%
3%
3%
Flushinga
1%
2%
3%
3%
Pain cialis drug impotence limb
1%
1%
3%
3%
Cialis for Once Daily Use
In three placebo-controlled Phase 3 clinical trials of 12 or 24 weeks duration, mean age was 58 years (range 21 to 82) and the discontinuation rate due to adverse events in patients treated with tadalafil was 4.1%, compared to 2.8% in placebo-treated patients.
The following adverse events were reported in clinical trials of 12 weeks duration:
Table 2: Treatment-Emergent Adverse Events Reported by ≥2% of Patients Treated cialis drug impotence Cialis for Once Daily Use (2.5 or 5 mg) and More Frequent on Drug than Placebo in the Three Primary Placebo-Controlled Phase 3 Studies at 12 weeks (Including a Study in Patients with Diabetes) for Cialis cialis drug impotence Once Daily Use
Adverse Event
Placebo
(N=248)
Tadalafil 2.5 mg
(N=196)
Tadalafil 5 mg
(N=304)
Headache
5%
3%
6%
Dyspepsia
2%
3%
5%
Nasopharyngitis
4%
4%
3%
Back pain
1%
3%
3%
Upper respiratory tract infection
1%
3%
3%
Flushing
1%
1%
3%
Influenza
2%
3%
2%
Myalgia
1%
2%
2%
Cough
0%
4%
2%
Diarrhea
0%
1%
2%
Nasal congestion
0%
2%
2%
Pain in extremity
0%
1%
2%
Bronchitis
1%
2%
0%
Urinary tract infection
0%
2%
0%
Gastroesophageal reflux
0%
2%
1%
Abdominal pain
0%
2%
1%
The following adverse events were reported over 24 weeks treatment duration in one placebo-controlled Phase 3 clinical study:
Table 3: Treatment-Emergent Adverse Events Reported by ≥2% of Patients Treated with Cialis for Once Daily Use (2.5 or 5 mg) and More Frequent on Drug than Placebo in One Placebo-Controlled Phase 3 Study of 24 Weeks Treatment Duration for Cialis for Once Daily Use
Adverse Event
Placebo
(N=94)
Tadalafil 2.5 mg
(N=96)
Tadalafil 5 mg
(N=97)
Nasopharyngitis
5%
6%
6%
Gastroenteritis viral
2%
3%
5%
Influenza
3%
5%
3%
Back Pain
3%
5%
2%
Upper Respiratory Tract Infection
0%
3%
4%
Dyspepsia
1%
4%
1%
Gastroesophageal Reflux Disease
0%
3%
2%
Myalgia
2%
4%
1%
Hypertension
0%
1%
3%
Nasal Congestion
0%
0%
4%
Back pain or myalgia was reported at incidence rates described in Tables 1 and 2. In tadalafil clinical pharmacology trials, back pain or myalgia generally occurred 12 to 24 hours after dosing and typically resolved within 48 hours. Many of these events were reported to occur during or cialis drug impotence after sexual activity, and a few were reported to occur shortly after the use cialis drug impotence Cialis without sexual activity. Most, but not all, of these patients had preexisting cardiovascular risk factors. The list does not include adverse events that are reported from clinical trials and that are listed elsewhere in this section.
Cardiovascular and cerebrovascular — Serious cardiovascular events, including myocardial infarction, sudden cardiac death, stroke, chest pain, palpitations, and tachycardia, have been reported postmarketing in temporal association cialis drug impotence the use of tadalafil. It is not possible to determine whether these reported events are related directly to the use of Cialis, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors .
Urogenital — priapism .
Top
Side Effects by Body System
Cardiovascular
Cardiovascular side effects have included angina pectoris, chest pain, hypotension, hypertension, myocardial infarction, postural hypotension, palpitations, syncope, and tachycardia.
Dermatologic
Dermatologic side effects have included pruritus, rash, and sweating.
Gastrointestinal
Gastrointestinal side effects have included dyspepsia, diarrhea, dry mouth, dysphagia, esophagitis, gastroesophageal reflux, gastritis, loose stools, nausea, upper abdominal pain, and vomiting.
General
General side effects have included asthenia, face edema, facial flushing, fatigue, and pain in a limb.
Genitourinary
Genitourinary side effects have included increased erection and spontaneous penile erection.
Hepatic
Hepatic side effects have included abnormal liver function tests such as an increased GGTP.
Musculoskeletal
Musculoskeletal side effects have included back pain or myalgia, arthralgia, and neck pain.
Respiratory
Respiratory side effects have included nasal congestion, dyspnea, epistaxis, pharyngitis, nasopharyngitis, upper respiratory tract infection, and bronchitis.
Nervous system
Nervous system side effects have included headache, dizziness, hypesthesia, insomnia, paresthesia, somnolence, migraine and vertigo. In studies of Cialis for once daily use, events of back pain and myalgia were generally mild or moderate with a discontinuation rate of 0.3%.
Across all studies with any Cialis dose, reports of changes in color vision were rare (<0.1% of patients).
The following section identifies additional, less frequent events (<2%) reported in controlled clinical trials of Cialis for once daily use or use as needed. In some of the cases, medical conditions and other factors were reported that may have also played a role in the cialis drug impotence adverse events. A causal relationship of these events to Cialis is uncertain. In studies of Cialis for once daily use, events of back pain and myalgia were generally mild or moderate with a discontinuation rate of 0.3%.
Across all studies with any Cialis dose, reports of changes in cialis drug impotence vision were rare (<0.1% of patients).
The following section identifies additional, less frequent events (<2%) reported in controlled clinical trials of Cialis for once daily use or use as needed.
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reported for cialis drug impotence for use as needed:
Table 1: Treatment-Emergent Adverse Events Reported by ≥2% of Patients Treated with Cialis (10 or 20 mg) and More Frequent on Drug than Placebo in the Eight Primary Placebo-Controlled Phase 3 Studies (Including a Study in Patients with Diabetes) for Cialis for Use as Needed
a The term flushing includes: facial flushing and flushing
Adverse Event
Placebo
(N=476)
Tadalafil 5 mg
(N=151)
Tadalafil 10 mg
(N=394)
Tadalafil 20 mg
(N=635)
Headache
5%
11%
11%
15%
Dyspepsia
1%
4%
8%
10%
Back pain
3%
3%
5%
6%
Myalgia
1%
1%
4%
3%
Nasal congestion
1%
2%
3%
3%
Flushinga
1%
2%
3%
3%
Pain in limb
1%
1%
3%
3%
Cialis for Once Daily Use
In three placebo-controlled Phase 3 clinical trials of 12 or 24 weeks duration, mean age cialis drug impotence 58 years (range 21 to 82) and the discontinuation rate due to adverse events in patients treated with tadalafil was cialis drug impotence compared to 2.8% in placebo-treated patients.
The following adverse events were reported in clinical trials of 12 weeks duration:
Table 2: Treatment-Emergent Adverse Events Reported by ≥2% of Patients Treated with Cialis for Once Daily Use (2.5 or 5 mg) and More cialis drug impotence on Drug than cialis drug impotence in the Three Primary Placebo-Controlled Phase 3 Studies at 12 weeks (Including a Study in Patients with Diabetes) for Cialis for Once Daily Use
Adverse Event
Placebo
(N=248)
Tadalafil 2.5 mg
(N=196)
Tadalafil 5 mg
(N=304)
Headache
5%
3%
6%
Dyspepsia
2%
3%
5%
Nasopharyngitis
4%
4%
3%
Back pain
1%
3%
3%
Upper respiratory tract infection
1%
3%
3%
Flushing
1%
1%
3%
Influenza
2%
3%
2%
Myalgia
1%
2%
2%
Cough
0%
4%
2%
Diarrhea
0%
1%
2%
Nasal congestion
0%
2%
2%
Pain in extremity
0%
1%
2%
Bronchitis
1%
2%
0%
Urinary tract infection
0%
2%
0%
Gastroesophageal reflux
0%
2%
1%
Abdominal pain
0%
2%
1%
The following adverse events were reported over 24 weeks treatment duration in one placebo-controlled Phase 3 clinical study:
Table 3: Treatment-Emergent Adverse Events Reported by ≥2% of Patients Treated with Cialis for Once Daily Use (2.5 or 5 mg) and More Frequent on Drug than Placebo in One Placebo-Controlled Phase 3 Study of 24 Weeks Treatment Duration for Cialis for Once Daily Use
Adverse Event
Placebo
(N=94)
Tadalafil 2.5 mg
(N=96)
Tadalafil 5 mg
(N=97)
Nasopharyngitis
5%
6%
6%
Gastroenteritis viral
2%
3%
5%
Influenza
3%
5%
3%
Back Pain
3%
5%
2%
Upper Respiratory Tract Infection
0%
3%
4%
Dyspepsia
1%
4%
1%
Gastroesophageal Reflux Disease
0%
3%
2%
Myalgia
2%
4%
1%
Hypertension
0%
1%
3%
Nasal Congestion
0%
0%
4%
Back pain or myalgia was reported at incidence rates described in Tables 1 and 2. Diagnostic testing, including measures for inflammation, muscle injury, or renal damage revealed no evidence of medically significant underlying pathology. In the 1-year open label extension cialis drug impotence back pain and myalgia were reported in 5.5% and 1.3% of patients, respectively. Overall, approximately 0.5% of all subjects treated with Cialis for on demand use discontinued treatment as a consequence of back pain/myalgia. In many cases, medical follow-up information was limited.
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