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In general, pain was reported as mild or moderate in severity and resolved without medical treatment, but severe back pain was reported with a low frequency (<5% of all reports). 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 uses of cialis 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. Others were reported to have occurred hours to days after the use of Cialis and sexual activity. reported for Cialis for use as needed: Table 1: Treatment-Emergent uses of cialis Events Reported by ≥2% of Patients Treated with Cialis (10 or 20 mg) and More Frequent on Drug than Placebo in the Eight uses of cialis 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 uses of cialis 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 uses of cialis 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 uses of cialis 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 uses of cialis 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 for Once Daily Use Adverse Event Placebo (N=248) Tadalafil 2.5 mg (N=196) Tadalafil uses of cialis 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 uses of cialis following adverse events were reported over 24 weeks treatment duration in one placebo-controlled Phase 3 clinical study: Table uses of cialis 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. Most, but not all, of these patients had underlying anatomic or vascular risk factors for development of NAION, including but not necessarily limited to: low cup to disc ratio (“crowded disc”), age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia, and smoking. Incidence rates uses of cialis Cialis for once daily use are described in Table 2. 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 uses of cialis events (<2%) reported in controlled clinical trials of Cialis for once daily use or use as needed. In the uses of cialis open label extension study, back pain and myalgia were reported in 5.5% and 1.3% of patients, respectively. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal uses of cialis to drug exposure. Others were reported to have uses of cialis hours to days after the use of Cialis and sexual activity. In some cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. 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 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 was 58 years (range 21 to 82) and the discontinuation rate due to adverse events in patients uses of cialis 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 with Cialis for Once Daily Use (2.5 or 5 mg) and More Frequent on Drug than uses of cialis 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 uses of cialis 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 uses of cialis 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 uses of cialis 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 some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events. In many cases, medical follow-up information was limited.

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Effect on Blood Pressure When Administered With Alpha Blockers Six randomized, double-blinded, crossover clinical pharmacology studies were conducted to investigate the potential interaction of tadalafil with alpha-blocker agents in healthy male subjects . At the 24-hour timepoint, (more specifically, 22 to 26 hours), 53/144 (37%) patients reported at least 1 successful intercourse in the placebo group versus 84/138 (61%) in the Cialis 20-mg group. However, Cialis may also be taken daily (at a lower dose), regardless of when sexual activity is planned.

 

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