χαπια στυτικής δυσλειτουργείας

[markelos]

Καλησπέρα σε όλους.
Ξεκίνησα μια νεα θεραπεία που μου πρότεινε ο ουρολόγος ο οποίος με παρακολουθεί η οποία ειναι  λήψη χαπιών στυ.δυσλειτουργείας (CIALIS 5 mg)για διάστημα τουλάχιστον 6 μηνών.Ειναι κάτι νεο που ξεκίνησε στην Αμερική και αφορα άτομα με προβλήματα του κατωτέρου ουροποιητικού συστήματος και περιλαμβάνει και την προστατίτιδα.Στις εώς τώρα μελέτες τα αποτελέσματα ειναι ενθαρυντικά.Εγω βρίσκομαι στις 2 εβδομάδες αλλά θα σας ενημερώνω διαρκώς για την εξέλιξη μου.Να σημειώσω οτι τα χάπια αυτα δεν μου έχουν παρουσιάσει καμια απο τις γνωστές παρενέργεις και κυρίως την ρινική συμφόρηση και την κεφαλαλγία που χαλούν την διάθεση αρκετα μετά την  χρήση ανάλογων σκευασμάτων.

[aaa]

και εμένα μου πρότεινε το ίδιο χάπι CIALIS 5 γνωστός ουρολόγος Δεν το είχα διαβάσει πουθενα για αυτό δεν το πήρα αλλά ακόμα δεν το έχω ξεκινήσει γιατί δεν το έχω δει στις παγκόσμιες ιατρικές οδηγίες, από πολύ καταξιωμένο συνδρομητικό site που απευθύνεται σε ιατρούς. http://www.chronic-prostatitis.com/index.php?topic=244.0
Αφού έχω δει βελτίωση από την πρώτη οδηγία του που ήταν να πάρω OMNIC
Θα σκέφτομαι και το δεύτερο σκέλος της οδηγίας.
Από κάτω παγκόσμιες αναγνωρισμένες οδηγίες για το CIALIS

[aaa]

Tadalafil: Drug information (CIALIS)

For abbreviations and symbols that may be used in Lexicomp (show table)
Brand Names: U.S.
•   Adcirca®;
•   Cialis®
Brand Names: Canada
•   Adcirca®;
•   Cialis®
Pharmacologic Category
•   Phosphodiesterase-5 Enzyme Inhibitor
Dosing: Adult
Benign prostatic hyperplasia (with or without concomitant erectile dysfunction) (Cialis®): Oral: 5 mg once daily
Dosing adjustment with concomitant medications: CYP3A4 inhibitors (strong): 2.5 mg once daily; maximum: 2.5 mg once daily
Erectile dysfunction (Cialis®): Oral:
As-needed dosing: 10 mg (U.S. labeling) or 20 mg (Canadian labeling) at least 30 minutes prior to anticipated sexual activity (dosing range: 5-20 mg); to be given as one single dose and not given more than once daily. Note: Erectile function may be improved for up to 36 hours following a single dose; adjust dose.
Once-daily dosing: 2.5 mg once daily (U.S. labeling) or 5 mg once daily (Canadian labeling) to be given at approximately the same time daily without regard to timing of sexual activity. Dose may be adjusted based on tolerability (dosage range: 2.5-5 mg/day).
Dosing adjustment with concomitant medications:
U.S. labeling: Alpha1-blockers: If stabilized on either alpha-blockers or tadalafil therapy, initiate new therapy with the other agent at the lowest possible dose.
Canadian labeling: Nonselective alpha-blockers (eg, doxazosin): As-needed dosing: 10 mg at least 30 minutes prior to anticipated sexual activity
CYP3A4 inhibitors (strong):
As-needed dosing:
U.S. labeling: Maximum: 10 mg, not to be given more frequently than every 72 hours
Canadian labeling: 10 mg, not to be given more frequently than every 48 hours (maximum 3 doses/week); may increase to 20 mg if lower dose is tolerated but ineffective. Discontinue use if 10 mg dose is not tolerated.
Once-daily dosing:
U.S. labeling: 2.5 mg once daily; maximum: 2.5 mg once daily
Canadian labeling: 2.5-5 mg once daily
Pulmonary arterial hypertension (Adcirca®): Oral: 40 mg once daily
Dosing adjustment with concomitant medications: Coadministration with protease inhibitor regimen:
Concurrent use with atazanavir/ritonavir, darunavir/ritonavir, fosamprenavir, ritonavir, saquinavir/ritonavir, tipranavir/ritonavir:
Coadministration of tadalafil in patients currently receiving one of these protease inhibitor regimens for at least 1 week: Initiate tadalafil at 20 mg once daily; increase to 40 mg once daily based on individual tolerability.
Coadministration of one of these protease inhibitor regimens in patients currently receiving tadalafil: Discontinue tadalafil at least 24 hours prior to the initiation of the protease inhibitor regimen. After at least 1 week of the protease inhibitor regimen, resume tadalafil at 20 mg once daily; increase to 40 mg once daily based on individual tolerability.
Concurrent use with indinavir or nelfinavir:
Patient receiving indinavir/nelfinavir when initiating tadalafil: Initiate tadalafil at 20 mg once daily; increase to 40 mg once daily based on individual tolerability
Patient receiving tadalafil when initiating indinavir/nelfinavir: Adjust tadalafil to 20 mg once daily; increase to 40 mg once daily based on individual tolerability
Dosing: Geriatric
Refer to adult dosing. No dose adjustment for patients >65 years of age in the absence of renal or hepatic impairment.
Dosing: Renal Impairment
Benign prostatic hyperplasia (with or without concomitant erectile dysfunction) (Cialis®):
Clcr ≥51 mL/minute: No dosage adjustment necessary.
Clcr 30-50 mL/minute: Initial: 2.5 mg once daily; maximum: 5 mg once daily.
Clcr <30 mL/minute: Use not recommended.
ESRD requiring hemodialysis: Use not recommended.
Erectile dysfunction (Cialis®):
As-needed use:
U.S. labeling:
Clcr ≥51 mL/minute: No dosage adjustment necessary.
Clcr 30-50 mL/minute: Initial: 5 mg once daily; maximum: 10 mg (not to be given more frequently than every 48 hours).
Clcr <30 mL/minute: Maximum: 5 mg (not to be given more frequently than every 72 hours).
ESRD requiring hemodialysis: Maximum: 5 mg (not to be given more frequently than every 72 hours).
Canadian labeling:
Clcr >80 mL/minute: No dosage adjustment necessary.
Clcr ≥31-80 mL/minute: 10 mg, not to be given more frequently than every 48 hours (maximum 3 doses/week); may increase to 20 mg if lower dose is tolerated but ineffective. Discontinue use if 10 mg dose is not tolerated.
Clcr <30 mL/minute: Use with extreme caution; has not been adequately studied.
ESRD requiring hemodialysis: Use with extreme caution; has not been adequately studied.
Once-daily use:
Clcr ≥31 mL/minute: No dosage adjustment necessary.
Clcr <30 mL/minute: Use not recommended.
ESRD requiring hemodialysis: Use not recommended.
Pulmonary arterial hypertension (Adcirca®):
Clcr >80 mL/minute: No dosage adjustment necessary.
Clcr 31-80 mL/minute: Initial: 20 mg once daily; increase to 40 mg once daily based on individual tolerability.
Clcr ≤30 mL/minute: Avoid use due to increased tadalafil exposure, limited clinical experience, and lack of ability to influence clearance by dialysis.
Dosing: Hepatic Impairment
Benign prostatic hyperplasia (with or without concomitant erectile dysfunction) (Cialis®):
Mild-to-moderate hepatic impairment (Child-Pugh class A or B): Use with caution.
Severe hepatic impairment (Child-Pugh class C): Use is not recommended.
Erectile dysfunction (Cialis®):
As-needed use:
U.S. labeling:
Mild-to-moderate impairment (Child-Pugh class A or B): Use with caution; dose should not exceed 10 mg once daily.
Severe impairment (Child-Pugh class C): Use is not recommended.
Canadian labeling:
Mild-to-moderate impairment (Child-Pugh class A or B): 10 mg, not to be given more frequently than every 48 hours (maximum 3 doses/week); may increase to 20 mg if lower dose is tolerated but ineffective. Discontinue use if 10 mg dose is not tolerated.
Severe impairment (Child-Pugh class C): Use with extreme caution; has not been adequately studied.
Once-daily use:
U.S. labeling:
Mild-to-moderate impairment (Child-Pugh class A or B): Use with caution.
Severe impairment (Child-Pugh class C): Use is not recommended.
Canadian labeling:
Mild-to-moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary.
Severe impairment (Child-Pugh class C): Use with extreme caution; has not been adequately studied.
Pulmonary arterial hypertension (Adcirca®):
Mild-to-moderate hepatic impairment (Child-Pugh class A or B): Use with caution; consider initial dose of 20 mg once daily.
Severe hepatic impairment (Child-Pugh class C): Avoid use; has not been studied in patients with severe hepatic cirrhosis.
Dosage Forms: U.S.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, oral:
Adcirca®: 20 mg
Cialis®: 2.5 mg, 5 mg, 10 mg, 20 mg
Generic Equivalent Available: U.S.
No
Administration
May be administered with or without food.
Adcirca®: Administer daily dose all at once; dividing doses throughout the day is not advised.
Cialis®: When used on an as-needed basis, should be taken at least 30 minutes prior to sexual activity. When used on a once-daily basis, should be taken at the same time each day, without regard to timing of sexual activity.

[aaa]

Use
Adcirca®: Treatment of pulmonary arterial hypertension (PAH) (WHO Group I) to improve exercise ability
Cialis®: Treatment of erectile dysfunction (ED); treatment of signs and symptoms of benign prostatic hyperplasia (BPH)
Medication Safety Issues
Sound-alike/look-alike issues:
Tadalafil may be confused with sildenafil, vardenafil
Adcirca® may be confused with Advair® Diskus®, Advair® HFA, Advicor®
Adverse Reactions Significant
Based upon usual doses for either indication. For erectile dysfunction, similar adverse events are reported with once-daily versus intermittent dosing, but are generally lower than with doses used intermittently.
>10%:
Cardiovascular: Flushing (1% to 13%; dose related)
Central nervous system: Headache (3% to 42%; dose related)
Gastrointestinal: Dyspepsia (1% to 13%), nausea (10% to 11%)
Neuromuscular & skeletal: Myalgia (1% to 14%; dose related), back pain (2% to 12%), extremity pain (1% to 11%)
Respiratory: Respiratory tract infection (3% to 13%), nasopharyngitis (2% to 13%)
2% to 10%:
Cardiovascular: Hypertension (1% to 3%)
Gastrointestinal: Gastroenteritis (viral; 3% to 5%), GERD (1% to 3%), abdominal pain (1% to 2%), diarrhea (1% to 2%)
Genitourinary: Urinary tract infection (≤2%)
Respiratory: Nasal congestion (≤9%), cough (2% to 4%), bronchitis (≤2%)
Miscellaneous: Flu-like syndrome (2% to 5%)
<2% (Limited to important or life-threatening): Amnesia (transient global), angina pectoris, arthralgia, blurred vision, chest pain, color vision decreased, conjunctival hyperemia, conjunctivitis, diaphoresis, dizziness, dysphagia, dyspnea, epistaxis, esophagitis, exfoliative dermatitis, eye pain, eyelid swelling, facial edema, fatigue, gastritis, GGTP increased, hearing decreased, hearing loss, hepatic enzymes increased, hypoesthesia, hypotension, insomnia, lacrimation, migraine, MI, neck pain, nonarteritic ischemic optic neuropathy (NAION), pain, palpitation, paresthesia, pharyngitis, postural hypotension, priapism, pruritus, rash, retinal artery occlusion, retinal vein occlusion, seizure, somnolence, spontaneous penile erection, Stevens-Johnson syndrome, stroke, sudden cardiac death, syncope, tachycardia, tinnitus, urticaria, vertigo, visual field loss, vomiting, weakness, xerostomia
Contraindications
Known serious hypersensitivity to tadalafil or any component of the formulation; concurrent use (regularly/intermittently) of organic nitrates in any form (eg, nitroglycerin, isosorbide dinitrate)
Warnings/Precautions
Concerns related to adverse effects:
• Anginal chest pain: Patients experiencing anginal chest pain after tadalafil administration should seek immediate medical attention (also see "Concurrent drug therapy issues").
• Color discrimination: May cause dose-related impairment of color discrimination. Use caution in patients with retinitis pigmentosa; a minority have genetic disorders of retinal phosphodiesterases (no safety information available).
• Hearing loss: Sudden decrease or loss of hearing has been reported rarely; hearing changes may be accompanied by tinnitus and dizziness. Instruct patients to seek medical assistance for sudden decrease in hearing or loss of hearing. A direct relationship between therapy and hearing loss has not been determined.
• Hypotension: Decreases in blood pressure may occur due to vasodilator effects; use with caution in patients with left ventricular outflow obstruction (aortic stenosis or hypertrophic obstructive cardiomyopathy); may be more sensitive to hypotensive actions. Concurrent use with alpha-adrenergic antagonist therapy may cause symptomatic hypotension; patients should be hemodynamically stable prior to initiating therapy at the lowest possible dose. Avoid or limit concurrent substantial ethanol consumption as this may increase the risk of symptomatic hypotension.
• Priapism: Painful erection >6 hours in duration; rare. Instruct patient to seek medical assistance for erection lasting >4 hours. Use with caution in patients who have conditions which may predispose them to priapism (eg, sickle cell anemia, multiple myeloma, leukemia).
• Vision loss: Vision loss (rare) may be a sign of nonarteritic anterior ischemic optic neuropathy (NAION). Instruct patients to seek medical assistance for sudden loss of vision in one or both eyes. Risk may be increased with history of vision loss or NAION in one eye. Other risk factors for NAION include low cup-to-disc ratio ("crowded disc"), coronary artery disease, diabetes, hypertension, hyperlipidemia, smoking, and >50 years of age. Safety has not been evaluated in patients with known degenerative retinal disorders (eg, retinitis pigmentosa); use is not recommended.
Disease-related concerns:
• Anatomical penis deformation: Use with caution in patients with anatomical deformation of the penis (angulation, cavernosal fibrosis, or Peyronie's disease).
• Bleeding disorders: Use with caution in patients with bleeding disorders; safety and efficacy have not been established. In vitro studies have suggested a decreased effect on platelet aggregation.
• Cardiovascular disease: Use is not recommended in patients with hypotension (<90/50 mm Hg), uncontrolled hypertension (>170/100 mm Hg), NYHA class II-IV heart failure within the last 6 months, uncontrolled arrhythmias, stroke within the last 6 months, MI within the last 3 months, unstable angina or angina during sexual intercourse; safety and efficacy have not been evaluated in these patients. Safety and efficacy in PAH have not been evaluated in patients with clinically significant aortic and/or mitral valve disease, life-threatening arrhythmias, hypotension (<90/50 mm Hg), uncontrolled hypertension, significant left ventricular dysfunction, pericardial constriction, restrictive or congestive cardiomyopathy, symptomatic coronary artery disease. Use caution in patients with left ventricular outflow obstruction (eg, aortic stenosis, hypertrophic obstructive cardiomyopathy); may be more sensitive to vasodilator effects. There is a degree of cardiac risk associated with sexual activity; therefore, physicians may wish to consider the cardiovascular status of their patients prior to initiating any treatment for erectile dysfunction.
• Hepatic impairment: Use with caution in patients with mild-to-moderate hepatic impairment; dosage adjustment/limitation is needed. Use is not recommended in patients with severe hepatic impairment or cirrhosis.
• Peptic ulcer disease: Use with caution in patients with active peptic ulcer disease due to effect on platelets (bleeding); safety and efficacy have not been established.
• Pulmonary veno-occlusive disease (PVOD): Pulmonary vasodilators may exacerbate the cardiovascular status in patients with PVOD. Use is not recommended; no clinical data exists in patients with PVOD. In patients with unrecognized PVOD, signs of pulmonary edema should prompt investigation into this diagnosis.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment/limitation is needed.
Concurrent drug therapy issues:
• Alpha-blockers: When used for erectile dysfunction, use with caution in patients taking alpha-blockers; may cause hypotension. Safety of this combination may be affected by other antihypertensives and intravascular volume depletion. Patients should be hemodynamically stable prior to initiating therapy. Initiate tadalafil at the lowest recommended dose. Alpha-blockers should be initiated at the lowest recommended dose in patients currently taking tadalafil. When used for treatment of BPH, concomitant use with alpha-blockers is not recommended; discontinue alpha-blocker at least 1 day before initiating tadalafil.
• High potential for interactions: BPH/Erectile dysfunction: Use with caution in patients taking strong CYP3A4 inhibitors (see Drug Interactions); consider alternative agents that avoid or lessen the potential for CYP-mediated interactions. Once-daily tadalafil dosing results in continuous plasma levels; use caution when administered concurrently with these medications. PAH: Avoid use in patients taking strong CYP3A4 inducers/inhibitors. Use in patients receiving or about to receive ritonavir requires dosage adjustment or interruption of therapy, respectively. Canadian labeling does not recommend use of tadalafil in patients with PAH who are also receiving protease inhibitors.
• Nitrates: Concomitant use (regularly/intermittently) with all forms of nitrates is contraindicated. Nitrate-mediated vasodilation is markedly exaggerated and prolonged in the presence of PDE-5 inhibitors. When tadalafil is used for BPH, erectile dysfunction, or PAH and nitrate administration is medically necessary (eg, chest pain refractory to other treatments) following the use of tadalafil, at least 48 hours should elapse after the tadalafil dose and nitrate administration. When used for PAH, per the manufacturer, nitrate may be administered within 48 hours of tadalafil. For both situations, administration of nitrates should only be done under close medical supervision with hemodynamic monitoring.
• Other phosphodiesterase-5 (PDE-5) inhibitors: Safety and efficacy with other tadalafil brands or other PDE-5 inhibitors (ie, sildenafil and vardenafil) have not been established. Patients should be informed not to take with other tadalafil brands or other PDE-5 inhibitors.
• Other treatments for erectile dysfunction: Safety and efficacy with other treatments for erectile dysfunction have not been established; use is not recommended.
Special populations:
• Elderly: Use with caution.
Other warnings/precautions:
• Appropriate use: Potential underlying causes of erectile dysfunction or BPH should be evaluated prior to treatment.
Metabolism/Transport Effects
Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Drug Interactions
(For additional information: Launch Lexi-Interact™ Drug Interactions Program)
Alpha1-Blockers: Phosphodiesterase 5 Inhibitors may enhance the hypotensive effect of Alpha1-Blockers. Management: Ensure patient is stable on one agent prior to initiating the other, and always initiate combination using the lowest possible dose of the drug being added. When tadalafil is used for treatment of BPH, concurrent alpha 1-blockers are not recommended. Risk D: Consider therapy modification
Amyl Nitrite: Phosphodiesterase 5 Inhibitors may enhance the vasodilatory effect of Amyl Nitrite. Risk X: Avoid combination

[aaa]

Antifungal Agents (Azole Derivatives, Systemic): May decrease the metabolism of Phosphodiesterase 5 Inhibitors. Risk D: Consider therapy modification
Antihypertensives: Phosphodiesterase 5 Inhibitors may enhance the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Boceprevir: May increase the serum concentration of Tadalafil. Management: Avoid tadalafil when used for treatment of pulmonary arterial hypertension in patients receiving boceprevir. Tadalafil for erectile dysfunction should be limited to 10 mg every 72 hours with close monitoring for tadalafil toxicity. Risk X: Avoid combination
Bosentan: Phosphodiesterase 5 Inhibitors may increase the serum concentration of Bosentan. Bosentan may decrease the serum concentration of Phosphodiesterase 5 Inhibitors. Risk C: Monitor therapy
CYP3A4 Inducers (Strong): May decrease the serum concentration of Tadalafil. Management: Erectile dysfunction: monitor for decreased effectiveness - no standard dose adjustments recommended. Avoid use of tadalafil for pulmonary arterial hypertension in patients receiving a strong CYP3A4 inducer. Risk D: Consider therapy modification
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Tadalafil. Management: Recommendations regarding use of tadalafil in patients also receiving strong CYP3A4 inhibitors may vary based on indication and/or international labeling. Consult appropriate product labeling. Exceptions: Ritonavir. Risk D: Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Etravirine: May decrease the serum concentration of Phosphodiesterase 5 Inhibitors. Management: No empiric dosage adjustments are recommended with concomitant therapy; however, dose of the phosphodiesterase inhibitor may need to be altered based on clinical response. Risk C: Monitor therapy
Ivacaftor: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Mifepristone: May increase the serum concentration of CYP3A4 Substrates. Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. Risk D: Consider therapy modification
Phosphodiesterase 5 Inhibitors: May enhance the adverse/toxic effect of other Phosphodiesterase 5 Inhibitors. Risk X: Avoid combination
Ritonavir: May increase the serum concentration of Tadalafil. Management: Recommendations regarding use of tadalafil in patients also receiving ritonavir may vary based on indication and/or international labeling. Consult appropriate product labeling. Risk D: Consider therapy modification
Sapropterin: May enhance the hypotensive effect of Phosphodiesterase 5 Inhibitors. Risk C: Monitor therapy
Telaprevir: May increase the serum concentration of Tadalafil. Management: Concurrent use of tadalafil for treatment of pulmonary arterial hypertension is contraindicated with telaprevir. Tadalafil for erectile dysfunction should be limited to 10 mg per 72 hours, with close monitoring for tadalafil toxicity. Risk X: Avoid combination
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Vasodilators (Organic Nitrates): Phosphodiesterase 5 Inhibitors may enhance the vasodilatory effect of Vasodilators (Organic Nitrates). Risk X: Avoid combination
Ethanol/Nutrition/Herb Interactions
Ethanol: Substantial consumption of ethanol may increase the risk of hypotension and orthostasis. Lower ethanol consumption has not been associated with significant changes in blood pressure or increase in orthostatic symptoms. Management: Avoid or limit ethanol consumption.
Food: Rate and extent of absorption are not affected by food. Grapefruit juice may increase serum levels/toxicity of tadalafil. Management: Use of grapefruit juice should be limited or avoided.
Herb/Nutraceutical: St John's wort may decrease the levels/effectiveness of tadalafil. Management: Avoid or use caution with concomitant use.
Pregnancy Risk Factor
B (show table)
Pregnancy Implications
Teratogenic events were not reported in animal reproduction studies. Postnatal development and pup survival was decreased at some doses. There are no adequate and well-controlled studies in pregnant women. Less than 0.0005% is found in the semen of healthy males.
Lactation
Excretion in breast milk unknown/use caution
Dietary Considerations
May be taken with or without food.
Pricing: U.S. (www.drugstore.com)
Tablets (Adcirca)
20 mg (60): $1348.95
Tablets (Cialis)
2.5 mg (15): $75.99
5 mg (10): $49.99
5 mg (30): $133.97
10 mg (10): $224.99
20 mg (10): $224.99
Monitoring Parameters
Blood pressure, response and adverse effects; urine flow, PSA
International Brand Names
•   36 Horas (PY);
•   Adcirca (AT, CZ, DK, EE, FR, GB, IE, NO, PT, SE);
•   Cialis (AR, AT, AU, BB, BE, BF, BG, BJ, BR, BS, CH, CI, CL, CN, CO, CR, CZ, DE, DK, DO, EE, ES, ET, FI, FR, GB, GH, GM, GN, GR, HK, HN, ID, IE, IL, IT, JM, KE, KP, LR, MA, ML, MR, MT, MU, MW, MX, MY, NE, NG, NI, NL, NO, NZ, PA, PE, PH, PL, PT, RU, SC, SD, SE, SG, SK, SL, SN, SV, TH, TN, TR, TT, TW, TZ, UG, VE, ZA, ZM, ZW);
•   Forzest (IN);
•   Pasport (TR);
•   Xpandyl (GT);
•   Zydalis (IN)
Mechanism of Action
BPH: Exact mechanism unknown; effects likely due to PDE-5 mediated reduction in smooth muscle and endothelial cell proliferation, decreased nerve activity, and increased smooth muscle relaxation and tissue perfusion of the prostate and bladder
Erectile dysfunction: Does not directly cause penile erections, but affects the response to sexual stimulation. The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation and inflow of blood to the corpus cavernosum. Tadalafil enhances the effect of NO by inhibiting phosphodiesterase type 5 (PDE-5), which is responsible for degradation of cGMP in the corpus cavernosum; when sexual stimulation causes local release of NO, inhibition of PDE-5 by tadalafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. At recommended doses, it has no effect in the absence of sexual stimulation.
PAH: Inhibits phosphodiesterase type 5 (PDE-5) in smooth muscle of pulmonary vasculature where PDE-5 is responsible for the degradation of cyclic guanosine monophosphate (cGMP). Increased cGMP concentration results in pulmonary vasculature relaxation; vasodilation in the pulmonary bed and the systemic circulation (to a lesser degree) may occur.
Pharmacodynamics/Kinetics
Onset of action: Within 1 hour
Peak effect (pulmonary artery vasodilation): 75-90 minutes (Ghofrani, 2004)
Duration: Erectile dysfunction: Up to 36 hours
Distribution: Vd: 63-77 L
Protein binding: 94%
Metabolism: Hepatic, via CYP3A4 to metabolites (inactive)
Half-life elimination: 15-17.5 hours; Pulmonary hypertension (not receiving bosentan): 35 hours
Time to peak, plasma: ~2-4 hours (range: 30 minutes to 8 hours)
Excretion: Feces (~61%, predominantly as metabolites); urine (~36%, predominantly as metabolites)
Use of UpToDate is subject to the Subscription and License Agreement.
REFERENCES
1.   Andersson KE, de Groat WC, McVary KT, et al, "Tadalafil for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Pathophysiology and Mechanism(s) of Action," Neurourol Urodyn, 2011, 30(3):292-301.
2.   Anderson JL, Adams CD, Antman EM, et al, "2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines," Circulation, 2011, 123(18):e426-579. [PubMed 21444888]
3.   Antman EM, Anbe DT, Armstrong PW, et al, "ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)," Circulation, 2004, 110(9):e82-292. [PubMed 15339869]
4.   Cheitlin MD, Hutter AM Jr, Brindis RG, et al, "Use of Sildenafil (Viagra®) in Patients With Cardiovascular Disease," J Am Coll Cardiol, 1999, 33(1):273-82. [PubMed 9935041]
5.   Curran M and Keating G, "Tadalafil," Drugs, 2003, 63(20):2203-12; discussion 2213-4. [PubMed 14498756]
6.   Daugan A, Grondin P, Ruault C, et al, "The Discovery of Tadalafil: A Novel and Highly Selective PDE-5 Inhibitor. 2: 2,3,6,7,12,12a-hexahydropyrazino[1′,2′:1,6]pyrido[3,4-b]indole-1,4-dione Analogues," J Med Chem, 2003, 46(21):4533-42.
7.   Fraunfelder FW, "Visual Side Effects Associated With Erectile Dysfunction Agents," Am J Ophthal, 2005, 140 (4):723-24. [PubMed 16226525]
8.   Galie N, Brundage BH, Ghofrani HA, et al, "Tadalafil Therapy for Pulmonary Arterial Hypertenstion," Circulation, 2009, 119(22):2894-903. [PubMed 19470885]
9.   Ghofrani HA, Voswinckel R, Reichenberger F, et al, "Differences in Hemodynamic and Oxygenation Responses to Three Different Phosphodiesterase-5 Inhibitors in Patients with Pulmonary Arterial Hypertension," J Am Coll Cardiol, 2004, 44(7):1488-96. [PubMed 15464333]
10.   Jackson G, Rosen RC, Kloner RA, et al, "The Second Princeton Consensus on Sexual Dysfunction and Cardiac Risk: New Guidelines for Sexual Medicine," J Sex Med, 2006, 3(1):28-36. [PubMed 16409215]
11.   Kloner RA, Mitchell M, and Emmick JT, "Cardiovascular Effects of Tadalafil," Am J Cardiol, 2003, 92(9A):37M-46M. [PubMed 14609622]
12.   Kloner RA, Mitchell M, and Emmick JT, "Cardiovascular Effects of Tadalafil in Patients on Common Antihypertensive Therapies," Am J Cardiol, 2003, 92(9A):47M-57M. [PubMed 14609623]
13.   McLaughlin VV, Archer SL, Badesch DB, et al, "ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association Developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association," J Am Coll Cardiol, 2009, 53(17):1573–619. [PubMed 19389575]
14.   McVary KT, "Clinical Practice. Erectile Dysfunction," N Engl J Med, 2007, 357(24):2472-81. [PubMed 18077811]
15.   Padma-Nathan H, "Efficacy and Tolerability of Tadalafil, A Novel Phosphodiesterase 5 Inhibitor, in Treatment of Erectile Dysfunction," Am J Cardiol, 2003, 92(9A):19-25. [PubMed

[markelos]

Mετα απο μερικους μηνες με χαπια στυτ.δυσλειτ.τα οποια στην αρχη ειχαν αποδώσει τα μεγιστα(ειχε μειωθει-σχεδον εξαλειφθει ο πόνος)η στυση ηταν άψογη ξεφνικα και μεσα σε μια μερα τα χαπια δεν έκαναν ΤΙΠΟΤΑ.Παρολα αυτα τα συνεχισα για λιγο σχετικα χρονικο διάστημα και μετα τα σταμάτησα.Πηγα στον ουρολόγο και μου ειπε οτι ειμαι πάλι φουλ στην φλεγμονη και να ξαναπάρω αντιβίωση.Μετα απο μερικες ερωτήσεις μου μου ειπε οτι αν εχει βλάβη ο προστάτης τα χάπια αυτα και στην δόση που τα έπαιρνα ειναι λογικο να μην κάνουν τιποτα οποτε ΠΑΠΑΛΑ και αυτο!!!!!!!Ισα ισα που πιστευω πλέον οτι αν έχεις κάποιο θεμα με τον προστατη σου και εσυ προκαλεις κατα κάποιον τροπο τεχνιτη στυση τοτε επιβαρύνεις μια ηδη δυσκολη κατασταση.Τι να πω δεν ξερω......

[Φαέθων]

Δείτε ένα ποστ σχετικό με αυτό το θέμα εδώ: http://www.chronic-prostatitis.com/index.php?topic=250.msg2655#msg2655