DRUG CLASS AND MECHANISM: Tadalafil is an oral drug that is used for treating impotence (the inability to attain or maintain a penile erection). It is in a class of drugs called phosphodiesterase inhibitors that also includes sildenafil (Viagra) and vardenafil (Levitra).

Erection of the penis is caused by the filling of the penis with blood. Filling occurs because the blood vessels that bring blood to the penis increase in size and deliver more blood to the penis, and, at the same time, the blood vessels that take blood away from the penis decrease in size and remove less blood from the penis.

Sexual stimulation that leads to an erection causes the production and release of nitric oxide in the penis. The nitric oxide causes an enzyme, guanylate cyclase, to produce cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for increasing and decreasing the size of the blood vessels carrying blood to and from the penis, respectively, and causing the erection. When the cGMP is destroyed by another enzyme, phosphodiesterase-5, the blood vessels return to their normal size, blood leaves the penis, and the erection ends. Tadalafil prevents phosphodiesterase-5 from destroying cGMP so that cGMP stays around longer. The persistence of cGMP leads to a more prolonged engorgement of the penis with blood.

Tadalafil was approved by the FDA in November, 2003.

PRESCRIPTION: Yes.

GENERIC AVAILABLE: No.

PREPARATIONS: Tablets: 5, 10, and 20 mg.

STORAGE: Store at room temperature between 15-30°C (59-86°F).

PRESCRIBED FOR: Tadalafil is used for the treatment of impotence.

DOSING: For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity. Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.

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PARIS (Reuters) - French custom officials have intercepted a shipment of 224,000 faker cheap viagra and Tadalafil anti-impotence pills worth 2.4 million euros ($3.5 million), the Budget Ministry said on Monday.

The copies of the best-selling drugs were found on December 18 during a search at the French capital's main air hub at Roissy, in a freight shipment on its way to Brazil from India. "Branded Powergra and Erectalis, each box contained, in fact, four tablets in the characteristic shape and coloring material of Viagra or cheap cialis pills," Budget Minister Eric Werth\'s office, which is also in charge of impost, said in a statement.

"The companies Pfizer and Eli Lilly, which severally own the Viagra and Cialis brands, quickly confirmed the counterfeit nature of these products and the 224,000 pills were seized," Werth's office added.

Confused about all of the erectile dysfunction meds being pitched to improve your love life? Just want to know what you can do to be at your healthy, sexual best this Valentine's Day? Urologist Peter Burrows, MD, joined us on Feb. 10 to answer your questions about men's sexual health

MODERATOR:
Welcome to WebMD Live, Dr. Burrows. We see so many ads for medications to treat erectile dysfunction (ED). Is ED on the rise or is it simply a matter of new medications coming to market?

BURROWS:
I think it began with Pfizer when they introduced Viagra in 1998. They removed the stigma of erectile dysfunction or impotency. Before this, we never knew the incidence or the true amount of men who suffered from erectile dysfunction. So, with consumer-directed advertising and doctors' comfort levels about discussing erectile dysfunction, we learned how many men truly had this problem. Now there is no longer the stigma with discussing ED and there are three companies with effective medications; it seems that both physicians and patients are interested in learning and treating this condition.

"The choice of which medication to take depends on how the man and his partner typically engage in sexual activity."

MODERATOR: Can you explain the differences and similarities in the three most common ED meds: Viagra, Levitra and Cialis?

BURROWS:
They all work by inhibiting an enzyme called phosphodiesterase type V (PDE-V). This enzyme is found specifically in erectile tissue.

The three medications differ slightly on their side effect profile, their rate of action and their duration of action:

• Viagra and Levitra are very similar in the rate of uptake, in that the majority of men will have the effect of the medication between 30 and 60 minutes and the medication is metabolized after 8 hours.
• Cialis is slightly slower in uptake, approximately 60 minutes, but has a duration lasting 36 hours.

The choice of which medication to take depends on how the man and his partner typically engage in sexual activity. Some men prefer having a medication that works on demand and is out of their bodies within 8 hours. Some men enjoy the spontaneity allowed by a medication with a long half-life and they do not need to time when the medication is taken relative to sexual activity.

MEMBER QUESTION:
I am a 60-year-old man who occasionally uses Viagra, but there are other times that I don't. Am I creating a dependence on the drug?

BURROWS:
No. The medication works on demand and does not create immunity. That is, you will not need more of the medication as time goes on, even if you take it on daily basis.

MEMBER QUESTION:
When taking any of the prescribed ED drugs over a long period of time, are there any lasting side effects?

BURROWS:
The side effects of all three medications last only as long as the medication is in the bloodstream. There does not appear to be any long-lasting side effects once it has been metabolized.

MODERATOR:
The warning to seek medical attention if erection lasts longer than 4 hours has been the subject of jokes, but it really isn't a laughing matter, is it?

BURROWS:
This condition is known as priapism, and it is no joking matter. However, prolonged erection or priapism from this class of medications is exceedingly rare. To my recollection, there have only been a handful of patients worldwide to have had this condition and the majority of these patients have had other conditions or medications that can promote priapism.

The reason priapism is serious is any erection lasting more than two hours can create permanent scarring of the erectile tissue, making future potency difficult or impossible. And as the drug companies suggest, if an erection should last more than four hours, emergency contact to an urologist or emergency room should be initiated for prompt treatment. When treatment is offered quickly, potency can be restored with minimal loss.

Treatment begins with taking vasoconstrictors, such as pseudoephedrine, found in the over-the- counter medication Sudafed, also application of ice to the penis to help the blood vessels constrict. If these maneuvers are unsuccessful, then a doctor will inject a very small amount of a vasoconstrictor into the penis, such as epinephrine. Rarely, if these maneuvers are ineffective, the physician will withdraw a small amount of blood from the penis to initiate detumescence.

"The reason priapism is serious is any erection lasting more than two hours can create permanent scarring of the erectile tissue, making future potency difficult or impossible."

MODERATOR:
Who is a good candidate for these medications? And who should avoid them?

BURROWS:
The list to avoid is easier than who is a good candidate. Men who should avoid these medications are:

• Men who are on nitrates, such as nitroglycerine, Indur or Nitropaste. The interaction of the PDV family with nitroglycerine can trigger a drop in blood pressure which can be life threatening.
• Men with severe coronary artery disease who cannot tolerate exercise should be counseled by a cardiologist if they can tolerate exercise stress.
• Men with a rare condition called Retinitis Pigmentosa should never take this class of medications.

This leaves the vast majority of men, who may have diabetes, hypertension or surgeries, who would be excellent candidates for this class of medications.

sourse

• Lack of sexual desire
• Problems with ejaculation or orgasm.
   

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