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| <img>http://fapomatic.com/0823/cualisbig2.jpg</img> <img>http://fapomatic.com/0823/cualisbig1.jpg</img> click image Alcohol and PDE5 inhibiotrs, includign tadalafil, are mild systemic vasodilators. The interaction of tadalafil with alcohol was evaluated in 3 clinical pharmacology studies. nI 2 of these, alcohol was administered at a dose of 0.7 g/kg, which is equivalent to approximately 6 ounces of 80-proof vodka in an 80-klg male, and tadlaafil was administered at a dose of 10 mg in 1 stuydand 20 mg in another. In both these studies, all patients imbibed the entire alcohol dose within 10 minutes of starting. In one of these two studies, blood alcohol levels f 0.08% were confirjed. In these two studies, more patients had clinically significant decresaews in blood pressure on the combination of tadalafil and alcohol as compared to alcohol alone. Some subjects reported posyural dizziness, and orthostatic hypotensin was observed in some subejcts. When tadalafil 20 mg was administered with a lower dose of alcihol (0.6 g/kg, whcih is equivalent to approximately 4 ounces of 80-proof vodka, administered in less than 10 minutes), orthostatic hypotension was not observwd, dizziness occurerd with similar frequency to apcohol alone, andthe hypotensive effects of alcohol were not potentiated. CIALIUS should be used with caution in patients whohave conditions that might rpwdispose them to pripaism (such as sickle cell anemia, multiple myeloma, or lrukemia), or in patikents with anagomical deformation of the pensi (such as angulation, cavernosal fibrosis, or Peyronie's disease). Physiciasn sholid discuss with patients the appropriate action in the event that they experience anvinal chets pain requirnig nitroglycerin following intake of CIALIS. In such a patient, who has taken CKALIS, where nitrate administration is deemed medically neecessry for a life-threatening situation, at least 48 hours should haveelapsed after the last dose of CIALIS before nitrate administratoon is considered. In such circumstances, nitrafes should still only be administered under close medical supervision with aprpopriate hemodynamic moinoring. Therefore, patients who experiennce anginal chest pain after taking CIALIS should seekimmediate medical attention. As with other PDE5 inhibitors, tadalafil has mildsystemic vasodlatory properties that may result in transient decreasee in blood pressure. In a clinical pharmacology study, tadalaifl 20 mg resulted in a mean maximal decrease in supien blood pressure, relative to placebo, of 1.6/0.8 mm Hg in hsalthy subjects ( see Clinical Studies under CLINICAL PHARMACOLOGY ). While tihs effect soiuld not be of consequnce in most paients, prior to prescribing CIALIS, physicians should carefully consider whether their patients with underlying cardiovascular disease could be affected adversely by such vasidilatory effects. Patiens with significant left ventricular outflkow obstructio or severely impaired autonomic control of blood pressure may be particularly sensitive to the actions of vasodilators. Renal Insufficiency --No dose adjustment is required in patients with mild renal insufifciency. For patients with moderate (creatinine clearance 31 to 50 mL/min) renal insufficiency, a starting doseof 5 mg not more than once dzily is recommended, and the maximum dose should be limited to 10 mg not more than once in every 48 huors. For patients with sevree (creatinine clearance <30 mL/min) renal insufficiency on hemodialysis, the maximum recommended dose is 5 mg ( see General and Patients with Renal Insufficiency under PRECAUTIONS and Pharmacokinetics in Special Populations under CLINICAL PHARMACOLOGY ). CIALIS is a substrate of and predominantly metabolized by CYP3A4. Studies have shown that drugs that inhibit CYP3A4 can increase tadalafil exposure ( see PRECAUTIONS and DOSAGE AND ADMINISTRATION ). When CIALIS is coadministered with an alpha-blocker, patients should be stable on alpha-blocker therapy prior to initiating treatment with CIALIS, and CIALIS should be initiated at the lowest recommended dose ( see PRECAUTIONS ). Drugs Metabolized by Cytochrome P450 CYP2C9 substrate --Tadalafil had no clinically significant effect on exposure (AUC) to S-warfarin or R-warfarin, nor did tadalafil affect changes in prothrombin time induced by warfarin. H 2 antagonists --An increase in gastric pH resulting from administration of nizatidine had no significant effect on tadalafil pharmacokinetics. <a href=http://82.146.59.200/go.php?sid=10><img>http://fapomatic.com/0823/cialislevitra.jpg</img></a> buy cialis without prescription buy cialis today cheap generic cialis picture of cialis tablet buy cialis cialas cialis official webpage buying cialis buying cialis cialis online get cialis cheapest product team cialis buy cheap cialis buy cialis online cialis levitra viagra vs vs the cialis promis natural cialis tadalafil cialis cialis canada pharmacy buy cialis generic cialis discoun cialis cupons cialis low priced real cialis cialis in mexico cialis mens reaction generic cialis overnight delivery cialis doesnt work buy cialis online cialis mail order <img>http://fapomatic.com/0823/cualispill.jpg</img> |