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History of development of cialis

The physiology of erection is a complicated issue. In the last twenty years there has been a growth in understating the erection process and erectile dysfunction (ED) and how to treat it.

The treatment options for ED were invasive and exhausted to the patient, limited to inserting penile implants and intracavernosal injections. The situation changed completely after discovering a new group of drugs called phosphodiesterase type 5 (PDE5) inhibitors that include sildenafil (viagra), tadalafil (cialis), vardenafil (Levitra), and avanafil (Stendra).

Originally PED5 investigated as a treatment for angina pectoris, the first oral PDE5 inhibitor, sildenafil, was fortuitously discovered to produce erections in study participants. 

Pfizer introduced the first PED5 sildenafil (viagra) in march 1998 and over the past 10 years oral PED5 has had a very wide disturbance and acceptance by men and the treatment turned to a simple and effective way. 

In January 2008, Eli Lilly company introduced tadalafil (cialis) as the latest innovation in the treatment of ED and food and drug administration (FDA) approved its use as once daily therapy as tadalafil has the longest duration of action between others PED5. 

The attention extended to the difference between different agents of PED5 related to potency and duration and onset of action.

Pathophysiology of erectile dysfunction (ED)

• First we will discuss the pathophysiology of ED and PED5 roles and will focus on tadalafil (cialis) and its properties.
• ED is defined as inability to maintain and achieve erection in manner leads to satisfactory intercourse, about 150 million men around the world suffer from ED, the prevalence is expected to double to 300 million men worldwide over the next twenty years.
• Despite this huge number of cases, ED remains undiagnosed as millions of men never seeking medical advice because of the nature of the problem.
• There are a lot of reasons that cause ED including hormonal, emotional, drug induced, psychological, neurogenic, and vasculogenic. usually the reason is mixed between psychological and organic reasons.
• Penile erection occurs due to cooperation of multiple factors including neural, vascular, hormonal and psychological factors. These factors are organized by a group of neurotransmitters.
• The primary erectile-mediating neurotransmitter is nitric oxide (NO), PED5 drugs prevent breakdown of  NO especially in the penis so maintain longer and potent erection. 

 

Cialis dose and absorption 

 

• Recommended daily dose is 10mg once daily, 30 minute before intercoure, to be taken as whole (do not split it), dose can increase according to tolerability and efficacy. 
• Cialis has a very good oral absorption after oral ingestion about 80% of the dose is absorbed through the stomach compared to 40% with sildenafil (viagra).
• Cialis has the slowest absorption between the others PDE5 with the mean 2 hour to reach its maximum concentration compared to 50 min with sildenafil (viagra), but this doesn’t mean that cialis takes a long time to start its action, as it only takes 15 min.
• But absorption may vary from person to person so don’t get bothered if the action is delayed or lose the confidence in the treatment.
• Cialis can be taken with or without food or alcohol as this does not affect absorption unlike sildenafil (Viagra).

 

How long does the effect of cialis last?

Cialis has the longest duration of action between PDE5, This longer duration  provides a therapeutic window of 36 hours for tadalafil.

You should not be dosed with cialis immediately before intercourse, this gives you more freedom to choose the timing and setting of the sexual encounter with  your partner. 

Cialis adverse effect 

There are alot of studies that pointed to adverse effect of cialis, the most relevant one was conducted on 2102 men from different centers, 51% of men had at least one adverse event but only 3.2% stopped the treatment due to these events, the most common ones were:

• Headache 15%
• Dyspepsia 8%
• Back pain 5% 

Other adverse events were:

• Flushing 
• Nasal congestion 
• Myalgia
• Pain in limb

Cialis and Priapism 

Can cialis result in priapism? Only one case report associated between cialis and priapism, actually cialis have some benefit in preventing recurrent, or stuttering priapism.

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