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For those considering the use of tadalafil (Cialis), it is crucial to be aware of the potential risks and necessary precautions. Please read the following information carefully and consult with your healthcare provider if you have any concerns or questions.

• Heart Problems: If you have any heart conditions, it's important to discuss these with your healthcare provider before starting tadalafil (Cialis). This medication may not be safe for individuals with certain heart-related conditions, including severe heart failure or those who have experienced a recent heart attack or stroke. Additionally, those with high or low blood pressure should exercise caution and consult their provider.

• Low Blood Pressure: Combining tadalafil (Cialis) with alpha blockers or medications for high blood pressure can lead to dangerously low blood pressure. Medications such as ritonavir (Norvir) can alter the breakdown of tadalafil in your body, increasing the risk of side effects like low blood pressure. Regular blood pressure monitoring may be advised by your healthcare provider. Be cautious when standing up from sitting or lying down, as this can cause dizziness and increase the risk of falls. Alcohol consumption can exacerbate this effect; therefore, reducing alcohol intake is recommended. Never use tadalafil (Cialis) with nitrate medications for chest pain, as this can cause a sudden and unsafe drop in blood pressure.

• Prolonged Erection: Although rare, tadalafil (Cialis) may cause prolonged erections lasting more than four hours (priapism), which can lead to permanent penile damage if not treated promptly. The risk is higher for individuals with conditions affecting the penis, sickle cell anemia, multiple myeloma, or leukemia. Seek immediate medical attention if you experience an erection lasting more than four hours or if accompanied by pain.

• Vision Changes: Sudden changes in vision in one or both eyes require urgent medical evaluation, as tadalafil (Cialis) can cause irreversible eye damage in rare cases. Individuals over 50 or those with a "crowded" optic disc or blood vessel issues in the eye are at greater risk. Ensure your healthcare provider is aware of your complete medical history before using this medication.

• Hearing Loss: Some users have reported hearing loss, often accompanied by tinnitus or dizziness. If you notice any changes in your hearing, seek emergency medical attention.

• Drug Interactions: Tadalafil (Cialis) can interact negatively with several medications. It's vital to disclose all current medications to your healthcare provider before starting tadalafil (Cialis). Particularly, avoid using it with nitrate medications, as this can dangerously lower blood pressure. If you're on blood pressure medications, your provider may advise against tadalafil until your condition stabilizes. Caution is also advised when used with oral azole antifungals or ritonavir (Norvir), as these may increase the likelihood of side effects such as headaches, flushing, and vision changes.

• Contraindications: Tadalafil (Cialis) should not be used if you are taking nitrate medications for chest pain or guanylate cyclase stimulators like Adempas (riociguat), as these situations pose serious health risks.

In case of an overdose, seek emergency medical assistance immediately. Always follow your healthcare provider's instructions and discuss any concerns with them to ensure safe and effective use of tadalafil (Cialis).

Common side effects:

• Headache
• Upset stomach
• Back pain
• Muscle pain
• Runny or stuffy nose
• Sore throat
• Symptoms resembling a common cold
• Flushing
• Dizziness

Serious side effects:

• Severe dizziness
• Fainting
• Chest pain
• Nausea during sexual activity
• Sudden loss of vision
• Sudden loss of hearing
• Ringing in the ears
• Painful or prolonged erection lasting more than four hours
• Severe allergic reaction (rash, itching, swelling, severe dizziness, or difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Nitrates (such as Nitroglycerin, isosorbide dinitrate)
• Recreational drugs containing amyl or butyl nitrite ('poppers')
• Riociguat
• Vericiguat
• Boceprevir
• Telaprevir

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Alpha blockers (such as Doxazosin, Tamsulosin)
• Azole antifungals (such as Itraconazole, Ketoconazole)
• Macrolide antibiotics (such as Clarithromycin, Erythromycin)
• HIV protease inhibitors (such as Fosamprenavir, Ritonavir)
• Cobicistat