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Loss of vision in one eye due to non-arterial anterior ischemic optic neuropathy (NAPION) (regardless of the connection with the use of PDE5 inhibitors) concomitant use of doxazosin, guanylate cyclase stimulants such as riociguat, and drugs for the treatment of erectile dysfunction.

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Cialis is mainly metabolized with the participation of the CYP3A4 enzyme. Taking ketoconazole, a selective inhibitor of CYP3A4, at a dose of 200 mg per day, increases the effect of the drug (AUC) (10 mg) by 2 times and Cmax by 15% compared with the same indicators with Cialis monotherapy. Taking ketoconazole at a dose of 400 mg per day increases the effect of Cialis (AUC) (20 mg) by 4 times and Cmax by 22%. Ritonavir, a protease inhibitor, 200 mg twice a day, which is an inhibitor of CYP3A4, CYP2C9, CYP2C19 and CYP2D6, doubles the effect of Cialis (20 mg) without changing Cmax. Although specific interactions have not been studied, other protease inhibitors, such as saquinavir, as well as other CYP3A4 inhibitors, such as erythromycin, clarithromycin, itraconazole and grapefruit juice, should be taken with caution in conjunction with Cialis, since an increase in plasma concentrations of the drug can be expected.

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The selective inducer of CYP3A4, rifampin (rifampicin, 600 mg per day), reduces the effect of a single dose of Cialis (AUC) (10 mg) by 88% and Cmax by 46%, relative to AUC and Cmax values ​​with Cialis monotherapy. Reducing the effect of the drug can reduce the effectiveness of Cialis; the magnitude of the decrease in efficiency is unknown. When taking the drug once a day, you can expect a decrease in the effectiveness of Cialis in the case of a joint appointment with rifampin. The simultaneous use of other inducers of CYP3A4, such as phenobarbital, phenytoin and carbamazepine, may also lead to a decrease in the plasma concentration of Cialis.

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Simultaneous administration of antacids (magnesium hydroxide / aluminum hydroxide) and Cialis reduces the absorption rate of the drug without changing the area under the pharmacokinetic curve (AUC) for Cialis.

Cialis does not affect the effect of warfarin in relation to prothrombin time.

An increase in gastric pH as a result of taking the histamine H 2 receptor blocker nizatidine did not affect the pharmacokinetics of Cialis. The safety and efficacy of using Cialis in combination with other PDE5 inhibitors or alternative methods of treating erectile dysfunction have not been studied, therefore the use of such combinations is not recommended.

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Cialis has no clinically significant effect on the pharmacokinetics of S-warfarin or R-warfarin.

Cialis does not increase the duration of bleeding caused by acetylsalicylic acid.

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Tadalafil (10 mg, with the exception of interaction studies with angiotensin II receptor blockers and amlodipine, in which a dose of 20 mg was used) did not have a clinically significant interaction with drugs of any of these classes. In a clinical pharmacological study, the interaction of tadalafil (20 mg), taken in combination with several (up to 4) classes of antihypertensive drugs, was studied.

In patients taking multiple antihypertensive drugs, changes in blood pressure measured on an outpatient basis were correlated with measures to regulate pressure. In patients whose blood pressure was under careful drug regulation, its decrease was minimal, and similar to that in healthy study participants.

In patients whose blood pressure was not regulated, its decrease was greater, although this decrease did not lead to the appearance of hypotensive symptoms in most of the observed. In patients receiving co-administered antihypertensive drugs, tadalafil 20 mg can cause a decrease in blood pressure, which (with the exception of alpha-blockers, see above) is usually minimal and most likely does not lead to clinically significant manifestations.

Analysis of the third phase of clinical trials did not show any difference in the occurrence of side effects in patients taking tadalafil in parallel with taking antihypertensive drugs or in isolation. However, it is necessary to warn patients taking antihypertensive drugs about a possible decrease in blood pressure.

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