Drugs Log

Canadian drug stores have begun stocking a new full-time version of an anti-impotence drug its makers say will allow men to be sexually “spontaneous,” day and night.

Cialis was originally designed to be taken on an “as needed” basis, with one dose lasting 24 to 36 hours, earning it the moniker “Le Weekend” when first approved in Europe in 2002.

Now it’s being repackaged and sold in a once-a-day, lower-dose version. Taken daily, the drug builds in a man’s body until it reaches a circulating level in the bloodstream that would allow a man to be sexually active “whenever the moment is right,” according to a news release issued by drug giant, Eli Lilly.

Dr. Gerald Brock says the once-a-day pill will appeal to men who find timing an issue.

“Taking the drug on a daily basis and having complete spontaneity is going to be a real, genuine advance,” says Brock, a urologist at St. Joseph’s Health Care in London, Ont. Brock has received speakers’ fees and research grants in the past from Eli Lilly.

Once-a-day Cialis will cost $3.80 per capsule, before dispensing fees.

Some critics are uncomfortable with the drug’s expansion and the idea of men taking erectile enhancers in perpetuity, or recreationally. Last year, more than 1.6 million prescriptions for erectile dysfunction drugs were dispensed by Canadian drugstores, according to prescription drug tracking firm IMS Health Canada. About 593,000 of those prescriptions were for tadalafil, the chemical name for Cialis.

“The limited virtue of these erectile dysfunction drugs was that men only needed to take it once in a while, as opposed to statins or osteoporosis drugs or anti-hypertensives,” says Leonore Tiefer, an associate clinical professor of psychiatry at New York University School of Medicine and Albert Einstein College of Medicine in New York.

“On the surface, it seems like it makes life easier, but we know more drugs lead to more complications. In this case, it might be interpersonal complications.

“Is this something that the sexual partner has to give consent to, or even have knowledge of? Unless they’re using it for masturbation, they’re expecting to use it with a partner. If she doesn’t know this, she’s not being given her entitlement to consent.”

Another question is safety. Cialis belongs to a class of drugs known as PDE-5 inhibitors that includes Viagra and Levitra. The pills act on the chemical signals that open up the blood vessels in the penis.

“Is it safe to take a PDE-5 inhibitor every day? It probably is. These drugs are probably much safer than Aspirin,” says Dr. J. Paul Whelan, Braley-Gordon Chair of Urology at McMaster University in Hamilton.

The drugs aren’t thought to benefit men with normal sexual function. And there can be rare side effects, Whelan says, such as severe back muscle spasms.

He says once-a-day erectile dysfunction drugs can help with what is known as “penile rehabilitation” after prostate cancer surgery.

In addition, men who experience side effects with the “on demand” Cialis may better tolerate the once-a-day version, which comes in 2.5 and 5 milligram capsules, says Brock.

“And finally, we as urologists have people who are very sexually active — they may be having sex two or three or more times per week. By taking a very small dose of Cialis every day they can actually take less medication, have greater spontaneity, have lower side effects and, I think, at the end of the day have greater patient and partner satisfaction.”

About 50 per cent of men between the ages 40 and 70 experience erectile problems but only about half of those seek help for erectile dysfunction, or ED, Brock said.

Diabetes, high cholesterol, vascular disease, smoking, stress and relationship issues can increase the risk of erectile problems, Brock said.

Side effects of Cialis include headache, facial flushing and indigestion. The drug should not be used by men who are taking nitrates or those with cardiac disease “for whom sexual activity is not advisable,” Eli Lilly says.

How should I take Cialis?

Take Cialis exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label.

Take this medication with a full glass of water.

Cialis can be taken with or without food.

Cialis is usually taken only when needed, just before sexual activity. The medication can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.

Do not take Cialis more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. Store this medication at room temperature away from moisture and heat.

What should I avoid while taking Cialis?

Avoid drinking alcohol, which can increase some of the side effects of Cialis.

Grapefruit and grapefruit juice may interact with Cialis. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.

What other drugs will affect Cialis?
Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite (”poppers”).

Before taking Cialis, tell your doctor about all other medications you use for erectile dysfunction, or if you are using any of the following medications:

• cimetidine (Tagamet, Tagamet HB);
• erythromycin (E-Mycin, Eryc, Ery-Tab) or clarithromycin (Biaxin);
• doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin);
• HIV medicines such as amprenavir (Agenerase), tipranavir (Aptivus), darunavir (Prezista), efavirenz (Sustiva), nevirapine (Viramune), indinavir (Crixivan), saquinavir (Invirase, Fortovase), lopinavir/ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), atazanavir (Reyataz), or nelfinavir (Viracept);
• itraconazole (Sporanox) or ketoconazole (Nizoral);
• carbamazepine (Tegretol), phenobarbital (Luminal), or phenytoin (Dilantin); or
• rifampin (Rifadin, Rimactane).

Keywords for this article:

• Canadian drug stores
• anti-impotence drug
• Cialis every day
• Cialis cost
• Eli Lilly