Manual Tadalafil Treatment Plan

Thank you for choosing Manual. We were happy to approve your Tadalafil order, and now want to provide you with a few pieces of additional advice to help improve your treatment. We understand this is an initial step in your journey to improve your erectile dysfunction (ED) and general wellness, and we want to be here to support you through the whole process. Any worries, concerns, questions – we are here for you.

As a first step it’s important for you to take the time to read the manufacturer’s patient information leaflet (PIL) enclosed in your box. This gives you a lot of information about how to take the medication, what to avoid, side-effects and potential interactions with other medications.

Causes of ED

Now your Tadalafil is being freshly packed for you and it’s a good start, but we also advise exploring if there are any underlying causes that may need more specific treatment.

So broadly speaking there are two main causes of ED: physical (organic) and psychological causes. In most men usually it’s a combination of factors. Typically those over 40 years of age are more likely to have more physical elements limiting their ability to get erections, and those under 40 have a tendency to be impacted by more psychological factors. Now this is a generalisation, and so it’s always advisable to look a bit deeper into the causes.

Morning erections are also a good indication of the cause. They are the body’s way of providing oxygen to preserve the penis. Now loss of night-time/morning erections strongly suggests a more physical (organic) cause.

When we say physical (organic) causes this covers a spectrum of issues that include high blood pressure, diabetes, high cholesterol, thyroid conditions, prostate problems, abnormal hormone levels, and anatomical issues such as a tight foreskin.

Psychological causes range from new relationship anxiety, depression, stress, porn-addiction. Typically this ED is improved during holidays or reduced stress. Often you still have morning erections with these causes.

As part of a full assessment of your ED, if you haven’t had these tests before (or in the last year), we advise arranging to see your regular GP/doctor for a number of checks which include:

  • Cardiovascular health: Blood pressure measurements and a cholesterol blood test. There is now overwhelming evidence that ED is strongly associated with cardiovascular disease. The penile blood vessels gradually get narrower over time, and this limits the blood flow needed to sustain an erection.
  • Diabetes: A blood sugar level test also known as HbA1c. Diabetes is a cause of ED.
  • Hormone imbalance: Check your testosterone, prolactin and thyroid levels. Hormonal imbalances may contribute to ED.  
  • Prostate assessment: This may be advised in your case, especially if you have prostate symptoms (such as poor urinary stream, frequency of urinating etc.). This can involve a blood test and physical examination of your prostate gland.
  • Depression/Anxiety/Psychosexual issues: If you believe you may have underlying problems which could be leading to a psychological cause for your ED, its best to explore this further with your GP or seek psychosexual counselling. It’s good to talk.
  • Smoking: May cause damage to your blood vessels, affecting blood flow and hence contributing to ED. If you are a smoker, it is worth trying to quit to improve your overall health too. Joining a smoking cessation service has been shown to be a more effective way to quit smoking.
  • Alcohol: Drink within limits! The combination of excessive alcohol and sildenafil may cause a drop in blood pressure, lowering testosterone and impacting your erections.  
  • BMI: A healthy BMI (Body Mass Index) not only helps improve ED but your overall health. Having a healthy weight reduces risks of developing diabetes, high blood pressure and high cholesterol. As outlined above,  all these factors may contribute to the physical causes of ED. It is important to maintain a healthy weight by eating a balanced diet and exercising regularly!

What is Tadalafil?

In 2003, the pharmaceutical company named Eli Lilly launched Cialis as an alternative ED medication. Cialis is the original brand of the active ingredient ‘Tadalafil’. Like, Viagra was for Sildenafil. The patent for Cialis (Tadalafil) lasted until November 2017, and now generic (unbranded) versions are allowed by other companies. Tadalafil belongs to the same family, known as phosphodiesterase-5 (PDE5) inhibitors, which work to relax the smooth muscle in the penis and increase blood food in order to promote and sustain an erection.

More about Tadalafil and Erections?

It’s hard to get hard: your brain, heart, hormones and a few other bits and bobs all need to come together – which can be tricky at any age. Sometimes this all breaks down and you can’t get or stay hard long enough to have satisfactory sexual intercourse – a condition known as erectile dysfunction. This is where we can help! So the Tadalafil we have prescribed you,  is one of the most popular tablets that is given to men who need help with ED. By being both a safe and effective treatment, its use is commonly approved in a countless number of men across the globe, who experience different degrees and causes of ED.

It’s the generic unbranded version of Cialis and it’s just as effective. Tadalafil is a common treatment for ED, known to last upto 36 hours and clinically proven to be a highly effective treatment for most men. Take it as you need it. Enjoy sex, and reduce your worries about not getting an erection!

How Tadalafil works?

It works by inhibiting an enzyme known as phosphodiesterase inhibitor (PDE5) associated with muscle contraction in penile tissue. Tadalafil allows the blood vessels to relax and expand, leading to increased blood flow into the penis and Voila you have an erection! Don’t forget it works only when you are sexually stimulated and there is some va va voom.

Be aware Tadalafil does not protect you from sexually transmitted diseases (STDs), a condom does.

How do I take it?

  • Take one tablet of Tadalafil 30 minutes before sex, which can last upto 36 hours. Its long acting nature makes it suitable for spontaneous sex.
  • Unlike Sildenafil, its onset of effectiveness is not delayed by food, and it can be taken at a spontaneous time in your daily routine!
  • Drink within limits (14 units per week). More than 2 units of alcohol will make tadalafil less effective.
  • Do not take more than one tablet within 24 hours, if Tadalafil is not effective after sexual stimulation, please speak to our clinicians.
  • Tadalafil should not be taken within 24 hours of taking other ED medication such as Viagra, Levitra or Spedra.
  • If you are taking any other medications whether over the counter or prescription only medications, please make sure the clinicians are aware (if not already mentioned in your clinical questionnaire).
  • It is important that you are aware of certain ‘street drugs’ may interact with Tadalafil. If you are using illicit drugs e.g. ‘Aromas, Poppers or Odorisers’, please make sure the clinicians are aware as the combination could be dangerously fatal!

How effective is Tadalafil?

Tadalafil is known to be the faster and longer acting brother of Sildenafil. It can work within 30mins compared with 1 hour with Sildenafil and its effects can last for 36 hours compared with 4.5 hours with Sildenafil. This does not mean you would have erections that won’t settle! It could allow you to achieve erections without having to plan your dosage timing in advance of sex. You could get away with taking one pill on a Friday night and this drug could help last you over the weekend. If Tadalafil does not work for you, please do not give up and get in contact with our clinicians who are happy to help.

What are the side-effects?

Phosphodiesterase inhibitors are generally safe and well tolerated, however all medicines have the potential for causing side-effects. The good news is, the majority of these are mild and not all men get them and in fact, research data has indicated tadalafil to have the lowest rate of adverse effects, showcasing it as having the highest tolerability profile.

Side-effects include lightheadedness, headaches, indigestion, muscle aches, facial flushing and nasal congestion. Symptoms could last longer in some individuals, owing to the longer duration of action of tadalafil in comparison to sildenafil. However, these are usually mild and not every patient experiences these symptoms.

More serious side-effects, which are rare include; breathing difficulties, visual disturbances, kidney or liver dysfunction, widespread rashes, agitation, chest pain, anaphylaxis (a severe allergic reaction) and priapism (a painful and persistent erection that lasts for > 4 hours). If any of the rare but serious side-effects happen please go to your local Accident and Emergency immediately or call 999. If you have any concerns regarding the side-effects, please stop taking the medication and contact us via your Manual record.

What if I am taking other medicines?

It is important that you are completely honest with us when completing the questionnaire as some medicines are not safe to take with Tadalafil.

Interactions include:

Alpha blockers (such as tamsulosin, alfuzosin, doxazosin or terazosin). This could result to your blood pressure dropping dangerously low. Tadalafil should NOT be taken with alpha blockers.

Nitrates (such as GTN (Glyceryl trinitrate) commonly used to manage chest pain associated with angina, or rectal GTN ointment used for anal fissures). The combination of nitrates with sildenafil may result to your blood pressure to drop dangerously low. DO NOT TAKE Tadalafil if you have been prescribed Nitrates.

Please inform our clinicians via your patient account messaging facility: if you start taking any new medicines or if there are any significant changes to your medical history. Also if you experience any significant side-effects or want further advice on your treatment.

It is also important you inform your GP about the medicines you take, so they are fully informed. So it is advisable that you inform them of what you have been prescribed.

Until then, we hope to see you back again!