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Features of long-term use of Cialis in patients with erectile dysfunction.
Phosphodiesterase type 5 inhibitors are the drugs of the first choice in patients with erectile dysfunction. Tadalafil, which has been successfully used to treat erectile dysfunction on demand, can be used continuously once a day for months or even years.
The use of tadalafil contributes to a significant improvement in erectile dysfunction without side effects. Erectile dysfunction (ED) is defined as the inability to obtain or maintain a penile erection sufficient for intercourse lasting three months or more. The incidence of ED, especially in older men, is associated with many risk factors, often associated with each other: age, diabetes, atherosclerosis, arterial hypertension, pressure, obesity, smoking, alcohol abuse, and physical inactivity. Diabetes is one of the main risk factors for developing erectile dysfunction.
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Erectile dysfunction can also be an early sign of atherosclerosis and coronary heart disease. Such a relationship between the development of erectile dysfunction and the presence of concomitant diseases is due to a single mechanism – damage to the vascular endothelium.
Microangiopathies result in dysregulation of the nitric oxide (NO) system. Formed in nerve endings and endothelial cells during sexual arousal, NO activates the guanylate cyclase system, leading to an increase in the concentration of cyclic guanosine monophosphate (cGMP). cGMP activates a specific protein kinase, which causes a decrease in the calcium concentration inside the cell and relaxation of the smooth muscle cells of the arteries, which leads to an increase in blood flow to the cavernous bodies of the penis and the appearance of an erection.
With insufficient production of NO by ischemic or damaged endothelium, the concentration of cGMP in vascular smooth muscle cells decreases, as a result of which there is no increase in blood flow to the cavernous bodies and no effective erection occurs. However, the tissue concentration of cGMP is regulated by both the rate of synthesis and the rate of its destruction under the action of PDE-5. Inhibition of cGMP degradation by phosphodiesterase 5 inhibitors leads to an increase in its concentration in smooth muscle cells, which promotes erection. Initially developed as nitrovasodilators for the treatment of coronary heart disease, PDE-5 inhibitors have demonstrated a strong affinity specifically for the vascular endothelium of the cavernous tissue.
The three most popular type 5 PDE inhibitors are sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). The pharmacokinetics of these drugs differ significantly. The half-life of sildenafil and vardenafil is 4 hours, tadalafil is 16-17 hours.
Recently, a number of studies have been conducted proving that the constant use of tadalafil not only helps maintain erectile function but can also be used to treat benign prostatic hyperplasia.
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Tadalafil with long-term use in doses of Cialis 2.5 / 5 mg does not affect urodynamic parameters – maximum flow, pressure during urination. When taking tadalafil at a dose of 5 mg once a day, the quality of men’s sexual life is significantly higher.
As part of an increase in the number of studies on the subsequent use of Cialis Daily in the clinical setting, the discussion of side effects and complications associated with taking the drug continues.
Many men with erectile dysfunction have comorbidities of the cardiovascular system, and the safety of treating such patients is of particular concern. In a multicenter study in 36 clinics, the dynamics of cardiovascular diseases were assessed when taking tadalafil at a dose of 2.5 mg per day. The study included 12,000 men (mean age) with erectile dysfunction treated with tadalafil. The study did not include patients with premature ejaculation, penile prostheses, anatomical abnormalities, or secondary erectile dysfunction (eg, hypogonadism).
At the beginning of the study, the structure of comorbidities was as follows: arterial hypertension – 31%, diabetes mellitus – 21%, hyperlipidemia – 17%. Cases of adverse cardiovascular events (ACV) were retrospectively analyzed: myocardial infarction, sudden cardiovascular and cerebrovascular death. Patients were also divided into risk groups, including obesity, smoking, and age over 65 years.
The data show that the incidence of serious cardiovascular events in the early stages of treatment with tadalafil ranged from 0.17/100 to 0.54/100 cases in placebo-controlled and open studies. The incidence of serious cardiovascular events was comparable in men with erectile dysfunction treated with tadalafil and men treated with a placebo.
In conclusion, the drug tadalafil, successfully used for the treatment of erectile dysfunction on demand, can be used continuously once a day for several months or even years. Estimates of the long-term use of the Cialis brand are high, especially considering the interests of both partners, and the side effects are comparable to placebo.
At the same time, the study evaluated the effect of tadalafil treatment on serological biomarkers of endothelial dysfunction, reflecting inflammatory and oxidative processes in the arteries. The study did not reveal statistically significant changes in the levels of C-reactive protein, nitrotyrosine and other markers in any of the treatment groups. No significant changes in carbohydrate metabolism were observed during the study. Side effects reported in patients included headache, back pain, and dyspepsia. Lower back pain was significantly more common in patients taking tadalafil 5 mg than in patients taking Cialis 2.5 mg.
Since erectile dysfunction is a chronic disease requiring ongoing treatment, along with the studies described above, the efficacy and safety of long-term use of tadalafil was studied.
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No serious side effects were identified during the study, the most common of which were: dyspepsia, headache, flu-like symptoms, nasopharyngitis, and back pain.
An important aspect of tadalafil therapy is the once-daily regimen. – the time of onset of the clinical effect of the drug. The study of this aspect was devoted to a randomized multicenter study in comparison with a placebo. The number of patients who had successful intercourse between day 1 and day 2 of tadalafil was statistically significantly higher compared to placebo. On day 10 of treatment, 10% of patients taking tadalafil 68 mg reported successful intercourse attempts compared with 5% of patients taking placebo. Thus, taking tadalafil at a dose of 37 mg/day significantly improves sexual function after 5 days.
The effect of regular Cialis intake on vascular endothelial function and its ability to improve erection after discontinuation of the drug was studied in an open crossover study comparing Cialis at a dose of 20 mg every other day with the same dose on demand. In this study, the benefit of regular tadalafil administration was demonstrated by a positive effect on characteristics of vascular endothelial function of the corpora cavernosa, such as penile Doppler data (peak systolic velocity and corpus cavernosum dilatation index). . In the group of patients taking tadalafil, a more significant improvement in spontaneous erections was regularly noted, and the positive effects of the drug were noted 2 weeks after its withdrawal.
Thus, according to clinical studies, treatment with tadalafil once a day is effective and safe. Efficiency does not decrease with prolonged use of the drug, and the frequency of side effects is relatively lower when taking tadalafil in the « on-demand » regimen.
The undoubted advantages of this treatment regimen include the complete absence of psychological dependence, given the round-the-clock effectiveness, and a positive effect on the quality of life of patients and their partners.
Treatment with Cialis Daily does not depend on food and alcohol intake, allowing the patient to lead a normal life without changing habits and maintaining the spontaneity of sexual activity. The effect of the regular use of tadalafil in relatively small doses develops quite quickly and persists throughout the entire time of taking the drug. A positive effect on the function of the endothelium of the corpora cavernosa indicates that tadalafil, with regular long-term use, can improve erection even after discontinuation of the drug.
