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From arousal to erection: how Cialis® Together works
Cialis® Together contains 10mg of tadalafil, which increases blood flow to the penis during sexual stimulation. This helps people with erectile dysfunction (ED) to get and maintain an erection for successful intercourse for up to 36 hours, but only when sexually aroused.
Cialis® Together belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. These treatments block the action of the PDE5 enzyme a protein that normally works to make an erect penis soft again.3,4 By blocking PDE5, Cialis® Together enhances the effect of the body’s natural erection producing chemicals, like nitric oxide (NO) and cyclic guanosine monophosphate (cGMP).4,5
This causes relaxation of smooth muscle in the penile tissues, leading to inflow of blood to the penis, which produces an erection.4
Cialis® Together only works with sexual stimulation, and the erection should subside after sexual activity.
The science behind Cialis® Together
Nitric oxide release
During sexual stimulation, NO is released into the corpus cavernosum3,4
cGMP production
Influx of NO results in the production of cGMP3,4
Increased blood flow
Accumulation of cGMP leads to smooth muscle relaxation in the corpus cavernosum and increased blood flow to the penis, producing an erection3–5
PDE5
An erection is stopped by an enzyme called PDE5, which breaks down cGMP and reduces blood flow to the penis3–5
Cialis® Together
Cialis® Together is a selective, reversible inhibitor of cGMP-specific PDE5. Blocking PDE5 increases the levels of cGMP in the corpus cavernosum, facilitating smooth muscle relaxation and blood flow to the penis. This helps people with ED achieve and maintain an erection when they're sexually stimulated.3,4
In two clinical studies involving 706 patients with ED, Cialis® Together demonstrated significant improvement vs placebo in:
When it comes to ED medication, time matters
Increased spontaneity6
Over 5x greater improvement from baseline in spontaneity domain score vs sildenafil 50mg (LS mean change from baseline = 0.13 vs. 0.02, respectively; P=0.010)
Greater sexual
self-confidence6
27% greater improvement from baseline in sexual self-confidence domain score vs sildenafil 50mg (LS mean change from baseline = 0.93 vs 0.73, respectively; P=0.001)
Reduced time concerns6
3x greater reduction from baseline in time concerns domain score vs sildenafil 50mg (LS mean change from baseline = -0.08 vs 0.04, respectively; P=0.008)
Safety and tolerability
Generally well tolerated,
with a similar safety profile to sildenafil6,7
Supported by 20 years
of real-world clinical experience
as a prescription-only medicine8
Commonly reported side effects (occuring in ≥1/100 to <1/10 patients)
of Cialis® Together are headache, flushing, nasal congestion, dyspepsia,
back pain, myalgia and pain in extremities.
Please, you can help provide more information on the safety of this medicine by reporting side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
The reported adverse reactions were transient, and generally mild or moderate.
Cialis® Together has negligible influence on the ability to drive or use machines. Although the frequency of reports of dizziness in placebo and tadalafil arms in clinical trials was similar, patients should be aware of how they react to Cialis® Together, before driving or using machines.
See Cialis® Together Summary of Product Characteristics for full safety information.
What healthcare experts say
“ Cialis Together is effective for up to 36 hours. Whilst it does last longer than sildenafil, its safety profile is similar with lower cases of headaches – a common side effect with ED treatments.”
-Fin McCaul, Pharmacist
“ Cialis Together contains tadalafil, a PDE5 inhibitor- first line treatment for ED, that is now available over the counter. Using a streamlined checklist with only 9 questions it is easier than ever to provide treatment to consumers.”
-Fin McCaul, Pharmacist
“ Customers now have the option to complete the checklist online as well as instore with you. Due to interactions with other medications, it is important to go through this to ensure safe supply.”
-Fin McCaul, Pharmacist
Providing Cialis® Together
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Indicated in adult men (aged ≥18 years) with ED
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Recommended dose of Cialis® Together is one 10mg tablet taken at least 30 minutes prior to anticipated sexual activity
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Maximum dose frequency is one tablet per day. Cialis® Together is not recommended for continuous daily use. Men who use this product frequently (i.e. at least twice weekly) should consult their physician to discuss whether a once-daily regimen with the lowest doses of tadalafil would be more suitable
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Can be taken with or without food, consumption of alcohol shall be limited to small or moderate amounts
Cialis® Together is available to order from your wholesaler of choice.
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Adult men with ED who are ≥18 years of age are suitable for Cialis® Together.
No dose adjustments required in:
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Elderly patients
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Patients with mild or moderate hepatic or renal impairment
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Patients with diabetes*
* Specific interaction studies with antidiabetic medicinal products were not conducted.
See Cialis® Together Summary of Product Characteristics for full eligibility criteria and warnings and precautions.
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Cialis® Together is not indicated for women, or men under 18 years of age. It is not intended for use by men without ED.
Other patients who should not take Cialis® Together include:
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Men with cardiac disease for whom sexual activity is inadvisable
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Patients who have loss of vision in one eye due to non-arteritic anterior ischaemic optic neuropathy
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People who use nitric oxide donors (such as amyl nitrite [“poppers”], nicorandil or molsidomine) or nitrates in any form
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Patients taking guanylate cyclase stimulators such as riociguat
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Patients with anatomical deformations of the penis
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Patients with hypersensitivity to the active substance or any of the excipients listed in section 6.1 of the Summary of Product Characteristics
The following groups of patients with cardiovascular disease (CVD) are also not suitable:
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Myocardial infarction within the last 90 days
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Unstable angina or angina occurring during sexual intercourse
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New York Heart Association Class 2 or greater heart failure in the last 6 months
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Uncontrolled arrhythmias, hypotension (<90/50mmHG), or uncontrolled hypertension
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Stroke within the last 6 months
See Cialis® Together Summary of Product Characteristics for full eligibility criteria and warnings and precautions.
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Refer patients to their GP before providing Cialis® Together if they:
- Have conditions that may predispose them to priapism (such as sickle cell anaemia, multiple myeloma or leukaemia)
- Are receiving concomitant treatment with alpha blockers or CYP3A4 inhibitors
- Have severe renal or hepatic impairment
- Have undergone pelvic surgery or radical non-nerve sparing prostatectomy
- Have a known hereditary degenerative retinal disorder such as retinitis pigmentosa
- Have left ventricular outflow obstruction or multiple system atrophy
- Show no improvement of ED symptoms after taking Cialis® Together on several consecutive occasions or if ED worsens
See Cialis® Together Summary of Product Characteristics for full eligibility criteria and warnings and precautions.
You’re not just helping patients. You’re helping their partners too9,10
Talking together
Sometimes, talking about sensitive subjects like ED requires a bit more consideration.
To help you out, we've included some conversation starters that might be useful when discussing ED and Cialis® Together with your patients.
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ED is when a person cannot get, or keep a hard, erect penis suitable for sexual activity. It can occur at any age but is most common in people over 40 years old.11
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Cialis® Together works by increasing blood flow into your penis when you’re sexually stimulated, helping you to get and keep an erection.
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One tablet will help you respond to your partner for up to 36 hours. This doesn’t mean you will have a constant erection for 36 hours, as you need to be sexually stimulated for Cialis® Together to work.
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Obesity, smoking, lack of exercise, excessive alcohol consumption and substance abuse can all contribute to ED.11 As well as taking your ED medication, could you make any changes to your current lifestyle to try and limit these risk factors?
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Your ED could be an early warning sign of another condition, like heart disease or diabetes.
It is recommended to schedule an appointment with your GP in the next 6 months for a health check, where they might look at things like testosterone, blood sugar, cholesterol, and blood pressure.
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Most people will achieve an erection the first or second time they use Cialis® Together.
However, patients may need to take Cialis® Together a number of times on different occasions (maximum one 10mg tablet per day) before they can achieve a penile erection satisfactory for sexual activity. If symptoms of ED have not improved after taking Cialis® Together on several consecutive occasions, or if their erectile dysfunction worsens, patients should be advised to consult their physician.
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Patients can consume alcohol with Cialis® Together. However, excessive alcohol consumption may temporarily reduce a man's ability to get an erection, and consuming alcohol with Cialis® Together may increase the risk of dizziness when standing up. Patients should be advised not to drink large amounts of alcohol before sexual activity.12
Pharmacy materials
Learn how your pharmacy and Cialis® Together can help those with ED.
Some handy resources to support you in providing Cialis® Together, from the initial patient consultation through to repeat purchases and patient referral.
Pharmacist checklist quick guide
A concise guide to assist assessment of a patient’s suitability for Cialis® Together
Checklist for patient use
Completed by patients to determine their suitability for Cialis® Together
Referral and repeat purchase cards
Information cards to complete and give to patients based on the outcome of their assessment
Pharmacy guide
Summarises key product information to aid understanding of who is suitable for Cialis® Together and what advice to give
Full Cialis® Together product information
Did you know?
A projected 8 million men in the UK experienced ED in 202113
Click below to find out more about ED.
- Cialis Together 10mg tablets. Summary of Product Characteristics. February 2023.
- Viagra Connect®. Summary of Product Characteristics. October 2022.
- Burnett AL. J Clin Hypertens 2006; 8(12 Suppl 4): 53–62..
- Huang S and Lie JD. PT 2013; 38(7): 407–419
- Cruz-Burgos M et al. Front Oncol 2021; 11: 627229.
- Hatzimouratidis K et al. Int J Impot Res 2014; 26(6): 223–229.
- Eardley I et al. BJU Int 2005; 96(9): 1323–1332.
- Sanofi Data on File. Prepared: 10.02.2023.
- Hackett G et al. J Sex Med 2018; 15(4): 430–457.
- Elterman DS et al. Res Rep Urol 2021; 13: 79–86.
- NHS. Erectile dysfunction (impotence) July 2023. Available at https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/. Accessed: August 2023.
- Cialis® Together. Patient Information Leaflet. January 2023.
- Estimated from the Office for National Statistics (ONS) 2021 UK population data and Irrational quantitative survey 2021, where 3,445 (i.e. 34%) of 10,197 adult men qualified or identified as suffering from Erectile Dysfunction.
- Dean J et al. J Sex Med 2006; 3(4): 650–661.
Abbreviations
cGMP, cyclic guanosine monophosphate; CVD, cardiovascular disease; CYP3A4, cytochrome P450 3A4; ED, erectile dysfunction; GP, general practitioner; LS, least squares; NO, nitric oxide; OTC, over-the-counter; PDE5, phosphodiesterase type 5.
References:
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.