Tell your health care provider if you:

• have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack
• have low blood pressure or have high blood pressure that is not controlled
• have had a stroke
• have liver problems
• have kidney problems or require dialysis
• have retinitis pigmentosa, a rare genetic (runs in families) eye disease
• have stomach ulcers
• have a bleeding problem
• have a deformed penis shape or Peyronie’s disease
• have had an erection that lasted more than 4 hours
• have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia

Tell your doctor about all the medicines you take including prescription and non-prescription
medicines, vitamins, and herbal supplements. Cialis and other medicines may affect each other.
Especially tell your doctor if you take any of the following:
• medicines called nitrates
• medicines called alpha blockers. These include Hytrin®?(terazosin), Flomax®?(tamsulosin), Cardura®?(doxazosin), Minipress®?(prazosin) or Uroxatral?(alfuzosin).
• ritonavir (Norvir®) or indinavir (Crixivan®)
• ketoconazole or itraconazole (such as Nizoral®?or Sporanox®)
• erythromycin
• other medicines or treatments for ED

Allergies- Tell your doctor if you have ever had any unusual or allergic reaction to tadalafil. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy-Tadalafil is for use in men only. Tadalafil has not been studied in pregnant women. Tadalafil has not been shown to cause birth defects or other problems in animals.

Breast-feeding-Tadalafil is for use in men only. It is not known whether tadalafil passes into human breast milk.

Children-Tadalfil is not for use in children.

Older adults-This medicine has been tested in a limited number of patients 65 years of age or older and has not been shown to cause different side effects or problems in older people than it does in younger adults.

Other medicines-Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking tadalafil, it is especially important that your doctor and pharmacist know if you are taking any of the following: " Erectile dysfunction medicines-these medicines should not be used at the same time as tadalafil because the safety of using these medicines in combination has not been proven. " Nitrates (medicine used to treat chest pain [e.g., nitroglycerin])-these medicines should not be used at the same time as tadalafil because they can cause very low blood pressure and serious side effects " Alcoholic beverages- drinking alcohol can cause an increased chance of some side effects. " Alpha blockers, other than tamsulosin 0.4 mg taken once a day (medicine for high blood pressure)-these medicines should not be used at the same time as tadalafil because they can cause very low blood pressure and serious side effects " Erythromycin (e.g., Apo-erythro) or " Itraconazole (e.g., Sporanox) or " Ketoconazole (e.g., Nizoral) or " Grapefruit juice or " Ritonavir (e.g., Norvir) or " Saquinavir (e.g., Fortovase, Invirase)-These medicines or food may increase your chance of getting side effects.

Other medical problems-The presence of other medical problems may affect the use of tadalafil. Make sure you tell your doctor if you have any other medical problems, especially:

• Angina
• Arrhythmia
• Hypotension
• Hypertension
• Stroke
• Heart attack
• Heart failure
• Retinal disorders
• Kidney disease (severe)-Cialis should be used with caution in these patients and a lower dose may be needed
• Liver disease-Cialis should not be used in patients with serious liver disease; in patients with less serious liver disease, tadalafil should be used with caution and a lower dose may be needed
• Abnormal penis, including curved penis and birth defects of the penis-chance of problems occurring may be increased and this medicine should be used with caution in these patients
• Bleeding disorders
• Stomach ulcers-chance of problems occurring may be increased; it is not known if the medicine is safe for use in these patients
• Heart disease, underlying-chance of low blood pressure occurring is greater; tadalafil should be used carefully in these patients
• Heart blood flow problems-these conditions may cause you to be more sensitive to tadalafil
• Sickle-cell anemia
• Bone marrow cancer
• Leukemia (blood related cancer)-tadalafil should be used with caution in these patients as problems with prolonged erection of the penis may occur