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    The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability.
    Counsel patients not to take CIALIS more than once each day.
    If your patient misses a dose, he may take it when he remembers.
    Men may respond differently.
    CIALIS is contraindicated in patients using any form of organic nitrate, either regularly and/or intermittently, as the combination could cause a sudden, unsafe drop in blood pressure.
    CIALIS is contraindicated in patients using a guanylate cyclase (GC) stimulator, such as riociguat.

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    PDE5 inhibitors, including CIALIS, may potentiate the hypotensive effects of GC stimulators.
    Patients should stop sexual activity and get medical help right away if they experience symptoms such as chest pain, dizziness, or nausea during sex.
    The most common side effects with CIALIS are headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose.
    These side effects usually go away after a few hours.
    Back pain and muscle aches usually go away within 2 days.
    Creatinine clearance 30 to 50 mL/min: A starting dose of 2.5 mg is recommended.
    Mild or moderate (Child-Pugh Class A or B): CIALIS for once daily use has not been extensively evaluated in patients with hepatic impairment.

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