Erectile dysfunction (ED) – inability to achieve and (or) maintain an erection sufficient for sexual activity. This term was proposed in 1992 by the National Institute of Health of the U.S. instead of the term “impotence” and most accurately reflects the essence of the problem.
ED may be suspected if persistent or recurrent inability to attain and (or) keep an erection occurs in at least half of the cases. Given the pronounced negative impact of ED on quality of life of men, the need for therapy of this disorder is beyond doubt. The most effective among the drugs used to treat erectile dysfunction, now are inhibitors of phosphodiesterase 5-th type (PDE5): sildenafil (viagra), tadalafil (cialis) and vardenafil (levitra). Preparations of this group are modulators of erection: they do not cause it directly, but increase the relaxing effect of nitric oxide through cGMP by blocking the enzyme PDE5. As a result of increased blood flow in the cavernous bodies of the penis occurs and is supported by the physiological erection. It is crucial that in the absence of sexual stimulation, PDE5 inhibitors have no effect. The effectiveness of PDE5 inhibitors demonstrated at practically all forms of ED. However, most patients is accompanied by organic psychogenic factors in the development of sexual disorders. All psychological problems contribute to the weighting of ED. In most cases they are accompanied by aggravating factors, organic erectile dysfunction, at least – the immediate causes of its development. Sexual failure, which is possible in every healthy men is associated with organic sexual dysfunction, and further attempts of sexual intimacy with men waiting there fear of failure. The result is a frequent focus on erection and as a consequence of reduction of psychogenic component of erection. Anxiety occurs in men with partial or random failure during intercourse, ie at the stage of “unreliable” and not “impossible” sufficient erection, resulting in achieving an erection during subsequent sexual intercourse more difficult. As a consequence, often sexual life of patients becomes secondary, which creates prerequisites for the development of “syndrome ED”. All these factors lead to a decrease in motivation psychogenic erectile function. Thus, the optimal treatment of erectile dysfunction is the use of drugs, whose action is least likely to affect the physiological component of psychogenic sexual activity.
Such properties are possessed by the drug Cialis (tadalafil), the main feature of which is the long half-life drug – 17,5 h, which provides a significantly greater duration of its action. The presence of prolonged effect of Cialis has been demonstrated in a multicenter, randomized, double-blind, placebo-controlled study with parallel group study conducted in the United States. 483 men with ED (mean age 58 years) were randomly assigned to six equal groups of treatments (placebo, Cialis 10 mg or Cialis 20 mg) and duration of the drug (24 or 36 hours). The study noted that more than 60% of patients taking Cialis 20 mg, the duration of its effective action was 36 h.

Despite the fact that the time to reach maximum concentration of Cialis in the blood a bit more than with Viagra, it was statistically significant response to the reception teacher ¬ Rata in a dose of 20 mg was observed in 32% of patients at the 16 th minute after administration, while 52% of men — 30 th minute. In contrast to Viagra ingestion and alcohol does not cause delay or deterioration suction Cialis. Thus, when single dose of Cialis were observed effect of the drug on the concentration of alcohol in the blood and blood pressure. In the application of Cialis (20 mg), the average plasma concentration of 378 ng / ml. About 50% of the dose is metabolized under the action of cytochrome P-450, which is characterized by great genetic polymorphism. Removing Cialis provided mainly by the liver, mainly by isoenzyme CYP 3A4 [15]. According to studies, Cialis a carry ¬ comes under good, side effects are usually mild or moderate severity and usually diminish with continued treatment, the frequency cancellation due to adverse events with ¬ put 2,1% in the Cialis group and 1.3% in the placebo group. The most frequently noted headache and dyspepsia (14 and 10% respectively), less often – back pain, nasal congestion, myalgia and ¬ Livs blood to the face.

Cialis has not only a highly effective and well tolerated, but also due to long-term, returns the natural sexual relations. First and foremost is the spontaneity of intercourse and lack of time, depending on dose, as a result of research ¬ tion of psychological aspects of sexual intercourse, it was found that up to 50% of patients prefer not to schedule their sex life in advance. The patient was withdrawn direct psychological dependence on medication and it is possible to maintain the natural sexual life, which is extremely important in the presence of additional psychogenic factors, aggravating ED. For example, a study by Moncada et al. (2003) compared two modes Cialis dosage: three times a week and at the request of the patient. Patients in both groups used a long period of effectiveness of Cialis for the commission of sexual attempts without a clear time dependence of the drug – 73% of sexual attempts in group 1 and 49% in group 2 occurred after 4 h and later after taking the drug. The frequency of sexual attempts was comparable in both groups. The study authors conclude that Cialis effectiveness over a long period allows us to offer a new paradigm of treatment of ED, namely the use of the drug in the exchange rate regime, irrespective of the planned sexual activity.

Given the importance of spontaneity in sexual activity, and research data on the preferences of patients, there have been studies aimed at developing methods for continuous therapy Cialis, based on the fact that after 5 days of continuous reception in the blood plasma reached equilibrium concentration of the drug, sufficient for the development and maintenance of effect with little individual variability. Efficacy and safety of Cialis therapy 1 time a day were evaluated in various multicenter randomized placebo controlled studies in men with ED. Thus, in one study evaluated the efficacy and safety of daily Cialis therapy at a dose of 5 and 10 mg compared with placebo. The study included heterosexual men aged over 18 years with ED, is not less than 3 months. before inclusion in the study. Patients did not use any other methods of treatment of ED. Patients with ED which has developed as a result of hypogonadism, radical prostatectomy (except bilateral nerve preserving prostatectomy), severe renal or hepatic failure, decompensation of diabetes mellitus, unstable angina, requiring admission of nitrates, and cardiac failure in the study were not included. Thus, the study included 268 men who received placebo, Cialis 5 and 10 mg in the ratio 1:2:2, respectively. Treatment lasted for 12-15 weeks. Of the 268 patients completed the study 234 (50 of them received a placebo, 93 – Cialis 5 mg, 91 – Cialis 10 mg). Daily intake of Cialis at a dose of 5 and 10 mg significantly improved erectile function of patients compared with placebo. The effectiveness of the drug did not depend on the initial severity of ED. So, against a placebo increase of IIEF scores averaged 0.9, while on the background of 5 and 10 mg of Cialis – 9,7 and 9,4 (p <0,001). The percentage of patients who responded "yes" to question SEPQ2 ( «Were you able to enter the penis into the vagina partner?"), Against Helicobacter pylori eradication, placebo increased by 11,2%, and background therapy Cialis 5 and 10 mg — at 36,5 and 39,4% respectively. In addition, the percentage of patients who responded "yes" to question SEPQ3 ( «Are there still an erection long enough for successful intercourse?"), Against Helicobacter pylori eradication, placebo increased by 13,2%, and background therapy Cialis 5 and 10 mg – at 45,5 and 50,1% respectively (p <0,001). It should be noted that the complete elimination of ED was achieved only in 8.3% of men treated with placebo, whereas men treated with Cialis in doses of 5 and 10 mg, the complete elimination of ED was achieved in 51,5 and 50,5% respectively. At the same time positively to the question GAQ ("improved if therapy is carried out by your erections?") Answered 28.3% of patients treated with placebo, whereas while taking Cialis at a dose of 5 and 10 mg of the figure was 84,5 and 84, 6%, respectively. Side effects of therapy were expressed mild in 53.8% and a moderate degree in 32.8% of patients. This dyspepsia, headache, back pain, stomach, and myalgia were less common in patients who received Cialis 5 mg (from 2,8 to 6,4%), compared with patients who received Cialis 10 mg ( from 6,7% to 11,4%). Of the 34 patients who discontinued the study, 9 (3,4%) because of side effects (1 because of headache (placebo), and 1 because of headaches and dizziness (Cialis 5 mg), and 1 because of myalgia, headache, dyspepsia and dyspnea, 2 because of abdominal pain (Cialis 10 mg).
In another multicenter placebo-controlled study evaluated efficacy and safety of daily administration of Cialis at a dose of 2.5 and 5 mg in the treatment of ED. The study included 287 men. Exclusion criteria were consistent with those in the study described above. Men who previously received PDE5 inhibitor without effect, as in the study were not included. Patients were randomized into 3 groups: placebo (n = 94), Cialis 2.5 mg (n = 96) and Cialis 5 mg (n = 97). Treatment lasted for 24 weeks, with patients taking the drug at the same time, regardless of sexual activity. Against the background of daily administration of Cialis erectile function of patients improved significantly. Thus, the increase in IIEF scores among patients treated with placebo, Cialis 2.5 and 5 mg was on average 1.2, 6.1 and 7.0, respectively, while the percentage of patients who responded “yes” to question SEPQ2, against the background of Helicobacter pylori eradication amounted to respectively 5.2, 24.3 and 26.2% while for the question SEPQ3 these indicators were 9,5, 31,2 and 35,1% (p <0,001 for all parameters comparisons). At the same time positively to the GAQ question answered 26.1% of patients treated with placebo, whereas while taking Cialis at a dose of 2.5 and 5 mg of the figure was 62,8 and 72,8% respectively. Adverse effects identified in the research process, in most cases were moderate. The most frequent side effects were: nasopharyngitis, gastroenteritis, lower back pain, dyspepsia, gastroesophageal reflux, myalgia, headache and hypertension. Side effects were detected only in 2.4% of patients (placebo – 2 patients, tadalafil 2.5 mg – 2 patients; tadalafil 5 mg – 3 patients). One patient who received Cialis in dose of 2.5 mg, developed myocardial infarction, not leading to death.

Given that erectile dysfunction is a chronic disease requiring ongoing treatment, along with the above-described studies have examined the efficacy and safety of prolonged use by patients Cialis mode 1 time per day. During the study, patients aged over 18 years, with varying degrees and etiology of erectile dysfunction received Cialis 5 mg daily for 1 year (n = 234) or 2 years (n = 238). Indicators of erectile function in patients receiving Cialis for the year improved by an average of 9,6 and 8,4 points, sexual satisfaction – 3,6 and 3,0 points, overall satisfaction – 2,7 and 2,8 points respectively. In addition, a 2-year study of a positive answer to the question GAQ 78,9% of patients. The study did not reveal any serious side effects. The most frequent side effects were: a 1-year study – dyspepsia (9.4%), headache (9.4%), pain (7.3%), flu-like symptoms (5.6%) in 2 -year-old – hypertension (6.3%), nasopharyngitis (5.9%), sinusitis (5.9%) and pain (5.0%).
Thus, at present the choice of ED therapy is large enough. The drug Cialis was necessary number ¬ ethical clinical research, which has proved its effectiveness ¬ efficiency and safety in patients with ED. Cialis 10 and 20 mg of successfully treating erectile dysfunction regardless of initial severity, aetiology and associated diseases. It is well tolerated and is effective up to 36 hours after application, due to the long half-life, it can be taken once a day – a regime that some patients and their partners are less burdensome. Most of the patients and their partners for treatment of ED preferred Cialis compared with other PDE5 inhibitors. The undoubted advantages of the PREPARE ¬ ta can be attributed to a prolonged action, as well as the independence of the effect of food intake and alcohol, allowing the patient to normal life, without changing their habits. In addition, according to current clinical studies, Cialis therapy in the mode 1 time per day is also effective and safe, while the efficiency does not decrease with prolonged use of the drug, and the frequency of side effects comparable to that at the reception as Cialis online on demand, so and other PDE5 inhibitors. The undoubted advantages of this mode of therapy may include a complete lack of psychological dependence on the time of ingestion.