If you are not under the regular care of a physician, or have never before consulted your doctor about your ED, you should have a complete medical history and physical examination to determine the cause of your impotence before taking Cialis®. Although the changes in retinal function were temporary in men who took the recommended dose, and occurred in only 3% of those participating in the clinical trials, people with eye conditions affecting the retina, such as macular degeneration or retinitis pigmentosa, should be cautious about using Cialis®. In addition, side effects associated with Cialis® could have potentially serious consequences for some men. Cialis® does not work for everyone suffering from ED, and no evidence suggests that Cialis® enhances the performance of healthy potent men. Also, physicians are concerned that some men will experiment with higher-than-recom-mended doses.

One concern is that healthy men are seeking to take Cialis® as a way to enhance their sexual performance and pleasure. According to one newspaper report, as many as 40,000 people a day were seeking prescriptions. During the first month of availability, demand for Cialis® was unprecedented. The bad news is a real danger of misuse and overuse, partly because of the level of media attention Cialis® has received. Patients taking long-acting or short-acting nitrate drugs; Caution should be exercised in patients: with stable coronary disease (pre-tadalafil treadmill test may be indicated to assess the risk of cardiac ischemia during sexual intercourse); with congestive heart failure who have borderline low blood pressure and low volume status; who are on a complicated, multidrug, antihypertension therapy regimen; who are on other medications or have conditions that can prolong the duration of action of tadalafil. Now, men from all walks of life, including former Senator Robert Dole, are willing to discuss it on national television. The good news is that it has drawn much-needed attention to a problem that has been undertreated, primarily because men have felt uncomfortable discussing it with their doctors. The FDA approval of Cialis® in March 1998 created tremendous excitement in the medical community and in the general public.