special instructions With extreme caution and only in case of emergency it is possible to use tadalafil in patients with severe renal failure (CC ≤ 30 ml / min) and severe liver failure. During treatment with tadalafil, patients with moderate renal insufficiency (CC from 31 to 50 ml / min) were more likely to have back pain compared with patients with mild renal insufficiency (CC from 51 to 80 ml / min) or healthy volunteers . In patients with CC ≤ 50 ml / min, tadalafil should be used with caution. Therefore, the treatment of erectile dysfunction, including with tadalafil should not be used in men with heart diseases in which sexual activity is not recommended. The potential risk of complications due to sexual activity in patients with diseases of the cardiovascular system should be considered: myocardial infarction in the last 90 days; unstable angina or angina that occurs during intercourse; chronic heart failure (NYHA functional class II and above), which has developed over the past 6 months; uncontrolled heart rhythm disturbances; arterial hypotension (blood pressure less than 90/50 mm Hg) or uncontrolled arterial hypertension; stroke suffered in the last 6 months. With caution, tadalafil should be used in patients with a predisposition to priapism (for example, with sickle cell anemia, multiple myeloma or leukemia) or in patients with anatomical deformation of the penis (for example, during angulation, cavernous fibrosis or Peyronie's disease). The patient should be informed of the need to immediately consult a doctor in case of an erection lasting 4 hours or more. Untimely treatment of priapism leads to damage to the tissues of the penis, as a result of this, a long-term loss of potency may occur. With the use of tadalafil, no cases of priapism have been reported. The use of tadalafil in combination with other types of treatment for erectile dysfunction is not recommended.

Erectile dysfunction (ED) is commonly called impotence. It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.

Standard ED treatments include prescription medications, vacuum pumps, implants, and surgery, but many men prefer natural options. Research has found that some natural options can improve ED symptoms. Read on to learn about natural options that have research to back them up.

Read more: ED causes »

Indications Erectile dysfunction Contraindications Simultaneous administration of preparations containing any organic nitrates; children and adolescents under 18 years of age; hypersensitivity to tadalafil Pregnancy and lactation The drug is not used in women Dosage and administration Inside. The use of Cialis as indicated by erectile dysfunction (ED). For patients with frequent sexual activity (more than 2 times a week): the recommended frequency of administration is daily, 5 mg once a day, at the same time, regardless of food intake. The daily dose can be reduced to 2.5 mg, depending on individual sensitivity. For patients with infrequent sexual activity (less than 2 times a week): it is recommended to prescribe the drug Cialis at a dose of 20 mg, immediately before sexual activity, according to the instructions for medical use of the drug. The maximum daily dose of Cialis is 20 mg. The use of Cialis as indicated by BPH or ED / BPH. The recommended dose of Cialis when used once a day is 5 mg; the drug should be taken at approximately the same time of the day, regardless of the time of sexual activity. The duration of treatment is set by the doctor individually. In patients with mild renal failure (Cl creatinine from 51 to 80 ml / min) and moderate (creatinine Cl from 31 to 50 ml / min) dose adjustment is not required. In patients with severe renal failure (Cl creatinine <30 ml / min and on hemodialysis): the use of Cialis is contraindicated

Called the herbal Viagra, Panax ginseng (red ginseng) has solid research behind it. Researchers reviewed seven studies Trusted Source of red ginseng and ED in 2008. Dosages ranged from 600 to 1,000 milligrams (mg) three times daily. They concluded there was “suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction.”

More current research is examining how red ginseng influences ED. Ginsenosides are one element present in Panax ginseng extract that have action at the cellular level to improve erection.

The action of Panax ginseng appears to be most effective Trusted Source for those with high lipids in their blood and metabolic syndrome. This herb is known Trusted Source to have anti-inflammatory action, improve lung function, and improve blood flow in other diseases — all characteristics that may reduce ED.

Side effects Most often: headache, dyspepsia. Perhaps: back pain, myalgia, nasal congestion, flushing of the face. Rarely: swelling of the eyelids, eye pain, conjunctival hyperemia, dizziness Overdose Symptoms: with a single administration to healthy individuals of tadalafil in a dose of up to 500 mg and in patients with erectile dysfunction - repeatedly up to 100 mg / day, undesirable effects were the same as when using the drug in lower doses. Treatment: in case of an overdose, standard symptomatic treatment is necessary. With hemodialysis, tadalafil is practically not excreted. Interaction with other drugs Tadalafil is mainly metabolized by the CYP3A4 enzyme. The selective inhibitor of CYP3A4 ketoconazole increases AUC by 107%, and rifampicin reduces it by 88%. Although specific interactions have not been studied, it can be assumed that protease inhibitors such as ritonavir and saquinavir, as well as CYP3A4 inhibitors such as erythromycin and itraconazole, increase tadalafil activity. With the simultaneous administration of antacid (magnesium hydroxide / aluminum hydroxide) and tadalafil, the absorption rate of the latter decreases without changing its AUC. Tadalafil enhances the hypotensive effect of nitrates. This occurs as a result of the additive effect of nitrates and tadalafil on the metabolism of nitric oxide and cGMP. Therefore, the use of tadalafil in patients receiving nitrates is contraindicated

One small study indicated that Rhodiola rosea may be helpful. Twenty-six out of 35 men were given 150 to 200 mg a day for three months. They experienced substantially improved sexual function. This herb has been shown to improve energy and reduce fatigue. More studies are needed to understand action and ensure safety.

Dosage and administration Inside. The use of Cialis as indicated by erectile dysfunction (ED). For patients with frequent sexual activity (more than 2 times a week): the recommended frequency of administration is daily, 5 mg once a day, at the same time, regardless of food intake. The daily dose can be reduced to 2.5 mg, depending on individual sensitivity. For patients with infrequent sexual activity (less than 2 times a week): it is recommended to prescribe the drug Cialis at a dose of 20 mg, immediately before sexual activity, according to the instructions for medical use of the drug. The maximum daily dose of Cialis is 20 mg. The use of Cialis as indicated by BPH or ED / BPH. The recommended dose of Cialis when used once a day is 5 mg; the drug should be taken at approximately the same time of the day, regardless of the time of sexual activity. The duration of treatment is set by the doctor individually. In patients with mild renal failure (Cl creatinine from 51 to 80 ml / min) and moderate (creatinine Cl from 31 to 50 ml / min) dose adjustment is not required. In patients with severe renal failure (Cl creatinine <30 ml / min and on hemodialysis): the use of Cialis is contraindicated

Dehydroepiandrosterone (DHEA) is a natural hormone produced by your adrenal glands. It can be converted to both estrogen and testosterone in the body. Scientists make the dietary supplement from wild yam and soy.

The influential Massachusetts male aging study Trusted Source showed that men with ED were more likely to have low levels of DHEA. In 2009, 40 men with ED participated in another study in which half receiving 50 mg DHEA and half receiving a placebo once a day for six months. Those receiving the DHEA were more likely to achieve and maintain an erection.

More recently, DHEA has been identified as an option for treatment of ED for men with concurrent diabetes. ED commonly affects these men because of hormonal issues as well as diabetes complications that interfere with blood flow to organs.

L-arginine is an amino acid naturally present in your body. It helps make nitric oxide. Nitric oxide relaxes blood vessels to facilitate a successful erection and is essential for healthy sexual functioning.

Researchers studied Trusted Source the effects of L-arginine on ED. Thirty-one percent of men with ED taking 5 grams of L-arginine per day experienced significant improvements in sexual function.

A second study Trusted Source showed that L-arginine combined with pycnogenol, a plant product from tree bark, restored sexual ability to 80 percent of participants after two months. Ninety-two percent had restored sexual ability after three months.

Another placebo-controlled study Trusted Source found that L-arginine in combination with other medications was well-tolerated, safe, and effective for mild-to-moderate ED.

Though studies are mixed, many show positive results when acupuncture is used to treat ED. A 1999 study Trusted Source , for example, found that acupuncture improved the quality of erections and restored sexual activity in 39 percent of participants.

A later study published in 2003 Trusted Source reported that 21 percent of ED patients who received acupuncture had improved erections. Other studies have shown conflicting results, but this treatment has potential and may work for you.

The risks of acupuncture Trusted Source are low if provided by a licensed acupuncturist. Acupuncture shows promise for treating ED, but more studies are needed.

This supplement is extracted from the bark of the African yohimbe tree. Some studies Trusted Source have shown positive effects on sexual performance with use of this drug.

However, the American Urological Association doesn’t recommend yohimbe as an ED treatment. This is because there’s not a lot of evidence proving it works. Its side effects might be damaging to health. These include increased blood pressure and heart rate, irritability, and tremor.

If you decide you want to try yohimbe, be sure to talk to your doctor beforehand.

Read more: Medications to treat ED »

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Other alternative therapies thought to help ED include zinc supplements (especially for men who are low in zinc), the herb ashwagandha (also called Indian ginseng), and ginkgo biloba, but more studies are needed to know with certainty.

If you have symptoms of ED, it’s important to check with your doctor before trying any treatments on your own. This is because ED can be a sign of other health problems. For instance, heart disease or high cholesterol could cause ED symptoms. With a diagnosis, your doctor could recommend a number of steps that would likely improve both your heart health and your ED. These steps include lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.

If other health issues aren’t found to be the cause of your ED, your doctor will likely prescribe some common treatments. However, you may also choose natural options — just be sure to discuss them with your doctor first.

Whichever route you take, keep in mind that ED is a common condition that’s very treatable. With some trial and error, you’re likely to find a treatment that works for you and your partner.

It’s important to remember that the U.S. Food and Drug Administration doesn’t regulate quality, strength, purity, or packaging of herbs. If you choose to take herbs, be sure to get them from a reliable source.

In many cases, changes to your lifestyle and diet can help ease ED symptoms. Lifestyle changes that could help improve your sexual function include exercising and losing weight. They also include stopping smoking and curbing your alcohol intake.

Your diet can also affect your sexual performance. For information on which foods might benefit you, such as cocoa and pistachios, check out this article on diet and ED.

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