Cialis Together

Long-acting treatment for erectile dysfunction

Cialis Together® is a pharmacy medicine erectile dysfunction (ED) in adult men aged 18 years and over. Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity.

Cialis Together® contains tadalafil, which belongs to a group of medicines known as phosphodiesterase type-5 (PDE-5) inhibitors. It works by relaxing blood vessels in the penis, allowing blood flow into the penis during sexual stimulation and helping to achieve an erection. Cialis Together® does not cause an erection on its own; sexual stimulation is required.

Cialis Together® is available in a single 10 mg strength and is designed for on-demand use. It is known for its longer duration of action compared with some other erectile dysfunction medicines.

Access Cialis Together® following an online consultation

Start the online consultation and complete a confidential medical questionnaire.

A UK-registered pharmacist will review your information to determine whether Cialis Together® may be suitable for you. If appropriate, the medicine can be supplied following this assessment.

Important health advice

It is important to have a check-up with your doctor as soon as possible within the first 6 months of using Cialis Together® to ensure that your erection problems are not caused by another serious health condition.

Even if you feel healthy, your erection problems may be linked to other serious health conditions. Erectile dysfunction may be an early sign of:

• Heart and blood vessel problems
• Diabetes
• High blood pressure
• Depression

You should discuss your symptoms and these conditions with your doctor if you have not already done so.

What is Cialis Together®?

Cialis Together® is a pharmacy medicine for erectile dysfunction in adult men. It supports the body's natural erectile response by improving blood flow to the penis during sexual stimulation.

You can get an erection, when sexually stimulated, in 30 minutes and for up to 36 hours after taking one Cialis Together® tablet. This longer duration distinguishes Cialis Together® from some other PDE-5 inhibitors.

What is the active substance in Cialis Together®?

The active substance in Cialis Together® is tadalafil.

Tadalafil inhibits the PDE-5 enzyme, which plays a role in regulating blood flow in the penis. By inhibiting this enzyme, tadalafil enhances the natural erectile response when sexual stimulation occurs.

Who may be considered for Cialis Together®?

Cialis Together® may be suitable for men aged 18 years and over with erectile dysfunction, following a pharmacist assessment.

During the consultation, the pharmacist will consider:

• cardiovascular health and fitness for sexual activity
• current medicines (including nitrate medicines)
• relevant medical history (including liver, kidney or eye conditions)

Cialis Together® is not suitable for everyone. A pharmacist assessment is required before supply.

What dosage is available?

Cialis Together® is available as 10 mg tadalafil tablets only.

The recommended dose is one 10 mg tablet, taken as needed at least 30 minutes before sexual activity.

Do not take more than one tablet in 24 hours.

How is Cialis Together® taken?

Always take Cialis Together® exactly as described in the patient information leaflet or as advised by your pharmacist.

General guidance includes:

• Take one tablet as needed, at least 30 minutes before sexual activity
• Swallow the tablet whole with water
• Cialis Together® can be taken with or without food
• Do not take more than one tablet per day
• Sexual stimulation is required for the medicine to work

You will not get an erection just by taking Cialis Together®. This medicine will only help you get an erection if you are sexually aroused. You and your partner will need to engage in foreplay, just as you would if you were not taking a medicine for erectile dysfunction.

How long does Cialis Together® take to work and how long does it last?

You can get an erection, when sexually stimulated, in 30 minutes and for up to 36 hours after taking one Cialis Together® tablet.

Remember to relax and be patient. There is no rush. If you are not successful the first time, try to have sex again, but remember you can only take one tablet a day. For most men, Cialis Together® will work the first or second time they try it. If it has been some time since you were able to get or keep an erection, it may take several attempts before you are able to achieve an erection.

What can affect the effect of Cialis Together®?

The effect of Cialis Together® may vary depending on individual factors and circumstances. Examples that may influence response include:

• Excessive alcohol consumption (may reduce effectiveness and increase side effects)
• Underlying health conditions (e.g., diabetes or cardiovascular disease)
• Certain medicines that interact with tadalafil
• Lack of sexual arousal or stimulation

When should Cialis Together® not be used?

Do not take Cialis Together® if you:

• do not have erectile dysfunction
• are allergic to tadalafil or any of the ingredients
• take nitrate medicines (such as glyceryl trinitrate, isosorbide mononitrate, isosorbide dinitrate) or nitric oxide donors (such as amyl nitrite ("poppers"), nicorandil, molsidomine or sodium nitroprusside) for chest pain or heart failure
• take riociguat or other guanylate cyclase stimulators for high blood pressure in the lungs
• have been advised by your doctor to avoid sexual activity because of heart or blood vessel problems (such as recent heart attack within the last 90 days or stroke within the last 6 months, unstable angina or severe cardiac failure)
• have low blood pressure or uncontrolled high blood pressure
• have ever had loss of vision because of non-arteritic anterior ischemic optic neuropathy (NAION), a condition described as "stroke of the eye"
• have a deformed penis (such as angulation, cavernosal fibrosis or Peyronie's disease)

Cialis Together® is not suitable for women or for anyone under 18 years of age.

Always inform the pharmacist about your full medical history and current medicines before taking Cialis Together®.

Warnings and precautions

Cardiovascular risk factors

Sexual activity can put extra strain on your heart. If you have a heart problem or think you might have a heart problem, you should tell your pharmacist or doctor.

Before taking Cialis Together®, tell your pharmacist or doctor if you:

• get very breathless or feel any pain in the chest with light or moderate activity (e.g., walking briskly for 20 minutes or climbing two flights of stairs)
• have or have ever had any heart disease or heart surgery (e.g., valvular heart disease, cardiomyopathy, arrhythmia)
• have high blood pressure that is not controlled
• have an abnormal or impaired left lower heart chamber
• have a restriction of blood flow from the heart (e.g., aortic stenosis)
• have Multiple System Atrophy (a rare condition causing severe loss of control of blood pressure)

Other risk factors

Talk to your pharmacist or doctor before taking Cialis Together® if you:

• have ever had an erection lasting more than 4 hours (priapism) or have any condition which can cause priapism (including sickle cell anaemia, leukaemia or multiple myeloma)
• have any deformation of your penis
• have a serious liver problem
• have a severe kidney problem
• have a stomach ulcer or bleeding disorder

Additional warnings

Speak to your doctor if you have:

• undergone pelvic surgery or removal of all or part of the prostate gland in which nerves of the prostate are cut (radical non-nerve-sparing prostatectomy)
• known hereditary degenerative retinal disorders such as retinitis pigmentosa

If you experience sudden decrease or loss of vision, or your vision is distorted or dimmed while taking Cialis Together®, stop taking the tablets and contact your doctor immediately.

If you experience decreased or sudden hearing loss, stop taking Cialis Together® and contact your doctor immediately.

Interactions with other medicines, food and drink

Some medicines may interact with Cialis Together®. Tell your pharmacist if you take

Do not take Cialis Together® if you take:

• Nitrate medicines (such as glyceryl trinitrate, isosorbide mononitrate, isosorbide dinitrate) or nitric oxide donors (such as amyl nitrite ("poppers"), nicorandil, molsidomine or sodium nitroprusside) for chest pain or heart failure
• Riociguat or other guanylate cyclase stimulators for high blood pressure in the lungs

Tell your pharmacist before using Cialis Together® if you take:

• Alpha-blockers (such as alfuzosin, doxazosin or tamsulosin) for urinary problems or high blood pressure
• Other medicines to treat high blood pressure
• Finasteride for benign prostatic hyperplasia
• Itraconazole or ketoconazole (medicines to treat fungal infections)
• Rifampicin, erythromycin or clarithromycin (antibiotics)
• Ritonavir or saquinavir (protease inhibitors for HIV)
• Phenobarbital, phenytoin and carbamazepine (anticonvulsant medicines)
• Other treatments for erectile dysfunction
• Theophylline (to treat asthma)
• Cimetidine (for heartburn and stomach ulcers)

Food and drink interactions:

• Grapefruit juice may affect how well Cialis Together® will work and must be avoided
• Drinking excessive alcohol can temporarily reduce your ability to get an erection. To get maximum benefit from your medicine, you are advised not to drink large amounts of alcohol before sexual activity

Recreational drugs:

Do not take amyl nitrite (also known as "poppers") as recreational drugs, as the combination may lead to a dangerous fall in blood pressure.

Avoid the use of Cialis Together® with other recreational drugs (including but not limited to nitrous oxide, GHB/GBL, methamphetamines, MDMA/ecstasy, ketamine, flunitrazepam, cannabis, opioids, cocaine, etc.), as it may lead to side effects such as dizziness, decreased blood pressure, stroke or heart attack, seizures, priapism and coma.

What side effects can occur?

Like all medicines, Cialis Together® can cause side effects, although not everyone experiences them. These effects are normally mild to moderate in nature.

Seek medical attention immediately if you experience:

• An allergic reaction (uncommon): Symptoms include sudden wheeziness, difficulty breathing or dizziness, swelling of the eyelids, face, lips or throat, rashes
• Chest pains (uncommon): If this occurs before, during or after intercourse, get in a semi-sitting position and try to relax. DO NOT use nitrates to treat chest pain. Seek immediate medical help
• Persistent and sometimes painful erection lasting longer than 4 hours (rare)
• Sudden decrease or loss of vision (rare), distorted, dimmed, blurred central vision or sudden decrease of vision (frequency not known)
• Sudden decrease or loss of hearing (frequency not known)
• Stevens-Johnson Syndrome (SJS) (rare): A rare, serious disorder of the skin causing flu-like symptoms and a painful rash that spreads and blisters

Common side effects (may affect up to 1 in 10 people):

• Headache
• Back pain
• Muscle aches
• Pain in arms and legs
• Facial flushing
• Nasal congestion
• Indigestion

Uncommon side effects (may affect up to 1 in 100 people):

• Dizziness, stomach ache, feeling sick, being sick (vomiting), reflux
• Blurred vision, eye pain, difficulty in breathing
• Presence of blood in urine, prolonged erection
• Pounding heartbeat sensation, fast heart rate
• High blood pressure, low blood pressure
• Nose bleeds, ringing in the ears
• Swelling of the hands, feet or ankles, feeling tired

Rare side effects (may affect up to 1 in 1,000 people):

• Fainting, seizures and passing memory loss
• Swelling of the eyelids, red eyes, sudden decrease or loss of hearing
• Hives (itchy red welts on the surface of the skin)
• Penile bleeding, presence of blood in semen, increased sweating

Heart attack and stroke have also been reported rarely in men taking Cialis Together®. Most of these men had known heart problems before taking this medicine.

Some additional rare side effects have been reported in men taking Cialis Together® that were not seen in clinical trials, including migraine, swelling of the face, serious allergic reaction, serious skin rashes, some disorders affecting blood flow to the eyes, irregular heartbeats, angina and sudden cardiac death.

The side effect dizziness has been reported more frequently in men over 75 years of age taking Cialis Together®. Diarrhoea has been reported more frequently in men over 65 years of age.

Reporting side effects (UK)

Suspected adverse reactions can be reported via the MHRA Yellow Card scheme or by searching for MHRA Yellow Card in the Google Play or Apple App Store.

Driving and operating machinery

Some men taking Cialis Together® in clinical studies have reported dizziness. Check carefully how you react to the tablets before driving or using machines.

Storage information

• Keep out of the sight and reach of children
• Store in the original package to protect from moisture
• Do not store above 30°C
• Do not use after the expiry date shown on the pack

Cialis Together® active substance and excipients

Active substance:

• Tadalafil 10 mg per tablet

Other ingredients:

• Tablet core: lactose monohydrate (see warnings), croscarmellose sodium, hydroxypropylcellulose, microcrystalline cellulose, sodium laurilsulfate, magnesium stearate
• Film-coat: lactose monohydrate, hypromellose, triacetin, titanium dioxide (E171), iron oxide yellow (E172), talc.

Cialis Together® contains lactose. If you have an intolerance to some sugars, contact your doctor before taking this medicine.

Cialis Together® contains sodium. This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially 'sodium-free'.

Patient information leaflet

Always read the UK patient information leaflet before taking Cialis Together®. The leaflet contains complete information on safe use, side effects and storage.