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Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention [see Warnings and Precautions (5.1)].In clinical pharmacology studies using single dose tadalafil (5 to 20mg), tadalafil exposure (AUC) approximately doubled in subjects with mild (creatinine clearance 51 to 80 ml/min) or moderate (creatinine clearance 31 to 50 ml/min) renal impairment and in subjects with end-stage renal disease on dialysis. In haemodialysis patients, Cmax was 41% higher than that observed in healthy subjects. Haemodialysis contributes negligibly to tadalafil elimination.

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In a rat prenatal and postnatal development study at doses of 60, 200, and 1000 mg/kg, a reduction in postnatal survival of pups was observed. The no observed effect level (NOEL) for maternal toxicity was 200 mg/kg/day and for developmental toxicity was 30 mg/kg/day. This gives approximately 16 and 10 fold exposure multiples, respectively, of the human AUC for the MRHD of 20 mg. viagra 50 mg Immediately telephone your doctor or the Australian Poisons Information Centre (telephone 13 11 26) or the New Zealand National Poisons Centre (0800 POISON or 0800 764 766), or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much CIALIS.As is the case in most prescription drugs, Cialis needs to be taken with medical guidance and also in the prescribed quantity. The dosage is carefully derived by the doctor after a careful review of the patient’s problem and medical history. Hence the patient should not attempt to make any modifications in it by himself. Cialis needs to be taken before sexual intercourse. The medicine does not have to be taken with food. Usually a standard dose of 10mg is prescribed to most patients. However depending on individual needs, the dose could be doubled up to 20mg. If need be the dosage could be reduced by 5mg. But all these changes can take place only under medical supervision. Not more than one pill must be taken within 24 hours.

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