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Cialis Together is actually the same as ordinary Cialis, but branded and supplied in a different way. It is presented in a pack which can be supplied by pharmacies over the counter without a prescription. The active ingredient is tadalafil. Tadalafil is also available as a generic tablet at a significantly lower price than both Cialis Together or Cialis. Tadalafil and Cialis both require a prescription, which can be an electronic or online prescription.

Cialis Together is the same strength as tadalafil 10mg or Cialis 10mg. Cialis Together is only available as 10mg tablets, in packs of 4 or 8. Cialis and tadalafil are available in many strengths, either as daily 2.5mg and 5mg tablets, or as, 'when needed' 10mg and 20mg tablets.

Erectile dysfunction (ED) assessment

An assessment by a pharmacist must be carried out before buying Cialis Together. This assessment can be carried out online, or by a pharmacist in-store. The in-store assessment may require an appointment.

Dr Fox pharmacy provides an online assessment for Cialis Together and other ED treatment, which includes medical information about erectile dysfunction and its treatment. At the end of the online assessment a range of ED medicines can be requested, including Cialis Together. Alternative ED treatments such as Cialis, Viagra, and Spedra, and generic tadalafil, sildenafil, and vardenafil are also available. All available strengths and various quantities and combinations can be requested.

It is important that men with erectile dysfunction are properly assessed and advised about treatment. This should include consulting a doctor prior to obtaining treatment online, particularly if erectile dysfunction has started recently or is worsening.

Causes of erectile dysfunction

ED is common, affecting up to 40% of men by the age of 50. Most men with ED are in reasonable health. Despite a widespread belief, low testosterone levels are not a common cause. However, ED can sometimes be a symptom of underlying health problems such as diabetes, high cholesterol, high blood pressure, reduced blood circulation, heart disease, and stroke.

ED can also be caused by stress, performance anxiety, psychosexual problems, and lifestyle choices such as smoking, heavy drinking, obesity, and lack of exercise can make it worse. Symptoms may well improve if these issues are addressed. Occasional treatment with medication such as Cialis Together can be effective in breaking a cycle of anxiety and failure.

Other causes include spinal injury or operations on the prostate or bowel. Regular cycling for 3 or more hours a day may also contribute to ED.

Who can use Cialis Together?

Cialis Together is suitable for adult men diagnosed with ED - the inability to get or maintain an erection firm enough for sex. The active ingredient, tadalafil, has been shown to significantly improve the ability to obtain a hard erect penis suitable for sexual activity.

ED medication should not be used by women, or under 18s.

Cautions

• Sexual activity carries a possible risk to patients with heart disease because it puts an extra strain on the heart. Do not take Cialis Together if you have serious heart disease or had a heart attack within the last 90 days.
• Do not take Cialis Together if you:
  • Had a stroke within the last 6 months.
  • Have low blood pressure or uncontrolled high blood pressure.
  • Ever had loss of vision because of non-arteritic anterior ischemic optic neuropathy (NAION), a condition often described as 'stroke of the eye'.
• Grapefruit juice and alcohol are both likely to reduce the effectiveness of Cialis Together.
• A reduction in sperm has been noted in some men. These effects are unlikely to lead to a lack of fertility.
• Some men taking tadalafil (the active ingredient in Cialis Together) in clinical studies reported dizziness. Check carefully how you react to the tablets before driving or using machines.
• Cialis Together should not be taken at the same time or within 24 hours of taking Cialis/tadalafil, Viagra/sildenafil, Levitra/vardenafil, or Spedra/avanafil.

If you have any of the following conditions you should discuss with your regular doctor before taking Cialis Together:

• Sickle cell anaemia (an abnormality of red blood cells).
• Multiple myeloma (cancer of the bone marrow).
• Leukaemia (cancer of the blood cells).
• Any deformity of your penis.
• A serious liver or kidney problem.

How do erectile dysfunction medicines work?

Both Cialis and Cialis Together are brand names for a medicine with the medical name of tadalafil. Tadalafil works by helping the blood vessels in the penis to relax, allowing an increased flow of blood into the penis during sexual stimulation. It does this by blocking the action of an enzyme called phosphodiesterase 5 (PDE5). It belongs to the class of PDE5 inhibitor medications.

Other tablet treatments for erectile dysfunction are all PDE5 inhibitors. These include Viagra (sildenafil), Levitra (vardenafil), and Spedra (avanafil). The main difference between these treatments is the duration of action. They stay active for different lengths of time: 1 tablet of Cialis or Cialis Together (tadalafil) will last up to 36 hours; Spedra (avanafil) and Viagra (sildenafil) last about 4 hours; Levitra (vardenafil) lasts between 4 and 5 hours. This does not mean that an erection will last for 4 or 36 hours, but that the tablet will augment and support sexual performance during that time.

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Effectiveness of Cialis Together

Clinical studies show tadalafil (the active ingredient in Cialis Together) significantly improves erectile dysfunction and the ability to have successful sexual intercourse.

Erectile dysfunction category	Mild	Moderate	Severe
Improved erections with tadalafil	86%	83%	72%

It is not known if tadalafil is effective in patients who have had pelvic surgery or removal of all or part of the prostate gland.

How to take Cialis Together

Take one 10mg tablet as needed, at least 30 minutes before sexual activity. Tablets should be swallowed whole with water and can be taken with or without food. Do not take more than 1 tablet a day.

Sexual stimulation is required for Cialis Together to be effective.

Cialis Together should not be taken at the same time as, or within 24 hours of, taking other oral erectile dysfunction treatments, e.g. Viagra/sildenafil, Levitra/vardenafil, or Spedra/avanafil.

Other medicines and Cialis Together

Cialis Together should not be taken if also taking any of the following medications:

• HIV and cancer chemotherapy medications.
• Antifungal treatments like itraconazole or ketoconazole.
• Alpha-blocker blood pressure medications, also sometimes used to treat prostate enlargement - includes doxazosin, prazosin, alfuzosin, terazosin, indoramin, and tamsulosin.
• Antibiotics such as erythromycin, clarithromycin, or rifampicin.
• Anticonvulsants such as phenobarbital, phenytoin, or carbamazepine.
• Nitrates for angina or heart failure - including glyceryl trinitrate; isosorbide mononitrate; isosorbide dinitrate; GTN spray, tablet, patch or gel; nicorandil; or sodium nitroprusside - serious reaction possible.
• Any recreational drugs, particularly amyl nitrate ('Poppers') - serious reaction possible.
• Riociguat for high blood pressure in the lungs.

If in any doubt about other medication, please message our doctors or consult your regular doctor before ordering Cialis Together online.

Possible side effects of Cialis Together

Significant side effects are unusual and don't happen to everyone. The most common side effects of Cialis Together (tadalafil) include headache, dizziness, back pain, muscle aches, pain in the arms or legs, nasal congestion, flushing, indigestion, and a visual colour distortion with a bluish or yellowish tinge to vision. This is not dangerous and fades after a few hours and is a recognised side effect of all ED drugs.

In the rare event of serious side effects men should seek immediate medical advice. This applies particularly to chest pains (possibly heart), loss of vision, and prolonged and painful erections (priapism). Priapism can lead to permanent damage to the penis and is a medical emergency requiring urgent medical attention through a hospital A&E department.

For a full list of possible side effects see the patient information leaflet for Cialis Together.

Other options for treating ED

Other treatments for ED include topical applications (creams and gels applied direct to the penis), injections into the penis, and various surgical devices. These are available from specialist ED/urology services. Counselling may help if psychological causes are causing ED. Improved diet and lifestyle choices can also help.

Tadalafil can also be prescribed to treat symptoms of an enlarged prostate (benign prostatic hyperplasia), and in higher doses for the rare condition, pulmonary hypertension. Dr Fox supplies tadalafil, Cialis and Cialis Together to treat erectile dysfunction only.

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