If you are taking tadalafil to treat erectile dysfunction, follow your doctor’s directions and the guidelines in this paragraph. The dose may be increased to 20 mg or decreased to 5 mg, based on individual efficacy and tolerability. Tadalafil is in a class of medications called phosphodiesterase PDE inhibitors. Consideration should be given to the following: ED Patients should be stable on alpha-blocker therapy prior to initiating a PDE5 inhibitor. In trials of CIALIS for once daily use, a total of , , and were treated for at least 6 months, 1 year, and 2 years, respectively.Three Cialis mg to 5 mg subjects, three Cialis 5 mg subjects and two placebo subjects discontinued study participation due to an adverse event (AE). Nasal congestion was the only AE leading to discontinuation reported by more than one subject (two subjects in the tadalafil to 5 mg group). Patients should not use CIALIS if sex is inadvisable due to cardiovascular status ().Use of CIALIS with alpha-blockers, antihypertensives or substantial amounts of alcohol (≥5 units) may lead to hypotension (, ).CIALIS is not recommended in combination with alpha-blockers for the treatment of BPH because efficacy of the . CIALIS for Use as Needed. Creatinine clearance 30 to 50 mL/min: A starting dose of 5 mg not more than once per day is recommended, and the maximum dose is 10 mg not more than once in every 48 hours. Creatinine clearance less than 30 mL/min or on hemodialysis: The maximum dose is 5 mg not more than once in every 72 hours [see .