Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Tadalafil (Cialis) is the third oral medicine approved by the U.S.
FDA for the treatment of erectile dysfunction. Like sildenafil (Viagra) and
vardenafil (Levitra), tadalafil inhibits PDE5 (as described earlier).
How effective is tadalafil (Cialis)?
The safety and efficacy of tadalafil in the treatment of erectile dysfunction was evaluated in 22 clinical trials involving more than 4,000 men. Seven of these trials were randomized, prospective, placebo-controlled studies of 12 weeks' duration. Two of these studies (involving 402 men) were conducted in the United States, and the other five studies (involving 1,112 men) were conducted outside the United states. Two of these trials were conducted in special populations with erectile dysfunction; one in men with diabetes mellitus, another in men who developed erectile dysfunction after nerve-sparing prostate cancer surgery.
Effectiveness of tadalafil in these studies was assessed using a sexual
function questionnaire. Study participants also were asked if they were able to
achieve vaginal penetration and to maintain erections long enough for successful
intercourse.
In all seven trials, tadalafil was significantly better than placebo in
improving men's ability to achieve and maintain erections. Improvements in
erectile function was observed in some patients at 30 minutes after taking a
dose; and improvements can last for up to 36 hours after taking Cialis when
compared to placebo.
How should tadalafil (Cialis) be administered?
The recommended starting dose of tadalafil for most patients is 10 mg taken
orally approximately one hour before sexual activity. The dose may be adjusted
higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The
maximum recommended dosing frequency is once per day, although for many patients tadalafil can be taken less frequently since the improvement in erectile function
may last 36 hours. Tadalafil may be taken with or without food.
What are the side effects of tadalafil (Cialis)?
Tadalafil is generally well tolerated with only mild side effects. The most
common side effects reported include headache, indigestion, back pain, muscle
aches, facial flushing, and nasal congestion.
Back pain and muscle aches occurred in less than 7% of patients and usually
occurred 12-24 hours after taking tadalafil. The back pain and muscle
aches associated with tadalafil were characterized by mild to moderate muscle
discomfort in the lower back, buttocks, and thighs, often aggravated by lying
down. The back and muscle aches resolved in most patients without treatment
within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and
nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Advil, or Aleve
were effective. Approximately 0.5% of all the patients using tadalafil
discontinued the drug due to back pain or muscle aches.
Reports of abnormal vision were rare; it occurred in less than 0.1% of
patients using tadalafil.
There have been rare reports of priapism (prolonged and painful erections
lasting more than six hours) with the use of oral PDE5 inhibitors such as
vardenafil, sildenafil, and tadalafil. Men with blood cell diseases such as
sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks
of developing priapism. Untreated priapism can cause injury to the penile tissue
and lead to permanent loss of potency. If there is prolonged erection (longer
than four hours), immediate medical assistance should be sought.
Who should not use tadalafil (Cialis)?
Tadalafil can cause hypotension (abnormally low blood pressure, which can
lead to fainting and even shock) when given to patients who are taking nitrates.
Patients taking nitrates daily
should not take tadalafil. Most commonly used
nitrates are medications to relieve angina (chest pain due to insufficient blood
supply to heart muscle because of narrowing of the coronary arteries). These
include nitroglycerine tablets, patches, ointments, sprays, pastes, and
isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl
nitrate and butyl nitrate are found in some recreational drugs called "poppers."
Tadalafil should not be used with alpha-blockers (except Flomax), medicines
used to treat high blood pressure and benign prostate hypertrophy (BPH) because
the combination of tadalafil and an alpha-blocker may lower the blood pressure
greatly and lead to dizziness and fainting. Examples of alpha-blockers include
tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin
(Uroxatral), and prazosin (Minipress). The only alpha-blocker that can be used
safely with tadalafil is tamsulosin (Flomax). When tadalafil (20 mg) was given
to healthy men taking 0.4 mg of Flomax daily, there was no significant decrease
in blood pressure and so patients on this dose of tamsulosin (Flomax) can be prescribed
tadalafil. The only alpha blocker that has not been tested with tadalafil is
alfuzosin (Uroxatral) and no recommendations can be made regarding the interaction between
the two.
Tadalafil is not recommended for men with the following conditions:
unstable angina (chest pain due to coronary artery
disease that occurs at rest or with minimal physical exertion),
low blood pressure (a resting systolic blood pressure
less than 90mm Hg),
uncontrolled high blood pressure (greater than
170/110 mm Hg),
recent stroke or heart attack (within six months),
severe heart failure or disease of the heart
valves, for example, aortic stenosis,
retinitis pigmentosa.
Therefore, men with these conditions should not use tadalafil without having
these conditions evaluated and stabilized first. For example, men with
uncontrolled high blood pressure should have their blood pressure controlled; and
men with potentially life-threatening abnormal heart rhythms should have these
rhythms controlled.
When there is angina or heart failure, the doctor may need to determine
whether the heart has enough reserve to safely carry out the work necessary for
sexual activity by performing cardiac treadmill stress testing.
What precautions should be taken when using tadalafil?
In most healthy men, some of the drug will remain in the body for more than
two
days after a single dose of tadalafil. Metabolism (clearing of the drug from the
body) of tadalafil can be slowed by liver disease, kidney disease, and
concurrent use of certain medications (such as erythromycin, ketoconazole, and
protease inhibitors). Slowed breakdown allows tadalafil to stay in the body
longer and potentially increase the risk for side effects. Therefore, the dose
and frequency of tadalafil has to be lowered in the following examples:
Medications such as erythromycin, ketoconazole (Nizoral), itraconazole
(Sporanox), ritonavir (Norvir), and indinavir (Crixivan) can slow the
breakdown of tadalafil. Therefore men taking these medications should not take
more than 10 mg of tadalafil and should not take tadalafil more frequently
than every 72 hours.
No tadalafil dose adjustment is necessary for men
with only mild kidney disease. Men with moderately severe kidney impairment
should start tadalafil at 5 mg every 24 hours and not to exceed the maximum
dose of 10 mg taken every 48 hours. In men with severe kidney disease and on
dialysis, the maximum dose should not exceed 5 mg.
Men with severe liver disease should not take tadalafil. Men with mild to
moderate liver disease should not exceed tadalafil dose of 10 mg once daily.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular trauma, testicular torsion, testicular cancer, epididymitis, and orchitis. Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever, nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in the testicles.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Male sexual dysfunction can be caused by physical or psychological problems. Common sexual problems in men include erectile dysfunction (impotence or ED), premature ejaculation and loss of libido. Treatment for sexual dysfunction in men may involve medication, hormone therapy, psychological therapy, and the use of mechanical aids.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Penis disorders (male reproductive problems) include priapism, Peyronie's disease, balanitis, phimosis, paraphimosis, and penile cancer. Read on for causes, symptoms, diagnosis, and treatment. These disorders can affect a man's fertility and sexual functioning. A variety of treatments are available for these disorders.
Prolactinoma is an adenoma (benign tumor) of the pituitary gland. Causes of many prolactinomas are unknown. Symptoms in women include changes in menstruation and infertility, decreased libido, or painful intercourse due to vaginal dryness. The most common symptom in men is impotence (erectile dysfunction). Treatment of prolactinomas are medication or surgery.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Peyronie's disease is a condition characterized by a hard lump, or plaque, that forms within the penis. Symptoms of Peyronie's disease range from mild to severe. Treatment for Peyronie's disease includes medication, and often surgery.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
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