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Avoid drinking alcohol, which can increase some of the side effects of Cialis.

Grapefruit and grapefruit juice may interact with Cialis. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.

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Seek emergency medical attention if you think you have used too much of Cialis.

Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

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Since Cialis is used as needed, you are not likely to be on a dosing schedule.

If you take Cialis every day and you miss a dose, take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do nottake extra medicine to make up the missed dose.

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Take Cialis exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Taking this medication in larger doses will not make it more effective, and could cause dangerous side effects.

Cialis can be taken with or without food.

This medication is usually taken only when needed, just before sexual activity. However, Cialis may also be taken daily (at a lower dose), regardless of when sexual activity is planned. Follow your doctor’s instructions.

Cialis can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.

Do not take Cialis more than once a day. Allow 24 hours to pass between doses. If you take the medication daily, take it at the same time each day. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. Store this medication at room temperature away from moisture and heat.

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Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket), or recreational drugs such as amyl nitrate or nitrite (“poppers”) Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

If you have certain conditions, you may need a dose adjustment or special tests to safely take Cialis. Before taking this medication, tell your doctor if you are allergic to any drugs, or if you have:

* heart disease or heart rhythm problems;
* a recent history a heart attack (within the past 90 days);
* a recent history of stroke or congestive heart failure (within the past 6 months);
* angina (chest pain);
* high or low blood pressure;
* liver disease;
* kidney disease (or if you are on dialysis);
* a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
* a bleeding disorder such as hemophilia;
* a stomach ulcer;
* retinitis pigmentosa (an inherited condition of the eye);
* a physical deformity of the penis (such as Peyronie’s disease); or
* if you have been told you should not have sexual intercourse for health reasons.

This medication can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Cialis, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Cialis is the actual cause of vision loss. Stop using Cialis and get emergency medical help if you have sudden vision loss.

Cialis FDA pregnancy category B: Although Cialis is not for use in women, this medication is not expected to be harmful to an unborn baby. Do not use Cialis without telling your doctor if you are pregnant or plan to become pregnant during treatment. Although this medication is not for use in women, it is not known if tadalafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (“poppers”). Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack. If you become dizzy or nauseated during sexual activity, or if you have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Cialis. Do not take this medication more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Cialis can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Cialis, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether this medication is the actual cause of vision loss.

Stop using Cialis and get emergency medical help if you have sudden vision loss.

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Cialis relaxes muscles and increases blood flow to particular areas of the body. It is a phosphodiesterase inhibitor.

Cialis is used to treat erectile dysfunction (impotence). It works by helping to increase blood flow into the penis during sexual stimulation. This helps you to achieve and maintain an erection.

Cialis may also be used for purposes other than those listed in this medication guide.

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Celexa is excreted in human milk. Side effects have been reported in two nursing infants. The manufacturer recommends that a decision should be made to discontinue nursing or discontinue the drug taking into account the importance of the drug to the mother.

One study has reported that the relative dose to a suckling infant is similar to that reported for fluoxetine, and higher than that reported for fluvoxamine, paroxetine, or sertraline. Two cases have been reported of infants experiencing excessive somnolence, decreased feeding, and weight loss in relation to breast-feeding from a mother receiving Celexa. Milk/serum concentration ratios based on single pairs of samples from the two patients ranged from 1.16 to 1.88. Based on this, the absolute dose a suckling infant may ingest would be in the range of 4.3 to 17.6 micrograms/kg. The relative dose would be 0.7% to 5.9% of the weight- adjusted maternal dose. In one case the infant was reported to have recovered completely once the infant’s mother discontinued the Celexa. According to another case report, the relative infant Celexa dose from breast milk is approximately 9% of the weight- adjusted maternal dose. A study of seven women taking Celexa and their infants has reported that the plasma concentrations of Celexa and demethylCelexa in the infants were very low or absent and there were no adverse effects.

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A possible case of Celexa- induced withdrawal effects has been described in an infant which began within the first few days following delivery. Symptoms included apneas, superficial breathing, sleep disorders, and hypotonia which changed to hypertonia before all symptoms gradually subsided and completely disappeared after 3 weeks. The 33- year- old mother had received Celexa 40 mg daily throughout the pregnancy. The results of a cohort study indicate that 30% of neonates who had prolonged exposure to SSRIs in utero experience symptoms, in a dose- response manner, of a neonatal abstinence syndrome (e.g., tremor, gastrointestinal or sleep disturbances, hypertonicity, high- pitched cry) after birth. The authors suggest that infants exposed to SSRIs should be closely monitored for a minimum of 48 hours after birth.

Celexa has been assigned to pregnancy category C by the FDA. Celexa and its metabolites have been shown to cross the placenta. Human spontaneous abortion has been reported by the manufacturer. Neonates exposed to Celexa (and other SSRIs and SNRIs) late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. (Such complications can arise immediately upon delivery.) Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. (These features are consistent with either a direct toxic effect of SSRIs and SNRIs, or possibly a drug discontinuation syndrome.) In some cases, the clinical picture is consistent with serotonin syndrome. The results of a prospective comparative study (n=396 pregnant women) indicate that Celexa use during embryogenesis is not associated with an apparent major teratogenic risk in humans. However, Celexa should be given during pregnancy and particularly during the third trimester, only if the potential benefits outweigh the potential risks to the fetus.

Celexa may cause harm to the fetus if it is used during the last 3 months of pregnancy. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Celexa while you are pregnant. Celexa is found in breast milk. Do not breast-feed while taking Celexa.

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Along with its needed effects, Celexa may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Celexa More common side effects
* Decrease in sexual desire or ability

Celexa Less common side effects
* Agitation
* blurred vision
* confusion
* fever
* increase in frequency of urination or amount of urine produced
* lack of emotion
* loss of memory
* menstrual changes
* skin rash or itching
* trouble in breathing

Celexa Rare side effects
* Anxiety
* behavior change similar to drunkenness
* bleeding gums
* breast tenderness or enlargement or unusual secretion of milk (in females)
* difficulty with concentrating
* dizziness or fainting
* increased hunger
* irregular heartbeat
* irritability
* lethargy
* low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, or lack of energy)
* mood or mental changes
* nervousness
* nose bleed
* painful urination
* purple or red spots on skin
* sore throat, fever, and chills
* rapid weight gain
* red or irritated eyes
* redness, tenderness, itching, burning, or peeling of skin
* seizures
* serotonin syndrome (agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching)
* shakiness
* slow or irregular heartbeat (less than 50 beats per minute)
* stupor
* swelling of the face, ankles, or hands
* trouble with holding or releasing urine
* unusual or sudden body or facial movements or postures
* unusual tiredness or weakness

Celexa Incidence not known side effects
* Abdominal or stomach pain
* back or leg pains
* black, tarry stools
* bleeding gums
* bloating
* bloody stools
* chest pain
* confusion as to time, place, or person
* constipation
* cough
* darkened urine
* difficult or fast breathing
* difficulty swallowing
* drooling
* fast, slow, or irregular heartbeat
* fatigue
* general body swelling
* hallucinations
* hive-like swelling on the face, eyelids, lips, tongue, or throat
* hives
* holding false beliefs that cannot be changed by fact
* impaired consciousness, ranging from confusion to coma
* indigestion
* itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
* loss of appetite
* loss of bladder control
* loss of consciousness
* muscle cramps or spasms
* muscle tightness
* muscle twitching or jerking
* nervousness
* nosebleeds
* pale skin
* penile erections, frequent or continuing
* recurrent fainting
* redness, tenderness, itching, burning, or peeling of skin
* restlessness or agitation
* rhythmic movement of muscles
* shortness of breath
* skin rash
* swelling of breasts or unusual milk production
* tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over affected area
* tightness in chest
* total body jerking
* twitching, twisting, uncontrolled repetitive movements of tongue, lips, face, arms, or legs
* uncontrolled jerking or twisting movements
* unusual excitement
* vomiting of blood or material that looks like coffee grounds
* wheezing
* yellowing of the eyes or skin

Celexa Symptoms of overdose
* Bluish colored skin or lips
* confusion
* convulsions (seizures)
* coma
* deep or fast breathing with dizziness
* dizziness
* drowsiness
* fainting
* fast heartbeat
* general feeling of discomfort or illness
* loss of memory
* muscle pain
* nausea
* sleepiness
* slow or irregular heartbeat
* sweating
* trembling or shaking
* vomiting
* weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Celexa More common side effects
* Drowsiness
* dry mouth
* nausea
* sleepiness or unusual drowsiness
* trouble in sleeping

Celexa Less common side effects
* Abdominal pain
* anxiety
* body aches or pain
* change in sense of taste
* chills
* diarrhea
* difficulty with breathing
* gas
* headache
* headache (severe and throbbing)
* heartburn
* increased sweating
* increased yawning
* loss of appetite
* loss of voice
* nasal congestion
* pain in muscles or joints
* sneezing
* sore throat
* stuffy or runny nose
* tingling, burning, or prickly feelings on skin
* tooth grinding
* trembling or shaking
* unusual increase or decrease in weight
* unusual tiredness or weakness
* vomiting
* watering of mouth

Celexa Incidence not known side effects
* Bruising
* inability to sit still
* large, flat, blue or purplish patches in the skin
* need to keep moving
* restlessness
* uncontrolled eye movements

After you stop using Celexa, it may still produce some side effects that need attention. During this period of time, check with your doctor immediately if you notice the following side effects:
* Anxiety
* dizziness
* nervousness
* trembling or shaking

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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