Patients who demonstrate hemodynamic instability on alpha-blocker therapy alone are at increased risk of symptomatic hypotension with concomitant use of PDE5 inhibitors. The use of CIALIS once per day has not been extensively evaluated in patients with hepatic impairment and therefore, caution is advised. CIALIS should be used with caution in patients who have conditions that might predispose them to priapism such as sickle cell anemia, multiple myeloma, or leukemia , or in patients with anatomical deformation of the penis such as angulation, cavernosal fibrosis, or Peyronie’s disease. In those patients already taking an optimized dose of PDE5 inhibitor, alpha-blocker therapy should be initiated at the lowest dose. Tadalafil may not be safe for people with certain medical conditions, including people who have had a stroke , have coronary heart disease or retinitis pigmentosa an eye disease. In some patients, concomitant use of these two drug classes can lower blood pressure significantly [see Drug Interactions 7.Private ($) Add to Cart This medicine may not be right for you. Read the warnings before purchase. Incorrect use may be harmful. Follow the directions for use. If symptoms persist talk to your healthcare professional. The pharmacist reserves the right to not supply according to our professional obligations. AdBuy Approved ED Treatments For Longer, Harder Erections. Aussie GP’s, Free Delivery. Chat With Certified Aussie GP’s And Get Approved ED Treatments For Longer $2 A Use · Trusted By K+ Aussies · Prescribed By Aussie GPs. · Blue & Weekend PillTypes: Blue Pill, Weekend Pill, Speak To A GP Now. How can I buy tadalafil? You need a prescription from a doctor to buy tadalafil. You can buy it from a store-based pharmacy or reputable online pharmacy with a prescription. Some people buy tadalafil online without a prescription. This isn’t a good idea, as you can’t be sure whether these pills contain the medicine or are counterfeit.