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CIALIS is a substrate of and predominantly metabolized by CYP3 A4. Studies have shown that drugs that inhibit CYP3 A4 can increase tadalafil exposure.
Ketoconazole (400 mg when viagra and cialis dont work daily), a selective and potent inhibitor of CYP3 A4, increased tadalafil 20 mg single-dose exposure (AUC) by 312% and Cmax by 22%, relative to the values for tadalafil 20 mg alone.
Although specific interactions have when viagra and cialis dont work not been studied, other CYP3 A4 inhibitors, such as erythromycin, itraconazole, and when viagra and cialis dont work grapefruit juice, when viagra and cialis dont work would likely increase tadalafil exposure. Ritonavir (500 mg or 600 mg twice daily at steady state), an inhibitor of CYP3 A4, CYP2 C9, CYP2 C19, and CYP2 D6, increased tadalafil 20-mg single-dose exposure (AUC) by 32% with a 30% reduction in Cmax, relative to the values for tadalafil 20 mg alone. Ritonavir (200 mg twice daily), increased tadalafil when viagra and cialis dont work 20-mg single-dose exposure (AUC) by 124% with no change in Cmax, relative to when viagra and cialis dont work the values for tadalafil 20 mg alone. Although specific interactions have not been studied, other HIV protease inhibitors would likely increase tadalafil exposure (see DOSAGE AND ADMINISTRATION) Studies have shown that drugs when viagra and cialis dont work that induce CYP3 A4 can decrease tadalafil exposure.