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Daily Cialis: treatment breakthrough — or marketing ploy?
Some of the tragicomedy on television is unscripted, as when a news report showing Hurricane Gustav filing its fangs on the Louisiana coast segued to an advertisement for the erectile-dysfunction drug Cialis.
Forget about storm surges and death by drowning, there’s a new dosing regimen for Cialis, and you’re gonna love it! Cialis for daily use: “A very effective option for men who want to be ready any time the moment is right .”
Though Gustav has long since blown itself out, the Cialis-for-daily-use campaign continues to churn. You might not remember the name Cialis, but you’ll probably recall graying couples addressing each other with coquettish body language, who then somehow end up perched in a set of his-and-her clawfoot bathtubs on a cliff overlooking the ocean. Or as depicted on a Cialis website, directly on the beach with the surf swirling beneath the porcelain. I don’t know what one of those bathtubs weighs, but I imagine a man must have to be very motivated to lug a couple of those into position. Wine and flowers seems like a much more back-friendly option.
Watching these ads raised a couple of questions for me: Is a splash of gray around the temples a marker for erectile dysfunction, or is it just a marketing ploy? And is this new daily-use dosing regimen a breakthrough for the treatment of erectile dysfunction (ED), or just a marketing ploy?
“It’s a breakthrough marketing ploy,” answered Dr. Bill Utz, a Minneapolis urologist (a surgeon specializing in genitourinary tract problems). “They’re not adding a new indication here — it’s still for erectile dysfunction. They’re just changing the mode, the dosing,” explained Utz.
Campaign has been a success
Not particularly impressed by the clinical usefulness of Cialis for daily use, Utz readily admits that the marketing campaign has been a success. “I mean I had five or six people today ask me about this,” Utz lamented. “I’m just to the point of nausea on this direct-to-consumer advertising.”
To review, there are three major ED drugs on the market: Viagra, Levitra, and Cialis. They work through the same mechanism, but Cialis lasts longer — about thirty-six hours. Hence the nickname “The Weekender,” because taking it on Friday evening means one can be “ready” through Saturday evening without having to redose. That leaves plenty of time on Sunday to drag the damn bathtubs back to the house.
But what does “any time the moment is right” really mean, and does that claim hold up? All three ED drugs are absorbed rapidly, but they still must be taken 30 to 60 minutes prior to the event in order for them to work. This requires adding some forethought to foreplay, which in some circumstances could get a little clumsy or awkward.
According to data from the Cialis package insert, two hours after taking a 20 milligram (mg) tablet of Cialis, drug levels peak at over 300 micrograms per liter (ug/L). At 36 hours, the advertised outside window of effectiveness for Cialis, blood levels fall to around 100 ug/L, then taper off to almost zero four days later. By comparison, a single 5 mg tablet produces a much smaller peak, less than 100 ug/L; a 5 mg taken daily establishes a baseline blood level of around 70-80 ug/L, with a peak of about 130ug/L after each dose.
Low level maintained
Using this data, what “any time the moment is right” really means that if a man is taking a 5 mg tablet every day and suddenly his partner wants to trip the light fantastic, he wouldn’t have to slow things down, take a pill, and wait 30 to 60 minutes. He has a low level of Cialis in his blood that might be effective. Might. If he doesn’t want take any chances, he’d still be better off taking his daily 5 mg right before the event, so as to take advantage of the peak effect (though Lilly recommends dosing the same time every day). But that approach eliminates the “any time,” no-waiting convenience of the daily-use dose, which is why one was taking it in the first place.
One possible advantage is that taking a smaller amount of the drug on a daily basis might alleviate some of the dose-dependent side effects that come with the 10-20 mg spur-of-the-romantic-moment dose. Bigger doses lead to bigger drug level peaks and higher chances of side effects.
Dr. Utz agreed, but noted, “There are two sides to that equation [lower dosing can lower the side effects]. There are clearly some people who have fairly brittle ED where the 5mg tablet isn’t enough. They need higher doses, the higher blood levels, to have the drug be effective.”
Lilly’s website doesn’t comment on any potential advantages of the daily regimen except to say, “This may be a good low-dose option for men who anticipate frequent sexual activity (twice a week or more ).”
Men who are sexually active at that clip — twice a week or more — may also find themselves running out of pills, since most insurance plans that cover these erectile-dysfunction medications (and not all do) limit prescriptions to six or eight pills per month.
How have insurers responded to the idea of paying for a daily pill prescribed for a non-life-threatening condition, just so that its plan members can be “at the ready”?
Since Utz hasn’t prescribed Cialis for daily use, he couldn’t say for sure, but he had a pretty good guess. “What do you think they’re going to say?” Utz asked rhetorically. “I’ve got news for you: They’re going to look into it and say, ‘No way are we doing that. 5 mg or 20 mg, you take your pick.’ “
Utz is correct. Representatives from Medica, Health Partners and Blue Cross and Blue Shield of Minnesota told me that while coverage of ED drugs varies by individual plan, none offers a plan covering Cialis for daily use.
Regardless of who is picking up the tab, an additional problem with Cialis for daily use is compliance. Yes, sex and sexual health can be powerful motivators, but so should the risk of a heart attack, or a stroke, or the malaise that comes with poorly controlled diabetes. And yet study after study shows that people have a hard time (logistically or financially) consistently taking drugs that are essential to their health. So why should this be any different? In this case, miss a few pills and your Cialis blood levels fall below the therapeutic range: You may not be ready, and as a physician friend of mine quipped, it could be several months before the stars realign and the opportunity presents itself again.
But guilt can also be a powerful motivator, which is an obvious benefit to daily-dosed Cialis: using guilt to put one’s partner in the mood. “You mean I’m swallowing this pill every day of the week and you’re not interested?”
Or just stick with the clawfoot bathtubs, and remember to lift from the knees.
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Average Cost of Cialis is Now $41.12: Click for More
Cialis is a popular treatment for erectile dysfunction.
Cialis was approved by the US Food and Drug Administration (FDA) in November 2003.
It was the third prescription medication for erectile dysfunction (ED) that was approved in the US, after Viagra and Levitra, and is distributed and marketed worldwide by a company called Lilly ICOS, LLC, which is a joint venture between ICOS Corporation and Eli Lilly.
Cialis is available in four doses: 2.5 mg, 5 mg, 10 mg, and 20 mg. The typical starting dose in 10 mg, but men have room to maneuver upward or downward in terms of dosage if they find that the 10 mg dosage isn’t quite right for them. The active ingredient in Cialis is a substance called tadalafil, which belongs to a class of drugs known as PDE-5 inhibitors. Viagra and Levitra are also PDE-5 inhibitors. Typically, Cialis is taken on an “as-needed” basis for erectile dysfunction.
How Does Cialis Differ from Viagra and Levitra?
Cialis differs in two fundamental ways from Viagra and Levitra. The main difference, and one that Lilly ICOS has used heavily in marketing Cialis, is that it has a much longer half-life: 36 hours, versus 4 to 6 hours for Viagra and Levitra. You may have seen Cialis advertised as “The Weekend Pill,” on the logic that a man could take Cialis on Friday night and still feel the effects on Sunday morning.
The other main way Cialis differs from Viagra and Levitra is that it can be taken at a low dosage in a daily regimen. Typically, daily Cialis is taken at a 5 mg dosage, though some men take the 2.5 mg dosage with good results. Cialis daily therapy is also used to treat symptoms of a condition called benign prostatic hyperplasia, which is a fairly common, non-cancerous enlargement of the prostate gland.
How Much Does Cialis Cost in the United States?
Cialis isn’t cheap, but then neither are Viagra or Levitra. The drug won’t go off-patent in the United States until 2017, so don’t expect price relief for another couple of years. If you are prescribed the typical 10 mg dosage of Cialis, you’ll pay around $41 per tablet.
Viagra and Levitra are a few dollars cheaper per tablet, but Cialis can last far longer, so the extra cost of Cialis may be worth it to some men. For example, over the course of a weekend, a man may need to take 2 Viagra or Levitra (You’re not supposed to take more than one in a 24-hour period), but he may experience relief from ED for the entire weekend with only one Cialis. The following table lists prices per 10 mg tablet at a selection of pharmacies in five cities. As you can see, there’s not a lot of variation in price, but shopping around could save you a dollar or so per tablet.
Another Safe Way to Acquire Cialis
When you obtain Cialis from your physician, of course, you also have to factor in the cost of your time and the cost of visiting your doctor in terms of your co-payment or payment toward your health insurance deductible. Then there is the time cost of taking the prescription to a pharmacy and having it filled.
You can end up cooling your heels for a long time in a busy pharmacy.
Another option that many men have discovered to be quite convenient is using an online medical facilitator. These services allow you to submit your Cialis prescription via fax or email, and if you don’t have a prescription, they can connect you with a doctor who can evaluate your medical history and, if you’re a good candidate for Cialis, write an online prescription, which is then filled by the medical facilitator. Some medical facilitators charge for a medical consultation and some don’t, so ask if you’re not sure. Even if Cialis costs more per pill through a medical facilitator, the savings on the medical consultation and the convenience of online ordering and quick home delivery make it a preferable option for many men.
Evaluating Your Choices
One thing you should never do if you’re considering taking Cialis for ED is to turn to sketchy online sites offering what they claim to be Cialis at an unusually low price. Medications for ED are among the most commonly counterfeited, for several reasons. Mainly, counterfeiters do it to make money. But they also know that a lot of men, despite more openness about ED, don’t want to talk to a doctor about the problem and are willing to take chances ordering from an online “pharmacy” offering it without a prescription for a low price.
If you find Cialis (or Viagra or Levitra) online at a price significantly cheaper than what you’d pay at your local pharmacy, you can bet it’s counterfeit, and there’s no telling what it’s made of. It could be made from relatively harmless filler ingredients, or it could contain dangerous ingredients. Counterfeit Viagra has been found to contain a number of potentially dangerous ingredients. Work with your own physician or a trusted online medical facilitator to obtain Cialis, because the risks of rogue online pharmacies are simply too great.
Cialis is an enormously popular medication for erectile dysfunction. It has been taken safely by millions of men, who love the convenience of either daily Cialis therapy or taking it on an as-needed basis and enjoying long-lasting relief from ED. AccessRx.com is a medical facilitator that has been in business for over 15 years, providing prescription medications including Cialis to over half a million customers. AccessRx.com only works with US-licensed pharmacists, and is committed to the highest standards for customer service and online ordering security.
AccessRx is a USA corporation founded in 1998. Since, we have become one of the top online providers in FDA-approved, brand-name medications. We specializes in providing our over 500,000 customers with relevant product and condition information created by our professional editorial staff which includes our team of medical writers, medical practitioners and health educators. AccessRx Staff on Facebook
Mary Hiers – AccessRx Medical Writer
Mary Hiers is a full-time writer with a background in engineering and print journalism as well as writing about a wide variety of health care topics. She lives in Tennessee and is the author of two works of fiction. Mary earned her bachelor’s and master’s degrees from the University of Tennessee and the University of Tennessee Space Institute. Mary Hiers on Google+
Lisa Furgison – AccessRx Medical Writer
As a journalist Lisa enjoys writing about a variety of topics. Over the course of the last ten years she has been involved in television news as well as print and online publications. Medical news has always been a favorite for this native New Yorker because she gets to stay on top of the latest developments in a rapidly changing field. Lisa Furgison on Google+
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