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In December 2003, the Food and Drug Administration approved Cialis for sale in the United States as the third ED prescription drug pill (after Viagra and Levitra). Cialis`es 36-hour effectiveness earned it the nickname, "The Weekend Pill"

How Cialis works?
Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.

The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Cialis inhibits PDE5, however, because sexual stimulation is required to initiate the local penile release of nitric oxide, Cialis`es inhibition of PDE5 will have no effect without direct sexual stimulation of the penis. The recommended Cialis starting dose for most men is 10 mg, taken as needed before sexual activity (but not more than once daily). The dose may be increased to 20 mg or decreased to 5mg, per its efficacy and the man`s personal tolerance of the drug. In June 2007, the European Commission approved low-dose (2.5 mg and 5 mg) Cialis to be used as single-daily ED therapy.
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