- 1 About German Remedies (Zydus Cadila)
- 2 Scientific Studies on Tadalafil
- 3 Description and Mechanism of Action of Tadalafil
- 4 TADORA Benefits for Men with Erectile Dysfunction
- 5 Doses and Length of Therapy
- 6 Adverse Reactions and Alerts
- 7 Drug-to-Drug Dangerous Interactions
- 8 Customer Reviews
- 9 TADORA Price, Forms on the Market and Dosage
- 10 Reference List
- 11 Editor's Rating
TADORA 20mg/5mg pills are one of the products of German Remedies, a pharmaceutical company based in India. TADORA pills come in two variants which come in two dosage forms, 20 mg and 5 mg [1,2].
The condition, ED, affects a significant number of the male population with varying ages. ED does not only affect the older population, but it also affects males who are young as well. ED is a consequence of diseases, trauma, medications, and psychological factors and should be treated. Currently, there are a number of treatments available for ED which patients can use. One of those treatments includes Tadalafil, which is a potent agent in restoring the male erectile function.
Other conditions where Tadalafil products like TADORA are used for are benign prostatic hyperplasia (BPH) and pulmonary arterial hypertension (PAH). Tadalafil helps regain normal urine function in patients with lower urinary tract symptoms caused by BPH and also helps lower blood pressure in hypertensive patients diagnosed with PAH .
About German Remedies (Zydus Cadila)
The company German Remedies was founded in 1949  and is a company which is concerned with the manufacturing, export, and marketing of pharmaceutical preparations and chemicals for various uses . The company’s outputs include products for the areas of healthcare (female), respiratory diseases, cardiovascular care, oncology, gastroenterology, and diagnostics .
German Remedies is known for their products like deriphyllin, primolut-n, proluton depot, oral estrogens (Progynova), oral progestogen (Noreta HRT), intestinal anti-inflammatory products (Salofalk GR), hepato-protectants (Silimar), and anti-cancer agents (Dobixin) . Aside from these products, German remedies is capable of producing pharmaceutical-grade formulations in the forms of oral and injectable liquids, tablets and capsules, ointments, gels, powders, granules, and suppositories .
Today, German Remedies is operating as a subsidiary company of one of India’s renowned drug manufacturers, Zydus Cadila/Cadila Healthcare Limited . Cadila Healthcare Limited is India’s 4th largest pharmaceutical company and is focused on the manufacture of high-quality pharmaceutical products in the areas of respiratory, dermatology, pain management, and anti-infectives .
Cadila is also dedicated to research and development in the areas of small molecules, peptides, biologics (therapeutic proteins, monoclonal antibodies, biosimilars, novel biologics), vaccines (live viral vaccines and recombinant vaccines), and in the areas of existing diseases and conditions . There was no mention of the approvals and the accreditations for German Remedies/Cadila Healthcare, but being a multi-awarded pharmaceutical company, the high quality of the products manufactured by the company (Cadila) is implied.
Scientific Studies on Tadalafil
Tadalafil is only one of the treatments widely available in the market for the treatment of erectile dysfunction (ED). Before Tadalafil was used, Sildenafil Citrate was widely used for the treatment of erectile dysfunction. Tadalafil was one of the most recent discoveries for the phosphodiesterase type 5 (PDE5) inhibitors for the treatment of erectile dysfunction in patients. The study of Skoumal et al in 2004, “Efficacy and Treatment Satisfaction with On-Demand Tadalafil (Cialis®) in Men with Erectile Dysfunction” studied the effectiveness of the brand-name Tadalafil treatment when used in patients with ED . 443 men diagnosed with erectile dysfunction (ED) who went on initially 4 weeks without any PDE5I treatment were administered either placebo or 20 mg Tadalafil on a 12-week period . The patients were classified into 3 groups according to ED severity using IEEF-EF (International Index of Erectile Function-Erectile Function) and were given either Tadalafil or placebo . The effectiveness of the treatment was determined using questions from the SEP (Sexual Encounter Profile) diary, GAQ (Global Assessment Questions), and the change in the IIEF-EF baseline values . Patient satisfaction for the treatment was gauged using EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) . There were 409 patients who were able to complete the trial and the results favored Tadalafil over placebo use based on all parameters (IIEF-EF change, SEP, GAQ, and EDITS) . Overall, 86% of the treated patient population was satisfied with the Tadalafil administration . However, there were side effects common to Tadalafil use, although the percentage is small (headache-7.2% and flushing-4.6) . There was also one patient who discontinued the treatment due to back pain . Overall, the authors concluded that Tadalafil administered on-demand significantly improved mild to severe ED cases and was well-tolerated by patients .
There are also recommendations for the daily administration of Tadalafil aside from administering the drug on an on-demand basis. One of the studies which explored Tadalafil effectiveness for this method of administration was the study by Egerdie et al in 2012, “Tadalafil 2.5 or 5 mg Administered Once Daily for 12 Weeks in Men with Both Erectile Dysfunction and Signs and Symptoms of Benign Prostatic Hyperplasia: Results of a Randomized, Placebo-Controlled, Double-Blind Study”, which studied whether the daily administration of Tadalafil in patients with ED and with benign prostatic hyperplasia (BPH) . According to the authors, ED and BPH (lower urinary tract symptoms/LUTS) are usually comorbid, especially in the male geriatric population . The study assessed if 2.5 mg or 5 mg of Tadalafil, when administered daily for 12 weeks, is effective in the management of ED and BPH-LUTS on patients (patients with ED for more than 3 months and BPH-LUTS for more than 6 months) . 198 patients were given 2.5 mg of Tadalafil, 208 patients were given 5 mg of Tadalafil, and 200 were given placebo . Based on the results of the evaluated by the authors, both Tadalafil doses improved the IIEF-EF (International Index of Erectile Function-erectile function) scores of the patients, although only the daily 5 mg dose improved the IPSS (International Prostate Symptom Score), SEP Q3 (Sexual Encounter Profile Question 3), and BII (BPH Impact Index) scores of the patients significantly . The authors concluded that 5 mg of Tadalafil is both effective and safe to take by patients for the management of their comorbid ED and BPH-LUTS .
Description and Mechanism of Action of Tadalafil
In the simplest sense, Tadalafil improves erectile function by mediating the relaxation of the corpus cavernosum’s vascular smooth muscle . But, the drug actually does not directly affect the erection mechanism; the restoration of the erectile function is merely the consequence of the drug’s actual function as a PDE5I (phosphodiesterase type 5 inhibitor). PDE5Is like Tadalafil, as their name suggests, inhibit the action of the PDE5 enzyme in the penile vascularity. This PDE5 breaks down the major player in the erectile response, the cGMP (cyclic guanosine monophosphate) which is the one stimulating the relaxation of the vascular smooth muscle in the corpus cavernosum.
Since there is no PDE5 to break down the action of cGMP, patients treated with Tadalafil have improved erectile response. Tadalafil’s half-life is longer than the other PDE5 inhibitors, so patients treated with Tadalafil are able to enjoy their erectile control for longer (up to 36 hours).
TADORA Benefits for Men with Erectile Dysfunction
Tadalafil is highly effective in the treatment of erectile dysfunction in patients, even those with comorbid diseases. Tadalafil is effective in treating ED in patients with diabetes, who are seldom responsive to other PDE5 inhibitor treatments. Aside from the effectiveness of Tadalafil in patients who are suffering from impotence, other diseases are also successfully managed by the drug like pulmonary arterial hypertension (PAH) and LUTS secondary to BPH.
Patients can expect their improvement of their erectile control every time they are administered with Tadalafil. Patients who are into daily Tadalafil administration are also able to experience good results from the drug.
Doses and Length of Therapy
The usual dose recommendation for Tadalafil intake is an initial 10 mg of the medication on an on-demand basis. From the patient response to Tadalafil, the doctors may adjust the dose higher or lower, depending on the patient need. According to vendor information, Tadalafil products are best taken anywhere between 30-4 hours prior to the sexual activity, and best taken without meals .
Patients are limited to take only one dose of Tadalafil per day and should be taken only as needed. Another option for patients with ED is to take the medication on a daily basis; there are certain Tadalafil brands which are meant to be taken once daily but in lower doses. Daily Tadalafil administration requires a dose of 2.5-5 mg for ED (but also for BPH-LUTS) daily.
No recommendations for Tadalafil length of intake are published, but since the drug is not yet a cure for ED, as long as the patients are prescribed with the drug, they can take it.
Adverse Reactions and Alerts
Some patients are affected by the intake of Tadalafil, while other patients are usually asymptomatic of the side effects. Common side effects reported for Tadalafil use are headaches, back pain, and flushing , along with stuffy nose, dyspepsia, nasopharyngitis, and diarrhea.
Aside from those common side effects, though, there are a few rare symptoms patients may want to look out for like blurred vision, chest pain, irregular heartbeat, priapism, and allergic reaction symptoms. If patients experience any of these, they should stop taking the drug and consult the doctor immediately.
Drug-to-Drug Dangerous Interactions
Patients should be careful with the drugs they administer with Tadalafil, especially the patients with other medical conditions and maintenance meds. Nitrate-containing medications (those for high blood pressure, angina, cardiovascular diseases, etc.) should not be taken with Tadalafil, as Tadalafil works to lower the blood pressure of the patients administered with the drug. When taken together, PDE5Is like Tadalafil and blood pressure meds can cause a blood pressure crisis.
Aside from the nitrates, patients are also not advised to take antifungals, antibiotics, HIV/AIDS treatments, and other medicines. To be sure, patients should consult their doctors first before taking any Tadalafil drug to prevent adverse drug interactions.
Out of all the online reviews for various Tadalafil-containing medications, one review was available for TADORA 20mg/5mg. The review was from Rxhippocratis.com and was positive about the effectiveness of the product.
Although the review was positive towards the effect of TADORA, it is just a singular review and does not cover all the patient comments for the product. But, I still think that the product is recommendable enough, as generics for Tadalafil, especially those from reputable companies, are as effective or are nearly as effective as the brand-name treatments, as they have the same active pharmaceutical ingredient and vary just on the inactive ingredients.
TADORA Price, Forms on the Market and Dosage
The price of TADORA on Vgraustralia.com is not actually cheap, but the price is still affordable in comparison with the existing Tadalafil brand-name treatments. As it can be seen on the image below, the price per unit of TADORA costs $2.25-$3.75, with the lowest price per unit indicated for the largest number of pills (64 pieces).
The thing is with these online shops is that they are able to offer better (lower) prices for patients who are able to purchase greater amounts of the same product. Some Internet pharmacies like Vgraustralia.com are also able to give freebie pills for every purchase, which can help buyers to save in cost.
TADORA 20mg/5mg’s shipping is not restricted, so patients from all over the world are able to have the product shipped to their homes. Patients who find it convenient to order medication online can benefit from online stores selling products like TADORA. Vgraustralia.com, one of the vendors of the drug also caters to countries like the US, Australia, or Canada, and asks for a minimal shipping fee (depending on the buyer preference). Shipping fees for TADORA from the mentioned online store are either $10 or $30, depending on the courier preference for the product.
- Pharmacy2home.com: Tadora 20 Mg (Tadalafil). Accessible at: http://www.pharmacy2home.com/tadora-20.htm
- Vgraustralia.com: Tadora. Accessible at: http://vgraustralia.com/tadora-online.html
- 1mg.com: TADORA 20 MG TABLET. Accessible at: https://www.1mg.com/drugs/tadora-20-mg-tablet-36039
- Moneycontrol.com: German Remedies. Accessible at: http://www.moneycontrol.com/company-facts/germanremedies/history/GR
- Bloomberg.com: Company Overview of German Remedies Private Ltd. Accessible at: http://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=878543
- Zyduscadila: The Company. Accessible from: http://zyduscadila.com/
- Skoumal R, Chen J, Kula K, Breza J, Calomfirescu N, Basson BR, Kopernicky V. Efficacy and treatment satisfaction with on-demand Tadalafil (Cialis®) in men with erectile dysfunction. European urology. 2004 Sep 30;46(3):362-9. Accessible from: http://www.sciencedirect.com/science/article/pii/S0302283804002374
- Egerdie RB, Auerbach S, Roehrborn CG, Costa P, Garza MS, Esler AL, Wong DG, Secrest RJ. Tadalafil 2.5 or 5 mg administered once daily for 12 weeks in men with both erectile dysfunction and signs and symptoms of benign prostatic hyperplasia: Results of a randomized, placebo‐controlled, double‐blind study. The journal of sexual medicine. 2012 Jan 1;9(1):271-81. Accessible from: http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02504.x/full