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    Excipient(s) with known effect: Lactose (as monohydrate) Each 20 mg film-coated tablet contains 367.584 mg lactose (as monohydrate). It is indicated in adults for the treatment of pulmonary arterial hypertension (PAH) classified as WHO functional class II and III, to improve exercise capacity (see section 5.1). In order for tadalafil to be effective for the treatment of erectile dysfunction, sexual stimulation is required. Efficacy has been shown in idiopathic PAH (IPAH) and in PAH related to collagen vascular disease. Erectile dysfunction in adult Men In general, the recommended dose is 10 mg taken prior to anticipated sexual activity and with or without food. In those patients in whom tadalafil 10 mg does not produce an adequate effect, 20 mg might be tried. It may be taken at least 30 minutes prior to sexual activity. Tadalafil 10 mg and 20 mg is intended for use prior to anticipated sexual activity and it is not recommended for continuous daily use. Pulmonary arterial hypertension Treatment should only be initiated and monitored by a physician experienced in the treatment of PAH. Tadalafil relaxes muscles of the blood vessels and increases blood flow to particular areas of the body. Tadalafil under the name of Cialis is used to treat erectile dysfunction (impotence) and symptoms of benign prostatic hypertrophy (enlarged prostate). Another brand of tadalafil is Adcirca, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. Do not take tadalafil if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as "poppers". Taking tadalafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure. Some medicines can cause unwanted or dangerous effects when used with tadalafil. Tell your doctor about all your current medicines, especially riociguat (Adempas).

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