Abhirise 40 Mg (Tadalafil)

The approved maximum tadalafil dose for ED is 20 mg.

Abhirise 40 mg contains double that amount.

Clinical studies show erectile benefit plateaus at 20 mg.

Doses above 20 mg give little or no extra benefit.

Side effects, however, continue to increase with dose.

Back pain and muscle ache rise notably at higher doses.

Higher strength does not mean firmer or longer results.

Most men respond well at 10 mg or 20 mg.

Never step up to 40 mg on your own initiative.

Use this strength only if a doctor specifically prescribes it.

40 mg once daily is approved for pulmonary arterial hypertension.

That is a serious lung and heart condition.

It is a different medicine product with a different licence.

It is prescribed and monitored by hospital specialists.

That regimen is not a model for treating erectile dysfunction.

Do not take an ED dose if you already take tadalafil for lung disease.

Doubling up in this way can be dangerous.

Tadalafil has a half-life of about 17.5 hours.

At 40 mg, blood levels are higher and persist longer.

Allow at least 48 hours between a dose and any nitrate.

Ask your doctor whether a longer interval applies to you.

Tell emergency staff even if you dosed two days earlier.

Abhirise 40 is an oral tablet containing tadalafil 40 mg.

It is marketed for erectile dysfunction (ED).

40 mg is above the approved maximum ED dose of 20 mg.

Tadalafil belongs to the PDE-5 inhibitor drug class.

Tadalafil is the longest-acting PDE-5 inhibitor available.

Its effect can last up to 36 hours.

The tablet is swallowed whole with water.

It is taken only when needed, not daily.

The medicine works only during sexual stimulation.

It does not increase sexual desire or libido.

It does not cure the underlying cause of ED.

It offers no protection against HIV or other STIs.

It is not a hormone, steroid, or aphrodisiac.

Abhirise 40 is intended for adult men only.

Women and anyone under 18 must not use it.

ED can signal heart, hormonal, or vascular disease.

A full medical assessment should precede any ED treatment.

Sexual stimulation triggers nitric oxide release in penile tissue.

Nitric oxide activates an enzyme called guanylate cyclase.

This enzyme raises cyclic guanosine monophosphate (cGMP) levels.

cGMP relaxes smooth muscle in the corpus cavernosum.

Relaxed muscle allows penile arteries to widen.

Blood flows in and fills the erectile chambers.

Expanding tissue compresses the veins, trapping blood inside.

This produces and sustains a firm erection.

An enzyme called PDE-5 breaks cGMP down.

Rapid breakdown makes the erection fade too early.

Tadalafil blocks PDE-5, so cGMP stays elevated longer.

Blood flow is therefore maintained during sexual activity.

Why more is not better: PDE-5 enzymes in the penis become largely saturated at around 20 mg. Extra drug cannot block much more enzyme there. It only raises drug levels elsewhere in the body. That increases side effects without improving the erection.

Why back pain worsens at higher doses: Tadalafil also affects an enzyme called PDE-11. This is thought to explain the back and muscle pain some men report. Higher doses affect PDE-11 more. Back pain is therefore more likely at 40 mg than at 20 mg.

Key point: Without sexual stimulation, no nitric oxide is released. The medicine then has nothing to act on.

Take one dose at least 30 minutes before sexual activity.

Usually 30 to 60 minutes, sometimes up to 2 hours.

The effect can last up to 36 hours.

Allow at least 48 hours after a dose before any nitrate.

adalafil absorption is not affected by food

Use a 10 mg or 20 mg product if a reduced dose is prescribed.

Not applicable. This medicine is used only as needed.

Take the tablet exactly as your doctor prescribed.

Confirm with your doctor why 40 mg rather than 20 mg.

Swallow the tablet whole with a glass of water.

Do not chew, crush, or split the tablet.

Take it at least 30 minutes before sexual activity.

It may be taken with or without food.

A heavy meal does not delay the effect.

Sexual stimulation is required for the medicine to work.

The effect may persist for up to 36 hours.

Take no more than one tablet in 24 hours.

Do not combine it with any other ED medicine.

Do not take a second tablet if the first seems weak.

Wait a full 24 hours before considering another dose.

Expect back pain to be more likely at this strength.

Tell your doctor if side effects trouble you.

Ask about reducing to 20 mg if they do.

Do not share your tablets with anyone else.

Take any nitrate medicine in any form.

Nitrates include glyceryl trinitrate and isosorbide mononitrate or dinitrate.

This covers nitrate sprays, patches, and sublingual tablets.

Take nicorandil, a nitrate-like anti-anginal medicine.

Use amyl nitrite or butyl nitrite recreationally (“poppers”).

Take riociguat or another guanylate cyclase stimulator.

Already take tadalafil for pulmonary arterial hypertension.

Are allergic to tadalafil or any tablet excipient.

Have had a heart attack within the last 3 months.

Have had a stroke within the last 6 months.

Have unstable angina or angina during sexual intercourse.

Have uncontrolled arrhythmia or severe heart failure.

Have severe low blood pressure below 90/50 mmHg.

Have uncontrolled high blood pressure.

Have severe liver disease, such as decompensated cirrhosis.

Have retinitis pigmentosa or another inherited retinal disease.

Nitrates plus tadalafil can cause a fatal drop in blood pressure. Never combine them. Allow at least 48 hours between a dose and any nitrate medicine.

Tadalafil is also prescribed at 40 mg daily for pulmonary arterial hypertension. If you take it for that condition, do not take any additional tadalafil for ED.

Any heart disease, arrhythmia, or heart valve problem.

A previous heart attack, stroke, or bypass surgery.

Angina, or any prescription for nitrates in the past.

High blood pressure or low blood pressure.

Pulmonary hypertension, or any lung circulation disorder.

Liver disease or hepatitis of any type.

Kidney disease or reduced kidney function.

Any eye disease or sudden vision loss previously.

Hearing loss, tinnitus, or other ear disorders.

Sickle cell anaemia, leukaemia, or multiple myeloma.

Any bleeding disorder or clotting problem.

An active or recent stomach ulcer.

A penile deformity such as Peyronie’s disease or angulation.

Cavernosal fibrosis or a previous prolonged erection.

Chronic back pain or a spinal condition.

An enlarged prostate, or treatment for it.

Diabetes, especially if poorly controlled.

Recent or planned surgery, including dental procedures.

This matters more at 40 mg. Blood levels are already above the approved ED maximum.

Both tadalafil and alcohol lower blood pressure. The risk of dizziness is greater at higher tadalafil doses.

A doctor has specifically prescribed 40 mg for me.

I have discussed why 40 mg rather than 20 mg.

I do not take tadalafil for pulmonary hypertension.

I have taken no nitrate medicine in 48 hours.

I will need no nitrate medicine for 48 hours.

I have not used poppers or amyl nitrite.

I have taken no other ED medicine today.

I have not taken a dose in the last 24 hours.

I take no interacting antifungal or antibiotic.

My doctor knows all my current medicines.

My heart is fit enough for sexual activity.

I have avoided grapefruit juice.

I have limited or avoided alcohol.

I know the effect may last up to 36 hours.

The blister is sealed and the expiry date valid.

I know the emergency warning signs listed below.

Note on back pain: This is the side effect most affected by dose. It usually starts 12 to 24 hours after dosing. It normally settles within 48 hours. If it troubles you, ask your doctor about 20 mg instead.

If side effects trouble you at 40 mg, a lower dose is likely to work just as well. The erectile benefit does not increase above 20 mg.

All nitrates: glyceryl trinitrate, isosorbide mononitrate, isosorbide dinitrate.

Nicorandil, a nitrate-like anti-anginal medicine.

Amyl nitrite and butyl nitrite (“poppers”).

Riociguat and other soluble guanylate cyclase stimulators.

Tadalafil prescribed for pulmonary arterial hypertension.

Other PDE-5 inhibitors: sildenafil, vardenafil, avanafil, udenafil.

Alprostadil or any other erectile dysfunction treatment.

Alpha-blockers: tamsulosin, doxazosin, alfuzosin, terazosin.

Antifungals: ketoconazole, itraconazole, voriconazole.

Macrolide antibiotics: erythromycin, clarithromycin.

HIV protease inhibitors: ritonavir, saquinavir, cobicistat-boosted regimens.

Bosentan, used in pulmonary hypertension.

Blood pressure medicines, including amlodipine and diuretics.

Any medicine for an enlarged prostate.

Rifampicin, an antibiotic used for tuberculosis.

Carbamazepine, phenytoin, and phenobarbital.

St John’s Wort, a herbal antidepressant.

An erection lasting longer than 4 hours (priapism).

A painful erection that will not subside.

Chest pain, pressure, or tightness during or after sex.

Pain spreading to the jaw, neck, or left arm.

Sudden loss of vision in one or both eyes.

Sudden decrease or loss of hearing.

Ringing in the ears with dizziness.

Fainting, collapse, or severe persistent dizziness.

Severe shortness of breath.

Swelling of the face, lips, tongue, or throat.

Widespread rash with blistering or peeling skin.

Severe back pain that does not ease within 48 hours.

Signs of stroke: sudden weakness, slurred speech, facial droop.

Tell emergency staff you have taken tadalafil. State the dose as 40 mg. They must not give you nitrate medicines. Mention it even if you took it two days ago. Tadalafil remains active far longer than sildenafil. Untreated priapism can cause permanent erectile damage within hours.

Contains tadalafil, a well-studied and widely used molecule.

Tadalafil is approved worldwide for erectile dysfunction at up to 20 mg.

The effect can last up to 36 hours.

Food does not affect absorption or onset.

There is no pressure to time a dose precisely.

Visual side effects are less common than with sildenafil.

Taken only when needed, not daily.

It does not work better than 20 mg for erectile dysfunction.

It does not produce a firmer erection than 20 mg.

It does not last meaningfully longer than 20 mg.

It does not act faster than 20 mg.

A higher chance of back pain and muscle ache.

A higher chance of headache and indigestion.

Side effects more likely to persist into the next day.

Higher blood levels with no matching benefit.

Anyone using tadalafil for the first time.

Men aged 65 and over.

Men with liver or kidney impairment.

Men taking alpha-blockers or CYP3A4 inhibitors.

Men who experienced side effects at 20 mg.

Men with existing back or spinal problems.

Anyone treated with tadalafil for lung disease.

Choose the lowest dose that works for you. For erectile dysfunction, that is rarely above 20 mg. Only your doctor can confirm whether 40 mg is appropriate.

Store below 30°C in a cool, dry place.

Protect tablets from direct sunlight and heat.

Keep tablets sealed in the original blister until use.

Do not store in the bathroom or near a sink.

Moisture and humidity can degrade the tablets.

Do not transfer tablets into unlabelled containers.

Keep the original pack for the drug name and strength.

Never mix these with tadalafil prescribed for lung disease.

Do not freeze or refrigerate this product.

Keep it out of the sight and reach of children.

Accidental ingestion by a child is a medical emergency.

Check the expiry date printed on the pack.

Never use tablets after the expiry date.

Discard damaged, cracked, or discoloured tablets.

Dispose of unused medicine through a pharmacy take-back scheme.

Do not flush tablets or throw them in household waste.