Cialis AdWatch—deconstructing the ED drug ad

The United States Coast Guard is rightly proud of its longstanding motto, Semper Paratus (Latin for Always Ready). But the term took on a new meaning in January, when the Food and Drug Administration (FDA) approved the new once daily 2.5 mg and 5mg doses of tadalafil (Cialis), one of three oral drugs available for the treatment of erectile dysfunction. The drug, manufactured by pharmaceutical giant Eli Lilly and the third in a new class of drugs known as phosphodiesterase (PDE) inhibitors, was originally approved in 2003 for use on an "as you need it" basis.

In this, our third video in the Consumer Reports AdWatch series, we dissect a recent Cialis ad and tell you some information that the ad doesn't. Our accompanying Web piece also outlines some preventive measures you should consider before asking your doctor for a drug treatment.

Affectionately known as "The Weekender," Cialis differs from its two predecessors, sildenafil (Viagra) and vardenafil (Levitra) by having a chemical structure that prolongs its effect for up to 36 hours. That's more than seven times longer than its brother drugs. The advertising moguls (Eli Lilly spent close to $152 million promoting Cialis to the public in 2007) explain the drug's longer half-life by touting the advantages of sexual spontaneity and avoiding having to plan sexual relations in advance. And now, with the approval of the daily dose, the impotent male can be semper paratus for any opportunity.

Such convenience and ease of use has the potential to overlook several warnings about side effects and precautions. Side effects common to Cialis (and the other two PDE inhibitors) include headache, heartburn, muscular aches and pains, runny nose, and flushing. Much less common are potential adverse reactions, such as visual and hearing problems. Priapism (prolonged erection) can be a medical emergency.

The use of certain drugs absolutely precludes the use of Cialis (and the other two PDE inhibitors). Those drugs include nitrates (Imdur, Ismo, Isordil, and Nitro-dur), often used for heart pain. Caution is also advised if a class of medications known as alpha blockers are being taken because of the risk of blood pressure dropping too much. These are used by some not only to treat high blood pressure but also for treating symptoms associated with having an enlarged prostate. They include doxazosin (Cardura), tamsulosin (Flomax), and terazosin (Hytrin). Other drugs, such as the antibiotic erythromycin and certain anti-fungal drugs may increase blood levels of Cialis and add to the possibility of side effects. The same may well apply to grapefruit juice.

The cost—though less than the other doses—is not inconsequential when taken every day and insurance coverage can be limited. At about $5 per dose, a daily 2.5 mg Cialis may not prove to be as popular as the original 20 mg weekender version.

As part of our research for this AdWatch, we surveyed 2,511 men aged 18 and older to get their views on ED drugs, including this Cialis ad. Read more to find out what guys think of ED drug ads.

—Marvin M. Lipman, M.D., chief medical advisor

Get comprehensive information about erectile dysfunction, including ED Treatment Ratings (available to subscribers).