Generic Sildalist (Sildenafil Citrate 100 mg + Tadalafil 20 mg)

Introduction

Sildalis is a fixed-dose oral tablet that contains sildenafil citrate 100 mg and tadalafil 20 mg. Both active ingredients belong to the phosphodiesterase-type 5 (PDE5) inhibitor class, which promotes smooth-muscle relaxation in the vasculature of the penis and pulmonary arteries. The product is marketed as a cost-effective alternative for adult patients who require a longer duration of action than sildenafil alone but desire a lower dose of tadalafil for tolerability. The tablet is available in a 100/20 mg strength and is supplied by licensed manufacturers that comply with international pharmaceutical standards. In addition to its primary indication for erectile dysfunction (ED), the combination has been explored off-label for pulmonary arterial hypertension (PAH) and lower-urinary-tract symptoms related to benign prostatic hyperplasia (BPH).

What is Sildalis?

Sildalis is a combination medication that pairs two well-established PDE5 inhibitors-sildenafil citrate 100 mg and tadalafil 20 mg-into a single pill. The product is classified as a “dual-PDE5 inhibitor” formulation. While individual sildenafil and tadalafil products have been on the market for more than two decades, the combined formulation is newer and is typically supplied by generic-drug manufacturers rather than the original branded companies. The tablet contains the active ingredients together with standard excipients such as microcrystalline cellulose, lactose, and magnesium stearate.

How Sildalis Works

Sildenafil and tadalafil inhibit the enzyme phosphodiesterase-type 5, which degrades cyclic guanosine monophosphate (cG → cGMP) in vascular smooth muscle. By blocking PDE5, the drugs allow cGMP to accumulate, leading to relaxation of smooth muscle and vasodilation in response to nitric oxide release. In the corpus cavernosum, this results in increased blood flow that facilitates erection when sexual stimulation occurs. In the pulmonary vasculature, enhanced cGMP production reduces vascular resistance, improving exercise capacity in PAH patients.

The pharmacokinetic profile of the two agents differs: sildenafil reaches peak plasma concentrations within 30-120 minutes and has a half-life of about 4 hours, whereas tadalafil reaches peak levels in 2 hours and has a longer half-life of roughly 17.5 hours. By combining a full therapeutic dose of sildenafil with a low dose of tadalafil, Sildalis aims to provide rapid onset (from sildenafil) together with an extended therapeutic window (from tadalafil) without requiring multiple daily tablets.

Conditions Treated with Sildalis

Erectile Dysfunction (ED) - Both sildenafil and tadalafil are approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of erectile dysfunction in adult males. The combination delivers an immediate-onset effect from sildenafil while extending the window of efficacy through the longer-acting tadalafil component.

Rationale: PDE5 inhibition restores the NO-cGMP pathway needed for penile erection; the dual-dose strategy can benefit men who experience variable timing of sexual activity.

Pulmonary Arterial Hypertension (PAH) - Sildenafil is approved for PAH; tadalafil has also received approval for this indication in several regions. Although the Sildalis formulation itself lacks a regulatory label for PAH, clinicians sometimes consider off-label use of the combined product to harness both rapid and sustained pulmonary vasodilation.

Rationale: The additive effect on cGMP may improve hemodynamics, but formal approval for the combination has not been granted.

Off-Label and Investigational Uses of Sildalis

• Benign Prostatic Hyperplasia (BPH)-related Lower Urinary Tract Symptoms - Tadalafil 5 mg is approved for BPH, and limited clinical data suggest that higher-dose tadalafil (including 20 mg) may improve urinary flow. Some studies have explored the synergistic use of sildenafil with tadalafil for BPH, reporting modest improvements in International Prostate Symptom Score (IPSS).

• Raynaud’s Phenomenon - Small pilot trials have examined PDE5 inhibitors for vasospastic disorders. Combined therapy may enhance peripheral blood flow, but evidence remains preliminary.

• Sexual Dysfunction in Women - Although not approved, PDE5 inhibitors have been studied in female sexual arousal disorder. Early-phase research indicates possible benefit, yet safety data are insufficient.

All off-label applications lack formal regulatory endorsement. Patients should discuss these possibilities only with a qualified healthcare professional who can weigh the scientific evidence against individual risk factors.

Is Sildalis the Right Medication for You?

Sildalis may be appropriate for adult males who:

• Have a confirmed diagnosis of erectile dysfunction and need both rapid onset and extended duration of action.
• Experience variability in timing of sexual activity (e.g., spontaneous encounters) and therefore benefit from a combination formulation.
• Have previously tolerated both sildenafil and tadalafil individually without serious adverse events.

Contraindications include:

• Concomitant use of nitrates (e.g., nitroglycerin) or nitric oxide donors, which can cause profound hypotension.
• Severe uncontrolled hypertension or recent myocardial infarction.
• Known hypersensitivity to sildenafil, tadalafil, or any tablet excipients.
• Retinitis pigmentosa or hereditary degenerative retinal disorders, as PDE5 inhibitors may affect visual perception.

Patients with moderate hepatic impairment or severe renal dysfunction should use Sildalis only under medical supervision, with possible dose adjustments.

Risks, Side Effects, and Interactions

Common

• Headache
• Flushing
• Dyspepsia (indigestion)
• Nasal congestion
• Visual disturbances (e.g., blurred vision)

These effects are typically mild and resolve within a few hours.

Rare

• Priapism (prolonged erection > 4 hours) - requires emergency medical care.
• Auditory changes (tinnitus or hearing loss)
• Myalgia or back pain (more common with tadalafil)

Serious

• Severe hypotension, especially when combined with nitrates or alpha-blockers.
• Acute cardiac events (myocardial infarction, arrhythmia) in patients with pre-existing cardiovascular disease.
• Vision loss due to non-arteritic anterior ischemic optic neuropathy (NAION).

Drug-Drug Interactions

• Nitrates (e.g., isosorbide dinitrate) - co-administration can precipitate dangerous blood pressure drops.
• Alpha-blockers (e.g., tamsulosin) - may cause additive hypotensive effects; dose titration is recommended.
• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) - increase plasma concentrations of both sildenafil and tadalafil, raising the risk of adverse events.
• CYP3A4 inducers (e.g., rifampin, carbamazepine) - may reduce efficacy by accelerating drug clearance.

Drug-Food Interactions

• High-fat meals can delay sildenafil absorption, reducing onset speed.
• Grapefruit juice inhibits CYP3A4 and may increase drug exposure; patients should avoid large quantities.

Patients should refrain from consuming excessive alcohol while using Sildalis, as alcohol can potentiate hypotensive effects and impair erectile response.

Use: Dosing, Missed Dose, Overdose

Standard Dosing - For erectile dysfunction, the recommended regimen is one tablet (100 mg sildenafil + 20 mg tadalafil) taken as needed, not more than once per 24 hours. The tablet can be taken with or without food; however, a high-fat meal may delay the sildenafil component’s onset.

Missed Dose - If a patient forgets to take the tablet and it has been more than 12 hours since the last dose, they may take another dose, provided that the total daily dose does not exceed one tablet. Taking a second dose within 12 hours may increase the risk of hypotension and adverse events and should be avoided.

Overdose - Symptoms of overdose include severe hypotension, dizziness, fainting, prolonged erection, and cardiac irregularities. Patients should seek immediate medical attention if they experience any of these signs. Management is supportive: intravenous fluids, blood pressure monitoring, and, in severe cases, administration of antihypotensive agents.

Practical Precautions -

• Avoid operating heavy machinery or driving until the individual knows how Sildalis affects them, especially after the first few doses.
• Do not combine with recreational nitrates (e.g., “poppers”) or any medication containing nitroglycerin.
• Store tablets at room temperature, protected from excess moisture and direct sunlight.

FAQ

• What should I know about traveling with Sildalis? Sildalis tablets are stable at 25 °C (77 °F) for up to two years when kept in their original blister pack. When traveling internationally, store them in a sealed plastic bag to protect against humidity and keep the package with you in carry-on luggage to avoid temperature extremes in checked baggage.

• Can I take Sildalis with a high-fat meal? A high-fat meal may delay the absorption of sildenafil, extending the onset time by up to one hour. Tadalafil’s absorption is less affected. If a rapid effect is needed, consider taking the tablet on an empty stomach or after a light meal.

• What does the Sildalis tablet look like? The tablet is typically blue-white bicolored, round, and imprinted with “100/20” on one side to indicate the sildenafil and tadalafil strengths. Inactive ingredients include microcrystalline cellulose and lactose.

• Is Sildalis subject to drug testing for athletes? PDE5 inhibitors are not prohibited by the World Anti-Doping Agency (WADA). However, competitive athletes should disclose any medication use to their anti-doping authority, as some sporting bodies may request documentation.

• Are there regional formulation differences for Sildalis? Generic manufacturers may use slightly different excipients based on local regulatory requirements. For example, European-marketed tablets often contain low-dolomite calcium carbonate, whereas North-American versions may use magnesium stearate. These differences do not affect the active ingredients’ efficacy.

• What is the history behind combining sildenafil and tadalafil? Early pre-clinical studies in the s revealed that both drugs target the same PDE5 enzyme but have distinct pharmacokinetic profiles. Researchers hypothesized that a fixed-dose combination could offer both rapid onset and prolonged duration, leading to pilot formulations in the early s. Formal clinical trials evaluating the combined product have been limited, influencing its off-label status.

• How does Sildalis compare to taking sildenafil and tadalafil separately? When administered separately, dosing flexibility allows clinicians to tailor the timing and total daily exposure. The combined tablet simplifies regimen adherence by delivering both agents in a single dose, which may improve compliance in patients who prefer fewer tablets.

• Does Sildalis affect blood sugar levels? PDE5 inhibitors have no direct impact on glucose metabolism. However, patients with diabetes should be aware that severe hypotension can impair renal perfusion, potentially influencing glycemic control indirectly. Routine monitoring is advisable.

• Can I use Sildalis if I have a history of retinal disease? Patients with retinal disorders such as retinitis pigmentosa should avoid PDE5 inhibitors due to the risk of visual side effects, including transient color vision changes and rare cases of NAION. Consultation with an ophthalmologist is recommended before initiating therapy.

Glossary

Phosphodiesterase-type 5 (PDE5) Inhibitor

A class of drugs that block the enzyme PDE5, preventing the breakdown of cGMP and thereby promoting smooth-muscle relaxation in specific vascular beds.

cGMP (Cyclic Guanosine Monophosphate)

A second messenger molecule that mediates vasodilation; increased levels lead to relaxation of smooth muscle in the penis and pulmonary arteries.

Priapism

A prolonged, often painful erection lasting more than four hours, unrelated to sexual stimulation, which requires urgent medical intervention to prevent tissue damage.

Buying Sildalis from Our Online Pharmacy

Patients seeking reliable and affordable access to Sildalis can obtain the medication through our online pharmacy. Our service partners with licensed, overseas pharmacies that source the generic formulation from certified manufacturers adhering to Good Manufacturing Practice (GMP) standards.

• Cost Efficiency - Prices are set close to the manufacturer’s baseline, reducing the financial burden compared with branded equivalents.
• Verified Quality - Each batch undergoes independent testing for potency, purity, and dissolution, ensuring that the product meets international pharmacopeial criteria.
• Discreet Delivery - Orders are packaged in neutral, unbranded envelopes and shipped via reputable carriers; standard express delivery arrives within 7 days, while regular airmail typically reaches the destination in approximately three weeks.
• Privacy Assurance - Our pharmacy broker model respects patient confidentiality; no personal health information is shared beyond what is necessary for safe fulfillment.

By choosing our online pharmacy, patients gain a secure and convenient pathway to obtain Sildalis when local pharmacies lack stock, insurance coverage is insufficient, or privacy concerns are paramount.

Disclaimer

The content presented regarding Sildalis serves solely as general informational material and does not substitute for professional medical advice. Treatment decisions, including those relating to off-label applications, must be made under the supervision of a qualified healthcare provider. Readers are presumed to be responsible adults capable of making informed health choices. Our online pharmacy provides access to Sildalis for individuals who may encounter limited availability through traditional pharmacies, encounter insurance restrictions, or desire a cost-effective generic alternative. Always discuss any medication initiation, modification, or discontinuation with your physician.