Correct dosage info. please

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number8
New Member


Date Joined Nov 2009
Total Posts : 7
   Posted 11/29/2009 10:40 PM (GMT -6)   
Hi to all,

I'm new on this forum. I was diagnosed with Prostate cancer late last year at the age of 43! In February 2009 I underwent a dual nerve sparing open RP.

My urologist prescribed 5 mg daily of Cialis daily. My erections are not great - maybe 60% of what they were pre-op. I've read a few threads on this very informative site and it seems a mixed bag in terms of the correct dosage is for daily Cialis. I see a lot of you guys have been prescribed with 10 mg of daily Cialis. If I take 2 x 5mg tabs. instead I do feel that my penis does seem fuller - even in the flacid state.

I brought up the subject with my urologist last month and he said that I should just continue with 5md daily as there is no evidence increasing it would make any difference. Any info would be a great help.

One last thing - has any of you guys switched from Cialis to Viagra with better results ? and if so what daily dosage of Viagra did you take.

Many thanks,

Number 8

T40
Regular Member


Date Joined Oct 2009
Total Posts : 103
   Posted 11/29/2009 10:43 PM (GMT -6)   
Someone correct me if I am wrong but 5mg is a low dosage. 20mg is what is typically used for intercourse when it comes to cialis. Again, I could be wrong. I don't use cialis because it gives me horrible back spasms. Viagra is 100mg. The biggest difference between the two is cialis is longer duration. Viagra lasts about 4 hours.

T40
Age 40
Pre-op PSA was 5.8 from wellness test on May 19, 09
Follow up test from uro was 4.6 with a 9.3% free psa
Gleason 3+3 in one core, 3+4 in second core of 12 samples taken
Uro recommended Robotic for someone of my age. My research confirms.
Surgery performed August 19th, 09.
One side nerves spared. Nerve graft on other side.
Six weeks incontinence almost over. ED a work in progress but seeing some response.
Post op October 2nd, 2009 All margins were negative. PSA results in a few days.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 11/30/2009 3:41 AM (GMT -6)   
Number8,
Welcome to the forum, a place where much good and valuable information is to be found and posted by those in the same boat. T40 is correct ---- 5mg is a low dose. 2.5mg to 5mg daily is the level normally recommended for promoting a good blood flow in the region following surgery ----------------------- appropriate "Wham bam, thank you m'am" dosage is dependent on the reaction the drug has on the particular patient.

This from Eli Lily
"DOSAGE AND ADMINISTRATION-----------------------
• CIALIS for use as needed: Starting dose: 10 mg up to once daily. Increase
to 20 mg or decrease to 5 mg based upon efficacy/tolerability. Improves
erectile function compared to placebo up to 36 hours post dose (2.1).
• CIALIS for once daily use: 2.5 mg taken once daily, without regard to
timing of sexual activity. May increase to 5 mg based upon efficacy and
tolerability (2.1).
• CIALIS may be taken without regard to food (2.2).
---------------------DOSAGE FORMS AND STRENGTHS----------------------
Tablets (not scored): 2.5 mg, 5 mg, 10 mg, 20 mg (3).
"

Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 11/30/2009 2:46:43 AM (GMT-7)


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 11/30/2009 5:55 AM (GMT -6)   
these guys are right. Daily dose is 5mg. For normal guys, this is the always ready for sex dose. Post surgery, this is just a healing agent. And that is clearly what your doc want for you - the therapeutic 'get the blood flowing so things heal' therapy. Don't take anyting more than that on a daily dose since it builds up in your system and the side effects can be painful. If you want to pop a viagra to see if you can get an erection, skip a day from cialis and take 100mg viagra.
Welcome to the boards. stick around. Would you mind giving us your stats in a signature? It's just helpful to remember who is who and what is what.
Again, glad you're here.
Paul
46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
One year PSA - undectable!

ED Website: www.FrankTalk.org - frank discussions of Erectile Dysfunction - check it out.


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 11/30/2009 7:10 AM (GMT -6)   
I was on the 5mg Cialis daily dose for approx 2 months initially, and I never had any erections from it. After meeting with an ED dr, he told me the 5mg was for a healthy male that has ED for problems other than an RP performed and that I would need at the very least either 10mg of Cialis a day or 20mg every other day for increased blood flow

Cialis has the highest half life of the 3 ED oral drugs, so on day 2 of the 10mg daily routine, you still have 2-3mg of the prior days dosage still in your blood stream

If I were to attempt intercourse, then the full 20mg dosage 1 hr prior would really be the required dosage
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 11/30/2009 7:11 AM (GMT -6)   

Number 8,

You should push the MD to give you samples of each of the available ED oral medications:  Cialis, Viagra, Levitra (am I missing any?).  You need to try them all as they each work differently and each user has different results.

I didn't get anything useful out of Cialis except a whopping headache the next day.  Viagra did some good, but nothing exceptional.  100mg was not noticeably better than 50mg for me, but get them to give you 100mg -- you can cut them in half (and even in 1/4 if that is enough).  100mg pills cost the exact same as the 50mg pills.  Levitra (10mg) is currently working best for me, and no significant side effects. 

But, I gave up on all of them at about the 3 month post surgery point, and have only started trying them again.  Didn't get much response from the Levitra in the early tests, but it's doing a pretty good job now.  So, maybe a few trials spaced out in time make sense.  I will try the other two again as well.

Has anyone tried combos (e.g. Levitra and Viagra together)?  Has anyone tried double dose of Levitra (20mg) -- ill effects?


51 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
PSA at 0 for just over a year now.
 
 


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 11/30/2009 7:52 AM (GMT -6)   
Rolerbe

I tried a combo for the 3 ed drugs, never all 3 at the same time and never took them at the same time. I spread them out say 8 hrs apart when I tried them

With Viagra and Levitra they are both way gone after 8 hours so each other never conflicted , I tried 20mg of Cialis then 8 hrs later tried 20mg of Levitra or 50mg or even 100mng Viagra, no real additional side effects, nor erection either

For me Cialis caused great back pain and I stopped taking it when the samples ran out

At some point around my 1 yr post surgery date I may try Levitra and/or Viagra again, until then I am more than happy with my tried and true Trimix routine
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 11/30/2009 6:06 PM (GMT -6)   
Cialis in the afternoon and a viagra before sex was part of my doc's regimen for me. No side effects to speak of.
Most ED docs will do combo therapy of oral meds with almost anything else - injections, pumps, caverject, etc.
Paul
46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
One year PSA - undectable!

ED Website: www.FrankTalk.org - frank discussions of Erectile Dysfunction - check it out.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 12/1/2009 6:37 AM (GMT -6)   

Greetings, Number 8.  Just like several others, I would encourage you to talk to your doc about trying other alternatives.  My doc says that Cialis and Levitra work similarly but that Cialis does have a longer effacacy.  He gave me samples of both and then I ordered the ADC version of both.  I am coming up on 2 years now (Feb) and for me (and we are all different) the ADC version of Levitra works best .  It is 20mg I believe.  The only side effects I have from either Cialis or Levitra is a stuffy nose for a couple of hours.

For what it's worth, my doc says that Viagara works differently than the other 2 and doesn't use it unless the first 2 don't work.  However, he will prescribe it if the first 2 don't work.  Bottom line, try all 3 if needed (at appropriate spacing in between of course) and find something that works.  David


Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


number8
New Member


Date Joined Nov 2009
Total Posts : 7
   Posted 12/1/2009 3:33 PM (GMT -6)   
Paul1959 said...
Cialis in the afternoon and a viagra before sex was part of my doc's regimen for me. No side effects to speak of.
Most ED docs will do combo therapy of oral meds with almost anything else - injections, pumps, caverject, etc.
Paul


Hi Paul,

Good advice - I think I will try your method. Would it be possible to tell me what dosage of Cialis you take each day and what dosage of Viagra you take before sex ? It would be very helpful - I will ask my doc too prescribe me the Viagra - which I haven't tried yet.
r
Many thanks,

Number 8

ericf10
New Member


Date Joined Dec 2009
Total Posts : 2
   Posted 12/6/2009 7:37 PM (GMT -6)   
I received a 30-day 5mg daily trial of Cialis. In an effort to minimize the monthly expense, can I take two pills (10mg) one hour prior to sexual activity? What would be the difference in taking 10mg of the daily dose vs. 10mg of the 36-hour dose?

Post Edited (ericf10) : 12/6/2009 6:58:50 PM (GMT-7)


number8
New Member


Date Joined Nov 2009
Total Posts : 7
   Posted 12/6/2009 10:16 PM (GMT -6)   
ericf10 said...
I received a 30-day 5mg daily trial of Cialis. In an effort to minimize the monthly expense, can I take two pills (10mg) one hour prior to sexual activity? What would be the difference in taking 10mg of the daily dose vs. 10mg of the 36-hour dose?


Hi Eric,

Welcome to the board. There would be no difference at all as both methods deliver 10 mg. However I know it would be cheaper to buy the 10 mg rather than using 2 x 5mg. I would also advice you to try a 20 mg tablet before sex - the 5 mg ones are just to get the blood moving in the right direction.

Let me know how you get on,

Number 8

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/6/2009 10:34 PM (GMT -6)   
Hi Eric,

I agree with Number 8 the 10mg is just for blood flow, a full 20mg would really be needed to get the erection benefit of Cialis.

In reality that 30day trial is 7 full dosages, taking a 5mg pill will do zilch in the erection aid dept and , not much at all for blood flow
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0

Post Edited (MrGimpy) : 12/7/2009 5:24:54 AM (GMT-7)


ericf10
New Member


Date Joined Dec 2009
Total Posts : 2
   Posted 12/7/2009 6:07 AM (GMT -6)   
For $45, my insurance covers one month's dosage so I can get 4- 20mg pills or 30 - 5mg.  My calculations give the total dosage as 80mg for the former and 150mg for the later.  I would get over twice as much of the medication for the same price.  If I took 4 - 5mg, would that work the same as one 20mg and give me 36 hours of effectiveness?  

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/7/2009 6:23 AM (GMT -6)   
ericf10,

Yes taking 4x5mg is the same as taking a single 20mg pill, but note that the half life in Cialis while being much longer than the others is all but done after even 24 hours, there is not a whole lot left in your bloodstream.

If you wish it to last a full 36hours, then you may want to experiment with taking 3x5mg pills then the last 5mg pill 24 hours later to make sure saturation in the cells stays high

Or 2x5mg pills, then take another 5mg one 12 hours later spread 2x over the weekend

This method will keep the most Mg in your blood stream for a more on-demand ability
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 12/7/2009 6:26 AM (GMT -6)   
Number 8
Sorry I did not see your question. I took 20 mg cialis in the afternoon and 100 mg viagra at night and it worked well. i no longer need that. You will get better as times goes on. I respond to any of the oral meds just fine. If that's where I end up for life, I am one of the lucky ones and very grateful.
www.franktalk.org ED website for PCa guys


46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
One year PSA - undectable!


number8
New Member


Date Joined Nov 2009
Total Posts : 7
   Posted 12/7/2009 3:43 PM (GMT -6)   
Paul1959 said...
Number 8
Sorry I did not see your question. I took 20 mg cialis in the afternoon and 100 mg viagra at night and it worked well. i no longer need that. You will get better as times goes on. I respond to any of the oral meds just fine. If that's where I end up for life, I am one of the lucky ones and very grateful.


Hi Paul,

Thanks for the update. Am I right in saying that you took the Cialis 20 mg in the afternoon and then the 100 mg Viagra in the evening on demand when the need arose as opposed to daily ? Just want to be clear as I'm not sure I could afford that pattern !!

Since joining this forum I've decide to up my daily dose of Cialis to 7.5 mg. I cut in half a 5mg tablet. It seems to be working better already. In the flacid state my penis seems more like it used to be. It really does help with your self esteem. My urologist said it would not make any difference - however it does and I seem to learn more from the guys on this forum - who have actual real life experiences. I would even consider upping it to 10 mg daily with having a 20 mg tab on demand.

What do you guys think ?

Regards,

Number 8

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 12/7/2009 3:53 PM (GMT -6)   
if the doc sees no health risks with using it, then if it were me, I can't see why I wouldn't go ahead and give the full monty 20mg. dose a try. Remember, it doesn't work by itself, it takes physically and mentally being stimulated to work. Find a good magazine, website or movie or a helpful spouse and give it a test drive. LOL
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/7/2009 4:35 PM (GMT -6)   
Number 8,

I second what James C suggests, go for it and see what happens with a 20mg dose

If that does not work so great for you or if the cost is to much then go with the way cheaper shot route, warn your lady though, nothing can stop you for 1-2 hrs !!!
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


number8
New Member


Date Joined Nov 2009
Total Posts : 7
   Posted 12/7/2009 5:36 PM (GMT -6)   
James C. said...
if the doc sees no health risks with using it, then if it were me, I can't see why I wouldn't go ahead and give the full monty 20mg. dose a try. Remember, it doesn't work by itself, it takes physically and mentally being stimulated to work. Find a good magazine, website or movie or a helpful spouse and give it a test drive. LOL



Thanks James.

Just want to be clear - are you saying try the 20 mg daily or just on demand or are you saying take 10 mg daily and then a 20 mg on demand? Sorry for any confussion.

All the best,

Number 8

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 12/7/2009 7:02 PM (GMT -6)   
I was suggesting that if you were seeing some manly results at 7.5 and was considering trying 10mg, then for a one time test, I'd personally try a full 20mg regular dose to see where I stood, or if I stood at all.... smilewinkgrin As to maintainence dose's, I won't venture to say what to take, discuss with your doctor.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN

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