HealthRX.com · Printable question sheet
Cialis safety signals questions for your prescriber or pharmacist
Use this sheet before or at a visit about Cialis (tadalafil) to record your medicines, check nitrate use, list vision, hearing and erection changes, and bring questions about the FDA safety signals in this article.
Your Cialis and medicine history
Write what applies to you. Leave blank if not relevant.
Cialis or tadalafil product and strengthCopy from the pharmacy label
Date of most recent Cialis tabletWrite the day and month
Nitrate medicines or sprays ever usedInclude nitroglycerin and isosorbide
Other prescription and over the counter medicines
Blood pressure or heart medicines
Past eye, ear or skin reactionsNote what happened and when
Before the visit
Bring this sheet to the appointment or pharmacy counter.
- Bring every medicine bottle or a written list of all medicines and supplements.
- Confirm with the pharmacist that no nitrate product appears on your list.
- Note any sudden vision or hearing change and when it started.
- Write down any erection that lasted a long time and how it was handled.
- Check with your prescriber which emergency plan applies if you ever need a nitrate.
- Bring your insurance card if you want to ask about coverage for a Cialis prescription.
Questions to ask
- Does any medicine I take count as a nitrate that Cialis must not be used with?
- How long after my last Cialis tablet should my care team wait before any nitrate is considered?
- What should I do if a sudden change in vision or hearing happens while I take Cialis?
- Which signs of a long lasting erection need emergency care, and where should I go?
- Do my eye or hearing symptoms need a specialist check before I continue this medicine?
- Are the headache and back pain rates in the label likely to apply to someone with my health history?
- Is there a lower risk option I should discuss given my other medicines?
Symptoms to track
Record each change, even if it seems minor, and bring the log to visits.
| Date | Symptom | How long it lasted | Action taken |
|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.