Read the three locks as side-effect columns, not brand colours
Billboards sell a blue diamond, a weekend, a fast peak. This matrix sells the adverse tables attached to the three strengths Brynza actually locked. If the nitrate screen fails, close the tab.
Numbers are label-anchored ranges from the three monographs. Individual patients move. Depth lives on the columns, not on this sheet.
Daily tadalafil 2.5 mg is a continuous exposure. Sildenafil 25 mg and vardenafil 20 mg are as-needed peaks. Comparing their side-effect percentages as if they were the same experiment is how internet tables lie. Use each column's own study set.
Mail a figure that drifted to [email protected]. This desk does not dispense and does not sign a script.
Brynza locked three strengths so this sheet cannot slide back to 'Cialis 20, Viagra 50, Levitra 10' - the postcard every neighbour site already used. Daily 2.5, first-rung 25, ceiling 20. If a man is on a different milligram, the column still helps, but the percentages on this grid belong to those locks.
Stimulation is required on every row. A tablet swallowed for confidence without arousal is a flush experiment. Say that once, then stop repeating it in every cell.
Shared stops before any milligram talk
Daily tadalafil is the strictest in practice because trough never returns to zero. Sildenafil is the strictest in wording because the safe nitrate gap is not numbered. Vardenafil sits in between with a 24-hour pharmacology hint that still does not authorise a home GTN spray.
In Poland, crushing chest pain after any of these tablets is 112. Do not self-give nitrate. The hospital owns that minute.
Recreational nitrites (poppers) count on all three labels. Men who only admit 'heart spray' and hide the club chemical still trigger the wall. Ask both ways. Weekend plans and weddings do not punch a hole in it.
Riociguat is easy to miss because it is not a GTN spray. It is a soluble-guanylate-cyclase stimulator. Combined cGMP rise is the same idea. If PAH drugs are on the list, stop the ED PDE5 conversation until the pulmonary team speaks. Adcirca and Revatio are already in-class.
- Organic nitrates or nitrites, regular or intermittent, including poppers: class contraindication.
- Riociguat: same wall.
- After tadalafil: if a nitrate is later judged necessary in a life-threatening case, wait ≥48 h and monitor.
- After sildenafil: the PI says the safe nitrate interval is unknown, even at 24 h.
- After vardenafil 20 mg: NTG at 1 and 4 h still potentiated hypotension in healthy men; not at 24 h. The contraindication still stands.
- Two PDE5 products the same day: stop. Headache and pressure stack, not synergy.
- Unstable angina, recent infarction, or a man who cannot climb a flight: defer the whole class.
What to tell the couple in one minute
If they hate a clock and will swallow a tablet every morning, the 2.5 mg daily tadalafil column is the honest AE talk: quieter headache than folklore, real cough and back cells, 48-hour nitrate wall.
If they will fast and want a short window, 25 mg sildenafil is the flush talk: 16% headache, 10% flush, vision still quiet at this rung, dinner is the usual false failure.
If a friend already handed them a 20 mg Levitra strip, the first sentence is QT and the second is 'that is a ceiling'. Rhinitis and flush climb. Staxyn is not that strip.
Partner preference about planning is real. It does not outrank a GTN spray in the same toiletry bag.
Age alone does not pick the row. A 71-year-old can be a 25 mg sildenafil start, a 2.5 mg daily tadalafil start, or a 5 mg vardenafil start. The locked 20 mg Levitra tablet is the last of those conversations, not the first.
Renal cuts differ. Daily tadalafil stops in severe renal disease. Sildenafil 25 mg is already the consider-start under CLcr under 30. Vardenafil's hepatic row blocks 20 mg at Child-Pugh B. Copying one organ table across three INNs is how locums overdose a cirrhotic man.
Psychogenic ED still needs the therapy referral. A matrix row will not repair a relationship fight. Do not imply that.
The four-hour erection and the sudden dark
These sentences look copy-pasted because the labels copied them. The difference is exposure time: daily tadalafil is still on board the next morning when a man notices the eye. As-needed peaks have usually fallen by then. The stop instruction does not wait for a half-life lecture.
Dial 112 in Poland for collapse, crushing chest pain, or an erection that will not leave. This sheet is not a ward.
Shared rare-event script
- Erection past 4 hours: emergency care on all three. Tissue loss is the cost of waiting.
- Sudden vision loss: stop the class, urgent ophthalmology. NAION language is shared.
- Sudden hearing drop, tinnitus, dizziness: stop the class, seek care. Causality not proven; instruction is still stop.
- Sickle cell disease, myeloma, leukaemia, Peyronie deformity: higher mechanical or priapism risk - urology before the first swallow of any row.
- PAH products (Adcirca, Revatio) are not ED add-ons.
Headache, flush, back, vision, QT - the five rows that actually differ
Common class noise is headache, flush, dyspepsia, and a blocked nose. The useful rows are the ones that are not interchangeable. Read across, then open the column that matches the complaint you already have.
A man who quit tadalafil because his lumbar ache arrived the next afternoon should not be told 'all PDE5 drugs do that'. They do not, not on that clock. A man who quit sildenafil because Sunday dinner ate the peak should not be told the molecule is weak until someone repeats 25 mg fasted.
Vardenafil's rhinitis cell (9% versus 3% placebo) is the forgotten row. Men call it a cold and add a decongestant. Ask about the 20 mg step first.
Dyspepsia: 4% on daily tadalafil 2.5, 3% on sildenafil 25, 4% pooled on vardenafil. The number looks similar. The clock does not. Sildenafil dyspepsia climbs to 17% at 100 mg - a later column, not this lock. Tadalafil GERD 2% on 2.5 mg is the daily-table extra.
Dropout: 4.1% versus 2.8% on daily tadalafil studies; 3.4% versus 1.1% on vardenafil placebo-controlled trials. Sildenafil's Table 1 is an event table, not a dropout table. Do not invent a 'Viagra quit rate' from flush percentages.
| Row | Tadalafil 2.5 mg daily | Sildenafil 25 mg | Vardenafil 20 mg ceiling |
|---|---|---|---|
| Headache in the cited table | 3% (placebo 5%) in 12-week daily ED set | 16% (placebo 7%) fixed-dose | 15% pooled 5/10/20 (placebo 4%); dose effect toward 20 |
| Flush / skin warmth | 1% at 2.5 (placebo 1%); 3% at 5 mg | 10% at 25 mg (placebo 2%) | 11% pooled (placebo 1%); climbs 5→20 |
| Back / muscle | 3% back; 12-24 h delay, ~48 h fade | 3% back at 25 mg - not the delayed tadalafil pattern | 2.0% vs 1.7% placebo - not the daily Cialis story |
| Vision tint | Class NAION stop; tint not the 11% sildenafil-100 story | 1% at 25 mg; 11% at 100 mg | Class NAION stop; 120 mg volunteer dose often 'abnormal vision' |
| QT paperwork | Standard class caution | Standard class caution | Dedicated 10/80 mg study vs moxifloxacin; avoid LQTS and IA/III |
| Food friction | Label: food does not change rate or extent | High-fat: Tmax +60 min, Cmax -29% | High-fat: Cmax -18% to -50% |
Dinner versus duration versus ECG
Half-lives still matter once the AE row is chosen. Tadalafil ~17.5 h and a PRN window up to 36 hours live on the weekend sidebar, not on this daily lock. Sildenafil and vardenafil sit near 4-5 hours. None of that rewrites the one-dose-per-day rule.
Alpha-blockers: stabilize first, then start low - tadalafil 2.5 daily or 5 mg PRN, sildenafil 25, vardenafil 5. A 20 mg Levitra first night on terazosin is a teaching case this desk does not want to reprint.
| If the man says… | First matrix move | Column to open |
|---|---|---|
| I never know which night | Daily 2.5 tadalafil lock; accept delayed back as the tax | tadalafil column |
| Dinner is sacred and 25 mg 'did nothing' | Repeat 25 mg fasted before a class switch | sildenafil column |
| I want the ceiling tablet my friend uses | QT list first; 20 mg is not a start in the elderly or on alphas | vardenafil column |
| Lumbar ache the next day | Name it as tadalafil's delay; do not blame the mattress first | daily issue |
| I take amiodarone | Vardenafil is the avoid row; do not 'just use 10' | QT set |
Failed one agent after a proper trial - then switch
A proper sildenafil trial at this desk means at least one fasted 25 mg swallow inside the 30-minute-to-4-hour window, nitrate screen documented, no same-day redose. Failure after kotlet is a meal note, not a class note. See the meal sidebar.
A proper daily tadalafil trial means same-clock 2.5 mg for long enough to reach steady state - several days - without a borrowed 20 mg on top. Next-day lumbar ache that fades by 48 hours is an expected tax, not automatic failure. See the daily issue.
A proper vardenafil trial means the QT list is clean, the start was not a silent 20 mg in a 68-year-old on tamsulosin, and the plate was not a Cmax haircut. See the onset issue.
Insurance that only covers sildenafil does not rewrite tadalafil's food advantage. It rewrites the counselling: print the meal sidebar beside the sildenafil column. This matrix will not invent a compare coupon.
CYP3A4 caps that refuse a class default
Ketoconazole 400 mg daily raised a 20 mg tadalafil AUC by 312%. That number does not translate into a sildenafil milligram. Pull the current pair table. Tomasz fails any Issue that invents a 'PDE5 + ritonavir = half tablet' rule.
Rifampin cut a 10 mg tadalafil AUC by 88%. Daily efficacy can fade. The Cialis label does not invent a compensatory dose. Sildenafil and vardenafil inducer stories are thinner on the US inserts; do not copy the 88% onto them. If a man on rifampin says 'the tablet died', that is a clinic visit, not a silent climb to 20 or 100.
Grapefruit is 'likely' for tadalafil on the PI, not a numbered AUC. Treat it as noise around a potent-inhibitor month, not as a separate religion.
| Inhibitor story | Tadalafil daily lock | Sildenafil 25 lock | Vardenafil 20 lock |
|---|---|---|---|
| Potent CYP3A4 (keto, itra…) | Daily max already 2.5 mg | Consider 25 mg start (often already the lock) | Do not treat 20 as available; pair-specific cuts |
| Ritonavir | Daily max 2.5 mg | 25 mg; not again for 48 h (AUC 11-fold) | 2.5 mg; not again for 72 h (AUC 49-fold at 5 mg study dose) |
| Indinavir | Treat as potent 3A4; daily 2.5 cap | Strong-inhibitor start logic | 2.5 mg / 24 h (AUC 16-fold at 10 mg) |
| Erythromycin | Likely ↑ exposure (not a numbered daily cut beyond potent-inhibitor logic) | Consider 25 mg (Cmax +160%, AUC +182%) | Pair table - not a 20 mg casual night |
Two PDE5 tablets the same day
Daily tadalafil plus a 'just tonight' sildenafil is the mail this desk deletes twice a week. Both drugs raise cGMP. Headache, flush, and hypotension add. There is no labelled synergy bonus.
BPH on tadalafil 5 mg daily plus holiday Viagra is specialist-only territory with a written rationale, not a matrix permission. The 2.5 mg lock on the tadalafil column is even less of a platform for a second INN.
Friend-blister tours - Friday Cialis, Saturday Viagra, Sunday Levitra - are how QT lists and nitrate bags get skipped. Pick one row. Chart it.
What a Warsaw locum should say out loud at the window
Read the nitrate question before the brand. Regular spray, intermittent spray, paste, poppers, riociguat. If any yes, the matrix closes. If the man is unsure, the tablet waits. Weddings do not override that drill.
Name the lock you are dispensing. Daily 2.5 tadalafil is not a weekend 20. Sildenafil 25 is not a 100 mg vision story. Vardenafil 20 is not a 10 mg start and is not Staxyn. Saying the milligram aloud catches the wrong NDC faster than a colour check.
Ask the QT list only when vardenafil is the pick, but do not skip the class hearing and vision stops on the other two. Sudden dark and sudden deafness are shared scripts. Four hours of erection is shared. 112 is shared.
If only sildenafil is reimbursed, co-print the meal sidebar. If the man already has a 2.5 mg daily bottle, do not sell a holiday 20 mg tadalafil strip without a documented switch. If a friend already handed him Levitra 20, run QT before the first legal fill, not after the first faint.
This sheet is literacy. The signature on the script is still the prescriber's. Nowy Świat will correct a drifted figure by mail. It will not adjust a dose by return thread.
Half-lives in one breath: tadalafil about 17.5 hours, sildenafil about 4, vardenafil about 4-5 unless ritonavir stretches it to 26. Those numbers explain leftover Saturday coverage on a PRN tadalafil lane and leftover morning exposure on the daily 2.5 lock. They do not authorise a second INN at midnight.
Bioavailability trivia for the student pile: sildenafil mean 41%, vardenafil about 15%, tadalafil not stated as a percent on the US insert. Do not invent 81%. Food: tadalafil unchanged, sildenafil Cmax -29% and Tmax +60 minutes, vardenafil Cmax -18% to -50%. That is the dinner row.
Alpha-blocker start lows again, because locums forget: tadalafil 2.5 daily or 5 mg PRN, sildenafil 25, vardenafil 5. The locked 20 mg Levitra tablet is not that start. A man already wobbly on doxazosin alone is the faint waiting to happen.
Formulation traps belong on the identity slips: Revatio is not Viagra 25, Adcirca is not daily Cialis 2.5, Staxyn is not Levitra 20. Say the product name at the window. A generic INN in a quiet box is still the molecule on this sheet if the milligram matches the lock.
When a man has already failed one proper trial, switch. When he has failed a dinner, repeat the same INN fasted. That distinction is the whole point of filing side effects before brand loyalty.
Issue date on this sheet is 21 August 2026. If a later CHPL moves a percentage, mail the paragraph. Do not treat last year's printout as current proof. A drifted cell is a Proof failure, not a branding exercise.
Literacy ledger - no invented compare dollar
This matrix will not print a three-drug coupon. Price the INN on the e-script. Cash cells live on each column. The pills below are official pharmacy pages only.
GoodRx stays in captions on the three columns, not as a href on a Walmart row. Brynza does not dispense. A combo blister from an online stall is not a matrix pick.
| Pharmacy | Strength / count | Column note | Official page |
|---|---|---|---|
| Walmart | Ask labelled INN | No invented matrix coupon | Walmart pharmacy |
| Rite Aid | Ask labelled INN | Nitrate hold on tadalafil, sildenafil, and vardenafil | Rite Aid pharmacy |
| Harris Teeter | Ask labelled INN | Cash lives on each column, not this sheet | Harris Teeter pharmacy |
| H-E-B | Ask labelled INN | Not a combo blister | H-E-B pharmacy |
Issue stamp and the six sidebars
Columns: tadalafil 2.5 daily, sildenafil 25, vardenafil 20. Sidebars: daily issue, weekend set, meal, dose column, QT set, onset issue.
Confirm any change with the prescriber. Brynza matrix educates. 112 if someone is collapsing.
Sources
- DailyMed Cialis once-daily Table 2 - 2.5 mg AE cells; 48-hour nitrate language
- DailyMed Viagra Table 1 - 25 mg fixed-dose AE; high-fat Tmax +60 min, Cmax -29%
- DailyMed / Levitra PI - pooled 5/10/20 AE; QT study 10 mg and 80 mg vs moxifloxacin; high-fat Cmax -18% to -50%
- Class labels - priapism >4 h, NAION and sudden hearing stop-instructions
Checked against the current label and reviewed by Dr. Tomasz Krajewski. See Brief, Set, Proof, Issue.