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Similar products
The product in question here is one of those that makes you pause and really examine the data. We’re looking at a compounded formulation marketed as “Extra Super Cialis,” which typically combines Tadalafil, the active pharmaceutical ingredient in the branded Cialis, with Dapoxetine, the component found in some treatments for premature ejaculation. It’s not a single, approved drug but rather a combination product that exists in a regulatory gray area in many markets, often sourced from compounding pharmacies or international online suppliers. Its stated purpose is to address both erectile dysfunction and premature ejaculation concurrently, a common dual complaint in men’s health clinics. I first encountered it when a patient, let’s call him Mark, a 52-year-old with hypertension, brought in a blister pack he’d ordered online, asking if it was “the real deal.” That sent me down a rabbit hole of literature review and consultations with our hospital’s pharmacology department.
Extra Super Cialis: Dual-Action Therapy for Erectile and Ejaculatory Dysfunction - Evidence-Based Review
1. Introduction: What is Extra Super Cialis? Its Role in Modern Men’s Health
So, what is Extra Super Cialis? In clinical terms, it’s a fixed-dose combination product that isn’t approved by major regulatory bodies like the FDA or EMA. It typically contains Tadalafil, a long-acting phosphodiesterase type 5 (PDE5) inhibitor, and Dapoxetine, a short-acting selective serotonin reuptake inhibitor (SSRI). The concept is pharmacologically logical – tackle two of the most prevalent male sexual dysfunctions with one agent. Tadalafil for the erectile component, Dapoxetine for the ejaculatory control. You see patients like Mark, and you understand the appeal. He didn’t want to take two separate pills; he wanted a simple solution for his complex sexual health issues. The “Extra Super” branding is purely marketing, but it speaks to the desire for a potent, all-in-one solution. Its role, unofficially, is to fill a gap that many men perceive exists between their symptoms and the available, approved single-agent therapies.
2. Key Components and Bioavailability of Extra Super Cialis
The composition is the core of the discussion. You have Tadalafil, usually at 20mg, which is the standard dose for on-demand use for ED. Its bioavailability is about 36%, and it’s not significantly affected by food, which is one of its advantages. Peak plasma concentration hits around 2 hours post-dose and it has that famous long half-life of 17.5 hours. Then you have Dapoxetine, typically dosed at 30mg or 60mg in these formulations. Its bioavailability is a bit higher, around 42%, and it’s rapidly absorbed, with a Tmax of 1-2 hours. The critical point, and this is where our pharmacy team raised red flags, is the interaction potential. Dapoxetine is metabolized by multiple CYP enzymes, including 3A4 and 2D6, and Tadalafil is a mild CYP3A4 substrate. When you combine them, you’re potentially altering the pharmacokinetics of one or both. The “super” part of the name doesn’t refer to any enhanced absorption technology; it’s just a marketing term for the combination itself. We had a long debate in our department about whether the convenience outweighed the unpredictable pharmacokinetics.
3. Mechanism of Action: Scientific Substantiation for Extra Super Cialis
How does Extra Super Cialis work? It’s two distinct mechanisms working in parallel, not synergistically. Let’s break it down. Tadalafil’s mechanism of action is well-established: it inhibits PDE5 in the corpus cavernosum of the penis. This increases cyclic guanosine monophosphate (cGMP) levels, which leads to smooth muscle relaxation and increased blood flow, facilitating an erection in response to sexual stimulation. Think of it as removing the brake on the physiological process.
Dapoxetine’s mechanism is different. It’s a rapid-onset, short-duration SSRI. It increases serotonin activity in the synaptic cleft in the central nervous system, specifically believed to enhance the serotonergic tone in the hypothalamic nuclei involved in the ejaculatory reflex. This raises the threshold for ejaculation, effectively delaying it. It doesn’t numb sensation; it modulates the neurochemical trigger.
The “extra” effect isn’t a new pharmacological action; it’s simply the concurrent action of two drugs with different targets. One works peripherally on vascular tissue, the other centrally on neuronal control. I remember presenting this to our residents and one of them asked, “So it’s like having a gas pedal and a brake for two different systems?” Exactly. But the problem is they’re in the same car, and we don’t have perfect data on how they interact in the real world, outside of controlled trials for the individual components.
4. Indications for Use: What is Extra Super Cialis Effective For?
The primary indication men seek this for is the concurrent presence of erectile dysfunction and premature ejaculation. This is more common than many realize.
Extra Super Cialis for Concurrent ED and PE
This is the core use case. A patient has both difficulties achieving/maintaining an erection and a short intravaginal ejaculatory latency time (IELT). The idea is to treat both with one pill. In my practice, I’ve seen maybe a dozen patients who have used it. Mark, our 52-year-old, reported a definite improvement in both parameters, but he also experienced significant dizziness and nausea, which he attributed to “the strength” of the pill, but was likely the Dapoxetine.
Extra Super Cialis for Predominantly Psychogenic Sexual Dysfunction
Sometimes the ED has a strong psychological component exacerbated by performance anxiety related to rapid ejaculation. By pharmacologically guaranteeing a better erection and delayed ejaculation, it can break the cycle of anxiety. I had a patient, David, 41, whose PE was driving his ED. A trial of this combination (after a thorough cardiac workup) did help him reset his psychological baseline, after which he was able to transition to behavioral therapy alone.
Extra Super Cialis for Treatment-Resistant Cases
Some men don’t get sufficient benefit from monotherapy for one condition, and the lingering issue exacerbates the other. This is a last-resort option before more invasive treatments. The evidence here is purely anecdotal. We had a case, Robert, 60, with diabetic ED and lifelong PE. Standard Tadalafil gave him a decent erection but didn’t touch the PE, which then caused frustration and made the ED worse. The combination did provide a more satisfactory overall sexual experience for him and his partner.
5. Instructions for Use: Dosage and Course of Administration
This is where it gets messy because there’s no standardized prescribing information. Based on the typical compounded formulations and the known pharmacology of the individual drugs, the following is a general guide, but it must be emphasized: this should not be undertaken without direct medical supervision.
| Indication | Typical Tadalafil Dose | Typical Dapoxetine Dose | Timing | Administration Notes |
|---|---|---|---|---|
| Concurrent ED & PE | 20 mg | 30 mg or 60 mg | 1-3 hours before anticipated sexual activity | Start with the lower Dapoxetine dose. Take with a full glass of water. |
| Dose Titration | Fixed (20 mg) | Can be increased to 60 mg if 30 mg is ineffective and tolerated | As above | Do not take more than one dose in a 24-hour period. |
The “course of administration” is typically on-demand, not daily. The side effects are essentially the combined side effect profiles of each drug. For Tadalafil: headache, dyspepsia, back pain, myalgia, nasal congestion, flushing. For Dapoxetine: nausea, dizziness, headache, diarrhea. When combined, the risk of vasovagal-type symptoms (dizziness, lightheadedness) seems higher in my limited observation. Mark, the first patient I mentioned, had to lie down for an hour after his first dose due to dizziness. He said it was worth it for the efficacy, but that’s a significant adverse effect.
6. Contraindications and Drug Interactions of Extra Super Cialis
The contraindications are extensive and serious. This is not a benign supplement.
Absolute Contraindications:
- Patients using any form of organic nitrates (e.g., nitroglycerin, isosorbide mononitrate) or guanylate cyclase stimulators (e.g., riociguat). The risk of profound, life-threatening hypotension is extreme.
- Significant cardiovascular disease (e.g., unstable angina, recent MI, heart failure).
- Severe hepatic impairment.
- History of orthostatic hypotension.
- Significant psychiatric disorders.
Major Drug Interactions: This is the critical section. The interaction profile is a minefield.
- Strong CYP3A4 Inhibitors: Drugs like ketoconazole, ritonavir, clarithromycin. These can drastically increase the levels of both Tadalafil and Dapoxetine, leading to severe toxicity.
- Other Alpha-blockers: For hypertension or BPH. This can cause a dangerous drop in blood pressure. A separation of several hours is not sufficient with Tadalafil’s long half-life.
- Other SSRIs or SNRIs: Combining with Dapoxetine increases the risk of Serotonin Syndrome, a potentially fatal condition. I had a near-miss with a patient who didn’t disclose he was on a low-dose SNRI for neuropathic pain. He experienced tremor, agitation, and confusion after taking the combination pill. We caught it in time, but it was a stark reminder.
- Moderate CYP3A4 inhibitors and CYP2D6 inhibitors also require extreme caution.
Is it safe during pregnancy? The question is irrelevant as it is for male use only, but it highlights the kind of basic safety query that gets overlooked.
7. Clinical Studies and Evidence Base for Extra Super Cialis
Here’s the rub: there are no large-scale, randomized, placebo-controlled trials for this specific fixed-dose combination “Extra Super Cialis.” The evidence is extrapolated from studies on the individual components.
Tadalafil alone has a massive evidence base for ED, with dozens of high-quality studies showing significant improvement in IIEF scores and successful intercourse attempts. Its efficacy is not in question.
Dapoxetine has been studied specifically for PE. A 2019 meta-analysis in BJU International concluded that Dapoxetine 30mg and 60mg significantly improved IELT and patient-reported outcomes compared to placebo.
However, studies on the combination are scarce. A small 2015 study in the International Journal of Impotence Research looked at Tadalafil 10mg daily plus Dapoxetine 30mg on-demand versus each monotherapy. It found the combination was superior in men with both conditions, particularly in measures of sexual satisfaction. But the sample size was small (n=120), and it wasn’t the “Extra Super” 20mg Tadalafil formulation. The lack of robust data is the biggest strike against it. We’re essentially practicing a form of off-label polypharmacy without the rigorous safety net of a tested fixed-dose combination.
8. Comparing Extra Super Cialis with Similar Products and Choosing a Quality Product
When patients ask me to compare or which is better, my first response is to steer them towards approved, single-entity drugs prescribed separately. That gives us dosing flexibility and a clearer safety profile.
Comparison with Branded Cialis (Tadalafil) alone:
- Cialis: Treats ED only. Well-studied, predictable safety profile. FDA-approved.
- Extra Super Cialis: Treats ED and PE. Unpredictable quality and pharmacokinetics. Not FDA-approved. Higher risk of side effects.
Comparison with Other Online “Super” Formulations (e.g., “Super Kamagra” - Sildenafil + Dapoxetine):
- The main difference is the PDE5 inhibitor. Tadalafil (in “Cialis” types) is longer-acting. Sildenafil (in “Viagra” types) is shorter-acting. The choice depends on the desired duration of effect for the ED component. The Dapoxetine component is the same. The quality control of these products from unverified online sources is the paramount concern. A 2017 study found that a significant percentage of such products sold online contained incorrect doses or undeclared ingredients.
How to choose a quality product? My professional advice is: don’t. If the combination is medically necessary, a legitimate compounding pharmacy can prepare it under a doctor’s prescription, with verified ingredients and doses. Purchasing “Extra Super Cialis” from an online source is a gamble with your health. The variation between batches and suppliers is unknown.
9. Frequently Asked Questions (FAQ) about Extra Super Cialis
What is the recommended course of Extra Super Cialis to achieve results?
It’s an on-demand therapy, not a continuous course. You take one tablet 1-3 hours before sexual activity. It should not be taken daily. The “results” are immediate for that specific sexual encounter.
Can Extra Super Cialis be combined with alcohol?
It is not recommended. Alcohol can potentiate the blood-pressure-lowering effects of Tadalafil and increase the risk of dizziness and orthostatic hypotension from Dapoxetine. It’s a recipe for a fall or a fainting episode.
Is a prescription required for Extra Super Cialis?
Legally, yes, as it contains prescription-only pharmaceutical ingredients. However, many online pharmacies bypass this requirement, which is a major red flag for the legitimacy and safety of the product.
What should I do if I experience a prolonged erection?
An erection lasting more than 4 hours (priapism) is a medical emergency. You must seek immediate medical attention at an emergency department to prevent permanent damage to the penile tissues.
10. Conclusion: Validity of Extra Super Cialis Use in Clinical Practice
So, after all this, where do we land on the validity of Extra Super Cialis? The pharmacological premise is sound. Treating comorbid ED and PE with a single agent is a compelling concept. However, the execution in the form of this unregulated, fixed-dose combination product is fraught with risk. The lack of a consistent evidence base, the unpredictable quality from online sources, and the significant interaction potential make it a therapy I cannot recommend in good conscience outside of a very controlled, supervised setting with a trusted compounding pharmacy.
The risk-benefit profile is skewed towards risk for most patients. The benefit of convenience does not outweigh the potential for serious adverse drug interactions or the consequences of consuming a product of unknown purity and concentration. For men like Mark, David, and Robert, the desire for a simple solution is understandable. But in medicine, simple is rarely safe when it comes to potent pharmaceuticals.
Personal Anecdote & Follow-up:
I still think about Mark. He was so hopeful when he brought in that blister pack. After our long discussion about the risks, he was disappointed. We agreed on a different path: a daily low-dose Tadalafil for his ED, which gave him a more spontaneous background efficacy, and we worked on behavioral techniques for the PE, with the option of a separate, prescribed Dapoxetine dose in the future if needed. It was more complicated than one pill, but it was safer. I saw him for a follow-up 6 months later. The ED was well-controlled, and he and his wife were working with a therapist on the PE, making slow but meaningful progress. He thanked me for “not just giving him what he wanted, but what he needed.” That’s the core of it, isn’t it? Another patient, Leo, a 48-year-old, didn’t listen. He ordered the “Extra Super” online anyway. He ended up in the ER with severe hypotension after taking it following a few beers. He was okay, but it was a scare. He’s now on a properly managed regimen. These cases are the real evidence. The allure of a “super” pill is powerful, but the reality of practice teaches you that careful, individualized medicine, even if it’s less glamorous, is almost always the right path. The longitudinal data from my own small cohort shows that patients do better with separate, tailored agents and non-pharmacological support. The testimonials I value aren’t about the power of a pill, but about regained confidence and safety through a managed therapeutic relationship.