Had a patient in, let's call him George. George is in his early sixties, managing some BPH, and also experiencing the kind of erectile difficulties that often accompany that particular life stage and its associated vascular changes. We'd had good success with tadalafil for him previously – specifically, he’d been on Cialis 5mg daily for a while, which helped both his urinary symptoms (a nice off-label perk of daily tadalafil) and his erectile function. He was happy, life was good.
Then, as often happens, his insurance formulary changed, or he hit the "doughnut hole," or some other vagary of the pharmaceutical-industrial complex kicked in, and his out-of-pocket cost for branded Cialis went through the roof. So, his GP, quite sensibly, switched him to generic tadalafil 5mg daily. Standard practice, should be bioequivalent, no problem, right?
Wrong. Or at least, wrong in George’s perception. He comes into my clinic looking a bit glum. "Doc," he says, "this new stuff just isn't the same. It’s not working like the Cialis did." He pulls out a blister pack of a generic tadalafil, and then, from another pocket, a strip of something called Vidalista 20mg. "I got this Vidalista from a mate who gets it online. He said it’s stronger. I’ve been cutting the 20mg ones into quarters to try and get my 5mg, but it’s still not like the Cialis was. And sometimes this Vidalista gives me a bit of a backache."
Deep breaths, John, deep breaths. Here we have a multi-layered problem. Firstly, the perception that "generic isn't as good." Secondly, the introduction of an unlicensed, internet-sourced medication (vidalista 20 mg). Thirdly, the inherent inaccuracies of pill-splitting when the pill isn't scored for it and the dose is critical.
Let's unpack Vidalista first. Like Kamagra, Vidalista is a brand name for tadalafil, manufactured by Centurion Laboratories in India. It’s widely available online without a prescription, often in various strengths – 20mg, 40mg, even 60mg and 80mg, which are well above approved daily or on-demand dosages for Cialis. And just like other medications sourced this way, there's no guarantee of quality, exact dosage, or freedom from contaminants. The "backache" George mentioned is a known, though not universal, side effect of tadalafil, but it could certainly be exacerbated by inconsistent dosing from crudely quartered, high-strength Vidalista tablets.
The core issue, though, was George’s conviction that his legitimate, pharmacy-dispensed generic tadalafil wasn't working as well as branded Cialis, which then led him down the rabbit hole of seeking out Vidalista. This is a common psychological hurdle. Patients get used to a brand name, a pill color, a packet shape. When that changes, even if the active ingredient is identical and bioequivalent, they can experience a nocebo effect – they expect it to be less effective, and so it is, for them. Or, there could be subtle differences in inactive ingredients (fillers, binders) that, while not affecting the drug's core action, might lead to a slightly different subjective experience for a very small number of sensitive individuals, though this is rare for a drug like tadalafil.
"George," I explained, "the generic tadalafil you got from your pharmacy should be working just like Cialis. It has the same active ingredient, tadalafil, in the same amount, and it's made to the same strict standards. Sometimes, just the change in appearance of the pill can make us feel like it’s different. But this Vidalista… that’s a different kettle of fish. You don’t really know what you’re getting with that, and cutting up those high-strength tablets is a very inexact science."
We talked about the importance of sticking to prescribed, regulated medications. I reassured him about the efficacy of generic tadalafil. I also gently pointed out that his ED might have other contributing factors that had subtly worsened over time, and he was attributing the change solely to the switch from Cialis to generic. Stress, diet, exercise, underlying vascular health – these things aren't static.
We agreed to get him back on a steady, prescribed 5mg daily dose of a reputable generic tadalafil from his local pharmacy. I also suggested he stop the Vidalista experiment immediately. If, after a consistent month or two on the prescribed generic, he still felt it wasn't providing the benefit he expected, we could then re-evaluate. Perhaps a trial of on-demand, higher-dose prescribed tadalafil (like 10mg or 20mg, taken as needed) might be an option, rather than daily, if his primary concern was purely ED and not so much the LUTS benefit. But the key was to use a legitimate product at a known dose.
It’s a tricky conversation. You don't want to dismiss a patient's experience, but you also need to guide them away from potentially risky self-medication with products like Vidalista. Building trust and providing clear education about generics, and the dangers of unregulated online pharmacies, is paramount. Vidalista might promise a potent punch, but it’s a punch in the dark.
And if you want more detailed and professional information, here’s the link: https://www.imedix.com/drugs/vidalista/