Get a Cialis prescription online

If you think you have erectile dysfunction, speak with a doctor on Maple about being prescribed Cialis online in Canada.

Cialis Price: How Much Does Cialis Cost?

If you’ve been diagnosed with erectile dysfunction (ED), your healthcare provider may suggest using a medication such as Cialis® to relieve your symptoms and improve your sexual health.

Known for its long duration of action, Cialis is one of the most popular medications available for treating ED. It contains the active ingredient tadalafil and belongs to a class of drugs referred to as PDE5 inhibitors.

Although Cialis was originally only available as a brand name medication, it’s now also available as a generic.

The price of Cialis can vary based on a number of factors, including the specific dosage of Cialis you’re prescribed and whether you prefer to use brand name Cialis or a more affordable generic version.

Below, we’ve explained how pricing for Cialis works, as well as how much you’ll typically need to pay to purchase this medication.

We’ve also answered several common questions about Cialis’s availability, differences between Cialis and generic tadalafil, and more.

Cialis: The Basics

Before we go into detail about the price of Cialis, let’s briefly cover some of the basics about this medication.

Cialis is an ED medication that contains the active ingredient tadalafil. It’s known for its duration of action. Unlike sildenafil (the active ingredient in Viagra®), which lasts for about four hours per dose, a single dose of Cialis can provide relief from ED for up to 36 hours.

Thanks to its longer-than-average duration of action, Cialis is often referred to as the “weekend pill” for treating erectile dysfunction.

You may prefer Cialis to other ED medications if you want something that can last for the entire day, without any need to take medication before sex. Cialis’s long-lasting effects make it a good option if you don’t know exactly when you’ll have sex during the day and want to be prepared.

Cialis was first approved by the FDA in 2003 as a treatment for erectile dysfunction. Like other medications for ED, it’s also occasionally prescribed to treat other medical conditions, including benign prostatic hyperplasia (BPH, or prostate enlargement).As a treatment for ED, Cialis works by inhibiting an enzyme referred to as phosphodiesterase-5 (PDE5), which plays a major role in controlling blood flow to your penis.

By inhibiting PDE5, Cialis expands the blood vessels that supply your penis, making it easier for you to get and maintain an erection when you feel sexually aroused.

One thing to understand about Cialis (and other ED medications) is that it only increases blood flow. Contrary to popular belief, Cialis doesn’t have any real impact on your sex drive and won’t cause you to get an erection if you aren’t in the mood for sexual activity.

As with many ED medications, brand name Cialis is significantly more expensive than tadalafil (generic Cialis).

Currently, we offer brand name Cialis from $958 per month and generic tadalafil from just $82 per month as part of our range of erectile dysfunction treatments.

genuine Viagra® makes it possible

How Much Do Cialis and Tadalafil Cost?

The price of Cialis can vary based on numerous factors, including where you’re purchasing this medication, the precise dosage of Cialis you’re prescribed, your current health insurance status and whether you opt for brand name Cialis from Eli Lilly and Company or generic tadalafil.

Cialis comes in tablet form and is available in several doses, ranging from 2.5mg all the way up to 20mg. Some Cialis tablets are designed for use as needed one hour before sex, while others are designed for daily use.

The price of brand name Cialis can range from $12 to upwards of $70 per tablet, depending on the specific dosage of the medication. For a month’s supply, typical pricing ranges from $380 to $1,000 or more, again depending on the dosage you’re prescribed.

We offer the once-a-day version of Cialis online through our telehealth platform for a total price of $958 per month.

Like other medications, Cialis is available as a generic. Generic tadalafil costs significantly less than brand name Cialis, making it a better choice if you’re looking for optimal value for money.

The price of generic tadalafil can vary based on the dosage. However, most versions of generic tadalafil cost between $5 and $25 per tablet.

We offer generic tadalafil from $82 per month. This medication contains exactly the same active ingredient as brand name Cialis, but is available at a significantly lower price.

Since both Cialis and tadalafil are available in several dosages, it’s important to make sure that you compare medications of the same dosage when you check and compare prices online.

Considering using Cialis long term? Our guide to long-term use of Cialis goes into greater detail about what to be aware of before using Cialis or generic tadalafil for several years.

Get a Cialis prescription online

Are you looking to get Cialis online? You can get your medication prescribed online in minutes and delivered straight to your door. Please note that medications will only be prescribed if the doctor feels it is appropriate and safe for you.

Get a confidential diagnosis by text, video or audio chat.

How to get Cialis online in Canada with Maple.

headache

• abdominal pain
• sexual health
• skin problem
• minor injury
• diarrhea / constipation
• other

First, choose your symptoms

There are many reasons why you could be experiencing erectile dysfunction, like stress, anxiety and lack of sleep.

If you don’t have employer / insurer coverage, fees may apply since many of our services aren’t covered by provincial health plans. This is often because of our use of secure messaging and a national network of doctors and nurse practitioners.

If payment is required, visits start at $69 and include the prescriptions for Cialis if the doctor deems it necessary.

For more information on our pricing, click here.

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Next, you’ll hear from the doctor

Once you’ve entered your symptoms, a doctor or nurse practitioner will review your case. If they’re able to help, your visit will start; if they can’t help, you’ll be notified before your consultation begins and you won’t be charged. You’re only charged if you speak with a Maple doctor.

Most often, you’ll speak to your doctor or nurse practitioner over text, though they may request audio or video chat if it’ll help with your diagnosis.

Get your medication

You’ll get a prescription right on Maple, so you can send it to any pharmacy for pickup, or you can have it shipped with free delivery.

In some cases, a prescription won’t be recommended by the doctor. They will let you know if this is the case. Doctors may also not be able to prescribe some medications in certain provinces or regions.

Note: Maple is not a pharmaceutical manufacturer, nor are we an online pharmacy. This means you’ll need to buy the medication from the pharmacy itself once you have your prescription.

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Frequently Asked Questions

What is Cialis and how does it work?

Cialis (tadalafil) is a type of medication used to treat erectile dysfunction . Medication used to treat erectile dysfunction works by increasing the body’s blood flow to the penis with sexual stimulation. This makes erections firmer and more likely to be adequate for intercourse because of a prolonged erection.

What is the difference between Cialis and Viagra?

While Cialis and Viagra can both be used to treat erectile dysfunction, each has its own unique properties that make it more suitable depending on the situation and the person taking it. The differences can include dosage amount, frequency, side effects, duration, risks, and more.

This is why it’s always important to speak to your healthcare provider before using Cialis or Viagra to determine which is best for you. With Maple, you can speak with a doctor online in minutes to inquire about a prescription for Cialis in Canada.

How do you use Cialis?

You can take Cialis as needed, and only once every 24 hours. It typically takes 30 to 60 minutes for the medication to start working and has an effect that lasts up to 36 hours. Cialis comes in different dosages depending on what you and your doctor determine to be most suitable for your needs.

You can connect with a doctor on Maple in minutes who can prescribe Cialis online in Canada at their discretion.

What are the side effects and risks of Cialis?

Common side effects of Cialis include flushing, headache, and muscle aches. You should always speak to your healthcare provider before taking Cialis — they’ll decide whether it is right for you.

What’s the most important information I should know about Cialis?

Do not take Cialis if you take any nitrate medications. Nitrate medications are used to treat chest pain (angina). A sudden drop in blood pressure caused by combining Cialis and these medications can cause you to feel dizzy, faint, or have a heart attack or stroke. This is why it’s always recommended to speak directly with a doctor before receiving a prescription for Cialis.

How does Cialis affect your mood?

In one study, a low dose of Cialis was shown to improve depressive symptoms as well as ED. However, individual results may vary. The doctor may recommend a follow-up appointment to see how Cialis affects your mood as well as how it’s working for you overall.

How long does it take for Cialis to peak?

Cialis typically takes around 30 minutes to start working, peaks around two hours after taking the recommended dose, and can last up to 36 hours. However, individual results may vary.

To buy Cialis online, you’ll need to speak with a healthcare provider first since you cannot get Cialis without a prescription from a doctor. If you’re having trouble with sexual stimulation and aren’t experiencing prolonged erections, connect with a doctor on Maple in minutes for a Cialis prescription.

Who should not take Cialis?

• Take nitrate medications such as nitroglycerin
• Use street drugs called “poppers” such as amyl nitrate or amyl nitrite, and butyl nitrate
• Take any medications called guanylate cyclase stimulators such as Adempas (riociguat)
• Are allergic to tadalafil, as contained in Cialis, or any of the ingredients in Cialis.

If you think you have erectile dysfunction, speak with a doctor on Maple about being prescribed Cialis online in Canada.

Is Cialis over the counter?

Cialis is a prescription medication, therefore you aren’t able to get Cialis without a prescription from a doctor. If you believe you’re experiencing erectile dysfunction, it’s important to speak with a doctor to find out if a prescription is the best treatment method.

Does Cialis expire?

Cialis does expire. It has an average shelf life of one year, but this can change based on a number of factors, including the manufacturer, storage, and more. Some pharmacists believe it may be effective for as long as two years. However, it isn’t always listed with a firm expiration date.

For full effectiveness, it’s recommended to assume it expires one year after it’s dispensed. Taking expired Cialis is not dangerous, as long as the regular dosage is followed, but it may not be as effective.

What is Maple?

Maple connects you with doctors and other healthcare providers online via text, audio, or video. After you log in to your Maple account, you can request an online consultation.

Consultations work similarly to in-person appointments — the doctor can examine you as needed, ask questions about your symptoms, go through your health history, and determine if an online Cialias (tadalafil) prescription is right for you. If they think your condition is more serious, they may tell you to go to a clinic for an in-person, hands-on examination.

Once you talk to a doctor on Maple about ED and they prescribe Cialis online, you’ll have the option to send the prescription to a local pharmacy or you can get your medication delivered within one to two business days at no extra cost.

Cialis

The active ingredient used in this medication and its equivalents is TADALAFIL (Oral route) – ta-DAL-a-fil. The most frequently available dosage forms being tablet. Check with your doctor to see if one of the forms is a fit for you.

Uses For Cialis

Tadalafil is used to treat men who have erectile dysfunction (also called sexual impotence). Tadalafil belongs to a group of medicines called phosphodiesterase 5 (PDE5) inhibitors. These medicines prevent an enzyme called phosphodiesterase type-5 from working too quickly. The penis is one of the areas where this enzyme works.

Erectile dysfunction is a condition where the penis does not harden and expand when a man is sexually excited, or when he cannot keep an erection. When a man is sexually stimulated, his body’s normal response is to increase blood flow to his penis to produce an erection. By controlling the enzyme, tadalafil helps to maintain an erection after the penis is stroked by increasing blood flow to the penis. Without physical action to the penis, such as that occurring during sexual intercourse, tadalafil will not work to cause an erection.

Ordering Cialis from KamaHealth.ca

When placing an order for Cialis online from KamaHealth.ca, you can trust that we are providing you with the highest quality medications at the lowest price available. We pride ourselves on offering an unmatched customer service experience.

We offer more than just lower prices on Cialis and free shipping. Our customer service compared to other Canadian pharmacies is unmatched. Our trained patient service representatives are available to answer most of your questions. KamaHealth.ca also has a team of professional pharmacists that can also offer you a prescription consultation or answer questions about any other drug you may be taking. It’s this difference that sets KamaHealth.ca apart and makes ordering Cialis from us, safe, easy and convenient.

This medicine is available only with your doctor’s prescription.

Cialis (Tadalafil)

Take advantage of this Cialis Coupon, available online only at our Canadian Pharmacy! This coupon code is applicable on your order over $50 and cannot be combined with other codes and is for one-time use only. We help lower your Brand and Generic Cialis price with our helpful Pharmacy coupons.

Learn How to Buy Cialis Online

Here at PricePro Pharmacy we have made it easy to buy Cialis online.

You can call 1-855-776-0079, chat, or place an order through the website at your convenience.

Please note a Cialis prescription is required to place an order. The prescription can be submitted by email, fax to 1-855-776-0006 or uploaded directly online here.

As you know many online pharmacies claim to offer Cialis and Tadalafil online; however, we strongly recommend to avoid rogue pharmacies that do not require a prescription. This is for your safety and well-being to ensure you receive quality medication. All of our partner pharmacies and fully licensed and verified, so we take pride in offering high quality medication at discount prices.

The following dosages for Cialis are available:

You can select from either a brand or generic product based on your prescription.

The manufacturer of the brand medication is Eli Lilly and have options as product of Canada, Turkey, Spain, or United Kingdom.

As for generic Tadalafil, we offer product manufactured by Sava Medica, Sun Pharma, Cipla, Teva, Jamp Pharma, and various UK generic manufacturers.

When you click on “CHECK PRICES” you can view more details for Cialis online at PricePro Pharmacy.

Cialis Cost

Cialis price at our online pharmacy is offered where you can save up to 70% compared to your local US pharmacy. We offer:

• $115.00 for 28 tablets of Cialis 5mg
• As low as $3.39 per tablet when you order a 90-day supply of medication

The average Cialis cost in the United States is:

When you buy Cialis online from PricePro Pharmacy we can save you 73% on your Cialis 5mg prescription. That is a huge-savings plus you get your medication shipped direct to your home.

Tadalafil Cost

Our discount price of Tadalafil 5mg is:

In the US, the cost of Tadalafil is extremely high without any insurance or coupons:

We offer an incredible savings of 92% on Tadalafil 5mg tablets. Stop paying more for your prescription drugs.

**Please refer to updated pricing on product selection cards above when placing an order.*

Cialis Coupon

Apply Cialis online coupon code CIA10 – $10 instant savings on your order!

Take advantage of our pharmacy coupon for Cialis for additional savings on your first order.

You don’t need need insurance to take advantage of this low pricing.

Tadalafil Coupon

We don’t have a specific coupon code for Tadalafil, though we make things simple. You can apply CIA10 coupon code to the generic Cialis option.

Be sure to take advantage of our promotions and apply code CIA10 when you buy Tadalafil online at PricePro Pharmacy

Generic Cialis

We offer a Tadalafil generic in the following dosages:

Both brand Cialis and generic Cialis contain the same active ingredient known as Tadalafil.

Generic medications are much lower in cost and are equally effective.

Shipping Times

The estimated shipping times depend on the medication ordered:

• Product of Canada or UK – 7 to 10 business days
• Product of India, Spain, or Turkey – 10 to 18 business days

There is a standard shipping charge of $9.95 applied to each order.

Once you medication ships you will receive an email alert with the applicable tracking information.

Our Canadian pharmacy Tadalafil is available with an EXPRESS shipping option which is the fastest shipping method of 3-5 business days.

In our online checkout you can view shipping options available based on the medication option added.

Refill Prescription

We make it simple to refill your Tadalafil prescription. Simply login to your online pharmacy account and view your prescription history and if you have a valid Rx on file.

You can re-order online or by calling 1-855-776-0079 or chatting with us.

Our friendly refill reminder will update you by phone or email as to the preferred time to re-order based on your last prescription fill and estimated shipping times.

Buy Tadalafil at PricePro Pharmacy knowing that you are saving up up 90% compared to your local drugstore.

Cialis Summary

Tadalafil, more commonly known and sold under the brand name, Cialis, was originally developed by the biotechnology company ICOS. It was then developed and marketed globally by Lilly ICOS, LLC, a joint collaboration of the ICOS Corporation and Eli Lilly and Company. You can save on brand name and generic Cialis by shopping online at our Canadian pharmacy.

The drug is used primarily to treat male sexual function problems, specifically erectile dysfunction or impotence, by increasing blood flow to the penis. In combination with sexual stimulation, Cialis helps men to get, and maintain an erection.

Tadalafil is also used to treat symptoms of benign prostatic hyperplasia- BPH (enlarged prostate) such as difficulty in the flow of urine, weak stream and the need to urinate frequently or urgently. The drug accomplishes this by relaxing the smooth muscles found in both the prostate and bladder.

This ED med is classified as a phosphodiesterase type 5 inhibitor (PDE5) used in its ED focus to block the degradation of a specific enzyme, cGMP, on the muscle cells of the corpus cavernosum of the penis. The main difference between Cialis and its main competitors, Viagra, and Levitra, is a distinctly longer half-life of an approximate 17.5 hours, compared to 4-5 hours.

Frequently Asked Questions About Cialis & Tadalafil

What is Cialis used for?

• Cialis, is used by men to treat erectile dysfunction (ED). ED is when a man cannot get, or keep a hard, erection suitable for sexual activity. It can also help treat the symptoms of benign prostatic hyperplasia (BPH). These symptoms include the need to urinate frequently and feeling like your bladder is always full.

How does Cialis work?

• After sexual stimulation, Tadalafil works by allowing the blood vessels in your penis to relax which increase the blood flow into your penis. This increased blood flow improves erectile function. It is important to note that this ED med only works with sexual stimulation, it does not increase sexual desire alone. It also relaxes muscles of the prostate and bladder, which can help manage BPH.

Who should not take Tadalafil?

• If you are taking any medicine that contains nitrates then you should not take Cialis. Nitrates are often found in prescription medication used in treating chest pain secondary to heart disease. Nitrates combined with Tadalafil can cause your blood pressure to suddenly fall to a life-threatening level. Do not take if you have had a previous episode of an eye problem called NAION or if you taking Adempas medication.

What are the dosages available?

• The following strengths are available: 2.5mg, 5mg, 10mg, and 20mg tablet. The tablets which are yellow color are in the shape of almonds have the following markings: “C2½, “C5”, “C10”, or “C20” marked on one side. The active ingredient in each tablet is tadalafil.

What is the max dosage?

• When taking Cialis for ED it typically is taken as on-demand dosing. You should not take more than the prescribed dose of 10mg or 20mg tablet per day.

What are the common side effects?

• The most common side effects include a headache, indigestion, back pain, nasal congestion, muscle aches, facial flushing, and dizziness. If you have an erection which lasts continuously for more than 4 hours, you should contact a doctor immediately. If you experience vision changes, stop taking this ED med and contact your doctor immediately.

How long does it take to work?

How long do the effects last?

• You can engage in sexual activity up to 36 hours after taking a tablet. Important to note that the amount of time for Tadalafil to work varies from person to person.

Can you take Tadalafil tablet with food?

Can you take with alcohol?

Do you need a prescription to buy Cialis online?

Is it safe to order from a Canadian Pharmacy?

• When looking to buy online from a Canadian Pharmacy you want to assure you are ordering from a safe reputable online drugstore like PricePro Pharmacy. Be sure the pharmacy requires a prescription and vetted by organizations such as PharmacyChecker for verification purposes. Also, watch for trust signals to make the shopping experience safe such Norton Shopping Guarantee and SSL secure transactions. We’ve set an example and are routinely regarded as the best Canadian online pharmacy for our client’s needs.

Are coupons available?

• You can find Rx coupons on our website. Take advantage of this great offer for more savings on your prescription medications. This coupon can also be applied to generic Cialis for more savings when shopping our online Canadian pharmacy.

Is a generic Cialis available?

• There is a Cialis generic available to order. It is known as Tadalafil and can be ordered here at our PricePro Canadian Pharmacy. Tadacip made by Cipla is popular option ordered online.

Are Cialis and Tadalafil the same medication?

Why is there a big price difference between the brand and generic Tadalafil medication?

• Cialis is more expensive than Tadalafil as the Brand company has done the research and development for the medication and to balance those costs the company sets pricing based on their business model for further R&D for more medications to come through the pipeline. Once the patent expires other manufacturers can make the generic of the brand medication and provide more competitive pricing which in the end give you more options and more savings.

Is Cialis better than Viagra or Levitra?

• Cialis, Levitra, and Viagra all belong to a group of medications called PDE-5 inhibitors. They all work by the same mechanism to to treat erectile dysfunction (ED). Cialis is effective for up 36 hours while Viagra and Levitra are both effective up to 4 hours. ED treatment effectiveness can vary for men, at times your doctor may switch medications if the desired effects are not found.

Can you take Cialis once daily?

• Low-dose 2.5mg or 5mg tablets are typically taken at the same time every day. While the 10mg or 20mg tablets are used for on-demand dosing for treatment of erectile dysfunction.

How does low-dose Tadalafil help BPH?

• Cialis works to relieve symptoms of such as the sensation of not fully emptying the bladder or the frequent need to urinate. These BPH symptoms are treated by relaxing the muscles in the prostate and bladder. It can be used to treat males who suffer from BPH and erectile dysfunction.

Cialis (Tadalafil) Medication Information

Uses

Cialis is a drug commonly used to treat erectile dysfunction (ED) or benign prostatic hyperplasia (BPH). It works by relaxing the smooth muscle of the prostate and the corpus cavernosum. When using Cialis for ED, it is only effective with sexual stimulation.

Dosage

As needed for Erectile Dysfunction (ED):

The starting dose is 10 mg by mouth, about 30 minutes before sexual activity. The dose may be increased to 20 mg or decreased to 5 mg. The effect lasts for 36 hours in most men, so the dose should only be used once per day.

Once-daily for Erectile Dysfunction (ED):

Start at 2.5 mg by mouth daily. The dose can be increased to 5 mg by mouth once daily.

Side Effects

While taking Cialis, you may have the following side effects:

Precautions

Cialis is contraindicated in people who take prescription nitrate because the combination can cause severely low blood pressure. Other sources of nitrates, like those in foods, should also be avoided while taking Cialis.

An erection lasting longer than four hours is called priapism and is a medical emergency. Seek medical attention right away, or you could experience permanent damage to the penis.

Talk with your doctor to make sure your heart is healthy enough for Cialis before starting the medication.

If you have a history of kidney or liver dysfunction, the dose might need to be adjusted.

Interactions

Common drug-drug interactions with Cialis may include:

• Alcohol
• Alpha-blockers
• Amyl nitrite
• Blood pressure medications
• Clarithromycin
• Diltiazem
• Erythromycin
• Grapefruit juice
• Itraconazole
• Ketoconazole
• Nitrates
• Rifampin
• Ritonavir
• Verapamil

Storage

Store close to room temperature 25°C (77°F), with variation no greater than 15-30°C (59-86°F). Do not store in the bathroom, kitchen, or other rooms with high humidity.

Pharmacist Tips

• Cialis lasts much longer than other medications for ED. It begins working in 30 minutes and can last for up to 36 hours.
• Do not take more than one Cialis per day, even if you are using it for ED and BPH.
• Do not drink too much alcohol while taking Cialis because it can increase the risk of dizziness, fast heart rate, or low blood pressure.

Cialis FAQs

Not usually, but it can cause mild vision changes like seeing a blue tinge.

Should I combine Cialis with other ED medications?

No. Cialis should never be combined with other ED medications.

If you are taking it for ED, you can skip the dose or take it as soon as you remember. If you are taking it for BPH, take it when you remember and never double up the dose.

Related Drugs

References

Can’t buy love? Drug price hikes put sex beyond reach

A display of medicine for impotence and for sexual problems. (AP Photo/Gregory Bull)

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TRENTON, N.J. — Imagine not being able to afford one of life’s great pleasures — sex.

That’s true for many older couples, doctors say. Soaring prices for prescription medicines for impotence and other problems have put the remedies out of reach for some.

Without insurance coverage, Viagra and Cialis cost about $50 a pill, triple their 2010 list prices. The new “female Viagra,” a daily pill for low sex drive called Addyi, costs $800 per month. Older products for women also have seen huge price run-ups, Truven Health Analytics data show.

“Many of them don’t get past the pharmacy counter once they see the price,” says Sheryl Kingsberg, a University Hospitals-Cleveland Medical Center behavioural psychologist and researcher who counsels men and women.

What people actually pay out of pocket varies. Some insurance prescription plans, including Medicare, cover some of the medicines. Some plans don’t cover any, arguing they’re not medically necessary. Many require steep copayments or limit the number of impotence pills per prescription.

“Once you get to a certain price point, sex becomes a financial decision,” says Dr. Elizabeth Kavaler, a sexual dysfunction specialist at New York’s Lenox Hill Hospital. “It takes a lot of the joy out of this.”

Five of six specialists interviewed by The Associated Press say patients have told them they’ve given up sex because of the cost.

Now, a little relief is coming. Late next year, Viagra and Cialis will get at least one generic competitor costing slightly less; prices will plunge later when more generics reach the market. For women, an Addyi rival is in late-stage testing. A few other products now have generic versions, and other options are in development.

A generation ago, long-married couples accepted their sex lives trailing off with age, Kavaler says. Key hormone levels drop with age, reducing sex drive and causing problems such as impotence and vaginal dryness, which often makes intercourse painful.

Today, midlife divorce is more common, divorced or widowed men and women often seek new partners, and sex becomes important again. Meanwhile, they’re bombarded by ads for impotence remedies and other treatments.

“Couples in their 50s, 60s and 70s are more sexual than they’ve ever been,” says Kavaler.

Until Pfizer launched the first impotence pill, Viagra, in 1998, there were few options for men besides penile implants and injections. Viagra and Cialis each quickly topped $1 billion in global annual sales, and products for women’s symptoms eventually followed. However, price hikes appear to be limiting usage for some products in the U.S., where prices aren’t regulated.

Since 2010, the number of Viagra prescriptions filled in the U.S. has fallen 42 per cent to about 5 million a year. Meanwhile, prescriptions for Cialis, which now has a popular daily pill option, have gone up slightly, according to health data firm QuintilesIMS.

Popular women’s estrogen products such as Vagifem vaginal tablets and Estrace cream also have seen prescriptions decline in recent years. Addyi, only on the market for a year, has had dismal sales.

Dr. Lauren Streicher offers women four treatment options, and most pick Vagifem. A month’s supply costs $170 and insurance coverage is limited. A generic version, Yuvafem, just launched at a slightly cheaper price.

“They go to their pharmacy and see how much it costs, and then they call me up and say, ‘I can’t do it,”‘ says Streicher, director of the Center for Sexual Medicine and Menopause at Northwestern University’s medical school in Chicago.

But not being able to have sex “is a deal-breaker in a lot of relationships,” she adds.

The drugs’ makers insist list prices far exceed the negotiated prices insurers pay them and say they price products based on their value. According to the companies, nearly all their customers are insured. Pfizer says most insured Viagra users pay $6 to $8 per pill, for instance.

Patients unwilling to forego sex, doctors say, split pills or otherwise ration medicines, beg for scarce samples or seek copay discount coupons. Men with enlarged prostates can request Cialis because it’s also approved for that condition, usually with insurance coverage. Some women make do with over-the-counter lubricants.

Many shop for price, which can vary widely by pharmacy.

Others take a big risk, buying “herbal Viagra” at gas stations or ordering Viagra online from “Canadian pharmacies” that likely sell counterfeit drugs made in poor countries, says Dr. Irwin Goldstein, director of San Diego Sexual Medicine.

Dr. Nachum Katlowitz, head of urology at New York’s Staten Island University Hospital, offers an alternative costing about $1 per pill at some pharmacies. The active ingredient in Viagra –sildenafil — is also in Pfizer’s now-generic blood pressure pill Revatio but at one-fifth the dose.

One of his patients, a 62-year-old hospital technician, takes several of the blood pressure pills before sex.

“I couldn’t afford it if I had to pay for Viagra,” says Robert, who asked that his last name not be used to protect his privacy.

He’s experienced modest improvements and says he and his wife of 28 years now enjoy sex twice as often.