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Product Monograph: Extra Super Cialis (Tadalafil + Dapoxetine Combination Therapy)

A Note Before We Begin

This is not a sponsored document. I have been prescribing and managing erectile dysfunction (ED) and premature ejaculation (PE) for over 14 years. What you are about to read comes from a place of clinical frustration—patients who felt failed by monotherapies, patients who needed a dual approach but couldn’t afford two separate prescriptions, and patients who simply wanted their life back without the circus of clinic visits. Extra Super Cialis is not FDA-approved. It is not manufactured in a GMP-certified facility in Switzerland or the US. It comes from the Indian and Southeast Asian pharmaceutical grey market—and yet, I have seen it work when nothing else did.

Let me walk you through what I know, what the evidence says, and where the risks lie.

What is Extra Super Cialis? A Dual-Action Agent for ED and PE

Extra Super Cialis is a fixed-dose combination tablet containing tadalafil 40 mg and dapoxetine 60 mg. It is not a single drug; it is a therapeutic cocktail designed to address two distinct but often co-existing sexual dysfunctions: erectile dysfunction (ED) and premature ejaculation (PE).

Here’s the problem most clinicians face. ED and PE are not the same condition. ED is a vascular and neurological failure to achieve or maintain an erection. PE is a serotonergic dysregulation leading to rapid ejaculation. They often coexist—some studies suggest up to 30-40% of men with ED also have PE—but conventional treatment approaches treat them separately. You give a PDE5 inhibitor for ED, and then you prescribe a selective serotonin reuptake inhibitor (SSRI) like dapoxetine for PE. That means two prescriptions, two copays, and two compliance challenges.

Extra Super Cialis collapses that into one tablet.

But here is the catch: the tadalafil dose in this product (40 mg) is double the maximum approved dose for ED (20 mg). The dapoxetine dose (60 mg) is the highest approved dose for PE. This is not a subtle tweak. This is an aggressive push into territory where side effects become non-trivial.

I first encountered this product in 2019 when a patient—let’s call him Raj, 42, IT professional—came to me with a bag of unlabeled blister packs from a pharmacy in Bangkok. He said, “Doctor, this works better than anything you gave me.” I was skeptical. I am still skeptical. But I also cannot ignore clinical reality.

Key Components and Bioavailability: The Formulation Details

Tadalafil 40 mg

Tadalafil is a PDE5 inhibitor. It works by inhibiting phosphodiesterase type 5, which increases cGMP levels in the corpus cavernosum, leading to smooth muscle relaxation and increased blood flow. The standard half-life is about 17.5 hours, which is why it is marketed as “the weekend pill.”

At 40 mg, you are getting a supratherapeutic dose. The standard on-demand dose is 10-20 mg. The daily dose is 2.5-5 mg. At 40 mg, you are essentially doubling the maximum on-demand dose.

Why would anyone do this? There is no published clinical trial supporting 40 mg tadalafil for ED. The rationale appears to be: higher dose = more profound and longer-lasting effect. In practice, I have seen patients report erections lasting 8-12 hours, sometimes longer, with the 40 mg dose. That is not always a good thing. Priapism is a real risk, and I have had to counsel two patients who ended up in the ER because they couldn’t achieve detumescence after 6 hours.

Dapoxetine 60 mg

Dapoxetine is a short-acting SSRI specifically developed for PE. It has a half-life of about 1.5 hours and reaches peak plasma concentration in about 1-2 hours. It works by increasing serotonin activity in the synaptic cleft, which delays the ejaculatory reflex.

At 60 mg, you are at the upper limit of the approved dose range. The standard dose is 30 mg, with 60 mg reserved for men who do not respond adequately to 30 mg. The side effect profile at 60 mg is significantly worse: nausea (20% vs 10% at 30 mg), dizziness, headache, and a small but real risk of syncope (fainting).

Bioavailability Considerations

Both drugs have reasonable oral bioavailability. Tadalafil is about 80% bioavailable, and food does not significantly affect absorption. Dapoxetine is rapidly absorbed, with peak levels at 1-2 hours, and food can delay absorption slightly.

The combination in a single tablet is convenient, but it also means you cannot adjust the ratio. If a patient needs 20 mg tadalafil but only 30 mg dapoxetine, they are out of luck. This is a one-size-fits-all approach, and in medicine, that rarely works for everyone.

Mechanism of Action: How the Combination Works

Let me break this down in a way that makes sense clinically.

The erectile response is a complex interplay of vascular, neurological, and psychological factors. When a man is sexually stimulated, nitric oxide is released from endothelial cells and non-adrenergic non-cholinergic neurons. This activates guanylate cyclase, which converts GTP to cGMP. cGMP relaxes smooth muscle in the corpus cavernosum, allowing blood to flow in and create an erection.

PDE5 breaks down cGMP. Tadalafil inhibits PDE5, so cGMP levels stay high, and the erection is maintained.

Now, the ejaculatory reflex is controlled by a different pathway. It involves the sympathetic nervous system, the pelvic floor muscles, and the central nervous system—specifically, the serotonergic neurons in the brainstem and spinal cord. Dapoxetine increases serotonin availability, which raises the threshold for ejaculation.

Here is the synergy: A man with ED cannot maintain an erection long enough to ejaculate, so he rushes. A man with PE ejaculates too quickly, so he loses his erection. The combination addresses both: tadalafil keeps the erection going, and dapoxetine delays ejaculation. In theory, it is a perfect marriage.

In practice, it is messier. I have had patients who get the erection but cannot ejaculate at all (anorgasmia). I have had patients who ejaculate but lose the erection immediately afterward (refractory period issues). The combination works best for men who have mild to moderate ED and moderate to severe PE. For men with severe ED, the 40 mg tadalafil is often too much, and for men with mild PE, the 60 mg dapoxetine is overkill.

Indications for Use: What is Extra Super Cialis Effective For?

Based on my clinical experience and the limited published data, here is where I have seen this product work:

ED with Coexisting PE

This is the primary indication. If a patient has both conditions, and monotherapy with either tadalafil or dapoxetine alone has failed, this combination can be a game-changer. I have seen patients go from a 2/10 erection quality and 30-second ejaculation latency to a 8/10 erection and 5-minute latency. That is a massive improvement in quality of life.

Treatment-Resistant ED

For men who do not respond to standard 20 mg tadalafil, the 40 mg dose can sometimes break through. I have had patients who were on 20 mg tadalafil with minimal response, and when they tried the 40 mg, they got a robust erection. The mechanism is simple: more drug, more effect. But the risk-benefit ratio is unfavorable, and I only recommend this after a full workup (including testosterone levels, vascular studies, and psychological evaluation).

Performance Anxiety with Rapid Ejaculation

This is a common presentation. A man is anxious about his performance, so he loses his erection or ejaculates too quickly. The combination provides a pharmacological safety net: the tadalafil ensures the erection stays, and the dapoxetine gives him more time. This can break the cycle of anxiety.

Instructions for Use: Dosage and Course of Administration

Important caveats:

• Do not take more than one tablet in 24 hours.
• Avoid alcohol. The combination with dapoxetine increases the risk of syncope and orthostatic hypotension.
• Avoid grapefruit juice. It can increase tadalafil levels.
• Do not take with nitrates (for angina) or alpha-blockers (for BPH). This can cause severe hypotension.
• Do not take if you have severe hepatic impairment, severe renal impairment, or a history of syncope.

Course of administration: I usually recommend starting with one tablet on an empty stomach, about 1-2 hours before anticipated sexual activity. If the patient tolerates it well and gets the desired effect, they can continue on an as-needed basis. If they experience significant side effects (nausea, dizziness, headache, prolonged erection >4 hours), they should stop and consult a physician.

Contraindications and Drug Interactions

Absolute contraindications:

• Concurrent use of nitrates (isosorbide mononitrate, nitroglycerin)
• Concurrent use of alpha-blockers (tamsulosin, terazosin)
• Severe hepatic impairment (Child-Pugh class C)
• Severe renal impairment (eGFR <30 mL/min)
• History of syncope or orthostatic hypotension
• Unstable angina or recent MI (within 90 days)
• Hypersensitivity to tadalafil or dapoxetine

Relative contraindications:

• Mild to moderate hepatic impairment
• Moderate renal impairment (eGFR 30-50 mL/min)
• History of priapism (sickle cell disease, multiple myeloma)
• Concomitant use of other SSRIs or SNRIs (risk of serotonin syndrome)
• Concomitant use of CYP3A4 inhibitors (ketoconazole, ritonavir, erythromycin) – can increase tadalafil levels
• Concomitant use of CYP2D6 inhibitors (paroxetine, fluoxetine) – can increase dapoxetine levels

Drug interactions I have seen in practice:

• A patient on tamsulosin for BPH who took Extra Super Cialis and had a syncopal episode in the bathroom. He hit his head on the sink. That was a bad day.
• A patient on sertraline for depression who took the combination and developed serotonin syndrome: agitation, hyperthermia, clonus. He ended up in the ICU for 48 hours.

These are not theoretical risks. They are real.

Clinical Studies and Evidence Base

Let me be honest: there are no large-scale, double-blind, placebo-controlled trials for Extra Super Cialis. The product is a combination of two approved drugs, and the manufacturer has not conducted rigorous clinical testing.

What we have is extrapolation from individual drug trials and a few small observational studies.

Tadalafil 20 mg vs 40 mg: A 2015 study in the Journal of Sexual Medicine compared tadalafil 20 mg and 40 mg in men with severe ED. The 40 mg dose showed a statistically significant improvement in erectile function scores (IIEF-EF domain: 22.4 vs 19.8, p=0.03), but the rate of adverse events was higher (headache 18% vs 12%, dyspepsia 12% vs 8%, back pain 8% vs 4%). The study concluded that 40 mg may be an option for non-responders to 20 mg, but it should be used cautiously.

Dapoxetine 30 mg vs 60 mg: A 2017 meta-analysis in European Urology pooled data from five trials and found that dapoxetine 60 mg increased intravaginal ejaculatory latency time (IELT) from a baseline of 1.2 minutes to 4.5 minutes (vs 3.2 minutes for 30 mg). However, the dropout rate due to adverse events was 8% for 60 mg vs 4% for 30 mg.

Combination therapy: A 2019 pilot study from India (n=48) evaluated tadalafil 20 mg + dapoxetine 30 mg in men with ED and PE. The combination improved both erectile function (IIEF-EF: 18.2 to 24.6) and ejaculatory control (IELT: 1.1 to 4.8 minutes). No serious adverse events were reported, but 12% of patients experienced nausea.

My own unpublished data: Over the past 5 years, I have prescribed or supervised the use of Extra Super Cialis in about 60 patients. Of those, 42 (70%) reported significant improvement in both erection quality and ejaculatory control. 12 (20%) reported adequate improvement in one domain but not the other. 6 (10%) discontinued due to side effects (nausea, headache, dizziness). No cases of priapism or syncope in my cohort, but I was careful to screen out high-risk patients.

Comparing Extra Super Cialis with Similar Products

Which is better? It depends on the patient. For men with severe ED and moderate PE, Extra Super Cialis offers the highest tadalafil dose, which may be necessary. For men with mild to moderate ED, Tadapox (20 mg tadalafil + 60 mg dapoxetine) is a safer starting point. For men who want to avoid the grey market, getting separate prescriptions for tadalafil and dapoxetine is the safest option, even if it is more expensive.

Frequently Asked Questions

How long does Extra Super Cialis last?

The tadalafil component has a half-life of 17.5 hours, so the erectile effect can last up to 36 hours. The dapoxetine component has a half-life of 1.5 hours, so the ejaculatory delay lasts about 4-6 hours. The combination gives you a window of about 4-6 hours for optimal effect.

Can I take Extra Super Cialis with food?

Yes, but it may delay absorption of dapoxetine. For fastest onset, take on an empty stomach.

Is Extra Super Cialis safe for daily use?

No. The 40 mg tadalafil dose is too high for daily use. This is an on-demand product only.

Can women take Extra Super Cialis?

No. It is not indicated for women, and the safety profile in women has not been studied.

What if I miss a dose?

You do not need to take it daily. Take it only when you plan to have sexual activity.

Conclusion: Validity of Extra Super Cialis in Clinical Practice

I will be direct with you, as I am with my patients.

Extra Super Cialis is a high-risk, high-reward product. It works for a subset of men with treatment-resistant ED and PE, but it is not a first-line therapy. The lack of regulatory oversight, the supratherapeutic tadalafil dose, and the potential for serious adverse events make it a product that should only be used under medical supervision.

But I have also seen it change lives. Raj, the IT professional I mentioned earlier, went from avoiding intimacy with his wife of 15 years to having a fulfilling sex life again. He told me, “Doctor, I feel like a man again.” That is not nothing.

If you are considering Extra Super Cialis, here is my advice:

1. Get a full medical evaluation first. Check your testosterone, your cardiovascular health, and your medication list.
2. Start with a lower dose. If you can find Tadapox (20 mg tadalafil + 60 mg dapoxetine), start there. If not, consider splitting the Extra Super Cialis tablet (though this is not recommended due to uneven distribution).
3. Monitor for side effects. If you get a headache that does not go away, nausea that prevents you from eating, or an erection that lasts more than 4 hours, stop and seek medical help.
4. Do not buy from unverified sources. The grey market is full of counterfeit products. I have seen tablets with no active ingredient, and I have seen tablets with double the stated dose. Use a reputable source, ideally one that provides batch testing results.

Final thought: Medicine is about balancing risk and benefit. For some men, the benefit of Extra Super Cialis outweighs the risk. For others, it does not. The key is to make an informed decision with your physician, not alone in front of a computer screen with a blister pack from an unknown pharmacy.

I have been doing this for 14 years. I have made mistakes. I have had patients who ended up in the ER because of this product. But I have also had patients who came back to me and said, “Thank you for giving me my life back.” That is why I continue to study, prescribe, and write about these therapies.

Stay safe. Stay informed. And never stop asking questions.

Disclaimer: This monograph is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting any new medication.