That’s not to say there aren’t just as many illegitimate sites. It may be difficult to remain firm despite wanting to have sex. Those with a history of blood pressure or heart issues, hormonal imbalances, mental health issues, and diabetes should consult their doctor before trying PDE5 inhibitors. The mechanism of action for ED pills is simple: They inhibit the PDE5 enzyme which regulates the signals responsible for the smooth muscle tissue. The most common symptoms of erectile dysfunction include difficulty achieving or maintaining an erection and reduced sexual desire. Most companies have an FAQ or shipping policy page you can reference to learn whether discreet packaging is available. All PDE5 inhibitors, including Viagra and Cialis, require a valid prescription regardless of the pharmacy or provider.Brand names for tadalafil include Cialis. The cost for tadalafil oral tablet 5 mg is around $27 for a supply of 90 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. Each medication comes in several strengths, but the per-dose price is the same regardless of the. The cost of the medication is from $ per month for Cialis and from $40 per month for tadalafil. Online consultations are free of charge. Insurance does not cover product fees, but Hims writes.