Follow your doctor’s directions carefully, and ask your doctor or pharmacist to explain any part you do not understand. Do not chew on it or break it apart. Do not stop taking tadalafil without talking to your doctor. Sexual activity may be a strain on your heart, especially if you have heart disease. What should I talk to my doctor about when considering if Cialis is right for me?CIALIS for Use as Needed. Creatinine clearance 30 to 50 mL/min: A starting dose of 5 mg not more than once per day is recommended, and the maximum dose is 10 mg not more than once in every 48 hours. Creatinine clearance less than 30 mL/min or on hemodialysis: The maximum dose is 5 mg not more than once in every 72 hours [see . headache. indigestion. back pain. muscle pain. flushing. stuffy nose. Patients who get back pain and muscle aches usually get them 12 to 24 hours after taking Cialis and these usually go away by. Dosage range: mg to 5 mg. Frequency: once daily, regardless of the timing of sexual activity. Cialis’s recommended dosage when it’s taken as needed for ED is as follows. Dosage range: 5 mg to 20 mg. Frequency: one dose at least 30 minutes before sexual activity, with a maximum of one dose per day*.