CIALIS, VIAGRA and LEVITRA all inhibit the same enzyme which is PDE5 (phosphodiesterase type 5) in the penis. Since all these drugs work in a similar fashion, it is not recommended to take these medications at the same time (NO PHYSICIAN WOULD WRITE A PRESCRIPTION TO TAKE THESE MEDICATIONS AT THE SAME TIME). Therefore, if the customer sends in an order for any two medications and the prescription is written by the same doctor then we have to confirm the dosage – if not clearly indicated in the sig. If the prescription is written by two different doctors, we need to call the customer to inform him of the risks involved in combining the two medications and confirm which doctor we can call to verify the prescription.