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Cialis 20 works by increasing blood flow to the penis during sexual stimulation, which helps men achieve and maintain an erection. The 20 mg dose is considered a higher strength and is typically taken as needed, usually about 30 minutes before sexual activity. Cialis is part of a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which relax the blood vessels and improve blood flow. In addition to ED, Cialis can also be used for BPH,