Tadacip 20 mg, which contains Tadalafil, is often used to treat erectile dysfunction (ED). It may be considered in cases of severe ED under the following circumstances:

1. Diagnosis of Severe ED: When a healthcare provider has diagnosed you with severe ED, characterized by a consistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity.

2. Ineffectiveness of Other Treatments: When other treatments for ED, such as lower doses of oral medications (like Sildenafil or Vardenafil), have not been effective or have not provided sufficient relief.

3. Patient Preference: When a patient prefers the longer duration of action associated with Tadacip 20mg. Tadacip 20 mg can remain effective for up to 36 hours, which may be beneficial for those seeking more spontaneity in their sexual activity.

4. Medical Evaluation: When a thorough medical evaluation has been conducted, and it's determined that Tadalafil is appropriate based on the patient's overall health, any underlying conditions, and potential drug interactions.

5. Assessment of Cardiovascular Health: Before starting Tadacip 20 mg, it's important to assess cardiovascular health, as Tadalafil can affect blood pressure and interact with medications used for cardiovascular conditions.

6. Compliance with Prescribed Guidelines: When the use of Tadacip 20 mg aligns with the prescribed dosage and usage guidelines provided by a healthcare provider. Adhering to these guidelines ensures safety and efficacy.

7. Monitoring and Follow-Up: When there is a plan for regular monitoring and follow-up to assess the effectiveness of the treatment and manage any potential side effects or interactions.

Always consult with a healthcare provider to determine the most appropriate treatment for severe erectile dysfunction based on individual health needs and medical history.