tadalafil
Tadalafil (Cialis) is taken by mouth either as needed before sexual activity or once daily for erectile dysfunction (ED). It's also taken once daily to treat symptoms from an enlarged prostate (benign prostatic hyperplasia, or BPH). Tadalafil (Cialis) is available both as brand-name and generic tablets. Common side effects of this medication include headache and indigestion. Tadalafil (Cialis) does interact with some medications, such as heart and blood pressure medications, and taking them together could lead to very low blood pressure and dizziness.
What is Tadalafil (Cialis)?
What is Tadalafil (Cialis) used for?
Erectile dysfunction
Benign prostatic hyperplasia (BPH)
How Tadalafil (Cialis) works
Tadalafil (Cialis) is a phosphodiesterase-5 enzyme (PDE-5) inhibitor. It works by blocking PDE-5. This is a protein in your body that breaks down the molecules that normally cause an erection. When it blocks PDE-5, tadalafil (Cialis) helps an erection occur by allowing certain muscles in the penis to relax and the penis to fill with blood.
While it's not fully clear how tadalafil (Cialis) helps treat symptoms of BPH, researchers think it helps relax the muscles in the prostate (a small gland in the groin).
Drug Facts
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What are the side effects of Tadalafil (Cialis)?
Common Side Effects
- Headache (3-6%)
- Runny nose, sore throat, and other symptoms of the common cold (3-6%)
- Indigestion (4-5%)
- Stomach upset (3-5%)
- Back pain (3%)
- Headache (11-15%)
- Indigestion (4-10%)
- Back pain (3-6%)
Other Side Effects
- Muscle ache
- Flushing
- Pain in arms or legs
- Diarrhea
- Dizziness
Serious Side Effects
- Erection lasting for more than 4 hours
- Vision loss
- Dangerously low blood pressure: feeling faint or weak, dizziness, blurry vision, feeling confused
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Arm, back, or jaw pain
blurred vision
chest pain, discomfort, tightness, or heaviness
chills
cold sweats
confusion
dizziness
fainting
faintness or lightheadedness when getting up suddenly from a lying or sitting position
fast or irregular heartbeat
headache
hearing loss
increased erection
nervousness
pain or discomfort in the arms, jaw, back, or neck
pounding in the ears
slow or fast heartbeat
spontaneous penile erection
sweating
unusual tiredness or weakness
vomiting
Rare
Painful or prolonged erection of the penis
Incidence not known
Blindness
blistering, peeling, or loosening of the skin
cracks in the skin
decrease or change in vision
difficulty with speaking
double vision
fast, irregular, pounding, or racing heartbeat or pulse
headache, severe and throbbing
hives or welts, itching, skin rash
inability to move the arms, legs, or facial muscles
inability to speak
joint or muscle pain
loss of heat from the body
numbness or tingling of the face, hands, or feet
red skin lesions, often with a purple center
red, irritated eyes
red, swollen skin
redness of the skin
redness or soreness of the eyes
slow speech
sores, ulcers, or white spots in the mouth or on the lips
stomach pain
sudden cardiac death
swelling of the feet or lower legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Bloody nose
body aches or pain
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
burning, dry, or itching eyes
burning feeling in the chest or stomach
congestion
difficulty with moving
difficulty with swallowing
dryness or soreness of the throat
excessive eye discharge
feeling of constant movement of self or surroundings
feeling of warmth, redness of the face, neck, arms and occasionally, upper chest
hoarseness
lack or loss of strength
loose stools
muscle aching, cramping, or stiffness
neck pain
pain in the arms or legs
pain or burning in the throat
redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
reduced sensitivity to touch
runny or stuffy nose
sensation of spinning
sleepiness or unusual drowsiness
stomach upset
swelling of the eyelids
swelling or puffiness of the eyes or face
swollen joints
tearing
tender, swollen glands in the neck
tenderness in the stomach area
trouble with sleeping
upper stomach pain
voice changes
watering of the eyes
Rare
Changes in color vision
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Tadalafil (Cialis)
Pros
One of the first-choice medications for treating ED
Can be taken either as needed or on a regular basis for those who need it more regularly
Lasts longer than other medications taken for ED
Can treat ED and BPH at the same time
Available as a lower-cost generic
Cons
Not recommended if you've had a heart attack in the past 3 months, or a stroke or heart failure in the past 6 months
Can't be used if you've recently taken nitrates like isosorbide mononitrate (Monoket) or nitroglycerin (Nitrostat)
Takes longer to work compared to some other medications for ED
Can cause side effects like headache, stomach upset, and back pain
Pharmacist tips for Tadalafil (Cialis)
Tadalafil (Cialis) can be taken with or without food, since food doesn't affect how well the medication works. Don't split the tablets, since the entire dose should be taken.
If you're taking tadalafil (Cialis) daily, take it at the same time every day for it to work best for you.
Don't take more than one dose of tadalafil (Cialis) unless instructed by your provider. Doing so could lead to more side effects like low blood pressure, dizziness, and vision problems.
If you get muscle or back pain with tadalafil (Cialis), it should get better in about 2 days. Talk to your provider if your symptoms don't improve.
If you have an erection for more than 4 hours, go to the emergency department right away as this can lead to damage to the penis.
Tadalafil (Cialis) doesn't stop the spread of sexually transmitted infections (STIs) like herpes or HIV. Be sure to practice safe sex by using a latex or polyurethane condom.
More on Tadalafil (Cialis) tips
Frequently asked questions about Tadalafil (Cialis)
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What are the risks and warnings for Tadalafil (Cialis)?
Tadalafil (Cialis) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart problems
Risk factors: Existing heart condition | Recent heart attack or stroke in past 6 months | High or low blood pressure
Tell your provider if you have any heart conditions before starting tadalafil (Cialis). Sexual activity isn't recommended for people with certain heart-related conditions, such as very serious heart failure. Tadalafil (Cialis) hasn't been studied in people who have certain conditions, such as recent heart attacks or strokes. If you have a heart condition, talk with your provider about whether tadalafil (Cialis) is safe for you.
Low blood pressure
Risk factors: Taking alpha blockers | Taking medications for high blood pressure or chest pain (angina) | Drinking alcohol
If you're taking alpha blockers or medications for high blood pressure with tadalafil (Cialis), your blood pressure may drop too low. Some medications like ritonavir (Norvir) can affect how tadalafil (Cialis) is broken down in your body, which can lead to having too much of it in your system. This can lead to more side effects, like low blood pressure. Your provider might ask you to check your blood pressure regularly if you're taking these other medications. Be very careful getting up from a sitting or lying down position since this can make you feel dizzy and more likely to fall. Drinking alcohol can also cause low blood pressure. Avoid or lower your alcohol consumption when taking tadalafil (Cialis). You should never take tadalafil (Cialis) when taking nitrate medication for chest pain (angina) because it can cause your blood pressure to suddenly drop to unsafe levels.
Prolonged erection
Risk factors: Medical conditions that affect the penis | Sickle cell anemia | Multiple myeloma | Leukemia
Rarely, some people who took tadalafil (Cialis) reported having an erection that lasted for more than 4 hours (priapism). If not treated in time, this can lead to permanent damage to your penis. You're at higher risk for these side effects if you have other conditions affecting your penis, or if you have sickle cell anemia, multiple myeloma, or leukemia. Get medical help right away if you have an erection that lasts longer than 4 hours or if you feel pain during an erection.
Vision changes
Risk factors: Age 50 years or older | "Crowded" optic disc | Blood vessel problems in the eye
If you suddenly notice changes in your vision in one or both eyes, go to the emergency room or call your provider right away. Although rare, tadalafil (Cialis) can cause permanent eye damage. If your provider has told you that you have a "crowded" optic disc, you might be at higher risk for vision changes with tadalafil (Cialis). Tell your provider about your full medical history before taking tadalafil (Cialis).
Hearing loss
Some people who took tadalafil (Cialis) reported experiencing hearing loss. This could happen along with ringing in the ears (tinnitus) and dizziness. Go to the emergency room or call your provider right away if you notice changes in your hearing in one or both ears.
Interactions with other medications
Risk factors: Age 65 years or older | Liver problems | Kidney problems | Taking nitrate medications | Taking blood pressure medications | Taking alpha blockers | Taking certain antifungals or antivirals
Tadalafil (Cialis) can have serious interactions with certain medications. It's important that you tell your provider about all the medications you're taking before you start tadalafil (Cialis). For example, you shouldn't take tadalafil (Cialis) with nitrate medications because this combination can cause your blood pressure to drop dangerously low. If you're taking other blood pressure medications, your provider might not recommend tadalafil (Cialis) until your blood pressure is under control. Taking tadalafil (Cialis) with medications, like oral azole antifungals and ritonavir (Norvir), can put you at higher risk for side effects, such as headaches, flushing, and vision changes.
Tadalafil (Cialis) dosage forms
Typical dosing for Tadalafil (Cialis)
Erectile dysfunction (taken as needed): The typical starting dose is 10 mg by mouth about 30 minutes before sexual activity up to once per day as needed. Your provider will adjust your dose based on your response.
Erectile dysfunction (taken daily): The typical starting dose is 2.5 mg by mouth at the same time every day, without regard to timing of sexual activity. Your provider will adjust your dose based on your response.
Benign prostatic hyperplasia alone or with erectile dysfunction: The typical dose is 5 mg by mouth at the same time every day.
Your dose might differ if you have liver or kidney problems, or if you're taking certain medications.
More on Tadalafil (Cialis) dosage forms
Interactions between Tadalafil (Cialis) and other drugs
More on Tadalafil (Cialis) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Amyl Nitrite
- Boceprevir
- Erythrityl Tetranitrate
- Isosorbide Dinitrate
- Isosorbide Mononitrate
- Nitroglycerin
- Pentaerythritol Tetranitrate
- Propatyl Nitrate
- Riociguat
- Telaprevir
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfuzosin
- Atazanavir
- Bunazosin
- Clarithromycin
- Cobicistat
- Darunavir
- Erythromycin
- Fosamprenavir
- Indinavir
- Itraconazole
- Ketoconazole
- Lopinavir
- Moxisylyte
- Nefazodone
- Phenoxybenzamine
- Phentolamine
- Prazosin
- Ritonavir
- Saquinavir
- Simeprevir
- Simvastatin
- Tamsulosin
- Telithromycin
- Terazosin
- Tipranavir
- Trimazosin
- Urapidil
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Tadalafil (Cialis) cost?
Tadalafil (Cialis) contraindications
Taking a nitrate medication for chest pain (angina)
Taking guanylate cyclase (GC) stimulators, such as Adempas (riociguat)
What are alternatives to Tadalafil (Cialis)?
Erectile dysfunction
Benign prostatic hyperplasia (BPH)
What is the latest news about Tadalafil (Cialis)?
Tadalafil (Cialis) images
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References
Best studies we foundBurnett, A. L., et al. (2018). Erectile dysfunction: AUA guideline. The Journal of Urology.
Hatzimouratidis, K. (2014). A review of the use of tadalafil in the treatment of benign prostatic hyperplasia in men with and without erectile dysfunction. Therapeutic Advances in Urology.
Levine, G. N., et al. (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation.
Lupin Pharmaceuticals, Inc. (2023). TADALAFIL tablet, film coated [package insert]. DailyMed.
National Institute on Aging. (2020). Prostate problems.
Somani, A. N., et al. (2023). Pseudopapilledema.
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