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Tadalafil: Uses, Side Effects & More

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 04/08/2021

Updated 01/16/2024

Tadalafil is a medication you’ve probably never heard of — until you find yourself in the position to need it. To be fair, most people are more acquainted with its brand-name offering, Cialis®.

Believe it or not, millions of men the world over have turned to Cialis for help with numerous health conditions.

Maybe you’re looking up tadalafil facts or need guidance for managing erectile dysfunction (ED). We’ll cover all the basics here, but know the instructions and safety protocols for using it are going to be the same as with Cialis.

Below, we’ll summarize how this medication can be used, what it does and what schedule to follow to use it safely. (Hint: It changes situationally). We’ll also go over potential health risks and what could happen if tadalafil isn’t used correctly — or under the care of a healthcare professional.

Tadalafil belongs to a category of prescription medications known as phosphodiesterase type 5 (PDE5) inhibitors.

This particular version was approved in 2003 by the FDA (U.S. Food and Drug Administration). But the PDE5-inhibiting medications have been commercially available since 1998, following the introduction of sildenafil (the active ingredient in Viagra®).

PDE5 inhibitors block the PDE5 enzyme, which results in relaxed smooth muscle in the blood vessels. This makes for healthier blood flow in multiple circulatory scenarios, which we’ll look at in more detail.

Tadalafil can help with a type of high blood pressure (hypertension), benign prostatic hyperplasia (BPH) and erectile dysfunction.

Tadalafil for Erectile Dysfunction

Arguably, the most famous use case for tadalafil is for the management of ED.

Since PDE5 inhibitors help relax the smooth muscle cells in the arteries that supply the penis, they can encourage more blood to flow to the penis. This makes erections possible for guys who struggle to get or maintain an erection without treatment for erectile dysfunction.

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Tadalafil for Benign Prostatic Hyperplasia

BPH is a complicated term for an enlarged prostate — a condition common among aging men. Untreated benign prostatic hyperplasia symptoms could lead to bladder or kidney problems down the road. 

BPH may result in urination problems, including:

  • Feeling like your bladder is always full

  • Weak flow of urine

  • Straining while peeing

  • Difficulty emptying your bladder

  • Urgent urination

Research indicates that tadalafil can improve the quality of life and symptoms of BPH for men with erectile dysfunction.

Tadalafil for Pulmonary Arterial Hypertension

Tadalafil can be sold under several names, which is why we have to get into a quick digression about Adcirca® versus Cialis medications. While both use the same active ingredient (tadalafil), Adcirca’s dosage is much higher, as it’s formulated not for ED but for pulmonary arterial hypertension, which is a type of high blood pressure in the lungs.

Tadalafil dosage and dosing frequency depend on how and why you’re using the medication.

For the treatment of erectile dysfunction, you can take a dose of tadalafil once daily or as needed. When the medication is in your system, it can help you achieve an erection after being exposed to some form of sexual stimulation (whether it’s foreplay with a partner, porn or tantalizing thoughts).

Tadalafil is effective for up to 36 hours and stays in the body longer than other ED medications. That’s why it’s often called the “weekend pill. For someone with a regular or frequent sex life, this can make things a lot easier. 

On the other hand, as-needed tadalafil can be much more affordable simply because you’re buying fewer pills. Even if your dosage is increased or decreased from the starting dose of 10 milligrams (mg), you’ll still pay less over time with as-needed use. 

When taken once daily, tadalafil is prescribed at a dose of 2.5 mg or 5 mg. 

For the treatment of BPH, daily tadalafil is taken in 5 mg dosages.

For pulmonary arterial hypertension, the dose of tadalafil is 40 mg daily. 

Regardless of what you’re treating, tadalafil should be taken around the same time each day — unless, of course, it’s being used as needed.

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If your sexual activity or prostate health is in question, tadalafil could be an essential solution to the management of those problems.

But even though this medication is considered safe and effective, it’s crucial to know about the potential drug interactions, side effects and medical conditions tadalafil could interfere with.

With every prescription drug, there’s a risk of side effects. According to the FDA, common side effects of tadalafil include:

  • Headache

  • Upset stomach

  • Back pain

  • Nasal congestion (stuffy nose)

  • Limb pain (in the arms or legs)

  • Flushing

  • Muscle pain 

Serious side effects require medical attention. These include hearing loss, prolonged erection (priapism) and vision loss.

Allergic reactions are rare, but they can happen with any medication. Additionally, tadalafil sometimes reacts poorly when combined with alcohol, certain supplements, nitrites, nitrates (like nitroglycerin or amyl nitrate), alpha blockers and antihypertensives.

There’s a risk of tadalafil interactions with other meds, too. So definitely tell your provider about any medications you’re taking, especially:

  • Erythromycin

  • Ketoconazole

  • Vardenafil

  • Clarithromycin

  • Doxazosin

  • Itraconazole

  • Ritonavir

  • Rifampin

  • Riociguat

  • Tamsulosin 

  • Isosorbide mononitrate 

  • Isosorbide dinitrate

Your healthcare provider also needs to know if you’re being treated for or have conditions like:

  • Liver disease

  • Kidney disease

  • Sickle cell anemia

  • Leukemia

  • Bleeding disorders

  • Heart disease and heart problems like angina or pulmonary arterial hypertension

  • Peyronie’s disease

  • Ulcers

  • Retinitis pigmentosa (eye disease affecting the retina)

Oh, and drinking grapefruit juice or breastfeeding while on this medication can also be dangerous — so don’t do it.

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Whether you’re on your way to pick up a tadalafil prescription or doing some Google searches ahead of a very scary urology appointment, you can rest easy. The medication is safe, ED is common, and this treatment path is effective for many men. 

Here are the key takeaways from what we’ve discussed:

  • Tadalafil (as generic Cialis) is a PDE5 inhibitor approved by the FDA for the treatment of two conditions: erectile dysfunction and benign prostatic hyperplasia. Tadalafil (as generic Adcirca) is approved by the FDA for the treatment of pulmonary arterial hypertension.

  • It’s considered one of the safest erectile dysfunction medications on the market today.

  • Tadalafil can be prescribed at varying doses depending on your needs, your response to the medication and the side effects you experience.

  • There are other options. Medications like vardenafil (Levitra®), sildenafil (and brand-name Viagra) and avanafil (Stendra®) can also treat ED. These meds can even be taken in discreet forms, like our chewable hard mints.

For more on how long tadalafil lasts, the risks and rewards of daily Cialis, tadalafil dosage and its potential side effects, check out our guides.

Still have questions? Connect with a healthcare provider on our telehealth platform to see if this medication might be a good treatment option for you.

6 Sources

  1. 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, 6(4), 135–147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054509/.
  2. Benign prostatic hyperplasia (BPH). Benign Prostatic Hyperplasia (BPH): Symptoms, Diagnosis & Treatment - Urology Care Foundation. (n.d.). https://www.urologyhealth.org/urology-a-z/b/benign-prostatic-hyperplasia-(bph).
  3. HIGHLIGHTS OF PRESCRIBING INFORMATION: CIALIS (tadalafil) tablets, for oral use. (n.d.-a). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf.
  4. HIGHLIGHTS OF PRESCRIBING INFORMATION: VIAGRA® (sildenafil citrate) tablets, for oral use. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf
  5. Dhaliwal A, Gupta M. PDE5 Inhibitors. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549843/.
  6. Ng M, Baradhi KM. Benign Prostatic Hyperplasia. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558920/.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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