Tadalafil is a prescription medicine commonly used to treat erectile dysfunction (ED). It can help a man achieve and maintain an erection when he is sexually stimulated. Because its effect can last longer than that of some other ED tablets, tadalafil is sometimes called the “weekend pill”. This does not mean an erection lasts for 36 hours; it means the medicine may support erections during that window when sexual stimulation occurs.
ED can occasionally affect anyone. When it is persistent, however, it may be linked to diabetes, high blood pressure, high cholesterol, obesity, smoking, low testosterone, medication side effects, psychological stress, or cardiovascular disease. A medical assessment is important, especially when ED is new or worsening.
How Does Tadalafil Work?
Tadalafil belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors. During sexual stimulation, it helps blood vessels in the penis relax so that blood flow can increase. Tadalafil does not create sexual desire, does not cause an automatic erection, and is not an aphrodisiac.
How Is Tadalafil Taken for ED?
Doctors generally prescribe tadalafil in one of two ways:
- As needed: commonly started at 10 mg before expected sexual activity and adjusted by the prescribing doctor according to response and side effects. Its effect may begin within about 30 minutes, often peaks later, and can last for up to 36 hours.
- Once daily: a lower dose, commonly 2.5 mg or 5 mg, taken at roughly the same time each day. This may suit men who prefer greater spontaneity or who also have urinary symptoms from an enlarged prostate.
The right regimen depends on general health, kidney and liver function, other medicines, frequency of sexual activity, and personal preference. Do not take more than one dose a day or change the prescribed dose without medical advice.
What Are the Benefits?
- A long period in which sexual activity can be attempted
- Daily and as-needed options
- Can be taken with or without food
- The 5 mg daily regimen may also improve lower urinary tract symptoms in selected men with benign prostate enlargement
Tadalafil treats the erectile symptom; it does not necessarily correct the underlying cause. Lifestyle changes and treatment of diabetes, blood pressure, cholesterol, obesity, smoking, sleep problems, or psychological factors may also be needed.
Common Side Effects
Most side effects are mild and temporary. They can include:
- Headache or facial flushing
- Indigestion
- Blocked or stuffy nose
- Back pain or muscle aches
- Dizziness
Speak with the prescribing doctor if side effects are troublesome, persistent, or unexpected.
Who Should Not Take Tadalafil?
Never combine tadalafil with nitrate medicines used for chest pain, such as nitroglycerin or isosorbide, or with recreational “poppers”. The combination can cause a dangerous fall in blood pressure. Tadalafil must also not be combined with the pulmonary hypertension medicine riociguat.
Tell your doctor about heart disease, a recent heart attack or stroke, low or uncontrolled blood pressure, kidney or liver disease, previous sudden vision loss, bleeding disorders, penile curvature, or conditions that increase the risk of a prolonged erection. Sexual activity itself may be unsafe in some people with unstable cardiovascular disease.
Alpha-blockers and blood-pressure medicines can add to tadalafil’s blood-pressure-lowering effect. Some antibiotics, antifungals, HIV medicines, and seizure medicines may alter tadalafil levels. Heavy alcohol intake can increase dizziness and low blood pressure and can also worsen erections. Always share a complete medicine and supplement list with the prescriber.
When Is Urgent Care Needed?
Seek urgent medical help for chest pain, an erection lasting more than four hours, sudden loss or marked reduction of vision or hearing, severe breathlessness, fainting, or signs of an allergic reaction. If chest pain occurs, do not take a nitrate; tell the emergency team when tadalafil was last taken.
Tadalafil and Male Fertility
Tadalafil may help couples when ED makes timed intercourse difficult, but it is not a treatment for low sperm count or poor sperm quality. Men trying to conceive who have persistent ED should have both sexual health and fertility factors assessed rather than relying only on an ED tablet.
The Bottom Line
Tadalafil is an effective first-line option for many men with erectile dysfunction when it is prescribed after an appropriate assessment. The best dose and schedule are individual, and important interactions – especially with nitrates – must be ruled out.
This article provides general information and is not a prescription. Consult a qualified clinician for diagnosis and treatment suited to your health and current medicines.