Experiences with
Tadalafil

Tadalafil is a medicine used to treat erection problems (erectile dysfunction) and symptoms of an enlarged prostate (benign prostate enlargement).

It's also sometimes used to treat pulmonary hypertension (high blood pressure in the blood vessels that supply the lungs).

If you have erection problems, tadalafil works by temporarily increasing blood flow to the penis when you get sexually excited.

If you have symptoms of an enlarged prostate gland, such as difficulty peeing or needing to pee urgently, tadalafil works by relaxing the muscles in the prostate and bladder.

In pulmonary hypertension it works by relaxing blood vessels in the chest.

Tadalafil is available on prescription only. It comes as tablets.

You can only get it on prescription for erectile dysfunction if you have a specific condition such as multiple sclerosis or a spinal cord injury.

Tadalafil is not usually used to treat benign prostate enlargement because there is not enough evidence about how well it works.

If you do not meet the NHS criteria for tadalafil, you may get a private prescription from a doctor. This means you'll need to pay the full cost of the medicine.

Who can take tadalafil

Most men aged 18 and over can take tadalafil for erectile dysfunction.

Most adults aged 18 and over can take it for pulmonary hypertension.

Who may not be able to take tadalafil

Tadalafil is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

have ever had an allergic reaction to tadalafil or any other medicine
are taking medicines called nitrates for chest pain (angina)
have a serious heart and liver problem
have recently had a stroke or a heart attack
have low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
have ever lost your vision due to reduced blood flow to the eye
have sickle cell anaemia (an abnormality of red blood cells)
have leukaemia (cancer of blood cells)
have multiple myeloma (cancer of bone marrow)
have Peyronie's disease (curved penis) or a similar problem with your penis
have a liver or kidney condition
have a heart condition – your doctor will advise you whether your heart can take the additional strain of having sex

Dosage and strength

Tadalafil comes as 2.5mg, 5mg, 10mg and 20mg tablets.

Dose for erectile dysfunction

The usual dose of tadalafil for erectile dysfunction is 10mg when you need it. Do not take more than 1 tablet a day.

Your doctor may increase or decrease your dose, depending on how well it works and how often you take it.

The effects may last longer than 24 hours, so you're not recommended to take the 10mg or 20mg tablets every day.

For the tablet to work properly, you'll need to be sexually excited.

Dose for benign prostate enlargement

Tadalafil for an enlarged prostate comes as 2.5mg or 5mg tablets. The usual dose is 5mg, taken once a day.

If you're being treated for both benign prostate enlargement and erectile dysfunction, the dose is 5mg.

Dose for pulmonary hypertension

Tadalafil for pulmonary hypertension comes as 20mg tablets.

The usual dose is 40mg – two 20mg tablets, taken once a day.

If you have kidney or liver problems your doctor might decrease the starting dose to 10mg or 20mg.

How to take it

Swallow your tablets whole with a drink of water or juice (but not grapefruit juice).

For erectile dysfunction, take 1 tablet at least 30 minutes before you want to have sex.

If you are taking tadalafil for prostate enlargement, you can take your tablet in the morning or evening, but it's best to take it at the same time each day.

Tadalafil tablets for pulmonary hypertension are large and may be difficult to swallow.

If you forget to take it

If you have:

benign prostate enlargement – take it as soon as you remember and then continue as usual
pulmonary hypertension – take it within 8 hours if you can. If you remember after 8 hours, skip the missed dose and take the next dose at the usual time

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much tadalafil can cause side effects, including:

headache
dizziness
indigestion
stuffy nose
changes to your vision (such as blurred vision)

you take more than your prescribed dose of tadalafil

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the tadalafil packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

Common side effects of tadalafil happen in more than 1 in 100 people.

If you're taking it for erection problems you're unlikely to get side effects as you're only taking it for a short time.

If you're taking tadalafil for pulmonary hypertension and get these side effects, there are things you can do to help cope with them:

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Headaches should usually go away after the first week of taking tadalafil. Talk to your doctor if they last longer than a week or are severe.

It may help if you stick to simple meals and avoid rich or spicy food. If you're taking tadalafil for pulmonary hypertension, it may help to take it after a meal or snack.

Try cutting down on coffee, tea and alcohol. It might help to keep the room cool and use a fan. You could also spray your face with cool water or sip cold or iced drinks.

The flushing should go away after a few days.

If you need something to ease the discomfort, try taking an antacid, but do not put off going to the doctor if it bothers you. They may be able to prescribe an extra medicine to protect your stomach.

Speak to a pharmacist or doctor. They may be able to recommend a nasal spray that helps.

If you get unusual muscle ache that is not from exercise or physical work, ask your pharmacist to recommend a suitable painkiller. Talk to your doctor if the aches continue.

Side effects will usually go away when you stop taking the tablets. Talk to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

you have sudden loss of vision or sudden problems with your hearing – stop taking tadalafil if this happens
you have a prolonged or painful erection, especially if it lasts for more than 2 hours

Find your nearest A&E

you have a seizure or fit
you have chest pain

Stop taking tadalafil if you get any of these symptoms.

If you get chest pain during or after sex and you usually use nitrates, such as glyceryl trinitrate (GTN) , do not take them to treat your chest pain.

A&E safety messaging (for 999 only)

In rare cases, tadalafil can cause a serious allergic reaction (anaphylaxis).

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of tadalafil. For a full list, see the leaflet inside your medicine packet.

Tadalafil and pregnancy

Tadalafil is not often prescribed in pregnancy, but it may be recommended if you have pulmonary hypertension.

Pulmonary hypertension is an extremely serious condition in pregnancy. If you have this condition, it's important to use reliable contraception (for example a contraceptive implant or a coil) and to talk to your doctor before trying for a baby. You heart condition will need to be assessed so that you can be given information on the risks of pregnancy to your health.

If you become pregnant while taking tadalafil, you will usually be recommended to continue to take it throughout pregnancy. This is because the risks from pulmonary hypertension are potentially life-threatening without treatment.

It's important to let your doctors know that you are pregnant as early as possible. This is because you will need to be reviewed in a specialist pregnancy and heart clinic throughout your pregnancy. You will be considered a high-risk pregnancy and will have a lot of additional care.

Tadalafil and breastfeeding

If you are breastfeeding and have pulmonary hypertension, tadalafil is not usually prescribed, unless a specialist recommends it.

Tadalafil and fertility

There's no evidence to suggest that taking tadalafil will reduce fertility in either women or men.

However, speak to a pharmacist or doctor before taking it if you're trying to get pregnant.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

Some medicines do not mix well with tadalafil.

Tell your doctor or pharmacist if you're taking these medicines before you start tadalafil:

nitrates for chest pain, such as glyceryl trinitrate (GTN)
riociguat for pulmonary hypertension

Mixing tadalafil with herbal remedies and supplements

There are lots of treatments that claim to be a "herbal Cialis", but there is no such thing.

A herbal Cialis has never been approved as a treatment for erectile dysfunction. These treatments may also be fake or unsafe.

Some complementary therapies may have ingredients that could affect the way tadalafil works and cause side effects.

There's not enough information to say whether complementary medicines, herbal remedies and supplements are safe to take with tadalafil. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert