How To Take Tadalafil Safely

Tadalafil (best known by the brand name Cialis) is a licensed medicine for erectile dysfunction (ED). It works by improving blood flow to the penis, helping to achieve and maintain an erection.

When prescribed appropriately, Tadalafil has a well-established safety profile.

Like any medicine, it isn’t right for everyone, and there are important interactions and cautions you should know before taking it.

Key Points

• Tadalafil is safe for most healthy adult males
• It should not be taken with certain medication such as nitrates (used to treat angina)
• Other medication such as alpha blockers and HIV treatment can interact with Tadalafil, so dose adjustments are required
• It should not be taken by men who have certain medical conditions such as low blood pressure or severe heart failure
• Some men may experience unwanted effects. In these cases, a dose adjustment or alternative may be beneficial

Avoid Tadalafil and seek medical advice if any of the following apply:

• You use nitrates or riociguat — there is risk of a dangerous drop in blood pressure
• You’ve had a recent heart attack or stroke, have severe heart disease, very low blood pressure, or are advised to avoid sexual activity
• You’ve had sudden vision loss due to NAION or certain hereditary retinal disorders
• You have severe liver or kidney disease, significant blood disorders, or penile deformity (e.g., Peyronie’s)

When to speak to your doctor

Before taking Tadalafil, speak to your doctor if:

• You take medication, especially alpha-blockers, medication for BPH, antifungals, epilepsy medication and certain antibiotics
• You have heart disease
• You have a stomach ulcer

Most healthy adult men with erectile dysfunction can take Tadalafil.

If you have a medical condition or take medication, a clinician will need to check your medicines and medical history.

If you do not have any medication conditions, or you are not taking any medication, it is very likely that Tadalafil is safe for you to take.

There are two different doses of Tadalafil:

On-demand (10mg and 20mg)

• Start 10 mg at least 30 minutes before sexual activity
• Adjust to 20 mg if needed and tolerated, or 5 mg if you’re sensitive to side effects
• Effects can last up to 36 hours; it is not recommended to use the 10 mg/20 mg tablets every day

Once-daily (2.5mg and 5mg)

• 2.5 mg to 5 mg once daily, taken at the same time each day
• Maximum dosing frequency is once per day
• Effectiveness is similar to on-demand dosing; choice depends on preference, frequency of sex, and tolerability

Do not take more than one dose in 24 hours.

Most Tadalafil side effects are mild and settle within a few hours.

Common ones include:

• Headache
• Indigestion/heartburn
• Flushing (warm face)
• Blocked nose
• Muscle or back pain
• Dizziness
• Nausea

Stop taking Tadalafil and seek urgent medical attention if you develop:

• Chest pain, fainting, or symptoms of severe low blood pressure
• Sudden vision or hearing loss
• A painful erection or one lasting longer than 4 hours (priapism)

Speak to your doctor if:

• You start taking a new medication or develop a medical condition
• Side effects are troublesome or persistent despite dose adjustments
• Tadalafil is not working for you

If a clinician advises against Tadalafil, you still have options. The right choice depends on your medical history and the cause of ED.

Non–PDE5 options (safe with nitrates)

• Vacuum erection device (VED): Creates an erection mechanically and a constriction ring helps maintain it.
• Counselling/sex therapy (CBT, couples therapy): Helpful when anxiety, stress or performance pressure contribute.

If side effects were the problem

• Try a different medication within the same class (with prescriber advice):
  • Sildenafil (Viagra-equivalent): often starts at 50 mg on demand (see our article Tadalafil vs Sildenafil)
  • Vardenafil: often starts at 10 mg on demand
  • Avanafil: often starts at 100 mg on demand (rapid onset)
• Tweak mealtimes and alcohol intake: Avoid heavy meals and alcohol with Tadalafil

If Tadalafil is unsuitable because of a medical condition

• Review your heart health: Your clinician may stabilise blood pressure, angina, or heart failure first; once safe for sexual activity, treatment options can be revisited.
• Check your hormones: If low testosterone is confirmed, treating hypogonadism can improve erections and PDE5 response.
• Check your prostate: Treat LUTS/BPH (e.g., alpha-blocker or 5-alpha-reductase inhibitor) and reassess ED.
• Diabetes, obesity, smoking, sleep apnoea: Optimising these often improves erections and medication response.

Tadalafil has a very high safety profile and is used safely by many men around the world.

It may not be suitable if you have medical condition such as angina, you take certain medication such as nitrates, or you are experiencing unwanted effects.

In almost all cases, there are alternatives.