Tadalafil

Generic name

Tadalafil

Active ingredient

Tadalafil

Product type

Small-molecule medicine

Drug class

PDE5 inhibitors

Brand names

UK Cialis, Cialis Together, Adcirca · US Cialis, Adcirca

Routes

Oral

Dosage forms

Tablet

Also known as

Cialis, Cialis Together, Adcirca

Usual preparations

Tablets. (summary of the cited reference, not a prescription)

Onset and duration

UK patient leaflets say tadalafil may still be effective up to 36 hours after taking the tablet.

Monitoring

The NHS advises telling a doctor or pharmacist about any medical conditions and about medicines, including GTN for chest pain, before taking tadalafil.

Availability by country

Legal status differs between countries and can change; each row cites the document it was taken from and applies only to the country named.

What it is used for

• Erection problems (erectile dysfunction), the main use the NHS names.
• Urinary problems caused by an enlarged prostate (benign prostate enlargement).
• Pulmonary arterial hypertension.
• Second-line treatment for Raynaud's phenomenon and digital ulcers, according to one NHS hospital leaflet.

How it works in the body

Tadalafil belongs to a group of medicines called PDE5 inhibitors. StatPearls describes these medicines as stopping the PDE5 enzyme from breaking down a chemical messenger called cGMP. UK patient leaflets say tadalafil does not cause an erection by itself, and sexual stimulation is still needed. StatPearls says its effect on the prostate and bladder helps relieve enlarged prostate symptoms by relaxing these tissues and improving urine flow.

Cautions and interactions

• The NHS says tadalafil is not usually taken with nitrates, such as GTN for chest pain, and advises asking a pharmacist or doctor if you take them.
• StatPearls describes the nitrate-related fall in blood pressure as potentially life-threatening.
• Poppers (amyl nitrate) or illegal drugs such as amphetamines, ecstasy and cocaine can increase the risk of serious side effects.
• The NHS advises avoiding grapefruit juice.
• Alcohol can cause dizziness or light-headedness by lowering blood pressure.
• The NHS says tadalafil may not be suitable after a serious reaction to it before or a recent heart attack or stroke.
• Liver or kidney problems, certain blood cancers such as leukaemia, sickle cell anaemia and a curved or bent penis that makes erections painful or difficult are also listed.
• Past vision loss in one eye from reduced blood flow to the optic nerve is listed too.
• The NHS advises avoiding tadalafil in pregnancy and while breastfeeding.
• Local NHS guidance lists uncontrolled high blood pressure as a reason for caution.
• A review says alpha-blockers call for caution when used with PDE5 inhibitors.

Interactions

Interactions documented in the official sources cited on each card. The list covers the medicines represented on this site and is not exhaustive; how the interaction data is compiled.

No pair records for this medicine are in the sources currently represented by Anatomy Nexus. Absence from this list does not mean no interaction exists.

Same-class and related medicines

Same class: PDE5 inhibitors

Medicines that share the class of Tadalafil. They are separate medicines with their own licences, doses and interactions, not alternative names for Tadalafil.

Related medicines

Medicines often discussed alongside Tadalafil: used together, compared with it, or acting on the same problem by a different route.

Key facts

What is tadalafil used for?

The NHS says tadalafil is mainly used to treat erection problems. It is also sometimes prescribed for urinary problems linked to an enlarged prostate (benign prostate enlargement), and for pulmonary arterial hypertension, which is high blood pressure in the blood vessels to the lungs. Brand names include Cialis, Cialis Together and Adcirca.

A hospital patient leaflet describes both sildenafil and tadalafil as second-line treatments for Raynaud's phenomenon and for digital ulcers, which are sores on the fingers and toes. The MHRA has reclassified Cialis Together tablets as a pharmacy medicine.

How does tadalafil work?

Tadalafil belongs to a group of medicines called PDE5 inhibitors. StatPearls says PDE5 inhibitors stop the PDE5 enzyme from breaking down cGMP, a chemical messenger. UK patient leaflets say tadalafil does not cause an erection by itself, and sexual stimulation is still needed.

StatPearls adds that tadalafil's effect on the prostate and bladder helps relieve symptoms of benign prostatic hyperplasia by relaxing these tissues and improving urine flow. UK patient leaflets say the medicine may still be effective up to 36 hours after taking the tablet.

What are the side effects of tadalafil?

The NHS lists indigestion, muscle aches, back pain, a blocked nose, a flushed face and headaches as common side effects.

The NHS says serious side effects are possible but most are rare, and to call NHS 111 if you think you are having a serious side effect. The serious side effects it lists include an allergic reaction (anaphylaxis) with a swollen throat or tongue, a raised itchy rash or difficulty breathing, sudden changes in hearing or eyesight, a painful or prolonged erection, seizures, palpitations and chest pain. NHS medicine pages for similar drugs, such as sildenafil, give 999 for swelling of the lips, mouth or throat or difficulty breathing. For a painful or prolonged erection, hospital guidance advises 999 or A&E. MedlinePlus advises calling a doctor right away for a sudden loss of vision or hearing, which may come with ringing in the ears or dizziness.

Tadalafil with other medicines, drugs and alcohol

The NHS says tadalafil is not usually taken with nitrates, such as GTN for chest pain, and advises asking a pharmacist or doctor if you take them. StatPearls describes the nitrate-related low blood pressure as potentially life-threatening. UK product information says tadalafil makes the blood-pressure-lowering effect of nitrates stronger, so using them together is contraindicated.

The NHS says poppers (amyl nitrate) and illegal drugs such as amphetamines, ecstasy and cocaine can increase the risk of serious side effects. The NHS advises avoiding grapefruit juice. Alcohol can cause dizziness or light-headedness through lower blood pressure. An NHS Highland guideline says tadalafil and sildenafil are contraindicated with nitrates and nicorandil, and a review calls for caution with alpha-blockers.

Who needs extra care with tadalafil?

The NHS says tadalafil may not be suitable for everyone. This includes people who have had a serious reaction to it before or who have recently had a heart attack or stroke. It also includes people with liver or kidney problems.

Blood cancers such as leukaemia and sickle cell anaemia are also listed. So are past vision loss in one eye from reduced blood flow to the optic nerve, and a curved or bent penis that makes erections painful or difficult. Local NHS guidance lists uncontrolled high blood pressure as a reason for caution. The NHS advises avoiding tadalafil in pregnancy and while breastfeeding.

Frequently asked questions