Description

Who can use tadalafil?

Tadalafil is suitable for adult men diagnosed with erectile dysfunction – the inability to get or maintain an erection firm enough for sex. Tadalafil has been shown to significantly improve the ability of obtaining a hard erect penis suitable for sexual activity.

How tadalafil works

Tadalafil, like other erectile dysfunction tablet treatments such as Viagra (sildenafil), Levitra (vardenafil), and Spedra (avanafil), works by helping the blood vessels in your penis to relax, allowing the flow of blood into your penis during sexual stimulation.

These medicines achieve this effect by blocking an enzyme called PDE5 – they are ‘PDE5 inhibitors’. They have very little effect on other parts of the body.

Tablet treatments for erectile dysfunction augment and support sexual performance and relationships.

The ‘weekend pill’

Tadalafil is sometimes known as the weekend pill. This reflects its prolonged duration of action – up to 36 hours. A tablet taken on Friday night will still be active on Sunday morning.

This long duration of action, compared with 4 hours for Viagra (sildenafil) and Spedra (avanafil), and 4-5 hours for Levitra (vardenafil), has led to tadalafil becoming increasingly popular.

For further information read How long does tadalafil last?

How to take tadalafil for erectile dysfunction

Tadalafil tablets come in four strengths: 2.5mg, 5mg, 10mg, and 20mg. Most men take a 10mg or 20mg tablet when they need it. The lower doses of 2.5mg and 5mg are for daily use, although some men may find a single 5mg tablet taken on an occasional basis is all they need.

Taking tadalafil for the first time

The normal starting dose is a single 10mg tablet taken at least 30 minutes before sexual activity. Swallow tablets whole with water and can be taken with or without food.

Sexual stimulation is required for tadalafil to be effective.

Repeated trials of treatment at one dose are recommended before changing to a higher strength tablet. There is no benefit in taking a higher dose than is needed. Tadalafil should not be taken at the same time as, or within 24 hours of, taking other oral erectile dysfunction treatments.

As required dosage (10mg, 20mg)

Most men take tadalafil as and when they need it at least 30 mins before anticipated sexual activity.

A single tablet of tadalafil 10mg or 20mg remains active for up to 36 hours. Men usually take a tablet ‘as required’ when they expect to be sexually active in the following 36 hours. The maximum dose is 20mg in a 24 hour period. 10mg-20mg is not recommended for continuous daily use.

Continuous daily dosage (2.5mg, 5mg)

Men who require treatment twice weekly or more on a regular basis may prefer to take a 2.5mg or 5mg low dose tablet every day. Tadalafil (and branded Cialis) is the only type of ED tablet with a low-dose daily regime.

The recommended dose is 5mg taken once a day at approximately the same time of day. The dose may be decreased to 2.5mg daily based on individual tolerability. The low dose daily tablets provide treatment on a continuous basis, although it may take several days to build-up to an effective dose.

Men should consult their regular doctors before starting on regular daily treatment.

Effectiveness of tadalafil

Clinical studies show tadalafil significantly improves erectile dysfunction and the ability to have successful sexual intercourse.

No dose adjustments are recommended in elderly or diabetic patients.

It is not known if tadalafil is effective in patients who have had pelvic surgery or removal of all or part of the prostate gland.

Read patient reviews of tadalafil below.

Who should NOT take tadalafil

All men with erectile dysfunction should consult a doctor face-to-face before obtaining supplies online. Dr Fox consultations check for contraindications and interactions with other medicines, but do not replace an initial consultation and diagnosis with your regular doctor where physical examination and tests can be carried out.

Warnings and precautions

Sexual activity carries a possible risk to patients with heart disease because it puts an extra strain on your heart.

Do not take tadalafil if you:

• Have serious heart disease or recently had a heart attack within the last 90 days.
• Had a stroke within the last 6 months.
• Have low blood pressure or uncontrolled high blood pressure.
• Ever had loss of vision because of non-arteritic anterior ischemic optic neuropathy (NAION), a condition described as ‘stroke of the eye’.

If you have any of the following conditions you should discuss with your regular doctor before taking tadalafil:

• Sickle cell anaemia (an abnormality of red blood cells).
• Multiple myeloma (cancer of the bone marrow).
• Leukaemia (cancer of the blood cells).
• Any deformity of your penis.
• A serious liver or kidney problem.

Tadalafil and other medicines

Tadalafil should not be taken if on the following medication:

• Within 24 hours of taking Viagra/sildenafil, Levitra/vardenafil, or Spedra/avanafil.
• Indinavir and ritonavir for the treatment of HIV.
• Itraconazole or ketoconazole anti-fungals.
• Nitrates for angina, including isosorbide mononitrate, isosorbide dinitrate, nicorandil, and glyceryl trinitrate – serious reactions possible.
• Recreational drugs such as amyl nitrate (‘poppers’) – serious reactions possible.
• Blood pressure tablets known as alpha-blockers, also sometimes used to treat prostate enlargement – includes doxazosin, prazosin, alfuzosin, terazosin, indoramin, and tamsulosin.
• Antibiotics such as erythromycin, clarithromycin, or rifampicin.
• Anticonvulsants such as phenobarbital, phenytoin, or carbamazepine.

If in doubt please message our doctors or consult your regular doctor before ordering tadalafil online.

Other cautions

• Alcohol and Grapefruit juice may affect how well tadalafil works.
• A reduction in sperm was seen in some men. These effects are unlikely to lead to a lack of fertility.
• Some men taking tadalafil in clinical studies reported dizziness. Check carefully how you react to the tablets before driving or using machines.
• Tadalafil can contain lactose and negligible amounts of sodium.
• Severe renal impairment: 10mg is the maximum recommended dose; daily dosing is not recommended.
• Women and children: tadalafil is not intended for use by under 18s or by women. Keep all medicine out of the sight and reach of children.

Possible side effects of tadalafil

Significant side effects are unusual. Side effects are more likely with higher strength tablets. The minimum effective strength tablet is therefore advised.

The most common side effect is a bluish or yellowish tinge to vision. This is not dangerous and fades as the tablets wear off. A similar visual discolouration is common with other erectile dysfunction treatments.

Other common side effects (affecting 1%-10%) include headache, back pain, muscle aches, pain in the arms or legs, nasal congestion, facial flushing, and indigestion.

A very rare but serious side effect is priapism – a continuous painful erection over a period of hours. Priapism can lead to permanent damage to the penis and is a medical emergency requiring urgent medical attention through a hospital A&E department.

The manufacturer’s patient leaflet included in packs contains a full list of side effects.

Alternative treatments

Not all men need a tablet that works for up to 36 hours. Other oral PDE5 treatments include Viagra (sildenafil), Levitra (vardenafil), and Spedra (avanafil) which typically last 4 hours.

Compare erectile dysfunction tablets

Other treatments for ED include topical applications, injections into the penis, and surgical devices. Counselling may help if psychological causes are causing ED. Improved diet and lifestyle choices can also help.

Tadalafil is also sometimes prescribed to treat benign prostatic hyperplasia (enlarged prostate) symptoms, and under specialist supervision in higher doses for a condition called pulmonary hypertension.

Generic tadalafil or branded Cialis

Generic tadalafil became legally available in the UK in November 2017, after the exclusive license of the pharmaceutical company Lilly for branded Cialis ended. Cialis is the brand name used by Lilly for its original brand of the medicine tadalafil. Tadalafil is the medical name. They are the same medicine.

Up until its exclusive license ended, only the original developer Lilly was permitted sell tadalafil legally in the UK. After the exclusive license ended other pharmaceutical companies were able to legally supply tadalafil and the prices have dropped. These other brands of generic Cialis are usually marketed as ‘tadalafil’.

Dr Fox may supply any UK licensed brand of tadalafil (Accord, Aspire, Cipla, Crescent, Clydesdale, Kosei, Medreich, Milpharm, Mylan, Noumed, Strides Pharma, Sovereign, Sun, Teva). Patients can request a preferred brand after making an order.

The active ingredient and medical effects of original branded Cialis and generic tadalafil are the same because the active ingredient, tadalafil, is the same. Strict regulation and quality control apply to the manufacture and supply of both.

Generic medicines are medically identical to branded originals and are usually cheaper.

Causes of erectile dysfunction

Erectile dysfunction (ED) is common, affecting up to 40% of men by the age of fifty. Most men with erectile dysfunction are in reasonable health, although it may be a sign of poor circulation and narrowing of the arteries.

Diabetes, high cholesterol, low testosterone, low or high thyroid hormone, obesity, and reduced blood circulation can all contribute to erectile dysfunction. Erectile dysfunction can be associated with heart disease and stroke. Treatment of the underlying causes may improve symptoms and prevent associated disease.

Erectile dysfunction can be caused by stress, psychosexual problems, and lifestyle choices such as smoking, heavy drinking, obesity, and lack of exercise. Symptoms may well improve when these issues are addressed. Other causes may include spinal injury or operations on the prostate or bowel. Regular cycling for 3 or more hours a day may also contribute to ED.

It is important to have a face-to-face consultation with a GP, particularly if erectile dysfunction has started recently or is worsening. GPs will undertake an assessment, possibly perform tests, and provide advice.