Tadalafil

Tadalafil is a medicine that treats two related but different conditions in adult men: Erectile dysfunction – This is when a man cannot get, or keep, an erection hard enough for satisfactory sexual activity. Tadalafil works by temporarily relaxing the blood vessels in your penis, which allows more blood to flow in when you become sexually excited. This helps you achieve and maintain a firm erection. Benign prostatic hyperplasia – This is an age‑related enlargement of the prostate gland that can cause urinary symptoms such as difficulty starting to pee, a weak stream, a feeling of not emptying your bladder fully, and needing to pee frequently (including at night). Tadalafil helps by relaxing the muscles in your prostate and bladder, which can improve urine flow and reduce these symptoms. The medicine belongs to a group called PDE5 inhibitors. It is important to know that tadalafil does not work if there is no sexual stimulation – you still need to be sexually aroused for it to help with an erection. Tadalafil is available on prescription only. In the UK, you can get it on an NHS prescription for erectile dysfunction only if you have a specific medical condition such as multiple sclerosis or a spinal cord injury. If you do not meet the NHS criteria, you can get a private prescription from a doctor or from an online pharmacy.

Tadalafil works by temporarily blocking an enzyme called PDE5. In your penis, PDE5's job is to "turn off" an erection once it is no longer needed. By blocking this enzyme, tadalafil allows the blood vessels in your penis to stay relaxed for longer when you are sexually aroused, which helps you get and keep a firm erection. The main difference between tadalafil and sildenafil (Viagra) is how long it lasts. Tadalafil has a much longer "half‑life" – about 17.5 hours, compared to around 3‑4 hours for sildenafil. This means that a single dose of tadalafil can help you achieve an erection for up to 36 hours after taking it. This gives you much more flexibility. You are not under pressure to have sex within a narrow window. You can take it on a Friday evening and still be able to respond to sexual stimulation throughout the weekend. A very important point is that tadalafil does not produce an erection on its own. You still need to be sexually aroused for it to work.

Tadalafil can be taken in two different ways, depending on your needs. Option 1: Taking it “as needed” (on‑demand use) This is the most common way for men who have sex occasionally, not daily. The recommended starting dose is 10 mg, taken before you expect to have sex. You can take it anywhere from 30 minutes to 12 hours before sexual activity, but it usually takes effect within 30 to 60 minutes. If 10 mg does not work well enough for you, your doctor may increase the dose to 20 mg. You should take no more than one tablet in any 24‑hour period. This method is not recommended for continuous daily use. Option 2: Taking it once a day (daily dosing) This is for men who anticipate having sex at least twice a week and prefer to be ready whenever the moment arises. The recommended dose is 5 mg, taken once a day at approximately the same time each day. You do not need to time your dose around sexual activity – the medicine works continuously in the background. If you have side effects with 5 mg, your doctor may reduce the dose to 2.5 mg once a day. It can take up to 5 days of daily dosing to reach a steady level in your blood. The appropriateness of daily dosing should be reassessed periodically by your doctor. General advice You can take tadalafil with or without food. Unlike sildenafil, tadalafil is not significantly affected by a heavy meal. Swallow the tablet whole with a glass of water. If you have an erection that lasts longer than 4 hours, you must seek emergency medical help immediately.

Tadalafil comes in four standard strengths: 2.5 mg – only used for once‑daily dosing. A lower dose may be tried if 5 mg causes side effects. 5 mg – the standard once‑daily dose, taken at the same time every day. 10 mg – the standard starting dose for “as needed” use. 20 mg – the maximum strength for “as needed” use, for men who find 10 mg insufficient. Your doctor or pharmacist will help you decide which dose is right for you based on: How often you have sex Whether you have tried other ED medicines before Your age Any other medical conditions you have Any other medicines you are taking How do you know if your dose is right? If you are using the 5 mg daily dose, you should give it at least 6 weeks of regular use before deciding whether it is working for you. If you are using the 10 mg or 20 mg “as needed” dose, you should try it at least 3‑4 times to get a fair assessment. If you have side effects that bother you, your doctor may lower your dose. If the dose does not work well enough, your doctor may try a higher dose or a different ED medicine. Never change your dose on your own. Always speak to a doctor or pharmacist first.

Once you take tadalafil, it starts working within 30 to 60 minutes and can continue working for up to 36 hours. What if you take it and it doesn’t work? There are several possible reasons: You were not sufficiently sexually aroused. Tadalafil is not an aphrodisiac – it will not create an erection on its own. You still need to be turned on by touch, kissing, or other stimulation. You did not wait long enough. Some men find they need up to 2 hours for the full effect, especially after a meal. You have an underlying medical problem that tadalafil cannot overcome, such as very low testosterone levels, nerve damage from diabetes or surgery, or severe blood vessel disease. You are taking other medicines that interfere with tadalafil. Some medicines can reduce how well it works. If you have taken tadalafil exactly as directed on several occasions and you still cannot get or keep an erection firm enough for sex, you should speak to your doctor. There are other treatments available.

Most people tolerate tadalafil well, but side effects can occur. The good news is that they are usually mild and go away on their own. Common side effects – these affect up to 1 in 10 users: Headache – this is the most common side effect, reported by about 12‑15% of men. It is usually mild and can be treated with paracetamol or ibuprofen, but do not take nitrates for it. Back pain – affects about 6‑7% of users. Interestingly, this is more common with tadalafil than with other ED medicines. The pain is usually felt in the lower back and can last for up to 48 hours. It is often described as a dull ache rather than a sharp pain. Muscle pain (myalgia) – affects about 5‑6% of users. Like back pain, this is more common with tadalafil and usually settles within a couple of days. Flushing – redness and warmth of your face and neck, affecting about 4‑5% of users. Indigestion or acid reflux – affects about 4‑5% of users. Nasal congestion – a stuffy or runny nose, affecting about 3‑4% of users. Dizziness – affects about 2% of users. Less common side effects (affect up to 1 in 100 users): Blurred vision Ringing in your ears (tinnitus) Swelling of your eyelids or eyes Red eyes Heartburn Nausea Serious side effects (rare but you need to know about them) : Priapism – a painful erection that will not go away. This is rare, but if you have an erection that lasts more than 4 hours, you must seek emergency medical attention immediately. If it is not treated, priapism can cause permanent damage to your penis and lead to long‑term erectile dysfunction. This is a medical emergency, not something to wait out. Sudden vision loss in one or both eyes – this can be a sign of a rare but serious condition called non‑arteritic anterior ischaemic optic neuropathy (NAION). If you experience sudden vision loss, stop taking tadalafil and seek medical help urgently. This is more likely if you have certain risk factors, including diabetes, high blood pressure, heart disease, or if you have ever had similar vision problems before. Sudden hearing loss – some people have reported a sudden decrease in hearing, sometimes accompanied by ringing in the ears (tinnitus) or dizziness. If this happens, stop taking tadalafil and contact a doctor. Heart attack or stroke – very rare, but the risk may be increased in men with pre‑existing heart disease. Severe allergic reaction – swelling of your face, lips, tongue or throat, or difficulty breathing. This is very rare, but if it happens, seek emergency medical help immediately. When to seek medical help: If you develop an erection that lasts more than 4 hours. If you lose your vision suddenly. If you develop chest pain, severe dizziness or nausea during sex. Stop sexual activity and seek medical attention immediately. If you have a widespread rash or blistering skin.

There are several groups of people who must not take tadalafil. This is very important. Do NOT take tadalafil if: You take any medicine called a nitrate. Nitrates are prescribed for chest pain (angina). Common nitrate medicines include glyceryl trinitrate (GTN) , isosorbide mononitrate, isosorbide dinitrate, and nicorandil. Taking tadalafil with a nitrate can cause your blood pressure to drop suddenly and dangerously, leading to fainting, heart attack, or even death. This is an absolute contraindication. You take “poppers” – amyl nitrite, often sold as a recreational drug, is also a nitrate. If you use poppers, you must not take tadalafil. The combination can be fatal. You take a medicine called riociguat (Adempas). This is used to treat a form of high blood pressure in the lungs (pulmonary hypertension). The combination can also cause a dangerous drop in blood pressure. You have been advised by a doctor to avoid sexual activity because of a heart problem. If you have unstable angina, severe heart failure, or have had a heart attack within the last 90 days or a stroke within the last 6 months, you should not take tadalafil. You have low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension). You have ever had loss of vision because of a condition called non‑arteritic anterior ischaemic optic neuropathy (NAION) – sometimes described as a “stroke of the eye”. You do not have an erection problem. Tadalafil will not provide any benefit to a man with normal erectile function. You are allergic to tadalafil or any of the other ingredients in the tablet.

Yes, tadalafil can interact with several other medicines. Some interactions are dangerous, while others are manageable. Dangerous interactions (do not take tadalafil at all): Nitrates – as described above. This is absolute. Riociguat (Adempas) – also absolute. Interactions that need caution (tell your doctor before starting tadalafil): Alpha‑blockers – medicines such as doxazosin, tamsulosin (Flomax) , terazosin, alfuzosin, and silodosin. These are often prescribed for high blood pressure or for prostate problems (benign prostatic hyperplasia). Taking tadalafil with an alpha‑blocker can cause a drop in blood pressure that leads to dizziness or fainting. If you take an alpha‑blocker, your doctor may start you on a lower dose of tadalafil (5 mg daily or 10 mg as needed) and may advise you to take the two medicines at different times of day. HIV protease inhibitors – medicines such as ritonavir, indinavir, saquinavir, or atazanavir. These can increase the level of tadalafil in your blood, leading to a greater risk of side effects. Your doctor will usually limit your tadalafil dose to 10 mg every 72 hours. Some antibiotics and antifungals – particularly erythromycin, clarithromycin, itraconazole, ketoconazole, and voriconazole. These can also increase tadalafil levels. Your doctor may advise a lower dose. Other PDE5 inhibitors – do not take tadalafil together with other ED medicines such as sildenafil (Viagra) or vardenafil (Levitra). Using more than one type at the same time will not improve the effect but will greatly increase the risk of side effects. What about alcohol? Moderate drinking (one or two units) is generally fine with tadalafil. However, alcohol can also lower your blood pressure and can make it harder to get an erection. Drinking heavily before taking tadalafil may mean the medicine does not work as well, and you may feel more dizzy or lightheaded than usual. What about grapefruit juice? If you are taking tadalafil for pulmonary hypertension (high blood pressure in the lungs), you should not drink grapefruit juice, as it affects the way the medicine works. For erectile dysfunction, the effect is less clear, but it is generally best to avoid large amounts of grapefruit juice while taking tadalafil.

You need to be careful. You should discuss tadalafil with your doctor or pharmacist if you have any of the following: Heart problems such as a recent heart attack (within the last 90 days), unstable angina (chest pain that comes on unpredictably or at rest), or severe heart failure. Tadalafil may be unsafe for you if you have significant heart disease. High blood pressure that is not well controlled or low blood pressure. A stroke or transient ischaemic attack (TIA) within the last 6 months. Severe liver problems (Child‑Pugh Class C). Tadalafil can be used, but with caution. Once‑daily dosing has not been evaluated in patients with severe liver impairment, and a 10 mg dose is the maximum recommended. Severe kidney problems (including those on dialysis). The maximum recommended dose is 10 mg. Once‑daily dosing is not recommended. A physical deformity of the penis – such as Peyronie’s disease (where the penis is curved) or any other condition that could make erections painful. A blood disorder – such as sickle cell anaemia, multiple myeloma, or leukaemia. These conditions increase the risk of priapism (a painful, prolonged erection). A rare eye disease called retinitis pigmentosa – which runs in families. A stomach ulcer – tadalafil can sometimes cause indigestion or aggravate an existing ulcer. A bleeding disorder – such as haemophilia. If you have any of these conditions, you may still be able to take tadalafil, but your doctor will need to start you on a lower dose and monitor you carefully.

Tadalafil is not licensed for use in women for sexual dysfunction, so this question does not usually apply to the erectile dysfunction version of the medicine. However, tadalafil is sometimes used for pulmonary arterial hypertension – a serious condition that can affect women. If you are taking tadalafil for pulmonary hypertension and you become pregnant, it is important to continue taking it, as the condition itself is life‑threatening without treatment. You should be reviewed at a specialist pregnancy heart clinic. For fertility, there is no clear evidence that taking tadalafil reduces fertility in men. However, if you are trying to conceive with a partner, speak to your doctor before taking it.

In the UK, tadalafil is prescription‑only. You cannot buy it over the counter without a prescription. However, you can get a prescription for tadalafil through: Your NHS GP – but this is usually only available for erectile dysfunction if you have a specific medical condition such as multiple sclerosis, Parkinson’s disease, or a spinal cord injury. A private prescription from a doctor or an online pharmacy – you will need to pay the full cost of the medicine. This is the most common route for most men. A pharmacy under a Patient Group Direction (PGD) – some pharmacies can supply tadalafil for erectile dysfunction after a consultation with the pharmacist, but this is still a “prescription‑only” service, not an over‑the‑counter sale. You should never buy tadalafil from unregulated online sellers or from friends. Counterfeit ED medicines are common and can contain dangerous substances, including industrial dyes, floor wax, or even other drugs that could harm you. Always buy from a registered pharmacy – either in person or from a legitimate online pharmacy that is registered with the General Pharmaceutical Council.

Store below 25°C (room temperature) in a dry place, away from direct sunlight and heat. Keep the blister pack or bottle in its outer carton to protect it from moisture. Keep the medicine out of the sight and reach of children. Do not use the tablets after the expiry date printed on the packaging. The active ingredient becomes less effective over time. If you have any leftover tablets, do not throw them away in household waste or pour them down the sink. Take them to your local pharmacy, where they will be disposed of safely.