Active ingredient: tadalafil. Dosages: 10 / 20 mg on demand, or 5 mg daily.
What it is
A PDE5-inhibitor tablet taken by mouth, for adult men with erectile dysfunction. A daily low dose also eases prostate symptoms (lower urinary tract symptoms from BPH, an indication for which tadalafil is authorised) and it cannot be combined with nitrate heart medicines.How it works
Arousal releases nitric oxide
Sexual stimulation triggers the release of nitric oxide, which raises cGMP in the erectile tissue.
Tadalafil blocks the PDE5 enzyme
Tadalafil is a selective, reversible blocker of phosphodiesterase type 5 (PDE5), whose normal job is to break cGMP back down. With PDE5 blocked, cGMP builds up instead of being cleared away as fast as it appears.
Blood flows in, erection follows
Higher cGMP relaxes the smooth muscle in the arteries of the corpus cavernosum, so blood flows into the penis and an erection can form. The same relaxation happens in the prostate and bladder, which is why a daily dose can also ease urinary symptoms.
EU authorisation
Tadalafil has been authorised for use in the EU since 12 November 2002 (EMA EPAR — Cialis, EMEA/H/C/000436).What the studies reported
Integrated trial data pooled five 12-week manufacturer-run trials; the reported 7.9-point IIEF (erectile function score) change is the within-group change from baseline, not the difference from placebo. (J Urol 2002, PMID 12352386.)Dosing
- On demand
- Daily
One tablet — 10 mg or 20 mg — at least 30 minutes before sexual activity. Effect window: up to 36 hours.
What has been reported
All of the following are listed as common (1 in 100 to 1 in 10 men) in the EU product information, with frequency generally rising at higher doses.Non-arteritic anterior ischaemic optic neuropathy (NAION)
Non-arteritic anterior ischaemic optic neuropathy (NAION)
Contraindicated in men who have lost vision in one eye because of NAION, whether or not the episode was linked to a PDE5 inhibitor.
Use with nitrates
Use with nitrates
Contraindicated with nitrate medicines and with guanylate cyclase stimulators, and after a recent heart attack (within 3 months) or stroke (within 6 months). Nitrates and poppers are contraindicated: blood pressure can fall dangerously.
Erections lasting more than 4 hours
Erections lasting more than 4 hours
Seek emergency medical attention immediately for an erection lasting more than 4 hours, sudden vision loss, or chest pain.
Storage
Store at room temperature below 25°C. Keep in the original packaging to protect from light and moisture. Do not use after the expiry date on the carton.What to expect
Most side effects are usually mild and temporary. Contact the doctor for persistent back pain or muscle aches; seek emergency care immediately for an erection lasting more than 4 hours, sudden vision or hearing changes, or chest pain.How Hi-Doctor handles it
A licensed doctor reviews every sexual-health case and recommends what fits the history and goals, weighing the on-demand versus daily approach with the patient. Medication is paid separately at a pharmacy; see pricing for what the consultation fee covers.Sources
- EMA EPAR — Cialis (tadalafil), EMEA/H/C/000436, marketing authorisation issued 12/11/2002
- EMA — Cialis EPAR product information (SmPC sections 4.2, 4.8, 5.1)
- J Urol 2002 — Efficacy and safety of tadalafil: results of integrated analyses (PMID 12352386)
Related reading
- Erectile dysfunction — what the doctor rules out first
- Sildenafil — the shorter-acting PDE5 inhibitor a doctor may consider instead
- Safety and eligibility
- How Hi-Doctor works
Start a consultation
Sexual health consultation
Answer the sexual health questionnaire and a registered doctor reviews it.
They decide whether treatment is appropriate, which one, and at what dose —
and declining is a normal outcome. See what it costs
and how the review works.