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Highlights for tadalafil

1. Tadalafil oral tablet is available as a generic drug and as brand-name drugs. Brand names: Cialis, Adcirca.
2. Tadalafil comes only as a tablet you take by mouth.
3. Tadalafil is used to treat the symptoms of two conditions found in men: benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Tadalafil is also used to treat pulmonary arterial hypertension (PAH).

Tadalafil side effects

Tadalafil oral tablet doesn't usually cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with tadalafil include:

• headache
• upset stomach
• back pain
• muscle aches
• flushing (reddish skin)
• stuffy or runny nose
• diarrhea

If these effects are mild, they may go away within a few days or a couple of weeks. If they're more severe or don't go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you're having a medical emergency. Serious side effects and their symptoms can include the following:

• Priapism (in men). Symptoms can include:
  • a painful erection that won't go away
• Vision changes. Symptoms can include:
  • seeing a shade of blue when looking at objects
  • trouble telling the difference between the colors blue and green
  • a sudden decrease or loss of vision in one or both eyes
• Hearing loss. Symptoms can include:
  • a sudden loss or decrease in hearing
  • ringing in the ears
  • dizziness
• Low blood pressure. Symptoms can include:
  • feeling lightheaded or dizzy
  • fainting
  • angina (chest pain

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

What is tadalafil?

Tadalafil is a prescription drug. It comes as an oral tablet.

Tadalafil oral tablet is available as the brand-name drugs Cialis and Adcirca. It's also available in a generic form. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

Why it's used

Tadalafil (Cialis) is used for treatment of benign prostatic hyperplasia (BPH) or erectile dysfunction (ED), or both conditions. Tadalafil (Adcirca) is used to treat pulmonary arterial hypertension (PAH).

With BPH, the prostate gland is enlarged but isn't cancerous. It can pinch or squeeze your urethra (the tube that carries urine from the kidneys out of the body). Symptoms of BPH include trouble urinating, painful urination, and a frequent or urgent need to urinate.

With ED, the penis doesn't fill up with enough blood to harden and expand when a man is sexually excited. ED can also prevent a man from keeping an erection.

PAH is a rare but serious form of high blood pressure. It occurs in the pulmonary arteries, which are blood vessels in your lungs.

How tadalafil is used

How long before sex should you take tadalafil? Tadalafil can be prescribed in two different ways, either a daily dosage or on an as-needed basis. Your doctor will prescribe either one. If you're taking tadalafil on an as-needed basis, you should take it at least 30 minutes before sex. If you're taking it daily, try to take it around the same time every day.

How often should you take tadalafil? Tadalafil should not be taken more than once in a 24-hour period. If you miss a dose during this period, take the missed dose as soon as possible. However, never double your dosages. If you miss a dose and you're already due for the next one, skip the missed dose.

Should tadalafil be taken with food? Tadalafil can be taken with or without food and is not affected by the type of food you take with it.

How it works

Tadalafil belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Tadalafil may help relax the muscle in your prostate and bladder. This could help improve your BPH symptoms.

To improve ED symptoms, tadalafil helps increase blood flow to the penis. This can help you get and keep an erection. For tadalafil to help you have an erection, you need to be sexually aroused.

For PAH, tadalafil works to improve your ability to exercise by relaxing blood vessels in your lungs. This increases blood flow.

Important warnings

• Heart disease warning. You shouldn't use tadalafil if you have a heart condition and your doctor has advised against sexual activity. Call your doctor right away if you have symptoms during sex such as chest pain, dizziness, or nausea. Sexual activity can put an extra strain on your heart. This is especially true if your heart is already weak from a heart attack or heart disease.
• Priapism warning. Priapism is an erection that won't go away. Without treatment, this condition could cause permanent damage to your penis. This damage includes impotence (not being able to have an erection). If you get an erection that lasts more than 4 hours, call your doctor right away.

Tadalafil may interact with other medications

Tadalafil oral tablets can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you're taking. To find out how this drug might interact with something else you're taking, talk with your doctor or pharmacist.

Examples of drugs that can cause interactions with tadalafil are listed below.

Angina drugs (nitrates)

If you take tadalafil with nitrates, your blood pressure could suddenly drop to dangerously low levels. This could make you dizzy or cause you to faint. Examples of nitrates include:

• nitroglycerin
• isosorbide dinitrate
• isosorbide mononitrate
• amyl nitrite
• butyl nitrite

High blood pressure or prostate drugs (alpha-blockers)

If you take tadalafil with certain alpha-blockers, your blood pressure could suddenly drop to low levels that are dangerous. This could make you dizzy or cause you to faint. Examples of these drugs include:

• terazosin
• tamsulosin
• doxazosin
• prazosin
• alfuzosin

Certain HIV drugs

Taking tadalafil with certain HIV drugs could increase tadalafil levels in your blood. This can lead to low blood pressure, dizziness and fainting, and vision problems. In men, it can also lead to priapism. These drugs are protease inhibitors and include ritonavir and lopinavir/ritonavir.

Oral antifungal drugs

Taking certain antifungal drugs with tadalafil may increase levels of tadalafil in your blood. This can lead to low blood pressure, dizziness and fainting, and vision problems. In men, it can also lead to priapism. Examples of these drugs include ketoconazole and itraconazole.

Antibiotics

Taking certain antibiotics with tadalafil may raise the level of tadalafil in your blood. This can lead to low blood pressure, dizziness and fainting, and vision problems. In men, it can also lead to priapism. Examples of these drugs include:

• clarithromycin
• erythromycin
• telithromycin

Other types of antibiotics may lower the level of tadalafil in your blood. This could prevent tadalafil from working well. This includes drugs such as rifampin.

Other erectile dysfunction (ED) drugs

These medications work in the same way as tadalafil. If you take them with tadalafil, it increases your risk for side effects. Examples of these drugs include sildenafil and vardenafil.

Other pulmonary arterial hypertension (PAH) drugs

If you take tadalafil with other types of PAH drugs, your blood pressure could suddenly drop to dangerously low levels. The drug riociguat is in this drug class.

Stomach acid drugs

Taking these medications with tadalafil may keep your body from absorbing tadalafil well. An example of this type of drug is magnesium hydroxide/aluminum hydroxide.

Epilepsy drugs

Taking certain anti-seizure drugs with tadalafil may lower the level of tadalafil in your blood. This could prevent tadalafil from working well. Examples of these drugs include:

• carbamazepine
• phenytoin
• phenobarbital

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you're taking.

Tadalafil warnings

This drug comes with several warnings.

Allergy warning

Tadalafil can cause a severe allergic reaction. Symptoms can include:

• rash
• hives
• trouble breathing or swallowing
• swelling of your lips, throat, or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don't take this drug again if you've ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Grapefruit interaction warning

Eating grapefruit or drinking grapefruit juice may increase the levels of tadalafil in your blood. This raises your risk for side effects.

Alcohol interaction warning

Don't drink large amounts of alcohol when taking tadalafil. Both alcohol and tadalafil can dilate (widen) your blood vessels. When used together, they can cause your blood pressure to drop.

Warnings for people with certain health conditions

For people with heart disease: Sexual activity creates a risk for your heart. Using tadalafil may increase that risk. Don't use tadalafil if you have a heart condition and your doctor has advised against sexual activity.

For people at risk for prolonged erections: Tadalafil may cause priapism. This condition causes a painful, long-lasting erection. It is a medical emergency. Talk with your doctor before using tadalafil if you have a condition that puts you at higher risk for priapism. These conditions include blood cell conditions such as sickle cell anemia, multiple myeloma, or leukemia Peyronie's disease (a curved or deformed penis).

For people with vision problems: Retinitis pigmentosa is a rare genetic eye disease. Tadalafil hasn't been studied in people with this condition, and its use isn't recommended. Tell your doctor if you've ever had severe vision loss, including a condition called NAION (non-arteritic anterior ischemic optic neuropathy). If you've had NAION and take tadalafil, you may be at increased risk for having NAION again.

For people with kidney disease or on dialysis: Your body may not be able to get rid of tadalafil correctly. This means the drug would stay in your body longer and raise your risk for side effects. Your doctor may start you on a lower dosage, have you take it less often, or not prescribe it at all.

For people with liver problems: Your body may not process tadalafil correctly. This means the drug would stay in your body longer and raise your risk for side effects. Your doctor may start you on a lower dosage, have you take it less often, or not prescribe it at all.

For people with bleeding disorders or peptic ulcers: Tadalafil hasn't been studied in people with these conditions. Using tadalafil may cause or worsen bleeding or ulcers. If you take tadalafil, your doctor may monitor you more closely.

Warnings for other groups

For pregnant women: Studies of this drug in pregnant animals haven't shown risk to the fetus. However, there aren't enough studies done in pregnant women using the drug for PAH to show whether the drug poses a risk to a human fetus.

Talk with your doctor if you're pregnant or planning to become pregnant. Animal studies don't always predict the way humans would respond. Therefore, this drug should only be used in pregnancy if clearly needed.

For women who are breastfeeding: It isn't known if tadalafil passes into breast milk. If it does, it may cause serious effects in a child who is breastfed. Talk with your doctor if you're taking tadalafil and you want to breastfeed.

For seniors: If you are age 65 years or older, your body may process this drug more slowly. Your doctor may start you on a lower dosage so that tadalafil doesn't build up too much in your body. High levels of the drug in your body can be dangerous.

For children: Children younger than 18 years old shouldn't use tadalafil. It's not known if tadalafil is safe and effective in children.

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How to take tadalafil

All possible dosages may not be included here. Your doctor will tell you what dosage is right for you. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Dosage for benign prostatic hyperplasia (BPH)

Generic: Tadalafil

• Form: oral tablet
• Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Brand: Cialis

• Form: oral tablet
• Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Adult dosage (ages 18'64 years)

• Typical dosage: One 5-mg tablet per day.
• When to take your dose: Take it at about the same time each day. Don't take tadalafil more than once per day.
• When using with other drugs: If you're taking tadalafil with finasteride (another drug used to treat BPH), your tadalafil dosage will be 5 mg once daily for up to 26 weeks.

Child dosage (ages 0'17 years)

This medication hasn't been studied in children. It shouldn't be used in children under age 18 years.

Senior dosage (ages 65 years and older)

Your body processes this drug more slowly. Your doctor may start you on a lowered dosage to keep the drug from building up too much in your body. Too much of the drug in your body can be dangerous.

Dosage for erectile dysfunction (ED)

Generic: Tadalafil

• Form: oral tablet
• Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Brand: Cialis

• Form: oral tablet
• Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Adult dosage (ages 18'64 years)

Tadalafil can be used either as needed or taken once a day. Don't take tadalafil more than once per day.

For as-needed use:

• Typical starting dosage: 10 mg.
• Dosage increases: Your doctor may increase your dose to 20 mg or decrease it to 5 mg. This depends on how tadalafil is working for you and how well your body reacts to it.
• When to take your dose: Take one tadalafil tablet before you expect to have sexual activity. You may have sexual activity 30 minutes after taking tadalafil and up to 36 hours afterward.

For once-daily use:

• Typical starting dosage: 2.5 mg per day.
• Dosage increases: Your doctor may increase your dose to 5 mg per day, depending on how well tadalafil is working for you and how well your body reacts to it.
• When to take your dose: Take one tadalafil tablet every day. Take it at about the same time each day. You may try to have sexual activity at any time between doses.

Child dosage (ages 0'17 years)

This medication hasn't been studied in children. It shouldn't be used in children under age 18 years.

Senior dosage (ages 65 years and older)

Your body processes this drug more slowly. Your doctor may start you on a lowered dosage to keep the drug from building up too much in your body. Too much of the drug in your body can be dangerous.

Dosage for erectile dysfunction and benign prostatic hyperplasia (ED/BPH)

Generic: Tadalafil

• Form: oral tablet
• Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Brand: Cialis

• Form: oral tablet
• Strengths: 2.5 mg, 5 mg, 10 mg, and 20 mg

Adult dosage (ages 18'64 years)

• Typical dosage: One 5-mg tablet every day.
• When to take your dose: Take this drug at about the same time each day. Don't take tadalafil more than once per day. You may try to have sexual activity at any time between doses. You need to be sexually aroused for tadalafil to help you have an erection.

Child dosage (ages 0'17 years)

This medication hasn't been studied in children. It shouldn't be used in children under age 18 years.

Senior dosage (ages 65 years and older)

Your body processes this drug more slowly. Your doctor may start you on a lowered dosage to keep the drug from building up too much in your body. Too much of the drug in your body can be dangerous.

Dosage for pulmonary arterial hypertension (PAH)

Brand: Adcirca

• Form: oral tablet
• Strengths: 20 mg

Adult dosage (ages 18'64 years)

• Typical starting dosage: 40 mg (taken as two 20-mg tablets) once per day.
• When to take your dose: Take this dose at about the same time each day.

Child dosage (ages 0'17 years)

This medication hasn't been studied in children. It shouldn't be used in children under age 18 years.

Senior dosage (ages 65 years and older)

Your body processes this drug more slowly. Your doctor may start you on a lowered dosage to keep the drug from building up too much in your body. Too much of the drug in your body can be dangerous.

Special dosage considerations

• For people with kidney disease: Your body gets rid of tadalafil partly through your kidneys. If your kidneys aren't working well, more of the drug may stay in your body longer. This raises your risk for side effects. Your doctor may decide to lower your dosage, have you take it less often, or not prescribe it at all for you. This depends on how severe your kidney disease is and whether you are on dialysis.
• For people with liver disease: Tadalafil is processed by your liver. If your liver isn't working well, more of the drug may stay in your body longer. This raises your risk for side effects. Your doctor may decide to lower your dosage of tadalafil, have you take it less often, or not prescribe it at all for you. This depends on how severe your liver disease is.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Tadalafil oral tablet is used for long-term treatment. It comes with risks if you don't take it as prescribed.

If you stop or don't take it on schedule: If you're being treated for BPH, your BPH symptoms may not improve. These may include trouble starting to urinate, straining while trying to urinate, and a weak urine flow. They may also include frequent urges to urinate.

If you're being treated for ED, you may not be able to get and keep an erection during sexual activity.

If you're being treated for PAH, it won't help you feel better. It won't decrease your symptoms, such as shortness of breath during physical activity.

If you take too much: You will be at an increased risk for side effects.

If you think you've taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222- or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take it when you remember, but don't take more than one dose per day. Never try to catch up by taking two doses at once. This could cause dangerous side effects.

How to tell if the drug is working: Your symptoms of BPH, ED, or PAH should improve.

Important considerations for taking tadalafil

Keep these considerations in mind if your doctor prescribes tadalafil for you.

General

• If your doctor told you to take tadalafil once daily, you should take it every day at about the same time.
• Don't cut your tadalafil tablets. You should take the entire dose.

Storage

• Store tadalafil at room temperature between 59°F and 86°F (15°C and 30°C).
• Keep this drug away from high temperatures.
• Don't store this medication in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don't worry about airport X-ray machines. They can't harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don't put this medication in your car's glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Before prescribing tadalafil, your doctor may do blood tests. These tests will check how well your liver and kidneys are working. If your test results aren't normal or if you have liver or kidney disease, your doctor may change your prescription. Your doctor may start you on a lower dosage of tadalafil, have you take it less often, or not prescribe it at all for you.

If you're taking tadalafil for BPH, your doctor may perform an exam and do a blood test called a prostate-specific antigen (PSA). This is because the symptoms of BPH and prostate cancer can be similar. These tests will help make sure you don't have prostate cancer before you start taking tadalafil.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Frequently asked questions about tadalafil

How long does tadalafil last? Tadalafil can last within the body for 36 hours, so it's important to avoid taking more than one tablet in a 24-hour time frame. It's also important to note that in order to see the effects of the tablet for ED, you must be sexually aroused.

Does tadalafil lower blood pressure? Tadalafil works by opening up blood vessels in the body, which makes it easier for blood to flow. For this reason, the drug may help lower blood pressure.

Is tadalafil stronger than Viagra? Tadalafil and Viagra both work to treat erectile dysfunction, and the main difference between the two is how long tadalafil lasts in comparison to tadalafil. Tadalafil can last for up to 36 hours in the body, while Viagra can last up to 5 hours.

Are there any alternatives?

There are other drugs available to treat your condition. Some may better suit you than others. Talk with your doctor about other options that may work for you.

Tadalafil vs. sildenafil

Tadalafil and sildenafil are very alike in terms of the conditions they treat. Both drugs can treat ED and PAH; however, tadalafil can also treat BPH.

Tadalafil also lasts longer in the body than sildenafil. Sildenafil typically lasts between 2 and 5 hours, while tadalafil can last up to 36 hours. The downside to the longer-lasting effects of tadalafil can also mean that side effects of the drug can also last longer.

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Comparing Tadalafil (Generic Cialis) and Sildenafil (Generic Viagra)

When patients come to us looking for relief from their erectile dysfunction, they are faced with a preliminary decision of which medication, tadalafil or sildenafil, is better. Back in the day, when these medications were still on patent AND named Cialis and Viagra, respectively, they were very costly. These were the days of fighting with and often losing to insurance companies. Now that generics are available, so many more people can take advantage of these great, highly effective drugs. We often suggest that patients taking ED medications for the first time try both separately to see which works best for them with the fewest side effects. Ultimately, with prices as low as they are, there's little financial risk in seeing which is best for our patient's unique circumstances.

Comparing the Mechanism of Action

Regarding how sildenafil and tadalafil work, they are very similar in that they are both PDE-5 inhibitors. This means they slow or stop the action of the phosphodiesterase type five enzyme in the body. This mechanism increases blood flow to the penis when a man is aroused. It's worth noting, however, that these medications do not increase sexual desire. Instead, they allow the penis to better fill with blood and achieve a satisfactory erection. With both of these drugs, however, patients must realize that they do not have 100% success and that the success rate has a lot to do with the severity of ed. Also, patients must understand that it is normal to have to increase one's dose as the problem of ed progresses and that nearly all patients that had initial success with ed pills will eventually lose that degree of success and may need other help.

Comparing Which Works Faster

Both drugs take approximately 30 to 60 minutes to begin working and allow patients to achieve the erection they expect. Peak concentration in the blood is reached after two hours for tadalafil and about one hour for sildenafil. As such, we always suggest taking medication about an hour or two before sexual activity. The time it takes for the drug to function will vary between patients, so use prior experience as a guide.

Of note, sildenafil, a generic Viagra, can be somewhat inhibited after eating a large meal containing fatty foods, and this is not a concern with tadalafil (generic Cialis). We often suggest sildenafil for married couples or long-term partners with a more predictable sex life. Cialis may be more appropriate for patients who are dating, as the big meals often associated with early dating can cause sildenafil to be less effective.

Comparing Which Lasts Longer

Regarding which medication allows an erection to last longer, the clear winner is tadalafil. Sildenafil remains effective for four to six hours, while tadalafil will enable patients to achieve erections up to 36 hours after ingestion, an effect usually seen in younger patients or lesser degrees of ED. In both cases, the drug does not increase desire, instead allowing for a better erection when the desire is present.

Comparing Side Effects

As with any medication, side effects are associated with both sildenafil and tadalafil. Generally, however, both drugs are well tolerated and have few severe side effects.

Patients taking sildenafil may experience headaches, nausea, flushing, stuffy nose, and on occasion, indigestion, or dizziness. Patients may also develop a blue hue to their vision. Most of these side effects are transient and will disappear after stopping the drug. Loss of vision is a potentially severe side effect of sildenafil in certain very rare clinical situations, and you should stop the drug and get medical help immediately if this occurs, as this can, in very rare cases, lead to permanent blindness. Patients with certain eye problems, cardiovascular and metabolic diseases (high cholesterol, high blood pressure, and type 2 diabetes), and smokers may be at higher risk.

Patients taking tadalafil have a slightly different side effect profile. Like sildenafil, tadalafil can cause headaches, indigestion, and nasal congestion. However, tadalafil can also cause unique symptoms like back pain, cough, and upper respiratory tract infections.

Interestingly, while both drugs have side effects, recent studies have shown that they may reduce the risk of early death from heart disease by up to 25%. This does not make them a treatment for heart disease, nor does it replace any therapies you may currently be taking for cardiovascular issues.

Both drugs have a relatively mild risk profile. It is worth noting that any side effects experienced from tadalafil will typically last longer because the drug remains in the bloodstream significantly longer than sildenafil.

Comparing Drug Interactions

If you've been prescribed ED medication in the past, or if you are looking for a prescription now, you will undoubtedly be asked whether you take nitrates. Nitrates like nitroglycerin can cause a sudden drop in blood pressure and even lead to heart attack or stroke. Patients on nitroglycerin typically have serious cardiovascular issues that make taking ED medication risky in the first place. Patients taking recreational 'poppers,' including amyl nitrate, amyl nitrite, and butyl nitrate, should not take ED medication. Speak to your doctor or pharmacist about other drug interactions to ensure safety when taking your ED meds.

Does Either Medication Reverse ED?

Dr. Engel likes to analogize erectile dysfunction to a roller coaster. Typically, there is a slow movement toward ED. However, once erectile dysfunction begins interfering with sexual activity, it is a downward slope that generally cannot be reversed. Erectile dysfunction medications help improve blood flow to the penis at least transiently. However, the underlying vascular issues associated with ED typically worsen with age, and there's simply nothing we can do about it. As such, eventually, these drugs will no longer offer satisfying erections, at which point we need to consider further treatments, including injections or penile prostheses (implants).

Which Makes You Harder?

While both drugs offer about the same quality of erection, slightly more men achieved a satisfactory erection with sildenafil, according to a study.¹ However, as mentioned above, tadalafil remains in the bloodstream longer and, in the same study, was preferred by more men, probably for that reason.

The Bottom Line

With generic prices as low as they are, Dr. Engel believes that there is no single erectile dysfunction drug that should be prescribed to every patient. As mentioned above, each drug has its unique benefit and risk profile, which should be discussed during your consultation. With prices as they are, most patients can safely order both sildenafil and tadalafil to see which works best for them. Of course, if you experience any side effects with either drug, stop and switch to the other medication. If the side effects are severe or long-lasting, seek prompt medical attention.

Reference:

1Doggrell SA. Comparison of clinical trials with sildenafil, vardenafil, and tadalafil in erectile dysfunction. Expert Opin Pharmacother. Jan;6(1):75-84. doi: 10./.6.1.75. PMID: .

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