The Side Effects Of Tadalafil: What You Need To Know

Looking to start an erectile dysfunction treatment? It’s important to know which is right for you, and about any side effects you may be likely to experience before you start your treatment. We spoke to our experts at ZipHealth about one of our top erectile dysfunction medications, tadalafil, to learn everything there is to know about side effects and your suitability for treatment.

What is Tadalafil (Cialis)?

Tadalafil is a popular medication for erectile dysfunction (ED). Marketed under various brand names, including Cialis, tadalafil is known for its affordability and longer lasting effects in comparison to sildenafil (Viagra).

How does tadalafil work?

Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor*, a type of medication that’s primarily used to treat erectile dysfunction. It works by relaxing the muscles and increasing blood flow to the penis, helping men achieve and maintain an erection.

It’s important to note that tadalafil is only for people experiencing erectile dysfunction, and also won’t work without sexual stimulation. You and your partner will need to engage in usual sexual activity, just as you would if you were not taking medicine for erectile dysfunction.

What are the possible side effects of tadalafil?

Like all medications, tadalafil can cause side effects, but not everybody gets them. These side effects are normally mild and temporary. Let’s take a look.

Common Side Effects

Headaches, congestion and muscle pain

Headaches and nasal congestion (stuffy nose) are frequent side effects, likely due to the increased blood flow and vasodilation effects of the medication. Muscle pain, including back pain and pain in the limbs, may also occur, usually fading within 48 hours.

Digestive Issues: Nausea and Diarrhea

Some people taking tadalafil may experience an upset stomach, such as nausea and diarrhea. These symptoms tend to subside as the body adjusts to the medication.

Flushing and skin reactions

Flushing, or redness of the face and neck, is another common side effect of PDE5 inhibitors. This occurs due to the dilation of blood vessels near the skin. In some cases, users might also experience mild skin reactions, such as rashes.

Serious Side Effects

Though rare, tadalafil can cause serious side effects that require immediate medical attention or permanent damage. These include:

• Priapism: An erection lasting more than four hours. This condition can cause permanent damage to the penis if not treated promptly.
• Sudden vision loss: A rare but serious condition known as non-arteritic anterior ischemic optic neuropathy (NAION), which can lead to sudden vision loss.
• Hearing loss: Sudden decrease or loss of hearing, sometimes accompanied by ringing in the ears and dizziness.
• Severe Allergic reactions: Symptoms such as swelling of the face, lips, tongue, or throat, and difficulty breathing indicate a severe allergic reaction.

If you experience any of the following side effects, stop using the medicine and seek urgent medical attention:

• Allergic reactions, including rashes.
• Chest pain 
• Sudden loss of vision, distorted, dimmed, blurred central vision, or sudden decrease of vision.
• Priapism, which is a prolonged and possibly painful erection. If you have an erection like this, which lasts continuously for more than 4 hours, you should seek medical attention immediately.

Other side effects have been reported:

Uncommon (seen in 1 to 10 in every 1,000 people):

• Dizziness, stomach pain, feeling sick, being sick (vomiting), reflux, blurred vision, eye pain, difficulty in breathing, presence of blood in urine, prolonged erection, pounding heartbeat sensation, a fast heart rate, high blood pressure, low blood pressure, nose bleeds, ringing in the ears, swelling of the hands, feet, or ankles, and feeling tired.

Rare (seen in 1 to 10 in every 10,000 people):

• Fainting, seizures and passing memory loss, swelling of the eyelids, red eyes, sudden decrease or loss of hearing, hives (itchy red welts on the surface of the skin), penile bleeding, presence of blood in semen, and increased sweating.

Heart attack and stroke have also been reported rarely in men taking tadalafil. Most of these men had known heart problems before taking this medicine. Partial, temporary, or permanent decrease or loss of vision in one or both eyes has been rarely reported. 

Reporting side effects

If you notice any side effects after taking tadalafil, talk to your prescriber or doctor. This includes any possible side effects not listed in your patient information leaflet.

If you experience a sudden decrease or loss of vision, or your vision is distorted or dimmed while taking tadalafil, stop taking it and contact your doctor immediately. Decreased or sudden hearing loss has been noted in some people. Although it’s not known if this is directly related to tadalafil, if you experience decreased or sudden hearing loss, stop taking the medication and contact your doctor immediately.

What you need to know before taking tadalafil

Do not take tadalafil if you:

• Are allergic to tadalafil or any of the other ingredients of this medicine.
• Are taking any form of organic nitrate or nitric oxide donors such as amyl nitrite. This is a group of medicines (“nitrates”) used in the treatment of angina pectoris (“chest pain”). Tadalafil has been shown to increase the effects of these medicines. If you’re taking any form of nitrate or are unsure, tell your doctor.
• Have serious heart disease or recently had a heart attack within the last 90 days.
• Recently had a stroke within the last 6 months.
• Have low blood pressure or uncontrolled high blood pressure.
• Ever had a loss of vision because of non-arteritic anterior ischemic optic neuropathy (NAION), a condition described as “stroke of the eye”.
• Are taking riociguat. This drug is used to treat pulmonary arterial hypertension (i.e., high blood pressure in the lungs) and chronic thromboembolic pulmonary hypertension (i.e., high blood pressure in the lungs secondary to blood clots). PDE5 inhibitors, such as tadalafil, have been shown to increase the hypotensive effects of this medicine. If you’re taking riociguat or are unsure, tell your doctor.

Warnings and precautions for tadalafil

Be aware that, because sexual activity puts an extra strain on your heart, it carries a possible risk to people with heart disease. If you have a heart problem, speak to your doctor before taking an erectile dysfunction treatment.

Tadalafil is also not intended for use by women, or adolescents under the age of 18.

Other medicines and considerations

Some medicines may be affected by tadalafil, or they may affect how well it works. Tell your prescriber or pharmacist if you’re already taking:

• An alpha-blocker (used to treat high blood pressure or urinary symptoms associated with benign prostatic hyperplasia).
• Other medicines to treat high blood pressure.
• Riociguat.
• A 5-alpha reductase inhibitor (used to treat benign prostatic hyperplasia).
• Medicines such as ketoconazole tablets (to treat fungal infections) and protease inhibitors for treatment of AIDS or HIV infection.
• Phenobarbital, phenytoin, and carbamazepine (anticonvulsant medicines).
• Rifampicin, erythromycin, clarithromycin, or itraconazole.
• Other treatments for erectile dysfunction.

How to take tadalafil tablets

Always take this medicine exactly as your prescriber has told you — this will typically be with water, and your tablet can be taken with or without food.

The recommended starting dose of tadalafil is one 10 mg tablet before sexual activity. If the effect of this dose is too weak, your prescriber may increase your dose of tadalafil to 20 mg.You can take a tadalafil tablet at least 30 minutes before sexual activity, and it may still be effective up to 36 hours after taking the tablet. Don't take tadalafil more than once a day. 

It’s important to note that PDE5 inhibitors like tadalafil won't work without sexual stimulation. Drinking alcohol may affect your ability to get an erection and may temporarily lower your blood pressure. If you have taken or are planning to take tadalafil, avoid excessive drinking (blood alcohol level of 0.08% or greater), since this may increase the risk of dizziness when standing up. Grapefruit juice may also affect how well tadalafil will work and should be taken with caution.

Is tadalafil right for me?

If you’re looking to start an erectile dysfunction treatment like tadalafil, head to ZipHealth to start a fast, free online consultation with our licensed healthcare professionals now.

References

1. Cialis 10mg film-coated tablets - Patient Information Leaflet (PIL) - (emc) [Internet]. www.medicines.org.uk. Available from: https://www.medicines.org.uk/emc/product/7431/pil#about-medicine