Cialis (tadalafil)

How long does Cialis last?

Cialis can work for up to 36 hours in your body.

To treat erectile dysfunction (ED), your doctor may have you take Cialis only as needed before sexual activity. (See the “Cialis dosage” section below to learn more.) In this case, Cialis may keep working for up to 36 hours in helping you have and maintain erections during that time.

However, if you take Cialis each day for either benign prostatic hyperplasia (BPH) or ED, you’ll consistently have medication in your system. Therefore, it will continue to work throughout the day.

Cialis vs. Viagra

You may wonder how Cialis compares with other medications that are prescribed for similar uses. Here we look at how Cialis and Viagra are alike and different.

Note: Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

Ingredients

The active ingredient in Cialis is tadalafil. The active ingredient in Viagra is sildenafil. Both Cialis and Viagra belong to a group of medications called phosphodiesterase 5 (PDE5) inhibitors.

Uses

The FDA has approved Cialis and Viagra to treat erectile dysfunction (ED) in males. ED is a condition in which you can’t get or maintain an erection.

Cialis is also FDA-approved to treat:

• symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination
• ED and symptoms of BPH together

Drug forms and administration

Both Cialis and Viagra come as tablets that you swallow. Cialis may be taken once a day or just when needed for sexual activity. Usually, Viagra is taken only as needed for sexual activity.

Side effects and risks

Cialis and Viagra both contain medications to treat ED. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Cialis, with Viagra, or with both drugs (when taken individually).

• Can occur with Cialis:
  • pain in your arms or legs
  • heartburn
• Can occur with Viagra:
  • abnormal vision
• Can occur with both Cialis and Viagra:
  • headache
  • flushing
  • stuffy nose
  • back pain
  • muscle pain
  • nausea
  • dizziness
  • rash

Serious side effects

This list contains examples of serious side effects that can occur with Cialis and Viagra when taken individually.

• prolonged erection (an erection that lasts more than 4 hours)
• loss of vision
• changes in hearing, such as trouble hearing or ringing in your ears
• allergic reaction
• changes in blood pressure

Effectiveness

Cialis and Viagra have different FDA-approved uses, but they’re both used to treat ED.

The use of Cialis and Viagra in treating ED has been directly compared in clinical studies.

One study’s results

One study compared people who took Cialis either once a day or as needed with people who took Viagra as needed.

• The study showed that people in the Cialis group had more improvement in their sexual confidence than those in the Viagra group.
• The Cialis group was also less concerned about how long their erection lasted than the Viagra group. This is because Cialis works longer than Viagra.

Results from a second study

In another ED study, people took either Cialis as needed or Viagra as needed for 4 weeks. They then switched to the other medication for an additional 4 weeks. Finally, people decided which drug they preferred.

Researchers found that more than twice as many people preferred Cialis over Viagra. Most often, people reported that they preferred Cialis because the medication lasts longer in the body.

The study also looked at how well the drugs worked to treat ED, based on the International Index of Erectile Function (IIEF) survey. A higher IIEF score meant that erectile function was better, so ED symptoms improved.

IIEF scores increased by about the same amount (on average) in people who took Cialis or Viagra. Average scores for self-esteem and relationship quality were also about equal in the two groups.

Costs

Cialis and Viagra are both brand-name drugs. Currently, there are generic forms of both drugs. The generic form of Cialis is called tadalafil. The generic form of Viagra is called sildenafil. Brand-name medications usually cost more than generics.

The actual price you’ll pay for any of these drugs depends on your insurance plan, your location, and the pharmacy you use.

Visit Optum Perks to find coupons and savings for Cialis and Viagra.

Cialis uses

The Food and Drug Administration (FDA) approves prescription drugs such as Cialis to treat certain conditions. Cialis may also be prescribed off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is prescribed to treat a different condition.

Note: Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

Cialis for benign prostatic hyperplasia (BPH)

Cialis is approved by the FDA to treat the symptoms of benign prostatic hyperplasia.

BPH is a condition that can occur in males as they age. It happens when the prostate gland slowly increases in size but isn’t cancerous. As the prostate gland gets bigger, it begins to push on your urethra. So eventually you may experience symptoms of BPH, including:

• needing to urinate often, especially at night
• straining to urinate
• producing a weak stream of urine
• being unable to urinate
• feeling that your bladder didn’t empty after urinating

To learn more about BPH, you can refer to our men’s health hub.

Effectiveness

Cialis was an effective medication to treat symptoms of BPH in clinical trials.

Researchers used a scale called the International Prostate Symptom Score (IPSS). IPSS is a questionnaire that was given to people to determine whether their BPH symptoms improved. The symptoms included urinary urgency (sudden need to urinate), weak urine stream, and straining to urinate.

A higher score meant that symptoms of BPH were worse. The goal was to have a lower score, which indicates that people have had fewer and less severe symptoms of BPH.

The studies looked at people with BPH who took Cialis or a placebo (treatment with no active drug). Researchers found that people who took Cialis had more of a decrease in their IPSS score than people who took a placebo. This means that the Cialis group noticed a larger decrease in the number and severity of BPH symptoms than the placebo group.

Cialis for erectile dysfunction (ED)

Cialis is FDA-approved to treat erectile dysfunction.

ED is a condition in which a male may have trouble having or maintaining an erection so they can have sex. There are many different causes of ED, including:

• illness
• conditions that can affect the nerves or blood, such as diabetes or high cholesterol
• emotional factors, such as stress, depression, or anxiety

Sometimes ED can be helped by simply addressing the cause, such as treating an illness or anxiety. In other cases, you may need medication such as Cialis to treat your ED.

To learn more about ED, you can refer to our men’s health hub.

Effectiveness

Cialis was shown in clinical trials to be an effective medication to treat ED. The drug was studied using part of a survey called the International Index of Erectile Function (IIEF). A higher score on the IIEF meant that erectile function was better, so ED symptoms were reduced. The people in the study took the survey after 4 weeks.

One trial looked at people who took Cialis or a placebo only when needed to treat their ED. People who took Cialis had their IIEF scores improve significantly. This means their ED symptoms eased while they were taking Cialis.

People who took a placebo either lost points or had their score improve by less than a point. Losing points on the scale means their ED symptoms worsened.

In another trial, people took Cialis or a placebo on an everyday basis to treat their ED. The study showed that for people who took Cialis, their IIEF scores improved significantly. This means their ED symptoms eased while they were taking Cialis. In comparison, people who took a placebo had their scores improve by a much lower amount.

Cialis for ED and BPH

Cialis is FDA-approved to treat both ED and the symptoms of BPH together. These are two different conditions and aren’t usually caused by the same issues. For details on ED and BPH, see the “Cialis for benign prostatic hyperplasia (BPH)” and “Cialis for erectile dysfunction (ED)” sections above.

In some cases, medications for BPH, such as dutasteride (Avodart), may cause a lower libido (sex drive) and result in ED. However, ED and BPH are common in aging males, and aren’t necessarily related.

Effectiveness

Cialis was an effective medication in clinical trials for people with both ED and BPH. The studies used two different questionnaires, one for ED symptoms and one for BPH symptoms, to determine how well the medication worked.

Measuring results for BPH symptoms

To measure improvement of BPH, researchers used a scale called the International Prostate Symptom Score (IPSS). IPSS is a questionnaire that was given to people to determine whether their BPH symptoms improved. The symptoms included urinary urgency (sudden need to urinate), weak urine stream, and straining to urinate.

A higher score meant that symptoms of BPH were worse. The goal was to have a lower score, which indicates that people have had fewer and less severe symptoms of BPH.

Researchers found that people with ED and BPH who took Cialis reported a more significant decrease in their IPSS scores than people who took a placebo. This means that, on average, people who took Cialis noticed a larger decrease in their BPH symptoms than people who took a placebo.

Measuring results for ED

To measure the improvement of ED symptoms, researchers used part of a survey called the International Index of Erectile Function (IIEF). People with both ED and BPH took the survey after 4 weeks. A higher score on the IIEF meant that erectile function was better, so ED symptoms improved.

Researchers found that people who took Cialis had a more significant increase in their IIEF scores (on average) than people who took a placebo. This means that people who took Cialis usually had greater erectile function than people who took a placebo.

Off-label use for Cialis

In addition to the uses listed above, Cialis may be prescribed off-label for other purposes. Off-label drug use is when a drug that’s approved for one use is prescribed for a different one that’s not approved. Below is an example of an off-label use for Cialis.

Cialis for ureteral stones

Cialis isn’t FDA-approved to treat ureteral stones (a type of kidney stone). However, it may be prescribed off-label for this purpose. A clinical trial compared Cialis with tamsulosin (Flomax), a drug that’s often used to treat ureteral stones. The study showed that more people who took Cialis were able to pass their stones than people who took tamsulosin.

Ureteral stones usually start out as kidney stones and then move into the ureter (the tube that urine travels in from the kidney to the bladder). Kidney stones are minerals that form a stone inside a kidney.

Cialis may work to treat ureteral stones by relaxing the ureter muscles. This makes the ureter wider, which can help you pass the stones more easily.

If you have questions about taking Cialis for ureteral stones, talk with your doctor.

Cialis generic

Cialis is available as a generic drug called tadalafil. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

In some cases, the brand-name drug and the generic version may come in different forms and strengths.

Cialis dosage

The Cialis dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re taking Cialis to treat
• your age
• other medical conditions you may have
• how often you’re taking Cialis

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

If you have certain conditions, such as kidney or liver problems, your doctor may have you start with a low dose of Cialis. This is done so that the medication doesn’t affect your other conditions.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

In addition to the information below, you can see this comprehensive article about the dosages of Cialis.

Drug forms and strengths: 2.5 mg, 5 mg, 10 mg, 20 mg

Cialis comes as an oral tablet. It’s available in four strengths: 2.5 milligrams (mg), 5 mg, 10 mg, and 20 mg.

Dosage for benign prostatic hyperplasia (BPH)

For symptoms of BPH, the recommended dosage of Cialis is 5 mg once a day. You should take the drug at about the same time each day.

In some cases, your doctor may have you take 5 mg of Cialis a day along with finasteride (Proscar) to treat BPH. (See the “Cialis use with other drugs” section below to learn more.) If you take both Cialis and finasteride, you’ll usually take these two drugs for up to 26 weeks.

Dosage for erectile dysfunction (ED)

Here’s some information on the Cialis dosages for ED.

Cialis taken as needed

If your doctor recommends that you take Cialis only as needed for ED, the usual dosage is 10 mg before sexual activity.

Your doctor may reduce this to 5 mg if the medication is working too well. But if this dose doesn’t work for you, your doctor may increase your dose back to 10 mg.

If the 10-mg dose of Cialis isn’t working well enough, your doctor may increase it to 20 mg. The maximum dose of Cialis that can be taken in a day is 20 mg.

You should not take Cialis more than once a day. In clinical trials, Cialis helped with ED symptoms for up to 36 hours after their dose. So if you’re taking the medication only as needed, you shouldn’t have to take it every day.

Note: It’s very important that you take only the amount of Cialis that your doctor instructs you to take. And be sure to speak with them if you feel you need more of the drug, rather than increasing your dosage yourself.

Cialis taken once a day

Cialis can also be taken once a day to treat ED. In this case, the dosage usually starts at 2.5 mg a day. If this daily dosage doesn’t work well enough to treat your ED, your doctor may increase it to 5 mg a day.

And if your doctor recommends using Cialis every day, you should take the drug at about the same time each day. You don’t need to take Cialis before sexual activity unless your doctor says you should take the drug only as needed. (See the “Cialis taken as needed” section right above to learn more.)

Note: It’s very important that you take only the amount of Cialis that your doctor instructs you to take. And be sure to speak with them if you feel you need more of the drug, rather than increasing your dosage yourself.

Dosage for ED and BPH

To treat both ED and symptoms of BPH together, the typical dose of Cialis is 5 mg, once a day. You should try to take your dose at about the same time each day.

Higher dosages of Cialis

The approved dosages of Cialis for ED, BPH symptoms, or both, are between 2.5 mg and 20 mg a day or as needed. Dosages higher than 20 mg a day haven’t been studied, and it’s not known what side effects may occur with them.

For example, if you take your “as-needed” dose of 20 mg twice a day, you’ll end up taking 40 mg. This dose is too high and may cause serious side effects, such as decreased blood pressure.

Note: It’s very important that you take only the amount of Cialis that your doctor instructs you to take. And be sure to speak with them if you feel you need more of the drug, rather than increasing your dosage yourself.

What if I miss a dose?

If you forget to take your once-a-day dose of Cialis, take it as soon as you remember. However, never take two doses in 1 day. If you missed your dose yesterday, just skip the missed dose and continue with your once-a-day dosing.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to take this drug long term?

If you’re taking Cialis to treat BPH, this medication may be a long-term treatment. Cialis may also be taken to treat ED long term.

But in some cases, your doctor may determine the cause of your ED, such as depression or an illness. In such instances, you may be able to stop taking Cialis after the cause of your ED has been treated.

Cialis side effects

Cialis can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Cialis. These lists don’t include all possible side effects.

For more information on the possible side effects of Cialis, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Cialis, you can do so through MedWatch.

Mild side effects

Mild side effects of Cialis can include:*

• headache
• heartburn
• back pain
• muscle pain
• stuffy nose
• flushing
• pain in your arms or legs

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Cialis. To learn about other mild side effects, talk with your doctor or pharmacist, or see Cialis’s prescribing information.

Serious side effects

Serious side effects from Cialis aren’t common, but they can occur. 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.

Changes in hearing can be a serious side effect of Cialis. Symptoms can include:

• trouble hearing
• hearing loss
• ringing in your ears
• dizziness
• loss of vision

Other serious side effects, explained in more detail below in “Side effect details,” include:

• allergic reaction
• changes in blood pressure
• prolonged erection (an erection that lasts more than 4 hours)

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause. However, you can also see this article for details about the potential side effects of Cialis.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Cialis. Allergic reactions did occur in clinical trials of Cialis, but it wasn’t reported how many people had them.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. This may include skin conditions such as Stevens-Johnson syndrome (a life threatening rash). Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing
• severe rash, which may cause painful blisters

Call your doctor right away if you have a severe allergic reaction to Cialis. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Headache

Headache is a common side effect that may occur with Cialis.

If you have headaches that are bothersome to you while using Cialis, talk with your doctor. They may be able to recommend ways to help ease this side effect.

Changes in blood pressure

Changes in blood pressure are a possible side effect of taking Cialis. Low blood pressure occurs most often while taking this medication. But high blood pressure can occur as well.

Low blood pressure

A decrease in blood pressure may be more likely if you’re taking Cialis along with other medications that can also lower blood pressure.

Symptoms of low blood pressure can include:

• dizziness
• blurry vision
• fainting

If you have these symptoms while taking Cialis, tell your doctor right away. They’ll help determine what’s causing the low blood pressure and the best way to treat it.

High blood pressure

Although rare, Cialis may also increase your blood pressure. This side effect was reported only in people who took Cialis once a day for erectile dysfunction (ED).

If you have any symptoms of high blood pressure, such as headaches or chest pain, tell your doctor right away. They’ll help determine what’s causing the increase in blood pressure and the best way to treat it.

Back pain

Back pain is a common side effect with Cialis. It usually occurs between 12 and 24 hours after taking Cialis. Usually, back pain goes away within 2 days of taking your dose.

While taking Cialis, if you have back pain that’s bothersome to you or doesn’t go away, talk with your doctor. They may be able to recommend ways to help ease this side effect. Your doctor may also do more testing to see what’s causing your back pain.

Heartburn

Heartburn is a common side effect of Cialis.

If you have heartburn that’s bothersome to you while taking Cialis, talk with your doctor. They may be able to recommend ways to treat this side effect.

Prolonged erection

It’s possible to get a prolonged erection that lasts more than 4 hours while taking Cialis.

This side effect can lead to priapism, which is a painful erection lasting longer than 4 hours. It’s considered an emergency because it can cause permanent damage to your penis, such as being unable to have erections at all.

If you have an erection that lasts longer than 4 hours while using Cialis, see a doctor or go to the hospital right away. The prolonged erection should be treated as soon as possible so that it doesn’t cause lasting damage.

How to avoid Cialis side effects

The best way to take Cialis is to use it exactly as your doctor directs, either once a day at the same time each day or only as needed. You should not take any other medications to treat erectile dysfunction (ED) while you’re using Cialis, unless your doctor says that it’s safe. And you should never take Cialis more than once a day. Taking Cialis more often than prescribed or in high doses can increase your risk of side effects.

If you drink alcohol, it’s important to avoid drinking too much alcohol while you’re taking Cialis. (See the “Cialis and alcohol” section below to learn more.)

In addition, be sure to talk with your doctor or pharmacist about any other medications that you’re taking. They’ll be able to determine whether the drugs may interact with Cialis and whether that may lead to an increased risk of side effects. If you have any questions about the best way to avoid specific side effects from Cialis, talk with your doctor.

Cialis vs. vardenafil (Levitra)

Like Viagra, the drug vardenafil (Levitra) has uses similar to those of Cialis. Here’s a comparison of how Cialis and vardenafil are alike and different.

Note: Levitra, the brand-name version of the generic drug vardenafil, is discontinued and no longer available.

Ingredients

The active ingredient in Cialis is tadalafil. Vardenafil is a generic drug, which is an exact copy of the active ingredient in a brand-name medication (in this case, Levitra, which is discontinued). Both Cialis and vardenafil belong to a group of medications called phosphodiesterase 5 (PDE5) inhibitors.

Uses

The Food and Drug Administration (FDA) has approved Cialis and vardenafil to treat erectile dysfunction (ED) in males.* ED is a condition in which you can’t get or keep an erection.

Cialis is also FDA-approved to treat the following in males:

• symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination
• ED and symptoms of BPH together

* Sex and gender exist on spectrums. Use of the term “male” in this article refers to sex assigned at birth.

Drug forms and administration

Both Cialis and vardenafil come as tablets that you swallow. Cialis can be taken once a day or as needed for sexual activity. Vardenafil is taken only as needed for sexual activity.

Side effects and risks

Cialis and vardenafil both contain medications used to treat ED. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Cialis, with vardenafil, or with each drug (when taken individually).

• Can occur with Cialis:
  • pain in your arms or legs
• Can occur with vardenafil:
  • sinus infection
  • flu symptoms, such as fever and cold sweats
  • kidney problems, such as an increased level of creatine kinase (a measure of kidney function) in your blood
• Can occur with both Cialis and vardenafil:
  • headache
  • flushing
  • stuffy nose
  • heartburn
  • back pain
  • muscle pain
  • dizziness
  • nausea

Serious side effects

These lists contain examples of serious side effects that can occur with Cialis, with vardenafil, or with both drugs (when taken individually).

• Can occur with Cialis:
  • no unique serious side effects
• Can occur with vardenafil:
  • changes in heart rhythm called long QT syndrome
• Can occur with both Cialis and vardenafil:
  • prolonged erection (an erection that lasts more than 4 hours)
  • allergic reaction
  • loss of vision
  • changes in hearing, such as trouble hearing or ringing in your ears
  • changes in blood pressure

Effectiveness

Cialis and vardenafil have different FDA-approved uses, but they’re both used to treat ED.

Studies have found both Cialis and vardenafil to be effective for treating ED.

Costs

Vardenafil is a generic drug, and Cialis is a brand-name drug. Brand-name medications usually cost more than generics. A generic form of Cialis, called tadalafil, is available.

The actual price you’ll pay for either of these drugs depends on your insurance plan, your location, and the pharmacy you use.

Cialis vs. Adcirca

Here’s a look at how the drugs Cialis and Adcirca compare.

Note: Sex and gender exist on spectrums. Use of the terms “male” and “female” in this article refers to sex assigned at birth.

Uses

Both Cialis and Adcirca have the same active ingredient, tadalafil. However, the Food and Drug Administration (FDA) has approved the drugs to treat different conditions.

Cialis is FDA-approved to treat the following in males:

• erectile dysfunction (ED), a condition in which you can’t get or keep an erection
• symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination
• ED and symptoms of BPH together

Adcirca is approved to treat a type of high blood pressure in your lungs called pulmonary arterial hypertension (PAH). The drug is approved for use in males and females. PAH is a specific kind of pulmonary hypertension that occurs in the arteries of your lungs.

Although these medications are very similar, they can’t be swapped. This means that if you’re taking Cialis for ED or symptoms of BPH, you should not take Adcirca instead. And if you’re taking Adcirca for PAH, you should not take Cialis instead.

Drug forms and administration

Although the active ingredient is the same in both Cialis and Adcirca, the two drugs have different dosages. If you’re taking Cialis, your dosage may be 2.5 mg to 20 mg as needed before sexual activity or once a day. But if you’re taking Adcirca, your dosage is usually 40 mg a day.

How to take Cialis

You should take Cialis according to your doctor’s or healthcare professional’s instructions.

Cialis comes as a tablet that you swallow.

When to take

Your doctor may have you take Cialis once a day or just as needed for sexual activity. If you have questions about how often you can take Cialis if you’re using it as needed, talk with your doctor. Keep in mind that you should never take Cialis more than once a day.

The best time to take Cialis depends on whether you’re taking it once a day or only as needed. If you’re using the medication once a day, be sure to take it at about the same time each day.

If you’re taking Cialis only as needed, you may wonder how long before having sex you should take it. The best time to take an “as-needed” dose is about 2 hours before sex. This is because on average, it takes the drug 2 hours to be at its highest level in your body. So at about 2 hours, you’ll have the best effects from the medication. However, some people may have better erectile function 30 minutes after they take the drug.

To help make sure that you don’t miss a once-a-day dose, try setting a reminder on your phone. A medication timer may be useful, too.

Taking Cialis with food

You can take Cialis with or without food.

Can Cialis be crushed, split, or chewed?

You should not crush, split, or chew Cialis. Swallow the tablet whole. It’s not known if the medication will be as safe and effective if you crush, split, or chew it.

Common questions about Cialis

Here are answers to some frequently asked questions about Cialis.

Can women take Cialis?

No. Cialis isn’t approved for use in females.* However, there are other options to treat low sex drive in females.

Bremelanotide (Vyleesi) is an injectable medication that works on an area of your brain to increase sexual desire. This drug is also known as PT-141. Another medication used to treat low sex drive in females is flibanserin (Addyi).

If you have questions about treating low sex drive, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Does Cialis work and is it safe?

Yes. Before the FDA approves a medication, it must test the drug for safety and effectiveness. Clinical trials show that Cialis is a safe and effective drug to treat erectile dysfunction (ED), benign prostatic hyperplasia (BPH), or both. Cialis is FDA-approved.

However, for some people, Cialis may not be a safe option. This can include people with heart conditions such as an irregular heart rhythm and people who take other medications such as nitrates. (See the “Cialis precautions” section below to learn more.)

Before you start taking Cialis, be sure to tell your doctor about any medical conditions you have and any medications you’re taking. They’ll be able to decide whether Cialis is a safe choice for you. And talk with your doctor if you have any concerns.

Will Cialis help me keep an erection after ejaculating?

No. After ejaculation, you’ll likely lose your erection even if you’re taking Cialis.

After ejaculation occurs, your sexual arousal usually decreases. This means that you’ll likely lose your erection after ejaculation.

However, Cialis can still work up to 36 hours after you take your dose. So the drug may help you get another erection.

How long does Cialis stay in your system?

Cialis can stay in your system for more than 2 days after a dose. If you’re using the medication as needed, the drug may still increase your ability to get and maintain an erection 2 days after your last dose.

Can Cialis be used to treat ED after prostate surgery?

Yes, Cialis can be used to treat ED after prostate surgery.

A clinical trial was done in people with ED who had surgery to have their prostate removed. The people used either Cialis or a placebo (treatment with no active drug) as needed. After 4 weeks, the people took a portion of a survey called the International Index of Erectile Function (IIEF). A higher score on the IIEF meant that erectile function was better, so ED symptoms improved.

The study showed that people who took Cialis after prostate surgery had a significant increase in average IIEF scores. In comparison, people who took a placebo after prostate surgery had a smaller increase in average IIEF scores.

If you have questions about using Cialis to treat ED after prostate surgery, talk with your doctor.

Does Cialis increase the size of a man’s penis?

No. Cialis doesn’t increase the size of a penis. However, the medication does increase blood flow to the area. So if the penis wasn’t able to become fully erect before taking Cialis, it may appear larger after taking Cialis.

Although Cialis doesn’t change the size of the penis, the drug can increase the ability to have an erection.

How Cialis works

Cialis is approved to treat erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both of these conditions.

Erectile dysfunction explained

An erection occurs when blood flows into the penis and remains there for a period of time. This happens because the blood vessels and muscles in the penis relax and open up, allowing more blood to flow into the area.

Cyclic guanosine monophosphate (GMP) is a chemical in your body that relaxes the muscles in the penis and increases blood flow into the penis. With ED, this activity isn’t working properly, so you can’t have or maintain an erection.

What Cialis does for ED

Cialis belongs to a group of medications called phosphodiesterase 5 (PDE5) inhibitors. It works to treat ED by blocking PDE5. When PDE5 is blocked, your body makes more cyclic GMP. And when you have more cyclic GMP, the blood vessels and muscles in your penis relax. This allows more blood to flow in and produce an erection.

Benign prostatic hyperplasia explained

BPH is a condition in which the prostate gland gets larger but isn’t cancerous. BPH may cause problems with urination such as the need to urinate frequently or having to urinate more often at night.

What Cialis does for BPH symptoms

Cialis is approved to treat the symptoms of BPH, but it’s not known exactly how the drug does this. It’s believed that Cialis works by relaxing muscles in your bladder, which allows you to urinate more easily.

How long does it take for Cialis to work?

Clinical trials show that Cialis may work as quickly as 30 minutes after you take your dose. However, in some people, the medication may take up to 6 hours until you notice it working.

On average, it takes about 2 hours for Cialis to peak. This is how long it takes for you to have the highest level of medication in your body. This is when the drug should work the best to treat your ED, symptoms of BPH, or both conditions.

Cialis and alcohol

Both alcohol and Cialis can decrease your blood pressure. So if you drink alcohol while taking this medication, it’s recommended that you don’t drink too much. This may help prevent your blood pressure from becoming too low.

Having five or more drinks (five shots or glasses of wine or beer) along with Cialis can increase the risk of side effects. In addition to decreased blood pressure, these side effects can include:

• increased heart rate
• dizziness
• headache

If you drink alcohol, talk with your doctor about what amount is safe to drink while you’re taking Cialis.

Alternatives to Cialis

Other drugs are available that can treat your erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both. Some medications may be a better fit for you than others. If you’re interested in finding an alternative to Cialis, talk with your doctor. They can tell you about other drugs that may work well for you.

Note: Some of the drugs listed here are prescribed off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is prescribed to treat a different condition.

Alternatives for benign prostatic hyperplasia (BPH)

Examples of other drugs that may be used to treat symptoms of BPH include:

• alfuzosin (Uroxatral)
• doxazosin (Cardura)
• silodosin (Rapaflo)
• tamsulosin (Flomax)
• dutasteride (Avodart)
• finasteride (Proscar)

Alternatives for erectile dysfunction (ED)

Examples of other drugs that may be used to treat ED include:

• sildenafil (Viagra)
• vardenafil
• avanafil (Stendra)

Alternatives for ED and BPH

Cialis is the only medication that the Food and Drug Administration (FDA) has approved to treat both ED and symptoms of BPH together. However, other combinations of drugs may be used for this purpose. Also, other single medications may be used off-label to treat both ED and symptoms of BPH together.

Examples of other drugs that may be used to treat ED and symptoms of BPH together include:

• sildenafil (Viagra)
• vardenafil
• finasteride/sildenafil
• finasteride/vardenafil

Cialis overdose

Taking more than the recommended dosage of Cialis can lead to serious side effects.

Do not take more Cialis than your doctor recommends.

Overdose symptoms

Overdose symptoms are similar to the typical side effects of Cialis. For more about side effects, see the “Cialis side effects” section above.

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Cialis use with other drugs

If you’re taking Cialis, you usually won’t have to take other medications with it.

But if you have a prostate condition called benign prostatic hyperplasia (BPH), your doctor may first prescribe a drug called finasteride (Proscar).

Finasteride is a first-line treatment (the first treatment used) when medications are recommended for BPH. This is because the drug shrinks the prostate by blocking the growth of prostate cells. Cialis treats the symptoms of BPH by reducing the prostate gland muscle tone, but it doesn’t block the growth of the cells.

Finasteride can help also ease symptoms of BPH, such as having to urinate suddenly and more often than usual. However, this medication can cause negative sexual side effects such as decreased libido (sex drive) and erectile dysfunction. To help ease these side effects, your doctor may have you also take Cialis.

If you have questions about using Cialis and finasteride, talk with your doctor.

What can I take to enhance Cialis?

You should not take anything in addition to Cialis to enhance the drug, unless your doctor tells you to.

Cialis expiration, storage, and disposal

When you get Cialis from the pharmacy, the pharmacist will add an expiration date to the label on the package or bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication remains effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about how to correctly dispose of it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

You should store Cialis tablets at 77°F (25°C). But you can keep them between 59°F and 86°F (15°C and 30°C) for short periods of time, if needed. Store Cialis in a tightly sealed container away from light. And avoid keeping this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Cialis and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Cialis interactions

Cialis can interact with several other medications. It can also interact with certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

Note: In addition to the information below, you can refer to this article about Cialis interactions.

Cialis and other medications

Below is a list of medications that can interact with Cialis. This list doesn’t contain all drugs that may interact with Cialis.

Before taking Cialis, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. You can also see this detailed article about Cialis and its interactions.

Cialis and nitrates

You should not take Cialis if you’re taking a medication called a nitrate. This type of drug may be used for chest pain. Taking nitrates along with Cialis can cause a serious decrease in your blood pressure.

Examples of nitrates include:

• nitroglycerin
• isosorbide mononitrate (Monoket)
• isosorbide dinitrate (Isordil)

However, in some cases, your doctor may give you a nitrate: for example, if you have chest pain and your life is at risk, and it’s been at least 48 hours since your last dose of Cialis. After you receive the nitrate, your doctor will likely monitor you to make sure your blood pressure doesn’t drop to an unsafe level.

Cialis and alpha-blockers

Both Cialis and medications called alpha-blockers can cause a decrease in blood pressure. So taking these medications together can cause blood pressure to drop further.

If you have benign prostatic hyperplasia (BPH) and are taking a medication called an alpha-blocker, you should not use Cialis.

And if you have erectile dysfunction (ED) and are taking an alpha-blocker, your doctor will likely lower your dose of Cialis.

Examples of alpha-blocker drugs include:

• tamsulosin (Flomax)
• alfuzosin (Uroxatral)
• doxazosin (Cardura)

Before taking Cialis, tell your doctor about any medications that you use, including alpha-blockers.

Cialis and medications that lower blood pressure

Cialis may reduce your blood pressure. So if you’re taking other medications to reduce your blood pressure, taking Cialis along with them may cause a larger drop in blood pressure.

Examples of blood pressure medications include:

• amlodipine (Norvasc)
• metoprolol (Toprol XL, Lopressor)
• enalapril (Vasotec)

Before you start Cialis treatment, tell your doctor if you’re taking any blood pressure drugs. They may give you a lower dose of Cialis or monitor you more often.

Cialis and medications to treat heartburn

If you’re taking Cialis and use antacids to treat heartburn, the antacids may decrease the level of Cialis that your body absorbs. This means that you may not get the full dose of Cialis, so it may not work as well to treat your ED or symptoms of BPH.

Examples of antacids include:

• calcium carbonate (Tums)
• aluminum hydroxide/magnesium hydroxide (Mylanta)

Before you start using Cialis, tell your doctor if you’re taking antacids. Talk with them about how far apart to take the doses of each drug if you need to use both medications.

Cialis and CYP3A4 inhibitors

Cialis is broken down in your body by an enzyme in your liver called CYP3A4. (An enzyme is a protein that aids chemical changes in your body.) Certain drugs can inhibit (block) this enzyme from working. So if the enzyme is unable to break down Cialis, the level of Cialis in your body may get too high. This can be dangerous and may increase your risk of side effects from Cialis.

Examples of medications that can block CYP3A4 from working include:

• antifungal drugs, such as:
  • ketoconazole
  • itraconazole (Sporanox)
• antibiotic drugs, such as:
  • erythromycin (Ery-Tab)
• HIV medications, such as:
  • ritonavir (Norvir)

Cialis and CYP3A4 inducers

Before starting Cialis treatment, talk with your doctor about any medications that you’re taking. They’ll be able to determine whether the drugs are CYP3A4 inhibitors and whether they can interact with Cialis. In some cases, your doctor may recommend a lower dose of Cialis or a different medication to treat your ED, symptoms of BPH, or both.

Cialis is broken down in your liver by an enzyme called CYP3A4. Certain drugs may induce (increase the activity of) CYP3A4, making it work better or faster than usual. This means that your body may break down Cialis more quickly than it should, so the drug may not work as well as it should.

Examples of drugs that induce CYP3A4 include:

• rifampin (Rifadin)
• carbamazepine (Tegretol)
• phenytoin (Dilantin)
• phenobarbital

Before you start Cialis treatment, talk with your doctor about any medications that you’re taking. They’ll be able to determine whether the drugs are CYP3A4 inducers and whether they can interact with Cialis. In some cases, your doctor may recommend a different medication to treat your ED, symptoms of BPH, or both.

Cialis and guanylate cyclase stimulators

You should not take Cialis if you’re using a type of drug called a guanylate cyclase stimulator. This kind of medication is used to treat pulmonary hypertension (a type of high blood pressure in your lungs). Using a guanylate cyclase stimulator along with Cialis may cause your blood pressure to become dangerously low.

An example of a guanylate cyclase stimulator is riociguat (Adempas). This medication can be used to treat pulmonary hypertension (PH) that happens in the arteries of your lungs (pulmonary arterial hypertension) or PH that happens due to a blood clot in your lungs.

Before taking Cialis, talk with your doctor about any medications you’re using for pulmonary hypertension. If you’re taking riociguat, they’ll likely recommend a different medication to treat your ED, BPH symptoms, or both.

Cialis and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Cialis. However, you should still check with your doctor or pharmacist before using any of these products while taking Cialis.

Cialis and foods

Here’s some information about how Cialis may interact with alcohol and grapefruit.

Alcohol

Both alcohol and Cialis can decrease your blood pressure. So if you drink alcohol while taking this medication, it’s recommended that you don’t drink too much. This may help prevent your blood pressure from becoming too low. For more information, see the “Cialis and alcohol” section above.

Grapefruit

While you take Cialis, it’s best to avoid eating grapefruit and drinking grapefruit juice.

Cialis is broken down in your body by an enzyme in your liver called CYP3A4. Grapefruit blocks that enzyme from working. So if the enzyme is unable to break down Cialis, the level of Cialis in your body may get too high. This can be dangerous and may increase your risk of side effects from Cialis.

Cialis cost

As with all medications, the cost of Cialis can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Cialis, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Cialis.

If you’re not sure whether you’ll need to get prior authorization for Cialis, contact your insurance company.

For more information about the cost of Cialis, see this in-depth article.

Financial and insurance assistance

If you need financial support to pay for Cialis, or if you need help understanding your insurance coverage, reach out to your insurance company. They can help you and tell you if there are any financial assistance options available.

You can also see below for price estimates of Cialis based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits.

Generic version

Cialis is available in a generic form called tadalafil. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs.

If your doctor has prescribed Cialis and you’re interested in using tadalafil instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

Cialis and pregnancy

Cialis is not approved for use in females.* It’s not known if Cialis is safe or effective for use during pregnancy.

Animal studies showed no problems with development of the fetus when pregnant animals were given Cialis. However, animal studies don’t always predict what will happen in humans.

If you have questions about Cialis use during pregnancy, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Cialis and birth control

If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Cialis.

It’s important to note that Cialis is not approved for use in females.*

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Cialis and breastfeeding

Cialis is not approved for use in females.* It’s not known if Cialis passes into breast milk or if it can be harmful to a child who’s breastfed.

In animal studies, Cialis was present in breast milk. But animal studies don’t always predict what will happen in humans.

If you have questions about Cialis and breastfeeding, talk with your doctor.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.