Who benefits most
- Men who dislike planning doses before sex.
- Inconsistent responders to on-demand pills.
- ED plus urinary symptoms (frequency, weak stream) from BPH.
- Couples wanting flexibility across a 24–36 h window.
How it works
Tadalafil is a PDE-5 inhibitor that enhances nitric-oxide–cGMP signaling in penile tissue. Daily low-dose maintains stable plasma levels, improving erection quality and urinary flow (via smooth-muscle relaxation in the prostate/bladder neck). Sexual stimulation is still required.
Dosing and timing
- Standard start: 5 mg once daily, same time each day.
- Sensitive users: 2.5 mg daily for a week, then increase to 5 mg if tolerated.
- Missed dose: Take when remembered unless close to next dose. Do not double.
- One PDE-5 at a time: Do not stack with sildenafil or extra tadalafil on the same day unless a clinician directs.
Onset and expectations
- Some effect can appear in a few days.
- Typical steady response within 1–2 weeks; full evaluation by 4 weeks.
- If response is partial, review basics (sleep, alcohol, arousal) and consider adjuncts (pelvic-floor training).
Food, alcohol, and lifestyle
- Food: Tadalafil is food-agnostic; take with or without meals.
- Alcohol: Keep to ≤1 drink on active evenings; heavy drinking blunts erections and raises risk of dizziness.
- Training: 150 min/week cardio + 2 strength sessions, weight management, and 7–9 h sleep improve outcomes.
Safety and contraindications
- Do not use with nitrates (e.g., nitroglycerin) or riociguat.
- Caution with alpha-blockers (e.g., tamsulosin); spacing and dose adjustments may be needed—ask your clinician.
- Share a full med list (BP meds, SSRIs, finasteride, antihistamines).
- Stop and seek care for chest pain, sudden vision/hearing changes, severe dizziness/syncope, or priapism (erection >4 h).
Side effects and fixes
- Common: Headache, flushing, nasal congestion, dyspepsia, back or muscle aches. Usually mild and transient.
- Tips: Hydrate, take with food if stomach upset, dose at night if backache bothers daytime, use OTC analgesic if appropriate.
- When to call: Persistent or severe effects, new cardiovascular symptoms.
Daily vs on-demand: choose deliberately
- Daily 5 mg: Best for spontaneity, mixed ED+BPH, frequent sexual activity, or inconsistent response to on-demand.
- On-demand 10–20 mg: Best for infrequent planned encounters or if you want a single higher exposure.
Optimization checklist
- Take at the same time daily for consistent levels.
- Keep alcohol low on active nights.
- Build a 15–20 min arousal runway; use lubricant to protect sensitivity.
- Log outcomes (time, arousal, alcohol, effects) for 2–4 weeks.
- If still inconsistent, discuss titration, switching class, or addressing anxiety/sleep apnea.
Telehealth flow (typical, e.g., MyfirmX)
- 5–10 min intake + photo ID.
- Clinician review; video call if needed.
- If appropriate, Rx to a licensed pharmacy.
- Refill timing and address management online.
FAQs
Does daily tadalafil work without arousal?
No. Stimulation is required.
Can I take extra pills before sex?
Do not add on-demand doses to your daily regimen unless your clinician approves and guides timing.
How long before I judge success?
Give daily 5 mg 2–4 weeks with consistent habits before changing plan.
What if I also use alpha-blockers for BPH?
Often compatible, but timing and dose may need adjustment. Coordinate with your prescriber.
Can I stop suddenly?
Yes, but discuss if you’re using it for BPH symptoms; they may recur.