Common questions about tadalafil - Brand names: Cialis, Adcirca

Tadalafil belongs to a group of medicines called phosphodiesterase 5 (PDE5) inhibitors.

If you have erectile dysfunction, it works by temporarily increasing blood flow to the penis when you get sexually excited.

It helps reduce symptoms of an enlarged prostate gland, such as difficulty peeing or needing to pee urgently, by relaxing the muscles in the prostate and bladder.

It helps pulmonary hypertension by relaxing blood vessels in the chest. This increases blood supply to the lungs and reduces the workload of the heart.

Tadalafil usually starts to work within 30 to 60 minutes.

If you're taking it for erectile dysfunction, it's triggered by sexual stimulation, so you need to be aroused for it to work.

If you're taking it for erectile dysfunction, you should be able to get an erection at any time between 30 minutes and 36 hours after taking tadalafil. You need to be sexually excited for it to work.

Your erection should go away after you have had sex.

Tadalafil works well for erectile dysfunction.

If tadalafil does not work for you, it may be because:

• you have not waited long enough after taking it before trying to have sex
• you have waited too long after taking it to have sex
• the dose is not high enough
• you're not sexually aroused enough

No – do not take tadalafil more than once a day.

Other medicines are usually taken on demand, 30 to 60 minutes before sexual activity.

The alternatives to tadalafil work for up to 4 hours. If you take tadalafil, it can be effective for up to 36 hours.

If tadalafil does not work, there are other tablets you could try that work in a similar way, such as:

• sildenafil (Viagra)
• avanafil (Spedra)
• vardenafil (Levitra)

Only sildenafil (Viagra) is available without prescription.

You can take tadalafil and vardenafil with or without food.

However, it's best to take sildenafil and avanafil on an empty stomach for fastest effects. Eating a meal that is high in fat may delay the effect of vardenafil.

Alprostadil (only available with a prescription) is a synthetic hormone that helps to stimulate blood flow to the penis.

Alprostadil comes as:

• an injection directly into your penis
• a small pellet placed inside your urethra (the tube that carries pee from your bladder to the tip of your penis)

If you cannot get erections because of a hormonal problem, your doctor may refer you to an endocrinologist (a doctor who specialises in the treatment of hormonal problems). They may recommend hormone injections to bring your body's levels back to normal.

Other treatments for erectile dysfunction include:

• a vacuum pump
• psychological treatments
• penile implants
• pelvic floor muscle exercises

Some complementary therapies, such as acupuncture, have been claimed to treat erectile dysfunction. But there's little evidence they work.

Tadalafil (5mg only) is the only medicine in its group (phosphodiesterase 5 (PDE5) inhibitors) that treats an enlarged prostate.

Other medicines prescribed are:

• 5-alpha reductase inhibitors, such as finasteride and dutasteride
• alpha-blockers, such as tamsulosin and alfuzosin

If tadalafil does not work, a doctor might recommend sildenafil, which works in a similar way.

Other medicines used to treat pulmonary hypertension are:

• endothelin receptor antagonists – such as bosentan, ambrisentan and macitentan
• soluble guanylate cyclase stimulators – such as riociguat
• prostaglandins – such as epoprostenol, iloprost and treprostinil
• calcium channel blockers – nifedipine, diltiazem, nicardipine and amlodipine

Women can use tadalafil for pulmonary hypertension.

There's no good evidence that tadalafil works for women with sexual problems.

Tadalafil does not affect any type of contraception, including the combined pill and emergency contraception.

Occasionally tadalafil can make you feel dizzy. If this happens to you, do not drive, cycle or use machines or tools until you feel better.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking tadalafil. GOV.UK has more information on the law on drugs and driving.

Having 1 beer or glass of wine is unlikely to stop or delay tadalafil from working. But if you're taking it for erectile dysfunction, drinking lots of alcohol can make it more difficult to get an erection.

To get the most benefit from tadalafil, do not drink heavily before taking it.

Do not drink grapefruit juice if you're taking tadalafil. It can affect the way the medicine works.

Erectile dysfunction can often be improved if you make changes to your lifestyle, such as:

• maintaining a healthy weight
• quitting smoking
• cutting down on the amount of alcohol you drink
• not taking recreational drugs
• exercising
• reducing stress

If you're taking tadalafil to treat symptoms of an enlarged prostate gland, you might be able to help the symptoms by making some simple changes to your lifestyle:

• drink fewer fizzy drinks and less alcohol, and cut down on caffeine (including tea, coffee, energy drinks and cola) and artificial sweeteners – these can irritate the bladder and make peeing more uncomfortable
• drink less liquid in the evening – try to reduce the amount you drink in the evening and avoid drinking anything for 2 hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day
• empty your bladder – remember to go to the toilet before long journeys if you know you will not be able to reach a toilet easily
• try double voiding – this means waiting a few moments after you have finished peeing before trying to go again. It can help you empty your bladder properly. But take care not to strain or push
• check your medicines – check with a doctor whether any medicines you take, such as antidepressants or decongestants, may be making your symptoms worse
• eat more fibre – eating more fruit, vegetables and wholegrains helps you avoid constipation, which can put pressure on the bladder and make symptoms of an enlarged prostate worse

Taking poppers (amyl nitrite) with tadalafil can have a dangerous effect on your heart.

It can also be dangerous to take tadalafil with:

• stimulants like MDMA (ecstasy) or cocaine
• hallucinogens like LSD
• novel psychoactive substances (which used to be known as legal highs) like mephedrone

Tadalafil has not been properly tested with recreational drugs.

Talk to a doctor if you think you might use any recreational drugs with tadalafil.

You can find out about the side effects of recreational drugs on the Frank website.