Cialis (Tadalafil)
Also sold as: Cialis, Tadacip, Megalis, Tadarise, Tazzle, Adcirca (PAH)
Pregnancy
Cat N/A
Lactation
Unknown
Schedule
H
Forms
Tablet 2.5mg, 5mg, 10mg, 20mg
Indications
- Erectile dysfunction (ED) — on-demand or daily low-dose
- Benign prostatic hyperplasia (BPH) — lower urinary tract symptoms
- ED + BPH (combination indication)
- Pulmonary arterial hypertension (PAH) — Adcirca
Adult Dosing
ED (on-demand)
10 mg PO 30-60 minutes before sexual activity; may increase to 20 mg or reduce to 5 mg
Effect lasts 24-36 hours ("weekend pill"). Max once per day.
ED (daily low-dose)
2.5-5 mg PO once daily
At same time each day; suitable for frequent activity (>2×/week) or easier scheduling
BPH / ED+BPH
5 mg PO once daily
Ongoing
PAH
40 mg PO once daily
Pediatric Dosing
No paediatric ED/BPH indication
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 31-50 mL/min | Max 5 mg/day (daily) or 10 mg every 48 hours (on-demand) |
| CrCl < 30 mL/min | 5 mg on-demand (not daily dosing); avoid if on HD |
Hepatic Adjustment
Mild-moderate: max 10 mg on-demand; avoid daily dosing in Child-Pugh B. Severe (Child-Pugh C): AVOID.
Pregnancy & Lactation
Pregnancy: Category N/A
Male medication. PAH use in women: specialist guided.
Lactation: Unknown
Not applicable (male drug)
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Nitrates (all forms) | ABSOLUTE CONTRAINDICATION — severe, potentially fatal hypotension. 48-hour minimum separation required but avoidance preferred. | Major |
| Alpha-blockers (tamsulosin, doxazosin) | Additive hypotension — use cautiously; established stable alpha-blocker therapy first | Major |
| Riociguat | ABSOLUTE CONTRAINDICATION | Major |
| CYP3A4 inhibitors (ritonavir, ketoconazole) | Increase tadalafil levels — max 10 mg every 72 hours | Major |
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Side Effects
Common
- Headache
- Back pain / myalgia (unique to tadalafil — PDE-11 inhibition in muscle)
- Dyspepsia
- Nasal congestion
- Flushing
- Limb pain
Serious / Discontinue If
- Severe hypotension (with nitrates)
- NAION (sudden vision loss)
- Priapism (> 4 hours — emergency)
- Sudden hearing loss
Contraindications
- Any nitrate use
- Riociguat
- Severe hepatic impairment
- Recent stroke/MI
- Severe hypotension
- Unstable angina or angina during intercourse
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Tadacip 20mg | Cipla | 4 tab ₹245 |
| Megalis 20mg | Macleods | 4 tab ₹225 |
| Tazzle 10mg | Sun Pharma | 4 tab ₹245 |
| Tadarise 20mg | Sunrise Remedies | 4 tab ₹195 |
| Cialis 20mg | Eli Lilly | 4 tab ₹985 |
Patient Counseling Points
- ⚠️ NEVER take with nitrates (GTN, isosorbide) — fatal blood pressure drop
- Longest-acting PDE-5 inhibitor — effect up to 36 hours
- Back ache and muscle pain are common and unique to tadalafil — usually resolve after 12-24 hours
- Daily 5 mg: take at same time every day regardless of planned activity
- Erection > 4 hours: emergency — go to hospital immediately
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Clinically reviewed by: Dr. Rajiv Nair, MCh (Urology), Consultant Urologist
Last reviewed: 2026-04-01
References
- BNF — Tadalafil
- EAU ED Guidelines 2023
- EAU BPH Guidelines 2023
- ESC PAH Guidelines 2022