What Is Cialis?
Cialis is a prescription medicine used to treat erectile dysfunction (ED) in adult men.
It contains the active ingredient tadalafil, which belongs to the phosphodiesterase type 5 inhibitor class of medicines.
The European Union authorised Cialis in 2002, and its EU marketing authorisation remains active.
Cialis is available as tablets containing:
- 2.5mg
- 5mg
- 10mg
- 20mg
Tadalafil is also used in some adult men for the treatment of signs and symptoms of benign prostatic hyperplasia (BPH), an enlarged prostate that can affect urinary flow.
For erectile dysfunction, Cialis only works in the presence of sexual stimulation.
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What Is the Active Ingredient in Cialis?
The active ingredient in Cialis is tadalafil.
Tadalafil is a PDE5 inhibitor, the same broad class of medicines as:
- sildenafil;
- avanafil; and
- vardenafil.
Although these medicines act on the same general pathway, they differ in areas such as:
- duration of action;
- recommended dosing;
- onset;
- interactions;
- individual response; and
- side-effect profile.
Generic tadalafil medicines contain the same active substance as Cialis. EMA-authorised generic tadalafil products are developed to match the reference medicine in relevant clinical and pharmaceutical characteristics.
How Does Tadalafil Work?
During sexual stimulation, the body produces a chemical messenger called cyclic guanosine monophosphate (cGMP).
cGMP causes smooth muscle in the erectile tissue of the penis to relax, allowing increased blood flow.
An enzyme called PDE5 normally breaks cGMP down.
Tadalafil inhibits PDE5.
By slowing the breakdown of cGMP, tadalafil helps support increased blood flow to the penis during sexual stimulation, making it easier to achieve and maintain an erection.
Cialis does not cause an erection by itself.
Cialis does not:
- act as an aphrodisiac;
- automatically create sexual desire;
- permanently increase erection size;
- directly increase testosterone; or
- work without sexual stimulation.
What Is Erectile Dysfunction?
Erectile dysfunction is difficulty achieving or maintaining an erection firm enough for satisfactory sexual activity.
It may occur occasionally or persist over time.
Possible contributors include:
- cardiovascular disease;
- diabetes;
- obesity;
- high blood pressure;
- high cholesterol;
- smoking;
- alcohol;
- some prescription medicines;
- stress;
- anxiety;
- depression; and
- relationship or performance concerns.
Persistent erectile dysfunction can sometimes be associated with underlying cardiovascular or metabolic disease, so ongoing symptoms should not always be treated purely as a sexual-performance issue.
Who May Be Suitable for Cialis?
Cialis is authorised for adult men with erectile dysfunction.
Suitability depends on individual factors such as:
- cardiovascular health;
- current medicines;
- blood pressure;
- kidney function;
- liver function;
- previous ED treatments;
- eye conditions;
- frequency of sexual activity; and
- other medical history.
Some men may be more suited to on-demand tadalafil, while others may be considered for a lower-dose once-daily regimen.
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How Do You Take Tadalafil for Erectile Dysfunction?
Cialis can be prescribed in different ways depending on how frequently treatment is needed.
On-Demand Cialis
EMA information states that the usual recommended on-demand dose for erectile dysfunction is:
10mg taken at least 30 minutes before sexual activity.
If 10mg is not sufficiently effective and treatment is otherwise well tolerated, the dose may be increased to 20mg.
Continuous daily use of 10mg or 20mg is not recommended.
Once-Daily Cialis
For men who anticipate frequent sexual activity, such as around twice a week or more, a lower once-daily dose may be considered.
The usual once-daily dose is:
5mg once daily, with a possible reduction to 2.5mg once daily depending on tolerability.
Daily Cialis should generally be taken around the same time each day.
What Cialis Strength Should I Take?
The correct strength depends on your prescribed regimen and individual circumstances.
Cialis 2.5mg
This is the lowest available strength and may be used as part of a once-daily treatment approach where a lower dose is appropriate.
Cialis 5mg
5mg is commonly used for once-daily tadalafil treatment.
It is also the recommended daily dose for men being treated for benign prostatic hyperplasia or for both ED and BPH.
Cialis 10mg
10mg is the usual starting on-demand dose for erectile dysfunction.
Cialis 20mg
20mg is the higher on-demand dose that may be considered if 10mg is not sufficiently effective and the higher strength is appropriate.
Do not change your dose without professional advice.
How Long Before Sex Should I Take Cialis?
On-demand Cialis is generally taken at least 30 minutes before sexual activity.
However, taking the tablet does not automatically produce an erection.
Sexual stimulation is required.
One of the major advantages associated with tadalafil is its longer duration of pharmacological activity compared with some other PDE5 inhibitors, giving a wider period in which sexual activity may be possible.
This does not mean an erection lasts continuously throughout that period.
How Long Does Cialis Last?
Tadalafil is known for its relatively long duration of action.
Its effects may remain clinically useful for up to around 36 hours after an on-demand dose in some men.
This is why tadalafil is sometimes informally described as a longer-window ED medicine.
That does not mean:
- an erection persists for 36 hours;
- sexual activity can occur without stimulation; or
- every patient experiences the same duration.
The medicine supports erectile response when sexual stimulation occurs during the effective period.
Does Cialis Work Without Sexual Stimulation?
No.
EMA specifically states that sexual stimulation is required for tadalafil to work in erectile dysfunction.
Tadalafil improves the normal erectile blood-flow response.
It does not independently create sexual arousal.
Can I Take Cialis With Food?
Yes.
Cialis can generally be taken with or without food.
This can make tadalafil more convenient for some men compared with medicines whose onset may be more noticeably affected by food intake.
You should still follow the instructions supplied with your prescribed product.
What Is Daily Cialis?
Daily Cialis refers to a lower-dose tadalafil regimen taken every day, rather than only before planned sexual activity.
EMA states that daily tadalafil may be considered for men who expect frequent use, based on the doctor’s judgment.
A daily regimen can provide greater spontaneity because treatment is maintained continuously rather than requiring a tablet before each occasion.
Daily dosing should still be reviewed periodically to ensure it remains appropriate.
Is Daily Cialis Better Than On-Demand Cialis?
Neither approach is automatically better.
The most appropriate regimen depends on factors such as:
- frequency of sexual activity;
- individual response;
- side effects;
- medical history;
- personal preference; and
- prescriber judgment.
On-demand treatment may suit men who require ED medication less frequently.
Daily tadalafil may suit some men who anticipate more frequent sexual activity or who also have symptoms of benign prostatic hyperplasia.
How Effective Is Tadalafil?
Cialis has been studied extensively for erectile dysfunction.
EMA concluded that its benefits outweigh its risks for treatment of ED and granted an EU-wide marketing authorisation.
As with any erectile dysfunction treatment, effectiveness varies.
Response can depend on:
- the underlying cause of ED;
- correct timing;
- sexual stimulation;
- alcohol consumption;
- health conditions;
- medicines; and
- the chosen dose.
No ED medicine works for every person.
What If Tadalafil Does Not Work the First Time?
An unsuccessful attempt does not necessarily mean tadalafil is ineffective.
Possible factors include:
- insufficient sexual stimulation;
- anxiety;
- incorrect timing;
- excessive alcohol;
- inappropriate dose;
- another medicine;
- underlying cardiovascular or neurological disease; or
- a different cause of erectile dysfunction.
Do not take additional Cialis doses outside the prescribed regimen.
If treatment repeatedly does not work, speak with an appropriate healthcare professional.
What Are the Common Side Effects of Cialis?
Like all medicines, Cialis can cause side effects.
Common tadalafil effects can include:
- headache;
- indigestion;
- back pain;
- muscle aches;
- flushing;
- nasal congestion; and
- other gastrointestinal or circulatory symptoms.
Not everyone experiences side effects.
The likelihood and severity can vary according to dose and individual response.
Always read the current patient information leaflet supplied with your medicine.
Can Cialis Cause Serious Side Effects?
Serious reactions are uncommon but may require urgent medical attention.
Seek prompt medical help if you develop symptoms such as:
- severe chest pain;
- a prolonged or painful erection;
- sudden significant vision changes;
- sudden hearing problems;
- fainting or severe dizziness; or
- signs of a serious allergic reaction.
Do not rely on an online product page in situations where urgent medical assessment may be needed.
Can Cialis Be Taken With Nitrates?
No.
Like other PDE5 inhibitors, tadalafil must not be combined with nitrate medicines because the combination can cause a potentially dangerous drop in blood pressure.
This can include nitrate medicines used for angina.
Always provide a complete list of your medicines during your consultation.
Who Should Not Take Cialis?
Cialis is not suitable for everyone.
Important factors that may prevent or limit use include:
- certain serious cardiovascular conditions;
- use of nitrate medicines;
- significantly low blood pressure;
- some recent cardiovascular events;
- severe kidney impairment;
- severe liver impairment;
- certain eye conditions; and
- other contraindications in the current product information.
EMA notes that people with severe liver or kidney impairment should not take more than 10mg in a single dose, while once-daily dosing is not recommended for severe kidney impairment.
Can I Take Cialis if I Have Heart Problems?
Cardiovascular suitability matters because sexual activity itself increases physical demand.
Men with significant heart disease or those taking nitrate medicines require particular caution.
You should not start tadalafil without disclosing:
- heart disease;
- chest pain;
- previous heart attack;
- stroke;
- abnormal blood pressure; or
- cardiovascular medicines.
Can I Drink Alcohol With Cialis?
Small amounts of alcohol may not necessarily prevent tadalafil from working.
However, excessive alcohol can:
- impair erectile function;
- worsen dizziness;
- lower blood pressure; and
- make treatment less reliable.
Keeping alcohol moderate may improve both sexual performance and treatment tolerability.
Does Cialis Increase Sex Drive?
No.
Cialis helps with the physical erectile response, not sexual desire.
It does not directly increase libido.
A person experiencing low sexual desire may require assessment for different contributing factors, including hormonal, psychological or relationship issues.
Does Cialis Increase Testosterone?
No.
Tadalafil is not testosterone replacement therapy and is not prescribed to increase testosterone levels.
ED and low testosterone can sometimes occur together, but they are not the same condition.
Cialis and Benign Prostatic Hyperplasia
Cialis has another authorised use beyond erectile dysfunction.
EMA states that tadalafil can be used in adult men to treat the signs and symptoms of benign prostatic hyperplasia, or BPH.
BPH is a non-cancerous enlargement of the prostate that can lead to urinary symptoms such as:
- weak urinary flow;
- difficulty starting urination;
- frequent urination; or
- feeling that the bladder has not fully emptied.
The authorised dose for BPH is generally 5mg once daily.
A man with both BPH and ED may therefore have additional reasons for tadalafil treatment.
Cialis vs Generic Tadalafil
Cialis and generic tadalafil contain the same active ingredient: tadalafil.
Authorised generic tadalafil medicines are developed to match the reference medicine.
Cialis
- Original branded tadalafil
- Available in 2.5mg, 5mg, 10mg and 20mg
- Long-established EU authorisation
Generic Tadalafil
- Same active ingredient
- Often less expensive
- May differ in manufacturer, packaging, tablet appearance and inactive ingredients
Cialis vs Viagra
Cialis and Viagra are both PDE5 inhibitors but contain different active ingredients.
Cialis
Contains tadalafil.
It has a longer treatment window and can also be used as a once-daily low-dose regimen.
Viagra
Contains sildenafil.
It is usually taken on demand approximately one hour before sexual activity.
Both require sexual stimulation to work.
Cialis vs Spedra
Cialis contains tadalafil, while Spedra contains avanafil.
Both are PDE5 inhibitors, but they differ in:
- onset;
- duration;
- dosing;
- interaction profile; and
- individual response.
Cialis vs Vardenafil
Cialis contains tadalafil.
Vardenafil is another PDE5 inhibitor used for erectile dysfunction.
Tadalafil is generally recognised for its longer duration, whereas vardenafil is normally used on demand.
Choice should be based on the patient’s health, response and preferences rather than assuming one is universally superior.
Cialis vs ED Pump Treatment
Some men may prefer or require a non-medication treatment.
A vacuum erection device such as the VaxAid Deluxe ED Pump Kit uses negative pressure to help draw blood into the penis.
This may be relevant for people who:
- cannot use PDE5 inhibitors;
- prefer a drug-free option;
- experience medication side effects; or
- have not responded adequately to tablets.
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