How long does tadalafil last?

In this article:

• How long does tadalafil last?
• How long does it take to work?
• Optmizing effectiveness
• Side effects
• Treatment timeline
• Alternatives

In this article

• How long does tadalafil last?
• How long does it take to work?
• Optmizing effectiveness
• Side effects
• Treatment timeline
• Alternatives

Most recognizable by its brand name, Cialis, tadalafil is a well-known erectile dysfunction (ED) medication that works by relaxing blood vessels to improve blood flow to the penis. These same effects can treat benign prostatic hyperplasia (BPH), a condition that causes difficulty urinating due to an enlarged prostate. Plus, it’s not just for men. Tadalifil improves symptoms of pulmonary arterial hypertension (PAH), or high blood pressure in the lungs, in both men and women.

Given the time-sensitive nature of romantic situations, one of the most common questions people have when they start taking tadalafil is, “How long does it take to work?,” followed by, “How long do its effects last?” While other ED meds, like Viagra (sildenafil), have a short window of opportunity after taking a little blue pill, Cialis is longer acting. It remains active in your system for up to 36 hours. Here’s what you can expect from each dose.

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How long does tadalafil last?

“I tell my patients tadalafil is often called the ‘weekend pill’ because it can remain effective for up to 36 hours,” says Jason Carter, MD, a urologist and medical adviser at Aeroflow Urology. “That doesn’t mean you have a constant erection. It means the medication stays active in your system and can support better erections during that window.”

However, patients who want to get the maximum effect for ED may want to plan to enjoy the benefits earlier, rather than later. “The first 12 hours are probably your best bet,” explains Evan Goldfischer, MD, a urologist and past president of the Large Urology Group Practice Association (LUGPA).

Tadalafil belongs to a class of medications called phosphodiesterase 5 (PDE5) inhibitors that block the action of a specific enzyme in the lungs and penis to improve blood flow. When combined with sexual stimulation, this helps facilitate an erection. 

Tadalafil has a half-life of 17.5 hours, which is longer than most other PDE5 inhibitors (such as avanafil or vardenafil) and makes it better suited to daily use, according to research. “The duration of tadalafil can vary based on factors like dosing strategy, individual metabolism, baseline vascular health, renal function, heavy alcohol use, and psychological factors like anxiety, performance pressure, and relationship stress,” notes Dr. Carter.

How long does tadalafil take to work?

For ED, “it can take about 15 to 20 minutes,” says Steven Morganstern, MD, a urologist, surgeon, and founder of Rejuvall Health Centers in Atlanta, Georgia. However, you can’t just take a tablet and expect magic results. 

“Now remember, it doesn’t create the erection,” Dr. Morganstern says. “You still have to have stimulation there and the correct levels of amino acids and hormones. For example, if you have low testosterone, the medication will be ineffective and will not help.” 

For relief of BPH or PAH, the medication must reach a therapeutic level for maximum benefits.

“Typically, at the lower dose, while you can get some effects immediately, really it takes five continuous doses to get steady levels,” Dr. Morganstern notes. 

Optimizing tadalafil’s effectiveness and duration

To make sure that tadalafil works well when you want it to, there are some factors to consider:

• Timing: If you’re taking a daily dose of tadalafil, experts typically recommend taking it around the same time each day. If you’re taking it as-needed for ED, swallow the pill at least 30 minutes before planned sexual activity.
• Dose: The wrong dose may play a role in less-than-optimal results. “Under-dosing or ill-timed dosing is the most common reason tadalafil isn’t effective,” says Dr. Carter.
• Meals: According to the manufacturer’s information for Cialis, it can be taken “without regard to food.” Just note that a dose after a large meal may slow down its peak effects. “Some men experience an earlier onset of their erection if they take tadalafil on an empty stomach,” Erika Gray, Pharm.D., founder and chief medical officer at Toolbox Genomicsnotes 
• Alcohol consumption: “It’s okay to have a glass of wine,” Dr. Goldfischer says. However, drinking a lot of alcohol could diminish the medication’s effectiveness and increase adverse effects. Drinking more than four drinks while taking tadalafil can increase the risk of side effects such as headache, dizziness, a rapid heart rate, and low blood pressure. 
• Interactions:  Tadalafil is not recommended for people who take nitrates for chest pain, because it can lead to dangerously low blood pressure. You should also avoid combining tadalafil with guanylate cyclase stimulators, strong CYP3A4 inhibitors, CYP3A4 inducers, and other ED medications. It’s also important to avoid eating grapefruit or drinking grapefruit juice if you’re taking tadalafil, since grapefruit can increase the concentration of tadalafil in the bloodstream.

Always share a list of all other over-the-counter and prescription medications you are taking with a healthcare professional before taking tadalafil to avoid a dangerous drug interaction.

Tadalafil side effects

The most common side effects of tadalafil are 

• Back pain
• Facial flushing or redness
• Headache
• Nausea
• Indigestion
• Stuffy nose
• Muscle aches.

“It doesn’t really alter physically how you feel unless you experience side effects,” says Dr. Morganstern. “Some patients I’ve treated have complained of soreness or back pain, and it can cause some soreness, especially in the legs.”

Rarely, it is possible to experience more serious side effects when taking tadalafil. These can include:

• Symptoms of an allergic reaction, such as hives or swelling of the face, mouth, or tongue
• Dizziness or faintness
• Blurry vision or sudden vision loss
• Ringing in the ears or hearing loss
• A prolonged or painful erection 

It’s also possible to experience a stroke or a heart attack. If you develop any of these symptoms, seek medical attention right away. You should not take tadalafil if you have sickle cell anemia, leukemia, heart conditions, low blood pressure, uncontrolled high blood pressure, multiple myeloma, kidney disease, or liver problems. 

How long should you take tadalafil?

Generally speaking, long-term use of tadalafil is fine for most people. It will not cause withdrawal symptoms, either, if you decide to stop taking it. “You can stop and start it at will,” says Dr. Goldfischer. “There’s no tapering effect or anything like that.” 

Taking tadalafil for a longer duration does not change its effectiveness. “Many men don’t understand that if these medications stop working, it’s not because they’re no longer effective, but maybe because the patient is aging,” Dr. Morganstern says. “If it doesn’t work anymore for them, that means that something else has changed physiologically, and you need to see a specialist to figure out what’s changed, not a family doctor. For example, many patients with ED have heart disease, and that’s what is causing the (erectile) dysfunction.”

Also, the prostate continues to grow as men age, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). So while a person with BPH can also take tadalafil long-term, the prostate may get large enough that this particular medication won’t work anymore. At that point, they may need to consider switching to a different medication or consider a surgical procedure, adds Dr. Goldfischer.

Tadalafil alternatives

For some people, however, tadalafil is not the best choice of medications due to an underlying medical condition, drug interaction, or intolerable side effects. Luckily, there are options for each condition tadalafil treats.

Erectile dysfunction alternatives

“Every medication in this arena can have side effects, and every patient should be treated as an individual based on the cause of their ED,” Dr. Morganstern says. “One PDE5 inhibitor might not be right for someone else. Viagra tends to give more of an altered sensation. You typically get fewer side effects with tadalafil and Levitra, and then there’s also avanafil.”

BPH alternatives

People with BPH who cannot take tadalafil might opt for another medication, such as a 5-alpha reductase inhibitor, which blocks hormonal changes that allow the prostate to keep growing. These include Proscar (finasteride) and Avodart (dutasteride). 

Another option is a medication from the category known as alpha blockers, which relax the muscle of the bladder neck and prostate to make it easier to urinate. This category includes medications such as Uroxatral (alfuzosin), Cardura (doxazosin), Flomax (tamsulosin), Rapaflo (silodosin), and terazosin. 

Surgical options may also be an option for some people struggling with BPH. You can also make lifestyle changes that might make it easier to cope with having BPH, such as trying not to “hold” your urine for a long period of time, emptying your bladder completely when you use the toilet, and limiting your caffeine and alcohol intake, as well as limiting your fluid intake before bedtime.

PAH alternatives

In addition to PDE5 inhibitors, the types of treatment options to help people manage PAH include:

• Soluble guanylate cyclase stimulators (SGCS)
• Endothelin receptor antagonists (ERAs)
• Prostacyclin analogues
• Selective IP receptor agonist
• Prostacyclin mimetics 
• Sotatercept-(csrk) (Winrevair)

Work with your healthcare team to find the medication or lifestyle change that works best for you and your lifestyle.